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PubMed1982

Medicare program; limitation of reasonable charges for services in hospital outpatient settings--HCFA. Final rule with comment period.

These Regulations limit reasonable charge reimbursement for certain physicians' services furnished in hospital outpatient settings. This will be accomplished by refining the application of Medicare reasonable charge screens to reflect more accurately the reasonable charges for physicians' professional medical services in hospital outpatient settings. The regulations are needed to implement recent legislation that is designed to prevent duplicate payment for overhead expenses associated with the delivery of those services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

Medicare program; reasonable charge limitations--HCFA. Final rule with comment period.

This final rule implements section 9304(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985 which enacted section 1842(b)(8) of the Social Security Act (Act). In accordance with section 1842(b)(8) of the Act, we specify the circumstances under which HCFA or its Medicare Part B carriers will consider establishing special reasonable charge payment limits for services (including supplies and equipment) reimbursed under Part B of the Medicare program. The rule describes the factors HCFA or a carrier will consider and the procedures it will follow in establishing them. The limits would be either an upper limit to correct a grossly excessive charge or a lower limit to correct a grossly deficient charge. In either case, the limit would be either a specific dollar amount, or a special method used in determining reasonable charges to be allowed for a particular service or category of service. The purpose of this rule is to establish a stronger framework for setting special reasonable charge limits for services when the standard reimbursement methodology results in payments that are grossly excessive or deficient. A related purpose is to protect the Medicare program from excessive outlays and to prevent any adverse effects on both Medicare beneficiaries and consumers in general that we believe would result from a lack of such limits. The rule also will protect suppliers from reimbursement that is grossly deficient.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Medicare program; reasonable charge limitations--HCFA. Final rule.

This final rule sets forth the circumstances under which HCFA will consider establishing special reasonable charge payment limits for physicians' services reimbursed under Part B of the Medicare program. The rule describes the factors that HCFA will consider and establishing the limits. The purpose of this rule is to bring the regulations into conformance with the provisions of section 9333 of the Omnibus Budget Reconciliation Act of 1986. As amended, the law stipulates the specific circumstances under which the Secretary may establish special reasonable charge limits for physicians' services. The rule also responds to the public comments received on the final rule with comment period that set forth the general principles for establishing special reasonable charge limits.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Employing oral examinations (viva voce) in assessing dental students' clinical reasoning skills.

The development and evaluation of a comprehensive oral examination system are described. These examinations are designed to measure, in an authentic manner, graduating students' understanding and use of the clinical reasoning and professional communications skills employed in the diagnosis, treatment, and management of realistic clinical situations. The examination cases were developed from actual clinic cases, enhanced to fit the requirements of the examination. Faculty members were provided with training sessions designed to promote consistency of administration and scoring. A mock oral examination was held to acquaint students with the process and to help reduce their anxiety. The results suggest that the oral examination is a reasonably valid and reliable approach to assessing clinical reasoning skills and that graduating students demonstrated competency in the areas tested.

Chi-Square Distribution↗
PubMed1999

Reasons why South African qualified dentists are working in the UK.

Various reasons are provided why professional people are leaving or had left the country since 1990. A substantial number of these emigrants were dentists who went to practise their profession in the United Kingdom (UK). The purpose of this study was to determine, by way of a questionnaire, why some South African qualified dentists prefer to practise their profession in the UK. The results showed that the high level of crime and violence in South Africa is the most important reason why South African qualified dentists are leaving or have left the country. Economical considerations, either their own financial position or the general economy of the country also appear to be an important reason why South African qualified dentists are moving abroad.

Crime↗
PubMed2000

Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress.

