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PubMed2001

Psychiatrists' knowledge and attitudes about costs of commonly prescribed treatments in psychiatry.

A survey was conducted to assess psychiatrists' knowledge and attitudes regarding the costs of various psychiatric treatments. Psychiatrists (n = 500) were randomly selected from the membership of the Ohio Psychiatric Association. The survey explored several aspects of psychiatrists' knowledge of costs, including estimated prices of 24 specific psychiatric treatments (frequently used psychotropic medications, laboratory tests, and inpatient and outpatient procedures) as well as their level of confidence in their estimates. The survey also asked a series of attitude/opinion questions and specific demographic data. The psychiatrists (n = 265, 59% response) perceived that knowing the costs of treatments was an important consideration when choosing a particular treatment. Psychiatrists' actual knowledge of the costs of treatment was inconsistent with their beliefs of the importance of knowing the costs as well as their reported confidence in their knowledge of costs. Information about the costs of psychiatric treatments is an important clinical consideration and a program to improve clinicians' knowledge of the costs of psychiatric treatment could occur during residency training.

Adult↗
PubMed2003

Age, skill, and contextual cuing in target detection.

This study examined the extent to which structural regularities inherent in visual arrays help to guide target detection and reduce age-related differences in skilled visual search performance. The target-detection performance of medical laboratory technologists in 2 age groups (M = 24.3 years and M = 49.0 years) and age-matched novices was assessed using images of bacterial morphology taken from Gram's stain photomicrographs as targets and search arrays. For skilled observers, response times were longer for middle-aged adults than for young adults except when external location cues were available, or when contextual cues inherent in the array were available to guide target detection. These results demonstrate that contextual information aids the skilled search of middle-aged experts, and suggest that contextual cuing is 1 means by which middle-aged adults can circumvent the effects of normally age-deficient processes on performance in a skilled domain.

Adult↗
PubMed2006

Bench partners.

Explore the source record for details and available documents.

Career Mobility↗
PubMed2024

Algorithms for the identification of prevalent diabetes in the All of Us Research Program validated using polygenic scores.

The All of Us Research Program (AoU) is an initiative designed to gather a comprehensive and diverse dataset from at least one million individuals across the USA. This longitudinal cohort study aims to advance research by providing a rich resource of genetic and phenotypic information, enabling powerful studies on the epidemiology and genetics of human diseases. One critical challenge to maximizing its use is the development of accurate algorithms that can efficiently and accurately identify well-defined disease and disease-free participants for case-control studies. This study aimed to develop and validate type 1 (T1D) and type 2 diabetes (T2D) algorithms in the AoU cohort, using electronic health record (EHR) and survey data. Building on existing algorithms and using diagnosis codes, medications, laboratory results, and survey data, we developed and implemented algorithms for identifying prevalent cases of type 1 and type 2 diabetes. The first set of algorithms used only EHR data (EHR-only), and the second set used a combination of EHR and survey data (EHR+). A universal algorithm was also developed to identify individuals without diabetes. The performance of each algorithm was evaluated by testing its association with polygenic scores (PSs) for type 1 and type 2 diabetes. We demonstrated the feasibility and utility of using AoU EHR and survey data to employ diabetes algorithms. For T1D, the EHR-only algorithm showed a stronger association with T1D-PS compared to the EHR + algorithm (DeLong p-value = 3 × 10-5). For T2D, the EHR + algorithm outperformed both the EHR-only and the existing T2D definition provided in the AoU Phenotyping Library (DeLong p-values = 0.03 and 1 × 10-4, respectively), identifying 25.79% and 22.57% more cases, respectively, and providing an improved association with T2D PS. We provide a new validated type 1 diabetes definition and an improved type 2 diabetes definition in AoU, which are freely available for diabetes research in the AoU. These algorithms ensure consistency of diabetes definitions in the cohort, facilitating high-quality diabetes research.

Humans↗
PubMed2003

Preparation of a purified fibrinogen calibration material for Clauss method and turbidimetric immunoassay possessing biological activity and antigenicity.

Fibrinogen plays a major role in basic coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT). These show high interlaboratory variation because of inaccurate instrumental calibration. The same is true of the fibrinogen assay, despite its being a quantitative assay. Most medical laboratories use automated coagulometers and commercially available calibration materials (calibrators) to obtain an accurate fibrinogen value, but, when checked, calibrators have been found to deviate from the assigned value. The Japan Society of Laboratory Medicine (JSLM) has identified the need for a reliable plasma fibrinogen standard. To enhance the reliability of calibrator fibrinogen values and thereby remedy the poor precision and accuracy of plasma fibrinogen testing, we undertook the preparation of a standard calibration material applicable to both the Clauss method and turbidimetric immunoassay (TIA). The calibrator was prepared from fresh human plasma by glycine precipitation and virus inactivation followed by affinity chromatography to remove contaminated plasminogen. In the resulting product, clottable fibrinogen accounted for 95% of total protein and within-run precision showed a CV of less than 1.8%. We believe the preparation will become a candidate material for laboratory and manufacturer use in Japan.

