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PubMed1995

The Gambia: cost and effectiveness of a mobile maternal health care service, West Kiang.

A relatively small body of knowledge has been generated in the past to identify the cost-effectiveness of mobile versus static clinics, or combinations thereof. The changes introduced by the new mobile maternal health care service offered an opportunity to address the issue of cost-effectiveness of changes introduced to a specific geographical area. Considerably higher total costs were incurred, particularly as a result of increased training and staffing. However, evidence (Foord, 1993) has shown that several key measures of process eg. number of haemoglobin tests taken and haemoglobin levels increased significantly. Therefore the extra expenditure created clear service improvements. Linking such changes to reductions in mortality was more difficult as the population size and rarity of maternal deaths made it difficult to show statistically significant differences. The results should only provide part of the information required by decision makers, for a number of reasons. First, this cost-effectiveness analysis provided no information regarding any form of equity. Secondly, many factors affect cost-effectiveness ratios and further investigation of the organisation and management of the mobile service may highlight further room for improvement within the service itself, thus improving the efficiency. In this case there were grounds for re-assessing costs in relation to training, undertaking an assessment of staffing needs and increasing accountability in the use of resources. This study gives detailed information on the structure of costs for a mobile unit. It is unusual in its consideration of how a mobile team fits into the structure of existing health services and implications of provision on other levels of service.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1996

The Ontario Cancer Treatment Practice Guidelines Initiative.

The Ontario Cancer Treatment Practice Guidelines Initiative was established in 1993 to develop clinical practice guidelines for cancer treatment in Ontario, Canada. First, an organizational structure, consisting of a coordinating committee, a methods resource group, and disease site groups, was put in place. Central to the development of guidelines are the 10 provincial site groups, which use a methodologic framework, the practice guidelines development cycle, to formulate the guidelines. When a preliminary evidence-based recommendation is developed by a site group, it is sent out to a sample of community practitioners for input and is modified based on their feedback. The final product is the practice guideline. Further research is required to determine optimal dissemination strategies and evaluate the impact of these guidelines.

Evidence-Based Medicine↗
PubMed1997

[Evaluation and quality management in multiple trauma care].

In total quality management of polytraumatised patients, it is necessary to use analysis of structure, process and outcome quality to search for problem areas and improvement possibilities. The structure includes the attributes of material and human resources. The process denotes the real treatment course with the demand for treatment guidelines (algorithm) and an exact documentation of treatment. To prove the outcome quality, an internal and external judgement is possible. Our own results show that quality assessment, concerning the process as well as the internal and external quality outcome, brings a significant improvement to the care of polytrauma patients.

Algorithms↗
PubMed2026

Factors influencing the enhancement of the new iron triangle in healthcare organisations.

PURPOSE: A new paradigm, "healthcare's new iron triangle," has been developed to emphasise the technological perspective of healthcare delivery, focusing on automation, value and empathy. The study aims to build a conceptual model and to identify factors for the enhancement of the new iron triangle in healthcare organisations. DESIGN/METHODOLOGY/APPROACH: The healthcare organisation is the primary focus point of the current study. To determine the factors, a survey of the literature and healthcare experts' opinions was conducted. The healthcare professionals validated the identified factors. Data for this study were gathered using a closed-ended questionnaire and scheduled interviews. The study employed "Total Interpretive Structural Modeling methodology and Matriced' Impacts Croise´s Multiplication Appliqué´ a UN Classement/Cross-Impact Matrix Multiplication Applied to a Classification (MICMAC) analysis" to address the "why" and "how" the factors interact and prioritise the identified factors. FINDINGS: The study found that organisational structure (F8), artificial intelligence (F1), innovation (F2) and human resources (F5) are the driving or key factors of the study. RESEARCH LIMITATIONS/IMPLICATIONS: The study primarily focused on identifying factors for the enhancement of a new iron triangle in healthcare organisations. The scope could eventually be expanded to explore more areas. PRACTICAL IMPLICATIONS: Academics and other stakeholders will have a better understanding of the key drivers for the enhancement of the new iron triangle in healthcare organisations. ORIGINALITY/VALUE: In this study, total interpretive structural modeling and cross-impact MICMAC analysis are proposed as an innovative approach to address the new iron triangle in healthcare organisations.

Humans↗
PubMed2004

Assessing biophysical energy transfer mechanisms in living systems: the basis of life processes.

