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The optometrist encounters patients who do not adhere or comply with his recommended treatment. This problem of non-adherence adversely affects both the optometrist and the patient. A general framework is presented which the optometrist can use to evaluate his effectiveness at improving adherence. This framework includes problem formulation, joint development of the treatment plan, extended responsibility, and systematic followup.
A team approach to problem solving in which a health care center and a supplier worked together to improve product quality is described and a detailed example is provided. When the health care center began using a new supplier for i.v. solutions and equipment, the supplier's incomplete product line and recurrent functional problems with products led to dissatisfaction of staff members. The supplier suggested that the health care center and supplier form a quality action team. The team addressed eight product concerns by using a total quality management process. For each concern, the team defined the problem and formulated a problem statement, collected data and determined the contributing factors to the problem, developed an action plan for solving the problem, and executed the plan and monitored its impact. After the first meeting, the team met monthly to monitor progress and discuss new ways they could work together to improve product quality and reduce costs. The implementation of the action plans allowed the health care center to realize cost savings and increased staff members' satisfaction with the supplier's products. A quality action team, composed of representatives from a health care center and one of its suppliers, used a total quality management process to solve problems to the satisfaction of both sets of participants.
Currently, risk assessments of the potential human health effects associated with exposure to pathogens are utilizing the conceptual framework that was developed to assess risks associated with chemical exposures. However, the applicability of the chemical framework is problematic due to many issues that are unique to assessing risks associated with pathogens. These include, but are not limited to, an assessment of pathogen/host interactions, consideration of secondary spread, consideration of short- and long-term immunity, and an assessment of conditions that allow the microorganism to propagate. To address this concern, a working group was convened to develop a conceptual framework to assess the risks of human disease associated with exposure to pathogenic microorganisms. The framework that was developed consists of three phases: problem formulation, analysis (which includes characterization of exposure and human health effects), and risk characterization. The framework emphasizes the dynamic and iterative nature of the risk assessment process, and allows wide latitude for planning and conducting risk assessments in diverse situations, each based on the common principles discussed in the framework.
Planning is a common tool for addressing important health issues, especially urgent ones, and has been reintroduced recently in several federal, state, and local public health programs. This article presents a case study of planning and policy making concerning the reemergence of tuberculosis in urban areas, using Washington, D.C. and New York City as examples. Planning was unsuccessful in D.C. because it failed to acknowledge the important political and bureaucratic aspects of policy making. In New York City, on the other hand, planning played a central role in policy-making efforts, and the health department took a leadership role in building a consensus on the problem, formulating strategies, and overcoming implementation obstacles. This article concludes with several key considerations for making planning more effective in health policy-making.
Two predominant source formulations for the inverse problem of electrocardiology currently exist. They involve the reconstruction of epicardial potentials or myocardial activation times from noninvasively recorded torso surface potentials. Each of these formulations have their advantages, however, they have not been systematically compared against each other. We present results from a simulation study which compared a number of epicardial potential (Tikhonov, Truncated singular value decomposition (TSVD), Greensite-Tikhonov and Greensite-TSVD), and a myocardial activation time formulation for the inverse problem of electrocardiology. A number of different methods were also used to determine the appropriate level of regularization (optimal, L-curve, zero-crossing, and composite residual and smoothing operator) to apply to each formulation. The simulation study was conducted using an anatomically based boundary element porcine model with a variety of cardiac sources. Varying levels of geometric error were introduced to the system and solutions were computed using each of the inverse algorithms. Results show that under pure Gaussian noise potential-based methods performed best at low noise levels while the activation-based method was less effected by higher noise levels. In the presence of correlated geometric error, the activation-based method out performed the potential methods, with the Greensite-Tikhonov method being the most favored potential-based method when using the L-curve or zero-crossing method to determine the regularization parameter.
A scientific article should convey valid information to the reader. To reach this goal, the article must meet several criteria. First, the problem must be clearly stated. For example with medical imaging, the two types of studies are: -a descriptive study depicting a particular situation; -a comparative analytical study, either evaluating a diagnostic method or searching for prognostic factors. The process of defining the sample population can be distinguished: -Experimental studies can compare two groups of people who, after drawing lots, received differential treatment. -Alternatively, observational studies can investigate either representative samples, exposed versus nonexposed cases, or control cases. Characteristics of the variables are very important. Statistical methods facilitate the analysis of three types of variables: qualitative, quantitative and survival variables. Statistical analysis is used to extrapolate the results of the sample population of the study to the target population. Then, presentation, interpretation and extrapolation of the results must be done using three methods: First, the descriptive study should accurately depict the disease. It must be representative of the pathology relative to the clinical manifestations and avoid any bias. Then, the comparative analytical study for revealing the prognostic factors. These types of studies can be divided into three steps: -by performing the suitable statistical tests, a significant correlation between the prognostic factors and the outcome of the disease can or cannot be demonstrated; -any bias must be eliminated; -this correlation can be quantified by measuring it as a risk; Finally, the evaluation of the diagnostic methods are mostly used in medical imaging to determine which factors need to be measured. Five criteria can be followed for these types of studies: -to obtain good technical quality; -to interpret the results consistently; -to give valid information (requiring proper classification of the clinical signs of the patients according to the definition of disease); -to be helpful in determining the treatment; -to be efficient for the patient and the population. The results of a study on the diagnostic value of a medical test must be expressed as an index of sensitivity, or the rate of true positives versus negatives. This facilitates the calculation of the positive predictive value, i.e. the probability for a patient to become ill if the medical test is positive, versus the negative predictive value, i.e. the probability for a patient to remain healthy if the test is negative. The rigorous methodology of scientific work requires: -clear formulation of the problem; -good definition of the situation and the variables to be measured; -the proper method to collect the data; -the description of the study protocol.
