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PubMed1995

Nurses' retirement preparation.

Nurses expect that professional achievement and dedication to society will reward them with economic security in their later years. Such rewards may not be theirs without deliberate and careful attention to early preparation. This study showed that although nurses expect an adequate income during retirement, their current pension, benefit, and savings status suggests otherwise. Nurses who do not actively manage personal finances or attend to details of employment benefit packages place themselves at distinct risk for economic crisis during their decades of retirement.

Aged↗
PubMed1995

The business acumen of Canadian plastic surgeons.

We as plastic surgeons are engrossed and consumed by our quest to optimize patient care. In so doing, we are often distracted by that aspect of our practice which has direct bearing on patient care yet for which we are the least prepared--the business aspect. The entire population of Canadian plastic surgeons was surveyed in an effort to establish real and perceived needs of this group with respect to the business management of their practices. The survey elicited demographic information, information on business educational background, interest, and current commitment in acquiring business knowledge, and a final category of questions dealing with how well these surgeons function as business managers. Of the 315 plastic surgeons surveyed, 122 (39 percent) responded, which, in and of itself, indicates an interest in this aspect of their practices. Twelve respondents were excluded from the study for various reasons. Eighty of the 110 remaining respondents (72 percent) used a hospital-integrated facility for both emergency and elective outpatient procedures. Eighty-four of the 110 respondents (76 percent) indicated that 10 percent of their hours per week of inpatient booked operating time was canceled. Ninety-three percent of respondents felt that a business course to familiarize surgeons with common business situations and areas of personal finance would be beneficial. Few were previously educated in business, and similarly, few had great ongoing interest in business, although the majority of respondents used publications specifically dealing with financial matters (provided by the Canadian Medical Association). Twenty-three percent of respondents saw themselves in a growing role as businesspeople; 24 percent felt this dual role was enjoyable, while 29 percent felt this role was forced on them. A total of 21 percent of respondents did not see themselves as businesspeople at all. The six basic functions of a manager (planning, acquiring, organizing, actuating, controlling, and evaluating) were all made use of by these practicing surgeons, although the evaluating and controlling functions seemed to predominate managerial time. These surgeons do recognize, for the most part, that a surgical practice is a form of business enterprise as well as a professional endeavor. Patient care, which is of paramount importance, is affected by the business aspect of our practices. The Canadian plastic surgeons surveyed have expressed the lack of business education and training as a problem. In the present medical environment, we need to be more responsible and efficient in our business practices through education and training in this aspect of our practices.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2006

Development and validation of an index to predict activity of daily living dependence in community-dwelling elders.

BACKGROUND: Maintaining independence in daily functioning is an important health outcome in older adults. A key measure of functional independence in elders is the ability to do activities of daily living (ADL) without the assistance of another person. However, few prognostic indices have been developed that stratify elders into groups at variable risk for developing ADL dependence. OBJECTIVE: We sought to develop and validate a prognostic index that distinguishes between elders at different risk of ADL dependence. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We studied subjects enrolled in Asset and Health Dynamics Among the Oldest Old (AHEAD), a nationally representative cohort of elders older than the age of 70. We included 5239 subjects (mean age, 77) reporting that they could do each of 5 ADL (bathing, dressing, toileting, transferring, and eating) without the assistance of another person at baseline. Subjects were divided into development (n = 3245) and validation (n = 1994) samples based on region of the United States. Our primary outcome was the need for help (dependence) with at least one ADL at 2 years. We used logistic regression to select among predictor variables encompassing several domains: demographic characteristics, comorbid conditions, functional status, cognitive status, and general health indicators. RESULTS: The 9 independent predictors of 2-year ADL dependence were age older than 80, diabetes, difficulty walking several blocks, difficulty bathing or dressing, need for help with personal finances, difficulty lifting 10 pounds, inability to name the Vice President, history of falling, and low body mass index. We created a risk score by assigning 1 point to each risk factor. In the development sample, rates of 2-year ADL dependence in subjects with 0, 1, 2, 3, 4, and 5 or more risk factors were 1.3%, 2.8%, 3.8%, 10%, 22%, and 33%, respectively (P < 0.001, roc area = 0.79). In the validation sample, the rates were 0.7%, 4.3%, 8.7%, 11%, 18%, and 40% (P < 0.001, roc area = 0.77). The risk score also discriminated between subjects at variable risk for a combined outcome of either ADL decline or death (4.3%, 7.6%, 15%, 21%, 30%, and 47%). CONCLUSION: Using data available from patient reports, we validated a simple risk index that distinguished between elders at variable risk of ADL dependence. This index may be useful for identifying elders at high risk of poor outcomes or for risk adjustment.

