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PubMed2004

Economics and preventing hospital-acquired infection.

The economics of preventing hospital-acquired infections is most often described in general terms. The underlying concepts and mechanisms are rarely made explicit but should be understood for research and policy-making. We define the key economic concepts and specify an illustrative model that uses hypothetical data to identify how two related questions might be addressed: 1) how much should be invested for infection control, and 2) what are the most appropriate infection-control programs? We aim to make explicit the economics of preventing hospital-acquired infections.

Cost-Benefit Analysis↗
PubMed2006

Small interfering RNA-mediated knockdown of notch ligands in primary CD4+ T cells and dendritic cells enhances cytokine production.

The key interaction in the adaptive immune system's response to pathogenic challenge occurs at the interface between APCs and T cells. Families of costimulatory and coinhibitory molecules function in association with the cytokine microenvironment to orchestrate appropriate T cell activation programs. Recent data have demonstrated that the Notch receptor and its ligands also function at the APC:T interface. In this study, we describe synthetic small interfering RNA (siRNA) sequences targeting the human Notch ligands Delta1, Jagged1 and Jagged2. Transfection of these siRNAs into human primary CD4(+) T cells and monocyte-derived dendritic cells leads to knockdown of endogenous Notch ligand message. Knockdown of any one of these three Notch ligands in dendritic cells enhanced IFN-gamma production from allogeneic CD4(+) T cells in MLR. In contrast, Delta1 knockdown in CD4(+) T cells selectively enhanced production of IFN-gamma, IL-2, and IL-5 in response to polyclonal stimulation, while Jagged1 or Jagged2 knockdown had no effect. Strikingly, blockade of Notch cleavage with a gamma secretase inhibitor failed to affect cytokine production in this system, implying that Delta1 can influence cytokine production via a Notch cleavage-independent mechanism. These data show for the first time that the Notch pathway can be targeted by siRNA, and that its antagonism may be a unique therapeutic opportunity for immune enhancement.

Animals↗
PubMed1986

In vivo efficacy of chloroquine treatment for Plasmodium falciparum in Malawian children under five years of age.

In 1984 the government of Malawi instituted a program to reduce malaria mortality and morbidity in children less than 5 years of age as a part of the Combatting Childhood Communicable Diseases (CCCD) program. To define the appropriate malaria therapy regimen, investigators used a quality assurance design in a simplified 7-day in vivo drug response study with follow-up observations on day 2 (D2), D3, and D7 after the initial day of the study (D0). The efficacy of oral chloroquine was assessed in 224 children who were enrolled at 6 sites, 2 in each of the 3 administrative regions of Malawi. Parasitological failure, defined as failure of parasitemia to decrease by 75% of the value by D3 or presence of any detectable parasitemia on D7, ranged from 41%-65% following administration of chloroquine 25 mg (base)/kg. However, only 8% of children who were parasitemic on D7 were febrile or judged to be ill. Considering these therapeutic results and the higher cost and limited availability of alternative therapies, chloroquine 25 mg/kg therapy was adopted as the primary therapy for malaria.

Administration, Oral↗
PubMed1998

[Stress and anticortisols--17-ketosteroid sulfate conjugate as a biomarker in tissue repair and recovery].

We attempted to determine compounds in human urine which, differing from cortisol (17-OHCS), show high values in healthy individuals, decrease with failing health, clearly decline with advancing disease and finally reach very low values in severe disease. We have eventually established that 17-ketosteroid sulfate conjugates (17-KS-S) are the compounds we were searching for. Hans Selye regarded stress as the rate of wear and tear and 17-OHCS as its indicator, but we considered that, differing from inanimate objects, living organisms consume energy to cope with stress and "repair" "wear and tear" of the tissue and "recover" its function. This concept led us to determine the organism's requirement for two mechanisms: "Wear and tear" which could be represented by the secretion of 17-OHCS (Selye), and "repair and recovery", which could be determined by the amounts of 17-KS-S derived from dehydroepiandrosterone (DHEA)-sulfate, a product of the adrenal cortex, which enhances neuronal survival, longterm memory, maintains the function of peripheral tissues, and stimulates immune system (17-KS mainly consists of 17-KS-S and 17-KS glucuronides 17-KS-G, the latter derived from cortisol, DHEA and testosterone). We hold that stress response is a series of biological process, beginning from CRH.ACTH and catecholamines, cortisol (17-OHCS), followed by insulin, acting as an anabolic agent and finally DHEA (17-KS-S) leads the tissues to repair by utilizing produced energy. Balanced changes of hormones, such as 17-KS-S, 17-OHCS, cortisol, catecholamines and insulin are seen in healthy individuals under healthy lifestyles and disruption of the balance brings apparent reduction in 17-KS-S. From this standpoint, we wish to develop research in interrelations between biologically antagonistic 17-KS-S and 17-OHCS, focusing particularly at 17-KS-S, which represents a contact point for mind and body, the healthy state of which is kept by appropriate sleeping and exercise programs on the basis of adequate food intake. The above three factors, 17-KS-S, 17-OHCS, and 17-KS-G, are expressed in creatinine ratio (mg/g creatinine).

