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PubMedDate not supplied

Implementation and evaluation of a new automated interactive image analysis system.

OBJECTIVE: To compare automated interactive screening using the ThinPrep Imaging System with independent manual primary screening of 12,000 routine ThinPrep slides. STUDY DESIGN: With the first 6,000 cases, the Review Scopes (RS) screening results from the 22 fields of view (FOV) only were compared to independent manual primary screening. In the next 6,000 cases, any abnormality detected in the 22 FOV resulted in full manual screening on the cytotechnologist's own microscope. Sensitivity and specificity together with their 95% CIs were calculatedfor each method. RESULTS: In the first set of 6, 000 cases, diagnostic sensitivity and specificity of the imager were 85.19% and 96.67%, respectively. The diagnostic sensitivity and specificity of manual primary screening were 89.38% and 98.42%. This highersensitivity and specificity of manual primary screening were found to be statistically significant. The second set of 6,000 cases demonstrated no significant statistical difference in sensitivity or specificity between the sets of data. CONCLUSION: The results from our study show that the sensitivity and specificity of the imager technology are equivalent to those of manual primary screening. The system is ideally suited to the rapid screening of negative cases, allowing increased laboratory productivity and greater throughput of cases on a daily basis.

Carcinoma↗
PubMed2004

Self-help: What future role in health care for low and middle-income countries?

In the debate on 'Third options' for health care delivery in low- and middle-income countries it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform.Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a de-personalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure.In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as self-help groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems - they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.

Editorial↗
PubMed2006

Assessing country-level efforts to link research to action.

We developed a framework for assessing country-level efforts to link research to action. The framework has four elements. The first element assesses the general climate (how those who fund research, universities, researchers and users of research support or place value on efforts to link research to action). The second element addresses the production of research (how priority setting ensures that users' needs are identified and how scoping reviews, systematic reviews and single studies are undertaken to address these needs). The third element addresses the mix of four clusters of activities used to link research to action. These include push efforts (how strategies are used to support action based on the messages arising from research), efforts to facilitate "user pull" (how "one-stop shopping" is provided for optimally packaged high-quality reviews either alone or as part of a national electronic library for health, how these reviews are profiled during "teachable moments" such as intense media coverage, and how rapid-response units meet users' needs for the best research), "user pull" efforts undertaken by those who use research (how users assess their capacity to use research and how structures and processes are changed to support the use of research) and exchange efforts (how meaningful partnerships between researchers and users help them to jointly ask and answer relevant questions). The fourth element addresses approaches to evaluation (how support is provided for rigorous evaluations of efforts to link research to action).

Biomedical Research↗
PubMed2006

School nurse practice: a decade of change.

Good practice requires an evidence base and criteria for assessment, which was the subject of a scope review of school nurse practice across the four countries of the UK. The findings demonstrate a rich base of research into service practice, particularly in the last decade. School nursing practice has experienced a paradigm shift from a medical to a social model of care. The service now works from a public health ethos and has a preventive agenda. The focus is on the child rather than a service for schools and school nurses work in teams rather than alone. Under-resourcing continues to beleaguer school nurse practice and there are areas that need further study, particularly large-scale research into the costs and benefits of school nursing.

Adolescent↗
PubMed1989

Medicare program; peer review organizations; revised scopes of work for Maryland; New Jersey; the Virgin Islands; and Guam, American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands--HCFA.

This notice describes requirements for the third Scope of Work for Utilization and Quality Control Peer Review Organizations (PROs). Specifically, this notice: (a) Identifies the requirements of the third Scopes of Work in Maryland and the Virgin Islands; (b) Recognizes the continuing requirements of the Scope of Work currently in effect in the PRO area of Guam/American Samoa/Northern Mariana Islands/the Trust Territory of the Pacific; and (c) Announces a change in the Scope of Work in effect in New Jersey. This notice also implements section 4091(b)(1) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203), which requires us to publish a new policy or procedure adopted by the Secretary that affects substantially the performance of contract obligations at least 30 days before the date the policy or procedure is to be used. It also implements other provisions of Pub. L. 100-203, as well as requirements of the Omnibus Budget Reconciliation Act of 1986.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Medicare program; description of the Health Care Financing Administration's evaluation methodology for the Peer Review Organization 5th Scope of Work contracts--HCFA. General notice with comment period.

This notice describes how HCFA intends to evaluate the Peer Review Organizations (PROs) for quality improvement activities, under their 5th Scope of Work (SOW) contracts, for efficiency and effectiveness in accordance with the Social Security Act. In accordance with the provisions of the Government Performance and Results Act of 1993, the 5th SOW contracts with the PROs are performance-based contracts.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Physician participation in quality management. Expanding the goals of peer review to detect both practitioner and system error.

