Leukemia inhibitory factor involvement in human ulcerative colitis and its potential role in malignant course

This article is based on the report, Anticipating and Assessing Health Care Technology, written in the Netherlands between 1985-88. The project was carried out because of increasing concern in the Dutch Ministry of Health (STG, then WVC) about the costs and benefits of new technologies for health care. At that time, there were no established models for early identification, so the project was not only the most extensive such effort to that date, but had to develop its own methods. Overseen by a special commission, the project staff identified many future and emerging technologies in health care and assessed selected technologies. Although the actual information produced was quickly dated and the project was discontinued in 1988, it did stimulate the Ministry of Health to ask the Dutch Health Council (Gezondheidsraad) to continuously identify important new technologies. The reports also demonstrated the potential usefulness of such an effort to Dutch policy makers, and probably to those in other countries as well.     

Which are the best information sources for identifying emerging health care technologies? An international Delphi survey

The purpose of this survey was to assess potential information sources for identifying new health care technologies. A three-round Delphi study was conducted, involving 38 selected experts who suggested and assessed potential sources by applying agreed criteria. Twenty-six potential information sources were considered. Timeliness, time efficiency, and sensitivity were important criteria in determining which were the most important sources. The eight recommended sources were: pharmaceutical journals, pharmaceutical and biotechnology companies, specialist medical journals, key medical journals, medical engineering companies, private health care providers, newsletters and bulletins from other health technology assessment agencies, and groups of expert health professionals. There is a need to use a combination of sources because the most useful sources will vary according to the type of technology under consideration.     

Information technology applications in quality assurance and quality improvement, Part II

Many information technologies have been or could be applied to efforts to measure and improve health care quality. This article reviews the recent literature in medical informatics, quality assurance, and quality improvement to identify these and current, emerging, and potential technologies.     

Physical mapping and characterization of 5S rRNA genes in Douglas-fir

A critical mass of Internet users will soon enable wide diffusion of electronic communication within medical practice. E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. Unless these technologies are implemented with substantial forethought, they may disturb delicate balances in the patient-physician relationship, widen social disparities in health outcomes, and create barriers to access to health care. This paper seeks to identify the promise and pitfalls of electronic patient-physician communication before such technology becomes widely distributed. A research agenda is proposed that would provide data that are useful for careful shaping of the communications infrastructure. The paper addresses the need to 1) define appropriate use of the various modes of patient-physician communication, 2) ensure the security and confidentiality of patient information, 3) create user interfaces that guide patients in effective use of the technology, 4) proactively assess medicolegal liability, and 5) ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy.     

High-tech with the human touch: Using telehealth to reach America's children.

[Correction Notice: An erratum for this article was reported in Vol 31(2) of Professional Psychology: Research and Practice (see record 2007-17403-001). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov.] In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The identification of new health care technologies by the Health Council of The Netherlands

The article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.     

Roles of the federal and state governments in outcomes assessment

Both federal and state governments have mandates to collect, analyze, and disseminate health care information. The federal government is the single largest payer for health care and health services research. Its agencies, the Healthcare Finance Administration (HCFA) and the Agency for Healthcare Policy Research (AHCPR) play a major role in shaping information strategies for all health care stakeholders. State governments are among those stakeholders and are fertile grounds for experimentation, change, and learning. Building effective federal-state partnerships and public-private partnerships can help foster innovation in health data collection and analysis, as well as identify new strategies for information dissemination.     

Women with little or no prenatal care during pregnancy. Results of a study of twenty departments

OBJECTIVES: To estimate the frequency of women who have little or no health care during pregnancy, to assess associated perinatal risk, and to identify the corresponding risk factors. METHODS: Women who consulted less than 4 times or who began consultation during the third trimester were identified in public and private maternity units in 20 French departments. These women were compared with a sample of women from the same institutions who consulted regularly. RESULTS: The percentage of pregnant women with little or no care was 1.1%. Risk of premature birth was increased 4-fold compared with women who consulted regularly. Women who consulted little were very young, multiparous or living alone with no health care insurance. These women stated that the reason for not consulting was that their pregnancy was not accepted, financial difficulties and administrative problems. CONCLUSION: The lack of regular medical care results from social obstacles, especially in foreign born women but is also related to personal problems which are difficult to identify and manage.     

Pregnancy and oral health: utilization of the oral health care system by pregnant women in North Dakota

There is little data on the oral health of pregnant women in North Dakota. In response, the Dental Program of the North Dakota Department of Health included two oral health questions on a survey sent to 2,250 new mothers in the state. The oral health questions were designed to gather information on the proportion of pregnant women using the oral health care system and to identify major barriers to receiving oral health care services. The survey response rate was 65 percent. Just under half of the women responding (43.2%) had visited the dentist during their pregnancy. The major reason cited for not visiting the dentist was that they were not having any problems. There appears to be a lack of knowledge regarding the need for this particular aspect of prenatal care.     

