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PubMed1993

Difficulties in developing a respite program.

St. Paul's Hospital Palliative Care Unit is a 15-bed integrated AIDS and non-AIDS unit that has been open since 1989. A respite program has also been operating since 1989. Overall admissions to the unit have comprised approximately one-third AIDS patients and two-thirds non-AIDS patients. However, the respite patients have consisted of about two-thirds AIDS patients and one-third non-AIDS patients. The 53 patients in the first three years of the respite program have generated 96 respite admissions and 37 non-respite admissions. In the course of developing this program a number of questions and issues have arisen relating to goals and objectives of the respite program, perceptions of the patient and caregivers, and the effectiveness of the program. A review of the utilization patterns of this program and a discussion of selected case histories will be instructional for those who are considering developing their own respite programs.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Personality characteristics of sex offenders: a review.

Research utilizing psychometric instruments to assess personality characteristics of sex offenders is reviewed. A methodological shortcoming of this research is the frequent use of the MMPI. It is argued that this test was originally developed as a measure of types of psychopathology and has not been validated as a personality test. Studies using tests other than the MMPI have seldom controlled for institutionalization and impression management. Further, little attention has been paid to criminal history, making it difficult to conclude that the current offense is representative of past behavior. In the case of child molesting, there has been a failure to specify and/or control for age and sex of victim and degree of force used. Results suggest that men who engage in rape and child molesting are guilt-ridden individuals who inhibit aggression, but these findings are tentative because of the aforementioned methodological problems.

Child↗
PubMed1985

The role of an intensive care unit in a community hospital. A ten-year review with observations on utilization past, present, and future.

A retrospective ten-year review of the surgical-intensive-care-unit utilization practices at Riverside Community Hospital revealed that, according to the author's criteria, an average of 32% of over 800 yearly admissions could have been safely managed in a less intensive and expensive environment. The admission practices, monitoring parameters, length of stay, and intensity of nursing interaction were evaluated and compared with those of published reports. Prospective payment by diagnosis-related groups will likely force a change in the existing use of surgical intensive care units. Surgeons are urged to examine the utilization of their hospitals' intensive care units and actively work with their hospital administration to establish intermediate care units so that patients will not be jeopardized by the impending fiscal constraints of diagnosis-related groups.

Aged↗
PubMed1991

Studies in utilization of drugs: a review of different methods.

Pharmaceutical expenses are 19% of social security expenses in Spain. Studies of prescription habits, prescription prevalence, therapeutic profiles, prescription compliance and incidence reports are thus required. Different methods to study utilization of drugs are discussed and examples of each method are provided. The number of registered pharmaceutical specialties varies between 21000 in Germany (2900 active substances) and 1000 (700) in Iceland. The thiazide consumption varies between 4.3 daily defined doses (DDD) per 1000 inhab./day in Spain and 42.9 in Sweden. Medication errors were caused by recording problems in 6.5% of all drug distributions.

Drug Prescriptions↗
PubMed1997

Utilization of hospital services by the elderly: geriatric crisis in one Canadian single payer system.

As the number and proportion of elderly persons in the Canadian population increase, utilization of health services by the elderly becomes a growing concern for health service insurers, financial managers and policy makers, as well as for care providers. The purpose of this paper is to present the results of a study to analyse the use of hospital services by the elderly in Alberta since the introduction of a universal single payer health care insurance system in 1970. The study period coincides with the implementation of publicly-financed comprehensive medical and hospital insurance programmes for all Alberta residents, making it possible to perform historical and population-based utilization analyses. Thus the data used for the study included all hospital discharge abstracts generated by all Alberta hospitals from 1971 to 1991. Trends in hospital service utilization by the elderly in terms of total number of separations, patient-days, and per case measures such as average length of stay as well as per capita utilization rates were reviewed to identify utilization patterns over the study period. Further, relative per capita utilization measures, in comparison with the base year (1971), age group 15-44, male, metropolitan residents, were derived and historical trends identified. A series of regression analyses were carried out to estimate the effects of age, sex and origin on utilization rates. In addition, for the period of 1984-1991, Diagnosis Related Groups (DRG) case weights were used to measure per capita and per case rates and to analyse historical relative utilization rates over the 8-year period. In general, there has been a significant decline in hospital utilization by Albertans under the publicly-financed single payer system, but utilization rates for elderly have remained high, resulting in high relative utilization rates in comparison with other age groups. It was also noted that per capita utilization rates for rural residents were substantially higher than urban residents. It appears that these higher utilization rates by the elderly and rural residents in combination with tight bed and financial control by the government have been causing significant bed shortage problems for non-elderly elective patients in urban areas.

Adolescent↗
PubMed1994

Emergency department utilization by adolescents.

