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PubMed1995

[Quality control in anesthesiology. Results of a prospective study following the recommendations of the German Society of Anesthesiology and Intensive Care].

The German Social Law has required quality assurance (QA) procedures since 1989. The measures must be suitable to allow "comparing investigations". In 1992 the German Society of Anaesthesiology and Intensive Care Medicine published recommendations for QA in anaesthesia: most problems during an anaesthetic should be documented in a standardised manner, and thus, a list of 63 pitfalls, events, and complications (PECs) and five degrees of severity were defined. The goal of this study was to determine the frequency of PECs in anaesthesia and to correlate PECs with procedures and preoperative health status. MATERIALS AND METHODS. Demographic data, preoperative findings, type and duration of anaesthesia and operation, and kind and severity of PECs were integrated in an automatically readable anaesthetic data record (ARADR). During 12 months all anaesthetics in our department were documented by the ARADR; the records were read by a reading device and the data stored in a modern SQL database (Informix). Degrees of severity: I. PEC leads to reaction of anaesthetist, no impact for recovery room (RR); II. impact for RR, no impact on transfer to ward; III. significant prolongation of RR stay or additional monitoring on ward; IV. PEC leads to intensive care unit admission; V. disabling damage or death. RESULTS. In all, 18350 anaesthetics were recorded (9055 male, 9295 female); the median age was 41 years (1 day-99 years). In 4251 (23.2%) anaesthetics 5927 PECs occurred, 3412 of them involving the cardiovascular and 949 the respiratory system, the latter with a tendency to higher degrees of severity. PECs caused by technical equipment (126) or lesions caused by anaesthesists (342) had no fatal outcomes and were less severe. Patients in ASA class I had 12.3% anaesthetics with PECs, ASA II 23.3%, ASA III 33.8%, ASA IV 34.9%, and ASA V 58.5%. PECs of degrees IV and V showed a higher incidence in the higher ASA classes. There was no fatal PEC in an ASA class I patient and only one (of 13615) in an elective procedure. Emergency cases had more frequent and more severe PECs: 16 of 19 PECs of degree V were in ASA class IV and V patients and 15 in emergency situations, all of them in surgical patients. Patients with cardiovascular disease had a more frequent incidence of PECs by a factor of 1.39 to 5.93 than those without such disease. CONCLUSIONS. Standardised incident reporting by defined PECs seems a good way to describe problems in anaesthesia. The types of PECs in our study had a similar distribution to those in other investigations, but there was a tendency to less frequent fatal PECs in ASA classes I to IV and more frequent ones in ASA class V. We expect better comparability when multicenter studies are done using identical methods in the next few years. Perhaps different patients collectives with special risks will be detected; efforts in quality improvement could focus on these patients.

Adolescent↗
PubMed2000

Coordinating the care of the chronically ill in a world of managed care.

The systems required to provide coordinated health care to the chronically ill within a managed care contract are complex. As an integrated health care delivery system assuming shared financial risk of enrollees in a Medicare + Choice contract, many care processes need to be created to meet the needs of the clients and administrators. Nursing case management and physician partnering are integral to the creation of the care model. The fiscal data demonstrated, for clients in this model, that there was an overall decrease in the inpatient length of stay, hospital days per thousand, and 30-day readmission rates.

Case Management↗
PubMed2003

Use of cancer susceptibility testing among primary care physicians.

Primary care physicians (PCPs) are assuming greater roles in cancer risk assessment and susceptibility testing of patients. The objective of this study was to assess the beliefs and practices of PCPs relative to genetic susceptibility testing for cancer. A cross-sectional survey was mailed to 726 PCPs in community-based practices in southeastern Pennsylvania and southern New Jersey. Data were collected on physician background, cognitive and psychosocial factors, practice environment, and patient factors. The main outcome measure was physician self-reported recommendation or referral of patients for cancer genetic susceptibility testing in a 12-month period prior to the survey. Of those surveyed, 475 (65%) PCPs responded. Complete survey data were available for 433 PCPs. Multivariable analyses show that factors positively associated with PCP recommendation/referral included: patient inquiry about their need for genetic testing for cancer (p < 0.001); PCP belief that patient age is the best predictor of cancer risk (p = 0.01); PCP self-reported frequency of collecting patient diet information (p = 0.01) and medical history information (p = 0.01); and PCP participation in an integrated health system (p = 0.01). PCP use of cancer genetic susceptibility testing may be influenced by patient inquiry, provider beliefs about factors that affect cancer risk, provider collection of risk-assessment data, and provider practice environment.

