Biomedical subjects
Publications and source records attributed to J McCulloch.
Any increase in the use of invasive procedures carries with it an increased risk of cross-infection. The spread of the human immunodeficiency virus, together with increasing awareness of hepatitis B virus, cytomegalovirus and human papillomavirus have focused attention on the nature and adequacy of procedures to prevent cross-infection in general practice.
This paper tracks access, utilization, and costs of mental health care for a private employer over nine years during which mental health benefits were carved out of the medical plan and managed care was introduced. Prior to the carve-out, mental health costs increased by around 30 percent annually; in the first year after the change, costs dropped by more than 40 percent; in the six follow-up years, costs continued to decline slowly. This cost reduction was not attributable to decreased initial access, as the number of persons using any mental health care increased following the change. Instead, the cost reduction was the result of (1) fewer outpatient sessions per user, (2) reduced probability of an inpatient admission, (3) reduced length-of-stay for an inpatient episode, and (4) substantially lower costs per unit of service.
Debate continues about the cost and use of mental health services under managed care, as legislators consider various "parity" bills. This descriptive research replicates, broadens, and expands previously published case studies of single employers' data on cost and treatment prevalence in a large, diverse, national sample whose varied point-of-service benefits were provided by thirty employers representing multiple industries. Of those covered, 59,005 received treatment over the seven years studied. Of particular note is the pattern of increased use, increased care within the managed behavioral health organization network, and long-term cost reductions.
This paper describes the development of--and early efforts to validate--guidelines that indicate average amounts of service expected to be used by a population of patients with a given disorder who are served by a comprehensive mental health system. These guidelines address expected service use by individuals in 55 diagnostic groups. The purpose of these guidelines is to provide a gauge for evaluating the amounts of service being delivered by managed care organizations. Three population-based guidelines (for attention-deficit/hyperactivity disorder, major depressive disorder, and schizophrenia) are compared to actual amounts of service delivered to enrollees in large behavioral health care systems.
The impact of computers on healthcare delivery and management is both significant and increasing. Coupled with its potential educational benefits, computer-assisted instruction (CAI) has much to offer healthcare professionals. However, the individuals directly responsible for training nurses and other personnel typically have little knowledge about how computers can be used for training purposes. A series of workshops was designed for hospital educators and clinical nurse specialists to help them become computer literate and to provide them with the skills to evaluate, develop, and appropriately implement instructional software was emphasized during a series of formal seminars, guided individual instruction, and guided independent practice laboratory sessions. This approach resulted in a significant increase in participants' knowledge about computers while maintaining their positive attitudes toward the instructional uses of computers. A well-designed staff development program can provide these crucial individuals with the skills and knowledge required to use microcomputers and CAI as effective teaching and learning tools.
This report focuses on nosocomial or hospital-acquired infections (HAIs), discussed extensively at this year's annual conference of the Infection Control Nurses' Association (ICNA) in September.
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This article discusses the general principles of infection control and outlines the role nurses can play in maintaining a safe environment. This article is the third and final part of our 1998 series on infection control.
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Explore the source record for details and available documents.