bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth and characterization of doped hippuric acid crystals for NLO devices
Authors: Suresh Kumar B. , Rajendra Babu K.
Published: May 2007

Modified hippuric acid (HA) single crystals have been grown from aqueous solution of acetone by doping with NaCl and KCl using slow evaporation technique at constant temperature, with the vision to improve the physicochemical properties of the sample. The characterisation of grown crystals was made by X‐ray powder diffraction, density and melting point measurements. TGA/DTA studies indicate that doped crystals are more stable than pure crystals. The optical transmission study and Kurtz powder SHG measurement shows the suitability of doped crystals for NLO applications. Dopant concentration is identified with ICP atomic emission spectrometer system. The Vicker's hardness studies at room temperature, carried out on (111) crystallographic plane shows increased hardness of the doped crystals. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Estimation of spontaneous antipolarization of ADP based on magnitude of fourth‐order electrooptic effect
Authors: Górski P. , Ledzion R. , Kucharczyk W.
Published: May 2007

Applying the relationship between the spontaneous birefringence of ADP appearing in the low‐temperature antiferroelectric phase with the spontaneous antipolarization, and taking into consideration the known experimental values for the quadratic and fourth‐order electrooptic effects, an estimate is made of the lower limit of the spontaneous antipolarization. The estimation, which employs the fourth‐order electrooptic effect, gives the antipolarization P = 1.2 · 10‐2 Cm‐2, a value comparable in magnitude to the spontaneous polarization observed in ferroelectrics belonging to the KDP family of crystals. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Specific features of the optical spectra in Tl2In2S3Se layered single crystals
Authors: Gasanly N. M. , Guler I. , Goksen K.
Published: May 2007

The optical properties of Tl2In2S3Se layered single crystals have been studied by means of transmission and reflection measurements in the wavelength range of 450‐1100 nm. The analysis of the absorption data revealed the presence of both optical indirect and direct transitions with energy band gaps of 2.16 and 2.42 eV, respectively. The observed coexistence of indirect and direct energy band gaps is related to the anisotropy of the Tl‐containing layered crystals. The dispersion of the refractive index is discussed in terms of the Wemple‐DiDomenico single‐effective‐oscillator model. The refractive index dispersion parameters: oscillator energy, dispersion energy, oscillator strength and zero‐frequency refractive index were found to be 4.78 eV, 43.58 eV, 13.18 × 1013 m–2 and 3.18, respectively. From X‐ray powder diffraction study, the parameters of monoclinic unit cell were determined. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Dielectric relaxation in ferroelectric TlInS2 layered crystals within metastable chaotic state
Authors: Şentürk E. , Tümbek L. , Mikailov F. A. , Salehli F.
Published: May 2007

The results of investigations low frequency dielectric relaxation in layered ferroelectric TlInS2 crystals are presented. The measurements were performed in the temperature range of 180‐230 K and in the frequency range of 5 kHz–1 MHz. Two different relaxation processes were observed in mentioned temperature interval. The crystal has “slow” and “fast” relaxation mechanisms in low and high frequency region, respectively. The presence of two different relaxation mechanisms in TlInS2 is discussed. (© 2007 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Involvement of nonclassical MHC class Ib molecules in heat shock protein‐mediated anti‐tumor responses
Authors: Goyos Ana , Guselnikov Sergey , Chida Asiya S. , Sniderhan Lynn F. , Maggirwar Sanjay B. , Nedelkovska Hristina , Robert Jacques
Published: May 2007

Nonclassical MHC class Ib (class Ib) genes are found in all jawed vertebrates, and their products are hypothesized to be indicators of intracellular stress and malignancy. They may be involved in immune recognition of classical MHC class Ia (class Ia)‐low or ‐negative tumor cells through their interaction with T cell receptors and/or non‐T cell inhibitory or triggering receptors expressed by NK cells and T cells. In the frog Xenopus, the molecular chaperone gp96 mediates a potent immune response involving antigen‐specific classical class Ia‐unrestricted CD8+ CTL (CCU‐CTL) against a transplantable thymic tumor (15/0) that does not express class Ia molecules. We hypothesized that Xenopus nonclassical class Ib gene products (XNC) are involved in gp96‐mediated CCU‐CTL anti‐tumor responses. To investigate the involvement of class Ib gene products in Xenopus anti‐tumor responses, we generated, for the first time in ectothermic vertebrates, stable tumor transfectants expressing short hairpin RNA (shRNA) to silence either XNC directly or β2m to prevent class Ib surface expression. Both types of 15/0 transfectants are more resistant to CCU‐CTL killing, more tumorigenic and more susceptible to NK‐like cell killing. This study provides in vitro and in vivo evidence of the evolutionary conservation of class Ib involvement in anti‐tumor CD8+ T cell responses.
Transition‐Metal (MnII and CoII) Complexes with the Heteropolymolybdate Fragment [AsVMo9O33]7–: Crystal Structures, Electrochemical and Magnetic Properties
Authors: Yang Yanyan , Xu Lin , Gao Guanggang , Li Fengyan , Qiu Yunfeng , Qu Xiaoshu , Liu Hong
Published: May 2007

