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[Development of the study on germplasm resources of medicinal plants: construction of core collection].

According to the successful experience of studying on crops, this paper introduced the conception of the core collection of medicinal plants, and analyzed the characteristic and the way to construct it. Studies on the core collection would fulfill the management and utilize the germplasm resources conveniently and provide a new idea and a method to study on the germplasm resources of medicinal plants. It is necessary to study on the core collection for the development of the germplasm resources of medicinal plants.

Chromatography, High Pressure Liquid↗

Questionnaire on health systems and national resources for control of respiratory health in low-income countries.

BACKGROUND: Due to increased exposure to risk factors such as ageing and tobacco smoking, chronic respiratory diseases (CRDs) have become a major cause of morbidity and mortality worldwide. Data on CRDs and their management in developing countries (DC) are nevertheless sparse and not comparable. OBJECTIVE: To implement and validate a standardised self-administered questionnaire to be proposed to health authorities to assess the resources of their health system for dealing with respiratory diseases. METHODS: The questionnaire concerned social security, description of the health system, human resources available within the system, initial training and continuing education of health personnel, existence of a list of essential drugs, vaccine coverage and specific resources involved in CRD and tobacco control. RESULTS: The validity of the criteria of the questionnaire was tested in Reunion Island, where health data are accessible and reliable, and was found to be satisfactory. Its acceptability and relevance were deemed appropriate in Tunisia and in Mozambique. CONCLUSION: The self-administered questionnaire is a simple, reliable and cheap tool. Although designed for the study of respiratory diseases, it can easily be transposed and adapted to other pathologies.

Chronic Disease↗

Nurses' perceptions of patients' requirements for nursing resources.

The study used semi-structured interviews in an interpretive research design to explore nurses' perceptions of patients requiring disproportionate amounts of nursing resources, and factors influencing those perceptions. A total of 50 senior nurses from a variety of medical and surgical settings, including a high dependency unit, were interviewed and the data analysed to determine common themes and differences between participants. The four major themes of patient characteristics, family needs, staffing and organisational context defined the factors nurses perceived as influencing their perceptions of patients' dependency. Patient requirements for nursing resources were seen as a continuum rather than a specific point, and were balanced on the combined influences of the four themes. At times, demands imposed on nursing resources lead to nurses' perceptions of delivering less than ideal care, stress and frustration. The latter applied particularly to factors that were outside of the control of nurses such as staffing levels and skill mix.

Attitude of Health Personnel↗

Blood transfusion is associated with infection and increased resource utilization in combat casualties.

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P < 0.01), a higher pulse rate (105 +/- 4 vs. 93 +/- 3, P < 0.0001), and a lower admission HCT (27 +/- 1 vs. 33 +/- 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 +/- 2.1 days vs. 1.4 +/- 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

Adult↗

Prioritizing future resources for epidemiologic research on old and newly emerging occupational hazards.

BACKGROUND: Inevitably, occupational epidemiologists must decide when and how to shift research attention and resources from investigations of old, established health hazards to a focus on newly emerging potential risk factors. As yet unknown occupational health consequences of burgeoning worldwide technologies, such as the microelectronics industry, and increasing recognition of the importance of common, yet non-traditional occupationally-related health effects, such as musculoskeletal disorders in office workers, give strong impetus for embarking in new directions. However, there remains much to be learned from continued investigation of well-established occupational hazards, such as asbestos, benzene, and lead. OBJECTIVES: A rational strategy for planning future research will need to consider optimizing resources. CONCLUSIONS: The following suggestions are offered. 1) First and foremost, occupational risk factors are most directly, and arguably most validly, identified by studying workers in well-defined cohorts, ideally when exposures are adequately characterized. To this end, industry-based cohort studies should be given priority, at least for older hazards, over population-based case-control and surveillance designs. 2) Defined cohorts with extensive exposure and health outcome data should continue to be followed, as resources permit; 3) Launching cohort studies for potential new hazards should incorporate extensive exposure assessments at the outset, and should preferentially select inception cohorts of newly hired workers. Valid biomarkers of pre-clinical disease will be especially valuable in this regard. 4) Capitalizing on new technological advances in exposure assessment, clinical medicine, molecular genetics should be encouraged

Biomarkers↗

[Fish resources and their conservation strategies in Hepu Dugong State Nature Reserve and its adjacent waters].

