Group dissemination of breast self-examination training technology. Training in breast self-examination (BSE) using the Florida silicone models was evaluated in three training conditions: small group with feedback on individual performance, small group without feedback, and individual with feedback. Assessments on models and breasts indicated no significant differences between conditions in the quality of examinations (eg, lumps detected, area covered). Support is given to the dissemination of BSE training technology in a group format.


Verbal behaviors and patterns exhibited by physicians during genetic counseling sessions. Research in interaction and interviewing behaviors usually has focused on the verbal behaviors exhibited by the interactants. These behaviors have been looked upon and analyzed in isolation, that is, as a single event. There is little or no information on physician-patient interactions that analyzes verbal behaviors as being a series of events related to each other. These behaviors, when seen as a chain of events, provide a different and revealing picture of those who exhibit them. A study was undertaken to gather information on physicians' verbal behaviors and verbal patterns during interactions involving genetic counseling. Physicians who were rated high in communication skills spent more time in the affective dimension of the interaction and exhibited more reflection of feelings, emotional probing, reassurance/support, and silence during the interaction with patients. These differences were found in both the sequential verbal pattern data and the individual verbal behavior data.


Recruitment literature.

Recruitment literature.


Group counseling in cardiac rehabilitation: effect on patient compliance. A multicenter clinical trial was conducted to evaluate the effects on compliance of a group counseling program for cardiac patients and spouses. The sample comprised 58 couples in which one of the partners had documented atherosclerotic heart disease and was enrolled in an outpatient cardiac rehabilitation program. The experimental intervention involved a ten-week series of group sessions based on symbolic interactionist role theory. The research used a quasi-experimental, three-group, time-series design: Experimental group 1 consisted of 17 patients and their spouses who participated in group counseling; experimental group 2 consisted of 22 patients and their spouses, but only the patients participated in the group series; the control group consisted of 19 patients and their spouses who did not participate in the experimental program. Data were collected at baseline, ten weeks, and six months on four cardiac risk factors: weight loss, blood pressure, exercise, and smoking. Repeated measures analysis of variance showed a significant difference (P less than 0.01) in mean body fat among treatment groups, with experimental group 2 having the greatest decrease over time. Patients in both experimental groups demonstrated lowered blood pressure, with a significant decrease (P less than 0.05) in systolic blood pressure. Again, the largest decrease was in experimental group 2. Changes in weekly exercise level were not significantly different among groups, although the highest compliance was reported by experimental group 1 patients. Results support the efficacy of group counseling based on an interactionist role theory framework to increase compliance. The anticipated effect of spouse participation was not confirmed.


Architectural literature.

Architectural literature.


Campaigning for blood.

Campaigning for blood.


Patient literature.

Patient literature.


OB literature.

OB literature.


Factors affecting the use of self-instructional material by patients with ischemic heart disease. This study addressed three questions concerning the feasibility of self-instruction by patients with ischemic heart disease in an acute-care teaching hospital. (1) Do patients complete a linear self-instructional booklet under conditions normally prevailing on a hospital ward? (2) Do patients perceive that activity in the ward environment and symptoms of illness affect use? (3) What aspects of activity and symptoms do patients report affect use? One hundred patients, 60 men and 40 women with an average age of 59 years, hospitalized with ischemic heart disease (acute myocardial infarction or unstable angina) were interviewed an average of six days after distribution of a self-instructional booklet as a component of a standard teaching program. Three subjects claimed not to have received the booklet; nine made no use of it; 73 made partial use of it; and 15 made complete use of it. Fifteen subjects claimed activity in the ward environment and 25 subjects claimed symptoms of illness affected use. Interruption, a noisy, busy atmosphere on the ward, and physical symptoms of ischemic heart disease were reported most frequently as factors affecting use. Results of the study suggest that a small percentage of patients will complete a self-instructional booklet. In addition to activity in the environment and symptoms of illness, factors not identified in this study also appear to influence the use of self-instructional material.


Ad gallery. A look to what's out there, what's working, and why.


Reference guide for good nutrition.

Reference guide for good nutrition.


Maternity services literature.

Maternity services literature.


Great expectations; great results. Maternity marketing.


For a father and his baby.

For a father and his baby.


Maternity open house.

Maternity open house.


Marketing from the inside out. What does marketing have to do with orderlies?


Out to walk. Fitness for unconvinced uncommitteds.


Direct mail for wellness promotion. A black bag(ful) of tricks.


Ad gallery.

Ad gallery.


Improving physicians' images. With help for and from their office assistants.


Dedicating a new program. Supercelebrity.


Marketing OB services raises awareness.

Marketing OB services raises awareness.


Diabetes education.

Diabetes education.


Computer communication PLUS.

Computer communication PLUS.


Diabetes manual. A hospital helps its patients and its colleagues.


Body shop in a box. Planning: packaging; promoting.


The heart of the fair is an affair of the heart.


"I'm going to be a St. V's nurse!" A booklet that told them so.


Home health services. Two approaches to doing it yourself.


Cutting daily rates.

Cutting daily rates.


Happy birthday hospital.

Happy birthday hospital.


Malpractice update: what new trends will affect you.


How to solve the malpractice crisis--the British way.


Guidelines for teaching the older adult. The needs and abilities of the aged learner may change as a result of normal aging processes, and clinicians involved in patient education must remember and allow for these changes if effective teaching is to take place. Knowledge of the visual, auditory, psychological, and social changes, the functional outcome of each of these changes, and the implications for teaching will help clinicians maintain effective communication with and health-care delivery to this population. Guidelines for modified teaching aids and techniques are provided in the Clip & Carry.


Find out about your state. Where are the newest malpractice hot spots?


Weighing and minimizing--the risks of joint venturing.


A day in the lives of respiratory therapists in the NICU.


The competitive advantages of cooperation.


Health care cost crisis unleashes innovation in hospital and nursing-home foodservice.


Helping children express grief through symbolic communication. Communication barriers erected by grieving children delay problem resolution. Use of the expressive arts--music, art, and body movement--in symbolic communication helps them to express overwhelming feelings and cope with trauma and stress.


Ventilatory and nonventilatory muscle exercise in COPD rehabilitation. For maximum benefit, a rehabilitation program for patients with chronic obstructive pulmonary disease (COPD) should include both ventilatory and nonventilatory muscle exercise. The 12-week, outpatient program at Malden (Mass) Hospital incorporates whole-body exercise (walking), inspiratory resistive loading, and use of supplemental oxygen. Exercise prescription is based on the work level requiring a minute ventilation equal to 50% of each patient's maximum breathing capacity. A cardiopulmonary exercise test, 12-minute walk, and endurance test provide the before and after rehabilitation testing protocol. Such a program can be implemented at a community hospital where most patients with COPD have their greatest access to medical care.


Mental health services for Chinese in a community health center. Serious mental health problems exist within the Chinese population of the United States. This article describes one center's attempt to meet the psychiatric needs of both nonpsychotic and psychotic Chinese patients through bilingual, culturally relevant treatments.


From mutual-aid self-help to professional service. Some mutual-aid self-help organizations develop into professional-bureaucratic human service organizations. The process of transforming them involves important changes in functions. Social workers who become part of the process can learn to work efficiently despite its tensions.


Chronic ventilator patients. Alternatives to hospital care. As the number of patients requiring chronic ventilator therapy increases, the shortage of facilities for this care becomes more and more acute. Nursing homes are unprepared to accept these patients or unwilling because of problems with reimbursement. Home care is only a limited option, but some innovative approaches at nursing homes in Illinois and Michigan may pave the way for a new health care model.


Elder abuse: issues for the practitioner. Workers assigned to cases of elder abuse experience significant problems related not only to the nature of the problem but also to their own feelings, biases, and attitudes about violence and the aging. This article examines the problems and suggests strategies for dealing with them.


Adolescent dialysands in group therapy.

Adolescent dialysands in group therapy. Adolescents are particularly vulnerable to the psychological effects of chronic illness and its treatment. Group treatment of girls with renal failure proved to be of therapeutic value in improving self-image and reducing emotional stress.


Respiratory and ventilatory management of critically ill children during transport. As more and more pediatric intensive care units are established throughout the country, transport systems for critically ill children assume increasing importance. This article concerns the personnel, equipment, and other requirements for a transport system and reviews the respiratory and ventilatory management of pediatric patients during transport.


THA's perspective on indigent health care.


A strategic analysis of the textile rental industry. 1985 update.


Health care and antitrust.

Health care and antitrust.


Indigent health care, a multidimensional problem. State Task Force on Indigent Health Care.


Medical indigency--facing facts, every day.


Care to the indigent: the voluntary hospital perspective.


Financing indigent care: the perspective of tax-paying hospitals.


Indigent care--the "bonnies" bite the bullet too.


A public hospital perspective on indigent health care.


Medical indigency: the legal backdrop.

Medical indigency: the legal backdrop.


Dental care for the AID patient: the dentist's perspective.


Using indicators in quality/appropriateness of anesthesia.


