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At least 1,351 records · Page 75Linked to original sources
PubMed1994

Current logistics of acute burn care in Singapore.

OBJECTIVE: To study logistic requirements in acute burn care in Singapore and to correlate statistics on fire, unnatural deaths and burns. DESIGN: Fire data (from Singapore Fire Safety Bureau), mortality data (from Institute of Science & Forensic Medicine) and burn data (from Burns Centre, Singapore General Hospital) were studied. SETTING: Severe burn victims often require prolonged treatment. Useful data was obtained in a 1,500-bed restructured government hospital. PARTICIPANTS: All reported and investigated fire incidents, coroner enquiries of unnatural deaths and admitted burn patients. INTERVENTION: General burn data obtained retrospectively from 398 burn admissions in 1988 and logistic burn data from 41 patients requiring fluid replacement regime. RESULTS: Fire data showed one burn admission in every 12 fires (398/4718), one burn death in every 314 fires (15/4174) or 55 unnatural deaths (15/828). Mortality data showed 15 burn deaths, two prior to admission, 7/13 admitted died of suicidal injuries and mortality rate was 3.3% (national annual average is 1.9%). General burn data showed adults 76% and children 24%, 3:1 male predominance; scalds (46%), fire (32%), explosions (11%) and others (11%). Seventy-eight patients (adults 58, children 20) required fluid resuscitation. Logistic burn data (average burn 35%, 28 partial thickness and 13 full thickness burns) were: ALOS 19.5 days, 2.4 major operations per patient (range 2-7), 56 minor procedures and 2.9 L blood transfusion per patient (those who were operated required 3.8 L and those not operated, 1 L per patient). Blood investigations increased with severity and pattern of injury, Acinetobacter species was commonest microorganisms, antibiotics were used in 66% of patients and commonest burn dressings were tullegra (T/G), followed by T/G with silverzine. CONCLUSION: Data presented useful for correlation of fire, mortality and burn statistics, resource allocation and new burn facility establishment.

Blood Transfusion↗
PubMed2001

Does managed mental health care reallocate resources to those with greater need for services?

Evidence points to the existence of two coexisting inefficiencies in mental health care resource allocation: those with need receive too limited or no care while those with no apparent need receive services. In addition to reducing costs, managed mental health care is expected to reallocate treatment resources to those with greater need for services. However, there are no empirical findings regarding this issue. This study tests whether managed mental health care has had a differential impact by level of need. Data consist of three waves of a community sample with a control group. The study finds that managed care has not succeeded in reallocating resources from the unlikely to the definite "needers."

Adolescent↗
PubMed2005

Empirical models of pollen limitation, resource acquisition, and mast seeding by a bee-pollinated wildflower.

Synchronous mast seeding is increasingly recognized as common in plant populations. Recent theoretical models show that synchronous mast seeding could be a consequence of resource allocation and storage within individual plants, coupled by pollen limitation in low-flowering years. We used long-term population and weather data to parameterize models of flowering based on stored resources and pollen limitation in Astragalus scaphoides, a bee-pollinated plant that flowers in alternate years. We used these models to test whether internal resource dynamics could explain mast seeding in A. scaphoides and, if so, whether synchrony was caused by pollen limitation and/or fluctuations in precipitation. We compared predictions of models that included all combinations of three factors: constant versus precipitation-dependent resource gain, uniform versus heterogeneous resource gain (among individual plants), and resource-dependent versus resource- and pollen-limited fruit set. Pollen limitation and heterogeneous resource gain were necessary and sufficient to explain alternate-year flowering, but precipitation increased the quantitative match between model predictions and flowering dynamics. Together, our results support the importance of density-dependent pollen limitation as an ultimate and proximate cause of mast seeding in A. scaphoides. Precipitation does not act as a direct cue for synchrony in this species but might affect long-term resource gain and fruiting dynamics.

Animals↗
PubMedDate not supplied

[Reflections on the meaning of nursing work loads and responsibility to establish safe staffing].

The methods for establishing nursing staff requirements , based on the caring needs of patients , take into consideration two parameters: the determination of the overall care requirements fundamental for programming nursing care; the quantification of the requirements as the time needed for care, classifying patients according to their degree of dependence, by the analysis of the pre-established parameters. Consequently, the approach to the evaluation of nursing staff requirements varies: in fact, when the focus is placed on the care necessary for different types of patients, the nursing practice is based on planning of care and the resulting criteria are more objective. On the other hand, when the approach focuses on an analysis of the division of available resources among the different types of patients, it is influenced by local factors and is less objective. The DRG system introduced in Italy in 1995 classifies patients on a medical basis and allocates resources accordingly. However, since this system does not take into account a nursing classification, it cannot extrapolate the true requirements of nursing resources: this means that financing does not adequately evaluate the costs of nursing care. The non-assessable aspects of nursing care and their significance are also taken into consideration.

