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Results for “Resource Allocation”

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At least 1,693 records · Page 94Linked to original sources

PubMed2005

Treatment of chronic rhinosinusitis with low-dose, long-term macrolide antibiotics: an evolving paradigm.

The 14-membered and 15-membered ring macrolide antibiotics express immunomodulatory effects in chronic respiratory disorders in humans that are distinct from their antimicrobial properties. These drugs downregulate the excessive immune and inflammatory responses observed in these conditions while promoting tissue repair. To this end, chronic rhinosinusitis is characterized by mucosal inflammation of nasal and sinus mucosa for more than 3 months and accounts for significant health care resource allocation due to difficulties in treatment. Clinical efficacy of macrolide antibiotics as biologic response modifiers in patients with chronic rhinosinusitis is suggested by compelling basic research and small, uncontrolled clinical studies. Hence, long-term, prospective double-blind placebo-controlled clinical studies are indicated to establish the utility of these drugs in the treatment of patients with chronic rhinosinusitis.

Animals↗

PubMed1999

Update on Hepatobiliary and Pulmonary Flukes.

Hepatobiliary and pulmonary trematodes continue to cause significant morbidity and mortality worldwide. This article provides a selected update on the clinical features, diagnosis, immunology, treatment, and control of infections caused by Clonorchis sinensis, Opisthorchis species, Fasciola hepatica, and Paragonimus species. Although recent molecular studies have elucidated novel mechanisms of immune evasion in Paragonimus westermani and F. hepatica, there are no immediate prospects for a vaccine for any of these trematodes. Although treatment of paragonimiasis, clonorchiasis, and opisthorchiasis was simplified with praziquantel in the 1980s, eradication of fascioliasis remains difficult because of the limited availablity of bithionol. Several experimental drugs have been tested as possible alternatives. Despite successful pilot public health programs designed to decrease transmission of these trematodes, their prevalence remains high and underlines the importance of allocating resources to control them.

Journal Article↗

PubMed1991

Coordinating cognitive information: task effects and individual differences in integrating information from several sources.

In many tasks people have to coordinate the information from several sources. An example would be driving a car while listening to directions. The driver has to establish a correspondence between a visual picture and verbal instructions. This paper addresses two questions concerning information coordination. Is there an ability to coordinate information received from several sources that is different from the ability to deal with information from each source, alone? Does coordination simply involve allocating resources to deal with the component tasks, or does the act of coordination itself constitute a separate task? Four experiments examined the coordination of a verbal component task with a visual-spatial and with an auditory component task. The results showed that the ability to coordinate perceptual and verbal information is separate from the ability to deal with either perceptual or verbal information, alone. A simple resource sharing model was not adequate in explaining how coordination occurred. We relate our results to a model in which perceptual reasoning occurs independently of verbal processing, but transforming perceptual information into a propositional form is affected by concurrent verbal processing.

Adult↗

PubMed1990

Health status in inflammatory bowel disease. Biological and behavioral considerations.

The existing clinical measures of disease activity for inflammatory bowel disease are insufficient to explain a patient's illness experience or health outcomes. Although many disease activity measures have been devised, they are not widely accepted by clinicians because existing ones are no better than a carefully obtained clinical assessment. Furthermore, health status is determined not only by disease activity, but also by the psychological state, cultural influences, degree of social support, and effects of complications, previous surgery, and medication. To develop more accurate appraisals of the impact and severity of IBD, we must prospectively evaluate the biological and psychosocial measures that predict clinically relevant outcomes. We should then be able to develop statistically weighted scales related to specific outcome variables. Such knowledge will help us to develop more sensitive measures of illness, particularly in patients with mild disease for whom present indices are insensitive. This type of assessment should also aid in the understanding of health care utilization, medical vs. surgical options, resource allocation, and the efficacy of therapeutic trials.

Adult↗

PubMed1985

Accident and emergency content of general surgical workload.