Materials management in smaller hospitals.


Productivity reporting.

Productivity reporting.


What can materials management do for you?


Product standardization and efficiency.

Product standardization and efficiency.


Texas Supreme Court may consider important case on damage recoveries.


A risk management program.

A risk management program.


Implementing respiratory care.

Implementing respiratory care.


Consultant pharmacist services surveyed.


Guarding against foodborne illness.

Guarding against foodborne illness.


U.S. Medicine interviews Edward N. Brandt, Jr.


Why fringe benefits are leveling off.

Why fringe benefits are leveling off.


Perspectives. Providers eye flat tax proposals.


Perspectives. 1984 in review: more to come.


Perspectives. The great American vaccine shortage.


Study tour in Portugal. Reality, evolution, culture, contrast and contradiction.


Study tour in Portugal. A medical view.

Study tour in Portugal. A medical view.


Study tour in Portugal. An architect's view.


Study tour in Portugal. A psychiatrist's view.


Hospital development in Japan.

Hospital development in Japan.


Churches are joining the health care team. Although the extent of formal health-related programs in churches has not been well defined, sufficient anecdotal and empiric evidence exists to indicate that churches are becoming more involved in matters related to the health of their congregations and their communities. A pioneer in this field discusses how churches have been joined by physicians, other health professionals, and major medical centers in a wholistic health care program.


The new university.

The new university.


Can a professional ethos be taught? A clinician's point of view.


Where would I like pharmacy administration to be in the 21st century?


If all pharmacists were ethical.

If all pharmacists were ethical.


The future of shared services.

The future of shared services.


At ACP session, an ancient code is scrutinized...does the Hippocratic Oath still apply?


The clock ticking. Congress tackles health items.


Pope John Paul II urges "human solidarity" with patients.


Financing graduate medical education.

Financing graduate medical education.


The validity and uses of the In-Training Examination.


An analysis of results of the In-Training Examination.


A program director's view of the In-Training Examination.


Four-star recovery suites.

Four-star recovery suites.


Farewell to fringe benefits?

Farewell to fringe benefits?


Medicare and Medicaid programs, health care financing research and demonstration cooperative agreements and grants and availability of funds for cooperative agreements and grants--HCFA. General notice. This notice announces the availability of HCFA funds for certain priority research and demonstration cooperative agreements and grants for the Federal fiscal year 1985. HCFA makes funds available for activities that will help to resolve major health care financing issues or to develop innovative methods for the administration of Medicare and Medicaid. This notice contains information about the subject areas for cooperative agreements and grants that will be given priority; project requirements; application procedures and other pertinent information. It also cancels the February 4, 1985 closing date for HCFA waiver-only applications that was announced on November 9, 1983.


Federal old-age, survivors, and disability insurance; listing of impairments--mental disorders--SSA. Proposed rules. These proposed amendments revise the medical evaluation criteria for mental disorders for the disability program in title II and title XVI of the Social Security Act. No substantial revisions have been made to these criteria since 1979. The proposed revisions reflect advances in medical treatment and in methods of evaluating certain mental impairments, and will provide up-to-date medical criteria for use in the evaluation of disability claims based on mental disorders.


National Library of Medicine programs--PHS. Notice of proposed rulemaking. The Public Health Service, HHS, proposes to revise the regulations for the programs of the National Library of Medicine. The proposed revisions would: (1) Permit the Regional Medical Libraries to recover part or all of the costs of providing photocopies of biomedical materials, (2) improve readability of the regulations, (3) update references to statutory authorities and uniform administrative requirements, and (4) revoke Part 63 (Traineeships) which is obsolete.


Health maintenance organizations--PHS. Final rule. This rule amends the Public Health Service regulations on health maintenance organizations (HMOs) to elaborate on the 1981 amendments to the HMO statute regarding member protection in the event of insolvency, community rating by class, and primary care within the service area of a non-metropolitan HMO. In addition, the rule removes regulatory provisions that are considered unnecessary or burdensome, such as the specification of contractual provisions, and increases one of the regulatory limits on copayments to permit HMOs to become more competitive. These amendments are made after consideration of public comments on the notice of proposed rulemaking (NPRM) published on March 22, 1983.


Privacy Act of 1974; report of new system--HCFA. Notice of new system of records. In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "Payments for Interns and Residents," HHS/HCFA/BPO No. 09-70-0524. We have provided background information about the proposed system in the "Supplementary Information" section below. HCFA invites public comments by March 18, 1985, with respect to routine uses of the system.


List of primary care health manpower shortage areas designated under Section 332 of the Public Health Service Act. This notice provides a list, updated as of September 30, 1984, of primary care health manpower shortage areas designated by the Secretary of Health and Human Services under the authority of section 332 of the Public Health Service Act.


Surveys find most employers self-funding health benefits.


Rx for drug plans. Halting the runaway cost of prescription coverage.


Cost-containment audit. Ailing health care plan may need exploratory surgery.


Wagner v. Saskatchewan College of Physicians and Surgeons: a case study in professional discipline.


Plug into greater energy savings.

Plug into greater energy savings.


Blood sampling that brings smiles!

Blood sampling that brings smiles!


Renal dialysis--high tech at a price.

Renal dialysis--high tech at a price.


An alternative health care setting for children with cancer: a residential summer camp. Increasing concern for the psychosocial needs of children with cancer has paralleled increasing survival rates. This paper discusses the way in which a summer camp program can help to meet many social needs of children with cancer. Also discussed is the proposal of a campsite to be operated year-round for families of children with cancer, and the way in which such a program can help to meet many needs of these families.


Community-based team approach to the management of children with cleft palate. The child born with a cleft palate may have many associated problems in feeding, respiration, dentition, hearing, speech, language, and intellectual development as well as in psycho-social development. If the cleft is associated with a specific craniofacial syndrome, other physical problems may be present such as cardiac, kidney, digital, and visual involvement. The need for an extensive treatment program can extend from birth through adulthood. Important to the successful habilitation of these children is the early involvement of a multitude of specialists working together with the family in a team approach. The primary task of the team is to make decisions concerning timing and sequence of intervention for each individual patient. Several models for the delivery of health care services to the patient with a cleft palate are now in use. A community-based team model will be described in this article as a unique approach to the management of this population and as one that may be implemented in a cost-effective manner in communities where cleft palate teams presently do not exist.


A clinical nurse specialist's role in the comprehensive management of attention deficit disorder. Attention deficit disorder or the hyperactivity syndrome is a common and chronic disorder of childhood, with potential ramifications in adolescence and into adult life. Treatment directed solely toward medication management has not been demonstrated to affect the outcome of this disorder significantly, and it is clear that comprehensive treatment is in order for these children. The role of a clinical nurse specialist with skills and abilities complementary to that of the child psychiatrist or pediatrician who can provide many of the ancillary and direct services needed by these patients is described.


American hospitals evaluate their computer systems in 1984.


Management information systems...definition and status.


High-technology vision center has eye-appealing sophistication.


Executive managers, take note!

Executive managers, take note!


Hospital learning center aids pediatric therapy.


Teleconferencing facilities take healthcare lead.


Integrated light & color makes positive contribution to patient rehabilitation.


Healthcare super-mart is new design trend.


Designer uses paint to color a low-budget hospital project.


Prototype hospital room provides privacy & amenities.


Memphis Methodist hospitals renovate with master plan.


Continuity of care video teleconference audience questions to panelists.


Situational ethics: an approach to resolving ethical dilemmas in discharge planning.


Physician attitudes on medical costs, alternatives.


Color, signage identify extended care facility.


Budgeting in health care.

Budgeting in health care.


Is there a general theory for health care budgeting? This article suggests that a broad theoretical framework is needed within which the empirical evidence about the results of the many different health care funding systems can be analysed. A possible framework is described. The article also proposes that when policy makers select the budgetary system most likely to produce the patterns of health care that are required they should also install output and quality controls designed to avoid any predictable and undesirable side effects. Reimbursement under the budget could be made conditional upon an adequate performance as measured by the controls.


Budgeting in health care systems.

Budgeting in health care systems. During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated output targets with defined budgets and incentives for decision makers to economise in their use of resources are being incorporated into experiments in the health care systems of Western Europe and the United States. Undue optimism about the success of these experiments must be avoided because these problems have existed in the West and in the Soviet bloc for decades and efficient solutions are noticeable by their absence.


Regional health budgeting in Western Europe. This article distinguishes in the first section three characteristics of regional budgeting in health care systems: geographical division of budgets, regional financial limits, and policy freedom for regional authorities. Following these and more general elements of regional budgeting systems sections 2 to 5 describe the situation in the U.K., Sweden, The Netherlands, and some other European countries. The first two countries have a developed regional budgeting system for health services paid by taxation. Other European countries are developing regional budgeting models which are to be combined with a social insurance system. Of these countries, the Netherlands are discussed in some detail. Based on the experiences with regional budgeting in different countries three hypotheses are generated which require further empirical research. They are: (1) One management tier on a regional level--or municipal or provincial level--is a condition for a regional budgeting system which contributes more to an integration of health services than a two-tier system. (2) Countries with a regional budgeting system with a regional financial limit superimposed by the state seem to spend a smaller percentage of their gross national product than other countries. (3) Countries with policy freedom on a local level show a faster growth rate for primary care than for hospital care.


