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PubMed2001

The cumulative effects of life event, personal and social resources on subjective well-being of elderly widowers.

A multidimensional Life Stress Model was used to test the independent contributions of background characteristics, personal resources, life event, and environmental influences on 200 widowers' levels of well-being, measured by the Affect Balance Scale. Stepwise regression analyses revealed that environmental resources were unrelated to negative affect which is influenced more by the life event and personal resource variables. The environmental resource variables, particularly interactions with friends and neighbors, mostly influenced positive affect. The explanatory model for well-being included multiple variables and explained 33 percent of the variance. Although background characteristics had the greatest impact, absence of hospitalization, higher mastery, higher self-esteem, contacts with friends, and interaction with neighbors enhanced well-being. The results support previous speculations on the importance of positive exchanges for positive affect. African-American widowers showed higher levels of well-being than Caucasian widowers did. The results advance knowledge about differences among elderly men.

Black or African American↗

PubMedDate not supplied

Evaluation of controlled vocabulary resources for development of a consumer entry vocabulary for diabetes.

BACKGROUND: Digital information technology can facilitate informed decision making by individuals regarding their personal health care. The digital divide separates those who do and those who do not have access to or otherwise make use of digital information. To close the digital divide, health care communications research must address a fundamental issue, the consumer vocabulary problem: consumers of health care, at least those who are laypersons, are not always familiar with the professional vocabulary and concepts used by providers of health care and by providers of health care information, and, conversely, health care and health care information providers are not always familiar with the vocabulary and concepts used by consumers. One way to address this problem is to develop a consumer entry vocabulary for health care communications. OBJECTIVES: To evaluate the potential of controlled vocabulary resources for supporting the development of consumer entry vocabulary for diabetes. METHODS: We used folk medical terms from the Dictionary of American Regional English project to create extended versions of 3 controlled vocabulary resources: the Unified Medical Language System Metathesaurus, the Eurodicautom of the European Commission's Translation Service, and the European Commission Glossary of popular and technical medical terms. We extracted consumer terms from consumer-authored materials, and physician terms from physician-authored materials. We used our extended versions of the vocabulary resources to link diabetes-related terms used by health care consumers to synonymous, nearly-synonymous, or closely-related terms used by family physicians. We also examined whether retrieval of diabetes-related World Wide Web information sites maintained by nonprofit health care professional organizations, academic organizations, or governmental organizations can be improved by substituting a physician term for its related consumer term in the query. RESULTS: The Dictionary of American Regional English extension of the Metathesaurus provided coverage, either direct or indirect, of approximately 23% of the natural language consumer-term-physician-term pairs. The Dictionary of American Regional English extension of the Eurodicautom provided coverage for 16% of the term pairs. Both the Metathesaurus and the Eurodicautom indirectly related more terms than they directly related. A high percentage of covered term pairs, with more indirectly covered pairs than directly covered pairs, might be one way to make the most out of expensive controlled vocabulary resources. We compared retrieval of diabetes-related Web information sites using the physician terms to retrieval using related consumer terms We based the comparison on retrieval of sites maintained by non-profit healthcare professional organizations, academic organizations, or governmental organizations. The number of such sites in the first 20 Results from a search was increased by substituting a physician term for its related consumer term in the query. This suggests that the Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom may be used to provide useful links from natural language consumer terms to natural language physician terms. CONCLUSIONS: The Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom should be investigated further for support of consumer entry vocabulary for diabetes.

Community Participation↗

PubMed2005

Shoestring budgets, band-AIDS, and team work: challenges and motivators in the development of a Web-based resource for undergraduate clinical skills teaching.

