Telemedicine in the federal sector: leveraging technology to improve access, care and outcomes.
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Government Agencies↗
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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.
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Long-term care: a woman's world.
Long-term care is a world disproportionately comprised of women as consumers and as providers. Women comprise 75 percent of nursing home residents, 97 percent of professional caregivers, and the vast majority of family caregivers for elderly relatives at home. This article explores how and why long-term care, both in an institutional setting and home-based, is primarily utilized by women. The gender differences in the provision of care are also examined. The three key approaches to payment for long-term care (private payer, insurance, and Medicaid) are a focus with an emphasis on the role of Medicaid. Long-term care looms as an explosive issue and an accessible target for future program cutbacks. Since women are the predominant customers and providers of long-term care, this should be a priority issue for the feminist agenda.
Aged↗
Trends and issues in the Medicaid 1915(c) waiver program.
Over the past 15 years, Medicaid 1915(c) home and community-based waivers have made a substantial contribution to States' efforts to transform their long-term care (LTC) systems from largely institutional to community-based systems. By 1997, every State had implemented a waiver program for at least some subgroups of individuals with disabilities, and expenditures increased from $3.8 million in 1982 to more than $8.1 billion in 1997. Emerging, as well as long-standing, policy issues related to the waiver program include concerns with access, variation in availability by disability group, State decisions related to the provision of community-based LTC, and evidence on effectiveness.
Community Health Services↗
HMO provider networks in Medicare+Choice: comparing Medicare and commercial lines of business.
The Medicare+Choice (M+C) program was intended to expand choice of managed care plans for Medicare beneficiaries. In the past few years, the opposite has occurred as many participating HMOs reduced Medicare service areas or withdrew from the program. This paper presents findings from a study of the provider networks of 85 HMOs that were participating in M+C in 1999. The study shows that provider networks serving Medicare enrollees are usually similar to those developed for HMOs' commercial line of business, but when they are different, Medicare provider networks are smaller. Most HMOs also had at least some problems maintaining their Medicare provider networks. These findings have implications for the future of the Medicare+Choice program and Medicare enrollees' access to health care.
Aged↗
Smoking cessation programs for adolescents.
Many smoking cessation programs for adult smokers are described in the medical and nursing literature. Programs designed to prevent smoking among adolescents and children also are prevalent in the literature. Despite these prevention programs, many adolescents choose to start smoking. Once adolescents begin smoking, it is difficult to find ways to help them quit. Few programs exist that are targeted to help this population with smoking cessation. This article provides an in-depth review of 5 smoking cessation programs designed for adolescents. Each of the programs presents unique strategies for helping teenage smokers quit. Techniques used in these programs include peer leadership, nicotine patch therapy, peer support, computer instruction, and one-on-one counseling with a nurse practitioner. Each program was studied for efficacy with adolescents. Although none of the programs reviewed showed remarkable success, they serve as guides for future program development. Additional programs need to be developed and studied with larger, more diverse populations. Nurses must identify or develop smoking cessation programs that meet the needs of all types of adolescents and are effective in helping them to quit. Once designed, these smoking cessation programs should be made accessible to adolescents in a variety of settings.
Adolescent↗
Access to firearms and risk for suicide in middle-aged and older adults.
Elderly white men are at the highest risk for suicide. Firearms are the most common method of suicide used by both men and women in later life, and a greater proportion of older than younger suicide victims use a gun. This psychological autopsy study aimed to test hypotheses concerning the risk for suicide associated with access to and storage of firearms. Subjects included 86 suicide victims age 50 years of age and over and 86 community control subjects individually matched on age, sex, race, and county of residence. Presence of a firearm in the home was associated with increased risk for suicide, even after controlling for psychiatric illness. Elevated risk was accounted for by access to handguns rather than long guns and was more pronounced in men than women. Among subjects who kept a gun in the home, storing the weapon loaded and unlocked were independent predictors of suicide. Findings support the potential benefit for suicide prevention of restricting access to handguns. Education programs for older persons, their families, and healthcare providers concerning the risks of having a gun in the home and reinforcement of rules for safe storage may contribute to reducing the rate of suicide in older people.
