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At least 145 records · Page 8Linked to original sources
PubMed2005

An exploration of central nervous system medication use and outcomes in stroke rehabilitation.

UNLABELLED: Conroy B, Zorowitz R, Horn SD, Ryser DK, Teraoka J, Smout RJ. An exploration of central nervous system medication use and outcomes in stroke rehabilitation. OBJECTIVE: To study associations between neurobehavioral impairments, use of neurotropic medications, and outcomes for inpatient stroke rehabilitation, controlling for a variety of confounding variables. DESIGN: Observational cohort study of post-stroke rehabilitation. SETTING: Six inpatient rehabilitation hospitals in the United States. PARTICIPANTS: Patients with moderate or severe strokes (N=919). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge disposition, FIM score change, and rehabilitation length of stay (LOS). RESULTS: Neurobehavioral impairments and use of many medications, including first-generation selective serotonin reuptake inhibitors, older traditional antipsychotic medications, and anti-Parkinsonian neuro-stimulants, have a statistical association with poorer outcomes, whereas use of the atypical antipsychotic medications has a positive association with improvement in motor FIM scores. Counter-intuitively, use of opioid analgesics is associated with a larger motor FIM score change but not an increase in LOS or reduced percentage of discharge to community. There was significant variation in use of neurotropic medications among the 6 study sites during inpatient stroke rehabilitation. CONCLUSIONS: There are many opportunities to enhance a stroke survivor's ability to benefit from acute inpatient stroke rehabilitation through improved understanding of associations of neurotropic medications with outcomes for different patient groups.

Activities of Daily Living↗
PubMed1989

Cancer risk in male veterans utilizing the Veterans Administration medical system.

Age-specific incidence curves, cumulative rates, and relative risks were estimated for selected malignancies among male veterans utilizing the Veterans Administration (VA) medical system during 1970 to 1982. Relative risks for malignant tumors of the lung, bronchus, larynx, oral cavity, and esophagus in males using VA hospitals were approximately double the rates for men of the Surveillance, Epidemiology, and End Results (SEER) cancer registry, thereby supporting the existence of strong effects of chronic cigarette smoking and alcohol consumption on the development of neoplasms at these specific anatomic sites. Relative to the SEER male population, there were significant reductions in the cumulative rates of neoplasms of the colon (15%) and extrahepatic biliary tract (30%), no differences in the rates of cancer of the stomach, small intestine, or pancreas, and a 50% increase in the cumulative rate of liver cancer among the veterans. Rates of malignancies of the genitourinary tract were similar in the VA and SEER registries with the exception of cancer of the penis, for which the cumulative rate was 50% higher in the veterans. These results are consistent with an excess of specific risk exposures among male veterans using VA hospitals, viz., cigarette smoking, alcohol consumption, poor nutrition, and other factors related to low socioeconomic status. The ultimate utility of the VA tumor registry will depend upon its exploitation by epidemiologists to provide leads for etiologic research.

Adult↗
PubMed2005

Two DL-based methods for auditing medical terminological systems.

Medical terminological systems (TSs) play an increasingly important role in health care by supporting recording, retrieval and analysis of patient information. As the size and complexity of TSs are growing, the need arises for means to audit them, i.e. verify and maintain (logical) consistency and (semantic) correctness of their contents. In this paper we describe two methods based on description logics (DLs) for the audit of TSs. One method uses non-primitive definitions to detect concepts with equivalent definitions. The other method is characterized by stringent assumptions that are made about concept definitions, in order to detect inconsistent definitions. We discuss the possibility of applying these methods to the Foundational Model of Anatomy (FMA) to demonstrate the potentials and pitfalls of these methods. We show that the methods are complementary, and can indeed improve the contents of medical TSs.

Anatomy↗
PubMed2002

Day to day use and service-related issues with the bone-anchored hearing aid: the Entific Medical Systems questionnaire.

