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Clear overall goals and physician participation make for a successful inhospital continuing medical education (CME) program. This article details an efficient procedure that will promote effective interaction between the CME planner and the physicians on the CME committee.
The demand for greater accountability in the social service arena has forced those responsible for funding and operating programs to look for more efficient ways to evaluate them. The board of directors of the nonprofit organization, as legally constituted, is the most appropriate body to exercise the accountability function.
Health care professionals are recognizing the need to treat their patients not only as individuals, but as part of a social network--the family. In order for health care organizations to provide a total family care program and, therefore, a more efficient and effective health care delivery system, they must develop and implement strategies to identify and treat all of the patient's needs--psychological, biological, and familial. Coordination among individual departments and personnel is critical to ensuring that resources meet these needs. The trend toward total patient and family services will continue to be emphasized and refined by the leaders in the health care industry.
There is general consensus that the present Medicare physician payment system and related policies should be revised. Therefore, the Health Care Financing Administration and Congress are examining the physician reimbursement system for potential changes that could reverse the inflationary incentives in the present system and induce greater incentives for efficiency and cost savings. Medicare program data and information are provided to assist health care managers and administrators in the development and analysis of Medicare physician research and policy initiatives. The data may also be helpful in monitoring and measuring the use and cost of Medicare physician and supplier services as related to program performance and administration.
The development of a computer-aided design system for a clinical crown restoration is reported. Initially, the shape of the standard crown was deformed and adapted on the die depending on the shape of the margin. Then, the measured occlusal record data were taken in the computer graphics, and the adapted crown was adjusted with these data to obtain the centric occlusion. The occlusal data were replaced with data obtained using a functionally generated path record and the occlusal interferences eliminated. The ends of the adapted crown were connected with the margin. Thus, the entire crown was efficiently designed using the computer program developed.
IVF is certainly one of the new medical technologies where ethical debates are the most frequent and heavy. Three illustrations will be presented: The improvement of ovulation induction techniques have increased the number of supernumerary embryos. How to deal with these embryos, on which principles and what do the patients think about it? Introduction in the early 90' of assisted fertilization techniques (ICSI) have largely extended IVF indications and improved the success++ rate. Nevertheless, it will be demonstrated that it's implementation was a hard process for which the creation of embryos for research was a crucial step, opening another passionate ethical debate. Oocyte donation which came true thanks to IVF, will give the opportunity to illustrate an unusual consequence of ethics on technical aspect; due to an ethical choice (anonymous donation) we have been able to improve by a factor 3 the clinical efficiency of our oocyte donation program. An example of enhancement of the technique due to ethics, a very important fact in the situation of shortage of oocytes for donation. In conclusion, it appears that the ethical debate does not only focus on the legitimacy of this "medicine of desire" but also demonstrate that the development as well as the daily practice of IVF makes a clear vision of ethical choices mandatory and indissociable of technical aspects themselves.
This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.
In the industrialized world, the incidence and prevalence of heart failure are dramatically rising. Characterized by a high mortality and morbidity, 1-2% of Switzerland's total health care expenditure is spent on this disease. Since the hospital admission rate of heart failure patients is extremely high, 70% of the costs result from hospitalizations. New therapeutic measures are urgently needed to reduce morbidity and therefore, hospital admission rate. Both, morbidity and hospitalization rate have been demonstrated to be reduced by multidisciplinary disease management programs. Such programs seem to be practical, efficient, and financially feasible and thus, should be evaluated in Switzerland.
This final rule establishes a standard for a unique employer identifier and requirements concerning its use by health plans, health care clearinghouses, and health care providers. The health plans, health care clearinghouses, and health care providers must use the identifier, among other uses, in connection with certain electronic transactions. The use of this identifier will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It will implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.
