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PubMed1985

Professional and system barriers to organ donation.

Like the public, the majority of hospital staff support the concept of organ donation. Some practical problems inhibit their full participation. We believe that the improvements suggested in this report will substantially enhance the participation of committed professionals in the organ donation process. Professional and system barriers to organ donation can be alleviated by clarifying procedures; providing educational opportunities; providing emotional support for professional staff; maintaining and improving communications and advice strategies; lobbying for the legal recognition of brain death; and improving remuneration systems for the physicians and hospitals.

Attitude of Health Personnel↗
PubMed1973

Nurse practitioners in primary care. 3. The southern Ontario randomized trial.

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.

Attitude of Health Personnel↗
PubMed1983

[Ethics of research in psychiatry. Comparison of France and the United States].

This article presents a comparison of research ethics in psychopharmacology in France and the United States. The authors present some elements of definition, etymology and of history. In addition, they study how this very specific research is actually done. Many questions are discussed, including the right of the patient, and the problem of normal volunteers. Other aspects are more technical i.e. remuneration, protocol, and the product. Finally the role of the ethics committees is investigated. These committees comprise the third component of the trial that consists of the research and the subject.

Clinical Trials as Topic↗
PubMed1978

[The role of prevention of infectious diseases in health maintenance].

The prophylaxis of infectious diseases is one of the triumphs of medical science. In examining the role and the responsibility of the physician in this activity the author emphasizes the importance of fundamental research (in the laboratory and the clinic), the need to employ prophylactic measures which are known to be effective, and, finally, the obligation of individual physicians and organized medicine to assume responsibility for problems which extend beyond their national boundaries. The encouragement of preventive medicine depends, among other factors, upon the development of a strong personal relationship between patient and physician. The current system for the remuneration of physicians hinders this relationship instead of promoting it.

Anti-Bacterial Agents↗
PubMed1984

[Role of the mentally retarded graduates of special schools].

The purpose of this investigation was to establish approaches that match a scientific knowledge of the role played by the mentally retarded person who has completed his studies at a Special School. The idea is to learn if he is able to play differents roles in the society, to form a family, to integrate himself in a stable job and to incorporate and participate in a responsive manner in different social groups. Thus, they have been compared with a normal group of similar characteristics. The principal results of the study have shown: Once the person has completed his studies at a special school which used every effort for rehabilitating and capaciting the individual for a responsible social development in life, to enable him to perform a remunerated activity, he discovers that he is "stigmatized", that it is very difficult to find work and of course to be incorporated to the occupational structure. This contributes to the person's anxiety and an increasing insecurity which derives in isolation and lack of social interchange with other people and transform him into a marginal person.

Education of Persons with Intellectual Disabilitie↗
PubMed1983

Characteristics, attitudes and personalities of AI donors.

The first 50 men recruited to an artificial insemination by donor (AID) programme have been assessed for their attitudes and characteristics using a basic questionnaire and a standard well evaluated personality inventory. The results have shown that donors can be characterized as stable and moderately extroverted people who come from a wide range of occupations. Their marital and parental status had no particular relationship to their desire to donate and most of them volunteered for altruistic reasons, financial remuneration being a poor inducement. Most subjects lived within the close environs of the Westmead Centre and preferred to donate during normal working hours. The inconvenience of donating appeared to be the most important factor in considering new approaches to recruiting semen donors.

Adult↗
PubMedDate not supplied

Trend analysis of surgery revenues at Osaka University Hospital.

To identify medical and administrative revenue trends at a surgical center, for use in strategic planning, an off-line data processing system utilizing coding sheets was developed. Data on 66,402 surgical procedures performed at the Osaka University Hospital Surgical Center between 1966 and 1981 were processed to study trends in revenues. Trend analysis shows that (a) revenues at the surgical center have been increasing year by year; (b) technical charges, such as operation and anesthesia fees, have increased with each revision of the medical remuneration system of Japanese government health insurance; and (c) the length of time patients stay in the operating room has gradually increased.