Activities of Daily Living↗
PubMed2005

Living donor adult liver transplantation: a longitudinal study of the donor's quality of life.

We report the results of a prospective, longitudinal quality of life survey on our adult right lobe (RL) liver donors. A total of 47 donors were enrolled; a standard SF-36 form and 43 questions developed by our team were completed before donation, at 1 week, and 1, 3, 6 and 12 months after donation. There were no donor deaths. Twenty-nine complications occurred in 16 patients. Major complication rate was 12.8%. Employment status and personal finances were identified as major stressors. All donors who wished to return to work did so by 1 year (mean 3.4 months). Individuals reported between 0 dollars and 25,000 dollars in losses (wages, travel, lodging, etc.). Relationships with recipients and other family members were not altered significantly. Anticipated pain (predonation) was greater than actual pain reported. Donors indicated satisfaction with the donation process regardless of recipient outcome. Physical complaints were significant at 1 week and 1 month, but returned to baseline. Donor mental health remained stable. In conclusion, RL donors found the experience to be a positive one throughout the first postdonation year. The study identified areas (finances, employment and expected recipient outcomes) to be stressed as future donors are evaluated.

Adult↗
PubMed2002

Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision.

This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.

Aged↗
PubMed2006

Sources of information on postgraduate medical training programs and medical specialty career resources-2006 update.

This is the final biennial update listing directories, journal articles, Web sites, and general books that aid the librarian, house officer, or medical student in finding information on medical residency and fellowship programs. The World Wide Web provides the most complete and up-to-date source of information about postgraduate training programs and specialties. This update continues to go beyond postgraduate training resources to include selected Web sites and books on curriculum vitae writing, practice management, personal finances, the "Match," certification and licensure examination preparation, lifestyle issues, job hunting, and the DEA license application process. Print resources are included if they provide information not on the Internet, have features that are particularly useful, or cover too many relevant topics in depth to be covered in a journal article or on a Web site. The Internet is a major marketing tool for hospitals seeking to recruit the best and brightest physicians for their training programs. Even the smallest community hospital has a Web site.

Education, Medical↗
PubMed2002

Barriers to blood glucose monitoring in a multiethnic community.

OBJECTIVE: We studied a multiethnic community to determine factors associated with blood glucose monitoring (BGM) and to determine the independent association between barriers to diabetes care and BGM. RESEARCH DESIGN AND METHODS: A total of 323 participants (35.6% European, 32.2% Maori, and 32.2% Pacific Islander) from the South Auckland Diabetes Project (free of major complications by self-report) completed a qualitative survey to determine barriers to diabetes care. Five barriers to diabetes care categories were generated including internal psychological (self efficacy/health beliefs), external psychological (psychosocial environment), internal physical (comorbidities/side effects of treatment), external physical (finance/access to care), and educational (knowledge of diabetes/services) barriers. RESULTS: Characteristics associated with BGM greater than or equal to twice weekly were female sex, HbA(1c) >8%, higher diabetes knowledge scores, and insulin use. Multivariate analyses demonstrated that those reporting external physical barriers (OR 0.47, 95% CI 0.26-0.84), external psychological barriers (0.55, 0.30-1.0), and internal psychological barriers (0.56, 0.32-1.0) were less likely to perform BGM independent of ethnicity, insulin use, age, sex, diabetes knowledge, and glycemic control. Further multivariate analyses demonstrated that those reporting external physical barriers, particularly related to personal finance, were less likely to perform BGM. CONCLUSIONS: These data demonstrate that patient-reported barriers to diabetes care are associated with BGM, particularly in relation to financial, psychosocial, and self-efficacy issues. Understanding these barriers and overcoming them within the context of the patient's ethnic environment may lead to increased participation in self-care.

