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At least 847 records · Page 47Linked to original sources

PubMed2005

State-funded comprehensive primary medical care service programs for medically underserved populations: 1995 vs 2000.

OBJECTIVES: We analyzed responses to the 2000 Comprehensive Primary Medical Care programs for Medically Underserved Populations Survey and compared them with the 1995 survey results to identify trends. METHODS: Surveys were mailed to all primary care program offices. State primary care program associations reviewed primary care program offices' responses and completed surveys for offices that did not respond. RESULTS: We identified 30 qualified primary care programs in 24 states that had an overall funding level of $215 million. Most states allowed funds to be spent on expanding service areas, buying equipment, and hiring and training staff. CONCLUSIONS: Although state funding has increased overall, many states do not have comprehensive primary care programs, and an increasing number of states are experiencing budget deficits that may lead to reductions in existing programs.

Budgets↗

PubMed1984

The benefits of comprehensive care of hemophilia: a five-year study of outcomes.

Eleven of 22 federally funded Comprehensive Hemophilia Centers have collected data on outcomes, before and after five years of this program's existence. Improved health, decreased hospitalization, decreased absenteeism, and a decrease in the unemployment rate from 36 per cent to 13 per cent were accompanied by decreased costs of care. In this model of a chronic handicapping illness, the early application of comprehensive care is preferable to the previous emphasis on end-stage rehabilitative efforts.

Community Health Centers↗

PubMedDate not supplied

Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme.

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

Activities of Daily Living↗

PubMed2004

[Comprehensive geriatric medicine].

This paper is written to make clear the new medical system in the elderly and to standardize of Geriatrics and care. There are two major important components in geriatrics and geriatric care which are comprehensive geriatric assessment and team approach. But this is sometimes difficulut to do geriatric medicine. This goal is to make clear the usefulness of comprehensive geriatric assessment (CGA) and team approach. And the research purpose is to make standardization of geriatric medicine and care of elderly patients and organization of professionals. I have studied QOL of elderly people in the community. The scale, SF36, was used in this study. I compared with QOL between elderly with dementia and healthy elderly. QOL was studied with statistical analysis of SPSS. Physical function and symptomatic vitality in lower items of QOL were much better in health people than demented elderly. But global subjective health was much better in demented elderly than healthy people in the community. And I made clinical path of dementia for examination in the hospital. The results were clinical path made clear the importance of team approaches and standard of medical course in the hospital. It was helpful in medicine and care and its bindings. Dr. Murashima and her group have developed a new check list of screening risk factor of long stay of elderly inpatient. And they studied about the effects of supportive group for discharge using assessment and team approaches. This unit has a good function which support home care of the elderly patients. Finally narrative based medicine is very important to take care for the elderly patients. It has been lacked to do the present medicine for the elderly patient by evidence based medicine. In conclusion, for the standardization of geriatrics, CGA is useful for support for the frail elderly and team approach is good for staff communication through team conference.

Aged↗

PubMed2003

Primary health care, selective or comprehensive, which way to go?

OBJECTIVE: To critically review the advantages and disadvantages of selective versus comprehensive Primary Health Care (PHC) approaches as a strategy towards improving health in the developing world. DATA SOURCES: Review of literature on PHC. DATA SELECTION: Relevant papers from western and developing world literature. DATA EXTRACTION: Search of Pub-Med, WHO/UNICEF reports, and relevant publications on PHC. DATA SYNTHESIS: Examination of principles behind PHC and practical experiences in PHC in the developing world. CONCLUSIONS: Selective PHC programs have improved specific aspects of health, frequently at the expense of other health sectors, but fail to address an individual's health in holistic manner, or the health infrastructure of countries. Selective PHC programs tend to focus only on a small subset of the community. Comprehensive PHC is expensive to implement, however addresses health of individuals more holistically, addresses both preventive and curative health care, and promotes health infrastructure development and community involvement, thereby providing more sustainable improvement of health in the whole community.

Comprehensive Health Care↗

PubMed1999

Student productivity under requirement and comprehensive care systems.

