Biomedical subjects

H Gardent

Publications and source records attributed to H Gardent.

3 recordsLinked to original sources

PubMed1997

Variation in training programmes for Resident Assessment Instrument implementation.

BACKGROUND: this paper provides an overview of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) training programmes in eight countries where the system has been introduced into nursing homes. Formal education and training in the skills of assessment and care planning of nursing home personnel is reputed to be poor. In response to this problem several researchers and clinicians view MDS/RAI implementation as an opportunity to upgrade staff knowledge in care of elderly people. RESULTS: the courses in the eight countries varied in content and length according to the different goals each interRAI researcher planned when the MDS/RAI was implemented. As expected the greatest differences in training approach were between the USA and other countries. In the USA, where the MDS/RAI was mandated for use in all nursing homes, tens of thousands of professionals had to be oriented to use the system in a relatively short period of time in order to comply with the law. The training programmes therefore tended to be very short compared with those that emerged in countries where the MDS/RAI was freely chosen and implemented.

Aged↗

PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 2. Facilitating decision making in public health for optimal dissemination of an innovation].

Only a specific public health policy can resolve the technical, ethical, and financial problems posed by the diffusion of prenatal diagnosis by amniocentesis for the prevention of Down's syndrome. The purpose of this article is to facilitate decision making in this field by evaluating the costs and benefits associated with the different prevention strategies. Beginning with projections of the number of Down's syndrome births to be expected among women of 35 and older to the year 2000 (assuming that no prenatal diagnosis are made), various objectives combining the age of the target population and usage rates are presented and discussed. An evaluation of the overall costs of prenatal diagnosis and caring for Down's syndrome patients shows that a policy reaching a 50% usage rate for women 38 and older would save up to 66 millions French francs (using the 1981 franc value). On the other hand, it is shown that lowering the incidence of Down's syndrome in a target population of women over 35 to the level of the younger population would imply a usage rate of at least 80%. This goal is unrealistic unless amniocentesis were to become a compulsory examination. In such case, women would be deprived of an essential freedom, in view of the related ethical issues. The authors lastly discuss the different means of increasing usage rates without inhibiting women's freedom of choice.

Adult↗

PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 1. Epidemiologic, medical and socioeconomic bases. The dissemination of a diagnostic innovation].

The article offers a detailed analysis of the characteristics of the supply and demand of prenatal diagnosis by amniocentesis in order to identify the major problems that must be faced in formulating a policy designed to diffuse the use of this technique. The data collected for the whole of France made it possible to evaluate exhaustively the increase in the number of prenatal diagnoses during the years 1972-1981; to determine the number and geographic distribution of the diagnostic centers; to identify the medical criteria justifying the examinations. A comprehensive survey covering all examinations performed in the Ile de France (Paris region) in 1979--which constituted 46.5% of all the prenatal diagnoses performed in France that year--made it possible to determine the predominant socioeconomic characteristics of the women who took this examination, revealing, particularly, the significant inequalities of access, with an underrepresentation of the least privileged socioprofessional categories. The confirmation of the influence of socioeconomic status on access to this medical innovation is further reinforced by the fact that usage rates vary widely according to place of residence; furthermore, it adds to the financial barriers implicit in any policy of having reimbursement of the examinations dependent upon Social Security conventions. A public health policy regulating the diffusion of this innovation must take into account the discriminatory aspects of the first phase of diffusion, as analyzed here.

Adult↗