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Patterns of health resource utilization, costs, and intensity of need for primary care clients receiving public health nursing case management.

Case management has been promoted as a managed care strategy that improves quality of care and contains costs. Health resource utilization patterns and associated costs were examined for a generalized primary care population receiving a public health nursing model of case management intervention during a 30-week period. Subjects were referred by providers practicing in an academic health science center and included two client subsamples: chronically ill adults and younger families requiring health maintenance. Health resource utilization patterns and associated costs were examined in relation to intensity of need for care levels as determined by the Community Health Intensity Rating Scale. Results of this pilot study suggest that during public health nursing case management intervention, health resource utilization patterns changed from the preintervention period. Total health resource utilization costs were correlated with care needs related to health management behavior of the chronically ill.

Adult↗

UCMP and the Internet help hospital libraries share resources.

The Medical Library Center of New York (MLCNY), a medical library consortium founded in 1959, has specialized in supporting resource sharing and fostering technological advances. In 1961, MLCNY developed and continues to maintain the Union Catalog of Medical Periodicals (UCMP), a resource tool including detailed data about the collections of more than 720 medical library participants. UCMP was one of the first library tools to capitalize on the benefits of computer technology and, from the beginning, invited hospital libraries to play a substantial role in its development. UCMP, beginning with products in print and later in microfiche, helped to create a new resource sharing environment. Today, UCMP continues to capitalize on new technology by providing access via the Internet and an Oracle-based search system providing subscribers with the benefits of: a database that contains serial holdings information on an issue specific level, a database that can be updated in real time, a system that provides multi-type searching and allows users to define how the results will be sorted, and an ordering function that can more precisely target libraries that have a specific issue of a medical journal. Current development of a Web-based system will ensure that UCMP continues to provide cost effective and efficient resource sharing in future years.

Catalogs as Topic↗

Measures for increased nutrition and utilization of non-conventional food resources during disasters in Africa.

The basic causes of the poor performance of the food and agricultural sector in the different parts of Africa are external, internal, and natural. The general recession in the Continent limits the capacity of the respective countries to import food to supplement inadequate domestic production and supplies. There are a number of nutritious food resources, both cultivated and gathered in the different ecological zones of Africa, whose production and consumption can be increased to ensure adequate food security and a nutritious diet, especially during disasters. These food resources could include: cereals, legumes, fruits, vegetables, fish, and insects. These food resources already are available over wide geographical areas in Africa and are utilized or utilized to a limited extent. Therefore, strategies to increase food supply, eradicate hunger and malnutrition, and keep people alive in times of disasters should have as a priority, the cultivation and consumption of non-conventional food resources in the respective communities and countries.

Africa↗

Student and faculty performance in clinical simulations with access to a searchable information resource.

In this study we explore how students' use of an easily accessible and searchable database affects their performance in clinical simulations. We do this by comparing performance of students with and without database access and compare these to a sample of faculty members. The literature supports the fact that interactive information resources can augment a clinician's problem solving ability in small clinical vignettes. We have taken the INQUIRER bacteriological database, containing detailed information on 63 medically important bacteria in 33 structured fields, and incorporated it into a computer-based clinical simulation. Subjects worked through the case-based clinical simulations with some having access to the INQUIRER information resource. Performance metrics were based on correct determination of the etiologic agent in the simulation and crosstabulated with student access of the information resource; more specifically it was determined whether the student displayed the database record describing the etiologic agent. Chi-square tests show statistical significance for this relationship (chi 2 = 3.922; p = 0.048). Results support the idea that students with database access in a clinical simulation environment can perform at a higher level than their counterparts who lack access to such information, reflecting favorably on the use of information resources in training environments.

Bacteriology↗

Clinically relevant dermatology resources and the Internet: An introductory guide for practicing physicians.