Over a 12-year period, the Birmingham implantation otology unit has implanted more than 300 patients with bone-anchored hearing aids (BAHA). The Entific Medical Systems questionnaire was administered to these patients to evaluate the day to day use of the BAHA, professional needs, after-care, wear and tear concerns and service related issues. Data analysis revealed that most patients used their BAHA for more than eight hours a day (90 per cent of BAHA users) and every day of the week (93 per cent of BAHA users). A high degree of satisfaction was expressed as regards sound amplification, listening to radio or television news, listening to music, speech perception in quiet conditions, during conversation with one person in noisy surroundings and conversation with family at home. Some degree of difficulty was expressed with the use of the BAHA during conversation with two or more people in noisy surroundings. A slow process of perceptual acclimatization was noticed with the majority of the patients. The majority of patients were pleased with the service as regards care of the wound, BAHA nursing clinics, device repairs and other service-related issues.

Adolescent↗
PubMed1997

Design considerations in penile prostheses: the American Medical Systems product line.

Penile prostheses represent an important treatment modality for erectile dysfunction. A review of the design considerations for penile prostheses is presented, using the American Medical Systems, Inc., product line as a practical example. Current models include both inflatable hydraulic and solid malleable designs. The challenge for the future is to develop devices with improved durability while optimizing ease of use and cosmetic appearance.

Humans↗
PubMed1998

[The issues of emergency medical system in patients with prehospital cardiac arrest complicating acute coronary syndrome in Japan].

Each year approximately 30,000 persons in Japan experience prehospital cardiac arrest complicating acute coronary syndrome, and about 96 percent of them die. The majority of these sudden cardiac deaths are the result of fatal arrhythmias that often can be stopped by rapid initial medical care. In Tokyo, however, the first responder to provide cardiopulmonary resuscitation are about 10 percent, the successful defibrillation rate by Japanese paramedics who are not authorized advanced cardiac life support (ACLS) with drugs are about 15 percent and there are very few cardiologists who have been engaged in ACLS and initial management of suspected acute coronary syndrome in the emergency department. Therefore, each community emergency medical system should develop a plan to provide rapid initial medical care to patients with cardiac arrest (those with and without acute coronary syndrome).

Acute Disease↗
PubMed1996

Munchausen syndrome by proxy. Child abuse in the medical system.

Munchausen syndrome by proxy often is managed differently from other forms of child maltreatment, although it is differentiated from them only by the active engagement with the medical profession in the production of morbidity. We suggest a more rigorous approach to Munchausen syndrome by proxy, with explicit acknowledgement that it is abuse and that the medical system is critical to its genesis. This leads us to question the broadness with which the label is applied (eg, in cases of imposed upper airway obstruction) and to argue for management strategies closer to those accepted for other forms of child maltreatment.

Child↗
PubMed1990

The programmable implantable medication system (PIMS): design features and pre-clinical trials.

This report describes the clinically significant design features of a variable rate implantable insulin infusion pump, the Programmable Implantable Medication System (PIMS), and its function in pre-clinical trials. PIMS has a number of unique features, including a solenoid, pulsatile pump design requiring minimal power (less than 15 microwatts) and a less-than-atmospheric pressure reservoir. Two-way communication is accomplished by radiotelemetry. The implanted device stores programs, and records its own hourly history of insulin delivery. Limits are set on total insulin delivery over time. Basal rates are adjustable, and patterned prandial insulin delivery curves can be programmed. Initial trials (3.1 dog-years) identified four problems which were corrected prior to final pre-clinical trials: microcracks in the diaphragm, a valve-seating leak, electronic failure of prototype microchips, and insulin aggregation. Sixteen dog-years of final pre-clinical trials with a single system design demonstrated that 5 pumps were still working continuously after up to 3.75 years (mean 3.3 years) without mechanical or electronic pump failure. The longest interval between reservoir refills was 5 months. Remaining potential causes of flow stoppage, however, include blockage of the peritoneal catheter by omentum (which occurred once), and air lock (which occurred two times).

Animals↗
PubMed1999

The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties.

