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At least 793 records · Page 44Linked to original sources
PubMed2005

The impact of medical students on rural general practitioner perceptors.

INTRODUCTION: As universities rely more heavily on rural GPs to precept medical students, the formation of symbiotic partnerships benefiting students, universities and GPs, becomes imperative. In order to develop and consolidate these partnerships Universities must understand who their rural GP preceptors are and how precepting impacts on them. METHODS: A review of the literature was undertaken to determine the significant themes of student impacts from articles where conclusions were clearly based on empirical findings. RESULTS: Forty-three articles were included in the final review, but only nine specifically looked at impacts on rural GPs. Impacts were categorised into six domains: personal; time; patient care; professional relationships and professional development; business and infrastructure; and recognition and remuneration. CONCLUSIONS: Literature specifically addressing the impact of precepting on rural GPs is scarce. Further studies are required to evaluate the relationship between the quality of teaching delivered to students, the type and length of student attachments and the likely impacts on rural GPs.

Australia↗
PubMed2004

Voluntary donors-need for a second look.

Voluntary non-remunerated blood donation is the source of the safest blood supply to the transfusion service. In the Indian set up where voluntary donations are fewer and poorly structured, safety of blood could still be compromised. This study was carried out to find out the seroprevalence of transfusion transmitted diseases among replacement and voluntary donors. A retrospective study of replacement and voluntary donors over a three and a half year period was carried out and the seroprevalence for human immunodeficiency virus (HIV), hepatitis B, hepatitis C, syphilis and malaria was noted. A total of 41122 donors were studied comprising of 94.7% replacement and 5.3% voluntary donors. The prevalence of transfusion transmitted diseases was marginally higher among voluntary donors (3.3%) as compared to replacement donors (2.9%). All cases of HIV were seen in the replacement donors while the figures for hepatitis B and C were marginally higher in the voluntary donors (p>0.05). Voluntary donations in our study were not voluntary in the real sense. There is a need to work on building a stronger voluntary donor base and to create awareness among the populace in order to gradually abolish the replacement donations; thereby ensuring the safety of blood and its products.

Blood Donors↗
PubMedDate not supplied

Seroprevalence of HIV infection among blood donors in Port Harcourt, Nigeria.

BACKGROUND: This study was undertaken to determine the seroprevalence of human immunodeficiency virus infection among blood donors living in the Niger Delta area of Nigeria. METHODS: A total of 1500 consecutive donors comprising 1481 males and 19 females were screened for HIV-I and HIV-II antibodies using the World Health Organization (WHO) approved Immunocomb HIV I and II test kit. All initially reactive samples were confirmed using the Genscreen HIV I and II test kit. RESULTS: The overall prevalence of HIV was 1.0%. The highest prevalence occurred in the 20 - 29 years age group (60%), followed by 30 - 39 years age group (21.5%). Commercial remunerated donors had the highest infection burden (1.4%) followed by the family replacement donors (0.7%) (p < 0.05). HIV-I accounted for the more predominant strain (0.8%). CONCLUSION: This study has shown an overall prevalence of 1% among blood donors in the Niger Delta area of Nigeria with the highest prevalence amongst donors in the 20 to 29 years age group. We advocate for the mandatory screening of donor units intended for transfusion and the immediate take off of the national blood transfusion service. Furthermore, there is an urgent need for the health education of the people of the Niger Delta area on preventive measures aimed at arresting the spread of HIV.

Adult↗
PubMedDate not supplied

[Life-style of medical personnel dwelling and working in agroindustrial area].

Results of sociological survey of medical personnel of typical agroindustrial area of Novgorod Oblast are presented. Data of self-registration of acute and chronic diseases and self-appraisal of one's health testify higher morbidity and health deterioration during last 3 years. Analysis of demographic characteristics, life-styles and labor conditions revealed complex of major factors impacting individual health and flow-out of professional medical personnel. Both amount of average monthly wage of physicians and paramedics, levels of their family income and welfare and as well degree of their inconsistence with cost of living of able-bodied population are established. Conditions of living and social maintenance, labor and off-labor activity, attitude to one's own health and spread of risk factors were analyzed. Management weaknesses of district and rural patient care institutions were established, including considerable exceeding of hygienic regulations established for medical personnel working load and higher spread of physical, chemical and biological risk factors of working environment harmful for health. Need in further enhancement of management of working process, occupational safety, labor remuneration and in increasing social safety, hygienic and curative activity of medical personnel is justified.

