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PubMed1996

SEOPF high-grade match algorithm: the effect of HLA matching with ROP trays in transplanting highly sensitized patients. Southern Organ Procurement Foundation.

The SEOPF high-grade match (HGM) algorithm for sharing kidneys was designed to increase utilization of kidneys for excellent HLA matches, decrease sharing for poor HLA matches, and improve the chances for highly sensitized patients to receive a kidney transplant through the use of ROP crossmatch trays. All retrieved kidneys from participating centers were offered to the system to be shared for high-grade HLA matches after six-antigen match obligations were satisfied with UNOS. Kidneys were shared according to HLA matches in the following priority: 1) 0-ABDR mismatch six - Antigen Matches. 2) 0-AB mismatch PRA > 40%, ROP tray negative crossmatch. 3) 0-BDR mismatch PRA > 40%, ROP tray negative crossmatch. 4) 0-BDR mismatch PRA < 40%. All patients with PRA's > 40% must be represented on the ROP tray to be considered for a shared kidney. Preliminary ROP tray crossmatch results must have been known for these patients in order to access the system. Here we report results of 126 shared kidneys using the HGM algorithm from January 1994 to September 1995. HLA typing concordance between the initial typing of cadaver donors by the donor center and repeat typing by recipient center was 94.7%. There were six (5.3%) typing discrepancies: HLA-A, no typing discrepancies; HLA-B, 2 (1.8%) typing discrepancies; and HLA-DR, 4 (3.5%) discrepancies. A total of 34 of 126 (27%) kidneys were shared for patients with high grade HLA matches, PRA's > 40% and a negative ROP tray. Twenty-eight of 34 (82.4%) shared kidneys were final crossmatch negative and transplanted into the intended recipient. Six of 34 (17.6%) shared kidneys were transplanted into backup recipients. All six of the intended recipients had positive final crossmatches using enhanced crossmatch procedures, such as antiglobulin and flow cytometry. In conclusion, the HLA concordance rate for shared kidneys within SEOPF was 94.7%. Kidney sharing using the HGM algorithm was very effective in transplanting highly sensitized patients when good HLA matching was combined with a negative ROP tray result.

Algorithms↗
PubMed1997

[Gestational diabetes: the use of an intensive treatment program at the regional level].

In this study the results are shown of the application of an intensified treatment program of Gestational Diabetes (GD) in a regional setting. From January 1991 to June 1995, 115 women with GD were attended at Mútua Hospital in Terrassa; 62.6% of them required insulin to optimize the metabolic control. When insulin dependent women were compared with non insulin dependent women, diagnosis was earlier; age, progestational age, serum glucose in the O'Sullivan test and diagnostic basal serum glucose in oral overload (GOO) were higher. Regarding perinatal results, the incidence of gestational hypertensive disturbances, hydramnios, and urinary tract infections were 7%, 1.7%, and 8%, respectively. Perinatal mortality was 0.86%. Delivery occurred after 37 weeks in 96.5% of cases and the cesarean section was performed in 26%; nevertheless, this rate was similar to that in the obstetric population attended at this institution (25%). Birth weight was high for gestational age in 7.8% of newborns (NB) and low in 2.5%. Factors associated with fetal weight included progestational maternal weight, ponderal increase during pregnancy and metabolic control (HbA1c). The present study suggests that the application of an intensified treatment program for GD can be carried out in a regional setting and with overall successful results.

Adult↗
PubMed1998

Emerging opportunities for educational partnerships between managed care organizations and academic health centers.

Medical schools, teaching hospitals, and managed care organizations have a vested interest in shaping the knowledge, skills, and attitudes of the next generation of physicians who must adapt to significant changes in the financing and delivery of health care. This article summarizes the rationale for educational partnerships between managed care and academic medicine based on a review of three decades of well-documented experimentation in the literature. Discussed are some of the most important characteristics of the successful partnerships being forged in the current healthcare environment based on new kinds of relationships between faculty and non-university clinician educators. What had been referred to in previous decades as the "teaching-HMO" is now being complemented by community-based links between academic health centers and managed care plans. Several public and private sources have been generous in providing venture capital to support many of these innovations. However, their continued operation will depend on models for health care networks that can identify and manage the revenue and costs associated with the missions of education, clinical services, and research.

