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PubMed2004

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data.

BACKGROUND: Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. METHOD: We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). RESULTS: Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. CONCLUSION: Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

Analysis of Variance↗
PubMed1982

Influence of demographic factors on annual Down's syndrome births in Ohio, 1970-1979, and the United States, 1920-1979.

Because of the high correlation between advanced maternal age and the risk of Down's syndrome, the demographic factors of population age structure and age-specific birth rates are expected to have considerable effect on Down's syndrome births. The principal objective of this research was to clarify the past and present role of dramatic changes in these two demographic factors within the United States in determining the number and incidence of Down's syndrome births, and the percentage of these births to women greater than or equal to 35. The main hypothesis is that demographic events, modified by increasing use of amniocentesis, adequately account for the general trends regarding Down's syndrome births reported in the recent literature, as opposed to other explanations such as environmental factors or a real biologic increase in Down's syndrome births in younger women. The hypothesis was tested using estimates of the annual number of Down's syndrome births in Ohio for 1970-1979, obtained through use of the Lincoln-Peterson Capture-Recapture method of estimating population size. These were compared to predicted N derived from Ohio demographic data and single year maternal age Down's syndrome risk rates from Upstate New York. The two values of N were in statistical agreement in 8 of the 10 years compared, and show an overall incidence of Down's syndrome in Ohio during the 1970s of 1.20. Using USA government demographic data and Ohio 1970-1979 single year maternal age Down's syndrome risk rates, predicted Down's syndrome births were derived for the USA during 1920-1979. The results show a long-term decline over the period in predicted number (6870 to 4232), incidence (2.42 to 1.23), and percentage of Down's syndrome births to women greater than or equal to 35 (64.3 to 23.4). A precipitous decline in all three values was obtained for the 1960s and early 1970s, with an abrupt end to the declines during the mid 1970s. Predicted number of Down's syndrome births rose 10.4% during the last half of the decade from a low of 3835 in 1975, and is expected to continue to rise rapidly throughout the 1980s, principally as a result of the large increase in the number of women moving into the older age categories.

Amniocentesis↗
PubMed2002

Medical privacy and its value for patients.

OBJECTIVES: To review privacy issues of medical information and current legal guidelines. DATA SOURCES: Government regulations and reports. CONCLUSIONS: Patients must have trust and confidence that the health care system will safeguard their health information and that it will not be used to discriminate against them through insurance or employment. IMPLICATIONS FOR NURSING PRACTICE: Health care professionals must be sensitive to the privacy needs of patients during the collection and storage of data, the access to information, and the sharing of patient information.

Confidentiality↗
PubMedDate not supplied

Public funding of family planning, sterilization and abortion services, 1987.

In FY 1987, the federal and state governments spent +386 million to provide family planning services. Medicaid was the leading source of public funding, accounting for 36 percent of all public monies spent on family planning. Title X of the Public Health Service Act provided 34 percent of total public funds, and two block-grant programs--Social Services and Maternal and Child Health--together were responsible for 17 percent of public support in this area. State governments, which spent a total of +50 million of their own revenues for family planning services, accounted for the remaining 13 percent of public funding. The federal and state governments together spent +65 million to subsidize contraceptive sterilization services in FY 1987. The federal government provided 97 percent of the funding, 88 percent through the Medicaid program. In addition, the federal and state governments spent +64 million to provide 189,000 abortions to poor women; less than one percent of these funds were contributed by the federal government. These data come from a survey of state health, welfare and Medicaid agencies carried out by The Alan Guttmacher Institute and should be viewed as approximations rather than as precise figures.

Abortion, Legal↗
PubMed1999

The medical dictionary for regulatory activities (MedDRA).

