Social implications of deinstitutionalization. Attacks on custodialism offered the hope of more humane treatment approaches. Mental health planners thought that the costs of state hospital care could be reduced by discharging patients into the community. For state governments, this involved a shift of costs and responsibility to the federal government. This shift was accompanied by an increase in cost-effective planning at both state and federal levels. Cost-effective planning uses corporate-style standardization techniques to provide precise, measured types of treatment to certain categories of patients. Such planning is primarily oriented to balanced ledgers of the government budget, rather than meeting specific human needs. The shift in costs also increases profits in the private sector. This is most noticeable in the nursing and boarding home industry where entrepreneurs derive large returns from a newly custodialism mainly funded by government reimbursements. The institutional overuse of psychiatric drugs is continued in community programs. Cost-effective approaches also involve firing mental health staff and increasing the workload of those remaining. Community mental health centers and state hospital deinstitutionalization programs have largely failed to meet most of their promises such as noninstitutional treatment, more humane care, prevention, and rehabilitation. These failures have produced the beginning of a delegitimation of the new mental health approaches. This delegitimation is also used as part of more general attacks on social services so prevalent in this period of economic crisis. This reinforces the reliance on cost-effective plans which do not benefit clients. It also poses the danger of increasing the number of persons classified as psychological misfit among the marginal underclass. Even though this is an unintended effect, it can then be used to deflect onto these victims popular resentment against big business and the government. Further, the growth of such a misfit group, along with other types of social decay, may prompt an increase in the already growing forms of social control psychotechnology such as psychosurgery.


Adolescents in transition: a look at a transitional treatment center. This article describes the structure, philosophy, and goals of a high expectations halfway house program for adolescents. The Transitional Treatment Center (TTC) is a residential treatment program for emotionally disturbed adolescents making the transition from institutionalization to independent community life. Topics covered are specification of the TTC program objectives, methods for monitoring residents' progress towards resocialization and plans for future programming.


Managing executive stress and other related subjects.


Community approaches to developing health care services.


Quality of working life in a health maintenance organization: comparison of medical and ancillary personnel.


Managing the ambulatory facility: setting up the information system.


Development of a comprehensive pediatric ambulatory care program in a community hospital.


Help you. Help us.

Help you. Help us.


Organizing among RNs: has labor found a fertile source?


State health planning law.

State health planning law.


Rate of return for nursing homes employing the market method.


A bridge between nursery school and nursing home.


Conflict and frustration.

Conflict and frustration.


Evaluation of adult training materials.

Evaluation of adult training materials.


Mechanisms for limiting liability.

Mechanisms for limiting liability.


Wheelchair management: developing a system for long-term care facilities.


Hospice as part of the care continuum in a comprehensive geriatric center.


A new campaign of caring for the aging: perspectives and prescriptions.


Multivariate analysis of health care services utilization among older Texans.


Community based health care: a model for the institutionalization of social change.


Human service delivery policy-making in American cities. The case of genetic disease trait-testing programs.


Managers of professional departments in teaching hospitals: a study of satisfaction.


Business office productivity: a practical program for improvement.


The EEOC's foray into sexual harassment: interpreting the new guidelines for employer liability.


Age and you.

Age and you.


National environmental health planning at the crossroads.


How do you handle patient billing disputes or patients questioning why your charges are so high?


Life satisfaction among middle-aged adults: a research note.


When grandma moves in.

When grandma moves in.


The nursing home visitor: who, when, where and for how long?


A study of the alienation of male and female nursing home patients.


Empathic understanding: an important skill for those who work with older adults.


The elderly: a holistic glimpse.

The elderly: a holistic glimpse.


Employee termination: proceed with care.


Health care coverage and costs: a major challenge for innovative managers.


Medical malpractice in Canada.

Medical malpractice in Canada.


Jehovah's Witnesses and child protection legislation: the right to refuse medical consent.


Consent of incompetents (minors and the mentally ill) to medical treatment.


Negligence and the pharmacist.

Negligence and the pharmacist.


Liability of custodial institutions for torts of patient-inmates.


The case of Tim Crawford: mental health legislation five years later.


Family physician: for whom the legal bells toll.


Abortion.

Abortion.


Merger of Milwaukee hospitals yields linen processing savings.


Vice-president brings financial stability to once-foundering laundry operation.


Dallas hospital linen director resigns due to lack of concern over theft.


Role of executive housekeeper will keep growing, says Chavis.


First independent central laundry in British Columbia, Canada opens.


Employee performance problems: what a laundry manager can do.


Health for all by the year 2000.

Health for all by the year 2000.


Here's the malpractice hit list for the'80s.


"Convenience clinics": your newest rival for patients?


When primary doctors run the whole show.


Capitation for pharmacy services: rationale, findings, and future plans.


Capitation payment for pharmacy services: are we ready?


Group practice: a concept in crisis.

Group practice: a concept in crisis.


Pharmacy services: achieving equitable reimbursement.


Capitation reimbursement for pharmacy services: a dissenting view.


Dynamic changes in medical group organizational structure.


Third-party reimbursement: new concepts and contemporary issues.


Hospitals in trouble. Crisis for doctors?


What should you do when a union knocks on your door?


The case against medical licensing.

The case against medical licensing.


Hospital corporate liability: the trend continues.


The case for medical licensure.

The case for medical licensure.


The open society and its enemies: growing professional secrecy in Massachusetts.


Reproductive freedom and the prevention of birth defects: a new and developing standard of medical care.


Group practice accounting principles.

Group practice accounting principles.


Patients' rights to confidentiality.

Patients' rights to confidentiality.


Let's keep caring, curing, quality, cost in proper perspective.


The Tucson Clinic, P.C.

The Tucson Clinic, P.C.


Doctor/manager relations.

Doctor/manager relations.


Home care furthers oncology patient rights.


Patient-centered care facilitates more personal contact.


The right of the patient to the best of caring.


Diving chamber treatment saves boy's life.


Access into mainstream health care: a ten-year retrospective.


Patient representatives assure hospital accountability.


Hospitals must improve professional communication between M.D., nurse.


Medical graduate cutbacks could spur resident, physician services.


Housekeeping supply costs rise 25%.

Housekeeping supply costs rise 25%.


Committed volume purchasing saves Texas group 7% to 39% on food costs.


Hospitals often underestimate HIS costs, overestimate system savings.


Shaky lifecare center put up for sale.

Shaky lifecare center put up for sale.


Hospital bond issue design ensures corporate restructuring freedom.


Reputation as well as cost figure in choosing a feasibility study firm.


Hospitals use industrial warehouse techniques to process supplies.


Survival strategy: play the acquisition game.


Nonprofit hospital groups make a move on investor-owned systems.


Planning: OMB rule delay allows time to apply for aid.


New leadership needed to mesh regulatory, planning strategies.


Hospitals mildly optimistic about wins by Reagan and conservatives.


Purchase groups leave Hospital Bureau Inc.


Revenue shortfall forces AHA to trim staff 11%.


Old GOP names and faces hitch back to Washington with Reagan.


CON regs hand HSAs a 'loaded gun'.

CON regs hand HSAs a 'loaded gun'.


Mexico's national healthcare system growing: may soon cover all citizens.


M.D. surplus--a dream, or letdown?

M.D. surplus--a dream, or letdown?


Hospitals emphasize guest relations.

Hospitals emphasize guest relations.


Interest rates surge to new highs.

Interest rates surge to new highs.


Authorities welcome more senior manager proposals.


Snowed under by regs, hospitals unbundle services.


Malpractice rates will rise sharply in '81, risk control execs believe.


4% of professional liability claims involve electromedical equipment.


Quality assurance pressures may spur use of epidemiology systems.


15% premium cut provides incentives to adhere to risk control program.


Nursing 'worth' key to shortage.

Nursing 'worth' key to shortage.


Manager education hard to grade.

Manager education hard to grade.


Location and capital spurring proprietary hospital growth.


For the well-dressed trend-setter: a surgical scrub suit.


One dealer's dilemma: the disappearing doctor.


British lack purchasing guidelines, says survey.


For better or worse: hospital costs and health insurance.


Ensuring adequate rewards for risk.

Ensuring adequate rewards for risk.


Chains lean to specialized outlets in home care market.


Plaintiffs to Court: 'A very simple case;' AHSC: No VHA member 'obligation' to buy.


Management development secrets.

Management development secrets.


Forms management solves problems: saves money.


The leadership matrix.

The leadership matrix.


The med ed numbers game: the "GMENAC" panel recommends severe cutbacks.


Life support: a three-way conflict.

Life support: a three-way conflict.


SI: past, present, and future.

SI: past, present, and future.


Shortage of pathologists in Canada: crisis or just a serious problem?


Cyclic scheduling via integer programs with circular ones. A fundamental problem of cyclic staffing is to size and schedule a minimum-cost workforce so that sufficient workers are on duty during each time period. This may be modeled as an integer linear program with a cyclically structured 0-1 constraint matrix. We identify a large class of such problems for which special structure permits the ILP to be solved parametrically as a bounded series of network flow problems. Moreover, an alternative solution technique is shown in which the continuous-valued LP is solved and the result rounded in a special way to yield an optimum solution to the ILP.


