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At least 37 records · Page 2Linked to original sources
PubMed1999

American Orthopaedic Foot and Ankle Society shoe survey of diabetic patients.

A one-page written survey was completed by 402 randomly selected patients with diabetes in five cities during a scheduled visit to their endocrinologist. Patients averaged 61.5 years of age and had been diagnosed with diabetes for 27.3 years. This study suggests that approximately 25% of adults with diabetes are at risk for developing foot ulcers, the precursor to deep infection leading to lower limb amputation. The goal at the inception of this project was to obtain benchmark data on the current level of prophylactic foot care being provided to adult patients with diabetes. The results of this survey suggest that most individuals with diabetes and their physicians are aware of potential diabetic foot morbidity, yet very few take advantage of prophylactic protective footware. Even fewer are presently taking advantage of benefits established through the Medicare Therapeutic Foot Bill. This survey highlights a substantial opportunity for improvement in the long-term care of individuals with diabetes.

Adolescent↗
PubMed2001

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities--update. Final rule.

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2002, as required by statute. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), relating to Medicare payments and consolidated billing for SNFs. As part of this annual update, we are rebasing and revising the routine SNF market basket to reflect 1997 total cost data (the latest available complete data on the structure of SNF costs), and modifying certain variables for some of the cost categories. Finally, we are implementing the transition of swing-bed facilities to the SNF PPS, effective with cost reporting periods beginning on and after July 1, 2002.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Children's rights in clinical research.

PURPOSE: To address the use of children and children's genetic information in research, analyze Icelandic laws as an example, review existing literature on children in clinical research, and describe nurses' actions as children's advocates. METHOD: An integrated literature review was conducted using theoretical and empirical literature on children as human subjects in clinical research. Five Icelandic laws were analyzed. FINDINGS: Legal protection of children as human subjects is an international issue and is lacking in Icelandic legislation. In spite of an identified need to protect children as human subjects, research on children's rights in clinical research is scarce. Nurses have not taken an active stance in protecting children as human subjects. CONCLUSIONS: The recently passed Bill on Health Sector Database in Iceland raises questions about protection of human subjects regardless of age and stature. The effects of this Icelandic case could have international implications regarding centralized health care databases, ownership of data, and related ethical and legal decisions.

Adolescent↗
PubMed1995

[Legal aspects of health insurance claims and their potential use as a data source for epidemiological research].

Health insurance claims are legal documents for the purpose of billing health care cost and not intended for medical certification. They contain valuable public health data as well as sensitive personal information which must be kept confidential. Conflicts arise between the public interest and the privacy protection when public health researchers attempt to perform studies using health insurance claims. This article examines the legal aspects of health insurance claims and proposes legitimate procedures and forms for using claims data in public health research: researchers should act as "contractors" to perform survey under the auspices of insurers instead of requesting the "disclosure" of the personal information.

Confidentiality↗
PubMed1996

Data security and patient confidentiality: the manager's role.

The maintenance of patient confidentiality is of utmost importance in the doctor patient relationship. With the advent of networks such as the National Health Service Wide Area Network in the UK, the potential to transmit identifiable clinical data will become greater. Links between general practitioners (GPs) and hospitals will allow the rapid transmission of data which if intercepted could be potentially embarrassing to the patient concerned. In 1994 the British Medical Association launched a draft bill on privacy and confidentiality and in association with this bill it is pushing for encryption of all clinical data across electronic networks. The manager's role within an acute hospital, community units and general practice, is to ensure that all employees are aware of the principles of data protection, security of hospital computer systems and that no obvious breaches of security can occur at publicly accessible terminals. Managers must be kept up to date with the latest developments in computer security such as digital signatures and be prepared to instigate these developments where practically possible. Managers must also take responsibility for the monitoring of access to terminals and be prepared to deal severely with staff who breach the code of confidentiality. Each manager must be kept informed of employees status with regard to their 'need to know' clearance level and also to promote confidentiality of patient details throughout the hospital. All of the management team must be prepared to train new staff in the principles of data security as they join the organisation and recognise their accountability if the programme fails. Data security and patient confidentiality is a broad responsibility in any healthcare organisation, with the Chief Executive accountable. In family practice, the partners are responsible and accountable. The British Medical Association believes as a matter of policy, that allowing access to personal health data without the patients consent, except in a legally allowable situation, should be a statutory offence.

Computer Communication Networks↗
PubMedDate not supplied

Population health effects of air quality changes due to forest fires in British Columbia in 2003: estimates from physician-visit billing data.

