Uniform cost accounting system for pharmacy: taking command of your accounting needs.
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Accounting↗
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New accounting technique takes replacement costs into account.
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Accounting↗
Controlled substance dispensing and accountability in United States anesthesiology residency programs.
Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiology training programs was conducted in the summer of 1990 to determine the level of CS dispensing and accountability within their programs. The survey demonstrated that CS dispensing and accountability varied considerably among programs, among hospitals associated with individual programs, and within geographically distinct anesthesia delivery areas within the separate hospitals. Nevertheless, most institutions were moving toward improved methods of CS dispensing and providing more and better CS accountability. The presence of significant CSD, particularly among anesthesiology residents, was reconfirmed. We were unable to correlate the level of accountability of CS with the incidence of CSD. It remains to be seen to what extent CS accountability will continue to develop and whether CSD prevalence will then be changed.
Anesthesia Department, Hospital↗
Accountability in health care: an essay on mechanisms, muddles, and mires.
This paper presents a critical evaluation of several theories of accountability and their applicability to health care concerns. The authors first provide a preliminary refinement of the imprecise concept of accountability itself and then examine four major types (political; bureaucratic; professional; and economic-consumer). Then, by using disciplinary perspectives provided by several schools of thought in political science (legislative supremacy; general manager theory; government by bureaucracy; objective responsibility; citizen participation), they discuss the degree of accountability presently found in various American health policies. After identifying the inherent dilemmmas within any credible accountability approach to health care programs as now utilized in the United States, the authors recommend that all types of accountability be integrated and strengthened by relying more explicitly on practices characteristic of development administration.
Delivery of Health Care↗
Perspectives on accountability in mental health and retardation services.
Public mental health and mental retardation agencies are under increasing pressure to demonstrate their accountability in fiscal, legal, program, and other areas. The author discusses some of the problems and issures in pinpointing accountability and identifies eight areas of accountability--to patients, to program and management staff, to a chief executive, to a legislative body, to the public, to one's profession, and to one's self. He describes ways in which accountability can be demonstrated and emphasizes that, for mental health professionals, the overriding issue in accountability must be the provision of high-quality care and treatment for the mentally ill and mentally retarded.
Behavior Therapy↗
Improving the efficiency of a community mental health agency: an accountant's view.
This paper describes the rules for the proper implementation of a responsibility accounting system in a mental health center. Responsibility accounting, which relates the costs to the functions that authorize their incurrence, is presented as a technique that aids the unit's manager in controlling costs. The article discusses the rules that should be followed for proper cost association, presents a illustrative statement for a mental health center, and discusses some existing practices, such as line--item accounting, that may appear to conform to good responsibility accounting practices but in reality do not.
Accounting↗
Test of an orienting-reaction-recovery account of short-interval autonomic conditioning.
The electrodermal and plethysmographic components of the orienting reaction in 24 subjects were examined in a conditioning-analog arrangement (tones and lights patterned analogously to CS and UCS presentations in classical conditioning) in order to test the orienting-reaction-recovery (ORR) account according to which apparent short-interval autonomic conditioning (SIAC) can be completely accounted for by an ORR effect. The form of the test was to see whether ORR following change from a repeatedly presented forward ('CS-UCS') analog would exceed that to change from a backward ('UCS-CS') analog, as is the case in SIAC with CS-alone test trials following repeated CS-UCS versus UCS-CS pairings. The results did not support the ORR account, although they were shown to be consistent with the relevant experimental literature, when critically examined, and to provide internal evidence for the adequacy of the present test of this particular formulation of the ORR account of SIAC.
Acoustic Stimulation↗
An accountability model for occupational therapy.
Clark recently challenged OTRs to investigate accountability theory. It is a topic which deserves attention. This paper describes briefly the nature of accountability theory and suggests how theory can be applied to occupational therapy practice. An accountability model based upon an education model is presented for occupational therapists who wish to design their own accountability plans. Examples are included to show how the model can be translated into operational terms.
Humans↗
18. Uniform cost accounting in long-term care.
Uniform cost data are essential for managing health services, establishing billing and reimbursement rates, and measuring effectiveness and impact. Although it is especially difficult in the case of long-term health care to develop standard cost accounting procedures because of the varied configurations of inpatient, intermediate, and ambulatory services, the overall approaches to cost accounting and its content can be made more uniform. With this purpose in mind, a general model of cost accounting is presented for a multilevel program of long-term services, together with a special method for ambulatory services using "hours accounted for" as the basic measure.
