Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Resource”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,549 records · Page 86Linked to original sources
PubMed2006

Does decentralisation improve human resource management in the health sector? A case study from China.

A major obstacle to the provision of health services is lack of an effective workforce. Human resource management (HRM) can improve the effectiveness of the workforce, though this is difficult in large bureaucratic organisations. Decentralisation is a common reform strategy and this paper sets out to examine whether HRM would be improved in decentralised settings. Indicators were developed for three areas of HR outcome: (i) appropriate staff numbers, with (ii) appropriate skills and experience, providing, (iii) appropriate inputs to organisational performance. An attempt was made to link these human resource (HR) outcomes to relevant HRM actions in two counties--one richer and one poorer--in Fujian Province, China. One general county hospital and 5 township health centres were selected for study in each country. A health facility-based survey collected information on characteristics of the workforce and staff surveys identified changes in the management of human resources and staff inputs to performance before and after decentralisation. Whilst some benefits were identified from decentralising HRM, the complexity of the decentralisation itself, and other external pressures coupled with inadequate capacity building meant that some HRM actions were not always aligned with health service objectives. Better planning and preparation coupled with strong monitoring would increase the chances of decentralisation improving HRM in the health sector.

China↗
PubMed2001

The role of cognitive resources in the valuation of near and far future events.

People's behaviors often appear short-sighted, suggesting they overvalue the near future and undervalue the far future. In three experiments, the present research focussed on the role of cognitive resources in the valuation of near and distant future events. Experiment 1 tested a new discounting paradigm for use in the subsequent experiments. Experiments 2 and 3 used different manipulations (time pressure and a concurrent tone task) to restrict the cognitive resources of participants valuing a series of future events. In both experiments, this manipulation caused an increase in the valuation of far future events but not in the valuations of near future events. Implications of these findings for the role of cognitive resources in time discounting processes are briefly discussed.

Adult↗
PubMed2000

Use of resources, quality of life, and clinical outcomes in patients with and without new Q waves after thrombolytic therapy for acute myocardial infarction (from the GUSTO-I trial).

Previous reports indicate that patients who do not develop Q waves after thrombolytic therapy are a different population with a better long-term survival than those who do develop Q waves. However, the use of resources, quality of life, and health status of this population have not been fully evaluated. Using data from the Economics and Quality of Life subset of the Global Utilization of Streptokinase and tPA for Occluded Arteries study, we examined 30-day and 1-year mortality, use of resources, and quality-of-life measures among 1,830 of 3,000 patients with acute myocardial infarction and ST-segment elevation treated with thrombolytic therapy. At hospital discharge, 555 patients (30.2%) had not developed Q waves. These patients had lower mortality than patients with Q waves at 30 days (1.6% vs 4.5%, p <0.01) and at 1 year (4.7% vs 6.8%, p <0.04). Recurrent chest pain and dyspnea were similar at 30 days and 1 year. Patients without Q waves had significantly more angiography and trends toward higher readmission, revascularization, and use of calcium antagonists at 30 days. Angiography, revascularization, readmission, and quality of life were equivalent from 30 days to 1 year, with no sign of late instability. Logistic regression analysis showed an association between in-hospital revascularization and better survival and quality of life at 1 year. Conversely, there was no association between in-hospital use of calcium antagonists and outcome to explain the lower mortality in non-Q-wave patients. The absence of Q waves after thrombolytic therapy is a marker of success, implying better prognosis and equivalent quality of life, use of resources, and health status than for patients with Q-wave acute myocardial infarction and no sign of long-term unstable clinical course.

Aged↗
PubMed1985

Paradox, change and choice: an economist's view of some current health care resource issues.