Waiting time in a multi-server cutoff-priority gueue, and its application to an urban ambulance service. We consider a priority queue in steady state with N servers, two classes of customers, and a cutoff service discipline. Low priority arrivals are "cut off" (refused immediate service) and placed in a queue whenever N1 or more servers are busy, in order to keep N-N1 servers free for high priority arrivals. A Poisson arrival process for each class, and a common exponential service rate, are assumed. Two models are considered: one where high priority customers queue for service and one where they are lost if all servers are busy at an arrival epoch. Results are obtained for the probability of n servers busy, the expected low priority waiting time, and (in the case where high priority customers do not queue) the complete low priority waiting time distribution. The results are applied to determine the number of ambulances required in an urban fleet which serves both emergency calls and low priority patients transfers.


Structured interviewing: avoiding selection problems. In place of the old-fashioned, casual interview, which is unreliable and occasionally invalid in the context of EEO and affirmative action developments, the authors propose the adoption of structured interviewing for job selection. They contend that objective testing--oral, written and physical--would be more reliable, avoid the labyrinth of EEO, and ultimately yield better candidates for the jobs offered.


Interpreting the new sexual harassment guidelines.


Career development: some questions and tentative answers--a future-oriented look at our methods of job enrichment. More and more employees are determining their own future within their work--a trend likely to pick up during the '80s.


A perinatal group in family practice.

A perinatal group in family practice. Pregnancy is a time of natural stress that can have a marked effect on the relationship of the expectant parents and, subsequently, on the child. A group was formed to provide emotional support for the women and to involve the husbands in the process. By offering this service in a family practice residency program, it not only has a beneficial effect on the outcome of the pregnancy but also gives family practice residents a valuable learning experience.


Developing a career guidance program through the job family concept. This addition to career pathing helps employees better understand themselves by probing the psychological characteristics of jobs and matching them to employee expectations.


An account of the proceedings in a Title VII pay discrimination case: Lemons versus the City and County of Denver.


Patient comprehension profiles: recent findings and strategies. Poor comprehension of instructions is a major cause of failure to achieve desired results in patient education. Tests to measure comprehension levels of patients and formulas to predict readability levels of materials can effectively determine gaps between instruction and comprehension. Strategies, many of which require a minimum amount of additional effort, can be applied to eliminate gaps and thereby achieve a better quality of care through educational programs.


A 25-year trend: what chief pharmacists think about detailmen.


Expected and actual knowledge of hospital patients.


Counselling needs of women with a maternal history of breast cancer. Thirty-nine women with a maternal history of breast cancer were interviewed to determine their needs, concerns, and health practices pertaining to breast cancer. Each said they had been profoundly affected by their mother's illness. Many had feelings of guilt and anxiety, which had arisen after the diagnosis of their mother's breast cancer. Although most subjects (79%) practiced breast self-examination (BSE), both examiners and nonexaminers felt that their emotional reactions to breast cancer might keep them from performing an adequate examination. Subjects sought frequent breast examinations from a health professional--59% had two or more examinations a year--and found they helped to relieve anxiety. Most of the subjects (82%) though their risk of breast cancer was increased because of their maternal history of breast cancer. They were also concerned about the effects of birth control pills, radiation, and other factors on their breast cancer risk. Although subjects were concerned about risk, they had only vague, and sometimes incorrect, information about the magnitude of the risk. Based on these findings, we suggest that, beginning at the time of their mother's diagnosis, women whose mothers have breast cancer would benefit from ongoing counseling on emotional issues from a service that provides information and counselling about breast cancer risk, from receiving instruction in BSE and from having regularly scheduled examinations from a health care professional.


Reducing preoperative anxiety in children: information versus emotional support. Many different programs are now being used to help children cope with the emotional trauma of hospitalization. This paper presents the results of a study that explored the relative effectiveness of the major components in these programs. Comprehensive intervention, which incorporates both emotional support and information about hospitalization, was found to be the most effective program in reducing preoperative anxiety. An intervention that consists only of emotional support was also found to be capable of reducing anxiety. Application of these findings to the care of hospitalized children and the design of future research methodologies are examined.


Long-term effects of empathy training on the interview skills of medical students. A study examining the effects of empathy training, three years after completion of the program, is reported. The results indicate that, while the students' ability to empathize declines significantly with time, their level of skill is still higher than that of students who receives no training and are at a comparable stage in their medical education. The findings provide further support for requiring a continuing emphasis on training undergraduates in communication skills throughout their medical curriculum.


Intervention to improve compliance with pediatric anticonvulsant therapy. Daily anticonvulsant drug therapy is the major treatment of seizure disorders. Compliance with the prescribed therapy is essential but not always achieved. Among 201 pediatric seizure clinic patients taking phenobarbital and phenytoin, 70 (35%) were judged noncompliant on at least one medication. The mothers of these patients were randomly assigned to experimental or control groups. An educational intervention in the form of a mothers' group discussion led by the clinic social worker was tested. On follow-up, medication compliance in the intervention group was judged significantly greater than that of the control group.


Parents' evaluations of genetic counselling. Genetic counseling represents a new and important health service, but little is known about how the clients of genetic clinics actually experience and view the genetic counseling process. This paper reports on the evaluations made by clients of a genetics clinic and their recommendations for ways to improve and expand this service. In their comments, clients stressed the need for more time and individual attention from genetic counsellors, additional follow-up and supportive counselling, and increased efforts to educate the general public about birth defects. Their recommendations are discussed in terms of the implications for developing and improving genetic counselling services.


Ethnicity and clinical care: Indians.

Ethnicity and clinical care: Indians.


New approach to finances at mental health center.


HMO in Congress' backyard is bailed out.


Employment patterns and related opinions: a survey of physical therapists. Physical therapy educators require specific information about the number of graduates who remain in the profession and about their opinions related to undergraduate training and their postgraduate requirements. A mail questionnaire survey of physical therapists who graduated from an Ontario university's physical therapy program between 1969 and 1978 was conducted to determine: occupational patterns, satisfaction with undergraduate preparation for employment, interest in graduate studies and, if the graduate was unemployed at that time, the need for re-entry preparation for employment. With one follow-up mailing to non-respondents, a response rate of 93.4 per cent was obtained. Of the 141 respondents, 110 were working full-time and 15 were working part-time in physical therapy. Eighty-eight per cent of employed physical therapy graduates agreed that their education had prepared them sufficiently for employment. Fifty-three per cent of the graduates indicated that they would like to pursue an area of clinical specialization through graduate study. It is concluded that the graduates of the program under study believe that they have been well prepared for employment; not only do they maintain a clinical interest in the profession, but they aspire to personal and professional advancement through graduate studies.


The doctor-physiotherapist relationship: the physiotherapists' perspective. A study of the professional relationship between physicians and physiotherapists, as perceived by physiotherapists, was undertaken. An analysis of the replies of a sample of physiotherapists to 20 closed-ended questions is presented in the context of the controversy about the proper relationship between medicine and physiotherapy. The data reveal that physiotherapists wish to strengthen their bond with physicians, but are not satisfied with the performance of doctors as team leaders, consultants, and resource personnel. It is possible, the data suggest, that the physician may not be the best qualified to act as team leader in every situation, for every aspect of medical treatment, for the care of every patient.


"Blues" cut federal employees' benefits.


Training middle management in cost containment techniques: a federally funded program.


Equipment specifications and performance standards: Education Committee, Midwest Region--AHRA.


Objective equipment selection and performance evaluation.


How long has it been since you reviewed your silver recovery contract?


Radiology management in the 1980's: are you prepared?


Format for comparing equipment specifications.


Physiotherapy into the 80's.

Physiotherapy into the 80's. During the 80's, physiotherapists will have to deal with many important issues such as effective legislation; the basic educational requirement for CPA membership; changes in the code of ethics; accreditation of educational and clinical programs; and standards for quality of care. The greatest challenge for physiotherapists may, however, lie in provision of cost-effective treatment. As governments shift from bedded to non-bedded services, the opportunities for physiotherapists to provide outpatient services may lie in increased private practice operations and the expanded services of community health centres, home care unit, and mobile clinics traveling to remote rural communities. Increasing demands by government and consumer groups for quality control of services provided will create a need for clinical research, to make certain that treatments are effective. Physiotherapists must continue to ensure that increases in the profession's basic educational requirement, body of knowledge, level of specialization, leadership development, resources, and status in the health team are adequate to meet the future expectations of the public sector. The problems facing physiotherapists in the '80s revolve around their credibility--as a professional groups, as clinicians and researchers in a specific field, and as members of a helping profession.


The ambulatory care survey at the University of Washington.


Functional value analysis of a physiotherapy department. In these days of rising health care expenditures and public demand for physiotherapy services, physiotherapy managers are faced with many decisions regarding demands for services which run counter to budgetary limitations. This paper presents a new methodology -- Functional Value Analysis (FVA) -- which the physiotherapy department manager can use as one solution to his problem of continuing the provision of services while under financial constraints. Functional Value Analysis is a process that can be used to analyze and determine the cost of various activities that occur in a physiotherapy department. This process can also be used to generate cost-saving ideas and to priorize them. The Task Force Committee of a Manitoban hospital wanted cost-saving ideas, for 30 per cent of its budget, documented. Therefore, the physiotherapy department, along with other professional service departments at the hospital, undertook such an FVA study in October of 1978. Out of the physiotherapy departments annual budget of $615,960, the department was able to document cost-saving ideas of $267,346. Functional Value Analysis is one tool for a department manager's use which can reduce costs in an organized logical manner.


Equipment specifications and performance standards for equipment pertaining to the nuclear medicine department.