BACKGROUND: The goals of peer review are to improve the quality of medical care and to provide fair review of individual practitioner actions, judged against the local standard of medical care. A new system for conducting peer review was evaluated which included in every case a root cause analysis to identify latent system flaws and a consideration of performance improvement projects to remedy these flaws. METHODS: The peer review committee of the medical service in a tertiary care, affiliated Department of Veterans Affairs Medical Center, which conducted the evaluation, was familiar with the local standards of care and the systems issues relevant to each case. Four questions were answered for each case: Was the quality of care less than ideal? If so, was the practitioner negligent? What system flaws contributed to the error or to the severity of injury? How could the system flaws be eliminated? RESULTS: Compared with the prior method of peer review, expanding the scope of review identified four times as many system problems (in 46% of cases versus 11%) without changing the incidence of finding provider negligence (21% preintervention versus 25% postintervention). Performance improvement projects were generated in 36 of 89 of these cases during the three-year period. DISCUSSION: Expanding the scope of peer review to include both root cause analysis and performance improvement thinking increased the detection of latent system flaws and the number of performance improvement projects without compromising the peer review committee's ability to identify negligence.

Hospitals, Veterans↗
PubMed1992

Medicare program; Peer Review Organizations: revised scopes of work for the District of Columbia, Puerto Rico, the Virgin Islands, and all states except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming--HCFA. Final notice.

This notice describes requirements for the review activities of Utilization and Quality Control Peer Review Organizations (PROs) under contract extensions of the Scope of Work for the District of Columbia, Puerto Rico, the Virgin Islands and all States except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming. Section 1153(h)(1) of the Social Security Act requires us to publish any new policy or procedure adopted by the Secretary that affects substantially the performance of PRO contract obligations at least 30 days before the date the policy or procedure is to be used. Specifically, this notice describes the way in which PRO contract requirements are changed and explains significant changes in the PRO program (e.g., the way in which cases will be selected for review) and also describes continuing requirements. This notice also implements provisions of the Omnibus Budget Reconciliation Act of 1990.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicare program; Peer Review Organizations: revised scopes of work for Delaware, Missouri, Montana, Nebraska, New Jersey, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming--HCFA. Final notice.

This notice describes requirements for the review activities of Utilization and Quality Control Peer Review Organizations (PROs) for the next contract cycle in the States listed above. Section 1153(h)(1) of the Social Security Act requires us to publish any new policy or procedure adopted by the Secretary that affects substantially the performance of PRO contract obligations at least 30 days before the date the policy or procedure is to be used. Specifically, this notice describes significant changes in the way in which cases will be selected for review and also describes continuing requirements. This notice also implements provisions of the Omnibus Budget Reconciliation Act of 1990 and announces the future direction of the PRO program.

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

Solid-phase extraction of phenols.

Sample preparation for phenol analysis using solid-phase extraction (SPE) is reviewed. The scope of the review has been restricted to the literature dealing with the analysis of phenols as the main objective. The use, advantages and disadvantages of silica sorbents, polymeric, functionalized, carbon-based and mixed available sorbents, when applied to the separation and preconcentration of phenols, as well as the available experimental devices, are discussed. Other aspects such as phenol derivatisation prior to SPE, solid-phase microextraction, matrix effects and the storage of phenols in SPE cartridges, have been also discussed.

Chromatography, Liquid↗
PubMed2002

Preventive capacity of subcutaneous immunotherapy.

PURPOSE OF REVIEW: The scope of this review is to highlight important and interesting articles about the preventive aspects and capacity of allergen-specific subcutaneous injection immunotherapy. RECENT FINDINGS: There is increasing amount of data that immunotherapy may have a preventive effect in carefully selected patients, both in the development of asthma in patients with allergic rhinitis and in the development of new immunoglobulin E-mediated sensitizations. SUMMARY: The preventive capacity of subcutaneous immunotherapy in suppression of the development of new immunoglobulin E sensitizations and the progression of the allergic disease into a more severe form are interesting topics in the field of allergen-specific immunotherapy. Allergen-specific immunotherapy, the subcutaneous administration of increasing doses of allergen extracts, is the only specific and curative approach towards the treatment of immunoglobulin E-mediated allergy. Immunotherapy affects the natural course of allergic disease, and induces prolonged clinical remission when the treatment is continued for several years, which has raised the question of whether it should be considered earlier in the management of allergic diseases. There is an urgent need for large controlled multi-center studies to show the preventive aspects in different patient populations.