BACKGROUND: Learning how to conduct a medical interview and perform a physical examination is fundamental to the practice of medicine; however, when this project began, the methods used to teach these skills to medical students at the University of Toronto (U of T) had not changed significantly since the early 1990s despite increasing outpatient care, shorter hospital stays, and heavy preceptor workloads. In response, a Web-based clinical skills resource was developed for the first-year undergraduate medical course-The Art and Science of Clinical Medicine I (ASCM I). OBJECTIVES: This paper examines our experiences with the development of the ASCM I website and details the challenges and motivators inherent in the production of a Web-based, multimedia medical education tool at a large Canadian medical school. METHODS: Interviews and a focus group were conducted with the development team to discover the factors that positively and negatively affected the development process. RESULTS: Motivating factors included team attributes such as strong leadership and judicious use of medical students and faculty volunteers as developers. Other motivators included a growing lack of instructional equivalency across diverse clinical teaching sites and financial and resource support by the Faculty of Medicine. Barriers to development included an administrative environment that did not yet fully incorporate information technology into its teaching vision and framework, a lack of academic incentive for faculty participation, and inadequate technical support, space, and equipment. CONCLUSIONS: The success of electronic educational resources such as the ASCM I website has caused a significant cultural shift within the Faculty of Medicine, resulting in the provision of more space, resources, and support for IT endeavours in the undergraduate medical curriculum.

Budgets↗

PubMed2005

An Internet-based cancer clinical trials matching resource.

BACKGROUND: Many patients are now accessing the Internet to obtain cancer clinical trials information. However, services offering clinical trials recruitment information have not been well defined. OBJECTIVES: This study describes one of the first Web-based cancer clinical trials matching resources and the demographics of users who were successfully matched. METHODS: OncoLink is the Internet-based educational resource managed by the University of Pennsylvania Cancer Center (UPCC) and serves between 1 and 2 million pages per month to over 385000 unique IP addresses. OncoLink launched one of the first clinical trials matching resources on the Internet that allowed patients to enter demographic data through a secure connection and be matched to clinical trials. For patients with matches to potential trials, appointments were facilitated with the principal investigators. RESULTS: While we did not keep track of patients who could not be matched, 627 patients who submitted online applications between January 2002 and April 2003 were successfully matched for potential enrollment in clinical trials. The mean age of the patient population was 56 years (range 18-88 years). Males represented 60% of the patient population, and over 90% of users were Caucasian. Most of the applications were from patients with colorectal cancer (13%), lung cancer (14%), melanoma (10%), and non-Hodgkin's lymphoma (9%). CONCLUSIONS: This report shows that a significant number of patients are willing to use the Internet for enrolling in clinical trials. Care must be taken to reach patients from a variety of socioeconomic and racial backgrounds. This Internet resource helps to facilitate a consultation with a cancer patient who is prescreened and motivated to enroll in clinical trials.

Adult↗

PubMed1995

Resource utilization and costs of care in the diabetes control and complications trial.

OBJECTIVE: To describe in detail the resources used and costs incurred in the clinical management of patients with insulin-dependent diabetes mellitus (IDDM) in the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS: The resources used for intensive and conventional therapy and to deal with the side effects of therapy were assessed at each of the 29 DCCT clinics and summarized. Unit costs were derived from the DCCT, manufacturers, and Medicare and chosen to reflect what an item would cost to a single-payer national health system. Costs were calculated as the product of resources used and unit costs. The costs of the research component of the DCCT were not included. RESULTS: In the DCCT, the annual cost of intensive therapy ($4,000 and $5,800/year for multiple daily injections and continuous subcutaneous insulin infusion, respectively) was approximately three times the cost of conventional therapy ($1,700/year). A large portion of the difference in cost was related to the greater frequency of outpatient visits and the greater resources used in self-care. CONCLUSIONS: DCCT intensive therapy is more expensive than conventional therapy, but it offers the hope of cost savings as a result of averted complications.

Costs and Cost Analysis↗

PubMed2004

Comparison of scores for abused and nonabused young adults on the Psychological Trauma and Resources Scale.