A radiology management information system designed to assist a new management team.


Legal forum: our radiology department is considering purchasing some new equipment.


The impact of regimentation on radiology departments.


A sample radiology administration job description.


Big government and hospital care: prescription for disaster.


The health services administration program at Quinnipiac College.


The master of health administration program at Loma Linda University.


Blues aid in hospital energy conservation.


The Center for Health Services Research at the University of Washington.


The graduate program in health administration at Duke University: financial alternatives.


Formal and informal care: discontinuities in a continuum. Informal caregiving by family, friends, neighbors, and self-help groups is being given greater attention as human-service policy seeks to establish a continuum of care knitting together professional efforts and informal helping. However, there are many contradictions in assumptions and perspectives about who should handle problems and in what way. Alternative modes of interaction are outlined to indicate the variety of relationships that have developed in response to differences in assumptions about care. Collaboration between formal and informal helping efforts requires that the informal sector be able to influence professional and organizational expectations regarding responsibility, authority, and credibility.


A systems approach to administrative preceptorship for undergraduate health administration students.


The perfect hospital...meeting M/E design parameters.


The hospital industry's new vulnerability to antitrust.


Variable staffing.

Variable staffing.


Coping with the 1980s.

Coping with the 1980s.


Utilization of alternate staff patterns as a cost-effective measure.


Working meetings that work.

Working meetings that work.


Competency by any other name: external degree programs.


The voluntary effort: facing a decade of decision.


Mental health center strives for quick return to community.


Hospital laundries should pay tax.

Hospital laundries should pay tax.


Hospital addicts: fakers who fool doctors.


Beyond cost containment.

Beyond cost containment.


Remedies for curing the "convenience shopper".


Interviewing: maximizing results.

Interviewing: maximizing results.


Improved cash flow: a cost containment tool.


Peer review...a part of the solution?

Peer review...a part of the solution?


MONITREND: a management tool to contain costs.


Federal influence on medical technology.


Volunteer chaplains: a spiritual resource for Southlake patients.


Product evaluation: a must for the cost-effective hospital.


Don't overlook profit when you're considering cost containment.


Can the consumer control health care costs?


Emergency room: hospital liability for physician negligence.


Opportunities for energy conservation.

Opportunities for energy conservation.


Recruitment and placement service working to fill manpower needs in Texas.


Alternatives to new construction.

Alternatives to new construction.


LIFE: putting physicians in touch with physicians.


Hospital risk management coming into its own.


Bringing medical care to underserved and boosting patient occupancy rate.


Flexible phasing: a must for long-term construction projects.


The role of the investment banker in construction financing.


Helping ourselves: the limits and potential of self-help.


SAVE in the Carolinas: new system helps contain supply costs.


Planning an approach for Q.A. evaluation.


Managing contractors and construction projects.


Informed consent in human experimentation: the scientist's responsibility--the subject's right.


Definition of death: an emerging consensus.


Massachusetts hospitals use trustees to defeat rate rules.


Nursing 1980: new responsibility, new liability.


Trustee development program: productivity and the hospital board.


Tax decisions bring good and bad news for hospitals. Three recent court decisions denying tax exemptions to shared hospital laundry service organizations should dispel the belief that tax exemptions will automatically be granted to shared service organizations. Two other decisions on the sale of goods and services to persons other than hospitals suggest that the IRS is moving toward a position that accepts certain services as indigenous to the exempt functions of a modern community hospital.


Managing your hospital's investments.

Managing your hospital's investments. If the board exercises control in investment management, trustees can balance conflicting demands between current cash needs and their fiduciary obligation to preserve capital. Appropriate organization, establishment of investment goals, and implementation of procedures to monitor investment performance all are necessary elements of control.


Leadership is the trustee's first duty.

Leadership is the trustee's first duty. The essence of leadership is in keeping alive that spirit in an organization that spurs it to uncommon accomplishment. Four attributes of leadership--competence, concern, spokesmanship, and character--are most important to the successful management of institutions.


Restructuring: a responsible alternative to hospital closure. For hospital boards faced with falling occupancy, restructuring the hospital and the health services system in which it functions may be the best way to ensure that the community continues to have access to needed services. This article outlines the more important aspects to be considered in any restructuring of health care services.


How to meet the new demands in ambulatory care. Faced with increasing pressures to become more competitive, many hospitals are rethinking their ambulatory care services. This article suggests considerations that should be addressed in the organization and design of ambulatory care services and outlines a plan of action for boards and administrations wishing to expand their involvement in ambulatory care.


DoD selects former liner as hospital for new 'RDF'.


They also serve who hold a hand and wait.


For some New York elderly, volunteers fill gaps in service.


Fresh air, sunshine, flowers combat doldrums, aid in rehab.


Student volunteers in mental health: their presence teaches.


Are subsidized employees volunteers? Certainly not!


Involvement of 3-5 year old children as volunteers.


Sanitizing: an important job for nursing homes.


"The crisis in health care for the poor.


Community support systems and urban mental health. The many social systems of which individuals are members have an important role in promoting and restoring mental health. Pilot projects have shown that "natural" support systems in communities can collaborate with mental health professionals in programs designed to promote mental health in communities. Government plans for community support systems for deinstitutionalized psychiatric patients have been very inadequate and have largely ignored natural support systems. Planners and providers should take advantage of the considerable resources for support which already exist in urban communities.


'Friend to Friend' brings non-family visitors to nursing home patients.


Student insights into a home health service.


The nursing home: a base for alternates of care programs.


Cardiac rehabilitation techniques in an educational therapy program.


Manual arts therapy in cardiac rehabilitation.


A corrective therapy program in cardiac rehabilitation.


Child care succeeds among the elderly.

Child care succeeds among the elderly.


Occupational therapy in cardiac rehabilitation.


Greenwich Village spirit embodied in the village nursing home.


St. Joseph's Manor: a self-contained community for the elderly.


Physical therapy in cardiac rehabilitation.


Emergicenters' challenge traditional paths of care.


Experts discuss investment potential.

Experts discuss investment potential.


What's happening to American integrity?

What's happening to American integrity?


Q. Can physicians and businessmen work together on problems of health care delivery? A. In Birmingham, Alabama, the answer is yes.


Design crucial to Canadian central.

Design crucial to Canadian central.


Why health care is a costly disgrace.

Why health care is a costly disgrace.


The mysteries of employee pricing solved.


A primer on implementing job redesign.

A primer on implementing job redesign.


How breakable is the chain of command?

How breakable is the chain of command?


A plea for our doctors.

A plea for our doctors.


Public Health Service--Privacy Act of 1974. Notification of new system of records: "clinical research; records of subjects in intramural research, epidemiology, demography, and biometry studies on aging.". In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to adopt a new system of records. "Clinical Research: Records of Subjects in Intramural Research, Epidemiology, Demography, and Biometry Studies on Aging." DHHS/NIH/NIA, 09-25-0142. These records will be used to accomplish scientific research conducted by intramural scientists employed by the National Institute on Aging (NIA), and by hospitals, universities, research centers and research foundation under contract with NIA. These research activities aim at determining the health status of individuals and changes in health status over time, the incidence and prevalence of certain diseases and problems of the aged in certain populations, and changes that take place as the individuals age who are under study.


Additional standards for human blood and blood products, source plasma (human); amendment of storage temperature requirements: Food and Drug Administration, Final rule. The Food and Drug Administration (FDA) is amending the storage temperature requirements for Source Plasma ((Human) intended for manufacture into injectable products. This change permits an inadvertent exposure of the product to an episode of storage temperature fluctuation between -20 degrees and -5 degrees C for no more than 72 hours without requiring relabeling of the frozen product from "Source Plasma (Human)" to "Source Plasma (Human) Salvaged." Data submitted to the agency demonstrate the satisfactory recovery of clotting factor concentrates from the plasma despite the temporary elevation of storage temperature.


More medical specialists are setting up practice in smaller towns, study shows.


More public hospitals are sold to firms despite objections from poor and aged.


Law reform survey--Part 7. Explaining the risks.


How much to tell the patient.

How much to tell the patient.


An occupational therapy program with the chronic care patient. The following is an example of what the occupational therapists at the Allan Memorial Institute in Montreal have done to accommodate the changing psychiatric population at the hospital. Over the past few years it seemed that certain of our programmes, being too high level, were no longer suitable for the more chronic type patient, being admitted. Thus, a re-examination of attitudes towards treatment was necessary as was the establishment of programmes with a different orientation. In doing this, the focus changed from former techniques such as projective art to a concentration on more reality oriented programmes for this group. The two programmes described are examples of this.


The alternate program; an alternative for chronic care. This paper describes a 2 1/2 year pilot project for long term schizophrenic patients. It describes the kind of patients involved, the program itself, the role of the staff, the results and finally the therapist's reflections working with chronic patients for long periods of time.


Identification of infection problems in intensive care units.


Isolation techniques in critical care units.


Prevention and control of infections in specialized areas--viral hepatitis.


Lower respiratory tract infections.

Lower respiratory tract infections.


Urinary tract infections.

Urinary tract infections.


Infection control considerations in the care of the immunosuppressed patient.


Coming: help in finding a medigap policy that makes sense.


Runaway hospital bills: what we can do.

Runaway hospital bills: what we can do.


Medical imaging: the nature of technological change and its impact on the cost-effectiveness of image recording.


AHSC denies VHA agreement violates antitrust laws.


