Organisation of ambulatory care by consumers. This paper deals with how consumers arrange their ambulatory care in a system such as the United States which offers many possible choices. Patterns of the different affiliations (sources) that people maintain throughout the year for ambulatory care are formed. The data were obtained in interviews in a sample survey of Rhode Island households conducted in 1974. Although most people in the sample (89.5 per cent) cluster with one to three sources of care, there were over 80 people with four or more affiliations. For those persons with a large number of affiliations, the provider sets become quite varied. Two conceptual typologies are formed, one focusing on type (private physicians versus places) and the other focusing on both the speciality of the physicians involved and the number of different affiliations involved. The United States, at least in theory, maintains a 'free market' health care system. Are there limitations of choice imposed by differential distributions of knowledge, income or age? A wide array of social, demographic, and illness variables were examined to determine their relationship to the patterns.


The process of neutralisation and the uncertainties of cystic fibrosis. The epidemiological uncertainties of a terminal illness would seem to prohibit the ritual exchange of faith and hope between patient and medical personnel. However, after interviews with people involved in cystic fibrosis networks, I argue that there exists a process of neutralising five epidemiological uncertainties of this disease: (1) aetiology; (2) genetics; (3) treatment; (4) societal reaction and (5) life expectancy. This process consists of five techniques corresponding to these five epidemiological uncertainties, respectively: (1) the modification of question; (2) the promise of research; (3) the uniqueness of each case; (4) the comparison with others and (5) the lack of an alternative to therapy. Neutralising the epidemiological uncertainties of this disease serves to support the swaying edifice of faith and hope and enables the people within the network to devote themselves to compliance with cystic fibrosis therapy.


Sentimental work in the technologized hospital. Sentiment is frequently involved in work either to get work done efficiently or because of humanistic considerations. This paper explores several questions: Are there different kinds of sentimental work? How is sentimental work carried out? When and where is it done; when not? Who does it? What is its relation to other types of work? When is it likely to be in focus for the workers? When is it visible, when invisible and to whom? What are its consequences: for work, staff, client and organization? The illustrative materials used in this paper are taken from research on the impact of technology on medical work in hospitals.


Perinatal mortality: the current debate. Using the parliamentary 'Short Report' on perinatal and neonatal mortality as a focus for analysis, this paper attempts a critical examination of recent trends in perinatal health policy debate, and suggests a polemical explanation of such trends. The paper begins by outlining the major concerns of current debate and unravelling the assumptions and apparent contradictions in both 'official' and popular arguments. It then utilises a framework and perspective adopted by Lewis in her recently published analysis of Edwardian maternal and infant welfare policy, in an attempt to make sense of the major contradictions identified. The importance of considering the ideological 'ends' of social policy movements--in this instance, a restating of the ideology of motherhood--over and above purported societal 'needs'--i.e. a reduction in perinatal mortality rates--is highlighted.


Avoiding errors in spirometry.

Avoiding errors in spirometry. Routine measurements of vital capacity, forced expired volume in one second, and forced expiratory flow are easy to make, and so are errors in these measurements. Even if the technologist observes all the rules in performing the tests, there is still a potential source of error in the machine.


Negotiation and the structure of discourse in medical consultation. Using audio tape recordings of consultations between mid-level providers and patients in a health maintenance organization, a model of medical negotiation is presented. This model conceptualizes negotiation as a process in which mid-level providers and patients introduce their perspectives on the definition and treatment of medical problems by linking together units of discourse (acts, turns, sequences and phases). This model clearly locates negotiation in observable activities of interactants and demonstrates how the process changes over the course of an encounter as provider and patient participate in the taking of a medical history, the performance of a physical examination, and the discussion of the problem and treatment. Because of the formal yet flexible nature of this model, it lends itself for use in comparative studies of medical practitioner-patient negotiation.


Competitive bidding and voucher payments for implementing the new federalism with special emphasis on programs for the aging. Principles from the economics of decentralization are applied to the planning and budgeting of social services for the elderly. The standard model of corporate decentralized planning and budgeting is extended to allow different levels of government to pursue qualitatively different goals. A safety-net voucher plan is also proposed to protect the most vunerable population from possible termination of services due to poorly formulated local plans. Such a decentralized planning and budgeting system would make Federal and State influence on local plans proportional to their contribution to total expenditures.


Analysis of cost and coverage of government financed primary health care services in Tanzania. A method for cost analysis is presented and applied to Primary Health Care Services in Tanzania. Primary care utilization figures are combined with budget and cost data to arrive at estimates of per capita and per visit cost. Data for analysis of geographical coverage, health care needs, and utilization are most readily available for the MCH sector of Primary Health Care Services, the most important health care sector in LDCs, which is used in this paper as a proxy for estimating health care needs and utilization. The importance of separating appropriately identified investment costs from recurrent costs is illustrated. Speedy implementation of health care for all requires assistance for investment costs, the recurrent costs of appropriately designed Primary Health Care Services being within the reach of developing nations themselves.


Medical-legal agreement on brain death: an assessment of the Uniform Determination of Death Act.


Should health service providers be strictly liable for product-related injuries? A legal and economic analysis.


Smoke control.

Smoke control.


Detectors.

Detectors.


Strategic public management and productivity: a "firehouse theory".


Markov models and the utilization of mental health services: a study of endogenously depressed patients. Patients in the mental health care system typically make more or less irregularly spaced visits to psychiatrists, both within and between episodes of a given illness. A Markov model is constructed which can predict the utilization of psychiatric services for such patients. Unlike previous Markov models of utilization, the current model takes as its starting point a model of an actual disease, specifically, endogenous depression. It is shown how one can estimate the parameters of both the model of utilization and the model of depression using data which were collected for clinical research purposes. The models provide reasonable fits to the data. Several applications of the models are worked out. In addition to predicting the utilization of mental health services, the models can be used to predict incidence, prevalence and recovery rates and to predict the changes in utilization which parallel changes in treatment regimens.


Chancers, pests and poor wee souls: problems of legitimation in psychiatric nursing. This paper explores the relationship between psychiatric nurses and 'problem' patients as a means of commenting on the occupation of psychiatric nursing. Proceeding from a detailed examination of the case of one particularly problematic female patient, and drawing on a body of observational and interview data relating mainly, though not exclusively, to nursing activity on two very different psychiatric wards, we argue that what is critical in determining nurses' categorization of some patients as 'problems' is not so much the level or nature of patients' demands, as much previous work has suggested, but rather the patient's willingness to legitimate the nurses' therapeutic aspirations. Possessing neither readily identifiable technical skills nor unambiguous authority, the psychiatric nurse must look to her dealings with patients to sustain a viable professional identity. 'Problem' patients are those who call attention to the fragility of nursing authority by rejecting, implicitly or explicitly, the special services that the psychiatric nurse stands ready to provide.


Fire safety & electronics.

Fire safety & electronics.


Big profit in private hospitals.

Big profit in private hospitals.


Advocacy: a conceptualization for social work practice.


The new mixed economy of welfare: public and private.


Involving consumers in decision-making.

Involving consumers in decision-making.


Ethical dilemmas in social work practice.


The policy implications of self-care.

The policy implications of self-care.


An immodest proposal.

An immodest proposal.


The mischievous medical model.

The mischievous medical model.


Conceptualizing self-evaluation of clinical practice.


Raising the self-esteem of mentally impaired nursing home residents.


Social workers, strikes, and service to clients.


Music and soap operas at work: background or distraction?


The negative side of promotion from within.


Danger: T.R. at work.

Danger: T.R. at work. State credential processes may require applicant groups to specify the dangers to the public and clients of unregulated practice. A model for the equitable display of therapeutic recreation concerns is proposed as well as a classification of negative worker behaviors. The self-study process described has implications for education, personnel justifications and the development of standards and ethics.


The contemporary social work record.

The contemporary social work record.


Hospital fund raising.

Hospital fund raising.


"What you do ahead to time is what counts most".


Financial watch.

Financial watch.


Breaking the language barrier.

Breaking the language barrier.


Treating cancer with heat.

Treating cancer with heat.


A vital link in reaching for recognition. An in-depth study of licensure and certification.


A universal infection control problem: clean up in the operating room.


Surgical technologists--professional or not?


Computers and a new world order.

Computers and a new world order.


Quality analysis in therapeutic recreation curricula. Within the last several years therapeutic recreation has witnessed an increasing concern over the quality of professional preparation programs. Unfortunately, few efforts have really focused on improving the depth of preparation although the scope of preparation is fairly well documented by accreditation criteria. Quality analysis elucidates curricula by considering: (1) the depth of competence desired, (2) the barriers to acquiring said knowledge and (3) who is responsible for disseminating the knowledge to students. Furthermore, quality analysis relative to therapeutic recreation curricula currently requires consideration of material from other disciplines and therapeutic recreation's unique perspective on traditional areas of learning. A competency cluster including knowledge related to anatomy, physiology, disabilities and limitations imposed by the disabling conditions and medical terminology was used as an example of quality analysis. Quality analysis revealed that the aforesaid competency cluster is not presently being transmitted adequately to students and that therapeutic recreation educators' need to assume more responsibility for disseminating knowledge related to the competencies discussed.