Diagnosis-Related Groups↗
PubMedDate not supplied

[The economic costs in the production of health services: from the cost of inputs to the cost of case management].

OBJECTIVE: To generate information on costs of health services. MATERIAL AND METHODS: Using Kessner's criteria the tracer conditions selected were: hypertension, diabetes, diarrhea and pneumonia. Case-management definitions were established and then, -using the case-management costing method-the production functions, inputs and unit costs necessary to meet the demand for medical care per condition. Data were processed in a spreadsheet software package to estimate in-patient and out-patient case-management costs. RESULTS: Findings from this study show that using in-patient and out-patient case-management costing it is possible to identify the relative weight of the different production functions and inputs. Using the relative frequencies, both production functions and inputs were classified in high, medium and low impact on the total case-management cost. CONCLUSIONS: This information suggests that planning, organization and resource allocation should be guided by in-patient and out-patient service demands for each tracer conditions. In addition we suggests direct action to stimulate the obtention of economic earnings from resources utilization in the most efficient way.

Adult↗
PubMed2002

High technology and nursing: ethical dilemmas nurses and physicians face on high-technology units in Norway.

Results from two studies of ethical dilemmas nurses and doctors experience on two high-technology units are compared and discussed. The qualitative comparative methodology of grounded theory was used to generate theoretical frameworks grounded in the empirical realities of the units. The ethical dilemmas they faced were related to: treating the one vs. the common good; end of life questions; and resource allocations with inadequate staffing. Similarities were related to intensity and urgency of nursing care and patient treatment, clear nursing ideologies based on treating humans within a framework of hope, embracing technology and scarce resources. Differences between the two study units were patient diagnosis, hierarchical structure on one unit while one had a vertical structure and decision-making processes, and finally how nursing knowledge and autonomy were used. The two studies demonstrated that clinical, ethical and administrative interactions and decisions are highly compounded, stressful and intertwined.

Biomedical Technology↗
PubMed2000

Hitting the target: the equitable distribution of health visitors across caseloads.

BACKGROUND: Health visitors in the United Kingdom work mainly with pre-school children and their mothers. Their distribution across the population is largely historical, highly variable and relates poorly to indicators of population need. METHODS: A range of largely routine data sources were used to describe the nature, variation and statistical determinants of the workload of individual health visitors in Sheffield, England, in 1996-1997. Regression models were tested relating measures of need and deprivation to the total number of client contacts. RESULTS: Caseloads were smaller in the most deprived areas, with wide variation. Most (93 per cent) contacts were with mothers and young children. Health visitors visited the clients designated as highest priority on average 4.7 times more often than routine clients. The main reasons for high priority ratings were child protection concerns, maternal mental health problems, child development and health concerns, and first-time mothers in the postnatal period. Half of all client contacts were with low-priority families for routine child health surveillance or were client initiated. Models based on the number of children under five and any one of a range of measures of social deprivation account for 57-59 per cent of variation in workload and could be used to allocate resources more equitably. CONCLUSIONS: Although most health visitors apparently subscribe to the principle of targeting, the extent varies widely. Constraints on targeting are routine child health surveillance reviews, and client demands. More equitable allocation of health visitors and more explicit targeting policies might increase the effectiveness of the health visiting service.

Child↗
PubMed2004

Status of end of life care in organizations providing services for older people with a developmental disability.

Volunteers of America conducted a national survey of directors of 500 organizations providing services to older people with an intellectual disability in order to establish a baseline for assessing current status of end of life care. The questionnaire contained 56 questions. The return rate was 32% (N = 160). Data analysis provided an overview of organizational needs, resource allocations, end of life care services currently provided, obstacles to care, methods for monitoring such care, and existing and recommended strategies for improving this care. Results underscored the needs for practical guidelines and resources, increased staffing and training, and policy-level reduction of obstacles to promote improved end of life care.

Aged↗
PubMed1994

Using cost-effectiveness analysis for formulary decision making: from theory into practice.

The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.

Cost-Benefit Analysis↗
PubMed1985

Physician and coding errors in patient records.