17-Hydroxycorticosteroids↗
PubMed1992

Preventing tetanus, influenza, and pneumococcal infection in adults.

Immunization remains the most cost-effective tool in preventive medicine. Many adults should receive seven immunizations: influenza, pneumococcal, measles, rubella, and hepatitis B vaccines and tetanus and diphtheria toxoids. This article will focus on the use of immunizations in adults to prevent tetanus, diphtheria, influenza, and pneumococcal disease and on some of the barriers and solutions to adequate immunization. Physician assistants can play a crucial role in preventing infectious diseases by organizing effective screening programs and routinely administering appropriate vaccines to their patients.

Adult↗
PubMed1995

Innovative programs for integrated delivery systems.

These programs are most effective under a MCO setting, but will succeed only if there are individuals within the organization to champion these programs. Many pharmacists have taken the lead and are working closely with manufacturers to identify the best use of these programs. These individuals ensure that the programs are implemented and that the appropriate pathways are followed. The pharmacist can assist in identifying those who are not using products appropriately. Using the manufacturer's resources (sales force) to supply the provider with educational material can help the provider follow the pathways and focus on appropriate use. The pharmacist can monitor the data and offer suggestions on program modifications. Therefore, the pharmacist plays a key role in meeting the challenges presented by outcomes performance programs and in creating an opportunity for the patient care organization to achieve its financial goals. With the MCO and manufacturer as partners, these programs will be successful and can increase the quality of care to MCO members who receive care in an institutional or community managed care setting.

Capitation Fee↗
PubMed1996

Modified capitation and treatment incentives for end stage renal disease.

This study developed a modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed to support appropriate treatment choices and protect health plans from undue financial risk. The payment method consists of risk-adjusted monthly capitated payments for individuals on dialysis or with functioning kidney grafts, lump sum event payments for expected incremental costs of kidney transplantations or graft failures, and outlier payments for expensive patients. The methodology explained 25 percent of variation in annual payments per patient. Risk adjustment captured substantial variations across patient groups. Outlier payments reduced health plan risk by up to 15 percent.

Capitation Fee↗
PubMed1996

Informal care for illness in rural southwest Uganda: the central role that women play.

In rural Uganda care for those who are ill tends to be home based because of inadequate and expensive health care facilities, lack of medication and poor staffing levels in health units. Research findings suggest that women are responsible for the bulk of caring activities. This paper questions the assumption that female informal carers are in a position to cope with illness episodes in the home. Data were collected from 54 female informants in a rural population in southwest Uganda. Supplementary data from in-depth interviews with survey participants and counsellors were also collected. Findings suggest that women are the main providers of informal care within the home. Many women, particularly in female-headed households, did not own or have direct access to the necessary finances to meet the family's health care needs as expected of them. Although relatives and friends were seen as a valuable resource, because of poor household proximity and financial constraints they were not always in a position to offer or provide assistance. The women also identified themselves as responsible for a variety of home and agricultural tasks; such activities were frequently disrupted by illness episodes. As women take on the additional burden of care for those with HIV/AIDS an inevitable conclusion is that their resources, both social and economic, will not be adequate. These data indicate the need for additional research and stress the importance of appropriate support and relief programs for those responsible for informal care.

Adolescent↗
PubMed1985

Strategy is a key to implementing a comprehensive education program.

In a time when the health care delivery system will be expected to do more with less, institutional administrations must pursue courses of action that will economize resources, but not compromise the quality of health care. Such is the case with patient education. The importance of educating patients must not be diluted, nor should the roles of providers be compromised in an attempt to be frugal. Approaches exist that can be productive if, on an organizational basis, institutional support is provided; audiences are targeted; programs are developed with appropriate involvement; and proper delivery systems are implemented.

Health Facilities↗
PubMed1986

Hospitals and self-help groups: opportunity and challenge.

