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Biomedical subjects

D Callahan

Publications and source records attributed to D Callahan.

At least 55 records · Page 3Linked to original sources
PubMed1994

Setting mental health priorities: problems and possibilities.

A recent project at the Hastings Center examined the question of priority setting in the provision of mental health services. A central issue was whether those services should be prioritized independently of other health services. The answer to that question was no: they should have full parity. Even so, priority setting can be a complex venture. At the heart of any such effort will be the relationship between empirical evidence on treatment outcomes and efficacy and the political and ethical interests that legitimately bear on interpreting and using that evidence. An argument is made that a priority should be given those whose suffering and inability to function in ordinary life is most pronounced, even if the available treatment for them is comparatively less efficacious than for other conditions.

Decision Making↗
PubMed1993

Comparison of a liquid solvent extraction technique and supercritical fluid extraction for the determination of alpha- and beta-carotene in vegetables.

An ethanol-pentane solvent extraction procedure and a supercritical CO2 extraction procedure are compared for the high-performance liquid chromatographic determination of alpha- and beta-carotene in vegetables. The vegetables tested included carrots, collard greens, turnips, turnip greens, kale, mustard greens, broccoli florets, zucchini, and squash. Homogenization of the sample prior to liquid or supercritical fluid extraction significantly improved recovery of the carotenoids. A combination of static and dynamic modes of extraction with ethanol modifier at 338 atm and 40 degrees C was necessary in order to achieve optimum recovery with the supercritical fluid procedure. beta-Carotene results with the supercritical CO2 procedure averaged 23% higher than results for the liquid extraction procedure. Only corn and carrots contained detectable levels of alpha-carotene, and, in both cases, liquid extraction yielded slightly higher results. Liquid extractions were performed in approximately 90 min, and supercritical fluid extractions were performed in 30 min; however, the supercritical fluid extractions procedure required less than 10 min of an analyst's time while the liquid extraction procedure was labor intensive.

Carotenoids↗
PubMed1993

Allocating health care resources. The vexing case of rehabilitation.

The allocation of resources to rehabilitation is beset with many difficulties. Among them are the general crisis in the American health care system and the problem of how to make a case for the role of rehabilitation. Rehabilitation must be prepared to show how and why it is a good medical and social investment in relation to other needs. Rehabilitation has played a secondary role in the American health care system because of overemphasis on curative and life-extending medicine. Rehabilitation must work to show that money invested in caring is as well spent as money aiming at the extension of life. It must also establish a fresh new vision of health care in general as well as illustrate where rehabilitation stands in a more integrated and coherent health care system. Improved quality of life, which rehabilitation can provide, is as important as saving and extending life.

Delivery of Health Care↗
PubMed1992

Reforming the health care system for children and the elderly to balance cure and care.

There is now a great disparity in the United States between resources going to the young, the nation's poorest age group, and to the elderly, the wealthiest age group, who are absorbing a greater and greater share of resources for health care. The author outlines reasons that these imbalances in the groups' access to resources have developed, and then demonstrates that, in the area of health care reform, an entitlement program for the young is not the answer: society must overcome its unwillingness and put into place a universal health care system. Even with such a system, the health care needs of the elderly will continue to grow and absorb more resources, both because the percentage of elderly is rising and because developments in medical technology continue to create new treatment possibilities and expectations. Should the health care needs of the elderly be allowed to absorb a more and more disproportionate share of the nation's resources compared with the resources used for the young? The author answers "No" and explains why he thinks (1) that medicine should become more oriented toward providing care, preventing premature death, and improving the quality of people's lives for a reasonable span of years (for example, until 80) and less toward saving lives of the very old and incurably ill at great cost; (2) that rationing and priority setting are inevitable because of limited resources; and (3) that the claims of children may on occasion need to be placed before those of the elderly. These changes can be made only if Americans change their health care system and some of their present values about the role of medicine.

Aged↗
PubMed1992

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.

Health Care Rationing↗
PubMed1991

Evaluating the Oregon priority plan.

The Oregon priority plan represents an innovative method of reforming its Medicaid program. It would replace the present system of limiting the number of people in the program with one that would, after setting priorities, limit treatment benefits. The strength of the plan is that it would provide all the poor with health care coverage; its potential drawback is that it might put expectant mothers and children at a disadvantage and possibility make some forms of needed care inaccessible to other groups as well. Despite the drawbacks and uncertainties of the priority plant, it deserves to be given a chance to prove itself.

Evaluation Studies as Topic↗