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At least 19 recordsLinked to original sources
PubMed1979

A single-bedtime-dose self-medication system.

A medication system in use at the Florida Mental Health Institute is based on the unit-dose procedure and weekly reviews of patients' medications. The program is aimed at reducing the use of polypharmacy and of concentrates and stabilizing patients on a single daily bedtime dose of medication. Once patients are stabilized on a single dose, they are trained by the nurses and through a drug group to manage their medications independently after discharge. The system has produced savings of up to 90 per cent of medication costs per patient and is gaining acceptance in other mental health facilities in the state. The authors believe it has the potential for even greater therapeutic and financial benefits by reducing the recidivism that occurs when discharged patients discontinue their drugs.

Adult↗
PubMed1991

The St Croix disaster and the National Disaster Medical System.

The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Disaster Planning↗
PubMed1989

Healers, deities, saints and doctors: elements for the analysis of medical systems.

This article provides the basic elements for the discussion and analysis of medical systems and their inter-dependency, with special reference to Latin America and, in particular, to the Andean countries. In a culturally diverse and socially stratified population, such as in contemporary Latin America, medical systems constitute a social representation resulting from the historical relationship between autochtonous medical cultures and those from other latitudes. The impregnation of scientific and popular knowledge results not only in the incorporation (and often expropriation) of folk in professional or scientific medicine, but also in the increasing 'medicalisation' of popular and traditional therapeutic practices. The emergent 'popular' medical system draws from both the professional and folk models, and in its actual practice, integrates both popular beliefs and materia medica with elements drawn from popular religions and pre-Hispanic deities. The degree of competitiveness, co-operation or 'integration' among medical systems depends mainly on the asymmetrical distribution of power and resources, and is conditioned by the population's behaviour in the management of disease. Existing pluralist systems of health care reveal a valuable array of survival strategies, which far outreach the proposals for integration called for by official sectors. On the other hand, knowledge derived from traditional medicine can contribute to the development of new models of clinical practice and to the expansion of the conventional epidemiological model.

Cultural Characteristics↗
PubMed1989

Traditional or transitional medical systems? Pharmacotherapy as a case for analysis.

Questions have been raised about the validity of labels such as 'western', 'alternative', and 'traditional' as applied to medical systems. This study shows that the rubric 'traditional' may be validly applied to clusters of medical systems sharing common elements that distinguish them from 'western' systems. At the same time, pluralism in diagnostic and therapeutic procedures must be recognized even within each system. The discussion in this paper analyzes explanatory models, drawing mainly from Asian examples and focussing on pharmaceuticals. A purely cognitive approach may however be insufficient in understanding the different medical systems. A review of socio-historical factors that influence medical systems highlights important processes such as cultural reinterpretation and indigenization that characterize what could be more appropriately described as transitional medical systems. Changes in cultural forms, such as the acceptance of western pharmaceuticals, may still rely on traditional cognitive frames of reference, suggesting eclecticism amid conservatism. Issues of theoretical and practical concern are outlined at the end of the article.

Asia↗
PubMedDate not supplied

Triage: in austere environments and echeloned medical systems.

Although triage as a medical sorting process was originally developed and applied to echeloned military field medical systems dealing with mass casualties, the term has now permeated most aspects of medical practice. This essay attempts to refocus on triage in military and disaster settings, emphasizing the relationship of the echeloned system organization to the triage process, and the various non-medical factors which may influence triage decisions and priorities. Due to the lack of any analogous civilian experience, it is essential that all health personnel who may be involved in an echeloned care system gain and maintain proficiency by frequent involvement in appropriate training exercises, the characteristics of which are described.

Disasters↗
PubMed1990

Computer modeling of emergency medical system performance.

Emergency medical services (EMS) system managers face difficult problems when determining the need for system expansion and unit deployment. Information relevant to the decision is often limited and frequently not in a usable format. This lack of usable information often results in decisions that create less-than-optimal EMS systems. A constant search for greater efficiency prompted the development of a computer simulation model to analyze the current EMS system operated by the Tucson Fire Department and to provide statistical information on the effects of potential vehicle base locations on system performance. The simulation model generates data that reflect a variety of parameters necessary in base location analysis. Included in the performance statistics for each unit and for the entire system are indicators of unit use rates, minimum and maximum response times, and proportion of calls reached within the critical response time of eight minutes or less. The model has been carefully validated and used in unit redeployment and unit activation in Tucson, Arizona.

Arizona↗
PubMed1991

Modeling of biological and medical systems: a systemic strategy.

