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PubMedDate not supplied

Updated forecasts of the costs of medical care for persons with AIDS, 1989-93.

Data on the number of AIDS cases reported to the Centers for Disease Control (CDC) from January 1984 to June 1989 are used to predict the number of AIDS cases that will be diagnosed during the years 1989 through 1993. Using quadratic and linear models with the most recent data, it is projected that about 44,000 cases will be diagnosed in 1989, 56,000 in 1990, 70,000 in 1991, 87,000 in 1992, and 104,000 in 1993. These projections are lower than estimates derived using data from January 1984 to June 1988, and they are similar to estimates derived by the CDC. The lifetime medical care cost of treating a person with AIDS is estimated to be about $75,000 (all estimates are in 1988 dollars) assuming that the average length of survival is 15 months and that the intensity of care (that is, the cost of medical care per month) does not fall as longevity rises. This total, $75,000, reflects recent increases in the length of survival and the diffusion of costly drug therapies (for example, AZT and aerosol pentamidine). This study forecasts that the cumulative lifetime medical care costs of treating all people diagnosed with AIDS during a given year to be about $3.3 billion in 1989, $4.3 billion in 1990, $5.3 billion in 1991, $6.5 billion in 1992, and $7.8 billion in 1993.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Forecasting pollen pollution: correlation with floral development.

Variations in the time course of flowering and in its intensity were recorded for regions in Israel along with variable climatic conditions. Such variations had an effect on pollen release into the air and on pollen counts. Two approaches for forecasting allergenic pollen dispersion were compared: (1) a survey of floral development and flowering intensity and (2) a survey of airborne pollen. There was a positive correlation between the survey of flowering and airborne pollen counts, although pollen was occasionally found after the flowering season. Further, it predicted fairly accurately the beginning of the flowering time of each species in each regio, the expected flowering duration, and intensity. Conducting a survey of flowering is a simple, easy and inexpensive operation. It is highly recommended for regions with variable climates.

Air Pollution↗
PubMed1988

National forecasts of the medical care costs of AIDS: 1988-1992.

Two statistical extrapolation models and data on the number of AIDS cases reported between January 1984 and June 1988 yield projections on the future numbers of AIDS cases which are considerably higher than those of earlier projections, while analysis of the lifetime cost of treating an AIDS patient in 1988 dollars yields estimates lower than most previous estimates. Based on an estimate of $60,000 per patient holding between 1988 and 1992, the analysis forecasts the cumulative lifetime medical care costs of treating all AIDS patients diagnosed with AIDS to be about $2.6 billion in 1988, $3.5 billion in 1989, $4.7 billion in 1990, $6.0 billion in 1991, and $7.5 billion in 1992.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Numerical forecasting of epidemics of influenza in Great Britain and Northern Ireland.

Examination of the weekly incidence data collected by the Research Unit of the Royal College of General Practitioners in England, Wales, Scotland and Northern Ireland, shows that, for influenza, the highest weekly total and the rate of decrease from such a peak over the next 4 weeks are highly correlated with the mean rate of weekly increase over the period 7 weeks before to 3 weeks before the peak week. Analysis of the mean rate of increase over 4-week periods of the incidence of the Febrile Common Cold showed that it rose to a critical value some 3-4 weeks ahead of the influenza peak week, thus identifying the significant initial period of influenza increase. Formulae for the numerical forecasting for the 7-week progress of an influenza epidemic were derived from the data for the years 1968-1974 (8 winters). These were then tested on the data for the years 1974-1981 (7 winters) with satisfactory results.

Forecasting↗
PubMed1981

Forecast of the future of hospital pharmacy in Australia.

