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PubMedDate not supplied

[Study of the work climate in four critical care units in a hospital].

A study was made of the work climate, which was understood to be the overall group of factors that influence nursing professionals in critical-care units. A descriptive study was made by carrying out an anonymous survey among the staff of four adult critical-care units: intensive care unit, coronary unit, reanimation unit, and cardiac postoperative care unit. The survey included seven factors: occupational satisfaction, occupational stress, occupational pressures, work relations, professional skills, professional training, and sociodemographic variables. Of 132 questionnaires completed, 80% of the persons who answered accepted their tasks, but only 51% indicated that they planned to continue in the critical-care unit. Sixty percent of the persons surveyed indicated that their work was stressful and that they felt physically fatigued as the workday progressed. Similarly, 60% reported that their work sometimes had a negative impact on family life and 35% indicated that it affected their health. Relations among members of the health-care team were reported as good by 90%. Seventy-five percent were capable of working independently and resolving situations at their own initiative. Ninety-five percent of the persons who completed the survey considered the possibilities for professional advancement to be scant and 88% were interested in the development of specialization. It was interesting that one third of the persons in the sample wanted to leave the hospital. Unit ergonomics had a negative effect on work activities. Staff felt a lack of information in spite of good relations with superiors and other team members. They felt the need for more social and professional recognition, as well as better economic remuneration, but they expected specialization to palliate these needs to some degree.

Adult↗
PubMed1999

'Bin bag' study: a survey of the research requests received by general practitioners and the primary health care team.

General practitioners receive a large and increasing number of unsolicited requests to participate in research. This study describes the volume and nature of research requests received by 18 primary care teams in a three-month period. On average, each practice receives 16 to 24 research requests each year. The most frequent request is to complete a questionnaire (32%). Only one-fifth of studies originate from academic or service general practice. Remuneration for participating in a study was only offered for 15% of studies. Although general practice teams feel swamped by research requests, this sensation may be exaggerated by invitations to participate in non-scientific surveys as well as true research projects. Practice teams would welcome help in distinguishing quality research proposals from the remainder.

Data Collection↗
PubMed2000

[Second opinion in tumor surgery. Valuable--but needing improvement].

In complicated oncological cases, a second opinion is desirable, also in the view of the care-providing surgeon. It serves interdisciplinary therapeutic planning, and helps improve the quality of treatment. In the case of highly consequential interventions, the patient has a legal right to a second opinion. On a practical level, however, the implementation of this possibility encounters problems: organizational shortcomings, incomplete patient documentation, the stresses of patient transportation, loss of valuable time, in particular in the case of postal consultation, following consultation in a center the carrying out of treatment there, whether at the urging of the doctors there or the patient himself, lack of remuneration for the efforts of the consultants. Today, however, all the necessary technical facilities are in place to enable various experts to be consulted, virtually simultaneously, on any case, via video-conferencing.

Germany↗
PubMed1999

Recruitment and retention of general practitioners in the UK: what are the problems and solutions?

Recruitment and retention of general practitioners (GPs) has become an issue of major concern in recent years. However, much of the evidence is anecdotal and some commentators continue to question the scale of workforce problems. Hence, there is a need to establish a clear picture of those instabilities (i.e. imbalances between demand and supply) that do exist in the GP labour market in the UK. Based on a review of the published literature, we identify problems that stem from: (i) the changing social composition of the workforce and the fact that a large proportion of qualified GPs are significantly underutilized within traditional career structures; and (ii) the considerable differences in the ability of local areas to match labour demand and supply. We argue that one way to address these problems would be to encourage greater flexibility in a number of areas highlighted in the literature: (i) time commitment across the working day and week; (ii) long-term career paths; (iii) training and education; and (iv) remuneration and contract conditions. Overall, although the evidence suggests that the predicted 'crisis' has not yet occurred in the GP labour market as a whole, there is no room for lack of imagination in planning terms. Workforce planners continue to emphasize national changes to the medical school intake as the means to balance labour demand and supply between the specialities; however, better retention and deployment of existing GP labour would arguably produce more effective supply-side solutions. In this context, current policy and practice developments (e.g. Primary Care Groups and Primary Care Act Pilot Sites) offer a unique learning base upon which to move forward.

Attitude of Health Personnel↗
PubMed1999

Perceived role of primary care physicians in Nova Scotia's reformed health care system. Qualitative study.

