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PubMedDate not supplied

[The principles of the dissemination of information on sexually transmitted infections and on the drugs used in delivering medical care].

An analysis is submitted of the problem of dissemination of information about infections caught by sexual intercourse or genital contact and about medication used in the treatment of this kind of pathology. The main principles are worked out of dissemination of medical information among different subjects who are interested in dissemination and securing information highlighting different aspects of the above problem. The presented approaches toward formation of information related to the problem of sexually transmitted infections permit harmonizing the interests of different subjects of the drug market and of the market of medical care to be delivered to patients presenting with the above kind of pathology.

Delivery of Health Care↗
PubMed1996

U.S. Healthcare's quality-based compensation model.

U.S. Healthcare has developed a quality-based compensation model through which its primary care physicians, hospitals, and specialists can earn additional compensation based on the quality and cost-effectiveness of the care they provide to their patients. The model clearly delineates the expectations of U.S. Healthcare, and in contrast with traditional payment models, encourages improvement in performance. In addition, the model aligns the incentives of U.S. Healthcare purchasers, participating providers, and members in order to provide high-quality, cost-effective care that maximizes patient outcomes.

Capitation Fee↗
PubMed1999

High fidelity correction of pressure signals from fluid-filled systems by harmonic analysis.

UNLABELLED: Fluid-filled systems are generally used for invasive pressure measurements in cardiology, anesthesiology and intensive care medicine. Wave reflection and attenuation cause considerable signal distortion. METHODS: The transducer signal is amplified (no filtering) and sampled (rate 1 kHz) using an autocorrelation based algorithm to detect instantaneous cycle length. A digital Fourier transformation (DFT) for each heart cycle is performed. Amplitude and phase distortion are corrected using data matrices determined in in vitro experiments or calibration measurements for each fluid-filled system to be used. As a measure for accuracy the maximum of the difference of reference and corrected pressures (DIFF) was selected. 960 analyses were performed to assess the impact of correction, used system, mean pressure, time and A/D sampling rate on the agreement with reference pressure. Clinical examples are presented. RESULTS: Mean pressure was correlated with DIFF (r = 0.83). The correction algorithm achieves a significant (p < 0.001) reduction of DIFF from 20-30 mm Hg to 0-5 mm Hg in the high pressure range and from 1-3 mm Hg to 0-1.5 mm Hg in the low pressure system in in vitro experiments and in clinical pressure recordings. Sampling frequency < 1 kHz reduces accuracy. CONCLUSIONS: High fidelity correction of pressure signals from fluid-filled systems by harmonic analysis is feasible.

Algorithms↗
PubMed2000

Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation.

Many complications after renal transplantation can be prevented if they are detected early. Guidelines have been developed for the prevention of diseases in the general population, but there are no comprehensive guidelines for the prevention of diseases and complications after renal transplantation. Therefore, the Clinical Practice Guidelines Committee of the American Society of Transplantation developed these guidelines to help physicians and other health care workers provide optimal care for renal transplant recipients. The guidelines are also intended to indirectly help patients receive the access to care that they need to ensure long-term allograft survival, by attempting to systematically define what that care encompasses. The guidelines are applicable to all adult and pediatric renal transplant recipients, and they cover the outpatient screening for and prevention of diseases and complications that commonly occur after renal transplantation. They do not cover the diagnosis and treatment of diseases and complications after they become manifest, and they do not cover the pretransplant evaluation of renal transplant candidates. The guidelines are comprehensive, but they do not pretend to cover every aspect of care. As much as possible, the guidelines are evidence-based, and each recommendation has been given a subjective grade to indicate the strength of evidence that supports the recommendation. It is hoped that these guidelines will provide a framework for additional discussion and research that will improve the care of renal transplant recipients.

Ambulatory Care↗
PubMed2001

[Cardiorespiratory arrest in the intensive care unit: theoretical considerations on factors related with iatrogenic events].

The attendance of Cardiopulmonary Resuscitation (CPR) demands rapidity, efficiency, scientific knowledge and technical ability. Still, an adequate infra structure is vital as well as the accomplishment of an harmonic and synchronized work and team performance, in order to promote the patient's backup. Iatrogenic factors related to attendance of CPR in the Intensive Care Unit may be due to professional inexperience, insufficient staff and problems with material or equipments. Thus, the team must be prepared to assist the patient efficiently, as resuscitation should restore the life process and not prolong the death process.

Cardiopulmonary Resuscitation↗
PubMed1999

[How great is the need for ambulatory rehabilitation in the orthopedics field?--Results of a multi-perspective approach].

