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Some pioneering health care organizations are taking the innovative step of capitalizing on their intranets, private networks that use Internet technologies and protocols, for human resources purposes. These providers and payers plan to use their intranets to enable employees to enroll a new family member in a benefit plan or check how many vacations days they have left.
Transport of Ca2+ across the membrane by the Ca2+-ATPase of skeletal muscle sarcoplasmic reticulum involves the transfer of two Ca2+ ions from a pair of cytoplasmic sites to a pair of luminal sites, driven by phosphorylation of the ATPase. The ATPase is inhibited by Mg2+ at alkaline pH values. Inhibition follows from a decrease in the rate of release of Ca2+ from the phosphorylated ATPase. Phosphorylation-induced release of Ca2+ from the ATPase is biphasic at alkaline pH, which is consistent with sequential release of Ca2+ from the phosphorylated ATPase; the rates of both components decrease with increasing Mg concentration. The effect of Mg2+ on the slow phase of release follows from the binding of Mg2+ at the empty outer luminal site, vacated by the release of the first Ca2+ ion. The effect of Mg2+ on the rate of release of the first Ca2+ ion could follow from binding to a gating site also affecting the binding of Ca2+ to the cytoplasmic sites.
OBJECTIVES: To assess the existence and extent of employment-related problems facing female family practitioners in the context of a rapidly growing number of female doctors in South Africa. SUBJECTS AND METHODS: A descriptive survey was conducted using bilingual questionnaires. These were posted to all 280 female family practitioners in private practice in the Western Cape. RESULTS: Of the 280 questionnaires posted 169 were returned, but 45 of these were missampled. A response rate of 53% was obtained. The largest age category was 30-39 years. Of those not in solo practice, 68 (75%) were able to negotiate the terms of their working hours, 13 (19%) negotiated sick leave on commencing work, and only half had paid leave. Vacation leave was negotiated by 34 (50%), while only 6 (9%) discussed maternity leave with employers or colleagues. Of the 124 practices included in the survey, 6 (5%) had formal arrangements to cope with maternity leave. One hundred and seven respondents (86%) felt there was a need for maternity leave guidelines in the private sector in South Africa. Regarding practice-related problems, 33 female family practitioners (27%) reported some incidents of sexual harassment by patients. Despite these constraints, 88 respondents (71%) planned to continue working in this field. CONCLUSION: Definite obstacles exist in private family practice with regard to working conditions, in particular the lack of national regulations regarding maternity leave and the absence of legislation on pregnancy discrimination. This has important implications for the inclusion of female doctors in group practices and managed health care organisations--private primary health care of the present and future!
In July this year, the closure of Cowley Road Hospital marked the completion of the biggest organisational change in Oxford's hospitals since the Radcliffe Infirmary first opened 200 years ago on St Luke's Day in 1770. The staff and geriatric patients from Cowley Road moved to the partly vacated infirmary and the Churchill Hospital for the purposes of rehabilitation and continuing care. Some of the acute beds had already moved to the John Radcliffe for the integration of general medicine and geriatric admissions, writes David Charles-Edwards, personnel officer, Oxford AHA.
Compensation packages, particularly for executives, are made up of five elements--salary, employee benefits, short-term incentives, long-term incentives, and perquisites. Of these, perquisites are probably the most misunderstood, according to author Bruce Ellig, vice-president of Corporate Compensation and Benefits for Pfizer Inc. The value of perquisites, or "perks," is their degree of exclusivity--that is, their worth as status symbols or "membership benefits" for those employees at or above a certain level in the company's hierarchy. And their value is enhanced when they (as some do) qualify for favorable tax treatment. True perks fall into six categories--time off with pay, executive services, nonperformance awards, health-care, survivor protection, and retirement coverage. Within these categories, perks take many forms. Time off with pay, for example, might include employment contracts, liberalized vacations, the privilege of working at home, disability benefits, sabbaticals, severance pay, or outplacement assistance. The use of perks varies among companies, but is more popular among small companies.