Academic Medical Centers↗
PubMed1989

Preservation activities and needs in U.S. biomedical libraries: a status report.

A national sample of health sciences and other types of libraries having significant holdings of biomedical literature was studied to determine the status of library preservation programs. Findings pertaining to 134 basic health sciences libraries and to ninety-seven resource libraries in the Regional Medical Library Program network are reported and discussed. Basic health sciences libraries participating in the study were primarily hospital libraries; resource libraries were primarily academic health sciences center libraries. Findings include information on topics perceived to be of greatest need for staff training and for informational or educational materials; on levels of preservation activity, staffing, and funding; and on capabilities for participating in a national cooperative preservation program. Efforts to identify general and special biomedical collections of potential importance to a national preservation program met with limited success.

Corrosion↗
PubMed1994

Genetic services in the United States.

Advances in medical genetics, including mapping of human genome, improved therapy for genetic disorders, and new screening tests for carrier detection and prenatal diagnosis, have created a growing demand for clinical genetic services in the United States. Such services (diagnosis, management, and genetic counseling) received support from state, federal, and private sources and were mostly based in academic medical centers. Gradually, such programs evolved into regional or state-wide activities with an emphasis on outreach clinics. Now, an increasing number of for-profit corporations have entered into this field. Clinical genetic teams usually include clinical geneticists and other professionals with expertise in the diagnosis and management of genetic conditions and skills in information presentation and family support. The American Board of Medical Genetics, the newest member of the American Board of Medical Specialties, provides certification for five categories of genetics professionals and sets standards for training programs. Based on personal experiences from the states of Alabama and Ohio and data from the Council of Regional Networks for Genetic Services, we show and compare trends of newborn screening programs and regional genetic services. The effects of economic and social trends as they impinge on genetic services are monitored via several databases in our center.

Alabama↗
PubMed1991

Regionalized perinatal transport systems: association with changes in location of birth, neonatal transport, and survival of very low birth weight deliveries.

Changes in both the location of very low birth weight births and in the number of infants selected for transport were chosen for the evaluation of regionalized perinatal care and its effectiveness in the Lowcountry Perinatal catchment area. The four-year period reviewed was characterized by the initiation of a well-defined regionalized perinatal transport program at the Medical University of South Carolina. In conjunction with this increased availability of transport, there was a statistically significant (p less than 0.02) increase in the number of VLBW neonates transported to MUSC after being delivered in community hospitals. This increase was accompanied by an increase in the proportion of infants referred for transport within the first hour of life. Among those neonates referred within the first four hours of life, survival was inversely proportional to the infant's age when the transport team arrived, suggesting that a rapid response by the neonatal transport team was associated with a significantly increased VLBW infant survival. Among all transported infants, in-utero continues to be the most efficacious means of transport for VLBW infants and that delivery of VLBW infants at regional medical centers continues to result in the most optimal survival.

Catchment Area, Health↗
PubMed1971

Small medical libraries can help also.

The Regional Medical Library program of the Dana Medical Library (Burlington, Vermont) is described. Practical problems of a regional program are discussed. A plea is made for providing regional service, however little or much, without waiting for surveys and large grants.

Information Services↗
PubMed1990

Interhospital referral of high-risk newborns in a rural regional perinatal program.

In light of increased competition for patients among hospitals, a trend toward deregionalization for perinatal programs and expansion of level II hospital neonatal intensive care services has been noted. This study investigates the determinants of the decision to transport very low birthweight (VLBW) babies born live at primary care community hospitals to a regional tertiary NICU or to a level II hospital in a semirural regional perinatal program. Data were collected from medical records of mothers and their newborns at 18 level I hospitals (primary care only), three level II hospitals (intermediate care), and the one tertiary hospital in the region. The sample includes all newborns with birthweights between 500 g and 1750 g born in 1983 (299). Despite dramatic increases in the proportion of very low birthweight deliveries at the tertiary center in the past decade, one third of the VLBW babies continue to be delivered at community hospitals in the study region. Although 25% of all transports from level I are to level II hospitals rather than to the level III hospital, birthweight and need for assisted ventilation were statistically significant determinants of transport of newborns from level I to level III hospitals rather than to a level II hospital. While both level I and level II hospitals are likely to transport newborns who need assisted ventilation to the level III hospital, the odds of transport are significantly higher for newborns born at level I as opposed to level II hospitals. Nontransported babies who were born at very low birthweight (less than 1000 g) died within 24 hours. The nontransported babies who survived had birthweights of greater than 1000 g, and fewer required assisted ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Experience with a partnership program for cardiac surgery at a regional military medical center.