Your best supplier in town: your community hospital.


Don't forget the patient!

Don't forget the patient!


70-bed hospital cuts forms down to size.


What's ahead in the 80's?

What's ahead in the 80's?


Quality assurance and patient consent.

Quality assurance and patient consent.


Public relations and nurse recruiting.

Public relations and nurse recruiting.


CAI tackles health care costs. Interview by Ned Barnett.


Metamorphosis of a medical center.

Metamorphosis of a medical center.


International surgical centers: surgery in Lund, Sweden.


The 'problem' employee: helping workers cope with personal crises can cut costs.


California HMO offers optional dental plan.


Rock concert disaster tests emergency plan.


Emergency care advertising pays for Nevada unit.


"Emergency med-phone"--call-in diagnosis cuts hospital patient load.


Rooftop heliport aids critical care access.


University of Nebraska: aircraft fleet enables far-reaching critical care.


Disaster plans set in motion by collision off Florida coast.


Mercy Hospital ED communicates directly with deaf persons via TTY.


Stress management improves quality of work life. The multimodal stress management program discussed in this article was developed in a hospital setting. Refined during the past five years, this intensive six-week course helps employees handle tension on and off the job by teaching them a variety of stress reduction techniques.


Health care educators assume new roles.

Health care educators assume new roles. The creation of a health care marketplace in the next few years will force hospital-based educators to redefine their responsibilities to the institution as a whole. Several experts in the field share their ideas on how educators can adapt their function to encompass the new challenge of competition facing hospitals today.


Although Vegas EMS is OK at fire, doubt remains.


Training and education function faces critical choices. This article sets forth a framework within which the hospital training and education function can assess its current philosophy and subsequent actions. The choices that the function makes will determine whether its future orientation will be a dynamic or a static one.


Oregon nurse designs latest in ED fashions.


Developing an adverse drug reaction program in nursing homes. The study of 826 geriatric nursing home patients was undertaken by a pharmacist to determine the incidence of adverse reactions to drugs. A formalized adverse drug reaction reporting program was used as the basis for the detection of unwanted drug effects. Approximately 27% of patients experienced a moderate to severe adverse effect. Five groups of drugs accounted for three-quarters of the reactions detected. The majority of these reactions were predictable and preventable. Females over the age of 70 on large quantities of drugs were significantly more susceptible to experiencing an adverse reaction. Physicians implemented 76% of pharmacist initiated recommendations for the treatment of adverse effects and were appreciative of increased pharmacy involvement. The implementation of such recommendations was felt to have substantially reduced the incidence of drug-induced acute hospitalizations. Although the information was generated in nursing homes, it may be generalized to other geriatric specialty areas such as medical wards and extended care units. Several recommendations are provided on how other pharmacists can implement similar clinical services in their areas of professional practice.


Health care in jails: an evaluation of the American Medical Association's pilot projects. In 1975 the American Medical Association was awarded a grant by the Law Enforcement Assistance Administration to conduct pilot projects to improve the quality of health care in jails. The medical societies of six states were selected as subgrantees and projects were initiated in thirty jails. The evaluation of these projects involved both process and impact components. The principle criterion for the process evaluation was the success of jails in meeting the standard of health care for jails that were established by the AMA as part of the project. The principle criterion employed in the impact assessment was the extent of improvement in the early detection of inmates' health problems. The project was determined to be successful in both the process and the impact evaluation, although notable improvements in jail health care are still to be made.


Assessing your group's public image: start from your patient's perspective.


The shock fighters.

The shock fighters.


Forming a rural satellite network.

Forming a rural satellite network. Group practices enter into a satellite program for many different reasons, the most frequent probably being an effort to expand their referral base. But establishing a successful satellite system is always difficult; either the satellite service area overlaps and intrudes into someone else's "territory" or the area in which the satellite is located has no other pre-existing medical support services of any kind, in which case a group's attempt to "fill the void" often feels like stepping into it. This latter case could have been the fate for the Tarboro Clinic had we not been fortunate enough to become involved in a unique partnership alliance to bring quality health care services to eastern North Carolina.


The provider, the regulator, the researcher: a look at multi-institutional systems.


Renal dialysis: new regulations graft efficiencies onto ESRD program.


Developing a budget.

Developing a budget.


The physician in group practice.

The physician in group practice.


25 die in nursing home.

25 die in nursing home. On July 14, 1980, at approximately 9:30 pm, a fire in the Extendicare Skilled Nursing Facility in Mississauga, Ontario, resulted in the deaths of 25 patients, most of them elderly. The area of origin of the accidental fire was a patient room on the top floor of the three-story, fire-resistive building. Significant factors that contributed to the fatalities in this fire were rapid fire development, the failure to extinguish the fire in its incipient stage, failure to keep the door to the room of origin closed, improper staff actions, and delayed alarm to the fire department.


Howard University Hospital fire, Washington, D.C.--successful construction and reactions prevent fatalities. If the arsonist who set fire to the fourth floor of this hospital intended to destroy the whole hospital, his plans were foiled by the hospital's lifesafety systems and the quick action of the hospital staff. Corridor smoke detectors activated the building fire alarm system, notified the hospital fire brigade and staff, notified the fire department, and closed the corridor smokestop doors. Members of the staff immediately closed the doors to all patient rooms in the area of the fire that were exposed to smoke and heat, and then began evacuating patients from the area. There were no fatalities in this fire. Although this fire is four years old, we think it is worth studying for its contrasts with Mississauga.


Public relations entails more than press agentry. Citing both current and early contributors to the field of fund raising and public relations, the author asserts in this paper that the need for effective communication is just as great in the non-profit sector as it is in business. Attempts must be made to gain public support and to educate the community of the function, obstacles, achievements, and goals of a nonprofit agency.


Future of development rests with fund raisers. Coordinated efforts in the '80s will make this the "golden age of philanthropy," the author believes. The going will not be easy, however. He outlines here the problems facing philanthropy and offers some poignant solutions and encouragement.


Curbing costs? Consult your computer.

Curbing costs? Consult your computer.


Plan, then expand.

Plan, then expand.


Systems planning smooths the way for primary nursing in a new facility.


Holistic care for the 60+: volunteers and a community make it happen.


Mental health: progress but in slow tempo. The stigma of 'certification as a lunatic' was much reduced by the Mental Health Act of 1930 but, despite enlightenment on psychiatric problems particularly since the last war, progress towards a better form of care for the mentally ill has been slow. Hospital care has improved over the past 50 years, but once in the community patients still suffer from isolation. In this article Professor Sir Denis Hill traces the advances made since 1930 and poses the question, 'How far have we come since'.


Priorities: the art of upsetting the patient. Management is about achieving objectives, and one of the main objects of the health service is to provide a high standard of care to patients. So when they are unnecessarily upset, inconvenienced or annoyed, it is reasonable to ask what is wrong with management, at ward level or above. Ann Gabell, a midwife with recent experience as a patient, poses questions for managers of several disciplines and functions.


Work for minds on the mend.

Work for minds on the mend. People suffering from mental illness need the opportunity to regain their self-esteem and find an identity. 'Restore', a pioneer scheme in Oxford, provides a new approach to the provision of sheltered work for the mentally ill. Here Paul Fletcher describes how the scheme has brought a new dimension to the psychiatric services.


Voluntary services: cause rather than concept. Voluntary enterprise is deeply rooted in British social life. There is no reason to assume it will be any less crucial in the remaining thousand weeks of the twentieth century than it has in the past. This was the burden of a talk given by David Hobman, director, Age Concern England, to an NCSS seminar.


Energy conservation: when the bill is in millions. Current energy economy measures are estimated to be saving the NHS 30 m pounds a year. It is believed that at least another 30 m pounds at today's prices can be saved without affecting direct patient care or general comfort levels in hospitals. This article by V.E. Skegg, superintending engineer, DHSS, outlines the nature of the problem and the steps being taken. It also emphasises the need for the active co-operation of all staff, both administrative and other disciplines, particularly in the use of electricity, if the amount and cost of energy is to be contained.


The impact of video technology on the use of drug information resources.


Health and safety--6: wise words from a friend.


The illusory partitions between school, community and hospital health education.


Inventory transfer receipts.

Inventory transfer receipts.


Competition slows inflation rate for medical-surgical supplies.


Price monitor: trash can liners.

Price monitor: trash can liners.


Drug monitoring and adverse drug reactions: a basic program for prescription summation.


ABC inventory control: an analysis.

ABC inventory control: an analysis.


Activities of a college based drug information center.


Spreading the word on materials management.


Oversupply due to back-order shipment.

Oversupply due to back-order shipment.


Color-coded dot system reduces inventory headaches.


Revisiting the solution market.

Revisiting the solution market.


Purchasing agent extraordinaire--do you see yourself here?


What will quality assurance mean to infection control practitioners?


Unsuspected hepatitis A case spreads infections to hospital employees.


Study examines policy; how well is it followed?


Reagan's prescription for health industry: cut federal costs.


Proposed nursing home regulations no assurance of improved care.


St. Francis Hospital, Honolulu. Comprehensive renal disease program crosses geographic boundaries. Six satellite facilities affiliated with one hospital enable distant residents and visitors to receive dialysis treatment. Patients may opt for self-care, assisted care, or transplantation, and receive psychological, pastoral, nutrition, and rehabilitation services.


