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At least 1,117 records · Page 62Linked to original sources
PubMed1999

Effect of CD34(+) cell dose on resource utilization in patients after high-dose chemotherapy with peripheral-blood stem-cell support.

PURPOSE: The mean time to neutrophil and platelet recovery for patients receiving high-dose chemotherapy (HDC) supported with peripheral-blood stem cells (PBSCs) is related to the dose of CD34(+) cells infused. The effect of cell dose on resource utilization after transplantation has not been previously reported. MATERIALS AND METHODS: We assessed CD34(+) cell dose and resource utilization for 1,317 patients undergoing transplantation with PBSCs from April 1991 to June 1997. PBSCs were collected after mobilization with chemotherapy and recombinant human granulocyte colony-stimulating factor (rhG-CSF). Daily measurement of the CD34(+) content of the PBSC collection was performed by a central laboratory using a single CD34(+) analysis technique. Resource utilization included engraftment parameters, length of stay, and transfusion requirements for 100 days posttransplantation. Analysis included descriptive statistics and multiple regression. RESULTS: Mean patient age was 47 years, and 86% of patients were female. Median cell dose was 3.6 x 10(6)/kg and 13.2 x 10(6)/kg for patients receiving less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) or more CD34(+) cells/kg, respectively. Patients receiving less than 5. 0 x 10(6) CD34(+) cells/kg were more likely to have metastatic breast cancer or non-Hodgkin's lymphoma and required more platelet and RBC transfusions, 3.3 more hospital days, and increased antibiotic and antifungal use. In univariate analysis, the cost of care was $41,516 (+/-$20,876 SD) and $32,382 (+/-$16,353 SD) for patients with less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) or more CD34(+) cells/kg, respectively. In multivariate analysis, patients with less than 5.0 x 10(6) CD34(+) cells/kg had an increase in costs of $5,062 (+/- $1,262 SE). CONCLUSION: Infusion of more than 5.0 x 10(6) CD34(+) cells/kg was associated with a reduction in resource utilization. Achieving a target of 5.0 x 10(6) CD34(+) cells/kg should have important clinical and economic benefits for patients.

Adolescent↗
PubMed2001

Pfiesteria-related educational products and information resources available to the public, health officials, and researchers.

Public and political concerns about Pfiesteria from 1997 to the present vastly exceed the attention given to other harmful algal bloom (HAB) issues in the United States. To some extent, the intense focus on Pfiesteria has served to increase attention on HABs in general. Given the strong and continuing public, political, and research interests in Pfiesteria piscicida Steidinger & Burkholder and related organisms, there is a clear need for information and resources of many different types. This article provides information on Pfiesteria-related educational products and information resources available to the general public, health officials, and researchers. These resources are compiled into five categories: reports; website resources; state outreach and communication programs; fact sheets; and training manuals and documentaries. Over the last few years there has been rapid expansion in the amount of Pfiesteria-related information available, particularly on the Internet, and it is scattered among many different sources.

Animals↗
PubMed2001

Resource effects on access to long-term care for frail older people.

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.

Black or African American↗
PubMed1999

Health information resources: tradition and innovation in a medical school curriculum.

Changes in LCME accreditation for medical colleges fostered the development of Health Information Resources, a required, for-credit course created by the Saint Louis University Health Sciences Center Library Reference Department for the first-year medical school curriculum. Six content areas were developed for inclusion in the syllabus: "Electronic Resources Survival Kit"; "Introduction to Problem Based Resources"; "Introduction to Literature Searching"; "MEDLINE Searching Hands-On/Publishing Pearls & Pitfalls"; "The World Wide Web and Patient Information"; and "Introduction to Electronic Mail." A combination of lectures, hands-on instruction, and active learning techniques were employed in the teaching of this class. Submission of a Health Information Resource Guide and a two-part final exam were required.

Academic Medical Centers↗
PubMed2004

Resource navigation for clinical authors.