A Partnership Program between USAF Medical Center, Wright-Patterson (WPAFB) and Miami Valley Hospital (MVH), Dayton, Ohio, was created through CHAMPUS to provide cardiac surgical services for eligible patients. During the first year of this program, 82 patients underwent 89 percutaneous transluminal coronary angioplasty (PTCA) procedures. Sixty-one patients underwent cardiac surgery at WPAFB, 50 were referred to MVH due to ineligibility or other reasons, and five were referred to other military or civilian hospitals. The program has been successful with low morbidity and mortality (3%). Cost savings for PTCAs was $241,853 and for cardiac surgery was $462,046.

Cardiac Surgical Procedures↗
PubMed2005

Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention.

BACKGROUND: Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). Transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes compared to fibrinolysis in Europe. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States. METHODS: We designed a standardized protocol and integrated system of transfer for patients with STEMI. We report the door-to-balloon times for the pre- and postpilot patients in the index hospital and describe the details of the current Level 1 MI Program. RESULTS: In the 15 months before the pilot project, the door-to-balloon time for patients receiving ad hoc transfer for direct PCI was 192 minutes, similar to the national average. The door-to-balloon time for the patients receiving rescue PCI after failed thrombolysis was 221 minutes. The standardized protocol decreased door-to-balloon time to 98 minutes in the pilot trial (P < .01) and has now been applied successfully in 29 community hospitals. CONCLUSIONS: Rapid transfer of patients with STEMI is feasible in the United States using a standardized protocol and integrated transfer system. This requires a team approach with cooperation between cardiologists, emergency physicians, nurses, and the emergency medical system as well as various health care organizations.

Angioplasty, Balloon, Coronary↗
PubMed2003

Teleconsultation: rejected and emerging uses.

OBJECTIVE: The aim of this paper is to analyse telemedicine as a new means to improve health care accessibility. METHOD: A case study design was used to understand how medical specialists perceived, made sense of, and appropriated a teleconsultation system. RESULTS AND CONCLUSIONS: The technology was used neither in the manner nor to the extent anticipated by its designers. A fundamental modification to the traditional medical consultation process has emerged. Unable to be used as a substitute to the traditional medical consultation process, the teleconsultation system imposes a greater burden on the shoulders of participating physicians who, after a few trials, returned to their traditional mode of practice.

Decision Support Systems, Clinical↗
PubMed2003

Tribal connections health information outreach: results, evaluation, and challenges.

In 1997, the National Library of Medicine (NLM), a component of the National Institutes of Health (NIH), initiated a program of intensified outreach to Native Americans, initially focusing on the Pacific Northwest in collaboration with the Pacific Northwest Regional Medical Library (PNRML). This initiative, known as the Tribal Connections Project, emphasized the establishment or strengthening of Internet connections at select Indian reservations and Alaska Native villages and related needs assessment and training. The hope was that these efforts would improve tribal access to health information available via the Internet and the Web. Phase I included sixteen tribal sites--eight in Washington, four in Alaska, two in Montana, and one each in Oregon and Idaho. Phase I results indicate that the project was successful in assessing local needs and building awareness of the Internet, forging new partnerships with and between the participating Indian reservations and Alaska Native villages and other organizations, making real improvements in the information technology (IT) infrastructure and Internet connectivity at fifteen of sixteen sites, and conducting training sessions with several hundred tribal participants across thirteen sites. Most importantly, the project demonstrated the key role of tribal community involvement and empowerment and contributed to development of an outreach evaluation field manual and the evolving concept of community-based outreach. The knowledge gained from Tribal Connections Project Phase I is helping refine and enhance subsequent NLM-sponsored tribal connections and similar community outreach efforts.

Community-Institutional Relations↗