Health care delivery is a major industry in the United States, consuming large quantities of human and physical capital and generating impressive quantities of products, ideas, trained personnel and health services. The focus of current public policy attention upon the medical profession, which has only in this century become a highly respected scientific profession, is not on its substantial accomplishments, but on the health care delivery system as a consumer (generator?) of over 10% of our annual gross national product. The overwhelming focus of current public policy and public sentiment is on cost containment (i.e., developing strategies to limit the flow of resources into the existing health care delivery system). This shift in public sentiment and new focus of public policy is, in some sense, a paradox in view of the spectacular advances in medical science and access to health care that the medical profession has delivered in the last 2 decades. The source of this anxiety and the cause of current initiatives in public policy and private practices with respect to health care is costs. The health care sector has not only consumed more resources than anticipated, but has also been characterized by unusually rapidly escalating prices and skyrocketing government resource commitments. As a result, we are asking new questions and seeking new initiatives. We are asking whether the institutions and practices that characterize the existing health care delivery system are the most suitable arrangements for our future. This article raises some of the issues entailed by these questions and details some of the choices which lie ahead for the health care industry.

Cost Control↗
PubMed2003

American ophthalmology graduate medical education and the web: current state of internet resource utilization.

PURPOSE: To evaluate the presence and accessibility of ophthalmology graduate medical education (GME) programs on the internet and the degree to which web-based resources are currently being utilized by American Ophthalmology training programs. DESIGN: Prospective sampling of internet postings of ophthalmology GME programs. METHODS: Ophthalmology residency programs listed in the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) online website (http://www.ama-assn.org/ama/pub/category/2997. html) were evaluated. Departmental websites were accessed either directly from the FREIDA website or from one of eight search engines or four metacrawlers utilized in the study. Each site was evaluated for the presence, extent, and type of postings in the following categories: residency, medical student resources, faculty, patient care, video utilization, and links. RESULTS: Departments with websites numbered 102 (83%). Specific posting rates were residency 84%; medical student resource 12%; faculty 72%; patient care 69%; video 2%; links 70%. CONCLUSIONS: Most departments have websites, but only a small number have postings in all categories.

Education, Medical, Graduate↗
PubMedDate not supplied

Health resource utilization and clinical outcomes with risperidone therapy in patients with serious mental illness.

This report is an analysis of our experience with risperidone therapy in a veteran population with severe, suboptimally responsive psychosis from a perspective of clinical response and health resource utilization. We conducted a computer search for all patients who received risperidone therapy at our facility from February 1994 until July 1, 1996. Risperidone at our facility is prescribed when psychiatric symptoms appear to be refractory or suboptimally responsive to conventional antipsychotic therapy. A control group of patients on conventional antipsychotic therapy were also selected via the electronic data base. One hundred twenty-nine patients received risperidone therapy at a mean dosage of 5.05+/-2.4 mg/d, for a mean duration of 247.4+/-223.5 days. The largest proportion of patients (48.1%) had marked improvement on risperidone therapy. There were 35 patients who received at least 1 year of risperidone therapy. These patients had a significant decrease in hospital length of stay (LOS) from 80.7 to 28.7 days (P = .003) on risperidone with no compensatory increase in outpatient visits. The group of patients who received conventional antipsychotic therapy during the study time period had a more modest mean reduction in LOS over a 2-year time period from 78.9 days during the initial identified year of conventional antipsychotic therapy to 56.4 days during the second identified year of conventional antipsychotic therapy (P = .2). However, when change in LOS for the entire group was compared, the difference in change in LOS between risperidone and conventional antipsychotic treated patients did not reach statistical significance (P = .2). This preliminary study concurs with other reports that risperidone therapy may be effective in severely mentally ill patients and may be associated with significant reductions in health resource utilization. Comparison of resource utilization between patients receiving risperidone and conventional antipsychotic therapy is still unclear and should be explored in larger and prospective studies.

Antipsychotic Agents↗
PubMed1994

Dual task performance in amnesic and normal people: does resource depletion cause amnesia?