BACKGROUND: Major forest fires near populated areas during 2003 exacted a huge economic toll on communities in British Columbia. We designed a study to examine associations between PM2.5 and PM10 levels and physician visits in two affected communities. METHODS: Measurements of 24-hour averages of particulate matter (PM10 and PM2.5) obtained from the monitoring network of the BC Ministry of Water, Land and Air Protection were used to define weeks where forest fires resulted in increases in ambient PM. Weekly rates of physician visits for respiratory (ICD-9 codes 460-519), cardiovascular (390-459) and mental illnesses (290-319) obtained through the Medical Services Plan of BC, were compared for 2003 and aggregates of the 10 previous years. RESULTS: Both the Kelowna and Kamloops regions experienced five weeks of elevated 24-hour average PM levels, although maximum levels in Kelowna were greater. In the Kelowna region, increases in physician visits for respiratory diseases of between 46 and 78% above 10-year mean rates were observed for three weeks during the forest fire period. Similar effects were not observed in Kamloops. Effects on visits for cardiovascular diseases or mental disorders were not seen in either community. INTERPRETATION: Forest fire smoke was associated with an excess of respiratory complaints in Kelowna area residents. The lack of a similar effect in Kamloops is likely due to the population being exposed to lower levels of PM. The absence of apparent cardiovascular health effects may be due to selective effects of forest fire smoke on respiratory tract disease.

Air Pollution↗
PubMed2003

Uncertainties for endocrine disrupters: our view on progress.

The hypothesis that hormonally active compounds in the environment--endocrine disrupters--are having a significant impact on human and ecological health has captured the public's attention like no other toxicity concern since the publication of Rachel Carson's Silent Spring 1962. In the early 1990s, Theo Colborn and others began to synthesize information about the potential impacts of endocrine-mediated toxicity in the scientific literature (Colborn and Clement, 1992) and the popular press (Colborn et al., 1997). Recognizing the possibility of an emerging health threat, the U.S. Environmental Protection Agency (EPA) convened two international workshops in 1995 (Ankley et al., 1997; Kavlock et al., 1996) that identified research needs relative to future risk assessments for endocrine-disrupting chemicals (EDCs). These workshops identified effects on reproductive, neurological, and immunological function, as well as carcinogenesis as the major endpoints of concern and made a number of recommendations for research. Subsequently, the EPA developed a research strategy to begin addressing the recommendations (EPA, 1998a), and the federal government as a whole, working through the White House's Committee on the Environment and Natural Resources, increased funding levels and coordinated research programs to fill the major data gaps (Reiter et al., 1998). In parallel with these research efforts that were attempting to define the scope and nature of the endocrine disruptor hypothesis, the U.S. Congress added provisions to the Food Quality Protection Act (FQPA) and the Safe Drinking Water Act of 1996 to require the testing of food-use pesticides and drinking water contaminants, respectively, for estrogenicity and other hormonal activity. These bills were enacted into law, giving the EPA the mandate to implement them. The EPA, with the help of an external advisory committee, the Endocrine Disruptor Screening and Testing Advisory Committee (EDSTAC), determined that other hormonal activity should include androgens and compounds that affect thyroid function, and expanded the mandate to include all chemicals under EPA's jurisdiction, potentially including the 70,000 chemicals regulated under the Toxic Substances Control Act (Endocrine Disruptor Screening and Testing Advisory Committee [EDSTAC], 1998). EDSTAC recommended an extensive process of prioritization, screening, and testing of chemicals for endocrine-disrupting activity, including a screening battery that involves a combination of at least eight in vitro and in vivo assays spanning a number of taxa (EDSTAC, 1998). What started out as a hypothesis has become one of the biggest testing programs conceived in the history of toxicology and the only one that has ever been based on mechanism of action as its premise. As we pass the 10th anniversary of the emergence of the endocrine disruptor hypothesis, it is useful to look back on the progress that has been made in answering the nine questions posed as data gaps in the EPA's research strategy (EPA, 1998a)--not only to see what we have learned, but also to examine whether the questions are still appropriate for the goal, what gaps remain, and what directions should be emphasized in the future.

Animals↗
PubMedDate not supplied

Effectiveness, accountability, and efficiency.

Management of health care is compromised by its singular reliance on billing information--i.e., a claims trail tells little of what providers think. It relates to neither prevention of disease nor reduction of unnecessary health care costs. Billing information is not the substrate to be used in the pursuit of appropriateness, effectiveness, and value. To improve medical management of health care, a protected, but accessible clinical database is needed.

Data Collection↗
PubMed1985

Integration of database capabilities into a patient reporting system.

A database design is described which automatically archives computer-generated patient imaging and radioassay reports. Selected phrases are condensed so that data storage will be efficient without sacrificing a prose style of report. An indexed file structure has been used to facilitate rapid record retrieval even when several hundred thousand records are stored. Personnel time is considerably reduced for recalling patient records, preparing periodic summaries of studies completed, and performing administrative functions such as billing and keeping track of checked out images. Complex queries, such as "list all the patients between the ages of 50 and 60 on digitalis referred for a stress cardiac study, with left ventricular ejection fraction less than 40% and apical dyskinesis," become feasible. A system for data backup is described to protect against catastrophic data loss.

Computers↗
PubMed2005

Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units.

Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)-positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses' station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices.

Air Microbiology↗
PubMed1993

Users and uses of patient records. Report of the Council on Scientific Affairs. Council on Scientific Affairs, American Medical Association.

At present, there is significant momentum for developing and implementing computer-based patient records systems. It is essential that their development be guided by the functional requirements of the users and uses of patient records. Users can be grouped into seven categories: providers, patients, educators, researchers, payers, managers and reviewers, and licensing and accrediting agencies and professional associations. Uses of patient records include fostering continuity of care, supporting diagnosis and choice of therapy, assessing and managing health risks, documenting the services provided, maintaining accurate medical histories, billing and verifying payment, documenting professionals' experience, teaching students, preparing conferences and presentations, conducting research, formulating practice guidelines, and providing data to support utilization review, quality assurance, accreditation, and licensure. Patient records can be classified as primary records used by professionals while providing health care services or secondary records derived from primary records to aid nonclinical users. Protecting the confidentiality of patient information will restrict access to primary records for some users and should prevent inclusion of sensitive data in secondary records. The design features to be incorporated into computer-based record systems should expand the record's function from that of a simple device for documenting events into a powerful tool for providing and managing care.

American Medical Association↗
PubMedDate not supplied

Individual insurance: how much financial protection does it provide?

This paper examines the comparative financial protection provided by individual and group health insurance. Data sources include two national surveys of employer-based health plans and e-health insurance listings for individual coverage on the World Wide Web. Data on the use and cost of services are from the National Medical Expenditure Survey (NMES), a national household survey of Americans. We estimate that individual insurance pays on average 63 percent of the health care bill, whereas group health insurance pays 75 percent. Deductibles are much higher in individual insurance, and covered benefits are more meager. At 200 percent of poverty, the top 25 percent of health care users with individual coverage would spend 11 percent of their income for out-of-pocket health care expenses, as opposed to 6 percent for persons with group coverage.

Actuarial Analysis↗
PubMed1998

Two routes to privacy protection: a comparison of health information legislation in Canada and the United States.

The privacy of health information is a subject of great sensitivity in both Canada and the United States. As a result of public demands for more effective protection of such information as medical records, Canada and, particularly, its provincial governments, have implemented extensive legislation. The United States, on the other hand, has largely confined its efforts to private sector initiatives that are more reflective of voluntary codes than legal statutes. Because new technologic developments facilitate data sharing in the medical field, especially in the face of a continual reduction of healthcare budgets, the concern for privacy protection in this domain has intensified. Correspondingly, there has been a gradual theoretical shift in protective health information policies on both sides of the border. As Canada pushes to extend its federal and provincial legislation to the private sector, the United States is on the brink of approving a national bill that would protect the privacy of personal medical records. It is becoming evident that efforts to secure the privacy of health information in both countries are converging.

Canada↗
PubMedDate not supplied

Statewide survey of risk factor prevalence: the Ohio experience.

In 1982, a statewide survey was conducted to determine the prevalence of health risk factors among Ohio's population. The survey was mandated by a health education-risk reduction grant to the Ohio Department of Health. The background, development, and validation of the survey instrument are described. The four goals of "Health Ohio"--the collection of descriptive statistics on selected risk factors for adult Ohioans, the compilation of baseline data, the development of a standard methodology for a prevalence survey, and the reporting of these findings for potential users of the data--were achieved. The population sample consisted of 607 Ohioans aged 18 and older who were polled by telephone. Subjects were selected through a modified random digit dialing technique. As a result of this technique and the designation of a specific household respondent, demographic characteristics of the sample matched those of the State's population in the 1980 census. Among the implications of the survey findings were the needs to (a) remove economic barriers that apparently impede the installation of residential smoke detectors, (b) initiate health education at an earlier age to counter cigarette smoking trends, and (c) encourage adult self-determination in reducing health risk. The February 1982 "Health Ohio" data describing the need for intervention to reduce health risk factors have become the basis for health education-risk reduction efforts of the Ohio Department of Health. In addition, "Health Ohio" has spawned two local prevalence surveys in the State; these resulted in more precise local data on the prevalence of health risk factors. Other multiplier effects of health education-risk reduction projects should be documented for future reference.

Adolescent↗
PubMed1980

Patient confidentiality and privacy: the Federal initiative.

Individual privacy rights are considered in the context of our increasingly computerized society. Guidelines for the maintenance of confidentiality of health care records are reviewed, and the provisions of four bills under consideration by Congress are examined. The dangers of legislation that authorizes government access to mental health treatment data are underlined, and preventive action on the part of mental health professionals is urged.

Civil Rights↗
PubMed2002

Employer-sponsored insurance: how much financial protection does it provide?

The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers. Individuals who incur high costs pay a smaller share of the bill than do those with lower levels of spending. The generosity of employer-sponsored plans increased slightly in the 1990s.

Adult↗