Sample records for hungarian managed care


    Directory of Open Access Journals (Sweden)

    Gabriella KECZER


    Full Text Available Transformation of the management of traditional higher education institutionsemerged in Hungary following the change of the political system in 1990,however, an appropriate answer has not been found to date. The first step inthe management of reform is identification of the issues that need to beresolved through the implementation of changes.The present research has been aimed at identifying the present weaknessesof the inner management system of traditional Hungarian universities, thusfind a solid starting point for reforming it. I conducted in-depth interviews inthe course of research, with 10 top university managers who represent 9institutions, thus the majority of traditional Hungarian universities. Such aresearch has not been made at least for the last decade.In my paper first I present the current legal framework of the system ofuniversity management. Then I give an assessment of it on the basis of theinterviews, analysing the deficiencies, the external and internal obstacles toefficient management I conclude that the present leaders of theuniversities can exactly identify those deficiencies of the system and therelated external and internal circumstances that lead to disturbed operationand low efficiency. The results obtained through the interviews suggest that areform of the internal management should rearrange intra-university powerrelations and harmonize scopes of responsibility and competence. A shifttoward a stronger central, rectoral and a more limited faculty- and bodyrelatedmanagement appears necessary.

  2. Knowledge-Management in the Hungarian Economy

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    J. Varga


    Full Text Available The key to a successful crisis management is prevention. In crisis management, not only the strategy and scenario development play an important role. One way to deal with the financial crisis is to cut costs by downsizing and reducing production, but, as some businesses have chosen, it is also possible to invest in innovation and quality improvement. Value creation for customers is essential, even if consumption may temporarily decline during this period. As soon as the recession ends, new products may be in competitive advantage against the competitors who have been trying to adapt with reduced prices. This study examines the strategies and management tools of businesses that have experienced only a small decline or even a business-growth during the global financial crisis. It highlights the importance of investing in innovation, quality management and human recourses, since these are critical factors also in prevention and crisis management, not only in income maximization.

  3. [Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. (United States)

    Párniczky, Andrea; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Morvay, Zita; Oláh, Attila; Pap, Ákos; Sahin-Tóth, Miklós; Szabó, Flóra; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Veres, Gábor; Szücs, Ákos; Lásztity, Natália


    Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.


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    Maheshkumar P. Joshi


    Full Text Available There is a need for more comparative empirical research that examines middle manager roles in strategic change. This paper reports a study of middle managers in two dynamic settings: the Asia/Pacific region – Malaysia and Thailand; and Central/Eastern Europe – Hungary. Results of 213 respondents across three countries indicate that middle managers from all three tend toward use of authoritarian management styles even in proactive strategic change situations. However, Hungarians are less likely to use these styles than Thai and Malaysian middle managers. For all three countries, managers with less work experience were found to have lower tendencies to use an authoritarian style of implementation. When top managers exhibit an aggressive strategic posture, middle-managers from all three countries are also less likely to use an authoritarian style.Firms that want to stay competitive in the global market place must continuously evolve by successfully accomplishing strategic change (Struckman & Yammarino 2003. Although senior managers are critical in leading the strategic change process, even the best-planned strategic changes will not achieve their full potential unless they are well implemented. Part of the strategic leadership responsibility, therefore, includes establishing a climate in which the organization's rank and file will experience both a positive attitude about change and the confidence to actively seek change opportunities (Kanter 2003. Research attention is bringing more insight into the important roles of middle-managers in this process of implementing strategic change (Balogun & Jenkins 2003; Floyd & Wooldridge, 1992, 1994; Wooldridge & Floyd 1990. Although there is little doubt that active support by middle managers is critical for the strategies to be well implemented (Guth & MacMillan 1986, there remain many important questions with regard to how middle managers participate in this process (Balogun 2003.The need for research

  5. Quality Management in Hungarian Higher Education: Organisational Responses to Governmental Policy (United States)

    Csizmadia, Tibor; Enders, Jurgen; Westerheijden, Don F.


    This article focuses on responses of higher education institutions to governmental policy. We investigate the influence of organisational characteristics on the implementation of quality management in Hungarian higher education institutions. Our theoretical framework is based on organisational theories (resource dependency and…

  6. Quality Management in Hungarian Higher Education: Organisational Responses to Governmental Policy (United States)

    Csizmadia, Tibor; Enders, Jurgen; Westerheijden, Don F.


    This article focuses on responses of higher education institutions to governmental policy. We investigate the influence of organisational characteristics on the implementation of quality management in Hungarian higher education institutions. Our theoretical framework is based on organisational theories (resource dependency and…

  7. Quality management and patient safety: survey results from 102 Hungarian hospitals.

    NARCIS (Netherlands)

    Makai, P.; Klazinga, N.; Wagner, C.; Boncz, I.; Gulácsi, L.