The Psychological Trauma and Psychological Resources Scale has been developed to identify adolescents and adults who have experienced traumatic events, i.e., physical, sexual, or emotional abuse and neglect. The scale also attempts to identify the presence of compensatory or resource factors such as social support that may serve to ameliorate the effects of traumatic events. 98 college participants who reported a history of abuse were compared with 464 nonabused students on the seven subscales. As predicted, the abused participants reported significantly more incidents of abuse and neglect than the nontraumatized group. In addition, the abused group reported receiving less emotional support, and they were less likely to use positive self-talk as a way to decrease emotional distress. These results provide empirical support for using the Psychological Trauma and Psychological Resources Scale to identify individuals with a history of abuse. Findings underscore the importance of assessing resource variables that may moderate the effects of abuse.

Adaptation, Psychological↗

PubMedDate not supplied

Disability, resources, role demands and mobility handicap.

Research on disablement highlights a wide variability in the impact of disabling conditions on individuals' lives. However, in most of this work, the relationships between impairment/disability and features of individuals' social and physical environments are not specified conceptually. Recent conceptual work in the context of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) suggests that the impact of impairment/disability on individuals' lives is contingent on levels of resources and other aspects of social context. The research question addressed in this paper is whether selected social factors affect the impact of impairment/disability on mobility handicap, defined as 'the individual's ability to move about effectively in his/her surroundings'. Two types of social factors are considered: resources such as help from others or having a car available; and social role obligations such as having a job or visiting relatives. Data are derived from a 1986 probability sample of 570 individuals with disabilities living in communities in Calderdale, Yorkshire, England. Multiple-regression models indicate that the impact of walking disability on mobility handicap was reduced by availability of a car in the household and school or job obligations. Other impairments/disabilities, resources and social role demands examined did not act on mobility outcomes in this manner. Implications for conceptualizing and testing relationships between impairment, disability, handicap and social and physical environments are discussed. A critical task for future research is the investigation of personal and social resources and barriers that may moderate the impact of disability on individuals' lives.

Activities of Daily Living↗

PubMed1996

Effect of feedback on resource use and morbidity in hip and knee arthroplasty in an integrated group practice setting.

OBJECTIVE: To assess the effect of a structured program of feedback about resource utilization and morbidity on resource consumption and complications in an orthopedic surgical practice. DESIGN: We prospectively analyzed use and outcomes before and after an intervention (departmental data presentation). MATERIAL AND METHODS: Feedback on resource utilization and morbidity for 2,820 patients who underwent a primary total hip or knee arthroplasty for a diagnosis of osteoarthritis between Jan. 1, 1990, and Dec. 31, 1992, was provided to members of the orthopedic department of an academic medical center. Data were adjusted for severity of disease. RESULTS: On reassessment 18 months after the beginning of the feedback program, total charges and length of hospital stay for hip or knee arthroplasty were significantly reduced. Interpractitioner variability was also reduced but not significantly. The feedback process was instrumental in identifying a specific complication--pulmonary embolism after bilateral total knee replacement--which was significantly reduced by addition of warfarin prophylaxis. CONCLUSION: The intervention was successful in reducing resource use (length of hospital stay) and complications (pulmonary embolism). In addition, total charges for hip and knee arthroplasty declined significantly at a time when medical center charges overall were increasing. Efforts to maintain continuous improvement will primarily focus on the development of critical pathways.

Critical Pathways↗

PubMed2006

Managing anthelmintic resistance in small ruminant livestock of resource-poor farmers in South Africa.

