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At least 1,153 records · Page 64Linked to original sources
PubMed1983

[Perinatal mortality in the Grand Duchy of Luxembourg. The trend from 1969 to 1979].

A systematic survey on perinatal mortality has been carried out in Grand Duchy of Luxembourg for eleven years: a 40 to 100 reduction of the rate is noticed, decreasing from 20.6 p. 1 000 in 1969 to 11.9 p. 1 000 in 1978 with a more distinct reduction of the early neonatal component. Important differences are observed in various geographical places both in the rates and in the evolution during the studied period. Differences associated with socioeconomic factors, maternal age and civil status at birth seem to fade out. During the whole period, perinatal mortality rates are lower in foreigners and more particularly in recent immigrants than in Luxembourg people. The chronological aspect of the evolution suggests that these facts are correlated with the adoption of preventive measures in perinatality. This program seems to be efficient not only by globally reducing perinatal mortality but also by decreasing social inequalities in perinatality.

Birth Rate↗
PubMed1980

Surgical decision analysis. Methodological aspects of statistical evaluations in therapeutic trials.

This report aims at discussing some of the sources of error and pitfalls involved in evaluating the efficiency of alternative modes of therapy in clinical materials. One of the main obstacles in such analysis is that the therapeutic groups are basically different due to the original selection of patients. In a previous paper (Pellettieri, 1980) a special method was worked out to circumvent this problem. The method requires that the variables of main prognostic importance can be identified. Patients in the different therapeutic groups who have identical patterns of combination of variables (risk profiles) can then be compared and the efficiency of different treatment programs can be evaluated. We believe that this method can be used in other fields of medicine.

Adult↗
PubMed1994

[Value of individualized rehabilitation at the ventilatory threshold level in moderately severe chronic obstructive pulmonary disease].

In order to study the efficiency of individual training programs at the ventilatory threshold level, twenty COPD patients were randomized into two groups and studied over a two-month period. At the start, during, and at the end of the study all subjects performed incremental exercise tests. The trained group (59.60 SEM +/- 2.75 years) walked four times a week at the heart rate corresponding to the metabolic level of ventilatory threshold. The other group served as controls (58.2 +/- 1.80 years). A marked increase in the symptom-limited oxygen consumption (+/- 25%) (p < 0.01), the maximal ventilation (+20%) (p < 0.01), and the ventilatory threshold (+19%) (p < 0.05) was found in the trained group. No modification was recorded in the control group. The ventilatory pattern at submaximal intensities expressed in percentage of the initial oxygen consumption showed significant differences between groups, the trained-group ventilation decreased at 50% and 75% VO2 sl (p < 0.05). The breathing frequency also decreased at 50% and 75% VO2 sl (p > 0.05). Moreover, we observed an increase in the oxygen pulse at 50% VO2 sl (p < 0.05). In conclusion, this study demonstrates that individualized training at the ventilatory threshold level increases exercise tolerance and produces better ventilatory comfort in COPD patients.

Anaerobic Threshold↗
PubMed1994

[Possibilities for modifying risk factors for chromosome abnormalities--advantages of the so-called "triple" marker studies in comparison with pure "maternal age screening"].

We have offered the so-called "triple-marker screening" since May 1991 to all patients who came for prenatal care and did not select an invasive procedure primarily. First evaluation of 5210 cases revealed that 3.7% were test-positive for neural tube defects, 13.8% for Down's syndrome and 0.5% for both at the same time. The explanation for the comparatively high "test-positive" rate of 13.5% is the maternal age distribution with the median at 31.4 years. The highest number of women selecting triple-marker determinations was in the age group of 35 years. We detected 16 cases of Down's syndrome and in this group the majority of women was below 35 years. The decision of women to have an invasive procedure was obviously very much influenced by the actual risk assessment, because amniocentesis was chosen by 72/85 (84.8%) of women with a risk of more than 1:50, 192/290 (66.2%) of women in the risk category of 1:51 to 1:200 and 182/333 (54.6%) in the risk category of 1:201 to 1:400. The follow-up is not yet complete, but there is already good evidence for the efficiency of the screening program. Triple-marker screening also proved predictive in 10 cases of trisomy 18 and 8 cases of triploidy in this series. As a cut-off value we chose the risk of 1:386 which is equivalent to the odds of a 35 year old to have a child with Down's syndrome at birth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Quality in occupational health care: management's view.

