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At least 1,207 records · Page 67Linked to original sources
PubMed1993

Medical team interdependence as a determinant of use of clinical resources.

OBJECTIVE: Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources. DATA SOURCES/STUDY SETTING: Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec. STUDY DESIGN: Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks. PRINCIPAL FINDINGS: Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork. CONCLUSIONS: Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked.

Dependency, Psychological↗
PubMed1993

ENB--resource and careers department.

The English National Board for Nursing, Midwifery and Health Visiting is aware that, in the current climate of change, a range of information is required by nurses, midwives and health visitors to enable them to update their professional knowledge and plan their careers. In response to this need the Board offers a comprehensive range of services through the Resource and Careers Department based in Sheffield. I will describe in detail the services provided by the Resource Section and then give a brief overview of the role and functions of the other sections, i.e. Publications, Careers Service and Projects. The Resource Section comprises three separate but interactive parts. These are the Health Care Database, Open Learning Resource and Reference Room and ENB Campus.

Databases, Factual↗
PubMed1996

Variations in avoidable mortality in relation to health care resources and urbanization level.

"Avoidable" mortality may be defined as causes of death whose occurrence is closely related to medical intervention. Areas with particular health care delivery problems can be identified through a geographical comparison of these "avoidable deaths." Mortality data for Valencia from 1982 to 1990 were examined to determine whether or not the availability of medical care resources in the area influenced the occurrence of avoidable deaths. We identified variations in mortality from avoidable causes, grouped according to the differences in levels of urbanization and health care resources, in the 537 municipalities of the Valencian community. (In Spain, the municipality is the lowest administrative division.) Linear regression analysis was performed to predict or estimate this relationship. Only in a small number of avoidable causes did the mortality trend for males differ significantly from 0 (p < 0.005) in relation to different levels of urbanization and health care resources. A direct association between these two variables was observed in males with regards to pneumonia, tuberculosis, chronic rheumatic heart disease, and bacterial infection. In females, a relationship between "avoidable" mortality rates and the differences in urbanization and health care resources was found in cervical cancer, pneumonia, abdominal hernias, and cholecystitis. Mortality from asthma and cardiovascular disease (in both males and females) declined faster in urbanized, high income areas than in rural areas. The results clearly demonstrate the considerable mortality risk associated with living in urban areas. On the contrary, we found very little correlation between health service access and mortality.

Adolescent↗
PubMed1997

Bioethics for clinicians: 13. Resource allocation.

Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician's fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.

Canada↗
PubMed1997

Linking a clinical system to heterogeneous information resources.

We present a model for providing clinical information system (CIS) users with quick access to high quality information resources. We have developed a chest X-ray information button application which is attached to the chest X-ray reports in the CIS at the Columbia Presbyterian Medical Center. The application generates questions based on clinical information, user interest, generic question templates, and resource availability. It then provides answers to the questions through integrated access to heterogeneous information resources including the CIS itself and publicly accessible Web resources.

Computer Communication Networks↗
PubMedDate not supplied

Cancer resources for providers in the rural community.

Rural residents with cancer face many challenges--lack of specialized local care, cost, and travel requirements--in receiving high-quality cancer care. Rural physicians, nurses, social workers, and pharmacists have limited resources to provide or coordinate the quality of care needed for these patients. Although resources are sparse, creative collaboration and capitalization on community cohesiveness may provide patients and healthcare professionals with needed resources in rural areas. Transportation for cancer patients, for example, might be obtained through local community organizations. Healthcare professionals may use various national cancer and rural health organizations and Internet sites as resources for updated oncology literature and for information on upcoming oncology conferences and partnerships with urban cancer care providers.

Computer Communication Networks↗
PubMed1998

Resource allocation in general practice care.

OBJECTIVE: Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia. METHOD: Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice. RESULTS: There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested. CONCLUSIONS: Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Australia↗
PubMed1997

Evaluation of a measure of learned resourcefulness for elders.

