PubMed Health⌕ Search

Biomedical subjects

R M Grimes

Publications and source records attributed to R M Grimes.

53 records · Page 3Linked to original sources
PubMed1976

Health planning in the United States: an old idea with a new significance.

This paper examines major features of the National Health Planning and Resources Development Act of 1974 (P.L. 93-641), a piece of legislation that would radically restructure the health planning system of the United States. The Act combines several, previously uncoordinated, health planning and health resources development agencies into one coordinated program. The program is to consist of statutorily restricted federal agency which will generally oversee the operation of the program, a state program directed by a consumer-dominated board and a series of locally based, generally private, nonprofit, consumer-dominated corporations ("Health Systems Agencies") which will carry the bulk of the planning functions. The resource development portion of the act grants funds for a variety of programs. These include both grants and loans (at very favorable interest rates) for medical facilities. In addition there are funds available for innovative projects which hold the prospect of improving health services and environmental conditions within the community. The act also provides the states and local organizations with substantial power over a large portion of the allocations made under the Public Health Act and specifies the process by which health planning must be carried out. Each local planning agency must design a long range health plan for its community and prepare a one-year plan for carrying out portions of the health system plan. These two documents then are used to create State Health plans, plans for construction, modernization or conversion of health facilities and criteria for judging the appropriateness of health services offered in the local areas and in each state. The act seems to create a mechanism whereby the health industry could be quickly converted into a heavily regulated industry. This regulatory process could be implemented in conjunction with national health insurance or by itself.

Financing, Government↗
PubMed1976

An approach to an index of hospital performance.

Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a test on data collected from 32 Texas hospitals.

Accreditation↗
PubMed1976

The organization of effective hospitals.

An analysis of 32 hospitals for effectiveness, organization structure, integrative mechanisms, and coordinative aspects reveals some common characteristics that can guide managers in structuring their own organizations.

Attitude of Health Personnel↗
PubMedDate not supplied

Psychological states in HIV disease and the nursing response.

The authors review the four major psychological states of HIV infection as described by Nichols (1985) and adapt these manifestations for use by the nurse in the clinical setting. The states and their likely impacts are described. The diagnostic tools for recognizing the states, assessment questions that help establish the patient's psychological state, and nursing interventions are included.

Adaptation, Psychological↗
PubMedDate not supplied

A collaborative program between a school of public health and a local health department to increase HIV testing of pregnant women.

OBJECTIVE: This study evaluates the effectiveness of a continuing medical education (CME) program that sought to increase HIV testing of women attending maternity clinics of the City of Houston Department of Health and Human Services (HDHHS). The CME program consisted of 14 training sessions given in 1995, 1996, 1997, 1999, and 2000. Educational objectives included increasing patient knowledge of HIV perinatal testing, increasing patient appreciation of the importance of HIV testing, and developing staff skills in educating and counseling women to accept HIV testing during pregnancy. METHODS: The CME program was based on assessment of clinician learning needs and an algorithm of the testing process, both jointly developed by faculty from the University of Texas Health Science Center at Houston School of Public Health and HDHHS personnel. The algorithm was also used to assess the care delivered. The CME was evaluated by examining changes in the percentage of women tested in the maternity clinics. RESULTS: In 1995, the year before the education program, 5.7% of women seen in the maternity clinics were tested for HIV. After the program began, testing rates rose to 64.2% in 1996, 65.5% in 1997, and 43.3% in 1998. Given the decline in testing in 1998, additional CME sessions were conducted in 1999-2000. The rate of testing rose to 62.3% in 1999 and 76.5% in 2000. CONCLUSION: Cooperative planning between university and health department personnel can create CME programs that alter provider behaviors and service delivery patterns to increase HIV testing. Outcomes need to be regularly monitored, however, to determine the need for maintenance or performance reinforcement.

AIDS Serodiagnosis↗
PubMedDate not supplied

Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations.

OBJECTIVE: The Houston Department of Health and Human Services (HDHHS) has a centralized process for notifying and setting up follow-up appointments for women with abnormal Pap smears who are clients of HDHHS health centers. Faculty and a student from the University of Texas School of Public Health and HDHHS personnel jointly conducted a study to evaluate the process and performance of the system. METHODS: The study examined two subpopulations: women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions (ASCUS/LGSIL) and women with high-grade squamous intraepithelial lesions or atypical glandular cells of undetermined significance (HGSIL/AGCUS). A retrospective study was conducted of data on women attending eight HDHHS clinics during the period from February 1996 through August 2000. Records of 1,216 women referred for evaluation of abnormal Pap smears were reviewed. Process effectiveness was measured by the number of successful contacts made and the number of appointments set up. Performance was measured by compliance with referral appointments. Predictors included race/ethnicity, age, co-existence of a sexually transmitted disease, number of prior referrals, type of patient visit, and health center attended. RESULTS: HDHHS staff successfully notified 95.6% of women with ASCUS/LGSIL and 97.9% of women with HGSIL/AGCUS. Using performance criteria as outcome measures, high-risk women requiring targeted interventions were identified. Overall, 84.2% of women scheduled appointments. Among those with ASCUS/LGSIL, women identified as African American were 53% less likely to accept an appointment and 45% less likely to show up for the appointment than those identified as Hispanic or "other." Age and type of patient visit appeared to be significantly associated with patient compliance behavior. CONCLUSION: The study describes the effectiveness of a centralized patient follow-up process for women at risk for cervical cancer.

Adolescent↗
PubMedDate not supplied

Biotransformation of a 1,5-benzodiazepine, triflubazam, by man.

The biotransformation of triblubazam (ORF 8063; 1-methyl-5-phenyl-7-trifluoromethyl-1H-1,5-benzodiazepin-2,4-[3H,5H]-dione) was studied in man. Seven male subjects received a chronic regimen of orally administered triblubazam for 19 consecutive days and their urine was collected for 29 days. Seven urinary metabolites were isolated by application of Sephadex LH-20 column chromatography and preparative thin-layer chromatography. Six of the purified compounds were subsequently characterized by utilizing thin-layer and gas-liquid chromatography and infrared, nuclear magnetic resonance, and mass spectrometry. The structure of a seventh metabolite was established by the use of an enzymatic assay involving catechol O-methyl-transferase. These compounds included unchanged triflubazam, the N-desmethyl catechol derivative, the 4'-hydroxyphenyl derivative, N-desmethyltriflubazam, the N-desmethyl dihydrodiol derivative, the N-desmethyl-4'-hydroxy compound, and the N-desmethyl-3'-methoxy-4'-hydroxy derivative. Unlike the situation in the metabolism of 1,4-benzodiazepines by man, no C3-hydroxylated derivatives of triflubazam were isolated. The metabolism of triblubazam by man is characterized by extensive N-demethylation, aromatic hydroxylation, aromatic O-methylation, and dihydrodiol formation.

Anti-Anxiety Agents↗