The Web continues to grow in a largely unregulated manner. It is an established role of health sciences librarians to assist busy clinicians and other health care professionals cope with "information overload" by helping them locate useful and valuable information resources. One time-honored means of doing so is to prepare annotated bibliographies of such resources, perhaps no more so than to manage such cross-disciplinary topics as writing for publication. This article recommends resources to assist clinician writers publishing their research and other writings and suggests search strategies to update these resources as needed.

Information Storage and Retrieval↗
PubMed2005

Can family socioeconomic resources account for racial and ethnic test score gaps?

This article considers whether the disparate socioeconomic circumstances of families in which white, black, and Hispanic children grow up account for the racial and ethnic gaps in school readiness among American preschoolers. It first reviews why family socioeconomic resources might matter for children's school readiness. The authors concentrate on four key components of parent socioeconomic status that are particularly relevant for children's well-being--income, education, family structure, and neighborhood conditions. They survey a range of relevant policies and programs that might help to close socioeconomic gaps, for example, by increasing family incomes or maternal educational attainment, strengthening families, and improving poor neighborhoods. Their survey of links between socioeconomic resources and test score gaps indicates that resource differences account for about half of the standard deviation-about 8 points on a test with a standard deviation of 15-of the differences. Yet, the policy implications of this are far from clear. They note that although policies are designed to improve aspects of "socioeconomic status" (for example, income, education, family structure), no policy improves "socioeconomic status" directly. Second, they caution that good policy is based on an understanding of causal relationships between family background and children outcomes, as well as cost-effectiveness. They conclude that boosting the family incomes of preschool children may be a promising intervention to reduce racial and ethnic school readiness gaps. However, given the lack of successful large-scale interventions, the authors suggest giving only a modest role to programs that address parents' socioeconomic resources. They suggest that policies that directly target children may be the most efficient way to narrow school readiness gaps.

Bias↗
PubMed2004

Osteoporosis and the global competition for health care resources.

Global aging superimposed on existing infectious diseases and trauma will aggravate competition for health care resources to diagnose and treat osteoporosis. Efforts to implement public health measures are needed, but the targeted approach to assessment and treatment of high-risk individuals must also be refined. Increases in the elderly population worldwide will cause a dramatic rise in osteoporotic fractures, but other age-related diseases will increase as well. Changes will be superimposed on existing public health problems (e.g., malaria, alcoholism), and these acute health care needs will take priority in some areas. Societies in most parts of the world may have to limit osteoporosis control to broad public health measures, and such efforts (e.g., calcium and vitamin D supplementation) should be supported. In these regions, clinical decision-making will generally be limited to treating patients with fractures (who presumably have already failed any public health measures in place), or in a few wealthy countries, to patients with low bone density identified by case-finding. Case-finding approaches will vary with the resources available, although unselective (mass) screening by bone densitometry is largely ineffective and unaffordable anywhere. The key to clinical decision-making on behalf of individuals will be an assessment of absolute fracture risk, and the tools needed to predict the risk of an osteoporotic fracture over the next 10 years are now being developed. These include bone density measures, but also incorporate other risk factors (e.g., fracture history, corticosteroid use), which may allow extension of fracture risk prediction to nonwhite populations and to men. Even with a universal risk prediction tool, cost-effective treatment thresholds will vary by country based on the level of fracture risk in the region and on the resources available for health care. To better compete for these resources, efforts should be made to lower the cost of osteoporosis interventions. Additionally, evidence is needed that these interventions are really effective in reducing fractures in the community.

Aging↗
PubMed2005

Five-day telithromycin once daily is as effective as 10-day clarithromycin twice daily for the treatment of acute exacerbations of chronic bronchitis and is associated with reduced health-care resource utilization.

