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PubMed2003

Use these proven strategies to expand enrollment, engagement in DM programs.

Get a handle on how to boost enrollment in DM programs. There is little doubt that DM programs could make a much bigger impact--if only potential participants would sign up and engage. The fact is, some strategies work better than others at getting--and keeping--the attention of eligible individuals. And many DM programmers are simply not up to speed on the latest techniques. Find out what a panel of experts has to say about the best ways to attract and engage DM participants.

Chronic Disease↗
PubMed2003

Original article pilot screening for fragile X carrier in pregnant women of southern Taiwan.

BACKGROUND: Carrier detection before or at early pregnancy through a wide screening program may be a practical approach to prevent the fragile X syndrome. However, prior to implementation of such a program, the carrier prevalence in a population and availability of effective screening tests should be evaluated. METHODS: One thousand and two pregnant women were randomly selected from our obstetric clinic and screened for FMRI mutation. Each woman was examined individually using a simple non-radioactive PCR, as well as in pool with two other women using high-resolution Southern blot hybridization. RESULTS: One third of women could be excluded from carrier status by PCR alone, while the rest had to be screened using Southern-blot hybridization in pool with two other women. This screening strategy was reliable and efficient, and suitable for large-scale screening. Among the 1002 women, no carrier of either premutation or full mutation was found. Allele with intermediate CGG-repeat between 40 and 52 was found in only 22 women (2.2%). CONCLUSIONS: Estimation of female fragile X carrier rate in Taiwan could not be made in the present study, due to insufficient sample size. However, the results indicated clearly that the rate in Taiwan was significantly lower than that of Israel (0/1002 vs. 1/113, p = 0.003), and also lower than those from other western counties (1/186-259, p = 0.020-0.049). We doubt that the cost-efficiency of such a wide screening program in Taiwan is acceptable. However, the effective screening strategy proposed in this study would be very helpful for women with family history of mental deficiency of undetermined etiology.

Female↗
PubMed1992

Private geriatric care management: how families are served.

This article provides a synopsis of a 1987 study of private care management and looks at the reasons why individuals and families seek out and use the services of private care managers. Among the most common reasons are: to negotiate the long-term-care system, to get help in filling out forms, to get objective assistance in assessing options, to mediate family conflict over what to do, and to plan and monitor the care of family members.

Aged↗
PubMed2004

Use of complementary and alternative medicine in Israel: 2000 vs. 1993.

BACKGROUND: Complementary and alternative medical care has gained increasing popularity in western societies in recent years. OBJECTIVES: To provide a cross-sectional and temporal (2000 vs. 1993) analysis of the use of complementary and alternative medicine in Israel. METHODS: The subjects studied represented the Israeli Jewish urban population aged 45-75 years. Full sit-down interviews were conducted with 2,003 respondents in 1993 and 2,505 respondents in 2000. RESULTS: For 1993, 6% of the population reported on consultations with CAM providers during the previous year. For 2000, that proportion increased to 10%. Being a woman, having higher education, enjoying better economic status, being younger, living in a big city, and being dissatisfied with specialists' care were all positively related to the use of non-conventional medicine, particularly in 2000. In both years, more than 50% of the consultations were with acupuncturists and homeopaths. However, chiropractors have doubled their market shares, and lower back pain became the leading problem for which care was sought. The main reason for consulting CAM was a reluctance to use too many drugs or to undergo an invasive procedure. However, a significant proportion of the users continue to use conventional medicine concurrently. Seventy-five percent in 2000 and 60% in 1993 reported that the treatment helped. CONCLUSIONS: Between 1993 and 2000, CAM in Israel changed from an infant industry into a mainstream medical commodity, reflected in both prevalence and different patterns of consumption.

Age Factors↗
PubMed1992

An outpatient-focused program for childhood diabetes: design, implementation, and effectiveness.