A study was undertaken to forecast the future of hospital pharmacy in Australia over the next 10-20 years. Future activities of hospital pharmacists, activities that should be downgraded or abandoned, and problems predicted to confront hospital pharmacists were identified. A modified Delphi technique using a series of three questionnaires, interspersed with controlled opinion feedback, was employed. In hospitals throughout Australia, 68 directors of pharmacy participated in the study. The final response rate of the survey was 72% (49/68). The consensus was that hospital pharmacists should: (1) perform activities that have a strong clinical emphasis, make greater use of computers in many areas of practice, offer extended hours of service, help develop graduate and postgraduate courses, and undertake a greater role in teaching and research; (2) downgrade activities of a repetitive, nonprofessional nature, especially those that could be performed by support personnel, such as bulk manufacturing, clerical duties, drug repackaging and handling, and dispensing procedures; and (3) abandon the purchase of nonpharmaceutical products, the manufacture of products commercially available, and certain clerical functions. It was predicted that pharmacists may face problems relating to financial restriction, managerial ability, quality of staff, and loss of professional integrity in the future. The results suggested that the future of hospital pharmacy in Australia will be subject to considerable change with respect to the activities undertaken by pharmacists and the problems that the profession may confront.

Australia↗
PubMed1994

Forecasting the effects of health reform on US physician workforce requirement. Evidence from HMO staffing patterns.

This article provides an estimate of the effects of health reform on the US physician workforce requirement. Its basic methodology is to extrapolate current patterns of staffing within managed care plans to the reshaped health care system of the year 2000. In this analysis it is assumed that 40% to 65% of Americans will be receiving care from integrated managed care networks in the near future, and that all citizens will be covered by some type of health insurance. On the basis of these assumptions, this article forecasts that in the year 2000, (1) there will be an overall surplus of about 165,000 patient care physicians; (2) the requirement and supply of primary care physicians will be in relative balance; and (3) the supply of specialists will outstrip the requirement by more than 60%. In summation, it appears that national health reform--based largely on an expansion of managed care networks--will have significant impact on the US physician workforce. Concerns have been raised by others that health system reform's shift toward more primary and preventive care will be stymied by workforce availability. This study underscores this concern to some degree. However, the evidence presented herein suggests that the issue is not so much a primary care provider shortage as a specialty care surplus.

Demography↗
PubMed1994

Quantitative applications: forecasting and costing nursing service at an Army community hospital.

The utilization of a quantitative method of forecasting, coupled with an existing patient classification system (the Army's Workload Management System for Nursing), provides a creative costing tool for managing nursing resources at military medical facilities. Although the nursing management options discussed in this article are focused on a downsizing situation at an Army Community Hospital, they are applicable throughout military medical facilities.

Forecasting↗
PubMed1993

Forecasting survival in the medical intensive care unit: a comparison of clinical prognoses with formal estimates.

Physicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient's stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient's first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.

Forecasting↗
PubMed1997

['Public Health Status Forecasting 1997': the sum of the parts].

The 1997 edition of Public Health Status and Forecasts, a comprehensive epidemiological overview of the health of the Dutch nation, suggests some important new strategies for the development of a more 'evidence-based health policy'. The growing gap between life expectancy in general and healthy life expectancy demands a stronger effort in the prevention of unhealthy lifestyles, especially smoking. Many indicators of health show the first signs of decline for the coming 10-20 years. The growing burden of chronic diseases and longlasting handicaps points towards a doubling of the present yearly rise in the health budget to at least 2%. Methodological innovations in measuring health effects are a striking feature of the 1997 'explorations' report.

Adolescent↗
PubMedDate not supplied

Forecasting the nursing workforce in a dynamic health care market.

The ability to discern the interacting factors that affect supply and demand for nurses could help nurse educators and nurse leaders allocate resources to meet these needs. Forecasting models must take into account the interactions of three crucial groups of health care providers--physicians, nurse practitioners, and physician's assistants. Buerhaus has noted that market size, wages, preferences for nursing services, and availability of substitutes influence the demand for nursing services. Changes in nurse supply resulting from Medicare reimbursement for nursing services have not been studied, though it could safely be projected that such reimbursement will increase nurse supply. Nurses with baccalaureate degrees and advanced practice preparation will be in the greatest demand in ambulatory care, managed care, public health, and home care settings, raising concerns again that the educational mix is in need of adjustment upwards.