The International Conference on Harmonisation has agreed upon the structure and content of the Medical Dictionary for Regulatory Activities (MedDRA) version 2.0 which should become available in the early part of 1999. This medical terminology is intended for use in the pre- and postmarketing phases of the medicines regulatory process, covering diagnoses, symptoms and signs, adverse drug reactions and therapeutic indications, the names and qualitative results of investigations, surgical and medical procedures, and medical/social history. It can be used for recording adverse events and medical history in clinical trials, in the analysis and tabulations of data from these trials and in the expedited submission of safety data to government regulatory authorities, as well as in constructing standard product information and documentation for applications for marketing authorisation. After licensing of a medicine, it may be used in pharmacovigilance and is expected to be the preferred terminology for international electronic regulatory communication. MedDRA is a hierarchical terminology with 5 levels and is multiaxial: terms may exist in more than 1 vertical axis, providing specificity of terms for data entry and flexibility in data retrieval. Terms in MedDRA were derived from several sources including the WHO's adverse reaction terminology (WHO-ART), Coding Symbols for a Thesaurus of Adverse Reaction Terms (COSTART), International Classification of Diseases (ICD) 9 and ICD9-CM. It will be maintained, further developed and distributed by a Maintenance Support Services Organisation (MSSO). It is anticipated that using MedDRA will improve the quality of data captured on databases, support effective analysis by providing clinically relevant groupings of terms and facilitate electronic communication of data, although as a new tool, users will need to invest time in gaining expertise in its use.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Policy evaluation research. Measuring the independent variables.

The purpose of this article is to evaluate the accuracy of three methods used to obtain policy data: (a) government agency surveys, (b) secondary sources, and (c) historical legal research. Changes in laws were identified for all 48 contiguous states for the period 1968 to 1994. Legal research is most accurate for well-established laws that have consistent legal descriptions across nearly all states. Laws that are recently enacted, adopted by only a few states, and treated in a legally inconsistent manner across states require a multistage data collection method to identify accurate policy change information.

Adult↗
PubMed1999

Differences in the role and administrative relationships of medical directors in community and migrant health centers.

This study examined differences in medical directors of Community and Migrant Health Centers (C/MHCs) in the United States based on the size of the center, including demographics, job characteristics, roles, and their relationship with C/MHC administrators and governing boards. Data for this analysis came from a 1996 cross-sectional survey of Community and Migrant Health Centers medical directors. A total of 411 centers (68.3% surveyed) responded to the survey including 240 rural centers (67.4%) and 171 urban (68.7%) centers. Small centers were categorized as those with three or fewer physicians (n = 136), medium centers had more than three but less than eight ETE physicians (n = 14), and large centers had eight or more ETE physicians (n = 109). Several differences were found regarding the medical directors' roles and relationships with the administrator and governing boards on the size of the center. Large C/MHC medical directors had more autonomy than did small and medium C/MHC medical directors including in the areas of managing clinical staff, the budget, and strategic planning activities. They spent more time cultivating community resources than small and medium center counterparts and were more likely to possess the management skills needed in their role than do those in small and medium centers. They also reported a stronger working relationship with the C/MHC administrator and had more input with the C/MHC board than small or medium medical directors.

Ambulatory Care Facilities↗
PubMed2000

Assessment of reporting and recording system of communicable diseases in Jeddah Region.

OBJECTIVE: To determine the rate of reporting communicable diseases in Jeddah region, and to compare the recording system between the governmental and private sector. METHODS: This is a review of records study, in which the reports of communicable diseases from all hospitals and health centers (with or without cases) were studied, during the period of study; 1st to 25th international weeks 1999, and the reporting rate was calculated. A simple random sample was collected from these international weeks to evaluate the quality of recorded information. RESULTS: The reporting rate was 74%. Private hospitals have the highest rate in reporting (87%) and polyclinics have the least (67%). The recording rate was above 90% for administrative data. Personal data was complete except for patient name (76.5%), address (20%), and occupation (73%). The most prominent defect in the disease data was found to be in recording the mode of infection (13%), followed by previous vaccination (29%), date of symptoms (89%), and date of diagnosis (98%). Mode of infection was recorded in (40.5%) of cases by primary health care centers, but in polyclinics in only 1% of cases. Previous vaccination was recorded better by governmental sectors; (29%) by governmental hospital and (49%) by primary health care centers while in the private sectors the rate was (21%) by polyclinic and (25%) by private hospital. Date of symptoms was recorded in 90% of cases in all sectors except in governmental hospitals where it was only (50%). Date of diagnosis was recorded in more than (95%) in all sectors. The results show a statistical significant difference between different health sectors in recording data where government hospitals were least in recording doctor's name and in putting an official stamp in the form (p< 0.001); primary health care centers were the best in recording patient name and occupation (p< 0.001); polyclinics were least in recording mode of infection and previous vaccination (p< 0.001); for recording date of symptoms private hospitals were the best (p< 0.001). CONCLUSION: The reporting rate in Jeddah region was 74%, but its usefulness was diminished because of the incomplete, absent or incorrect personal and disease data.