An assessment of treatment enjoyment and effectiveness in psychiatric hospitalization. A study examining treatment enjoyment and effectiveness revealed significant correlations in twelve of thirteen identified therapies. Based on an assessment as reported by twenty-four psychiatric inpatients, levels of treatment effectiveness increased during the course of hospitalization. It is concluded that therapeutic recreation plays a significant role in the over-all socializing process characterized by increasing levels of enjoyment in interpersonal relationships which are perceived as significantly related to positive treatment outcome.


National Council for Therapeutic Recreation Certification--certification standards for therapeutic recreation personnel.


Assessment interviewing techniques: a useful tool in developing individual program plans. This article presents a number of interviewing techniques that can complement other assessment tools and assist recreation therapists in achieving their intended goals. An interviewing guide is also presented which may be used to help direct an assessment interview and insure that essential interview points are covered.


Diagnostic testing in the emergency department.


Emergency department radiology.

Emergency department radiology.


QA and problem solving: working together.


Controlling pharmacy inventory...for bottom-line results.


The institutional pharmacist and infection control.


How secure is your pharmacy?

How secure is your pharmacy?


Surgical pharmacy satellite operations.

Surgical pharmacy satellite operations.


Justifying a full-time pharmacist in your smaller hospital.


Denial of staff privileges: a hospital's discretion.


Freestanding "emergency" care centers. Diagnosis: a misnomer?


The perfect system.

The perfect system.


Developing a central information source.


Health maintenance organizations: a brief history of the HMO in Texas.


Home health care. Perspectives for hospital pharmacy services.


The integration of QA and risk management.


The responsibility for financing. Part 3.


Medical malpractice and the statute of limitations: an absolute two-year cutoff date?


Outpatient facilities present special concerns for IC practitioners.


Manufacturers' tips on paper product quality.


How do you find qualified personnel for your hospital?


Pooled credit plans offer financing alternatives to independent hospitals. Using the collective financial strength of a group of not-for-profit health care institutions to finance capital needs has become an increasingly popular concept. This article discusses the significant advantages and disadvantages of the concept, provides an overview of the development of multi-institutional financing arrangements, and describes the generic forms of credit poolings. It also outlines three broad areas of inquiry to be explored by potential participants before entering a pooled credit arrangement: the relationships among participants, the availability of assets to support debt, and corporate planning and strategy.


Lower interest rates mean that a refinancing might save a bundle. Two recent developments provide compelling reasons for hospitals to consider refinancing or advance refunding their existing debt: the precipitous fall in interest rates since August 1982 and the outcome of recent litigation that permits hospitals to recoup the issuance costs of refinancing or refunding bonds. These favorable developments, coupled with increasing concern over restrictive covenants, will cause many hospitals to evaluate a refunding sometime this year.


Nursing home industry launches voting programs for patients.


Purchasers' views on buying paper goods.


It's time to return to basics and renew philanthropy efforts. Boards' inattention--rather than any lack of interest by donors--may account for the slippage (by percentage) of philanthropy as a source  of hospital capital. Actually, total giving is up, and the author maintains that it's time for hospital boards to reexamine their efforts at philanthropy. A focus on individual and corporate giving is recommended.


Ohio nursing home becomes politically oriented.


The consultant dietitian and the social worker.


Mass. examines home care: how it affects the family.


HHS study calls mandated dual participation unfeasible.


Nursing home costs rose 17.4%, last year.


Government grants exemptions to hospitals.


Doctors' nursing home visit patterns exposed in study.


Stalled regulations may surface shortly.


New Congress addressing Social Security's woes.


Dentists sink teeth into nursing home calls.


Nutrition and the decubitus ulcer.

Nutrition and the decubitus ulcer.


Deregulation moratorium imposed by Congress.


Behind the explosion in self-help groups.


If you live to be 100--it won't be unusual.


If you want to donate a body organ.

If you want to donate a body organ.


Criminally insane turned loose too soon?


Vet center prospects improving.

Vet center prospects improving.


Claiming whistleblowing irrelevant, U.S. alludes to TV show in VA case.


Who'll watch the kids? Working parents' worry.


Group urges cuts in federal facilities.

Group urges cuts in federal facilities.


New approaches to revenue centers. Cost and expense reduction.


How to plan for a productive and satisfactory meeting.


Helpful hints for designing a successful volunteer conference.


Child abuse programs.

Child abuse programs.


Taking the mystery out of volunteer publications.


Preferred provider organizations.

Preferred provider organizations.


Family medicine today: a dialogue with the American Academy of Family Physicians.


Future family physicians get early community contact in Morehouse curriculum. The pre-clinical curriculum of the Morehouse School of Medicine is unique in several ways. One of the ways in which this curriculum is unique is the manner in which it has involved practicing physicians in the education of medical students during their first two years of medical school. Throughout the country, many physicians have expressed an interest in this involvement of community physicians in the teaching of medical students during what might be their most impressionable period of development. The article which follows describes concisely the development of Community Medicine and Family Practice at the Morehouse School of Medicine, highlighting the issues which relate to the role of community physicians in the teaching of medical students during the pre-clinical years. It is the contention of Morehouse officials that the involvement of practicing physicians in the early education of medical students is very important and that it does not necessitate a compromise of the basic science education which is taking place at this time.


Introducing AHA's Center for Urban Hospitals.


'The future of urban hospitals'.

'The future of urban hospitals'.


A call for advocacy and rededication to "health care for all".


Wellness and prevention: educating the family and contacts. Historically, the healing arts have been devoted to curing those already sick. Only in recent decades has disease prevention by vaccination, quarantine, regulation of food, water and drugs, proper garbage and water disposal and health education become procedures utilized by the medical and allied health practitioners. Today, maintenance of wellness is the novel but desirable role to be undertaken by health professionals. To do this, doctors and allied health personnel must become conversant with information from many scientific and social disciplines, must become skillful communicators and teachers, and must be personal examples of wellness. This role - especially of education and communication - must be carried out not only with clients but also with the family and contacts of patients.


A critique of Theory Z.

A critique of Theory Z. Ouchi's Theory Z prescribes how employees should be motivated for increased productivity. Based on the theoretical work of Emile Durkheim, it views the modern large corporation as a communal alternative to the shortcomings of other institutions in industrial mass society. Ouchi's assertion that Japan is the industrial society in which Theory Z has flourished received limited support from research findings. Moreover, Ouchi's grounding of the theory in humanistic management seem unwarranted.


Project health care at Bellevue Hospital. Project Health Care is a program which uses college students considering careers in health care, as summer volunteers in the Emergency Department of a large, municipal hospital. It began with a small group in 1981, and was expanded the following year to include 16 students. The program was designed to provide opportunities for service and observation in various out-patient settings, seminars, lectures and individual and group projects. The project benefitted all participants. For the Emergency Department staff it stimulated better communication with non-professionals; for the hospital it provided intelligent, enthusiastic volunteer help while aiding community relations, and for the volunteers it provided an opportunity to make educated career decisions.


The hypothesized effects of ability in the turnover process. Findings from studies that have investigated the relationship between task-relevant ability and turnover have been inconsistent. A process model is presented that suggests that ability may be related to turnover through the individual's perception of both the ease and desirability of movement. The potential effect of ability on the turnover process and its practical and theoretical implications are discussed.


A systems paradigm of organizational adaptations to the social environment. In order to define generic research questions and to develop a typology of organizational social performance concepts, a systems paradigm for organizational adaptations to social environments is advocated. The active distinction between descriptive, normative, and evaluative inquiry is emphasized. Organizational social responsibility, social responsiveness, and social responses are defined in context of the systems paradigm. In addition, a categorical model of organizational social responses that directly affect the quality of work life and the quantity of life is outlined.


The business of the polygraph. How and why companies use the 'lie detector'. And why civil libertarians are distressed.


The price of giving. Charity begins with the tax laws.


The Social Security Fix.

The Social Security Fix.


The Islamic Code of Medical Ethics.

The Islamic Code of Medical Ethics.


Psychiatric sequelae of torture, and implications for torture.


The relationship among perceptual similarity, sex, and performance ratings in manager-subordinate dyads. The relationship of perceptual similarity and sex in both manager and subordinate performance appraisals within manager-subordinate dyads was investigated. Perceptual similarity accounted for a sizable percentage of performance rating variance. Significantly lower performance appraisals were found in dyads in which there was mutual perceptual dissimilarity between managers and subordinates.


Job and life satisfactions: a causal analysis of their relationships.


Drug utilization in general and family practice by characteristics of physicians and office visits: National Ambulatory Medical Care Survey, 1980.


Utilization of psychotropic drugs in office-based ambulatory care: National Ambulatory Medical Care Survey, 1980 and 1981.


1981 summary: National Ambulatory Medical Care Survey.


New health hazards in sealed buildings.

New health hazards in sealed buildings.


Art therapy with two quadriplegic patients.


Children's self-images before, during, and after psychiatric hospitalization.


