Care Products Research Articles

Innovation of health care provision: Observations made during the development of two care products in The Netherlands

In an implementation project in The Netherlands a small investigation was made of the most urgent needs of older home care clients. Two potential client groups for the development of specific care-arrangements were selected: “older persons becoming lonely and inactive”, and “partners/caregivers of patients with dementia”. The care-arrangement “Attention Care” aims to support lonely persons and the care-arrangement “Monitoring of Behavior” aims to provide surveillance at a distance to support the care giving relative of a dementia patient. For both groups the care arrangements use video telephony to communicate with professional caregivers. This paper presents results obtained during the pilot implementation. At the client level the results are encouraging, for both care arrangements positive responses can be noted. However, the pilots are up to now not followed by a full scale implementation of the care arrangements. In the analysis of the results obtained the process of care innovation is discussed. It is concluded that both the healthcare system as well as the individual care organization lack a real stimulus to change practice.

Care Platforms: A Basic Building Block For Care Delivery

Without significant operational reform within the nation's health care delivery organizations, new financing models, payment systems, or structures are unlikely to realize their promise. Adapting insights from high-performing companies in other high-risk, high-cost, science- and technology-based industries, we propose the "care platform" as an organizing framework for internal operations in diversified provider organizations to increase the quality, reliability, and efficiency of care delivery. A care platform organizes "care production" around similar work, rather than organs or specialties; integrates standard and custom care processes; and surrounds them with specifically configured information and business systems. Such organizational designs imply new roles for physicians.

The Net Costs of Medical Training

One of the stages of medical training is the internship, where doctors-to-be (interns) face the real world of medical practice for the first time, under the supervision of a graduated physician. According to the career choice, the internship takes place at a provider of primary or secondary care. Hosting institutions often claim compensation for the training provided. The goal of this study is to identify the impact of the presence of the interns on the costs of providing care by the hosting institutions. We contribute by jointly considering several important effects. On the one hand, interns are a fixed exogenous factor on the beginning of their learning curve, taking extra time and resources from both the hosting institution and the supervisor. On the other hand, interns can be regarded as a less expensive substitute to nurses and/or graduate physicians, in the production of health care, both in primary care centres and hospitals. Therefore, interns are a specific input that hosting institutions take into account when organizing health care delivery. The net effect can be either positive or negative. The data used comes from Portuguese primary care centres and hospitals. Regression analysis was used to estimate their impact on the cost structure. The results point out to a negligible impact of the interns in the total cost structure of primary care hosting institutions. In the case of hospitals, the presence of interns represents an extra cost to the institution, above the yearly wage. Furthermore, there is a positive relation between dimension and cost to the hospital. Therefore, net training costs (defined as the costs incurred by the hosting institution above the wage paid) seem to be largely compensated by the activity performed by interns, and training compensations, over and above the interns salary should be relatively minor.

Factors affecting productive efficiency in primary care clinics

This study examines factors affecting the productive efficiency of primary care clinics. The empirical analysis uses a single-stage stochastic frontier regression model, in which factors affecting productive efficiency are specified as part of the inefficiency error component and estimated simultaneously with the production function. The study population includes primary care clinics in the US Military Health System from 1999 through 2003; the analytical data set is an unbalanced panel of 442 observations. The study's main results were that primary care clinics not associated with medical centres had significantly higher levels of productive efficiency than those associated with medical centres and that having proportionately more civilian staff (and thus less turnover) had a positive impact on productive efficiency. Due to their nature, these findings would be expected to also be applicable to the production of primary care in other settings. A key implication of the results is that improvements in productive efficiency should be a top priority, given the possibility for providing more primary care visits without increases in cost.

Provision of products: should we be concerned?

The field of stoma care and incontinence nursing is currently crossing murky waters while revisions are being made to the reimbursement and remuneration provision of stoma care and incontinence products. It will change the future of stoma care and incontinence nursing as we currently know it, and concerns have been highlighted within the media that these changes may well be detrimental to patient care (Staines, 2007).