Ambulatory Care Facilities↗
PubMedDate not supplied

Quantification of procedures and resuscitations in an emergency medicine residency.

Currently, there are no data that govern the number of procedures that are necessary to promote competence during emergency medicine (EM) training. Nonetheless, the Residency Review Committee requires each program to report the average number of procedures and resuscitations performed by its residents. For 7 years, we have used a computer database to track resuscitation and procedure experience for 42 residents. We have documented resident experience both in our 36,000-visit Level I Trauma Center emergency department and during off-service rotations in our 400-bed university teaching hospital. We report data from four graduating classes (n = 24). We estimate that residents have recorded 60% of the actual procedures performed. The 24 residents documented 11,947 procedures, averaging 498 per resident (range 264-1055), and participated in 3432 resuscitations, or 143 per resident (range 64-379). Mean and standard deviations are reported for 20 specific EM procedures and 4 types of resuscitations. EM residents perform a large number of procedures, but there is wide inter-resident variability. There is no documentation that some residents perform even one of some rare but critical procedures. This tracking system suggests, then, that procedure simulations, or cadaver and animal models, must be developed and used to enhance experience. This program can be modified to track resident experience in any specialty, as well as to document supervision by faculty and support credentialling inquiries.

California↗
PubMed2002

How comprehensive are the basic packages of health services? An international comparison of six health insurance systems.

OBJECTIVES: Interest in the composition of the health care menu has grown. Its outwardly comprehensive nature is as rhetorical as the slogans of universal access and affordability. This paper summarizes the international part of a report to the Swiss government, in which we explored the basic package of services covered by social health insurance in France, Germany, Israel, Luxembourg, The Netherlands and Switzerland. The aim of the initial report was to check the appropriateness of the Swiss catalogue, with special attention to the risk of unequal access to health care by rationing of effective services. In this paper, we highlight the major differences in service coverage between the countries and address the possible factors explaining those differences. METHODS: The contents of the basic packages of the six countries were compared using data from government ministries and sickness funds. RESULTS: Coverage is most comprehensive in Germany and Switzerland; these are also the countries with the greatest total health expenditure. Three countries separated nursing care from other types of health care by creating an independent insurance scheme. Some health care benefits are also covered under the heading of social care. High out-of-pocket payments are increasingly used as hidden rationing instruments. CONCLUSIONS: The present comparison highlights the multi-factorial character of the choices made in six countries in order to keep their health care menu within the possibilities offered by available resources.

Comprehensive Health Care↗
PubMed1995

Impact of user charges on vulnerable groups: the case of Kibwezi in rural Kenya.

The Government of Kenya introduced user fees for inpatient and curative outpatient care at its hospitals and health centres in December 1989. Children under five years old and those judged by the health staff to be indigent were among the groups exempted from fees. In September 1990, outpatient registration fees were removed, but other fees were retained. This paper describes the effects of these policy changes on the use of health services in Kibwezi division, a poor rural area. It focuses particularly on the impact of the fees on access to care by children and the poor. The assessment is based on attendance data from government health facilities and on a longitudinal household survey of health care utilization, which covered the nine months during which all fees were charged and two months following the removal of the registration fees. Attendance at government fee-charging health facilities for both outpatient and inpatient care was lower during the period when full fees were charged than during the same months of the previous year. Outpatient attendances rose again when the registration fees were lifted. The study households reported lower levels of utilization of public hospitals and health centres when full fees were in force than during the period after the registration fees were lifted. The pattern of utilization by young children, who were exempted from fees, mirrored that of the rest of the population, suggesting that they were not fully protected from the adverse effects of fees. The poorest households made much less use of the fee-charging government facilities than the better-off households.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Government registries containing sensitive health data and the implementation of EU directive on the protection of personal data in Finland.