Cross-Sectional Studies↗
PubMed2002

Health care reform: opportunities for professional chaplains to build intentional communities of learners by integrating faith, science, quality, and systems thinking.

Albert Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we created them" (www.brainyquote.com). Health care reform has brought professional chaplains to a place of chaos-a place that raises many questions about the past, present and future. This chaos presents tremendous opportunities for professional chaplains to increase their capacities in building intentional communities of learners by integrating faith, science, quality and systems thinking. Pastoral care givers must truly understand the pressures from all sides and the new emerging paradigm of integrated health care delivery. Without this understanding, we will not see the opportunities and challenges of integrating pastoral and spiritual care in the emerging structures and systems. The future of chaplaincy largely will depend on the quality of the data, quality of our conversations and our ability to thinking together through dialogue.

Health Care Reform↗
PubMed2006

One stop shop versus collaborative integration: what is the best way of delivering sexual health services?

OBJECTIVES: To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people's services) and explore their relative strengths and weaknesses. METHODS: Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). RESULTS: The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having "integrated" services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over-centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. CONCLUSION: Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach.

Ambulatory Care↗
PubMedDate not supplied

Health status and use of health services as reported by the older residents of the Baka neighborhood, Jerusalem.

The large increase in the aging population in Israel, particularly of people over 75, requires the upgrading of health services and their integration into comprehensive social support systems, which will help reduce the need for admission to institutions for long-term care. In our study, interviews were conducted with 77% of the residents of the Jerusalem neighborhood of Baka aged 60 and over and the data were supplemented by partial information on a further 20%. Our findings are similar to those reported from other surveys of the aged in Israel and indicate a high degree of unmet health needs in this population. Many of the problems of the elderly relate more to their social and cultural backgrounds than to objective measures of morbidity and they can only be partially solved by classical health services, even efficient ones. There is an urgent need for the development of integrated health, social and community service and support systems to meet the needs of this rapidly growing community.

Aged↗
PubMed2001

Monitoring and surveillance for rare health-related events: a review from the veterinary perspective.

Disease monitoring and surveillance systems (MOSSs) have become one of the major components of veterinary activity. Such systems are used to assess the existing levels of prevalence, the effectiveness of control programmes and, after disease eradication, to document the continued absence of disease from a given region or zone. With decreasing disease or infection prevalence, traditional approaches become less reliable and increasingly costly. The objective of this work was to summarize and discuss methodological issues related to veterinary (animal health) MOSSs. There are considerable inconsistencies in the use of the terms 'monitoring' and 'surveillance'. Passive as well as active MOSS have their disadvantages when used for rare health-related events such as emerging and re-emerging diseases. There is a need for evaluation and improvement of these approaches. Integrated systems that call for the use of several parallel surveillance activities seem to be the favoured approach, and analytical methods to combine MOSS data from various sources into a population prevalence, or probability of disease freedom, are under development. The health and safety of the animal and human generations depends on our continuous ability to detect, monitor and control newly emerging or re-emerging livestock diseases and zoonoses rapidly. Uniform surveillance definitions, sound scientifically based approaches that use the resources and data available, and a pool of researchers and veterinary public health officials with sufficient training in epidemiology, are critically important to handle this challenging task.

Animals↗
PubMed2001

An ecosystem approach to malaria control in an urban setting.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.

Animals↗
PubMed2024

Multi-ancestry meta-analysis of tobacco use disorder identifies 461 potential risk genes and reveals associations with multiple health outcomes.

