bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiologic Evaluation of Renal Trauma: Part 1
Authors: Goodacre Brian , vanSonnenberg Eric
Published: January 2017

A variety of radiologic investigations exist for the evaluation of patients with suspected renal trauma. The decision to undertake a particular radiologic study should be based on the mechanism of injury (blunt versus penetrating), likelihood of associated intraperitoneal injury, age and stability of the patient, and presence of hematuria. Adult patients with blunt trauma who are hemodynamically stable and exhibit only microscopic hematuria typically do not require radiologic evaluation, while any stable patient with penetrating trauma to the flank region should undergo an imaging study regardless of the results of a urinalysis. The great majority of renal injuries are mild, consisting of contusions, small hematomas, and superficial lacerations. Deep lacerations, fractures, sizable hematomas or urinomas, and limited urinary extravasation all are more significant injuries for which computed tomography (CT) has proven to be useful in detection and therapeutic planning. Severe injuries such as traumatic renal artery occlusion, ureteropelvic junction (UPJ) disruption, and “shattered” kidney all mandate intervention either to salvage or remove the injured kidney. Radiologic techniques can be both diagnostic and therapeutic in many of these situations. Transcatheter embolization of bleeding vessels and percutaneous drainage of urinomas are examples of the definitive or adjunctive roles which interventional radiology has now assumed in many centers.
Donor Action: A Quality Assurance Program for Intensive Care Units That Increases Organ Donation
Authors: Wight Celia , Cohen Bernard , Roels Leo , Miranda Blanca
Published: January 2017

Donor Action (DA) is an international initiative that helps intensive care units (ICUs) improve donation. Existing best practices from around the world have been incorporated into this quality assurance program. Following a validated diagnostic review, areas of weakness in donation practices are identified and the appropriate changes introduced. Corrective measures have been developed in the form of five “core” program modules which correspond to critical steps in the donation process and can be used together or alone according to specific identified needs. Medical records review (MRR) and hospital attitude surveys (HAS) were performed in 11 ICUs in Spain (2), The Netherlands (2), the United Kingdom (1), and Canada (6). Baseline data were gathered on the units potential for donation, staff attitudes toward donation, and self-reported skills/confidence in performing a range of donation roles. Analysis of these data were used to customize the program to individual ICU requirements. MRR data from 579 cases showed a 69% (398) potential for donation from which only 31% (124) were realized. Detection and management failures (166; 42%) and refusal to donate (104; 26%) were the major reasons for loss of potential donors. The HAS returns from staff (2,129) showed consistently strong perceptions that organ donation saves lives (97%). Support for donation (94%) and willingness to donate their own organs (79%) were high in all country samples. Ratings of skills/confidence were highest for comforting the family (70%), with much lower comfort levels reported on explaining brain death (44%), introducing organ donation (38%), and presenting a family with the option for donation (31%). Following introduction of the appropriate program modules, a sustained (2–year) effect of a 33% increase in donation rates is demonstrated. The Donor Action HAS and MRR are useful tools in identifying problems within the donation process and lead to the introduction of improvement strategies integral to the Donor Action program that result in an increase in organ donation.
Propofol: Effects on the Central Nervous System
Authors: Tobias Joseph D.
Published: January 2017

Propofol remains a popular agent for providing intraoperative anesthesia as well as sedation during mechanical ventilation in the intensive care unit (ICU) setting. In addition to its sedative/anxiolytic properties, propofol has been shown to have several beneficial effects on central nervous system (CNS) parameters such as cerebral metabolic rate for oxygen, cerebral blood flow, and intracranial pressure. These properties have been demonstrated in both laboratory animals and in clinical investigations In humans. This article reviews the available literature concerning the effects of propofol on CNS dynamics and discusses its possible application as a therapeutic agent in patients with altered intracranial compliance and/or increased intracranial pressure.
The Use of Transpyloric Enteral Nutrition in the Critically Ill Child
Authors: Sánchez César , López-Herce Jesús , de Guerra María Moreno , Carrillo Angel , Moral Ramón , Sancho Luis
Published: January 2017