Two novel heteropolymolybdates, [(CH3)4N]8n[M(H2O)5]2n(H3O)2n[{M(H2O)5}2(MAsVMo9O33)2]n[M(H2O)4(MAsVMo9O33)2]n·20nH2O (M = Mn2+, 1; M = Co2+, 2), constructed from the new fragment (AsVMo9O33)7– and a transition metal have been synthesized in aqueous solution and characterized by elemental analysis, IR spectroscopy, thermal gravimetric analysis, and single‐crystal X‐ray diffraction. Structurally the title complexes resemble a sandwich‐type complex because they involve the coordination of two transition metals to two [AsVMo9O33]7– fragments, which derive from the well‐known B‐β‐Keggin structure. Compounds 1 and 2 exhibit a one‐dimensional chain‐like framework [M(H2O)4(MAsVMo9O33)2]8n– with isolated {[M(H2O)5]2(MAsVMo9O33)2}6– units residing among the chains. The magnetic properties of the two complexes were investigated to indicate typical antiferromagnetic interactions through the MnII–O–MnII bridge unit for complex 1 and the CoII–O–CoII bridge unit for complex 2. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Gel‐free IEF in a membrane‐sealed multicompartment cell for proteome prefractionation
Authors: Lam Hoang‐Trang , Antonioli Paolo , Righetti Pier Giorgio , Citterio Attilio , Girault Hubert
Published: May 2007

A minidevice for performing gel‐free proteome prefractionation via conventional IEF in soluble carrier ampholyte buffers is reported here. It consists of a compact block of polyoxymethylene in which eight samples and two electrode chambers are machined. Each of the eight sample chambers can be filled with up to 120 μL of sample and has the following size: 7 mm width, 3 mm depth and 10 mm height. The anodic and cathodic compartments have the same width and height as the sample chambers, but with a depth of 6 mm, thus accepting up to 250 μL of electrodic solutions. Focusing is in general accomplished in 2 h with a voltage gradient of up to 1000 V (7 cm electrode distance). Easy fractionation and collection of the content of the eight chambers is achieved by simply pressing a rubber diaphragm against the edges of the thin walls separating each well, this automatically breaking liquid continuity. The performance of this device has been tested by subfractionating total cell lysates of a human cancer cell line (U2Os) and of Escherichia coli bacterial cells, and by analysing the content of each chamber by mono‐dimensional SDS‐PAGE and 2‐D maps.
Toward a global characterization of the phosphoproteome in prostate cancer cells: Identification of phosphoproteins in the LNCaP cell line
Authors: Giorgianni Francesco , Zhao Yingxin , Desiderio Dominic M. , Beranova‐Giorgianni Sarka
Published: May 2007

Protein phosphorylation plays a major role in most cell‐signaling pathways in all eukaryotic cells. Disruptions in phosphorylation‐mediated cell‐signaling events are associated with various diseases, including cancer. Here, we applied a fully non‐gel‐based methodology to obtain an initial panel of phosphoproteins from the LNCaP human prostate cancer cell line. The analytical strategy involved enrichment of phosphopeptides by immobilized metal ion affinity chromatography, the use of POROS Oligo R3 to capture phosphopeptides that were not retained with a C18 packing, and gas‐phase fractionation in the m/z dimension to extend the dynamic range of the LC‐MS/MS analysis. In this pilot investigation, 137 phosphorylation sites in 81 phosphoproteins were identified. The characterized phosphoproteins include kinases, co‐regulators of steroid receptors, and a number of cancer‐related proteins.
The probability function of the compound Poisson process and an application to aftershock sequence in Turkey
Authors: Özel Gamze , İnal Ceyhan
Published: May 2007

