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At least 1,189 records · Page 66Linked to original sources
PubMed1996

[Cost assessment in a fragmented psychiatric treatment system].

While Anglo-American countries increasingly integrate cost-effectiveness-studies into mental health care, in Germany there is still a basic need for empirical data with regard to the cost of care for the mentally ill. This study assesses the total cost of community mental health care of 66 schizophrenic patients prospectively over the course of 12 months. The comprehensive community care of the patients proved to be 43% of the cost of long-term treatment in a state mental hospital. Rehabilitative need, as well as living conditions and gender, showed significant influence on the total cost of community care.

Adolescent↗
PubMed2006

Indices for the assessment of environmental pollution of the Baltic Sea coasts: integrated assessment of a multi-biomarker approach.

Two mathematical methods to assess the "health status" of flounder (Platichthys flesus), eelpout (Zoarces viviparus) and blue mussel (Mytilus spp.) populations of the Baltic Sea were applied on selected biomarker data collected during the EU project "BEEP" (Biological Effects of Environmental Pollution on Marine Coastal Ecosystems). The Bioeffect Assessment Index (BAI) and the Integrated Biomarker Index (IBR) combine different biomarkers to single values, which can be used to describe the toxically-induced stress level of populations in different areas. Both indices determined here produced essentially similar results, which in most cases agreed with the known contamination levels in the different study areas. Advantages and limitations of index applications and interpretations are critically discussed. The use of indices provides comprehensive information about biological effects of pollution in marine organisms and may therefore serve as a useful tool for environmental management by ranking the pollution status of marine coastal areas.

Animals↗
PubMedDate not supplied

Identification of nurse-family intervention sites to decrease health-related family boundary ambiguity in PICU.

The most common explanation of parental stress associated with hospitalized children is based on individual stress theory. Using a family stress and family systems approach with an emphasis on examining family integrity, this qualitative study selected families in the Pediatric Intensive Care Unit (PICU) with high boundary ambiguity in the caregiving environment and identified potential sites for nursing actions that impede or assist families in maintaining family integrity. Within three days of admission of their child to a major tertiary children's hospital PICU, 29 families were recruited and screened with a Health-Related Family Boundary Ambiguity Scale. High scoring families (n = 11) were interviewed using an open-ended method. Data were analyzed using a content analysis method, and results were interpreted within a family systems framework. The following three potential areas of intervention to encourage family integrity during acute illness of a child were identified: fostering family normalcy, respecting family rights, and strengthening the family boundary. Implications for initiating or improving family centered care in the PICU are discussed.

Adolescent↗
PubMed1999

Physical health and post-traumatic stress disorder: review and synthesis.

This article reviews the empirical evidence on post-traumatic stress disorder (PTSD) and physical health and considers this evidence in light of the physical health outcomes associated with other psychiatric disorders. The existing data show that PTSD is associated with poor self-reported health and increased utilization of medical services. To a lesser extent, the data also show an association between PTSD and increased morbidity. Possible psychological, behavioral, and biological mechanisms are discussed, and a model integrating these mechanisms is presented.

Health↗
PubMed1996

Recent initiatives in U.S. hospital supply management.

A variety of health care industry changes affect hospital/system materiel management directors as never before. Among them: the switch to patient care in alternative sites, system integration, new health care partnerships, and evolving technology and benchmarking needs. The key drivers for management include total product cost, compliance, standardization, utilization, and long-term partnering.

Cost Savings↗
PubMed1993

Building an information management infrastructure in the 90s: the Vanderbilt experiment.

The course that an organization takes to create a competitive information management infrastructure is determined by a series of decisions, each of which balances tradeoffs. Key success factors include sequencing projects to reflect data requirements; obtaining benefits as cost is incurred; establishing an architecture that permits integration of applications; managing project scope; and establishing a data friendly culture.

Academic Medical Centers↗
PubMed1998

The World Health Organisation and the prevention of deafness and hearing impairment caused by noise.