Adult↗
PubMed2006

GP job satisfaction in view of contract reform: a national survey.

BACKGROUND: Job satisfaction has been associated with intentions to quit and aspects of quality of care. In 2001, GP job satisfaction in England had fallen to its lowest point for over a decade. AIM: To assess GP job satisfaction and stressors immediately prior to implementation of the 2004 contract. DESIGN OF STUDY: National survey of a random sample of GPs. SETTING: England. METHOD: One thousand, nine hundred and fifty principal and salaried GPs surveyed in February 2004 were compared with 1828 principals surveyed in 1998 and 1841 principal and salaried GPs surveyed in 2001. Job satisfaction and stressor scores were adjusted for 2004 age-sex distributions. Determinants of overall satisfaction were examined through ordinary least squares regression. RESULTS: The 2004 response rate was 53%. GPs were most dissatisfied with hours of work, recognition for good work and remuneration, and experienced most pressure from paperwork, increasing workloads and having insufficient time. The majority of doctors were satisfied with their job overall. Satisfaction was higher than in 2001 and approximately the same as in 1998. Overall stress in 2004 was lower than in 2001 but still higher than in 1998. After allowing for personal, practice and job characteristics, higher satisfaction was associated with lower job stress, involvement in decision making, increasing job interest and ability to meet conflicting demands. CONCLUSIONS: Despite recent initiatives to enhance workforce capacity and working lives for GPs, workload, time pressures and job control remain potential areas of concern. Addressing such issues may be key to maintaining morale as the new contract is implemented.

Adult↗
PubMedDate not supplied

[Cohort study methodology of the ITINERE Project on heroin users in three Spanish cities and main characteristics of the participants].

BACKGROUND: Cohort studies make it possible to monitor the health impact of drug use and to identify related factors. We describe the methodology and baseline characteristics of a cohort of heroin users designed with this objective. METHODS: The participants were 991 young, community-recruited heroin users in Barcelona, Madrid and Seville. Most subjects were named by other participants (39.7%) or by non-participating drug users or ex-users (44.7%). A computer-aided questionnaire was administered (self-administered with audio for questions related with sex). A dried-blood spot sample was collected and anthropometric measurements were made. Both participants and recruiters received remuneration. Univariate and bivariate statistical methods were used. RESULTS: Some 42.4% had changed the main route of heroin administration, mainly to injection in Barcelona and to the pulmonary route in Seville. About 75.8% (Barcelona), 49.8% (Madrid), and 15.5% (Seville) had injected drugs in the last 12 months. In Madrid and Seville, 96-97% used heroin in base form, while in Barcelona heroin hydrochloride predominated. Heroin and cocaine were frequently mixed in the same dose (generally base cocaine in Madrid and Seville, and cocaine hydrochloride in Barcelona). CONCLUSIONS: Important geographic differences persist in the prevalence of drug injection and in the patterns of heroin and cocaine use, which could explain the unequal distribution of some health problems. The difficulties encountered in recruiting the sample suggest that the incidence of heroin use has declined considerably.

Adult↗
PubMedDate not supplied

Maternal and newborn care: practices and beliefs of traditional birth attendants in Sindh, Pakistan.

Maternal mortality, infant mortality and neonatal mortality are high in Pakistan where maternal health services depend upon traditional birth attendants (TBAs). We examined the practices of TBAs in Dadu district in rural Sindh from September to November 1998 by interviewing and hosting focus group discussions with 17 TBAs. Health care personnel and other important members of the community were also interviewed. TBAs worked in areas demarcated by extended families, ethnicity or geographical access and a system of seniority was observed. Only one TBA was formally trained and antenatal and postnatal care concepts, cleanliness and equipment were inadequate. Communities trusted the TBAs and remunerated them according to factors particular to each birth. TBAs need training and to be linked with the formal health sector to effect change and to decrease maternal and neonatal mortality.

Adult↗
PubMed2006

An analysis of alternative funding for physicians practicing gynecologic oncology in Ontario, Canada prior to 2001.

