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Health Care rationing

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https://www.readbyqxmd.com/read/28208098/-don-t-think-i-m-going-to-leave-you-over-it-accounts-of-changing-hepatitis-c-status-among-couples-who-inject-drugs
#1
Jake Rance, Carla Treloar, Suzanne Fraser, Joanne Bryant, Tim Rhodes
BACKGROUND: While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care...
January 31, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28192746/changing-the-navigator-s-course-how-the-increasing-rationalization-of-healthcare-influences-access-for-undocumented-immigrants-under-the-affordable-care-act
#2
Laura López-Sanders
A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison...
February 2, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28185714/choosing-wisely-the-top-5-recommendations-from-the-italian-panel-of-the-national-guidelines-for-the-management-of-acute-pharyngitis-in-children
#3
Elena Chiappini, Barbara Bortone, Giuseppe Di Mauro, Susanna Esposito, Luisa Galli, Massimo Landi, Andrea Novelli, Paola Marchisio, Gian Luigi Marseglia, Nicola Principi, Maurizio de Martino
PURPOSE: With the aim to reduce waste in the health care system and avoid risks associated with unnecessary treatment, the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children joined the Choosing Wisely initiative. METHODS: An ad hoc Choosing Wisely task force was selected to develop a candidate list of items for the top-5 list on pharyngitis medicine. Through a process of literature review and consensus, the final list of 5 items was chosen...
February 6, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28169041/treatment-of-postmenopausal-osteoporosis-a-literature-based-algorithm-for-use-in-the-public-health-care-system
#4
Ellen Luz Pereira Caires, Mailze Campos Bezerra, Ana Flávia Torquato de Araújo Junqueira, Sheila Márcia de Araújo Fontenele, Silvana Cristina de Albuquerque Andrade, Catarina Brasil d'Alva
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies...
December 27, 2016: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/28157723/integrated-care-pathway-for-rectal-cancer-treatment-health-care-resource-utilization-costs-and-outcomes
#5
Silvia T Kobayashi, Maria D P E Diz, Alessandro G Campolina, Patricia C De Soárez, Ulysses Ribeiro, Sergio C Nahas, Karina G M C Vasconcelos, Fernanda Capareli, Ivan Cecconello, Paulo M Hoff
AIM: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. METHODS: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group)...
February 2, 2017: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/28139511/evaluation-of-outpatient-antibiotic-use-in-beijing-general-hospitals-in-2015
#6
Chuan Yang, Wen-Qiang Cai, Zi-Jun Zhou
BACKGROUND: Medical misuse of antibiotics is associated with the acquisition and spread of antibiotic resistance, resulting in a lack of effective drugs and increased health-care cost. Nevertheless, inappropriate antibiotic use in China remains common and the situation requires urgent improvement. Here, we analyzed the prescriptions of antibiotics and evaluated the rationality of antibiotic use among outpatients in Beijing general hospitals during 2015. METHODS: We collected basic medical insurance claim data from January 1, 2015 to December 31, 2015 in 507 general hospitals of Beijing...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28133598/health-care-as-a-universal-right
#7
Rui Nunes, Sofia B Nunes, Guilhermina Rego
PURPOSE: Most developed societies recognise the existence of a basic right of access to health care of appropriate quality, considering it a positive welfare right. It can even be one of the most important achievements of pluralistic and secular societies. The main objective of this study is to suggest the foundations for a universal right to health care, meaning the right of access to health care of appropriate quality. A second objective is to propose the necessary tools so that access to health care is viable in a specific commonwealth in accordance with available resources...
2017: Zeitschrift Für Gesundheitswissenschaften, Journal of Public Health
https://www.readbyqxmd.com/read/28133401/physician-agency-and-patient-survival
#8
Mireille G Jacobson, Tom Y Chang, Craig C Earle, Joseph P Newhouse
We investigate the role of physician agency in determining health care supply and patient outcomes. We show that an increase in health care supply due to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior rationing of effective care. Furthermore, physician market structure matters in determining the welfare effects of changes in private physician incentives. We then analyze a change to Medicare fees that caused physicians to increase their provision of chemotherapy...
February 2017: Journal of Economic Behavior & Organization
https://www.readbyqxmd.com/read/28131024/-too-much-medicine-insights-and-explanations-from-economic-theory-and-research
#9
Martin Hensher, John Tisdell, Craig Zimitat
Increasing attention has been paid in recent years to the problem of "too much medicine", whereby patients receive unnecessary investigations and treatments providing them with little or no benefit, but which expose them to risks of harm. Despite this phenomenon potentially constituting an inefficient use of health care resources, it has received limited direct attention from health economists. This paper considers "too much medicine" as a form of overconsumption, drawing on research from health economics, behavioural economics and ecological economics to identify possible explanations for and drivers of overconsumption...
January 18, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28125990/an-assessment-of-staffing-needs-at-a-hiv-clinic-in-a-western-kenya-using-the-who-workload-indicators-of-staffing-need-wisn-2011
#10
B Burmen, N Owuor, P Mitei
BACKGROUND: An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province)...
January 26, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/28125965/microbiological-point-of-care-testing-before-antibiotic-prescribing-in-primary-care-considerable-variations-between-practices
#11
Steffen Haldrup, Reimar W Thomsen, Flemming Bro, Robert Skov, Lars Bjerrum, Mette Søgaard
BACKGROUND: Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. We examined use of POCT in Denmark, including patient- and general practitioner (GP)-related predictors. METHODS: We linked nationwide health care databases to assess POCT use (C-reactive protein (CRP), group A streptococcal (GAS) antigen swabs, bacteriological cultures, and urine test strips) per 1,000 overall GP consultations, 2004-2013. We computed odds ratios (OR) of POCT in patients prescribed antibiotics according to patient and GP age and sex, GP practice type, location, and workload...
