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PubMed1986

Consultative psychiatry in both private and public general hospitals.

Most psychiatric patients obtain care in the nonpsychiatric units of general hospitals. Two groups of 100 psychiatric consultation patients in a private hospital setting and in a public hospital were compared. Significant differences were found. Patients in the public hospital were medically, psychiatrically, and socioeconomically more disabled. In the private setting, psychiatric consultants were usually seen as members of a treatment team. The public facility expected consultants to function as psychiatric triage officers. However, both patient groups had a similar frequency of psychiatric illness and had an equal need for psychiatric services.

Adjustment Disorders↗
PubMed1984

A private strain-specific idiotype-like structure discovered on CBA-anti-C57BL/6 T lymphocytes.

Using rabbit anti-CBA-anti-C57BL/6 sera, a private strain-specific idiotype-like determinant(s) was detected by cellular radioimmunoassay on activated CBA-anti-C57BL/6 T cells. This structure was not expressed on other activated T lymphocytes: CBA-anti-BALB/c; C3H-anti-C57BL/6; AKR-anti-C57BL/6; A/Sn-anti-C57BL/6; BALB/c- anti-C57BL/6; DBA/2-anti-C57BL/6. It is suggested that the gene(s) coding for the private strain-specific idiotype-like determinant(s) of T-cell antigen-recognizing receptors is not located within the murine H-2 complex.

Animals↗
PubMed1989

The private demand for nursing home care.

The fact that many nursing home patients are mentally and physically disabled has led some observers to conclude that they represent irrational consumers who are incapable of disciplining the nursing home care markets. This assumption has, in turn, led policy makers to favor regulatory solutions to nursing home problems. This paper tests the accuracy of this assumption by estimating a demand equation for private nursing home patients. Evidence if found that the private patients' response to price and quality differences among nursing homes is generally systematic and consistent with expectations derived from a conventional constrained optimization model of their behavior. Such behavior is generally consistent with consumer rationality. Some implications for public policy are discussed.

Aged↗
PubMed1991

Genetic predictive testing and private insurances.

Genetic information is a potential tool for selection of job applicants and of candidates for insurance. Social implications of genetic information may represent a threshold for the access to health care facilities. Some of the issues related to the use of predictive genetic information by private life and health insurance companies are discussed. They include the potential threat for the privacy of the individual and his relatives, the pressure to undergo genetic testing and the social consequences of the use of genetic information by private insurance companies. The justified financial interests of insurance companies and the interests of the individual to have his privacy protected and to be able to partake in social attainments have to be brought into balance. A ban on genetic testing in connection with access to insurances and a limitation to the use of existing genetic information have been suggested by the Dutch Health Council. This approach to the problem should be adopted throughout the European Communities, so that medical progress does not turn out to be against the interests of the consumer.

AIDS Serodiagnosis↗
PubMed2006

Challenges in design and transition to a private room model in the neonatal intensive care unit.

As the need for neonatal intensive care units (NICU) continues to increase, a growing body of evidence on the developmentally appropriate healing environment for neonates suggests that changes are needed in NICU design. The private room NICU model is emerging as an alternative to large multi-bed wards; however, some have suggested that such a radical design change may be difficult to implement. This article presents the experience of one unit in the design and transition from a traditional setting to the private room model. Using change theory, this model was developed with staff input throughout the entire design and implementation process, resulting in a successful transition, as suggested by preliminary data on patient outcomes, family experiences, and nursing staff satisfaction.

Continuity of Patient Care↗
PubMed2005

Prevalence of adequate control of increased serum low-density lipoprotein cholesterol in self-pay or Medicare patients versus Medicaid or private insurance patients followed in a University General Medicine Clinic.

In a study of 514 patients with increased serum low-density lipoprotein (LDL) cholesterol followed in a general medicine clinic at a university hospital, the serum LDL cholesterol in patients with coronary heart disease (CHD), other atherosclerotic vascular disease, or diabetes mellitus was <100 mg/dl in 219 of 276 patients (79%) with Medicaid or private insurance and in 28 of 67 self-pay or Medicare patients (42%) without pharmaceutical coverage (p <0.001). The serum LDL cholesterol was <130 mg/dl in patients with 2+ risk factor and a 10-year risk for CHD of < or =20% or <160 mg/dl in patients with a 0 to 1 risk factor, and a 10-year risk for CHD of <10% in 54 of 141 patients (38%) with Medicaid or private insurance and in 5 of 30 self-pay or Medicare patients (17%) (p <0.025).

Aged↗
PubMed2006

Private specificities of heterologous immunity.