Gastrointestinal parasitism is one of the most important disease complexes of sheep and goats impacting on the resource-poor livestock farmer. Of the responsible nematodes, Haemonchus contortus, a blood-sucking worm of the abomasum, poses possibly the greatest threat. Over the past several decades, the worm has been controlled through the use of anthelmintics, but the emergence of anthelmintic resistance has threatened this chemotherapeutic approach. In Africa, the overall prevalence of anthelmintic resistance has not been extensively investigated, particularly within the resource-poor farming sector, but resistance has been reported from at least 14 countries with most of the reports emanating from Kenya and South Africa and the majority concerning H. contortus. While levels of resistance under commercial sheep farming systems in South Africa is considered to be amongst the worst in the world, resistance has also been reported from the resource-poor farming sector. Increases in productivity and reproduction of livestock and the development of markets for sale of animals are seen by international funding bodies as a way out of poverty for communities that keep livestock. This must lead to the greater need for parasite control. At such times, the risk of levels of anthelmintic resistance escalating is much greater and there is therefore a need to look at alternatives to their use. Proposed strategies include the appropriate, but judicious use of anthelmintics by application of the FAMACHA system and the use of alternatives to anthelmintics such as strategic nutrient supplementation. It is also very clear that there is a strong demand for knowledge about animal diseases, including helminthosis, and their effective management in the resource-poor livestock farming communities. This is an important challenge to meet.

Animals↗

PubMed2006

[What causes self-control failure in delayed-cost dilemma: the role of affective expectancy and regulatory resource].

Two studies were conducted to examine the effect of affects on self-control behavior in delayed cost dilemma. Results of Study 1 suggested that long term negative affects such as regret and self-disgust might have facilitating effects on motivation of self-control if they were anticipated before delayed-cost dilemma situations, but inhibiting effects on self-efficacy of control when experienced after dilemma situations. Study 2 examined the effect of affect priming on self-control in eating behavior, as well as an interaction effect of anticipated affect and regulatory resource on it. Results indicated that participants who had enough regulatory resource succeeded in self-control, i.e. they ate less, regardless of the type of affect priming, but those who did not have sufficient resource and were not primed with long-term negative affects failed to control their behavior. It was argued that regulatory resource explanation of self-control should be expanded to the theory including anticipated affects.

Adult↗

PubMed1987

Care of very low birthweight infants with limited neonatal intensive care resources.

The advanced technology that is available to treat the tiniest infants has raised the legal and moral dilemma of where and how to distribute limited intensive care resources. In one neonatal intensive care unit it was determined that approximately 80% of its resources over a two-year period were utilized by very low birthweight infants, in spite of the fact that these infants comprised less than 50% of the total admissions to the unit. It was not possible to offer all very low birthweight infants full intensive care; to make this possible, it was calculated that resources would have to increase by 26%. In the present economic climate, and with limited numbers of nurses who are skilled in neonatal intensive care, the prospects for extra resources are poor. What action can or should be taken, legally and morally, when no facilities exist to treat a live-born infant who may possibly benefit from intensive care?

Australia↗

PubMed1998

Web-based resources for clinical protocol management.

The data monitoring regulatory procedures, and administrative tasks associated with protocol management have become increasingly complex. Relational database technology and Internet-based connectivity offer resources to improve the quality and efficiency of protocol operations. At Fox Chase Cancer Center, we have developed a suite of database applications for protocol management and tracking of patient accrual. All data transactions and reporting occur through a graphical web browser interface using standard Internet technology. Security and confidentiality have been addressed through encryption, user authentication, address restriction, and database authority. Database management has been tightly integrated with protocol operations to avoid duplication of resources and effort. Data query functions also extend to other institutional resources, such as tumor registry and the hospital clinical laboratory, to further reduce the need for redundant data storage. Newer components, such as chemotherapy orders and toxicity reporting, have been incorporated in a modular fashion. Although custom software development can be expensive and time-consuming, it offers the best opportunity for successful integration with existing resources, staff, and procedures, as well as collaboration with other institutions.

Clinical Protocols↗

PubMed1991

Allocating health resources ethically: new roles for administrators and clinicians.