In a 12-month period from 1 January to 31 December 1982, 1064 patients were admitted under the care of one consultant general surgeon. Of these, 485 came through the Accident and Emergency (A & E) Department; details of their management are presented. All the data were collected prospectively, stored on microcomputer discs and later analysed. The surgical cases provided adequate material for training but the planning of curricula did not allow all the A & E trainees to be adequately exposed to it. Head injuries accounted for nearly one-third of the emergency workload and were well managed, but more children with this diagnosis were admitted than was necessary. About one-quarter of the investigations performed did not contribute usefully to management; adequate discussion between the laboratories and clinicians and the laying-down of written guidelines may reduce the number of unnecessary investigations. A system which enables casualty officers to follow up the patients whom they admit will help trainees to confirm or refute their initial diagnostic impressions, and should be encouraged. A knowledge of the number, type and outcome of treatment of general surgical cases passing through the A & E Department is important in planning curricula and also for allocating resources.

Accidents↗

PubMed1995

Changes in health care: challenges for information system design.

It is widely recognized that the systematic availability of medical care services is a vital component of the social network. Although particular political, cultural and economic factors lead to different strategic approaches in different countries, all are faced with balancing resource allocation against the perceived desirability of the results. In many countries the social urgency to address this issue has reached a critical status. All of the current changes and challenges in health care delivery are to a large extent being driven by these considerations. Information systems consisting of telecommunication and computing technologies will play a key role in supporting emerging delivery systems. The purpose of this brief paper is to identify the major themes within this complex network of considerations and to serve perhaps as a road map in on-going system design and evaluation efforts.

Computer Systems↗

PubMed1989

Developing professional responsibility in maternity care in Hong Kong.

A simple questionnaire was used to document basic information surrounding all perinatal deaths in Hong Kong. Coordinators were appointed for every maternity unit. Replies were sent by mail to the Obstetrical and Gynaecological Society. Using volunteer time and minimum budget, the data were collated and analyzed. The main causes of death were congenital anomalies, intrauterine death of unknown cause and prematurity. There was significant difference in performance when the University units were compared with the private and Government units. Changes in resource allocation and modification of clinical practice may be recommended as a result of such audit.

Cause of Death↗

PubMed1995

Syphilis control in pregnancy: decentralization of screening facilities to primary care level, a demonstration project in Nairobi, Kenya.

A decentralized syphilis control program in pregnant women was implemented in nine Nairobi City Council antenatal clinics between July 1992 and August 1993, whereby pregnant women were screened for syphilis, treated before leaving the clinic if RPR seroreactive, and counselled on the importance of partner treatment and sexual abstinence during treatment in order to protect their unborn babies from getting congenital syphilis. A total of 13,131 pregnant women were screened for syphilis (RPR test), 87.3% of seroreactive women were treated on site and 50% of partners returned to the clinic and were treated. The prevalence of RPR reactivity was 6.5%. Based on other data the program could theoretically have prevented 413 cases of congenital syphilis at a cost of approximately 50 USD per prevented case. This demonstration project shows that decentralized prevention of congenital syphilis in antenatal clinics by nurses is feasible and inexpensive and should receive priority in resource allocation in reproductive health and child survival programs.

Female↗

PubMed1996

The quality of life of renal dialysis patients: trying to find the missing measurement.

The physiological status of the individual renal patient is monitored regularly to ensure adequate dialysis is maintained, however, the psychosocial status of the renal patient is not subject to the same amount of attention. This study aimed to determine the Quality of Life and psychosocial needs of a sample of renal dialysis patients (n = 170), and to consider methods of routine clinical assessment and evaluation. Difficulties with psychosocial adjustment and physical symptoms were demonstrated. These findings provide evidence for the need to routinely assess psychosocial status in this patient population. There are some scales which could be incorporated into standard settings and used as outcome measures to assess the effectiveness of interventions, and for planning and resource allocation purposes.

Activities of Daily Living↗

PubMed1985

Using economic analysis to determine the resource consequences of choices made in planning clinical trials.