LP Medical Specialists decided to open a branch clinic in response to pronounced community need. While building a branch clinic facility was initially intended for future implementation, the community's immediate need prompted the group to establish the branch in a temporary facility. By leasing a vacated school building which was transformed into a medical clinic through the addition of demountable partitions, the group was able to expand its services and establish its image as a caring provider in the community--all while justifying expenditures that would not detract from the group's plans to build a future permanent facility.
Emergency after-hour pharmacy services in many hospitals have been replaced by 24-hour, 7-day/week pharmacy services. A survey questionnaire was published in Hospital Pharmacy, February 1983, to be completed by hospital pharmacies that provide a pharmacist in the hospital 24 hours a day, 7-days a week. Usable responses were received from 185 hospitals. The type of hospitals and the number of beds of these hospitals varied greatly. The differing responses concerning staffing, scheduling, hours of the post-midnight shift, arrangement of vacations and holidays, the factors used in selling the concept to administration, and the handling of compensation are presented.
A data base management system (System 2000) was utilized to develop a pharmacy personnel inventory that would allow the pharmacy and hospital administrators to quickly and easily obtain biographic and demographic information about employees in a large pharmacy department. The inventory provides personal information about each employee and administrative data such as previous employment and salary histories, benefits packages, and special skills. In addition, the personnel inventory provides other administrative functions including: 1) a tally of vacation or sick days accrued; 2) salary and merit increase information for pay evaluations; 3) a personnel telephone directory; 4) the immediate access to employee emergency contact information; 5) a tally of continuing education credits accrued by each pharmacist; 6) a list of languages, other than English, spoken by pharmacy personnel; 7) pharmacist licensure information; and 8) a list of the ethnic groups represented in the department for use in equal opportunity employment. Computer-prompted instructions allow use of the system by individuals with little or no computer background. Implementation of the system required less than 200 hours and maintenance costs have been relatively minimal. Recent advances in computer technology have made data base management systems similar to that described in this report, a realistic investment for the administrative needs of even the smaller hospital pharmacy.
The technological advances of modern society mean that family members have expanded obligations to care for newborns with severe impairments, who would have died in previous eras. This biological imbalance has created a moral one as well, for to care is to be penalized. Often this moral heroism can be sustained as a vacation only in communities based on the ideal of Christian love. Severely impaired children impose great physical and emotional stress on their parents, which can push the parents to the limits if they are unable to tap into altruistic emotions. Historically, children were not accorded moral status in the West until the Christian influence brought them into the moral community and encouraged parental responsibility. To fulfill their obligations, perhaps parents should bring their child with impairments home and relinquish care only when they find the burden too great. They are obligated to try because they brought the child into existence (biological-causal argument), because this caring is a reflection of God's image, and because children have a moral claim on their parents. Limits to parental obligations exist when continued care would be psychologically destructive for the parents, would conflict with obligations to other family members, particularly siblings, or would be harmful to the child because the atmosphere is no longer nurturing and loving.
These regulations change the reimbursement system by which Medicare pays for outpatient maintenance dialysis and related physician and laboratory services. These changes establish a prospective method of payment for maintenance dialysis, whether furnished at home or in a hospital-based or independent dialysis facility, and revise other aspects of the reimbursement system to encourage home dialysis and provide incentives for economy and efficiency in furnishing these services. These amendments implement section 2145 of the Omnibus Budget Reconciliation Act of 1981. We expect that these changes will improve our administration of the end-stage renal disease program and enable us to control the rapidly growing costs of furnishing dialysis. The controls on quality of care that have been in effect since the beginning of the program will continue to apply. These regulations will also ensure access to care by providing for adequate reimbursement to isolated, essential facilities, where patients have no alternative sources of dialysis care. These regulations also provide for time-limited approval for Medicare participation of special purpose renal dialysis facilities. As a general rule we have not approved facilities such as transient or mobile units set up for emergency purposes or to serve vacationing dialysis patients in State parks and children's camps. This change in regulations will remove this limitation.
The use of locum tenens physicians (physicians who work temporary assignments) began decades ago when primary care physicians arranged coverage for their private practices while on vacation. Today, the placement of locum tenens physicians has evolved into a national business. The reason for the increase in the use of locum tenens physicians is because of the benefits they can offer. They can prevent a hospital, HMO, clinic, or physician practice from losing market share due to a gap in medical coverage.
