How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?

Summarizes findings on U.S. patients' ability to manage their health and health care by income level, education, Medicaid status, and health status. Examines access to care by level of engagement among the chronically ill. Discusses policy implications

A Growing Hole in the Safety Net: Physician Charity Care Declines Again

Examines reasons for the decline in the number of physicians providing free or reduced cost health care in proportion to the number of uninsured Americans, in the last decade. Includes implications related to the decline in access to medical care

Inclination Measurement of Human Movement Using a 3-D Accelerometer With Autocalibration

In the medical field, accelerometers are often used for measuring inclination of body segments and activity of daily living (ADL) because they are small and require little power. A drawback of using accelerometers is the poor quality of inclination estimate for movements with large accelerations. This paper describes the design and performance of a Kalman filter to estimate inclination from the signals of a triaxial accelerometer. This design is based on assumptions concerning the frequency content of the acceleration of the movement that is measured, the knowledge that the magnitude of the gravity is 1 g and taking into account a fluctuating sensor offset. It is shown that for measuring trunk and pelvis inclination during the functional three-dimensional activity of stacking crates, the inclination error that is made is approximately 2/spl deg/ root-mean square. This is nearly twice as accurate as compared to current methods based on low-pass filtering of accelerometer signals

Lumbar puncture for the generalist

The safe and successful performance of a lumbar puncture demands a working and yet specific knowledge as well as competency in performance. This review aims to aid understanding of the knowledge framework, the pitfalls and complications of lumbar puncture. It includes special reference to three dimensional relationships, functional anatomy, imaging anatomy, normal variation and living anatomy. A lumbar puncture is a commonly performed procedure for diagnostic and therapeutic purposes. Epidural and spinal anaesthesia, for example, are common in obstetric practice and involve the same technique as a lumbar puncture except for the endpoint of the needle being in the epidural space and subarachnoid space respectively. The procedure is by no means innocuous and some anatomical pitfalls include inability to find the correct entry site for placement of the lumbar puncture needle and lack of awareness of structures in relation to the advancing needle. Headache is the most common complication and it is important to avoid traumatic and dry taps, herniation syndromes and injury to the terminal end of the spinal cord. With a thorough knowledge of the contraindications, the regional anatomy and rationale of the technique and adequate prior skills practice, a lumbar puncture can be performed safely and successfully