Empirical findings on the association between education and child health status: discussion. The 3 papers presented in this section attempt to explain variations in child mortality.  They use regression models in which a large number of independent variables appear in a reduced form obtained from an underlying structural system.  These papers, which are essentially multivariate analyses of infant mortality using micro or household data, manifest 2 general problems.  The 1st problem is that education is 1 of the independent variables to these analyses and is of special interest to this conference.  However, education is closely associated with other possibly strong determinants of infant mortality and, in general, data are unavailable on these other determinants.  Education in these regression analyses tends to represent the pure effects of education and also the effect of the other socioeconomic variables with which it happens to be either statistically or causally related.  The 2nd general area of concern is that none of the papers is able to shed much light on the precise mechanisms by which education might affect health condition and mortality.  The 3 papers recognize these 2 problems and are unable to do much about them.  The papers do, however, come up with several interesting findings.  Simmons and Bernstein report as their main finding that postneonatal mortality is determined to an important extent by preferences within the family for additional male or female children.  These preferences or attitudes lead to either to neglect or to extra care of new children, and hence have an important effect on mortality patterns.  The education variable, relating to the education of the mother and father, is of somewhat less importance.  Chowdhury reports that education is relatively unimportant as a determinant of mortality.  He suggests that there may nonetheless be some indirect influence of education or health.  The main finding of Rosenzweig and Schultz is that health care programs offered by the public sector, like free clinics and public hospitals, tend to be redistributive.  The programs result in the greater reductions in mortality among the less educated segments of the population.  Whether their education variable represents itself or income, the finding that the health programs are redistributive or egalitarian stands up either way.


Estimating the covariates of childhood mortality from retrospective reports of mothers. In this paper we compare various models for estimating the covariates of childhood mortality from the type of data commonly available in developing countries. Specifically, we examine how much precision is lost as various pieces of information, such as dates of birth and death for each child, are discarded. The conclusion which we reach is that even incomplete mortality data of the type collected in household surveys or censuses can yield estimates which are very close to those based on the much richer wealth of data collected in detailed maternity histories. Two substantive conclusions of interest are that in the two countries (Sri Lanka and Korea) we examined, the education of the father has a significant and pronounced effect on childhood mortality even when the mother's education is controlled, and once other covariates are controlled, there is no difference between urban and rural childhood mortality.


Mechanisms of interaction between education and health: discussion.


Literacy, education and health development: research priorities. How education and health are linked in developing countries and what educational activities produce change are quite uncertain. Questions for research on these concerns are noted, and it is suggested that prospective longitudinal studies, household surveys, and field observations might well be added to the more usual multivariate analyses of records. Analyses of educational program implementation alternatives are also suggested.


Literacy, education and health development: policy implications. The statistical evidence on the relationship between education and health is impressively strong, but a causal link remains to be established. Despite this weakness, however, the evidence is much more solid than that on which policy decisions concerning health and education are normally made. Although further research is needed, the findings currently available are adequate to support advocacy of a higher priority to education in development and health improvement strategies.


Operating theatre feature: some guidelines.


The evaluation of educational and economic effects on life expectation by linear regression analysis. Socioeconomic effects are supposed to have a fairly long time delay in regard to health development. Taking into consideration time lags, correlation and regression analysis are executed to explain the difference in health levels which exist among countries. The infant mortality rate, life expectation at birth, adult literacy rate, proportions of school enrollment and GNP per capita are taken as variables and their characteristics are discussed. In addition, countries are divided into three groups, i.e. low income, middle income, and industrialized countries, to show that the educational and economic effects on health development vary according to the economic level of the countries.


Socio-economic profile and performance of CHVs in Gujarat: implications for selection and support. What type of person should be selected as Community Health Volunteer (CHV) has been a matter of debate. This study relates socio-economic characteristics--age, sex, marital status, education, caste, organisation membership and landownership--with performance on direct patient care, mother and child health, family welfare and environmental sanitation. The paper further suggests strategies for selection, training and support in case of CHVs whose performance is poor. Age, sex, marital status, education, organizational membership and caste are examined as factors influencing the performance of community health volunteers (CHVs) in direct patient care, maternal and child health, family welfare and environmental sanitation.  The study produced information that might be useful in recruiting CHVs.  Strategies are offered for selection of CHVs based on the particular needs of a village.


Outcomes of literacy: how to measure them.


The social context of education and health. This paper stresses that the relationship between education and health cannot be meaningfully analysed in isolation from the economic and cultural matrix of society of which it is an integral part. An examination of the different kinds of education available to Third Worlders shows that formal schooling is generally regarded as a passport to urban employment. It therefore accentuates socioeconomic differentiation. Altogether, education for the sake of increased knowledge and/or improved welfare is a luxury only the wealthier can afford. Moreover, an examination of the culture-specificity of health concepts is taken to show how Western health care is inappropriate in settings where health is seen as an indicator of morality. Numerous case materials are used as evidence for the argument presented here. The final section of the paper devoted to "policy implications" emphasises that low levels of education and health are symbolic of under-development. Formal education or Western type health care are no panacea, nor even palliatives for the poverty syndrome. Appropriate education associated with appropriate health measures may help to alleviate the worst evils of disease.


The home environment of the malnourished-deprived child. The extent of childhood malnutrition-deprivation throughout the world is indicated and its nature and the forms it takes are described. An account is given of several studies carried out by the author and his colleagues in Lebanon. An investigation of failure to thrive in young children revealed that in an apparently homogeneous low socioeconomic group there was a wide spectrum of physical growth which correlated closely with a number of home environment variables. Another study of the mental development of some of these children carried out over several years showed that children with even mild growth failure had a statistically significant impairment of mental development as compared with their apparently healthy siblings, also living in a home environment characterized by deprivation. The far reaching consequences are emphasized. In a third study which investigated the formal education of mothers, their nutritional knowledge and practices and the growth of their children, the indices were found to be interrelated to some extent. Finally, a small study gave some indication, perhaps contrary to general belief, that the rapid social change undergone by families who migrate from the country to an urban slum may be associated with an improvement in nutrition of the children.


Continuing education and competency: some critical unresolved issues. There are numerous dilemmas and contradictory philosophies that the health professions face in planning programs and goals for continuing education and competency. Among the issues that are discussed are: (1) whether learning should be based on prescriptive or felt needs; (2) whether the ultimate objectives should be toward fostering practitioner safety or competence; and (3) whether the focus of assessment should be at the entry or advanced level. The discussion points out that continuing education does not, by its mere presence, assure continuing competency, and several suggestions are offered. First, there is no satisfactory definition of clinical competence to use in structuring program objectives or assessing their attainment. For example, if incompetence is considered to be the manifestation of patient harm, how serious must the harm be and how many patients must be harmed? This is an extremely difficult and complex issue, but one that must be faced. Second, the consuming public should be better informed and educated in identifying marginal practitioners. This is seen as an important, although currently lacking, component of voluntary approaches to continuing competency. Finally, reference is made to the potential of criterion-referenced testing for defining acceptable skill thresholds.


Medical education units.

Medical education units. To assist faculty members in the planning, execution, and evaluation of teaching-learning activities many medical schools around the world have established medical education units or centers. The more advanced units are helping other medical schools by means of direct support in the latter's curriculum development efforts or through training of personnel who would man the latter's own units. In 1969 the WHO arranged a network of teacher training centers to facilitate this type of cooperation. There are other networks and direct bilateral collaboration schemes as well, especially in the Americas and Europe. For the medical schools in the Southeast Asian region the WHO has designated three advanced units (at the Chulalongkorn University in Thailand, the University of New South Wales in Australia, and the University of Sri Lanka) as regional teacher training centers. In spite of the efforts of these units the development of medical education units in the Southeast Asian medical schools is still far from satisfactory. This is partly caused by a lack of information regarding the objectives and organizations of such units. The following presentation tries to fill this gap.


Health policy, student selection and curriculum reform. Student selection is a major component of the training process. This paper argues that the traditional approach taken to selection--using the criterion-prediction model--has limited utility in the training of health care professionals. Not only are there additional educational purposes which selection can fulfil (such as increasing the heterogeneity of students, encouraging realistic self-selection and providing the first exposure to the "ethos" of a profession), but selection can also be used as a direct strategy to assist in the implementation of health service policies--for example, by contributing to social equalization, community participation in health services and community responsibility for health.


Adolescent pregnancy, public policy, and the research community.


Research paradigms and mental health policy.


Independence of VHA buyers an issue in antitrust suit.


The utilization of research in the national health policy debate: a case example.


Off-site distribution offers challenges, opportunities.


Product report: syringes, needles, gloves--purchaser's view.


Product report: syringes, needles, gloves--manufacturers' view.


Five steps to a lost charge recovery program.


Computer bits: commodity coding, Part II.


Proposal threatens hospital, nursing home funding.


Taking inventory.

Taking inventory.


Simplest solution to an ancient problem.


Keep track of their performance.

Keep track of their performance.


Holding a captive market hostage.

Holding a captive market hostage.


Wound watch.

Wound watch.


They don't just lock the doors.

They don't just lock the doors.


