PubMed Health⌕ Search

Biomedical subjects

M Shanahan

Publications and source records attributed to M Shanahan.

At least 19 recordsLinked to original sources
PubMed2004

A cost-effectiveness analysis of buprenorphine-assisted heroin withdrawal.

The purpose of this study was to conduct a cost-effectiveness analysis of detoxification from heroin using buprenorphine in a specialist clinic versus a shared care setting. A randomized controlled trial was conducted with a total of 115 heroin-dependent patients receiving a 5-day treatment regime of buprenorphine. The specialist clinic was a community-based treatment agency in inner-city Sydney. Shared care involved treatment by a general practitioner supplemented by weekend dispensing and some concurrent counselling at the specialist clinic. Quantification of resource use was limited to inputs for treatment provision. The primary outcome measure used in the economic analysis was the proportion of each group that completed detoxification and achieved an initial 7-day period of abstinence. Buprenorphine detoxification in the shared care setting was estimated to be 24 dollars more expensive per patient than treatment at the clinic, which had an average treatment cost of 332 dollars per patient. Twenty-three per cent of the shared care patients and 22% of the clinic patients reported no opiate use during the withdrawal period. These results suggest that the provision of buprenorphine treatment for heroin dependence in shared care and clinic appear to be equally cost-effective.

Adolescent↗
PubMed2001

Counting the cost: estimating the economic benefit of pedophile treatment programs.

OBJECTIVE: The principal objective of this paper is to identify the economic costs and benefits of pedophile treatment programs incorporating both the tangible and intangible cost of sexual abuse to victims. METHOD: Cost estimates of cognitive behavioral therapy programs in Australian prisons are compared against the tangible and intangible costs to victims of being sexually abused. Estimates are prepared that take into account a number of problematic issues. These include the range of possible recidivism rates for treatment programs; the uncertainty surrounding the number of child sexual molestation offences committed by recidivists; and the methodological problems associated with estimating the intangible costs of sexual abuse on victims. RESULTS: Despite the variation in parameter estimates that impact on the cost-benefit analysis of pedophile treatment programs, it is found that potential range of economic costs from child sexual abuse are substantial and the economic benefits to be derived from appropriate and effective treatment programs are high. CONCLUSIONS: Based on a reasonable set of parameter estimates, in-prison, cognitive therapy treatment programs for pedophiles are likely to be of net benefit to society. Despite this, a critical area of future research must include further methodological developments in estimating the quantitative impact of child sexual abuse in the community.

Australia↗
PubMed2001

Fig-eating by vertebrate frugivores: a global review.

The consumption of figs (the fruit of Ficus spp.: Moraceae) by vertebrates is reviewed using data from the literature, unpublished accounts and new field data from Borneo and Hong Kong. Records of frugivory from over 75 countries are presented for 260 Ficus species (approximately 30% of described species). Explanations are presented for geographical and taxonomic gaps in the otherwise extensive literature. In addition to a small number of reptiles and fishes, 1274 bird and mammal species in 523 genera and 92 families are known to eat figs. In terms of the number of species and genera of fig-eaters and the number of fig species eaten we identify the avian families interacting most with Ficus to be Columbidae, Psittacidae, Pycnonotidae, Bucerotidae, Sturnidae and Lybiidae. Among mammals, the major fig-eating families are Pteropodidae, Cercopithecidae, Sciuridae, Phyllostomidae and Cebidae. We assess the role these and other frugivores play in Ficus seed dispersal and identify fig-specialists. In most, but not all, cases fig specialists provide effective seed dispersal services to the Ficus species on which they feed. The diversity of fig-eaters is explained with respect to fig design and nutrient content, phenology of fig ripening and the diversity of fig presentation. Whilst at a gross level there exists considerable overlap between birds, arboreal mammals and fruit bats with regard to the fig species they consume, closer analysis, based on evidence from across the tropics, suggests that discrete guilds of Ficus species differentially attract subsets of sympatric frugivore communities. This dispersal guild structure is determined by interspecific differences in fig design and presentation. Throughout our examination of the fig-frugivore interaction we consider phylogenetic factors and make comparisons between large-scale biogeographical regions. Our dataset supports previous claims that Ficus is the most important plant genus for tropical frugivores. We explore the concept of figs as keystone resources and suggest criteria for future investigations of their dietary importance. Finally, fully referenced lists of frugivores recorded at each Ficus species and of Ficus species in the diet of each frugivore are presented as online appendices. In situations where ecological information is incomplete or its retrieval is impractical, this valuable resource will assist conservationists in evaluating the role of figs or their frugivores in tropical forest sites.