Rationing of health care is an inevitable correlate of living in a world of finite resources. It is morally necessary. The Hippocratic ethic commits clinicians to do whatever will benefit the patient and therefore must be abandoned in a world of moral rationing. After looking at some unacceptable preliminary strategies, two patient-centered adjustments in the Hippocratic ethic, adopting a more objective standard of patient benefit and adding a principle of patient autonomy, are defended. Still, however, cutting the fat out of the system will not be sufficient. A true social ethic of resource allocation will be necessary. A social contract approach supports a principle of equity as a necessary supplement to utility and cost-benefit analysis. It does not follow, however, that clinicians must take on these social ethical decisions. Clinicians should be exempt from normal social ethics so they are free to pursue the objective welfare of patients (provided they consent to such benefit). Administrators are in no better position to allocate scarce resources. What is needed is input from patients to (a) set categorical limits on their own care, (b) articulate principles for fine-tuning the allocation decisions, and (c) supervise professional agents who will make specific gatekeeping decisions for allocating a pool of resources legitimately thought to belong to the patient population. Neither administrators nor clinicians will be responsible for rationing decisions. In 1989 we spent $604.1 billion on health (U.S. Department of Health and Human Services 1990). That is almost $2 billion a day. Sometimes the benefits are dramatic: the pneumonia cured, the heart transplanted, the children spared from infectious diseases with immunizations that cost only pennies. Even so, the American health care system leaves much to be desired. Many other countries have higher life expectancy at birth. Infant mortality in the United States is far higher than countries like Japan and Sweden (United Nations Children's Fund 1990). If we look at the distribution of health status in the United States, the problems look even worse. Today, depending on the study, about 13 to 15 percent of the population has no health insurance at all (U.S. Bureau of the Census 1989; Short, Monheit, and Beauregard 1989). Another 13 percent is woefully underinsured (Farley 1985). Social variables such as income, education, and race reveal dramatically different health status (Short, Monheit, and Beauregard 1989; Farley 1985). To respond to these needs, rationing will be essential.(ABSTRACT TRUNCATED AT 400 WORDS)

Cost Control↗

PubMed1992

A human resources decision support model: nurse deployment patterns in one Canadian system.

Optimal deployment of current staff--as opposed to recruitment of new staff--has been recognized as an effective strategy for dealing with nurse human resource shortages in hospitals, especially during periods of overall nursing shortages. In this article we present a model for maximizing current nursing staff resources by incorporating three dimensions of staff deployment: workforce stability, employment mix, and average paid hours. Using centralized provincial payroll data from British Columbia, we analyzed a set of three indices that measure these factors to examine patterns of nurse deployment and their impact on total nurse human resource requirements. Furthermore, by constructing hypothetical scenarios and changing the parameters according to possible situations depicted by the model, it is possible to demonstrate the impact of alternate management strategies on nurse requirements. The results emphasize the need for dealing with staff deployment in a multidimensional manner that may vary by facility type; it is not the size of the full-time nursing component alone that should be the dominant consideration for all facilities. Innovative approaches to management are called for to maximize the deployment of a limited human resource pool.

British Columbia↗

PubMed1997

Diagnostic certainty and hospital resource use.

OBJECTIVE: To determine whether the house staff's subjective probability estimates of their initial admitting diagnoses are independent predictors of in-hospital resource consumption. DESIGN: Descriptive correlational study. SETTING: Academic medical center inpatient setting. PATIENTS: Patients admitted to general medicine wards. MEASUREMENTS: A visual analog scale with hash marks at 0, 25, 50, 75 and 100 was used to obtain a subjective probability estimate that the house staff's initial admitting diagnosis was a correct diagnosis. This provided the measure of diagnostic "certainty" at the time of admission. Patient demographic data, prior hospital stays, distance from hospital, MedisGroups scores, outlier status and vital status at discharge were obtained from administrative systems. Length of stay, total charges, cost estimates (total departmental), and number of consultations were obtained from the hospital-based transaction master database. RESULTS: House staff evaluated 1,778 admissions, 77.2% were assigned a diagnostic certainty rating of 75% or higher. In univariate analysis, the certainty rating did not vary with the MedisGroups score, outlier status or vital status at discharge. It varied with prior stays and measures of resource use. In multivariate analysis, the certainty rating was a significant factor accounting for variation in each of the measures of resource utilization with the exception of adjusted pharmacy charges. CONCLUSIONS: Even in a teaching hospital only a small proportion of patients had an "uncertain" diagnosis (22.8%). Nonetheless, the certainty variables were significantly related to measures of resource consumption including length of stay, total costs and number of consults obtained.