Despite the necessity to expand the outpatient rehabilitation system in Germany the development up to now must be described as quite reluctant. As yet there is a considerable lack of information about the demand for such care in Germany. On the basis of a complex study design insurants, applicants for medical rehabilitation, physicians in a rehabilitation hospital and general practitioners were asked how they estimated the demand for outpatient orthopedic rehabilitation care. Resulting data unanimously show a substantial demand in roughly one third of insurants who desire rehabilitation, clearly exceeding the already realized outpatient care. The investigation also illustrated that physicians often are uncertain as to their decisions and that depending on the respective point of view (insurants or different groups of physicians) there are different preferences as to the kind of rehabilitative care for the benefit of one specific patient. The results stress not only the fact that there is a demand for information of insurants and their referring physicians regarding the new outpatient rehabilitation offer, but also reveal the demand for a development of differential indication criteria for outpatient and inpatient rehabilitation, as well as for definite procedural regulations which should be harmonized among all insurers.

Adult↗
PubMedDate not supplied

Twenty-five years revisited.

In May 1998, we celebrated the 25th anniversary of the Society of Gastroenterology Nurses & Associates (SGNA). It was in 1974 that a group of dedicated people met in San Francisco under the leadership of Marna Harmon Schirmer to found an organization dedicated to the professional needs of health care providers working in the gastroenterology diagnostic and treatment setting. Through the efforts of these dedicated people and those who followed them, this organization has grown into the recognized specialty SGNA is today. SGNA has its roots in the historical development of clinical gastroenterology practice and the diagnostic tools made possible through advances in technology. Throughout the years, these changes continue to affect not only the delivery of patient care but also the specialty of gastroenterology nursing. This article explores the history of GI nurses--how we began, where we are now, and what we can expect in the future.

Endoscopy↗
PubMed1990

[The fight against doping: international and national efforts as exemplified by the Convention of the Council of Europe and the doping regulations of the Swiss National Association for Sports].

The international and national efforts to flight doping in sports are shown by the examples of the Anti-Doping Convention of the Council of Europe and the regulations of the Swiss Association of Sports. Major efforts are made in the fields of education and information, search for and application of optimal methods for training and care as well as dope-controls at and out of competitions. The harmonization of the anti-doping regulations and the disciplinary procedures that have to follow the principles of natural justice are considered to be important. The Swiss regulations allow, at variance with international customs, to treat injured athletes therapeutically with doping-substances.

Anabolic Agents↗
PubMed2001

Healthy pregnancy program in a national managed care organization: evaluation of satisfaction and health behavior outcomes.

OBJECTIVE: To evaluate satisfaction with the Healthy Pregnancy Program (HPP), which was developed to educate and coordinate the care of pregnant women in a managed care setting. STUDY DESIGN: Telephone survey. PATIENTS AND METHODS: A random sample of program participants at 3 large health plans were contacted by telephone to evaluate their satisfaction with the program overall and with its components, including an educational booklet and telephone contact with a HPP nurse as needed. Women also were asked about changes in health behaviors (smoking, alcohol use, diet, and stress) resulting directly from participation in the HPP. Of 1155 eligible women participating in HPP who delivered a baby from April 1997 through March 1998, 684 completed the survey. The response rate was 59%. RESULTS: Overall satisfaction with the HPP was reported by 96% of the women, and 76% reported the 2 highest ratings of satisfaction (completely or very satisfied). Reports of satisfaction were more likely for women who entered the program early in pregnancy, who read the booklet, and who had more telephone contacts. In general, at least half of the women in each behavior category reported improving their behavior, especially if they were younger, identified as high risk, or having their first child. Verbatim comments supported the high satisfaction levels. CONCLUSIONS: The HPP is an example of a program that was developed to improve healthcare delivery in a managed care setting and, when evaluated, was found to result in highly satisfied mothers likely to improve their health behaviors.

Adult↗
PubMedDate not supplied

Physician prescribing patterns of oral corticosteroids for musculoskeletal injuries.

BACKGROUND: There is considerable controversy as to when and if oral corticosteroids are indicated for musculoskeletal injury. Although the perception is that sports medicine physicians prescribe oral corticosteroids frequently, there is no documentation of this behavior in the literature. The purpose of this study was to obtain a description of the corticosteroid-prescribing patterns of primary care sports medicine physicians and look for common indications. METHODS: A two-page questionnaire was included in the registration packets of 195 physicians at a national sports medicine conference. RESULTS: Ninety-nine questionnaires were returned. Fifty-eight (58.6%) of the physicians reported prescribing oral corticosteroids for musculoskeletal injuries. Physicians who prescribed corticosteroids for injuries averaged 6.6 prescriptions per month. Prednisone was the corticosteroid prescribed by 82% of physicians. The average prescription length was 7 days. One half of the physicians (51.7%) tapered the dose. The most common starting dose (mode) was 60 mg. CONCLUSIONS: Despite little evidence to support their use, primary care sports medicine physicians commonly prescribe corticosteroids.