Learned resourcefulness is important in promoting independence and healthy, productive lifestyles among older adults, and therefore it is essential to have a measure of learned resourcefulness that is reliable and valid for this population. However, for elders published psychometric tests of Roseblaum's Self-Control Schedule (SCS), which is the measure of learned resourcefulness, are limited to internal consistency estimates. This study examined the ease of administration and psychometric properties of the SCS in three samples of healthy elders (age 65+). The findings yield promising evidence that the instrument is fairly easy for elders to understand when administered during face-to-face interviews. Evidence of reliability and validity is considerable, and the SCS shows acceptable internal consistency and construct validity. These findings support the potential usefulness of the measure of learned resourcefulness for adults.

Adaptation, Psychological↗
PubMed1997

The use of limited critical care resources: an ethical dilemma.

The following article consists of a review of the literature surrounding the issue of persistent vegetative state (PVS) patients and resource allocation. The author attempts to analyze the question: Should limited critical care resources be used on PVS patients at the risk of denying those resources to others? The author explores such factors as: prognosis and recovery in PVS, life expectancy, and quality of life. As well, resource availability and ICU costs involved in sustaining the life of a PVS patient are examined. Finally, principles such as non-maleficence and beneficence; as well as the critical care professionals attitudes toward this issue; and the moral, ethical, and emotional dilemmas are discussed.

Adolescent↗
PubMed1998

The SNOMED DICOM microglossary: controlled terminology resource for data interchange in biomedical imaging.

This paper describes an authoritative, non-proprietary information resource that provides an efficient mechanism for embedding specialized clinical knowledge into the design of healthcare telecommunications systems. The resource marries two types of data interchange standards, a message/electronic-document standard and a terminology standard. In technical terms, it is part protocol and part database. Industry, academia, professional specialty societies, and the federal government participated in its development. The development of multi-specialty content has broadly engaged biomedical domain experts to an unprecedented degree in voluntary, non-proprietary message/document-standards development. The resource is the SNOMED DICOM Microglossary (SDM), a message-terminology (or document-content) mapping resource. The message/electronic-document standard is DICOM (Digital Imaging and Communications in Medicine). The terminology standard is SNOMED, (Systematized Nomenclature of Human and Veterinary Medicine). The SDM specifies the mapping of multi-specialty imaging terminology from SNOMED to DICOM data elements. DICOM provides semantic constraints and a framework for discourse that are lacking in SNOMED. Thus the message standard and the computer-based terminology both depend upon and complete each other. The combination is synergistic. By substitution of different templates of specialty terminology from the SDM, a generic message template, such as the DICOM Visible Light (Color Diagnostic) Image or the DICOM Structured Reporting specification can be reconfigured for diverse applications. Professional societies, with technical assistance from the College of American Pathologists, contribute and maintain their portions of the terminology, and can use SDM templates and term lists in clinical practice guidelines for the structure and content of computer-based patient records.

Artificial Intelligence↗
PubMed1994

Gender, resistance and land: interlinked struggles over resources and meanings in South Asia.

This article examines the nature of women's resistance to gender inequities in resource distribution and ideological representation. It argues that to understand how women perceive these inequities it is necessary to take into account not only their overt protests but also the many covert forms their resistance might take. At the same time, to significantly alter gendered structures of property and power it appears necessary to move beyond 'individual-covert' to 'group-overt' (organized collective) resistance. These issues are examined here especially in the context of women's struggles for land rights and gender equality in South Asia. Although historically South Asian women have been important participants in peasant movements, these movements have not been typified by women demanding independent land rights or contesting iniquitous gender relations within the movements and within their families. Some recent challenges in this direction indicate that attaining gender equality in the distribution of productive resources will require a simultaneous struggle against constraining ideological constructions of gender, including (in many regions) associated social practices such as purdah. And in both types of struggle (namely concerning resources and gender ideologies), group-overt resistance is likely to be of critical importance.

Agriculture↗
PubMed1995

Population trends in resource-dependent counties.

"Resource-dependent communities in the United States have a history of economic instability and population decline. In this article, national county-level data were used to compare population trends during the 1980s of resource-dependent counties with counties economically dependent on other sustenance activities. It was found that resource-dependent counties were significantly more likely to experience population declines during the 1980s than other types of counties. This relationship remained significant even when the effects of several variables were statistically controlled."

Americas↗
PubMed2002

Migration, markets, and mangrove resource use on Kosrae, Federated States of Micronesia.