At present the Scientific and Research Laboratory of Preventive and Social Medicine is concerned with an extensive longitudinal research "Detection and reduction of sensory and motor disorders". Specialists from various paediatrics disciplines and some 200 health community paediatricians from six districts on the CR and SSR participate in the research. The research comprises children born in these districts in one calendar year. In part 1 the authors give an account of the basis formulation of the research problem and its incorporation within a wider framework. The aim of the research is to reduce the incidence and prevalence of sensory and motor disorders or to test techniques of the early detection of symptoms which signalize the risks of various affections, and to create prerequisites for further improvement of the programme of preventive care of the child population.
Purposes and tasks of the complex medical and genetic study of West-Siberian inhabitants were formulated. Demographic parameters for the North Khanty inhabitants, such as size, dynamics of the tertiary sex ratio, marriage structure and migration processes were presented. Mating and intrapopulation migration patterns are determined by spatial subdivision, because of the vast territory and the traditional way of life, and by isolation by distance. Index of the isolocal endogamy equals to 0.364. The portion of mixed marriages is 22.7% and that of the gametic contribution of immigrants - 7.3%. Inbreeding coefficient by isonymy is 0.00097. Effective population size of the five subpopulations studied as a whole is 25% of their total number.
In order to give practical guidance to interested therapists, the author uses four illustrative cases to show how the technique of cognitive behaviour therapy can be applied in the clinical setting in Nigeria. First, a detailed cognitive assessment of the predisposing, precipitating and perpetuating factors associated with the presenting complaints is carried out. This helps the patient to realise that the symptoms are predictable, and therefore potentially surmountable. Second, the patient and therapist jointly formulate the problem in a few itemised statements. Third, the patient and therapist jointly articulate a set of cognitions (statements of insight) by which the problem in each formulated statement can be overcome. Fourth, as homework exercises, the patient affirms the set of cognitions at least twice daily, as if instructing him/herself (self-instructional training). This helps to make the insights received in therapy sessions to become deeply ingrained in consciousness, and positively affect behaviour in ordinary circumstances of daily living. Finally, a "diary of daily transformation" is articulated, with which the patient monitors the self, in order to see that insights obtained are applied in daily living experience. Educated, articulate and committed patients with circumscribed psychological problems can achieve significant improvement in 3-20 weekly sessions.
In the clinical practice, there are a number of instances in which the request tailored to each patient must be satisfied with a combination of ready-made medical supplies. For example, in intravenous infusion and feeding, an appropriate combination of commercially available bottles must be chosen such that fluid, electrolyte, and nutritional requirements can be satisfied for the individual patient. Menu planning also has the same feature. However, the problem of the optimal combination of medical supplies is difficult to solve exactly and quickly even with the aid of the computer, because of the combinatorial nature of this problem. We formulate the combinatorial problem of medical supplies as a nonlinear all-integer programming problem and present a fast exact algorithm to solve the problem. The proposed algorithm is proved to find an optimal combination in an acceptable calculation time for medical problems of the usual size.
One hundred and twenty four water-insoluble drugs were included in a study for their action on diamine oxidase (DAO) after solubilization with 61 detergents. 16 detergents were themselves not water-soluble and were not further investigated. A further 3 detergents affected the extraction procedure and 7 of the remaining 42 detergents themselves inhibited the activity of canine intestinal DAO in vitro. Only 5 detergents fulfilled all prerequisites for our DAO assay, including the solubilization of 76 water-insoluble drugs. Each of these 5 detergents had an individual range of suitability in our test system. 3/76 drugs inhibited DAO in concentrations up to 10(-3) M. This result is in contrast to our study with water-soluble substances, where 16% were DAO inhibitors. Since detergents can block the enzyme which is responsible for histamine catabolism, some of the observed adverse reactions to drugs could arise because of the presence of such detergents in the formulation.
Disputing the concept of "psychic dependence", the authors review six motivations to use addictive drugs, four of which pertain to the moment of assumption of the habit, and two of which, identifiable with physical and psychic dependence, depend on breaking of the habit. While physical dependence is linked to withdrawal syndrome, psychic dependence, in the authors' opinion, is related to a longstanding previous state of true of masked endogenous depression (in this case it would be well termed "neuropsychological dependence"), and the drug taking is only a maladaptive self-medication. This thesis is substantiated by the literature reporting, in chronic drug addicts, the use of the whole series of antidepressants (i.e. tricyclics, doxepine, lithium, etc.) with noticeable therapeutical success. In accordance with other reports and with personal experience, the authors assign great importance to the drugs acting, directly or indirectly, on GABA, i.e. L-glutamine, piracetam, and, particularly, N-dipropylacetic acid.
Plasma concentrations of 8-methoxypsoralen were measured in 8 psoriatic patients after administration of two commercial solid formulations and of an 8-methoxypsoralen solution. Systemic availability as measured by the area under the concentration versus time curve was much higher for the solution than for the two commercial formulations. For the solid formulations, a large inter- and intraindividual variation in plasma concentrations was found and in many cases no plasma levels could be measured. Administration of the solution gave always more reproducible plasma concentrations in function of time.
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Finite population estimation problems are formulated as prediction problems under superpopulation models. For linear regression models, a general theorem on optimal linear estimation is presented. The theorem is applied to simple cross-classification models to generate and analyze various statistics for estimating small area totals. These statistics include the synthetic and composite estimators, as well as some interesting alternatives.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.