The Veterans Administration's discharge abstract system was studied to identify error frequency, source, and effect in five Veterans Administration hospitals. We reviewed 1,829 medical records from 21 services for concordance with the abstract; sampling provided 95% confidence for each service. Of these records, 1,499 (82%) differed from the abstract in at least one item. Of 20,260 items, 4,360 (22%) were incorrect, with three error sources: physician (62%), coding (35%), and keypunch (3%). We projected 2.14 physician and 0.81 coding errors in the average abstract. Eighty-nine percent of projected physician errors were failures to report a procedure or diagnosis. Coding was subjective and errors were synergistic with physician errors. We projected that correction of errors would change 19% of the records for diagnosis-related group purposes and substantially increase future resource allocation. This effect varied considerably by service.

Abstracting and Indexing↗
PubMed2026

Doublesex gene influences sex differentiation and embryonic development in predatory mite Phytoseiulus persimilis.

BACKGROUND: Phytoseiulus persimilis is an effective biocontrol agent characterized by paternal genome elimination (PGE), an unusual reproductive system in which males eliminate the paternal genome during embryogenesis. However, the molecular mechanism underlying sex determination and reproductive regulation in this species remain poorly understood. RESULTS: Transcriptome-based analyses identified two doublesex (dsx) homologs, Ppdsx1 and Ppdsx2, as candidate regulators of reproduction. Weighted gene co-expression network analysis (WGCNA) assigned Ppdsx2 to a pre-mating-associated co-expression module enriched for reproductive and signaling pathways. Functional analyses revealed clear divergence between the two genes. RNA interference (RNAi) of Ppdsx1 reduced the proportion of female offspring, whereas RNAi of Ppdsx2 induced sex reversal, developmental abnormalities, and impaired egg viability. Yeast two-hybrid and glutathione S-transferase (GST) pull-down assays further demonstrated interactions between Dsx proteins and vitellogenin (Vg)-derived fragments identified from a complementary DNA (cDNA) library screen, suggesting a previously unrecognized connection between sex determination and reproductive nutrient allocation. CONCLUSIONS: Ppdsx1 contributes to maintenance of the female developmental pathway, whereas Ppdsx2 represents a strong candidate component of the PGE-associated sex-determination cascade. The observed Dsx-Vg fragment interaction suggests a potential link between reproductive developmental programs and nutrient allocation pathways. These findings provide new insights into the molecular basis of sex determination and reproductive regulation in phytoseiid mites and establish a foundation for future studies on the coupling of reproductive development and resource allocation. © 2026 Society of Chemical Industry.

Animals↗
PubMed2000

The Westmead Pediatric TBI Multidisciplinary Outcome study: use of functional outcomes data to determine resource prioritization.

OBJECTIVE: To measure functional outcome in the 2 years after traumatic brain injury (TBI) in 2 groups of children and to determine the usefulness of a TBI severity classification system for resource allocation. DESIGN: Prospective inception cohort study with 3 assessment points during the 2 years after trauma. SETTING: Tertiary pediatric trauma center in Sydney, Australia. PARTICIPANTS: Eighty-one consecutive admissions aged 0 to 14 years. Fifty-one were allocated to the Mild (n = 26) or Severe (n = 25) TBI groups, according to preset determinants of severity; 30 admissions with non-TBI trauma constituted the control group. MAIN OUTCOME MEASURES: Standardized psychometric and clinical assessments of cognition, communication and feeding ability, motor performance (ambulation, fine and gross motor), neurologic status, self-care independence, and school/academic performance. RESULTS: Those with Mild TBI severity had no significant deficits at the 2-year data point. In contrast, those in the Severe TBI group demonstrated continued problems with fine motor performance, neurologic status, self care, and school/academic performance. CONCLUSIONS: A classification system has been developed that may be useful in the allocation of children with a TBI, age younger than 15 years, to 1 of 2 severity groups early in their rehabilitation. This classification system may be useful in determining areas of high and low resource prioritization.

Adolescent↗
PubMed2002

Ethical issues in geriatric medicine: a unique problematic?

It is commonly believed that geriatric medicine generates a distinctive set of ethical problems. Implicated are such issues as resource allocation, competence and consent, advance directives, medical futility and deliberate death. It is also argued that it would be unjust to allow the elderly to compete with younger populations for expensive and scarce healthcare resources because the elderly "have already lived," and that treating them the same as these other populations would diminish the available resources unfairly, prolong a life of inevitably failing health and result in increased health care expenditures. In fact, however, this perception of ethical uniqueness is mistaken. Differences in medical conditions, demographics and aetiology should not be allowed to obscure the fact that ethical issues in geriatric medicine are essentially the same as those faced in any other area of health care, and that the solutions that are adopted in the geriatric context must be consistent with the ethical principles that are followed elsewhere. The paper argues that the root of the mistaken perception lies in the abandonment of the Hippocratic mandate of medicine and in an unreflective adherence to the belief that medical advances are inevitably beneficial. It is suggested that a return to patient-centred medicine and the use of ethics impact analyses before introducing medical advances may be ethically appropriate.

