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PubMed1985

Some cons of PROs.

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Professional Review Organizations↗
PubMed2002

Developing a sustainable energy strategy for a water utility. Part I: A review of the UK legislative framework.

Increasing political effort to improve water quality across the UK and Europe has led to water and sewerage companies investing heavily in high-tech wastewater treatment plants capable of producing high quality effluents. Consequently, amounts of bought-in electricity used for wastewater treatment has and will continue to increase significantly over coming years, while greater provision of enhanced sewage treatment also produces greater volumes of sewage sludge requiring treatment and disposal. Over the same period, tougher controls on the quality of biosolids applied to agricultural land have also been introduced, while there has been an international attempt to reduce the use of fossil-fuel derived power sources because of concerns over global warming. The latter has brought about the introduction of financial instruments, such as the Climate Change Levy, to curb energy use, promote energy efficiency and encourage the development of renewable energy technologies. These factors are set to drive-up the costs of providing adequate sewage treatment services, while at the same time, a tough regulatory line taken to control profits on regional monopolies held by the UK water companies will significantly reduce their revenues over the period 2000-05. The result is that, financially, UK water and sewerage companies face their most challenging period since privatisation in 1989. This paper briefly outlines the current regulations relating to water quality and energy use that will affect water company operations over coming years.

Conservation of Natural Resources↗
PubMed2002

Developing a sustainable energy strategy for a water utility. Part II: A review of potential technologies and approaches.

Environmental legislation is increasing the amounts of bought-in electricity required for sewage treatment, and generating larger volumes of sewage sludge to be treated and disposed of. Concurrently, concerns over global warming and food safety from sewage sludge recycling on agricultural land is augmenting the costs of conventional sewage and sludge treatment technologies and practices. This paper reviews some emerging technologies and practices that may assist in mitigating these problems in the future. In addition, a number of potential renewable energy technologies available to water companies are reviewed. Results suggest that through the take-up of new technologies, current and future water quality standards could be delivered in a more sustainable way. However, this series of papers also highlights that institutional and political conflicts may have inadvertently failed to recognise the wider effects of improving water quality and lessened the financial support necessary for their widespread take-up. It is also suggested that through the use of a Strategic Environmental Assessment (SEA) approach, stakeholders could gain a better understanding of the broader environmental effects of achieving certain water quality standards and develop policy and long-term investment strategies accordingly. However, to fulfill the information requirements of an SEA, an appropriate appraisal tool that considers many of these factors in unison is required, and a possible technique is suggested.

Conservation of Natural Resources↗
PubMed2005

Compliance with an infectious disease specialist's advisory consultations on targeted antibiotic usage.

This study was conducted to evaluate the appropriateness of the use of targeted antibiotics, and to analyze compliance and the short-term impact of targeted antibiotic advisory consultations, as implemented in our hospital in October 2002. Targeted antibiotics included glycopeptides, carbapenems, antipseudomonal cephalosporins, and aminoglycosides. A total of 339 prescriptions were reviewed from October 2002 through March 2003. Antimicrobial utilization density (AUD), which was the defined daily dose divided by 1000 patient days, was compared quarterly. Overall, 85.6% of the prescriptions were inappropriate, with 73.7% being inappropriate for therapeutic use and 100% inappropriate for prophylactic use. The overall compliance rate of attending physicians with the antibiotic advisory consultations was 46.5%. Compliance was higher in medical services than in surgical services (64.2% vs 43.1%; P = 0.005) and for therapeutic use than for prophylactic use (54.7% vs 36.5%; P = 0.001). The use of all parenteral antibiotics in the hospital decreased, from 770.8 AUD during the first quarter in 2002 to 626.8 AUD during the second quarter in 2003 (P < 0.01). In conclusion, inappropriate antibiotic use for treatment and prophylaxis is common in our hospital. A targeted antibiotic advisory consultation may be an alternative means of ensuring more appropriate antibiotic use. However, more efficient antibiotic control measures should be developed and implemented, and prospective and continuous monitoring of antibiotic use is required.

Adult↗
PubMed1978

Physician responsibility for the cost of unnecessary medical services.

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

Costs and Cost Analysis↗
PubMedDate not supplied

Quantification of standards for length-of-stay based upon optimal patient care and standard medical practice.

Length-of-stay criteria are being developed by the Allegheny Professional Standards Review Organization (APSRO) in western Pennsylvania. In order to statistically document the standard of practice at the Eye and Ear Hospital of Pittsburgh, a retrospective review of patients who underwent laryngectomy with or without radical neck dissection was performed. Results demonstrated that routinely allowing only one day preoperative assessment deviates significantly from optimal medical practice and may place some patients at increased risk, especially for postoperative complications. From a cost-effective health care delivery point of view, abbreviated preoperative preparation contributes negatively to postoperative length-of-stay which was the most costly component of hospital health care for this group of patients. The development of appropriate standards of medical practice criteria using preexisting HEW mechanisms and scientifically designed prospective studies should be encouraged.

Age Factors↗
PubMed1976

External peer review of skilled nursing care in Minnesota.

External peer review of each of the 8917 Medicaid patients in 228 Skilled Nursing Facilities in Minnesota demonstrated characteristics and needs of patients and produced documented recommendations for Medical Evaluation Studies to strengthen multiple aspects of treatment programs. As a whole, Medicaid patients were well placed and well cared for. However, wide variations were observed in individual facilities. Principal problem areas were those which prevail in all long term care facilities in this country: weakness of individualized treatment, weakness of restorative goal-oriented treatment, severe mental/emotional/behavioral disabilities, lack of strong leadership in medical and nursing professions, and weakness of psychosocial support programs.

Activities of Daily Living↗
PubMed1993

Nutritional management of replacement sheep utilizing southern forages: a review.

Intensive sheep production systems seem to be an appropriate means of fully using the available resources, particularly the forages, of the southern region. In such systems, ewes should lamb first at approximately 1 yr of age. Programs to accomplish this goal must be well-planned and carefully integrated and executed. The primary goal is to achieve two-thirds of the ewe's projected mature weight before exposure for breeding. General management must reduce heat stress and parasitism. Forage quality must be maintained at a level consistent with National Research Council requirements for energy and protein. Protein is not normally a limiting factor. Energy supplementation and grazing pressure can be used to maintain growth without over-condition, which reduces subsequent performance.

Animal Feed↗