The number of dermatology sites on the Internet is growing rapidly and the resources they offer are of great benefit to dermatologists and physicians. The mainstay of dermatologic diagnosis is that of visual inspection and gross morphology, therefore, the use of improved imaging techniques, which allow for the rapid collection, electronic transmission, and indexing of images aids in the accurate recognition and interpretation of skin lesions. The graphic nature of the field of dermatology kindly lends itself to the use of the Internet. The enhanced ability to access information,and share expert opinion worldwide will help lessen inappropriate treatment or delayed referral to an appropriate specialist and facilitate the accurate diagnosis of various dermatologic diseases. Concerns about the quality of data are examined and an evaluation scheme proposed. An overview of available resources is presented along with links to additional resources to aid the reader in the identification of additional sites to explore. Sites were selected with the goal of identifying those that provide a broad range of information worthwhile to the dermatologist and general practitioner. Resources including, but not limited to, image atlases, electronic texts, drug databases, case study archives, laboratory testing, and clinical procedures are examined.

Dermatology↗

Healthcare users and computerised resources.

This paper concerns users' views on computerised resources. The focus concerns a software tool that could be used to allow safety conscious user manipulation of the combination of these computerised resources. It is of concern to the authors that computerised resources used in healthcare should reflect users' working practices rather than working practices being changed to reflect computerised resources.

Attitude to Computers↗

Strategic human resource management: redefining the role of the manager and worker.

Health-care managers have long been sensitive to the importance of physical resources (technology, space) and financial resources to the success of service delivery. During the last several decades, the value and potential for development of a third element, the human resource has gained new recognition. The importance of viewing personnel as an expandable resource, addressed in an organization's strategic plan, is crucial to meet challenges faced in a rapidly changing health-care environment.

Delivery of Health Care↗

[Resource diagnosis with children].

Traditionally the task of diagnosis in psychotherapy with children is the description of the disturbed behavior and the analysis of its causes. But the deficit-oriented perspective leads as a rule to a neglection of the clients', positive potentials, whose inquiry and therapeutic use for the success of therapy is however, following new findings of therapeutic effect research, of eminent significance. By this article a concept of resource diagnosis is introduced that demonstrates by several examples from the practice different methods of resource analysis with children based on a resource taxonomy. Finally a detailed case presentation illustrates the enlarged possibilities which are offered by the combined application of deficit and resource analytic results for therapy planning and intervention.

Absenteeism↗

Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical work carried out in Balochistan to develop a system of resource allocation and budgeting that is needs-based, in line with policies of decentralization, and implementable within existing technical constraints. However, the development of technical systems, while necessary, is not a sufficient condition for the implementation of a resource allocation and decentralized budgeting system. This is illustrated by analysing the constraints that have been encountered in the development of such a system in Balochistan.

Budgets↗

The role of social and psychologic resources in caregiving of cancer patients.

BACKGROUND: The role of social support and personality within the cancer caregiving process has remained a relatively unexplored area. The current longitudinal study examines the main and moderating effects on caregiver experiences and caregiver's depression over time of various social and psychologic resources. METHODS: Newly diagnosed colorectal carcinoma patients and their partners (N = 148) were included and data were obtained at three measurement points: 2 weeks prior to hospital admission and 3 months and 6 months after discharge. The initial and change scores of the caregiver's negative and positive social interactions and personality attributes (mastery, neuroticism, and extraversion) were included to assess their impact on caregiver experiences and depression over time. RESULTS: The main effects of social and psychologic resources on caregiver experiences were found to be small to absent. With respect to caregiver depression, both initial scores and changes in neuroticism, mastery, and negative social interactions were shown to have substantial main effects over time. Moreover, daily emotional support and mastery modified the relations between caregiver experiences and caregiver depression. Caregivers with a low level of daily emotional support, as well as those with a low score on mastery and who also perceived caregiving in a more negative way were identified as more depressed over time. CONCLUSIONS: The results of the current study demonstrate the importance of including various social and psychologic resources in studying the cancer caregiving process. It illustrates the distinctive impact of these resources on the depression of caregivers of patients with cancer, and therefore helps healthcare providers understand why some persons adapt better than others to their caregiving role.