OBJECTIVE: To explain the energetic physiologic basis for acupuncture electroconductance effects and for gas discharge visualization (GDV) assessment methods, using a quantum biophysical model of entropy and information flows. DESCRIPTION: The main reservoir of free energy in biologic processes is electron-excited states of complex molecular systems. Communities of delocalized excited pi-electrons in protein macromolecules are the basis of this energy reservoir. Specific structural-protein complexes within the mass of the skin provide channels of heightened electron conductivity, measured at acupuncture points on the surface. Stimulated impulse emissions from the skin are also developed mainly by transport of delocalized pi-electrons. Stimulated by high voltage impulses, optical emissions, with amplification in gaseous discharge, are registered by optical sensors (GDV). This quantum model supports an argument that GDV techniques provide indirect judgment about the level of energy resources at the molecular level of functioning in structural-protein complexes. Several years of GDV research have provided clinical correlations with well-accepted physiologic parameters. For example, postsurgery recovery progress is correlated with GDV parameters and GDV assessments provide independent diagnostic measures of psychophysical reserves in athletes. CONCLUSION: GDV methods for investigating human functional states, by assessing electro-optical parameters of the skin, are based on the registration of physical processes emerging from electron components of tissue conductivity.

Acupuncture Points↗
PubMed2006

Neighborhood age structure and its implications for health.

Age structure at the neighborhood level is rarely considered in contextual studies of health. However, age structure can play a critical role in shaping community life, the availability of resources, and the opportunities for social engagement-all factors that, research suggests, have direct and indirect effects on health. Age structure can be theorized as a compositional effect and as a contextual effect. In addition, the dynamic nature of age structure and the utility of a life course perspective as applied to neighborhood effects research merits attention. Four Chicago neighborhoods are summarized to illustrate how age structure varies across small space, suggesting that neighborhood age structure should be considered a key structural covariate in contextual research on health. Considering age structure implies incorporating not only meaningful cut points for important age groups (e.g., proportion 65 years and over) but attention to the shape of the distribution as well.

Adolescent↗
PubMed2004

The CDKN2A database: Integrating allelic variants with evolution, structure, function, and disease association.

In this report, we introduce the CDKN2A Database, an online database of germline and somatic variants of the CDKN2A tumor suppressor gene recorded in human disease through the year 2002, annotated with evolutionary, structural, and functional information. The CDKN2A Database improves upon existing resources by: 1) including both somatic mutations and germline variants, thereby adding the perspective of somatic cell carcinogenesis to that of hereditary cancer predisposition; 2) including information that assists with the interpretation of allelic variants, such as other primary data (sequences, structures, alignments, functional measurements, and literature references) and annotations (extensive text, figures, and a tree-based phylogenetic classification); and 3) providing the information in a format that allows a user to either download the database or to easily manipulate it online. We describe the database structure, content, current uses, and potential implications (http://biodesktop.uvm.edu/perl/p16).

Alleles↗
PubMed1986

Ethics and resource allocation: an economist's view.

This paper debates some of the issues involved in attempting to apply economic analysis to the health care sector when medical ethics plays such an important part in determining the allocation of resources in that sector. Two distinct ethical positions are highlighted as being fundamental to the understanding of resource allocation in this sector -- deontological and utilitarian theories of ethics. It is argued that medical ethics are often narrowly conceived in that there is a tendency for the individual, rather than society at large, to form the focal point of the production of the service "health care'. Thus medical ethics have been dominated by individualistic ethical coded which do not fully consider questions relating to resource allocation at a social level. It is further argued that the structure of the health care sector augments these "individualistic' ethics. It is also suggested that different actors in the health care sector address questions of resource allocation with respect to different time periods, and that this serves to further enhance the influence of "individualistic' ethical codes in this sector.

Cost-Benefit Analysis↗
PubMed1998

A validation study of molecular descriptors for the rational design of peptide libraries.

Important molecular descriptors used for establishing quantitative structure-activity relationships are investigated to classify similar versus dissimilar peptides. When searching new lead structures, synthesizing and testing compounds which are too similar wastes time and resources. In contrast, any lead optimization program requires the investigation of similar compounds to that lead. Thus, it is important to maximize or minimize the structural diversity of peptides to design useful compound libraries for lead finding or lead refinement projects. If a molecular descriptor is a useful measure of similarity for the design of peptide libraries, small differences in this descriptor for a pair of molecules should only translate into small biological differences. Using this paradigm as a basis for descriptor validation, it was possible to rank different molecular descriptors. Those physicochemical descriptors are 2D fingerprints and five experimentally or theoretically derived principal property scales. Some theoretically derived metrics are obtained by computing interaction energies or similarity indices on predefined 3D grid points using canonical conformations for individual amino acids. The resulting 3D data matrices are analyzed using a principal component analysis leading to three principal properties for CoMFA (Comparative Molecular Field Analysis) or CoMSIA (Comparative Molecular Similarity Index Analysis) derived molecular fields. The descriptor validation results reveal the applicability of design tools on peptide data sets. Experimentally derived descriptors, in general, are more acceptable than computationally derived metrics, while the latter provide a statistically valid alternative to characterize novel building blocks. The CoMSIA metrics perform slightly better than the CoMFA-based principal properties, while GRID-based descriptors are always less acceptable.