Total Quality Management (TQM) is a continual improvement process that requires common sense, education and training, and the ability to communicate and work as part of a team. TQM can improve all aspects of a business, including health, safety, and environmental functions. Physicians and nonphysician managers can use TQM to identify and respond to customer needs and improve the efficiency and effectiveness of programs. Examples of TQM to improve medical programs have included (1) an Audit Program that assesses medical programs and provides specific measurements ("metrics") of medical programs, and (2) a team that developed an Alternative Return-to-Work Program, which now assists in early rehabilitation of injured employees. In addition to expecting its physicians to be knowledgeable, fair, and objective, management expects them to use and understand TQM principles.

Humans↗
PubMed1993

Some developments on the affected-pedigree-member method of linkage analysis.

Some improvements are presented for the affected-pedigree-member method of linkage analysis, which is a generalization of the sib-pair method. The test statistic is extended to include contrasts between affected and unaffected pedigree members, so that it now utilizes marker information from all typed pedigree members rather than just the typed affected members. Computer simulation using a sample pedigree of 14 individuals shows that this modification can substantially increase statistical power where there is a direct association between marker variation and disease and where disease risk is elevated in carriers of the disease allele. Data on Huntington disease in 16 British families, which were analyzed previously using only the affected individuals, are reanalyzed with the unaffected individuals included. Strong rejection of the null hypothesis of no association between Huntington disease and the HindIII polymorphism is confirmed, but the particular families in which the association is significant differs from that obtained through an analysis based only on affected individuals and reflects more closely the results obtained from a lod-score analysis. The test statistic is also modified here to incorporate contrasts between individuals of zero kinship, if needed. This enables contrasts between individuals from different pedigrees, as well as contrasts involving individuals sampled from the general population, to be incorporated into the test of association. For population data, the methodology reduces to a type of contingency-table analysis, in which the rows of the table correspond to different marker-locus genotypes and in which the two columns categorize subjects into an "affected" group versus an "unaffected," or control, group. This aspect of the methodology is illustrated using two population data sets, the first relating APO-E genotype to the frequency of individuals undergoing maintenance hemodialysis and the second relating APO-B genotype to the frequency of coronary artery disease. The present methodology confirms the lack of association between marker and disease in the former data set and confirms the presence of association in the latter. Finally, the methodology is formulated here in terms of ordinary, multiperson kinship coefficients rather than in terms of the generalized kinship coefficients originally proposed. This greatly reduces the number of coefficients to be calculated, thereby enhancing the computational efficiency of the computer program.

Apolipoproteins B↗
PubMed1993

Matrix effects in the derivatization of amino acids with naphthalene dicarboxaldehyde, 9-fluorenylmethyl chloroformate and phenylisothiocyanate.

Pre-column derivatizations of amino acids often present two major challenges: 1) automation, due to the multi-step manipulations for pH control, reagent addition, mixing and extraction, and 2) effect of matrices in the sample such as salts, buffers and surfactants. Both issues have been addressed in a previous publication on derivatization methods using 9-fluorenylmethyl chloroformate (FMOC) and phenylisothiocyanate (PITC). In this paper, a third method of derivatization, which has recently been developed and published, was studied to address the same issues. The derivatization reagent, naphthalene-2,3-dicarboxaldehyde (NDA), is a modification from o-phthalaldehyde (OPA) and yields more stable derivatives with high fluorescence efficiencies. An autosampler was programmed to mix amino acid samples with cyanide and NDA reagent, allow a programmed reaction time and finally inject onto the HPLC. To study sample matrix effects, amino acid samples were spiked with various concentrations of Tris-HCl, phenol, citrate, sulfosalicylic acid, sodium chloride and sodium dodecyl sulfate. The recoveries of amino acids in varied sample matrices were compared to pure amino acid standards. The matrix effects using the NDA method were similar to those using the FMOC method. Comparisons of all three methods (NDA, FMOC and PITC) are discussed and tabulated.