Economic aspects of smoking.

Economic aspects of smoking. Smoking has become a major issue for public health policy in recent years. This paper deals with the economic aspects of smoking. First, we outline the basic concepts of welfare economics which subsequently are used as the normative framework of the analysis. In particular, we stress the role of efficiency as a criterion for economic policy evaluation. Second, we demonstrate that smoking is associated with several market failures, notably externalities and dependency/addiction (non-rational behavior). Third, costs and benefits of smoking are considered. We argue that the benefits of smoking are the satisfaction (utility) which the consumers derive from it rather than the employment effect of producing tobacco products or the revenues of the excise tax on these products. A general model for estimating the costs of smoking is developed and various cost concepts are discussed. Empirical cost estimates are presented for Switzerland. In 1976, estimated social (economic) costs of smoking were between 560 and 800 million Swiss francs while the external costs were between 140 and 260 million francs. Contrary to a widely held belief, smoking hardly influenced health care costs because the higher medical care costs of smokers during their lifetime are offset by their reduced life expectancy. The last section deals with intervention strategies to reduce smoking: anti-smoking publicity, advertising restrictions, and taxation. We discuss these three instruments on a conceptual level and summarize previous empirical studies. The main results are: (1) Both publicity and taxation offer a considerable potential as deterrents of cigarette demand. (2) The results for Switzerland imply that publicity campaigns are likely to be efficient in the sense that expected campaign benefits outweigh its costs.


Caring for the infirm: a task for the individual or for a social insurance programme? In West Germany, seventy per cent of all nursing home patients receive only a pocket-money, for social health insurances are responsible only for the care of "sick" people, but not of those needing only "care". The infirm individual, however, rarely can pay for the costs of nursing homes out of his own revenue. Despite general agreement that guarding against the financial risks of becoming dependent on nursing is insufficient there is little consensus on what a new concept should look like. Some proposals are more concerned with avoiding cost-expansion than with effective health care. On the one hand, the implementation of a new branch in the social insurance system, called "nursing insurance", is demanded, which would pay for the stay in nursing homes. On the other hand, it is emphasized that the capacity for voluntary individual provision should be strengthened as well as the families' means to care for their bedridden members. This paper presents the discussion and outlines implications for health care of the various proposals.


Programme budgeting: an aid to planning and priority setting in health care. Programme budgeting can assist in overcoming some of the current problems besetting health care planning and management. In particular, health services suffer from lack of (i) explicit objectives; (ii) comprehensive overviews; (iii) knowledge of production functions; (iv) incentives for efficiency; and (v) inappropriate budgeting structures. Programme budgeting while not in itself capable of overcoming all these problems can create an information framework which first highlights but secondly fosters amelioration of these problems. In essence programme budgeting links outputs and inputs by health care programme. This facilitates monitoring, planning, control and the fostering of evaluation. Two examples of the use of programme budgets are presented.


A child is born, or a tale of moral hazard.


Diet and primary prevention of cancer.

Diet and primary prevention of cancer. Various assessments have been made of the contribution of diet to the risk of developing cancer in industrialized societies. The evidence available for a causal relationship between diet factors and cancer of specific sites is still incomplete and further research is needed to fill gaps in knowledge. Nevertheless given the limited effectiveness of available therapy in the treatment of established disease, preventive measures based on available evidence should receive active consideration, particularly as they are unlikely to be hazardous in other respects and as they approximate to changes in food supply and diet recommended for general health maintenance. Prevention must address itself to the nature of the food supply, to the choice of the foods that constitute the normal diet and the way in which these are stored and prepared both domestically and industrially. The objectives of a primary prevention programme would be to develop dietary intake patterns that would meet established requirements for health maintenance, would minimize the intake of carcinogens and optimize the intake of inhibitors. The feasibility of public health measures in respect of these objectives is examined and the cost effectiveness assessed. Potential problems arising from the implementations are considered. Measures include the modification of agricultural practices and of food processing techniques as well as various approaches to nutrition education, and modification of food intake patterns. It is concluded that considerable experience exists in other areas of nutrition intervention to suggest that primary prevention of cancer in respect of dietary factors is feasible and would complement other public health activities in this area.


When to buy, when to lease.

When to buy, when to lease.


Selecting reliable vendors.

Selecting reliable vendors.


Chickenpox, shingles and EMS.

Chickenpox, shingles and EMS.


Client-centered health education: a chance for provider change.


Client-centered treatment for the alcoholic in an ambulatory care setting.


Health risk appraisals: use and misuse.

Health risk appraisals: use and misuse.


State legislative requirements for CPR certification of EMS personnel.


An interactive model for wellness: a systems approach.


The issue of women's health: a matter of record.


Volunteers in patient education: is there a role?


Use of benefit segmentation in designing family health programs.


An advocacy model for health care professionals.


A bit more: computers. Basics & beyond.

A bit more: computers. Basics & beyond.


Incentives that "pay".

Incentives that "pay".


A team effort at MMC of Long Beach.

A team effort at MMC of Long Beach.


Westminister Village: dining facilities.


New treasury proposals' effects on non-profits.


Some states recognize broad role in care of medically indigent.


Humana administrator hails teamwork of staff in artificial heart implant drama.


Mounting pressures cause rise in hospital hybridization.


Competition provides impetus for the transformation of the health marketplace.


FAH scholarship total rises to 57 with 14 new winners in '84.


Health education: a boon to humanity or a fantasy and fraud? The health education profession in the United States has been influenced by three major forces in recent years: sociomedical phenomena resulting in a public demand for health education, disease specificity of the practice of health education, and the process of professional credentialing. While these three forces are looked upon by many as beneficial to the profession, they also pose significant threats to the viability of the profession. Health educators must deal with these threats if the health education profession is to significantly benefit humanity. Otherwise, the profession may be ultimately perceived as a fantasy and fraud.


The new game in health care: who will profit.


Statistics at work. Admission impossible?


Monte Carlo method in the health service.


Mental health censuses in Mersey RHA.

Mental health censuses in Mersey RHA.


Out patient referrals.

Out patient referrals.


Unemployment and its effect on high-level wellness.


Variations in hospital throughput.

Variations in hospital throughput.


Unit management. Re-ordering managers' roles and responsibilities.


Staff relations. A build-up of too much pressure.


Estate management. A willing guide.

Estate management. A willing guide.


Civil Defense. Preparing for the wounds of war without the NHS.


Nurses' uniforms. Safety and style.

Nurses' uniforms. Safety and style.


Ireland. What divides and unites Donegal and Derry.


Management development. Breaking the management mould.


Libraries. The struggle for status.

Libraries. The struggle for status.


Libraries. Why every manager should have one.


Benefits. Where patients may lose out.

Benefits. Where patients may lose out.


Registers. Keeping tabs on mental handicap.


Stoke Mandeville fights the two-nation image.


Performance indicators. The quality and the width.


Community care: evaluating the options.

Community care: evaluating the options.


Libraries. Rapid reference and retrieval systems.


Libraries. Integrated information online for health.


Libraries. Charting unexplored areas of research services.


Internal auditing.

Internal auditing.


Status: Compucare. Interview by Bill W. Childs.


Using the differential costing concept for healthcare decisions.


Hospital information systems: the next three generations.


Ethics and success--the relationship.

Ethics and success--the relationship.


The drug file.

The drug file.


Is productivity effective?

Is productivity effective?


Hackley Hospital upgrades to the IBM S/38 Model 40.


Electronic spread sheets.

Electronic spread sheets.


Preparing a proper resume.

Preparing a proper resume.


Divisible obligations of a contract.

Divisible obligations of a contract.


How much do you know about the legal aspects of purchasing?


PA's holding down TP prices.

PA's holding down TP prices.


The economics of hospital supply prices.


How to save money on your next bulk oxygen buy.


Administration tips the scales in group purchasing involvement.


Unloading your surplus equipment.

Unloading your surplus equipment.


Modification of the sales contract.

Modification of the sales contract.


Controlling your suture inventory.

Controlling your suture inventory.


Why worry about volunteers?

Why worry about volunteers?


How the New Jersey Hospital Association bids reference labs.


Planning family practitioner services.

Planning family practitioner services.


The NHS response to Asians--is it enough?


Recent innovations in the use of computers at Rampton Hospital.


Change without growth: the challenge for management.


Planning residential services for mentally handicapped people: variation in demand across territories and over time.


The practical implementation of Griffiths. The contractual issues.


Results of monitoring and computer modelling.


Solar energy project at Torbay Hospital. Monitoring--data collection and processing.


The Engineering Assembly and regional structure.


The supply, processing and distribution supervisor.


