Does Use of CAM for Specific Health Problems Increase With Reduced Access to Care?

The objective of this paper was to determine predictors of complementary and alternative medicine (CAM) use among individuals with specific health problems. Data were derived from the 1998 Medical Expenditure Panel Survey (MEPS). After adjustment for potential confounders, individuals with perceived barriers to obatining care were more likely to use any CAM treatment (OR 2.16), herbal therapy (OR 2.70) and spiritual care (OR 3.99) for a specific health problem. Individuals dissatisfied with their familys access to care were more likely to use acupuncture (OR 3.43). Dissatisfaction with quality of care was associated with increased use of spiritual therapy (OR 4.74). Perceptions of inadequate access to health care may contribute to utilization of CAM therapies; such therapies in this instance appear to be used as an alternative to mainstream medicine.     

What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior?

Alerts and prompts represent promising types of decision support in electronic prescribing to tackle inadequacies in prescribing. A systematic review was conducted to evaluate the efficacy of computerized drug alerts and prompts searching EMBASE, CINHAL, MEDLINE, and PsychINFO up to May 2007. Studies assessing the impact of electronic alerts and prompts on clinicians' prescribing behavior were selected and categorized by decision support type. Most alerts and prompts (23 out of 27) demonstrated benefit in improving prescribing behavior and/or reducing error rates. The impact appeared to vary based on the type of decision support. Some of these alerts (n = 5) reported a positive impact on clinical and health service management outcomes. For many categories of reminders, the number of studies was very small and few data were available from the outpatient setting. None of the studies evaluated features that might make alerts and prompts more effective. Details of an updated search run in Jan 2009 are included in the supplement section of this review.     

Using Support Vector Machine to Predict Eco-environment Burden： A Case Study of Wuhan, Hubei Province, China

Objective The human socio-economic development depends on the planet＇s natural capital. Humans have had a considerable impact on the earth, such as resources depression and environment deterioration. The objective of this study was to assess the impact of socio-economic development on the ecological environment of Wuhan, Hubei Province, China, during the general planning period 2006-2020. Methods Support vector machine （SVM） model was constructed to simulate the process of eco-economic system of Wuhan. Socio-economic factors of urban total ecological footprint （TEF） were selected by partial least squares （PLS） and leave-one-out cross validation （LOOCV）. Historical data of socio-economic factors as inputs, and corresponding historical data of TEF as target outputs, were presented to identify and validate the SVM model. When predicted input data after 2005 were presented to trained model as generalization sets, TEFs of 2005, 2006,…, till 2020 were simulated as output in succession. Results Up to 2020, the district would have suffered an accumulative TEF of 28.374 million gha, which was over 1.5 times that of 2004 and nearly 3 times that of 1988. The per capita EF would be up to 3.019 gha in 2020. Contusions The simulation indicated that although the increase rate of GDP would be restricted in a lower level during the general planning period, urban ecological environment burden could not respond to the socio-economic circumstances promptly. SVM provides tools for dynamic assessment of regional eco-environment. However, there still exist limitations and disadvantages in the model. We believe that the next logical step in deriving better dynamic models of ecosystem is to integrate SVM and other algorithms or technologies.     

Study on Weighting of Amount of Nursing Care Using Data on Index of Patient’s Need for Nursing and System Approach

The importance of appropriate staffing of nurses has been emphasized and optimal provision of nursing care has increased in order to improve the quality of nursing service. Since the introduction of the nursing information system in 1987, we have creatively categorized the classification of index of patients need for nursing to collect ever-objective data on the index of patients need for nursing and utilized it as an indicator to evaluate the amount of nursing care necessary for patients. We also weighted the index of patients need for nursing and categorized it into categories A, B, and C based on the accumulated data on the index of patients need for nursing, and calculated the cost of nursing care by adding the nurse salary data to the weighting. In addition, we developed a system in which measurement of amount of nursing care based on the data on the index of patients need for nursing and calculation of nursing care cost could be done by utilizing the hospital Data Warehouse (DWH) and adopted a system approach that could contribute to improvement in patient service and make hospital management better.     