Animals↗
PubMed2001

To HITH or not to HITH: making a decision about establishing hospital in the home.

Hospital in the home is increasingly being considered as an alternative for the provision of acute care. This article provides an overview of Hospital in the Home in Australia, discussing some of the issues that should be considered when determining whether to establish or fund hospital in the home programs such as whether efficiency is increased, care is improved and whether patients perceive more choice. These issues are discussed in the context of a transparent funding strategy that is aimed at achieving predefined goals and objectives.

Australia↗
PubMed2001

The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis.

OBJECTIVE: To compare ultrasonography with bone scintigraphy in the diagnosis of plantar fasciitis and to compare ultrasound-guided injection with palpation-guided injection in the management of idiopathic plantar fasciitis. METHODS: Twenty-three patients with a clinical diagnosis of idiopathic plantar fasciitis in 28 heels underwent ultrasonography and bone scintigraphy of both heels at baseline. The patients were randomized to ultrasound- or palpation-guided injection of triamcinolone hexacetonide and xylocaine into the plantar fascia. The 100 mm visual analogue scale (VAS) of pain, the heel tenderness index (HTI), and ultrasonography were performed at baseline and follow-up (mean=13.4 weeks). RESULTS: The mean thickness (+/-standard error of the mean) of the plantar fascia, measured by ultrasonography, was 5.7+/-0.3 mm in symptomatic heels as compared with 3.8+/-0.2 mm in asymptomatic heels (P<0.001). Ultrasonography findings correlated with bone scintigraphic findings in the diagnosis of plantar fasciitis (P<0.001). Fourteen heels were randomized to ultrasound-guided injection, 10 heels were randomized to palpation-guided injection and four heels were not injected. Ultrasound- and palpation-guided injection resulted in significant mean improvements in VAS [39.6+/-9.2 (ultrasound) vs 41.5+/-8 (palpation)] and HTI [1.35+/-0.2 (ultrasound) vs 1.3+/-0.4 (palpation)]. There was no significant difference in the response rate following corticosteroid injection by either modality (ultrasound=13/14, palpation=8/10). Following injection, the mean thickness of the plantar fascia decreased from 5.7+/-0.3 mm to 4.65+/-0.4 mm (P<0.01). CONCLUSION: Ultrasonography and bone scintigraphy are equally effective in the diagnosis of plantar fasciitis. Ultrasound-guided injection is effective in the management of plantar fasciitis but is not more effective than palpation-guided injection. Ultrasonography may be used as an objective measure of response to treatment in plantar fasciitis.

Fasciitis↗
PubMed2001

The economics of child sex-offender rehabilitation programs: beyond Prentky & Burgess.

In a 1990 article in this journal, Prentky and Burgess examined cost-effectiveness of the rehabilitation of child molesters. Their estimates were based on the tangible costs of incarceration and particular recidivism rates. This paper extends those findings by estimating the intangible costs of child sexual abuse and a range of recidivism rates. The result is to focus greater attention on the efficacy of treatment programs and the potential economic damage done to children by child molesters.

Child↗
PubMed2001

Assessing the value of hospital-in-the-home: lessons from Australia.

OBJECTIVES: To identify factors that influence the cost-effectiveness of hospital-in-the-home (HITH) and to discuss the impact of funding arrangements in creating incentives or disincentives for the establishment of HITH services. METHODS: A review of HITH services in Australia was undertaken. Based on the review, factors affecting the relative costs of HITH and conventional care were identified, in particular, the effect of funding and organisational arrangements on the incentives for managers and providers to choose between HITH and conventional care. RESULTS: The review of HITH services identified a wide range of models of HITH in Australia. Factors identified as important to the success of HITH included demographic and location issues, referral mechanisms, the choice of staffing and the management of the programme. However, it was clear that the structure of the programme often related to funding arrangements. Issues such as 'incentive funding', establishment costs and opportunity for cost-shifting were identified as being relevant to incentives for the efficient provision of HITH. CONCLUSIONS: Evaluations are essential to inform decisions about whether HITH is likely to be a viable and cost-effective alternative to inpatient care. However, the relative costs of HITH and conventional care will depend on local factors. From the point of view of the decision-maker, these will be affected by funding and organisational arrangements. Funders must be aware that complex financial incentives may mask the true costs of HITH services relative to hospital services. They need to ensure that the incentives created by funding arrangements are transparent.