Animals↗
PubMed2006

[Inspection of the Hospital Infection Control Programs of Health Services by the Health Surveillance: a diagnosis of the situation].

This study was aimed at recognizing and comparing the inspection conditions of the Hospital Infection Control Programs (HICP) through agents of two Technical Groups of Health Surveillance, in 2002, with the use of questionnaires. The results show that the agents have some knowledge about HI, but most of them did not inspect HICPs, were not trained to do so and did not follow specific guidelines nor used other resources. The most mentioned type of inspection was the inspection of physical structure, followed by HICP meeting records and statistics. It was concluded that the main difficulties in HICP inspection are concentrated on the lack of personnel, resources, motivation and technical capacity. It was also observed in the results a heterogeneity between the groups.

Brazil↗
PubMed2002

Developing a cardiac rehabilitation education resource for rural health workers in Queensland: reviewing the process and outcomes.

The provision of cardiac rehabilitation services to people living in rural and remote areas is often limited to the nearest large hospital situated in urban coastal centres, leaving a gap in the rehabilitation of cardiac patients. This paper discusses the development, composition and the results of a process evaluation of a cardiac rehabilitation education resource for rural health workers. The development of the structure and content of the manual were informed by a review of current rehabilitation literature, the results of focus groups with 60 rural health workers in five Queensland rural centres, and survey results of 135 rural cardiac patients admitted to five Queensland hospitals. The draft manual was trialled by health workers in seven rural centres throughout Queensland by the National Heart Foundation (Queensland Division). The results of the process evaluation provided valuable feedback on the efficacy of the manual as an educational resource for rural health workers in the cardiac rehabilitation of their patients. Specific content in the educational resource was strengthened as a result of this evaluation. The limitations of the evaluation and suggestions for its improvement are also discussed. The paper highlights the importance of this level of evaluation in the development of health promotion education resources.

Australia↗
PubMed1990

NRL-3D: a sequence-structure database derived from the protein data bank (PDB) and searchable within the PIR environment.

The protein identification resource (PIR) and the Brookhaven National Laboratory protein data bank (PDB) are well-known databases for primary sequences and three-dimensional structures of proteins, respectively. Lesk et al, have compared the primary sequences in these two databases and concluded that the sequences in them are not redundant. Moreover, PIR programs can not be used directly on PDB files to access primary sequences because the FORMATS of these two data bases are different. We have developed a sequence-structure database, called NRL-3D, from the sequences, chain identification and the residue numbers of proteins in the PDB. This new database is designed such that it can be used in conjunction with PIR programs to search and extract sequences of interest and the corresponding three-dimensional coordinates from the structures in PDB.

Amino Acid Sequence↗
PubMed1999

Effects of an organized critical care service on outcomes and resource utilization: a cohort study.

OBJECTIVE: To determine whether the presence of an on-site, organized, supervised critical service improves care and decreases resource utilization. DESIGN: The study compared two patient cohorts admitted to a surgical intensive care unit during the same period of time. The study cohort was cared for by an on-site critical care team supervised by an intensivist. The control cohort was cared for by a team with patient care responsibilities in multiple sites supervised by a general surgeon. The main outcome measures were duration of stay, resource utilization, and complication rate. SETTING: Study patients were general surgical patients in an academic medical center. RESULTS: Despite having higher Acute Physiology and Chronic Health Evaluation II scores, patients cared for by the critical care service spent less time in the surgical intensive care unit, used fewer resources, had fewer complications and had lower total hospital charges. The difference between the two cohorts was most evident in patients with the worst APACHE II score. CONCLUSIONS: Critical care interventions are expensive and have a narrow safety margin. It is essential to develop structured and validated approaches to study the delivery of this resource. In this study, the critical care service model performed favorably both in terms of quality and cost.

APACHE↗
PubMed2005

Using multilevel models for assessing the variability of multinational resource use and cost data.

Multinational economic evaluations often calculate a single measure of cost-effectiveness using cost data pooled across several countries. To assess the validity of pooling international cost data the reasons for cost variation across countries need to be assessed. Previously, ordinary least-squares (OLS) regression models have been used to identify factors associated with variability in resource use and total costs. However, multilevel models (MLMs), which accommodate the hierarchical structure of the data, may be more appropriate. This paper compares these different techniques using a multinational dataset comprising case-mix, resource use and cost data on 1300 stroke admissions from 13 centres in 11 European countries. OLS and MLMs were used to estimate the effect of patient and centre-level covariates on the total length of hospital stay (LOS) and total cost. MLMs with normal and gamma distributions for the data within centres were compared. The results from the OLS model showed that both patient and centre-level covariates were associated with LOS and total cost. The estimates from the MLMs showed that none of the centre-level characteristics were associated with LOS, and the level of spending on health was the centre-level variable most highly associated with total cost. We conclude that using OLS models for assessing international variation can lead to incorrect inferences, and that MLMs are more appropriate for assessing why resource use and costs vary across centres.

