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PubMed2003

[Continuing medical professional development in Uruguay as the country faces the 21st century].

This paper outlines the evolution of the concept of continuing medical professional development in Uruguay, as that professional development has progressed from independent and varied efforts that were not coordinated or evaluated to a plan that is aimed at improving the quality of educational activities and programs and making them accessible to all the physicians in the country. In contrast to countries where scientific societies and medical associations preside over continuing professional development, in Uruguay the Graduate School of the School of Medicine of the University of the Republic has taken on managing and developing this process. The key objective of this process is for the Graduate School to work in conjunction with other leading players in professional development to create a national system of continuing medical professional development. This system should be interinstitutional and include both public and private entities. By having the key public institutions (the Graduate School and the Ministry of Public Health) working with private entities (medical associations, scientific societies, and health care institutions), there should be an adequate balance of interests. The national professional development system should work in the most decentralized manner possible and should be based on a network of units distributed around the entire country, but with centralized coordination. The system's interinstitutional character should ensure high technical and ethical standards as well as a balance among the governmental, commercial, professional, and university components. This system should serve as the basis for extending this activity to all health personnel in Uruguay. While the national system is still being finalized, the Graduate School has implemented a process of accrediting institutions that are involved in continuing professional medical development. The aim of this accreditation process is to improve the educational offerings for physicians and to generate practical experience that will serve the future system.

Education, Medical, Continuing↗
PubMed2005

Newborn screening for developmental disabilities: reframing presumptive benefit.

A fundamental tenet of newborn screening is that screening should lead to a proven benefit for the infant. The standard is usually construed as medical benefit that significantly improves a child's health. Screening for many conditions that cause developmental disabilities does not currently meet this standard. We argue for expanding concepts of presumptive benefit. Newborn screening provides access to early intervention programs that are shown to positively influence child development and support families. Consumers want information about their children's health and their own reproductive risk, and they have a broader view than policymakers of what constitutes a treatable disorder. Newborn screening provides other societal benefits that, in the absence of data showing harm and with appropriate attention to ethical and legal issues, warrant consideration of an expansion of targets for newborn screening.

Child↗
PubMed1977

Affecting the supply of rural physicians.

A model describing physician supply and distribution is described. Two surveys obtained information to examine elements of the model. The first survey identified a group of primary care physicians that had considered rural locations but ultimately selected an urban location. This sub-group, 29 per cent of the primary care supply pool, received a follow-up survey to provide more information about how they made their choice. About one-half of them finally chose on the basis of factors other than metropolitan/non-metropolitan considerations. For this half, some of the factors that entered into the decision were the availability of physician specialists, nearby hospital facilities, and access to medical school programs. Such factors could be affected by future policy decisions, but the cost is unknown. Even if such policy decisions were made, and appropriate programs instituted, the results would probably not solve the problem of disproportionate physician distribution. The most likely-to-succeed approach to increasing the number of rural physicians remains that of increasing the number of entrants to medical school with a rural background.

Career Choice↗
PubMed2000

Hunger in legal immigrants in California, Texas, and Illinois.

OBJECTIVES: This study determined the prevalence of food insecurity and hunger in low-income legal immigrants. METHODS: We conducted a cross-sectional survey of Latino and Asian legal immigrants attending urban clinics and community centers in California, Texas, and Illinois with a food security questionnaire. RESULTS: Among 630 respondents, 40% of the households were food insecure without hunger and 41% were food insecure with hunger. Independent predictors of hunger were income below federal poverty level (odds ratio [OR] = 2.72, 95% confidence interval [CI] = 1.72, 4.30), receipt of food stamps (OR = 2.53, 95% CI = 1.57, 4.09), Latino ethnicity (OR = 2.39, 95% CI = 1.49, 3.82), and poor English (OR = 1.76, 95% CI = 1.10, 2.82). CONCLUSIONS: The prevalence of hunger among low-income legal immigrants is unacceptably high. Access to food assistance programs is important for the health and well-being of this population.

Adult↗
PubMed2004

Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association.

Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two-thirds of all deaths in the U.S. and about US dollars 700 billion in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity-the major risk factors for these diseases-and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the American Cancer Society, American Diabetes Association, and American Heart Association review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.

American Cancer Society↗
PubMedDate not supplied

Preventing cancer, cardiovascular disease, and diabetes: a common agenda for theAmerican Cancer Society, the American Diabetes Association, and the American Heart Association.

Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two-thirds of all deaths in the United States and about 700 billion US dollars in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity-the major risk factors for these diseases-and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the American Cancer Society, the American Diabetes Association, and the American Heart Association review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.

Cardiovascular Diseases↗
PubMedDate not supplied

Competence, continuing education, and computers.

A survey of RNs in South Dakota was performed to determine their perceived level of competence, the extent to which their continuing nursing education (CNE) needs are being met, and their use of computers for CNE. Nationally certified nurses rated themselves significantly more competent than nurses who are not nationally certified. Fewer than half of the RNs reported their CNE needs were being met despite geographic access to CNE and programs available in their specialty. Three-fourths of nurses had computers at home while 76% had computers at work, yet fewer than 20% of nurses used these computers for CNE.

Attitude of Health Personnel↗
PubMed1998

Making cancer bearable: the Interlink Community Cancer Nurses model of supportive care.

Most cancer patients and their families experience the full impact of their diagnosis and the disruptions cancer brings to their lives in their own homes and communities. Access to supportive care programs within the community is critical if we are to assist these individuals in coping and adjusting to the realities of cancer. Interlink Community Cancer Nurses, a nonprofit nursing agency, provides supportive care across the continuum of cancer care from early diagnosis and treatment through to remission and/or palliative care through its independent model of supportive care delivered by expert oncology nurses. The program utilizes a unique, client-centred model of care delivery to ensure that needs are met, and to link patients to community services which promote their ability to meet the demands of cancer. Interlink's program of supportive care demonstrates that oncology nurses can make a significant impact on the outcomes of cancer for individuals and their families which may impact on cost, influence survival and enhance quality of life.

Community Health Nursing↗
PubMed1994

The application of future technologies to medical informatics.

Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go.

Computer Systems↗
PubMedDate not supplied

Ethicists address various issues on the ethics of reform.

After a slow start at the gate, ethics seems to be gaining on other interest groups (financing, restructuring, etc.) in vying for attention in the race for health care reform. Although still far removed from the inside track, ethics may yet prove to be a dark horse capable of moving toward a more central presence, and of being an important contender in the final choice of a health reform program.

Ethics, Medical↗
PubMed1994

Collaborative self-management strategies for patients with respiratory disease.

The effectiveness of collaborative self-management of respiratory disorders has been most clearly demonstrated in asthma. In both adults and children with severe asthma requiring emergency care and hospitalizations, collaborative self-management can decrease not only the need for emergency care and hospitalization but also time lost from work and school, thereby increasing the patients' ability to be full and active participants in the community. Collaborative self-management is best provided in a comprehensive program that includes ready access to healthcare professionals, education, behavioral therapy, and peak-flow monitoring. The relative value of each of these components and the value of single components applied simultaneously is unclear. In some studies, asthma symptoms and medication adherence have also improved following implementation of collaborative self-management. The available data indicate that collaborative self-management should be considered as a potential therapeutic adjunct in the management of every patient with asthma and should be routinely employed with patients who have severe disease as defined by emergency room use and hospitalizations. Additional investigations should be conducted in patients with other respiratory diseases to define the role of collaborative self-management. Nonetheless, state-of-the-art medical care and the nature of the patient-physician relationship in the 1990s dictates that collaborative self-management be routinely employed in the optimal outpatient management of any individual who is interested in participating in his or her own healthcare. However, individualization of the practitioner-patient relationship is necessary. Not all patients desire to play an active role in their illness and its management. The personality, attitudes, and desires of individuals in assisting in their own management must be assessed. Theory would suggest that patients who do not appear to have an interest in self-management may have low self-efficacy that may be increased by educational efforts. Improved self-efficacy and active participation in disease management may result in beneficial outcomes. It is clear that the physician-patient relationship has changed over the past decade. As patients have been empowered to act in their own best interests, the physician's role as an educator and facilitator has become more prominent than ever. Even if medical investigations had not demonstrated any beneficial effects of collaborative self-management, patients have the right to participate in decisions affecting their healthcare and are increasingly exercising that right. Respiratory care practitioners are in a unique position to enhance collaborative self-management. In the home environment, RCPs can foster smoking cessation and serve as a liaison between patients and physicians.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

Charitable remainder trusts provide a creative source of capital.

Operating margins for hospitals continue to shrink, making it increasingly difficult for hospitals to realize returns high enough to replace capital. Thus, accumulating capital through hospital earnings will continue to be difficult. Credit ratings will continue to drop as not-for-profit hospital operations remain marginal, making access to capital through debt markets more expensive. As a result, not-for-profit hospitals will need to develop creative ways of accessing capital through gifting programs. One such creative way is through the use of charitable remainder trusts--planned gifts that can take three to seven years to mature but can provide long-term-thinking hospital executives with an innovative source of capital.

