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PubMedDate not supplied

[Practicability of cataract surgery at university hospitals: searching for an economic model].

UNLABELLED: Resources available for health care all over the world are not enough to cover all the demand in this sector. Cataract Free Zones conducted in many regions of the country show that only 10% to 20% of blind patients caused by senile cataract can get operated on. PURPOSE: To demonstrate feasibility of a model for cataract surgery with intraocular lens implantation at the Clinical Hospital from the University of Campinas, Unicamp, São Paulo, when considering the remuneration payed by the government for universitary services. METHODS: Costs with disposable material were collected for extracapsular cataract surgery, with posterior intraocular lens implant, at the Clinical Hospital, Unicamp. The model includes outpatient surgery under local anesthesia, and costs rationalization in acquisition and wear of material. University Hospitals have a different situation in the health system, where fixed costs and part of the variable costs of cataract surgery are subsidized by the State government. RESULTS: Cataract surgery performed under the proposed methodology is economically feasible, considering disposable components only, and the price achieved was US$ 77 with government payment of US$ 474. More surgical interventions increases the efficiency of the institution, provides more surgical training to residents and better community health care. CONCLUSION: The authors consider that it is an obligation of University Hospitals, regard their commitment with training, research and quality of eye care deliverance, to increase the number of cataract surgeries for the lowest possible price.

Ambulatory Surgical Procedures↗
PubMed1994

Nurses' work: balancing personal and professional caregiving careers.

Forty full-time nurses who were also responsible for providing care to individuals in their private lives volunteered for a qualitative study of combined caregiving careers. Each respondent kept a diary of caregiving activities during two representative 24-hour periods, and was interviewed prior to, and after diary-recording. Most nurses experienced high levels of stress associated with caregiving in both their professional and private lives. In general, they were relatively satisfied with their lives in both spheres, and felt a slightly greater sense of control in their work lives than in their home lives. Regarding the tensions/conflicts they alluded to, the following themes emerged: an ethic of high expectation, feeling torn between two worlds, a sense of working in isolation, and working in overdrive. The rewards/benefits included remuneration, recognition and self-esteem, opportunities for personal growth, and opportunities for family growth.

Adaptation, Psychological↗
PubMed1995

Hospital in the home units. Early issues for GP involvement.

This paper reviews the early challenges for Hospital in the Home units which choose to utilise general practitioner skills. A model is described. Issues surrounding GP selection, remuneration, responsibility, leadership, and other hurdles are described. Since alternatives to GP involvement exist, GPs should be prepared to seize this important opportunity.

Home Care Services, Hospital-Based↗
PubMed1994

The effect of changes in caries prevalence on general dental practice.

There have been many changes in the organisation and structure of general dental practice in the UK in recent years. Some of these have been due to the changes in caries prevalence. Other changes have been caused by shifts in the system of remuneration under the National Health Service (NHS), which may themselves have been influenced by falling caries levels. It is also pertinent to consider the ways in which dental practice has affected caries rates, since, arguably some of the changes in caries prevalence have been due to developments in dental practice.

Adolescent↗
PubMed1976

[Félix Kánitz on animal husbandry in northern Bulgaria and the Stara Planina at the end of the Turkish occupation].

The Hungarian geographer, archaeologist, and ethnographer Kánitz Félix, great friend and admirer of the Bulgarian people has left valuable and comprehensive information about North Bulgaria and the Balkan Mountain by the end of the Ottoman oppression in his work La Bulgarie Danubienne et le Balkan (1882). The book contains also valuable references concerning the animal breeding activities within the 1860-1880 period in this part of the world. In the mountainous region in Bulgaria sheep- and goat-breeding were well developed, and this accounted to a large extent for the destruction of forests. Numerous and large flocks of sheep were raised in Dobrouja, a portion of which belonged to the famous shepherds of the town of Kotel. During the winter season a great number of flocks from Transylvania were also kept in this region. The breeding of sheep was the main source of meat supply both for North Bulgaria and the Balkan Mount region and for the markets of the Ottoman Empire. It also yielded a total of 120,000 okas of wool (78 okas = 100 kg) annually to meet the needs of the Empire manufacture as centered at that time in the town of Sliven for the production of textiles for the army. The raising of cattle was also prosperous during the same time. On the other hand, stock breeding was unfavourably influenced by heavy taxing in the form of both cash payment and remuneration in kind, by requisitioning (especially in war time) and the endless thefts and robberies done by tatars and cherkesses that had moved to this country from Caucasus. This exploitation concerned equally Bulgarian and Turkish animal breeders.