Obtaining the probability function is a problem in the compound Poisson process. In this study, the explicit probability function of the compound Poisson process is derived. By means of written macros, some numerical examples are also given to illustrate the usage of the probability function. Also as an application, 94 destructive earthquakes having surface wave magnitudes Ms ≥ 5.0 and their aftershocks within one month occurred in Turkey between 1903 and 2005 are considered. By using this data set, the probability function of the total number of aftershocks is obtained. Copyright © 2007 John Wiley & Sons, Ltd.
Role of endoscopic surgery in the management of selected malignant epithelial neoplasms of the naso‐ethmoidal complex
Authors: Nicolai Piero , Castelnuovo Paolo , Lombardi Davide , Battaglia Paolo , Bignami Maurizio , Pianta Luca , Tomenzoli Davide
Published: May 2007

Background.

This study reviews the outcome of patients with adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the naso‐ethmoidal complex treated by endoscopic surgery.

Methods.

Sixteen patients underwent a purely endoscopic excision of AC (n = 12) or SCC (n = 4) at 2 university hospitals. All patients were prospectively followed by endoscopic and MRI evaluations.

Results.

The tumor originated from the ethmoid in 13 cases and the nasal fossa in 3. Lesions were staged as follows: 5 T1, 10 T2, and 1 T3. Adjuvant radiotherapy was delivered in 7 cases. Follow‐up (range, 28–70 months; mean, 47.25) was available for all patients. One patient died for brain metastases 28 months after surgery. Another patient required salvage craniofacial resection and radiotherapy for recurrent AC. Five‐year disease‐specific and disease‐free survival rates were 93.3% and 87.0%, respectively.

Conclusions.

In selected T1‐T2 lesions of the naso‐ethmoidal complex, endoscopic surgery seems to offer a satisfactory alternative to external procedures. © 2007 Wiley Periodicals, Inc. Head Neck, 2007
Hospital management: Integrating the dual hierarchy?
Authors: Pool Jeroen
Published: May 2007

Traditionally, hospitals are seen as dual hierarchies: in addition to the formal administrative pyramid, the professional medical system forms a second line of authority. Equally traditional, this poses substantial problems for hospital management.

The present study reported in this article took place as part of a larger research project on Industrial Democracy in Europe (IDE‐2), aimed at studying changes in industrial relations and internal relations in metal and insurance companies. In the Netherlands, this project was enlarged to include hospitals.

A number of significant changes have taken place in the past decade in Dutch general hospitals. As a reaction to environmental changes, e.g. in legislation, planning and financing, organizational structures have shown interesting developments. Examples are an increased hospital size due to mergers, the emergence of mid‐level management, divisionalization (inpatient vs outpatient wards), and integration of medical specialists in the organization. As a result, several changes in power positions have occurred, mainly at the strategic decision level: middle and top management have gained while the medical profession has lost some influence. The Works Council has established its position, and made a significant gain in influence on strategic decision making.
Essential national health research in developing countries: Health‐care financing and the quality of care
Authors: Wouters Annemarie V.
Published: May 2007

New research integrating expertise in financing and quality assurance is critical at times when resource constraints threaten to undermine the sustainability of effective healthcare services. Cost‐effectiveness is related to the quality of the health‐care intervention. In the economics literature, health‐care demand studies generally indicate that quality is an important determinant of utilization patterns, but do not clearly identify those components of quality most important to the patient. On the supply side, cost analyses have not closely examined cost‐quality tradeoffs, nor the net costs of quality. Policy makers must determine the affordability of cost‐recovery mechanisms, which include both increases in price and quality. Further research should identify those aspects of quality which will maximize effectiveness at the least cost, thus helping to promote the financial sustainability of the health service.
Productivity and quality of public hospital medical staff: A dominican case study
Authors: Lewis Maureen A. , Sulvetta Margaret B. , la Forgia Gerard M.
Published: May 2007

Medical care personnel constitute a major portion of health‐care costs and are an important determinant of quality. Personnel policy, especially regarding physicians and nurses, is central to the level and type of care provided, and ultimately to the resources expended. There is increasing evidence that state health systems in many Latin American countries face the apparently paradoxical situation of oversupply of physicians coupled with the undersupply of physician services. Yet, productivity of medical staff in public facilities in Latin America is a relatively unexplored area. Further, little is known about the relationship between productivity of medical staff and quality of services provided in developing countries.