UNLABELLED: TNF alpha receptors participate in programmed cell death. TNF R2 efficiently assists TNF R7 effects by ligand passing. Structure of TNF alpha receptors influences TNF activity in vivo and the structure of TNF R2 gene may suggest post-transcription modification based on alternative splicing. The aim of the study was to analyse the expression of gene coding TNF alpha receptors R2 and R7 by estimation of mRNA expression of differentiated thyroid carcinomas in comparison to surrounding tissue free from neoplastic infiltration and search for differently spliced TNF alpha R2/R7 isophorms. The study included seven patients with histopathologically confirmed follicular thyroid cancer. Tissue samples removed from tumor region were obtained from the follicular thyroid cancer patients undergoing surgical treatment. The samples were divided into two parts. The first one was routinely examined histopathologically, the second was used for RNA extraction and the number of TNF and its receptors mRNA copies were subsequently quantified. RESULTS: 1) The presence of TNF alpha expression was observed in all examined samples, in contrast to TNF R1 expression; 2) The high level of TNF alpha expression was noted both for typical and sought TNF R2/R7 isoforms and 3) A considerable number of samples displayed higher levels of TNF R2 isoforms than TNF R2/R7 mRNA expression. Genetic disregulation observed in neoplastic disease usually concerns dysfunction of cytokines receptor genes.
The purpose of this study is to investigate the reasons that rural people in Nan Province choose particular contraceptive methods, and places of services. The study utilizes the data from the study on the Impact and Efficiency of the Family Planning Program in Thailand: Phase II, which applied in-depth interview and small group discussion techniques. Findings indicate that wanting to limit the number of children to 2, wanting to space pregnancy, the limit of land, the conflict with working situation, and economic hardship are the reasons for using family planning. The major sources of contraception are health center, community health office, village health volunteer, village health practitioner, the border patrol police unit, and the military unit including other government agencies in the areas. As for the reasons for choosing a particular contraceptive method, convenience in practice and on obtaining services, desire for more children and concern over side effects are important.
By routine newborn screening for galactose blood level elevations a great difference in the frequency of Galactosemia by transferase deficiency was observed between Eastern- and Western-Austria. This made enzymatic heterozygousity determinations desirable. At the same time it should be examined whether the frequency of homozygotes found by screening correlates with the frequency derived from the heterozygousity frequency. In a first step the region of Vienna was studied. 377 unselected blood samples were examined following BEUTLER-BALUDA's method. As technical control samples of 9 homozygotes and 12 heterozygotes as found by screening were examined but not included in the frequency study. Arranged following age groups a slight but significant decrease of enzym activity with increasing age could be confirmed (23,89 versus 21,99 U/g Hb). This, increasing the overlapping between normals and heterozygotes of different ages possibly should be kept in mind in individual heterzygousity determinations. The enzymatically determined frequency of heterozygotes was found to be twice as high as the frequency calculated from the frequency of biochemically detected but enzymatically proven homozygotes (1:53 versus 1:99). A comparison of the heterozygousity frequencies found in literature with the results of the most efficient (technically most reliable) screening programs shows that this discrepancy is great and general. Bases on heterozygousity frequencies the frequency of homozygotes found by screening programs seems to be at least 50% too low. Analysis of theoretical possibilities for loss of homozygotes by screening programs makes this explanation highly improbable. It seems more probable that the enzymatically determined heterozygotes frequency is too high by including still undefined allels or allel combinations which result in about half normal activity but not in disturbances resembling classical Galactosemia.
This final rule adopts standards for the security of electronic protected health information to be implemented by health plans, health care clearinghouses, and certain health care providers. The use of the security standards will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general by establishing a level of protection for certain electronic health information. This final rule implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
BACKGROUND: The aim of this work was to determine the prevalence of tobacco smoking among workers of an asbestos processing plant. MATERIALS AND METHODS: Records of medical consultations and prophylactic examinations performed at the Outpatient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Łódź, Poland, covering the period of over 40 years, were the source of information about 1353 workers (802 men and 551 women). The employment duration of the majority (85.6%) of workers was 10 years or more. RESULTS: In the study population, only about one third (33.7%) of workers declared themselves as non-smokers, 42.9% of workers were current smokers and 23.4% ex-smokers. Smoking was significantly more frequent among men (57.1% of current and 27.2% of ex-smokers) than among women (22.3% and 17.8%, respectively). The largest percentage of current smokers (79.7% of men and 60.3% of women) was found in the age group below 40 years. Comparison of standardized values of smoking parameters showed a larger proportion of smokers in the study group than in the general population in Poland (45.2% vs. 38.7%). However, the workers started smoking at somewhat older age (22.0 yr vs. 20.1 yr), smoked less cigarettes per day (15.2 vs. 20.7) and continued smoking for somewhat shorter period (20.8 yr vs. 23 yr). CONCLUSIONS: A high proportion of tobacco smokers among workers of asbestos processing plant shows a low efficiency of anti-smoking programs carried out in this population. This highlights the need to take more effective measures in this group of workers who are already exposed to a very harmful agent.