Tobacco use disorder (TUD) is the most prevalent substance use disorder in the world. Genetic factors influence smoking behaviours and although strides have been made using genome-wide association studies to identify risk variants, most variants identified have been for nicotine consumption, rather than TUD. Here we leveraged four US biobanks to perform a multi-ancestral meta-analysis of TUD (derived via electronic health records) in 653,790 individuals (495,005 European, 114,420 African American and 44,365 Latin American) and data from UK Biobank (ncombined&#x2009;=&#x2009;898,680). We identified 88 independent risk loci; integration with functional genomic tools uncovered 461 potential risk genes, primarily expressed in the brain. TUD was genetically correlated with smoking and psychiatric traits from traditionally ascertained cohorts, externalizing behaviours in children and hundreds of medical outcomes, including HIV infection, heart disease and pain. This work furthers our biological understanding of TUD and establishes electronic health records as a source of phenotypic information for studying the genetics of TUD.

Humans↗
PubMed1997

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

BACKGROUND: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. METHODS: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. RESULTS: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. CONCLUSIONS: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Adolescent↗
PubMed1996

Gay men's safer sex behavior: an integration of three models.

This cross-sectional study explored gay men's sexual risk behavior from the perspective of three popular conceptual models, the health belief model, the theory of reasoned action, and social cognitive theory. Data were collected from sexually active gay men via anonymous questionnaire containing questions about sexual behavior and items related to the constructs comprising the three models. Using structural equation modeling techniques (LISREL 8), self-reported condom use was examined from the perspective of each theory. The results suggested that a substantial part of the variance in unprotected anal intercourse could be explained by conceptually analogous constructs common to these models. These constructs referred to the cognitive-affective reactions toward condoms and to the social context of using condoms. An additional variable unique to social cognitive theory, self-efficacy, added to the explained variance in the criterion above and beyond the variables that were common to the models. Relevant variables from the three theories were integrated into an expanded self-efficacy model.

Adolescent↗
PubMed2004

Effects of a tailored follow-up intervention on health behaviors, beliefs, and attitudes.

BACKGROUND: The high rates of relapse that tend to occur after short-term behavioral interventions indicate the need for maintenance programs that promote long-term adherence to new behavior patterns. Computer-tailored health messages that are mailed to participants or given in brief telephone calls offer an innovative and time-efficient alternative to ongoing face-to-face contact with healthcare providers. METHODS: Following a 1-year behavior change program, 22 North Carolina health departments were randomly assigned to a follow-up intervention or control condition. Data were collected from 1999 to 2001 by telephone-administered surveys at preintervention and postintervention for 511 low-income, midlife adult women enrolled in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program at local North Carolina health departments. During the year after the behavior change program, intervention participants were mailed six sets of computer-tailored health messages and received two computer-tailored telephone counseling sessions. Main outcomes of dietary and physical activity behaviors, beliefs, and attitudes were measured. RESULTS: Intervention participants were more likely to move forward into more advanced stages of physical activity change (p = 0.02); control participants were more likely to increase their level of dietary social support at follow-up (p = 0.05). Both groups maintained low levels of reported saturated fat and cholesterol intake at follow-up. No changes were seen in physical activity in either group. CONCLUSIONS: Mailed computer-tailored health messages and telephone counseling calls favorably modified forward physical activity stage movement but did not appreciably affect any other psychosocial or behavioral outcomes.

Attitude to Health↗
PubMed1995

[The incidence of occupational diseases: a study of medical evaluations for work incapacity in Barcelona (1987-1991)].