Normal peoples' memory can be seriously disrupted if their cognitive resources are depleted by means of an experimental manipulation (such as distraction at encoding or at retrieval). By analogy, it has also been suggested that amnesia might result directly from pathological loss of cognitive capacity. This hypothesis was examined in 12 mixed amnesics and 12 normal people by means of a 'dual task' study. It was argued that if amnesics have reduced cognitive resources they should be disproportionately impaired in dual task performance relative to single task performance and in comparison to controls. This result was unambiguously demonstrated using a visual (letter detection) task combined with an auditory (semantic decision) task. However, correlations with measures of frontal function and with indicants of severity of amnesia proved insignificant and so the role of resource depletion in amnesia remains, as yet, unproven.

Adult↗
PubMed1986

Coexistence of two competitors on one resource and one inhibitor: a chemostat model based on bacteria and antibiotics.

We present a continuous time model of the dynamics of two species competing for a single limiting resource in the presence of a substance that inhibits the growth of one of the species. Resource and inhibitor are both derived from external sources. These inputs, and all other model parameters, are assumed to be constant in space and time. There exist conditions that permit the stable coexistence of the competitors, provided that the sensitive species is more efficient in exploiting the limiting resource, and the resistant species removes the inhibitor from the environment. There exists a subset of these conditions wherein the sensitive species can become established if and only if the resistant species is already established. If the resistant species does not remove the inhibitor from the environment, then coexistence of sensitive and resistant species is structurally unstable. If the resistant species produces the inhibitor, then coexistence is dynamically unstable. We review several studies of bacterial competition in the presence of antibiotics that support these conclusions.

Anti-Bacterial Agents↗
PubMed2002

Natural resource damage assessments in the United States: rules and procedures for compensation from spills of hazardous substances and oil in waterways under US jurisdiction.

Natural Resource Damage Assessment (NRDA) procedures in the US involve the use of uniform federally approved rules and procedures to assess economic losses and/or address restoration of injured resources that result from spills of hazardous substances and/or oil and petroleum substances in waterways under US jurisdiction. This effort started in the 1980s and involves two federal agencies that have developed separate federally approved procedures and rules, the US Department of Interior (US DOI) and the US Department of Commerce, National Oceanographic and Atmospheric Administration (US DOC, NOAA). This paper provides a brief overview of the federal laws applicable to resource damage assessments in the US, review of NRDA rules and procedures, and progress to date regarding US cases.

Environment↗
PubMed2001

Resource allocation for epidemic control over short time horizons.

We present a model for allocation of epidemic control resources among a set of interventions. We assume that the epidemic is modeled by a general compartmental epidemic model, and that interventions change one or more of the parameters that describe the epidemic. Associated with each intervention is a 'production function' that relates the amount invested in the intervention to values of parameters in the epidemic model. The goal is to maximize quality-adjusted life years gained or the number of new infections averted over a fixed time horizon, subject to a budget constraint. Unlike previous models, our model allows for interacting populations and non-linear interacting production functions and does not require a long time horizon. We show that an analytical solution to the model may be difficult or impossible to derive, even for simple cases. Therefore, we derive a method of approximating the objective functions. We use the approximations to gain insight into the optimal resource allocation for three problem instances. We also develop heuristics for solving the general resource allocation problem. We present results of numerical studies using our approximations and heuristics. Finally, we discuss implications and applications of this work.

Communicable Disease Control↗
PubMed1996

High-grade astrocytomas: resource use, clinical outcomes, and cost of care.