Stress related to ethical decision-making is a serious consequence of frequent encounters with ethical dilemmas for oncology nurses. A descriptive, correlational design using survey techniques was used as a study design with a nationwide sample of 229 oncology nurses. The results indicated nurses experienced an average of 32 different types of ethical dilemmas within the past year on a daily basis. Pain management is the most frequently cited ethical dilemma, followed by cost containment issues and making quality of life and other decisions in the patient's best interest. Approximately 80% of respondents rated their ethics stress level as a 6 or above on a scale of 0 to 10. Forty-three percent of the sample indicated they use an independent or "sovereign" style of moral reasoning, 23% rely on or accommodate to the judgment of others, and 34% use characteristics of both moral reasoning styles. Understanding the relationships among style of moral reasoning, coping style, and ethics stress can assist nurses and administrators to deal more effectively with the increased moral distress found in many oncology practice settings today. Findings suggest specific interventions for reducing ethics stress in this population of nurses.

Adaptation, Psychological↗
PubMedDate not supplied

[Characteristics of nursing students attending the University Courses for Nursing Diploma at Trento: reasons for their choices in the first trimester].

Motivations and reasons for the choice of the nursing course were explored in the students applying for the university nursing courses from 1995 to 1998. Aim of the study was to trace a picture of students' characteristics but also to have elements to promote campaigns for increasing the number of applicants. Overall, 183 first year students (70 in 1995; 60 in 1996 and 53 in 1997) were administered a questionnaire with questions related to socioanagraphic data, reasons for the choice of the University Diploma in Nursing Sciences (DUSI) and aspects of the nursing profession considered positive and negative. The 87% of the students had previous work experiences, more than 20% in the health field and a larger number in the social field. The main reasons for choosing the DUSI are the strong connections between theory and practice and the opportunity of working soon after the course. Fifty per cent of the students make definitely up their mind on the final choice of becoming a nurse during the course: in fact only 55% of the students are moderately-strongly convinced of practising the nursing profession when they enter the curriculum. The data are commented on with special attention to the implications for the contents and strategies of a campaign or ad hoc initiatives aimed at increasing the number of students that apply to the nursing courses.

Adult↗
PubMed2000

Social variation in reasons for contacting general practice out-of-hours: implications for daytime service provision?

BACKGROUND: Contact with general practice out-of-hours services increases with socioeconomic deprivation. The reasons for this association are unclear but may include variations in access to daytime services or differences in morbidity. AIM: To identify the reasons for contact with the Glasgow Emergency Medical Service (GEMS) in relation to patient sociodemographic characteristics and the nature of the presenting problem. METHOD: All contacts with GEMS over a one-week period (n = 3193) in October 1996 were identified and a random 1:2 sample were sent a postal questionnaire investigating their reasons for contacting the service. Sociodemographic data and presenting problems were extracted from the service contact sheet. Data were analysed using correspondence analysis. RESULTS: Correspondence analysis identified two factors characterised as 'perceived problems with daytime services' and 'perceived urgency'. Scores on the former dimension were significantly associated with age (P < 0.0001), gender (P < 0.0001), socioeconomic category (P < 0.0001), and presenting problem (P = 0.015) and scores were higher in adults, in males, among the non-affluent (particularly those resident in deprived areas), and in those presenting with a musculoskeletal problem. Scores on the latter dimension were significantly associated with age (P < 0.0001) and presenting problem (P < 0.0001). Scores tended to increase after childhood and for each of the five most frequent categories of presenting problem relative to other symptoms. CONCLUSIONS: Compared to those from affluent areas, patients from non-affluent areas appear to perceive difficulties accessing their general practitioner during surgery hours and may contact out-of-hours services as an alternative.

Adolescent↗
PubMed2000

[Elderly people admitted to hospital for social reasons. Patients' and their networks' perceptions of problems and expectations prior to the admission].

Elderly people may be admitted to hospital for social reasons. The aim of this study was to describe problems that lead to the admission and the expectations of the elderly and their network. Thirty-nine qualitative interviews were made with 39 informants. Data were analysed according to Grounded Theory. The backgrounds for the admissions were a mixture of social, psychological and physical reasons. The elderly found themselves isolated, lonely and sometimes afraid. They had no expectations of treatment. The network hoped that the admission would mean changes at home and in primary healthcare. Admissions due to social reasons should be avoided, but were necessary as there were no other solutions. Suggestions are presented.