Kosrae, Federated States of Micronesia, is a prototype of an island economy prone to economic crowding. Average family size is large, the habitable land area is small, economic activity is limited, and household dependence on natural resources for fuel and food is high. We analyze how economic crowding--and its mitigation through trade and migration policies--affects mangrove resource use. A comparison of household survey data from 1996 and 2000 indicates that despite decreases in US aid and public-sector jobs, average household consumption of mangrove resources has not increased. Migration and remittances have allowed the purchase of imported fuel and building materials substituting for mangrove wood. Despite changing preferences and shifts toward import consumption, population growth and further declines in US financial support will likely cause aggregate demand for mangrove and upland wood to rise. Moreover, continued emigration may accelerate the export of mangrove crabs to off-island Kosraeans.

Animals↗
PubMed1985

Medical care for the poor: finite resources, infinite need.

Health care in this nation is becoming multitiered--with the poor in jeopardy of being excluded from even minimal care--because of the mistaken belief that money can buy unlimited health care for everyone. But our medical resources are finite, and choices must be made on how to distribute those resources. These choices should be based on a carefully reasoned concept of distributive justice; but even more important, they should be rooted in a Christian sense of community and in the conviction that service to others is more important than life itself. At least three basic models of justice can be identified. Market justice follows the general rule, To each according to his or her ability to pay. Merit justice holds that medical care should be apportioned relative to patients' efforts to stay healthy. Needs-based justice maintains that individuals' needs should be the sole criterion for allocating health care. Developing and testing such concepts of justice is necessary, but it is not enough. As those with economic and social power increasingly capture society's medical resources to keep their own deaths at bay through costly and extraordinary forms of treatment, Christians may well be impelled to take a stand in behalf of those who are being deprived of basic care. This stand may even include forgoing extraordinary treatment for themselves and accepting the appropriateness of their own deaths. Such a witness to the world, however, must be founded in faith and in Christian belief regarding the meaning of death.

Christianity↗
PubMed2005

[Survey scheme of the main Chinese medicines resources].

The survey of Chinese medicines resources concerns the development of the traditional Chinese medicine industry. It also directly influences the modernization process of traditional Chinese medicines. Owing to lacking of the scientific data on the Chinese medicines resources, it is a extremely urgent work to carry out survey of main Chinese medicine resources in nationwide. This paper explains the meaning and necessity. And it also investigated the survey object, contents, new technologies and methods.

Conservation of Natural Resources↗
PubMedDate not supplied

[Specialists teams for trauma-related disorders--in short supply in Sweden. There is a lack of both resources and effective therapeutic methods, a survey shows].

Psychological effects of serious traumas can cause severe personal suffering for the individual and will also mean a great economical loss för the individual and for the society in terms of decreased functioning due to illness. The Swedish National Center for Disaster Psychiatry has done a survey to investigate the public resources for acute psychosocial support and for treatment of disorders after psychological traumas. The organization of psychosocial support within the public health care system after major disasters is functioning all over Sweden. Twenty-seven clinics were identified. A majority of these clinics have specialized in the support and treatment of victims of war and torture. Fifty percent of the public medical service areas do not have specialist clinics for treatment of trauma related disorders. At many places there is a lack of specialist treatment resources for people who have developed disorders after experiences of assaults, serious accidents or other types of life threats or sudden loss. There is an obvious need of increased resources in this area.

Crisis Intervention↗
PubMed1990

Allocation of medical resources: problems faced by the practicing neurosurgeon.

The allocation of medical resources by the neurosurgeon begins with the patient-physician relationship and is increasingly affected by managers of third-party payers, the desire for patient autonomy, quality assurance regulation, state regulatory requirements, and the present recriminatory legal system. In addition, fiscal constraints within institutions impact on decisions regarding the allocation of medical resources by the physician. Beyond these micro-allocation problems lie the macro-allocation difficulties at the levels of state and federal government, where concepts of equality and justice--as they relate to allocation of resources--are altered by political forces; aging populations; new, devastating diseases; availability of rapidly improving technical, diagnostic, and treatment modalities; and the attendant costs and related tax burdens on the populace.

Government Regulation↗
PubMed1989

Resource allocation decisions in critical care nursing.

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.

Beneficence↗