Age Factors↗
Neo-isolationism, balanced-budget conservatism, and the fiscal impacts of immigrants.
"A rise in neo-isolationism in the United States has given encouragement to a new fiscal politics of immigration. Growing anti-immigrant sentiment has coalesced with forces of fiscal conservatism to make immigrants an easy target of budget cuts. Limits on legal alien access to social welfare programs that are contained in the 1996 welfare and immigration reform acts seem motivated not so much by a guiding philosophy of what it means to be a member of American society as by a desire to shrink the size of the federal government and to produce a balanced budget. Even more than in the past, the consequence of a shrinking welfare state is to metamorphose legal immigrants from public charges to windfall gains for the federal treasury."
Americas↗
The clinical pharmacist as a preceptor in a family practice residency training program.
BACKGROUND: According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. METHODS: A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. RESULTS: Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most common therapeutic categories encompassed cardiovascular, psychiatric, infectious disease, and neurologic disorders. Seventy-six percent of questions were answered using clinical knowledge and experience, while 24% were based on published resources. CONCLUSIONS: Based on more than 2,000 precepting encounters between a faculty pharmacist and family practice residents, most encounters represented requests by residents for information on general drug management of diseases. The pharmacist answered most questions based on clinical knowledge and experience. Evaluations of the pharmacist by the residents indicated that she is an effective teacher and useful in helping take care of patients.
Data Collection↗
Exercise in Heart Failure: A Synthesis of Current Research.
Exercise intolerance, as a hallmark symptom in patients with heart failure, has been the focus of numerous research initiatives in recent years. The purpose of this review is to synthesize the current literature in order to provide the clinician with an understanding of the state of knowledge regarding the role of exercise in treatment of heart failure. Many studies speak to the effect of exercise training in this population. While sample sizes have been small and restricted predominantly to male subjects with ischemic cardiomyopathies, strong support has been documented in favor of beneficial effects of exercise in heart failure. Future research should target more representative subject pools (i.e., females, non-ischemic cardiomyopathies, cultural minorities, frail elderly, and NYHA class IV), evaluation of impact on quality of life outcomes, exploration of different types and intensity of exercise, and formulation of specific activity prescription tools which can guide practitioners in making activity and/or exercise recommendations to those patients who have no access, or limited access, to cardiac rehabilitation programs.
Journal Article↗
14th International AIDS Conference--Barcelona 7-12 July 2002.
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AIDS Vaccines↗
Health-promoting behaviors of African-American rural women.
A primary role of nurse practitioners is to promote health. This study describes the practice of health-promoting behaviors of 75 African-American women in rural northwest Florida. The convenience sample completed the 94 Health-Promoting Lifestyle Profile (HPLP), which measures six aspects of health behavior, including exercise, nutrition, and stress management. Demographic factors were also examined in relation to participation in health-promoting behaviors. Findings showed women scoring the highest in interpersonal support and the lowest in exercise and nutrition on the HPLP subscales. Also, women with higher education and an income above $10,000 a year practiced more health-promoting behaviors. Those with less education, a lower income, and more family members practiced fewer health-promoting behaviors. Older women tended to exercise less and reported less interpersonal support. Nurse practitioners can encourage health promotion among African-American women. They can utilize strategies that maximize women's perceived benefits and self-efficacy while minimizing perceived barriers to health-promoting behaviors. Churches, worksites, and schools are suggested as accessible settings for providing programs and services to this population.
Adolescent↗
[Thomas' shunt for hemodialysis: dysfunction and its percutaneous treatment].
PURPOSE: To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). MATERIALS AND METHODS: Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). RESULTS: A total of 61 interventions were performed during the period of follow-up. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a "jet" of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or "flap" at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a "valve" effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0.01 (table II). CONCLUSIONS: Percutaneous treatment of TS dysfunction was proved to be effective in maintaining long-term patency. This type of fistula affords an alternative to tunneled central venous catheters.