Training the "clinical scientist" through a combined industrial/academic fellowship. A novel two-year fellowship program is described which provides specialized training both in clinical drug research and drug development methodology for pharmacists with previous clinical experience. Pharmaceutical industry, university and hospital research facilities are used as the training laboratories, and collectively offer theoretical as well as practical research skills development. Traditional didactic and laboratory training are provided within university and hospital environments with emphasis in the conduct of clinical trials. Extramural experience with pharmaceutical industry provides a corollary experience which includes exposure to ethical, legal and regulatory issues involving both investigational and marketed drugs. Following successful completion of the fellowship, the pharmacist is expected to have developed the fundamental skills necessary for a career in academia, pharmaceutical industry, or clinical practice.


The development and evaluation of an interdisciplinary health training program: a pharmacy perspective. This program integrates training with the clinical interdisciplinary aspects of health care by directly involving pharmacy and other health professional students in an on-going team model of health care delivery. The training program model allows pharmacy students to learn the conceptual basis of team care and to experience directly how this concept is applied in an ambulatory health care setting. Learning strategies include specialty and team delivery of health care, participation in weekly interdisciplinary team training seminars, involvement in problem-solving and other skill building activities, and development of an interdisciplinary team project. Program evaluation results have indicated that students perceive that the interdisciplinary training increased their knowledge and positive attitudes towards interdisciplinary teams. The training also increased their sensitivity to patients, and enhanced the understanding of the problems of delivering health care to an urban community. The results have also shown that through this structured interdisciplinary experience, students reported having a better understanding of the roles of other health professionals and a greater awareness of how these different roles are integrated into a health care team.


The use of patient instructors to teach interviewing skills. A program which utilizes patient instructors (PI) to teach and evaluate interviewing skills of pharmacy students is described. The PIs were programmed with a history of either hypertension, chronic pulmonary disease, or congestive heart failure. Content areas within each history included past and present drug therapy, adverse drug reactions, drug interactions, as well as socioeconomic and other factors affecting therapy. The interviews were done with small groups of students and followed by PI evaluation of interview content and process. The majority of students felt the experience helped them assess and improve their interviewing skills and agreed the program should continue. The advantages of utilizing PIs to teach interviewing skills are discussed.


Computers will become indispensable, MDs say.


Minnesota insurer signs hospital contracts. Under the PPO type plan, participating subscribers will get a 7% cut in premiums.


Medical care access, costs debated.

Medical care access, costs debated.


Economist predicts decade of hospital closings and MD income erosion.


Growth rate of HMOs is slowing down.

Growth rate of HMOs is slowing down.


To stem costs, impose 'discipline', New York freezing hospital construction for 1 year.


Fine arts gallery in retirement center nurtures creativity.


Adopt-a-school. Six Chicago-area hospitals have 'adopted' elementary and high schools to teach youngsters about medicine.


Costs mark debate on artificial heart.

Costs mark debate on artificial heart.


Rx for recreation: part of the doctor's role.


Watch quality, official tells HMOs.

Watch quality, official tells HMOs.


U.S. management firm launches experiment with Canadian hospital.


New California PPOs producing tumult among physicians.


Reaching the confused and withdrawn through music.


Diagnostic patients get free room at hospital.


Economic realities altering profession, medical leaders told.


Hospitals face N.Y. building moratorium.


Linen control.

Linen control.


Growing from within.

Growing from within.


The year ahead.

The year ahead.


Entering our profession through the back door.


A co-op that is run like a rental plant.


The cost involved.

The cost involved.


Barriers and microbial penetration.

Barriers and microbial penetration.


Run tests before deciding.

Run tests before deciding.


An upgraded linen control system drastically reduced linen losses.


Linen security. Don't lock the door too late.


The institutional market. The rental viewpoint.


The institutional market. The laundry manager's viewpoint.


Minor adjustments.

Minor adjustments.


Laundry managers accept column ideas.

Laundry managers accept column ideas.


The 'magic asterisk' revisited...staying the course: what it means for US public health.


An experiment in continuing medical education.


Hospitals find past recruitment of nurses too successful.


The federal government's regulatory challenge...who is running medicine?


Johns Hopkins planner urges changes in US health care policies.


Emergency room radiology. Profile of a typical facility and preliminary report on a dedicated system. According to a questionnaire survey of emergency room satellite radiologic units in US hospitals, the criteria for optimal radiologic service to seriously ill and injured patients seen in hospital emergency areas are not being satisfied. The survey identifies the salient characteristics of this growing sector of radiologic practice and points to the need for a dedicated emergency room roentgenographic system.


The radiology administrator as personnel manager.


Microcomputer-assisted evaluation of pediatric echocardiograms.


Clinical issues of middle age and later life. Mental health problems of middle and late life are the focus of this article. Among topics discussed are adjustment reactions to mid-life, late-life transitions, and stressful life events. Emerging mental health problems during this period are considered as a function of increased stress that is not mediated by social supports or effective strategies in coping. Sex differences in adjustive tasks during mid-life and the later years are presented. The impact of family dynamics on mental health is considered. Age-related differences in specific types of mental disorders, including organic problems, schizophrenia, and depression, are reviewed. Sexual problems, substance abuse, and psychosomatic problems are reviewed in the context of clinical problems during middle and late life. Diversity and individual differences in responses to the stresses of life transitions are emphasized while psychosocial strengths of older persons that promote mental health are portrayed.


Death and survivorship: the final transition. In spite of some recent increases in services for bereaved persons, the availability of such services is minimal. The process of grieving itself takes place in time in several ways: the extent to which the death is sudden, expected, and timely; the passage of time from the beginning of anticipatory grieving before the actual death through the diminishing effects of the loss over an extended period of time; and the age and stage in life of the grieving persons. During the grieving process the survivors often develop physical and health problems, face psychological and emotional distress, encounter difficulties with social relationships, and must cope with numerous practical issues. The subsequent adjustment of widows and widowers appears to be related to the extent to which there had been the opportunity for open communication. Whether widows fare better than widowers after the death is uncertain; research has provided conflicting results and equally conflicting interpretations of the results.


Diagnostic ultrasound: hazardous or safe?


Computers in ultrasound practice.

Computers in ultrasound practice. As computerization becomes pervasive in medical practice, direct physician-computer interaction can be expected to increase. With respect to ultrasound, physicians can use computers in the measurement, interpretation, reporting, filing, and retrieval of data. Such use will increase as a growing number of well-designed packages and network capabilities become available.


Trials and tribulations of the radiology administrator: interdepartmental relations. Many interdepartmental problems stem from a lack of understanding of just how the radiology department works. In this article, radiology administrators discuss their approaches to improving interdepartmental relations. These include one-on-one talks with department heads and supervisors, orientation meetings, and meetings of department heads.


Transitions and models of intervention.

Transitions and models of intervention. All transitions are associated with change. People, basically conservative by nature, tend to resist change. Any intervention needs to consider that reactions to a transition are affected by prior experience, by the way transitions are viewed in an individual's social network, and by what learning opportunities are available. Responses can be viewed as typical under the circumstances, with rites of passage and helpers available to guide people in coping; or they can be viewed as a result of deficits in the individual for which treatment is prescribed. To facilitate change, seen as an expected event, individuals need to be linked to resources and information. They need role models and legitimation of their feelings. Learning, at such times of stress, seems to be facilitated by the availability of a peer, in the sense that the helper has had a similar experience. This help is available in mutual help groups. However, many kinds of help need to be available. The goal of any help is to empower the individual to cope in ways that promote growth and change.


Choosing a film-screen combination for polytomography. The results of a study of nine film-screen combinations seem to indicate that it is possible to reduce the radiation dose for polytomography without loss of diagnostic quality. The reduction in radiation exposure can be substantial when 16 to 25 exposures are taken in a routine study. Benefits in addition to the lower patient dose are lower tube heat loading and longer tube life.


Conventional tomography with a digital vascular imaging system. Digital conventional tomography may be performed using a digital vascular imaging (DVI) system. Digital synthesis and removal of blur from multiple tomographic sections were accomplished by computer with a single motion of the source-receptor (x-ray tube-image intensifier) complex. Tomographic application of a DVI system was evaluated by phantom simulations.


A tale of two companies.

A tale of two companies.


Results of testing of an angiographic catheter. A catheter composed of two dissimilar plastics has been found to be virtually indestructible under severe experimental conditions. Compared with four other types of commercially available catheters, it rates well in terms of flow rate, bursting strength, memory, radiodensity, and thrombogenicity.


Intergovernmental redirection.

Intergovernmental redirection. Intergovernmental reformers have long attempted to remedy the system's more apparent defects, especially the recent buildup in federal-state-local relations as Washington's involvement became broader and deeper. These remedies have included incremental and procedural changes, rationalization of federal aid and program delivery instruments, and total overhaul of the system through functional realignment. Efforts in the past have proved only marginally successful, essentially due to the fact that Congress had become the dominant architect and defender of the system. The world of intergovernmental relations changed dramatically from 1978 on, due to the poor performance of the economy, antitax and antispending sentiment, public-sector retrenchment, and fiscal deterioration at the federal level. Decentralization, competition, and fragmentation characterize the contemporary do-it-yourself federalism. President Reagan's proposed swap, turnback, and trust-fund package of New Federalism seeks to capture these changes in a system realignment. I examine these changes in light of whither intergovernmental relations go in the 1980s.


Finding people. Eight steps to better employment interviews.


Can we repair the cracks in the Social Security system?


Telemarketing fund raising by phone.

Telemarketing fund raising by phone.