Lipids from Mycobacterium leprae cell wall suppress T-cell activation in vivo and in vitro

The need for an ethics of medical justice in Latin America is asserted in the context of a review of concepts of justice throughout history and of changing governmental perspectives on provision of health care in the US and other developed countries. The current view that individuals are primarily human resources is at odds with a long tradition asserting the intrinsic dignity of human beings. English-speaking bioethicists began in the 1960s to stress the principal of autonomy of patients, recognizing their right to make decisions on their own lives and medical care equally with the physician. At the same time, the US has approved no legislation establishing a right to health care, which is rather regarded as a private good. Governments are increasingly inclined to renounce their role as direct providers of health care. The liberal democratic state until recently understood that it fulfilled its ethical commitment to promoting social justice through provision of health care. Nevertheless, societies that stress the importance of the individual in decision-making and that conceive of health as a private good are confronted with the contradiction of apparently irreconcilable visions. With infinite demand for health services and limited health resources, the discourse of autonomy has slowly been replaced by a discourse of distributive justice. The most appropriate version of distributive justice for Latin America is probably that which affirms the duty of assisting those most in need. The prevalence of malnutrition, misery, and premature death in the world is a clear sign of imbalance. If the essential dignity of all human beings and not just of the elite is to be affirmed, medical justice must become the most urgent priority of Latin America.     

Using structured text and templates to capture health status outcomes in the electronic health record

BACKGROUND: Because of the difficulty of implementing clinical outcomes-focused quality improvement (QI) projects, most organizations' efforts and comparative quality report cards have centered on structure and process indicators or on outcomes captured in administrative data systems. Ultimately, however, health care is intended to improve health. Health status is now frequently included in the set of quality of care information requested by purchasers of health care, accrediting and governmental agencies, and consumer groups. Subsequently, users of electronic health record (EHR) systems are demanding that the EHR support the collection and comparative analysis of health status information over time and by clinical population and provider. APPROACH: As opposed to the current practice in most organizations of collecting health status data via an annual mail survey, the approach discussed in this article utilizes standardized coding and classification (SCC) systems and standardized surveys to capture health status information in the EHR during the routine course of care delivery through the use of templates built on structured text. This method is illustrated with examples from the WAVE EHR. The EHR-based structured text and template approach facilitates the incorporation of health status measurement into the documentation of the patient-provider encounter, builds on recognized SCC systems and standardized surveys, and enables information retrieval for a variety of analyses, including those focused on QI. CONCLUSIONS: Health status outcomes are an essential component of an information set focused on health care quality. To routinely capture and analyze health status variables, SCC systems and standardized health status surveys are necessary.     

"High-Tech With the Human Touch: Using Telehealth to Reach America's Children." Correction to Wasem and Puskin (2000).

Reports an error in "High-tech with the human touch: Using telehealth to reach America's children" by Cathy Wasem and Dena Puskin (Professional Psychology: Research and Practice, 2000[Feb], Vol 31[1], 3-4). On page 4, the last sentence of text incorrectly reads, "For additional telehealth project, policy, legal, and funding information, visit OAT's web site at http://www.telehealth.hrsa.gov." The correct web site address is http://telehealth.hrsa.gov. (The following abstract of the original article appeared in record 2007-17617-001.) In the past decade, we have seen new telecommunication and information technologies used to provide health services, health professional and consumer education, and public health and administrative services. The application of these tools to health care, commonly referred to as telehealth, provides an unprecedented opportunity, as we embark on a new millennium, to take services to those in need-to "carry the water to the desert." Telehealth provides both a means to increase access, and to reengineer the processes of care, enhancing the equality and effectiveness of health services. This article illustrates how telehealth has helped children and youth in various health care settings. Many of these projects have been initiated with federal funds from OAT or other federal agencies. Some of the projects use technologies that require special phone lines and expensive equipment ranging from $15,000 to $50,000; others run over regular phone lines and use equipment costing between $500 to $1,000. Psychologists are involved in many of these projects as initiators of services, as members of multidisciplinary teams, and as researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of philosophy, bio-mathematics, biometry and model theory for medicine]

STUDY OBJECTIVE: Poor attendance to antenatal visits was studied to identify risk factors and to analyse the association with adverse pregnancy outcome. DESIGN: All poor attenders and a sample of good attenders were compared within three groups of women: women < 20 years, French women > or = 20 years, and foreigners > or = 20 years. SETTING: 20 French districts including 85,000 births from January to June 1993. SUBJECTS: 848 poor attenders and 759 good attenders. Poor attenders made fewer than four antenatal visits or began care during or after the sixth month. Good attenders made at least four visits and began care before the sixth month. MAIN RESULTS: 1.1% of the women were poor attenders. Risk factors for poor attendance were single status and lack of health insurance in the group under 20; young age, high parity, and single status in the French group aged over 20; and single status and lack of health insurance in the foreign group aged over 20. For poor attenders, the odds ratios for preterm delivery were 5.8 (95% CI: 3.2, 10.5) among French women and 3.3 (95% CI: 1.5, 7.4) among foreign women with health insurance. Poor attendance was not associated with poor pregnancy outcome in the group under 20, and among foreign women over 20 without health insurance, but both groups had high rates of preterm delivery and low birth weight. CONCLUSION: Lack of health insurance is an important barrier to health care during pregnancy. Poor antenatal care is an important risk factor for adverse pregnancy outcome among women who have easy access to health care services.     