Animal Husbandry↗
PubMed1993

Attitudes of private general practitioners towards health care in South Africa.

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5,000 was conducted to explore attitudes towards health care. A response rate of 67.4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents: (i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasison fee-for-service.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Interest in HIV vaccines among injection drug users in Baltimore, Maryland.

To gauge interest about participation in human immunodeficiency virus type 1 (HIV vaccines, we interviewed 375 HIV-seronegative injecting drug users who are participants in an ongoing longitudinal study of HIV infection. Nearly all (93%) responded that they thought it likely that an HIV vaccine would become available, and 85% expressed interest in participating in a study of vaccine effectiveness. However, levels of interest decreased to 47% when respondents were informed that the vaccine might result in a positive HIV test and to 27% when offered to be in a study where the vaccine might contain a piece of the virus. Factors that increased interest in trial participation included assurances of confidentiality, being fully informed about the protocol and remuneration. Most respondents (78%) felt that injecting drug users would maintain other risk reduction activities (e.g., condom use) if they participated in a vaccine study. These data suggest a high level of interest for participation in HIV vaccine trials, but that more education about vaccines and the risks involved is needed. Ongoing communication with the community and responsiveness to community concerns is crucial to achieve a successful vaccine study.

AIDS Vaccines↗
PubMed1995

What do experienced GPs really need in communication skills training?

In studying the connections between the verbal interactions in general practice consultations and outcomes such as patient and doctor satisfaction, the authors developed an interest in the various sources of occupational stress for Australian GPs. Doctors and their patients do not necessarily agree about how satisfactory a consultation was, raising questions about whose definition of quality in medical care should prevail. Doctors' concerns about exceeding the Health Insurance Commission (HIC) norms for frequency and length of consultations seemed to inhibit them from providing the listening time some patients need. Complexity of consultations proved difficult to rate reliably. Experienced GPs in a preceptor role expressed mixed feelings about the value of communication skills training compared with changes in remuneration policies. We seek comment from readers about these observations.

Communication↗
PubMed1994

The role of the restorative dentist in the diagnosis and maintenance phases of implant therapy--Part II: Prosthetic planning.

Prosthetic planning is critical to the success of the diagnostic phase of implant therapy and is used to establish fixture numbers, position and the optimal occlusal scheme, based on the design of the definitive prosthesis. The prosthetic needs of the patient, anticipated functional and parafunctional forces, restoration fabrication and serviceability are all considered. A clear picture of the intended rehabilitation is provided to the surgical team and expedites the consultation between implant team members. Comprehensive diagnostic planning using mounted diagnostic casts and diagnostic wax-ups will provide definite parameters for fixture number, position and alignment, and permit the fabrication of radiographic and surgical templates as the treatment sequence progresses. Patients need to be informed of the time and expense involved in the diagnostic phase of implant therapy prior to the initiation of the planning process. The practitioner conducting the selection and planning phase is entitled and should expect financial remuneration commensurate with the time and effort required to achieve the objectives of this phase of implant therapy. The Planning Process Using mounted diagnostic casts and diagnostic wax-ups: 1. Establish fixture numbers and position; 2. Establish the optimal occlusal scheme; 3. Design the definitive prosthesis; 4. Fabricate a surgical template. Design Principles--Summary 1. The location and number of fixtures dictates the prosthetic design and influences restorative success. 2. A restoration must be designed to distribute forces to the fixtures without overloading the bone, and therefore be able to withstand anticipated functional and parafunctional loading. 3. Design for optimal function and esthetics with a regard for patient comfort and maintenance.

Bite Force↗
PubMed1994

Veterans' psychiatric benefits: enter courts and attorneys.

In 1988, the Veterans Judicial Review Act (VJRA) was signed into law, ending more than a century of Congressional measures that kept veterans' benefits claims completely out of the appellate court system. Before this new law, any decision made by the Department of Veterans' Affairs (VA) about a veteran's claim was final, and there was no recourse for independent judgment of an appeal. The legislation modified the existing Board of Veterans Appeals (BVA) to enhance its independence from the Veterans' Administration and established a new Court of Veterans Appeals (CVA) with jurisdiction to review BVA decisions. Veterans' benefits proceedings have not only been insulated from the courts, they also have been undesirable to private attorneys, because since 1864 Congress has prohibited attorneys from charging more than $10 to advocate a VA disability claim. The new law allows attorneys to represent veterans before the CVA and receive appropriate remuneration. In 1991, the number of veterans was estimated at 26,897,000, and VA disability compensation programs spent $9.6 billion. Currently, there are about 2,179,000 veterans receiving service-connected monetary compensation; approximately 13.5 percent (293,200) have a primary psychiatric disability. The CVA is a specialized Article I court that has seven justices and sits in Washington, D.C. In its formative years, the Court has reached decisions that have had an impact on the veterans' psychiatric benefits examination process. Now more than ever, non-VA psychiatrists may be asked to offer probative opinions in veterans' benefits proceedings. The authors review VA psychiatric disability procedures and, using case examples, discuss both precedent decisions involving VA psychiatric claimants and the evolving standards of judicial review.