Taking the case of a large public hospital in the Dominican Republic, this study examines the quality of hospital structure and process as it relates to the functions and performance of physicians, and to a lesser extent, nurses. Based on a patient‐based survey, data were collected on physician and nurse time allocations in outpatient, emergency, surgery and inpatient wards, the types of services provided, and the time costs of providing them.

The analysis focuses on medical staff performance according to the professional levels of physicians and nurses providing care, and the time spent attending to patients and conducting supervisory tasks. The gap between contracted and expended physician hours is examined. The paper concludes with a discussion of the policy implications for hospital management, particularly as they relate to incentives for medical personnel.
Addressing national and regional health needs: A framework for health planning
Authors: Stanton Bonita F. , Clemens John D. , Black Robert E.
Published: May 2007

Completion of the first decade since the Alma‐Ata Declaration of ‘health for all’ (1978) has led to numerous appraisals, in international forums, of progress achieved by the current primary health care strategy. Although this strategy appears to have contributed to improvements in selected health outcomes, changing circumstances in many developing countries may now require a more flexible and country‐specific approach to health care programming. This article argues for the development of a pragmatic framework: to articulate problems which should be addressed in the development of national health programs; and, to organize concepts and methodologies to address these problems. Such a framework should enable an assessment of currently implicit value judgments, and enable strategies to be considered that assess several input and output variables simultaneously. Moreover, this framework would, we believe, further the goal of improved health delivery at a national level, and serve as a guide for further methodologic and conceptual development.
The public and private sectors in health: Economic issues
Authors: Newbrander William , Parker David
Published: May 2007

Major changes in the public/private mix of health services are occurring in many countries. These changes may be analysed by examining the financing and provision of services and subsidization of the purchase of the factors of production. The public sector and not‐for‐profit and for‐profit elements of the private sector must be viewed as separate entities in such analyses due to their differing objectives, motives and form of operation. The issues to be dealt with by countries in finding the public/private mix which is appropriate for their health system and achieves their objectives include efficiency, quality, regulation, equity and consumer choice and satisfaction. The recommendations for action for countries include: promoting collaboration between private and public sectors; testing different public/private mix models; identifying appropriate expansion paths for private sector services; improving information for policy and planning decisions; enhancing management capacity; and, reviewing programme and project support. International agencies also have a role in this process by supporting countries through the provision of technical assistance, financial aid, promoting policy reviews, and facilitating the sharing of information and experiences among countries concerning these public/private mix issues.
Methods for cost analysis, cost recovery, and cost control for a public hospital in a developing country: Victoria Hospital, St. Lucia
Authors: Trisolini Michael G. , Russell Sharon Stanton , Gwynne Gretchen , Zschock Dieter K.
Published: May 2007

International attention has focused in recent years on methods for analysing costs of public hospitals in developing countries, with the goal of reducing the financial burden on governments by enabling improved resource allocation, by identifying areas for cost recovery and cost control, and by developing management systems to facilitate these efforts. A range of methods for cost analysis, cost recovery, and cost control are reviewed in this article, with illustrations of applications of the methods at Victoria Hospital, the national hospital in St. Lucia. Comparisons are made to similar studies in Belize, Lesotho, and the Dominican Republic.

Cost‐analysis methods focus on a detailed cost accounting effort which identifies the full financial costs of hospital operations and the unit costs of individual hospital services. Cost‐recovery methods include an analysis of cost‐related and other issues involved in setting fee levels for hospital services, determination of exemptions for certain population groups, and management of fee collection systems. Cost‐control methods include analysing the degree of managerial authority exercised by hospital managers in relation to the central Ministry of Health and other government departments, identifying opportunities and incentives for cost control by individual departments within the hospital, and evaluating methods for involving physicians and other clinical decision‐makers in cost control efforts. A diagnosis‐independent method for utilization review of clinical decisions, the Appropriateness Evaluation Protocol, is pilot‐tested and alternatives, including Diagnosis Related Groups, are discussed. Implementation issues related to long‐term systems development efforts are reviewed.
Private medicine in socialist China: A survey of the private medical market in Guangzhou
Authors: Yuen Peter P.
Published: May 2007