This retrospective study reviews the educational and patient care effects of changing from a numerical requirements-driven clinical curriculum to aa comprehensive care model driven by patient needs and led by faculty group leaders. In September 1994, the Columbia University School of Dental and Oral Surgery implemented a program in which all patient care shifted to a patient care completion model. Core assumptions included creating an educational setting where students were assigned to groups with continuously assigned faculty as group leaders, with intensive case discussion and monitoring of students' progress. All patient care took lace under the direction of the group leaders with involvement of other attending interdisciplinary faculty and auxiliary staff. Data suggest that, over the period of this study (1994-97), a significant increase occurred in the number of treatment plans completed by students with no compromise in the number of specific procedures completed by individual students. We concluded that a carefully structured and monitored comprehensive care/group leader-driven model is beneficial for both student education and patient care.

Chi-Square Distribution↗

PubMed2001

Comprehensive management of patients with type 2 diabetes: establishing priorities of care.

Type 2 diabetes is a complex metabolic disorder characterized by elevated blood glucose levels and a marked increase in the risk of cardiovascular disease (CVD). The increased CVD risk is caused by a unique cluster of metabolic abnormalities, including dyslipidemia, hypertension, insulin resistance, and hyperglycemia. To reduce the risk of cardiovascular complications in patients with type 2 diabetes, comprehensive management of risk factors is essential. Aggressive treatment of dyslipidemia and hypertension is known to benefit patients with type 2 diabetes. In addition, intensive glycemic control and targeted treatment of insulin resistance can further reduce the enormous burden of CVD in this high-risk population. Increasing evidence suggests that insulin resistance is one of the earliest markers of risk for both CVD and diabetes, and it is known that insulin resistance alone can significantly increase the risk of CVD. Type 2 diabetes and insulin resistance are both associated with disordered lipid metabolism, manifest in elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, and small, dense low-density lipoprotein cholesterol particles. Patients with type 2 diabetes and insulin resistance have an increased risk of hypertension, which further contributes to their CVD risk. Each of these factors can also contribute to the risk of microvascular disease. To ensure that patients with type 2 diabetes receive comprehensive, high-quality care, specific standards have been developed. These standards can help providers establish clear treatment targets, identify specific priorities of care, and use therapies of known efficacy to reduce the risk of complications. This review summarizes the current standards of care for patients with type 2 diabetes, with an emphasis on treatments that reduce the cardiovascular risk factors. Using a case study approach, it reviews the essential components of diabetes care and proposes a rational approach to these complex cases--an approach that should result in consistent, high-quality care.

Adult↗

PubMed2002

[A community-based prospective control study of comprehensive intervention in hypertensive patients].

OBJECTIVE: To explore the effect of comprehensive intervention and the prognosis of hypertensive patients in a community. METHODS: To monitor and follow up the hypertencive patients in a community and their families, to intervene comprehensively and prospectively and to make comparison with a control group. RESULTS: The blood pressure of the study group declined from (157.7 +/- 9.0) mm Hg (SBP), (95.0 +/- 16.5) mm Hg (DBP) before entry to (130.6 +/- 11.0) mm Hg (SBP), (80.0 +/- 12.0) mm Hg (DBP), at the end of the study, with significant difference as compared with that of a control group (P < 0.001). The decrement was significant (P < 0.005). Patients' life style was changed and life quality improved. The rate of complications, disability and mortality declined in the study group five times than those in the control group. The total score of SCL-90 was significantly declined in the study group than control group. CONCLUSIONS: The beneficial effect of community and family intervention and health knowledge education was confirmed in this study. There is still a long way to go for popularizing public health education, training professional health personnel and enhancing the compliance of hypertensive patients to treatment.

Community Health Services↗

PubMed2003

Comprehensive health care for women in Georgia.

In summary, comprehensive health care for women begins first with a paradigm shift that acknowledges women's health is more than reproductive health. Second, it requires viewing women's health issues from an across the lifespan perspective. This perspective includes addressing women's health beginning with the formative years, through reproductive health and sexuality to the frail elderly. The OWH has launched a statewide effort, with input from the leadership of Georgia, including an eleven-member advisory council attached to the office to develop a comprehensive women's health plan. The OWH will partner with public and private organizations, academic institutions and other government agencies to devise a course of action that addresses the health needs of all women, of all ages, including racial and ethnic backgrounds, and socioeconomic and education levels. This plan will serve as a guide for those organizations whose interest is meeting Healthy People 2010 broad objective of increasing the quality and years of healthy life for women.