Aged↗
PubMed2000

Patient desire and reasons for specialist referral in a gatekeeper-model managed care plan.

OBJECTIVE: To describe patient desire and reasons for specialist referrals in a gatekeeper-model managed care plan. STUDY DESIGN: Cross-sectional prospective study. PATIENTS AND METHODS: We developed a patient questionnaire to gather demographic data and to gauge patients' desire for specialist referral and their reasons for seeking such referral. The survey was administered at 2 sites--an ambulatory care facility of a university hospital and an internal medicine clinic in a suburban ambulatory care site. Patients asked to complete the questionnaire at the university hospital site were enrolled in a gatekeeper-model managed care plan (called CU Gold); those seen at the internal medicine clinic were enrolled in a group-model health maintenance organization. Patients were asked to complete the 1-page questionnaire in the waiting room before being seen by their primary care physician. RESULTS: Among the 860 CU Gold patients who met the inclusion criteria during the 3-month study period (September to December 1997), 112 (13%) reported a definite desire to see a specialist and 274 (32%) indicated a possible desire to see a specialist at the time of their primary care visit. Compared with the CU Gold patients, significantly fewer patients in the health maintenance organization indicated a definite desire to see a specialist (3% versus 13%), but a similar percentage expressed a possible desire to see a specialist (30% versus 32%). The difference in definite desire for referral between the 2 groups could not be explained by patient or primary care physician characteristics. The principal health concerns for which patients sought referral were musculoskeletal, genitourinary or gynecologic, or dermatologic problems. Need for reassurance (cited by 67% of patients), seeing a specialist before (56%), and believing the primary care physician lacked expertise (49%) were the primary reasons patients sought referral. Seventy-four percent of patients referred by their primary care provider and 54% of those not referred agreed it was a good idea to see their primary care physician first before seeing a specialist. CONCLUSIONS: Patients have a significant desire for specialist referral, driven by their need for reassurance, previous specialist referral, and belief that their primary care physician does not have the requisite expertise. Patients' expectations for referral varied significantly, depending on the healthcare system (academic primary care clinic or health maintenance organization) in which they were enrolled.

Adult↗
PubMed2000

[Relation between ethnicity and reason for referral of new patients to the Internal Medicine outpatient clinic of the Academic Hospital Rotterdam-Dijkzigt, 1997].

OBJECTIVE: To inventory the ethnic composition of the patients referred to an internal medicine outpatient clinic of a Dutch academic hospital and to determine to what extent ethnic minorities differ from Dutch patients in terms of referral reasons, taking relevant background characteristics into account. DESIGN: Cross-sectional analysis. METHOD: Data were collected on all new patients referred in 1997 for the first time to the internal medicine outpatient clinic of the Academic Hospital Dijkzigt, Rotterdam, the Netherlands, using the hospital information system (n = 3205). Patients were categorised into ethnic groups based on country of birth or name. Ethnic differences in referral reasons were tested for the 4 largest ethnic groups by means of logistic regression analysis with adjustment for age, sex, mean income of the zipcode area of the patients' residence and type of health insurance. RESULTS: The percentage of ethnic minorities amongst all referred patients was 22% (696/3205). The percentage of ethnic minorities among the patients referred from the catchment area of the outpatient clinic was 48% (209/440). Compared with Dutch patients Turkish patients were referred more often with stomach ache (odds ratio (OR): 4.26) and joint problems (OR: 7.16) as reasons. Moroccans were more often referred with stomach ache (OR: 4.10) and diabetes (OR: 4.51). Ethnic minorities were referred less often with dyslipidemia (Turks: OR: 0.11; Surinamese: OR: 0.17; Moroccans: 0 patients).

Abdominal Pain↗
PubMed2000

Automatic coding of reasons for hospital referral from general medicine free-text reports.

