[Analysis of morbidity and the ratio of patients with malignant lymphomas in the Russian Federation].
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Adolescent↗
SEARCH · PubMed Health
Results for “Federated analysis”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Paying the medical cost of the HIV epidemic: a review of policy options.
The complex health care needs of people with HIV infection highlight inadequacies in our health care financing system and raise the question of how best to pay for care. AIDS requires a broad continuum of care to maintain high quality and reasonable costs. A simultaneous need is to assure access to care for patients with HIV infection who lack insurance or entitlement to health care benefits. We suggest new and practical payment mechanisms that can encourage the availability of comprehensive care for people with HIV infection. We suggest changes in state and federal payment policies that would make the cost of providing AIDS care more of a collective, community responsibility. We recommend mandated workplace insurance, extension of Medicaid eligibility to all with incomes below the federal poverty level, an opportunity for individuals with incomes to 200% of the poverty level to purchase Medicaid coverage, mechanisms to encourage public and private agencies to pay for continued health insurance after loss of employment, and a shortened waiting period for Medicare disability.
Acquired Immunodeficiency Syndrome↗
A proposal for a federal AIDS immunization policy.
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Acquired Immunodeficiency Syndrome↗
Single-strand conformation polymorphism analysis with high throughput modifications, and its use in mutation detection in familial hypercholesterolemia. International Federation of Clinical Chemistry Scientific Division: Committee on Molecular Biology Techniques.
The identification of the specific mutation causing an inherited disease in a patient is the framework for the development of a rationale for therapy and of DNA-based tests for screening relatives. We present here a review of the single-strand conformational polymorphism (SSCP) method, which allows DNA fragments that have been amplified with specific primers and PCR to be scanned rapidly for any sequence variation. The general principles of the method are described, as are the major factors that must be considered in developing an optimal SSCP strategy, namely the length of the PCR fragment and the temperature of the gel run. Options for sample denaturing gel characteristics and detection of DNA fragments are discussed. In addition, several modifications are presented that have been developed for high-throughput mutational analysis. The application of these techniques to screen for mutations in the LDL receptor gene in patients with familial hypercholesterolemia are described.
DNA↗
Analysis of the nursing workforce crisis: a call to action.
In our integrative review of reports on the health care workforce shortage, we examined 15 reports that focused primarily on nursing and were conducted by various stakeholders. We studied these reports objectively, identifying problems and solutions as described by the authors, which we then categorized by theme. We found problems at both the national and institutional levels and noted that the reports contained similar problem and solution "themes." Yet we also found gaps between these-some problems had no solutions and some solutions didn't address any of the suggested problems. Gaps occurred among problems and solutions listed in the following theme categories: demand, health care economics, workforce planning, research and data support, and technology. Despite the urgent need, we still lack a national strategy designed to avert the nursing shortage. This review may provide a foundation for such a plan.We present the results of our analysis and our recommendations to the federal government and national organizations, to institutions, and to nurses. These recommendations don't provide a comprehensive strategy for averting the nursing shortage, but they do offer a basis upon which one may be created.
Health Planning↗
Analyzing the economic value of the hepatitis B--Haemophilus influenzae type B combination vaccine by reverse engineering a formulary selection algorithm.
Combination vaccines for pediatric immunization provide a means to reduce the number of separate injections required to immunize children. This paper reports the results of reverse engineering a vaccine selection algorithm to evaluate the economic value of a hepatitis B-Haemophilus influenzae type B combination vaccine that is currently under federal contract in the United States. This analysis captures the tradeoff between the cost assigned to administering an injection and the price of the vaccine that earns it a place in the lowest overall cost formulary. Given the current United States federally negotiated price for this combination vaccine (as of 9 August 2002), it provides a good economic value for those health-care providers or payers who value the cost associated with administering an injection to be at least US$ 4.02 or 5.01. These two values are a function of the number of doses of the combination vaccine required to be in the lowest overall cost formulary and whether the perinatal hepatitis B dose is administered. Moreover, as the cost of an injection increases, the combination vaccine provides a better value than monovalent vaccines.
Algorithms↗
Policy improvements for prevention of alcohol misuse by airline pilots.
