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At least 1,639 records · Page 91Linked to original sources
PubMed1991

Teaching hospital costs: the effects of medical staff characteristics.

This article examines the effect of medical staff behavior on the cost of hospital-based care and graduate medical education, and shows its implications for estimation of hospital costs. The empirical work brings a unique new data source for these characteristics to the estimation process. Our results indicate that there are important economies of scale and scope in hospital production, both for inpatient stays and for residency training. Controlling for medical staff characteristics significantly reduces the estimated costs of residency training. Staff characteristics may be capturing aspects of the quality of inpatient care and residency training provided by the hospital.

Costs and Cost Analysis↗
PubMed1991

[Reading habits of Norwegian physicians].

Norwegian doctors spend on average 3.4 hours per week reading medical literature. 2/3 of this time is spent on medical journals. These are the main findings in a survey of self-reported reading time among 760 Norwegian doctors. Hospital doctors read more than doctors working outside hospital (3.9 vs. 2.7 hours per week), and internists spend more time reading than surgeons and general practitioners do. All categories of doctors report spending approximately one hour per week reading other material than journals and articles, and the differences between groups as regards reading time are accounted for by differences in the time spent on medical journals. Nine out of ten doctors read Tidsskrift for Den norske laegeforening (the Journal of the Norwegian Medical Association) regularly, and 2/3 read Nordisk Medicine (the Nordic Medical Journal). Every fifth doctor reads at least one out of four specified international journals (British Medical Journal, Lancet, New England Journal of Medicine or JAMA). Only one out of fifteen Norwegian doctors reads Läkartidningen (the Swedish Medical Journal) and Ugeskrift for Laeger (the Danish Medical Journal) on a regular basis.

Humans↗
PubMed1991

Alternative dispute resolution of medical-legal issues.

Even the most casual observer of medical-legal litigation knows that such disputes take a long time to resolve, cost too much, and often leave parties no better off than before. Litigation also has deleterious effects where the parties have an ongoing relationship outside the courtroom. Such problems plague all litigation, however, and have prompted courts and legislatures to explore alternatives to the traditional means of solving private disputes through the filing and trial of lawsuits. In Texas, this effort resulted in the 1989 passage of the Texas Alternative Dispute Resolution Act (Texas ADR Act), which declares a state policy encouraging "the peaceable resolution of disputes....and the early settlement of pending litigation through voluntary settlement procedures" (1). This article examines alternative dispute resolution methods and explores their application to medical-legal issues.

Confidentiality↗
PubMed1990

[Fluoride deposition in the dental enamel following the use of a fluoride-containing gel studied by a nuclear physics method (PIGE)].

The caries-preventing activity of fluorine is a surfact in the medicine. Dentists and physicists analysed with a new nuclear physical method the fluorine uptake of the tooth enamel after application of new caries-preventive agents. The fluorine profile of the first 3 microns of the enamel surface from deciduous teeth was established after three years clinical treatment with two new developed fluorine gels from the VEB Leipziger Arzneimittelwerk in comparison with Elmexgelee and a control agent. The determination of the fluorine profiles was performed using proton-induced gamma rays emission (PIGE) on the 2-MV van de-Graaf accelerator of the institute of practical nuclear physics of the physical faculty from the Karl-Marx-Universität Leipzig. The two new developed gels and Elmexgelee caused a similar fluorine concentration in tooth enamel. The fluorine profiles from the new developed gel A and the clinical approved caries preventive agent Elmexgelee are comparable. Gel A is produced under the trade mark "Laweflour" by the VEB Leipziger Arzneimittelwerk.

Child↗
PubMed1990

Professional ethics in health care: an introduction.

Discussions about issues in medical ethics are often frustrated by the failure to distinguish other concerns: legal and institutional rules, personal values, and personal moralities. Progress can be made if the medical profession reaches a prior agreement on its core values--what the good physician ought to care about--and a consensus on how these values are to be respected by physicians facing ethical dilemmas.

Adult↗
PubMed1990

[Improving the diagnosis and treatment of pulmonary tuberculosis among the inmates of reformatory institutions of the Ministry of Home Affairs].

According to the data given by the authors, the tuberculosis morbidity rate in the populations under surveillance of the Ministry of Home Affairs was over that in the general population. High morbidity of such persons is often contributed to their antisocial way of life, and alcohol and drug addiction. Full coverage of these groups by means of X-ray screening, when they are held prisoners during the investigation period, makes it possible to detect all cases with active tuberculosis, to prevent the admission of undetected patients to the reformatory schools and thereby to stop the transmission of tuberculous infection. The observations should be conducted twice a year since these imprisoned groups may be recognized as being at high risk for tuberculosis. The clinical pattern of pulmonary tuberculosis is unfavorable in the convicted persons. Appropriate three-stage chemotherapy with the use of surgical interventions, if indicated permits one to achieve in the reformatory institutions of the Ministry of Home Affairs a high efficacy of treatment of ++newly-diagnosed pulmonary tuberculosis patients, which concurrently significantly decreases their epidemic danger for the general population when they are let free.

Adult↗
PubMed1990

Cardiac surgery for inmates in the Texas Department of Corrections.

All Texas prison inmates requiring hospitalization since 1983 have been transferred to a separate prison hospital adjacent to a tertiary care university hospital. We reviewed and analyzed the data regarding one major tertiary care service, namely cardiac surgery, to describe the rate of utilization of this service and its results. From January 1, 1984, to June 30, 1988, 73 inmates underwent 74 cardiac operations, 50 of which were coronary revascularizations. The age-adjusted rates of utilization for coronary artery bypass grafting were substantially higher for inmates over age 45 than for that described for the general population, whereas the utilization rates for valve surgery were comparable. There were no perioperative or late deaths, and 86% of the inmate patients are currently employed within the Texas Department of Corrections system or were employed at the time of their release. The utilization rates and the results of this representative tertiary medical care service for the state's prison population are comparable to those achieved in the private sector, and may have a substantial beneficial effect on inmate rehabilitation.

Adolescent↗
PubMed1990

To strike or not to strike? House-staff attitudes and behaviors during a hospital work action.

Work actions by house staff are an infrequent response to sometimes difficult working conditions, but they can have a notable effect on institutional cohesiveness and represent a challenge to traditional notions of medical ethics. To determine the extent of participation in a hospital-wide doctors' strike and factors associated with participation, we surveyed 432 house officers at a university-affiliated public hospital where a contract dispute had recently led to a 4-day work action. Of 257 respondents, 69% approved of the strike and 50% participated in it. Both strikers and nonstrikers agreed that quality of care and specific contract issues were important precipitants of the event. By logistic regression, factors independently associated with strike participation (P less than .05) included being unmarried, training in internal medicine or psychiatry, being in earlier stages of training, being assigned to an outpatient service at the time of the strike, holding a favorable view of physician activism, and perceiving nurses, faculty, peers, and the public to have favored the strike. These associations may provide a basis for understanding the individual and social determinants of house-staff strike activity.

Adult↗