To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who received TEN in a pediatric intensive care unit (PICU) of a tertiary university hospital. The type of nutrition used, its duration, medication administered, tolerance, gastrointestinal complications (vomiting, abdominal distension or excessive gastric residue, diarrhea, and pulmonary aspiration), nongastrointestinal complications, and mortality were assessed. A comparative analysis was made between the first 2 years of the study and the remaining period. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 ± 32.3 days (range 1–240 days). Forty-one patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One hundred seventeen patients (77%) received sedation and 65 (43%) received muscle relaxants, presenting no extra complications. Twenty-four patients (15.8%) presented with gastrointestinal complications: abdominal distension and/or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal intolerance was associated with pulmonary infection ( p < 0.05), altered hepatic function ( p < 0.001), and hypokalemia or hypocalcemia ( p < 0.05). Diarrhea was more frequent in patients with shock ( p < 0.05), altered hepatic function ( p < 0.05), excessive gastric residue ( p < 0.001), and hypokalemia or hypocalcemia ( p < 0.05). In the second study period, the number of patients on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher ( p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically ill child.
Use of Muscle Relaxants in the Intensive Care Unit
Authors: O'Connor Michael F. , Roizen Michael F.
Published: January 2017

Muscle relaxants are now routinely used in intensive care units despite the relative paucity of literature regarding their use, safety, and efficacy in this setting. Although the theory of the pharmacology of muscle relaxants is simple, many clinicians involved in critical care receive little or no formal education about their use either in medical school or during postgraduate training. Proper dosing, careful monitoring, awareness of possible side effects, and adequate sedation facilitate safe use of muscle relaxants in the intensive care unit. Muscle relaxants are not, however, a substitute for sedatives, hypnotics, amnesties, or analgesics and should rarely, if ever, be used without appropriate sedation and analgesia. A wide variety of agents now available with substantial differences in dosing, pharmacology, and side-effect profiles makes clearly delineated indications for use and end points for discontinuation necessary. Using muscle relaxants without monitoring is like using antiarrhythmics without an electrocardiograph.
Pharmacological Management of Labor
Authors: Jennings Jenifer C.
Published: January 2017

Normal spontaneous labor at term without maternal or fetal complications does not always occur. In these situations, pharmacological intervention is often the safest and most suitable method of delivery. The pharmacological management of labor includes the use of multiple agents that alter cervical dilatation and uterine contractions, resulting in delivery of the fetus and treatment of postpartum emergencies. This article provides a description of normal and abnormal labor patterns and possible peripartum complications. The use of oxytocin, ergot derivatives, and prostaglandins for augmentation of dysfunctional labor, induction of labor, and management of peripartum emergencies is discussed to provide information on availability of product, indications for use, clinical efficacy, potential adverse effects, and contraindications to use.
Status Epilepticus
Authors: Schroeder Donna J. , Alldredge Brian K.
Published: January 2017

Status epilepticus is a medical emergency that requires prompt intervention with effective anticonvulsant drug therapy to minimize the risk of morbidity and mortality. Although status epilepticus can occur as the first presentation of seizures, it is more common in patients who have a history of epilepsy. Metabolic disturbances, stroke, infection, and head trauma can also precipitate repetitive or continuous seizures and, if possible, the underlying etiology should be corrected as the first step in effective management. Permanent neurological sequelae are more likely as the duration of status epilepticus exceeds 90 minutes. In this regard, it is essential that anticonvulsant drug therapy is initiated as soon as possible. Benzodiazepines (diazepam, Iorazepam) are commonly used as the agents of choice for early termination of status epilepticus. Phenytoin and phenobarbital are also useful because of their long-lasting anticonvulsant effects. Other agents that may be useful under special circumstances include midazolam, fosphenytoin (phenytoin prodrug), sodium valproate, paraldehyde, and high-dose barbiturates.
Pharmacist Involvement in a Seizure Clinic
Authors: Hixson-Wallace Julie A. , Barham Beth , Miyahara Randell K. , Epstein Charles M.
Published: January 2017