Blood Coagulation Tests↗
PubMed2001

Knowledge, assessment and management of pain related to nursing procedures used with premature babies: questionnaire study for caregivers.

The aim of the study was to discover how much Finnish nursing staff know about the pain experienced by premature babies and about pain assessment. The types of helping methods used by caregivers in the nursing of premature babies were also studied. A semistructured questionnaire was sent in autumn 1995 to all registered nurses, practical children's nurses and medical laboratory technologists who take heel blood samples (n = 280) working in paediatric intensive care units in all Finnish university hospitals. The response rate was 70.4%. The structured questions were processed quantitatively at Kuopio University with the SPSS/PC+ data processing program (SPSS, Chicago, IL, USA), and the open questions were processed using quantitative content analysis. The results indicate that the respondents have rather extensive knowledge about the pain experienced by premature babies, pain assessment, pain management and about nursing and helping methods. Pain was assessed mostly on the basis of behaviour and physiological changes, and only infrequently on the basis of biochemical changes. The respondents described the helping methods they use in considerable detail. The most common was to increase the baby's feeling of security. The answers to the open questions revealed that the actions used by the respondents in pain assessment and pain management were not completely consistent with their knowledge. The results demonstrate that caregivers do not use their knowledge adequately in their pain management practices. Future studies should observe the three groups of caregivers in order to discover how they treat premature babies' pain.

Caregivers↗
PubMedDate not supplied

A 1-year cost-effectiveness model for the treatment of chronic schizophrenia with acute exacerbations in Belgium.

OBJECTIVE: A 1-year semi-Markov model was constructed to simulate the cost-effectiveness of atypical and typical antipsychotic treatments for schizophrenia. METHODS: The core model comprised nine 6-week cycles and includes events such as survival, response, adverse events, and compliance. The nature, duration, intensity, and timing of adverse events were incorporated. Compliance was modeled as a function of health state, time, and adverse events. Three first-line treatments were considered (risperidone, olanzapine, and haloperidol oral) and the transition probabilities of switching between five different therapies (haloperidol oral, haloperidol depot, risperidone, olanzapine and clozapine) were included. Effectiveness was modeled based on a modified method of TWiST (time without symptoms and toxicity). The direct costs of utilization of medical resources are taken into account, including five different patient care settings, consultations, neuroleptic medication, laboratory tests, and treatment of side-effects. RESULTS: This paper reports the methodology used to construct the model and the results obtained when it was applied to the treatment of patients with schizophrenia in the Belgian health care system. CONCLUSIONS: Over the study period, risperidone and olanzapine were more cost-effective than haloperidol and of the two major atypical drugs, risperidone was the more cost-effective.

Journal Article↗
PubMed1998

Prevention of infection in the immunocompromised host.

The Association for Professionals in Infection Control and Epidemiology, Inc, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. This learner-paced study package is designated for 1.1 contact hours. APIC's California nursing provider number is CEP 7146. This continuing medical laboratory education activity is recognized by the American Society of Clinical Pathologists as meeting the criteria for 1 CMLE credit hour. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Continuing Competence Recognition Program. (See the instructions and examination at the end of the article.)Infectious diseases represent a major cause of morbidity and mortality in immunocompromised patients. Infectious complications are often predictable and may be preventable. This article is an overview of practical considerations in the care of immunocompromised patients. Recognizing the compromised host, identifying and correcting risk factors in advance, and reducing sources of infection all play a role in prevention. Topics were chosen to include the areas of care that differ from the immune competent patient, such as diet, pet therapy, handwashing, immunizations, augmentation of host resistance, prevention of pneumonia, and antibiotic prophylaxis. National practice guidelines are cited when possible; evidence-based literature review and experience are applied to situations lacking consensus statements. Treatment decisions are made in areas for which information is often incomplete. A systematic approach to care of the immunocompromised host, tailored to the individual patient's needs, should reduce the risk of infection.

Cross Infection↗
PubMed2002

Cost-effectiveness comparison of therapy for psoriasis with a methotrexate-based regimen versus a rotation regimen of modified cyclosporine and methotrexate.

