[Agreement by which the National System for Integral Development of the Family should be integrated into the health sector].
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The family circle method is a process that allows individuals to draw a schematic diagram of their family system. It is closely allied with family systems theory and family medicine philosophy. The method is readily understandable with brief instructions. Individuals can create a family circle drawing in as little as two or three minutes. Once instructions are given, the presence of the physician is not required during the drawing. Family circle drawings will often illustrate, in graphic form, patterns of closeness and distance, of power and decision making, of family alliances and boundaries. The drawings provide at a glance an overview of the family system as seen by the person who does the drawing. The drawings are a rich source of information concerning family dynamics and are useful for setting goals for changes in the family system.
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In the face of increasing neonatal referrals from a large geographic region, community hospital resources was recruited and coordinated with regional center resources to facilitate "community-based" neonatal transport. All transport requests were first "triaged" by an attending neonatologist. Discriminant analysis was used to assess the impact of resource allocation decisions. Decisions regarding allocation of resources to an individual transport generally reflected geographic distance to be traveled, size of delivery service at referring hospital, and apparent degree of illness. Physicians participation in transports was reduced from 95% to 15% of the trips. The incorporation of community-based transport resources and nonphysician transport teams into a coordinated triage and transport process with existing center-based resources did not adversely affect neonatal survival. Capacity of the transport system was enhanced with these reallocations.
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Decentralized testing must be viewed as a component of the decentralized patient care that is prevalent today. It cannot be considered a separate component of the total laboratory process, but must be examined in the context of test ordering and test performance through test result disposition and use. The evolving configuration of the health-care delivery system necessitates a redefinition of risk to include four categories of risk: business, financial, insurable, and clinical quality. Reengineering the clinical laboratory process in today's health-care environment needs to incorporate all these risk issues, systems thinking, and available technology along with the changing practice of medicine.
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Neurodegenerative disorders are gaining increasing importance as the average age of the population progressively increases. It is therefore important to continue developing imaging techniques that will noninvasively, rapidly, and accurately diagnose such disorders. The major role of imaging in neurodegenerative disorders is to exclude the presence of treatable causes. By combining functional and anatomic imaging approaches, imaging has become a critical tool in the evaluation of these disorders.
Preparing the hospital for its new role in a capitated, managed care environment requires restructuring and re-engineering. Multiple approaches to achieving cost reductions while improving quality are discussed, with an emphasis on the nursing-led initiatives. An inventory of restructuring and re-engineering strategies from 15 university teaching hospitals is included.
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Many hospitals and medical staffs have established a physician-hospital organization (PHO) or are discussing the development of one to facilitate contracting with managed care organizations. Physician leadership is essential in the establishment of a PHO in order for physicians to maintain control over patient care. This article describes how one medical staff--at Sewickley Valley Hospital--formed a PHO with its hospital and then a network with other PHOs. It also explains how physicians play an active role in the organization.
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A new measuring system is described which is able to measure the dose applicated by a betatron by means of two redundant dose monitors and to control the dose distribution by a special chamber arrangement. The measuring system is completed by control equipments and a digital dose rate and energy measuring unity.
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