Treatment of childhood diabetes mellitus has undergone many recent changes, one of which is an increasing focus on outpatient management. In mid-1988, the pediatric diabetes clinic at Texas Children's Hospital began adopting an outpatient-focused treatment program using a care team. This report reviews our experience during this transition. Between 1987 and 1990, the percentage of new-onset patients who were never admitted to the hospital increased from 0 to 38%. Length of stay for new-onset patients who are admitted has declined. The shift in program focus has also led to decreased diabetes-related readmissions and length of stay per readmission. Estimated total patient cost savings exceed $100,000 per year for new-onset patients alone. Our results regarding patient care and cost-effectiveness agree with reports from other such diabetes treatment programs and support greater acceptance and use of this outpatient-focused approach.

Adolescent↗
PubMed2003

Health seeking behavior among insured persons under the Social Security Act, 1990.

Since having health insurance cannot guarantee access to care among the insured persons, their actual health seeking behavior should be evidence reflecting true access. Therefore, the study aimed to present the patterns of health seeking behavior among the insured persons who actually were able to get free services from their registered hospitals under the Social Security Scheme. Purposive sampling was done of 1,003 insured persons who were willing to participate in the study from small, medium and large establishments in the Huai Khwang district in Bangkok. A health diary was employed as one of the data collecting tools with a follow-up period of six months. The average illness rate found was 6.44 episodes/person/year. The characteristics of illnesses reported were described in terms of symptom groups, perceived severity, duration, work or non-work related cause. No treatment or self care, seeking help from non-registered health facilities and seeking help from registered hospitals and clinics were the patterns of health seeking behaviors found in the study. The patterns of health seeking behaviors among the participants varied depending on the stage of treatment, perceived severity of illness and types of additional health benefits. Seeking care from registered hospitals and clinics was found among the illnesses with a higher level of perceived severity, among the participants with chronic diseases, and among the illnesses that were treated with higher stages. Therefore, health insurance might not be able to guarantee true access to needed care for people unless the comprehensive health care provider networks are designed to cover more types of services, be more convenient and have more accessible health care providers.

Adult↗
PubMed2004

[How I treat...oropharyngeal mucositis associated with radiotherapy for head and neck cancer].

Oral mucositis the major acute effect of head and neck radiotherapy. According to the degree, irradiation may be compromised in dose and overall time with consequences on outcome. Up to now there is no standard accepted protocol. A strict program of local and general hygiene is mandatory. Analgesics are often required. Amifostine acts as a protector of salivary glands GM-CSF and G-CSF stimulate proliferation of mucosal basal cells. Sucralfate plays a barrier role. Camomile plant extract is anti-inflammatory, well tolerated and cheap. Povidone-iodine is better than chlorhexidine as an antiseptic agent. PTA lozenges with polymixin E, tobramycin and amphotericin B showed a marked power of selective microbial decontamination.

Head and Neck Neoplasms↗
PubMed1992

[Role of conservative surgery in the multidisciplinary treatment of Ewing's sarcoma in childhood].

BACKGROUND: In order to cure Ewing's sarcoma it is necessary to have an approach which considers the radical local control on the sites of macroscopic disease, along with the systemic control of micrometastases. On the present study the experience of the authors in analyzed, remarking the role of cytoreduction surgery on curability. METHODS: From January 1982 to August 1991, 24 patients with the mean age 13 years, 14 boys and 10 girls, previously untreated and with a pathology proven diagnosis have been treated by the authors. The treatment protocol included: alternating chemotherapy with cyclophosphamide, adriamycin, methotrexate, bleomycin, actinomycin D and vincristine; administered simultaneously with preoperative external radiation with a volume that completely included the affected bone and surrounding soft tissues for a total dose of 45 Gy/4.5 weeks. After a resting period of 4 weeks, resection of the involved bone and adjacent healthy bone was performed, followed by a single dose of 10-15 Gy of intraoperative radiotherapy to the tumor bed. Subsequently a custom prostheses or allograft was implanted. RESULTS: Twenty patients had localized disease and 4 had metastatic disease at diagnosis. In 16 cases the tumor was in extremities, 5 axial, and 3 extraskeletical. In 15 patients surgery with limb sparing techniques was performed, 8 had en block resection and one amputation (calcaneous location). At the time of this report 21 patient are alive (87%). Four had disease progression, of this 3 had died (12%). The actuarial disease free survival rate is 80% +/- 9% with a follow-up of 104 months, being the mean survival time of 85.5 months. CONCLUSIONS: The cytoreduction surgery included into a multidisciplinary approach permits to achieve a high rate of cure in Ewing's sarcoma. The toxicity of the program can be considered acceptable.