Billions from bandaids.

Billions from bandaids.


Recognizing the promotable employee.

Recognizing the promotable employee.


Taking it one step further.

Taking it one step further.


Longitudinal analysis of the problems of hospital administrators.


Organizational rationality, medicine, and the use of new knowledge in American hospitals.


Turnover of hospital chief executive officers: a hospital association perspective.


Hospital administration and medicine at the crossroads.


A letter to a young CEO.

A letter to a young CEO.


Medical office buildings and their influence upon facility utilization.


Health planning: the fourth generation.

Health planning: the fourth generation.


Focus groups: an innovative marketing research technique.


Quality circles and medical staffs.

Quality circles and medical staffs. Quality circles are a new phenomenon in American industry. Can the touted virtues of quality circles-improved morale, productivity, and product quality-be translated into the health care setting? In some departments, probably. But it remains to be seen if medical staff members will become major supporters of the quality circles movement. A future article will take a case study approach to show how the hospital medical staff of one hospital became involved with quality circles.


Philosophers take their art into classrooms, hospitals.


The latest word from the FDA: an exclusive interview with the commissioner. Interview by John A. Owen Jr..


Institutional support of continuing education as a fringe benefit for hospital pharmacists. The purpose of this study was to examine the extent to which hospital pharmacists in Wisconsin received compensation for continuing education (CE) from their institutions and to compare this with their participation in CE activities. The study was conducted by a mail questionnaire sent to all pharmacists practicing in a hospital setting in Wisconsin. The usable response rate was greater than 45%. Persons in administrative positions received greater support for CE activities than staff in the areas of registration fees (P less than 0.005), travel expenses (P less than 0.0005), dues for professional organizations (P less than 0.0005), and compensatory time (P less than 0.0005). Pharmacists in the sample participated in an average of 123.8 hours of CE yearly, including 77.2 hours of journal reading. Staff size influenced the method of obtaining CE, with smaller staffs relying more heavily on journals and larger staffs on in-house programs. The amount of compensation did not influence total CE participation, suggesting that other factors might influence CE participation.


A preview of 1981 hospital pharmacy operations.


Areawide survey of antimicrobial restriction policies and the role of hospital pharmacists.


The pharmacist and adverse drug reaction reporting. During premarketing trials, the number of patients exposed to a drug and the length of exposure to a drug are both limited. After marketing, many thousands, frequently millions, of patients are exposed to the drug over considerably longer periods of time, and adverse drug reactions not previously recognized appear. Because of these factors, postmarketing surveillance is extremely important. Pharmacists can contribute to drug safety and improved patient care by understanding and actively participating in the Food and Drug Administration's Spontaneous Reporting Program.


Audit of telephone usage in a centralized intravenous admixture area. An audit of telephone usage in an intravenous admixture area was performed. Over a two-day period (18 hours total) 252 calls were made or received. The average length of a call was 81 seconds. Surgery and medicine nursing units accounted for the majority of the cells. Missing orders or doses were the most frequent topic of calls. Telephone communication may require a large time commitment from pharmacists and prevent them from performing activities which are more easily documentable, such as compounding intravenous admixtures.


Maintaining competency of sterile products personnel. The literature is replete with articles concerning the importance of properly training and monitoring individuals assigned the responsibility of preparing sterile products. At the William L. Keller U.S. Army Community Hospital, the monitoring of these individuals has taken the form of a monthly examination composed of mathematical and technical functions.


Methodological observations on applied behavioral science. A review of single-subject methodologies in applied settings.


Collaborative practice revisited.

Collaborative practice revisited.


Maintaining organizational effectiveness during organizational retrenchment.


A healthy development: Chicago's Lakeshore Centre.


Basic and applied sociological work: divergence, convergence, or peaceful co-existence?


Hearings on a coordinated health information system: background and analysis.


Methodological observations on applied behavioral science. A measurement package for clinical workers.


American expectations of privacy in an information age.


Numerical approach to disease classification.


The health belief model and nutrition education. Five axioms of learning explain the stability of dietary practices and suggest approaches to teaching more healthful habits. These axioms include the influence of prior beliefs and attitudes upon people's interpretations, the fact that effective learning is incremental, the value of reinforcement, the habitual nature of much behavior, and the fact that learning includes both cognitions and skills. The Health Belief Model (HBM), a specification of the first axiom, holds that people are likely to follow health recommendations if they are motivated about their health and if they believe that they are susceptible to an ill health condition; that the occurrence of that condition would have serious impact on their lives; that following a particular set of health recommendations would be beneficial in reducing either their susceptibility to or the severity of the condition; and that the psychological benefits of following the health recommendation outweighs its costs. Educational diagnosis may be made by identifying peoples' status on each variable in the HBM and then formulating an educational plan directed toward modifying beliefs, as needed, taking into account the other learning axioms. An ethical stance is adopted that holds that informed individuals should be entitled to maintain the practices they prefer.


Information policy and health.

Information policy and health.


Increasing physician utilization of clinical information systems.


Clinical computing in Austria.

Clinical computing in Austria.


A model scheduling and appointment system for family practice programs and group practice. Phase I: Computerizing the physician's daily schedule.


Free text processing in clinical documentation.


Recommendations for hospital statistics in Europe.


How to buy a freezer.

How to buy a freezer.


WAMIS: a medical information system. Conception and clinical usage.


Anti-trust implications of coalitions for cost containment.


Maryland appraisal of patient programs.

Maryland appraisal of patient programs.


MAPP: how is it working in Maryland?

MAPP: how is it working in Maryland?


Meeting the press.

Meeting the press.


Quality of life as a way of life.

Quality of life as a way of life.


A small warning of history.

A small warning of history.


Chart of qualities.

Chart of qualities.


Big energy savings can come from changes.


The influence of music on psychiatric patients' immediate attitude change toward therapists. This study was undertaken to establish that in an audience situation, music may facilitate an immediate attitude change toward a therapist by patients. To determine the characteristics of such a change, recorded (popular and classical) and live (cello) music was employed. A semantic differential was used to measure attitude change by psychiatric inpatients and control subjects (medical students and student nurses). Significant attitude change were found when the music presented was the preference of the therapist and when this preference was conveyed to the audience. Patient breakdown into diagnostic categories also showed that patients with affective or alcoholic disorders showed significantly larger attitude change than the controls. Results are discussed in terms of cognitive consistency theories of attitude change, concluding that maximal attitude change toward a therapist occurs under conditions in which the therapist presents new aspects of behavior (in terms of previous exposure) to the patients.


Modelling inspection policies for building maintenance. A method of assessing the potential of an inspection maintenance policy as opposed to an existing breakdown maintenance policy for a building complex is developed. The method is based upon information likely to be available and specific subjective assessments which could be made available. Estimates of the expected number of defects identified at an inspection and the consequential cost saving are presented as functions of the inspection frequency.


MLA in Disneyland.

MLA in Disneyland.


Future forecasting with LEAP.

Future forecasting with LEAP. A rapidly changing business environment has caused numerous firms to adopt some form of environmental assessment as part of their strategic planning process. Extrapolative techniques and trend analysis are useful when forecasting for the short-term and in comparatively stable environments. Futuristic methodologies are appropriate in turbulent environments with long-term planning requirements. The Likelihood of Events Assessment Process (LEAP), a new method of forecasting developed by the author, is explained in detail using examples from a recent study which used top level life insurance executives to predict the relative likelihood of occurrence of planning dates for a set of events in the socio-political environment of business.


Will this concept work?

Will this concept work?


Center for Research: retirement planning.


Vision and mission of the church in the changing trends in health care.


Examining your black box.

Examining your black box. Effective management employs the skills of eliciting appropriate behavior and performance from people and successfully interacting with the environment. Formal management training is one tool that can help a medical group manager accomplish this objective. Another tool is a set of personal values which are consistent with the manager's actions. These values are neatly packaged in what the author calls a "black box." It makes for not only a healthy management style, but also a healthy person if the cognitions contained in one's black box are continually examined and weeded. To assist managers in identifying and examining the elements contained in their personal value sets, the author presents a few elements of his own black box.


Medical malpractice arbitration.

Medical malpractice arbitration. The medical malpractice problem has been a major contributor to the inflationary trend in healthcare costs. Arbitration, as an alternative to litigation, can be effective in alleviating many of the problems associated with malpractice suits. Authors Corbett and Leap present the results of their study of arbitration, including an examination of existing medical malpractice arbitration panels and their effectiveness. The results of the study are encouraging as arbitration is seen to bring advantages to both the plaintiff and the defendant, as well as reducing the amount of litigation and insurance-related problems.


A profile of the group practice administrator. Authors Hamity and Gauss have drawn a profile of today's group practice administrator based on data collected in an independently conducted survey. A report is given on the age, education, and professional background of the 546 respondents. Types of group practice, duties, responsibilities, problematic areas, and salaries and benefits are also discussed. In conclusion, the authors have identified the current and future trends which they believe their data has brought to light.