The WHO Programme for Prevention of Deafness and Hearing Impairment (PDH) is especially targeted at developing countries where there is a serious lack of accurate population-based data on the prevalence and causes of deafness and hearing impairment, including noise-induced hearing loss. However, opportunities exist for prevention of noise-induced hearing loss by primary, secondary and tertiary means and it is necessary for countries to measure the size of the problem and adopt strategies for its prevention. The World Health Assembly has passed two resolutions in relation to PDH, in 1985 and 1995. They affirmed that much deafness and hearing impairment is avoidable or remediable and that the greatest needs for the problem are in developing countries. The 1995 resolution estimated that there are 120 million persons with disabling hearing difficulties worldwide and urged member states to set up National Programmes for the prevention of deafness and hearing impairment, with the technical assistance of WHO. WHO-PDH addresses problems in this field of major public health importance which are amenable to intervention, giving priority to the poorest developing countries. These problems include ototoxicity, chronic otitis media, noise damage to hearing, inherited and congenital causes, and the provision of appropriate affordable hearing aid services. A fundamental requirement for the development of a National Plan and choice of preventive strategy for a National Programme is accurate, population-based data on the prevalence and causes of the problem. The PDH programme has developed a standardised Ear Disease Assessment Protocol to enable countries to conduct national surveys rapidly. A National Programme will require a set of integrated strategies to prevent deafness and hearing impairment. The PDH programme has already addressed two such causes, ototoxic drugs and chronic otitis media and will shortly produce guidelines for implementation of these strategies within the context of primary health care. The most recent meeting organised by the PDH programme at WHO, in the series on strategies for prevention, was on the prevention of noise-induced hearing loss, held in Geneva in October 1997. The participants concluded that exposure to excessive noise is the major avoidable cause of permanent hearing impairment worldwide. Noise-induced hearing loss is the most prevalent irreversible industrial disease, and the biggest compensatable occupational hazard. In developing countries, occupational noise and urban, environmental noise are increasing risk factors for hearing impairment. The meeting recommended that all countries should implement National Programmes for the Prevention of noise-induced hearing loss, integrated with Primary Health Care, and including elements on health promotion, and measures to reduce noise sources and introduce legislation and effective hearing conservation. There is an urgent need to obtain more, accurate epidemiological data on the problem, especially in developing countries. More research is needed on basic mechanisms and means of prevention.

Journal Article↗
PubMed2006

Change in approach and delivery of medical care in children with asthma: results from a multicenter emergency department educational asthma management program.

OBJECTIVES: The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers. METHODS: The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003) and phase II (October 1, 2003, to July 8, 2004). Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II. RESULTS: Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention. CONCLUSION: An ED-based childhood asthma tracking system can serve as a basis for designing and implementing an ED-based educational intervention. ED staff, primary care providers, and others can work together to promote asthma care.

Adolescent↗
PubMed2025

Integrative proteomic analysis provides novel therapeutic insights for etiological subtypes of diabetes.

AIMS: Type 2 diabetes (T2D) is a highly heterogeneous disease characterised by subtypes with variations in aetiology, disease progression, and risk of complications. However, potential drug targets for these subtypes have not been explored. This study aims to investigate potential drug targets by integrating proteomics. MATERIALS AND METHODS: Summary-level data of circulating proteins were extracted from the UK Biobank and the deCODE Health Study. Genetic associations with five diabetes subtypes were obtained from Swedish All New Diabetics in Scania and Malmö Diet and Cancer cohort, including severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD). The associations between circulating proteins and diabetes subtypes were assessed through Mendelian randomisation, followed by multiple sensitivity and colocalization analyses. Additionally, tissue-specific, pathway and functional enrichment analysis, assessment of protein druggability, and the protein-protein interaction (PPI) networks were used to further explore biological mechanisms and therapeutic potential. RESULTS: Genetically predicted levels of 2, 2, 9, 3, and 5 circulating proteins were associated with SIRD, SIDD, MARD, MOD, and SAID, respectively. Colocalization analyses further revealed links between GRN with MARD/SIRD, LILRB5 with SIDD/MARD, CR1 with MARD, TNFSF12 with MOD, and DAPK2 with SAID. Enrichment analysis suggested that these proteins were mainly enriched in blood and adipose tissues and involved in immune and inflammatory related pathways. PPI analysis revealed GRN, TNFSF12, and DAPK2 are associated with known T2D targets. CONCLUSIONS: Our study identified several potential drug targets for different subtypes of diabetes using an integrated genetic approach, yielding new insights for precision medicine of diabetes.