Computers↗
PubMed1983

Clinical practice plans in family practice residency programs.

This paper examines clinical practice plans (CPPs), systems for remunerating physician faculty based on their clinical productivity, in family practice residency programs. A stratified random sample of residency directors responded to a CPP survey. CPPs were found significantly more frequently in residencies (usually operated by universities) either with CPPs in their parent institutions or with high patient volume. Residencies operated by community hospitals were more likely to distribute CPP benefits to faculty based on individual clinical activity, whereas residencies operated by universities were more likely to distribute equal benefits to all faculty or to include academic as well as clinical activities in the benefit determination. While most residency directors felt that CPPs brought financial benefits to a residency and to individual faculty, many directors who did not have CPPs feared that such a plan would create conflicts between patient care and teaching. A case report tracing the evolution of a CPP in one university-administered residency is presented.

Faculty, Medical↗
PubMed1981

Financial issues which may affect the graduate dental education system.

This paper identifies issues, develops alternatives, and analyzes and evaluates the impact of trends and predicted changes in health care and health care financing; compares graduate dental education with nonprofessional and professional (especially medical) graduate education; and concludes there are greater similarities than differences in the financing of education in the academic disciplines and the professions. Two generalizations are drawn from this comparison: (1) practical experience under supervision precedes practice, and (2) the student pays for education solely for his or her benefit. Students are remunerated for productive work in lieu of compensated staff. This discussion identifies a distinction between medical and dental education that influences graduate dental education. In medicine, the prevailing practice in the clinical years is for students to observe care of patients provided by qualified physicians, in dentistry, prevailing practice is for students to provide care under the supervision of qualified dentists. A comparison of clinical training in medicine and dentistry discloses the following.

Education, Dental↗
PubMed1981

[Medical factors relevant to the course of vocational rehabilitation of spinal cord injured clients with complete paraplegia (author's transl)].

A group of 40 clients with complete paraplegia, selected on a number of criteria (such as extent and location of the spinal cord lesion, age, financially responsible agency) had been followed up from the onset of paralysis. At the end of the 5th year post-onset, the following was stated in the 37 survivors: 28 of the 37 paraplegics (75.7 percent) have achieved vocational resettlement (in the broadest possible meaning of that term); of these 28, 16 (43.3 percent) were employed in standard-remuneration occupations; 6 (16.2 percent) had entered training or retraining programmes; 6 (16.2 percent) were engaged in domiciliary activities for at least 5 hours a day or employed in a sheltered setting. None of the paraplegics drew unemployment benefits at the report time; 9 (24.3 percent) had not been resettled vocationally. The article reports on those factors of paraplegia that have comparatively favourable effect on a return to occupational activity (such as use of both arms, absence of psycho-organic syndromes, stability of the neurological syndrome), on permanently detrimental consequences of omitted or insufficient early treatment, as well as on the importance of secondary prevention measures following discharge from inpatient treatment.

Adult↗
PubMed1982

The insurance medical. Practical procedures.

The insurance medical examination is an integral part of day to day general practice. On a busy day it may develop into a race against the clock with short cuts made despite the handsome remuneration. In this article Dr Breidahl has outlined the disadvantage to our patients of taking these short cuts and in particular the opportunities missed for preventive medicine.

Australia↗
PubMed1982

The irresponsible expert witness: a failure of biomedical graduate education and professional accountability.

Many forces have created the epidemic of negligence and malpractice litigation. One of the contributing factors to the rising rate of nonmeritorious litigation is the increasing number of unequalified and irresponsible expert witnesses. The high remuneration has attracted physician-scientists who are unaware of the proper role of an expert witness. They are frequently manipulated by the attorneys and function as partisans rather than scholars. The role of the expert witness should be taught in medical and graduate school. Testimony should be taught in medical and graduate school. Testimony should be treated as a scholarly endeavor and experts should be encouraged to seek peer review of their opinions and not to testify secretly and in isolation. It is suggested that greater visibility of experts and their testimony (light of day phenomenon) should raise the quality of expert witness testimony and encourage more qualified experts to participate as expert witnesses, thus removing the stigmata usually associated with unqualified expert witnesses.