OMB considers changes in statutes covering nonprofit lobbying.


The IRS. Benevolent guide or antagonist?. Interview by Jonathan Walters.


Safety in hospitals.

Safety in hospitals.


What is the value of a Geriatric Assessment Unit in a teaching hospital? A comparative study of the management of elderly inpatients. This study at the Flinders Medical Centre, compared the management of 50 elderly patients, admitted acutely ill to the Geriatric Assessment Unit, with the management of 50 elderly patients admitted, under similar circumstances, to other medical units in the Centre. Patients under the care of the Geriatric Unit had a comparable mean length of stay, were on less medication at discharge, and were more likely to return home to their pre-admission accommodation, compared with patients admitted to other medical units. The multidisciplinary approach adopted in such units, coupled with increased utilization of community based services, appears to significantly limit rates of referral to institutional care.


Are you planning to care properly for Big Brother's parents?


Living-in parents: the hidden costs.

Living-in parents: the hidden costs.


Towards a career structure.

Towards a career structure.


Plugging the dollar drain.

Plugging the dollar drain.


Life-support systems: some moral reflections.


The ethical challenges of surgical training programs.


Modern medicine and the price of success.


President's commission offers guidelines on life-support therapy.


Negative references and legal liability.


Guri Dam: the challenge of trauma care.

Guri Dam: the challenge of trauma care.


Stalking the big bad wolf.

Stalking the big bad wolf.


More and better results through concentration.


Looking beyond individual productivity.

Looking beyond individual productivity.


Involvement in trauma care by ACS Fellows: a national survey.


Getting commitment by soliciting employee ideas.


Union organizing in the 1980s: the strike.


Overcoming resistance to change.

Overcoming resistance to change.


Cafeteria incentive plans: a new way to motivate.


How to delegate successfully.

How to delegate successfully.


Applying the management process to your work day.


How am I doing?

How am I doing?


What you need to know to be a supervisor.


Why supervisors don't delegate and employees won't accept responsibility.


This matter of discipline.

This matter of discipline.


Five steps to improving employee performance.


Prescription for profits.

Prescription for profits.


Heal thyself.

Heal thyself.


Prognosis: steady improvement but the nation's health-care system still lags behind the West's. Japan.


Keeping the patient in stitches.

Keeping the patient in stitches.


The panic over AIDS.

The panic over AIDS.


Child abuse and neglect prevention and treatment program--Office of Human Development Services. Final rule. The Department of Health and Human Services is issuing final regulations to implement the amendments to the Child Abuse Prevention and Treatment Act contained in Title 1 of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978, Pub. L. 95-266, as amended. The regulations also clarify, simplify and eliminate where repetitive of the statute, the rules governing the Child Abuse and Neglect Prevention and Treatment Program and those related to the coordination of Federal activities related to child abuse and neglect.


Social Security Amendments of 1983--Public Health Service. Notice of changes in the review thresholds under Section 1122. This notice provides information on the Social Security Amendments of 1983 (Pub. L. 98-21) which were effective upon enactment on April 20, 1983. Under Section 1122 of the Social Security Act, the expenditure threshold for reviews of capital expenditures is changed from $100,000 to $600,000 and an exemption from review is provided for HMOs (and similar entities) if certain conditions are met. In addition, the amendments require all hospitals participating in the Medicare program to provide their overall 3-year capital expenditure plans to the designated planning agency or other appropriate health planning agency in the State.


The Court stands by abortion.

The Court stands by abortion.


Health Care Financing Administration--statement of organization, functions, and delegations of authority.


Federal Employees Health Benefits Program--Office of Personnel Management. Final rule. These regulations call for the simultaneous submission of Federal Employees Health Benefit (FEHB) carriers' benefit and rate proposals. The regulations will permit an assessment of the impact of benefit and rate proposals on both the Government and enrollees in a more timely and orderly fashion than is possible with the present FEHB contract negotiation cycle.


Privacy Act of 1974; notification of new routine use--Public Health Service. In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new routine use permitting disclosure to contractors of information in the Privacy Act system of records 09-35-0044, "Health Professions Planning and Evaluation," HHS/HRA/OA.


Procurement regulations--Office of Personnel Management. Final rule. These regulations call for the simultaneous submission of Federal Employees Health Benefit (FEHB) carriers' benefit and rate proposals. The regulations will permit an assessment of the impact of benefit and rate proposals on both the Government and enrollees in a more timely and orderly fashion than is possible with the present FEHB contract negotiation cycle.


Health maintenance organizations--Public Health Service. Interim rule with request for comments. This notice amends the Public Health Service regulations on Federal qualification of health maintenance organizations [HMOs]. The purpose is to provide greater flexibility for already existing prepaid health care delivery systems to become transitionally qualified HMOs. Adoption of this amendment wil allow entities operating these systems to satisfy the requirement that basic health services be provided to members by demonstrating that members enrolled at the time of transitional qualification receive hospital services or are insured for hospital services through an arrangement not made by the HMO.


Occupational exposure to ethylene oxide--Occupational Safety and Health Administration. Proposed rule and notice of hearing. By this notice, the Occupational Safety and Health Administration (OSHA) is proposing to amend its existing occupational standard that regulates employee exposure to ethylene oxide (EtO). The basis for this action is a determination by the Assistant Secretary, based on animal and human data, that exposure to EtO at OSHA's current permissible exposure limit (PEL) of 50 parts EtO per million parts of air (50 ppm) as an eight (8)-hour time-weighted average (TWA) is inadequate for employee health protection. OSHA proposes to reduce the PEL for EtO to a TWA of 1 ppm. An "action level" of 0.5 ppm as a TWA is included in the proposal as a mechanism for exempting an employer from the obligation to comply with certain requirements, such as employee exposure monitoring and medical surveillance, in instances where the employer can demonstrate that the employees exposures are at very low levels. The proposal would provide for among other requirements certain methods of exposure control, personal protective equipment, measurement of employee exposures, training, medical surveillance, signs and labels, regulated areas, emergency procedures and recordkeeping.


Additional federal allotments to states for social services expenditures pursuant to the Title XX-Block Grants to States for Social Services--Office of Human Development Services, HHS. Section 2003 of the Social Security Act, as amended, authorizes $2.45 billion for allocation to the States for Social Services Block Grants--Fiscal Year 1983. Public Law 98-8, enacted March 245, 1983, appropriates an additional $225 million for Fiscal Year 1983. This notice contains State allotments and explanations of how the allotments were determined; conditions for receipt of these funds and other information.


Nondiscrimination on the basis of handicap in the provision of health care to handicapped infants--Office of the Secretary, HHS. Notice of court order declaring rule invalid. This notice is to advise that the interim final rule issued by the Department of Health and Human Services on March 7, 1983, 48 FR 9630, concerning discrimination in the provision of health care to handicapped infants, has been declared invalid and has no further force and effect.


States considering ways to cap health costs.


Arizona employers leading health cost battle.


Grants to state health planning and development agencies determination of population of the states--Health Resources and Services Administration. This notice provides the population figures the Department will use when it determines the amount of grants to State Health Planning and Development Agencies (State Agencies).


Malpractice pool stops payments on claims.


Before you sign PPO contract, do homework.


Pennsylvania willing to try competition before regulation.


San Diego employers behind push for local PPO.


Canadians have two health benefit sources.


Florida looking at several ways to cut costs.


West Virginia sets up rate commission.

West Virginia sets up rate commission.


Are you prepared for the approaching boom of elderly patients?


Avoid malpractice suits by communicating with your patients.


Blues dominate group benefit market: study.


Avoid libel suits by knowing the legal limits of defamation.


The act of profession.

The act of profession.


A clear definition of objectives is key in establishing a registered charity.


Catch-22 is alive and well and defining Canada's emergency medical system. Part 1.


Office design guidelines.

Office design guidelines.


You can break down the barriers of age discrimination.


Put less talk and more action into your meetings.


Should you be a Good Samaritan in the U.S.?


The Schweitzer hospital in Haiti needs you.


Medical records should be your best defence.


AIDS: bringing the gay patient out of the closet.


Identification and prevention of infections in the critically ill trauma population.


Reflections of a visiting physician. Interview by Ellen M. Gardner.


Autotransfusion in trauma.

Autotransfusion in trauma.


Plato's Protagoras: professional models, ethical concerns.


The importance of building trust and credibility.


Functions and techniques of employee evaluations.


Policy and procedure manual. Patient counseling.


VNA of Dallas--a model of modern home health care.


Burnout: possible? probable? preventable?


Sterilization and the mentally retarded.


Home care and adult protective services.


Implementation of a hospital pharmacy drug product selection program.


Pay compression: causes, results and possible solutions.


The role of thermography in breast cancer.


Costing out a wage and benefit package.