An investigation was made on the fish resources and fish habitats of Hepu Dugong State Nature Reserve and its adjacent waters from June 2003 to May 2004. The local fish markets were surveyed, and fishermen and fishmongers were interviewed to get fishery information. A total of 57 fish species belonging to 41 families and 14 orders were recorded, among which, 55 were bony fish, and 2 were elasmobranch. There were 41 fish species belonging to warm-water fish, and 37 fish species belonging to benthonic fish. The faunal characteristic was mainly of Northern Pacific and Indo-Pacific fauna. Devastating fishing and environmental pollution were the most serious threats to the local fishery resources, and some countermeasures were proposed for conservation and management of the resources.

Animals↗

Resource and appointment scheduling: closing the information loop.

Hospital-wide preparation is currently underway for a new patient care information system at Baystate Medical Center in Springfield, Massachusetts. Integral to this new system are two new products recently developed by the TDS Healthcare Systems Corporation: a permanent patient record system and a resource and appointment scheduling application. The new patient care information system can maintain up to 16 million records on-line and can be used throughout the medical center. This article will focus on the resource and appointment scheduling application and how it can be used to track resource utilization and close the information loop related to patient appointment activities.

Appointments and Schedules↗

[Studies on varietal resources of Chinese medicinal plants and their preservation].

The paper reviews the status of varietal resources of Chinese medicinal plants in China. The existing problems are analysed. Characteristics of these resources are dealt with. The results have shown that the study of varietal resources of Chinese medicinal plants must be strengthened for facilitating their production. Methods of varietal preservation of these plants are also discussed.

Conservation of Natural Resources↗

[Systematic exploitation of regional resources of Chinese herbal drugs].

This paper advances the concept of regional resources of Chinese herbal drugs and the policy-making pattern for the systematic exploitation of these resources. The AHP is used for the first time in the systematic study on the resources of Chinese herbal drugs in the Qingchenghou mountains, Sichuan, with the desired result that proves beneficial to the spheres of society, economy and ecology.

China↗

Differences in hospital resource allocation among sick newborns according to insurance coverage.

OBJECTIVE: To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services. DESIGN: Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition. SETTING: All California civilian acute-care hospitals. PATIENTS: Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751). MAIN OUTCOME MEASURES: Length of stay, total charges, and charges per day. RESULTS: Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured. CONCLUSIONS: The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.

California↗

Health resources management and physician control in a San Francisco, California, hospital.

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education.

Delivery of Health Care↗

[Economic analyses of health care. Cost benefit analyses promote better use of resources].

Resource constraints are accepted by most health care professionals. Economic analyses aim at employing scarce resources where they yield the maximum benefit to patients now and in the future. The two principle tools are cost-benefit-analysis (CBA) and cost-effectiveness-analysis (CEA). In CBA benefits are measured in monetary terms, whereas in CEA they are measured in non-monetary terms. Admittedly based on simplifications, economic analyses aim at stating explicitly the uncertainty of underlying assumptions. The basic idea of priority setting based on economic theory is not to minimize the health care budgets, but to maximize the health benefits. When some programmes are not recommended, it is not because they are useless, but because an alternative use of resources yields more benefit. The article summarizes the basic principles of CBA and CEA and discusses some examples of CEA.

Cost-Benefit Analysis↗

Age, resource consumption, and outcome for surgical patients at an academic medical center.

Many changes are under way in the payment for physician and hospital care of the surgical patient. Relatively little data have been analyzed on resource consumption for hospitalized surgical patients. The purpose of this study was to characterize hospital resource consumption and outcome by age for surgical patients. All surgical admissions at a large academic medical center from Jan. 1, 1985, through March 31, 1986, were analyzed by means of the diagnostic related group (DRG) format. Total costs (exclusive of physician fees) for the 7341 surgical patients studied were $58,206,815. Mean cost per patient, length of stay, percent of outliers, and mortality increased with age. DRG case-mix index and the number of procedures per patient peaked at age 69 and then decreased. Emergency admission was high for the young (i.e., aged 18 to 24 years) and for very elderly patients (i.e., aged over 75 years). Blood transfusions increased steadily as the age of the patient increased; use of surgical intensive care units increased until age 64 years, then plateaued. This study demonstrated a number of trends in surgical patient age and use of resources. Under prospective payment systems (i.e., DRG reimbursement) financial risk increased with the age of the patient. Length of hospital stay and mortality increased with age; however, DRG case-mix index and the number of procedures per patient peaked at age 69, which suggests that elderly surgical patients (i.e., those above 70 years of age) may be more severely ill on average than younger patients.