Adult↗

Conducting an inventory of informal community-based resources for children with physical disabilities: enhancing access and creating professional linkages.

This article describes the process involved in conducting a sample inventory of community-based sports, recreation/leisure, and arts resources that include children with physical disabilities in Monroe County, New York. The inventory instrument, Community Resource Inventory for Children with Physical Disabilities, was designed to examine organizational or group capacity to provide activities for children with physical disabilities. The inventory was administered by phone to organizations and groups identified as meeting the definition of a community-based resource. One hundred and six CBR informants were interviewed, each reporting one or two recreational activities provided at their site. The activities included arts, sports, or leisure offerings, with a total of 127 activities identified in the sample. The results of the study support the premise that community-based resources are receptive to providing activities for children with physical disabilities and to potential collaboration with therapists. Numerous barriers exixts, however, including environmental inaccessibility, lack of personnel training, and including environmental inaccesssbility, lack of personnel training, and costs of participation. The results suggest several educational and system-based changes that may promote future collaborative efforts between therapists and community-based organizations.

Adolescent↗

Pupillary responses and processing resources on the visual backward masking task.

Task-evoked pupillary responses were recorded during a visual backward masking task as an index of resource allocation. Increased pupillary dilation indicates increased allocation of processing resources to the task. Consistent with numerous studies, detection accuracy increased with longer interstimulus intervals and approximated no-mask accuracy in the 300-ms condition. Pupillary dilation responses were significantly greater during task performance (cognitive load) than during a passive stimulus viewing condition (no-load) and were significantly greater in the 300-ms condition than the no-mask condition. Consistent with models of early visual information processing, the results suggest that the mask demanded extra processing resources when it followed the target by more than 100 ms. Pupillography methods may be useful in evaluating the contribution and timing of resource-demanding processes during early visual information processing.

Adult↗

A study of factors related to the use of online resources by nurse educators.

A descriptive cross-sectional survey was used to collect data from nurse educators related to the use of online electronic resources for scholarly pursuits. The 35-question survey was divided into 4 sections, Environment, Stressor, Utilization, and Demographics information. Two open-ended questions were also included to allow respondents to elaborate on factors that they believed facilitated or detracted from use of online resources but were not adequately covered in the survey. Data were received from 489 respondents who were faculty members currently teaching in 1 of 38 colleges or universities located in the 6 New England states offering a minimum of a baccalaureate degree in nursing. Quantitative and qualitative data analysis revealed that many of the same issues, previously reported as deterrents to the use of computers, also play a significant role in preventing the use of online resources. The two open-ended questions provided clarification of facilitators and detractors to use of online resources and were used to understand better the quantitative results. Based on the findings of this study, recommendations for administrators, educators, staff developers, and technical support personnel are discussed.

Attitude to Computers↗

Health assessments of an 'at risk' population in general practice. Resource implications of identifying unmet health care needs--a case study.

OBJECTIVE: To estimate the resource implications associated with health care assessments for patients with chronic disease and those aged 75-years and over. SETTING: A four doctor general practice on the NSW Central Coast. METHOD: Examination of eligible patients according to health assessment guidelines, and development of health care plans where appropriate. Economic modelling of time and monetary resource requirements for these activities and the follow up management of identified health care issues. RESULTS: Eighty-four patients (80.8%) had a total of 181 additional health care issues identified--73 were geriatric specific, 32 preventive, 63 general medical and 13 of a support services nature. The assessments required a total of 61.5 hours (mean: 36 mins)--GP: 42 hours (mean: 24 mins); nurse: 20 hours (mean: 11 mins)--at a total cost to Medicare of $15,075 (mean: $145). Modelling of the resource requirements estimate a time requirement of 117.5 hours for the GP (mean: 1.1 hours), 57 hours for specialists (mean: 33 mins) and 140 hours for allied health providers (mean: 1.3 hours). The costs to the community are $11,511 for the GP (mean: $111), $18,791 for specialists (mean: $181) and $6688 for allied health care professionals (mean: $64). CONCLUSION: Health assessments of an 'at risk' population in general practice may be worthwhile. However, the resource requirements of all members of the health care system may be so high as to make it unsustainable.