Amino Acids↗
PubMed1993

The effect of command emphasis and monthly physical training on Army physical fitness scores in a National Guard Unit.

Individual fitness, an important component of combat readiness, has been found to be deficient in some Reserve Component units of the United States Army. We evaluated a program of monthly physical training in an environment of increasing emphasis on unit physical fitness in an effort to determine the effect on unit performance on the semi-annual Army Physical Fitness Test (APFT). This program was examined in a retrospective manner to establish its effectiveness over a 6-month period. No statistically significant improvement in APFT scores could be found over the course of the study, suggesting that such a program is not an efficient means of improving unit fitness in the Reserve Components of the United States Army.

Adult↗
PubMed1993

[Efficacy of hemoglobin-Alc, fructosamine, and 1,5-anhydroglucitol in community screening for diabetes mellitus].

To evaluate the efficacy of hemoglobin-Alc, fructosamine, and 1,5-anhydroglucitol tests in screening for diabetes mellitus in communities, the sensitivity and the specificity of these tests were observed on the island of Ojika, Goto islands, Nagasaki prefecture Japan. A 75 gram glucose tolerance test was performed simultaneously on every participant, and WHO diabetes mellitus criteria were used to classify individuals. A total of 554 males and 820 females, older than 34 years, participated in the examination, representing a response rate of 42% and 52% respectively, and 86 were classified as diabetic. The sensitivity and the specificity of several screening levels were determined for each test. Each of the tests attained greater than 70% sensitivity and specificity simultaneously, but could not achieve greater than an 80% level simultaneously. If screening levels are selected for a sensitivity of as low as 50%, it is possible to produce a high specificity of 97-98%. These results provide valuable information for the planning of efficient diabetes mellitus detection programs in communities.

Adult↗
PubMed1995

Capturing patients' perceptions in the computer-based patient record: essential prerequisites to the measurement of health-related outcomes.

The cost, quality, and outcomes of healthcare services have become the focus of national attention as providers, consumers, and payers of healthcare services grapple with healthcare reform in the United States. Given the importance of patient care data to the activities of all segments of the healthcare spectrum, the development and implementation of computer-based patient records (CPRs) has been recommended as CPRs have the potential to improve healthcare delivery, enhance outcomes research programs, and increase hospital efficiency [12]. The current paradigm shift in healthcare requires the active involvement of the patient in the delivery and evaluation of care. The patient must be considered as an essential user of CPRs in order to exploit the benefits of information technology for the purposes of outcome assessment. Research and development of the future CPRs must incorporate the needs of the patient. Systems should be designed to meet these needs in order to capture the patient's perceptions in CPRs.

Medical Records Systems, Computerized↗
PubMed1997

[Status and perspectives of quality assurance in socialized medical services].

Quality, quality assurance, and quality management are becoming more and more dominating topics in German public health. Quality is named as the most important goal of medical care in the public health related political discussions of physicians, hospitals, health insurances, and politicians but is affected by differences in political, economical, medical, and particular interests. To avoid a single-sided discussion about questions of quality (only with the goal of increasing efficiency and reducing costs), the society of physicians of Germany and the society of panel physicians published a common stock of 10 theses about medical quality assurance and quality improvement in the spring of 1996: (1) Medical quality assurance and quality improvement serve the patient. (2) Medical quality assurance and quality improvement do not primarily serve the improvement of economic efficiency. (3) Quality assurance programs have to be problem oriented and coordinated; quality in the ambulant and hospital setting cannot be different. (4) The appropriateness of quality assurance programs has to be evaluated firmly. (5) Transparency, communication, and cooperation are prerequisites of a successful quality assurance and quality improvement. (6) Comprehensive internal quality assurance is the foundation of continuous quality improvement. (7) External quality assurance should initiate the development of procedures for internal quality assurance. (8) Quality assurance has a chance for realization only if it is carried by the conviction and the effort of every participant to perform at relatively high quality, to subject his own doing to continuous checks and improvement, and to compare with others. (9) Quality has it's price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in public health. The current situation and future developments of quality assurance in ambulant health care are discussed in this paper.