Asthma↗
PubMed2003

T-cell immunotherapy of allergic disease: the role of CD8+ T cells.

PURPOSE OF REVIEW: The scope of this review is to place recent advances in T-cell immunotherapy into an account of our understanding of the potential role of CD8+ T cells in the pathogenesis of allergic disease. RECENT FINDINGS: Studies over the last year suggest that changes in CD8+ T-cell function may represent key events in successful T-cell immunotherapy. The first human human leukocyte antigen class I allergen epitopes have now been described and will provide further insights into the role of allergen-specific CD8+ T cells. SUMMARY: The coupling of recent technical advances in the study of antigen-specific T cells with the knowledge of human allergen class I epitopes will promote rapid progress in the field, with potential consequences for the diagnosis, monitoring and immunotherapeutic treatment of affected individuals.

CD8-Positive T-Lymphocytes↗
PubMed1980

Blood/gas equilibrium of carbon dioxide in lungs. A critical review.

(1) The scope of this review is to examine the experimental evidence for the existence of negative PCO2 differences between pulmonary capillary blood and lung gas, [delta PCO2(b-G)], which have been observed both during rebreathing, when CO2 was at equilibrium, and during steady state gas exchange, particularly in hypercapnia. (2) The mechanism that have been invoked to explain negative delta PCO2(b-G) include (i) slow equilibration of the system CO2/HCO3-/H+ in blood, and (ii) effects of a negatvely charged surface of the pulmonary capillary endothelium. While the first postulated mechanism appears to be quantitatively insufficient to explain the results, the second seems to lead to serious qualitative difficulties. (3) Existence of negative delta PCO2(b-G) in CO2 equilibrium would invalidate the basis of the conventional analysis of alveolar gas exchange. (4) A critical analysis of the experimental evidence for the existence of negative delta PCO2(b-G) is presented. It includes the identification of directional experimental errors leading to spurious negative delta PCO2(b-G), and a critical review of the literature data in this regard. (5) Results of own experiments, conducted in an attempt to consider all possible sources of error, are reported, revealing (i) perfect PCO2 equality between alveolar gas and blood in rebreathing equilibrium of CO2; (ii) absence of negative delta PCO2 (b-G) during steady state gas exchange in hypercapnia. (6)Both experiments and model calculations show that negative delta PCO2 between mixed venous blood and end-expired gas observed in birds at steady state of gas exchange are explained by a particular action of the Haldane effect in avian parabronchial lungs with cross-current arrangement of gas and blood flow. (7) It is concluded that the negative delta PCO2(b-G) reported in the literature are probably artifactual and that there is no adequate evidence to invalidate the traditional view according to which blood/gas CO2 equilibration in lungs leads to equal PCO2 in both media.

Animals↗
PubMed1984

Population screening and the early detection of dementing disorders in old age: a review.

The scope for the early detection of dementing disorders in the elderly by means of screening techniques is reviewed in the light of the basic principles of early disease detection. It is concluded that, while there is an increasingly urgent need for the development and application of psychogeriatric screening methods as a step towards preventive action, such methods are still at an early experimental stage. Prescriptive screening programmes are contra-indicated at present. The most immediate requirement is for evaluative research, which should be planned to take account both of the properties of the screening instruments and of the health-care and social settings in which these are to be applied. No major progress in this field can be expected unless it proves possible to integrate methods of early case-detection, and of systematic surveillance of the at-risk elderly, into the work of primary medical and social services.

Aged↗
PubMed2000

Mental health disorders in children and young people: scope, cause and prevention.

OBJECTIVE: To review the scope and characteristics of mental health disorders in children and young people in Australia; detail some emerging concepts of the causal pathways of mental health disorders in children and young people; and discuss aspects of the prevention of mental health disorders and the promotion of mental health in children and young people. METHOD: An integrated review of selected literature. RESULTS: (i) While as many as one in five Australian children aged from four to 17 have significant mental health problems there remains a need for prevalence estimates in subsections of the population, notably children and young people of Aboriginal and Torres Strait Islander descent; (ii) appropriate studies of gene-environment interaction will require better measurement and developmental exposition of those risk exposures that are known to be on the causal pathway to mental health disorder; and (iii) universal, selective and indicated prevention trials and evaluations directed at anxiety, depression and conduct disorder are needed. CONCLUSION: Preventive intervention and promotion in mental health must entail effective collaboration at national, state and local levels between health, welfare and education sectors. These sectors must be informed by high quality epidemiology and a knowledge of the causal pathways of mental health disorders. Such intervention must also improve the movement of scientific knowledge to political policy on one hand and to praxis on the other. This will require a clear and persistent vision of the urgency, costs and consequences of mental health disorders in children and young people coupled with effective leadership and political resolve.