DRG reimbursement in New Jersey: some initial results. New Jersey hospitals' experience with the DRG method of case mix reimbursement leads to the following conclusions: (1) the number of DRGs should be reduced; (2) all patients should not be charged the same payment rate; (3) a method is needed to adjust for intra-DRG shifts; and (4) hospitals need more information to manage efficiently.


DRGs: optional in Maryland's GIR system. Maryland hospitals prefer the guaranteed inpatient revenue system to the DRG method of case mix reimbursement for its flexibility of administration and ease of use in refining case groups.


DRGs: a management control tool in hospitals and multiinstitutional systems. DRGs can be the basis of an effective system of management control because they facilitate comparisons of indicators within and among hospitals.


Automated DRG systems: unanswered questions. Health care facilities seeking to prepare for a DRG-based or a similar case mix system may consider a range of options: microcomputers, shared computer services, a generalized data base management system.


Effective ministry unifies spiritual, professional life. Effective pastoral care departments are organized and periodically evaluated. Goals and objectives contribute to the department's effectiveness; they do not in themselves, however, transform the department into a religious community.


Court upholds hospital's exclusive contract service.


St. Mary's Hospital, Decatur, IL. Office nurse program enhances continuity of care.


Indirect rates: what they are to universities, hospital, and other nonprofit institutions.


President signs Paperwork Reduction Act; replaces and goes beyond Federal Reports Act.


OMB publishes memorandum on limiting federal support for hospital construction.


EEOC to expand national origin discrimination guidelines.


Congress passes Health Science Promotion Act; clarifies and amends health planning law.


Proposed grass roots lobbying rules would impact primarily on proprietary hospitals: allieds and hospitals encouraged to comment to avoid inconveniences.


Specs can protect you and cut costs.

Specs can protect you and cut costs.


You can make a big cut or a big mistake.


Decoration as a maintenance problem.

Decoration as a maintenance problem.


ICU nurses--the shortage question.

ICU nurses--the shortage question.


Managing the health care estate.

Managing the health care estate.


Chart your needs for the 80s.

Chart your needs for the 80s.


Energy conservation: potential for savings.


Medical technology: status quo or more regulation?


Post-graduate medical trainees must be a joint responsibility.


The role of the community hospital in addressing horizontal problems.


An alternative approach to career-oriented health administration education.


Patient advocates: how managers can work with them.


New manpower policy adopted: American Society of Internal Medicine.


Let's leave well enough alone.

Let's leave well enough alone.


Small hospitals will have to redefine their role.


Volunteer board members and continuing education: issues, realities, and questions.


Productivity measurement: improving practice efficiency.


Motivational theory applied to hospital pharmacy practice. In recent years a great deal of attention has been paid to motivation and job satisfaction among hospital pharmacy practitioners. Institutional pharmacy managers should become more aware of ways in which they can motivate members of their staff. Specifically, Frederick Herzberg's Two-Factor Theory is discussed in reference to its origination, major tenets, and practical applications in institutional pharmacy practice settings. Principally, Herzberg's theory explains needs of workers in terms of extrinsic factors called "hygienes" and intrinsic factors called "motivators." The theory suggests that job satisfaction and dissatisfaction are not opposites but two separate dimensions. According to this theory, an employee will be motivated if the task allows for the following: 1)actual achievement, 2) recognition for achievement, 3) increased responsibility, 4) opportunity for growth (professionally), and 5) chance for advancement. It is concluded that some of these suggested applications can be useful to managers who are faced with low morale among the members of their staff.


Legal authority and liability of hospital security officers.


A comparison of the pump syringe method with other methods for adding potassium chloride to Travenol large-volume parenterals.


Strategies in medical manpower: balancing geographic distribution.


Laundry managers should lead the way in controlling linen.


The hospital security professional: an approach to managing aggression.


Laundry, service employees stage walkout at 2 Baltimore hospitals.


A shift from specialty to primary care.

A shift from specialty to primary care.


Scientists must open a public dialogue about why we cannot survive in a no-risk society.


"Doctor, I'm one of Jehovah's Witnesses...".


A small hospital's approach to CME: teach one another.


Statistics for 4.33 day wards?

Statistics for 4.33 day wards?


Report and success rates in obtaining out-patient case notes.


Construction managers improve accuracy of building cost estimates.


Trustee group organizes to ensure stronger voice for board members.


SS alternative can save hospitals millions, improve retirement benefits.


Tragic hotel fires trigger disaster plans: fire forces hospital evacuation.


Homes must provide indigent beds.

Homes must provide indigent beds.


No startling regs, but competition bills, payment experiments in wings.


Congress will transfer policy reins.

Congress will transfer policy reins.


Bleak future for child health benefits.

Bleak future for child health benefits.


Groups devise creative pay plans.

Groups devise creative pay plans.


More competition, increasing capital needs spur hospitals to restructure.


Hospital tax-exempt market almost shut down by high rates, bond glut.


If you can wait, hold bond issues; '81 tax-exempt market will improve.


Gloomy economic prospects will spur hospital acquisition market.


Must accelerate raises for CEO, nursing director to stay competitive.


Hospitals feel recessionary twinges from prolonged, high umemployment.


Hospitals will spend 25% more for heating oil in 1981--if they're lucky.


Profit margin squeeze shoots supply costs up.


New patient monitors reduce nurse fatigue, simplify infection control.


FFT Doppler technology processes blood velocity information rapidly.


Manufacturers strongly promote vertical integration of ECG services.


Boston City Hospital installs first digital multi-modality imaging unit.


First digital radiography equipment makes splash in imaging market.


Managing financial crisis in the laboratory. Recently the Department of Pathology, Cooper Medical Center, suffered a sudden reduction in its operating budget. Here the author explains the cause of the crisis and he outlines, for those whose laboratories may experience a similar cut in funds, the steps his department took to meet the reduction without decreasing significantly the laboratory services provided.


Optimizing human resources: a case for preventive health and stress management. Traditionally, medical treatment in this country has focused on treatment of problems and illness after they've reached the point of crisis and pain. But now, managers are beginning to realize that preventive health and stree management can save money for the organization while improving the quality of worklife for employees.


Medical economics: lab fees and the office visit. Laboratory fees constitute a significantly greater part of the usual cost for an office visit than they do of the total hospital bill for inpatients. The author of this article shows how much greater, and how the laboratory share of the bill depends on where the testing is performed.


Patient case mix: it's not too early to become involved. The number and types of patients treated by a hospital is referred to as the patient case mix. One classification approach--Diagnosis Related Groups--is being used in New Jersey and Maryland to determine hospital reimbursement rates. In this article, the authors define the concept of the patient case mix, describe DRGs, and forecast the impact they may have on hospital laboratory operations.


Management principles to make employees feel like somebodys.


The other guy's shoes.

The other guy's shoes.


Cautions about cafeteria-style benefit plans.


Selecting the consultant.

Selecting the consultant.


Accreditation of personnel administrators: an alternative interpretation. As accreditation is a fairly new procedure to the field, it still continues to generate controversy. In this the first of two articles on accreditation, the author presents reasons for not taking the accreditation test.


Continuity of care and poisoning prevention education.


Accreditation of personnel administrators: theory and reality. As the second article in our series on accreditation, the author discusses the need for becoming accredited in personnel.


Education and counselling for cancer patients--lifting the shroud of silence. A demonstration education and counselling project for cancer patients was developed in a community hospital. A team comprising a psychologist and a nurse patient educator were added to existing hospital staff. Based on this experience, we have defined the primary educational and emotional needs of the cancer patient and delineated the related functions and activities of project staff. The organization, nature, and volume of the education and counselling services are presented to provide a framework for others interested in embarking on similar efforts.


How performance appraisal can tie communication to productivity.


Effective employee recognition: concepts and considerations. Employee rewards are an established method of recognizing good work--and are still extremely effective in maintaining a happy, productive workforce.


Effects of crisis intervention in road-injury patients. A study of crisis intervention in men hospitalized for road injuries and followed up three to four months later is described. Results show considerable psychiatric morbidity and potentially health-damaging behavior in a control group of 30 patients. Two other groups receiving different intensities of intervention had significant reductions in symptoms of mental distress and some reduction in physical complaints and work problems. They reported better social support and fewer financial problems and tended to have a shorter stay in the hospital. No differences in initial distress, injuries, or demographic characteristics were found that could account for the differences between the groups. Within groups, better support and fewer stress areas after injury were related to better outcome. These findings confirm the benefit of active crisis intervention, demonstrate the patients' needs for support, and highlight the possibly crucial role of social support. Directions for further research to overcome some limitations of the study are proposed.


Relationship of physician behavior to patient compliance. The authors investigated patients' perception of two aspects of physician behavior during patient-physician interaction, namely, explanation given to the patient and concern for the patient. The relationship between these factors and patient compliance with the therapeutic regimen was then determined. Results showed a statistically significant relationship between these two aspects of physician behavior and patient compliance: the more patients perceived the physician as giving explanations and showing concern, the better was patient compliance.


National health insurance: another alternative. The author proposes a national health insurance plan that would encourage the use of preventive medicine and involve a graduated voucher arrangement. The program would provide a limited amount of free care, copayment beyond the amount covered by vouchers, and catastrophic coverage beyond the copayment level. The maximum price of medical procedures would be set by the government, and would be varied to encourage provider relocation and innovative provider arrangements such as health maintenance organizations.


State hospitals--facing extinction?

State hospitals--facing extinction?