Combat Disorders↗
PubMedDate not supplied

Multiple variable motivators involved in the recruitment of physicians for the Indian Health Service.

Attracting physicians to serve in isolated areas, often with marginal facilities, support staff, and remuneration, has long been a problem of the Indian Health Service (IHS). Until recently the physician draft was instrumental in motivating physicians to accept such assignments. Realizing that this "negative incentive" would no longer operate when the draft ended as of July 1, 1973, in the fall of 1972 the IHS staff launched some major "positive" efforts to recruit physicians. The mass media and other communication techniques were used to try to sell U.S. physicians and medical students on what the Service could offer them in terms of adventure, challenge, personal fulfillment, idealism, and the opportunity to be part of a progressive, comprehensive health system. Such efforts assisted in recruiting 69 physicians to begin service in July 1973. These 69 were in addition to approximately 100 who had already been recruited from among persons who had expressed interest in joining the Indian Health Service or who had applied to it before inception of this major recruitment effort. As of July 1, 1973, however, the Service was still approximately 30 physicians short of filling 200 vacancies. In June and July of 1973, an evaluation was done to determine what had motivated the 169 physicians to join the Indian Health Service. They were asked an open ended question: What prompted you to seek employment with the Indian Health Service? Whether physicians listed personal, subjective motivators or recruitment techniques was of as much interest as the specific answers they gave. More than 75 percent (100 of 129) mentioned recruitment techniques, such as magazine advertisements, rather than personal motivating factors, such as challenge. Personal contact with a present or former IHS physician seemed to be especially influential in attracting physicians. The present state of the recruitment art does not provide the means to adequately identify, qualify, quantify, and rank the multiple motivators that prompt physicians to join a program such as that of the Indian Health Service; nor does it allow for meaningful, predetermined identification of a limited pool of physicians who would have a high probability of joining such a program. At present, the best recruitment strategy appears to be to saturate the entire physician "marketplace" stressing with a variety of techniques the positive aspects of IHS employment. Physicians then select themselves for such employment by exhibiting a more than casual interest in the Indian Health Service.

Advertising↗
PubMed1994

Investigation of an outbreak of hepatitis A in Irish haemophilia A patients.

Since 1990, Irish haemophilia A patients have been treated with solvent-detergent(SD)-treated virally inactivated high-purity factor VIII concentrate prepared from plasma from Irish voluntary non-remunerated donors. In 1992, 13 haemophilia A patients developed clinical hepatitis A and a further 17 patients showed serological evidence of recent infection by hepatitis A. All but 3 of these patients had had recent exposure to SD-treated product. A case-control study is underway to determine whether these cases represent transmission through product or environmentally acquired hepatitis A.

Blood Component Transfusion↗
PubMed1994

Are physicians meeting the needs of family caregivers of the frail elderly?

OBJECTIVE: To explore expressed needs, both formal and informal, of family caregivers of frail elderly. To evaluate roles of physicians. DESIGN: Questionnaire survey of members of the Montreal Jewish community providing care for frail elderly family members. SETTING: Jewish community of Montreal. PARTICIPANTS: Volunteer caregivers who were caring for a family member or friend 60 years or older, who had greatest responsibility for providing physical or emotional support to an elderly person, who saw themselves as caregivers, and who could speak English or French were studied. Of 118 volunteers, 32 were excluded because they withdrew for personal reasons or because they did not meet study criteria. MAIN OUTCOME MEASURES: Demographic variables, functional status of the care receiver, use of home care services, and needs assessment to identify additional services. RESULTS: An average of 75.4% respondents did not use formal support services. Just under half of caregivers were dissatisfied with the attention they received from the health care system, and more than one third expressed feelings of stress, depression, guilt, and isolation. CONCLUSIONS: Hypotheses for this discontent are presented. Physicians may be uninterested in helping caregivers; even if they were receptive to counseling caregivers, they could be poorly remunerated for the types of counseling sessions that are usual for caregivers; and being a professional caregiver to family caregivers is demanding in itself.