The magic wand.

The magic wand.


Computers: materiel management's future.


Materiel management: a nursing perspective.


Pharmacy and the law: a pharmacist/lawyer perspective.


Materiel management: present and future concepts.


The pharmacist as a member of the patient care team.


Materiel management and food service: a synergistic approach.


Internal marketing of materiel management.


A clinician's views of supply, processing and distribution.


The role of processing in implementing a case cart system.


The materiel manager's training: for now and tomorrow.


Developing your practice's business plan. Transplantation of organs and tissues provides the clinician with treatment options for many types of organ failure. However, nearly all transplant efforts are limited by a relative scarcity of donor material. Donor organ and tissue availability can be increased by developing suitable preservation methods and by improving the awareness of primary health care providers as to the needs and scope of therapeutic transplantation. Donor material capable of immediate function upon implantation will become available as increasingly effective techniques of tissue and organ preservation develop. These techniques are extremely important for lung, heart, and liver transplantation, where no artificial, long-term methods of support exist, making immediate function a necessity. In Part I of this article, the authors discuss the transplantation of cornea, kidney, heart, lung, and heart-lung block: Part II covers transplantation of liver, pancreas, skin, and bone marrow.


Detroit coalition adopts PPO policy statement.


Washington Supreme Court decides case re: removal of life support systems.


West Virginia hospital board composition law upheld.


Comparative statistics for health care coalitions available.


1984 annual tax wrap-up (Part 2).

1984 annual tax wrap-up (Part 2).


New Jersey Supreme Court outlines standards for treatment withdrawal.


Interpersonal conflict: strategies and guidelines for resolution. Historically, management theorists have recommended the avoidance or suppression of conflict. Modern management theorists recognize interpersonal conflict as an inevitable byproduct of growth and change. The issue is no longer avoidance of conflict but the strategy by which conflict is resolved. Various strategies of conflict resolution and the consequences of each are discussed in this article, along with guidelines for the effective use of confrontation strategy.


Show me your peer review and medical records.


South Carolina medical record department directors as health information managers. Is the job of medical record department director substantially the same in any acute care hospital? If not, what are some of the differences in roles and responsibilities? This study addresses that question as it relates to medical record department directors in South Carolina acute care general hospitals.


Streets to good health. The Veterans Replacement Hospital.


Closing the gender gap.

Closing the gender gap.


A sterling opportunity.

A sterling opportunity.


Dishing up sales.

Dishing up sales.


Effective introduction of change.

Effective introduction of change.


1984 as it was.

1984 as it was.


Closed medical staffs are not inevitable.


Regulating the cost of institutional healthcare through competitive bidding. A system for prospective rate setting based on the theory of auctions is proposed. In order to guarantee that competition will achieve public health goals, the State Health Planning and Development Agency will issue a limited number of patient day certificates. Hospitals can obtain these certificates by offering bids in the form of rate increases. Hospitals offering low rate increases will receive patient day certificates with authorized rate increases equal to their own proposed rate increases plus a bonus. Hospitals offering high rate increases will receive only a base rate increase equal to the smallest rate increase offered by any hospital. This approach enjoys the cost minimizing benefits of competition while restraining hospital capital expenditures.


The lure of risk-sharing arrangements. Interview by Emily Friedman.


Nothing ventured, nothing gained.

Nothing ventured, nothing gained.


Pricing hospital units of service using microcosting techniques. Traditionally, pricing of hospital-based ancillary and diagnostic services has been a reactionary response to a cost-based budgeting system. Revenue objectives have been determined by budgeted costs, new development, contractual allowances, and required net income. Since hospitals have found it difficult to accurately measure the costs of specific services, price setting has been reserved solely for senior management or for the financial division. Thus, operating managers and their professional (medico-administrative) counterparts have had little opportunity to participate in the price-setting process and, for the most part, have had little understanding of the cost components which should be analyzed before the rates are set. A great deal of confusion and questioning has developed surrounding the establishment of prices at the departmental level. Although hospitals have given some consideration to market forces, this element in the new competitive environment will have a greater impact on the services purchased by the various payors.


Drug usage guidelines, Part 2: Analysis of program outcome. The effect of integrating a Drug Usage Guidelines (DUG) program with a hospital formulary system was analyzed. Significant changes were observed in both the number of requests submitted to the P & T Committee and the number of drugs added to the formulary after implementation of the DUG program. Failure to follow the DUG submission protocol, particularly with respect to the requirement for supportive clinical data from the primary literature, led to delayed consideration and eventual withdrawal of several highly promoted drug products. The initial involvement of physicians in the planning and implementation of the DUG program has been an important factor in the continued success of the program.


Difference in composition of personnel among government, voluntary, and investor-owned U.S. community hospitals. The relationship between an organization's staff structure, particularly the relative proportions of its administrators and line staff, and the organization's size, ownership status, financial condition, and scope of services is a subject that has attracted a good deal of attention from organizational theorists. At the present time, the subject is especially important to the hospital industry because of widespread concern about hospital costs and interest in how personnel expenses contribute to these costs.


Maintaining clinical pharmacy services during cost containment. As new hospital reimbursement schemes are rapidly introduced into the hospital industry, the impact of cost containment measures will be felt by all departments of pharmacy. This paper describes how the pharmacy department at one community teaching hospital justified the continuation of clinical pharmacy programs when faced with an immediate 18% reduction in pharmacist staff. Various written communications and recommendations are provided to assist other hospital pharmacy departments that are facing or may face this dilemma.


Employee turnover revisited.

Employee turnover revisited.


Lawful uses of drugs purchased at preferential prices. The issue of use of pharmaceuticals purchased at preferential prices by hospital pharmacies in competition with community pharmacies has received great attention in recent years. The U.S. Supreme Court has addressed such issues twice within the past 10 years. The statutory basis for the lawsuits is explained and the history and implications of the Supreme Court decisions are discussed, with emphasis on the various categories of permissible and impermissible uses under the court's decisions. Implications for the hospital pharmacy are described and discussed.


Utilization reporting system facilitates physician practice analysis.


NMR issues for 1985 and beyond. Guideline report.


A computer-based emergency unit management system for a multi-institutional system.


Referrals form hospital emergency departments to primary care centers for nonurgent care.


Long term care dialogue. Community relations.


Volunteers in long term care: an all-staff responsibility.


Implementing EMT-D.

Implementing EMT-D.


CPR: are our assumptions valid?

CPR: are our assumptions valid?


Early education. EMS awareness project.

Early education. EMS awareness project.


Wellness/quality of life program in a long-term care facility.


The music therapy clinical intern: performance skills, academic knowledge, personal qualities, and interpersonal skills necessary for a student seeking clinical training. The music therapy curriculum consists of two distinct parts: the academic phase and the internship. The music therapy student must apply for a clinical internship during the last year of the academic phase, and the student is expected to evolve from student to professional music therapist during the internship phase. The present study sought to determine the skills, knowledge, and qualities clinical training directors considered most important for a prospective intern to possess. The sample population of the survey consisted of 25 clinical training directors from the Great Lakes Region. Results of the survey indicated that piano skills, knowledge of psychology, emotional maturity, and the ability to express needs and feelings were considered most important for the prospective intern to possess.


The use of volunteers in social group work as remotivation leaders.


Capitalism and Christian values: dilemma for Catholic health care.


Peaceful setting, individual care aid terminally ill patients.


Goal for pastoral letter: expose holes in "social safety net".


Restructuring helps ensure Ohio hospital's survival.


Bishops challenge facilities to act with hope, realism.


The Bishops and the economy. Draft is "more cautious than recent Popes".


Michael Novak comments on the pastoral draft.


Compensation: bonus versus wage increase. Health care facilities with increased revenues that wish to give year-end lump-sum bonuses must comply with fair labor standards to avoid recalculating regular pay and incurring retroactive overtime liability. Discretionary bonuses are excluded from the regular rate of pay. Circumstances in each case determine if a bonus is discretionary and thus excluded from the regular rate of pay. A "discretionary" bonus is one that the facility did not promise or announce and that employees have no reason to view as regular pay. To ensure their bonuses' discretionary status, facilities should not announce the bonus until just before or when they give it and should not discuss it with employee groups. Records should show that the facility (1) never before granted such a bonus, (2) had no plan to do so, (3) had not informed employees of it, and (4) has given the bonus only because of unexpected and probably nonrecurring profits.


Efficiency, new equity capital enable systems to compete. Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.


Values program allows employees to set performance standards. Through a pilot program in values enrichment at Sacred Heart Medical Center, Spokane, WA, employees learned to evaluate their own and others' work behaviors. They identified the values that they believed would promote the medical center's best interests, and they suggested actions that could help or hinder the attainment of five key values: compassion, care of the poor, respect for the dignity of every person, high-quality care of the whole person, and teamwork in care giving. Each of the medical center's 32 departments as well as its management system committee prepared evaluation tools to measure employee performance. These tools, based on employee suggestions, are essential to the institution's ongoing attention to its values. Employee screening procedures, including an application form, to discern potential employees' readiness to further the institution's stated values also were developed. Other program accomplishments included the formation of an ethics committee, recruitment of a staff ethicist, and production of a videotape for use in employee orientation and in-service sessions.