Humans↗
PubMed1998

Medical informatics education.

Medical Informatics is a multidisciplinary field, dealing mainly with informatics and technology applications in health care. Medical Informatics is composed from a number of sub-areas such as computer based patient record (CPR), processing of multimedia information (signals, images), coding and transmission through high speed networks of medical information (telematics), medical decision support systems, data security and integrity, integration of technologies in hospital and regional environments, and development of educational tools. The people who receive such an education are capable of development, integration and maintenance of complex hospital and health information systems both at departmental and regional levels. A very important issue however is the acceptance of information technology (IT) solutions engineered by medical informaticians from the medical personnel. In this paper we shall deal with the set-up of a medical informatics and medical technology educational environment, as well as the areas from medical informatics that the average user needs to be familiar with in order for the successful deployment of IT solutions in health care.

Curriculum↗
PubMed1988

The impact of prospective pricing on the information system in the health care industry.

The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment.

Data Collection↗
PubMed2003

Case-mix adjusting performance measures in a veteran population: pharmacy- and diagnosis-based approaches.

OBJECTIVE: To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. DATA SOURCES/STUDY SETTING: The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N = 126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. STUDY DESIGN: We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. PRINCIPAL FINDINGS: Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. CONCLUSIONS: Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.

Aged↗
PubMed2006

Developing a culture to sustain Ontario's Wait Time Strategy.

Ontario's Wait Time Strategy--a significant change management initiative--is designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas by December 2006 (cancer surgery, cardiac revascularization procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans). These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services beyond 2006. Change management initiatives are initially successful because of the significant time, attention and resources that are dedicated to the start-up effort. Many initiatives lose their momentum and impact and ultimately fail in the long run since it is difficult to sustain this level of intensity. The probability of success increases if a culture is developed to sustain the initiative into the future. A pivotal element for this sustained culture is accountability for achieving results. If Ontario is to reduce waits for quality healthcare services over the long term, it must shift from a paradigm where no one--or only a few--are accountable for achieving a particular set of results to one where a wide range of players is accountable for achieving a broad range of results. This includes explicit accountabilities of the public, healthcare providers (including physicians, other healthcare providers, professional associations and regulatory bodies), government and Local Health Integration Networks. Tools required to support these accountabilities include developing leaders, aligning incentives to reinforce what needs to be achieved, and developing information systems to provide the data needed to make decisions, and manage and improve performance.

Government↗
PubMedDate not supplied

Assuring public health professionals are prepared for the future: the UAB public health integrated core curriculum.

In response to calls to improve public health education and our own desire to provide a more relevant educational experience to our Master of Public Health students, the University of Alabama at Birmingham (UAB) School of Public Health designed, developed, and instituted a fully integrated public health core curriculum in the fall of 2001. This curriculum combines content from discipline-specific courses in biostatistics, environmental health, epidemiology, health administration, and the social and behavioral sciences, and delivers it in a 15 credit hour, team-taught course designed in modules covering such topics as tobacco, infectious diseases, and emergency preparedness. Weekly skills-building sessions increase student competence in data analysis and interpretation, communication, ethical decision-making, community-based interventions, and policy and program planning. Evaluations affirm that the integrated core is functioning as intended: as a means to provide critical content in the core disciplines in their applied context. As public health education continues to be debated, the UAB public health integrated core curriculum can serve as one model for providing quality instruction that is highly relevant to professional practice.