OBJECTIVE: To describe the clinical course, survival, resource use, and direct medical costs of care for patients with high-grade astrocytomas. MATERIAL AND METHODS: All patients with grade 3 or 4 astrocytoma who resided in Olmsted County, Minnesota, or one of the six adjacent counties and had a tissue diagnosis first made between 1987 and 1992 were studied. Clinical characteristics, initial management, use of resources, clinical course, survival, and medical charges were analyzed. RESULTS: Sixty-four patients, with a mean age of 62 years, were identified; 81% had glioblastoma multiforme. Approximately 60% underwent surgical resection, 80% had radiotherapy, and 50% had chemotherapy for initial management. After initial treatment (median duration, 116 days), approximately 75% of patients had a course with stable disease (median duration, 198 days). The overall median duration of survival was 323 days; lower grade and younger age were significantly associated with longer median survival-for example, 1,493 days for patients younger than 65 years with grade 3 astrocytomas and 205 days for patients 65 years old or older with grade 4 astrocytomas. The mean total direct medical charges were $67,887. CONCLUSION: In most patients with high-grade astrocytomas, a substantial period elapsed before disease progressed. Although the overall median duration of survival was less than 1 year, younger patients, especially those with grade 3 astrocytomas, had a longer survival. The management of patients with high-grade astrocytomas uses substantial health-care resources.

Adult↗
PubMed2003

Nursing care resources for individuals with intellectual and developmental disabilities across the life span.

This article provides resources that can be used by nurses working with individuals with intellectual and developmental disabilities (I/DD) across the life span and in a variety of settings. Resources include books, articles, videos, disability-related organizations, professional organizations, and agencies providing disability-related services. Additionally, resources are provided on a range of topics, including advocacy, issues across the lifespan for individuals with I/DD, health promotion, and legislation.

Adult↗
PubMed1999

Influence of specialty on pathology resource use in evaluation of cervical dysplasia.

OBJECTIVE: Colposcopy is performed by different providers, including nurse practitioners, family physicians, and gynecologists. The training and experience of these providers vary. The fiscal impact of provider type is unknown. This study evaluates pathology resource use by gynecologists and nongynecologists at the time of colposcopy. METHODS: A retrospective cohort study was performed. Data were collected by review of pathology reports and records of all patients with cervical dysplasia treated with cervical excision by loop electrosurgical excision procedure or cold knife conization at our institution between January 1, 1996, and December 31, 1997. Data were analyzed according to type of provider performing the colposcopy before the cervical excision. RESULTS: Gynecologists obtained a total of 190 biopsy specimens in 127 patients, with a mean number of 1.5 +/- 0.75 per patient and a median of 1. Nongynecologists took a total of 148 biopsy specimens in 44 patients, with a mean of 3.4 +/- 1.14 per patient and a median of 3 (P < .001). These differences persisted irrespective of presenting cytology. Nongynecologists were more likely to do endocervical curettage than gynecologists (95% compared with 82%, respectively, P < .001). Cervical dysplasia was diagnosed equally well, even though fewer biopsies were taken by gynecologists. CONCLUSION: Both groups of providers were equally capable of identifying dysplastic lesions. Despite equivalent diagnostic accuracy, nongynecologists used two to three times more pathology resources. If this pattern of use of resources exists at other clinical sites, patients with cervical dysplasia and payers would be better served by gynecologic rather than nongynecologic care.

Adult↗
PubMed2002

Linking biokinetics and consumer-resource dynamics of zinc accumulation in pond abalone Haliotis diversicolor supertexta.

A dynamic model that links biokinetics and consumer-resource dynamics for describing zinc (Zn) accumulation in abalone Haliotis diversicolor supertexta has been developed and then applied to Zn data from real abalone farms. The biokinetic parameters used in this study, uptake and depuration rate constants of abalone and their food source, red alga Gracilaria tenuistipitata var. liui, were obtained from a laboratory 14-d exposure experiment. We carried out a sensitivity analysis of the model by using the fractional factorial design technique, taking into account the influence of consumer-resource-related parameters such as growth and death rates and biomass and biokinetic parameters characterized by bioconcentration factor. Results indicate that the response time of biomagnification dynamics of Zn accumulation in abalone was influenced mainly by the growth rate of algae and biomass and the death rate of abalone and by interactions algae biomass and abalone death rate and abalone and algae biomass. New algae production results in substantially higher values of biomagnification factor. The linked model was then applied to field observations from a real-life situation of variable Zn concentrations occurring in abalone farms. Simulation results show that the predicted values are within a factor of 2 of the measured values (% errors range from 5.3 +/- 4% to 44.1+/- 8%). Both model analysis and model application to the abalone farms suggest that the linking influences between biokinetics and consumer-resource dynamics support Zn accumulation in H. diversicolor supertexta and in G. tenuistipitata var. liui as functions of Zn concentration in water and abundance of food occurring in abalone farms.