STUDY OBJECTIVES: To demonstrate equivalence in the clinical efficacy of telithromycin vs clarithromycin treatment of outpatients with acute exacerbations of chronic bronchitis (AECB), and to compare the tolerability and respiratory-related health-care resource utilization associated with these treatment regimens. DESIGN AND PATIENTS: A randomized, double-blind, multicenter, clinical study was conducted at 105 centers in 14 countries. Adult outpatients (age > or = 30 years) received oral telithromycin, 800 mg qd for 5 days (n = 270), or oral clarithromycin, 500 mg bid for 10 days (n = 282), for the treatment of AECB. Clinical and bacteriologic outcomes were assessed at the posttherapy/test-of-cure (TOC) visit (days 17 to 24; per-protocol population). Health-care resource utilization data were collected for each patient by investigators blinded to study medication up to the late posttherapy visit (days 31 to 36). RESULTS: Clinical cure rates at the posttherapy/TOC visit were comparable between the groups (telithromycin, 193 of 225 patients [85.8%]; clarithromycin, 206 of 231 patients [89.2%]); bacteriologic outcome was satisfactory for 59 of 72 telithromycin-treated patients (81.9%) vs 63 of 76 clarithromycin-treated patients (82.9%). Health-care resource utilization assessed up to the late posttherapy visit was lower in the telithromycin treatment group than the clarithromycin treatment group, with significantly fewer hospitalizations for respiratory-related causes (one hospitalization vs eight hospitalizations for a total of 4 inpatient days vs 39 inpatient days, respectively), significantly fewer AECB-related emergency department visits (0 vs 8), and fewer unscheduled outpatient visits (11 vs 18). Fewer telithromycin-treated patients reported days lost from work (21 of 91 patients [23.1%]; 133 days) compared with those receiving clarithromycin (30 of 98 patients [30.6%]; 141 days). Telithromycin was well tolerated; adverse events considered possibly related to study medication were reported by 61 of 269 patients (22.7%) and 100 of 280 patients (35.7%) receiving telithromycin and clarithromycin, respectively. CONCLUSIONS: In this study, 5-day telithromycin treatment was as effective and well tolerated as 10-day clarithromycin treatment for patients with AECB, and was associated with a reduced utilization of health-care resources.

Acute Disease↗
PubMed2006

Pharyngitis in low-resources settings: a pragmatic clinical approach to reduce unnecessary antibiotic use.

OBJECTIVE: Existing scoring systems for the diagnosis of group A streptococcus pharyngitis are insensitive or inapplicable in low-resources settings. Bacterial cultures and rapid tests can allow for antibiotic prescription abstention in high-income regions. These techniques are not feasible in many low-resources settings, and antibiotics often are prescribed for any pharyngitis episode. However, judicious antibiotics prescription in the community also is of concern in low-income countries. The objective of this study was to develop a clinical decision rule that allows for the reduction of empirical antibiotic therapy for children with pharyngitis in low-resources settings by identifying non-group A streptococcus pharyngitis. PATIENTS AND METHODS: We prospectively included children with pharyngitis in 3 public hospitals of Brazil during 9 months in 2004. We filled out clinical questionnaires and performed throat swabs. Bilateral chi2 (2-tailed test) and multivariate analysis were used to determine score categories. The outcome measures were sensitivity, specificity, positive likelihood ratio, and posttest probability of non-group A streptococcus infection with the clinical approach as compared with throat culture. RESULTS: A total of 163 of the 220 children had non-group A streptococcus pharyngitis (negative culture). We established a 3-questions decision rule (age and viral and bacterial signs) with 3 possible answers. The use of this score would prevent 41% to 55% of unnecessary antimicrobial prescriptions. The specificity of the score for non-group A streptococcus pharyngitis was >84%. CONCLUSION: Such a clinical decision rule could be helpful to reduce significantly unnecessary antibiotic prescriptions for pharyngitis in children in low-resources settings.

Anti-Bacterial Agents↗
PubMed2003

[Resource distribution for the Basic Care Plan with equity approach, Bogotá 2002].

OBJECTIVE: To apply a technique that will guide financial resources distribution for the Basic Care Plan for carrying out collective actions according to different health conditions. METHODS: A prior estimation of a global health index was performed by means of the analysis of major components prioritizing areas of Bogotá according to their health condition: "poor", "intermediate," and "good". A square minimum technique was applied to minimize difference between observed and expected global health index after resource investment. RESULTS: Resource distribution for the Basic Care Plan was achieved for twenty areas of Bogotá and a higher amount than the district median was allocated in areas with "poor" health conditions. Also, areas lacking universal health coverage were identified using the per capita resource allocation. CONCLUSIONS: This technique puts in evidence the disparity in health conditions between areas of "poor" health condition and those with "good" condition, in spite of the increased coverage of the Basic Plan of Attention, indicating the need of intersectorial social investment in these areas.

