Energy cost of propulsion in standard and ultralight wheelchairs in people with spinal cord injuries.
(1/801)
BACKGROUND AND PURPOSE: Wheelchair- and subject-related factors influence the efficiency of wheelchair propulsion. The purpose of this study was to compare wheelchair propulsion in ultralight and standard wheelchairs in people with different levels of spinal cord injury. SUBJECTS: Seventy-four subjects (mean age=26.2 years, SD=7.14, range=17-50) with spinal cord injury resulting in motor loss (30 with tetraplegia and 44 with paraplegia) were studied. METHOD: Each subject propelled standard and ultralight wheelchairs around an outdoor track at self-selected speeds, while data were collected at 4 predetermined intervals. Speed, distance traveled, and oxygen cost (VO2 mL/kg/m) were compared by wheelchair, group, and over time, using a Bonferroni correction. RESULTS: In the ultralight wheelchair, speed and distance traveled were greater for both subjects with paraplegia and subjects with tetraplegia, whereas VO2 was less only for subjects with paraplegia. Subjects with paraplegia propelled faster and farther than did subjects with tetraplegia. CONCLUSION AND DISCUSSION: The ultralight wheelchair improved the efficiency of propulsion in the tested subjects. Subjects with tetraplegia, especially at the C6 level, are limited in their ability to propel a wheelchair. (+info)
The effects of clonazepam on quality of life and work productivity in panic disorder.
(2/801)
Although panic disorder has been associated with impaired quality of life (QOL) and financial dependence, no prior study has examined whether a clinical intervention will improve these outcomes. This study examines the effects of clinically titrated doses of clonazepam versus placebo on QOL and work productivity (WP) in patients with panic disorder. QOL and WP were measured in conjunction with a randomized, double-blind, placebo-controlled trial. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment questionnaire were used to assess QOL and WP, respectively. Baseline assessments were obtained before randomizing patients to receive clinically titrated doses of clonazepam or placebo. Follow-up assessments were obtained after 6 weeks of therapy with the test drug or at premature termination from the study. Improvement on the SF-36 Mental Health Component Summary scale was more than twice as great with clonazepam than with placebo (P = 0.03). Clonazepam patients improved (P < 0.05) on all five measures of mental health-related QOL, and both measures of physical health-related QOL, and both measures of WP. Placebo patients improved on three of five measures of mental health-related QOL, but on no other measures. Patients with marked improvements on clinical measures of panic disorder severity, especially avoidance and fear of the main phobia, showed the greatest gains on the SF-36 Mental Health Component Summary scale. Clinically titrated doses of clonazepam significantly improved mental health-related QOL and WP in panic disorder patients. Lesser improvements were obtained with placebo. (+info)
Effect of compensation method on the behavior of primary care physicians in managed care organizations: evidence from interviews with physicians and medical leaders in Washington State.
(3/801)
The perceived relationship between primary care physician compensation and utilization of medical services in medical groups affiliated with one or more among six managed care organizations in the state of Washington was examined. Representatives from 67 medical group practices completed a survey designed to determine the organizational arrangements and norms that influence primary care practice and to provide information on how groups translate the payments they receive from health plans into individual physician compensation. Semistructured interviews with 72 individual key informants from 31 of the 67 groups were conducted to ascertain how compensation method affects physician practice. A team of raters read the transcripts and identified key themes that emerged from the interviews. The themes generated from the key informant interviews fell into three broad categories. The first was self-selection and satisfaction. Compensation method was a key factor for physicians in deciding where to practice. Physicians' satisfaction with compensation method was high in part because they chose compensation methods that fit with their practice styles and lifestyles. Second, compensation drives production. Physician production, particularly the number of patients seen, was believed to be strongly influenced by compensation method, whereas utilization of ancillary services, patient outcomes, and satisfaction are seen as much less likely to be influenced. The third theme involved future changes in compensation methods. Medical leaders, administrators, and primary care physicians in several groups indicated that they expected changes in the current compensation methods in the near future in the direction of incentive-based methods. The responses revealed in interviews with physicians and administrative leaders underscored the critical role compensation arrangements play in driving physician satisfaction and behavior. (+info)
Atypical antipsychotics and formulary decisions.
(4/801)
Although drug costs are a small fraction of the total direct costs of treating schizophrenia, managed care has focused on drug acquisition costs as an area of concern. There is pressure to demonstrate by outcome measures that the increased cost of the newer atypical antipsychotics versus traditional neuroleptics is justified. Decision makers want to be convinced that newer, more expensive treatment translates to value. Evidence accumulated to date suggests that the atypical agents are cost-effective. Studies show patients taking atypical antipsychotics have an improved quality of life, are more easily rehabilitated and reintegrated into the community, return to full- or part-time work more often, and prefer the newer agents to conventional antipsychotics. These benefits have been shown in studies of olanzapine versus haloperidol. Just as important, patients taking atypical antipsychotics show decreased medical care resource utilization, which results in cost savings. (+info)
Health insurance and productivity.