OBJECTIVE: To determine primary care physicians' perceptions of their role in a reformed health system. DESIGN: Qualitative study using in-depth interviews. SETTING: Province of Nova Scotia. PARTICIPANTS: Purposefully selected sample of 14 practising primary care physicians. MAIN OUTCOME FINDINGS: Participants identified seven aspects of their role: primarily, diagnosis and treatment of patient's medical problems; then coordination, counseling, education, advocacy, disease prevention, and gatekeeping. The range of activities and degree of responsibility assumed by participants, however, varied. Factors affecting role perception fell into three categories: philosophical view of health and medicine, willingness to collaborate, and practical realities. Participants differed in their understanding of primary health care and their overall vision of the health system. Remuneration policies and concerns about sharing accountability were factors preventing an integrated, collaborative approach to care. Personal, patient, and structural realities also limited physicians' roles. CONCLUSIONS: This sample of primary care physicians had diverse perceptions of their role. Results of this study could provide information for identifying issues that need to be addressed to facilitate changes taking place in the health care system.

Attitude of Health Personnel↗
PubMed1998

[Grievances in South African hospitals: from a nursing service management perspective].

The nursing service manager is accountable for adequate and efficient personnel management in the nursing service and the management of grievances is an important aspect of the personnel management function. The question arises, however, how and when grievances in nursing services arose and developed? The purpose of this article is to give a historical description of the development and management of grievances in nursing services for the time frame 1652-1990. An historical analysis was undertaken by means of news paper analysis, as well as other written resources. The results show that the development of grievances are related to the development of hospitals in South Africa and that grievances were poorly managed. The following conclusions are made: grievances in nursing are related to the establishment of hospitals; the first official grievance was lodged in 1824 by a surgeon; grievance are mainly related to the working conditions, remuneration and management; complaints with salaries and food were lodged by nurses as early as 1869; it appears as if nursing service managers are not adequately skilled in the management of grievances experienced by nursing staff--the same mistakes are made leading to strike action by nurses/midwives; unhappiness with the inappropriate manner in which grievances are managed lead to industrial action by nursing staff since 1889. Continuous empowerment of nursing services managers in the management of grievances is important and therefore the development of a model for grievance management in nursing services is also recommended.

Collective Bargaining↗
PubMed2000

[Delivery of home health care. Survey of the Quebec region].

OBJECTIVE: To describe the characteristics of home health care delivered by general practitioners and to identify the conditions that facilitate or hinder development of this practice. DESIGN: Mailed survey. SETTING: Quebec city region. PARTICIPANTS: General practitioners in private practice, family practice units, community health centres, or hospitals. MAIN OUTCOME MEASURES: A self-administered questionnaire was used to gather information on volume of home care provided, characteristics of clients and visits, methods of follow up, and factors that promoted or hindered home care. RESULTS: Of the 487 physicians surveyed, 58.1% (283) made housecalls to a clientele consisting mainly of elderly patients (87.6%): 42% saw fewer than five patients per week, and 31% spent 2 hours or less per week on housecalls. Close to two thirds (64%) devoted 15 to 30 minutes to these visits, and 90.2% said they used community health centres for assessment or home follow up of their patients. Difficulties with scheduling and methods of remuneration reportedly hampered development of this practice. CONCLUSION: Home care practice is widespread around Quebec city, but represents only a small portion of the clinical work of many GPs.

Delivery of Health Care↗
PubMed2000

[The situation of clinical examination in today's U.S. hospitals].

In the U.S., with the spread of managed care such as the Diagnostic Related Group/Prospective Payment System(DRS/PPS) introduced in 1983 into Medicare, the national elderly medical insurance system, and the Health Maintenance organization introduced in 1990 in the private medical insurance system, medical services have become limited, and remuneration of medical practice has been markedly restricted. As a result, hospital management has been pressed, and cooperation, merger, and absorption among hospitals as is observed among general enterprises have occurred. Hospitals have been making efforts to reduce expenses for survival. I introduced a part of the influence of such revisions in medical insurance systems on the medical care system, particularly the clinical examination field, by reporting the present state of the Beth Israel Medical Center(BIMC, New York) for which I have cooperated in the management of the Central Examination Room for many years, and information obtained in the UC. San Francisco Medical Center and Peninsula Hospital I visited when attending the meeting of the American Association of Clinical Chemistry(AACC) held in San Francisco on July 23-27, this year.

Financial Management, Hospital↗
PubMed2000

[Control of health care by the economist?].

Although the health care system has to deal with huge financial problems one cannot neglect that this labour-intensive service branch creates the most jobs with social security obligations. Corrective strategies will have to increase the orientation of health care to patients' needs which requires better information and more decision-making autonomy for the insured people as well as a maximising of efficiency. Competition needs to be strengthened in order to improve quality and reduce costs. This requires more contractual freedom for insurance funds and a dismantling of the current monopolistic structures. Finally, adequate remuneration schedules and patients' individual responsibility play a major role to meet the future challenges in the European internal market.

Cost-Benefit Analysis↗
PubMed2000

The hospital sector in Germany: an overview.