2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report

Background: This report is the 25th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) National Poison Data System (NPDS). During 2007, 60 of the nation's 61 U.S. Poison Centers upload case data automatically. The median upload time is 14 [5.3, 55] (median [25%, 75%]) min creating a real-time national exposure database and surveillance system.Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Fatalities were reviewed by a team of 29 medical and clinical toxicologists and assigned to 1 of 6 categories according to Relative Contribution to Fatality.Results: Over 4.2 million calls were captured by NPDS in 2007: 2,482,041 human exposure calls, 1,602,489 information requests, and 131,744 nonhuman exposure calls. Substances involved most frequently in all human exposures were analgesics (12.5% of all exposures). The most common exposures in children less than age 6 were cosmetics/personal care products (10.7% of pediatric exposures). Drug identification requests comprised 66.8% of all information calls. NPDS documented 1,597 human fatalities.Conclusions: Poisoning continues to be a significant cause of morbidity and mortality in the United States NPDS represents a valuable national resource to collect and monitor U.S. poisoning exposure cases. It offers one of the few real-time surveillance systems in existence, provides useful data, and is a model for public health surveillance.

Complications Associated With Care Product Use During Silicone Daily Wear of Hydrogel Contact Lens

Increased use of silicone hydrogel contact lenses for daily wear has necessitated a parallel rise in the use of multipurpose care solutions (MPS). This in turn has been accompanied by substantially more reports of solution related complications, in particular corneal staining and low grade infiltrates. Management of these problems involves reducing the impact of care system components on the ocular surface. Options for achieving this include use of low impact lens/MPS combinations, daily disposable lenses or hydrogen peroxide based disinfection systems.

PAR16 COST OF ANKYLOSING SPONDYLITIS IN CZECH REPUBLIC—DIRECT AND INDIRECT COSTS

COST OF ANKYLOSING SPONDYLITIS IN CZECH REPUBLIC—DIRECT AND INDIRECT COSTS Doležal T, Skoupa J, Cerna V Charles University, Prague, Czech Republic, Pharma Projects, Prague, Czech Republic OBJECTIVES: Ankylosing spondylitis (prevalence 1% of population) is a chronic inflammatory progressive disease characterised by pain, joint stiffness, and gradual loss of mobility leading to severe functional impairment. There are no cost-of-illness data available in Czech Republic or in Eastern Europe. To assess direct and indirect costs of ankylosing spondylitis we have analysed the data from a large patient cohort study. METHODS: Data of 1008 patients (average age 50.2 years) with ankylosing spondylitis were analysed. Patients were enrolled in a patientxs organisation survey named BEIA. Data on health care consumption and productivity loss were collected. For calculation of indirect cost the friction cost approach was applied. RESULTS: The average time from diagnosis was 23 years; 61% were male. Two thirds of patients were disabled and unable to work. The mean annual direct cost per patient is estimated at 1259 EUR (49%) and the indirect cost due to lost work capacity is 1314 EUR (51%). The major contributors to the total direct costs were physiotherapy, spa and rehabilitation clinics (67% of direct costs). Drug treatment contributed to 22% and hospital admissions to 5% of direct costs. CONCLUSION: The annual total direct plus indirect costs of one patient with ankylosing spondylitis in Czech Republic were 2573 EUR. The share of direct and indirect costs was almost equal. Our findings provide information on the burden of disease and a baseline for cost-effectiveness evaluation of new costly treatments.

The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function

To assess the effect of repeated application and removal of adhesive edges from wound-care products on cutaneous irritancy and barrier function in normal volunteer subjects. This was a study using a 'repeat-insult patch test'. Adhesive edges from six commonly used wound-care products were applied continuously to the same site (six applications over a 14-day period) in 30 normal volunteer subjects. The test sites were assessed clinically before product reapplication using established ranking scales for cutaneous erythema. The cumulative irritancy score (CIS) for each test site was determined by adding the erythema scores at days 3, 5, 8, 10, 12 and 15. At the study end the barrier function of each test site was assessed by measuring transepidermal water loss (TEWL). The CIS showed that the products fall into two distinct groups, with Mepilex, Tielle and Allevyn giving low scores and Biatain, Comfeel and DuoDERM higher scores. Statistical analysis indicated significant differences (p < 0.05) between Mepilex and Biatain, Mepilex and Comfeel, Mepilex and DuoDERM, Tielle and Biatain, Allevyn and Biatain. The mean TEWL values also indicated that the products fall into two distinct groups: Mepilex, Tielle and Allevyn with low mean values close to that of normal adjacent back skin and Biatain, Comfeel and DuoDERM with much higher mean values. Statistical analysis indicated that Mepilex, Tielle and Allevyn were not significantly different from normal skin (p < 0.05), whereas Biatain, Comfeel and DuoDERM were significantly higher than normal skin and the other products tested. The results show clear differences between products; the clinical scores and TEWL measurements indicate that the products fall into two distinct groups. This novel approach seems able to discriminate between adhesive borders and may be useful during product development and in selecting products for clinical trials.