Mutual aid self-help (MASH) groups can be a positive means of enabling persons to cope effectively with their health and personal problems. MASH groups provide emotional support, decrease anxiety, foster referrals to the hospital, reduce lengths of stay, and facilitate the discharged patient's reentry into the home and community. Yet this potentially valuable resource has been largely untapped by hospitals. Hospitals can take a number of steps to integrate their programs and services with MASH networks: Identify self-help groups in the hospital's service area. Establish liaison with groups that are of key interest to various hospital departments and programs. Make referrals to appropriate MASH groups as part of the discharge-planning process. Promote the development of MASH groups by appropriate hospital departments. Provide logistic support to self-help groups. Promote awareness of MASH Groups through specialized directories or tapes. Educate professional staff on the value, variety, and limitations of self-help groups. Provide consultation and speakers.

Attitude of Health Personnel↗
PubMed1999

Inpatient clinical decision-support systems: determining the ROI.

Healthcare providers faced with increasing pressure to provide high-quality, cost-effective care have implemented clinical decision-support programs to drive the appropriate process improvement activities needed to achieve successful care outcomes. Each of these activities requires the commitment of the necessary technology and human resources. To measure the return on investment (ROI) of decision-support activities, providers need to establish a methodology for capturing the costs and benefits of implementing decision-support-directed process-improvement activities.

Capital Expenditures↗
PubMedDate not supplied

Hemophilic arthropathy: evaluation of clinical and radiological characteristics and disability.

Hemophilia is an inherited bleeding disorder which produces its greatest morbidity in the musculoskeletal system. Musculoskeletal complications of hemophilia include acute hemarthrosis, chronic arthritis and hemophilic arthropathy. We studied the clinical and radiological characteristics of joint involvement in hemophiliacs. Functional loss was also demonstrated. There were 25 patients with a mean age of 17; the mean coagulant factor level was 4.2 percent. All the patients had hemarthrotic attacks. Knees were the most commonly affected joints followed by elbows, ankles and hips. The mean number of involved joints was 3.3. Even the patients with moderate disease had arthropathy. Sixty-four percent of the patients had pain and motion restrictions of the involved joints. Four patients developed intramuscular hematoma. We had patients at several radiological stages of severity. Radiological scores best correlated with age and the total number of involved joints. Various degrees of functional loss, namely disability, were observed. The disability score significantly correlated with the radiological score and age. The results of this study suggest that hemophilic arthropathy is an important problem and that multidisciplinary management is needed. Musculoskeletal care as well as appropriate and timely rehabilitation programs could prevent the development of sequelae.

Activities of Daily Living↗
PubMed2000

[Distortion product otoacoustic emission (DPOAEs) and newborn hearing screening: a feasibility and performance study].

In view of the great psychological effect deafness has on one's social life, the scientific community has long sought the best way to define the hearing function. The development of new technologies in this field has set "early intervention" as the primary target for screening. For this reason, within the contest of a program of audiological newborn hearing screening, the Authors have used data from a selected group of 1250 newborns to (a) compare the clinical feasibility and performance of three different DPOAE protocols and (b) establish the scoring criteria defining "pass" or "fail" responses. All subjects participating in this study were randomly selected and their normal hearing was verified by linear TEOAE recordings. The test was carried out, using an Otodynamics ILO92 Analyser version 5.60, on the second day of life or later (in case of extended recovery), during natural sleep and after feeding. The DPOAE recordings were elicited using asymmetric stimuli with L1 > L2 and a frequency-ratio of 1.22 following three different SPL protocols: 60-50 dB (PR1), 65-55 dB (PR2) and 75-65 dB (PR3). Five frequencies of the cubic distortion product (referring to f2) were tested with an ILO macro at 1.5 KHz, 2.0 KHz, 3.0 KHz, 4.0 KHz and 5.0 KHz. The statistical evaluation of differences in the signal-to-noise ratio (S/N) between the PR1 and PR2 protocols showed no significant differences. On the other hand significant differences were found between the PR3 and the PR2 S/N ratios, the former providing the best performance (higher values). The scoring criteria were defined by minimum free distribution tolerance intervals of the S/N ratios at the five tested frequencies. In conclusion this study confirms the feasibility of DPOAE recordings in a un iversal newborn hearing screening program and shows the appropriate pass-fail parameters to be used for this purpose. It should be noted that this approach enables acquisition of frequency-specific information which might further improve audiological diagnosis.

Cochlea↗
PubMedDate not supplied

Bacterial etiology of otitis media with effusion in a group of Lebanese children.