Alcohol abuse by airline pilots poses a potential danger to the safety and welfare of the flying public. This paper analyzes two strategies for reducing pilot-error aviation accidents: conducting background checks on pilots for driving-while-intoxicated (DWI) convictions and random preflight alcohol testing of airline pilots. Although both policies have been implemented, no empirical research had previously been conducted to justify either strategy. The results and conclusions of this study are based on analysis of data obtained from the Federal Aviation Administration on the flying performance of 70164 airline pilots. DWI convictions were found to be associated with a significantly greater risk of a pilot-error accident. In contrast, no evidence was found to validate the assumption that a random alcohol testing program could have prevented accidents. The results provide support for improving the existing DWI background check program and for reducing the sampling rate of random alcohol testing for airline pilots. This twofold strategy could result in greater improvements in aviation safety and reduced overall costs.
Accidents, Aviation↗
Quality-control materials in the USDA National Food and Nutrient Analysis Program (NFNAP).
The US Department of Agriculture (USDA) Nutrient Data Laboratory (NDL) develops and maintains the USDA National Nutrient Databank System (NDBS). Data are released from the NDBS for scientific and public use through the USDA National Nutrient Database for Standard Reference (SR) ( http://www.ars.usda.gov/ba/bhnrc/ndl ). In 1997 the NDL initiated the National Food and Nutrient Analysis Program (NFNAP) to update and expand its food-composition data. The program included: 1) nationwide probability-based sampling of foods; 2) central processing and archiving of food samples; 3) analysis of food components at commercial, government, and university laboratories; 4) incorporation of new analytical data into the NDBS; and 5) dissemination of these data to the scientific community. A key feature and strength of the NFNAP was a rigorous quality-control program that enabled independent verification of the accuracy and precision of analytical results. Custom-made food-control composites and/or commercially available certified reference materials were sent to the laboratories, blinded, with the samples. Data for these materials were essential to ongoing monitoring of analytical work, to identify and resolve suspected analytical problems, to ensure the accuracy and precision of results for the NFNAP food samples.
Agriculture↗
Impact of U.S. Federal welfare reform law on children with mental disorders receiving SSI.
An analysis of statistical reports from the Social Security Administration's Office of Research, Evaluation, and Statistics suggests that the Federal welfare reform law had a negative impact on the number of children under age 18 with mental disorders receiving SSI benefits. This was evident about a year after the enactment of welfare reform. Over a three-year time frame, 65 percent of the SSI children under age 18 were disabled based on a mental disorder. The study focused on the three diagnostic groups that are reported by the Social Security Administration within the diagnostic category of mental disorders: schizophrenia, psychiatric diagnoses, and mental retardation. By the end of the second year after the enactment of welfare reform, an increase was noted in the number of children with mental disorders receiving SSI, but the number was still less than the number before the enactment of welfare reform.
Adolescent↗
Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability.
Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.
Adolescent↗
Health care technology and the inevitability of resource allocation and rationing decisions. Part I.
Increasingly, it is recognized that resources available to meet health care needs are limited. Recently, this has been evidenced by reductions in federally funded health care programs and the leveling off of research funds made available to the National Institutes of Health. The problem of severely constrained resources is likely to become more acute, given new medical technology and the high cost of medical care. It is now apparent that both resource allocation and resource-rationing decisions will become inevitable, since not all persons with catastrophic or complicated medical conditions will be able to benefit from medical technology. While the careful assessment of health care technology can conceivably increase the efficiency of the health care delivery system, the methods by which allocation and rationing decisions are made must be improved. In doing so, it will ultimately be essential for this society to come to grips with life and death issues in a manner to which it is not accustomed.
Biomedical Research↗
Financial-ratio analysis and medical school management.
The value of a uniform program of financial assistance to medical education and research is questioned. Medical schools have an uneven ability to compensate for declining federal capitation and research grants. Financial-ratio analysis and cluster analysis are utilized to suggest four adaptive responses to future financial pressures. The four potential avenues of response involve reducing faculty size, expanding faculty involvement in medical practice plans, raising tuition, and in some cases increasing state-government support. Medical schools will also have to strive for better financial management if the 88 institutions revealed to be in poor financial health are to survive.
Education, Medical↗
The Patient Self-Determination Act and the future of advance directives.
Living wills and other advance directives currently play a limited role in medical decision making. A new federal law, the Patient Self-Determination Act, will require health care providers in hospitals, nursing homes, and other facilities to inquire about the presence of advance directives, to record patient preferences in the medical record, and to develop institutional policies regarding the implementation of these directives. Unfortunately, the law does little to promote discussion or preparation of advance directives before hospitalization. Additional efforts to promote the use of advance directives can take place in the outpatient medical care system, in attorneys' offices, or through health insurers. Because most people have not yet prepared an advance directive, we suggest that institutions develop treatment policies for situations in which the wishes of patients who lack decisional capacity are not known. These policies should be designed to promote the patients' best interests, as defined by the consensus of the institutions' staff and members of the surrounding community.