Australia↗
PubMed1999

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

OBJECTIVES: University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and countries, utilization review within a single hospital, and longitudinal research on health reform. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Community Health Planning↗
PubMed1999

Adding up provincial expenditures on health care for Manitobans: a POPULIS project. Population Health Information System.

OBJECTIVES: Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization. RESEARCH DESIGN: This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba. RESULTS: Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.

Adolescent↗
PubMed1999

Using the POPULIS framework for interprovincial comparisons of expenditures on health care. Population Health Information System.

OBJECTIVES: Motivated by Manitoba Health's desire to know how health spending in Manitoba compared with other provinces, this study is a descriptive project designed to inform the health policy process by comparing indicators of need and expenditure across Canada. RESEARCH DESIGN: Population characteristics that are known to influence the need for health care constitute the comparative data categories. FINDINGS: In terms of all five health status indicators and five of eight socioeconomic indicators, Manitoba ranked medium (fourth to seventh of 10 provinces) or average. Demographic characteristics placed Manitoba second to Saskatchewan in proportion of both elderly residents and Registered Indians. This is notable, because both groups traditionally have high health needs. With provincial characteristics established, the second part of the study compares provincial per capita health expenditure data with expected need for health care services. RESULTS: Overall, the study finds provincial health expenditures are not related to health care need indicators. Saskatchewan is a case in point; despite having similar population characteristics to Manitoba, Saskatchewan has a population with good health status and lower health care expenditures. This offers a model that invites further exploration. CONCLUSIONS: At the provincial level the amount of health care spending is not positively related to the need for health care.

Adolescent↗
PubMed1999

A comparative study of the costliness of Manitoba hospitals.

OBJECTIVES: In light of ongoing discussions about health care policy, this study offered a method of calculating costs at Manitoba hospitals that compared relative costliness of inpatient care provided in each hospital. RESEARCH DESIGN: This methodology also allowed comparisons across types of hospitals-teaching, community, major rural, intermediate and small rural, as well as northern isolated facilities. MEASURES: Data used in this project include basic hospital information, both financial and statistical, for each of the Manitoba hospitals, hospital charge information by case from the State of Maryland, and hospital discharge abstract information for Manitoba. The data from Maryland were used to create relative cost weights (RCWs) for refined diagnostic related groups (RDRGs) and were subsequently adjusted for Manitoba length of stay. These case weights were then applied to cases in Manitoba hospitals, and several other adjustments were made for nontypical cases. This case mix system allows cost comparisons across hospitals. RESULTS: In general, hospital case mix costing demonstrated variability in hospital costliness, not only across types of hospitals but also within hospitals of the same type and size. CONCLUSIONS: Costs at the teaching hospitals were found to be considerably higher than the average, even after accounting for acuity and case mix.

Bed Occupancy↗
PubMed1999

The unintended and unexpected impact of downsizing: costly hospitals become more costly.

OBJECTIVES: In this project we assessed the impact of 1992 budget cuts ($50 million, or approximately 7% of urban hospitals' budgets) on the relative costliness of Manitoba's hospitals. The cuts targeted the teaching hospitals, those institutions we had found to be particularly costly in a previous Manitoba Centre for Health Policy and Evaluation study. RESULTS: Unexpectedly, we found that because budget cuts were smaller proportionately than the number of beds closed, the care at the teaching hospitals (as well as at several other hospitals) became relatively more, not less, costly. Also quite contrary to public perceptions, once other expenditures such as new hospital programs and expansions were accounted for, the actual change in urban hospital expenditures over the years compared was less than 1%. CONCLUSIONS: The study highlighted the importance of monitoring program outcomes.

Adult↗
PubMed1998

How many physicians does Canada need to care for our aging population?