Accounting↗
PubMed1980

Taxation and its effect upon public and private health insurance and medical demand.

Multiple tax subsidies are available to many buyers and sellers of health insurance. These subsidies have the potential of creating excess demand for health insurance, which in turn can create excess demand for health services. A review of the literature on the effects of the tax subsidies on the price of health care shows that these subsidies, by raising prices in the medical sector, constrain the Medicare and Medicaid programs' ability to provide access to care for their beneficiaries.

Health Benefit Plans, Employee↗
PubMed1988

A perspective on long-term care for the elderly.

Long-term care represents a significant burden to the approximately 7 million elderly in need, their families, and the Medicaid program. Concerns exist about access, quality, cost, and the distribution of the burden of care. In this article each area is discussed, highlighting the principal issues, identifying the unique aspects that pertain to long-term care, and exploring the implications for research and policy development. Future trends, especially the growth of the elderly population, are expected to affect significantly the provision of long-term care. The considerable uncertainty about how these trends may impact on long-term care is described, and the critical role social choice will play in shaping the future long-term care system is emphasized.

Activities of Daily Living↗
PubMed1999

Clothing exchanges for Medicaid members boost immunizations, encourage well-child visits.

Want your Medicaid members to get their vaccinations and well-child visits? Try encouraging them with an incentive system that offers something they can use, like children's clothing. Arizona Physicians IPA Inc., a Phoenix-based Medicaid managed care organization, uses clothing exchanges to encourage preventive utilization and give members access to community outreach programs.

Arizona↗
PubMed1998

Educational benefits and cost savings from an interactive multimedia "best practice".

BACKGROUND: Developing and deploying "clinical practice guidelines" and "best practices" is a major strategic goal of our organization. We developed and evaluated a novel way of educating our colleagues on the office management of shoulder pain, using an interactive multimedia computer program to allow rapid access to user-selected audiovisual educational materials through a simple point and click interface. METHODS: Pre- and post-testing of 30 practicing primary care providers was conducted to assess ability to evaluate and manage patients who present with shoulder pain, and a post-use survey was administered to assess clinician acceptance and confidence, ability to use as a just-in-time tool, and changes in utilization of medical resources. RESULTS: Pre- and post-testing demonstrated that clinicians used this tool to improve their scores in a wide variety of clinical areas including history, physical examination, diagnosis, and management of conditions causing painful shoulder above their scores using textbooks and other traditional educational materials alone. The post-use survey showed outstanding acceptance by clinicians and their reported increased confidence as well as the potential for their increased abilities to translate into significant cost savings through more focused use of radiographic studies, orthopedic consultations, and physical therapy treatments. CONCLUSIONS: It was concluded that "The Multimedia Reference for Office Management of Shoulder Pain" is an effective and valuable learning resource for practicing clinicians, and demonstrates the potential to use an interactive multimedia tool to augment clinical skills and promote cost effective management of patients with this common clinical problem.

Attitude to Computers↗
PubMed2000

The use of information technology in improving medical performance. Part III. Patient-support tools.

Despite the proliferation of computer-based resources for patients, usefulness has been limited to date. Already, 17,000 biomedical Internet sites exist, and patients are increasingly finding support and knowledge on the Internet, but the accuracy of the information found is highly variable and difficult for patients to assess. Patients have also found value in electronic communication with physicians, although relatively few physicians routinely use email to communicate with patients on a regular basis. Nonetheless, patient-focused information technologies potentially will have profound effects on medical care. With advancing sophistication of technology, patients will increasingly be able to compare and choose doctors using the Internet and to access information that allows them to monitor and regulate the quality of their own care. Further, technologies will likely be developed to allow patients to increasingly manage their own care -- whether they are patients with chronic illnesses such as diabetes or congestive heart failure who use customized software to adjust drug dosages and other treatments or patients with such common illnesses as headache or gastrointestinal infection who access self-management programs that may even write prescriptions for them. Thoughtful analysis and policy development will be critical for ensuring that the benefits are maximized and potential harm minimized. Specific areas include assessing the effects on outcomes and the characteristics of patients and technologies that succeed with self-management, and developing policies regarding liability for Web-based medical transactions and the privacy of information provided to physicians by email and via interactive Web sites.

Biomedical Technology↗