Efficacy of health education efforts in hospitalized patients with serious cardiovascular illness: can teaching succeed? This investigation was designed to assess the effectiveness of a team approach to education for hospitalized patients with serious cardiovascular illnesses. No significant immediate increases in knowledge resulted from the educational program regardless of the patient's previous educational achievements. Modest, late posthospital gains were seen. The investigators question whether the anxiety associated with hospitalization for cardiac surgery or other acute life-threatening events may render ineffective educational efforts undertaken at times of physical and psychological stress.


Guidelines for record-keeping under privacy and open-access laws.


Professionalization and unionization: compatible after all?


SLA 1980 salary survey update.

SLA 1980 salary survey update.


Recipe for a new image in food services.


Marketing yourself in health care.

Marketing yourself in health care.


It's a manager's job.

It's a manager's job.


Providing that extra touch...

Providing that extra touch...


Quality nutrition education for patients.


Cost containment in the food services department.


Educators in action: control of quality with respect to educational programming in hospitals.


What trustees can do to maintain nonunion status. Key issues causing hospital employees to seek unionization include wages and benefits, job security, supervision, staffing, and interprofessional relationships. The board should address these issues through board policy, and it should monitor the implementation of that policy in several key areas.


Hospitals, HSA's and patient education: an opportunity for cooperation?


Regulation and the health care industry.


How much is a hospital worth?

How much is a hospital worth? In addition to their primary role of providing needed health care services, hospitals make an important economic contribution to their communities in jobs, payroll, and institutional purchases. The Wisconsin Hospital Association's economic value project sought to determine the extent to which Wisconsin hospitals contribute economically to their communities and to communicate the findings to opinion leaders throughout the state.


How to choose the right multihospital system. By asking questions that probe into seven important areas--system flexibility, governance, ownership of assets, support services, service area compatibility, financial performance, and political influence--trustees and CEOs can pick a multihospital system that best meets their hospital's needs.


Upjohn's interim care to ease nursing home wait list problems.


Emerging from yesterday: a story of survival.


Horticulture therapy: flora for the nursing home.


Corporate responsibilities of the consultant pharmacist.


Health care for "forgotten patients"--from colds to cancer therapy: tending migrant workers.


Health care for "forgotten patients"--burn treatment: space-age technology.


Health care for "forgotten patients"--at home or in hospital: help for the elderly.


NIH adopts ethics sanction.

NIH adopts ethics sanction.


Standardized CPR kit follows 7-year effort.


Good practices in mental health.

Good practices in mental health.


Participation in a GPMH local project study: the Oxfordshire experience.


European workshop on alternatives to mental hospitals: personal interpretation of the workshop.


Alternatives to mental hospitals: why do we need alternatives?


Alternatives to psychiatric hospitals in Belgium.


Developments in intra-mural and extra-mural alternatives to the mental hospital.


Crisis intervention, treatment and rehabilitation.


District psychiatric rehabilitation.

District psychiatric rehabilitation.


Alternatives to mental hospitals: closing comments.


Planning health care for the elderly mentally infirm.


The Worcester development project.

The Worcester development project.


Las Vegas MDs meet fire's challenge.

Las Vegas MDs meet fire's challenge.


Consulting the consultant.

Consulting the consultant.


Computer at work.

Computer at work.


Productivity boosted in renovated laundry.


Search for contemporary use of traditional language: the Medical Center in Mopti, Mali.


Spot check: in-service training programs.


Cheap shots: quality medical TV on a tight budget.


Rural surgeons of Colorado: the scope of their practice.


Tapping into the power of informal groups.


The American Hospital Association and the American Medical Association have developed a close relationship.


How to nourish the creative employee.

How to nourish the creative employee.


Projects grants for community health services; proposed rulemaking--Public Health Service. Notice of proposed rulemaking. The Assistant Secretary for Health with the approval of the Secretary of Health and Human Services proposes to revise the regulations governing the Community Health Centers grant program. The Health Services and Centers Amendments of 1978 made a number of changes in the statutory requirements governing the operation of the centers. The Amendments, among other things, change pharmacy services from supplemental to primary health services, establish priority for certain supplemental health services, provide an incentive for maximized collection of fees, permit conversion of certain centers from fee for service to prepaid operations, and change the governing board requirements or public centers. The proposed revisions are intended to revise the present regulations consistent with the revised statutory provisions.


Project grants for migrant health; proposed rulemaking--Public Health Service. Notice of proposed rulemaking. The Assistant Secretary for Health with the approval of the Secretary of Health and Human Services proposes to revise the regulations governing the Migrant Health Centers grant program. The Health Services and Centers Amendments of 1978 made a number of changes in the statutory requirements governing the operation of the centers. The Amendments, among other things, change pharmacy services from supplemental to primary health services, make former migratory agricultural workers who are disabled eligible for services, establish priority for certain supplemental health services, provide an incentive for maximized collection of fees, permit conversion for certain centers from fee for service to prepaid operations and change the governing board requirements for public centers. The proposed revisions are intended to revise the present regulations consistent with the revised statutory provisions.


Federal support for hospital construction in overbedded areas. This memorandum established policies and procedures to limit Federal financial support for the construction of hospitals in overbedded areas. The policy for Federal hospitals is that no new or replacement hospitals will be built in an overbedded area unless suitable, existing, non-Federal facilities cannot reasonably be acquired through purchase or lease. The policy for non-Federal facilities is that no Federal grants, loans, loan subsidies, or loan guarantees will be provided for hospital construction or renovation in an overbedded area, unless the proposed project is consistent with an approved local hospital facility plan or the Secretary of Health and Human Services (HHS) determines that it is necessary. In addition, legislation and regulations will be proposed to revise the current Medicare and Medicaid reimbursement policies for costs related to hospital construction or renovation. Finally, legislation will be proposed to revise Federal tax exempt bond financing for hospital construction and renovation in overbedded areas. This memorandum also prescribes agency responsibilities and procedures for implementing these policies.


Grant programs for schools and hospitals and for buildings owned by units of local government and public care institutions--Department of Energy. Notice of proposed rulemaking and public hearings. The Department of Energy proposes to issue revised regulations for administration of the grant programs providing financial assistance for schools, hospitals, buildings owned by units of local government, and public care institutions for the purpose of reducing energy consumption through technical assistance and energy conservation measure projects. In so doing, the Department proposes to amend 10 CFR 455 by making revisions to regulations published in the Federal Register on April 2, 1979 (44 FR 19340) and April 17, 1979 (44 FR 22940). Written comments are requested with respect to these proposed regulations, and public hearings will be held on the dates and in the locations specified below.


Prescription drug products that require patient package inserts; ampicillin and phenytoin--Food and Drug Administration. Final rule. The Food and Drug Administration (FDA) amends its patient package insert regulations to list ampicillin and phenytoin as drugs that must be dispensed with patient package inserts. The ampicillin patient package insert applies to drug products containing amoxicillin, ampicillin, or hetacillin. Elsewhere in this issue of the Federal Register, FDA announces the availability of final guideline patient package inserts for ampicillin and phenytoin and applies the agency's patient package insert regulations to them.


Income and employment taxes; self-insured medical reimbursement plans--Internal Revenue Service. Final regulations. This document contains final regulations relating to self-insured medical reimbursement plans and the withholding of income tax under these plans. Changes to the applicable law were made by the Revenue Act of 1978 and the Technical Corrections Act of 1979. These regulations provide necessary guidance to the public for compliance with the law and affect both employers who maintain self-insured medical reimbursement plans and certain employees who receive medical benefits under these plans.


Electrical standards: Occupational Safety and Health Administration. Final standard. In this final standard, the Occupational Safety and Health Administration (OSHA) establishes "Design Safety Standards for Electrical Systems." This standard revises Subpart S of 29 CFR Part 1910 and is intended to simplify and update the former standard. OSHA has determined that electrical hazards in the workplace pose a significant risk of injury or death to employees, and that these regulations which draw heavily on the experience of the National Electrical Code are reasonably necessary to provide protection from these hazards. The final rule places relevant requirements of the National Electrical Code (NEC) into the text of the regulations, making it unnecessary for employers to refer to the NEC to determine their obligations and unnecessary for OSHA to continue to incorporate the NEC by reference. Additionally, the final rule clarifies certain provisions which were misunderstood by certain interested parties.


Requirements applicable to sterilizations (hysterectomies)--Health Care Financing Administration. Proposed rule. Current Department regulations for the Medicaid and Public Health Service programs provide that no Federal funds are available for hysterectomies unless the woman or her representative has signed an acknowledgment that she was informed that the operation would make her sterile. These amended rules would eliminate the "acknowledgment requirement" in certain situations where the patient is already sterile or an emergency situation exists. We will also clarifying certain ambiguities. The purpose of the proposed regulations is to remove an unnecessary administrative burden created by the current requirements.


Requirements for a health maintenance organization--Public Health Service. Final regulations. These regulations amend the requirements for the operation of federally qualified health maintenance organizations (HMOs) regarding the disclosure of information by HMOs to members, potential members, and employers. These amendments are made to coordinate the requirements of the Employee Retirement Income Security Act of 1974 (ERISA) and Title XIII of the Public Health Service Act (the Act) so as to avoid any duplicative or otherwise unnecessary requirements that might result from the interaction of these laws.