The role of the clinical pharmacist in ambulatory care settings has expanded in the last several years. Various types of clinical pharmacy services in ambulatory clinics have been reported in the literature. This article seeks to describe the involvement of clinical pharmacists as primary-care givers in an outpatient neurology-seizure clinic of the Veterans Affairs Medical Center in Atlanta, GA. The Neurology-Seizure clinical pharmacy services are provided by faculty, residents, and students from Mercer University Southern School of Pharmacy. The faculty members have been granted clinical privileges to practice in the ambulatory clinics in order to function with authority to perform such duties as giving medication renewals, and writing in the medical chart. In the clinic itself, the pharmacist is responsible for providing a medication profile, an initial interview with the patient, a minor neurological examination, presentation of the patient to the attending neurologist, writing of a SOAP (subjective, objective, assessment and plan) note, an end-of-appointment consultation, completion of a clinic flow sheet, maintenance of the clinic record, follow-up phone calls relating the results of anti-epileptic drug levels, and monthly quality assurance summaries. Clinical pharmacist-supervised primary care outpatient clinics can be rewarding endeavors. Through close patient contact and interaction with attending physicians, pharmacists can greatly assist with pharmaceutical care and provide expert drug management of seizure patients.
Neuromuscular Blocking Agents
Authors: Donnelly Andrew J.
Published: January 2017

Neuromuscular blocking (NMB) agents are frequently used in the operating room (OR) as well as the intensive care units. The number of NMB agents available for use in these areas continues to increase. The clinician currently has 10 agents from which to choose, with another (rocuronium) soon to be available. NMB agents are classified as either depolarizing or nondepolarizing. Succinylcholine is the only depolarizing agent in clinical use today. It has the fastest onset of action of all NMB agents, but also the most adverse effects. The nondepolarizing agents as a group can be further differentiated by several characteristics: duration of action, cardiovascular effects, routes of metabolism/excretion, and cost. This allows an agent to be chosen based on patient parameters. Acetylcholinesterase inhibitors can be used to reverse residual neuromuscular blockade. The introduction of agents such as mivacurium, with a short duration of action, may reduce the need for acetylcholinesterase inhibitors; instead, neuromuscular function can be allowed to recover spontaneously. Finally, several factors must be considered when determining whether to add an agent to formulary: surgical case mix, patient acuity, agents currently on formulary, and cost of the new agent compared with those already on formulary.
Low Osmolar Contrast Agents: Pharmacoeconomic and Medicolegal Issues Surrounding Their Use
Authors: Norenberg Jeffrey P. , Hladik William B
Published: January 2017

Most healthcare experts agree that there is a growing disparity between the availability of technology and society's ability to pay for it. Because consumerism in healthcare has become so intimidating to many practitioners, they are often compelled to provide the best, most highly advanced technologies available, regardless of their costs, to all patients. As one study notes, “technological advance is the dominant factor in the upward spiral in healthcare costs.” There is general agreement that some controls must be placed on our healthcare expenditures as evidenced by the call for “healthcare reform.” In this article, one group of pharmaceuticals used in diagnostic imaging, low osmolar contrast media (LOCM), and their impact on healthcare are considered. These relatively new radiopaque contrast agents are equally effective for diagnosis and apparently somewhat safer than the traditional high osmolar contrast media (HOCM). One striking difference between the two categories of contrast agents is that the LOCM cost approximately 15 to 25 times that of the HOCM. This example provides an excellent illustration of the concerns related to cost and benefit in healthcare, and raises many medical, legal, economic, and public policy questions that are addressed in this article.
The Use of Monoclonal Antibodies for Radioscintigraphic Detection of Cancer
Authors: Harwood Steven J. , Abdel-Nabi Hani
Published: January 2017

Beginning with Ehrlich's original “magic bullet” concept of 1904, the pioneering human trials in the late 1970s of Goldenberg and Mach using polyclonal antibodies, and the Nobel Prize-winning work of Kohler and Milstein in 1975 for developing monoclonal antibody (MAb) technology, there has been much interest in the use of antibodies for detecting and treating cancer. Although not the revolutionary breakthrough that was initially hoped for, marked progress has been made. The Food and Drug Administration (FDA) has recently approved the intact murine IgG, 111-indium CYT-103 (satumomoab, Oncoscint™ Cytogen, Princeton, NJ) for clinical use in detecting colorectal and ovarian cancer. However, the agent has been approved for only a single, one-time use, because patients developed an immune response (human anti-mouse antibody, or HAMA) that alters MAb biodistribution and may limit the clinical effectiveness of this agent when repeat studies are performed. Other MAbs reacting with a variety of antigens and targeting numerous tumors, including breast, lung, prostate, and melanomas, are currently undergoing large-scale clinical trials. To reduce induction of immune responses, many of the agents use immunoglobulin fragments [Fab, or F(ab)2] labeled with the short-lived isotope 99m-technetium used for most routine nuclear medicine diagnostic testing. Future developments will use even smaller fragments such as single chain antibodies or custom synthesized molecular recognition units (small peptides containing only the specific antigen combining site). Presented herein is an overview of the past results and an assessment of the current status of radioimmunoscintigraphy for various neoplasms.
Positron Emission Tomography: Clinical Applications and Pharmaceutical Care
Authors: Hammes Richard J. , Babich John W.
Published: January 2017