Attitude to Health↗
PubMed2004

Variables associated with attrition from Uniformed Services University of the Health Sciences Medical School.

Attrition among medical students is a concern for the institution, the individual, and the profession. Disenrollment has an impact on the institution, in terms of academic reputation and resources expended, and the individual, in terms of self-esteem, personal finances, and opportunity costs. This study summarizes the results of an epidemiologic study of student attrition conducted at the only federal medical school in the United States--the Uniformed Services University of the Health Sciences in Bethesda, Maryland--and describes the association between demographic and selected quantitative variables for those students who graduated or remained enrolled and those who disenrolled. Both sex (female) and a decelerated curriculum were predictive of attrition in this medical student population. The records of the students who left Uniformed Services University of the Health Sciences without graduating were examined to ascertain the presence of noncognitive issues surrounding disenrollment; over one-half of the students who disenrolled left voluntarily and for nonacademic reasons.

Adult↗
PubMedDate not supplied

Creating new market space.

Most companies focus on matching and beating their rivals. As a result, their strategies tend to take on similar dimensions. What ensues is head-to-head competition based largely on incremental improvements in cost, quality, or both. The authors have studied how innovative companies break free from the competitive pack by staking out fundamentally new market space--that is, by creating products or services for which there are no direct competitors. This path to value innovation requires a different competitive mind-set and a systematic way of looking for opportunities. Instead of looking within the conventional boundaries that define how an industry competes, managers can look methodically across them. By so doing, they can find unoccupied territory that represents real value innovation. Rather than looking at competitors within their own industry, for example, managers can ask why customers make the trade-off between substitute products or services. Home Depot, for example, looked across the substitutes serving home improvement needs. Intuit looked across the substitutes available to individuals managing their personal finances. In both cases, powerful insights were derived from looking at familiar data from a new perspective. Similar insights can be gleaned by looking across strategic groups within an industry; across buyer groups; across complementary product and service offerings; across the functional-emotional orientation of an industry; and even across time. To help readers explore new market space systematically, the authors developed a tool, the value curve, that can be used to represent visually a range of value propositions.

Economic Competition↗
PubMed2002

Our wealth, our health--bellwether industries for decision tools and symbiotic stewardships.

This chapter examines the tea leaves of emerging technologies for the most fruitful areas of crossover value to health decisions, by spotting bellwether industries of similar information asymmetries. It examines changing tools and roles for growing consumer-centrism in personal finance, healthcare, private aviation, and law. It seeks to understand the technologies of managing and measuring, the transformations of growing transparencies in our processes, and how an increasing sense of collective stewardship forged between people and their machines can lead beyond effectiveness to wisdom, for individuals, communities, and the world. "The whole thing reminds me of the uncomfortable feeling I experienced when I first sought out investment advice. . . ..I concluded that I had to undertake the generalist's job myself; I had to take the high-level management of my investments into my own hands. Similarly, given the structure of the medical practice associated with prostate cancer, that's the only viable choice any patient has." Andy Grove, Co-Founder and Chair, Intel. "In the end, a symbiotic culture composed of human and digital individuals may be a more effective steward of the earth's resources than humans would be by themselves." Donald D. Chamberlin, author and ACM Fellow.

