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How people are treated when they need medical care depends on where in the world they are. In deciding which tools of the medical trade are used to treat disease and when they're used, location is paramount. A country's social policy, healthcare payment systems and cultural factors bear heavily on the utilization of medical technology. The cover story kicks off the magazine's third international healthcare section.
Pumpguns are shotguns with pump action whose injuries and wound mechanisms have several special features: extremely high kinetic energy of the shot (2500 to 3500 J) frequent cases of "Krönlein shots" (exenteration of the brain) punchmark/imprint immediately adjacent to the entrance wound from the front of the pipe magazine exit wounds from buckshot may be similar to pellet entrance injuries from a distant shotgun discharge the use of various shotgun cartridges (plastic ammunition, slug bullet, various lead pellets) within the same weapon. The change in the Austrian gun law and the banning of the pumpgun in 1995 is also discussed in the article.
This paper describes the clinical methodology and currently collected pedigrees from an ongoing genetic study of panic disorder. The main objectives are to (1) document the clinical aspects of the study for current [Knowles et al., 1998: Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:138-147] and future reports of genetic analysis; (2) assist other investigators working on the genetic aspects of panic disorder who wish to compare results; and (3) illustrate the numerous judgment calls required in such studies that may lead to methodological variability and could account for differences in findings between studies. We also describe initial strategies to identify more genetically homogeneous panic disorder subtypes. Families were recruited through letters to magazines, word of mouth referral, and screening in anxiety disorder clinics and were asked to participate if at initial diagnostic screening they appeared to have at least three members (in two generations) affected with panic disorder. Diagnostic evaluations included a lifetime clinician-administered semistructured psychiatric interview, family history assessment, and pertinent medical records. Diagnoses for linkage analysis are derived from a best-estimate procedure that includes independent review of all materials by two senior investigators. All clinical evaluations were done blind to genotypes. Fifty-five pedigrees including 679 individuals have been collected to date. DNA is available from 500 family members of whom almost half (48%) are definitely or probably affected with panic disorder. Most (93%) of these subjects were directly interviewed, and the clinical data include not only lifetime psychiatric and medical diagnoses and but also detailed narrative histories describing sequence and context of symptoms. Family sizes range from 4-36 individuals (mean = 12.3) and the number of affected individuals per family from 2-12.
At the beginning of this decade, health policy analysts and health management consultants went about the United States proclaiming that the sky was falling because something called "managed care" was about to revolutionize the financing and delivery of healthcare. In the process, it would rob US physicians not only of their long accustomed clinical freedom, but also of their long accustomed handsome incomes and job security. Understandably, in the face of many negative predictions, US physicians felt as if they were in dire straits. To be sure, the odd skirmish has been waged over healthcare costs and over clinical freedom. Viewed across the United States as a whole, however, managed care so far has been, in the words of a recent magazine article, "a mouse that roared." However, it is possible that a second revolution in the US healthcare system is yet to come, as Medicare and Medicaid turn over more and more of the functions of cost and quality control to private regulators. It is likely that the private regulators will consist of physician-driven integrated healthcare delivery systems, which take full capitation from Medicare and Medicaid and therefore assume full clinical control over healthcare, along with the financial risk inherent in capitation. For rheumatologists, this approach to healthcare represents both a danger and an opportunity.
Is sexual harassment a serious issue for managers, and does it occur as much in business as the popular press would have us believe? How difficult will it be to implement the newly issued EEOC guidelines? Out of a joint survey with Redbook magazine, HBR takes a look at these and other questions. Eliza Collins and Timothy Blodgett explore definitions of harassment, analyze respondents' replies, and suggest ways to counter the problem.
The National Hansen's Disease Center is a unique research, training, and treatment complex at Carville, LA, for Hansen's disease (leprosy), a chronic illness affecting an estimated 15 million people worldwide. The Daughters of Charity of St. Vincent de Paul helped establish it in 1896, and in 1921 the center became a federally funded institution. SUlfone drug treatment, a major advance, was begun there. Scientists at Carville study the disease's unknown mode of transmission; training administrators conduct learning seminars; and laboratory researchers produce bacteria samples to be distributed as possible vaccines. Some patients receive treatment and leave, whereas others reside at the self-contained community. Reconstructive surgery is performed there, and special footwear is made. Some patients work on The Star, a magazine dedicated to correcting misconceptions about the disease and its communicability. The center includes a school and a pool and golf course. Hansen's disease care programs are available in many states and are expanding to other areas.
A recent survey of CEOs, conducted by Hospitals magazine, shows that productivity studies are concentrating on staffing--especially in nursing, laboratory, surgical suite, medical records, and radiology.
Trade magazines, especially those directed toward health careproducts manufacturers and distributors, are currently carrying stories about so-called "illegal" diversion of goods by resale at nonprofit hospitals. What is this all about? What gives rise to the claim of illegality? What stance should responsible hospital materials managers take? In this dialogue, Doctor Decker describes the problem, outlines the issues involved, and makes some recommendations.