Identification of the main bacteria causing otitis media with effusion (OME) in a given population is essential. It indicates the degree of involvement of a given bacterium in a particular disease of that population. Knowledge of the most prevalent bacteria would initiate the search for the mode of acquisition of such bacteria and may aid in establishing appropriate control and prevention programs, which may decrease the incidence of OME. The rapid response of most OME to a variety of broad-spectrum antimicrobials deprives the clinician from knowing the particular bacteriologic agent prevailing in a community. With the emergence of resistant strains and the change over time of the relative distribution of bacteriologic agents known to cause OME, the identification of the bacterial etiology of OME in Lebanese children was initiated.

Anti-Bacterial Agents↗
PubMed2001

Food biotechnology: dietitians' resource needs as determined by selected Canadian key informants.

In a 1996 quantitative survey, we assessed selected Canadian dietitians' knowledge and attitudes toward biotechnology, particularly genetically altered foods. The results showed that, on average, dietitians held unfavourable attitudes and were concerned about safety and labelling issues. In the current study, qualitative methodology was used to explore dietitians' views on controversial issues and to investigate the adequacy of current biotechnology resources. Nationwide telephone interviews of 22 key informant dietitians were conducted in February and March 1999. Issues covered were food safety and quality, labelling, regulations, food production, education, and biotechnology resource needs. Findings indicated that dietitians' perspectives on biotechnology are diverse nationwide. Views about how biotechnology may affect small producers, the local economy, food choices, and food quality varied from very positive to very negative. Dietitians indicated a need for more education through discussions involving critical analysis and debate by various stakeholders. Respondents agreed that the national organization, Dietitians of Canada, has a role to play in continuing education. Most participants felt that more concise, balanced, and objective resources are needed. Further exploration of dietitians' educational needs would help in the development of appropriate educational materials and programs for nutrition professionals.

Canada↗
PubMed1996

Cervical Cancer among Asian American Women: A Neglected Publica Health Problem?

PURPOSE OF THE PAPER: Relatively little attention has been paid to cervical cancer control in Asian American populations. We summarize available cervical cancer incidence and mortality dat, present information on levels of Pap testing use, and review factors that may be associated with cervical cancer screening participation. METHODS: We reviewed the literature pertaining to cervical cancer and Pap testing among Asian populations in North America. PRINCIPAL FINDINGS: Cancer registry data suggest that women from Southease Asia have a nearly five­fold increased risk of invasive cervical cancer (when compared to non&shyHispanic White women). Filipino and Korean populations also have elevated risks. The excess invasive cervical cancer burden appears to be concentrated among women aged 40 and older. Pap testing use by Asians is less than for all toher racial/ethnic groups in the U.S., and recent studies suggest that over one­third of Vietnamese immigrants have never been screened. Barriers to Pap testing participation by less acculturated Asian women include a lack of familiarity with Western preventive concepts, a lack of knowledge concerning cervical cancer, embarrassment in association with gynecologic exams, the role of women in some Asian cultures, the cost of health care, and language difficulties. CONCLUSIONS: There is a considerable need for ethnoculturally appropriate cervical cancer control programs targeting Asian American populations. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is relevant to Asian American women from East, South, Southeast, and Island Asia.

Journal Article↗
PubMed2001

The effectiveness of a self-care management interactive multimedia module.

PURPOSE/OBJECTIVES: To develop and test an interactive multimedia module prototype designed to accommodate adults with limited literacy and without computer skills. DESIGN: Experimental, randomized, controlled, pretest, post-test. SETTING: Cancer treatment centers in California, Louisiana (pilot). New Hampshire, Pennsylvania, and Texas. SAMPLE: Outpatients who were at least 18 years old with a minimum fifth-grade reading level; 86 experimental treatment, 88 control. METHODS: Experimental treatment involved use of the interactive multimedia module; the control group received customary Instruction. FINDINGS: As compared to the control group, subjects in the experimental group had significant improvement (p = 0.0001; 257% gain) in self-care ability regardless of age, sex race, education, geographic location, reading ability, computer experience, or preferred learning style; a 6.515% increase in fatigue content covered and 16.775% Increase in instructional duration; and significantly greater benefit from sleep-related activities and a consistent, positive pattern of self-care behavior. CONCLUSIONS: The program is instructionally effective, appropriate for a wide and geographically diverse audience, and feasible for use in the ambulatory setting. IMPLICATIONS FOR NURSING PRACTICE: The interactive multimedia module is an effective, self-directed resource for individualized patient fatigue education.

Adaptation, Psychological↗