Governing body requirements for health systems agencies: Public Health Service. Notice of proposed rulemaking. These regulations set forth proposed amendments to the regulations governing the selection, composition and responsibility of health systems agency (HSA) governing bodies. They are intended to implement section 1512(b)(3) of the Public Health Service Act, as amended. The proposed regulations have been developed because some of the statutory provisions concerning body composition and selection require elaboration and regulation to ensure that they will be interpreted consistently with Congressional intent.


Content and format for labeling for human prescription drugs; amendment of effective date for certain biological products--Food and Drug Administration. Final rule. The Food and Drug Administration (FDA) amends the effective date of its regulations designating a required content and format for the professional labeling of certain biological products for human use. FDA is taking this action to reduce the burden of the regulations on manufacturers of certain biological products licensed after July 1, 1972.


Health education assistance loan program: Public Health Service. Final regulations. This rule amends regulations for the Health Education Assistance Loan (HEAL) Program, authorized by the PHS Act, by: (1) removing the prohibition against receipt of a HEAL loan during the same school year in which a student receives loans from other federally provided or assisted loan programs under part B of Title IV of the Higher Education Act of 1965, (2) establishing a more flexible definition of academic year, (3) raising the maximum amount which may be borrowed, (4) changing the maximum interest rate, and (5) redesignating the location of the regulations in the code of Federal Regulations (CFR).


Protection of human subjects; informed consent--Food and Drug Administration. Final rule. The Food and Drug Administration (FDA) is issuing regulations to provide protection for human subjects of clinical investigations conducted pursuant to requirements for prior submission to FDA or conducted in support of applications for permission to conduct further research or to market regulated products. The regulations clarify existing FDA requirements governing informed consent and provide protection of the rights and welfare of human subjects involved in research activities that fall within FDA's jurisdiction.


Protection of human subjects; standards for institutional review boards for clinical investigations--Food and Drug Administration. Final rule. The Food and Drug Administration (FDA or agency) is establishing standards governing the composition, operation, and responsibility of institutional review boards (IRBs) that review clinical investigations, involving human subjects, conducted pursuant to requirements for prior submission to FDA or conducted in support of applications for permission to conduct further research or to market regulated products. These regulations and the protection of human research subjects regulations adopted by the Department of Health and Human Services (HHS or Department) published in the January 26, 1981 issue of the Federal Register, establish a common framework for the operation of IRBs that review research funded by HHS and research conducted under FDA regulatory requirements. Compliance with these regulations is intended to provide protection of the rights and welfare of human subjects involved in clinical investigations.


Funding of health-related facilities and other projects under the Public Works and Development Facilities Program--Economic Development Administration. Interim rule. This interim rule modifies two regulations setting forth requirements for funding certain types of projects under the Public Works and Development Facilities Program. One regulation is amended to clarify its scope by noting that its requirements apply to Public Works Impact Program projects. The other regulation is amended to tighten its standards relating to economic impact and to specify that projects involving health-related facilities must be reviewed and approved by the Department of Health and Human Services and, if appropriate, the State Health Planning and Development Agency. In addition, a third regulation regarding project modification is amended to clarify the scope of one provision.


Multiple-address radio systems, allocation of forty-eight 25 kHz channels in the 900 MHz range; and establishment of a new standard for frequency tolerance in the 952-960 MHz band: Federal Communications Commission. Third notice of proposed rulemaking. In response to a petition, the Commission proposes the reallocation of forty-eight 25 kHz channels in the 928-929 and 952-960 MHz band segments to the Private Operational-Fixed Microwave Service and the Domestic Public Land Mobile Radio Service for distribution automation and wide-area control and repeater operations, respectively. The spectrum from 928 to 929 MHz is presently reserved for Land Mobile. The 952-950 MHz band is currently allocated to the Private Operational-Fixed Microwave Service and the International Control Services.


Implementation of state assistance program for training and education in emergency management--Federal Emergency Management Agency. Final rule. This rule sets forth a description of the FEMA training and education assistance program to the States. The program functions through State Cooperative Agreements and is designed to further comprehensive emergency management training including emergency preparedness planning, hazard mitigation, and disaster response and recovery. In response to State and local expressed needs, FEMA was formed to coordinate and manage all disaster planning and response in one Agency. The combined training responsibilities of predecessor agencies are now being administered by the Training and Education Office of FEMA using the State Cooperative Agreements and Regional Support Contracts as the vehicle to meet individual State training needs. This rule defines the objectives and elements of the program, the funding approach, and the State application/proposal.


Requirements and procedures applicable to appeals before the Departmental Grant Appeals Board--Department of Health and Human Services. Notice of proposed rulemaking. The Department of Health and Human Services (HHS) proposes to delete the material currently set forth in 45 CFR Part 16, and substitute new requirements and procedures applicable to disputes arising under certain HHS grants and other programs. HHS also proposes to add certain related provisions to 45 CFA Part 74, which contains general requirements applicable to all HHS grants and cooperative agreements. These proposed provisions are intended to improve the Department's capability to provide a fair, quick and flexible process for appeal from final written decisions.


Privacy Act of 1974; new system of records--Department of Health and Human Services. Notification of new system of records. Mental Health Epidemiologic and Biometric Research Data. In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing a notice of a proposal to initiate a new system of records in the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), National Institute of Mental Health (NIMH), entitled, "Mental Health Epidemiologic and Biometric Research Data, HHS/ADAMHA/NIMH." The purpose of the new system will be to maintain a data base for biometric and epidemiologic research in the area of mental health and mental illness. This system will allow the statistical analysis of research data to test hypotheses about relationships among the various items of information and generate new hypotheses to guide future research.


Graduate and professional study fellowships--Department of Education. Final regulations with invitation to comment. The Secretary issues final regulations for the Graduate and Professional Study Fellowships Program. The regulations, which implement Title IX, Part B of the Higher Education Act of 1965, have been amended to reflect the statutory changes in the Education Amendments of 1980 and to reflect changes required by the Education Department General Administrative Regulations (EDGAR). These regulations specify the selection criteria the Secretary uses in evaluating applications for fellowships for graduate and professional study, public service education, and studies in domestic mining and mineral and mineral fuel conservation. These regulations also describe application procedures, eligibility requirements, and the terms and conditions of an award.


If Reagan wants to trump the regulators, here's OMB's target list for openers.


When it goes to the bargaining table, labor looks to control health costs.


Codes questioned after rest home fire.

Codes questioned after rest home fire.


Medical claim fever sends rates soaring.


Firms drop Blue Shield for wraparound plans.


HMO hopes to deliver maternity cost savings.


An emergency department team--cooperation and control at their best.


The pharmacist and the health care team in a hospital setting.


Hospital administrators have a wide sphere of influence.


One Canadian Field Hospital: a MUST in an emergency.


How Canada's health professionals have been dragged into politics.


Health care of the elderly.

Health care of the elderly.


Reduced prescription size: a question of health care or money? The answer is health care, says pharmacy.


Reduced prescription size: a question of health care or money? The answer is money, say drug plans.


The pharmacist as an information provider to the patient.


Principles and guidelines for distribution of narcotic and other psychoactive drugs.


BC's Pharmacare speaks out.

BC's Pharmacare speaks out.


A retail day in the life of a hospital pharmacist.


The University of Toronto plans a drug information center. Interview by Sharon Jessup-Petticrew.


Must doctor's fees be so high?

Must doctor's fees be so high?


Dropping out of treatment: an evaluative index for a community mental health centre.


Issues in psychiatric day-care programs in non-urban areas: a case study. As community mental health continues to grow in credibility, it has expanded, not only into new areas of treatment (e.g., child abuse), but also into new geographical areas, such as rural Canada. However, transplantation of urban-based community mental health models into the rural community poses major problems. To illustrate such problems as well as possible solutions, this paper describes a day-care program in a non-urban area, the overall settings of the program, a description of its structure and the issues facing it, as well as some of the ways we have dealt with them. We then discuss some recent changes we made in the program and how we evaluated these, to illustrate how such a program can institute an ongoing program evaluation. Finally, some data on the outcome of the program is presented.


Mental health service priorities in a time of restraint.


A clinical model for use in mental health centres. The model presented is an attempt to provide a way of viewing and organizing the clinical process. Major factors involved in the process, ranging from the common characteristics of the setting to basic treatment guidelines, are identified. Although the original purpose of the model was to provide order and direction for those directing inpatient units, it can, with minor modifications, be used in a variety of settings by various professionals. For example, it has been used for staff development purposes in educational and mental health facilities. The model is not intended to be a delineation to the nth detail but is to be suggestive. It is sufficiently flexible to accomodate different theoretical approaches and thus serve as the basis for ongoing staff development and direction. How the model is specifically used and/or adapted is left to the reader's discretion, although some suggestions for its use will be presented.


Value analysis concepts set for Pa. pilot test.


Virginia nursing home adopts hospital-style MM.


Automated delivery: a case history.

Automated delivery: a case history.


Standardization nets savings.

Standardization nets savings.


Ministering to children and youth during illness.


A few facts about consignment buying.

A few facts about consignment buying.


New device approval system speeds product availability.


Long days, short weeks work for MM staff.


Value analysis: an innovation appears.

Value analysis: an innovation appears.


Conceptual issues relating to the representation of consumer interests on health systems agency boards.


Blind injustice and socially descriptive representatives, or, the cart without a horse.


Women in pharmacy.

