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What do we owe the elderly? Allocating social and health care resources.

The purpose of this report is to present the reflections of an international research group that focused its attention on the moral problems of care for the elderly in the years ahead, and in particular on the problem of an equitable and reasonable allocation of resources. By stressing the "moral" problems, we mean to call attention to an often neglected dimension of the public and professional discussion: that of the obligations owed to the elderly by individuals and society, the reciprocal obligations on the part of the elderly, and the ethical dilemmas that sensitive care for them cannot avoid. Most generally, we want to call attention to the often hidden value issues and considerations of a discussion that, in most countries, is restricted to economic and institutional arrangements only.

Age Factors↗

[Geriatric assessment in family practice--results of concerted action by 7 European countries].

General practitioners are faced with the complex medical care of an increasing number of older people. Traditional demand led care is not able to provide optimal management for this age group, since it has been shown that many important health problems remain unknown or not optimally treated. Preventive geriatric assessment offers primary health care providers new opportunities to focus their management on the particular health problems of older people. A European concerted action involving seven countries formed to develop a "standard assessment for elderly people in primary care (STEP)". The aim was threefold: 1) to identify important and preventable health problems in old age, 2) to supply health care planners and providers with scientific evidence of the corresponding preventive procedures, and 3) to initiate a practical assessment framework for use in European primary care practices. Using a strict methodological protocol, 33 health problems were identified that potentially improve health outcomes in preventive programs for older people. A summary of the evidence is given for each of the included health areas. Taking the best available evidence, patients' preferences, and practice conditions into account, a preventive assessment program was developed containing validated and accepted instruments. The approach is algorithmic with a simple problem identification level and a further diagnostic stage. All recommended procedures are harmonized for common European use. An evidence-based preventive assessment program is expected not only to prevent disease and minimize disability and handicap, but it also offers health care planners a European data set of older peoples' needs for optimized resource allocation.

Aged↗

Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity.

Despite the early onset of attention deficit disorder with hyperactivity (ADDH), there is a dearth of treatment studies with preschoolers with this disorder. Forty-six families with ADDH preschoolers were randomly assigned to either an immediate or a delayed group parent training program aimed at improving child compliance. Groups were balanced on demographic variables. Treatment outcome was evaluated by comparing the groups at pre- and posttreatment and 3-month follow-up on measures of parent-child interactions during free play, a compliance task, and parent-supervised activities, as well as on parent-completed Conners Hyperkinesis Index scores. Positive treatment effect was obtained on measures of compliance, parental style of interaction, and management skills. These improvements were maintained at 3-month follow-up. Evaluation of treatment effects on nontargeted child behaviors indicated no generalization.

Attention Deficit Disorder with Hyperactivity↗

Mainstreaming hearing-impaired students: the effect of effort in communicating on cooperation and interpersonal attraction.

Cooperative and individualistic learning experiences were compared in terms of their effects on interaction and relationships between hearing and hearing-impaired students. Two contradictory hypotheses were tested--one stating that the effort required for hearing and hearing-impaired students to communicate would lead to frustration, withdrawal, exclusion, and rejection; the other stating that cooperative learning experiences would lead to cross-handicap interpersonal attraction regardless of communication difficulties. Thirty 3rd-grade students (20 hearing and 10 hearing impaired) were assigned to conditions on a stratified, random basis controlling for handicap, sex, and ability level. They participated in the study for 55 min a day for 15 instructional days. The results indicate that subjects involved in cooperative learning experiences performed higher on measures of interaction and interpersonal attraction between hearing and hearing-impaired students than did subjects involved in individualistic learning experiences.

Achievement↗

Randomized clinical trials in neurosurgery.

Fifty-one randomized trials of neurosurgical topics have been identified. These have been analyzed for content, quality of reporting, and quality of statistical design and analysis. In general, there were major omissions in the reporting of critical portions of the studies, the statistical analysis was highly variable in quality, and the statistical power was low. Few, if any, major neurosurgical questions have been answered by clinical trials. This may reflect the generally low quality of these trials. To improve the quality of such trials, neurosurgeons must seek biostatistical advice in planning and conducting trials and must cooperate in multi-institutional trials to increase statistical power.

Clinical Trials as Topic↗

Trials on trial.

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Attitude↗