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A 1985 survey of hospital governing boards reveals some of the ways in which boards and physicians are communicating and cooperating, from physicians' membership on the board to nonphysician board members' involvement with medical staff committees.
PURPOSE: The delivery of quality care to all patients with cancer has been named as a national priority within the American health care system. This article addresses the issues critical to case identification in cancer quality measurement and recommends possible strategies for accurately identifying a population of cancer patients. METHODS: We present the measurement issues associated with the basic challenges of case identification strategies for quality measurement. We discuss two basic challenges: (1) accurately identifying all patients with the defining characteristics (eg, a diagnosis of breast cancer), and (2) identifying only patients with these characteristics. RESULTS: Possible options for identifying newly diagnosed patients include using claims or other administrative data, cancer registries, cancer registry rapid case ascertainment, pathology laboratories, and physicians' offices. In the published literature, the sensitivity of claims varies from 75% to 95%, whereas central registries must have a 90% completeness rate to be certified. Most of these approaches, however, involve limitations to obtaining valid and comparable data across multiple settings. CONCLUSION: Using an existing data collection system staffed by skilled data collectors and managers should result in substantially more accurate and timely data. Registry officials and the government agencies that provide their support should be encouraged to adopt quality-of-care analyses as an important purpose of the registry system and to enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis. In order to meet the growing demand for timely, accurate information about quality of care, registries are likely to require additional support so they can enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis.
During the 1980s, hospital governing boards struggled to solve a host of new and difficult problems while attempting to meet the needs of their communities. As we enter the last decade of the 20th century, different challenges lie ahead. To meet these challenges, hospital boards must first understand their various responsibilities. The results of this survey will provide a starting point to understand how hospitals are currently dealing with issues such as governing board composition and organization, board/CEO relations, and governing board operations. (Future articles in Trustee will focus on individual aspects of the survey.) In so doing, readers may begin to unlock the key to increased effectiveness.
Proteus mirabilis urease catalyzes the hydrolysis of urea, initiating the formation of urinary stones. The enzyme is critical for kidney colonization and the development of acute pyelonephritis. Urease is induced by urea and is not controlled by the nitrogen regulatory system (ntr) or catabolite repression. Purified whole-cell RNA from induced and uninduced cultures of P. mirabilis and Escherichia coli harboring cloned urease sequences was probed with a 4.2-kb BglI fragment from within the urease operon. Autoradiographs of slot blots demonstrated 4.2- and 5.8-fold increases, respectively, in urease-specific RNA upon induction with urea. Structural and accessory genes necessary for urease activity, ureD, A, B, C, E, and F, were previously cloned and sequenced (B. D. Jones and H. L. T. Mobley, J. Bacteriol. 171:6414-6422, 1989). A 1.2-kb EcoRV-BamHI restriction fragment upstream of these sequences confers inducibility upon the operon in trans. Nucleotide sequencing of this fragment revealed a single open reading frame of 882 nucleotides, designated ureR, which is transcribed in the direction opposite that of the urease structural and accessory genes and encodes a 293-amino-acid polypeptide predicted to be 33,415 Da in size. Autoradiographs of sodium dodecyl sulfate-polyacrylamide gels of [35S]methionine-labeled polypeptides obtained by in vitro transcription-translation of the PCR fragments carrying only ureR yielded a single band with an apparent molecular size of 32 kDa. Fragments carrying an in-frame deletion within ureR synthesized a truncated product. The predicted UreR amino acid sequence contains a potential helix-turn-helix motif and an associated AraC family signature and is similar to that predicted for a number of DNA-binding proteins, including E. coli proteins that regulate acid phosphatase synthesis (AppY), porin synthesis (EnvY), and rhamnose utilization (RhaR). These data suggest that UreR governs the inducibility of P. mirabilis urease.
The HPLC separation of the R,S and S,R enantiomers of pyrrolidinyl norephedrine on immobilized alpha-1 glycoprotein (AGP) was investigated. Conditions for the separation were varied using a premixed mobile phase containing an ammonium phosphate buffer and an organic modifier. The influence of mobile phase pH, ionic strength, organic modifier composition, modifier type, and temperature on the chiral selectivity and retention were investigated. The presented data demonstrate that independent phenomena govern the enantioselectivity and retention. Retention is a function of both ion exchange equilibria and hydrophobic adsorption. Thermodynamic data derived from van't Hoff plots illustrates that while enantioselectivity is also enthalpically driven, the magnitude of the enthalpy term is governed by pH. Enantioselectivity has little dependence on ionic strength. Hydrophobic interactions appear to foster hydrogen bonding interactions; the two appear to be mutually responsible for chiral selectivity. The chiral selectivity decreases as the pH is decreased and increases with mobile phase buffer strength.