Comprehensive Health Care↗

PubMed2003

Developing a group practice comprehensive care education curriculum.

In fall 2002 the University of Illinois at Chicago College of Dentistry implemented a Group Practice Comprehensive Care Clinical Education Curriculum. The primary responsibility for patient care has shifted in this comprehensive care curriculum from the students to the faculty and staff. Students have a primary responsibility for learning. This competency-based education curriculum utilizes a variety of student evaluation methods including self-evaluation, OSCE, and portfolio to verify competence. Formative evaluation methods are utilized in daily assessment of student performance. On-time graduation rates have increased from 60-70 percent to 96 percent, and regional board first-time pass rates have been maintained at 90+ percent. Overall predoctoral clinical productivity in the first full year of the program has increased by over 300,000 dollars.

Chicago↗

PubMed1992

[Follow-up options in institutional protection--"patient careers" in a comprehensive community psychiatric care system].

The recommendations for the reorganization of German psychiatry were associated with the expectation that institutional protection can be reduced in a comprehensive community care system on the longterm basis and that a stabilization can be achieved during treatment with a minimum share in full and partial hospitalization. To test this assumption we studied the institutional pathways of 136 chronic, mainly schizophrenic patients within the comprehensive care system of the Department of Social Psychiatry over two years. A cluster analysis of sequence and intensity of institutional care showed three major types of use of the system: as a rehabilitation system, as an alternative and flexible care system, and as a traditional "dual-care-system". These patterns of institutional pathways were analyzed regarding predictors from patient's history. Consequences are discussed concerning further development of community mental health, coordination of services and continuity of care.

Adult↗

PubMed1992

Comprehensive care for children with bleeding disorders. A physician's perspective.

As a result of recent advances in the understanding of hemostatic mechanisms--and the availability of more accurate diagnostic tests, effective replacement therapy and medications--most of the common bleeding disorders in children can be diagnosed and managed. Children with bleeding disorders often present with dental problems. Their comprehensive care requires specialized preventive and acute dental treatment. With improvements in dental care protocols and surgical procedures, the risk of excessive bleeding in these children as a result of dental procedures should be minimal, particularly if they are well prepared and treated beforehand. It is important for dentists to be familiar with these specialized dental care protocols and procedures, and knowledgeable about the medical treatment provided to children with bleeding disorders. This allows dentists to coordinate the care of a hemophiliac with his or her physician in a comprehensive manner.

Blood Coagulation Disorders↗

PubMed2005

Abandoning isolated free PSA screenings for more comprehensive cardiovascular and cancer screening and education.

The time is ripe to abandon free PSA screenings and replace them with free comprehensive health screenings. For example, cardiovascular disease (CVD) risk screening (cholesterol, blood pressure) that could also include PSA, weight measurement, and a variety of other tests and educational assessments just make more sense in terms of the larger picture of influencing all-cause morbidity and mortality. Numerous reasons are proffered for this important change. Abandoning this myopic single-disease only approach must be embraced by numerous medical centers and health professionals before this comprehensive approach can be successfully implemented.

Cardiovascular Diseases↗

PubMedDate not supplied

Mapping the functional anatomy of sentence comprehension and application to presurgical evaluation of patients with brain tumor.

BACKGROUND AND PURPOSE: The main clinical indication for functional MR imaging (fMRI) has been to preoperatively map the cortex. Motor paradigms to activate the cortex are simple and robust; however, language tasks show greater variability and difficulty. The aim of this study was to develop a language task with an adequate control task to engage the areas of the posterior temporal lobe responsible for sentence comprehension. METHODS: We performed a cloze paradigm requiring silent reading of a visually presented sentence-completion task based on semantic meaning versus a letter-scanning epoch requiring the completion of nonlinguistic strings or a rest period. Before this task was clinically used in two patients epilepsy and cavernous angioma, its feasibility and accuracy were tested in 14 healthy right-handed participants. RESULTS: Results showed significant activation of the posterior temporal cortex, including a broad area across the posterior left temporal cortex extending into the inferior parietal lobule. When the sentence completion-minus-letter string task was compared with the sentence completion-minus-rest task, increased activation was present in the posterior temporal lobe. CONCLUSION: Decreased significant activation during the sentence completion-minus-rest contrast may be attributed to increased noise from intersubject variability in the rest period. Our results suggest that this task elucidates areas important to reading comprehension in the posterior and inferior temporal regions that verbal fluency and auditory discrimination tasks do not. Data from two cases are summarized to exemplify the input of this task for neurosurgery.

Adult↗

PubMed2004

MEG analysis of "theory of mind" in emotional vignettes comprehension.

OBJECTIVE: Several studies suggested that an impaired "theory of mind" might play a key role in psychiatric disorders, such as autism and schizophrenia. Medial frontal lobe lesions of the right frontal lobe were reported to impair this ability. The aim of our study was to locate areas of the brain associated with the process of "theory of mind" in normal subjects. METHODS: In order to index the activity of brain areas related to "theory of mind" reasoning in sixteen normal adults, we administered an emotional ("happy", "sad", "angry" and "neutral") vignettes comprehension task during magnetoencephalography (MEG) recordings and analyzed these data by using SAM (synthetic aperture magnetometry), SPM99 and the permutation method. Subjects were presented with eight different videotaped social situations (each emotion has two vignettes) and were asked to indicate which emotion they represented. RESULTS: Statistically significant activation in the comparison of "happy"-"sad" and "angry"-"sad" was observed in the bilateral medial prefrontal cortices in the alpha frequency band. There were no significant differences in comparisons of each type of emotional vignette to the neutral vignettes, "happy"-"angry" comparison, and male-female comparisons. There was no significant difference in other frequency bands. CONCLUSION: This result suggests that bilateral medial prefrontal cortex are involved in the comprehension of emotional states of others.

Adult↗

PubMed2005

Participatory approaches in the co-design of a comprehensive referral system.

Reducing mortality rates for women and children in Third World countries requires improved access to quality, affordable health services. In this article, the authors describe the experiences of the University of Ottawa School of Nursing and its Chinese partner, the Yunnan Provincial Public Health Bureau, in developing and implementing a comprehensive referral system for impoverished rural women and children as part of the Yunnan Maternal and Child Health Project, a six-year dollar 6-million bilateral initiative implemented across 10 counties (population 2.2 million) in Yunnan province, China. Through engaging government officials, health workers, local leaders and village women in dialogue and reflection, Canadian and Chinese partners developed a common understanding about underlying determinants affecting maternal and child health services; explored appropriate intervention options; and developed an innovative comprehensive referral system.

Canada↗

PubMed2006

Computer animation and improved student comprehension of basic science concepts.

Many medical students have difficulty learning basic science, either because they find the material challenging to comprehend or because they believe it has limited clinical application. Computer-assisted instruction (CAI)--ie, computer animation--can clarify instruction by allowing students to visualize complex, dynamic processes in an interesting presentation. At West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg, a series of computer animations have been developed to present concepts in molecular and cellular biology. The author conducted an investigation to compare the efficacy of one representative computer animation with that of traditional textbook material. The subjects were 22 students who had been admitted to WVSOM but who had not yet begun classes. The experimental design of the study consisted of a prelesson test, a lesson, and a postlesson test. The lesson explained the process of deoxyribonucleic acid (DNA) replication using either a computer animation (n=12) or a chapter from a textbook (n=10). Lesson comprehension as measured by the tests was significantly higher for subjects who used the computer animation than for subjects who used the textbook (P<.01). Furthermore, reviewing the text after studying with the computer animation did not raise test scores, suggesting that the animation was sufficient for learning and the text was unnecessary. After the study, a majority of subjects indicated a preference for the animation over the text. These results demonstrate that CAI can be an effective tool for relating basic science to medical students by improving comprehension and eliciting interest in the lessons.

Adult↗

PubMed2005

Comprehensive care plus creative architecture.

The delivery of high-quality, comprehensive cancer care and the treatment environment go hand in hand with the patient's recovery. When the planning and design of a comprehensive cancer care program runs parallel to the operational expectations and functional standards, the building users (patients, staff, and physicians) benefit significantly. This behavioral response requires a sensitive interface during the campus master planning, architectural programming, and design phases. Each building component and user functioning along the "continuum of care" will have different expectations, programmatic needs, and design responses. This article addresses the community- and hospital-based elements of this continuum. The environment does affect the patient care and the care-giving team members. It may be a positive or, unfortunately, a negative response.

Comprehensive Health Care↗