Animals↗
PubMed2006

Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005.

BACKGROUND: The terrorist bombings in London on July 7, 2005, produced the largest mass casualty event in the UK since World War 2. The aim of this study was to analyse the prehospital and in-hospital response to the incident and identify system processes that optimise resource use and reduce critical mortality. METHODS: This study was a retrospective analysis of the London-wide prehospital response and the in-hospital response of one academic trauma centre. Data for injuries, outcome, triage, patient flow, and resource use were obtained by the review of emergency services and hospital records. FINDINGS: There were 775 casualties and 56 deaths, 53 at scene. 55 patients were triaged to priority dispatch and 20 patients were critically injured. Critical mortality was low at 15% and not due to poor availability of resources. Over-triage rates were reduced where advanced prehospital teams did initial scene triage. The Royal London Hospital received 194 casualties, 27 arrived as seriously injured. Maximum surge rate was 18 seriously injured patients per hour and resuscitation room capacity was reached within 15 min. 17 patients needed surgery and 264 units of blood products were used in the first 15 h, close to the hospital's routine daily blood use. INTERPRETATION: Critical mortality was reduced by rapid advanced major incident management and seems unrelated to over-triage. Hospital surge capacity can be maintained by repeated effective triage and implementing a hospital-wide damage control philosophy, keeping investigations to a minimum, and transferring patients rapidly to definitive care.

Emergency Medical Services↗
PubMed2001

Assessment of the association between blood pressure control and health care resource use.

BACKGROUND: Several studies have reported increased health care resource use among hypertensive patients with uncontrolled blood pressure (BP). OBJECTIVE: The purpose of this study was to investigate the relationship between BP control and health care resource use. METHODS: Data were obtained from the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study, a multicenter feasibility study of actual physician and patient behavior and clinical outcomes in a naturalistic setting. Adult patients with newly diagnosed hypertension were randomized to either Group 1 (treatment with diuretics or beta-blockers) or Group 2 (treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors) and followed for 5 +/- 1 months. Physicians practiced standard care while documenting medications, BP measurements, and health care resource use for their patients. A subsequent analysis evaluating the relationship between BP and physician visits was performed for the whole population and for a subpopulation of patients with at least 4 months of follow-up data. Cox regression was used to model time to next visit. RESULTS: A total of 512 patients with newly diagnosed hypertension were followed: 399 had follow-up data for at least 4 months. Baseline demographic characteristics were similar in the 2 groups. Kaplan-Meier curves and a log-rank test showed that the time to next visit for patients with uncontrolled BP was significantly shorter than for patients whose BP was controlled (P < 0.05). On average, patients with uncontrolled BP (> or = 140/90 mm Hg) had follow-up office visits approximately 13 days earlier than patients with controlled BP (< 140/90 mm Hg). This association remained significant after adjustment for repeated measures, and after exclusion of the first return visit. Cox regression analysis showed that higher systolic and diastolic BP measurements were significantly associated with a shorter time to next visit, after adjustment for age and sex. Total estimated costs during the study period were $170 per patient for medications and $283 per patient for office visits. CONCLUSIONS: In the CHOICE study, higher BP was associated with a shorter time to next visit. Office visits were the main cost driver in the short-term management of hypertension.

Adrenergic beta-Antagonists↗
PubMed2003

Hospital resource use and cost of treatment with linezolid versus teicoplanin for treatment of serious gram-positive bacterial infections among hospitalized patients from South America and Mexico: results from a multicenter trial.