PURPOSE: To present a model of health care delivery in South Africa that made health care services accessible and affordable to members of the community who do not have medical insurance. DATA SOURCES: Statutes and laws governing the practice of health care professionals in South Africa, published professional guidelines, local research data, and the author's experience of the model of health care delivery. CONCLUSIONS: The innovative and visionary approach of a few health care professionals has established a model of health care delivery specifically suited to their community's needs. This model of service delivery has provided an affordable and accessible health service to members of the local community, who have indicated their satisfaction with the service. IMPLICATIONS FOR PRACTICE: Economic and legal barriers to accessible and affordable health care services can be overcome to ensure that health care is available to the whole population. The nurse practitioner has an important role to play in making health care affordable and accessible to the community.
Yes, Mr. Hage admits the cost for health care is high--it's now 11% of the GNP. However, "society reaps real and tangible benefits from its availability," defends the author. This article questions a government which on the one hand denies appropriate care to many of those who need it most through health care cutbacks while on the other hand accepts a $500 billion bill for the S&L bailout.
For several years the Royal College of General Practitioners has been collecting data supplied by local doctors throughout Britain on some infectious diseases seen in their practices. We describe a method of computerisation of this information and statistical analyses. We are investigating the influence of external factors such as climate on the infectiousness of some diseases. A model is fitted involving a non homogeneous two-state Markov chain whose transition probabilities are governed by the explanatory data.
Records in public archives were evaluated for the period 1981-1991. Simple surveys of peoples and of technology and physical premises provided insight to gauge the attitudes of a local community in the Melbourne municipality and the Melbourne City Council towards composting of organic waste materials. There is a lag in perception and attitudes between the local community and the local government towards composting of organic refuse as a solid waste treatment option. The simple methodology of the study still made it possible to verify past and present perceptions and attitudes.
The interaction of the human immunodeficiency virus type 1 (HIV-1) nucleoprotein complex with the cell nuclear import machinery is necessary for viral replication in macrophages and for the establishment of infection in quiescent T lymphocytes. The karyophilic properties of two viral proteins, matrix (MA) and Vpr, are keys to this process. Here, we show that an early step of HIV-1 nuclear import is the recognition of the MA nuclear localization signal (NLS) by Rch1, a member of the karyopherin-alpha family. Furthermore, we demonstrate that an N-terminally truncated form of Rch1 which binds MA but fails to localize to the nucleus efficiently blocks MA- but not Vpr-mediated HIV-1 nuclear import. Correspondingly, NLS peptide inhibits the nuclear migration of MA but not that of Vpr and prevents the infection of terminally differentiated macrophages by vpr-defective virus but not wild-type virus. These results are consistent with a model in which Rch1 or another member of the karyopherin-alpha family, through the recognition of the MA NLS, participates in docking the HIV-1 nucleoprotein complex at the nuclear pore. In addition, our data suggest that Vpr governs HIV-1 nuclear import through a distinct pathway.
Data on board operating practices are presented from the 1979 AHA Survey of Hospital Governing Boards, the AHA's first comprehensive collection of data on hospital governing board structures, procedures, and composition.
OBJECTIVES: The study's objective was to better understand alcohol abuse and impaired driving behaviors in a First Nations community as it reflects systemic issues linked to historical, family and community experiences. STUDY DESIGN AND METHODS: Fifteen 18- to 29-year-old drivers participated in an exploratory eight-hour Talking Circle held according to traditional cultural practice. Four First Nations researchers, trained in Talking Circle protocol, and a Band Elder facilitated the data collection, data analysis according to emerging themes, and data verification. RESULTS: Federal government residential schools contribute to intergenerational effects which impact impaired driving in a northern First Nations community. Traditional parental role modeling has changed dramatically. Rather than guide children through a communally shared development process, many parents now expect their children to assume adult roles by expecting them to take care of their guardians when they drink excessive amounts of alcohol. Because a wall of silence exists between the young and old, many young people seek refuge with friends and peers, who subsequently influence them to abuse alcohol and engage in impaired driving. Many older Band members no longer serve as leaders for young people. Instead, they behave like peers and engage in activities that facilitate alcohol abuse and impaired driving. CONCLUSIONS: Historical institutions like federal government residential schools have contributed to systemic socio cultural problems which influence alcohol abuse and impaired driving. Hence there is a need for community-based intervention strategies that promote cultural healing. The healing journey can start with First Nations communities providing their people opportunities to share their stresses and traumas in supporting and nurturing environments.