January 26, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28123917/helping-health-care-providers-and-clinical-scientists-understand-apparently-irrational-policy-decisions
#12
REVIEW
Sandor J Demeter
Health care providers (HCP) and clinical scientists (CS) are generally most comfortable using evidence-based rational decision-making models. They become very frustrated when policymakers make decisions that, on the surface, seem irrational and unreasonable. However, such decisions usually make sense when analysed properly. The goal of this paper to provide a basic theoretical understanding of major policy models, to illustrate which models are most prevalent in publicly funded health care systems, and to propose a policy analysis framework to better understand the elements that drive policy decision-making...
December 21, 2016: Curēus
https://www.readbyqxmd.com/read/28115991/the-impact-of-economic-rationalization-prioritization-and-rationing-on-job-satisfaction-motivation-and-team-cohesion-in-hospitals-a-survey-among-retired-physician-executives-in-germany
#13
Joerg Schnoor, Elmar Braehler, Mohamed Ghanem, Christoph E Heyde
BACKGROUND: The growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.e. rationalization, prioritization and rationing, on job satisfaction, motivation and team cohesion should be quantified...
2017: Patient Safety in Surgery
https://www.readbyqxmd.com/read/28114872/still-elegantly-muddling-through-nice-and-uncertainty-in-decision-making-about-the-rationing-of-expensive-medicines-in-england
#14
Michael Calnan, Ferhana Hashem, Patrick Brown
This article examines the "technological appraisals" carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, but in practice, decision making remains highly complex and uncertain. This article draws on ethnographic data-interviews with a range of stakeholders and decision makers (n = 41), observations of public and closed appraisal meetings, and documentary analysis-regarding the decision-making processes involving three pharmaceutical products...
January 1, 2017: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/28097842/in-hospital-capacity-building-in-research-and-management-for-pediatric-professionals
#15
Graciela Demirdjian, Susana Rodríguez, Juan C Vassallo, Vilma Irazola, Josefa Rodríguez
We describe an educational strategy aimed at capacity-building of hospital health care professionals in research and management initiated at a pediatric hospital in 2006, and the results obtained eight years after its implementation. Research and Management in Pediatrics (GIP) is an annual 250-hour course combining meetings and off-site assignments delivered through the Hospital's on-line campus. It provides students with practical tools for research (epidemiology, methodology, bibliographic search, evidencebased medicine, biostatistics) and management (strategic planning, management programs, health services research, quality improvement, health economics)...
1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28092624/changes-in-reticulorumen-content-temperature-and-ph-according-to-time-of-day-and-yearly-seasons
#16
R Antanaitis, V Žilaitis, V Juozaitienė, R Stoškus, M Televičius
The monitoring of rumen content temperature can be useful for the evaluation of cow health condition and heat. The aim of this research was to evaluate the influence of the circadian rhythm (time of day) and season on reticulorumen acidity (pH) and temperatures (RT) in lactating dairy cows. The research was performed on ten 2nd - lactation, clinically healthy Lithuanian Black and White fresh dairy cows (up to 1 day after calving). The cows were milked twice daily at 05:00 and 17:00. The cows were kept in a loose housing system, and were fed a feed ration throughout the year at the same time, balanced according to their physiological needs...
December 1, 2016: Polish Journal of Veterinary Sciences
https://www.readbyqxmd.com/read/28077751/performance-of-health-workers-using-an-electronic-algorithm-for-the-management-of-childhood-illness-in-tanzania-a-pilot-implementation-study
#17
Clotilde Rambaud-Althaus, Amani Shao, Josephine Samaka, Ndeniria Swai, Seneca Perri, Judith Kahama-Maro, Marc Mitchell, Valérie D'Acremont, Blaise Genton
In low-resource settings, where qualified health workers (HWs) are scarce and childhood mortality high, rational antimicrobial prescription for childhood illnesses is a challenge. To assess whether smartphones running guidelines, as compared with paper support, improve consultation process and rational use of medicines for children, a pilot cluster-randomized controlled study was conducted in Tanzania. Nine primary health-care facilities (HFs) were randomized into three arms: 1) paper algorithm, 2) electronic algorithm on a smartphone, and 3) control...
January 11, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28076546/pharmacist-s-contribution-to-the-promotion-of-access-and-rational-use-of-essential-medicines-in-sus
#18
Daniela Oliveira de Melo, Lia Lusitana Cardozo de Castro
Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of São Paulo. Pharmacist's activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28052877/blood-pressure-measurement-anno-2016
#19
REVIEW
Jan A Staessen, Yan Li, Azusa Hara, Kei Asayama, Eamon Dolan, Eoin O'Brien
The rational management of hypertension (HT) inevitably starts with accurate measurement of blood pressure (BP). The recently published Systolic Blood Pressure Intervention Trial implemented automated office BP measurement. However, event-driven studies have overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-Hour ambulatory BP monitoring is the preferred method of BP measurement and addresses major issues not covered by conventional or automated office BP measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the time window of the day during which BP is most predictive of adverse cardiovascular outcome), hypotension, or masked HT, a condition that affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP measurement...
January 4, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/28052061/integrated-genomic-characterization-of-oesophageal-carcinoma
#20
(no author information available yet)
Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas...
January 12, 2017: Nature
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