Age Factors↗

[Health resources allocation in Canada provinces: the role of indicators of health needs].

In an attempt to limit their health care expenditures Canadian provinces have strengthened the necessity to allocate health care resources according to their population needs. The difficulties and limitations of the needs-based approach are explored. First, indicators of population needs for health care were introduced into a formula of resource allocation for hospital-based services in England in the late 1970. Secondly, there are broad similarities between both the philosophy and resource allocation strategies of Canada and Britain. Thirdly, the main definition of a needs indicator is to measure the level of equity- or inequity-in the distribution of health care resources between regions. Fourthly, a needs indicator, as least as developed by the Canadian provinces, concerns general and specialized services that should be found in each of their regions. Fifthly, a needs indicator constitutes a tool for the calculation of a capitation rate. Finally, future research should focus on parameters which are not an integral part of the allocation method, but which have a strong impact, in the attainment of regional equity such as administrative decisions that are taken when budgets are to be allocated or reduced between regions.

Canada↗

New generation pharmacogenomic tools: a SNP linkage disequilibrium Map, validated SNP assay resource, and high-throughput instrumentation system for large-scale genetic studies.

Since public and private efforts announced the first draft of the human genome last year, researchers have reported great numbers of single nucleotide polymorphisms (SNPs). We believe that the availability of well-mapped, quality SNP markers constitutes the gateway to a revolution in genetics and personalized medicine that will lead to better diagnosis and treatment of common complex disorders. A new generation of tools and public SNP resources for pharmacogenomic and genetic studies--specifically for candidate-gene, candidate-region, and whole-genome association studies--will form part of the new scientific landscape. This will only be possible through the greater accessibility of SNP resources and superior high-throughput instrumentation-assay systems that enable affordable, highly productive large-scale genetic studies. We are contributing to this effort by developing a high-quality linkage disequilibrium SNP marker map and an accompanying set of ready-to-use, validated SNP assays across every gene in the human genome. This effort incorporates both the public sequence and SNP data sources, and Celera Genomics' human genome assembly and enormous resource ofphysically mapped SNPs (approximately 4,000,000 unique records). This article discusses our approach and methodology for designing the map, choosing quality SNPs, designing and validating these assays, and obtaining population frequency ofthe polymorphisms. We also discuss an advanced, high-performance SNP assay chemisty--a new generation of the TaqMan probe-based, 5' nuclease assay-and high-throughput instrumentation-software system for large-scale genotyping. We provide the new SNP map and validation information, validated SNP assays and reagents, and instrumentation systems as a novel resource for genetic discoveries.

Alleles↗

Hospital restructuring and nursing staff well-being: the role of personal resources.

This study examined the role played by two personal resources, job mobility options and financial resources, among nursing staff during a period of major hospital restructuring and downsizing. Data were collected from 1362 staff nurses using questionnaires. Personal resources were hypothesized to have direct and indirect effects on job satisfaction and psychological well-being in a model of hospital restructuring and its effects. The model included four variables: extent of hospital restructuring, future threats to the workplace, job satisfaction, and psychosomatic symptoms. LISREL analyses indicated that financial resources reduced perceptions of future workplace threats and psychosomatic symptoms while job mobility options were associated with higher levels of job satisfaction.

Career Mobility↗

Internet resources for dentistry: utilization of the Internet to support professional growth, decision making, and patient care.

The use of computers as an information resource in dentistry has grown dramatically over the past ten years. Fueled by the availability of more powerful computers, societal acceptance of computer-based resources, and the development of the Internet, millions of documents now provide a tremendously important repository of information for healthcare providers. Those involved in delivery of dental care need to know how to access and use this information for their professional development and to support clinically related activities. This paper presents issues related to the use of the Internet. It also provides information on the use of search engines to find resources (websites) on the Internet and descriptions of some available resources of interest to those involved in oral healthcare.

Decision Making↗