Actuarial Analysis↗
PubMed2005

HIV/AIDS and the Black Church: what are the barriers to prevention services?

UNLABELLED: The HIV/AIDS epidemic continues to have a devastating impact on the black community in the United States. Trusted community institutions within the black community--the Black Church among them--have often been reluctant to respond to the epidemic in a manner commensurate with the scope of the problem. The aim of the current study was to understand the barriers to HIV/AIDS prevention services offered by black churches in a northeastern metropolitan area by surveying the ministers who lead the churches. METHODS: The study team constructed a 25-item questionnaire that asked questions about the ministers' and congregational demographics as well as general health and/or HIV/AIDS prevention services offered by the churches. The overall response rate was 82% (N=18). RESULTS: 83.3% (N=15) of the ministers surveyed reported financial barriers as reason for not providing HIV/AIDS prevention services. A majority of the ministers also perceived HIV/AIDS to be a problem in their communities. DISCUSSION: The resource-related nature of the barriers and the eagerness of the ministers to get more involved suggest that fostering creative partnerships between AIDS service organizations and churches may encourage more churches to offer HIV/AIDS prevention programming in a culturally acceptable manner.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Shooting arrows in the dark: the policies and practices of waitlist management in Canada.

Wait times for medical procedures in Canada are universally thought to be too long, particularly for elective procedures. In this paper we point out the conceptual and practical difficulties surrounding wait list management in Canada. We suggest that while waits need to exist as a distributive allocation policy, the data to make informed decisions about wait times and their impact on patient care is absent. We also show that current waitlist initiatives lack an underlying conceptual model of why waits occur. The paper concludes with a discussion of why operational research (OR) models are not in greater use for wait list management and suggest a program of research to improve knowledge uptake for OR models.

Canada↗
PubMed1990

Blood conservation.

The importance of blood conservation to minimize homologous blood use after cardiac surgery is well-accepted. The most successful programs to this end are the products of an integrated approach to blood conservation that begins with preoperative patient screening and carries through the postoperative period. Salvage and reinfusion of shed blood both intra- and postoperatively are important components of any such program. Other practices that help reduce blood loss and decrease the use of banked blood are also important. It is the combination of techniques and a consistent philosophy regarding the importance of blood conservation that will yield the best results. Programs that decrease the use of banked blood help today's cardiac surgeon provide safer, less costly operations for his or her patients.

Blood Banks↗
PubMed1990

A systematic primary care office-based smoking cessation program.

There is a large discrepancy between apparent potential and actual practice of smoking cessation activities by physicians. This paper describes the 2-year results of an integrated system to support such physician activities with all of their tobacco-using patients. The system consists of organized identification, progress records, brief physician messages, follow-up, and assistance; it focuses on those most interested in quitting. Introduction of the system to one clinic was associated with an initial threefold to fivefold increase in quit rates of all clinic patients using tobacco. After 2 years, the overall quit rate was approximately 20%, rising to 33% for those tobacco users with more clinic contacts or at least 1 year from the first to the latest contact. Such a program has been well accepted by patients, physicians, and office staff and seems to provide the support needed for a feasible and effective long-term smoking cessation intervention in primary care practices.

Adult↗