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Given the present climate concerning hospital costs, it has become imperative for hospitals to take steps to ensure that they provide care in the most efficient possible manner. Donald N. Sharp Memorial Community Hospital has developed a system that allows it to respond with unusual precision to changing patient workloads. Both staffing and other operations can be altered to meet a changing patient census.
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The entomological inoculation rate is presented as a comprehensive indicator of malaria transmission level, its relative changes reflecting the risk of potential epidemic development. This rate is a known function of several epidemiological direct factors and is particularly sensitive to the survival rate and the sporogonic cycle of the vector. Although not yet fully quantifiable, relationships exist between direct factors responsible for the transmission of infection and certain meteorological and environmental indirect factors like air temperature, relative humidity, or importation of malaria parasites.The establishment of a two-stage monitoring system is suggested: the first stage would involve setting up a warning system based on the surveillance of the relevant indirect factors; at the appropriate time, this would trigger the second stage monitoring of the epidemiological direct factors having a definite bearing on the development of malaria outbreaks. It is recognized that the gain in reliability of the proposed approach depends largely on the progress still to be achieved in the quantification of the complex system of relations connecting the main direct factors with single or combined indirect factors. It is also noted that the proposed monitoring system should, in due course, provide the decision-makers with the epidemiological information required for the selection and implementation of intervention measures designed to prevent epidemic resurgences.
The first description in the English language of Küntscher nailing by the originator himself in 1948 is reviewed. His predictions regarding its possibilities in bone and joint surgery are compared with their fulfillment in later years.
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Hospitals will continue to react to rising costs, access to health care, and fragmentation of the delivery system. If they respond wisely, the future will be bright. Otherwise the negative trends of today may accelerate.
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This paper reviews the historical background and the theoretical development of models for the analysis of data from capture-recapture or multiple-record systems for estimating the size of closed populations. The models and methods were originally developed for use in fisheries and wildlife biology and were later adapted for use in connection with human populations. Application to epidemiology came much later. The simplest capture-recapture model involves two lists or samples and has four key assumptions: that the population is closed, that individuals can be matched from capture to recapture, that capture in the second sample is independent of capture in the first sample, and that the capture probabilities are homogeneous across all individuals in the population. Log-linear models provide a convenient representation for this basic capture-recapture model and its extensions to K lists. The paper provides an overview for these models and illustrates how they allow for dependency among the lists and heterogeneity in the population. The use of log-linear models for estimation in the presence of both dependence and heterogeneity is illustrated on a four-list example involving ascertainment of diabetes using data gathered in 1988 from residents of Casale Monferrato, Italy. The final section of the paper discusses techniques for model selection in the context of models for estimating the size of populations.
This article evaluates the potential epidemiologic uses of capture-recapture, which include the primary area of determining disease frequency. Capture-recapture may be a means to effectively "count" new cases (incidence) or count existing cases (prevalence). Specific applications of capture-recapture in epidemiology are presented, one of which is its use in estimating death rates in a region close to Calcutta, India. The method also has considerable potential to assess suicides, and it may be the only technique to assess disease frequency in developing countries. In addition to generating an estimate of population size, another application of capture-recapture is to assess the costs of ascertainment relative to the degree of accuracy. This approach provides a formal means for assessing the cost-benefits of lists for the identification of cases. The authors believe that with careful and appropriate use, capture-recapture methods will provide a new approach that can considerably improve our ability to monitor disease.