In the planning stages of a clinical trial, investigators and funding agencies must make decisions which affect the conduct of those trials. One such decision concerns the choice of the minimum difference in outcomes between experimental and control therapies which would be considered clinically important, a variable which is used to calculate the sample size requirement. This choice is often determined by arbitrary rules-of-thumb. In order to make explicit the resource implications of such arbitrary choices this paper describes a cost-effectiveness model which determines the consequences (in resource allocation terms) of attempting to demonstrate smaller differences in outcomes. Incorporating economic principles into the decision making process in planning clinical trials may be helpful in allowing investigators and funding agencies to set priorities when allocating funds across trials competing for a fixed research budget.

Clinical Trials as Topic↗

PubMed1989

The effects of central processing strategies on learning disabled, mildly retarded, average, and gifted children's elaborative encoding abilities.

The purpose of these studies was to examine potential central processing strategy differences among subgroups of children on a series of elaborative encoding tasks. To this end, two experiments included four ability groups (slow learners, learning disabled, average, and intellectually gifted children) who recalled words embedded in sentences. In general, the results suggest that lower verbal and learning ability subgroups recalled less information during elaboratorive encoding conditions than higher ability groups. More importantly, however, the results indicated that lower ability groups differed from higher ability groups in how they shared, discriminated, and selectively allocated resources between the central and secondary recall tasks. The results were discussed within a framework that views individual differences in encoding as reflecting central processing (i.e., resource monitoring) deficiencies.

Aptitude↗

PubMed1986

Type A, test performance and salivary cortisol.

Forty first year medical students, previously screened for the presence or absence of the Type A behavior pattern, collected saliva samples for four days leading up to the first major examination of their medical school course. It was observed that the day of the examination produced substantially different patterns of salivary cortisol concentrations for Type A and non-A subjects, depending on their level of performance. The Type A subjects who scored above the median on the examination showed higher concentrations of salivary cortisol than Type A subjects who scored below the median. The reverse of this pattern was found for non-A subjects. Visual analog scale ratings of subjective stress showed no behavior pattern effects and a very low correlation with the salivary cortisol concentrations. The results support the view that the occurrence of physiological arousal associated with the Type A behaviour pattern is intermittent and dependent on situational factors such as expectation of success and actual success. This is consistent with conceptualizing the Type A pattern as a strategy for resource allocation which may be elective, rather then the behavioural manifestation of an automatic physical response to stress.

Achievement↗

PubMed1995

Transgenic lambda/lacI mutagenicity assay: statistical determination of sample size.

Statistical analysis of the lambda/lacI transgenic mutagenicity assay was used to determine optimal sample size and resource allocation in terms of number of animals and number of recovered target genes (recovered phage) required to demonstrate a statistically significant induction in mutant frequency. Statistical assumptions as applied to mutagenicity data are discussed for a number of frequently used statistical analyses. Log transformations are suggested as a means of meeting statistical assumptions and examples are given on interpreting results of analyses of log transformed data. The data analyzed in this study indicate that 300,000 lambda plaques from each of five animals should be analyzed per treatment group in order to detect a doubling of mutant frequencies. Additional sensitivity is gained primarily through increase of animal number and not the number of phage rescued, due to inherent animal-to-animal variability.

Animals↗

PubMed1988

Epidemiology and tropical public health: current and future contributions with particular emphasis on the role of the London School of Hygiene and Tropical Medicine.

This paper presents a forward look at the contribution of epidemiology to public health in developing countries and pays particular attention to the present and future role of the London School of Hygiene and Tropical Medicine. Three types of epidemiology are distinguished for the purposes of the paper: micro-epidemiology, desk epidemiology and macro-epidemiology. Micro-epidemiology, the application of epidemiology to particular health problems in particular settings, is illustrated through examples in both child and adult health. More emphasis on acute respiratory infections in children, maternal and neonatal health, and adult health in general is advocated. The contributions of desk epidemiology are illustrated through examples of the exploration of the effects of confounding and mis-classification. Continued attention to theoretical and methodological issues is essential if the quality and cost-effectiveness of field studies are to continue to improve. Macro-epidemiology is concerned with the absolute and relative contributions of particular causes or diseases to the overall burden of ill-health in a population. It is a young field in which important advances may be made in the 1990s. Its results are highly relevant to policy making and resource allocation in the health sector. In conclusion, the relationship between epidemiologists in developed and developing countries is briefly discussed and some recommendations are made.

