Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Comercialización de los Servicios de Salud/métodos , Administración de Línea de Producción , Continuidad de la Atención al Paciente/organización & administración , Prestación Integrada de Atención de Salud/economía , Competencia Económica , Hospitales Comunitarios , Relaciones Interinstitucionales , Sistemas Multiinstitucionales , New Jersey , Derivación y ConsultaRESUMEN
Seven years ago, leaders at Community Medical Center in Toms River, NJ, made a decision to forge a new direction in health care delivery--to look beyond just the physical health care needs of the community and also address nutrition, housing, social support, environment, and educational needs. Today, Community Medical Center serves as a national model for how a community benefit initiative can work. In this article, the authors talk about the rationale behind the hospital's community benefit initiative, the evolution of the process over first and second generations, and points of learning for hospitals wishing to take the lead in improving the health status of their communities.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Relaciones Comunidad-Institución , Hospitales Comunitarios/organización & administración , Promoción de la Salud/organización & administración , Hospitales con más de 500 Camas , New Jersey , Objetivos Organizacionales , Filosofía , Desarrollo de Programa/métodosRESUMEN
One hundred forty-three patients with gliomas of astrocytic origin (61 with glioblastomas multiforme (GM) and 82 with astrocytomas) received an intravenous infusion of bromodeoxyuridine (BUdR), 150-200 mg/m2 at the time of surgery, to label tumor cells undergoing DNA synthesis. BUdR-labeled cells were identified by the indirect immunoperoxidase method using anti-BUdR monoclonal antibodies. The percentage of BUdR-labeled cells, or BUdR labeling index (LI), was calculated by microscopic examination of selected viable areas of the tissue sections. The GMs had a median LI of 7.5%, and three quarters of these tumors had LIs greater than 5%. Highly anaplastic astrocytomas (HAAs) and moderately anaplastic astrocytomas (MoAAs) had median LIs of 2.3% and less than 1%, respectively. Among the HAAs, the LI was 1% to 5% in 56% of tumors, greater than 5% in 26%, and less than 1% in 18%. More than 60% of MoAAs had LIs less than 1%, which agrees with the slow clinical progression of this type of tumor, and the remainder had LIs of 1.4% to 9.3%. These results show that histopathologically similar tumors may have different proliferative potentials. Measuring the proliferative potential of individual gliomas is therefore crucial for predicting the prognosis more accurately and for devising more tumor-specific treatment regimens for individual patients.