OBJECTIVE: To consider the policy issue of physician reimbursement by examining the events that preceded the Ontario Gynecologic Oncologists moving from a fee-for-service environment to an alternate payment plan in 2001. METHODS: The sources of information included a literature search, reviewing Canadian newspapers, interactions with key leaders in the field (Ontario Medication Association, University physicians), and meeting minutes from both university and provincial groups considering alternate payment plans. RESULTS: The problem for Ontario Gynecologic Oncologists involved the goal of providing excellent clinical care, undergraduate and postgraduate education, research and administration in the midst of problems with recruitment, retention and remuneration. Multiple causes for this problem included limitations in health care spending and a fee for service payment schedule that did not adequately reimburse complex care. This funding problem got on the agenda as a result of a front page article in the national newspaper and letters of concern solicited from local members of the provincial parliament. The policy formulation needed to account for alternate financial options and the roles of institutional structures such as the universities, Cancer Care Ontario and the Ontario University Health Science Centers. The influences on the evolution of the new funding policy included the actors, their interests, their values, research on the topic and institutions. CONCLUSION: The tensions between the goal of excellence in care, education, research and administration and difficulties with recruitment, retention and reimbursement, led the Ontario Gynecologic Oncologists to seek an alternate mechanism of reimbursement from the fee-for-service model.

Adult↗
PubMedDate not supplied

The Japanese health-care system and reimbursement for dialysis.

Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.

Aged↗
PubMed2006

Upervision: how can the gap be bridged?

The purpose of this study was to explore midwives' perceptions of the role of statutory supervision in Northern Ireland (NI). This study, conducted in 2002, was the first study of midwifery supervision in NI. A convenience sample of midwives volunteered. Data collection was through semi-structured interviews while data analysis was performed using the Glaser and Strauss (1967) form of constant comparison of the data, field notes and memoranda made during the interviews. A grounded theory methodology was adopted. Midwives in NI openly acknowledge their lack of understanding regarding the role of the supervisor. They want more informal mechanisms of supervision to improve professional relationships with supervisors. They require it to be more transparent and less covert in its conduct, while supervisors need to be able to demonstrate clinical credibility. Strategies offered by midwives to 'bridge the gap' included the provision of study days and lunch-time seminars on supervisory issues to complement the one-to-one review sessions. Protected time to conduct supervisory meetings was seen as essential and financial remuneration for conducting supervisory duties was recommended. Independently choosing one's own supervisor and increasing their number to decrease the supervisor:midwife ratio would facilitate 'closing the gap'.

Clinical Competence↗
PubMed2006

General surgery in crisis--factors that impact on a career in general surgery.

INTRODUCTION: The Association of Surgeons of South Africa (ASSA), because of a concern about the decline in the number of applicants for registrar posts, undertook this study into the various factors that may influence the choice of surgery as career option. METHODS: The study involved a combination of desk research and structured interviews with heads of departments, specialists, and registrars in general surgery. RESULTS: The reasons for choosing general surgery as a career included the immediately visible results of a surgeon's efforts and the practical and intellectual challenge of the specialty. General surgery continued to enjoy a high status in society. The greater focus on primary health care has affected facilities at tertiary and secondary institutions. General surgeons worked excessively long hours, which was associated with increased levels of stress and placed severe strains on family life. All respondents felt that their levels of remuneration were 'poor' in relation to other disciplines and professions. CONCLUSION: In this study we identified various factors that impacted either positively or negatively on the choice of general surgery as a career option.

Career Choice↗
PubMed2006

Spousal perspectives on factors influencing recruitment and retention of rural family physicians.

INTRODUCTION: Recruiting and retaining medical personnel to rural communities is a human resource challenge. Studies suggest that the spouse's experiences and perceptions of a rural community are among the most influential factors in a physician's decision to remain in or leave a rural practice. This study describes the factors that both directly and indirectly influence spousal contentment and explores how these factors contribute toward recruitment and retention of physicians to rural practice locations. METHODS: In this explorative study, 13 interviews were conducted with spouses of rural physicians to gain a better understanding of spousal concerns and experience regarding rural living. Participants in the present study included the spouses of general practitioners and family physicians practising and living in rural communities (population<or=10,000) on the Burin and Bonavista peninsulas of Newfoundland and Labrador. Specialists, residents and locums were excluded from the study. RESULTS: The findings indicate that physician workload and community integration most highly influence spousal contentment. Other factors, including licensure, remuneration and physician demand, indirectly influence spousal contentment and, ultimately, practice location decisions. Many of the factors that directly influence spousal contentment are personal, and, as a result, it is difficult to implement policies that will influence them. CONCLUSION: The physician's spouse is highly influential in the decision to move to, remain in, or leave a rural practice location. Understanding the factors that contribute to, and detract from, spouses' contentment in rural practice offers useful insights for human resource policies.