Costing out a wage and benefit package. Labor costs represent the largest single cost of operation for most organizations. For the unionized employer, the compensation package is determined during contract negotiations. It is important for both union and management negotiators to be able to identify the cost of a proposed agreement. Both parties to a contract should know whether a proposed compensation package is consistent with an organization's ability to pay. In addition, when "trading" demands, both parties should be aware of the cost of the demands being traded. An approach to costing out a labor agreement has been presented in this article. While it can be described as the standard approach, it is subject to several criticisms. Typically, it is applied in a way that assumes that history will repeat itself. In addition, it focuses on the direct cost of a proposed compensation package. While this is certainly relevant, the impact of the compensation package on organization profits is more important. Finally, the time value of money is not taken into account. This would be important if a multi-year contract is being negotiated. While there are legitimate concerns about the approach presented here, our objective is to provide the reader with a basic approach to costing out a wage and benefit package. Anyone involved in contract negotiations or, in the nonunion firm, anyone responsible for administering a wage and benefit program, should be aware of the problems that we have described and seek out reference materials to provide guidance in addressing them.


Hospitals sponsor half of all child-care centers--but that doesn't match the need.


Patient controlled analgesia.

Patient controlled analgesia.


Preventing equipment-related incidents.

Preventing equipment-related incidents.


Preferred provider organizations.

Preferred provider organizations.


Health fairs are more than a community relations scheme; they save dollars and detect health problems early.


Clinical engineering trends for 1983.

Clinical engineering trends for 1983.


Comparable worth. Will focusing on the value of work performed increase RN job satisfaction?


Safety checklists.

Safety checklists.


Defibrillator discharge unit "boom box".


Inhouse rebuilding and maintenance program meets the requirements of a busy CCU.


Ethylene oxide and nitrous oxide waste gas monitoring--a BMET manual.


Risk management reporting.

Risk management reporting.


Ethylene oxide (ETO) emergency plan.

Ethylene oxide (ETO) emergency plan.


Patient opinion surveys. Effective marketing tool--or ego tripping?


Self-insuring employee health benefits continues to be a cost-effective option.


Employee opinion surveys.

Employee opinion surveys.


A check-in time schedule for reservation patients eases the traffic jam in admitting--and elsewhere.


Emergency rooms. The challenge of free-standing competitors--and non-paying patients.


On-line computer analysis of hemodynamic data. As we come more and more to depend on computers, we need assurance of their reliability and accuracy. Toward this end, a comparison of computer and manual analyses of hemodynamic data was undertaken. The results, reported here, support computer reliability.


HISSG--tackling healthcare information system problems together.


Word processing in healthcare: guidelines and a case study. If controlling or reducing healthcare costs while providing the best possible patient service is your goal, then word processing is an auxiliary method of information processing that you should examine closely. Handled properly, word processing delivers significant benefits: improved collections, increased cash flow, reduced paperwork, increased donations to healthcare foundations, improved productivity and improved document quality. Mishandled, word processing does little more than provide you with expensive typewriters.


Spotlight on transcutaneous monitoring.

Spotlight on transcutaneous monitoring.


Getting the most from word processing.

Getting the most from word processing. Users of word processing in healthcare organizations do not get the productivity they should with today's word processing technology. The technology performs well, better each year, but healthcare users haven't organized their operations to maximize productivity. Out-of-date ideas about office work, lack of organized direction in the use of word processing technology and a continuing resistance to change all contribute to the loss of potential productivity increases from word processing in healthcare organizations.


Workup of the hypertensive patient.

Workup of the hypertensive patient.


Cardiac pacing for the young at heart.

Cardiac pacing for the young at heart.


Neonatal blood pressure. More than cuffs and stethoscopes.


Focus: Great Britain . . . a second look. Interview by Karen M. Richards.


A few observations that may explain high DP costs.


Physicians and computers: trends for the 80's. Interview by O. George Kennedy.


Healthcare ferment aids hospital design community.


Health consortium's CAD system unites competing architects.


Pulmonary function laboratory, the Mason Clinic. This laboratory, equipped to perform more than a score of different tests, provides diagnostic support for 125 board-certified physicians in joint private practice and for the 320-bed Virginia Mason Hospital. Nearly half of the 50 outpatients seen each day in the laboratory have been referred by physicians outside the Seattle area.


It's child's play for Kenosha kids in healthcare tower.


Transmitting echocardiograms by telephone. The feasibility of sending echocardiographic tracings to distant places by means of telephonic facsimile equipment has been investigated, and the quality of the transmitted copies was found to be acceptable. Three models were used for transmission, and although they presently have some technical limitations, use of satellites promises to enhance their capacity. Use of the already available technology will allow remotely located echocardiographers to benefit from the expertise of consultants in this field. Rapid telephonic access to referral centers, especially for difficult cases, will prevent potential interpretation errors and will give the referring physicians another tool for upgrading their interpretative skills. Transmission of echocardiographic tracings could thus become another means of continuing medical education in a constantly evolving field.


Effective catheterization laboratory management. Managing a catheterization laboratory requires both attention to basic managerial principles and consideration of the difficulties that operating a highly specialized, state-of-the-art technical facility presents. Paying careful attention to communication, staff development, and budgeting will help avert potential problems.


Healthcare facilities colors keyed to standards.


Continuity of care: a view from California.


A scenario on discharge planning.

A scenario on discharge planning.


Controlled patient movement vital in healthcare seating.


The cancer ward: scapegoating revisited.


Right-and left-brain approaches to death education. Some recent advances in the understanding of brain function are considered in terms of their potential impact on death education. The notion of right- and left-brain cognitive styles is examined in terms of the pedagogic impact it may have on an individual's capacity to understand and therefore be educated on the subject of death. The idea that the human brain (mind?) relates to death in two diametrically opposed ways is discussed and a holistic death educational format is proposed based on the synthesis of these two oppositional styles.


Group health plans improving in Belgium.


$30 million nursing home serves human needs, adheres to codes.


Administration tax cap proposal criticized.


Atria brings future look to hospital expansion.


Study investigates costs of various cancer treatments.


Hospice program seen as health care alternative.


Learning how to purchase good medical care can produce managed health care costs.


The ATS proficiency testing program for blood gas laboratories.


Quality assurance, reasonable cost are goals of preferred provider group, medical advisory plan.


Business coalitions use slow approach to wellness.


Reviewing potential of second-opinion programs.


Health care data collection: putting the right numbers in and getting usable numbers out.


Diagnoses and procedures form basis of data.


Collecting health statistics a national concern.


Transillumination helpful in the speedy diagnosing of neonates.


Physician involvement, careful scrutiny, changes in game's rules needed for cost containment.


Changing established behavior to cut health costs.


EEOC regulations for older workers' health plans create problems for employers and administrators.


Slight rise in NIH budget; approval seems likely.


Freestanding emergency centers.

Freestanding emergency centers.


The control of mattress rotation.

The control of mattress rotation.


Getting the most mattress for your money.


The National Association of Freestanding Emergency Centers.


Contract management: is 50% of the hospital market within reach? Part 1.


"No-wax" floorings. Illusion, science fiction or fact?


Caring for resilient and hard floors.

Caring for resilient and hard floors.


Why all the sudden interest in quality?

Why all the sudden interest in quality?


Quality assurance--a case in point.

Quality assurance--a case in point.


The role of computers in environmental services and its impact on patient care.


The selection and evaluation of supplies.


The challenge in a changing health care environment.


Standards.

Standards.


Disclosure or non-disclosure: that is the question.


Alcohol-related emergencies.

Alcohol-related emergencies.


How to save money on your radio purchases.


Failure to establish standards.

Failure to establish standards.


The future of EMS communications.

The future of EMS communications.


Real-world problems with zoned evacuation.


Trauma centers: operations.

Trauma centers: operations.


Aspects of stochastic modeling for structural firesafety. A brief review is presented of methods for stochastic modeling of fires of sufficient severity to threaten the structural safety of buildings. Information is provided on the rate of fire occurrences according to the floor area at risk for the major occupancy types.


A logic-tree approach to the St. Crispin Hospital fire. Fatality or injury due to fire is an aspect of the working of an entire system. That is, casualty due to fire represents a failure of a system and ultimately, this includes the social system within which we live. As part of such a consideration, many different techniques and models may be used, and one such technique is that of logic-tree analysis.


Throw away the rules.

Throw away the rules.


Chart auditing.

Chart auditing.


The high cost of crime.

The high cost of crime.


Using learning contracts for EMT instruction.


EMS interconnect.

EMS interconnect.


Why Glenyce Feeney stands alone.

Why Glenyce Feeney stands alone.


How to involve hospital patients in the foodservice.


How to prevent hospital malnutrition.

How to prevent hospital malnutrition.


Portable radio communications for emergency medical services.


From the other side of the tray.

From the other side of the tray.


Herrick Hospital: dining facilities.

Herrick Hospital: dining facilities.


Barry Hutchings. Hospitals. Interview by Nancy Madlin.


Competitors and colleagues.

Competitors and colleagues.


Giving up 11.7% despite gloomy economic backdrop.


Fee-for-service and prepay MDs.

Fee-for-service and prepay MDs.


The Chrysler story: how an ailing American firm is tackling health care cost problem.


Bye-bye to the buy-out blues.

Bye-bye to the buy-out blues.


Why administrators sometimes fail.

Why administrators sometimes fail.


Postal rate increases hinge on Commission, courts, board.


Team building may enhance development effectiveness.


Cable watch out! DBS is on the way!

Cable watch out! DBS is on the way!


Use direct mail ... in planned giving.

Use direct mail ... in planned giving.


Developing a sensible fund raising strategy.


From equal share to 70% productivity.

From equal share to 70% productivity.