Colombia↗
PubMedDate not supplied

[Equity and geographic distribution of financial resources in health systems].

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.

Brazil↗
PubMedDate not supplied

[Impact of health care reform on human resources and employment management].

According to those in charge of health sector reform, human resources are the key component of health sector reform processes and offer health services their greatest competitive advantage. With the help of the Observatory for Human Resources within Health Sector Reform promoted by the Pan American Health Organization and other groups, countries of the Region of the Americas have now begun to gather, in a methodical fashion, tangible evidence of the decisive importance of human resources within health sector reform initiatives and particularly of the impact of these initiatives on health personnel. This mutual influence is the main theme of this article, which explores the most disturbing aspects of health sector reform from a human resources perspective, including job instability and conflicting interests of employers and employees.

Caribbean Region↗
PubMed2002

Mineralisation assays of some organic resources of aquatic systems.

Assays were carried out to evaluate the consumption of dissolved oxygen resulting from mineralisation processes in resources usually found in aquatic systems. They were also aimed at estimating the oxygen uptake rate of each investigated process. Experiments were conducted using substrates from 3 different places. A fixed amount of substrate was added to 5 litres of water from Lagoa do Infernão that was previously filtered with glass wool. After adding the substrates the bottles were aired and the amount of dissolved oxygen and the temperature were monitored for 55 days. The occurrence of anaerobic processes was avoided by reoxygenating the bottles. The experimental results were fitted to a first order kinetics model, from which the consumption of dissolved oxygen owing to mineralisation processes was obtained. The amount of oxygen uptake from the mineralisation processes appeared in the following decreasing order: Wolffia sp., Cabomba sp., Lemna sp., DOM (Dissolved Organic Matter), Salvinia sp., Scirpus cubensis, stem, Eichhornia azurea, sediment and humic compounds. The deoxygenation rates (day-1) were: 0.267 (humic compounds), 0.230 (Lemna sp.), 0.199 (E. azurea), 0.166 (S. cubensis), 0.132 (sediment), 0.126 (DOM), 0.093 (Cabomba sp.), 0.091 (stem), 0.079 (Salvinia sp. and Wolffia sp.). From these results, 2 groups of resources could be identified: the first one consists of detritus with higher amounts of labile (ready to use) compounds, which show a higher global oxygen uptake during the mineralisation process; the second one consists mainly of resources that show refracting characteristics. However, when the consumption rates are analysed it is noted that the mineralised parts of the refracting substrates can be easier to process than the labile fractions of the less refracting resources.

Absorption↗
PubMed2000

How resource allocation decisions are made in the health care market.

This paper describes how economists view resource allocation decisions in health care markets. The basic economic decisions that must be made in any economic system and the resource allocation decisions in a perfectly competitive market are described. An idealized market can achieve an efficient allocation of resources and is contrasted with a more realistic description of the numerous ways in which health care markets depart from the perfectly competitive ideal. The implications of these departures for health care policy are discussed, along with key controversies concerning reliance upon markets for resource allocation in health care. In particular, the failure of competitive markets to achieve what many consider an equitable distribution of health care is emphasized. The paper concludes with some practical observations on how pharmacists can use the increasing emphasis on economic efficiency to the advantage of their profession.

Decision Making↗
PubMed2006

Consumer-resource body-size relationships in natural food webs.

It has been suggested that differences in body size between consumer and resource species may have important implications for interaction strengths, population dynamics, and eventually food web structure, function, and evolution. Still, the general distribution of consumer-'resource body-size ratios in real ecosystems, and whether they vary systematically among habitats or broad taxonomic groups, is poorly understood. Using a unique global database on consumer and resource body sizes, we show that the mean body-size ratios of aquatic herbivorous and detritivorous consumers are several orders of magnitude larger than those of carnivorous predators. Carnivorous predator-prey body-size ratios vary across different habitats and predator and prey types (invertebrates, ectotherm, and endotherm vertebrates). Predator-prey body-size ratios are on average significantly higher (1) in freshwater habitats than in marine or terrestrial habitats, (2) for vertebrate than for invertebrate predators, and (3) for invertebrate than for ectotherm vertebrate prey. If recent studies that relate body-size ratios to interaction strengths are general, our results suggest that mean consumer-resource interaction strengths may vary systematically across different habitat categories and consumer types.