Positron emission tomography {PET) is a nuclear medicine imaging technique which exploits the unique physical characteristics of radionuclides that decay by positron emission. These characteristics allow for in vivo quantitative measurement of three-dimensional distributions of radioactivity with a spatial resolution of 5 mm using current detector technology. In addition to these physical advantages, PET is the only imaging technique that can use the short-lived positron emitting radionuclides of the so-called “organic” elements: carbon (C-11), nitrogen (N-13), and oxygen (0–15). These elements are the building blocks of physiological compounds and can be used to study most enzymes, receptors, and other metabolically important compounds and their associated reactions. PET allows for the study of a variety of physiological and biochemical processes through the application of particular radiopharmaceuticals. PET has also been used to study the interaction of receptor-specific ligands in several receptor systems including dopaminergic, adrenergic, serotinergic, and opiod. C-11 and F-18 labeled receptor ligands have been used to study receptor selectivity and receptor concentrations in vivo. Recently, PET has been used to measure the pharmacokinetics of several novel antibiotics in humans allowing the direct measurement of tissue concentrations and correlation with classical pharmacokinetic parameters. This review discusses some of the current applications of PET in more detail.
Reimbursement for Cognitive Services: The Community Pharmacist's Role
Authors: Memoli Gene A.
Published: January 2017

Pharmacists of the 1990s must anticipate a continued decline in their distributive role and a continuing expansion in their nondistributive role. The Pharmaceutical Care model will lead to the further development and expansion of nondistributive services that are knowledge-based. Cognitive Services, the pharmacy service model center to the Pharmaceutical Care model, will become more important to the practice. Now that many pharmacists have implemented Cognitive Services and are receiving reimbursement for these services, we will see continued growth. Many of our colleagues are receiving reimbursement for Cognitive Services on a regular basis both from the payors and the patient. The mechanisms (ie, written documentation, patient clearance, claim generation) are now presently documented and used in community pharmacy practice. The HCFA form 1500 is a standard form for submitting claims. The documentation and mechanisms required to achieve reimbursement for Cognitive Services are discussed in this article. Proper documentation of the need for care and the services (interventions) provided by the pharmacist are essential to achieving full reimbursement.
Pharmaceutical Care in the Home Care Setting: Focus on Total Parenteral Nutrition
Authors: Wright Brenda
Published: January 2017

Cognitive services provided by the pharmacist have played a critical role in the successful development and implementation of home infusion services in the 1970s and 1980s. Pharmacists, working with the health care team that manages patients who receive infusion therapy in the home, used their clinical skills to support patients and other team members. They did this by evaluating patients before admission to the service, along with supporting the training, education, and monitoring of the patients receiving infusion therapy in the home. These services were provided on an ongoing basis.
Integrating Home Health Care into Managed Care: Getting the Physician Involved
Authors: Kupka Nancy J. , Trubitt Mitchell J. , Goldberg Allen I.
Published: January 2017

The importance of developing a partnership to establish a health system that will improve the health of individuals in the home, and in the community, is presented from three perspectives: payer, home health care provider, and physician. From all perspectives, physician involvement is necessary for the success of home health care. Strategies to increase physicians' involvement include physician education and enhanced reimbursement, key components to improving their use of home health care services. These two factors were not adequately addressed in the past and must be the focus for the future. However, bringing the partnership of payer, provider, and physician to a reality is not the sole responsibility of just one group. Rather, all participants working together within the system are responsible for the evolution of a new and better health system. Technology will also impact the future practice of medicine and home health care, and will allow providers and patients to have better access to each other. Improved access will ultimately result in increased satisfaction and better outcomes for patients.
Expanding the Concept of Empowerment
Authors: Huddleston Donna , Alexander Rinda
Published: January 2017

In home health care, quality leadership empowers employees to provide high standards of care to meet client/patient satisfaction. These standards of care require performance evaluations based on job descriptions and what constitutes a “good job.” The cluster evaluation ranking procedure meets these requirements. For groups of employees with the same job description, the cluster evaluation information is useful for continuous quality improvement in the area of human resources.
Theoretical Perspectives on Consciousness, Energy and Healing
Authors: Martin Leonide L.
Published: January 2017