Adult↗
Drug card setback highlights need for cost relief.
Under Bush's prescription card program, Medicare beneficiaries could access the mechanisms used by the privately insured population to lower prescription drug costs and use the leverage of the senior market share to negotiate deeper discounts from drug manufacturers.
Aged↗
CASE STUDIES for Dentistry: development of a tool to author interactive, multimedia, computer-based patient simulations.
Computer-based patient simulations have been used to enhance the dental curriculum since the 1980s. This article describes the development of CASE STUDIES for Dentistry (CSD), a patient case simulation building template, developed at Virginia Commonwealth University, with which authors who have no programming expertise can create realistic, effective, interactive multimedia patient simulations by entering their own information and images into a straightforward, fill in the blanks interface. This program was written with Authorware, by Macromedia Inc. Design considerations included emphasis on information collection and analysis, synthesis of collected information, hypothesis proposal and testing, diagnosis, and treatment planning. The program consists of easily accessible interfaces for both authors and students. Authors build simulated patients using typed-in text and their own images. Faculty can build computer-based simulated patients so that students can immediately practice what they learn in class within a simulated doctor-patient relationship. CSD allows building simulations ranging from simple to complex patients in multiple disciplines. Robust feedback and other features allow students to learn both process and content in a self-directed, interactive environment.
Computer Simulation↗
The use of dried bakery products in a free-choice feeding method for small-scale broiler production.
Waste material from bakeries is an unconventional energy feed source which is available in sufficient quantities for use in small-scale broiler production in South Africa. Small-scale broiler producers do not have access to the computer programs required to balance home-mixed rations. This investigation confirms that the use of dried bakery products (DBP) in a 2-stage, free-choice method can be used to compensate for this lack. A total of 570 day-old male broiler chickens was assigned to 3 feeding treatments: the control group was fed a 2-stage feeding programme using standard commercial starter and grower rations. The 2nd group received a commercial starter ration up to Day 7 and was thereafter given a choice of a commercial starter ration with normal salt content (0.35%) and DBP. The 3rd group was fed a commercial starter ration up to Day 7, then offered a choice of commercial starter ration with a lower salt content (0.1%) and DBP. The low salt alternative was used to test whether the higher salt percentage in DBP influenced the choice of feed by the birds. It was found that the control group consumed significantly more feed (P < 0.05) and was significantly heavier (P < 0.05) than the experimental groups. However, there was no significant difference between the 2 experimental groups, which indicated that salt content did not play a role in the choice of ration. Feed consumption by both experimental groups was about one-third less than the control group, but the profit margin, as calculated using gross margin analysis, was approximately 15 % higher. It was therefore concluded that dried bakery products can be profitably incorporated as an energy feed source, using the free-choice feeding method, in small-scale broiler enterprises.
Animal Feed↗
Unique partnership makes a solid case for on-site DM.
Don't discount such factors as high visibility and easy access when putting together your DM program. These advantages figured strongly into the development of a unique diabetes program in Massachusetts that is actually making a profit for the provider group that funds the program. In fact, the effort has gotten so much positive attention that other practices are now referring patients to the program.
Boston↗
[Entry inhibitors: enfuvirtide, a reality for antiretroviral therapy].
Entry inhibitors make up a new class of antiretroviral agents that block HIV entry into body cells. The recent approval of the fusion inhibitor T-20 or enfuvirtide by both FDA and the European Agency for the Evaluation of Medicinal Products (EMEA) is a first step in the expansion of a therapeutic armamentarium that is expected to increase in at least half a dozen new drugs in oncoming years. T-20 is indicated for the treatment of HIV-1 infection--in combination with other antiretroviral drugs--in patients who are resistant to both protease and reverse transcriptase inhibitors. In phase III studies, T-20 has demonstrated adequate efficacy and safety at 24 weeks after treatment, but long-term effects remain to be established. Until it finally becomes available in Spain, the compassionate use-related Early Access to T-20 Program allows it to be employed in our country for patients who meet criteria specified in the manufacturers users guide.
Acquired Immunodeficiency Syndrome↗