Biomedical Technology↗
PubMed1990

Credentialing for international fellowships.

The common market may provide a unique opportunity to develop certification models between countries as some of the economic, social, and language barriers begin to soften. International fellowships must be encouraged, especially those from the third world, but with the understanding that the purpose of such international education is for the fellow to return to the country of origin and improve the health care delivery there, not to improve the personal finances of the fellow in an adopted country. The autocratic dogmatic certification by the decreed blessing of the department chair must give way to objective examination by impartial boards. There are too many differences now to establish an international certifying process, but everyone must encourage and work toward common professional, educational, political, national, and economic goals so that eventually such certifying might be possible. Dialogue between boards in the United States and analogous bodies in other countries (such as colleges of surgeons) to nurture the definition of necessary core knowledge, standardize examination design and technique, and eventually develop reciprocity for requirements to take examinations should also be encouraged.

Certification↗
PubMed1984

Anesthesiologists' practice of obstetric anesthesiology.

Physicians trained in obstetric anesthesia and no longer practicing it were questioned regarding conditions that were responsible for their leaving the field. A questionnaire was prepared to determine whether the physicians' activity in obstetric anesthesia continued after fellowship training. The survey yielded a response rate of 76%. Forty-two percent of the respondents spend more than 40% of their clinical anesthesia time in obstetric anesthesia, and 58% spend less than 40% in it. The reasons for less of an emphasis on obstetric anesthesia were finances, personal matters, lack of recognition, long hours and too much call, and lack of stimulation.

Anesthesia, Obstetrical↗
PubMed1997

[Responsibility of the vaccinating physician].

Liability for vaccination concerns no fault liability for public financement. Personal liability of physicians may be engaged in cases of non-informed consent or in cases of malpractice.

France↗
PubMed1990

Financing health care for persons with HIV infection: guidelines for state action.

Financing health care for persons with HIV infection is an increasing burden on states and their taxpayers. The major problems of state policy in the 1990s are how to organize and finance both early detection of infection and preventive drug treatment for persons without symptoms and how to provide a full range of health and social services for infected persons whose life expectancy is unknown. This article first describes the shift in the perceptions of HIV infection from a plague to a chronic disease and the implications of this shift for state government. Then it places the history of financing for health care in the context of general health care financing policy during the past decade. Next it describes the history of state action to finance care for HIV infection, especially the use of of Medicaid Waivers, problems of state financing for expensive prescription drugs, and state initiatives, especially in California, Michigan, New Jersey and New York. Finally, the article presents seven policy questions that states should consider in deciding what, if any, legislation or regulations to enact in order to organize treatment and pay some or all of the costs of care for persons with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Making fair decisions about financing care for persons with AIDS.

An estimated 40 percent of the nation's 55,000 persons with acquired immunodeficiency syndrome (AIDS) have received care under the Medicaid Program, which is administered by the Health Care Financing Administration (HCFA) and funded jointly by the Federal Government and the States. In fiscal year 1988, Medicaid will spend between $700 and $750 million for AIDS care and treatment. Medicaid spending on AIDS is likely to reach $2.4 billion by fiscal year 1992, an estimate that does not include costs of treatment with zidovudine (AZT). Four policy principles are proposed for meeting this new cost burden in a way that is fair, responsive, efficient, and in harmony with our current joint public-private system of health care financing. The four guidelines are to (a) treat AIDS as any other serious disease, without the creation of a disease-specific entitlement program; (b) bring AIDS treatment financing into the mainstream of the health care financing system, making it a shared responsibility and promoting initiatives such as high-risk insurance pools: (c) give States the flexibility to meet local needs, including Medicaid home care and community-based care services waivers; (d) encourage health care professionals to meet their obligation to care for AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Medicaid-financed residential care for persons with mental retardation.

Two sources of Medicaid support for persons with mental retardation and related conditions (MR/RC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States.

Community Mental Health Services↗