Newspapers, magazines, and media continue to describe the severe financial stress hospitals face. Hospitals are not receiving increases in revenue to offset the increasing costs of operation. The preferred way for most hospitals to survive in the future is to be able to provide the same, if not better, quality service at a reduced cost. The manager who can operate his or her business at an ever-reducing cost will continue to be in demand. If the hospital is to remain competitive, the increases in salary expense and the decreases in admissions have to be offset somehow. The only logical thing available is to improve the productivity of the current resources in the hospital. It is unfair for a department administrator to expect a reduction in resource consumption, without providing the manager with some means of measuring the effectiveness of what is happening in the department. The system described here would give the manager the means of such measurement.
Psychiatrist and consumer attitudes toward the advertising of psychiatric services are examined. The results indicate that consumers are consistently more favorable than psychiatrists toward psychiatric services advertising. Both groups felt that professional magazines are the most appropriate media for psychiatrists who advertise. The psychiatrists reported a higher level of exposure to advertising of psychiatric services than did the consumers. However, some apprehension about psychiatric services advertising also was reported. Managerial implications for advertising usage by the practicing psychiatrist are presented.
The key to effective decision-making in health care institutions--now and in the future--is data: accurate, reliable, well-understood information about your patients and about your institution's operations. Much of the data you need for decision support are now available in your financial, patient information, and departmental systems. To put it to work in ways that will meet the challenges of the 1980s, you need to develop more effective ways to use this information. A decision-support system requires, above all, integrated data, flexible access, and the capability to extract and summarize relevant information from a mass of detail. Effective decision-support systems require powerful hardware and sophisticated software. Even more, they require planning and self-education on your part. You must understand your current system and your future needs. You must also educate yourself about the computer market-place and the many systems options available to you. Read books and magazines, attend conferences, contact vendors. Above all, talk to users of any system you are considering for your institution. The resources in this Guidebook can start you on your way.
Rapidly emerging in public debate as the key to the future of the health care industry is quality. One can hardly pick up a health care magazine or journal or listen to a discussion among health care professionals without quality becoming a concern. Despite virtually universal agreement on the importance of the generic term and secondary agreement on the importance of being able to measure it, discussion bogs down in either of two ways. It may become overwhelmed by the sheer magnitude of the task of describing all the elements of health care quality, or the different viewpoints of individuals will yield quite variable understandings of what the term "quality of health care" means. To make substantial progress in improving health care quality, we will need to come to an agreement on terms.
The rapid rise of health-care education has been much noted and discussed of late. Most of the prominent A-V magazines feature articles about health-care education programs, ads for soft-ware production aimed at different health-care needs, and tips on in-house production of materials. Rarely, however, do authors address themselves to how particular hospital needs are perceived, assessed, defined, and--given the preceding requirements--met with specific in-house productions.
The author presents the beginnings of scientific medical associations in Poland in the 18th century. The associations contributed significantly to popularization of the achievements of medicine and were uniting the medical circle when medical schools were closed. Medical magazines edited and published by these associations were the platform of the exchange of scientific experiences what approached Polish science to European level.
Ever since Harvard's David Eisenberg, MD, published his groundbreaking findings in the New England Journal of Medicine in 1993 (for example, that there were more visits to complementary or alternative medicine practitioners in 1990 than to all general practitioners and family practice physicians combined; and 83 million adults were spending about $11 billion on alternative or complementary medicine), interest in the marketplace implications has grown. Anne Alexander, editor of Prevention magazine, and Leah Kliger, principal of The Lakes Group, Lake Stevens, WA, provided some new information at The Alliance For Healthcare Strategy and Marketing's Annual Conference in March.
Dentistry has faced the same access issues that have spurred telemedicine development in other fields. However, until recently dentistry has lagged behind in adopting telemedicine. The findings of the Association of Telemedicine Service Provider's (ATSP; www.atsp.org) 1998 Report on US Telemedicine Activity, done collaboratively with Telemedicine Today Magazine, are instructive. Of over 40,000 teleconsults among 139 U.S. programs performed in 1997, only 200 were dental teleconsults--all done by one program. Although that figure represents a significant increase over the 4 dental teleconsults reported in 1996, teledentistry has a long way to go. The first steps are now being taken. At the schools of dentistry at the University of California at Los Angeles and the University of Bristol in Bristol, England, two different approaches to teledentistry are being actively explored. Telemedicine Today spoke with lead researchers at each school to discuss these programs.
Children on long-term ventilation without adequate support have already been a topic of reports a few times. An inquiry conducted by the Vestische Kinderklinik confirmed this for 14 patients on ventilation in the area of Westfalen-Lippe. According to estimates in the weekly magazine "Der Spiegel" there are about 200 affected children and adolescents. Even in situations of continuous pressure, basic human needs and rights are not to be neglected, they are to be taken into consideration at each medical, therapeutic and pedagogic intervention. From such a "holistic" point of view the living surroundings of those patients should not be exclusively or mainly defined by ICU needs. Even more, due to the development in intensive care medicine, there should be the possibility of a compromise under "regular living circumstances", ensuring an optimal cooperation of medical "life-security" as well as psychological (including the family) and pedagogical guidance and help. With the concept of "flat sharing groups for ventilated children and adolescents" we promote a complex model that seems to be able to fulfil the requirements stated above. The idea of integration as well as the paradigm of "self-determined life" should be taken into account.
More and more hospital marketing and public relations executives are recognizing that publications, such as newsletters and magazines, are a very important part of their arsenal of marketing tools. They're also finding that custom publishers are valuable allies when it comes to target market opportunities.