Ambulatory Care↗
Estimating HIV prevalence and projecting AIDS incidence in the United States: a model that accounts for therapy and changes in the surveillance definition of AIDS.
The AIDS incubation distribution is changing in calendar time because of treatment and changes in the surveillance definition of AIDS. To obtain reliable estimates of HIV prevalence and projections of AIDS incidence in the 1990s using the method of backcalculation, we constructed an appropriate incubation distribution for each calendar date of infection. We parameterized the impact of treatment on the incubation distribution by specifying the relative hazard for AIDS in treated versus untreated people as a function of duration of HIV infection. To account for trends in the incubation distribution, we modelled the prevalence of treatment, the distribution of treatment onset times, and the impact of the revision of the AIDS surveillance definition in 1987. We selected and evaluated backcalculation models based on consistency with external information. We defined a 'plausible range' of estimates that took into account uncertainty about the natural incubation distribution and treatment efficacy, as well as bootstrap assessment of stochastic error. Using these methods, we projected that national United States AIDS incidence will plateau during 1991-1994 at over 50,000 cases per year. Projections exhibited substantial systematic uncertainty, and we calculated a plausible range for AIDS incidence in 1994 of 42,300 to 70,700 cases. An estimated 628,000 to 988,000 cumulative HIV infections occurred as of 1 January 1991. After accounting for AIDS mortality, we estimated that 484,000 to 844,000 people were living with HIV infection on 1 January 1991. Favourable trends in HIV incidence appeared in gay men and intravenous drug users. Plausible ranges for our estimates overlapped with those from a 'stage model' approach to incorporating treatment effects in backcalculations. Our approach, however, tended to yield smaller estimates of epidemic size, mainly because the parameters used with the stage model implied that more treatment was in use and that treatment was more effective than in our model.
Acquired Immunodeficiency Syndrome↗
Mechanisms of chromosome banding. IX. Are variations in DNA base composition adequate to account for quinacrine, Hoechst 33258 and daunomycin banding?
Prior studies on subfractions of mouse and Kangaroo rat DNA have suggested that variations in base concentration within a given genome may not be great enough to account for Q-banding. To examine this with another species, calf DNA was subfractionated by CsCl ultracentrifugation into GC-rich satellites and the main band DNA was further fractionated into AT-rich, intermediate and GC-rich portions. The effect of varying concentrations of these DNAs on quinacrine and Hoechst 33258 fluorescence was examined. Although with both compounds there was less fluorescence in the presence of the GC-rich satellites than main band fractions, these results per se did not answer the question of whether the variation in base composition alone was adequate to account for chromosome banding. To answer this the fluorescence observed in the presence of DNA of a given base composition was related to the fluorescence observed in the presence of DNA of 40% GC content (F/F40). This allowed the derivation of a term B which indicated the relative change in fluorescence per 1% change in base composition of DNA. To determine the percent change in fluorescence observed in Q-banding, the photoelectric recordings of Caspersson et al. (1971) were used. From these data we conclude: 1. Quinacrine is twice as sensitive to changes in base composition as Hoechst 33258. 2. Variation in the base content of DNA along the base content of DNA along the chromosome is sufficient to account for most Q-banding, except possibly for some of the extremes of quinacrine fluorescence. This was further examined with daunomycin. Even though daunomycin gives good fluorescent banding, DNAs varying in base composition from 100 to 40% GC content all resulted in the same relative fluorescence of 0.03. However, in the presence of poly (dA-dT) the relative fluorescence was 0.85, indicating a great sensitivity to very AT-rich DNA. This suggests that with daunomycin and possibly other fluorochromes, stretches of very AT-rich DNA may be more important in fluorescent banding than simple variation in mean base composition.
Adenine Nucleotides↗
First person account: what it is like to be treated like a CMI.