The German health care system has recently experienced far reaching reforms within its hospital sector, including a new financing and remuneration system, the life span of which is to the year 2003. The reforms have been based on the DRG-system already in operation in another country. Other regulations of the new reform involve the system of quality assurance and quality management in German hospitals and a new form of supply of services, the so called "integrated care" system, the introduction of which was to overcome the fragmented system of ambulatory and stationary medical care in Germany. This article, in short, presents an overview of the hospital sector in Germany and reports on the latest developments resulting from implementation of the health care reform.

Efficiency, Organizational↗
PubMed2001

[Developing the best and the brightest in academic surgery for next generation].

Major advances have been achieved in surgery during the past century and further dynamic changes are expected along with progress in immunology, tissue and mechanical engineering, etc. in the 21st century. However, fewer medical students will choose the surgical field as their specialty, primarily due to the long training period, and inadequate income as compared to the heavy workload. To recruit the best and the brightest students in surgery, early exposure to the positive aspects of the surgical field is desirable. The training system should be further refined, and a sufficient number of positions with appropriate remuneration must be mode available.

Education, Medical, Graduate↗
PubMed2001

[Collaboration between family physicians and home care professionals. Is it possible?].

OBJECTIVE: To describe perceptions of physicians and home care professionals working in local community service centres (CLSCs) with respect to collaboration on home care follow up, and to identify conditions likely to help or hinder cooperation. DESIGN: Descriptive study using individual and group interviews. SETTING: Areas served by three CLSCs in the Quebec city region. PARTICIPANTS: Forty-five general practitioners with large home care practices and coordinators and representatives of CLSC home care teams. MAIN OUTCOME MEASURES: Perceptions of physicians and home care professionals with respect to interprofessional cooperation on and barriers to home care follow up. RESULTS: Most participants thought that cooperation would be beneficial to complex case management and continuity of follow-up care. In practice, however, cooperation is hindered by differences in medical practice and home care team service delivery and in methods of remuneration, and lack of knowledge of the other field of practice. CONCLUSION: All participants recognized the importance of cooperation. This study did not reveal any real integration of medical and CLSC home care services. Efforts must be made to identify the strategies most conducive to improving interprofessional cooperation.

Canada↗
PubMed2001

[The factor of spread of POCT in USA].

In the U.S., with the adaptation of the Diagnostic Related Group/Prospective Payment System(DRS/PPS) of Medicare, and the spread of the Managed Care such as the Health Maintenance organization(HMO), medical services have become limited, and remuneration of medical practice has been markedly restricted. As a result, hospital management has been pressed, and cooperation, merger, and absorption of hospitals is observed among general enterprises. Hospitals have been making efforts to reduce expenses for survival. I introduced a part of the influence of such revisions on the clinical examination field, and the factor of the spread of point of care testing(POCT).

Hospital Administration↗
PubMed2001

Royal College of Anaesthetists Tutors. A survey of their duties and resources.

Royal College of Anaesthetists Tutors have a key role in the delivery of postgraduate anaesthetic training in the UK. We report the results of a postal questionnaire sent to all College Tutors in April 2000. An 89% response rate (253 of 283 Tutors) was received. Respondents were responsible for a median 11 trainees. Forty-nine Tutors with responsibility for larger numbers of trainees had the assistance of a deputy. The duties of a College Tutor comprised the organisation and delivery of training, appraisal and assessment, and 73% of respondents undertook all of these. In addition, a proportion had other administrative duties. The average time spent on College Tutor duties was 1.6 notional half days. Almost two-thirds of Tutors received some resources (time or remuneration) for their duties.

Adult↗
PubMed2001

[Referral and management in geriatrics and geriatric rehabilitation with special reference to medical case fee schedules and diagnosis related groups (DRGs)].

Every system of payment of flat-rate case charges results in an economically determined optimizing of treatment processes. This presupposes a high level of co-operation between all those involved in the treatment process. Collaboration must extend over occupational groups (doctors, nursing staff and therapists), over departments (specialist geriatric competence and specialist knowledge) and must increasingly take place in a manner extending over sectors (inpatient, partly inpatient and outpatient). To this end, interdisciplinary, team-oriented modes of working provide the direction to be followed in geriatrics. What is essential for efficient patient management is for patient allocation control to be implemented in good time, with individual requirements regarding treatment being provided by the most suitable department. This will only be possible, in perspective, by implementing binding treatment guidelines and quality standards, as well as the timely interdisciplinary incorporation of acute geriatrics, e.g. by participation of the admission wards of the clinics. Geriatrics in acute hospitals has demonstrated its value and has become an indispensable element of appropriate health provision in Germany. The retention of this structure of geriatric care presupposes that, in the future, the DRG system of geriatric services will also be included with a sufficient measure of differentiation and that consequently an appropriate level of remuneration for geriatric services will be ensured. As the DRG system has not been applied internationally, up until now, in the area of acute geriatrics, suitable adjustments to the system of the basic Australian AR-DRG system are absolutely essential.