This article is concerned with the influence of age and research support on the frequency of technical innovation and economic growth. Based on the observations of Mumford and Gustafson, the authors argue that major contributions are derived from the creation of new understandings brought about by the integration and reorganization of existing understandings [1]. It is also argued that the creation of new understandings is most likely to occur in the earlier phases of people's careers when capable individuals are placed in an environment that will support innovative efforts. To examine these hypotheses and their broader economic implications, data were obtained from government sources describing the percentage of the population between the ages of twenty-five and forty-four, and between the ages of forty-five and sixty-four, as well as the percentage of the gross national product devoted to research and development efforts, the percentage of individual patents awarded, and deviations from long-term trends in the gross national product. These data were then analyzed in a time series analysis covering the period from 1929 to 1984. The results indicated that research support and age influenced the number of patents awarded which, in turn, influenced deviations in the gross national product. On the basis of these observations and the underlying theory, the authors conclude that substantially greater attention should be given to the development and maintenance of creative potential.
How are changes in the health care environment and in the roles and responsibilities of governing boards affecting board committee structures? This article, based on a recent survey of board chairmen, looks at the latest trends in standing board committees, from which type of committees are most prevalent to recent changes in nonboard membership.
OBJECTIVE: Two theories--agency and managerialism--are compared with respect to their usefulness in explaining the role of insiders on the hospital board: whether their participation enhances or impairs board financial decision making. DATA SOURCES/STUDY SETTING: The study used 1985 hospital financial and governing board data for a representative sample of acute care California hospitals. STUDY DESIGN: Relationships were examined cross-sectionally between the presence or absence of insiders on the board and measures of hospital financial viability while controlling for the organizational factors of system affiliation, ownership, size, region, and corporate restructuring. PRINCIPAL FINDINGS: Multiple regression analysis found significant relationships between insider (CEO, medical staff) participation and hospital viability. CONCLUSIONS: These results support the managerial theory of governance by suggesting that the CEO and medical staff provide informational advantages to the hospital governing board. However, the cross-sectional design points to the need for future longitudinal studies in order to sequence these relationships between insider participation and improved hospital viability.
OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: Data Sources.- Twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PSYCHINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. SELECTION CRITERIA: Data Selection.- Randomized controlled trials of interventions among particiapnts with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. Of 7014 studies identified, 19 (0. 3%) met the inclusion criteria. DATA COLLECTION AND ANALYSIS: Data Extraction.- Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Data Synthesis.- In completed trials, interventions for problem drinking were associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27-65%. Several interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. REVIEWER'S CONCLUSIONS: Conclusion.- Interventions for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to evaluate the effect of treating problem drinking on injuries.
To truly enjoy the benefits of the information age, public health agencies at each level of government must work together to plan and implement integrated information systems that meet the needs of our dynamic profession. The Joint Council of Governmental Public Health Agencies, comprised of state and local health officials, has worked to identify the solutions to public health's information needs. Investments in integrated systems that support service delivery to clients will improve program management and enhance accountability for public funds. The ability to produce good, client-centered data will be essential as the nation's health and welfare systems change.
This study compares selected characteristics of community hospital governing boards with those of high technology industries acknowledged for successful transitions in a rapidly changing competitive environment. Sponsored by the Estes Park Institute, the purpose of this investigation was to identify emerging governance issues and to propose a normative model for nonprofit community health care systems. Results suggest that for health care systems to succeed in a rapidly changing competitive environment, strategic alterations in top-level governance structures will be necessary to focus on market-driven policy issues, with accompanying changes toward smaller boards composed of expert directors. Trends and implications for board terms, committee structures, and relationships between the board and chief executive officers are also discussed.