Delivery of Health Care↗
PubMed1991

Evaluation of bayesian forecasting for individualized gentamicin dosage in infants weighing 1000 g or less.

We evaluated the use of Bayesian forecasting for gentamicin therapy in outborn infants weighing 1000 g or less irrespective of postnatal age. Dosages were individualized using a computer program, guided by early serum gentamicin assays after a loading dose and a database of population kinetics. Steady-state gentamicin levels achieved were compared with those from a regimen based on guidelines. A total of 26 gentamicin courses were individualized in 19 infants of 22 to 33 weeks' gestation, weighing 500 to 1000 g at 1 to 41 days of age. All steady-state trough levels were between 1 and 2.4 mg/L; peak levels were between 4.4 and 9.3 mg/L. The 95% confidence intervals were in almost identical ranges. The prevalence of toxic and suboptimal trough levels was less when compared with that of 23 gentamicin courses based on guidelines in 17 control infants. We conclude that early individualized gentamicin dosage over a range of postnatal age is a practical alternative and serum level distributions appear superior.

Bayes Theorem↗
PubMed1993

Comparison of vancomycin pharmacokinetics in hospitalized elderly and young patients using a Bayesian forecaster.

Limited data have been published that compare the pharmacokinetic parameters of vancomycin in elderly versus young patients. This study was designed to assess vancomycin pharmacokinetics in 148 elderly (> or = 60 years of age) and 140 young (18-59 years of age) hospitalized infected patients. Serum vancomycin concentrations were determined using fluorescence polarization immunoassay. Serum concentration-versus-time data were fitted to a two-compartment Bayesian forecasting program. Elderly versus young vancomycin pharmacokinetic parameters derived were as follows (patients with serum creatinine < or = 1.5 mg/dL); mean +/- standard deviation terminal disposition half-life (t1/2) of 17.8 +/- 11.8 versus 7.5 +/- 6.7 hours, respectively, P < .05; volume of distribution (Vz) of 74.2 +/- 32.3 versus 67.0 +/- 30.7 L, respectively, P = .16; and total body clearance (CL) of 0.71 +/- 0.41 versus 1.22 +/- 0.50 mL/min/kg, respectively, P < .05. Comparing subjects with normal serum creatinine values (< or = 1.5 mg/dL), the elderly required smaller daily doses as compared with the young group to maintain target peak and trough vancomycin serum concentrations (18.2 +/- 5.8 verus 25.2 +/- 7.8 mg/kg/day, P < .05). Stepwise multiple regression models for the pharmacokinetic parameters were developed to assess the predictive power of age, controlling for the effects of gender, total body weight, serum creatinine, and creatinine clearance. Age was consistently an independent and significant predictor of t1/2, Vz, and CL. These data demonstrate that elderly patients exhibit significant differences in vancomycin pharmacokinetic parameters compared with young patients and constitute a patient population in need of individualized vancomycin dosing due to substantial heterogeneity in physiologic and pharmacokinetic parameters.

Adolescent↗
PubMed1990

Forecasting spore concentrations: a time series approach.

Fungal basidiospores and Cladosporium spores are the two most numerous spore types in the air of Dublin and its surroundings. They are known to have allergenic components, and the aim of the study described here is to develop a predictive model for these spores. A very simple model, which combines an estimated diurnal rhythm with a simple, one-parameter time series model, provided good short-term forecasts. The one-step prediction error variance was reduced by 88% for Cladosporium spores and by 98% for basidiospores.

Air Microbiology↗
PubMed2006

Time series forecasting of cyanobacteria blooms in the Crestuma Reservoir (Douro River, Portugal) using artificial neural networks.