Aged↗
PubMed1995

Reducing imaging costs in Manitoba, Canada.

Manitoba, Canada, has serious debt and deficit problems and spends one-third of its revenue on health care. Manitoba Health, the single government carrier, has requested a 5-year management plan from the Provincial Imaging Advisory Committee to maintain and improve the present services within reduced funding [1]. The committee members are radiologists, nuclear medicine specialists, physicists, physicians, hospital officials, and senior government staff. In 1993, each Manitoba hospital prepared a 5-year plan for imaging equipment purchases based on projected patient and attending staff needs. The requests for services and new imaging technology exceed planned resource allocations. I was asked by Manitoba Health in July 1993 to prepare a cost restraint position paper with a target of 10% savings to help with government restraint and to allow some transfer of resources for continuing growth in imaging. The approach was to consult widely and to seek methods of significant cost savings that Canadian society might accept (Table 1). Areas of potential savings now are being considered by ad hoc committees appointed by hospitals and Manitoba Health. Several are being implemented on a trial basis.

Contrast Media↗
PubMedDate not supplied

The Gambian National Impregnated Bed Net Programme: evaluation of effectiveness by means of case-control studies.

Two case-control studies, one on mortality and the other on malaria morbidity, were carried out in order to evaluate the impact of the Gambian National Insecticide Bed Net Programme during the second year of intervention and to explore the feasibility of such a study for the evaluation of programme effectiveness. For the mortality study, children 1-9 years old who died during the 1993 rainy season were matched by age and sex with 2 healthy controls from the same village. For the morbidity study, children 1-9 years old attending Fatoto or Jahalia Health Centres in The Gambia and who had fever and parasitaemia > or = 5000/microL were matched by age with a child attending the health centres without fever or parasitaemia. An additional healthy control was recruited from the case's village. No impact of insecticide-treated bed nets on mortality was detected and this was in keeping with the results obtained by prospective surveillance. A protective effect of insecticide-treated nets on malaria morbidity was detected when cases were compared with controls recruited at the health centres. However, this disappeared when cases were compared with controls recruited from the cases' villages. The mortality case-control study suggested that reducing the time between onset of disease and treatment may have an important impact on childhood mortality. In order to calculate programme cost-effectiveness, important for informed resource allocations to be made by health managers, it is essential to obtain evidence of effectiveness. This can be done by means of case-control studies, which are easier to carry out and require fewer resources than prospective surveillance. Nevertheless, it is necessary to be conscious of their pitfalls, particularly of the bias involved in the choice of cases and controls. The measurement of insecticide on the nets of the cases or controls is essential for such studies.

Case-Control Studies↗
PubMed1983

Performance of concurrent tasks: a psychophysiological analysis of the reciprocity of information-processing resources.

The resources allocated to a primary and secondary task are reciprocal. Subjects performed a tracking task in which the discrete displacements of the tracking cursor could be used to elicit event-related brain potentials. As the resource demands of the tracking task were increased, potentials elicited by the task-defined events increased in amplitude, whereas those elicited by secondary task auditory stimuli decreased.

Evoked Potentials↗
PubMed2000

Developing a value-added Web site.

Once a healthcare organization has decided to establish a Web site on the Internet, it must next determine its implementation strategy, based on a full understanding of the goals of the site and the range of Web content and service offerings available in the marketplace. Although some organizations may choose to develop and maintain a Web site using exclusively in-house resources, most healthcare organizations will find that they can minimize the costs associated with this effort by making judicious use of outsourcing services. Whichever approach is used, it is important that financial managers charged with allocating resources for Web-site development and maintenance understand the implications, including relative financial impact, of key issues and options.

Advertising↗
PubMed1998

[Follow up of a schizophrenic patient in general practice].

GEOGRAPHIC SECTORS: In France, the public psychiatric health care system is divided into geographic sectors. Each sector is attributed to a psychiatric team and health care institutions. Each psychiatric unit in public hospitals is responsible for a given sector. LEGAL FRAMEWORK: The legal framework for sectorialization was established in 1960 and has been completed by various administrative and legislative regulations which define the missions of the sector and application modalities. RESOURCE ALLOCATION: Changing attitudes in psychiatric care, therapeutic techniques and economic goals have had an effect on the notion of sectorialization. Current policies tend towards the development of intersector exchange to make better use of available resources and better meet the objectives of the public health care system.

Delivery of Health Care↗