This study analyses the size and the characteristics of the private medical market in Guangzhou. Legislations related to the regulation of private medical establishments are examined. Data collected reveal that private sector provision of health services in China is still small and lacks sophistication. The article recommends further reforms in the fees and charges system; loosening of the restrictions of public doctors to undertake private practice; contracting‐out some of the state health services to private practitioners; and, creating a more favourable environment for private investment in the health care industry.
Quality of care in decentralized primary care clinics: A conceptual framework
Authors: Gross Revital , Benbassat Jochanan , Nirel Nurit , Cohen Miriam
Published: May 2007

In an attempt to provide high quality medical care, despite limited resources, health care providers in various countries have introduced decentralization into their health care services. It has been assumed that the delegation of authority to the local levels of the organization will enhance their ability to respond to local needs, and improve cost containment without compromising the quality of care. However, to date, few empirical studies have explored the relationship between decentralization and such projected outcomes.

In this article we present a conceptual framework for analyzing possible consequences of decentralization on dimensions of quality of primary health care. We also suggest a framework for defining decentralization programs by their key components, and employ these frameworks to analyse a specific decentralization program being implemented in Israel's largest health maintenance organization (HMO).

While we identify the dimensions most likely to be affected, we also conclude that data presently available do not permit a definitive prediction of whether the overall effect of decentralization on quality of care will be positive or negative. The potential reaction of a unit to the elements of change introduced by a decentralization program is influenced by the structural, cultural and management characteristics of that unit. Therefore, future attempts to decentralize health care organizations should be accompanied by close monitoring.
A knowledge‐based system for monitoring immunization coverage in Papua new Guinea
Authors: Cibulskis Richard E. , Crouch‐Chivers Paul R. , Posonai Enoch , Moni Coleman , Thomason Jane A.
Published: May 2007

Microcomputers have great potential to improve health service management in developing countries. In addition to their commonly recognized abilities to process numerical information, they can also provide assistance in interpreting it. They can highlight problems that require attention, suggest possible reasons why problems occur and suggest appropriate managerial responses. Computer programs which perform these more advanced functions are often known as knowledge‐based systems (KBSs) since they incorporate the knowledge of experts in the area addressed by the system. Such systems are increasingly being used to support decision making in commerce and public administration and offer great potential to the health sector. This article presents preliminary results of work to develop a KBS to help mid‐level managers monitor and evaluate health service provision in Papua New Guinea. It considers issues in the design and development of KBSs and discusses their future potential.
Developing health services management in South Africa: The question of transformation
Authors: Ong Bie Nio , Joseph Dawn
Published: May 2007

The end of the Apartheid system in South Africa will have a major impact on its public sector, and the health service in particular. The key player in the process of transformation, the African National Congress, has put forward proposals for a National Health Service. The need for a management cadre to bring about and maintain these major changes is slowly being recognized. This article considers the impact of the proposed changes for health service management, and argues that management education has to produce people who possess both strategic and operational competencies to effect the transformation of an unequal and divisive health service into one that offers an equitable and high quality service to all South Africans.
The NHS internal market: Economic aspects of its medium‐term development
Authors: Whynes David K.
Published: May 2007

With the re‐election of the Conservative Party in the United Kingdom in April 1992, it is now likely that the major reforms of its National Health Service as outlined in the 1989 White Paper—Working for Patients—and embodied in the 1990 National Health Service and Community Care Act will be implemented to completion. This article examines the reforms as a re‐structuring of incentives facing agencies within the internal market for health care, and forecasts how agency behaviour is likely to change as a result of such re‐structuring. Medium‐term implications of the reforms for hospitals, general practitioners and patients are derived. A number of problems in the continued development of the internal market are anticipated.
Internal market reforms of health care systems and the allied health professions: An international perspective
Authors: Boyce Rosalie A.
Published: May 2007

Fundamental reshaping of the organization of health services is occurring in publically funded health care systems introducing internal market reforms. Management of clinical activity and the introduction of competition through contract‐based processes has concentrated on the impacts on medicine and nursing. This article reports early experiences of the consequences of restructuring on the allied health professions from a five‐country fieldwork study. Data suggest that decisions on new organizational structures for allied health professions are likely to effect their potential to participate competitively in the market reforms of health care systems.
Health services reforms: Political and managerial aims—an international perspective
Authors: Battistella Roger
Published: May 2007