Healthcare delivery in the Federal Republic of Germany. By broadening your knowledge of healthcare delivery systems, you can grow as a healthcare administrator and play a larger leadership role in healthcare planning for the future at the local, state, and even national levels. Overseas conferences sponsored by the American College of Medical Group Administrators (ACMGA) provide a unique opportunity for detailed exposure to the healthcare delivery systems of other countries. An abstract of papers presented at the ACMGA 1981 conference in Munich has been prepared by the author, sketching an outline of the history, organization, problems, and future trends of medical care in the Federal Republic of Germany.


HMO: the concept, new evidence, implications. HMOs have been the most controversial alternative healthcare delivery system in the US. As a first step towards understanding the concept and state of HMOs, a description is offered, including a review of basic characteristics, types, and general financial incentives and disincentives. Although the performance of HMOs has also been the subject of recent debate, there is evidence that studies of performance have been inconclusive, and while observations about the effects of HMOs appear frequently in the literature, the causes are not actually known. To provide more conclusive information on the performance of HMOs, the American Medical Association conducted several related studies during the tenure of the authors. Results and implications of these studies are presented.


Here comes NMR.

Here comes NMR.


Loss prevention: a systems approach.

Loss prevention: a systems approach.


Review committee helps keep everyone happy.


An ethylene oxide action plan that works.


Matching talents to problems.

Matching talents to problems. Which type of manager are you--the superstar, the visionary, the traditionalist, the catalyst, or old reliable? There are as many useful managerial skills, abilities, and approaches as there are managers. By carefully analyzing the problems at hand in your organization and assigning employees with particular management talents to correct the problems for which they are best suited, your organization can be strengthened. The author identifies several of the talent areas most important to good management, and matches talents to specific problems.


Application of management engineering techniques. Management engineering techniques have proven to be beneficial tools in the analysis and improvement of a medical organization's productive resources. Though used more extensively in the hospital setting, the techniques can be applied to medical groups as a means to furthering the quality of patient care while improving the utilization of resources. An overview of the concept of management engineering is presented through the definition of basic techniques and the illustration of projects employing these methods in the medical group practice setting.


Careful planning reduces patient falls, lowers liability risks.


Safety in hospitals assumes major management role.


Prudent waste management.

Prudent waste management.


New employees are safety oriented.

New employees are safety oriented.


Law guards M.D.'s privacy, but gives board access to psychiatric records.


Grand Prix in the backyard.

Grand Prix in the backyard.


Round 2: AHSC jabs at antitrust charges.


Sexual harassment hurts productivity.

Sexual harassment hurts productivity.


Tax-exempt bond rules put off investors.


FTC, multihospital chains face off on antitrust impact of acquisitions.


Standard design saves money, time needed to build a satellite hospital.


The Midwest: for-profits' new frontier.

The Midwest: for-profits' new frontier.


Risk management: beware of workshops' quick 'certification.'.


Risk management, 'healthy' hospital-insurers grapple with commercial firms.


Risk management: managers target broad quality assurance goal.


What does a home health agency really want from suppliers.


New purchasing group focuses on distributor needs.


Management information systems in the HMO environment. Realization of the unique potential of a health maintenance organization is dependent on the availability of adequate, accurate, and timely information. The particular data needed are determined by the structure of the organization; the physician compensation plans; requirements for state, federal, or other reporting; and many other factors. The author introduces the concept and objectives of the HMO, and presents the management information systems necessary for planning and monitoring HMO performance: patient information, utilization information, and management information for the staff and nonstaff HMO.


Group buying in the '80s.

Group buying in the '80s.


Economics, politics curb bed expansion, encourage nursing home consolidation.


Nursing homes residents need safety, comfort in wheelchairs.


Fire officials disrupt area decubitus ulcer pad market.


Demand for tissue trauma products remains steady; emphasizes prevention.


Dilemmas of managing participation.

Dilemmas of managing participation. There are two reasons that current corporate efforts to achieve employee "participation" often seem fragile and temporary: unrealistic expectations about the appropriate use of participation and a failure to manage participation efforts for maximum success. Participation is most appropriate when, for example, expertise is diffused, issues are controversial, problems cut across existing roles, or the development of people is desired; autonomy and individual responsibility may be more appropriate under the opposite conditions. Kanter discusses six sets of dilemmas that must be resolved to ensure that participating teams work effectively for the organization: dilemmas around initiation, structure, issue choice, teamwork, links between teams and their environment, and evaluation/continuation. Kanter concludes that participation works best when it is well managed. Participation is best viewed not as a permanent "program" or a "formula" but as temporary episodes of high involvement alternating with a more routine everyday structure.


Organizational change techniques: their present, their future. To help carry out their responsibility of managing rapid and often unexpected change, managers have an available set of techniques: organizational behavior modification, management by objectives, management development, organization development, management auditing, and a control cycle of planning, implementation, and control. Each of these has a format that species the procedures to be followed to bring about organizational change. Michael emphasizes that such formats are preferable to a haphazard, trial-and-error approach that may produce unanticipated results. In part because some techniques are newer than others, data from a research project of planning and control that Michael conducted show different rates of usage by a sample of Fortune 500 companies. The control cycle is the most widely used; organizational behavior modification the least widely used. The use of these techniques of organizational change is likely to vary in some ways and experience may bring about changes in the techniques. Michael concludes that the newer breed of managers who are versed in the social sciences, mathematics, and the computer are likely to spread new techniques in the organizational world.


HIAA joins coalition in push to cure health care woes of umemployed.


Increased productivity & quality: you can have both!


OHMC: a new tool for success.

OHMC: a new tool for success.


Health care under scrutiny ... innovations needed.


Communications deregulation: making it work for you.


Emergency room accounts: using a customized approach to collections.


Coping: implications for health practitioners. Because coping plays an important role in sustaining individuals' overall functioning in illness, professionals need to become more skilled in maximizing its potential. The practitioner who takes the responsibility for assessing and strengthening clients; coping skills can lessen the negative impact of the illness. Although present theory on coping provides only initial guidance for this endeavor, a number of useful models and tool are available to study the coping process. Their introduction into clinical practice is strongly recommended.


Behavioral diagnosis: a practical approach to patient education. Patient education is receiving increasing interest from persons interested in improving adherence to regimens and in preventing disease. Yet a number of empirical studies have cast doubts on the notion that patient education actually can influence behavior. This article compares and contrasts two paradigms of patient education, one based on the teaching approach and the other based on a behavioral diagnosis. The behavioral diagnosis is the assessment of influences on the desired patient behavior. It includes consideration of individual, social, environmental, and medical regimen factors that may either impede or facilitate behavior. The process of performing a behavioral diagnosis is presented, and clinical experience using this approach is described.


Sources of support perceived by parents of children with cancer: implications for counselling. Providing social support for families of pediatric cancer patients remains a challenge. The perceived helpfulness of 11 potential support sources was assessed by 107 parents of children with cancer. They rated the spouse, the medical community, and parents from a mutual help group as the most helpful. Mental health professionals and the church were seen less frequently and perceived as less helpful. No significant differences were found in the patterns of social support among parents with children in different stages of treatment. More than half the parents responding to a question on what they needed most during their children's illness mentioned emotional support and counselling. Mental health professionals may find that crisis/supportive and educative models and frequent contact are useful counselling approaches in dealing with families of cancer patients. A team approach to pediatric oncological treatment, consisting of a primary physician, nurse, and psychological consultant, may be a way to optimize the early and flexible involvement of psychosocial staff in total care.


Development of effective teaching strategies on drug information for teenagers. A pilot study was carried out to compare two methods of teaching teenage girls about aspirin use. Both individual and group instruction were effective in increasing knowledge after the intervention. Individual instruction appeared to result in better retention of knowledge six weeks later, although the difference in test scores was not significant. The pilot study helped to identify deficiencies in research methods and instruments, which will be revised before we undertake a larger scale study.


Attitudes toward health in social networks: their influence on physician utilization. Many variables contribute to medical consumption. This study concentrates on those that can relate to health education, namely, (1) attitudes, beliefs, and behavioral intentions concerning health and medical care and (2) the influence of the patient's social network on medical consumption. Both complexes appear to influence the number of physician visits by three selected groups of patients. Emotional components are more influential than cognitive ones. Support from the social network appears to reinforce rather than replace professional help. The question is how health educators can adjust strategies to these findings.


Epilepsy self-help groups: collaboration with professionals. Two sequential cases of professional-self-help/mutual aid collaboration are described. The first was a federally funded demonstration project to develop epilepsy self-help groups in 15 cities. It involved a "mixed strategy" of national and local collaboration, where decision-making, and problem solving was vested in persons with epilepsy. The second related case was the "action learning workshop" that combined research with extension work. Knowledge about self-help group development and persons with epilepsy was advanced at the same time that a national network and alliance of epilepsy self-help groups was developed.


The role of a self-help clearinghouse.

The role of a self-help clearinghouse. As the number of self-help groups continues to proliferate, the formation of an umbrella body is suggested. A Self-Help Clearinghouse would serve as such an umbrella through the establishment of an information, referral and research service for mutual aid groups in an area. It would also be available to offer technical assistance to existing groups and assistance in the formation of new self-help groups. As a prevention service, it can be integrated into a comprehensive community mental health service system or operated under other auspices. In either case, it is a barometer of community stressors and offers great promise in strengthening social supports, coping skills, and competence provided by self-help groups.