Perspectives on consciousness and energy in the theoretical models of Rogers and Newman are explored and related to philosophies of evolutionary idealists and Eastern metaphysicians. Parallels are drawn to the views of some quantum physicists concerning the nature of reality. The levels, characteristics and evolution of consciousness are examined from these perspectives. The expression of consciousness through energy fields, as postulated by Rogers, Newman and Eastern philosophies is described, with some suggestedapplications to nursing care, health and healing.
Cultural Aspects of Caring for Mexican-American Clients
Authors: Plawecki Henry M. , Plawecki Judith A.
Published: January 2017

Cultural factors greatly influence the Mexican-American individual's perception of health, illness and acceptable care regimens. Population projections indicate that Hispanics, a majority of which are Mexican–Americans, will become the largest minority group in the United States. Family structure, health/illness beliefs and traditional health practices can affect the client's acceptance and compliance with prescribed health care regimens. Mexican-Americans will be influenced by cultural sensitivity, access and costs when choosing a health care provider. Nurses need to understand and recognize the importance of providing culturally appropriate care to a rapidly increasing Mexican-American population.
The Endogenous Healing Process in Black Women
Authors: Hibdon Sharon L. Scandrett
Published: January 2017

Healing is a term utilized in health care; however, understanding of this inherent process has been minimal. Knowledge of the client's own process of healing is important to advance nursing science and to alter health care approaches used to enhance the client's own innate processes. The art of nursing has long utilized the concept of healing; now, the science of nursing needs to systematically identify recurring elements of healing. The purpose of this paper is to identify the existence and characteristics of an endogenous healing process.

Two qualitative strategies, audiotaped semistructured interviews and a daily health diary, were utilized to obtain information about the women's healing process. The sample consisted of forty–two southern Black adult women between the ages of 22 and 58. Thirty women were asymptomatic and twelve were symptomatic.

Taped interviews were transcribed and examined in a cross–comparative method. Results show that several aspects of the endogenous healing process emerged and achieved theoretical clarification: awareness, appraisal and alignment. Two additional concepts emerged which need further clarification.
A Validation of Instruments for Measuring Temperament and Attachment in a Mother-Child Dyad
Authors: Owsley Vicki B.
Published: January 2017

A mother and child are active partners in the development of a reciprocal system of reactions to form an attachment relationship. Facilitation of a healthy maternal–child relationship is a goal toward which pediatric nurses direct their interventions. Tb accurately assess the temperaments of both mothers and young children, and their attachment behaviors, reliable and valid measuring instruments are necessary.

The findings of this study support the need for further research on the construct validity of the NYLS Temperament and Attachment Q–set instruments. Factor analyses demonstrated the NYLS Young Adult Questionnaire to have seven subscales rather than thenine stipulated in the literature. Evidence of robust factors was not presented. Watersand Deane (1985) stipulated four criterion sorts for the Attachment Q–set. Four factors were interpreted with three of them congruent with the literature. There was evidence of the factors being robust. To further insure creditable construct validity studies, multiple samples from different populations need to be employed in future studies.
Indicator-Based Systems of Performance Management in the National Health Service: A Comparison of the Perceptions of Local- and National-Level Managers
Authors: Jones G. T.
Published: January 2017

Historically, the UK Government has policed the use of National Health Service (NHS) resources through the centralization of control. With the majority of resource-draining decisions being taken by clinicians, however, professional financial accountability is becoming more important within the NHS management structure. Variations in clinical performance can be monitored through the use of performance indicators, although these are not without their problems. The use of league tables of such indicators in the national press is now infamous and there is much anecdotal evidence about the intraorganizational conflict arising from the use of such tables. A questionnaire survey and interview study of clinical directors, clinical service directors and business managers in several Scottish NHS Trusts was undertaken to ascertain the perceptions of local-level managers on the issue of performance indicators. Interviews were also carried out with a number of personnel in the Scottish Office Department of Economics and Information, the Division of Health Gain and the Finance Directorate. This paper explores the differences between the perceptions of the managers at these two levels of the NHS with regards to issues of performance measurement, intraorganizational conflict and corporate vision.
Characteristics of Health Maintenance Organizations and Their Influence on Efficiency
Authors: Draper D. A. , Solti I. , Ozcan Y. A.
Published: January 2017