AIMS: To assess the extent of Auckland medical students' debt, the types of debt accrued and to establish data on part-time employment, income, parental support and living circumstances for these students. METHODS: Medical students at the University of Auckland were asked to complete a written survey questionnaire, which was distributed in lecture classes for years 1-5 and by mail for year 6. The questionnaire asked about biographical data, types and amounts of debt, the use of student loan scheme money, employment, income, student allowances, parental financial support and living situation. Students not sent the survey by mail were informed about the survey several days prior to receiving it to enable them to collate the necessary financial information. Data entry was completed via an electronic scanning system and questionnaire responses were analysed using a tabular analysis of the various classes. RESULTS: There were 522 responses received, comprising 73% of students (48% male, 52% female). The major source of debt was to the Government student loan scheme (39% of students in year 1, rising to 75% in year 6). Average (median) debt to the Government loan scheme rises from $5000 in year 1 to $26,000 in year 6. Fourteen per cent of students receive a targeted student allowance and 30% have a part-time job. Average summer vacation earnings do not exceed $4000. Thirty-four percent receive no financial support from their parents and 18% receive support with some costs only. With the exceptions of students in year 1, more than 50% of students live away from home. CONCLUSION: Medical students are predominantly in debt to the Government student loan scheme and the level rises by approximately $5000 per year from year 1 to year 6. It is expected that these levels will increase in the future.
Absenteeism can be categorized as either uncontrollable or controllable. Uncontrollable absences include family illness, accidents, jury duty and unexpected emergencies. A typical controllable absence may be dissatisfaction with the job. No matter which type, absenteeism is disruptive to the organization, reduces the quality of patient care and raises operating costs. The Bureau of Labor Statistics has established a standard for comparing the rate of absenteesim with other departments or organizations. The rate is equal to the number of days absent times 100, divided by the number of days worked. Four percent or more is considered excessive. Absence policies are often not used for the purposes they were intended. Managers may want to take a critical look at their policies, rather than accept abuse as routine or over-hiring staff to make up for absent staff. If, in fact, it's time to change your policy, you'll want to run possible changes by a legal advisor. You may also want to take a look at your corporate culture. Is it encouraging absenteeism? One company that paid employees who didn't use their sick time had to eliminate this benefit for budgetary reason. Its average sick time then increased 60%. You may want to use your culture to spread corporate norms. Employees are expected to be at work: those who are there on the job are more likely to receive promotions, for example. Paid-leave banks have been introduced by many companies to allow broader time-off flexibility for employees. Such a bank includes holidays, sick and vacation time, grouped together for use by the employee. A final word: employees will rise or sink to the level of your expectations.
Last year, the city of New Orleans, LA, was spared what could have been one of the greatest tragedies to ever befall a major American city. In September, Hurricane Georges, which had caused hundreds of deaths and massive destruction in the Caribbean, was heading straight toward New Orleans. The vicious storm had the strength to potentially submerge the low-lying city, protected only by levees. Although New Orleans escaped serious damage when Georges veered off at the last moment, the threat posed by the hurricane resulted in a massive evacuation. More than 1.5 million people were ordered or urged to vacate the city and coastal Louisiana, though not all complied. About 10,000 people took shelter in the Superdome, home of the New Orleans Saints, while thousands more filled other designated shelters in the city. At local hospitals, people took refuge in offices, waiting rooms, conference rooms, hallways, and any other space available. In this report, we'll give details on how six hospitals and health facilities prepared to meet the hurricane, how they fared during the emergency, and how their disaster plans worked. Three of them are covered in this month's issue.