Effects of a support group on the emotional impact of cesarean childbirth. Childbirth by cesarean, especially when unexpected, can be a source of acute emotional distress, stemming from unmet expectations for childbirth and the experience of major surgery, among other factors. Some women experience negative feelings months or years after the birth. A difficult cesarean birth experience has potential negative effects on a woman's relationship with her spouse or infant. Cesarean support groups play an important role in the prevention of emotional distress by facilitating the resolution of the birth experiences and allowing women to plan and prepare for more positive birth experiences in the future.


Helping people to help themselves: self-help and prevention--introduction.


The Parents' Auxiliary of Little People of America: a self-help model of social support for families of short-statured children. Average-sized parents of newborn and young dwarf children characteristically experience emotional distress growing out of a lack of knowledge about the practical and social problems their child will experience. The Parents' Auxiliary of Little People of America provides information and advise which enables parents to deal successfully with the medical and logistical problems of child rearing and their short-statured child's development. It further offers social and psychological support that legitimizes self-image for dwarfs and their families, and provides role models of happy, effectively functioning adult dwarfs and children who have made successful adaptations to the average-sized world around them.


Mutual-help groups: members' views of their benefits and of roles for professionals. Members of 18 self-help groups in Canada were surveyed as to the benefits of participation in mutual help groups and the roles for professionals in such groups. Three distinctions are made among mutual help groups: (1) those dealing with loss-transition (L-T), (2) those with members one step removed (OSR) from the problem, and (3) groups for stress, coping and support (SC&S). Members in OSR groups feel they benefit significantly more from participation than SC&S group members, while many L-T members feel they could get along well without the group if they had to. Members of SC&S groups tend to favor indirect involvement of professionals and see professional help and mutual help as complementary, more than do members of L-T and OSR groups. The traditional health care system is found to ignore the needs of L-T and OSR group members; mutual help thus provides a critical source of support and education for these people.


Preventive processes in self-help groups: Parents Anonymous.


Effects of participation in a self-help group for bereaved parents: compassionate friends. Results of a panel survey study on bereaved parents are reported. Member and non-member groups, reflecting increasing levels of involvement in Compassionate Friends, are compared for trends in changes in depression and personal growth. While no differences in depression were detected a linear trend was evidenced in personal growth. Those parents who were most involved in the group were more likely to maintain a sense of positive personal change over the one year time span of the study. Reasons for the specific impact of self help group involvement are discussed.


Self-help participation and quality of life: a study of the staff of Recovery, Inc. This report explores mental health outcomes reported by the self-help group leaders and administrators of Recovery, Inc.: The Association of Nervous and Former Mental Patients. Following Campbell (1976), both global and domain-specific quality of life indicators are used as measures of mental health. The contributions of the leader's income, health history, and Recovery career variables are also examined and the general findings are compared to a normative population. The data indicates that Recovery participation is associated with positive mental status reports, particularly in global self-ratings. Residual areas requirng supplementary human service intervention are specified.


Professional attitudes, awareness and use of self-help groups. The aim of this project was to contribute information on an important aspect of the self-help movement: the nature of its relationship with professional mental and physical health practitioners. Focusing on the professions of psychology, social work, psychiatry, medicine and nursing, the goal was to ascertain the degree to which these professionals were aware of selected self-help groups in Toronto, the extent to which they used them and their attitudes toward these self-help groups. Data obtained from 308 professionals indicated that they have some degree of familiarity with self-help groups in the community, are prepared to inform their clients about groups which may be helpful to them, are prepared to make referrals to such groups and hold favorable attitudes toward such groups.


Parents United of Oregon: a natural history of a self-help group for sexually abusive families.


Direct dialing for baby information: 572-BABY gets you helpful and free advice.


Hospital "800" number: toll free referrals widen the market.


First aid calendar: a band aid for image, services and donations.


Musical logos for radio: using audio to adjust an image.


Competitive hospital TV spots: see spots run.


Newsletter input form: inhouse journalism, self taught.


Image advertising: sensitive ad helps position a rehab hospital.


Benefits brochure: reminding employees about the virtues of working there.


Cardiac rehab booklet. Write it; use it; share it; sell it.


Health care center advertising.

Health care center advertising.


Advertise your physicians.

Advertise your physicians.


Consecutive giving club: a hospital development club encourages every-year participation.


Media push: how to gain credibility with the media.


Frequency analysis of commercially available vibrators. The tonic vibration reflex -- elicitation of a muscle contraction by mechanical vibration -- is a well documented physiological phenomenon of particular relevance to physiotherapy. Among the critical features pertaining to the effectiveness of its use in clinical practice are the mechanical attributes of the vibrator used to elicit the reflex. Because physiological responses differ with vibrations of varying frequency and amplitude, it is necessary to measure these characteristics before a commercial vibrator is used therapeutically: Facilities and equipment for performing such tests are, however, not readily available to physiotherapists. The purpose of this study, therefore, was to measure and compare frequencies of a variety of commercially available vibrators under varying load conditions and over time. Vibrators from major Canadian retail outlets and manufacturers were obtained and, through the use of both mechanical and optical methods, a total of 19 models were frequency-calibrated. The results of the study permit discussion related to the suitability and reliability of each model and provide specific guidance to physiotherapy departments in the selection of appropriate therapeutic vibrators. The results also indicate that the mode of application, such as strapping the apparatus to the patient rather than having the operator hold it in her hand, affects the frequency in some models. The data related to frequency measurements, gained through this study, should enable therapists to make more effective use of commercially available vibrators in motor reeducation.


A perspective on "Physiotherapy Canada": results of 1981 readership survey. A readership survey was undertaken in 1981 by the editorial board of PHYSIOTHERAPY CANADA in order to identify the readers, ascertain their preferences and obtain their evaluation of the present content of the Journal. A questionnaire and a pre-addressed, prepaid response-card were included in the regular mailing of the January/February 1981 issue of the Journal. Analysis of the resulting data produced both descriptive and inferential statistics. Of the 6478 targeted population (readers on the mailing list), 440 (6.8%) replied. The response rate of physiotherapists was 7.3%. Although the low response rate makes it difficult to generalize the results to the readership at large, some helpful information was obtained. The majority of the respondents (84.3%) were physiotherapists, involved in clinical work (75.5%). Eighty-two per cent had never published an article. Although PHYSIOTHERAPY CANADA was the sole journal consulted by 29.7% of respondents, another 50.4% did consult from one to three additional journals. A clear preference for clinical articles was expressed. The low rate of publication claimed by respondents, however, and their predilection for using the Journal as a source of information rather than as a vehicle for disseminating reports of their own work, makes it difficult for the Journal to comply with their request.


Annual report survey.

Annual report survey.


Multi-lingual dental department: interpreter sorts things out for foreign patients.


Hospital tour: tips on scheduling and post tour surveys.


An all-purpose exhibit booth for recruiting and promoting at conventions.


Promotional city map: putting your hospital on the map as a community service.


Good health club for kids: extending wellness to children.


An HMO magazine: a "modest" magazine that gets 80% readership.


Opening a hospital satellite emergicenter: planning and promotion produce 3000 visitors!


Hospital winter olympics: morale was the moral.


Managing your risk control program.

Managing your risk control program.


Control of waste gas anesthetics.

Control of waste gas anesthetics.


Health factors relationship to accident rates.


The tension among multiple objectives in health administration education.


Report of the board of directors: Association of University Programs in Health Administration.


Report of the president: Association of University Programs in Health Administration.


Research policy statement of the AUPHA Board of Directors.


Health services administration education 1980-81: a report of AUPHA membrane graduate and baccalaureate programs and faculties.


A radiology department's response to consumer concerns regarding the hazards of low-dose radiation.


Thinking about the future.

Thinking about the future.


Improving public relations in the housekeeping department.


Radiology management: some thoughts for the future.


1981 AHRA clerical productivity survey.

1981 AHRA clerical productivity survey.


AHRA: the first ten years.

AHRA: the first ten years.


Carpet selection, installation and maintenance in hospitals and health care facilities.


Brain death.

Brain death.


Legal forum: Abstracts of recent malpractice cases in radiology.


Containment programs can brake steamrolling health care costs.


The control function of management.

The control function of management. The control function of management can be a critical determinant of organizational success. Most authors discuss control only through feedback and adjustment processes. This article takes a broader perspective on control and discusses the following questions: What is good control? Why are controls needed? How can good control be achieved? If multiple control strategies are feasible, how should the choice among them be made?


Strategic piggybacking--a self-subsidization strategy for nonprofit institutions. Nonprofit institutions often find that their socially worthwhile primary missions generate deficits. The author proposes a strategy for funding these shortfalls that is a synthesis of the specialization and diversified portfolio strategies. Following the method of strategic piggybacking, an organization should acquire or develop a business that is new for the institution and that may be unrelated to the institution's primary mission. The purpose of this new activity is to subsidize, at least in part, the deficit-producing primary mission.


