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PubMed1989

[Impact of social and health factors in the forecast of work activity of female workers of pre-retirement and retirement age receiving social benefits].

On the basis of a complex social and hygienic study along with the use of modern mathematical statistical methods the role of working and living conditions and health status of female workers having social benefits at chemical fibre production plants was demonstrated within the forecast of their labour activity when retired. Social factors, such as material remuneration and working conditions, were of primary importance in labour forecast for female workers before their retirement. Favourable working conditions and average material security level could ameliorate the labour forecast more than by 4 times.

Aged↗
PubMed1978

[Maintenance payments to the elderly (author's transl)].

The question of the extent older people sustain their livelihood through financial contribution from their children is important sociopolitically inasmuch as claims for payments under the Federal Social Welfare Scheme (Bundessozialhilfegesetz) can only be made where no such private financial support can be given by those next of kin responsible in law. It has been established that in approximately every 14th household in the Federal Republic such maintenance payments are made to at least one member of the older generation (either parents and/or parents-in-law). Seen together with the findings of other inquiries it appears justifiable to assume that these payments are more often remunerations recompensed either materially or otherwise by the older generation rather than a genuine alternative to (necessary) public welfare support. It must therefore be assumed that onesided private financial support carries the odium of "private relief" for the recipients, in which case it would run contrary to the intentions of social legislation.

Aged↗
PubMed1989

Health promotion and prevention.

Techniques of promotive and preventive health care include: The use of proactive skills in the consultation; and the co-ordinated use of posters and pamphlets with media campaigns. An efficient medical record and patient recall system; and a doctor initiated health check programme with selected patients. A cost effective method of informing practitioners includes: Ensuring access to continuing medical education by supporting FMP and post-graduate medical institutes. The provision of educational material for both the patient and doctor combined with media publicity campaigns. Supporting RACGP CHECKUP and library services for isolated practitioners. Suggested changes to undergraduate medical education are: Promotive and preventive health care delivery needs to be an inbuilt part of the curriculum. Promotive and preventive health care needs to be taught by both academic and private general practitioners who have received tutor training. It should be presented in tutorial form and during student attachment at surgeries. It needs to be followed up by continuing education by postgraduate institutes, the RACGP and FMP. Government input required includes: The provision of increased academic resources and continued funding of FMP. Remuneration for general practitioners who are involved in undergraduate teaching. Alteration of the fee structure to reward quality of care. Allowing Medicare rebate for promotive and preventive health care delivery.

Health Promotion↗
PubMed1989

[What is the value and utility value of medical practice based on?].

A collection of data acquired through study and experience are similar to computer software. Thus any part of data collection can be readily used at any given time. Similarly as software, they represent a value. Single acts of application, performed or expected to be performed, express the utility value. The paper describes value testing and recommends to use the term social utility value for value utilization. Both these factors should be used for determining the value of medical work (differentiated remuneration).

Czechoslovakia↗
PubMed1989

Permanent Working Group of European Junior Hospital Doctors. Policy statement on postgraduate medical education. Subcommittee on Postgraduate Training.

The Permanent Working Group of European Junior Hospital Doctors (PWG), representing junior doctors of 18 European countries, has amongst its foremost interests the quality of postgraduate medical training. Building upon the work of other groups, and notably that of the Advisory Committee on Medical Training (EC), it has developed its own policy statement on postgraduate training. The statement defines the aims of training and the needs of the trainee and proposes that these can only be met through a close relationship between the trainee and a clearly identified trainer. The duties of the trainer are set out, with emphasis on the need for both practical and theoretical teaching and on the importance of regular, unambiguous feedback regarding progress. Trainers themselves require remunerated time for carrying out these duties and training in educational methods. An appropriate balance between clinical and research experience may require an upper limit on the proportion of the training period which may be spent in research. Training programmes should be inspected and approved by appropriate professional bodies working to published criteria of sufficiency. The PWG believes that high levels of skill and knowledge amongst fully trained specialists can only be guaranteed when the training system identifies trainees' shortcomings at every stage and corrects them through unambiguous feedback.

Curriculum↗
PubMed1989

[Blood-saving procedures--legal aspects].