(5/801)
AIM: To provide a conceptual understanding of the basic relationship between health insurance and overall economic productivity, and to look at the human development index as a proxy for the quality of human capital. METHODS: Economic data and data related to human development in Central and Eastern European (CEE) countries, including Croatia, were compared to the European Union (EU) average. Data were selected out of databases provided by the International Monetary Fund, the Organization for Economic Cooperation and Development, and the United Nations. Income and growth rates were related to the EU averages. The human development index was used to compare the level of the average achievements in the longevity of life, knowledge, and quality of living in CEE countries. RESULTS: Relative to the EU-average, human development is lagging behind in CEE countries. Considering the world as a benchmark regarding human development, 8 out of 13 CEE countries exceed the world. However, all CEE countries have 3-28% lower human development than the industrialized countries. CONCLUSIONS: The specific challenge for transition countries is how to adopt strategies to translate economic progress into health and social gains through reliable institutions, among them social health insurance bodies. The institutions and the provision of social health insurance are particularly challenged at a turning point when transition in terms of macroeconomic stabilization, along with the consolidated organization and financing of social and health insurance schemes, is accommodated to a business cycle-driven market economy. (+info)
Global environmental impacts of agricultural expansion: the need for sustainable and efficient practices.
(6/801)
The recent intensification of agriculture, and the prospects of future intensification, will have major detrimental impacts on the nonagricultural terrestrial and aquatic ecosystems of the world. The doubling of agricultural food production during the past 35 years was associated with a 6.87-fold increase in nitrogen fertilization, a 3.48-fold increase in phosphorus fertilization, a 1.68-fold increase in the amount of irrigated cropland, and a 1.1-fold increase in land in cultivation. Based on a simple linear extension of past trends, the anticipated next doubling of global food production would be associated with approximately 3-fold increases in nitrogen and phosphorus fertilization rates, a doubling of the irrigated land area, and an 18% increase in cropland. These projected changes would have dramatic impacts on the diversity, composition, and functioning of the remaining natural ecosystems of the world, and on their ability to provide society with a variety of essential ecosystem services. The largest impacts would be on freshwater and marine ecosystems, which would be greatly eutrophied by high rates of nitrogen and phosphorus release from agricultural fields. Aquatic nutrient eutrophication can lead to loss of biodiversity, outbreaks of nuisance species, shifts in the structure of food chains, and impairment of fisheries. Because of aerial redistribution of various forms of nitrogen, agricultural intensification also would eutrophy many natural terrestrial ecosystems and contribute to atmospheric accumulation of greenhouse gases. These detrimental environmental impacts of agriculture can be minimized only if there is much more efficient use and recycling of nitrogen and phosphorus in agroecosystems. (+info)
Challenges associated with the incorporation of digital radiography into a picture archival and communication system.
(7/801)
Digital radiography (DR) has recently emerged as an attractive alternative to computed radiography (CR) for the acquisition of general radiographic studies in a digital environment. It offers the possibility of improved spatial and contrast resolution, decreased radiation dose due to improved efficiency of detection of x-ray photons, and perhaps most importantly, holds out the promise of increased technologist productivity. To achieve maximum efficiency, DR must be completely integrated into existing information systems, including the hospital and radiology information systems (HIS/RIS) and, when present, the picture archival and communication system (PACS). The early experience with the integration of DR at the Baltimore Veterans Affairs Medical Center (VAMC) has identified several challenges that exist to the successful integration of DR. DR has only recently been defined as a separate Digital Imaging and Communications in Medicine (DICOM) modality and images obtained will, at first, be listed under the category of CR. Matrix sizes with some DR products on the market exceed the current size limitations of some PACS. The patient throughput may be substantially greater with DR than with CR, and this in combination with the larger size of image files may result in greater demands for network and computer performance in the process of communication with the HIS/RIS and PACS. Additionally, in a hybrid department using both CR and DR, new rules must be defined for prefetching and display of general radiographic studies to permit these examinations to be retrieved and compared together. Advanced features that are planned for DR systems, such as dual-energy subtraction, tomosynthesis, and temporal subtraction, will likely require additional workstation tools beyond those currently available for CR. (+info)
Effects of scatter substraction on detection and quantitation in hepatic SPECT.
(8/801)
The purpose of this investigation was to examine the effects of subtractive scatter compensation methods on lesion detection and quantitation. METHODS: Receiver operating characteristic (ROC) methodology was used to measure human observer detection accuracy for tumors in the liver using synthetic images. Furthermore, ROC results were compared with mathematical models for detection and activity quantitation to examine (a) the potential for predicting human performance and (b) the relationship between the detection and quantitation tasks. Images with both low and high amounts of scatter were compared with the ideal case of images of primary photons only (i.e., perfect scatter rejection) and with images corrected by subtracting a scatter image estimated by the dual photopeak window method. RESULTS: With low contrast tumors in a low count background, the results showed that scatter subtraction improved quantitation but did not produce statistically significant increases in detection accuracy. However, primary images did produce some statistically significant improvements in detection accuracy when compared with uncorrected images, particularly for high levels of scatter. CONCLUSION: Although scatter subtraction methods may provide improved activity quantitation, they may not significantly improve detection for liver SPECT. The results imply that significant improvement in detection accuracy for the conditions tested may depend on the development of gamma cameras with better scatter rejection. (+info)