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Biomedical subjects

R Scheffler

Publications and source records attributed to R Scheffler.

16 recordsLinked to original sources
PubMed2001

The impact of realignment on utilization and cost of community-based mental health services in California.

Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.

Adult↗
PubMed1998

Supply dynamics of the mental health workforce: implications for health policy.

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.

Adolescent↗
PubMed1998

Mental health staffing in managed care organizations: a case study.

This paper examines temporal changes in staffing ratios and configuration of mental health providers per 100,000 members within two full-service staff-model health maintenance organizations (HMOs). Overall workforce reductions in all classes of mental health professionals occurred in the two HMOs from 1992 to 1995. Staffing ratios decreased in both HMOs for psychiatrists and psychologists. In one HMO, the ratio of clinical social workers also decreased over this period. Provider ratios from 1995 are benchmarked against state ratios per 100,000 population. Workforce mix for the two HMOs is contrasted with a single-year average for a large managed behavioral health (carve-out) organization. The authors discuss potential implications of the findings for training of several categories of mental health professionals.

Health Maintenance Organizations↗
PubMed1996

[Experiences with transverse resections and vertical incisions in treatment of tracheal stenoses and tracheal injuries].

BACKGROUND: The treatment of stenoses and traumatic lesions in subglottic and tracheal areas often requires long term follow-up. This study was undertaken to evaluate the efficiency of tracheal resections and vertical dissections with respect to the length and the quality of the treatment. PATIENTS: Thirty-one adult patients underwent tracheal resections. This group includes one patient with an esophagotracheal fistula which was closed after segmental resection. Two cases of traumatic tracheal lesions in the lower third of the trachea in children are also presented. RESULTS: Long-term intubation was the reason of stenosis in 93.5% of the patients. The tracheal stenosis was successfully resected in 87% of the patients without any complications. The healing process was not related to age and sex. The prognosis was influenced negatively by the type and frequency of previous treatments. We detected paresis of the recurrent nerve postoperatively in two patients. CONCLUSIONS: 1. Our experience has shown that tracheal resection is the optimal treatment of stenosis. 2. The transtracheal access in childhood is very suitable for the closure of tracheal lesions located in the lower third of the trachea.

Adolescent↗
PubMed1993

A specialized mental health plan for persons with severe mental illness under managed competition.

Many concerns have been raised about the special problems of providing care for severely mentally ill persons in a reformed health care system based on managed competition. The authors describe what will likely be basic features of the reformed system and discuss potential problems in serving this population. The authors recommend the development of special mental health maintenance organizations (MHMOs) that would serve only persons with severe mental illness. The MHMO would emphasize case management in the community and would provide a fixed point of responsibility for clinical care of these patients. Two methods of reimbursing MHMOs are proposed. Each region's health insurance purchasing cooperative (HIPC) could reimburse the MHMO on a capitated risk-adjusted basis. Alternatively, HIPCs could require the general health plan to operate or contract for MHMOs. In each case, the HIPC would provide quality-of-care oversight and assign a team to act as a gatekeeper for referrals to the MHMO.

Competitive Medical Plans↗
PubMed1993

The effect of different preparations of nasal decongestants on ciliary beat frequency in vitro.

Ciliated cells from the nasal mucosa of normal persons were collected in culture medium and exposed to either oxymetazoline without preservatives, oxymetazoline with preservatives, xylometazoline with preservatives, or sham (culture medium). There was a significant decrease in ciliary beat frequency only by the two drugs with preservatives after 20 min. After substitution of the test media with culture medium ciliary action did not recover in any group.

Cells, Cultured↗
PubMed1990

[Possible pathogenesis of swimming sinusitis].

To investigate the pathogenesis of swimmer's sinusitis, a group of 20 swimmers and 20 controls were interviewed and examined. Clinical examination was followed by rhinomanometry, sonography of the maxillary sinuses, a saccharin test to assess mucociliary transport in the nose, and a viable cytological sampling of the nasal mucosa. Anamnesis showed a preponderance of symptoms of sinusitis and chronic rhinitis in the swimmer group, as well as a reddening of the nasal mucosa and a swelling of the adenoids. Sonography showed mucosal thickening in the antrum in more cases among the swimmers. Rhinomanometry, the saccharin test, and viable cytological sampling revealed no significant differences between the groups. It is argued that pathogenesis is more probable through cooling of the skin of the face and the whole body than through entrance of water into the upper respiratory tract.

Adolescent↗
PubMed1984

Computed tomographic diagnosis of distal radio-ulnar joint disruption.

Distal radio-ulnar joint dislocation may be a difficult diagnosis using standard wrist radiographs. We report a patient in whom standard films did not convincingly demonstrate a dislocation which was well seen with computed tomographic scans of the wrist. Computed tomography may be the method of choice for demonstrating distal radio-ulnar joint dislocation when this is suspected clinically but not seen with standard films.

Adult↗
PubMed1976

[Direct demonstration of Coxiella burnetii from air samples on slides coated with kraton 1107].

Inactivated Coxiella burnetti (strain Henzerling) was introduced into a sealed chamber in aerosol form and recovered on Kraton 1107-coated slides with the aid of slit samplers. Following auramine staining, the coxiellae could be demonstrated directly by microscopy. Under the experimental conditions chosen, the limits of demonstrability were initial Coxiella contents of 2.26 X 10(3) in 14 L or 3.6 X 10(5) in 1 m3 of air.

Aerosols↗
PubMed1975

[Multiplication of coxiella burneti in different tissues and organs of embryonated eggs (author's transl)].

Multiplication and content of Coxiella burneti after infection of the yolk sac were studied in different tissues and organs of embryonated hen's eggs (yolk sac, CAM, allantoamnion, amniotic fluid, liver, muscles, spleen, and heart). Demonstration of the agent was performed from the 6th to the 11th day p.i. by direct microscopic methods (Stamp and auramine staining, fluorescent antibody technique); the Coxiella content was determined by titration in embryonated hen's eggs. Coxiellae could be demonstrated, apart from the yolk sac membrane, also in the intestine and CAM from the 7th day p.i., and in the other organs examined from the 11th day p.i. by means of microscopy. For the same period, embryonic death rates (ELD50) and egg infectivity (EID50) were determined separately. The highest numbers of Coxiella were consistently found in the yolk sac membrane (ELD50 10(4.0)-10(5.2); EID50 10(6.0)-10(7.8)). In the intestine, CAM, allantoamnion, and amniotic fluid, ELD50 values were between 10(2.0) and 10(2.8), EDI50 values between 10(4.8) and 10(5.2), on the 11th day p.i.. Titres were lower for muscles, liver, spleen, and heart of infected embryos.

Allantois↗
PubMedDate not supplied

Nasal physiology in swimmers and swimmers' sinusitis.

To investigate the pathogenesis of swimmers' sinusitis we questioned and examined a group of 20 swimmers and 20 controls. Clinical examination was followed by rhinomanometry, sonography of the maxillary sinuses, a saccharine test to assess mucociliary transport in the nose, and a viable cytological sampling of the nasal mucosa. The history showed a preponderance of symptoms of sinusitis and chronic rhinitis in the swimmers' group, as well as a reddening of the nasal mucosa and a swelling of the adenoids. Sonography showed mucosal thickening in the antrum in more cases among the swimmers. Rhinomanometry, saccharine test, and viable cytological sampling revealed no differences of significance between the groups. It is discussed that pathogenesis is more probable through cooling of the skin of the face and the whole body than by entrance of water into the upper respiratory tract.

Adolescent↗