A note on recent trends in the infant mortality-socioeconomic status relationship.


An analysis of the physician's professional liability for radiation of the fetus.


Further evidence on education and job satisfaction. Regression analysis of data from recent U.S. national surveys was used to estimate, for white men and women separately, the total effect of amount of education on job satisfaction and the effect net of extrinsic rewards (money, prestige, authority, and autonomy). We reasoned that education which does not lead to extrinsic rewards would lead to dissatisfaction with work by producing unfulfilled expectations and aspirations, and thus we hypothesized that the estimated effect of education on job satisfaction net of extrinsic rewards would be negative. The hypothesis was not supported for women and was only weakly supported for men, and thus the findings of this study do not suggest that any increase in overeducated workers will have a major negative impact on job satisfaction., The indicated total effect of education is positive for both sexes but is considerably stronger for women than for men.


Hospital linen rental: a logical development.


Re: "Low temperature washing for hospital linen.".


A stylish shift: nurses surveyed in 1971 and 1980 indicate that uniform styling has become more important.


Textile rental increases hospital sales.


Some recreation preferences of the mentally retarded.


Sources of resistance to computer technology in health care.


Concurrent quality assurance using a medical information system.


Louisiana hospital performs new balloon insertion procedure: unique balloon catheter improves heart procedure.


Richland Memorial Hospital is offering a new procedure for early diagnosis of breast cancer using...sonar technology.


The Criterion Referenced Performance Appraisal System can add to the effectiveness of the hospital and...improve quality of care.


The computer challenge: a personal and professional response.


Automated record tracking as a component of a management information system.


The process of planning an in-house computer system.


Marketing and its reliance on data--a new approach for hospital survival.


Networking: forming collectives to ensure survival and flexibility. Networking--the presence in one multihospital system of two or more types of interhospital relationships--offers freestanding not-for-profit hospitals the ability to form collectives that ensure organizational survival and managerial flexibility while safeguarding institutional autonomy. A prototype of an emerging health care network is Health West Foundation, a not-for-profit holding company that provides health care services through a network of affiliated components.


Requiring physicians to complete medical records.


The case for selling the county hospital.


Financial panel predicts long-term difficulties.


The medical information system: an administrative planning and marketing tool.


Is the decision to merge really a question of access to capital? Institutional mergers are not a panacea for hospitals with financial or operating problems, and the apparent advantage of multihospital systems does not lie in their access to capital and human resources. The critical disadvantage of independent hospitals may be the result of attitudes held by governing boards. This article suggests that boards adopt new business tenets, especially regarding accountability, risk, pricing, competition, regulation, innovation, resource management, and purpose.


How to stay out of court: tips to trustees from a lawyer.


When the only certainty is uncertainty.

When the only certainty is uncertainty.


Is deregulation likely to affect hospital design and construction? Is the deregulatory thrust of this administration having an effect on hospital design and construction? does it threaten to create an expansion and construction free-for-all in the industry? A number of architects and construction industry professionals comment on what effect, if any, they expect deregulation to have on health care construction, as well as the expected effect of financing and management in an increasingly competitive environment.


Saving on design doesn't save money, life-cycle costing studies show. Design and energy management decisions significantly affect both initial construction and ongoing operation costs. Because of their importance, they are examined in this article, which also provides some general background concerning construction project development and typical fees expected by architect/engineers and construction managers.


Corporate restructuring: walk before you run.


Straight talk about accountability, or, are you sure no one's listening?


Cooperation or conflict: the changing physician-hospital relationship.


Hospitals and economic perspectives: alternative care and treatment sources.


The Aga Khan hospitals and health services.


Design as a marketing tool: cater to your clients. competing successfully in the market and functioning efficiently often depend on a reassessment of the environment. Accordingly, upgraded convenience, comfort, and atmosphere have become major marketing mechanisms for hospitals. This article presents several examples of how hospitals have used design to provide marketing advantages.


The emerging role of hospitals for health care in India.


The relevance of primary health care for industrialized countries.


Health care in Hungary.

Health care in Hungary.


The relationship between primary health care in villages and hospitals.


Integrated health services in Hungary.

Integrated health services in Hungary.


The doctor-patient relationship: past, present and future subjunctive.


Aga Khan Foundation/WHO/CIDA Conference in Karachi, 1981. The role of hospitals in primary health care.


Nutrition counseling and ethnic diets.

Nutrition counseling and ethnic diets.


Input uncertainty and organizational coordination in hospital emergency units. The relationships among input uncertainty, means of coordination, and criteria of the organizational effectiveness of hospital emergency units were explored using data from 30 emergency units in six midwestern states. Input uncertainty generally was not associated with the use of various means of coordination. However, input uncertainty affected relationships between the means of coordination and the effectiveness criteria. Specifically, programmed means of coordination made a greater contribution to organizational effectiveness under conditions of low uncertainty than under conditions of high uncertainty. Conversely, nonprogrammed means of coordination made a greater contribution to organizational effectiveness when uncertainty was high than when it was low. Findings were interpreted and suggestions were advanced as to how emergency units might best solve their coordination problems under varying conditions of uncertainty.


A laundry that must meet high volume demands.


Recovering dollars from waste water.

Recovering dollars from waste water.


Rx for cost containment: leasing.

Rx for cost containment: leasing.


Cancer registries: how much do they cost and contribute to cancer prevention?


Multi-disciplinary cancer clinics--cost considerations.


Cost considerations in the management of early breast cancer.


The cost of clinical trials in cancer.

The cost of clinical trials in cancer.


Domiciliary nursing service for cancer patients.


The role of a self-help group in working with parents of a stillborn baby. A stillborn baby represents a unique loss because parents must mourn fantasies of an anticipated newborn rather than memories of a shared experience. A self-help group can facilitate parents' mourning process following a stillbirth. With family-to-family contact and group discussions, the reality of the stillbirth is validated, the empty feelings of the loss the parents are experiencing are acknowledged, and the guilt the couples are feeling is eased. Reports from parents indicate that restoration of hope for the future and improved marital communication are the most beneficial aspects of their participation in the group. The phases of mourning described by Bowlby and Parkes have been observed in the group studied here as over time the parents resolved their loss and reoriented their lives.


The probable impact of federal budget cuts on emergency medical services.


When surgeons are liable for other physicians' acts.


The value of trauma centers.

The value of trauma centers.


Mislabeling and patient liability issues for pharmacists. The potential for running afoul of the law by mislabeling a drug product at the time of dispensing is substantial. By understanding the law in this area, pharmacists can take steps to comply fully with the law and yet meet the needs of the patients they serve. State boards of pharmacy should acknowledge that they have an educational as well as a regulatory function and endeavor to educate their licensees of the law in this area.


Power--an essential need for effective managers: Part II.


Legal significance of drug interactions. Adverse drug interactions have always been of concern to the physician and pharmacist. Recently such events have been used as the basis for malpractice suits involving health professionals. Pharmacists have both a professional duty to avert such interactions if possible and a legal duty to know their responsibilities in this area. Patient counseling, the maintenance of patient profiles, and familiarity with the drug interaction literature through continuing education opportunities can aid pharmacists in detecting or preventing adverse interactions, while familiarity with the liability laws can help pharmacists protect their practices.


Profile of a unique community-based clinical pharmacy family practice program. The provision of clinical pharmaceutical services in family practice offices has aroused considerable national interest among both pharmacists and physicians. Many of these clinical pharmaceutical services and educational programs have been university-funded and/or rely on colleges of pharmacy for fiscal support. Few examples of community-funded, ambulatory care clinical pharmaceutical programs have been reported. Community Health Care, Inc., and Davenport Medical Education Foundation, Inc., are two health care programs which sponsor an innovative ambulatory care clinical pharmacy program. Community Health Care is a nonprofit corporation which utilizes a multidisciplinary team concept to provide comprehensive ambulatory care services to patients. Davenport Medical Education Foundation is a nonprofit corporation that provides a community-based family practice residency program. Because the two separate parent organizations have distinct goals requiring individualized clinical pharmaceutical services, the responsibilities of the clinical pharmacist have evolved to be comprehensive in scope.


Clinical pharmacy in an emergency medicine setting. A decentralized emergency medicine clinical pharmacy program was initiated and has operated now for over 1 year. The program attempted to answer two questions: is there a viable clinical pharmacy role in emergency medicine, and could staff pharmacists successfully function in such a role without formal clinical training and experience? Initial primary objectives were to provide an on-the-spot pharmaceutical consultation service and to initiate new or expanded traditional pharmacy support to staff and patients. A secondary objective was to provide expanded outpatient prescription service to emergency room patients.


Evaluation of antihypertensive drug prescribing in a primary care clinic. Although the National High Blood Pressure Education Program has been in existence since the early 1970's, reported evaluation of drug prescribing for ambulatory, hypertensive patients for conformance with the stepped-care approach and approved drug labeling is lacking in the literature. To study this, charts of hypertensive patients from a primary care clinic were retrospectively reviewed against explicit treatment criteria. It was found that nearly all the antihypertensive drug prescribing was in accord with the criteria, with the exception of the scheduling of return visits to the clinic and monitoring. The community pharmacist's role in improving patient monitoring is discussed.