This study examines the efficiency of Health Maintenance Organizations (HMOs) based on a sample of 249 HMOs operating in the United States in 1995. Data Envelopment Analysis (DEA) was used to calculate the level of technical efficiency for each HMO included in the sample. Further descriptive analyses were conducted examining various structural and operational characteristics of HMOs and their impact on efficiency. Federal qualification status, Medicare programme participation, combined Medicare and Medicaid programmes participation, chain affiliation and size were found to be significant influences on HMO efficiency.
Linking Health Outcomes and Resource Efficiency for Hospitalized Patients: Do Physicians with Low Mortality and Morbidity Rates Also Have Low Resource Expenditures?
Authors: Bradbury R. C. , Golec J. H. , Steen P M.
Published: January 2017

This study addresses the question of whether physicians with better health outcomes for their patients spend more or less to accomplish these results. Several studies have examined this outcome–cost relationship at the hospital level, but the results are conflicting. The study sample (using an administrative database [1995 MQPro Comparative Database, MediQual Systems, Inc., Westborough, MA, USA]) comprised 175 249 adult medical service admissions to 100 hospitals in 25 states spanning 26 diagnosis-related groups (DRGs) during 1993 and 1994. Logistic regression models were used to estimate the expected probability of in-hospital mortality or morbidity; age, sex, severity of illness on admission, year of admission, insurance status and hospital were controlled for. The regression residuals were employed as quality indicators. Residual charges and length of stay (LOS) were estimated for each patient using an ordinary least squares regression model and were employed as resource efficiency indicators. A positive, statistically significant association at the physician level was found between mean morbidity residuals and each of the three mean resource efficiency residuals (LOS, 1.42 beta coefficient; ancillary charges, 1.78; and total charges, 1.27, all significant at the P < 0.001 level). The same positive and significant association was found between mortality residuals and each resource efficiency residual (LOS, 0.77 beta coefficient; ancillary charges, 0.80; and total charges, 0.68, all significant at the P < 0.01 level) when patients staying only one or two days were excluded. The results support our hypothesis that, on average, physicians with lower adjusted mortality or morbidity rates also have lower adjusted resource expenditures.
Two at the Top: Relations between Chairs and Chief Executives in the NHS
Authors: Exworthy Mark , Robinson Ray
Published: January 2017

The relationship between the Chair and Chief Executives of Health Authorities (and Boards) and NHS Trusts denote the managerial and political character of the NHS, creating an organizational apex with ‘two at the top’. This article considers the nature of relationships between Chairs and Chief Executives in a variety of different NHS organizations according to two theoretical perspectives: role theory and negotiated order. Empirical evidence addresses the views of the roles of Chairs and Chief Executives, the content of their roles and the local and national factors which influence them (including critical incidents). Conclusions are drawn about the conceptualization of this crucial relationship in the NHS and also on the association between the Chair-Chief Executive relationship and organizational effectiveness.
Marginal-Cost Contracting in the NHS: Results of a Preliminary Survey
Authors: Beddow A. J. , Cohen D. R.
Published: January 2017

Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an ‘internal market’ in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery.
Death in Scotland and Nineteen Years of Resource Allocation
Authors: Coid Donald , Ogston Simon
Published: January 2017

The Scottish Health Authorities Revenue Equalisation (SHARE) programme has been operating since the late 1970s to allocate health services money on a more equitable basis between health boards. It is about to be replaced by a new method, however. The trends in per capita spending on healthcare services from the commencement of SHARE are examined here, as are changes in the relative experiences of mortality, in the 12 Scottish mainland health board regions. Every health board has committed increases in spending in real terms on services for their residents. Concurrently, the differential in boards' spending on their residents has reduced due to the effects of the SHARE process. Notwithstanding the global increase in expenditure on healthcare services, and the reduction in inequalities in resources between regions, inequality in the experience of mortality has increased within Scotland. The most important public health factors influencing mortality lie outside the control of healthcare providers.
Managing New Technology: Economics Research and Practical Decisions
Authors: Buxton M. J.
Published: January 2017

Rapidly advancing health technology poses problems for managers. Although clear conceptual frameworks exist for economic evaluation, in practice severe problems remain in carrying out timely research that is locally appropriate to the needs of managers. This paper explores some of these problems in the context of the policy analysis interface between economic research and the management of technology. In the light of experience gained from recent evaluation research it indicates how researchers and managers can each contribute to the provision of a stronger empirical basis for policy making and policy management.