The homologous blood transfusion bears some risks (infections, intolerance reactions) which cannot be controlled even if all requirements of medical diligence are met. The risk of an AIDS infection is much less important than that of hepatitis non A non B. However, this new disease is the reason that physicians, patients, as well as the public have become particularly aware of these risks. Among other measures of risk minimization by blood sparing procedures, the possibilities of autologous versus homologous transfusions have to be discussed, too. The autologous transfusion offers more security. From the legal point of view, the physician has to choose the less dangerous of two equally efficient methods as soon as this method is available for practical use. The donation of autoblood which has a limited range of application (elective interventions) is a recognized method, but its general realization is still hindered by unsolved problems of pharmacology law, organization and remuneration politics. The preparation of autoblood from intraoperative losses of blood is not yet possible at all department because of the high equipment costs and the personnel expenditure. The hospital institution is in charge of providing the equipment and the staff necessary for a medical care which meets the modern standard. The chief physicians have to inform the hospital institution about these requirements. If autologous transfusion procedures are practically not available, it depends on regional conditions if an information of the patient is obligatory or not.

Blood Transfusion, Autologous↗
PubMed1978

Sabbatical policies and their implementation at United States dental schools.

An ad hoc Committee on Sabbaticals created by the Council of Faculties of the AADS surveyed sabbatical policies and their implementation at dental schools in the United States. Data from a questionnaire completed by 56 of 60 members of the Council of Faculties reveal that a majority of U.S. dental schools have sabbatical policies but that dental educators are less likely to apply for or to be awarded sabbaticals than educators from other parts of the university, except perhaps the medical school. Information was also obtained on the regulations governing sabbaticals--interval between leaves, rates of remuneration, and rules defining how the leave may be spent. Finally, suggestions are made as to how this important benefit of academic life might be made more available to dental educators.

Education, Dental↗
PubMed1989

[Transfusion and AIDS].

The possibility of transfusion-induced HIV infection by some blood components and plasma derivatives has been recognized since 1982. The implementation of preventive measures has virtually eradicated the risk of HIV transmission by some blood products and dramatically reduced this risk with other blood products. However, the problem remains unresolved in those parts of the world which have a high prevalence of HIV infection and lack effective blood transfusion systems based on voluntary non-remunerated donors. The extremely low residual risk which in Western countries may still be associated with transmission of labile blood components should neither be denied nor unduly exaggerated. The measures currently in use to try and eradicate this risk consist of improvements in the quality of screening tests and of self-exclusion or questionnaire-based deferral of blood donors who have potentially been exposed to viral contamination. The latter challenge can only be faced through efficient information of prospective donors by physicians, public educators and mass media.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Renal cyst puncture studies.

The edict to contain costs and meet goals imposed by DRG remuneration policies mandates the work-up of asymptomatic renal mass lesions on an outpatient basis. This proved feasible in 98 per cent of patients. The vast majority of such mass lesions (82 to 90 per cent) is diagnosed with acceptable confidence by computed tomography and sonography alone. For a shrinking group of such patients, yet still 16 to 18 per cent, guided percutaneous aspiration biopsy is necessary to affirm the diagnosis. However, this technique has been refined during recent years to incorporate the use of thin needle equipment and can now be performed on an outpatient basis without significant risk of morbidity. For diagnosing hyperdense inflammatory and infected renal cysts, guided percutaneous aspiration is recommended as the most effective method. This procedure should take precedence over surgical exploration because it can diagnose and provide pertinent bacteriologic information that may determine the course of therapy. In many instances inflammatory cysts or even silent renal abscesses are diagnosed by a percutaneous aspiration technique that is then expanded to serve therapeutic purposes such as percutaneous drainage. Even these procedures can be performed safely on an outpatient basis provided the patient is followed closely. Because complications of percutaneous aspiration procedures are extremely rare, the procedure can be used safely on an outpatient basis. The impact of magnetic resonance imaging on the diagnosis of asymptomatic space-occupying lesions of the kidney is as yet not fully determined; however, this method appears promising for diagnosing some of the refractory lesions such as hemorrhagic cysts, aneurysms, or arteriovenous malformations.