Effect of hyperbaric oxygen therapy on survival after global cerebral ischemia in rats

Current education programmes for oral health care workers have failed to adapt to the changing oral health status and the changing demands made upon oral health care systems. In order to adapt, education systems need to recognise the forces that are influencing the demands on the oral health care system and identify the most appropriate solutions. The most logical solution is to develop programmes which reflect the Primary Health Care Approach (PHCA), and in particular emphasise inter-sectorial collaboration. The challenge for dental education systems is to identify mechanisms through which these principles can be applied.     

Using Intranet Technology in the ICU

Current information management tends to focus on patient information, although non-patient-derived information is equally important in the delivery of health care. Intranets, based on technologies derived from the global Internet and the World Wide Web, are a viable means to strategically bring nonclinical information to the point of care.     

Instructional intranets in graduate medical education

Changes in medicine, medical education, and technology have influenced graduate medical education (GME) and have altered many traditional concepts of resident training. Three issues in particular have led to changes. The first is the shortage of time that academic and community physicians have to devote to medical teaching because of the demands to bring in revenue through clinical practice. The second is the limited exposure that residents have to various medical conditions due to a shift in training venues from hospitals to ambulatory care settings. Last is residents' lack of training in using information technologies. The resultant deficits the exist in GME make it more difficult for residents to practice medicine in the most efficient manner. Hence, there is a need for health care professionals' education to address the coming demands of the 21st century. Instructional computer technology can be useful in bridging this gap. Intranets, internal organizational networks, are private versions of the World Wide Web that are often available only to members of a particular organization. This paper reviews changes in medicine and medical education, describes how instructional intranets can be incorporated into GME, and discusses the impact intranet and Internet technologies can have on GME.     

Common pediatric dental problems

Physicians who provide primary care for children have a unique position to provide diagnostic, triage, educational, and preventive dental care for patients. Several papers have been published regarding primary pediatricians' participation in the preventive dental health care of their patients. One publication, a survey of physicians in Alabama focusing on physicians' overall awareness of dental issues, concluded that most physicians believe they have a role in the oral health of their patients, yet most were not aware of the American Academy of Pediatric Dentistry's recommendations. Most physicians report that they routinely perform oral examinations during physical examinations of children and deliver preventive, oral information by the age of 6 months or earlier; however, most recommend that infants' first visit should be at 3 years of age, not at the time of first-tooth eruption as the authors recommend. Furthermore, many primary care physicians do not talk about oral health during prenatal counseling. Many physicians understand the preventive advantages of fluoride, yet most do not prescribe vitamin combinations that contain fluoride. If an understanding of the aforementioned issues of dental care, as well as aspects of preventive care in infants and children, become more uniform among primary care physicians, the prevention-based practice of pediatric dentistry will become much more successful, and children and adults will enjoy better dental health.     

Pharmacoeconomics and therapeutic drug monitoring

The ever increasing rate of inflation and the reality that resources for medical care are limited has led to significant changes in the reimbursement for health care services. These influences have convinced health care policy makers to closely evaluate innovative health services in terms of the benefits and costs. New pharmaceutical services must be economically justified in order to exist in the future. This is crucial to the expansion and adoption of pharmaceutical services. Application of economic evaluations is not new to the health care sector. Until recently, there were no incentives to transfer this interest into widespread use. As health care expenditures have escalated over the past two decades, the number of applications of these techniques has increased. Especially significant are cost-benefit and cost-effectiveness evaluations of medical practice, pharmaceuticals, and other health care technologies. Pharmacoeconomic analysis is an important tool to assist in the evaluation of new pharmaceutical services and technologies. Essentially, economic analytical methods are used to weigh the positive and negative consequences of alternative courses of action. The usefulness of pharmacoeconomic analyses is in resource allocation, with the purpose of achieving the highest return on investment or accomplishing a given objective in the least costly manner. Unfortunately, very few pharmacy programs have been evaluated using pharmacoeconomic techniques. The purpose of this article is to present various methods to assess the economic value of therapeutic drug monitoring services in society and for specific patient populations. Additionally, this article will review the previous attempts and various issues surrounding the economic justification of therapeutic drug monitoring.     

Access to health information and support: a public highway or a private road?

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information "haves" and "have-nots." This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes.