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991.
Fevzi Akinci Joseph Coyne Bernard Healey Joni Minear 《Disease Management & Health Outcomes》2004,12(5):285-298
When considering the trends in disease management, the focus of healthcare in the US has shifted from communicable diseases, which can most often be managed successfully, to chronic diseases, which are currently not managed very well. Chronic diseases, such as diabetes mellitus, become a lifelong health problem for the individual, the family, and in the workplace. Currently, there is no vaccine to prevent diabetes and no cure for diabetes once acquired. In order to improve the quality of care for diabetes, national performance measures have been developed to provide a unified set of diabetes-specific performance and outcome measures.The Diabetes Quality Improvement Project (DQIP) founded in 1997 through a partnership between the Center for Medicare and Medicaid Services, the National Committee for Quality Assurance, and the American Diabetes Association, established a single, standardized set of performance measures for diabetes care quality improvement and accountability in the US, which were published in 1998. The DQIP measures are noteworthy as a model for many other chronic diseases. Indeed, the DQIP represents the first widely adopted comprehensive performance measurement standards, not just for diabetes but for any single chronic disease. This is of further significance since it was developed by a coalition of public and private entities in the US.In order to prevent long-term complications from diabetes, there needs to be a physician-coordinated treatment plan involving a team approach to the problem. When such a physician-coordinated treatment plan is developed in conformance with the comprehensive performance measures, the prospects for a greater impact on diabetes might be enhanced.Overall, national performance measures for diabetes care have been widely adopted into health plan quality initiatives and have resulted in increased efforts to promote preventative screening and testing. Better compliance has lead to more stringent glucose control and helped to educate the public on the utility of the glycosylated hemoglobin level test for finding those at risk for microvascular and neuropathic complications. While more Americans with diabetes are receiving the recommended standards of care as a result of the implementation of national performance measures, diabetes management remains suboptimal but achievable.The authors concluded from this review that national performance measures have provided health plans and providers with objective tools to measure quality; however, these measures now need to move to prevention standards and initiatives. Policy development for diabetes care must continue to move from managing chronic illness to preventative screening of pre-diabetes through to identification and modification of lifestyle risk factors. 相似文献
992.
Lee M. Hilliard Mary H. Maddox Shenghui Tang Thomas H. Howard 《Disease Management & Health Outcomes》2004,12(6):393-398
Sickle cell disease (SCD), an inherited group of blood disorders, is a major public health problem worldwide. Patients experience severe anemia, increased risk of life-threatening infections, painful crisis, and chronic organ damage. Access to comprehensive care for SCD is known to improve outcomes; however, it is only reported from large urban centers serving one metropolitan area. Alabama, US, is a largely rural state with a significant number of children born each year with SCD. Prior to the development of our regional clinic network, the Children and Youth Sickle Network (CYSNSM), 50% of patients identified by newborn screening were not enrolled in comprehensive sickle cell care. The majority of non-enrolled patients lived in southern Alabama. Rural areas in this region are particularly plagued by poverty and poor access to healthcare. Life expectancy is equivalent to residents of Sri Lanka. This area has 15.7 doctors/10 000 residents compared with the statewide ratio of 41.9 doctors/10 000 residents.To improve access to care, a regional clinic network, the CYSNSM, was established in 1995. This paper reviews the impact of the CYSNSM on pediatrie SCD in Alabama over the first 5 years of implementation.Since its inception in 1995, the CYSNSM has provided care for 923 patients compared with 450 prior to the development of the clinic network. Currently, 90% of all cases identified by newborn screening are enrolled compared with 50% pre-CYSNSM. Prior to the network, the average age of patients at their first clinic visit was 21 months. In the post-CYSNSM period, the average age at first clinic visit decreased substantially to 5.3 months. Prior to the CYSNSM, patients traveled on average 90 miles to a comprehensive clinic. Post-CYSNSM, this distance has been cut in half to an average of 45 miles. A total of 70% of patients now live within 30 miles of a clinic. Most importantly, the infection death rate has decreased from 5.71 deaths/100 patient years to 1.94 deaths/100 patient years.The development, implementation, and evaluation of the CYSNSM show that comprehensive care delivery in a rural setting is feasible and improves outcomes in pediatric SCD. 相似文献
993.
Karin Ishikawa Tomihiko Tanino Yuichiro Ohtake Itaru Kimura Hiroshi Miyata Yukihiko Mashima 《Japanese journal of ophthalmology》2004,48(1):90-91
Purpose To review the outcome of surgery for strabismus due to ethmoid sinus surgery.Cases and Methods The series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position.Results The mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture.Conclusions Surgery for strabismus due to sinus surgery induces improvements in eye position and diplopia.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:425–432, 2003) 相似文献
994.
Samuel R. Friedman Barbara Tempalski Hannah Cooper Theresa Perlis Marie Keem Risa Friedman Peter L. Flom 《Journal of urban health》2004,81(3):377-400
This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas
to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and
human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area.
We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among
large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity
and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile
range 42–87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling
and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy
of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of
drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service
provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services. 相似文献
995.
Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. 相似文献
996.
997.
Herman Nys Sander Welie Tina Garanis-Papadatos Dimitris Ploumpidis 《Health care analysis》2004,12(4):329-337
The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today. 相似文献
998.
999.
1000.
Fumihito Ide Tomoyo Matsubara Miho Kaneko Takashi Ichiyama Tokuko Mukouyama Susumu Furukawa 《Pediatrics international》2004,46(3):337-341
BACKGROUND: The authors clarified the clinical significance of the measurement of serum concentrations of specific IgE antibodies to staphylococcal enterotoxin (SE) A- and SEB in atopic dermatitis (AD). METHODS: The serum concentrations of SEA- and SEB-specific IgE antibodies in 140 pediatric patients with AD were measured with an immuno CAP -radioallergosorbent test system (RAST). To check the cross-reaction of specific IgE antibodies to SEA/SEB and other allergens, the CAP RAST fluorescent enzyme immunoassay inhibition test was performed. RESULTS: Forty-seven patients (33.6%) tested positive for either SEA- or SEB-specific IgE antibodies. School children showed higher positive rates of SEA/SEB-specific IgE antibodies than infants or young children. The patients with severe AD and those with exacerbation of symptoms in summer, had higher positive rates of SEA/SEB-specific IgE antibodies than patients with mild AD or those with exacerbation in winter. In addition, the positive rates of specific IgE antibodies to both dog-dander and cat-dander were higher in patients with positive SEA/SEB-specific IgE antibodies than in patients with negative ones. No cross-reactions occurred among specific IgE antibodies to SEA/SEB and dog/cat dander with one patient's serum, which had positive IgE-specific antibodies against cat/dog dander and SEA/SEB. The positive rate of SEA/SEB-specific IgE antibodies in the patients with dogs and/or cats as pets was 48.4%, which was higher than in those with no pets. CONCLUSIONS: Atopic dermatitis patients who exhibit high positive rates of SEA/SEB-specific IgE antibodies were found to be school children, severe cases, cases with high serum concentrations of total IgE, cases with exacerbation in summer, and cases with dogs and/or cats as pets. The measurement of serum concentrations of specific IgE antibodies to SEA and SEB, thus has some value for evaluating AD patients. 相似文献