Ambulatory Care↗
PubMed1987

[An assessment of the social welfare system in the United Kingdom].

This report describes the British social welfare system with reference to expected future developments in Japanese medical care. In developed countries where the average life expectancy is high, a large percentage of the population is elderly, resulting in high social welfare expenditure. In Britain, the "social welfare state", the average life expectancy is similar to that of other developed countries, while expenditure by the Department of Health and Social Security is considered to be the lowest. For example, expenditure on medical care for an average elderly man is approximately 60% of that in Japan. Some of the reasons are as follows. The family practitioner services are medical services given to patients by doctors of their own choice. The family doctor undertakes the initial diagnosis and management, but may refer the patients for either specialized services or hospital consultation. The general basis for remuneration of the family doctor is a standard capitation fee and an allowance. This system does not lead to over diagnosis or excessive treatment. The numbers of medical consultations performed and prescriptions issued by British doctors is lower than that in Japan. In Japan the number of elderly persons who are incapable of caring for themselves is increasing and poses not only a financial burden, but also a social problem. In the UK, these patients are cared for by social welfare workers (Japanese nurses) or at health centres (unlike Japanese hospitals and homes for the aged) which is less costly than inpatient hospital care. The Government is responsible for the National Health Service.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Strategies to avoid unnecessary cesarean sections.

Because there is a 35 to 50 percent incidence of false-positive prediction of fetal compromise on fetal heart-rate monitoring patterns, many unnecessary cesarean sections are performed. To reduce the number of unnecessary cesarean sections, the physician is urged to consider the following: (1) fetal heart-rate monitoring is associated with higher rates of cesarean sections than in those not monitored; (2) only high-risk patients should be monitored provided the low-risk patient is at term, with a normal-sized infant, and does not convert to a high-risk patient while in labor; (3) maintenance of variability is a better predictor of absence of acidosis than is fetal scalp pH; (4) fetal scalp stimulation by firm digital pressure or gentle nontraumatic clamping of scalp tissue or acoustic stimulation obviates the need for fetal scalp pH confirmation of acidosis in 50 percent of cases; (5) monetary considerations may unconsciously lead to increased cesarean sections, since insurance companies remunerate at a higher level for those as compared with vaginal deliveries; and (6) more patients with prior cesarean section should be given a trial of labor, since the initial reason for cesarean section often is not a recurring one and many could successfully be delivered vaginally. Ultimately there is a risk inherent in any decision regarding method of delivery. The patient must understand this risk and share in the decision-making process as a knowledgeable person, aware of the limitation of her physician.

Cesarean Section↗
PubMed1986

Group practice in the Netherlands.

A survey was carried out on successes and failures in dental group practice in the Netherlands. The results provided insight into such matters as job satisfaction, remuneration and how time was spent by colleagues working in group practices as well as in the construction and organization of group practices themselves. A sharp increase in the creation of new group practices in 1971 was followed by a sudden decline after 1979 due to a variety of factors. The results of the survey show that four important aspects have to be discussed seriously and regularly by dentists working in a group practice. These are: cost, composition; cooperation; and character. 'Failures' in group practices are always in relation to one or more of these factors.

Group Practice, Dental↗
PubMed1987

[Psychiatric family care in Ravensburg-Weissenau--development and initial experiences].

It is unfortunate that mental patients with long-term hospitalisation patterns are still necessarily scheduled for long-term stay in mental hospitals and institutions designed for the care and treatment of psychiatric cases, since such institutions are characterized by a rather sterile, low-stimulation atmosphere underlining rather than relieving the severity of the disease. This article presents a possible alternative, namely, care of mental patients within the framework of a foster family; these patients has been hospitalised for a long time and are now living in families who are remunerated for their efforts and are given medical assistance in performing their task as hosts. An attempt is made to describe the initial work in setting up such host patterns, particularly during the first year after initiation of the scheme, and to point out the mistakes that were committed and the resulting re-orientation efforts. Case reports on host families and "guests" illustrate the principles of psychiatric family care.

Deinstitutionalization↗
PubMed1986

Effect of pharmacist interventions on drug therapy costs in a surgical intensive-care unit.