Decreased medication costs in a skilled nursing facility by clinical pharmacy services. After 1 month of monitoring the drug regimens of 25 randomly selected skilled nursing facility patients, clinically trained pharmacists were able to decrease the total number of medications from an average of 6.0 medications per patient to 4.2 medications per patient. Not only was the number of prescribed medications decreased, but also the total number of administered doses was decreased by 18.6%. The potential additive savings to the state of Washington through decreases in the number of state-funded medications, and to the skilled nursing facilities through decreases in nursing medication administration time, amount to $0.40 per patient per day or approximately $1.7 million annually.


Monitoring drug therapy: an applied approach. While it has been agreed that drug therapy monitoring in health care institutions is desirable and necessary, the pharmacists who carry out such programs must have a system that fills their special needs. Pharmaceutical Consultant Services, P.A. has developed a manual monitoring system to provide patient profiles for long-term care patients. This instruction guide explains the system and its application; pharmacists may wish to use this system or simply to learn from it.


Pharmaceutical services in a third-party system: an analysis. The pharmacy system of the U.S. Army Health Services Command (HSC) is presented as a model of a third-party governmentally operated pharmacy system. The system is analyzed for FY 1979 and compared with national averages for a similar time frame. Within HSC, the pharmacists to supported population ratio is 12:100,000, the pharmacist to technician ratio is 1:1.3, each outpatient pharmacy supports 54,041 people, each hospital supports 84,713 people, and the HSC pharmacy cost per beneficiary per year is $14.44. The average pharmacist's salary is $22,000 per year, and the average technician's salary is $13,000. When the resource commitment for pharmacy services by HSC is compared to national averages, HSC supports a given population with fewer pharmacists, less drug costs, and fewer pharmacy facilities. HSC also supports a given population with fewer beds and admissions than the national average. The salary per pharmacist is comparable for HSC and the national average; however, within HSC, technicians receive a larger salary than the national average. It is concluded that, for a given population, HSC commits fewer resources in support of pharmacy services than the national average.


Pharmaceutical services in long-term care facilities: a certificate approach to teaching skills. The University of Tennessee College of Pharmacy has developed a certificate program for Pharmaceutical Services in Long-Term Care Facilities. Pharmacists who are required to provide such services generally have had minimal experience in doing so. The certificate is composed of six home-study courses, a researched paper, and an on-site clerkship experience. Each pharmacist is evaluated for his or her mastery of the material at regular intervals. The program is designed to be completed in 6 months.


Prescriber, pharmacist, and patient interpretation of commonly used prescription directions. Prescriber, pharmacist, and patient interpretations of commonly used prescription directions were assessed. Results indicated that: 1) Attempts to make directions more time-specific without indicating actual hours for ingestion of the medication tends to lead to patient confusion and potential compliance problems; 2) Some prescribers do not understand the potential interpretation of their own directions; 3) Patients tend to base drug ingestion time on their lifestyles, and unless directions are actually time-specific (e.g., one at 8 a.m., 1 p.m., and 7.p.m.), compliance problems will probably continue; and 4) The prescribed and the pharmacist cannot assume understanding on the part of the patient for nonspecific directions. They must not only reinforce directions, but must also determine the patient's level of understanding, so that actual compliance with the directions intended has a chance for success.


The community pharmacist and health education. A behavioral-oriented approach to providing information to patients was examined. The goal of the approach was to produce behavioral change through health education. The pharmacist's role as a health educator was discussed, and patient education was distinguished from information dispensing. It was concluded that the preventive medicine concept makes the pharmacist's educational role important and requires communication and education skills to make that role viable. Pharmacy curricula and continuing education should address the need for such skills.


Hospital care in crisis: part 1.

Hospital care in crisis: part 1.


Pharmacy in the health care center: a model for health care delivery. Health care consumers use a plethora of services which are accessible on an ambulatory basis. These include the services of pharmacists, optometrists, nurses, dentists, audiologists, orthotics, and so forth. Since many of these services are provided in physically and financially separate facilities and often are not located in close proximity to one another, consumers may spend a large amount of time traveling between locations. Economic inefficiencies due to the size and dispersion of separate and independent facilities may produce an increase in the cost of ambulatory health care services. Thus, the concept of a health care center, an ambulatory health care analog to the multispecialty shopping center, is proposed as a potential alternative and improvement in the delivery of these services. Space, location, personnel, and initial capital requirements for a model health care center are projected based on existing data for the establishment of each separate auxiliary health care facility. Projections are made to determine the appropriate and necessary site for the health care center's trade area. Potential revenues are calculated by examining some pharmacy operations which are beginning to pioneer these areas and utilizing revenue figures for the various individual services. The results indicate that the pharmacy, as a frequently visited health care facility, may be an excellent choice around which to develop the health care center concept in metropolitan areas.


Power -- an essential need for effective managers: Part III.


Building a structured learning package.

Building a structured learning package. Pharmacists must become educators of patients and of pharmacy technical personnel. The literature cited in this paper has found that problems of patient compliance, personnel management, the high cost of medical care, and patient medical self-help may very well be solved in part through the application of competently written learning packages. One specific approach to learning package creation is illustrated in this paper, using the training of a unit-dose technician as an example. The subjects of student motivation, step-wise learning using subobjectives, learning feedback, material relevance, and student evaluation are discussed. Higher-level cognitive skills and readability are briefly discussed and illustrated to focus the readers' attention on the more difficult aspects of building learning packages.


Experiences with the compliance clinic: assessment of the effect. A retrospective study was conducted to determine the clinical and financial impact of a pharmacy-based compliance clinic. Charts of patients referred by physicians to the clinic were reviewed. Data were collected during compliance clinic consultation and compared to pre-clinic data to determine if the pharmacists' services were of merit. During the 33-month study period, 25 patients were referred to the pharmacy. Fourteen (56 percent) of these patients were seen regularly by the pharmacist. Eleven of the 14 patients (79 percent) achieved greater than 80 percent compliance with their medication regimen. Six of the 14 (43 percent) demonstrated significant reductions in emergency room visits comparing pre- and post-clinic records. Eight patients (57 percent) exhibited reduced hospitalization. Aggregate cost savings resulting from these reductions totalled $43,314 for the study period. It is concluded that: physicians are willing to ask pharmacists to assist in managing compliance problems; compliance can be improved when treatment is tailored to patient need; improved compliance may not result in better therapeutic outcome; and cost savings resulting from those patients responding can exceed the costs of providing the service.


Community-oriented hospital pharmacy services.


Prenatal drugs: patient information and its source. Pregnant women consume numerous medications, some of which are potentially harmful to the fetus. It is especially important that these women are provided with information about these drugs. This study was undertaken, in part, to document the amount of information pregnant women have about the drugs they consume and the sources of their information. Study participants were 304 women selected at random from the postpartum inpatients at a teaching hospital. Mothers were interviewed to obtain drug exposure data and to determine what, if any, information they had about the drugs. The source of information for each drug consumed was also determined. Results show that pregnant women have little information for each drugs they consume. Mothers most often cited primary medical personnel (physicians and nurses) as sources of information about specific drugs. In contrast, only six patients cited the pharmacist as a source of information about specific drugs. However, patients ranked the pharmacist high as a source of general drug information. This report emphasizes the need for more drug information for pregnant women and highlights the role of the pharmacist in providing such information.


The clinical pharmacist as a member of the burn team. Pharmacists are becoming involved increasingly in a patient care. At the University of California, San Diego Medical Center, a pharmacist has become a member of the multidisciplinary burn team. Through participation in work rounds and team conferences, the pharmacist has had a considerable beneficial impact on drug therapy, drug dosing, monitoring adverse drug reactions, and total parenteral nutrition. Specific benefits to patient care that the pharmacist provides are discussed and also the benefits derived in using a burn unit as a clinical teaching rotation for pharmacy students. The pharmacist has found his association with the burn unit to be professionally rewarding and the attending surgeons and surgical house staff have found his input to be valuable. The authors encourage other burn units to enlist a pharmacist as part of their burn team.


Pharmacists' and physicians' responses to the South Carolina Product Selection Act of 1978. The "Drug Product Selection act of 1978" became effective in South Carolina on January 1, 1979. All written prescription forms must be printed with two signature lines. Under the line at the left, "DISPENSE AS WRITTEN" must be printed. Under the line at the right, "SUBSTITUTION PERMITTED" must be printed. In addition, the pharmacist must receive the patient's consent before substitution can occur. This study investigated the impact of the Act on physicians' prescribing habits and pharmacists' responses to drug product selection initially and 3 months after enactment. The data were analyzed according to the drugs prescribed, permitted substitutions, physicians' specialties, use of correct prescription blank, drug category, date, and drug actually dispensed. Physicians permitted substitution for 27.19 percent of all prescriptions written. There were 499 prescriptions out of 1,835 authorizing substitutions. A total of 127 of these drugs were for single-source items, as 162 were written for generic items. In the remaining 210 prescriptions for brand name items, pharmacists selected another brand only 24 percent of the time.