Prenatal care and birthweight production: evidence from South America

Research using US data has shown that increases in prenatal care have positive effects on birthweight and that the existence of unobserved health heterogeneity tends to reduce the measured effect of prenatal care. This study extends extant research to the South American countries of Bolivia, Brazil, Columbia and Peru using data from the demographic and health surveys, finding a positive effect of increased prenatal care use on birthweight. Furthermore, the largest marginal effect of increased prenatal care use is found at low levels of usage. The results highlight both the usefulness of existing methodologies for estimating the effect of prenatal care on birthweight and the importance of extending these methodologies to data from countries other than the USA.

The “Choose With Care System”—Development of Education Materials to Support Informed Medicare Health Plan Choices

People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices. Choose with Care is an innovative decision support tool for employers to use to assist people approaching age 65 to learn about their Medicare health plan options and how to incorporate information on the quality of care and services offered by health plans into their choices. Employers are the targeted channel for distributing the Choose with Care materials because they are one of the most recognized and accessible formal intermediaries for information about health insurance. We used multiple methods to test the Choose with Care products. Product testing showed that the Choose with Care materials increase older consumers' knowledge of Medicare and how it relates to retiree health insurance and improves their comprehension and use of comparative quality information when choosing a health plan.

Half a century of the Patent Documentation Group (PDG) 1957–2007

The Patent Documentation Group (PDG) is a non-profit organisation consisting of companies using technical, patent and other intellectual property related information for their business. The PDG, which was founded in 1957 as a working group by 13 European chemical and petrochemical companies, seeks to promote the effective and efficient use of patent information. It has a reputation as an indispensable partner in all discussions relating to the quality and enhancement of patent information. The PDG currently comprises 40 multinational companies from eight different countries engaged in the automotive, chemical, electronics, engineering, household/personal care products, petrochemicals and the life science industries.

The resignification of management processes in care procedures in nursing

This study had as goal to discuss some aspects about the management processes in the care production in nursing. It’s made up by a critic reflective analysis, which aims to reflect on the questioning that was brought from the reading of texts used in a doctor and master’s course. During the subject’s development it was possible to identify, through the analysis of the suggested bibliography, the drifting away visualized by the nurses between the management and the care. However it’s possible to conclude that this is due to, in great part to these professionals’ graduation, which lead to the distortion on the comprehension of these subjects about the care procedures.

The resignification of management processes in care procedures in nursing

This study had as goal to discuss some aspects about the management processes in the care production in nursing. It’s made up by a critic reflective analysis, which aims to reflect on the questioning that was brought from the reading of texts used in a doctor and master’s course. During the subject’s development it was possible to identify, through the analysis of the suggested bibliography, the drifting away visualized by the nurses between the management and the care. However it’s possible to conclude that this is due to, in great part to these professionals’ graduation, which lead to the distortion on the comprehension of these subjects about the care procedures.

Determination of genetic toxicity and potential carcinogenicity in vitro--challenges post the Seventh Amendment to the European Cosmetics Directive