Adult↗

PubMedDate not supplied

How SmithKline Beecham makes better resource-allocation decisions.

Major resource-allocation decisions are never easy. For a pharmaceuticals company like SmithKline Beecham, the problem is this: How do you make good decisions in a high-risk, technically complex business when the information you need to make those decisions comes largely from the project champions who are competing against one another for resources? In 1993, the company experimented with ways of depoliticizing the process and improving the quality of decision making. In most resource-allocation processes, project advocates develop a single plan of action and present it as the only viable approach. In SB's new process, the company found an effective way to get around the all-or-nothing thinking that only reinforces the project-champion culture. Project teams were required--and helped--to create meaningful alternatives to current development plans. What would they do with more money? With less? With none at all? In another important departure from common practice, SB separated the discussion of project alternatives from their financial evaluations. In doing so, SB was able to avoid the premature evaluations that kill both creativity and the opportunity to improve decision making. The new process at SB has allowed the organization to spend less time arguing about how to value its R&D projects and more time figuring out how to make them more valuable. In the end, the company learned that by tackling the soft issues around resource allocation--such as information quality, credibility, and trust--it had also addressed the hard ones: how much to invest and where to invest it.

Decision Making, Organizational↗

PubMed1983

The hidden costs of treating severely ill patients: charges and resource consumption in an intensive care unit.

A detailed survey of the resources used by two common groups of intensive care unit (ICU) admissions in one medical center hospital found substantial cross-subsidization, with healthier patients admitted for monitoring using significantly less labor resources than sicker patients. Both groups had equal bed charges. This suggests that the resource costs of admitting stable patients to an ICU for monitoring are smaller than their average bed charge. On the other hand, the actual resource costs of treating sicker patients are almost twice their billed ICU charges. ICU care is approximately 3.8 times more expensive than routine hospital care, a higher ratio than previously estimated. These results should be considered when estimating the national cost of treating severely ill patients and when proposing changes in hospital reimbursement policies, especially with regard to ICU patients.

Ancillary Services, Hospital↗

PubMed1999

The role of resource allocation models in selecting clinical preventive services.

OBJECTIVE: To demonstrate the potential value and current limitations of using resource allocation models for selecting health services. DESIGN: To identify the most efficient mix of preventive services that could be offered by a managed care organization (MCO) for a fixed budget, an optimization model (greatest number of life years saved) and a cost-effectiveness model (rank order of most to least cost effective) were developed. Because of the lack of cost-effectiveness analyses that met the study criteria, only 9 preventive services were selected to demonstrate each model. PATIENTS AND METHODS: The 2 models were applied to a hypothetical managed care population of 100,000 enrollees with age, sex, and risk distribution similar to that of the US population. Data for the input variables were obtained from cost-effectiveness studies of 9 preventive services. Model variables included the target population, percent of enrollees who received the preventive service, the cost of the preventive service, life years saved, and cost-effectiveness ratios. RESULTS: The models demonstrated that efficient allocation of finite resources can be achieved. When budgets are limited, different premises between the 2 models may yield different health consequences. However, as the budgets were increased, results from the 2 models were more closely aligned. CONCLUSIONS: Resource allocation models have the potential for assisting MCOs in selecting a set of preventive services that will maximize population health. Before this potential can be fully realized, additional methodological development and cost-effectiveness studies are needed. The use of resource allocation should be examined for selecting all healthcare services.

Budgets↗