1. Evaluation of individual propensity to severe asthma using risk factors. 2. Regular follow-up at intervals of 3-4 months, regardless of the patient's stability in a given moment. 3. Measurements of pulmonary function at each visit and at home daily (PEF). 4. Monitoring evolution in relation to the need for specialist consultations and psychological care. 5. Factors influencing propensity to death should be treated specifically. 6. Designation of a person outside the family responsible for the patient's care. 7. Use of community resources. 8. Monitoring personal/family compliance with treatment programs. 9. Informing the patient and family about the patient's tendency to severe asthma. 10. Developing an emergency plan for facilitating communication when asthma becomes unstable. The plan should emphasize eliminating any delay in obtaining care during an attack. The plan should include: a) A list of preventive medications with dosing guidelines. The simplest possible regimens should be established. b) Criteria for using rescue medication and emergency care in each specific case. c) When the physician should be called in and what to do when the physician cannot be contacted. d) An exact description of the signs and symptoms that indicate that the patient should visit the emergency room without delay. Advance designation of the emergency service to be used. e) Suitable vacation planning. 11. Mechanisms guaranteeing fluid and effective communication between the unit and patients with severe asthma. a) Programs for physicians, nurses and receptionists who take calls to establish measures for recognizing, identifying risk factors, and preventing complications in patients with severe asthma. b) Compilation of a list of patients with severe asthma. c) Patients with severe asthma should be identified by a medical alert card. d) Calls from patients with severe asthma should be taken immediately.
A 13-year-old adolescent girl of Greek descent presented with fever of unknown origin and arthralgias of wrists and ankles 3 weeks following vacationing in Greece. On the initial physical examination there were no signs of arthritis and the neurologic signs were normal. On the outpatient follow-up, fever and arthralgia persisted and pedal pulses were absent. Magnetic resonance angiography (MRA) showed irregular narrowing of the iliac arteries. The diagnosis of Takayasu's arteritis was made and the symptoms improved rapidly with prednisone.
Soon after his 80th birthday in June 1955 celebrated in Kilchberg near Zürich Thomas Mann developed a swollen and painful left leg during his vacation on the seashore of Holland. The diagnosis of "thrombophlebitis" was made by Mülders from Leiden and confirmed by Wilhelm Löffler in Zürich. To the surprise of the treating doctors an irreversible shock occurred, when the famous poet and Nobel laureate was improving. The pathological diagnosis (Christoph Hedinger) was perforation of an iliac artery aneurysm on the left side with extensive retroperitoneal hematoma, compression and thrombosis of the iliac vein. Because of lacking apparative techniques correct intra vitam diagnosis was not yet possible in 1955, and life saving vascular surgery was available only shortly later. It is described how Thomas Mann himself experienced his last illness. His astonishing medical knowledge is illustrated by examples dealing with vascular medicine. A summary of his last year of life is given.
BACKGROUND: Because of the increasing work demands posed by the new supervisory requirements of IL 372, coupled with budget constraints resulting from decreasing external grant funding and shrinking practice revenues, departments must weigh workplace needs against faculty resources. Following a period of faculty shortage, the Department of Family Medicine at East Carolina University expected to achieve balance in staffing its department's clinical services, teaching obligations, and scholarly activities once additional faculty were hired. While relief from work obligations was noted once new hires were in place, there remained inadequate faculty to meet all the identified demands of the department. METHODS: To deal with this dilemma, a new approach was created to assess workforce availability and workload demands. Instead of assuming faculty availability based on an average daily or monthly schedule, an actual assessment of faculty availability and workload demands was performed. The method calculated the actual availability and work demands using weeks per year as the unit of measure, i.e., I half day per week of precepting requires 5.2 faculty weeks per year, and an average full-time faculty member is available 45 work weeks per year when vacation, national holidays, and departmental/educational leave time is accounted for. By calculating total weeks of departmental work demands and comparing to faculty availability, a true number of faculty members needed by a department can be accurately determined. RESULTS: During the period in question at East Carolina University, a comparison of work demands and faculty availability revealed that the department needed 2.8 additional faculty to cover the existing work requirements. If time were provided for leadership/management, research, and other administrative activities, then the actual need was for 8.25 additional faculty members. CONCLUSIONS: To meet the increasing time demands on faculty in academic medical centers, departments need to have an accurate accounting of both workforce availability and work demands. The faculty workload assessment model described in this report can be used to generate such an accounting.