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PubMedDate not supplied

[Identification, during development, of a methodology targeted at determining the positioning of new drugs for therapeutic strategies: examples of rheumatoid arthritis and cardiac insufficiency].

The Marketing Authorization (MA) granted to a new molecular entity does not allow for proper anticipation of its future positioning within the therapeutic strategy. A specific methodology should be devised as early as during the pre-MA development phase that could result in an initial positioning that should be subjected to further reappraisal with regard to scientific advances, the arrival of new treatments and further developments with this molecule. A methodology is thus proposed, based on early optimisation of the development plan, the granting of subsequent MAs, and reappraisal of the positioning within the strategy, based on analysis of all available data. It should be possible to take into account the economic context, within an agreed system with pre-defined medico-economic criteria. This may in turn raise the issue of the role of the various parties involved in this assessment, as well as how to understand the respective opinions of stakeholders: authorities, sponsors, prescribers and patients, each of whom has a specific view of the definition of the strategic objective that should apply to the disease concerned.

Arthritis, Rheumatoid↗
PubMed2002

Management of HIV in resource-poor countries, with a focus on sub-Saharan Africa.

HIV/AIDS is the modern world's greatest pandemic, the brunt of which falls on sub-Saharan Africa. HIV/AIDS control efforts have up till now focused mainly on prevention, with little attention paid to care. This approach must change, and prevention has to be linked with an essential package of care if there is to be any hope of reducing HIV incidence rates or curbing the morbidity and mortality associated with AIDS. The package of care includes psycho-social support, screening for sexually transmitted infections and tuberculosis, clinical care for opportunistic infections, palliative care for terminal illness, home based care, care and support for orphans, prevention of mother to child transmission of HIV, preventive therapy and the possibility of antiretroviral (ARV) drugs. Many countries in sub-Saharan Africa are developing plans to scale-up treatment and prevention programmes, including the use of ARV drugs. However, any meaningful challenge to the AIDS epidemic requires a huge scale-up of support from the international community, both for ARV drugs and for basic prevention and care packages.

Africa South of the Sahara↗
PubMed2002

The Armstrong Laboratory Aviation Personality Survey: development, norming, and validation.

This work describes the development of a new psychological test for aviators. The Armstrong Laboratory Aviation Personality Survey was developed through the integration of clinical theory, psychometric methods, and empirical testing. It is currently given to all incoming U.S. Air Force pilot candidates. Using a sample of 6,047 student pilots, a thorough test development plan was accomplished. The 15 final test scales assess personality, psychopathology, and crew interaction styles. The scales have normative data and are demonstrated to be reliable and valid. The Armstrong Laboratory Aviation Personality Survey is recommended for use in the aviation community for both clinical and research purposes. Future research is recommended and needed in the areas of training, airframe, and special duty selection. Additional clinical work is indicated in the areas of psychiatric, psychological, and aeromedical evaluations.

Adult↗
PubMed2003

[Emergency medicine tomorrow].

Emergency medical services (EMS) systems represent and important part within our health care system. However rapidly changing basic conditions define the need to reconsider current structures and objectives of the German EMS system and to implement appropriate modifications. The steadily decreasing number of emergency physicians advises to delegate more and more "technical" duties to paramedic personnel. In contrast the mobile intensive care unit will be reserved to cases in which complex treatment strategies or decisions have to be undertaken (i.e. thrombolysis). Moreover, the emergency physician's role will deeply expand beyond individual medical assistance. The most urgent duties Medical Advisers for Emergency Services will have to comply with are: 1. to develop plans of action and guidelines for paramedic personnel and 2. to secure a consistently high level of emergency medical care. As a consequence of ongoing structural reforms in the German Health Care System (ie. the implementation of diagnosis related groups, DRGs) emergency medicine will break down with traditional EMS structures. In contrast emergency medical departments of large hospitals will be reorganized to deliver both prehospital and in-hospital emergency medical care ("Centers of excellence"). Devoted to comply with clinical pathways this concept will improve medical efficacy as well as economic efficiency. The breakdown of traditional social structures as well as the increasing number of psychosocial emergencies constitute a major challenge to out EMS system. As it is not suitable to strictly differentiate medical from social emergencies we urgently need to establish integrated psychosocial networks. For a long period of time the role of the emergency physician has been restricted to the stabilisation of disturbed vital functions. To assure the competitiveness of the German EMS system it will be indispensible to expand our scope of practice. As anesthetists we should not hesitate to take over our new position as "managers in acute care medicine".

Clinical Competence↗
PubMed2003

Accounting for water quality effects of future urbanization: diffuse pollution loads estimates and control in Mantua's lakes (Italy).