During the 1960's and 1970's the Chinese government encouraged the 'rural cooperative medical systems' (RCMS), in order to ensure access to basic health care among the rural population. There was a break in the development of the RCMS in the early 1980's, as a consequence of market economic reforms. These reforms involved a shift from a communal to a household production system. As a result the collective way of financing rural health care was more or less abandoned. However, the government of the People's Republic of China was aware of the need to provide social protection against health care expenses. In March 1994 the government initiated a project to reestablish the RCMS. This project was implemented on a pilot basis in 14 counties of seven provinces. The reestablishment of the RCMS would be guided by the basic principles of health insurance. In October 1995, a first mid-term evaluation of the RCMS Project was held. One of the major research questions concerned the extent to which the RCMS had reduced the risk of paying health care bills that would otherwise be a burden on families. This article addresses this question and assesses the results obtained after two years of RCMS experimental work. A general finding is that the population structure by occupation and income varies, and that the RCMS has adapted itself to this variety. It is also confirmed that the burden of health care costs on families was reduced, more so in some counties than in others, but this reduction has been modest. The research results indicate that there is ample room for improvement. The outlook is hopeful, however. At the national level, there is now systematic thinking about RCMS. The current RCMS work is also having a considerable influence on other counties that are keen to reestablish the RCMS.

China↗
PubMed2002

New trends in the Japanese medical system in 2002.

The Japanese have enjoyed the longest average life span in the world for these ten years. The universal health insurance system with free access and low cost seems to play the most important role among the proposed causes. We didn't need to worry about the charges at hospitals when we consulted a doctor, although we had to pay a premium in proportion to our income, and we received a national benefit which was money-paid by tax-payers. Unfortunately, the economic depression started around 1990 has driven us to a difficult situation. We are now planning several new policies to prevent the bankruptcy of the universal health insurance system due to the reduction of the medical expenditure. New attempts, such as reduction in the number of hospital beds, shortening of the average hospital stay, introduction of a long-term care insurance system, and the reduction of fee schedule by 2.7% from April 2002, and so on are being considered. On the other hand, the percentage of medical expenditure to GDP in Japan is the lowest, along with England, among the developed countries. Having realized that the poor medical system was due to low medical expenditure, the British government decided to raise the budget of the national health service. The situation concerning medical expenditure in Japan might become the worst among developed countries in the near future.

Delivery of Health Care↗
PubMed1990

[The anesthesiologist's role in the French emergency medical system].

The present system of French emergency medicine and its philosophy were described from my experience at SAMU (service d'aide medicale urgente). Three factors of emergency medicine; pre-hospital care, emergency transport and emergency information service are managed by anesthesiologists. Anesthesiologists on duty at the tele-medicine center give medical team instructions to start at once. The team is composed of an anesthesiologist, a nurse and an ambulancier. They start to give intensive care medicine to critically ill patients on the spot. The philosophy of SAMU is that doctors should go out of the hospital. Anesthesiologists in the area organize the emergency medical system in France.

Anesthesiology↗
PubMed2004

Relief of pain and anxiety in pediatric patients in emergency medical systems.

Whether a component of a disease process, the result of acute injury, or a product of a diagnostic or therapeutic procedure, pain should be relieved and stress should be decreased for pediatric patients. Control of pain and stress for children who enter into the emergency medical system, from the prehospital arena to the emergency department, is a vital component of emergency care. Any barriers that prevent appropriate and timely administration of analgesia to the child who requires emergency medical treatment should be eliminated. Although more research and innovation are needed, every opportunity should be taken to use available methods of pain control. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can have a positive effect on providing comfort to children in the emergency setting.

Administration, Oral↗
PubMed2001

Use of a deployable medical system during the remodeling of an OR.

How can a five-suite OR be remodeled while providing continuous, cost-effective surgical procedures without decreasing workload? Such a question was met with an innovative answer at the Veterans Affairs Medical Center, Fresno, Calif. Deployable Medical System units were selected to provide surgical support. The decision-making process, challenges, and surgical capabilities will be reviewed. Methods of quality control are presented, and cost benefits are described.

California↗
PubMedDate not supplied

Technology: redesigning the medical system.

During the next century, medical technology will become the driving force in American health care, according to Leland Kaiser, Ph.D., FACMGA. Society will no longer view health care as simply a cost to be reduced to the lowest possible level. Health expenditures will be seen as a societal investment in human resource productivity.

Delivery of Health Care↗
PubMed1989

The Unani traditional medical system in India: a case study in health behaviour.

The study examines the practice of Unani traditional medicine in India. The case study is based on the Unani Clinic situated in Aligarh Town; patients, practitioner of Unani medicine, and para-medical staff were interviewed about their patterns of patients' health behaviour, of particular interest was the utilization of Unani medical facilities by people of different age groups and belonging to different socio-economic strata. Observations are made regarding effectiveness of the Unani medical system.

Adult↗