Activities of Daily Living↗
PubMedDate not supplied

[Preventable population mortality and an evaluation of the activities of the medical services].

To estimate the effectiveness of health service activities and work of individual doctors the author suggests to analyze retrospectively avoidable mortality caused to a considerable extent by the drawbacks of medical care. Thorough analysis of such cases allows to work out prior measures on improvement of health service activities which is especially urgent under condition of its limited financing. Being compared to standards the results of the expertise give a possibility to determine the quality of medical care and provide grounds for differentiated remuneration of medical personnel.

Adolescent↗
PubMedDate not supplied

The nurse extern practicum: a new partnership between education and service.

An externship was developed for academic credit but also offered financial remuneration for students. It is believed that a partnership between an educational institution and a health-care institution might offer students the opportunity not only for reality-based clinical practice, but also to enhance their education. Benefits to the agency include recruitment of students for future employment; benefits to the university include additional credit generation without additional revenues, because instructional costs are borne by the contracting health-care agency. Evaluations of this joint endeavor have been enthusiastic, with positive outcomes for all.

Education, Nursing, Continuing↗
PubMed1993

The right to participate in research studies.

Institutional review boards for the use of human subjects in scientific studies were initially established to focus on protection of human subjects from the risks of research. It has become evident in recent years, however, that it is also important to protect the rights of individuals to have access to the benefits of research participation. These include, but are not limited to, certain experimental drugs or treatments, closer monitoring, free care or direct remuneration, and societal benefits of results of studies on specific populations. Researchers, so long sensitized by their respective institutional review boards to the need for protection of the subjects, now must also focus on the added burden of efforts to include individuals and the increased efforts it may take to protect the safety and rights of certain populations, including patients with AIDS, women, minorities, children, and the elderly. Additional care must be taken to design appropriate studies, recruit an appropriate spectrum of the population, craft a complete yet understandable and nondeterent informed consent form, and make efforts to assure that participants are informed.

Beneficence↗
PubMedDate not supplied

[Work loss and depression. Impact of fluoxetine].

The goal of our study was to explore the impact of various antidepressant drugs on the relative risk of work loss in depressed patients. 1,852 depressed patients (DSM III-R) were observed using a "cross-sectional" design. Patients were included into five groups: patients without antidepressant treatment, patients treated with one of the main antidepressant drugs in France (amineptine amitriptyline, clomipramine and fluoxetine). Primary variables were the depression intensity (Hamilton scores) and job status (work loss). The other parameters (clinical, demographic, economic, therapeutic) were used as potentially predicting variables. Data have been collected through a network of 295 physicians (GP, Psychiatrists). The main socio-demographic characteristics of treated and untreated depressive patients, either working or absent from work, were predominantly female and city dwellers. A significant difference was found between working patients and work loss in terms of professional characteristics, i.e. type of employment (p < 0.001), type of employer (p < 0.05), level of responsibility (p < 0.01) and type of remuneration (p < 0.01). We found a positive correlation between depression severity and the risk of work loss (R2 = 0.86, p < 0.001). This risk was significantly lower with fluoxetine compared to other treatments. Pooling these data with data from clinical trials led to a saving of 2.4 days (vs clomipramine) to 4.7 days (vs amitriptyline) (p < 0.05, respectively) of work loss per patient for a 8-week treatment period.

Absenteeism↗
PubMed1993

Clinical research: any future?

Laboratory-based clinical research is in a severe crisis in Canada. The reasons are many and range from the serious inadequacy in the financial remuneration of research fellows going to the USA. or Europe for further training to the overpowering trend to seek solutions to clinical problems directly at the molecular and cellular levels instead of the traditional physiopathological approach. The language of molecular biology and genetics, with its innumerable acronyms, is quite foreign to clinical medicine. In addition, molecular biology research leaves little time for clinical care of patients. Steps should be taken to reinvigorate laboratory-based clinical research since it is the key transfer point of basic advances to clinical care. Fellowships of the order of $50 to $60,000 to research fellows going to the United States or abroad should be provided. Close collaboration between PhD scientists and clinical scientists, as so successfully achieved at the Clinical Research Institute of Montreal in the last 25 years, should be emphasized, and a greater percentage of funds from research agencies should be designated for the support of laboratory-based clinical research and for the training of clinical scientists.

Clinical Medicine↗