Health policy everywhere is in flux. In marked contrast with the impenetrable orthodoxy and inaction characteristic of past decades, health policy currently is in the midst of large‐scale upheaval. Many of the fundamental assumptions and principles that long guided health‐sector development are in the process of being turned upside down

Whether a country is rich or poor, it matters not. Virtually every country either has or is contemplating major reforms in its provisions for the organization and financing of health services. Moreover, the differences in health services structure which divided nations, are becoming smaller—to the point where formerly shunned international exchanges now are considered useful mediums for the exposition of common tensions and the exploration of choices for adapting health care to complex and new economic realities.
Decentralization of management responsibility: The case of danish hospitals
Authors: Pedersen L. D. , Pallesen Thomas , Pedersen Lars Dahl
Published: May 2007

This article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non‐staff expenditures especially are subjected to reductions. The system still seems to ‘favour’ doctors and nurses, but less than in a system with traditional budgetary institutions

The behaviour of the top‐management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top‐management team. The declining output makes it easier to departments ceteris paribus to keep within their budgets. And that makes it easier for the top‐management team to keep the overall hospital budget

The obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals.
A critical analysis of recent canadian health policy: Models for community‐based services
Authors: Crichton Anne
Published: May 2007

As part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community‐based services, but said that this would be done in the context of the developing organization of the national health insurance program

With the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the community

We found that organization theories were helpful for explaining developments in the health service as a whole and the place of community‐based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promotion.
Crowded outpatient departments in city hospitals of developing countries: A case study from Lesotho
Authors: Holdsworth G. , Garner P. A. , Harpham T.
Published: May 2007

‘Overuse’ of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or ‘reference centres’, as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital‐based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self‐referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over‐prescribe, particularly antibiotics and sedatives

The study suggests that in Maseru, the perception of ‘overuse’ is due to congestion and that improved patient flow management will reduce the numbers of patients waiting. Quality of care could be strengthened by regular audit of prescribing practices by clinicians in the hospital.
What kind of healthcare ‘internal market’? A cross‐europe view of the options
Authors: Sheaff Rod
Published: May 2007

Many governments are trying to invent new types of ‘internal’ healthcare market that will expose health services to competitive pressures to innovate, contain costs, raise service quality, and respond better to consumer demands; but not expose them to ‘market failures’ which prejudice universal access to ‘basic’ health services. Policy debates in this area are muddled and constricted by a failure to differentiate the variants of internal market that are available. This article outlines a taxonomy of the main types of internal market: primary doctor purchasing; managed competition; competitive bidding; social insurance; and compulsory private insurance. It notes their main structural characteristics and differences. Although internal market reforms have been intended to support the commercialization of healthcare, the idea of designing new types of economic structure to avoid market failure in healthcare has wider and more radical implications than most policy‐makers intend.
Management challenges and markets
Authors: Borgonovi Elio , Brovetto Paulo Rondo
Published: May 2007

The scarcity of resources in healthcare systems has general causes and country‐specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely on

Cost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country.
Health care cost‐recovery simulations from parametric estimates: Methodology and results for ogun state, Nigeria
Authors: Vogel Ronald J.
Published: May 2007

Cost recovery in the health care sector in developing countries can be a powerful tool for achieving efficiency and equity goals, and for mobilizing financial resources for the improvement of quality. However, there is only fragmentary empirical evidence on the revenue, quality and cost effects of cost‐recovery policies in the health care sector. Using parameter estimates from cost and demand functions that were derived from data from a facility and household interview survey in Ogun State, Nigeria, this article simulates various cost‐recovery scenarios for the public sector. The empirical results of the simulations show that, under certain realistic scenarios, cost recovery will generate additional revenue and improve quality. Equity would be enhanced by spending some of the additional net cost‐recovery revenue on health care for the poor.
Setting goals and targets for performance standards within the Swedish health care system
Authors: Axelsson Lilian , Svensson Per‐Gunnar
Published: May 2007

The development of any health care system towards setting goals and targets and intended outcomes—with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces—makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal‐setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process

The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It ‘stands and falls’ with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed, This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a ‘we‐feeling’ which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given

It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage achievement.
Developing strategies to encourage appropriate care‐seeking for children with acute respiratory infections: An example from Egypt
Authors: Herman Elizabeth , Black Robert E. , Wahba Saneya , Khallaf Nagwa
Published: May 2007