PURPOSE: To review adolescents' utilization of a hospital emergency department (ED) in a rural area, to identify their characteristics, and to explore their motivation to seek health care in this setting. METHODS: A retrospective chart survey of all 4932 adolescent visits (ages 12-18 years, 55.5% females) to the ED in a small town with a population of 55,000 serving a rural area was conducted for the calendar year 1989. Chief complaints and diagnoses were retrospectively categorized according to six groups: injury, pulmonary problems, Ob/Gyn, infection, nonspecific pain (complaint)/no diagnosis (diagnoses), and "other." RESULTS: There was an increasing number of visits with increasing age. Adolescents with private insurance, who accounted for 50% of patients, were more likely than self-paying adolescents (14%) and adolescents on Medicaid (36%) to have a primary care source and to have access to a telephone. Injury was the most common diagnosis with motor vehicle accidents (MVA) accounting for 15% of all injuries. Self-paying adolescents and those on Medicaid were more likely to be diagnosed with an infection or an Ob/Gyn problem than adolescents with health insurance. Only 5.9% of adolescents were admitted to the hospital service. 8.5% of adolescents were discharged from the ED without a diagnosis. 78% of these had complained about nonspecific pain. CONCLUSIONS: Many adolescents in this rural area were found not to have an identified primary care source and to seek health care in EDs. Illnesses that could have been prevented or treated in a more cost-effective setting thus become "emergencies." Primary care sources are needed that are accessible and acceptable to adolescents.

Adolescent↗
PubMed1993

Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

Data Collection↗
PubMedDate not supplied

A non-computer-dependent prospective review of blood and blood component utilization.

The effect that a prospective review of blood and blood component utilization had during a 1-year period at an 850-bed tertiary-care teaching hospital is reported. The review process, which has been in operation for 18 years, is based on institutionally developed usage guidelines for blood, fresh-frozen plasma (FFP), platelets (Plts), and cryoprecipitate (Cryo). The guidelines were developed by the hospital's Transfusion Medicine Committee. The review is initiated by the transfusion service technical personnel when an order is received. Back-up support is provided, as needed, by physicians on the service or by those pathology residents taking off-hour call. They consult with the ordering physician when questions arise as to the appropriateness of an order as it relates to the patient's clinical situation. Screening values used in the initial evaluation of each order are: hematocrit, less than or equal to 27 percent (0.27) for blood; prothrombin time, greater than or equal to 16 seconds, and/or activated partial thromboplastin time, greater than or equal to 60 seconds, for FFP; bleeding time, greater than or equal to 16 minutes and/or a platelet count of 20 to 100 x 10(3) per mm3 (20-100 x 10(9)/L), as related to clinical conditions, for Pits; and fibrinogen less than or equal to 120 mg per dL (1.2 g/L) for Cryo. Also taken into consideration is the stated clinical indication, which is provided when the requisition is submitted. As a result of the prospective review, orders for blood and/or components for 114 patients were canceled, and 51 patients received 207 blood components that were more appropriate for the clinical situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Component Transfusion↗
PubMed1998

Computational models in immunological methods: an historical review.

The utilization of computational models in immunology dates from the birth of the science. From the description of antibody-antigen binding to the structural models of receptors, models are utilized to bring fundamental understandings of the processes together with laboratory measurements to uncover implications of these data. In this review, an historical view of the role of computational models in the immunology laboratory is presented, and short mathematical descriptions are given of fundamental assays. In addition, the range of current uses of models is explored -- especially as seen through papers which have appeared in the Journal of Immunological Methods from volume 1 (1971/1972) to volume 208 (1997). Each paper which introduced a new mathematical, statistical, or computer simulation model, or introduced an enhancement to an instrument through a model in those volumes is cited and the type of computational model noted.

History, 20th Century↗
PubMedDate not supplied

Methylphenidate in children with hyperactivity: review and cost-utility analysis.

OBJECTIVE: To evaluate the effectiveness and cost effectiveness of methylphenidate in the treatment of children with hyperkinetic disorder as defined using ICD-10 criteria. DESIGN: Comprehensive literature review and cost utility analysis comparing methylphenidate treatment with placebo. Costs and effects were estimated from a NHS perspective according to the methodology developed by the previous South and West Development and Evaluation Committee. The number of Quality Adjusted Life Years (QALYs) gained was estimated by using the Index of Health Related Quality of Life to model treatment effects. RESULTS: Evidence from good and medium quality randomized controlled trials shows benefits of methylphenidate over weeks and months respectively. Evidence beyond 6 months is poorer and it is uncertain whether effects of methylphenidate persist into adolescence and adulthood. Methylphenidate is of reasonable cost-effectiveness when considering short- and medium- term benefits with an estimated cost per QALY of 7 pounds 400 to 9 pounds 200 at 1997 prices. CONCLUSIONS: Short-term treatment of hyperkinetic children with methylphenidate is effective and cost effective.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Transforming resource utilization data into information.

In view of increasing financial pressures, resource utilization management and review have become a primary focus for many healthcare organizations. Utilization strategies have been supported and enhanced by information technologies in many organizations. This paper describes the development and implementation of an on-line application for resource utilization review. Developed for use by clinicians and case managers, access to on-line utilization data has markedly influenced strategic clinical and financial decisions. Recommendations for future use and revisions are provided.

Data Display↗
PubMed2002

Recent development on computer aided tissue engineering--a review.

The utilization of computer-aided technologies in tissue engineering has evolved in the development of a new field of computer-aided tissue engineering (CATE). This article reviews recent development and application of enabling computer technology, imaging technology, computer-aided design and computer-aided manufacturing (CAD and CAM), and rapid prototyping (RP) technology in tissue engineering, particularly, in computer-aided tissue anatomical modeling, three-dimensional (3-D) anatomy visualization and 3-D reconstruction, CAD-based anatomical modeling, computer-aided tissue classification, computer-aided tissue implantation and prototype modeling assisted surgical planning and reconstruction.

Animals↗