The three shallow lakes of Mantua (Upper, Middle and Lower) formed by the Mincio River are today classified by Italian water authorities as sensitive areas, after, in the second half of the 20th century, the hydrologic regime of the lakes was heavily modified, and the influence of industrial activities operating in the 1960s--without much environmental consideration--created a substantial decline in the water quality of the lakes. The City of Mantua is one of the most vital industrial centers of Northern Italy, and development plans are under way, that should approximately double the extension of the urban and industrial area within the next 20 years. This paper deals with estimating the effects of the aforementioned urbanization on the future water quality of the three lakes.

Cities↗
PubMed2003

[Why a graduate diploma specializing in the management of health projects in Cote d'Ivoire?].

The achievement of the "health for all" objectives represents a particular challenge for developing countries where the morbidity rates and the number of deaths are increasing on an annual basis. In order the face this situation in Côte d'Ivoire, health action programmes were initiated on the one hand, and on the other, a type of decentralised responsibility was established for the coverage of the population's health at the health district level where these programmes are administered. However, serious insufficiencies were noted in the management of health projects as well as a lack of follow-up and evaluation by trained staff. Furthermore, it is imperative to have personnel qualified in managing health projects. In fact, this specialised training will allow for the attainment of knowledge and competencies necessary for the effective conception, development, planning, implementation and management of health action programmes at the national level as much as the district level. In addition, these health project specialists will be able to get involved at several levels in positions such as managers of national projects, technical advisors for national health directives, district managers, etc. Such training would contribute to the improvement of the population's health status and thus address the challenge of health for all.

Cote d'Ivoire↗
PubMed2003

Design and operation of the National Survey of Children with Special Health Care Needs, 2001.

OBJECTIVES: This report presents the development, plan, and operation of the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. This survey was designed to produce national and State-specific prevalence estimates of CSHCN, describe the types of services that they need and use, and assess aspects of the system of care for CSHCN. This study included two additional modules to provide health care coverage estimates for all children and to collect data on the reasons that low-income uninsured children lack health care coverage. Primary funding for this survey was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. METHODS: A random-digit-dial sample of households with children under 18 years of age was selected from each of the 50 States and the District of Columbia. Depending on the health care needs of the children in each household, a detailed interview was conducted for one randomly selected child with special needs and a brief health insurance interview was conducted for one randomly selected child without special needs. The respondent was the parent or guardian who knew the most about the child's health and health care. RESULTS: A total of 196,888 household screening interviews were completed from October 2000 to April 2002. This resulted in 38,866 completed special-needs interviews and 176,296 completed health insurance interviews for children without special needs. The weighted overall response rate for special-needs interviews was 61.0%.

Adolescent↗
PubMed2003

Appraisal of family doctors: an evaluation study.

BACKGROUND: Appraisal has evolved to become a key component of workforce management. However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes. AIMS: To evaluate the introduction of a pilot peer appraisal system in general practice and to gain insight into the reactions of appraisers and doctors. DESIGN OF STUDY: Semi-structured telephone interviews combined with participant surveys and documentary analysis. SETTING: Five health authorities in Wales. PARTICIPANTS: General practitioners (GPs) appointed as appraisers and volunteer practitioners (doctors). METHOD: Twenty-six appraisers were appointed and given training in the appraisal process, each appraising an average of eight individuals. Appraisers and appraised doctors participated in semi-structured telephone interviews and completed separate participant questionnaires. RESULTS: GPs willingly undertook peer appraisal in a volunteer-based pilot study where participation was recompensed. The majority of participating clinicians were positive, with appraisers reporting the most gain. Appraisers were enthusiastic, provided the process remained non-judgemental and did not threaten or burden their colleagues. Appraised doctors were less enthusiastic but the most significant perceived benefit was the opportunity to reflect on individual performance with a supportive colleague. There were, however, repeated concerns about time, confusion with revalidation and personal development plans, worries about including health and probity queries, and an opinion that the process would be entirely different if conducted with non-volunteers or by representatives of 'management'. CONCLUSION: This study illustrated three fundamental problems for appraisal systems in general practice. First, there is as yet no organisational hierarchy in general practice. Perhaps the aggregation of practices into primary care organisations will generate a hierarchy. Second, the question of who conducts appraisals then becomes pertinent; this study illustrates a professionally-led peer appraisal model. Third, the spectre of summative assessment causes problems in appraisal schemes. Typically, only mutually agreed summaries are kept for future use in appraisal systems (for example, for promotion or discipline). So the proposal to use GP annual appraisal documentation as the basis of a summative 'revalidation' exercise is at odds with orthodox personnel practice, which regards appraisal as a formative process.

Adult↗
PubMed1992

Recommendations: HIV/HBV infected health care workers. Connecticut Department of Health Services.

