Search PubMed⌕ Search

Biomedical subjects

M Brommels

Publications and source records attributed to M Brommels.

30 records · Page 2Linked to original sources
PubMed1990

Management education at the Nordic School of Public Health.

This article introduces the Program of Health Services Management at the Nordic School of Public Health in Gothenburg, Sweden, after its reorganization in 1987. The school is a joint effort of the governments of Denmark, Finland, Norway, Iceland, and Sweden. As background, some research on the effects of management training for physicians and on the significance of leadership is presented. This article focuses on the relationship between administration, management, and leadership. The program aims at a holistic approach. The appendix presents the main purposes and content of the program.

Curriculum↗
PubMed1988

Prognosis of elderly hospital patients with cerebral thrombosis.

Over 8000 patients with cerebral thrombosis (ICD-8 number 433) hospitalised between 1970 and 1980 were surveyed retrospectively for outcome and additional diseases. The case-fatality rates and long-term prognosis of the patients were strongly affected by age, and the number of patients requiring permanent hospital care rose sharply with increasing age. The case-fatality rates in the different age groups were as follows: under 50 years 6%, 50-64 years 16%, 65-74 years 32%, 75-84 years 48% and over 85 years 66%. The cumulative survival rates at 1 and 5 years were as follows: under 50 years 54 and 46%, 50-64 years and 38%, 65-74 years 60 and 20% and over 75 years 45 and 10%. Clinical manifest coronary heart disease clearly affected the prognosis of patients under 75 years, but the impact diminished with rising age. Although hypertension led to an earlier onset of ischemic stroke, it did not significantly influence the survival prognosis. In patients over 75 years additional diseases, e.g. diabetes, had no significant effect on case-fatality or long-term prognosis underlining the malignant nature of cerebral thrombosis itself.

Age Factors↗
PubMed1987

The incidence and prognosis of cerebrovascular disease in hospital patients in Helsinki, Finland, in the decade 1970-1980.

Over 21,000 hospital episodes due to cerebrovascular disease (CVD, ICD-8 nos. 430-438) were registered in the Helsinki hospitals in 1970-1980. Of those 17,629 were identified as new cases. The age-adjusted incidence of haemorrhagic and thrombotic stroke (430-433) declined during the period 1970-1975 from 221 to 139 cases/100,000 inhabitants, whereafter no further decrease was observed. The decline in incidence was significant in both sexes. Analysis by diagnosis group showed that the decrease was confined to the incidence of haemorrhagic stroke (430-432), whereas the incidence of thromboembolic stroke (433, 434) and transient ischaemic attacks (435) remained virtually unchanged. Survival was mainly determined by patient age and type of CVD. Intracerebral haemorrhage and occlusion of precerebral arteries exhibited the poorest short-term prognosis. About half of the patients hospitalised due to cerebral thrombosis and embolism survived over one year. Long-term prognosis of the major CVD groups was very poor with only 10% of the patients alive after eight years. Transient cerebral ischaemia and subarachnoid haemorrhage had a clearly better prognosis, the survival rates after eight years being 45 and 30%, respectively.

Adult↗
PubMed1987

Cerebrovascular disease: declining incidence but increasing hospital utilisation.

A total of 20,680 patients hospitalised in Helsinki during 1970-1980 due to cerebrovascular diseases were found when screening the Finnish National Hospital Discharge Register. The material was categorised according to three-digit ICD-8 diagnosis codes and age, and was analysed for case-fatality, length of stay and discharge status. By identifying all new cases an assessment of the incidence development during the study period was also possible. A fall in the overall age-standardised incidence of cerebrovascular disease was demonstrated, in accordance with disease register studies. The main reason was decline in incidence of haemorrhagic stoke (ICD-8 no. 431) and less well defined types of stroke (436-438). Ischaemic stroke (433), on the other hand, did not decrease in frequency. The diagnostic shift, occurring parallel with a growing mean age of patients, lead to decreasing acute mortality, increasing institutionalisation rates and longer stays in hospital, thus resulting in growing figures of hospital utilisation in spite of the declining incidence.

Aged↗
PubMed1985

The demand for physicians in Finland. Results from a specialty-based assessment of future development and need for service.

This paper presents a nation-wide planning project conducted in cooperation with the specialists' associations, the Finnish Medical Association and the Speciality Commission of the National Board of Health. An estimation of the demand for physicians in primary care, in various specialties and in non-hospital sectors is reported and discussed. As a result of the study, a reduction in the number of admissions to medical schools is recommended. An increase in postgraduate educational efforts, in research and development, and in continuing medical education should be the result of resources, thus made available.

Finland↗
PubMed1984

Measures of equity and efficiency in medical manpower planning. A prediction of internists needed in the Finnish national health service.

Several difficulties regarding manpower planning in health care based on need for service can be demonstrated. Easily obtainable utilisation numbers do not directly reflect demand or need for service, nor can they be used as an approximation of morbidity. Epidemiological studies, on the other hand, do not reveal "non-clinical" demand factors. Unmet demand cannot automatically be interpreted as undersupply or lack of resources. Planning according to predicted need has furthermore been severely handicapped by a nongrowing economy; it is rather asking for development through reallocation of resources. Consequently, another approach was chosen in this study - a prediction of internists needed in the Finnish national health service to ensure an equal supply and an efficient provision of services. Equity between regions was measured as number of specialists' positions, hospital admissions and out-patient visits per population. The number of admissions and visits per specialist's position was used as a measure of system efficiency. A density of specialists equal to the national mean in all regions would require a 21% increase in specialists' positions. A sensitivity analysis according to different levels of service supply as well as improved efficiency projected a 23-127% growth.

Finland↗
PubMedDate not supplied

Central and local control in Nordic health care: the public organisation spectrum revised.

One of the distinguishing characteristics of national health care systems is the degree of public involvement in service provision, funding and policy making. In international comparisons the Nordic countries are usually seen as a uniform group. Yet, the countries do have important differences, and a descriptive model was sought to demonstrate these, and, at the same time, to differentiate the concept of public control. Using the central-local dichotomy, differences within the public framework were demonstrated between the countries, e.g. in methods of funding, financial regulation, formal planning instruments, and control of resource allocation. Financial control and planning were identified as two distinct components of public control. An analysis of the degree of centralisation along both dimensions separated the Nordic countries, which are otherwise homogenous as to public sector dominance.

Decision Making, Organizational↗
PubMedDate not supplied

Combining data on health care utilization and socioeconomic status of a defined population: use of a population oriented health information system for regional planning.

Health services planning on a regional or national level needs information on health care utilization as well as data on the population to be served. Health or hospital information systems usually cover services provision and utilization, and population data for planning purposes must be obtained from other sources. In the health information system presented, hospital performance data are combined with census and socioeconomic data of the population. That makes cautious analysis of reasons for variation in health care utilization within the planning area possible. The HIS is regional, including 11 health care providers, and population based, linking data to municipality (38 in all). The system is described, including its structure, input registration, file content and output formats. An output example is presented. Necessary conditions for use of the HIS in planning activities are that the corresponding health care delivery system is comprehensive, the population served well defined, and that good control of patient flow and user behaviour is achieved. Use is limited by the character of information stored in the HIS: it is registered retrospectively and by routine. In a system covering various hospitals and municipalities, engaging different types of clerical and health care personnel, data reliability is also a critical issue.

Finland↗