Antiviral T-cell responses between individuals that have similar major histocompatibility complex molecules share similarities in epitope hierarchies and T-cell receptor variable gene usage (public specificities), yet the T-cell receptor amino acid sequences differ between individuals (private specificities). The significance of the private specificities of these repertoires is brought about under conditions of heterologous immunity and might have important consequences in anti-viral immunity and immunopathology.

Animals↗
PubMed2005

Incidence of epidural blood patch following obstetric regional analgesia in private Australian anaesthetic practice.

BACKGROUND: Collection of audit data about epidural blood patches has traditionally relied on voluntary reporting, which is notoriously incomplete. The records of Medicare-funded Australian private obstetric practice, which represents 30% of all deliveries, allow a novel method of central data collection and retrieval. METHOD: Data relating to all deliveries, epidurals and blood patches in private practice in Australia over a two-year period were retrieved from the Health Insurance Commission. RESULTS: The overall rate of epidural analgesia in labour was estimated at 30% and the proportion of epidurals that progressed to blood patching was 0.35%. The rate of epidural blood patching varied between states from 0.18% to 0.56%. CONCLUSION: Despite certain limitations of our data interpretation, we regard this technique as a useful audit tool capable of generating accurate and robust audit data that might otherwise be unobtainable.

Analgesia, Epidural↗
PubMed2007

Private and public self-awareness in social anxiety.

Clark and Wells' [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.

Adult↗
PubMed2007

Public policy, private landholders: perspectives on policy mechanisms for sustainable land management.

A variety of tools can be employed in support of environmental policy objectives, but achieving preferred outcomes also requires the cooperation of private landholders and others with vested interests in the land. The Land Stewardship project in the state of Victoria, Australia, is an initiative devoted to exploring the ways in which private landholders could be encouraged towards more sustainable land management. Following the view that the success of policy initiatives is contingent on effective stakeholder engagement, a component of the Land Stewardship project involved a dialogue with landholders about policy tools (e.g., regulation, economic instruments) that might be deployed to encourage improved land management practices. This paper provides an account of the views and attitudes of landholders, as revealed in a series of three workshops, which consisted of discussions about the factors influencing agriculture, participants' interpretations of sustainability, and policy methods. The focus of the paper is on what landholders believe to be the strengths and limitations of standard policy tools, and the essential requirements for these tools to deliver the best land management outcomes. One of the main findings of the project was a 'preference hierarchy' in respect of policy methods, according to which the strongest support was expressed for voluntary and education-based tools, followed by market-based instruments, with command-and-control regulation identified as a measure of 'last resort'. In the paper we reflect also on how the views and outlook of landholders should be positioned relative to other inputs in the design of policy interventions.

Australia↗
PubMed2004

Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis--a multicentre survey in private and public French hospitals.

Deep wound infection is a rare but dreaded postoperative complication after total hip prosthesis (THP) procedures but its incidence can be reduced by systemic antimicrobial prophylaxis. The objective of the present study was to evaluate whether antimicrobial prophylaxis for elective primary THP in patients without any history of hip infection, in orthopaedic wards, participating on a voluntary basis, in French public hospitals and private institutions, complies with published guidelines. Three types of data were collected from anaesthetic and surgical records (November 2000-January 2001) in participating hospitals: (1) administrative data on the hospitals and orthopaedic wards, (2) data on patients, (3) data on compliance of practices with five critical criteria derived from published French guidelines. These criteria concerned administration of prophylaxis, choice of antimicrobial agent, dose of first injection, timing of administration and total length of prophylaxis. Thirty institutions sent data files on 1257 THPs to the coordination centre. Compliance exceeded 80% for all criteria except one (interval between first and second injection). Cumulative compliance with the five criteria was 66.9%. Major compliance failures were an inappropriate interval between the first injection and incision, and total antimicrobial prophylaxis exceeding 48 h. Cumulative compliance was 87.9% in teaching hospitals, 61.8% in general hospitals and 67.7% in private institutions (P<1 x 10(-6)). It was slightly higher when the annual number of interventions was > or =100 (69.4 versus 62.3%; P<0.02). Although the protocol for antimicrobial prophylaxis in THP was clear and easy, one-third of practices did not conform with all five standards. Knowledge of the results by the participating institutions should encourage them to set up working groups to draft care protocols for THP and other surgical interventions, in order to improve practice and perhaps reduce costs.

Anti-Bacterial Agents↗
PubMedDate not supplied

Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.