Advance Directives↗
P21WAF1, P27KIP1, TP53 and C-MYC analysis in 204 ovarian carcinomas treated with platinum-based regimens.
BACKGROUND: The prognostic and predictive value of cell cycle regulatory proteins in ovarian cancer has not been established. We evaluated the clinical and biological significance of P21(WAF1), P27(KIP1), C-MYC, TP53 and Ki67 expressions in ovarian cancer patients. MATERIALS AND METHODS: Immunohistochemical analysis was performed on 204 ovarian carcinomas of International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IV treated with platinum-based chemotherapy. Multivariate analysis with Cox and logistic regression models was performed in the whole group, and in the TP53-negative and TP53-positive subgroups. RESULTS: High P21(WAF1) labeling index (LI) was an independent positive predictor of platinum-sensitive response (P = 0.02). Overall survival was positively influenced by P21(WAF1) LI (P = 0.02) or by P21(WAF1) plus P27(KIP1) LI (P = 0.004) in the TP53-negative group only. Ki67 LI showed borderline association with disease-free survival (P = 0.05). Growth fraction was negatively associated with P21(WAF1) and P27(KIP1) indices in the TP53-negative group (P = 0.023 and 0.008, respectively), and these associations were borderline or lost in the TP53-positive group. Endometrioid and clear cell carcinomas differed from other carcinomas by having a low incidence of TP53 accumulation, a high incidence of C-MYC overexpression (70%) and a low median Ki67 LI (all with P <0.001). CONCLUSIONS: We have shown an independent predictive value of P21(WAF1) LI in ovarian carcinoma patients. The prognostic value of P21(WAF1) and P21(WAF1) plus P27(KIP1) LI was determined by TP53 status. A high frequency of C-MYC overexpression in endometrioid and clear cell carcinomas may suggest its role in the development of these tumor types.
Adult↗
What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.
In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered. Each cohort was followed for 12 months before the program began and 12 months afterward. The outcome measures of primary interest were the differences over time in medical care expenditures paid by FEP and by all payers. Independent variables included indicators of program participation, type of heart disease, comorbidity measures, and demographics. From the perspective of the funding organization (FEP), the estimated return on investment for the pilot CHF disease management program was a savings of $1.08 in medical expenditure for every dollar spent on the program. Adding savings to other payers as well, the return on investment was a savings of $1.15 in medical expenditures per dollar spent on the program. The amount of savings depended upon CHF risk levels. The value of a pilot initiative and evaluation is that lessons for larger-scale efforts can be learned prior to full-scale rollout.
Adult↗
USMLE (United States medical licensing examination) step 1 examination. Legal vulnerability.
Since the passage of the Civil Rights Act of 1964, the courts have ruled that sponsors of job entry assessment procedures must demonstrate the absence of discrimination against minorities. If an assessment discriminates, the courts may prohibit the use of the assessment unless the assessment is linked to a job analysis and exhibits validity. In 1994, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) instituted a three-step USMLE examination program as a single pathway for medical licensure. The Step 1 examination is not linked to a physician job analysis, exhibits lower scores for minority groups, and lacks construct validity. To avoid the chaos and expense of a protracted legal challenge, the FSMB and the NBME may need to revise the Step 1 examination, or discontinue it as a requirement of medical licensure.
Civil Rights↗
The cost-effectiveness of voluntary counseling and testing of hospital patients for HIV.
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Cost-Benefit Analysis↗
The utility of Wechsler Adult Intelligence Scale profile analysis with prisoners.
Determined the efficacy of profile analysis with a prison population (63 white, 63 black) of the Petersburg Federal Correctional Institution as Ss. By use of Veldman's Hierarchical Profile Analysis, five distinctive WAIS profile types were derived empirically for each racial group. Analyses of covariance that controlled for full-scale IQ differences revealed significant differences among the profile types within each race in terms of Stanford Achievement Test scores and MMPI T-scores. Further, partial correlations indepepdent of full-scale IQ revealed significant relationships between some of the profile types and the commission of rule infractions while incarcerated. These findings are interpreted as supportive of profile analysis with inmate populations. However, it is suggested that further research be effected to cross-validate these findings.
Adolescent↗