Athletic Injuries↗
PubMed2001

Laparoscopic adrenalectomy. Personal experience in 78 patients.

Laparoscopic adrenalectomy has proved to be the technique of choice for the treatment of benign pathologies of the adrenals and also for the treatment of isolated adrenal metastases, especially arising from lung tumor, but it shouldn't be performed for primitive adrenal carcinoma. The harmonic scalpel is very useful for laparoscopic adrenalectomy showing a significant reduction in operative time. The Authors retrospectively investigated 78 laparoscopic adrenalectomies performed from April 1995 to April 2000 using a transperitoneal approach with the patient on a lateral position as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals also by means of new technological devices as the Harmonic scalpel. The 78 laparoscopic adrenalectomies were performed in 70 cases for benign neoplasms: incidentalomas 24, Cushing's disease 16, Conn's disease 20, pheochromocytomas 9, myelolipoma 1. In the remaining 8 patients laparoscopic adrenalectomy was performed in 7 cases for isolated adrenal masses (5 metastases, 2 adenomas) in neoplastic patients, and in 1 patient for a preoperatively diagnosed adrenal carcinoma. Patients operated for functioning neoplasms had all remission or improvement of symptoms and humoral parameters; patients operated for isolated adrenal metastases showed this survival: 3 patients 3 years asymptomatic and disease free, 1 patient 18 months, and 3 patients are still alive and healthy after 6-12-15 months. A fast onset of local recurrence was seen in a patient operated for a preoperatively diagnosed adrenal carcinoma. We analyzed the operating time dividing the patients in three groups: a) 14 patients operated in the first semester of 1998 when we completed the training curve (average operative time 120.7 minutes); b) 14 patients operated from 1998-1999 (average operative time 118 minutes); c) the last 14 patients (operated from December 1999 to April 2000) where surgery was performed using the Harmonic scalpel (HS) (average operative time 94 minutes). The analysis of the average operative time comparing groups B and C using T-Student Test showed a significant reduction (p = 0.004). The morbility rate was 2.6%, mortality 1.3%, and a conversion rate of 2.6%. Laparoscopic approach results to be an extremely reliable procedure also for the treatment of incidentalomas up to 4-5 cm in which the incidence of adrenal carcinoma is about 13%. Doubts may yet result for the treatment of adrenal carcinomas preoperatively diagnosed. When laparoscopic adrenalectomy in performed using HS the operative time is significantly reduced and surgery is easier.

Adrenalectomy↗
PubMed1990

Marketing in dentistry--have we got it right?

This article has been written jointly by Ingried Morris, a dentist, and Sheila Scott, a marketing consultant. Ingried discusses some of the reasons why her colleagues may reject the marketing approach to dentistry, while Sheila argues that many of these skepticisms are indeed good reasons to embrace the discipline wholeheartedly. We felt that the article posed many questions, often unspoken, that worry a number of the profession who find it difficult harmonizing their perception of a commercial technique--marketing--with treating their patients in a caring profession. The article then goes on to answer those questions and suggests that true marketing is indeed caring, and can only strengthen the quality of clinical care.

Advertising↗
PubMed1993

Nurses' care during labor: its effect on the cesarean birth rate of healthy, nulliparous women.

This retrospective study was designed to determine the influence of nurses' care during labor and delivery on the cesarean birth rate of healthy, nulliparous women. Labor and delivery nurses in a large, nonprofit hospital were grouped according to the cesarean birth rates of their healthy, nulliparous patients in spontaneous labor. Large differences in cesarean birth rates between nurses in the lowest quintile (near 4.9%) and the highest quintile (near 19%) were not explained by differences in maternal age and gravidity, attendance of mother at childbirth class, insurance status, reliance on public assistance, physician who attended labor, use of epidural anesthesia, augmentation of labor, dilation when the nurse assumed care, infant weight, or gestational age. In multivariate analysis, the elapsed time between when the nurse assumed care and birth was significantly shorter for patients of nurses in the lowest quintile of cesarean birth rate (4.4 hrs) compared with patients of nurses in the highest quintile (5.6 hrs). The former were also less likely to have forceps used to assist vaginal delivery than the latter (13% vs 26%). Nurses in the lowest quintile of cesarean birth rates were more likely to use a form to record psychosocial data than nurses in the highest quintile (35% vs 15%). The study suggests that nurses' care during labor is an important factor influencing cesarean birth rates.

Adult↗