Alabama↗
PubMed2002

Exercise prescribing: computer application in older adults.

PURPOSE: The purpose of this study was to determine if older adults are capable and willing to interact with a computerized exercise promotion interface and to determine to what extent they accept computer-generated exercise recommendations. DESIGN AND METHODS: Time and requests for assistance were recorded while 34 college-educated volunteers, equal numbers of men and women, ranging in age from 60 to 87, interfaced with a health promotion tool. The computerized exercise promotion tool's ease of use and the acceptability of the exercise recommendations made were rated by the participants. RESULTS: On average, completion of the items on the computer took 33 min and each participant made 3 requests for assistance, of which only 22% were mouse related. The system's ease of use and the exercise prescription acceptability ratings were high and independent of prior experience with computers. IMPLICATIONS: User friendliness of computerized health promotion tools will determine if, and how, health providers integrate these new technologies into daily practice. The participants in the study were able to complete the computerized items within a reasonable amount of time and with minimal assistance from the provider. These data support the potential of interactive technology in health promotion among the expanding older population.

Aged↗
PubMedDate not supplied

Mediation of the relationship between inner voice experiences and health-related quality of life.

PROBLEM: Appraisals tied to voice hearing and other subjective experiences pose serious challenges for nursing because of their implications for health and safety of voice hearers and others. METHOD: An exploratory, correlational design involving hierarchical analysis of data from 337 voice hearers. FINDINGS: Inner voice experiences and subjective-deficit symptoms each had significant negative, independent effects on perceptions of the integrity of the functional nervous system, self-esteem, and health-related quality of life. The combination of subjective-deficit symptoms, perceptions of the integrity of the functional nervous system and self-esteem significantly reduced the negative impact of inner voice experiences on health related quality of life (R2 = .511). Perceived integrity of the functional nervous system and self-esteem together almost completely attenuated the impact of voice hearing on subjects' health-related quality of life. CONCLUSION: These results highlight the need to develop strategies that can help voice hearers respond to inner experiences in a more positive manner.

Adaptation, Psychological↗
PubMed2000

Privacy and security compliance in the E-healthcare marketplace.

Complying with security and privacy regulations proposed by HHS in response to the Health Insurance Portability and Accountability Act (HIPAA) will require healthcare managers to address both internal and external business interactions and initiatives. The proposed regulations mandate certain procedures regarding administration, physical safeguards, technical security for data integrity and confidentiality, and technical security against unauthorized access. In particular, the proposed regulations require organizations to contractually ensure that vendors adhere to the regulations. Healthcare organizations also must implement training procedures for staff members who have contact with protected health information and designate a privacy officer to guard against improper disclosure of such information. Documented policies for organizational decision making are vital to an organization's efforts to implement procedures for compliance with the regulations.

Accreditation↗
PubMed2006

Integrating research, surveillance, and practice in environmental public health tracking.

The Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services is working with selected state and local health departments, academic centers, and others to develop an environmental public health tracking initiative to improve geographic and temporal surveillance of environmental hazards, exposures, and related health outcomes. The objective is to support policy strategies and interventions for disease prevention by communities and environmental health agencies at the federal, state, and local levels. The first 3 years of the initiative focused on supporting states and cities in developing capacity, information technology infrastructure, and pilot projects to demonstrate electronic linkage of environmental hazard or exposure data and disease data. The next phase requires implementation across states. This transition could provide opportunities to further integrate research, surveillance, and practice through attention to four areas. The first is to develop a shared and transparent knowledge base that draws on environmental health research and substantiates decisions about what to track and the interpretation of results. The second is to identify and address information needs of policy and stakeholder audiences in environmental health. The third is to adopt mechanisms for coordination, decision making, and governance that can incorporate and support the major entities involved. The fourth is to promote disease prevention by systematically identifying and addressing population-level environmental determinants of health and disease.

Disease↗