INTRODUCTION: Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. OBJECTIVE: To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. METHODS: A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. RESULTS: There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged < or = 50 years and 8,796 bystanders aged > 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged < or = 50 years was 313,214 dollars, and that for a bystander aged > 50 years was 785,040 dollars. Using a strategy of training only those < or = 50 years, 583 elders per cardiac arrest would need to be trained, with a cost of 53,383 dollars per life saved. CONCLUSION: Using these assumptions, current CPR training strategy is not a cost-effective intervention for home cardiac arrests. The high rate of elders witnessing CPR mandates focused CPR interventions for this population.

Aged↗
PubMed1998

Implementation of a computerized cardiovascular information system in a private hospital setting.

BACKGROUND: The use of clinical databases improves quality of care, reduces operating costs, helps secure managed care contracts, and assists in clinical research. Because of the large physician input required to maintain these systems, private institutions have often found them difficult to implement. At LDS Hospital in Salt Lake City, Utah, we developed a cardiovascular information system (LDS-CIS) patterned after the Duke University Cardiovascular Database and designed for ease of use in a private hospital setting. METHODS: Features of the LDS-CIS include concise single-page report forms, a relational database engine that is easily queried, automatic generation of final procedure reports, and merging of all data with the hospital's existing information system. So far, data from more than 14,000 patients have been entered. RESULTS: LDS-CIS provides access to data for research to improve patient care. For example, by using data generated by LDS-CIS, the policy requiring surgical backup during percutaneous transluminal coronary angioplasty was eliminated, resulting in no increased patient risk while saving nearly $1 million in 1 year. LDS-CIS generates physician feedback reports documenting performance compared with peers. This physician self-evaluation has standardized and improved care. Information from LDS-CIS has been instrumental in securing and maintaining managed care contracts. LDS-CIS risk analysis provides physicians with outcomes data specific to their current patient's demographics and level of disease to assist in point of care decisions. CONCLUSION: The use of LDS-CIS in the routine operations of LDS Hospital heart services has been found to be feasible, beneficial, and cost-effective.

Cardiac Catheterization↗
PubMed1998

A comparison of percutaneous transluminal coronary angioplasty in the Department of Veterans Affairs and in the private sector in the State of Washington.

Coronary angioplasty is performed > 1,000 times daily in a variety of health care settings in the public and private sectors in the USA. How outcomes for this procedure differ in the Department of Veterans Affairs and the private sector is unknown. The purpose of this study was to compare outcomes of coronary angioplasty performed in hospitals in the Department of Veterans Affairs and the State of Washington. This study used administrative data from the Department of Veterans Affairs patient treatment file (n = 8,326) and the State of Washington episode of illness file (n = 6,666) and included men who underwent coronary angioplasty in 1993 and 1994. Outcomes included (1) in-hospital mortality and mortality at 10 and 30 days after hospital admission, and (2) the use of coronary artery bypass surgery at similar intervals. Patients with a principal diagnosis of acute myocardial infarction were analyzed separately. Men in the Department of Veterans Affairs had more comorbid conditions than their counterparts in Washington State, and the length of hospital stay was longer in the former group. After using logistic regression to adjust for patient differences, mortality rates for the 2 groups of patients with acute myocardial infarction were similar, although bypass surgery was used more frequently in patients in Washington State. For patients without myocardial infarction, hospital and 10-day mortality did not differ with respect to health care system, and the use of bypass surgery subsequent to angioplasty was similar. In the Department of Veterans Affairs, most hospitals had low institutional caseloads (< 150 procedures per year), whereas > 40% of Washington State hospitals performed > or = 300 procedures per year. Although there were greatly differing institutional caseloads, mortality and the need for early bypass surgery were similar in the 2 systems.

Adult↗
PubMed2003

[Factors influencing secondary prevention of atherothrombotic disease in the private outpatient cardiology setting: results of the Prisma survey].