An earlier version of this paper was presented at the joint meeting of the Health Economists Study Group and Institute of Health Service Management, University of York, 6–8 July 1987. The author would like to thank Christopher Spry and Mike Drummond for helpful comments.
Stress, Mental Health & Job Satisfaction among Nurse Managers
Authors: Cooper Cary L. , Manning Carol A. , Poteet Gaye , Hingley Peter
Published: January 2017

This study investigated sources of stress and their effects on mental health and job satisfaction among nurse managers in the United States. One hundred and forty-four nurse managers completed questionnaires containing information concerning three kinds of variables: the degree of stress experienced at work, the personality of the individual, and characteristics of life situations away from work. It was found that in general the nurse managers were satisfied with their jobs, although they reported high stress on the job. They reported better mental health than normative groups. Using multivariate analysis, it was found that all three types of variables were necessary for prediction of mental health and job satisfaction. This finding supports the person-environment fit theory of occupational stress.
How Contracting Will Force Us to Ask Questions We Never Asked Before
Authors: Marchment Mike , Hoffmeyer Ullrich
Published: January 2017

This paper examines the impact of the separation of the purchaser from the provider and in particular the effects of placing service contracts. The paper assumes the role of the purchaser authority and examines some of the questions and assumptions that will influence the type of work to to be purchased.
Hospital Management by Product Lines
Authors: Janssen Richard , van Merode Frits
Published: January 2017

Over the last decennium many reforms of the reimbursement systems have taken place to improve the economic performance of health service organizations. These environmental changes have stimulated many hospital managers to introduce types of internal management control. Consequently budgeting is a very well known management tool. Less known in Europe is product-line management. The main purpose of this article is to introduce the concept of product-line management. Attention is paid to ways product lines can be defined in hospitals and which elements the implementation of product-line management envelope. Emphasis is laid on the consequences for the organizational structure and the cost information system. Finally, we deal with the advantages and disadvantages of product-line management.
Differences in Access and Quality of Care across HMO Types
Authors: Burns Lawton R. , Wholey Douglas R.
Published: January 2017

This paper investigates differences between various HMO types (eg, staff model, group model, IPA model) in their access and quality of care outcomes. Several sources of evidence are analyzed, including research findings reported in the health administration literature, survey data from a random sample of 42 HMOs, and accreditation data gathered from 26 HMOs in four states. Consistent with previous research, both the random sample survey data and the accreditation data indicate that group and staff model HMOs score more favorably than IPA models in terms of the level of services provided, preventive care, and various quality of care outcomes. Data from the random sample survey indicate that IPA models score more favorably on measures of patient satisfaction and access outcomes. These findings are consistent with speculation that IPAs trade off utilization and quality controls for patient access and physician autonomy. Contrary to speculation, the effect of HMO type on access and quality may be independent of the degree to which physicians are financially and organizationally tied to the HMO.
Power in the National Health Service: A Case Study of a Unit Considering NHS Trust Status
Authors: Peck Edward
Published: January 2017

There are a number of theoretical frameworks which aim to provide a language for understanding and discussing the nature of power and influence in organisational decision making. One of the most recent and comprehensive frameworks is that developed by Mintzberg. Following a resumé of the most pertinent sections of Mintzberg's framework, this paper uses it to investigate the power relationships in an NHS Mental Health Unit (MHU) considering NHS Trust status. This investigation reveals some important conclusions about the nature of power in the NHS but also explores some of the limitations of the framework as a descriptive and predictive tool.
Regulatory Intensity, Hospital Size and the Formalization of Medical Staff Organization in Hospitals
Authors: Leatt Peggy , O'Rourke Keith , Fried Bruce , Deber Raisa
Published: January 2017

Using a theory of organizational response to regulation, this study examined the effects of regulatory intensity and hospital size on the formalization of medical staff organization in Canadian hospitals. The general hypothesis was that, in provinces with greater regulatory intensity, hospitals would exhibit greater formalization of medical staff, and greater involvement of physicians in hospital governance and management; larger hospitals would have greater formalization of medical staff than smaller hospitals. Data from 574 hospitals indicated that both hospital size and provincial regulatory intensity were important factors predictive of the overall formalization of medical staff organization. Depending upon the provincial location, hospitals have developed different patterns of formalizing their medical staff structures.
Development of a Claim Review and Payment Model Utilizing Diagnosis Related Groups under the Korean Health Insurance
Authors: Shin Young Soo , Yeom Yong Kwon , Hwang Hark
Published: January 2017