Pastoral care staff participate on treatment team. Clinical department members at Marianjoy Rehabilitation Center identified problems with their staffing conferences, in which they plan patient care. The problems included a deemphasis on social and spiritual aspects and an overemphasis on billing concerns. To correct these difficulties, the hospital adopted the Patient Evaluation Conference System (PECS), adding a pastoral care component. Central to the new system is the addition of pastoral care data from scales that assess patient status in four areas: (1) awareness of spiritual dimension of disability, (2) knowledge of spiritual resources, (3) skill in spiritual self-management, and (4) use of spiritual resources. Pastoral care staff write evaluations in easily understood language so other staff members can understand pastoral care's purpose. They formulate specific short-term objectives in order to delineate the pastoral services needed. Integration with the treatment team has resulted in greater accountability for the pastoral care staff. Patient progress charts now include specific pastoral care goals, and a daily report of pastoral care services is included on patient bills, although no fee is charged. Program evaluation and feedback systems to enable pastoral care staff to make more accurate assessments are planned. The new system has enhanced staff communication, service documentation, discharge planning, and the quality of pastoral care.


Comprehensive radiological equipment management program. The increasing cost and complexity of state-of-the-art radiological equipment, and the need for more comprehensive safety and performance assurance, have increased maintenance expenditures to a level where they have become one of the largest operating expenses of radiology departments. To cope with this ever increasing expenditure, a comprehensive in-house maintenance program was implemented in our institution. This program properly balanced the capability of the radiology department's in-house technical personnel with support provided by equipment manufacturers' service organizations. Quality assurance activities are also included as an integral part of the entire program. Since the implementation of the program, an average 40% reduction in the annual maintenance expenditure has been observed.


New communications tools expand educational options. Administrators must make well-informed decisions regarding new communications technology to disseminate information to diverse constituencies in the facility and its service area. For example, communicating and using information about rapidly changing regulations is important in today's competitive environment. Administrators are faced with choosing from among such electronic media as satellite programming, telephone systems, cable television, and microwave radio to meet their institutions' needs. Teleconferences and closed-circuit educational programming also offer cost-efficient choices. Consultants can assist the management team in developing an appropriate system, whether sharing in an existing program or private network or installing an independent satellite-receiving dish, or "downlink." The team, including medical personnel, must choose the hardware that the institution can use most effectively in accomplishing its objectives. Studying other facilities' systems, such as St. Joseph Hospital, Providence, RI, with its independent receiving dish, shows the practical applications of the often confusing technology. Administrators should not be put off by "'technology frenzy." About 600 U.S. institutions have receiving stations or access to them; most will have them in the future. Even smaller facilities can become leaders with this cost-effective technology. Administrations must lead in accepting the challenge to improve health care communications.


Tax policy and the demand for health insurance. Estimates of the price and income elasticities of demand for health insurance are derived from econometric estimates of the parameters of a discrete choice model of health insurance demand using data from a survey of plan choices among a sample of federal government employees. The estimated income elasticity (+0.01) is similar to most previous estimates. The estimated price elasticity (-0.16) is in absolute value much less than the earlier previous estimates and somewhat less than the more recent previous estimates. Possible causes of these differences in price elasticity estimates are discussed.


Considering the effects of financial incentives and professional ethics on 'appropriate' medical care. This manuscript presents a model of an 'ethical' physician's allocation of time and income between work and leisure activities for various remuneration types and income levels. The physician is 'ethical' because, ceteris paribus, he prefers to provide that amount of medical care which he believes to be in the patient's best interests. Remuneration systems include fixed, time-based and output-based incomes. Only output-based income provides the physician with incentives which may (if the physician density and medical care price are sufficiently high) generate more-than-'appropriate' care per patient. Fixed and time-based incomes necessarily lead the physician to provide less-than-'appropriate' care.


Time series analysis of mortality and unemployment.


Regulating uncertain health hazards when there is changing risk information. The usual regulatory strategy for imperfectly understood risks is to regulate these hazards more stringently than would be dictated by myopic benefit-cost concerns. When downward irreversibilities are present and there are opportunities for learning more about the risk over time, it is optimal to under-regulate the risk initially and then tighten the regulatory requirements after adverse information is acquired. Upward irreversibilities that limit the ability to augment the health and safety investment level create the opposite result. The expected value of perfect prior information is a decreasing function of the probability of acquiring future risk information and the probability that the risk will be discovered to be severe.


The competition debate five years later.


Corporate benefit policies and health insurance costs. We tested the hypothesis that health insurance premium costs per employee are lower for employee groups where multiple health plans are offered and the employer pays a level dollar amount of the chosen premium than for employee groups where these two conditions are not met. Proposed national legislation relies on these conditions to create a competitive health care market. Data on 56 employee groups in 1981 and 66 employee groups in 1982 were collected from two surveys of large employers in Minnesota. Regression analysis of premium data from both surveys rejected the hypothesis. Indemnity plans in multiplan groups were cheaper if the employer paid a level dollar contribution versus a level percent (including 100) contribution. However, groups offered only an indemnity plan had lower premiums than groups meeting the two legislative conditions. These findings apply to both individual and family coverage premiums and are not caused by systematic differences in benefit provisions, employee demographics or factors influencing loading charges. Our findings cast doubt on attempts to achieve health care competition by legislative changes in insurance options and contribution methods.


Vaudois University Hospital--Lausanne, Switzerland.


Virucidal efficacy of hospital disinfectants and antiseptics. This article reviews the virucidal efficacy of the five main families of chemical disinfecting solutions: Alcohols, glutaraldehydes, iodophors, bisdiguanides and phenolics currently used in hospitals as disinfectants or antiseptics. Special emphasis was placed on the efficacy of these solutions against difficult-to-kill hydrophilic viruses, some of which are responsible for nosocomial infections in hospitals.


Condell Memorial Hospital--Libertyville, Illinois.


Electronic image systems for records management. Users of micrographics and those individuals who work with paper-based systems are probably intrigued by the promise of increased productivity available through optical disk technology. However, those with a thorough understanding of all that's been written about the technology are in the minority. This article hopes to help lift the veil of uncertainty surrounding the impact of optical disk technology as it applies to electronic document image systems, and to also add to the knowledge base of those who have already reached a respectable level of understanding.


Deposition: a voyage of discovery, or just a fishing expedition?


How efficient are sterile processing departments ... do you know?


Managing internal entrepreneurs.

Managing internal entrepreneurs. Creativity and entrepreneurship are vital to any organization, but bureaucracy and organizational restrictions can discourage these important traits in a company's employees. Often, attitudes and the general gestalt within a group can be more important than policies or pronouncements by management, but translating intangibles into concrete results is a mystery to many managers. This article, while it contains no revolutionary new ideas, is a summary of proven methods for igniting creative sparks in any organization.


The MDR rule.

The MDR rule.


Handling conflict.

Handling conflict.


Anti-bacterial agents seen as expendable.


Hospital laundry space shortage problem conquered with design, monorail system.


Baylor Medical Center laundry moves. Long wait pays off in new facility.


The evolution of a cooperative online network.


Sterilization monitoring.

Sterilization monitoring.


Health programs at risk in wake of '84 election. President Ronald Reagan's reelection suggests that government will continue to promote policies that favor marketplace allocation of medical care resources and that it will continue to cut social welfare programs, particularly health programs for the elderly and the poor. Unlike previous administrations, which focused on controlling private and public health care costs, President Reagan has targeted Medicare and Medicaid expenditures--a policy which has caused substantial cost shifting to underwrite hospitals' uncompensated and undercompensated care. Physician payment policies likely will receive the greatest attention in spending reduction efforts. Congress, as it showed in the president's first term, can cut spending sharply. Its task, however, has been complicated by the president's campaign declaration that defense spending and Social Security benefits were off-limits. Expected to lead health care debate on Capitol Hill are Sens. Albert Gore, Jr., D-TN, and Phil Gramm, R-TX, and Rep. James Jones, D-OK.


Linen control systems for hospitals.

Linen control systems for hospitals.


What the prepaid-care "boom" looks like from the inside.


Infection control and linen services.

Infection control and linen services.


How you'll feel the money squeeze on hospitals.


The importance of health record maintenance in the tuberculosis control programme in India.


Get ready for EcuMed.

Get ready for EcuMed.


The Achilles' heel of medicine.

The Achilles' heel of medicine.


"Rusk's folly:" rehabilitation.

"Rusk's folly:" rehabilitation.


American medicine in the year 2000.

American medicine in the year 2000.


The White House and the white coat.

The White House and the white coat.


NIH--a balancing act.

NIH--a balancing act.


Evolution of a "right to health care".

Evolution of a "right to health care".


NIH research: a window to the world of medicine.