Adult↗
PubMed1981

[Structure of medical care services].

This paper analyzes in detail the principal patterns of the organization or structure of medical care observed in Latin American countries. It reviews the salient features of their structures and examines the major strategies adopted for reorganizing them to respond to new operating requirements. The authors state the conceptual basis and the components of the structure of medical care services and their nature, and then discuss different organizational models both of health systems as a whole and of operating units within them. The four organizational models considered are public or government service, social security, group medicine, and private medicine. The aspects selected for review in these four models are financing, remunerations, the investment in technology, the local service units, the formal structure of the services, the user's participation, information for decision-making, equity and economic efficiency, and the capacity to deliver benefits. The paper emphasizes throughout the patent need for change at all levels of the structure of the services so as to attain the goals of coverage expansion and health for all by the year 2000. These changes must take account of factors deriving from population growth and the changes in the systems made necessary by the present state of the services. A few considerations are also presented on the principal problems that will confront health services in the process and, lastly, there is emphasis on the importance of health services research to establish the facts in each particular situation, and on the need to redirect the training of the manpower needed to attain the established goals.

Health Maintenance Organizations↗
PubMedDate not supplied

[Analysis of the situation of intensive care units].

Since 1990, the Sociedad Española de Enfermería Intensiva y Unidades Coronarias has carried out initiatives aiming to collect data which allows us to make an analysis of the status of the ICU nurses and the characteristics of the Units where these professionals develop their activity. This project was performed during 1992 and 1993, with a survey in 132 sanitary centres of the public network in the national territory, in which information about the number of ICUs and their number of beds, number of nurses and assistants in the institution and those ones specifically assigned to ICU, number of admissions, average stay, occupation percentage, admission causes, use of systems of valuation of the seriousness index, staff seniority, shift systems, staff stability, etc; all this data and others referring to 1991. From 53 hospitalary centres that answered the questionnaire, we obtained information of 94 ICUs in which there was an average of 10.4 beds, with 550 admissions per unit (average/year) and an index of occupation of 78%. The average number of nurses who work in each ICU was 22.7, with a nurse/bed ratio in the global calculation of staff of 2.18. In the analysis of shifts, the nurse/bed ratio was one nurse to every 2.08 patients (1:2.08) when there is a maximum of staff during the morning shift. This index is lower in the other shifts. The average of assistants is 12.1 with an assistant/bed ratio of 1.17. When studying the shifts systems, the rotatory shift outstands in 53.19% of ICUs and the existence of rotation systems of staff in other units is 8.5%. With reference to the characteristics of the staff, the average seniority of Nurses was 6.7 years, 76.4% have own their post and the percentage of new intake in 1991 was 22.5%. The lack of incentives to work in ICU is notable, the most problematic aspects being the insufficient economic remuneration, lack of motivation, scarce human resources and insufficient training, among others. Finally, according to the teaching and research activity performed in the units, 5.4% of ICUs have a nurse in the unit with exclusive dedication to teaching, in 20.4% there are nurses who keep a contractual relationship with University Nursing Schools, in 42.6% of the units there are training programs for the new staff and 67% perform some sort of research activity although in most of the cases it is only sporadic.

Adult↗
PubMed1995

Attitudes and beliefs about blood donation among adults in Mwanza Region, Tanzania.