The effect of interventions by a clinical pharmacist on the cost of drug therapy in a 14-bed surgical intensive-care unit (SICU) was evaluated. The SICU pharmacist provides both distributive and clinical services from a modified satellite pharmacy five days each week. During a 13-week study period that comprised 65 days, the pharmacist documented all interventions that resulted in a discontinuation of or change in drug therapy, all nonformulary-drug requests, the detection and avoidance of problems related to drug therapy, and the enrollment of patients in investigational drug studies (for which the pharmacy department received monetary remuneration). The effect of these interventions on the costs of drug therapy was calculated using drug acquisition costs and, for i.v. preparations, the cost of the i.v. fluid and the cost of preparing and checking the product. A total of 332 interventions during the study period represented $18,030 in potential cost avoidance, which would extrapolate to an annual cost avoidance of $72,122. The majority of interventions involved discontinuations of or changes in drug therapy, most often involving antimicrobials. This pharmacist had a positive impact on the cost of drug therapy in the SICU.

Costs and Cost Analysis↗
PubMed1986

[Leadership in the health services].

The concept of leadership is not centered on strength of conviction or the ability to inspire support from others. Authority requires obedience, which is unlikely to bring about substantive changes. There are three classical types of leadership: bureaucratic (which depends on the size of one's share of power within an institution), prestige (which depends on one's technical expertise and standing in one's profession), and political (which depends on the extent of one's power in society at large). Prestige leadership pertains to an occupation and applies particularly to the health professions, especially the medical profession. Change is conditioned by factors internal to the health field (such as technological innovations and dissatisfaction with remunerations and social standing in some occupations) and by elements in the social context. These elements include historical situations favorable to change (crises) and forces for preservation of the status quo.

Health Planning↗
PubMed1986

[The job market in health. Concepts and methods].

The eighties have been seen a rise in the number of studies done to identify trends in the health market. This interest is explained by the economic crisis, a surfeit of health professionals (and the resulting unemployment), and the spread of health research methods using a sociological approach. It is noted, however that research in this new field is impeded by a dissociation between theory and practice. A first approach to the idea of a work force comprises people in the health sector whose work skills are bought and sold. The concept is then broadened to encompass all persons employed in health--even those who are not paid--on the condition that they put in or be required to put in a regular number of hours per day (this includes the unemployed). The article examines the methodological difficulties involved in determining employment in health, notably the measurement of availability and use; the search for data on the number of occupations per individual and the number of remunerated and unremunerated posts; the nature of categorizing of self-employed, employee, and volunteer; the measurement of working time relative to a specific period of time and differentiating between employment in a health establishment and health employment in some other sector (in factories, for example). The article takes Brazil as its case in point.

Brazil↗
PubMed1985

Validation of the patient roster in a primary care practice.

Knowledge of the size of a practice population is an essential base for the evaluation of new forms of health care delivery and for epidemiologic research in primary care. Remuneration to providers in Ontario's Health Service Organization and Health Centre programs is partially based on the number of people listed on the patient roster as members of the practice. However, the accuracy of these rosters has never been determined. A mail and telephone survey was conducted to validate the roster in one such health center. A random sample of 1,065 households was contacted and a 78 percent response rate was obtained. The practice roster showed a population of 3,134. The age- and sex-adjusted estimate from the survey was 2,964 (+/- 262) individuals. The sensitivity, specificity, and accuracy of the roster were 0.90 or greater. It is concluded that this particular roster is a valid indicator of practice size, but caution is expressed about generalizing these results to other practices.

Capitation Fee↗
PubMed1985

A performance appraisal tool for nurse practitioners.

Performance appraisal can be an emotionally charged experience for both the supervisor and the employee. The accuracy of the appraisal is dependent not only upon the evaluator, but also upon the appropriateness of the tool being used for the task. An employee's career advancement, professional development, monetary remuneration and self-esteem often may depend upon the final outcome of the process. A group of nurse practitioners practicing in a wide variety of clinical and administrative roles at the Johns Hopkins Hospital formed a task force to develop a performance appraisal tool that would adequately reflect the nurse practitioner role and that could be individualized according to the work setting. A general overview of the development process, the tool, its scoring system and instructions for implementation are presented.

Employee Performance Appraisal↗