Legislation on the protection of personal data was first enacted in Finland in 1987 (Act 471/1987) and revised in 1999 (Act 523/1999). The Personal Registries Act of 1987 established a special authority, the "data protection ombudsman" to ensure that a citizen's right to privacy would be maintained despite increased usage of computerised registries containing sensitive data. Health care and medical research, however, have been largely outside the scope of effective scrutiny due to special legislation that gives health care authorities the right to gather and register information on the medical history of an individual citizen. In Finland, the National Research and Development Centre for Welfare and Health (STAKES)--which works in close co-operation with the Ministry of Social Affairs and Health--maintains or supervises several centralised registries containing sensitive data. These registries which are based on an exemption (Act 556/1989) from the general data protection legislation, contain in practice a complete database on all Finnish citizens that have used public health care services. Furthrmore, additional personal information is added into these databases. For example, the central registry on abortions contains not only the identification data of a subject who has had an abortion but also information on the reason for abortion and on the methods of contraception she used. It is noteworthy that these registers are not accessible to the physicians who treat the patient whose data is registered, but are used by the governmental authorities only. At the moment it is unclear whether the recent implementation of an EU directive into the Finnish legislation and the constitutional right to privacy in the revised Finnish constitution (effective from March 1, 2000 onwards) will have any impact on the content or usage of these centralised registers.

Confidentiality↗
PubMed1999

[Data protection as a personal right. Government Agency].

The sector-specific secrets are traditionally regarded as the historical predecessors of general data protection law. The lecture demonstrates that they are not only aimed at protecting the individual's right to self-determination of the handling of his personal data. It also indicates that those particular secrets are, at the same time, serving for further purposes which are of importance in their respective sectors. The general (omnibus) data protection statues are given attention in the light of the beginning of automated information processing and in their role of guaranteeing the right to personal privacy, a role which the Federal Constitutional Court underlined in its census decision of 1983 and which became of general relevance in the course of the further developments. In conclusion, the report particularizes that, inter alia, statutory adaptations and amendments are necessary in order to preserve the effects of the doctor-patient confidentiality under the conditions of modern data processing. The examples given are comprising: health data on chip cards, health data in networks and the electronic record of the patient.

Confidentiality↗
PubMed2003

[Characteristics of patients with intractable diseases receiving public financial aid for treatment--results of a nationwide survey, 1997].

OBJECTIVES: In order to clarify the characteristics of medical institutions visited by patients with selected intractable diseases, we analyzed data from the fourth nationwide survey in 1997. METHODS: We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. Out of 399,719 whose information was reported by prefectural governments, we analysed data of 370,232 patients whose medical institutions were reported. We performed detailed analysis on the relation between patients' residences and locations of medical institution which the patients visited, and on the characteristics of medical institutions. These analyses were respectively compared by sex and age, the beginning year of the financial aid, whether the patients were inpatients or outpatients, type of insurance, and clinical division where the patient was treated. RESULTS: 1. Analysis showed that 7.4% of all patients were treated in medical institutions outside the prefectures where they lived. Patients who lived in the neighboring prefectures of huge cities like Tokyo, tended to be treated in the medical institutions there. 2. We found that 23.5% of patients were treated in university hospitals, and 11.9% were seen in clinics. 3. There was a difference between patients with SMON and patients with myastenia gravis, pemphigus, epidermolysis bullosa or primary pulmonary hypertension. Of the two groups, the former preferred to visit clinics and be treated in medical institutions located in the same cities, towns, and villages where they lived. On the contrary, patients with the latter 4 diseases tended to visit large hospitals and be treated in those outside their prefectures. 4. Elderly patients over 70 years old tended to be treated in clinics or hospitals located in their neighborhoods. 5. Compared with past surveys, the percentage of patients treated in university hospitals had decreased, and that of patients treated in clinics had increased year by year. No change was found in the proportion of patients treated in medical institutions outside their prefectures. CONCLUSIONS: By the present analysis of a nationwide survey taken in fiscal year 1997, we were able to clarify the characteristics of medical institutions visited by patients with selected intractable diseases. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.