Although the coding of medical data is expected to benefit both patients and the health care system, its implementation as a manual process often represents a poorly attractive workload for the physician. For epidemiological purpose, we developed a simple automatic coding system based on string matching, which was designed to process free-text sentences stating reasons for hospital referral, as collected from general practitioners (GPs). This system relied on a look-up table, built up from 2590 reports giving a single reason for referral, which were coded manually according to the International Classification of Primary Care (ICPC). We tested the system by entering 797 new reasons for referral. The match rate was estimated at 77%, and the accuracy rate, at 80% at code level and 92% at chapter level. This simple system is now routinely used by a national epidemiological network of sentinel physicians.

Confidence Intervals↗
PubMed2001

Human rationality and the psychology of reasoning: where do we go from here?

British psychologists have been at the forefront of research into human reasoning for 40 years. This article describes some past research milestones within this tradition before outlining the major theoretical positions developed in the UK. Most British reasoning researchers have contributed to one or more of these positions. We identify a common theme that is emerging in all these approaches, that is, the problem of explaining how prior general knowledge affects reasoning. In our concluding comments we outline the challenges for future research posed by this problem.

Cognition↗
PubMed1998

[Analysis of reasons failed focal debridement in 109 patients with spinal tuberculosis].

OBJECTIVE: To explore reasons failed focal debridement in treating spinal tuberculosis patients and methods to cope with them. METHOD: One hundred nine patients with spinal tuberculosis who failed initial focal debridement from 1987 to 1996 were reviewed. RESULT: The reasons of operational failure were found to be the use of unreasonable regimens and existence of drug resistant strains; inappropriate operational indication, approach and treatment during operation; lesions involving several vertebrae, skipping destruction and complicating with other kinds of extrapulmonary tuberculosis. CONCLUSION: The key to successful treatment of the disease is to choose appropriate operative indication and approach, discard spinal cord pressure and rebuild spinal stability on the basis of reasonable chemotherapy regimen.

Adolescent↗
PubMedDate not supplied

Reasons for dental extractions in children.

PURPOSE: The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years. RESULTS: First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types. CONCLUSIONS: This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.

Adolescent↗
PubMed2001

Design of a CSCL environment for clinical reasoning learning and problem-based learning in medicine.

The medical curriculum is changing, student-centered learning is currently used in medical schools. Problem-based Learning and Clinical Reasoning Learning develop the students' reasoning strategies. CSCW (Computer-Supported Cooperative Work) technology is used in Problem-Based Learning systems. We have designed a CSCL (Computer-Supported Collaborative Learning) environment for improving group coordination and communication in Clinical Reasoning Learning sessions. To support these new educative technologies, a prototype has been developed.

Clinical Medicine↗
PubMed2001

The use of consequential reasoning in cancer chemotherapy.

Knowledge-based decision support systems traditionally rely on condition-action rule structures, an adequate representation for simple decisions. In complex domains an important part of decision-making includes analysis of the consequences of a decision. Consequential reasoning is particularly important in medicine as potential risk and/or benefit can be included. In this paper, a knowledge structure and inference engine is described that permits the representation and analysis of consequential reasoning in a computer-assisted decision support system. The use of consequential reasoning is then illustrated in an application designed to assist in cancer chemotherapy decisions. The result is a method that is sensitive to individual patient reactions to chemotherapy agents, permitting an individualized approach to therapy. Individualized drug therapy is becoming increasingly feasible due to advances made in the field of genomics. The system is structured so that new information can be incorporated easily. Although the application shown here is to chemotherapy, the general methodology can be used in any area in which the consequences should significantly influence the decision.

Artificial Intelligence↗
PubMed2001

Human rationality and the psychology of reasoning: Where do we go from here?

British psychologists have been at the forefront of research into human reasoning for 40 years. This article describes some past research milestones within this tradition before outlining the major theoretical positions developed in the UK. Most British reasoning researchers have contributed to one or more of these positions. We identify a common theme that is emerging in all these approaches, that is, the problem of explaining how prior general knowledge affects reasoning. In our concluding comments we outline the challenges for future research posed by this problem.

Journal Article↗