In control of their own destinies. Specialty groups build identities away from AMA.


Privileges, MD surplus, costs impel hospital staff turf battles.


Family practice is becoming the first victim of competition.


Gifts for the hospital that needs everything.


The nosocomial infection war.

The nosocomial infection war.


Landmark studies propel medicine forward.


Osteoporosis: looking at the whole picture.


Wellness comes to work.

Wellness comes to work.


Productivity: the magic word pays off.

Productivity: the magic word pays off.


Lab budgeting and cost accounting under DRGs.


The robots are coming.

The robots are coming.


A paperless microbiology laboratory.

A paperless microbiology laboratory.


Why I spent time as a hospital volunteer.


Southwest Detroit Hospital creates a multihospital system.


NME political donation is subject of FBI probe.


Collaborative problem solving.

Collaborative problem solving.


Nation's leading clinics expect more patient volume, facility expansion.


New York City's teaching hospitals look carefully at high-cost equipment.


Children's hospital sets up network by leasing other hospitals' nurseries.


Insurers' change in approach may threaten hospitals' margins.


PPOs must recognize divergent interests, incentives to succeed.


PPOs growing rapidly in CA market: study.


Ruling affirms liability of hospitals for emergency doctors' negligence.


District hospital board takes action against threat posed by referendum.


Low rates, tax reform and Medicare fears push hospitals into bond market.


Model staff bylaws debate involves 'code words', legal expert charges.


Patient costs for diagnostic tests drop average of 10% in ACEP project.


Hospitals must restructure emergency charges to retain patient base: expert.


HMO industry leaders want HCFA to tone down its peer review plans.


Greatwest picks Phoenix for next HMO expansion.


California Catholic hospital system buys statewide HMO, avoids start-up.


AMI, St. Luke's Episcopal discussing integrated delivery system for Houston.


Expert, hospital group join to form 'test tube' fertilization clinic venture.


Manor Care chain's large profits a result of wooing wealthy patients.


The way to control hospital costs lies between regulation, competition.


Council Shared Services planning to expand, diversify to boost sales.


X-ray manufacturers engaging in 'price war'.


Attorneys urge hospitals to combat PPOs with competition, not lawsuits.


Cost avoidance in a regional continuing education center. Continuing education is a professional fact of life. There are numerous reasons why health professionals continue their education: the knowledge explosion makes existing theory and practice obsolete; society is ever changing and becoming increasingly complex; professionals are required to improve the quality of services rendered because of increased demands for accountability; some individuals change roles (e.g., direct care provider to administrator) within a profession, or even change professions; and some professions (e.g., medicine, nursing) require documentation of participation for relicensure and/or recertification to practice. While there are compelling reasons for health professionals to continue their education, the state of economic affairs is such that both continuing education (CE) providers and participants must seek ways to avoid and/or reduce costs related to CE. This paper consists of a case study description of what one regional continuing education center has done to reduce costs without reducing services.


1984 and beyond. A panel discussion.

1984 and beyond. A panel discussion.


The future of transplantation. Has Congress forgotten the lessons of dialysis?


Prescription drugs and the elderly. Strategies for effective drug prescribing and use. The author explains why the elderly are particularly at risk for problems of noncompliance with prescribed drug regimens and describes some innovative strategies that can be used to prevent or reduce both inappropriate prescribing by physicians and noncompliance among the elderly. These strategies can be applied by health professionals providing or monitoring drug therapy for the elderly (primarily physicians and pharmacists) and some can also be undertaken by the elderly working in close collaboration with clinical pharmacists. The paper concludes with an examination of the potential role of continuing education in ameliorating some of the problems discussed here.


Physician-patient communication and medical malpractice.


Criteria for evaluating methods used to assess physician performance.


Designing education interventions to improve physician performance in office practice. Family doctors play a very important role in determining the health of the populace; however, surveys and expert opinions indicate that there is considerable room for improvement in the knowledge and skills of family physicians concerning the prevention, early detection and management of the major causes of death and disability. Effective Continuing Medical Education (CME) could help greatly to resolve this problem. THere is, however, little evidence that presently available systems of CME, though costly, are effective in improving either physician competence or patient health. Attractive and cost-effective CME methods are greatly needed. This study develops, field tests and evaluates more efficient office-based CME programs for family doctors. Prevention, early detection and improved management of cardiovascular disease and cancer are the primary goals. A pretest posttest control group and time series approach was chosen for the experimental design. Thirty-one family physicians are participating. Physician performance and patient outcome prior to and after education are being assessed largely through office record review.


Health care and costs. Abiding ethical problems.


Not-for-profits considering a sellout should think twice, fight takeovers.


The impact of two educational techniques on physician knowledge, performance and patient care. Few studies have examined change in physician performance as a result of participation in CME. In addition, there is no evidence in the literature that traditional didactic instruction is the most effective way to deliver CME. The purpose of our study was to compare two educational processes by which information is conferred (traditional didactic lecture and case study format) to determine their impact on physician cognitive knowledge, performance, and patient care.


Find leads university hospital to growth after state divestiture.


Patient care appraisal.

Patient care appraisal. This paper will highlight the contributions of Patient Care Appraisal at Dalhousie University to the developing field of CME research. Since that experience goes back in excess of twelve years, a comprehensive review in the space available would be very superficial. It would seem more appropriate for me to highlight for you the contribution we believe Patient Care Appraisal (PCA) research will make to the developing field of Continuing Medical Education research. I will begin with a brief review of the elements that make PCA relevant to the theme of this meeting, followed by a summary of our experience introducing the process into hospitals in our three provinces in the early 1970's. The first research project, which attempted to link PCA to physician behavior change in the ambulatory setting, began in 1977 and was followed by a project which links the process to patient health outcomes.


The evaluation of continuing education in the health professions.


Multis enter the health insurance field.


Multis courting teaching hospitals.

Multis courting teaching hospitals.


Multis encountering antitrust problems.

Multis encountering antitrust problems.


Third annual Multis compensation survey.


Multi marketers.

Multi marketers.


Urgent care centers. Should hospitals beware?


HIBCC scans success for bar code standard.


Insurance carriers: guidelines for a premium selection.


Performance appraisal without stress.

Performance appraisal without stress.


The legal nightmares of employee leasing.


How to help the elderly to comply with their drug therapy.


What is the role of today's P&T committee in hospital practice?


Controlling absenteeism: union and nonunion differences.


Development of an information system for a physiotherapy department. This paper outlines the rationale for the development of an information system and shows how much a system can become an effective management tool for physiotherapy department directors. The author points out the need to assess both costs and benefits before venturing into the world of computerized information systems, but also makes a case for the need to establish a useful system for the gathering and processing of data that will provide useful information, whether or not computers are used to store and analyze the data. A five-step approach to the development of an information system is presented. The steps include: system analysis, selection of design approach, systems design, implementation, and system maintenance. The author states that management information systems for the future--if they are to be efficient and effective---will require department heads to develop specific methodologies of approach.


How a patient rights society will affect your practice.


Risk identification and management in clinical practice. Techniques for risk appraisal, screening, and monitoring. The data on factors that adversely affect health status are mounting, and information on behavioral and environmental means of preventing certain types of disease is becoming more widely available; yet preventive medicine is still seen as a less dynamic form of clinical practice than the crisis-oriented, complaint-responsive form. In this article, first in a series, the author reviews attitudes toward preventive medicine, discusses factors that affect health, explains the notion of how "prospective" medicine can develop through the use of health hazard appraisal, and reviews his and other researchers' ideas about screening tests, periodic physical examinations, health monitoring, and risk-factor identification in physical exams.


How are medical futurists faring?

How are medical futurists faring?


Medicine in the '80s: confronting bioethics.


Malpractice risks of documentation.

Malpractice risks of documentation.


Do PPOs practice quality medicine?

Do PPOs practice quality medicine?


Government/interest group interaction in Ontario: a comparative study.


Management in action. A comparative analysis of radiology productivity. In June 1982 an outside consulting firm utilized management engineering techniques to analyze productivity levels of the Radiology Department at the Medical University of South Carolina Hospital. Identical methods were utilized for a follow-up study conducted in January 1984. Strategies for productivity improvement were assessed as measured by number of examinations accomplished daily by usual department staffing. Findings indicated that productivity had increased through better staff and room utilization, though some problems still existed with staffing and patient scheduling practices. These studies indicate that, through the establishment of productivity goals, continuous assessment and monitoring of productivity indicators can be effective management tools.


New concepts in planning: image and retrieval systems of the future.


Management in action. Manpower when you need it--using your staff efficiently. Recently, there has been much interest in developing and refining a uniform reporting system as a means toward productivity analysis within the radiology department. The management of the Department of Radiology at Morristown Memorial Hospital realizes that the efficiency of most departments varies at different times during the work week. We have developed a system which we feel is adaptable to many institutions and will allow the radiology manager to allocate resources in an informed and controlled manner.


Lessons on supervision.

Lessons on supervision.


