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At least 793 records · Page 44Linked to original sources
PubMed1989

An economical new process for incenter bicarbonate dialysate production: comparison with acetate in a large dialysis population.

It is generally agreed that bicarbonate dialysate is preferable to acetate dialysate, but the major limiting factors of high cost and technical difficulty in maintaining its stability for prolonged periods preclude its widespread use. The procedure developed by the authors stabilizes bicarbonate dialysate for up to 4 days, rendering bicarbonate dialysate feasible for routine out-patient use. HCO3 dialysate is produced in our dialysis unit after an initial investment of $10,000.00, at a cost per 4-h treatment of $1.22 at a dialysate flow of 500 cc/min. One hundred fifty-one chronic dialysis patients participated in an 18-week study to evaluate clinical symptomatology when bicarbonate was substituted for acetate as the dialysis base buffer. Evaluation of each dialysis treatment (total of 8,183 treatments) consisted of both subjective and objective criteria (vomiting, angina, cramps, hypotension, and frequency of use of mannitol, hypertonic saline, and nitroglycerine). The patients were unaware of the change in dialysate solutions. There was a significant reduction (p less than 0.001) in the incidence of vomiting, cramps, hypotension, nausea, flushing, and the use of mannitol and hypertonic saline during bicarbonate dialysate treatment compared with acetate dialysate. Shortness of breath, angina, mental confusion, and paresthesias were not statistically changed. Although the method of HCO3 dialysate production is associated with occasional higher bacterial count than currently recommended by AAMI standards, no adverse reactions were observed in patients treated with standard efficiency dialyzers. It is concluded that the process for incenter HCO3 production is safe, economical, and better tolerated than acetate dialysate.

Acetates↗
PubMed1984

Incentive theory III: Adaptive clocks.

Incentive theory is extended to address the phenomenon of autoshaping. To do so, it is necessary to permit the speed of the animal's internal clock to vary with rates of reinforcement; clock speed is the basis for the animal's calculations of reinforcement densities. This notion of an "adaptive clock" is consistent with other effects, such as the partial-reinforcement extinction effect, and permits us to deal with the various experimental manipulations that are found in autoshaping experiments from a unified perspective.

Animals↗
PubMed1977

The Credit-Incentive system: motivating the participation of patients in a day hospital.

The Credit-Incentive System, a modified token economy, is a means of motivating the participation of day hospital patients in therapeutic activities through the use of contingent rewards. Credits are earned by patients for engaging in a wide variety of prosocial tasks and activities and can be spent for coffee, a free lunch, special time with professional staff, recreational events, and time off from the treatment centre. The receipt of credits is accompanied by social approval and recognition from the staff and other patients. Evaluations have shown that the credit system doubles the participation rate of patients in a partial hospitalization programme. The system also enhanced group cohesiveness, provides practice and feedback for cognitive re-integration, and offers opportunities of learning self-management. The results of two experiments suggest that the symbolic and social rewards mediated by the credits are the most important components of their effectiveness.

Adolescent↗
PubMed1976

Incentive contrast in honey bees.

Bees trained to come to the laboratory for a 20% sucrose solution accept it readily, but bees trained with a 40% sucrose solution and tested with the 20% solution show a pattern of interrupted feeding that may last for several minutes. Bees trained with 20% and tested with 40% sucrose are undisturbed. When the animals are offered two samples of the 20% solution simultaneously, they drink to repletion from whichever they first taste on each visit, but if both a 20% and a 40% drop are offered the 20% solution is rejected after a single experience of the 40% solution. Although these results are analogous in many respects to incentive contrast effects found in mammals, they can be understood in sensory terms and do not require the assumption of learning about reward.

Animals↗
PubMed1977

Suckling as incentive to instrumental learning in preweanling rats.

Neonatal rats as young as 7 days of age learned, reversed, and retained a left-right discrimination with a nonlactating nipple as the incentive. These results have implications for the ontogeny of associative processes and for their neurological and neurochemical mediators.

Animals↗
PubMed1995

Present dangers and future threats: some perverse incentives in the NHS reforms.

The NHS reforms have come to mean all things to all men (and women). Identifying a market oriented purchaser-provider split as the conceptual heart of the reforms is still, however, useful. There are important perverse incentives in and around the NHS that are associated with the reforms; furthermore, many reactions to the resulting problems are paradoxical and often counterproductive. Hitherto most criticism of the reforms from the health policy and management community (as opposed to the professions and the public) has been tactical rather than fundamental. There are serious problems for the NHS associated both with the NHS market and with current, often tacit, strategies for the future of the service.

Community Health Services↗
PubMed2004

On the reorganization of incentive structure to promote delay tolerance: a therapeutic possibility for AD/HD?