Refilling prescriptions and physician consent. Much has been written regarding physicians' prescribing behavior. However, a literature search revealed a dearth of information regarding physicians' refilling behavior. The purpose of this study was to explore how authorization is given to community pharmacists for refilling a prescription by telephone. A total of 30 physicians (general practitioners and internists) was systematically selected with a random start from the telephone directory of a large metropolitan city. A surveyor acting as a registered pharmacist from a fictitious pharmacy called and requested refill authorization from a prescriber using a simulated patient's name and prescription. Half of the 30 phone calls utilized a controlled substance as the drug in question, and the remaining half utilized a noncontrolled legend drug. All of the phone calls were made either during late afternoon or evening. The results of this study show that 48.3 percent of the physicians authorized refills. Positive refill authorization was given in 29 percent of the instances with the controlled drug and 66 percent of the instances with the noncontrolled legend drug. Only 27.6 percent of the physicians checked their records.


A survey of pharmacist group practice.

A survey of pharmacist group practice.


Use of the countersuit by pharmacists who have been groundlessly sued for malpractice. Attorneys for patients who have been injured by adverse reactions to drugs often name as defendants the prescribing physician, the drug manufacturer, and the pharmacist. In many jurisdictions neither the law of warranty nor the law of strict liability will support a cause of action against a pharmacist who has done nothing more than correctly dispense a drug which was correctly prescribed. If the lawsuit against the pharmacist can be shown to have been filed for no other reason than to coerce a nuisance settlement or just to be cautious, the pharmacist may have available a remedy in the form of a countersuit. Malicious prosecution is one cause of action which might be maintainable as a countersuit. The elements of the cause of action are: 1) the initiation of a lawsuit; 2) lack of probable cause; 3) malice; 4) termination in favor of the pharmacist; and 5) damages. Lack of probable cause and malice are interrelated and are the two most difficult elements to prove. Abuse of process is another possible cause of action. The elements are: 1) an illegal, improper, or perverted use of the process; 2) an ulterior motive or purpose; and 3) damages. Other causes of action which have been considered by attorneys for groundlessly sued health professionals are barratry, defamation, attorney negligence, prima facie tort, and violation of a disciplinary rule.


PPIs: community pharmacists' perceptions. In order to measure pharmacists' perceptions about the PPis for estrogen and oral contraceptives, questionnaires were distributed to a random sample of 105 community pharmacists in a large midwestern city. Seventy completed questionnaires were returned, producing a response rate of 67 percent. A slight majority of the responding pharmacists indicated that pharmacists should be responsible for distribution of these PPIs but that physicians should be responsible for determining whether a patient should receive a PPI. The pharmacists indicated that patient information should be verbally communicated and accompanied by a written summary sheet and that patients neither read nor understand these PPIs. Although limited in size and geographic area, this study suggests that retail pharmacists have doubts about the current PPI program mandated by the Food and Drug administration.


Role effectiveness of a pharmacist in the maintenance of patients with hypertension and congestive heart failure. This study was designed to measure the role effectiveness of pharmacists in the management of patients with hypertension and congestive heart failure. Based on therapy protocols established by physicians and pharmacists prior to the study, the pharmacist was measured against the standard for providing primary care--i.e., the physician. The study showed that the pharmacist competently elected drug therapy and identified adverse drug reactions. As a group, the 20 study patients, whose therapy was determined by the pharmacist, were better managed than the 20 control patients (p less than 0.05). It is suggested that the pharmacist is effective in the role of managing patients with hypertension and congestive heart failure.


Inadequately written prescriptions: prescriber rationales for "take as needed" and "take as directed.". An audit of a large sample of prescriptions written by 39 physicians revealed considerable variation in the rate at which they specified adequate dosage instructions. When asked for their rationales for saying "Take as needed" or "Take as directed" on prescriptions, the physicians cited several circumstances where these instructions may be indicated. "Take as directed;; is defended 1) when the patient has a history of compliance with the regimen being prescribed; 2) when the prescription is accompanied by verbal or auxiliary written instructions; 3) when oral contraceptives are ordered; and 4) when the prescribers may need to make frequent changes in a regimen and wish to communicate these changes orally. "Take as needed" is defended when the drug is to be taken only when the patient determines that sufficient symptoms have appeared. Prescribers are cautioned to consider whether the assumed advantages of nonspecific dosage instructions are outweighed by the possible risks of patient confusion.


Patient behavior patterns regarding prescription refills. This study was conducted to examine the association between drug price, drug category, duration of coverage of the original prescription, units prescribed per day, and a patient's failure to obtain authorized refills of prescription medication. A two-stage sampling of pharmacies and prescriptions yielded a total sample of 1,058 prescriptions. The Drug Possession Ratio (DPR), defined as the ratio of number of days of medication dispensed to number of days of medication prescribed, was significantly related to drug price and drug category (p less than 0.05). The highest DPR was associated with the most expensive medication. Tranquilizers, antidepressants, and sedative hypnotics exhibited high DPR, while antihistamines and decongestants exhibited low DPR.


A drug self-administration program: a behavioral approach to patient education. This study is an evaluation of an in-hospital patient education and drug self-administration program. The main goal of this patient education strategy was to increase appropriate drug use by patients after they were discharged from the hospital. Patients first learned about their medications from hospital staff, including pharmacists, and then gradually assumed the responsibility for self-administration of their drugs. Patients practices taking their medication while hospital staff monitored their actions, correcting inappropriate use and reinforcing correct use. Results showed that the program significantly increased both levels of drug knowledge and patient compliance when compared to a control group. An analysis of covariance revealed that improved compliance was attributable to both participation in the program and to the increase in drug knowledge. Patients were more satisfied with pharmacy services and perceived the pharmacist as being more knowledgeable about prescription drugs after interacting with pharmacists in this program. Analysis of patient locus of control revealed that internally oriented patients complied better after participating in the program than did externally oriented patients. In the control group, externally oriented patients complied better after receiving typical hospital care than did internally oriented patients. Thus, results imply that this behavioral approach benefited internally oriented patients.


Pharmacy Education in the twenty-first century. Forecasted social and economic changes are reviewed in light of their potential impact on pharmacy practice and education. A similar approach is taken to speculation on drug technology with the prediction of major advances in the understanding of drug action at the molecular level and, with it, a closing of the gap between molecular and clinical knowledge. The components of the health care and educational systems are envisioned as linked through communications technology, creating an on-going information flow that develops and continues the competencies of the providers while optimizing conditions for patient care.


Legal aspects of clinical pharmacy practice. Recent trends in pharmacy have emphasized the concept of a more clinical professional role and a new level of skilled practice for pharmacists. These new roles and responsibilities create a number of legal questions concerning the clinical activities pharmacists can legally perform, and the liabilities pharmacists must bear in the performance or negligence of these duties. The law is not completely clear on all aspects of clinical pharmacy practice. This paper explores the legal basis of certain specific functions performed by pharmacists, and the inherent liabilities involved in the performance of these functions.


Compensation for consultant pharmacy services to long-term care facilities. Little has appeared in the professional pharmacy literature on the subject of compensation for consultant pharmacy services in the long-term care facility. The objective of this paper was to provide an historical review of this issue and to provide a potential methodology for determining the costs to the consultant of providing the comprehensive services as delineated in federal and state regulations. It is hoped that this methodology will become a standard mechanism for states to determine the costs of provision of the required services. The presented methodology indicates that in the region used as an example (central Connecticut), cost of providing comprehensive pharmacy consulting services are ten cents ($0.10) per patient/day.


The patient's rights to noncompliance.

The patient's rights to noncompliance.


Analysis of the use and potential use of the pharmacist in preventive health services.


California court imposes hospital liability for negligent acts of its independent staff physicians; reflects developing trend in malpractice cases.


Fifth Circuit finds exclusive contract for anesthesia services violates antitrust laws.


Regulation Z revised effective Oct. 1, 1982: hospitals should review applicability to credit practices.


Home health care and rapid rehospitalization. Early release from the hospital of the elderly ill patient may lead to failure of the home care plan and rapid rehospitalization. Review of 330 consecutive admissions to a large urban home health agency in 1980 revealed that 43 patients (13%) were rehospitalized within 2 weeks of admission. This high risk patient population is contrasted with the average home care population in terms of living arrangements, ambulatory status, primary diagnosis, age, sex, medications, etc. Home care was probably the appropriate long-term placement if better coordination between discharge planners, PSROs, physicians and home care staff could have been established with the extension of the hospital stay by 1-2 days and/or the provision of more intensive supportive care in the home at the time of admission to the home care agency. Simple guidelines for medical/social discharge planning to provide safer transfer of ill elderly patients from hospital to home are listed.


Home health agencies in the 1980s.

Home health agencies in the 1980s. This article presents a review of issues in home health, including a discussion of current political philosophy and its impact on home care, an identification of problems and barriers in the home health field, and some approaches to resolve these difficulties. Among the issues explored are the administrative structure and financing of home health agencies; manpower considerations, with particular attention to the role of nursing; business practices, productivity and the industry's image, and finally, the relationship between long-term services and acute care.