BACKGROUND: Linezolid is a novel oxazolidinone antibiotic that is effective for the treatment of gram-positive bacterial infections. The oral formulation has the potential to reduce length of stay (LOS) when used as a substitute for parenteral glycopeptide antibiotics. In a recent multinational trial comparing linezolid (i.v. followed by oral administration) with teicoplanin (i.v. alone or switched to i.m. administration), linezolid was found to have better efficacy (P = 0.005) and similar safety for treating serious gram-positive infections. OBJECTIVE: The purpose of this study was to compare hospital resource use (primarily LOS) and cost of treatment between linezolid and teicoplanin for hospitalized patients with serious gram-positive infections in South America and Mexico using data from the multinational trial. METHODS: In a multinational, Phase IIIb, open-label, comparator-controlled trial, data were collected from hospitalized patients in centers in 6 South America can countries and Mexico with suspected or confirmed serious gram-positive infections. Patients were randomly assigned to receive i.v. linezolid 600 mg BID (for the entire treatment period [7-28 days] or switched to oral linezolid 600 mg BID) or i.v. teicoplanin (for the entire treatment period or switched to i.m. teicoplanin) dosed per approved prescription information. Data on direct medical resource utilization were collected for each patient, including duration and doses of study medication, location of hospitalization and LOS, comedications, tests and procedures, and outpatient service usage. Unit costs for the medical resources were obtained from secondary sources. RESULTS: A total of 203 patients (97 treated with linezolid and 106 treated with teicoplanin) were enrolled from these 7 countries. The unadjusted results showed that compared with teicoplanin, patients treated with linezolid had a 3.1-day shorter mean i.v. antibiotic treatment duration (P < 0.001), a 2.0- to 2.2-day shorter median and mean LOS (P = 0.03), and a 311 US dollars lower mean total cost of treatment (P = NS). After controlling for age, race, sex, site of infection, inpatient location when the antibiotic treatment started, number of historical and current comorbidities, and whether the patient had a diagnosis of systemic inflammatory response syndrome or sepsis, the multivariate adjusted results were similar to the unadjusted results. The linezolid group had a 1.6-day shorter adjusted LOS or 66% greater odds of early discharge (P = 0.049) and a 335 US dollars lower adjusted mean total cost of treatment (P = NS). CONCLUSION: Linezolid was associated with shorter LOS and duration of IV antibiotic treatment than teicoplanin for serious gram-positive infections in the population studied. Linezolid therapy has the potential to reduce the total cost of treatment.

Acetamides↗
PubMed2001

Maximising health gain within available resources in the New Zealand public health system.

OBJECTIVE: to obtain intervention-condition-specific investment and disinvestment recommendations which optimise the potential for health gain from existing respiratory diseases resource expenditure; and to trial a health economics technique for this purpose, assessing its usefulness as a means of prioritising health services resource allocation. DESIGN: a programme budgeting and marginal analysis (PBMA) exercise drawing upon the expertise of an advisory group of clinicians, managers and consumer advocates, supported by health authority staff. SETTING: the Southern and Midland health regions in New Zealand which have populations of one million and seven hundred thousand respectively. HEALTH SYSTEM CONTEXT: publicly funded secondary care sector in which regional health authority (RHA) purchasers contract for services with health care providers. METHODS: available evidence on the marginal costs and benefits of services for respiratory diseases was examined by an advisory group who produced investment and disinvestment recommendations by consensus using agreed prioritisation criteria. RESULTS: A list of specific investment and disinvestment proposals. Implementation plans for a number of investments formed part of the business plans for both RHAs in 1997/1998. No disinvestments were planned. CONCLUSIONS: prioritisation methods like PBMA, which are explicit and rational, can produce defensible evidence-based recommendations with the additional benefit of the credibility and support of an expert advisory group. The process encourages co-operative working and may itself have enduring benefits. However, preparation and conduct of such exercises is resource intensive and requires careful planning. This exercise has provided valuable lessons for the conduct of future prioritisation work.

Delivery of Health Care↗