Is there a MedFirst office in your community?


Investor-owned hospital establishes first burn center in Hawaii.


"Little Sneaker" gives Texas hospital its first quadruplets.


Market audits can give a competitive edge.


Put the zip to work.

Put the zip to work.


Set up a foundation to aid hospital fund raising. The proliferation of government regulations are increasingly impinging on non-profit hospitals' ability to maneuver financially. The formation of a hospital foundation can help sequester assets, and spur fund raising while protecting tax-exempt status.


Development councils will solicit if board won't.


The health care industry and antitrust: a continuing exploration.


Corporate philanthropy poised for takeoff.


A perspective on non-formal education for health: the research potential of health fairs. The proliferation of health fairs provides a unique opportunity for the incorporation of research protocols into nonformal educational situations. One such fair, designed as a first step in implementing a health risk reduction program for a target population of parents and teachers of handicapped children, served as a catalyst for a comprehensive analysis of research possibilities. The health fair was organized and operated by faculty and graduate students of the University of Texas School of Public Health, following goals established by an advisory committee, which included representatives of the target population. Following the fair, there was an evaluation by participants, designers, implementers, and observers. This evaluation led to a more comprehensive assessment of health fairs in general as potential sites for research. The extensive feedback and indepth analyses generated a series of questions compatible with research paradigms.


Rape prevention through health education. Rape is one of the fastest rising, yet most under-reported crimes in the United States. The effects of rape can result in various physical, logical and legal complications in the life of the victim. This paper presents an overview of rape, including the definition and etiology of rape, rape myths, physical and psychological problems related to rape, treatment procedures, and most importantly, measures in health education that can help reduce the probability of rape occurrence. Reducing the likelihood that an individual will become a rape victim is an objective of preventive health education. This article can help people learn what rape encompasses, how it is likely to occur, and how to prevent or cope with such an experience.


Social networks as a means of health maintenance.


Health policy and the tobacco subsidy.

Health policy and the tobacco subsidy.


Preparing health educators for the workplace: a university-health insurance company alliance. The workplace is a relatively recent and an increasingly recognized setting for health education. In this article, philosophical and economic reasons for this movement of health education in the workplace are cited. Currently the workplace is one of the fastest growing markets for health education. In most institutions, preparing health educators for the workplace has not been adequately addressed. Consequently, an experimental course entitled "Health Promotion and Educational Strategies for the Workplace" was developed and taught at The Ohio State University in the summer of 1981. Besides an extensive reading list and lively class discussions, the course was team-taught primarily by a health education faculty member and a health insurance program manager/health educator.


Delivering health education programs: a model. The OPT/EVALUATE delivery model provides a system for applying principles of organizational management to the problems of administering health education. Whether one is a new health educator, or part of a health education team, solving operational problems calls for expertise in a variety of fields. Most health educators are not prepared for program administration functions. The article includes a diagram of the OPT/EVALUATE model and an Action Step Checklist. The checklist may be for professional self-assessment, for guiding internships and on-the-job training experiences, or for systematically coordinating a health education project. Each section of the checklist is explained in the article with resources for further reading. Individuals can adapt the OPT/EVALUATE model to their own work setting and target populations. The importance of the checklist steps will vary from project to project. Some specific steps may need to be added.


The Federation of State Medical Boards: past--present--future.


Death education coverage in selected health education books and periodicals. This article represents an attempt to ascertain the quantity of death and dying literature within selected health education periodicals and introductory health education books during the past 7 years. The study is part of an ongoing effort by the author to determine relationships between health education and death education. Approximately two-thirds of the general health education books reviewed now include chapters or sections on death-related phenomena. Four nationally refereed periodicals, viewed by the author as most useful to the health educator, have also been publishing a considerable number of death education pieces in recent years. Involvement by health educators, via the publication of death and dying information, should be viewed as a positive gesture toward achieving multidisciplinary goals within death education.


Organized medicine's expectations of medical licensing boards.


Curbing drug-related problems.

Curbing drug-related problems.


The search for meaning and its potential for affecting growth in bereaved parents. Because of the unique relationship between parent and child, the death of a child is a profound human loss which ultimately sends bereaved parents into a deep and painful existential "search for meaning." This search may ultimately be a key factor in a positive "growth" versus a negative "despair" resolution of the grief experience. This paper examines data from open-ended questions collected in three separate studies which asked bereaved parents in various ways to describe themselves. The purpose of this descriptive analysis was to seek clues in these self-descriptions regarding both positive and negative resolutions following the death of a child. Although the findings must be considered with caution because of convenience sample and the indirect methods of data collection, the findings indicate that many of the comments given by the parents suggest potentially positive outcomes.


The 1982 Herbert M. Platter luncheon address. Federal-state opportunities in health policy.


Relationship of medical licensure and specialty certification.


Recent developments in the assessment of physician competence.


Due process in disciplinary actions.

Due process in disciplinary actions.


Washington reins in the dialysis business.


Legal liability. The risk headache.

Legal liability. The risk headache.


Flexible budgeting.

Flexible budgeting.


Health planning. Removing the straitjacket.


Death education: enhancing competence across the life span. Life is full of major and minor events analogous to dying and death that few people realize exist. Throughout life there are a variety of loss situations (e.g., death of a pet, divorce, loss of a job, retirement, death of a friend or relative, etc.) that help to prepare individuals for their own death. If death educators can enhance the life skills necessary to cope with these life events, then perhaps, the individual will be better able to cope with their own death and the death of a significant other. This paper will present an overview of the basic tenets of life span intervention, provide a discussion of life skills directly related to dying and death, and suggest key points of positive intervention.


Low energy hospital.

Low energy hospital.


Mental health data. Saved from the scrapheap?


Exercises about death: facts, fiction, and values. Our concern in this paper is to examine exercises about death of the sort that are commonly used at the outset of death education courses and hospice training programs. We describe a variety of these exercises and report data from a representative sample of those which we have used in our own courses and workshops. Three issues are singled out for discussion: 1) compliance in the doing of these exercises; 2) content in the responses (especially as concerns timing or manner of death and focus of concern); and 3) interpretation of results (e.g., limitations of such exercises, shifts between expectations and desires, "realism," and alterations when additional considerations are introduced). Our conclusion is that we must be cautious in giving two much weight to the ostensible results of such exercises, either as regards personal significance or as research projects. Nevertheless, as we show, there is value in the process itself when seen in the light of a proper understanding of the goals of a death-related educational or training program.


'Stem doctor' melting pot.

'Stem doctor' melting pot.


Living, loving and losing: implications for health and well-being. Living, loving and losing - we live, we love and we lose - this is an integral part of life's unending circle. Throughout the lifecycle, we are confronted continually with experiences of loss and separation. The loss of a loved one through separation, divorce, or death is one of the most difficult experiences to be dealt with in a lifetime. How do we cope with the "crisis of loss" in our lives? If education is supposed to prepare one for life, then Death Education is crucial in assisting individuals to cope with "myriad loss issues." This paper will explore the implications of loss for health and well-being, and briefly review some of the research findings regarding the negative impact of grief and bereavement upon health. The stages of the grief process will be cited, mentioning some of the barriers to grief resolution. Most importantly, the positive aspects of loss upon life and health will be elaborated.


US medical corporations. Overpriced and over here?


Networking for health.

Networking for health.


The use of the computer in education: focusing on nutrition. The past few years have brought about renewed recognition of the important interrelationships between diet and disease. The disheartening popularity of food fads and highly questionable products is a signal that the health consumer not only views this as an important area but also has found professional sources of health guidance to be inadequate. With the increasing importance of nutrition as a national health priority, technological advances should be used to translate knowledge of nutrition to the public more efficiently.


Computers go on drug watch.

Computers go on drug watch.


Focusing on nutrition education: an essential for cancer prevention.


The role of nutrition in maintaining health and preventing disease. Health is much more than the absence of disease. It is a positive quality, emphasizing physical, social, intellectual, emotional, and spiritual well being. Optimum nutrition, providing all nutrients in both kind and amount, is the cornerstone of good health and the cutting edge of prevention. The foods we eat, and the nutrients they should provide, are the most important continuing environmental factors influencing our growth, development, functional abilities, and health. Nutritional knowledge, with education of both the general public, and particularly health professionals is critical if we are to succeed in significantly reducing the excessive premature morbidity and mortality from our leading killer diseases - heart disease, cancer, and stroke. How we structure our lifestyles, with proper nutrition, health habit discipline, and exercise programming, will have a great influence on personal health, and will help reduce our current catastrophic medical care expenditures.


A psychosocial model of health behavior: implications for nutrition education, research and policy. The paper presents a multidimensional psychological model of determinants of health behavior, tested empirically in three countries to ascertain its validity. The model postulates that given that ethnic, socioeconomic, and biological statuses (exogenous variables) are homogeneous, a health risk-taking behavior in a population is a function of direct, additive, and interaction effects of five categories of independent variables both internal to the persons and external in the action environment. Although the model is tested on contraceptive behavior, it is argued that the determinants and basic processes of this risk-taking behavior are similar to those involved in other health risk behaviors and that the five basic factors identified affect nutritional behaviors as well. The paper presents several broad implications on the model for nutrition education and research; but holds that specific implications could be best derived by the specialists in nutrition field. This paper presents a multidimensional psychosocial model of determinants of health behavior, tested empirically in 3 countries to ascertain its validity.  The model postulates that given that ethnic, socioeconomic, and biological statuses (exogenous variables) are homogeneous, a health risktaking behavior in a population is a function of direct, additive and interaction effects of 5 categories of independent variables both internal to the persons and external in the action environment.  Although the model is tested on contraceptive behavior, it is argued that the determinants and basic processes of this risktaking behavior are similar to those involved in other health risk behaviors and that the 5 basic factors identified affect nutritional behaviors as well.  The paper presents several broad implications of the model for nutrition education and research but holds that specific implications could be best derived by specialists in the field of nutrition.