Adult↗
PubMed1985

[Paid work, family and women's mental health.].

In this article, the results of a research on the influence of family and remunerated work on the mental health of women are presented. The impact of the working environment is analysed from the point of view of the characteristics of hiring, of the level of satisfaction at work and of the social support. The impact of the family environment is studied in the areas of shared responsabilities between married people, of the attitudes towards the presence of women in the work force, of single parentage and of family life cycles. Areas of long term and short term researches are proposed.

English Abstract↗
PubMed1985

[Non unionized professional pilots in Québec : from myth to real.].

In this article, the working conditions of 875 non syndicated professional pilots who work on small third class airline companies are analysed. This research was made on behalf of the pilots themselves through the intermediary of the Association of the Air People of Quebec. First, a socio-demographic profile of this masculine man power is outlined, made of young and low income persons. Emphasis is put on the working characteristics that are risk factors for health and security and on sources of stress for the pilots which are: the seasonal peaks, recurrent unemployment, remuneration by the volume of work done, un-sufficient rest, the employer's threats, the deficient state of the airplanes. It is also shown that certain symptoms are present in these workers: a general fatigue, headaches and insomnia. Lastly, their perception of their work and the satisfaction gained from it is presented.

English Abstract↗
PubMed2006

Software development for the estimation of the mean DRGs related treatment cost.

The purpose of the present study was the development and the initial implementation of a Medical Procedure Resources-Allocation and Cost-Capturing Software for the Estimation of the Mean DRGs associated Treatment Cost. The system provides means for the acquisition of health-care cost related data, based upon the actual Greek conditions, and includes Medical Equipment, Reagents, Consumables and Disposable Materials, Drugs, Man Power, Building Leasing and Infrastructure Maintenance expenditures, as the most important cost-components. The developed system was tested in the Operating Rooms (OR) and the Intensive Care Units (ICU), of a representative group of Hospitals. The obtained data have confirmed the reliability of the system for drafting DRGs in Greece; however, there is a discrepancy, between the high actual mean costs in the OR and the ICU, and the relatively low Health Insurance remuneration of the Hospitals.

Costs and Cost Analysis↗
PubMed2006

Gender, nursing and the PBRF.

Significant disparities between male and female academics exist with respect to remuneration, academic grading and PBRF scores--with women doing less well than men in each of these areas. There exists a range of gender-based distribution and outcome gaps within the university, and between universities and non-university tertiary education organisations. This situation, combined with a devaluing of academic subjects that have feminised knowledge bases, is suggestive of wider structural discrimination against women. In this article individualised explanations for the failure of women to progress are set in the context of a critical exploration of the PBRF evaluation methodology. It is argued that both academia and the PBRF research assessment exercise embody a form of academic masculinity that systematically disadvantages women in general and nursing in particular.

Faculty, Nursing↗
PubMed2005

Ready for prime time? Make your financial assistance policy a class act.

Today's regulatory climate makes it far from simple for hospitals to offer discounts to uninsured and indigent patients. Questions abound regarding whether offering such discounts might lead to reductions in Medicare payments for outliers, new technology, and bad debt. Offering waivers of coinsurance or deductibles may seem an attractive option, but routine waivers could implicate federal statutes regarding illegal remuneration and patient inducement. And across-the-board discounts to uninsured patients could change the calculation of a hospital's "usual charges," resulting in the hospital's violation of the statutory bar against having charges to Medicare that are "substantially in excess" of the "usual charges." The best course for hospitals is to have clearly defined financial assistance policies in place that reflect an awareness of all the related potential legal and regulatory concerns.

Financial Management, Hospital↗
PubMed1991

Medicare and Medicaid fraud and abuse regulations.

Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.

Fraud↗