From March to July 1999, 940 private cardiologists in France recruited 100,429 patients of whom 30,430 (30%) had a previous history of atherothrombotic disease. The prevalence of patients with a previous history of Myocardial Infarction (MI), Ischemic Stroke (IS) or Peripheral Arterial Disease (PAD) was 19.7%, 7.2% and 10.7% respectively. Among patients with a history of atherothrombotic disease, myocardial infarction was the most frequent diagnosis responsible for 65% of all consultations. Each cardiologist described the secondary prevention treatment for 3 consecutive patients among whom 1 corresponded to each of the 3 atherothrombotic territories. The most frequent cardiovascular risk factors were hypercholesterolemia for myocardial infarction (77.9%), smoking for PAD (32.5%) and hypertension for IS (73.2%). Diabetes mellitus (1/4 patients), obesity (1/3) and sedentary way of life (1/3) were equally prevalent for each of the atherothrombotic territories. More than 90% of the patients received an antithrombotic drug. Antiplatelet agents were largely prescribed, anticoagulants being more frequently used for patients with atrial fibrillation, symptomatic cardiac heart failure or stroke of embolic origin. Thienopyridines represent 17.9% of the prescriptions. The prescription rate of statins after MI (58.9%) is lower than in published studies in secondary prevention. The lack of lipid measurement and the delay since last measurement are non-prescription factors. The rates of prescription are even lower in case of PAD (44.6%) or IS history (33.3%). More than half of the patients (56.6%) are treated with beta-blockers and 40.1% with ACE inhibitors. These rates are similar to what has been published. Atherothrombotic disease represents a large part of the daily activity of private cardiologists and is not limited to coronary heart disease. Despite their proven efficacy, drugs for secondary prevention for MI, except antithrombotic drugs, are insufficiently prescribed. This under-prescription is even higher in patients with PAD or IS history and may be related to the lack of clinical trials in these specific territories.

Adrenergic beta-Antagonists↗
PubMed2001

How do patients choose private in vitro fertilization treatment? A customer survey in a tertiary fertility center in the United Kingdom.

OBJECTIVE: To assess the relevant factors affecting patients' decision when choosing a clinic for private, self-funded IVF treatment. DESIGN: Prospective anonymous closed questionnaires. SETTING: Single tertiary-care private IVF center. PATIENT(S): New patients attending primary consultation in a period of 7 months from September 1999 to March 2000. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary knowledge about the clinic, source of referral, knowledge of, availability of information pack, and familiarity with the clinic's success rates and treatment's price. The last question assessed the relative importance of each factor in the decision-making process according to the SERVQUAL model, modified version. All items were measured as perceptions on a 5-point Likert scale. 1 = not important, 3 = neutral, and 5 = very important. RESULTS(S): One hundred seventy-five patients completed the questionnaire. They were well informed and investigated the market before making their final choice. Patients collect information from many sources, including new channels such as the Internet. Up to one third of patients do not consult their doctor before treatment. By far the most relevant factor in decision making is the success rate (i.e., delivery rates) of the clinic, followed by recommendation by general practitioner (GP) or consultant (respectively, Likert scale score, 4.6; 95% confidence interval [CI], 4.5-4.7; and Likert scale score, 4.0; 95% CI, 3.9-4.2; P<.01). Other factors, such as cost of the treatment, friends and relatives' opinions, and distance from home were not relevant. CONCLUSION(S): Units that wish to thrive and increase their market share should deliver high-quality service and concentrate their efforts on excelling in performance.

Ambulatory Care Facilities↗
PubMed2003

Investigation of factors influencing burnout levels in the professional and private lives of nurses.

This is a descriptive, cross-sectional and partly analytic study aiming to determine the factors causing burnout in professional and private lives of nurses working in the university and state hospitals in a city. About 333 nurses were reached by sampling method. Data collection was made by a question form consisting of two parts. The first part was developed by the investigators. In this part, data on demographic, professional and private life conditions of individuals were collected. In the second part, "Maslach Burnout Inventory" was used to determine the burnout levels of individuals. The most important findings of the present study are as follows: higher education level, work experience and higher status decrease burnout while working at night shifts increases it. In addition, nurses who have problems in relations with the other team members and are not satisfied with their work conditions have higher levels of burnout. Having difficulty in childcare and in doing house chores, health problems of the nurse herself or her children, economic hardships and difficulties encountered in transportation are other factors increasing burnout.

Adaptation, Psychological↗
PubMed2002

Long-term impact on work and private life after Guillain-Barré syndrome.

OBJECTIVE: To determine the long-term impact of Guillain-Barré syndrome (GBS) on work and private life of patients and their partners. METHODS: Three to six years after the onset of GBS 150 patients who participated in the Dutch Guillain-Barré trial received a questionnaire specifically drafted for this study to survey their present psychosocial status. Furthermore, their present physical status was established. RESULTS: A total of 122 patients participated. Thirty-one percent showed moderate to serious physical residua after a functional assessment. Due to GBS, 38% of the patients who held a job had to change it, 44% altered their leisure activities, 37% of the patients did not function as well at home as before GBS and 39% reported a change in their partners' lives. Almost half of the patients still had negative comments on their present psychosocial situation. CONCLUSION: GBS has a serious long-term impact on the patients' work and private life and that of their partners.

Adult↗