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.
Research Note: Reliability of Self-Report Sickness Absence Data in the Health Service
Authors: Rees David , Cooper Cary L
Published: January 2017

Rees and Cooper (1990) used self-reports of sickness absence during the previous six months as a dependent measure in a diagnostic survey of stress in one health district. Comparison of self-reports with actual sickness absence showed that it achieved a high level of association (0.95) and can be recommended as an alternative to actual sickness data in studies in which, for whatever reason, actual sickness absence is difficult to obtain.
Decentralization of Decision-Making in Canada's Health System: The Sunnybrook Experience
Authors: Leatt Peggy , Murray Michael , Lemieux-Charles Louise
Published: January 2017

Though there is a significant literature which notes that physicians are fast becoming organizational members, there has been little research evidence to suggest that the adoption of new management models have actually facilitated their involvement. This study sought to examine whether a conscious effort at decentralizing decisions at the clinical unit level would actually result in increased involvement of physicians and other clinicians in decision-making at that level. Two major surveys examining individual roles and responsibilities and unit relationships with other units were conducted, at two points in time, in a large Canadian tertiary care centre. Results suggest that physicians had experienced an increase in administrative discretion. There was an overall increase of many groups in influencing clinical unit decisions with a perceived decrease in senior management influence in budget administration at the unit level. Lessons learned in conducting this type of research are described.
Types of Work Stress and Implications for the Role of General Practitioners
Authors: Spurgeon P. , Barwell F. , Maxwell R. , Partner GP
Published: January 2017

This study investigated a wide range of job-related characteristics which had the potential of acting as stressors for General Practitioners (GPs). Three hundred and four GPs completed a detailed questionnaire which sought audit information including practice workload factors, coping approaches and attitudinal information including sources of stress and the value of management training. Ten independent factors were identified as underpinning GP stress and using multi-variate analysis, it was shown that each of these factors is predicted by a separate and distinct set of variables. This finding suggests that it is inappropriate to simply talk about GP stress since it is a multi-dimensional concept. This finding has important implications for identifying potentially successful mechanisms of coping and support.
Design of Effective Health Decision Support Systems: Towards Automating the Health Administrator's Decision Processes
Authors: Tan J. K. H.
Published: January 2017

There has been very little evidence to suggest the effective use of, and demand for, computer-based systems by health care administrators to support their increasingly complex decision-making activities. This is so, despite a considerable amount of research attention paid to examining the efficiency and power of mathematical models, and the application of increasingly sophisticated Management Science Techniques to problems encountered within the health care system over the last several years. In recent times, advancing computer technology: 1) promises to close the gap between theory and practice, 2) creates a new perspective for computerized decision support in health care organisations, and 3) points to the need for new directions in research. This paper highlights the factors that are critical to the success of interfacing between health managerial decision-makers and effective computerized decision aids.
Business Planning in Hong Kong Hospitals: The Emergence of a Seamless Health Care Management Process
Authors: Thompson D.
Published: January 2017

This paper examines the progress made by public hospitals in Hong Kong in implementing a business planning approach. A review of available literature suggests two main exploratory themes. The first establishes the key features of business planning in the private sector. The second theme discusses the problems of adapting this approach to the distinctive requirements of the public sector. The literature also suggests three dimensions for evaluating planning: incremental-developmental; reactive-proactive; ends-means.

Qualitative data were collected by scrutinizing relevant organizational documentation and by discussions with focus groups formed by participants in the planning process. The data were analyzed against eight key elements of a business plan identified from the literature and from panels of business experts. These elements were found to be present in the Hospital Authority's plans but were less evident in hospital level plans. Because of the unitary nature of hospital organization in Hong Kong, it has been difficult for hospitals to break out of a reactive, incremental and ends-based pattern to a more imaginative identification of the distinctive business and market that they may be in. This is, however, changing rapidly and it is clear that there is in place a robust and ‘seamless’ health care management process.
Surgical ICU Underutilization Does not Significantly Discourage Discharge
Authors: Dexter F. , Pearson K. , Griffiths D. L. , Jebson P.
Published: January 2017

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.