Determinants of care‐seeking and patterns of referral for acute respiratory infections (ARIs) in children were studied in two communities in Ismailia, Egypt. A video was used to assess mothers' recognition and interpretation of clinical signs of serious illness. Mothers were questioned about which of the locally available provider options they would choose for four different locally‐defined ARI illnesses; they were also read brief descriptions of hypothetical cases, and asked how they would recommend treating children in those situations. These results were compared with reported care‐seeking practices during past ARI episodes that occurred in their own children

The results indicate that mothers generally recognize rapid or difficult breathing, but do not use the recognition to take appropriate actions. The data suggest that a substantial proportion of children in the study area, who are perceived to have severe respiratory illnesses, may not be brought to the government health facilities for treatment. Implications of the findings for the training policies and strategies of the Egyptian national ARI program are considered.
Inter‐organizational networks on the dutch home health care market
Authors: Mur‐Veeman Ingrid , Van Raak Arno
Published: May 2007

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age‐related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors

In order to promote coordinated care, Dutch health care providers are building inter‐organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter‐organizational networks contribute to the balance between quality and cost.
The effect of economic changes on health care and health in Chile
Authors: Montoya‐Aguilar Carlos , Marchant‐Cavieres Luis
Published: May 2007

The existence of possible associations between the economy and health in Chile, 1974‐1992, is documented. The gross domestic product fell in 1975‐1976 and again in 1982‐1983; at both times, the public expenditure on health care followed those falls. In addition, the sources of financing public expenditure and the patterns of health expenditure changed during the decades under study. Several indicators of health care activity, and of health and nutrition status consistently suggest an impact which results from the economic difficulties. Staffing levels and pay factors apparently played a role as intervening variables. The differences between the two crises are discussed, and reveal that the organization and programmes of the public health system seem to have been seriously affected. At the same time, they may still have played an important role in protecting the people—particularly, mothers and small children—from further damage.
Hospitals: To the next millennium
Authors: Braithwaite Jeffrey , Lazarus Leslie , Vining Ross F. , Soar Jeffrey
Published: May 2007

Hospitals are changing. Throughout the OECD the hospital, that enduring and pervasive organization which has delivered the vast majority of acute care services for decades, is being reconceptualized. We briefly analyse trends which clearly indicate that the existing concept of the hospital is rapidly coming to an end. The emerging model consists of a core facility comprising only the most acute services, intensive care, operating theatres and an accident and emergency unit, with all other services and units linked by information technology to each other and to the core facility. We explore some of the management challenges confronting those who will be responsible for taking their organization through the transition to the boundaryless hospital arrangement, discuss a number of the existing problems with today's hospitals which the new model has the propensity to resolve, and deal with some of the emerging issues which it brings with it.
Client‐centred accreditation
Authors: Heidemann Elma G.
Published: May 2007

The Canadian Council on Health Services Accreditation has restructured its approach to health services accreditation, moving from a focus on hospital departments to what is termed a client‐centred approach. This was a response to the philosophy of Continuous Quality Improvement, which has caused a rethinking of the approach to accreditation. The process of change has required total revision of the standards used, moving the focus from individual hospital or health service departments, to standards which describe the main processes of patient care within the organization. This has resulted in the need for new survey techniques and award structures.
Extending facility accreditation to the evaluation of care: The Australian experience
Authors: Collopy Brian T.
Published: May 2007

The Australian Council on Healthcare Standards (ACHS) has introduced clinical performance measures—clinical indicators—into the accreditation process. The indicators are developed with the assistance of the various medical colleges (professional associations of specialists). Sixteen such bodies are now in the program, with 150 draft indicators covering 90 areas of hospital practice. The development of a set of indicators passes through a number of stages to ensure their validity, and a process is in place to assess their reliability, reproducibility and responsiveness. The qualitative information available indicates a willingness on the part of health care facilities to address the indicators, and alter the process of care. It is anticipated that the quantitative information being collected in aggregate form will subsequently demonstrate an improvement in the outcome of care. Hospital specific information currently remains confidential to the ACHS and the particular health care facility. The public release of such information and the value of doing so remains undetermined.
Health care reform: Informing difficult choices
Authors: Maynard Alan , Bloor Karen
Published: May 2007