These recommendations have been developed in response to a congressional mandate and to public concern about transmission of HIV from health care workers to patients. Hepatitis B is also addressed in the recommendations. Both viruses are transmitted through blood-to-blood contact. The likelihood of transmission of HBV is very low, for HIV extraordinarily remote. The following are action steps to reduce this risk further: 1. The commissioner charges the professional associations and institutions to develop plans to educate their members, nonmembers, and employees on universal precautions, procedural modifications, and hepatitis B vaccination. They accept the charge. 2. The associations and institutions are charged with monitoring and assuring the compliance of their members, nonmembers and employees with the precautions. The Department of Health Services health facility licensing programs will incorporate review of infection control precautions into site reviews. Complaints of an institution's or individual practitioner's failure to follow the precautions will be investigated by the Department of Health Services Division of Hospital and Medical Care or Division of Medical Quality Assurance, respectively. 3. The professional associations will submit training plans and progress-to-date to the Commissioner of the Department of Health Services by 30 June 1992 and reports of training and assurance activities on 1 January 1993 and annually thereafter. 4. The department will not list specific hazardous procedures but will judge each case on an individual basis. 5. The department will not require health care workers to undergo HIV or HBV testing. It is recommended that workers who are at risk for HIV or HBV infection because of occupational exposure or personal behaviors be tested voluntarily. 6. The department recommends that infected workers seek advice from a state appointed and authorized review panel. The panel will review the practices of the worker, advise on infection control practices and monitor to assure compliance. Infected workers will be advised regarding notification of patients on a case-by-case basis. Institutional or professional association-based panels can also be consulted.(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

[Investigation on reproductive tract infection among floating married women of childbearing age in Fengtai district in Beijing].

OBJECTIVE: In order to develop plans for effective intervention measures, prevalence and health-seeking behavior related to reproductive tract infection among floating married women of childbearing age in Fengtai district in Beijing were studied. METHODS: Cross-sectional study was carried out. Two thousand and sixty-nine eligible women were randomly selected from strata based on their home provinces. From June to July 2001, the subjects were given face-to-face interview at the Fengtai family planning clinic in Beijing using standard questionnaire followed by gynecologic examination and laboratory tests. RESULTS: Thirty point three percent of the subjects were found to have reproductive tract infections (RTI) by laboratory tests. Prevalence rates of bacterial vaginosis, candida and trichomonas vaginitis were 22.2%, 4.9% and 2.1% respectively. Prevalence rates of chlamydia, gonorrhea, condyloma acuminatum and syphilis were 2.2%, 1.6%, 0.5% and 0.2% respectively. Of these infected women, only 43.1% (270/626) were symptomatic, and 61.5% (166/270) of these women with symptoms had sought treatment. CONCLUSION: Compared to other results in the literature, we found a relatively high prevalence of RTI in our study population. Only a small proportion of these infected women were symptomatic but only few of them sought treatment. We suggested that the provision of more family planning service and promotion of RTI knowledge to the floating women of childbearing age.

Adolescent↗
PubMed2003

Missed opportunities for vaccination in health facilities in Swaziland.

OBJECTIVES: To determine whether potential exists to increase vaccination coverage in Swaziland by reducing missed opportunities. DESIGN: The standard World Health Organisation Expanded Programme on Immunisation (WHO EPI) protocol for assessing missed opportunities for vaccination was used to conduct this study. It involved client exit interviews and review of health cards. SETTING: Selected variety of health facilities in Swaziland. SUBJECTS: Children less than 2 years of age and women of child-bearing age exiting each facility. OUTCOME MEASURES: Children and women eligible for vaccination exiting sampled health facilities. RESULTS: Fifty-four per cent of eligible children less than 2 years of age were missed for vaccination. This constitutes 26% of all children less than 2 years old leaving the facilities studied. Almost 100% of eligible women of childbearing age were missed for vaccination, constituting 88% of women leaving the study facilities. The distribution of the proportion of missed opportunities varied considerably between regions and health facility types. Missed opportunities occurred more frequently among those children requiring the first dose of all antigens and this may be linked to the high proportion of children missed for vaccination who did not possess a health card. Missed opportunities were more likely to occur in facilities providing integrated services. CONCLUSIONS: The frequent attendance at health facilities of the target group presents a valuable opportunity to increase vaccination coverage through avoidance of missed opportunities. All regions need to set vaccination coverage targets and develop plans to increase coverage, which should include strategies to ensure that all health workers routinely screen all clients for eligibility and vaccinate as required.

Adolescent↗
PubMed2003

Restructuring hospital-physician relationships for future success.

Integrating physicians into the Healthfirst administration through employment sowed seeds of mutual understanding among these two groups that would benefit the system immeasurably over the next several years. The immediate future, however, saw only cultural upheaval between our hospitals and newly employed physicians, hospitals and nonemployed physicians, employed and nonemployed physicians, as well as specialists and primary care providers. Traditional physician-relationship-building efforts became difficult, if not impossible, to maintain. Essentially, administration was forced to scrap ten years of physician-development plans in order to reconfigure a relations effort that would maintain hospital support from all sides while restructuring the employed medical group. This article describes the evolution of Healthfirst's approach to maintaining effective physician relationships within our healthcare system and its affiliated entities over the past decade. Specifically, the article details the manner in which our system has evolved physician-relations activity to maintain an effective strategy during times of significant change in the healthcare industry.