Adolescent↗

PubMed1988

Migration selectivity and the effects of public programs.

"A model of the spatial distribution of mobile heterogeneous agents is formulated to assess how a price change or program subsidy that is location-specific affects the composition of local residents via selective migration and thus biases evaluations of the effectiveness of the program based on its local consequences. Longitudinal data from Colombia are used to test the implications of migration selectivity. The findings confirm the existence of selective migration, suggesting that local subsidies to human capital attract high-income but, within income groups, low-fertility households and those with low human capital endowments. These migration patterns are shown to be consistent with the dominance of endowment over tastes heterogeneity in the population under plausible behavioral assumptions."

Americas↗

PubMed1990

Comparison of short-term and continuous chemotherapy (mitozantrone) for advanced breast cancer.

132 patients with advanced recurrent breast cancer were treated with four courses of mitozantrone 14 mg/m2 intravenously every 3 weeks (9 weeks). Patients showing disease stabilisation or objective response were randomised to stop chemotherapy or to continue until disease progression. At that stage 27% showed partial responses, 3% complete responses, and 10% disease stabilisation. 22 patients were randomised to continue chemotherapy and 21 to stop. There was no difference in time to disease progression, response duration, or survival between the two groups. Toxicity was mild during the first four courses of therapy. Thus, short courses of single-agent chemotherapy can produce similar therapeutic results to long-term chemotherapy, which has major implications for cost, resource allocation, and toxicity of therapy. Stopping chemotherapy early in responders did not cause rapid relapse. Since drug resistance apparently develops early during therapy, new approaches to modify resistance should be more useful than continuous chemotherapy.

Adult↗

PubMed1991

Priority setting: lessons from Oregon.

The state of Oregon has developed a unique method to set priorities for health services. The method is based on a cost-utility formula but also incorporates public attitudes and values. Using an explicit process, the Oregon Health Services Commission has completed the ranking of 714 condition-treatment pairs. The background, methods, and criticisms of the Oregon approach highlight key questions for managers and physicians in other health services when they allocate limited resources.

Community Participation↗

PubMed1991

Comparison of dexamethasone and ondansetron in the prophylaxis of emesis induced by moderately emetogenic chemotherapy.

A multicentre, randomised, double-blind, cross-over trial was done to compare the efficacy and safety of a serotonin receptor antagonist--ondansetron--and dexamethasone in the prophylaxis of acute and delayed emesis and nausea induced by moderately emetogenic non-platinum-containing chemotherapy regimens. Patients were treated as outpatients and received intravenous ondansetron 4 mg or dexamethasone 8 mg before chemotherapy and oral maintenance (ondansetron 4 mg every 6 h and dexamethasone reducing from 4 mg to 1 mg 6-hourly between days 1 and 5) for 5 days. 112 patients were treated (38 men, 73 women, 1 with no gender recorded; age range 30-73 years) and 100 were evaluable for cross-over analysis. Patients taking ondansetron or dexamethasone reported no significant difference in complete and major control of acute (83% vs 79%, p = 0.46) or delayed (82% vs 88%, p = 0.214) emesis (vomiting plus retches). Significantly more patients on dexamethasone (87%) than on ondansetron (72%) reported control of delayed nausea (days 2-5) (p = 0.003). Both drugs were well tolerated with no significant difference in the number of adverse events, and this is reflected by similar patient preference for ondansetron (40%) and dexamethasone (30%) (p = 0.244). Both drugs offer adequate out-patient control of chemotherapy-induced emesis; however, dexamethasone has an advantage in the control of delayed nausea, and also in terms of cost and resource allocation.

Acute Disease↗