AHRA Statistical/Resource Committee. Survey results: member/institution characteristics, including salary.


Five not so easy pieces.

Five not so easy pieces.


Radiology manager: the critical link in hospital-physician joint ventures. Mounting capitalization obstacles and growing competition require hospitals to explore nontraditional avenues in acquiring and offering services. This first of a two-article series outlines the reasons behind the increasing popularity of hospital-physician joint venture agreements for diagnostic imaging equipment, and the contributions radiology administrators should make in the formation of such enterprises.


Employee privacy: legal and research developments and implications for personnel administration. The contemporary emphasis on privacy has created a myriad of complex personnel problems and associated approaches to handle them. These privacy-oriented problems generally involve social, ethical, legal, managerial, and even political considerations. Personnel administrators are constantly confronted with the privacy issue. This article attempts to synthesize privacy information relevant to personnel administration, and to provide personnel administrators with managerial guidance for handling employee privacy problems in the work environment. It places particular emphasis on differentiating between ethical and legal aspects of privacy in our society, and, accordingly, on clarifying existing confusion over the impact of so-called "privacy laws" on personnel administration.


Informed consent--the controversy in radiology. Informed consent is more than a sheet of paper with indications, contraindications, possible side effects, and the physician's and patient's signature. It is a moral and legal Pandora's box. How much information does the patient really need to know? What information is the physician responsible for? What legal implications come into play during an emergency? Is informed consent necessary for IVPs? These topics and a brief history of the doctrine of informed consent should give the radiology administrator some insight into the medico-legal implications of informed consent.


The little hospital that could.

The little hospital that could.


Using thermography to document the presence of pain.


Using ratio analysis for financial accountability.


A systems approach to the management of a hospital for short-term patients. The endemic problems of health system management are reviewed, as is the difficulty of taking a systems viewpoint. It is argued, and demonstrated, that, by using some very simple ideas of system structure it is remarkably easy to draw up a diagram of system influences. Such a diagram is drawn for the case of psychiatric patients who recycle in the system. The diagram is analyzed from the point of view of its properties as a feedback control system, and it is shown that there are alternative, and probably more satisfactory, management practices. Suggestions are made for the practical implementation of such policies. Finally it is argued that influence diagrams may be useful as agenda for discussions, and that they offer advantages over conventional agenda.


Long-range hospital capital requirements planning: the state of the art, a proposal for change. A Hospital Capital Requirements Planning System is proposed to channel competition through the use of a regional planning model. This model would help to reduce the social deadweight loss arising from competition-induced uncertainty. The system would increase the internal long-range planning capacity of hospitals and improve the quality of the applications presented for Certificate of Need review. Both health systems planners and investment bankers should have better information with which to evaluate hospital capital investment proposals.


An application of multiattribute utility theory to the planning of emergency medical services. This research considers the problem of relating Emergency Medical Services (EMS) to patient outcome. The hypothesis is that response time alone may be misleading as an EMS performance criterion. This research uses methods for approximating multiattribute utility functions to consider both response time and on-the-scene care. The final result is an optimization problem where the response time and desired personnel requirements are decision variables. These are important inputs in the planning for Emergency Medical Services.


Guidelines and an illustration of the use of ecological data for seeking clues of excess risk. Ecological studies have acquired a bad reputation as weak scientific studies suffering from the ecological fallacy and many intractable limitations of data and method. In order to reduce these problems, it is suggested that analyses be focused on specific populations-at-risk, diseases, risk factors and places. In addition, seven guidelines are suggested which will limit the possibility of false positive results and provide the best clues for expensive, follow-up research. These guidelines are testing to make sure that the results are consistent across different times, places and methods. The guidelines were applied to finding the best clues for occupational-related cancers among white males aged 35-64 in the State of Illinois during 1950-1975. The most interesting clue found was that most coal mining areas in Illinois during the late 1960s and 1970s manifested the highest cancer mortality rates of trachea, bronchus, and lung and among the highest rates of increase of this type of cancer. This finding was unexpected because many studies have shown low lung cancer rates among coal miners.


Employee solicitation rights in the health-care industry--a proposal for change.


Low cost organization of a mental retardation facility staff library. A mental retardation facility staff library of 700 volumes required complete organization. Two restraining factors were lack of personnel and limited funds. A plan was developed to classify titles according to Library of Congress, with the subject heading catalog predominantly based on Medical Subject Headings (MeSH). A cataloging service was located which produced custom card sets and book labels from CATLINE and MARC computer databases. Where necessary, MARC records were edited to alter LC subject headings to MeSH terminology. Organization was accomplished at an average cost per title of less than $1.50.


Moving a medical center library.

Moving a medical center library. The relocation of a medical center library collection of 30,000 book and journal volumes and 600 audiovisuals is described. The planning and moving procedures which facilitated the move are detailed. A bibliography of the library literature concerning library moves is attached.


Fiscal accountability through effective risk management. This article conceptualizes the role that risk management should take in therapeutic recreation to help attain fiscal accountability. The public is becoming increasingly aware of risk or harm to patients associated with medical care and is demanding a higher level of care. A litigious public has created a tremendous amount of caution within the health care community. This caution often has led to a mandated conservative approach to therapeutic recreation programs. Therapeutic recreation is faced with the task of designing risk management programs which will lessen financial concerns while creating a safe and effective treatment environment.


Productivity analysis as a method of fiscal accountability for therapeutic recreation. This article reviews increasing pressures for fiscal accountability and describes productivity analysis and measurement as a method of demonstrating fiscal accountability for therapeutic recreation. The article reviews various aspects of productivity analysis and measurement, including definitions for productivity, a description of why productivity measurement is important to therapeutic recreation as a method of demonstrating fiscal accountability, and facts and myths about productivity analysis and measurement. A process of developing a productivity measurement system for therapeutic recreation is presented for consideration.


Fiscal management in therapeutic recreation: a perspective on educational preparation. This article examines the implications for the educational preparation of therapeutic recreation specialists of fiscal management trends in health care. Selected questions related to identification of fiscal management competencies, undergraduate and graduate curricula, and research needs are discussed.


Marketing therapeutic recreation services. The use of marketing strategies can enhance the delivery of therapeutic recreation services. This article discusses how agencies can adapt marketing techniques and use them to identify potential markets, improve image, evaluate external pressures, and maximize internal strengths. Four variables that can be controlled and manipulated in a proposed marketing plan are product, price, place and promotion.


Private foundations: a need for further explorations. Private foundations should be considered as a potential resource of funding projects initiated by recreation therapists. This article acquaints the reader with the viability of the private sector. Attention is given to exploring the various types of foundations and methods to research potential resources. Some of the procedures that would be useful in securing funds are also presented.


Combining risk management and quality assurance.


Social workers help hospitals cut costs.


Restructuring public hospitals.

Restructuring public hospitals.


Fledgling trustee lobbying efforts take wing. Lobbying. Advocacy. These are words that are attaining new meaning for hospital trustees. Throughout the country, as legislators attempt to formulate legislative solutions to rising health care costs and to develop more effective payment systems, more and more trustees are being called upon to tell the hospital's story and to represent the institutions and communities they serve in the political arena.


Recent court decision offers hopeful sign. Strict liability.


Interchange: rotating the chairmanship.

Interchange: rotating the chairmanship.


A special event can tell your story.

A special event can tell your story.


What 1985 holds in store for trustees.

What 1985 holds in store for trustees. What problems and challenges will governing boards face in 1985? A hospital trustee and board member of the Indiana Hospital Association presents an overview of the changing environment and the role tha trustees will be expected to play.


Privileges system deters disputes among medical staff specialists. With a growing number of physicians and dwindling opportunities to perform in-hospital procedures, medical staff privileges disputes are likely to increase. The author explains how a privileges process that is based on the individual physician's demonstrated ability instead of specially labels or character of training can prevent such disputes and protect the hospital from antitrust suits that may occur in connection with them.


Productivity efforts on the rise at most U.S. community hospitals. A recent survey of CEOs, conducted by Hospitals magazine, shows that productivity studies are concentrating on staffing--especially in nursing, laboratory, surgical suite, medical records, and radiology.


Social Security freeze? Facts behind the furor.


Risks and uncertainty dictate caution in hospital bond ratings.


The greatest gift: "I know I did all I could".


How hospices ease last days of the dying.


Bleak days for psychiatry--a search for answers.


Another form of age discrimination.

Another form of age discrimination.


The role of inferential accuracy in performance rating. The presence of shared implicit theories of performance is used in explaining the failure of behavioral anchors to improve performance ratings. It is proposed that efforts to improve rating accuracy also will be hampered by a preoccupation with observation. Instead, attention needs to be focused on the inferential accuracy of the rater and the cognitive processes and implicit theories upon which raters rely.


Guide for adult immunization.

Guide for adult immunization.


Services for families of the aged: which ones will work best?