A strategy in the frame of General System Theory is proposed for the study of biological systems for medical purposes. Its definition and use requires in each experiment the collaboration between physician and system scientists and hence the definition of a common language, by which the real system under study is described. The strategy is based on three intermingled steps: first an ingenuous model is proposed, gathering all the medical knowledge about the studied system, organized within an informal frame derived from the state space approach. Next, a functional model is derived, enlightening the organization of the relations in the medical model. Finally, this organization is formalized by the most suitable algebraic tools, which are thereafter translated into APL programs. This last version is used for simulation, which is exploited not only as a tool to describe and make provisions on the dynamics of the models, but also to deepen and improve the knowledge about the observed system.

Computer Simulation↗
PubMed1992

Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project.

Substantial time delays from symptom onset to diagnosis and treatment of patients with acute myocardial infarction have been demonstrated. To determine the relative importance of prehospital mode of patient transport and the relative impact of emergency medical system transport with or without a prehospital cellular electrocardiogram (ECG) on hospital time delays to initiation of thrombolytic therapy, four prospective parallel groups of patients with acute myocardial infarction were evaluated. The median hospital time delay to treatment median (twenty-fifth and seventy-fifth percentiles) was 64 minutes (46 and 87 minutes, respectively, for twenty-fifth and seventy-fifth percentiles) for patients transported by private automobile ("walk-in"); 55 minutes (45 and 68 minutes, respectively) for patients transported by local ambulance; 50 minutes (38 and 81 minutes, respectively) for patients transported by the emergency medical system without a prehospital ECG; and 30 minutes (27 and 35 minutes, respectively) for patients transported by the emergency medical system who had a 12-lead ECG transmitted from the field. Patients transported by the emergency medical system were randomized to receive cellular telephone transmission of a prehospital 12-lead ECG. Specialized emergency medical system transport alone did not facilitate in-hospital initiation of thrombolytic therapy in patients with acute myocardial infarction when compared with those brought by local ambulance or by private automobile. A significant reduction in hospital time delay to treatment was observed only in patients transported by the emergency medical system who had cellular transmission of a prehospital 12-lead ECG from the field.

Electrocardiography↗
PubMed1992

The effect of certain systemic medications on oral calculus formation.

A quantitative comparison was made of supragingival calculus that formed in individuals using systemic medications for defined systemic medical problems and individuals not using medication. Measurements of supragingival plaque and calculus were made on the lingual surfaces of the 4 mandibular incisors of 68 consecutive patients presenting for dental examinations and oral prophylaxes. Variables noted in addition to medication and plaque status were: age, sex, time interval since previous prophylaxis, and smoking status. Analysis of results indicated a statistically significant reduction of calculus among individuals medicated with beta-blockers, diuretics, anticholinergics, synthroid and allopurinol despite the high quantity of plaque present.

Adult↗
PubMed1989

A preliminary trial of the programmable implantable medication system for insulin delivery.

We undertook a trial to determine whether an implanted insulin-delivery system, the programmable implantable medication system (PIMS), could be used to treat patients with insulin-dependent diabetes. PIMS is a pulsatile, programmable pump with a battery life expectancy of five years. The reservoir is refilled transcutaneously every two months with a surfactant-stabilized human insulin preparation containing 400 U of insulin per milliliter. Eighteen patients received PIMS-delivered insulin for 4 to 25 months (mean, 18). The total PIMS-implantation experience comprised 28 patient-years. Good glycemic control was established and sustained during treatment (mean plasma glucose level, 7.3 mmol per liter; mean glycohemoglobin level, 8 percent [upper limit of normal, 7.5 percent]), with significantly reduced glycemic fluctuations. The total mean daily insulin dose did not change. Insulin solutions withdrawn from the pump reservoirs contained 92 percent native insulin and preserved biologic activity. There were no surgical or skin complications, severe hypoglycemic episodes, or instances of diabetic ketoacidosis. One pump was replaced because of a manufacturing defect, and four patients had catheter blockages due to omental-tissue encapsulation; two withdrew from the study and two had devices that were repaired successfully. The actuarial rate of survival of catheter function was 78 percent at 1.5 years. We conclude from this pilot study that insulin treatment with an implanted, variable-rate, programmable pump is feasible for periods up to two years.

Adult↗
PubMed1992

University of Maryland Medical System: American medicine's first teaching facility reinvents the academic hospital.

The University of Maryland Medical School, established in 1807, focused on bedside teaching. This emphasis has continued and expanded through the growth of University Hospital and, ultimately, the University of Maryland Medical System, such that Maryland can now boast of a superb medical care system providing excellent medical education and research opportunities in a patient care setting.

History, 19th Century↗