Women in pharmacy. The incomes, current positions, and work status of pharmacists were examined to assess whether the situation differs for males and females. Data on sex, region, age, marital status, education, and income were collected from a random sample of practicing pharmacists in six major urban centers in Canada. Women were more likely to earn less than +20,000 per year and to be employees rather than owners. Both men and women were just as likely to be managers. There is no sex difference in administrative positions for those under 30 years of age. It is at this age, when one starts moving up the professional ladder, that the sex differences emerge. It was also found that women are more likely than men to be part-time pharmacists. It is suggested that women's socialization and/or attitudinal or structural barriers at the work level account for the sex differences.


The development of Holter electrocardiography.


Intelligent noncompliance with special emphasis on the elderly. Intelligently noncompliant patients alter their prescribed therapy on a rational basis that often represents advanced therapeutic principles. The literature contains many examples of patients who alter their medication but still have good treatment outcome. Doses are altered to avoid adverse effects or because the dose was excessive or inconvenient. When compliance studies are done in a large heterogeneous group, the rates for different age groups are almost always similar. Health professionals have devised compliance-ensuring strategies such as educational programs and modification of the regimen. Use of compliance-ensuring strategies, however, opposes the current trend which advocates a more direct, active patient participation in treatment decisions.


Dollars down the drain: silver recovery programs at many hospitals can stand more polishing.


Are we wasting nursepower? More efficient use of RNs could help stem the shortage.


Cost containment, regional style: Northwest Ohio is setting standards for local programs.


Satellite pharmacists throughout the hospital have been able to establish more credible working relationships with other health care team members.


Death counseling and human development: issues and intricacies. Death counseling as a specialized service appeared in the 20th century in response to new needs for assistance with death-related crises and transitions. Significant experiences with death and dying can be viewed as maturational crises through which people learn to cope with themselves during adversity and change. Because these experiences have a significant impact on developmental tasks in childhood and adult life, the death counselor needs to be knowledgeable about human development across the lifespan and sensitive to the problems of communication across differences in age, sex, culture, and cohort experiences. Knowledge about the impact of different death-related experiences on individuals, families, and providers is also essential for understanding the disruptive effects of these events on persons and groups. Yet helping others by death counseling requires more than knowledge alone. It must be based on goals reflecting the integrity of those involved.


Impediments to communication in transition to terminal illness. Viewing themselves in two hypothetical roles-as terminal patients and as family members related to a terminal patient-48 adults were surveyed on their expectations and preferences about how information should be communicated when a terminal illness is first diagnosed. Identifying with the patient role, respondents believed patients should be told the truth immediately and unconditionally. In contrast, respondents indentifying with family members perceived conditions under which the rights of patients should be abridged. In this latter role, male respondents were significantly less likely than males to imagine themselves as able to inform a loved one about a terminal illness. Nevertheless, for both sexes, early childhood experiences communicating about death and dying were found to be a better predictor of the case with which respondents can imagine communicating with a terminally ill loved one than are current adult attitudes and experiences. Regardless of personal ease in discussing death, however, most respondents thought the physician, not family members or other health care professionals, should decide when and how the terminally ill adult should be informed--a noteworthy finding in light of the fact that 83 percent of all respondents consider physicians poorly equipped for this role.


The mourning of the health care professional: an important element in education about death and loss. This article explores the centrality of the mourning process in the education of developing health care professionals who are the survivors of complex and manifold losses. This was discussed in an elective seminar for senior medical students and graduate nurses. Learning about clinical responsibility often occurred in the context of loss and mourning. The outcome of mourning included for some a greater sensitivity to the impact of clinical interventions and a more accurate empathy for losses incurred by patients as a result of illness. Old and unresolved loss and mourning experiences were reawakened as a result of the seminar, which led to a sorting and mastering of these experiences. This is felt to be a common result of discussions about encounters with death and loss. Courses on death and dying for the health care professional, although important, are not sufficient by themselves for mastery of these topics. Clinical teachers must be aware of the student's response to loss and provide an atmosphere that legitimizes learning about these issues. The principles of awareness and open acknowledgement of loss and mourning are applicable to all health care settings.


Anticompetitive data dissemination in the medical profession: the conflict between the Sherman act and the First Amendment.


Satellites and public service organizations.


Washington struggle mirrors contention elsewhere.


Scribe system works like a charm in sarasota ED.


The development of a hospital pharmacy policy and procedure manual. The value of a complete and comprehensive departmental manual for a hospital pharmacy is well recognized as an important factor in establishing written acceptable policies and procedures by which the department operates. Other purposes include its use as an orientation guide for new employees and its fulfillment as a guide to the department's scope of service for hospital accreditation. The Department of Pharmacy at Sunnybrook Medical Centre formed a Policy and Procedure Committee with members representing each departmental division to develop such a manual. This paper outlines the establishment of the format, organization and writing style of the manual and the actual writing and review of chapters.


Channelling pharmacy manpower in the 80s.


The media and the emergency department.

The media and the emergency department.


King's Daughters' contract sets pace for Kentucky hospitals.


Quality assessment of emergency department activities.


Connecticut: big gains for 2,000 nursing home 1199ers.


Negotiating the emergency department contract, Part II: from the emergency physician's perspective.


Unions in group practice.

Unions in group practice.


Group practice mergers.

Group practice mergers.


Hospital categorization revisited.

Hospital categorization revisited.


Rural advanced EMT training--Part III.

Rural advanced EMT training--Part III.


Minicomputers for medical groups.

Minicomputers for medical groups.


The logistics of a disaster drill: Medex-78.


Negotiating the emergency department contract, Part I: from the hospital's perspective.


Emergency reaction driving--a total awareness program.


EMS in the hospital setting.

EMS in the hospital setting.


Who should testify?

Who should testify?


The days ahead for Bert Card, ASHFSA.

The days ahead for Bert Card, ASHFSA.


Administrative outlook: medical education in the emergency department.


How to solve ten great problems for fund raisers. Ten problems unique to fund raisers are quite easy to solve, according to this author, once they are diagnosed. But the solutions require more than program changes. Attitude plays a paramount role in fund raising success.


New trend: fund raisers on board of trustees.


Nonverbal communication.

Nonverbal communication.


FAH establishes nursing panel, asks changes in Planning, HMO Acts.


Marketing attains new respect in health care.


The next four years: budget crunch to affect health industry but hospitals not expected to be singled out.


Modern day fund raising: a whole new ball game. Modern technology and fierce competition for the philanthropic dollar have revolutionized fund raising. Some special approaches are now required. One approach this author recommends is the development of a symbolic theme appeal.


Raise 'friendships' first, dollars second. Fund raising by itself is not enough in the development game. What a non-profit must learn is the art of "friend raising," says this author. By building effective relationships among donor, development director and ceo, a non-profit is guaranteed a lasting and profitable future.


Election results bring dramatic changes to leadership, makeup of 97th Congress.


The physician glut is not around the corner--it's here now.


Phase out health planning by 1983, OMB recommends.


Budgetary restrictions, more state regs, anticipated in 1981.


Cottage hospitals: the charm has gone but the loyalties remain. 'You can't have a resort like this without a hospital,' argued a consultant at Tenby Cottage Hospital when Nick Davidson visited recently. But some staff members hold ambiguous attitudes to the building itself. Indeed, one would like to pull it down and replace it with a modern, purpose-built building.


Professional activity study: crunching the numbers across the Atlantic. It is particularly appropriate in 'International Health Record Year' that Dr Brian Moores, of Manchester University Institute of Science, should examine what professional activity studies have to offer. Here he looks at this American system of monitoring and compares it with HAA, which in contrast he describes as 'clinically impoverished'


Community hospitals: cornerstone of care for the future health service. What is the impact of the changing pattern of care in community hospitals and what are the implications for staff? Dr Alex Gatherer, Oxfordshire AHA(T) area medical officer, with the help of Katrina Bishop and Alexandre Kalache, a clinical lecturer in community medicine at Oxford University, tried to answer these and other questions.


New Administration, Congress must deal with PRRB, AHR.


New IRS hospital adult guidelines will increase tax disputes.


Disaster training pays off for Las Vegas hospitals.


Health centres: does small mean success? On May 16 this year the Journal published a special issue entitled 'Sixty years after the Dawson Report' in which Dr J. Gerald Beale wrote that a study of health centres proved that in many respects they had done more harm than good. Here Dr J. Ivory, GP; Mr F. H. Kirton, area works officer; and Mr. C. A. Clark, planning administrator, Northumberland AHA put an alternative view.


HSSJ guide to managerial salaries and conditions in the NHS.


Unit management: grass roots--land of opportunity. In the restructured NHS the unit administrator's job will be bigger and better, but less protected, than that of many sector administrators today. But Graham Millard, district administrator, Harrow HD, foresees opportunities for administrators to turn their backs on bureaucracy and concern themselves with the things that brought them into the health service in the first place. This paper is based on one given by him to a recent conference of the Association of Health Sector and Unit Administrators.


The next four years.

The next four years.


HAI, Missouri hospital mark 10th year of management contract.


Bringing sales experience to materials management.


Joint finance--3: hope for the dark years. For this concluding article on joint finance, Jef Smith, director of social services, Kingston-upon-Thames, gathered impressions from Newcastle, regional centre for the North-East, a city with a teaching hospital and many problems.


Beginning a materials management program.


Syringe prices in 1980--hospitals get a shot in the arm... and in the purse.


What is materials management? A MM's view.


What happened to the bond markets?

What happened to the bond markets?


The impact of on-line information retrieval in a college based drug information center.