This paper brings together two recent insights into attention deficit/hyperactivity disorder (AD/HD) to provide the rationale for a novel approach to treatment. First is the suggestion, backed up by data from randomized trials, that training and practice in carefully selected cognitive activities (executive and attentional training) and tasks can provide a way of modifying the processes underlying cognitive, especially executive, deficits in AD/HD. Second, is the idea that AD/HD is a neuropsychologically heterogeneous disorder resulting from motivational alterations, specifically an increased intolerance for delay, as well as executive deficits. The paper builds on these two insights to explore the possibility that the motivational alterations underpinning delay aversion can be modified through specific training regimes in a way equivalent to that found with executive and attentional training. The requirements for such an approach are set out. Delay fading is proposed as a possible basis for reorganizing delay experience, altering the incentive value of delay (e.g., increasing tolerance for delay), thereby reducing AD/HD symptoms.

Attention↗
PubMed1990

Breath-stacking increases the depth and duration of chest expansion by incentive spirometry.

Although the objective of incentive spirometry is to achieve and hold high lung volumes, many patients with pain or weakness are unable to sustain the effort needed to perform effective exercises. We questioned whether using a one-way valve to prevent exhalation would allow rest between inspiratory efforts and cause volume to cumulate during successive tidal efforts, improving both the depth and duration of the inspiratory maneuver. We studied 26 cooperative but naive patients recovering from surgery, trauma, or critical illness whose pain or weakness impaired ability to achieve and sustain deep inspiration. All subjects breathed via mouthpiece from a spirometer prefilled with 100% oxygen. Three different maneuvers were performed in random order by all subjects: (1) standard inspiratory capacity without valve or inspiratory hold, (2) inspiratory capacity (IC) with breathholding aided by a one-way valve, and (3) uncoached breath-stacking, during which successive tidal breaths were cumulated by one-way valving. A fourth maneuver was added in the last 13 subjects studied: an initial coached IC effort with subsequent valved stacking of tidal efforts. When compared with IC, "breath stacking" (valved) maneuvers increased inspired volume by an average of 15 to 20% (p less than 0.05). More importantly, there was a severalfold increase in the time over which high lung volume was sustained (p less than 0.001). Our results indicate that one-way valving helps to achieve and sustain deep inspiration, even in uncoached patients.

Humans↗
PubMed1984

A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery.

Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery. We prospectively randomized 172 patients into 1 of 4 groups: the control group (44 patients) received no respiratory treatment, the IPPB group (45 patients) received intermittent positive pressure breathing therapy for 15 min 4 times daily, the IS group (42 patients) was treated with incentive spirometry 4 times daily, and the DBE group (41 patients) carried out deep breathing exercises under supervision for 15 min 4 times daily. Roentgenographic changes, observed 24 h after surgery, were comparable in the 4 groups (20.5 to 36.6%). Pulmonary complications were defined as the development of 3 or more of 6 new findings: cough, phlegm, dyspnea, chest pain, temperature greater than 38 degrees C, pulse rate more than 100 beats/min. The frequency of development of pulmonary complications was 48% in the control group, 22% in the IPPB group (p less than 0.05), 21% in the IS group (p less than 0.05), and 22% in the DBE group (p less than 0.05). Side effects of respiratory treatment were observed only in the IPPB group (18%; p less than 0.05). Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group (mean +/- SD, 8.6 +/- 3 days) than in the control group (13 +/- 5 days). This difference was not observed for the other 2 treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed2005

Eliciting survey cooperation: incentives, self-interest, and norms of cooperation.

Given the weaker ties to community as noted by scholars such as Robert Putnam, survey researchers should not be surprised by a decline in survey participation over the past 10 years. This research analyzes the use of incentives coupled with introductory themes emphasizing cooperation and helpfulness--cooperative norms in American society--to understand their effects on survey response. This article analyzes two separate experiments (one phone and one mail) that provide evidence that norms of cooperation matter in the decision to participate in a survey, suggesting that this is particularly true at the refusal conversion stage. These results indicate that survey researchers may use such themes to their advantage, especially when conducting a nonresponse follow-up in a mail survey.

Cooperative Behavior↗
PubMed1997

Managerial perceptions of the incentives inherent in National Health Service capital charging.

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a 'free' good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.

Budgets↗
PubMed1995

Distinguishing starters from nonstarters in an employee physical activity incentive program.

Although the vast majority of Americans who are physically active are likely to extol its many physical, psychological, and social values, research indicates that approximately fifty percent of individuals who start a formal physical activity program will drop out in six months or less. The present study employed stepwise discriminant analytical techniques in an attempt to distinguish starters from nonstarters in an innovative employee physical activity incentive program. The results indicated that a combination of health beliefs and lifestyle characteristics, health locus of control expectancies, and physiological characteristics accurately discriminated 81.7% of the starters and nonstarters. It was concluded that physical activity programs need to be designed, implemented, and marketed in such a manner as to attract individuals who are sedentary, smoke, are unable to cope with home-mediated stress, have an external health locus of control expectancy, and/or have a high cardiovascular disease-risk factor profile.

Discriminant Analysis↗
PubMed2001

The potential of telemedicine: barriers, incentives and possibilities in the implementation phase.