Adolescent↗
PubMed2006

Effects of zeolites on cultures of marine micro-algae: A brief review.

GOAL, SCOPE AND BACKGROUND: The cation-exchange capacity of zeolites is well known and has been increasingly explored in different fields with both economic and environmental successes. In aquatic medium with low salinity, zeolites have found multiple applications. However, a review of the literature on the applications of zeolites in salt waters found relatively few articles, including some recently published papers. The purpose of this review is to present the state-of-the-art on applications of using zeolites for amending the trace elemental contents of salt water as well as the implications of this property for promoting marine micro-algal growth. MAIN FEATURES: This paper deals with the following features: Sorption capacity of zeolites including 1. application of zeolites in saltwater, 2. the role of silicon and zeolites on cultures of micro-algae, and 3. the role of organically chelated trace metals. RESULTS: The following competing factors have been identified as effects of zeolites on algal growth in salt water: (i) ammonia decrease: growth inhibition reduced; (ii) macro-nutrients increase, mainly silicon: stimulation of silicon-dependent algae; (iii) trace metals increase (desorption from zeolites) or decrease (adsorption): inhibition or stimulation, depending on the nature of the element and its concentration; and, (iv) changes in the chelating organics exudation: inhibition or stimulation of growth, depending on the (a) nature of the complexed element; (b) bioavailability of the complex; and (c) concentration of the elements simultaneously present in inorganic forms. DISCUSSION: Zeolites have been capable of stimulating the growth of the silicon-demanding marine micro-algae, like diatoms, mainly because they can act as a silicon buffer in seawater. Zeolites can also influence the yield of non-silicon-demanding algae, because the changes they can cause (liberation and adsorption of trace elements) in the composition of the medium. CONCLUSIONS: Zeolites have been capable of stimulating the growth of the marine micro-algae. However, the extent of ion exchange between zeolite and seawater, which conditions the effects, will depend on several factors: (1) initial metal concentration in seawater; (2) levels of trace metals in the zeolites (contaminants); (3) characteristics of the zeolites in terms of both ion-exchange capacity and specific affinities for the different cations; (4) quantity of zeolite per litre of solution; (5) pH and (6) response of the organism in terms of liberation of organic ligands. RECOMMENDATIONS AND PERSPECTIVES RECOMMENDATIONS: Therefore, a previous investigation in each particular case is recommended, in order to select the zeolitic characteristics and concentrations that will maximize the algal yield. PERSPECTIVES: Stimulation of phytoplankton growth can be economically relevant since phytoplankton constitutes the basis of the marine food webs and is required in fish farming nurseries in the marine aquaculture industry. Zeolites are cheap, only small amounts (few milligrams per liter of culture) are required and the addition of some micro-nutrients may be omitted. Therefore, the inclusion of zeolites in algal cultures in aquaculture may have economic advantages.

Adsorption↗
PubMedDate not supplied

Drug utilization review: mechanisms to improve its effectiveness and broaden its scope. The U.S. Pharmacopeia Drug Utilization Review Advisory Panel.

OBJECTIVE: To address important problems and needed changes in online and retrospective drug utilization review (DUR) programs. Emphasis is placed on reliability of DUR criteria and the shift of traditional retrospective DUR programs toward disease management and health care outcomes. DATA SOURCES: Published literature evaluating the role of online and retrospective DUR programs. STUDY SELECTION: Particular attention was given to studies assessing DUR criteria reliability and new interventions with retrospective DUR programs. DATA SYNTHESIS: A literature review was conducted along with an expert summary from the U.S. Pharmacopeia Drug Utilization Review Advisory Panel. Studies have revealed variations in DUR criteria that could be affecting clinical practice and patient care. Appropriate formal methodologies and use of consistent procedures in developing online prospective DUR programs and systems could help resolve these problems. Traditional retrospective DUR is also shifting to incorporate disease management and methodologies from health outcomes and pharmacoeconomics studies. CONCLUSIONS: Refinements are needed to improve the reliability and validity of online DUR criteria and to minimize false positive messages. Databases created as a result of DUR efforts have been used in new and innovative ways to incorporate health outcomes data and disease management interventions. Additional outcomes data, combined with quality assurance efforts, should increase the utility of DUR/disease management efforts in evaluating health systems while improving the effectiveness and efficiency of pharmacists' health care interventions.

Computer Systems↗