Delivery of Health Care, Integrated↗
PubMed2003

Assessment of slow sand filtration system for rural water supply schemes--a case study.

In India, water supply programmes form a part of National Development Plans and are implemented in a phased manner under the Five-Year Plans. A number of departments and ministries of the Central and State Governments have been vested with the responsibility for water supply and sanitation. Due to inherent advantages of slow sand filters over conventional rapid sand filters, the Panchayat Raj Engineering Department (PRED), Government of Andhra Pradesh has designed and constructed a number of slow sand filter plants for rural water supply schemes in the state. At the instance of Netherland Assisted Project (NAP) Office, Hyderabad, NEERI undertook a critical evaluation of the functioning of three slow sand filter plants in Andhra Pradesh and suggested improvements in construction, operation and maintenance (O&M) including a review of design criteria followed by PRED. The paper presents the outcome of these studies along with suggestions needed to bring about improvements in source protection, design, construction, O&M of slow sand filter and training programme to improve the quality of supervision.

Engineering↗
PubMedDate not supplied

Consultation-Liaison Psychiatry Literature Database (2003 update). Part I: Consultation - Liaison Literature Database: 2003 update and national lists.

Every day there are 10,000 scientific articles published. Since the Consultation-Liaison ("C-L") psychiatrist may be asked to consult on a patient with any medical illness, e.g., severe acute respiratory syndrome (SARS), malaria, cancer, stroke, amytrophic, lateral sclerosis, and a patient who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of key and essential current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this newest cross-over subspecialty of psychiatry-now called Psychosomatic Medicine. Experts selected because of their writings and acknowledged contributions to a specific clinical area or problem hope examined thousands of citations to choose those articles, chapters, books, or letters that they regard as most important to Psychosomatic Medicine. In addition, psychiatric specialists in six countries have provided their national Psychosomatic Medicine (Consultation-Liaison) lists as examples of what they regard as the most important teaching materials journals: Australia, Brazil, Greece, Mexico, Portugal, and Taiwan. It is our belief that a cogent, international, systematic review will provide the greatest success in creating a "regionally appropriate" teaching and consultation literature database with world-wide applicability. We review our current progress on this literature database and software, the technical system and data organization involved, the approach used to populate the literature system, and ongoing development plans to bring this system to the physician via mobile technologies.

Databases, Bibliographic↗
PubMed1992

Decrease of malaria morbidity with community participation in central Java.

Malaria is still a problem in Java-Bali, although the Malaria Eradication Program started in the 1950's. In the First National Five Year Development Plan it was changed to the Malaria Control Program with the aim to reduce the morbidity and mortality rates through surveillance and spraying interventions using the primary health care approach. In 1984 in Central Java there were malaria areas with an average annual parasite incidence (API) between 1 and 7.5 promille covering about six million population, nearly one third of the population of Central Java. In this study an intervention alternative was carried out with weekly chloroquine prophylaxis to children below 10 years of age in 3 malaria areas of central Java, namely the villages Bedono Kluwung and Kalikutes in Purworejo Regency and Pablengan in Karang Anyar Regency. Health education about malaria with a learning module was conducted by key persons as an element of community participation. The activities of the key persons increased the ongoing surveillance. After one and a half years intervention (July 1985-February 1987) the spleen rates, parasite rates and fever cases dropped to nearly zero in the three study villages. From the results of this study it was recommended that in a malaria risk area with an API of more than 1 promille, intervention with collective chloroquine protection to children below 10 years of age could reduce the API to 1 promille or less. This intervention should be carried out if there is an increase of cases in the area to prevent small outbreaks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Clinical management. Where medicine meets management. On reflection.

There is an urgent need for validated, feasible tools to assess doctors' performance. A peer-rating tool mapped to good medical practice (SPRAT) is feasible, valid and reliable. SPRAT is ideal for revalidation purposes and performs particularly well in areas that are traditionally difficult to assess. It can also inform personal development planning.

Employee Performance Appraisal↗
PubMed1992

Corporate funding of human services agencies.

This article reviews national trends in the organization of corporate giving to human services agencies, examines how corporations make funding decisions, and reports the results of a case study of philanthropic giving among 29 companies in Cambridge, Massachusetts. The study found that most corporations use an informal rather than a formal process for making funding decisions, with many firms relying on tradition, social contacts, and intuition to guide allocations. Suggestions that social services administrators can use to enhance development planning at their agencies are provided.

Community Health Services↗