A study was carried out to assess the attitudes and beliefs about blood donation among the population of Mwanza Region, Tanzania, in order to target better the voluntary blood donor recruitment and retention. A random sample of 1141 adults, 743 residents of Mwanza town and 398 from Mwanza rural areas were interviewed on aspects related to blood donation. A high proportion (26.4%) of interviewees had already given blood but only 3.8% had donated voluntarily within the last 10 years. Voluntary blood donation was correlated with secondary school attendance. We noted a positive attitude towards voluntary blood donation although the majority of people would do so only for an incentive in the form of remuneration. Respondents frequently thought that blood donation would infect them with HIV or damage their health. No correlation was found between fear to donate and self perceived risk for HIV infection. We found that a substantial number of men would accept pre-test counselling on HIV in order to "infect others" if found positive. Thus we recommend that HIV counselling should be done with extreme care and defer individuals with wrong intentions from blood donation. Donor recruitment campaigns should also focus on clearing wrong conceptions about blood donation through providing information on all aspects related to blood donation. Based on these findings, a scheme for blood donor recruitment and retention in Mwanza Region is proposed.

Adolescent↗
PubMed1995

[Man and forestry work--a chronologic perspective].

Forest work has been an object of systematic research for two centuries. The research includes studies of work methods and techniques, ergonomic aspects, field conditions, productivity, health problems, work safety, remuneration, psychological and sociological aspects of forest labour. Research in forest work originated in Central Europe but has since spread to all parts of the world. Viewing man and forest work from the 19th to the 21st centuries we can conclude the following: Until the mid-19th century forest work was carried out by human and animal power, aided by the force of gravity, water and wind. For man, it was one of the most difficult and dangerous jobs. Forest work demanded a large number of workers. The mid-1800s saw the beginning of mechanization of hard load motion in wood transportation. The mechanization of forest work is constantly increasing. Versatile multi-functional machines are introduced into various segments of forest work. Today, there is a wide range of work methods and techniques in forestry. At the same time, side by side, one can see forest operations performed entirely by human power and others, mechanized and fully automated. With the development of new work methods and techniques, and new forest products, the need for man's physical labour gives way to an increasing demand for general knowledge and expertise. Powerful, multi-functional machines, supported by information technology and operated by highly qualified professionals have stretched the limits of the sources of work energy and information flow in performance and optimization of forest work.(ABSTRACT TRUNCATED AT 250 WORDS)

Ergonomics↗
PubMed1995

Negotiating the nurse research coordinator role.

Ophthalmic nurses may be asked to be part of a research team. This article suggests ways the nurse can prepare for the research coordinator role and negotiate added compensation. Without preparation, the nurse's workload may not be adjusted to accommodate additional tasks and there may be a lack of remuneration. At worst, the nurse may fail to meet the expectations of the investigator and sponsor. Nurse research coordinators can learn new marketable skills, increase income, create opportunities for publications and speaking engagements, and widen their professional network. Sources of additional information about the research coordinator role are provided.

Humans↗
PubMed1995

[Problems of national health insurance reimbursement revision, especially for laboratory tests].

The reimbursement fees for laboratory tests are lowered at every revision of Health Insurance Reimbursement (HIR), carried out every 2 years. This leads to the financial trouble for laboratory operation in university hospitals as well as general hospitals. Medical care costs in Japan account for 6% of GNP and is not as high as that in advanced countries such as USA, Canada, and Germany. The Central Pharmaceutical Affairs Councils gives manufacturing and sales approval for in-vitro diagnostics after examination of the applied documents. The Committee on Application of Medical Care Remuneration in the Japan Medical Association decides the following; Propriety of reimbursement establishment for new in-vitro diagnostics, reimbursement fees for new in-vitro diagnostics, propriety of reimbursement establishment for medical devices and propriety of reimbursement for new drugs. The MOSS (Market-Oriented, Sector-Selective) approach was initiated also in the in-vitro diagnostics field in January 1985 the target of which is to abolish the economic barrier and relax regulations in Japan. The Ministry of Health and Welfare lowered the reimbursement fees based on actual prices in commercial laboratories, which is very low because of price dumping through excess competition. In future, we would like to propose additional reimbursement fees for in-house emergency tests. Furthermore, we would like to request the judgment fee for diagnosis of myelogram, immunoelectrophoresis and isoenzymes for which clinical laboratory physicians play a role.

Clinical Laboratory Techniques↗