Appeals behind closed doors.

Appeals behind closed doors.


Tender plant branches out.

Tender plant branches out.


Fringe benefits for the NHS.

Fringe benefits for the NHS.


Twelve steps to zero.

Twelve steps to zero.


Starting from scratch.

Starting from scratch.


Health Advisory Service. Some progress but could do better.


When the doors close on the dependent.

When the doors close on the dependent.


In touch with the patient.

In touch with the patient.


A tag on the telephone.

A tag on the telephone.


Good writing: source of power for hospital public relations people.


Saved by the bell.

Saved by the bell.


The consumer customer is making independent purchasing decisions more than ever before.


Officers on commission.

Officers on commission.


Christening the cruciform.

Christening the cruciform.


From Barclay to Black.

From Barclay to Black.


Too many patient cuts?

Too many patient cuts?


Wizards with figures.

Wizards with figures.


Coming out in the wash.

Coming out in the wash.


A model solution.

A model solution.


Nurses given health lessons.

Nurses given health lessons.


Winning the lift game.

Winning the lift game.


Calling on the catalyst.

Calling on the catalyst.


Proof of the pudding.

Proof of the pudding.


What's cooking in Brent?

What's cooking in Brent?


Day care made simple.

Day care made simple.


Have hospital, will travel.

Have hospital, will travel.


Computer use in materials management: where, exactly, are we?


Exchange cart vs. PAR stock: which is the best distribution system? Part IV.


The materials management-financial administration partnership.


Rate of salary growth slow in 1983.

Rate of salary growth slow in 1983.


Who will control health care?

Who will control health care? American medicine could be consumed by conflict in the years to come, says a Stanford University professor. The "battle" for control of health care pits teaching hospitals against community hospitals, and physicians against hospital management.


Cost-effective patient-care decisions is goal for new training.


For the home health agency--selecting the right computer system now.


Proposed legislation creates "community nursing centers".


25 hidden costs found in data processing.


Stressing "information" aspect of data processing.


'Service' is agency's name.

'Service' is agency's name.


Data processing professionals detail the growing importance of computer usage.


Home health agency enters computer era.

Home health agency enters computer era.


An interview with: James Hopkin.

An interview with: James Hopkin.


'Hospital watch' teaches employees, neighbors crime awareness/prevention.


Pre-employment screening: no easy way out.


Proper morgue security prevents costly employee mistakes, reduces thefts.


An interview with: Thomas Seals.

An interview with: Thomas Seals.


The new challenge: productivity.

The new challenge: productivity.


Bar soap becomes contaminated under in-use conditions.


Progress and problems with hospitals in developing countries.


Bonus for hospitals from heat recovery.

Bonus for hospitals from heat recovery.


This new medical information card could save your life.


An incinerator flue that failed twice.

An incinerator flue that failed twice.


Joint venture tendering.

Joint venture tendering.


Problems--maintenance and operations.

Problems--maintenance and operations.


Planned preventative maintenance systems.


Measured term contracting.

Measured term contracting.


Direct labour in competition.

Direct labour in competition.


Overlooking the incinerator?

Overlooking the incinerator?


Mortuary design--a long way to go.

Mortuary design--a long way to go.


Modern warehouse design.

Modern warehouse design.


Cardiology centre project.

Cardiology centre project.


Upgrading the Samaritan.

Upgrading the Samaritan.


Unit for the mentally handicapped.

Unit for the mentally handicapped.


A socio-medical study of infant mortality among disadvantaged blacks. This report profiles the woman at highest risk of a low birthweight delivery and infant death, in a generally disadvantaged, Black population in a major northeastern city which maintains one of the highest infant mortality rates in the nation. It discusses the existence of a very high risk subpopulation which contributes disproportionately and repeatedly to the infant and perinatal death statistics. If adequately identified, these women can be subject to intervention programs. Results show that within an inner-city Black population, where educational levels are relatively low and much of the reproductive segment is young and unmarried, the standard identification criteria of age, education, and marital status do not vary with poor pregnancy outcome. Furthermore, certain factors associated stereotypically with inner city lifestyle, such as drug abuse and venereal disease, also fail to distinguish women having normal and very low birthweight infants. Instead, alcoholism, smoking, low maternal weight at delivery, hypertension history, migrant status, ineffective contraception, prenatal care, violence, and relatively poor psychological adjustments and social support systems distinguish the study samples.


Citizen participation in neighborhood health centers for the poor: the politics of reform organizational change, 1965-77. Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.


Willingness to assist one's elderly parents: responses from United States and Japanese families.


The differential construction of social reality in chronically ill children: an interpretive perspective.


Levels of analysis and levels of need: cultural factors and the assessment of need for alcoholism treatment services in an urban community. This is a case study in techniques for combining qualitative and quantitative data in local community service needs assessments. Problems in available administrative statistics when applied to local communities are illustrated and discussed. Supplementation of epidemiologic estimates and utilization statistics with ethnographic, historical, and sample survey data is shown.


The pressure to conform: a study of foster grandparents at a state institution.


Social exchange and power in the care of the institutionalized aged.


Responsibilities of anthropological researchers in psychiatric clinical settings.


Alaskan villagers' views on problem drinking: "those who forget". Statewide statistics suggest that problems relating to alcohol abuse represent a major public health problem for Native Alaskans but very little is known about alcohol use on a community level, due to deficient reporting mechanisms and a lack of relevant research. The research reported here was designed to begin to fill this stated need. Alcohol use patterns, the extent of drinking, and associated problems as perceived by residents of two Alaskan Eskimo villages are documented. The structure and effects of alcohol programs in the villages, which represent local attempts to manage alcohol, are also examined. The research demonstrates that it cannot be assumed that all Native Alaskan communities have the same scale of drinking and consequent problems. Differential response to alcohol programs, which have essentially the same structure, is demonstrated and related to the recent development of contrasting levels of community organization in the two villages, which share a common cultural tradition. The utility of a comparative case study approach in examining alcohol problems in Native American communities and the need for expanded research for informed alcohol program planning and implementation are emphasized.


Experiential learning can improve the performance appraisal process.


The other face of performance appraisal.


Beyond orientation: assimilating new employees.


Illinois adopts total brain death definition of death.


U.S. Supreme Court tax decisions have implications for tax-exempt hospitals: lobbying activities and violations of public policy.


HHS reissues "Baby Doe" regulations; provider concerns remain unaddressed.


Do you know where your patients are?

Do you know where your patients are?


U.S. Supreme Court determines labor law cases.


Malpractice--are you covered?

Malpractice--are you covered?


The future management of property.

The future management of property.


Demand quality.

Demand quality.


Hospital planning--listen to the market and develop consensus.


Updating manuals is good policy.

Updating manuals is good policy.


Computerized drug delivery--a bit of preventive medicine.


New measures keep you on the safe side.

New measures keep you on the safe side.


Quality, not quantity, is the hallmark of good public relations.


Take pride in our system.

Take pride in our system.


On the brink of disaster.

On the brink of disaster.


Financial planning and management of health programmes in India. In this paper, the author deals with the financial planning and control of health programmes in India. The techniques of cost-effectiveness analysis and of performance budgeting are highly useful aids to management for implementation of monitoring and review of performance of the programmes are also essential for gauging the progress. Considers aspects of the financial planning and control of health programs in India.  The techniques of cost benefit analysis and cost effectiveness analysis are useful decision making tools for selection of programs that yield the greatest benefit at a given cost or a predetermined benefit at the least cost.  The approved budget provision for a program provides the authority for its implementation.  In performance budgeting, the budget is viewed as a work plan which specifies program targets to be achieved by the agency during the financial year.  Performance budgeting requires physical targets for output, which should be related to the required inputs, and assessment of efficiency of operations.  Successful performance budgeting requires a decentralized responsibility structure to ensure accountability of the various levels against their budgeted plans and targets.  Design of useful information and reporting systems is also crucial to the success of performance budgeting because they allow management to make on-course corrections when necessary.  Performance audits or evaluations should be conducted with reference to the specific objectives of the program, and in terms of predetermined norms and standards.


Proposed U.S. Health Promotion Office would spend $36.5 million in four years for clearinghouse, grants: NIH would have assistant director for prevention.


Tolsma would like to see corporations reach out with health promotion efforts to employee families. Interview by Lawrence M. O'Rourke.