Between 1998 and 1999, the Swedish Institute for Health Services Development (Spri) evaluated three applications in which specialist competence was being accessed via telemedicine. The results indicated that these kinds of application can be cost-effective in an organization well adapted to new technology and that telemedicine can improve continuity of care for patients. However, the new technology was seldom supported by the old organization and better education and technical support are needed. In a study called 'Incentives and Implementation', the Federation of Swedish County Councils interviewed people in Swedish health-care with a lot of experience of telemedicine. The interviewees agreed that telemedicine was likely to affect the whole structure of health-care. Peripheral competence was expected to increase and referral patterns to change, as well as the functions of the personnel and the hospitals. New working conditions and methods of work were expected to be made possible by telemedicine and health-care was expected to become more process oriented, partly because patients are likely to be more demanding and better informed. To be able to utilize this potential, health-care managers will have to show more interest in and commitment to telemedicine. Old organizational patterns must be called into question and be developed along with information technology and telemedicine. It is also important to give priority to training in telemedicine for physicians and nurses.

Attitude of Health Personnel↗
PubMedDate not supplied

Experiments in transforming the global workplace: incentives for and impediments to improving workplace conditions in China.

This article highlights current economic conditions in China and analyzes existing obstacles to improving workplace conditions and labor practices. There are significant disincentives to strengthening workplace protections, and downward pressures are currently worsening conditions in a number of economic sectors. However, there are also potential strategies for motivating multinational corporations (MNCs) and Chinese government agencies to improve workplace conditions and to implement international and national laws and corporate codes of conduct. Four key principles are discussed that hold promise for creating incentives and sustainable mechanisms to improve factory conditions: transparency, verification, and accountability for MNCs and Chinese government agencies, and greatly strengthening worker participation.

China↗
PubMed2003

Economic incentive in community nursing: attraction, rejection or indifference?

BACKGROUND: It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance.Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. CONCLUSION: Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should:bullet; Improve nurses' salary/income relativities (e.g. comparable pay/rates);bullet; Provide just compensation for job-related expenses (e.g. petrol, clothing);bullet; Introduce promotional opportunities within the clinical area, rewarding skill and competence development;bullet; Make available a range of financed rewards.- Direct (e.g. subsidized education, additional leave, insurance benefits);- Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies).

Journal Article↗
PubMed2004

The influence of financial incentives and racial status on the use of post-hospital care.

This study examines the influence of financial incentives and the racial status of the patient on the use of extended care following an episode of hospitalization. Post-hospital care (PHC) is defined as the services provided by a skilled nursing facility (SNF) or intermediate care facility (ICF) following discharge. The focus of the analysis is on the use or nonuse of PHC, the presence or absence of a delay in transfer to an ICF or SNF and, limited to those who experienced a postponement, the length of the delayed discharge. After controlling for multiple factors, the results indicate that Medicare beneficiaries were more likely to use PHC, less likely to experience a delay in discharge, and used fewer days of prolonged care. Medicaid recipients and uninsured patients experienced reduced access to PHC. The results also indicated that the access of Native Americans and Americans to PHC was impeded.

Aged↗
PubMed2001

Providing behavioral incentives for improved health in aging and Medicare cost control: a policy proposal for Universal Medical Savings Accounts.

This paper examines policy options for addressing health care challenges posed by the aging of the baby boom generation. Universal Medical Savings Accounts (UMSAs) are proposed. UMSAs are defined-contribution vouchers coupled with medical savings accounts. The proposal includes significant equity protections for those with low income/wealth, including balance billing limits and stop-loss protections, together with subsidies for risk-adjustment. The policy would control costs while promoting quality, accessible, and affordable health care. UMSAs provide new behavioral incentives, both for cost-conscious health care decision-making and for healthy lifestyle choices.

Aged↗
PubMed2005

ROPS retrofitting: measuring effectiveness of incentives and uncovering inherent barriers to success.

Tractor overturns are the leading cause of all tractor- and machinery-related fatalities in the agricultural industry. A rollover protective structure (ROPS) on a tractor is the most effective mechanism for protecting a tractor operator's life during a tractor overturn incident. Unfortunately, about half of all tractors presently in operation in the U.S. do not have a ROPS. Retrofitting such tractors with ROPS could result in an as much as a 99% reduction in fatalities associated with tractor overturns. The overall aim of this study was to determine the level of financial incentive required to motivate the maximum number of farmers to install ROPS on non-ROPS equipped tractors and thus affect the greatest level of change within the farming community. This was done by offering a range of subsidy levels by percentage and not by specific dollar amounts to a random sampling of New York farms. A secondary goal was to find any hidden problems associated with retrofitting. Study results showed that cost was not the only factor affecting farmers' reluctance to retrofit. A perceived and actual "hassle factor" was found to be endemic to the retrofitting process and a significant obstacle to farmers' willingness to retrofit, no matter the level of financial subsidy.

Accident Prevention↗