BACKGROUND: There is concern that the aging of Canada's population will strain our health care system. The authors address this concern by examining changes in the physician supply between 1986 and 1994 and by assessing the availability of physicians in 1994 relative to population growth and aging, and relative to supply levels in the benchmark province of Alberta. METHODS: Physician numbers were obtained from the Canadian Institute for Health Information. The amount of services provided by each specialty to each patient age group was analysed using Manitoba physician claims data. Population growth statistics were obtained from Statistics Canada. Age- and specialty-specific utilization data and age-specific population growth patterns were used to estimate the number and type of physicians that would have been required in each province to keep up with population growth between 1986 and 1994, in comparison with actual changes in the physician numbers. Physician supply in Alberta was used as a benchmark against which other provinces were measured. RESULTS: Overall, Canada's physician supply between 1986 and 1994 kept pace with population growth and aging. Some specialties grew much faster than population changes warranted, whereas others grew more slowly. By province, the supply of general practitioners (GPs) grew much faster than the population served in New Brunswick (16.6%), Alberta (6.5%) and Quebec (5.3%); the GP supply lagged behind in Prince Edward Island (-5.4%). Specialist supply outpaced population growth substantially in Nova Scotia (10.4%), Newfoundland (8.5%), New Brunswick (7.3%) and Saskatchewan (6.8%); it lagged behind in British Columbia (-9.2%). Using Alberta as the benchmark resulted in a different assessment: Newfoundland (15.5%) and BC (11.7%) had large surpluses of GPs by 1994, whereas PEI (-21.1%), New Brunswick (-14.8%) and Manitoba (-11.1%) had substantial deficits; Quebec (37.3%), Ontario (24.0%), Nova Scotia (11.6%), Manitoba (8.2%) and BC (7.6%) had large surpluses of specialists by 1994, whereas PEI (-28.6%), New Brunswick (-25.9%) and Newfoundland (-23.8%) had large deficits. INTERPRETATION: The aging of Canada's population poses no threat of shortage to the Canadian physician supply in general, nor to most specialist groups. The marked deviations in provincial physician supply from that of the benchmark province challenge us to understand the costs and benefits of variations in physician resources across Canada and to achieve a more equitable needs-based availability of physicians within provinces and across the country.

Adolescent↗
PubMed1998

Managing health services: how administrative data and population-based analyses can focus the agenda.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Canada↗
PubMed1997

Expression, purification, and characterization of an activated cytokine-suppressive anti-inflammatory drug-binding protein 2 (CSBP2) kinase from baculovirus-infected insect cells.

An activated form of the human cytokine-suppressive anti-inflammatory drug-binding protein 2 (CSBP2) kinase was expressed in Spodoptera frugiperda (SF9) cells from a baculovirus vector. To maximize expression and to facilitate purification of the recombinant protein, CSBP2 kinase was expressed as a carboxy-terminal fusion protein to glutathione S-transferase (GST). Under optimal conditions, 2-3 mg of GST-CSBP2 could be obtained per liter of infected cell culture. The fusion protein was easily purified from the soluble fraction of the total cell lysate under nondenaturing conditions by using a glutathione-Sepharose 4B affinity resin. As expected, the purified GST-CSBP2 fusion protein was approximately 68 kDa as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis and reacted with antibodies directed toward either the GST or the CSBP amino terminus. To obtain activated CSBP2, SF9 cells were coinfected with two recombinant baculovirus vectors: one that directed the synthesis of the GST-CSBP2 fusion protein and a second vector that directed the synthesis of a constitutively active form of the CSBP activating kinase, MKK3. Coexpression of GST-CSBP2 kinase with the MKK3 activator increased GST-CSBP2 activity 8- to 10-fold based on the ability of GST-CSBP2 to phosphorylate the substrate, myelin basic protein (MBP), and the ATF2 transcription factor, in vitro. Moreover, activated GST-CSBP2 was capable of activating a bacterially derived mitogen-activated protein kinase-activating protein kinase 2 in vitro. The activity of insect-derived GST-CSBP2 was also inhibited by the CSBP inhibitor, SB202190. We anticipate that the preparation and purification techniques described in this study will facilitate further biochemical characterization of this kinase.

Animals↗
PubMed1995

Are nurses aware of the differing health care needs of Vietnamese patients?

This study examined the knowledge a small group of community nurses have of the Vietnamese culture. In our multi-cultural society nurses are being challenged to offer culturally appropriate care. Provision of care depends on an accurate assessment of health care needs which may differ from those of the dominant culture. The results indicated a lack of knowledge of the Vietnamese culture and the specific health care practices of the Vietnamese. This lack of knowledge is being rectified by in-service education.

Attitude to Health↗
PubMed1995

Developing an epoetin alfa medication protocol to improve patient care and foster collaboration.

This article describes the process undertaken by the nursing staff, management staff, and education department of a community hospital-based outpatient dialysis unit to address the numerous issues related to the management of anemia in their dialysis population. Through good observations and assessments made by the nursing staff, major problems related to anemia management were identified. As a result, staff members developed a medication protocol and a tracking tool to better manage the anemia associated with chronic renal failure. Evaluation of this protocol and tracking tool demonstrated improvement in two clinical patient outcomes and two unit management outcomes.

Anemia↗