Some theoretical models in the study of health behaviour: implications for health systems in India. This paper attempts to highlight some of the presently accepted models of health, behaviour and their usage in explaining illness, sickness and utilisation behaviour. The limitations of each of the model have also been described. Finally an attempt has been made to visualise the applicability of such models on Indian health system. A viable model already tested has been proposed to assess the social patterns of seeking medical care in rural setting in India. Describes current models of health behavior and their utility and limitations in explaining illness, sickness and utilization of health services.  Individual or personality-oriented models, including Rosenstock's health belief model, Mechanic's illness behavior model, Anderson's medical care utilization model, and Kosa's illness behavior model, and socially oriented models, including Zola's health behavior model and Suchman's seeking care model are discussed, and a few reviews of health behavior models are mentioned.  Study of health and related behaviors in India is increasing, but few studies have benefited from provision of any model that would provide a holistic view of Indian health behavior.  Anthropological studies have demonstrated the need to understand health behavior in relation to a particular cultural milieu and to analyze factors which encourage or hinder optimal utilization of existing health services.  Models of health behavior that reflect these disparities are needed.


Mathematical models and their applications in medicine and health. Mathematical models have great potentialities as regards their utility in different disciplines of medicine and health. This paper attempts to elucidate their uses in the field. A brief mention of some models has also been made. Mathematical models are useful in epidemiologic research, planning and evaluation of preventive and control programmes, clinical trials, measurement of health, cost-benefit analysis, diagnosis of patients and in maximizing effectiveness of operations aimed at attaining specified goals within existing resources. Describes mathematical models that have been used in the field of health and provides examples of applications from the literature.  Descriptive models are useful in community diagnosis and other epidemiologic research, while predictive or simulation models elucidate the mechanisms of a phenomenon and predict its future course.  Such models do not take into account unknown forces entering at a future date.  Probabilistic and stochastic models are based on random approaches, but deterministic models have a relatively wider application to biological phenomena.  Operations research models, which depend on various indices such as cost-benefit ratios, suggest how the effectiveness of operations can be maximized.  Diagnostic models are formulated by assigning scores to various signs and symptoms as an aid to clinical diagnosis.  Rational models are derived in a logical way based on observation, theory, and assumptions about the behavior of physical components of a system, while empirical models reflect the main features of available data.  Important areas of application of models in medicine and health include epidemiologic research, prediction, planning and evaluation of preventive and control measures, measurement of level of health, cost benefit analysis, assessment of risks of illness, patient diagnosis, and maximizing effectiveness of operations.


Nationwide buying group helps market shared services.


Communicate through committees.

Communicate through committees.


Local autonomy is key to HCA material program.


Communication system between District Health Office and Primary Health Centre. This is a pilot study undertaken by the authors to analyse the communication system as prevalent in health services at District Health Office (DHO) and five Primary Health Centres (PHCs) under it. The five PHCs were randomly selected under DHO Bellary. The authors study the nature of communication of correspondences pertaining to establishment matters, health intelligence and health activities for the first quarter of the financial year between the DHO and PHCs level, pinpoint deficiencies and list out suggestions. A study was conducted of communications and correspondence between 5 randomly selected primary health centers (PHCs) and their district health office (DHO) from April to June, 1977, to evaluate their communication system.  A statistical assistant and a computer specialist using 3 different schedules analyzed correspondence pertaining to organizational and health matters.  Staff shortages and lack of supplies were found to hamper written communications and record keeping.  It was difficult to estimate the total quantity of letters sent and received as files were incomplete at both ends.  Communications were classified according to subject matter covered, type of communication, and urgency.  85% of communications issued by PHCs and the DHO were initial ones, and few follow-up letters were included.  Most communications did not require any reply.  Suggestions for improvement of the system by the staff focused on providing adequate personnel, equipment, and supplies, and allowing enough time for replying to avoid duplicate reports.  The authors suggest that more communications from the DHO to the PHCs are needed on implementation and supervision of health programs, that more communications are needed providing guidance and supervision to individual PHCs, and that records of monthly meetings at DHO and PHCs should be more complete.


Nursing background a plus for some material managers.


Perceived morbidity, utilisation of health services and factors affecting it in a rural area. A survey of perceived morbidity was carried out in rural population in eight villages and four wards of Saoner town, covering a total population of 8,876. The nature of illness was assessed by weekly visits to the families. History regarding treatment taken for disease and its source was taken. The overall incidence of perceived morbidity was 176.35 spells of sickness per 1000 population per month. Health care agency was contacted for 36.7 per cent spells of sickness. Utilisation of health services was found to be affected significantly by factors like age (chi 2 = 138.36), literacy (chi 2 = 14.123), type of occupation (chi 2 = 433.74), nature of illness (chi 2 = 83.578) and accessibility of health services. A health behaviour model of the population has also been discussed in this paper. A study of perceived morbidity was carried out among a total population of 8876 persons in 8 rural villages and 4 wards of Saoner town, Nagpur.  Occurrences of illness and source of treatment if any were assessed by weekly visits of paramedical workers.  1240 families were each surveyed at least 4 times in 1 month over a 1 year period.  1447 spells of sickness were reported, or 176.7 spells per 1000 population per month.  Information on utilization of health services was obtained for 1441, of which care from a health agency was sought in 529 cases, or 36.7%.  Utilization of health services was found to be affected significantly by age, education, type of occupation, literacy, seriousness of illness, and accessibility of services.  A conceptual model of the health behavior of the population, which shows the relationship between perceived morbidity, predisposing and enabling factors and utilization of health care, is described and discussed.


Living with your neighbour.

Living with your neighbour.


"Attitude" is the basic cause of employee theft and negative performance.


Armed-unarmed.

Armed-unarmed.


Tribal health programme.

Tribal health programme. In June 1978, the Department of Social Welfare, Government of Maharashtra, commissioned the Centre for Development Studies and Activities (CDSA), Pune, to prepare an Action Programme for the Improvement of Health in the Tribal Areas of Maharashtra. The following is the brief report submitted by CDSA. The Center for Development Studies and Activities, Pune, was commissioned to prepare this report detailing a plan of action for a health program in the tribal areas of Maharashtra, India.  Health problems were observed to be an integral aspect of tribal life; there has been a notable lack of development of productive potentials and there is an exploitative system of work and distribution.  90.17% of the people fall under the subsistency line in terms of per capita income needed to meet basic nutritional levels.  The system of "Indirect bondedness" which is based on labor contractors who are themselves tribals generates dependence on employers and perpetuates economic nonviability of households.  67% of the sample population suffered from calorie deficiency and 24% from protein deficiency.  87% spend more than 85% of income on food.  There is also an acute water deficiency for about 6 months of the year.  Over 60% of the villages included 54% of the population and are not connected by pucca roads so that medical help is not only difficult, but becomes impossible during early winter and during monsoons.  At the pregnancy health center (PHC) additional problems are identified including lack of adequate supplies of medicines, delay in salary payments and reimbursements to medical personnel, and lack of specialists available at the district level.  The action program suggests using health as an entry point in breaking the social structure pyramid so that constructive development of the area can begin.  Grass roots participation of the people is essential, as are adapting programs to local conditions, coordinating programs of various government agencies and levels, finding the necessary staff, and adequate monitoring.  6 major action areas, nutrition, family viability, training and institutional development, environmental hygiene, and the health, social and economic infrastructure are outlined in detail.


Healthcare security international.

Healthcare security international.


A prescription from the door doctor.

A prescription from the door doctor.


User fees: the experience of one large hospital with a market disincentive.


Education for health services administrators: an international study.


Alternatives to institutionalization.

Alternatives to institutionalization.


The teaching nursing home: development of a Canadian model.


The future is here . . . in your TV.

The future is here . . . in your TV.


A methodology for estimating ambulance requirements. Provision of adequate size of Ambulance fleet is a matter of concern for any hospital. For estimating ambulance requirements queuing analysis was used in this study. In this analysis incidence of long waiting times rather than mean waiting times were taken as the basis for estimating ambulance requirements in keeping with the desired service level.


State health manpower planning in the 1980s. Despite the importance of the state role in health manpower, past studies have documented fragmentation of effort, isolation of health manpower planning from other health policy channels and a relatively low level of interest in manpower issues on the part of state and local health planners. In evaluating the current capabilities of state level agencies to undertake increased responsibility for health manpower planning, this paper: 1) assesses the level of interest and involvement of state health planning and development agencies (SHPDAs) in health manpower planning; 2 (examines health manpower policy issues in states as evidenced in state health plans; and 3) describes the policy environment in which state health manpower planning is currently conducted.


Recruitment of a hospital director of security: hiring a key member of the management team.


Strong leadership improves performance.

Strong leadership improves performance.


Collections people need your support.

Collections people need your support.


A new way to train.

A new way to train.


Malpractice liability continues to expand. Increasingly, the courts are holding hospitals liable for medical malpractice, especially in cases involving either physician-hospital contractual arrangements or selection and review of hospital medical staff.


Dealing with differences.

Dealing with differences.


Ethics committees: trend for troubling times.


Ethicist in the hospital: the Cleveland Clinic experience. Having an ethicist as a member of the adjunct staff helped physicians, nurses, and other professional staff members more fully recognize and appreciate the ethical implications of medical practice.


How the public views hospitals.

How the public views hospitals.


National Center for Health Services Research--reorganization.


Coping with new reimbursement regs.

Coping with new reimbursement regs.


PPOs: should physicians do it themselves?