Adolescent↗
PubMed1985

Visuomotor tracking with delayed visual feedback.

A rhesus monkey and five human subjects used a hand-held joystick to track unpredictable continuously moving targets. Both monkey and human respond by making discrete ("step-and-hold") corrections of positional error, at an average frequency of 1.33 and 2.26 movements/second, respectively. By delaying visual feedback of joystick position, we could reduce these frequencies in a predictable manner. These results imply that the primate visuomotor system probably does not operate as a "sampled-data mechanism" governed by an asynchronous clock, but that inevitable delays in visuomotor feedback control determine the frequency of corrective movements.

Animals↗
PubMed2004

Malaria vectors in the changing environment of the southern Punjab, Pakistan.

The Pakistani Punjab experienced several devastating malaria epidemics during the twentieth century. Since the 1980s, however, malaria has been at a low ebb, while in other areas of Pakistan and neighbouring India malaria is on the increase. This raises the question of whether transmission in the Pakistani Punjab may have been influenced by a change in vector species abundance or composition, possibly induced by environmental changes. To investigate this question, routinely-collected government entomological data for the period 1970 to 1999 for the district of Bahawalnagar, in the Indus Basin irrigation system in the southern Punjab, was analysed. Our findings suggest that Anopheles stephensi has increased in prevalence and became more common than A. culicifacies during the 1980s. This shift in species dominance may be due to the large-scale ecological changes that have taken place in the Punjab, where irrigation-induced waterlogging of soil with related salinization has created an environment favourable for the more salt-tolerant A. stephensi. Some biotypes of A. stephensi are suspected of being less efficient vectors and, therefore, the shift in species dominance might have played a role in the reduced transmission in the Punjab, although further research is needed to investigate the effect of other transmission-influencing factors.

Animals↗
PubMed1998

Infant mortality: a multi-level analysis of individual and community risk factors.

This paper reports the results of an analysis of infant mortality based on a conceptual model that combines micro-level and macro-level variables taken from demographic, sociological and epidemiological research traditions. Using generalized hierarchical linear modeling techniques, we analyze 1988 and 1989 linked birth and death records for Upstate New York matched with county-level data from government and private sources. Net of health and sociodemographic risk factors. our results show that the number of per capita primary care physicians and local government expenditures on health care services and hospitals are positively linked to an increase in the probability of infant death and that our indicator of hospital facilities is negatively related to risk of death. We also find that some negative health behaviors and health resources of mothers are mediated by the local health care environment. Our results demonstrate the utility of combining perspectives from several disciplines when evaluating infant death, especially the impact of policy-related issues concerning health care service in

Humans↗
PubMed1999

The ethical foundation of informed consent in clinical research.

OBJECTIVES: To provide a foundation for understanding the ethical concept of informed consent with particular emphasis on the characteristics and principles that make it a moral imperative. DATA SOURCES: Government reports, published articles, and book chapters from the ethics literature. CONCLUSIONS: Informed consent is central to the conduct of cancer clinical trials and good patient care. It is a thoughtful, collaborative process whereby an individual gives autonomous authorization and the decision of the individual is respected by the health professionals. IMPLICATIONS FOR NURSING PRACTICE: Understanding the theory and practice of informed consent is an essential aspect of the nurses role. There are many challenges to this process in the oncology setting because of the severity of the diseases and the complexity of the research, and nurses must be prepared to assure that informed decision-making takes place.

Clinical Trials as Topic↗