Beware! There are risks associated with a total information system.


Chronic illness and staff burnout: revised expectation for change in the supportive-care model.


Arkansas statute mandates equal insurance coverage for outpatient psychiatric centers.


The collaborative model in transitioning patients from the hospital to day treatment.


California recommends stiffer EtO standard.


ECHO and the challenge of today.

ECHO and the challenge of today.


Focus: Japan. Interview by Karen M. Richards.


Department of Defense to the aid of the consumer.


The case of the disappearing scrub suits.


Managing information ... not data.

Managing information ... not data.


Systems approach to forms management recommended.


Mixed feelings on need for forms management programs.


Commodity coding, Part III.

Commodity coding, Part III.


Current issues in health policy making for the Government of British Columbia. A collection of occasional papers--U.B.C. Health Policy Study Group.


New PO form speeds orders.

New PO form speeds orders.


The application of two-way interactive television to the health care field: an administrative perspective.


The incompetent patient's right to die: who decides and how?


Beware the recent reimbursement changes.


Conflict or partnership? Matherlee looks at physicians and hospitals. Interview by Emily Friedman.


Emerging technologies spur equipment, design changes.


When physicians meet the press.

When physicians meet the press. Disasters involving multiple casualties or the injury or illness of a prominent person can push the hospital into the public relations spotlight. How the physician who is cast into the role of spokesman responds to the press can have significant ramifications for the hospital, the patient, and the public as well.


Management improvements outpace clinical innovations.


Devices boost accuracy, cut costs.

Devices boost accuracy, cut costs.


$1.2 million CT scanner boasts better images and gaster scans.


'Generic' requests for proposals spur competition, lower prices.


Planning NMR scanner suite attracts problems of housing powerful magnet.


More attention to managing with less.

More attention to managing with less.


Designers make room for digital units.

Designers make room for digital units.


NY court boosts non-branded care.

NY court boosts non-branded care.


Hospitals milk HEFR for low interest rates.


FTC wants to supervise hospital buys.

FTC wants to supervise hospital buys.


I.V. prices will rise as competitors drop out of market, analyst warns.


National firms plan dozens of alternative care unit.


Deficits spur ambulatory care reform.

Deficits spur ambulatory care reform.


Jobless rate pares hospital census.

Jobless rate pares hospital census.


Industry to feel squeeze of tightened tax rules.


Hospital PACs ring up more clout.

Hospital PACs ring up more clout.


Nonprofit networks link resources to grab piece of national markets.


System sets sights on regional frontier.


Risk managers take on role in hospital buy-outs.


AHA restates support for diploma schools.


Des Moines advertising campaign escalates hospitals' competition.


Hospital reimbursement and utilization incentives: a Maryland experiment.


Admitting physicians and returns to scale in the production of hospital service.


Physicians' work patterns under alternative methods of reimbursement.


The periodic survey of physicians: design and methodology.


Patterns in geographic location of physicians: 1968-1976.


The malpractice problem and its effects on medical practice.


Team development, Part 7: Its role at the workplace. In this windup of his series on team development (TD), Francis X. Mahoney, personnel development advisor for Exxon Company, U.S.A., sums up TD's advantages, shows how it can be used to meet organizational objectives, and indicates other ways of applying TD methods. Mahoney maintains that TD is truly "organization development (OD) at the front line" because they share the same objectives. For example, employee involvement and encouragement of initiative are OD goals and, as we have seen, TD gets people involved and encourages even those at the lowest level of the organization to contribute ideas and work together to solve work problems and implement the solutions. Mahoney hopes that this series will encourage internal and external OD experts to apply OD at levels not normally reached during regular assignments. TD activities can provide the basis for continuing activities between or after consultants' visits and after training programs. It can become a tool, particularly for first-time supervisors and middle managers, to improve productivity and teamwork. That, in essence, is what this series is all about--getting people to work together productively, effectively, and cohesively.


Strategies for organizational change: the role of the inside change agent. An awareness of the advantages and disadvantages of internal positioning becomes the foundation on which the internal change agent builds an effective action plan for change--a plan that matches the specifics of the organizational situation being confronted. Basic principles have been described here to help define the specific type of role that the integral change agent should take, and to increase the chances for a successful change. As a change agent, you also need to develop specific change strategies that fit your unique characteristics and circumstances. Then, through the ways you communicate and the ways in which you see human resources, interpersonal strategies for influencing others can increase your personal control over situations.


Relative changes in physicians' fees: evidence from the consumer price index.


Racial diversity in organizations and its implications for managements. In a productive organization, policies, programs, and job structures promote harmony in a racially diverse workforce and therefore utilize the talents and abilities of all its employees. But according to Ora D. Fant, vice-president and senior staff consultant with Goodmeasure, Inc., people of color are still often underutilized and isolated in the workplace, and this interferes with a true assessment of their contributions and value to the organization. Fant explains the dynamics behind such counterproductive treatment and offers both (1) organizationwide recommendations for effective workforce integration and (2) guidelines to help individual managers work more effectively with people of color.


Trends in physicians' incomes, expenses and fees: 1969-1976.


The physician-induced demand and target-income models: a survey of the issues.


Turnover benefits: the other side of the "costs" coin. High levels of turnover have traditionally been viewed by human resources managers as having a negative effect on the organization. But the authors--Idalene F. Kesner, associate instructor in business policy, and Dan R. Dalton, assistant professor of administrative and behavioral studies, both at the Graduate School of Business, Indiana University--maintain that responsible levels of employee turnover may have both direct and indirect benefits for the organization. Such benefits include displacement of poor performers, an infusion of new knowledge in the organization, and the stimulation of changes in policies and practices. In addition, of course, there are opportunities for cost reduction and consolidation. Using data compiled from the experience of a California public utility, the authors show how to calculate the direct, hard-dollar value of the savings that can be realized in regular pay, overtime pay, pension contributions, earned but unused sick leave, and other areas.


Planning a national health manpower policy: a critique and a strategy.


A disaggregated model of medical specialty choice.


Retention of medical school graduates: a case study of Michigan.


A model of physician location and pricing behavior.


Determinants of professional nurses' wages.


Nurse market policy simulations using an econometric model.


Health status maximization and manpower allocation.


Health promotion plays key role in hospital's plan to unlock nonpatient revenue-generating potential.


New developments in the market for rural health care.


Ethics: boards address issues beyond allocation of resources. Unprecedented advances in medical technology can save lives, but they also produce complex ethical questions for providers, patients, and government alike. What is the value of human life? When, if ever, is a life not worth saving? In which expensive technologies should limited resources be invested? These questions are reaching into the boardroom as trustees seek to shape institutional policy and help practitioners with the life and death decisions they face.


Hospitals tailor health promotion efforts to fit special needs of the elderly...


. . . And to capitalize on the concerns of adolescence.


Costs, capital, and planning dominate AHA convention platforms.


Wonder boards: how to build strong governing bodies 12 ways.


As I see it: Some spheres of influence have a direct effect on governing board actions.


Labor costs seen as culprit in rising hospital costs.


The erosion of the medical marketplace.

The erosion of the medical marketplace.


The demand for dental care services, by income and insurance status.


Physician pricing, costs, and income.

Physician pricing, costs, and income.


Incentive and organizational structure in health maintenance organizations.


Children's health and the family.

Children's health and the family.


The family's demand for health: evidence from a rural community.


Facility report: the University of Michigan respiratory therapy department.


The impact of computed tomography and ultrasonography on surgical practice.


Evaluating RT services by internal audit. The quality of services provided by respiratory therapists must be measured as part of a hospital's overall evaluation of patient care, as mandated by the Joint Commission on the Accreditation of Hospitals. An internal audit helps both the respiratory therapists and the attending physicians to know what kind of specific documentation is needed in the medical records to meet the desired standards. It also serves as a useful tool in identifying staff educational needs.


Operating surgeon's liability for the negligence of an assisting nurse.


Modern health-care technology: can we afford to use it?


Surgical application of lasers.

Surgical application of lasers.


Contact thermography: every picture tells a story.


The Tylenol scare: the death of seven people who took the drug triggers a nationwide alert--and a hunt for a madman.


Doctors, dairymen join in effort to clip the talons of the FTC.


Time running out on moves to ensure social security's financial solvency.


Welfare cheating--dealing with the problem and not with the image.


Doing what doctors do.

Doing what doctors do.


Sharing the wealth: the gap between rich and poor grows wider.


Mainframes in the hospital mainstream.

Mainframes in the hospital mainstream.


The five P's of CME: a structured approach to workshop management can maximize your meeting's productivity.


Federal labs come under scrutiny for their role in science research.


The selling of a hospital. Why increasing numbers of biomedical communicators will be working to promote hospital services with media presentations.


Firms hiking health plan deductibles: study.


Control Data Corp. subsidiary opens Chicago wellness center.


Government shares health cost hikes with workers.


Health care costs rise.

Health care costs rise.


Friendly feeling: United workers can get care at HMOs across the nation.


Absenteeism and benefits: days lost increase true health care costs.


Muriel Driver Memorial Lecture 1982.

Muriel Driver Memorial Lecture 1982.