Forecasting↗
PubMed1997

[Part of health costs related to malaria in a Cameroon enterprise].

In 1995 a survey was conducted in a metallurgical company in Cameroon to determine the percentage of health-related costs attributed to malaria. Both direct (consultation, hospitalizations, laboratory tests, and drugs) and indirect (sick pay, overtime, and lost production) costs were included. Total annual health-related expenditures were 4,125,000 FF. The average amount spent was 5,800 FF per family or 900 FF per eligible person. Malaria accounted for 1,272,000 FF or 31% of these expenditures. Thus the average amount spent for malaria was 1780 FF per family and 275 FF per eligible person. These figures indicate that a prevention program based mainly on use of impregnated mosquito nets, would be a highly cost-effective approach especially within the context of a well-organized health care system, a stable local population, a high mosquito biting nuisance, a good awareness of this nuisance, the possibility of social upheaval, and probable company support. Since a malaria-prevention program running at 50% efficiency would only decrease the malaria-related costs by about 12.5% of overall annual health expenditures, careful monitoring of cost-effectiveness would be necessary.

Adolescent↗
PubMed1998

Size does matter.

Hospital mergers, like Godzilla's comeback movie, promise that bulk means marketplace brawn. Yet as the dust settles, the payoff isn't always so clear. Promised efficiencies from merging duplicated programs--even shutting down entire hospitals--often fail to materialize. In fact, cutting the deal may turn out to be the easy part.

Cost Control↗
PubMed1998

[Koch's phenomenon after BCG vaccination and the two-step tuberculin test in elementary school children].

In Japan, BCG vaccination, which covers more than 90% of infants, has been given according to the national immunization policy. Moreover, first-grade children in elementary school are screened with tuberculin skin test, and those who show negative reaction in the Japanese standard, i.e. size of erythema less than 10 mm, are re-vaccinated with BCG according to the Tuberculosis Prevention Law. However, since the incidence of tuberculosis among children below age 14 is as low as 1.5/100,000 in Japan, it is time to reconsider the BCG vaccination policy. As the first step to assess the efficiency of the present program, we observed the occurrence of Koch's phenomenon after BCG vaccination in elementary school children in Chiba City in 1995 and 1996, and we introduced the two-step tuberculin test to elementary school children in 1997. Among 180 BCG vaccinated children in 1995 and 1996, 168 (93.3%) had been vaccinated by 4-year of age. We could follow local reaction of BCG re-vaccination and observed Koch's phenomenon in 117 (69.6%, 95% C.I. of 62.7-76.6%). Among 92 tuberculin negative children in 1997, 85 (92.4%) had been vaccinated by 4-year of age. In the two-step tuberculin test program of 85 initial negative-reactors, 63 (74.1%, 95% C.I. of 64.8-83.4%) turned to positive by the second test. Those results suggest that more than 69% of tuberculin-negative school children who were vaccinated previously maintained immunity with BCG. Our studies raised a problem of the current BCG re-vaccination policy that depends on the result of tuberculin test. Due to the discrepancy between tuberculin allergy and immunity in tuberculosis, many school children may be given BCG vaccination unnecessarily. Taking into consideration the incidence of tuberculosis in children, discontinuation of BCG re-vaccination policy at elementary school entrance should be considered.

BCG Vaccine↗
PubMed1998

[Prevalence of pressure ulcers of patient in home visiting nursing service].

