Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

<p>Abstract</p> <p>Background</p> <p>Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP) on call or the ED.</p> <p>Methods</p> <p>Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services.</p> <p>Results</p> <p>1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women.</p> <p>Conclusions</p> <p>Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.</p

Individual Farm Analysis Using a Simulation Model

I FAS (Individual Farm Analysis using a Simulation model) is a system that has been developedfor the analysis of the performance of individual farms, whereby the technical and economic data of a farm can be compared with the average data of a group offarms. The analysis of the deviation in farm performance from the average performance is done in two stages. First the deviation is analysed as quantitatively as possible by means of a simulation model using input data of the farm and the average input data of the group. Then an expert is called on to analyse the remainder of the deviation, i.e. the part of the deviation not explained by the model The remaining part is the deviation in farm performance from the average performance of the group, correctedfor the effects of differences in farm inputs used in the simulation model. Using a simulation model enables individual farm analysis to be done partly quantitatively - depending on the degree of detail of the model and the accounting system and their mutual correspondence - and makes it easier for the analysis of the remainder of the deviation

Conversion from Conventional to Biological Dairy Farming: Sustainability Aspects from a Farm Modelling Perspective

In this paper the central issue is to quantify economic and environmental consequences for dairy farms when converting to biological dairy farming. A linear programming model is used to model a typical extensive and intensive dairy farm in The Netherlands. From the results it appears that extensive farms benefit from conversion while intensive farms lose income. Environmental consequences are quite diverse. The nitrogen surplus after conversion is much lower than before while ammonia emission is higher after conversion due to a higher number of animals. On the extensive farm the phosphate surplus is much higher after conversion due to the fact that a shortage of nitrogen in the biological situation can only be made up by applying animal manure (slurry) from other farms with consequential overfertilization of phosphate. When environmental legislation is introduced, biological farms appear to lose more income than conventional farms

Ecological-economic modelling to support multi-objective policy making: A farming systems approach implemented for Tuscany

Currently, there is a major concern regarding agri-environmental issues. Farmers are viewed not only as food suppliers but also as the custodians of the countryside. This role of farmers has been officially acknowledged in the EU Common Agricultural Policy (CAP) through a number of regulations that enforce agri-environment schemes and cross-compliance. However, under some circumstances these regulations have proved to be ineffective. Organic farming can play an important role for agri-environment schemes. The main aim of this study is to show the relevance of the assessment of the environmental performance of conventional and organic farming systems for the development of efficient agri-environment schemes. An holistically designed ecological-economic model was applied under current EU regulations and different policy scenarios. The model is based on a standard linear programming farm model extended with emission and evaluation figures retrieved from ecological models. Spatial aspects, such as pedo-climatic conditions, were included in the model. The approach was implemented for the case of northern Tuscany. Results indicated that organic farming systems (OFSs) were environmentally more beneficial than conventional farming systems (CFSs) and that current CAP market and income support schemes gave cause for an intensification of farm production and for an increase of environmental harm. They also showed that conventional farmers willing to produce environmental performances comparable to those of organic agriculture or to comply with environmental sustainability thresholds (ESTs) incur opportunity costs due to the need of application of organic crop management and/or extensification of the crop plan. Conclusions were drawn on the environmental performances of OFSs and CFSs, the impact of EU policies on sustainability of agriculture, opportunity costs of environmental benefits and on the practical use of the modelling framework for policy design. (C) 2003 Elsevier B.V. All rights reserved

Ultrafast ytterbium-doped bulk lasers and laser amplifiers

We review recent achievements with ultrafast bulk lasers and amplifiers based on Yb:YAG and Yb:glass. Special attention is paid to those aspects of the quasi-three-level nature of these gain media that are important for short-pulse generation. The potential of Yb-doped media for efficient short-pulse generation and amplification is compared to their Nd-doped counterparts.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42156/1/340-69-1-3_90690003.pd

Design of an international multicentre RCT on group schema therapy for borderline personality disorder

Background Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. Methods/Design An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients’ and therapists’ experiences with GST, and studies on variables that might influence the effectiveness of GST. Discussion This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation and additional investigations, it will contribute to an evidence-based understanding of which treatment should be offered to patients with BPD from clinical, economic, and stakeholders’ perspectives