In this work, time series neural networks were used to predict the occurrence of toxic cyanobacterial blooms in Crestuma Reservoir, which is an important potable water supply for the Porto region, located in the north of Portugal. These models can potentially be used to provide water treatment plant operators with an early warning for developing cyanobacteria blooms. Physical, chemical, and biological parameters were collected at Crestuma Reservoir from 1999 to 2002. The data set was then divided into three independent time series, each with a fortnightly periodicity. One training series was used to "teach" the neural networks to predict results. Another series was used to verify the results, and to avoid over-fitting of the data. An additional independently collected data series was then used to test the efficacy of the model for predicting the abundance of cyanobacteria. All of the models tested in this study incorporated a prediction time (look-ahead parameter) equal to the sampling interval (two weeks). Various lag periods, from 2 to 52 weeks, were also investigated. The best model produced in this study provided the following correlations between the target and forecast values in the training, verification, and validation series: 1.000 (P = 0.000), 0.802 (P = 0.000), and 0.773 (P = 0.001), respectively. By applying this model to the three-year data set, we were able to predict fluctuations in cyanobacteria abundance in the Crestuma Reservoir, with a high level of precision. By incorporating a lag-period of eight weeks, we were able to detect secondary fluctuations in cyanobacterial abundance over the annual cycle.

Cyanobacteria↗
PubMed2001

Forecasting the start of the pollen season of Poaceae: evaluation of some methods based on meteorological factors.

The pollen of anemogamous plants is responsible for half the allergic diseases, that is to say a prevalence of 10% in the French population. Poaceae produce the first allergenic pollen almost everywhere. The work described in this article aimed to validate forecast methods for the use of physicians and allergic people who need accurate and early information on the first appearance of pollen in the air. The methods were based on meteorological parameters, mainly temperature. Four volumetric Hirst traps were used from 1995 to 1998, situated in two departments of Burgundy. Two of the methods tested proved to be of particular interest: the sum of the temperatures and the sum of Q10 values, an agrometeorological coefficient integrating temperature. A multiple regression, using maximum temperature and rainfall, was also performed but it gave slightly less accurate results. A chi 2-test was then used to compare the accuracy of the three methods. It was found that the date of onset of the pollen season could be predicted early enough to be useful in medical practice. Results were verified in 1999, and the research must be continued to obtain better statistical validity.

Allergens↗
PubMed2001

Model for forecasting Olea europaea L. airborne pollen in South-West Andalusia, Spain.

Data on predicted average and maximum airborne pollen concentrations and the dates on which these maximum values are expected are of undoubted value to allergists and allergy sufferers, as well as to agronomists. This paper reports on the development of predictive models for calculating total annual pollen output, on the basis of pollen and weather data compiled over the last 19 years (1982-2000) for Córdoba (Spain). Models were tested in order to predict the 2000 pollen season; in addition, and in view of the heavy rainfall recorded in spring 2000, the 1982-1998 data set was used to test the model for 1999. The results of the multiple regression analysis show that the variables exerting the greatest influence on the pollen index were rainfall in March and temperatures over the months prior to the flowering period. For prediction of maximum values and dates on which these values might be expected, the start of the pollen season was used as an additional independent variable. Temperature proved the best variable for this prediction. Results improved when the 5-day moving average was taken into account. Testing of the predictive model for 1999 and 2000 yielded fairly similar results. In both cases, the difference between expected and observed pollen data was no greater than 10%. However, significant differences were recorded between forecast and expected maximum and minimum values, owing to the influence of rainfall during the flowering period.

Allergens↗
PubMed1985

Forecasting the epidemic potential of influenza virus variants based on their molecular properties.

Sequence analysis of the influenza haemagglutinin, HA (H1 and H3) suggests that many antigenic variants that are identified but which do not become predominant differ from contemporary epidemic strains in one or two amino acids, in the region 188-193. This information may assist in the optimum selection of vaccine strains when multiple variants are co-circulating. Genome analysis of H1N1 virus, from 1977 to 1983 (but not of H3N2 virus thus far) has identified two instances when large changes in total genome sequence was associated with major epidemic activity. The early detection of such gross genetic changes may provide a further indicator that can be used to forecast the likelihood of more widespread activity than normal.

Amino Acid Sequence↗