A Study on the Stability of Ceftazidime to β-Lactamases

Ceftazidime (CTD), a new third generationof cephalosporins, is resistant to the β--Lac-tamases of .most Gram--negative bacteria. Thispaper presents the stability of CTD to β--Lac-     

Computer-generated Patient Education Materials: Do They Affect Professional Practice? : A Systematic Review

A systematic search of seven electronic databases was done to identify randomized controlled trials that assessed the effect of computer-generated patient education material (PEM) on professional practice. Three studies met the authors'' criteria.All three studies involved preventive care. All used a complex intervention of which computer-generated PEM was a major component. Improvements in practice were seen in all studies, although these gains were generally modest. One study showed improvement in patient outcomes. Mann-Whitney statistics calculated for the studies'' outcome measures ranged from 0.48 to 0.66, equivalent to risk differences of −4 to 32 percent.Computer-generated PEM seems to have a small, positive effect on professional practice. The small number of included studies and the complex nature of the interventions makes it difficult to draw conclusions about the ability of computer-generated PEM to change professional practice. Future work should involve well-defined interventions that can be clearly evaluated in terms of effect and cost.The traditional consultation between a health professional and a patient suffers from the flawed memories of both participants. A study by Kitching ¹ found that, on average, patients forget half of what they were told by a doctor within 5 min of leaving the consultation room. In addition, health professionals can easily forget to pass on important information to the patient. There is, therefore, scope for improvement in communication between professionals and patients.This is especially true if patients are to be more active participants in their own care. One solution proposed by Coulter et al. ² is to ensure that patients have access to written or audiovisual material that supplements the material discussed during the consultation, which can also be used to guide questioning during later consultations.This material could be delivered in several ways. Pre-printed booklets or leaflets are the most widely used method, ³ but some authors ^{4, 5} suggest that computerized clinical information systems should routinely include education materials. These materials could also be tailored to individual patients. Another method would be to use interactive educational software packages that allow the patient to direct the delivery of information. These packages have been used to combine audio, video, text, and graphics to provide information on a wide range of topics. ⁶ The Internet is also an increasingly important source of health information, although the quality of this information is currently variable. ⁷ Are health professionals willing to make use of education materials and packages in their practice? Other reviews have focused on patient behavior and outcomes. ^{8, 9} The health professional is, however, often the point of access to these materials, and an education package should, at the very least, be good enough for a professional to want to make it available to patients.Two potential barriers to increased use of education materials by professionals are storage and access problems (booklets and leaflets take up space and are not always to hand) and the need to keep the materials up to date. ¹⁰ Wilson ¹⁰ suggests computer-generated materials as a solution, because these materials are not subject to storage limitations and can be easily updated. Moreover, these materials are immediately available to the health care professional during a consultation, which is often not the case for preprinted leaflets. The computer system can also be used to remind the clinician about the patient information. ¹¹ However, use of computer-based materials may be limited by financial, administrative, and attitudinal barriers in a health care organization or among its health care professionals.As Mayberry and Mayberry ¹² point out, it is important that the effect of patient education material (PEM) should be assessed with the same rigor as other interventions. In this review, we aim to systematically determine the effects of computer-generated PEM on professional practice (our primary outcome) and on patient outcomes.     

Do studies of the nature of cases mislead about the reality of cases? A response to Pattison et al.

This article questions whether many are misled by current case studies. Three broad types of style of case study are described. A stark style, based on medical case studies, a fictionalised style in reaction, and a personal statement made in discussion groups by an original protagonist. Only the second type fits Pattison's category. Language remains an important issue, but to be examined as the case is lived in discussion rather than as a potentially reductionist study of the case as text.     

Access to Health Information and Support: A Public Highway or a Private Road?

Thomas R. Eng, VMD, MPH; Andrew Maxfield, PhD; Kevin Patrick, MD, MS; Mary Jo Deering, PhD; Scott C. Ratzan, MD, MPA, MA; David H. Gustafson, PhD

JAMA. 1998;280:1371-1375.

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.

     

Study on Perception of Potential Condom Use among Unmarried Migrants

Objective To understand the perception of potential condom use and its influencing factors so as to promote condom use among unmarried migrants Method A survey, using self-administered structured anonx‘mous questionnaire, was conducted among 1 092 unmarried migrants aged 15～24 years old in urban area of Shanghai. Results The unmarried migrants had some knowledge of condom. However, their knowledge level and their attitude towards condom use were not so optimistic. Subjects‘ knowledge of contraceptives and STD/AIDS had a positive influence on their attitude toward condom use. Subjects with positive attitude to condom use were more likely to use condom in sexual activity (OR=1.61). Conclusion Unmarried migrants have lower rate of condom use if they have insufficient knowledge of condom. Therefore, it is essential to strengthen the sexual health education among unmarried sex-active migrants in order to encourage contraceptive use, especially condom use.     