Age Factors↗
PubMed1990

The structure of readjustment after heart attack.

A comprehensive multivariate framework aimed at predicting the factors that enhance or impede readjustment after a heart attack, has been developed and empirically supported by a study among convalescents after heart attack. Application of multivariate techniques of data analysis revealed a 'structure' highlighting the relative weight of various 'demands' in impeding readjustment, and the relative significance of the individual's self-controlled resources in coping with these demands and thus enhance readjustment. The data further show the crucial role of the spouse in both enhancing resources and furthering readjustment. By distinguishing between three dimensions of readjustment--the affective, the instrumental, and the cognitive--the data further the understanding of the differential effects of various demands, resources, and spouse support on readjustment. The herein theoretically justified and empirically supported structure expands the earlier developed structure of readjustment of traumatically irreversible disabled persons, taking into consideration the peculiar situation of the convalescents after heart attack, the trilateral conceptualization of readjustment.

Adaptation, Psychological↗
PubMed2006

DWARF--a data warehouse system for analyzing protein families.

BACKGROUND: The emerging field of integrative bioinformatics provides the tools to organize and systematically analyze vast amounts of highly diverse biological data and thus allows to gain a novel understanding of complex biological systems. The data warehouse DWARF applies integrative bioinformatics approaches to the analysis of large protein families. DESCRIPTION: The data warehouse system DWARF integrates data on sequence, structure, and functional annotation for protein fold families. The underlying relational data model consists of three major sections representing entities related to the protein (biochemical function, source organism, classification to homologous families and superfamilies), the protein sequence (position-specific annotation, mutant information), and the protein structure (secondary structure information, superimposed tertiary structure). Tools for extracting, transforming and loading data from public available resources (ExPDB, GenBank, DSSP) are provided to populate the database. The data can be accessed by an interface for searching and browsing, and by analysis tools that operate on annotation, sequence, or structure. We applied DWARF to the family of alpha/beta-hydrolases to host the Lipase Engineering database. Release 2.3 contains 6138 sequences and 167 experimentally determined protein structures, which are assigned to 37 superfamilies 103 homologous families. CONCLUSION: DWARF has been designed for constructing databases of large structurally related protein families and for evaluating their sequence-structure-function relationships by a systematic analysis of sequence, structure and functional annotation. It has been applied to predict biochemical properties from sequence, and serves as a valuable tool for protein engineering.

Amino Acid Sequence↗
PubMed2007

GlycoMapsDB: a database of the accessible conformational space of glycosidic linkages.

Conformational energy maps of the glycosidic linkages are a valuable resource to gain information about preferred conformations and flexibility of carbohydrates. Here we present GlycoMapsDB, a new database containing more than 2500 calculated conformational maps for a variety of di- to pentasaccharide fragments contained in N- and O-glycans. Oligosaccharides representing branchpoints of N-glycans are included in the set of fragments, thus the influence of neighbouring residues is reflected in the conformational maps. During refinement of new crystal structures, maps contained in GlycoMapsDB can serve as a valuable resource to check whether the torsion values of a glycosidic linkage are located in an 'allowed' region similar to the Ramachandran plot analysis for proteins. This might help to improve the structural quality of the glycan data contained in the Protein Data Bank (PDB). A link between GlycoMapsDB and the PDB has been established so that the glycosidic torsions of all glycans contained in the PDB can be retrieved and compared to calculated data. The service is available at www.glycosciences.de/modeling/glycomapsdb/.

Carbohydrate Conformation↗
PubMed1994

Social support and social structure: a descriptive epidemiology.

Despite a very large and growing literature demonstrating the significance of social support for health and well-being, surprisingly little is known about the social distribution of this crucial resource. This paper presents data on the distribution of social support and support resources across social class, marital status, age and gender, with the aims of contributing toward an understanding of the impact of social structures on processes of social support, and of assessing the hypothesis that epidemiological variations in mental health arise partially from social support differences. The epidemiology of perceived social support was found to correspond closely to the epidemiology of psychological distress and disorder. The single exception involved gender, where a positive rather than negative relationship was observed, with women demonstrating the highest levels of both social support and psychological distress. The observed patterns of variation in social support link this significant adaptive resource to one's locations in the social structure and reinforce the conclusion that it represents a promising intervention target. The practical importance of these results, however, are not matched by theoretical significance. Except in the case of marital status, our findings largely discount the hypothesis that the social distribution of mental health is partially attributable to social support differences.

Adult↗