During the last decade, policy makers in a large number of countries have attempted various reforms of their health care systems. Health care reform has been described as a ‘global epidemic’ (Klein, 1993). All health care reforms consist of very complex policy choices, some of which are examined in this article. After an introductory exploration of ideological issues, the objectives of health care reformers are considered. Three major policy objectives of health care reform are examined: cost containment; efficiency; and, equity. Three types of reform which have been advocated are also considered: public planning; market regulation; and provider‐advocated reforms such as a ‘basic package’ with copayments and alternative means of finance. Finally, appropriate features of efficient health care reform are suggested, addressing explicit policy goals.
The financing and organization of health services in poor rural China: A case study in donglan county
Authors: Gu Xing‐Yuan , Tang Sheng‐Lan , Cao Su‐Hua
Published: May 2007

The socio‐economic reforms launched in China in the late 1970s led to rapid economic growth and, with it, health sector resources expanded rapidly. The rural health services have benefited from the policies of economic reform, but not in an optimal way, particularly in poor areas. This article uses a case study of a poor county—Donglan—to illustrate that the fiscal decentralization combined with the financial responsibility system have resulted in a weakening of financing and provision of rural health services in poor areas. The need for health facilities to generate revenue has had unfortunate consequences for the style of medical care, such as over‐prescription. In addition, the collapse of the cooperative medical system and the weakening of the three‐tier network of rural health care in Donglan have jeopardized preventive programs and threaten access to basic health care for the peasants, especially the poor. The study found evidence that preventive programs have deteriorated over the past years, the poor had financial difficulty in access to services, particularly hospital care, health facilities at township and village levels have been run down, and less training and supervision have been provided by upper‐level health facilities. The article concludes with recommendations for a strategy for rebuilding and strengthening the three‐tier network of rural health care, and for establishing a cooperative medical and health care scheme to ensure that the majority of peasants in Donglan can be guaranteed access to basic health services. Limited health resources will therefore be better used.
Health reform in Greece: Planning and implementation of a national health system
Authors: Tountas Yiannis , Stefannson Helga , Frissiras Spyros
Published: May 2007

The health system in Greece has for many years been in a state of continuous crisis. The basic aspects of this crisis involve: a fragmented administrative framework; low level of public expenditure; a significant private sector; inadequate hospitals; skewed manpower; and, a low level of primary care. In 1983, the National Health System (ESY) was established, as an effort to improve the above situation. This article presents the context of the ESY and the situation of the health system prior to and after the establishment of the ESY. The conclusion drawn is that many of the goals of the ESY have not been achieved or only partly achieved, and that a number of the above serious problems still persist.
Do formulation switches exacerbate existing medical illness? Results of an open‐label transition to orally disintegrating risperidone tablets
Authors: Chue Pierre , Prinzo Rosanna S. , Binder Carin E.
Published: May 2007

Background

Orally disintegrating risperidone tablets (Risperdal* M‐TABs*) present an alternative method of drug delivery that may benefit physicians struggling to treat non‐compliant patients, since it begins to dissolve within 5 s, preventing tablet cheeking or spitting.

Objectives

To evaluate safety and maintenance of effect in symptomatically stable patients transitioned from compressed risperidone tablets to orally disintegrating risperidone tablets.

Methods

This open‐label, multi‐centre study enrolled 82 adults from four diagnostic groups (major depressive disorder (MDD), n = 25; bipolar disorder (BP), n = 21; dementia (DE), n = 20; schizophrenia (SZ), n = 16). Patients were switched from their previous dosage of compressed tablets (0.5, 1.0, 2.0, 3.0, or 4.0 mg/day) to an equivalent dosage of orally disintegrating risperidone and followed for 4 weeks. The primary effectiveness parameter evaluated was the Clinical Global Impression—Severity (CGI‐S) scale.

Results

Most patients (24/25 MDD; 20/21 BP; 17/18 DE; 14/15 SZ) improved by 1 point on CGI‐S from baseline or experienced no change at endpoint. Adverse events (AEs) occurring in any group at a ≥10% incidence included headache (19%) and pharyngolaryngeal pain (10%), reported in the BP group only.

Conclusions

Patients stabilized on compressed risperidone tablets transitioned to the equivalent dose of orally disintegrating risperidone tablets with continued maintenance of effect, no decompensation and with minimal side effects. Copyright © 2007 John Wiley & Sons, Ltd.