The dynamics of interorganizational coordination. A theory was developed on the creation, growth, and decline of relationships among organizations and was tested, using a longitudinal study of 95 dyadic relationships among child care and health organizations in Texas. Using LISREL V, the test of the theory showed that substantial revision of the model was required to explain the data adequately. When the model was revised, important new patterns were revealed in the development of interorganizational relationships over time: (1) Perceptions of dependence on others for resources spurs the development of interorganizational relationships. Resource dependence is a powerful direct determinant of communications, resource transactions, and consensus; (2) The growth of interorganizational relationships is fostered by frequent communications to formalize the relationship and build consensus about the terms of the relationship among the parties involved; (3) Monetary transactions and client referrals entail different patterns of coordination; and (4) Consensus among parties in an interorganizational relationship is both a positive outcome of initial resource dependence and communications and has a negative influence on subsequent perceptions of resource dependence.


Computer-based prescription audit as a research, educational and management tool. An existing dedicated pharmacy computer system (MIDAS system, Alfred Hospital and Health Computing Services, Victoria) used primarily for pharmacy labelling and dispensing, has been rewritten for an in-house minicomputer, with enhancements that allow it to be used in budgetary predictions, drug use monitoring, therapeutic audit and as a research tool. An automatically updated hard copy record of individual patient prescription profiles is generated and represents a valuable addition to the patient medical record. Allied to automatic "sorting" and retrieval techniques, all patients on nominated drugs can be identified and their records examined for particular combination use. Current application to assessment of nifedipine- beta blocker use will be presented, as will an application to cimetidine audit. Prescriptions can be scanned and segregated in terms of numbers of prescriptions in addition to segregation in terms of a particular therapeutic agent. Initial application to audit has detected an unacceptable level of polypharmacy (more than 26% of all prescriptions involve greater than or equal to 5 items and more than 3% involved greater than or equal to 10 items). Statistical information on the volume and unit cost of outpatient prescribing allows a precise estimate of ongoing budgetary commitments, while trends in discharge medication profiles allow a basis for prediction of budgetary trends, particularly with respect to the use of recent additions to the formulary. The system allows for expansion at minimal cost with potentially revolutionary applications, for example, interactive prescriber education if and when "on-line" capabilities are developed. Cross-linking with relevant data-bases will allow a major expansion of applied research into therapeutic drug use and its consequences.


Strategies to improve drug use in hospitals.


Assuring rational antibiotic use: the impact of a joint microbiology-pharmacy surveillance program. A comprehensive antibiotic surveillance program conducted in cooperation with the Microbiology and Pharmacy departments in a teaching hospital is described. The program consists of a number of interrelated processes including the personal advice of specialists including a Clinical Microbiologist, Infection Control Nurse and Ward Pharmacists, re-educative strategies and non restrictive administrative policies. The program does not involve the use of formularies or published guidelines, and retains complete clinical freedom of choice for antibiotics. Studies, including antibiotic prevalence and prescribing surveys, indicate that the program has been an effective means of improving antibiotic use, reducing costs and promoting infection control. This has been achieved by educative means through the provision of relevant information on antibiotic principles, and opportunities for prescribers to improve their problem solving skills, resulting in long term attitudinal change.


The structure and operation of health service boards of management in South Australia. Although it is generally believed that boards of management in the health field have an important role to play in the attainment of an effective health system very little information is available on either their structure or operation. This article summarises the findings of a state-wide survey and also includes an analysis of board members' perception of board responsibilities and of their need for further education.


In the spotlight. Interview with Kenneth Lee, Health Economist, University of Leeds, U.K.. Interview by Johannes Stoelwinder. Ken Lee appointed to the staff of the Nuffield Centre, University of Leeds, as Lecturer in Health Economics in 1970. He is now Senior Lecturer and Director of the Master's Programme in Health Service Studies. His main teaching interests are in health planning and health economics, and he has carried out research and written extensively on approaches to health economics, health planning and management, care of the elderly, primary health care, health financing, and emergency health services.


Health service for a billion people. The organization of health care in the People's Republic of China.


The Master of Nursing Administration at the University of New South Wales. The funding of the Master of Nursing Administration program at the University of New South Wales by the Department of Health, N.S.W. in November 1983 has allowed the first intake of students to proceed from March 1984. This article provides the background to the MNA's development, as well as a description of its nursing components.


Hospital food service: is a chilled meal system best? Royal Prince Alfred Hospital, Sydney, introduced the first chilled meal system into a major Australian hospital twenty years ago. Recently the food service has been converted back to a centralised system with conventional food production. The change has resulted in reduced operating costs and better quality food. This suggests that a chilled food system is not always the most economical form of hospital food service.


Medicare: an early assessment of its impact.


Contractors can slash hospital bills, says study.


Report of the inquiry into the Royal Southern Memorial Hospital.


Ethical implications of cost control in health care.


The mechanism for containing medical care costs in Japan.


An activity analysis of electronic game simulators.


Ensuring the effectiveness of compensation programs.


Three philosophical positions of therapeutic recreation and their implications for professionalization and NTRS/NRPA.


Performance appraisal: a bold plan.

Performance appraisal: a bold plan.


Minnesota study: 37% of hospital employees admit to stealing supplies.


A model for estimating payroll expenses.


How to raise $16,000 on the way to Bermuda.


Visible evidence: effective newsletter designs.


Gifts from your ER.

Gifts from your ER.


Who won the PGA's Texas open? Santa Rosa Medical Center has won $200,000.


A greenhouse for patients.

A greenhouse for patients.


The paramedic pack.

The paramedic pack.


Poster PR: how to get 1000 area kids to think about your hospital.


Chest pain emergency center.

Chest pain emergency center.


Internal management seminar: encouraging leadership from within.


Prenatal newsletter: from (can you believe it) "The Great Expectations Society".


Parenting conference: seminar provides a flock of benefits to the hospital.


Day care for employees' children: a program so effective it can be marketed to other hospitals.


Energy conservation and the hospital.

Energy conservation and the hospital.


Campaigning against infection.

Campaigning against infection.


Patient admission literature.

Patient admission literature.


Advertising sports medicine.

Advertising sports medicine.


Recognizing employees with gift certificates.


Good health is good business.

Good health is good business.


Sentronic/book-mark library security system.


Almost everything you need to know about HMOs but haven't had time to think about.


Data-based research in therapeutic recreation: state of the art. During difficult financial times, it is critical not only to evaluate therapeutic recreation programs and document client progress but also to disseminate objective program data to therapeutic recreation and other practitioners. The purpose of this state-of-the-art research inquiry was to provide the therapeutic recreation discipline and other related helping professions with an accurate and current assessment of empirically based research concerning the provision of recreation for special populations. Eight professional journals in recreation, special education, and psychology from 1977 (the year of PL 94-142) through the current literature were reviewed. Articles using a data-based research methodology in the area of recreation/leisure for special populations were identified. Articles were analyzed according to target population, subject age, purpose of study, and research design. Of the 83 data-based research reports found, 40 studies addressed the mentally retarded population, 26 involved children (birth to 13 years), and the case study (23) and survey (23) research designs were most prevalent. A plea for future data-based research by therapeutic recreation professionals to improve services is made.


Short-term financing: the hospital perspective.


Health care is ministry.

Health care is ministry.


Roots, ruts and routes.

Roots, ruts and routes.


1942-1982: Forty years of chaplaincy: reflections and projections.


Reminiscence. A volunteer listening-visiting program for Congregational outreach.


Human dimensions in health care.

Human dimensions in health care.


Special edition on pastoral care. Proceedings of the Annual Convention, College of Chaplains, San Diego, California, March 20-23, 1983.


The chaplain's role in developing an oncology support team.


Maintaining ethical principles and surviving in a competitive environment.


Developing a structure for chaplaincy evaluation.


Cardiac catheterization laboratory, VA Medical Center, West Los Angeles. The cardiac catheterization laboratory at this VA facility provides a wide variety of services, using state-of-the-art technology, to a large population of veterans with cardiac problems.


Development of a pastoral care association in a sparsely populated area.


Paying Peter and Paul: benefits of a hospital-based lay pastoral visitation program.


Psychographic/lifestyle aspects for market targeting.


Uniqueness, opportunities and problems of chaplains in university-owned hospitals.


A businessman's view of professional liability.


Pastoral care in a level one trauma center emergency room.


The chaplain amid dilemmas of health care ethics.


The public image of surgery. Summary of panel discussion.


Does the ICU computer improve patient care? The introduction of sophisticated microprocessor-based instruments into the intensive care environment promises to relieve clinical staff of many routine duties and to provide more time for patient observation. A recent English survey investigates how much time can actually be saved thereby, and in what kinds of duties, and offers ideas on how to maintain clinical awareness when data logging has been automated.


A surgeon's perspective on professional liability.


Paying for mental health care in the private sector.


The federal government's perspective on professional liability.


The artificial heart: Act III.

The artificial heart: Act III.


Providing emotional help through alternative delivery.


Peer review program sets trends in claims processing.


Malpractice threat poses a complex solution.


Building a better benefit plan at Quaker Oats.