BACKGROUND: The number of professional diseases (PD) declared in Spain is low. The existence of diseases of labor etiology treated as a common disease is recognized, thus disregarding important labor health risks. METHODS: The incidence of PD in the province of Barcelona from 1987-1991 was prospectively studied by the Units of Medical Evaluation of Incapacities (UMEI). The sociodemographic, medical and administrative data of the cases of PD were reported by a protocol of data collection. The cases of PD are described and the annual incidence in relation with the active working population calculated. RESULTS: The UMEI of Barcelona confirmed 554 cases of PD of which 331 were evaluated as permanent invalidity over the five years of the study. The most frequent diagnoses of PD were pneumoconiosis, skin diseases, diseases causing tendinous fatigue and hypoacusis or deafness. Eleven neoplasms were reported, 9 being caused by asbestos. During the five years the incidence of PD increased from 76 cases to 144 per 100,000 active workers. The procedure of information probably underreported the incidence of PD. CONCLUSIONS: A low incidence of professional disease was observed. The clinical-labor history is generally not carried out. The way in which the Units of Medical Evaluation of Incapacities report data concerning incidence may contribute to greater detection of professional diseases on registration being integrated into a system of epidemiologic surveillance in which all the health care, labor and administrative centers were effectively coordinated.

Adult↗
PubMed1994

Costing shared care.

Growing interest in shared health care schemes over the last decade has received additional impetus with the introduction of GP fund holding and the internal market in health care provision. Ken Buckingham and colleagues report on the relative costs of such a scheme for asthma in comparison with the costs of conventional outpatient care. Data was collected during a randomised controlled trial of shared or integrated care for patients with chronic asthma, who had been referred to a hospital outpatient clinic.

Asthma↗
PubMed2000

Multipoint videoconferencing in health: a review of three years' experience in Queensland, Australia.

The objective was to review multipoint videoconferencing in Queensland Health from July 1996 to June 1999. Most videoconferencing has been conducted using desktop systems connected by integrated systems digital network (ISDN) at 128 kbps. Data on utilization and problems were extracted from monthly reports and a survey was conducted. Multipoint videoconferencing increased steadily over the 3 years from just and handful of conferences per month to 101 conferences and 703 hours of bridge use per month. Primary uses were education and administration. Relatively few technical failures and operator errors were recorded. But by 1999, late connection and low attendance were major problems. Survey responses indicated that multipoint videoconferencing met expectations at the great majority of sites. Most respondents were satisfied with the level of administrative and technical support provided. In this large and decentralized state, multipoint videoconferencing has proven a useful and effective means of bringing healthcare workers together for a common purpose, supplementing face-to-face events and other encounters mediated by communications technology such as satellite broadcasts and audioconferences.

Attitude of Health Personnel↗
PubMedDate not supplied

[Use of health care quality indicators in the study of the therapeutic-diagnostic process].

Definition of the notions "medical care quality" (MCQ) and "medical error" (ME) and their range depending on the negative effect of ME on the status of essential signs of MCQ, obligatory registration and possibility of universal description of all detected ME and their negative consequences by means of automated expert methods helped the authors develop quantitative parameters of the state of 3 components of MCQ. Based on these data, integral value of MCQ state and the structure of facultative MCQ were estimated.

Delivery of Health Care↗
PubMed1986

Pathogenesis of subclinical bovine mastitis: persistence, deterioration and improvement of various subclinical conditions monitored by means of the International Dairy Federation/Bovine Serum Albumin criteria.

From this investigation, it is apparent that owing to the superior diagnostic differentiating of udder conditions by means of the IDF/BSA criteria, a range of detailed data has become available which facilitates an unprecedented insight in the dynamic balancing during normal lactation of several health states determinable at subclinical levels. The findings therefore from different points of view augment the corresponding results generated during the preceding investigation by means of the IDF criteria of acknowledged diagnostic limitations. In general, the data suggests that regardless of the diagnostic technique used for determinations during normal lactation on bovine udder conditions, udder health as such depends on 3 major determinants, namely intramammary epithelial integrity, intramammary somatic cellular defence and intramammary bacterial challenge. Subclinical septic mastitis, clearly, develops through different types of gradually escalating deteriorations of health states which depend on several pathways of pathogenetic development. These are subject on the one hand to the 3 major determinants of udder health, and on the other hand to the nature and magnitude of their single and combined challenging. The deterioration of udder health in some quarters is opposed by the improvement of that in others which in the light of data on the rather transient persistence of health states implies, that deterioration of condition is at all levels of its development opposed directly but, possibly, somewhat delayed by the cow's efforts at restoring udder health as such to its completely normal level.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