The article that follows is part of the Schizophrenia Bulletin's ongoing First Person Accounts series. We hope that mental health professionals--the Bulletin's primary audience--will take this opportunity to learn about the issues and difficulties confronted by consumers of mental health care. In addition, we hope that these accounts will give patients and families a better sense of not being alone in confronting the problems that can be anticipated by persons with serious emotional difficulties. We welcome other contributions from patients, ex-patients, or family members. Our major editorial requirement is that such contributions be clearly written and organized, and that a novel or unique aspect of schizophrenia be described, with special emphasis on points that will be important for professionals. Clinicians who see articulate patients, with experiences they believe should be shared, might encourage these patients to submit their articles to First Person Accounts, Research Publications and Operations Center, NIMH, 5600 Fishers Lane, Rm. 10C-16, Rockville, MD 20857.
Adolescent↗
First person account: schizophrenia: some issues.
The article that follows is part of the Schizophrenia Bulletin's ongoing First Person Accounts series. We hope that mental health professionals--the Bulletin's primary audience--will take this opportunity to learn about the issues and difficulties confronted by consumers of mental health care. In addition, we hope that these accounts will give patients and families a better sense of not being alone in confronting the problems that can be anticipated by persons with serious emotional difficulties. We welcome other contributions from patients, ex-patients, or family members. Our major editorial requirement is that such contributions be clearly written and organized, and that a novel or unique aspect of schizophrenia be described, with special emphasis on points that will be important for professionals. Clinicians who see articulate patients, with experiences they believe should be shared, might encourage these patients to submit their articles to First Person Accounts, Division of Clinical Research, NIMH, 5600 Fishers Lane, Rm. 10C-16, Rockville, MD 20857.
Humans↗
Muscle accounts for glucose disposal but not blood lactate appearance during exercise after acclimatization to 4,300 m.
We hypothesized that the increased blood glucose disappearance (Rd) observed during exercise and after acclimatization to high altitude (4,300 m) could be attributed to net glucose uptake (G) by the legs and that the increased arterial lactate concentration and rate of appearance (Ra) on arrival at altitude and subsequent decrease with acclimatization were caused by changes in net muscle lactate release (L). To evaluate these hypotheses, seven healthy males [23 +/- 2 (SE) yr, 72.2 +/- 1.6 kg], on a controlled diet were studied in the postabsorptive condition at sea level, on acute exposure to 4,300 m, and after 3 wk of acclimatization to 4,300 m. Subjects received a primed-continuous infusion of [6,6-D2]glucose (Brooks et al., J. Appl. Physiol. 70: 919-927, 1991) and [3-13C]lactate (Brooks et al., J. Appl. Physiol. 71:333-341, 1991) and rested for a minimum of 90 min, followed immediately by 45 min of exercise at 101 +/- 3 W, which elicited 51.1 +/- 1% of the sea level peak O2 uptake (65 +/- 2% of both acute altitude and acclimatization peak O2 uptake). Glucose and lactate arteriovenous differences across the legs and arms and leg blood flow were measured. Leg G increased during exercise compared with rest, at altitude compared with sea level, and after acclimatization. Leg G accounted for 27-36% of Rd at rest and essentially all glucose Rd during exercise. A shunting of the blood glucose flux to active muscle during exercise at altitude is indicated. With acute altitude exposure, at 5 min of exercise L was elevated compared with sea level or after acclimatization, but from 15 to 45 min of exercise the pattern and magnitude of L from the legs varied and followed neither the pattern nor the magnitude of responses in arterial lactate concentration or Ra. Leg L accounted for 6-65% of lactate Ra at rest and 17-63% during exercise, but the percent Ra from L was not affected by altitude. Tracer-measured lactate extraction by legs accounted for 10-25% of lactate Rd at rest and 31-83% during exercise. Arms released lactate under all conditions except during exercise with acute exposure to high altitude, when the arms consumed lactate. Both active and inactive muscle beds demonstrated simultaneous lactate extraction and release. We conclude that active skeletal muscle is the predominant site of glucose disposal during exercise and at high altitude but not the sole source of blood lactate during exercise at sea level or high altitude.
Acclimatization↗
Apolipoprotein(a) gene accounts for greater than 90% of the variation in plasma lipoprotein(a) concentrations.