PURPOSE: To determine prevalence and risk factors for pressure ulcers of subjects in visiting nursing service stations. METHOD: Descriptive cross-sectional study. Data were collected by a mail survey questionnaire from 934 visiting nursing service stations that were listed in "Visiting nursing service stations list" in September 1995. RESULTS: Responses from 620 visiting nursing service stations were obtained (collection rate 66.4%). The sample consisted of 23,500 subjects, with a pressure ulcer prevalence rate of 14.6% (n = 3,441). Furthermore, the prevalence was 15.1% (n = 3,177) in the elderly of 65 years and older (n = 21,020). The observed prevalence among visiting nursing service stations ranges from 4.8% to 24.1%. In subjects with pressure ulcers, there were high rates of cerebral vascular diseases, dementia, Alzheimer's disease, urinary organ system diseases, and senility. On the other hand, subjects without pressure ulcers, had high rates of ischemic heart diseases, chronic respiratory organ diseases, and mental disease. The total number of pressure ulcers that were observed in 3,441 subjects was 5,158 and the number of the pressure ulcers per person was 1.64. The level of depth of I, II were observed at around 40%. CONCLUSION: The number of elderly people who necessitate medical treatment or nursing care in homes will be increasing in the future. A survey is needed to develop a program that will be efficient in early detection and care of pressure ulcers.

Aged↗
PubMed1985

Programming by objective links objectives to the cost of achieving them.

At present, few program budgeting models relate program objectives to the cost of achieving them. How can the manager know objectives are met efficiently? Is the objective worth the cost to achieve it? With the programming by objective model, such a link between cost, objectives, and efficiency is made. Using five separate but interrelated steps--planning, programming, budgeting, control, and evaluation--the manager can develop program and spending plans that relate costs and objectives and help the manager meet program objectives efficiently.

Budgets↗
PubMedDate not supplied

Using facilitators in mock codes: recasting the parts for success.

BACKGROUND: Members of the CHRISTUS Santa Rosa Children's Hospital staff development committee identified a need for a mock code program which would address a range of learning needs for nurses and other caregivers with varying levels of knowledge, skills, and experience. METHOD: We implemented a mock code program using experienced caregivers, usually emergency room and pediatric intensive care RNs and respiratory therapists to serve as facilitators to code participants during the mock code drills. Facilitators have dual roles of teaching and guiding the code participant as well as evaluating performance. RESULTS: Code participants and facilitators benefit from the design of this program. Debriefing session input and written program evaluations show that code participants value the opportunity to practice their skills in a nonthreatening situation in which they receive immediate feedback as needed. Facilitators learn to teach and coach and strengthen their own code knowledge and skills at the same time. CONCLUSION: This mock code program serves as a unique way to include novice and experienced nurses in mock codes together. The knowledge, skills, and confidence of the code participants and the facilitators have matured. The design of the program allows for immediate teaching/learning where needed, as well as appropriate evaluation. This program develops stronger, calmer, more efficient, and more confident nurses during codes. Practice and equipment changes can be based on findings from the mock codes. The program is invaluable to patients, staff, and hospital.

Cardiopulmonary Resuscitation↗
PubMed1980

Paving the way: training the influentials in population education.

A number of countries in Far East Asia are in the process of launching national population education programs. To get them off the ground and to keep them working needs the support of key personnel in the program. This means that basic training in population education should be given to key personnel to enable them to promote and efficiently run the population education programs. The Sub-Regional Group Training Course in Population Education organized by the Mobile Team of the Unesco Regional Office for Education in Asia and Oceania to be held in Bangkok from 18 August to 5 September is a response to this need. Training will be given to key personnel from Afghanistan, India, Nepal, and Pakistan. The specific objectives of the course are to provide the participants with: 1) opportunities for exchanges of information and experience; exposure to and involvement in developing population education curricula, teaching units and sample instructional materials; 2) an understanding of various strategies for curriculum development and methodologies used for designing and implementing programs; and 3) preparation as teams from each Member State able to contribute to the promotion of population education in school and out of school in their countries. The training course has 5 main thrusts, namely: 1) sharing of experiences and clarification of the concepts of population education; 2) development of population education curriculum; 3) development of teaching units; 4) development of sample alternative instructional materials; and 5) field visit to ongoing population education programs in Thailand. The content will cover: 1) the knowledge base which includes concepts, nature, issues and status of population education; demographic concepts, population and development; and 2) strategies and approaches such as those used in curriculum development and teaching units, methods of teaching, and instructional materials development. The training methodologies will include lecture and panel discussions, film shows, and practicum.

Community Health Workers↗