Academic Medical Centers↗

The Veterans Administration's resource allocation system.

This article is designed to provide a description of the Veterans Administration's resource allocation system: an acute care, DRG case mix-based model; a long-term care, resource utilization group (RUG-II) model; and an ambulatory care, capitalization system. Nursing issues regarding resource allocation are discussed.

Acute Disease↗

Tapping health care resources: a comparison of US and UK strategies.

The United Kingdom and the United States are both facing dramatic changes in health care delivery and resource allocation, brought about by advanced technology, limited financial (and in some cases human) resources and conflicting values regarding the right to health care. The differences and similarities of their health care systems provide a favourable research environment for comparing how the two countries acquire and allocate their respective health care resources. For the purpose of such a comparative study, two sites were selected, the London region of Central Thames and the US city of Energytown (only the names are fictitious). Central Thames is representative of an English region in size, administrative structure and health services; Energytown is representative of an oil city in the US Midwest. National policy, reductions in health care funds and size make the areas amenable to a comparative study.

Health Policy↗

Transportation or CT scanners: a theory and method of health resources allocation.

Cost containment and access to appropriate care are the two most frequently discussed issues in contemporary health policy. Conceiving of the health services available in specific regions as "packages" of diverse items, the authors of this article consider the economic trade-offs among the various resources needed for appropriate care. In the discussion that follows, we examine the trade-offs between two divergent offering of the health care system: high technology medicine and support services. Specifically, we examine several strategies designed to achieve an optimal mix of investments in CT scanners and transportation resources in the South Chicago region. Using linear programming as a method for examining these options, the authors found that 1) the proper location of CT scanners is as important for cost containment as optimal number, and 2) excess capacity in the utilization of a single resource--CT scanners--need not imply inefficiency in the overall delivery of the service. These findings help demonstrate the importance of viewing health care as a package of interrelated services, both for achieving cost containment and for providing access to appropriate care.

Catchment Area, Health↗

[Development of human resources and the Plan of Action].

This article (whose first part was published in the previous issue of Educación Médica y Salud) concludes an exhaustive review of manpower development in the Americas. This part considers the specific measures in this field enunciated in the Plan of Action; these measures pertain to four main areas: planning and programming of human resources, training in priority areas, utilization of human resources, and educational technology. The author discusses the present and future possibilities and obstacles of each of these activities and the steps to be taken to bring needs into line with real situations. It is of paramount importance that the national health authorities clearly spell out their policies for the development of human resources in the health field within the framework of general development policies. Another point to be insisted upon is the multiprofessional and multidisciplinary training of the health team and the importance of the education-service-supervision function, which usually results in permanent and continuing education, which in turn optimizes the utilization of personnel. However, none of this will be possible without an appropriate education technology with which to innovate, analyze and refine the entire education process and so meet the needs of both society and the health services.

Health Education↗

Statistical analysis of interdependence of country health resource variables, with special regard to manpower-related ones.

The analysis reported here was the latest in a series of efforts to clarify the relative importance of the health system and of socioeconomic factors to a nation's general level of health. The study has also quantified national and regional deviations from the general pattern as a basis for selective investigation of the effects of planned interventions.The analysis was unusually comprehensive in that it included 131 WHO Member States. As in a number of other studies, socioeconomic factors were found to account for much of the national variation in life expectancy. Inclusion of health resource variables added a special lagged effect which ultimately accounted for 90% of life expectancy variation. Evidence was also obtained that socioeconomic factors may operate partially through the development of health resources. It appears, therefore, that though socioeconomic factors are necessarily linked to health improvement, they are not sufficient in the absence of corresponding development of a viable health services infrastructure.Residual deviations from the general pattern varied systematically by WHO region in 30% of the cases. Most notably, in the African Region the number of physicians is well below even the modest level expected on the basis of the socioeconomic situation in the region. There is, however, considerable variation within individual countries, and it was not possible to find any significant relationship between the WHO manpower development programme and the national health resource parameters. It is therefore concluded that statistical analysis is of limited applicability in this field.

Global Health↗