Aged↗
PubMedDate not supplied

Medical ethics and controlled clinical trials.

The controlled clinical trial is a relatively new phenomenon; the first large clinical trial on evaluation of streptomycin in therapy of pulmonary tuberculosis occurred in 1946. In such a study, two or more groups of patients with similar characteristics are chosen by random allocation to receive one or more therapies. The essential ethical dilemma is based on the risk-benefit ratio of the new therapy. Ethical factors that must be considered in the design of controlled clinical trials include provision for informed consent, nature of alternate therapy, confidentiality of data, source of funding and potential conflict of interest, remuneration of subjects, criteria for ending participation of the subject, criteria for concluding the trial, compensation of injured subjects, compliance with institutional, municipal, state and federal regulations and provisions for special groups such as the fetus and pregnant woman, infants and young children, institutional patients and prisoners. Federal guidelines for research in specific areas are now available through the reports of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. To date, commission reports include recommendations for research in fetuses and pregnant women and in children. Protection of the subject is best provided by the the quality of the protocol, integrity of the investigator, valid informed consent, and review of the research program by an independent committee composed of scientists and consumers.

Child↗
PubMed2001

Levels of career satisfaction amongst dental healthcare professionals: comparison of dental therapists, dental hygienists and dental practitioners.

OBJECTIVE: To compare the levels of career satisfaction expressed by three professional groups working in dental health: dental therapists, dental hygienists and dental practitioners. BASIC RESEARCH DESIGN: Level of career satisfaction was assessed using a ten point scale in three surveys. Postal surveys were conducted of all dental therapists and dental hygienists registered with the General Dental Council. Data for dental practitioners were collected as part of the British Dental Association Omnibus Survey 2000. PARTICIPANTS: Data are reported for 227 dental therapists, 2,251 dental hygienists and 970 dental practitioners. RESULTS: Significant differences were found between groups in the level of career satisfaction expressed. Dental practitioners were less likely to express high levels of satisfaction in comparison with the other two professional groups. Within each group characteristics of the respondents were associated with satisfaction levels. Younger dental therapists and dental hygienists expressed lower levels of career satisfaction. The level of career satisfaction expressed by dental practitioners was associated with gender, place of work (North vs South UK), year of qualification, size of practice and system of remuneration. CONCLUSIONS: Dental practitioners express lower levels of job satisfaction in comparison to other groups of dental health care professionals. Job dissatisfaction among dental practitioners is related to a number of socio-demographic factors.

Adult↗
PubMed1996

[Not Available].

The psychiatric clinic St. Pirminsberg, a house with an impressive history. The early days of its existence were turbulent. At that time, medical care of the mentally disordered was neglected, patients being misunderstood and mistreated. The search for an appropriate place, that could house those "mad" people, met with a lot of difficulties. The government's, the doctors' and the people's views on the necessity of such an institution were too varied to make decisions easy. However, thanks to untiring initiative, the canton St. Gallen can now consider itself the proud owner of a wonderful psychiatric clinic. In Switzerland, St. Pirminsberg its the oldest institute for mental treatment after Munsterlingen and Geneva. At the same time, there were also a few private houses where the mentally sick were accommodated. Although these patients were usually relatives of wealthy families, they did, in fact, receive insufficient medical care. St. Pirminsberg's methods in therapy describe the development and modernization of psychiatry. The resident staff constantly endeavoured to satisfy the highest demands. In this respect, the work of famous personalities made a large contribution to the clinic. Each director and senior consultant has engraved his personal style on the institute. Some were primarily concerned with construction work to the building, others had to economize due to the financial situation. A few vested their interests exclusively in the science of psychiatry. All, however, had to cope with a shortage of staff, due to the rather remote situation of the clinic, the unsatisfactory remuneration and the demanding nursing care needed, often coupled with a great deal of responsibility. Cooperation with foreign clinics and those of other cantons was fruitful in human, medical and also financial aspects. Experiences were exchanged, decisions were made concerning education and schools for staff were founded. St. Priminsberg received recognition as an institute for further education towards specializing in psychiatry. A walk through today's clinic does not only mean seeing, but also experiencing history. Situated between the walls of the former monastery of St. Pirmin, the old part of the building, with its splendid ornamentation, can transport the visitor back to former times. Life in the clinic must have been difficult: massive, cold walls, mostly badly-lit rooms and corridors temporarily filled with beds must surely have had a very unfavourable effect on the disposition of the patients. Pavilions, erected later in a more useful but nonetheless pleasing style of architecture are equally impressive - new and old harmoniously united. Even in earlier times, people praised the beautiful countryside in which Pfäfers is situated. The outward appearance of the village has not changed in years. Its high location offers a wonderful view over the valley and provides a fresh, cool climate - an advantage which will always be held in great esteem by the clinic St. Pirminsberg.

History, 19th Century↗