This paper focuses on key issues of the organizational model of the influenza vaccination campaign in Lazio region, Italy, started during the 1999-2000 season. The following crucial features of the model are emphasized: a strong support given by Regional Health Agency; a high level of commitment of local health authorities; a considerable involvement of general practitioners; the appropriation of economical incentives related to different levels of coverage; an "ad hoc " information system. The model resulted in a remarkable increase of the number of vaccinations among elderly population (from about 420,000 in the 2000-2001 vaccination campaign to about 560,000 in the successive campaign) and of the correspondent levels of coverage (from 45.7% in the 2000-2001 vaccination campaign to 59.2% in the successive campaign). Nevertheless, further efforts should be provided to better identify population at risk, and to reach the most disadvantaged groups. Moreover, actions are to be performed to assess health and economic benefits of vaccination campaign, in order to improve the efficiency of health care planning programs.
PURPOSE OF REVIEW: Historically, diarrhea has been one of the most important diseases encountered during military operations. With more than 140,000 US military personnel currently deployed to the Middle East in support of the global war on terror, it is important for health care providers and planners to be aware of the incidence and potential impact of diarrheal disease in that region. RECENT FINDINGS: Recently published data from mid-deployment surveys assessing the incidence and clinical impact of diarrhea on troops deployed to Iraq and Afghanistan have been updated and presented along with a review of the recent literature concerning diarrheal pathogens of military concern in the Middle East. Of 4348 volunteers, 76% reported at least one diarrhea episode during their deployment and more than half reported multiple episodes. In 45% of subjects, diarrhea resulted in decreased job performance for a median of 3 days. Diarrhea resulted in 62% of subjects seeking medical care at least once, and 31% required intravenous rehydration. In 17% of subjects, diarrhea resulted in confinement to bed for a median of 2 days, causing an estimated 3.7 days (Poisson 95% CI, 3.4 to 4.0 days) of complete work loss per 100 person-months. SUMMARY: Despite modern preventive medicine efforts, diarrhea rates remain high, and the impact of illness remains a threat to military efficiency. Novel enteric disease research programs designed to decrease the impact of diarrhea on the military mission are needed. The development of enteric vaccines and appropriate treatment regimens remain a top priority.
The cases of tuberculosis in the Pediatric Units of the Basque Autonomous Community during the period of 1980-89 were studied. The annual incidence rate in the 0-4 year old age group was 5.8 per 100.00 in Biscay (95% confidence interval: 4.0-7.6), 5.9 (2.3-9.5) in Alava and 16.7 (12.7-20.7) in Guipúzcoa. Out of the 263 registered cases, 55 (21%) corresponded to meningitis and/or miliaria, 194 (74%) to respiratory tuberculosis and 14 (5%) to other clinical forms. Of these cases, the diagnosis in 83 (32%) was based on results from microbiological cultures, in 8 (3%) on histological examinations and in the remaining 172 (65%) on other diagnostic criteria. In 226 cases (86%) no scars were found nor were there any antecedents of BCG vaccination. In 32 patients (12%), there were scars or antecedents of BCG vaccinations and in 5 cases no information was available. The estimated protective effect of the BCG vaccination in the 0-4 year old group was 88% and in the 5-14 year old group 63%. We recommend that the efficiency of the BCG vaccination program be studied in order to assess the need of this program.
The paper presents the basic sections of the nonspecific prevention of tuberculosis. The main objective, tasks, and methods for solving the latter are formulated for each section. Emphasis is placed on the social and age groups of the population while doing sanitary and educational work. Attention is given to that it is necessary to evaluate the efficiency of implementation of educational programs, which is important for making amendments when the epidemic situation and the population's sanitary education change.