A Study on Using Improved Methenamine-silver Stain to Diagnosis of Pneumocystis carinii

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Do Neuroimaging Results Impact Prognosis of Epilepsy Surgery? A Meta-analysis

The neuroimaging results of drug-resistant epilepsy patients play an important role in the surgery decision and prognosis. The aim of this study was to evaluate the impact of these results on the efficacy of epilepay surgery, and then to explore surgical benefit for epilepsy patients with negative magnetic resonance (MR) images. Twenty-four subgroups describing the outcomes of 1475 epilepsy patients with positive-neuroimaging results and 696 patients with negative-neuroimaging results were involved in the meta-analysis. Overall, the odds of postoperational seizure-free rate were 2.03 times higher in magnetic resonance imaging-positive (MRI-positive) patients than in MRI-negative patients [odds ratio (OR)=2.03,95% CI (1.67,2.47),P<0.00001]. For patients with temporal lobe epilepsy (TLE), the odds were 1.76 times higher in those with MRI-positive results than in those with MRI-negative results [OR=1.76,95% CI (1.34,2.32), P<0.0001]. For patients with extra-temporal lobe epilepsy (extra-TLE), the odds were 2.88 times higher in MRI-positive patients than in MRI-negative patients [OR=2.88,95% CI(1.53,5.43),P=0.001]. It was concluded that the seizure-free rate of MRI-positive patients after surgery was higher than that of MRI-negative patients. For patients with negative results, an appropriate surgery should be concerned for TLE.     

How Can Activity-Based Costing Methodology Be Performed as a Powerful Tool to Calculate Costs and Secure Appropriate Patient Care?

Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment.     

Use of ABC Method in the Study of Lectin Receptors in Liver Tumors

The high affinity interaction of avidin-biotin inimmunoenzymatic techniques has provided a simple and sen-sitive method to localize antigens in formalin-fixed and paraf-fin-embedded tissues. The distribution of lectin receptors inprimary hepatooellular carcinoma, intrahepaticcholangiocarcinoma and cavernous hemangioma was studied     

Patient delay in responding to symptoms of possible heart attack: can we reduce time to care?

In Australia, many deaths and significant cardiac disability result from delayed response to symptoms of heart attack. Although delays due to transport and initiation of reperfusion therapy in hospital may contribute to late treatment, the major component of delay is the time patients take in deciding to seek help. A critical examination of campaigns to shorten patient delay concludes that they were based on a factual, short-term, non-targeted approach that included education and mass media strategies. They achieved equivocal results. One randomised controlled trial has been conducted. Although this showed an improved understanding of heart attack symptoms, it did not shorten pre-hospital delays. The implications of these findings are that future campaigns to shorten patient delay are likely to be more effective if they address the psychosocial and behavioural blocks to action, are ongoing rather than short term, and focus on people at highest risk, including those with known or high risk of coronary heart disease, those in rural locations, and Indigenous Australians. The National Heart Foundation of Australia proposes a comprehensive strategy to incorporate this approach into its future campaigns to reduce patient delay for suspected heart attack.     

Erythropoietic Protoporphyria （A Light,Polarization and Electron Microscopical Study of the Liver in One Patient）

Objective To explore the hepatic pathology of a patient with erythropoietic protoporphyria(EPP).Methods Percutaneous liver biopsy was performed with a Chiba needle in α 31year-old man suffering from EPP.The sample was fixed in 10% formalin solution,and the paraffin-embedded section was stained with H-E,PAS,etc.Unstained paraffin-embedded and H-E stained paraffin embedded sections were examined under polarization microscope.Ultrathin sections were examined in a transmission electron microscope.Results In H-E stained sections,deposits of dark reddish brown pigment were seen in the hepatocytes,Kupffer cells,portal macrophages and plugs in the lumen of bile canaliculi and ducts.Under light microscope,such deposits,with rare exception,exhibited striking birefringence with the unique shape of “Maltese cross”.Non-membrane limited compact masses of crystals were straight of slightly curved and their dimensions(40-640nm in length and 6-22nm in width)were different under the transmission electron microscope.Conclusion Microscopy,especially polarization microscopy,provides a highly sensitive and specific technique for the diagnosis of EPP.     

The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events

Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up.Methods A random sample of 2,031 participants(73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study(APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay(ELISA). The composite endpoint was a combination of first-eve...