BACKGROUND: Because health care resources are limited, therapeutic regimens should be assessed for their relative costs and effectiveness. OBJECTIVE: We assessed cost-effectiveness for treating psoriasis using two strategies: one consisted principally of methotrexate and the other was principally a rotational schedule of modified cyclosporine (Neoral) with methotrexate. METHODS: We performed a cost-effectiveness analysis using a computerized decision analytic model of simulated patients with moderate to severe psoriasis. Patients were randomly assigned to receive treatment with one of the two strategies. Direct costs included acquisition of medications, laboratory and physician fees, and costs of treating side effects. Because of uncertainty regarding rates of clearing of psoriasis, the relative efficacy of methotrexate and cyclosporine was varied over a wide range in a sensitivity analysis. RESULTS: In the base case over a 10-year treatment period, the methotrexate strategy cost $33,000 and provided approximately 2 years clear of psoriasis compared with $38,000 and approximately 4 years clear of psoriasis for the rotational strategy. When the relative effectiveness of cyclosporine to methotrexate in clearing psoriasis varied from approximately 1 to 20, the rotational strategy cost from $4100 to $2700 per incremental clear year. CONCLUSION: In selecting therapies for psoriasis patients, both costs and effectiveness should be considered. In this simulation, patients could obtain additional periods clear of psoriasis at an incremental cost by using cyclosporine in rotation with methotrexate. If even a small utility gain accompanies the complete clearing of psoriasis, such a strategy may be a worthwhile investment of resources comparable to other healthcare interventions.

Cost-Benefit Analysis↗
PubMed1989

Prevalence and seasonal fluctuations of intestinal parasitic infections in the Nablus area, West Bank of Jordan.

A total of 22,970 stool specimens collected from patients attending the Central Medical Laboratory in the city of Nablus in the period of 1981-1986 were examined for intestinal parasites. Of these 7412 (32.3%) were positive. Entamoeba histolytica (22.9%), Giardia lamblia (7.3%), and Ascaris lumbricoides (5.7%) were the most prevalent intestinal parasites found. Other intestinal parasites present included Hymenolepis nana, Trichomonas hominis, Trichuris trichiura, Taenia saginata, Enterobius vermicularis and Strongyloides stercoralis. Seasonal occurrence of intestinal parasites in the West Bank of Jordan was also studied in the period January 1981-August 1987. Lower prevalence rates of intestinal parasites generally occurred during winter and early spring. Peak incidence occurred during summer and early autumn. The reasons for these seasonal variations are discussed.

Ascariasis↗
PubMed1996

Outbreak of gentamicin-resistant Acinetobacter baumanii in an intensive care unit: clinical, epidemiological and microbiological features.

The clinical, epidemiological and microbiological features of an outbreak of infection and colonisation caused by gentamicin-resistant Acinetobacter baumanii (GRAB) in an 18-bed intensive care unit (ICU) of a 680-bed adult teaching hospital are described. A retrospective review of medical, laboratory and infection control records was followed by prospective surveillance. Typing of isolates was performed by restriction enzyme analysis (REA) of chromosomal DNA. The incidence of GRAB in the ICU increased from 1.26 cases per 1000 occupied bed days (OBDs) for January to June 1993, to 6.62 per 1000 OBDs for July to December 1993 (Chi square = 4.8, P < 0.05), confirming the existence of an outbreak. For the two year period, 1993 and 1994, a total of 45 cases of GRAB infection or colonisation was identified. Males and females were equally represented, with an age range of 16-79 years and a mean age of 51 years. Admitting diagnoses varied, with multiple trauma and head injury predominating (ten cases). For 35 of the 45 cases the initial site of GRAB isolation was sputum or other respiratory tract specimen. Specific treatment for GRAB was initiated in 23 patients, however no deaths were directly attributable to GRAB infection. The period of time between admission to the ICU and first isolation of GRAB ranged from three to 70 days with a median of nine days. Overall, ten (11%) of 91 staff hand samples and one of 37 (3%) environmental samples yielded GRAB. All GRAB isolates produced similar biochemical profiles and antibiotic resistance patterns, except for a group of five which were ciprofloxacin resistant. Thirty patient isolates, all ten staff hand isolates and the environmental isolate produced identical REA patterns. The remaining five patient isolates (all ciprofloxacin resistant) which were available for typing produced a different REA pattern. Our study has documented a moderate-sized outbreak of GRAB in an ICU setting. Typing of isolates using REA was useful in delineating outbreak strains. Carriage of GRAB on staff hands was demonstrated as the most likely source of infection. Despite institution of infection control measures GRAB now appears endemic in the ICU.

Acinetobacter↗