Genetic toxicology and its role in the detection of carcinogens is currently undergoing a period of reappraisal. There is an increasing interest in developing alternatives to animal testing and the three R's of reduction, refinement and replacement are the basis for EU and national animal protection laws the Seventh Amendment to the EU Cosmetics Directive will ban the marketing of cosmetic/personal care products that contain ingredients that have been tested in animal models. Thus in vivo tests such as the bone marrow micronucleus test, which has a key role in current testing strategies for genotoxicity, will not be available for this class of products. The attrition rate for new, valuable and safe chemicals tested in an in vitro-only testing battery, using the in vitro tests currently established for genotoxicity screening, will greatly increase once this legislation is in place. In addition there has been an explosion of knowledge concerning the cellular and molecular events leading to carcinogenesis. This knowledge has not yet been fully factored into screening chemicals for properties that are not directly linked to mutation induction. Thus there is a pressing need for new, more accurate approaches to determine genotoxicity and carcinogenicity. However, a considerable challenge is presented for these new approaches to be universally accepted and new tests sufficiently validated by March 2009 when the animal testing and marketing bans associated with the Seventh Amendment are due to come into force. This commentary brings together ideas and approaches from several international workshops and meetings to consider these issues.

Healthcare Electronic Records-Improving Productivity and Quality of Care

Healthcare Electronic Records-Improving Productivity and Quality of Care

The right incentives for high-quality, affordable care: a new form of regulated competition

In most Western health care systems, producing high-quality care efficiently is not rewarded by higher revenues. ‘Pay for performance’ schemes have emerged, rewarding improved performance of providers through financial incentives, but these schemes are simply overlaid on systems that are flawed [1,2]. In this editorial, we discuss a system with patients and providers in the leading roles, not imposing impossible burdens on patients, which induces providers to take the lead in providing high-quality care efficiently. The system would not rely on health plans or insurance companies contracting care for patients. In this system, patients themselves would ‘shop’ for their care, being guided by a system of ‘smart’ copays. Such a market set-up requires regulation to ensure the desired outcomes: timely, effective, safe, patient-oriented, affordable care. Here, we only discuss the model’s outlines. Four issues are paramount to such a system. First, equal access to a basic package of health care services that encompasses all ‘necessary’ care is essential (e.g. through an obligatory system of health insurance). Through regulation, risk-selection should be mitigated, or an adequate insurance pool to ensure equal access should be created. For systems that see ‘solidarity’ as a basic value, ensuring equity in this way is fundamental [3]. Second, competition should be organized around the integrated care for a patient’s disease or condition [4]. This care product (such as ‘diabetes care’) should ideally include all activities and materials that are part of the handling of this care: tests, hospital stay, physicians’ fees, home care, medication, and any complications that might occur as a result of the care received by the patient. This aligns with the Diagnosis Related Group (DRG)-like payment systems many countries have opted for. Often, a single organization will not be able to offer all components of …

PERFECTING THE SHOW TRIAL: THE CASE OF BARON VON UNGERN‐STERNBERG

The September 1921 trial of Baron R.F. von Ungern‐Sternberg, a brutal White commander who operated in the Far East during the Russian Civil War, represented a perfected model of early Soviet justice. The proceedings omitted most details of Ungern’s crimes and concentrated instead on explaining them as products of his social background. The trial’s didactic purpose was to educate the public about the evils of the old regime and prove that revolutionary vigilance would put an end to them. In this article it is argued that the careful production and staging of this trial represented an important precursor of the ‘show trial’ format that was later widely employed by the Soviet regime.

Crew Resource Management Training Research, Practice, and Lessons Learned

Crew resource management (CRM) training was introduced to the aviation community in 1979. Since then it has evolved and matured and is now being applied in a number of domains, including health care and offshore oil production. There is abundant literature resulting from research in the area, but there is no recent comprehensive review of the origins, current state, and future direction of CRM. The purpose of this chapter is to perform that review and provide the reader with an understanding of the research, practice, and training associated with CRM. We also provide a number of lessons learned based on the literature and our observations, as well as future needs of the community.

Hellp Syndrome / Pneumonitis Peripartum Cardiomyopathy: A Near Miss Mortality

A 24-year-old female was admitted in Apollo Hospitals, Ahmedabad with history of caesarian section 24 hrs ago for PET and triplet pregnancy. Her condition deteriorated after caesarian section. A clinical diagnosis of HELLP syndrome was made, supported by laboratory investigations. She stayed in hospital for 14 days with close monitoring in high dependency unit with supportive and symptomatic care and blood products. She also developed peripartum cardiomyopathy but a multidisciplinary team approach in the hospital saved the life of the patient which was a near miss mortality.