Animals↗
PubMed2000

Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience.

PURPOSE: To determine the relationship between family coping and resources and family adjustment and parental stress in the acute phase of the NICU experience. DESIGN: Correlational study based on the Resiliency Model of Family Stress, Adjustment, and Adaptation. Main study instruments included the State Anxiety scale of the State-Trait Anxiety Inventory, the Family Inventory of Resources for Management, the Family Crisis Oriented Personal Evaluation Scales, and the General Functioning subscale of the McMaster Family Assessment Device. SAMPLE: Data collected from 124 mother and father pairs within two to four days of their infant's admission to the NICU. MAIN OUTCOME VARIABLES: Family adjustment and parental stress. RESULTS: Adequate resources were more strongly related to positive adjustment and decreased stress than were either coping or being a first-time parent. The relationships among the variables were generally the same for both parents. Mothers utilized more coping strategies than did fathers. PRACTICE RECOMMENDATIONS: Families with limited resources should be identified early to facilitate their adjustment to the NICU.

Acute Disease↗
PubMed1996

Food and water intake as functions of resource consumption costs in a closed economy.

In two experiments, rats living in a closed economy were offered continuous, concurrent access to four resources: food, water, a nest, and a running wheel. Costs of consuming food and water were imposed with bar-press requirements, and the price of either one or both resources was raised. As the consumption cost increased, less was consumed in each bout of resource use. Bout frequency increased, but not sufficiently to compensate for the fall in bout size, and total intake fell. Food and water tended to be complementary resources, in that as intake of one fell with its price, intake of the other also decreased. This interaction was accounted for by the defense of the ratio of body water to lean body mass. As amount consumed decreased, increases in feed efficiency (weight gain per unit of food ingested) and the use of stored calories compensated for the reduced energy intake. There was evidence of competition between feeding and drinking at the higher costs: When both commodities were expensive, the decline in the intake of each one was greater than when only one commodity was expensive. Although the time spent nesting, running, and in unmonitored activity was adjusted when feeding or drinking took more of the rat's day, there was no particular activity that was sacrificed.

Animals↗
PubMed1998

Insomnia, health-related quality of life and healthcare resource consumption. A study of managed-care organisation enrollees.

OBJECTIVE: Insomnia is a prevalent sleep complaint which has been reported to be greatly associated with reduced health-related quality of life (HR-QOL) and increased healthcare resource use. This study documents the prevalence of insomnia, and its impact on patients' HR-QOL and healthcare resource use in managed-care settings in the US. DESIGN AND SETTING: A multi-site survey of 5 American Medical Group Association (AMGA) clinics was conducted. Each clinic mailed questionnaires to 1100 randomly selected individuals enrolled in its healthcare system and distributed questionnaires to 400 individuals during a clinic visit and prior to seeing a physician. The questionnaire was a form of the Health Status Questionnaire with the well-validated Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey, a 3-question depression screen, a sleep questionnaire, demographic variables, and questions about medical encounters and prescription and over-the-counter (OTC) drug use. MAIN OUTCOME MEASURES AND RESULTS: Approximately one-third of managed-care enrollees in this study reported insomnia with daytime dysfunction. Individuals with insomnia reported lower HR-QOL scores and increased healthcare resource use compared with individuals with no insomnia. After controlling for demographic variable and comorbid conditions, the negative association of insomnia remained significant on all HR-QOL scores, emergency room visits, calls to the physician and OTC drug use. CONCLUSIONS: Insomnia is significantly associated with reduced HR-QOL and increased healthcare resource use in enrollees of managed-care organisations.

Health Care Surveys↗