Plasma lipoprotein(a) [Lp(a)], a low density lipoprotein particle with an attached apolipoprotein(a) [apo(a)], varies widely in concentration between individuals. These concentration differences are heritable and inversely related to the number of kringle 4 repeats in the apo(a) gene. To define the genetic determinants of plasma Lp(a) levels, plasma Lp(a) concentrations and apo(a) genotypes were examined in 48 nuclear Caucasian families. Apo(a) genotypes were determined using a newly developed pulsed-field gel electrophoresis method which distinguished 19 different genotypes at the apo(a) locus. The apo(a) gene itself was found to account for virtually all the genetic variability in plasma Lp(a) levels. This conclusion was reached by analyzing plasma Lp(a) levels in siblings who shared zero, one, or two apo(a) genes that were identical by descent (ibd). Siblings with both apo(a) alleles ibd (n = 72) have strikingly similar plasma Lp(a) levels (r = 0.95), whereas those who shared no apo(a) alleles (n = 52), had dissimilar concentrations (r = -0.23). The apo(a) gene was estimated to be responsible for 91% of the variance of plasma Lp(a) concentration. The number of kringle 4 repeats in the apo(a) gene accounted for 69% of the variation, and yet to be defined cis-acting sequences at the apo(a) locus accounted for the remaining 22% of the inter-individual variation in plasma Lp(a) levels. During the course of these studies we observed the de novo generation of a new apo(a) allele, an event that occurred once in 376 meioses.
Alleles↗
Peer review: accountability and legal implications.
In summary, increasingly accountability implies the acceptance of peer review as an integral part of nursing practice. Peer review in turn presents a variety of ethical and legal implications and, beyond the scope of this discussion, educational, organizational and psychological implications as well. We must proceed to identify the components necessary to a sound peer review approach, starting with ethical issue and the necessary data base to measure outcomes of care right through the mechanisms of process and structural arrangements. Then, of course, we must ensure the application of rigorous examination of results. Whether QAPs as a whole or peer review as a specific, results are not dependent solely on the provider and client. Environmental and organizational factors must also be considered. Outcomes of care and performance are a function of the interaction of a variety of factors. In essence, the onus for assuring that the profession will meet its public accountability rests largely with each and every one of us. Every professional practitioner in the context of peer review will be compelled to be involved in assessment of the many dimensions of patient care. If professional self-requlation is to be effective, all professional nurses must be involved. In sum, we are the ones who must determine the what and the how of accountability for the nursing profession.
Ethics, Nursing↗
Genethics: project accountability via evaluation of teacher and student growth.
Accountability through demonstrated learning is increasingly being demanded by agencies funding science education projects. For example, the National Science Foundation requires evidence of the educational impact of programs designed to increase the scientific understanding and competencies of teachers and their students. The purpose of this paper is to share our human genetics educational experiences and accountability model with colleagues interested in serving the genetics educational needs of in-service secondary school science teachers and their students. Our accountability model is facilitated through (1) identifying the educational needs of the population of teachers to be served, (2) articulating goals and measurable objectives to meet these needs, and (3) then designing and implementing pretest/posttest questions to measure whether the objectives have been achieved. Comparison of entry and exit levels of performance on a 50-item test showed that teacher-participants learned a statistically significant amount of genetics content in our NSF-funded workshops. Teachers, in turn, administered a 25-item pretest/posttest to their secondary school students, and collective data from 121 classrooms across the United States revealed statistically significant increases in student knowledge of genetics content. Methods describing our attempts to evaluate teachers' use of pedagogical techniques and bioethical decision-making skills are briefly addressed.
Bioethics↗
Assuring accountability for the poor: patient advocates.
The three patient advocate groups that existed in this particular state hospital and differing structures, functions and degrees of effectiveness. However, all three seemed necessary to assure that the serving institution and its professionals would become accountable for the success or failure of their methods and performance. Two of the groups (relatives group and legal aid group) seemed to be functioning effectively within certain limits which each thought to be appropriate in advocating patient causes. Thus, they were providing the countervailing force that is a necessary component of accountability when the persons to be served are a powerless group. The consumer group being the powerless group was not effective in advocating its own cause. It would have been very beneficial to this group had they succeeded. There is a therapeutic effect of having control over one's own life that fosters independence and decreases withdrawal and feelings of alienation from the social order. Certainly these are the goals of the mental health professionals for their patients. In order to realize these goals certain changes would have to be made in the mental health code would have to be changed to include formalized grievance procedures and the desirability of consumer groups would have to be formally established. If this were so, consumers of mental health services might be more effective in advocating their own causes and would be more able to hold the serving institution accountable
Consumer Organizations↗