    OBJECTIVES: The aim of this study is to describe the development of quality management systems in Hungarian hospitals. It also aims to answer the policy question, whether a separate patient safety policy should be created additional to quality policies, on national as well as hospital level. METHOD:

  8. Quality management and patient safety: survey results from 102 Hungarian hospitals.

    NARCIS (Netherlands)

    Makai, P.; Klazinga, N.; Wagner, C.; Boncz, I.; Gulácsi, L.


    OBJECTIVES: The aim of this study is to describe the development of quality management systems in Hungarian hospitals. It also aims to answer the policy question, whether a separate patient safety policy should be created additional to quality policies, on national as well as hospital level. METHOD:

  9. [Types of conflicts and conflict management among Hungarian healthcare workers]. (United States)

    Csupor, Éva; Kuna, Ágnes; Pintér, Judit Nóra; Kaló, Zsuzsa; Csabai, Márta


    Efficient communication, conflict management and cooperation are the key factors of a successful patient care. This study is part of an international comparative research. The aim of this study is to unfold conflicts among healthcare workers. 73 healthcare workers were interviewed using a standardized interview protocol. The in-person interviews used the critical incident method. 30 interviews (15 doctors, 15 nurses) were analysed with the Atlas.ti 7 content analysis software. The sources, types, effects of conflicts and conflict management strategies were investigated. The content analysis unfolded the specificities of conflicts in healthcare based on personal experiences. Organizational hierarchy was a substantial source of conflict, especially among physicians, which originates from implicit rules. As a result of the avoiding conflict management the conflicts remain partly unresolved which has negative individual and group effect. Our conceptual framework helps to develop a proper intervention specific to healthcare. Orv. Hetil., 2017, 158(16), 625-632.

  10. [Work schedules in the Hungarian health care system and the sleep quality of nurses]. (United States)

    Fusz, Katalin; Pakai, Annamária; Kívés, Zsuzsanna; Szunomár, Szilvia; Regős, Annamária; Oláh, András


    One way of ensuring the continuity of health care is the shift work, which is burdensome and it can lead to sleep disturbances. The aim of the study was to measure the typical Hungarian nursing shift systems in hospitals, to analyse the causes of irregular work schedules, and to compare the sleep quality of nurses in different work schedules. 236 head nurses filled out the national online survey, and 217 nurses in clinics of the University of Pécs filled the Hungarian version of Bergen Shift Work Sleep Questionnaire. The head nurses provided data of 8697 nurses's schedules. 51.89% of nurses work in flexible shift system. 1944 employees work in regular shift system, most of them in the following order: 12-hour day shift and 12-hour night shift, followed by a one- or two-day rest. Where there is no system of shifts, the most frequent causes are the needs of nurses and the nurse shortage. Nurses who are working in irregular shift system had worse sleep quality than nurses who are working in flexible and regular shift system (p = 0.044). It would be helpful if the least burdensome shift system could be established.

  11. [Impact of reorganization of the Hungarian system of intensive care units in 2012]. (United States)

    Gresz, Miklós


    In 2012, the Hungarian system of intensive care units was reorganized. During this process, multidisciplinary units were separated from observation units. The author analysed certain indicators of the remaining intensive care units. The study was based on reports of National Health Insurance Fund between 2000 and 2015. After reorganization the number of the multidisciplinary intensive care units decreased by 20% and the number of beds decreased by 10%. Due to the reorganization, both the case-mix index and the days of mechanical ventilation increased significantly in the multidisciplinary intensive care units. In 2000, 12% of the patients were discharged directly from the intensive care units to home, but by 2014, this figure decreased to 3%. The bed-occupancy rate of the intensive care units did not change fundamentally and it was under 80% in each calendar day. In addition to the ICD leading groups I and J, the rate of "Sine morbo" (U9990) diagnosis decreased from 0.7% to 0.2%. Similarly, the ratio of R group which describes only symptoms decreased from 1.7% to 1.1%. In contrast, between the interventions the number of fluid and electrolyte imbalances and respiratory monitoring showed more than twofold increase. These results suggest that the reorganization was effective. The activity of the intensive care units has improved significantly, without disturbing patient care. The author suggests further analysis on the basis of the same criteria for other departments and the consistent continuation of the reorganization process. Orv. Hetil., 2016, 157(44), 1757-1761.

  12. [Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. (United States)

    Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Szücs, Ákos; Czakó, László


    Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  13. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service. (United States)

    Soti, Akos; Temesvari, Peter; Hetzman, Laszlo; Eross, Attila; Petroczy, Andras


    In 2011 the Hungarian Air Ambulance Nonprofit Limited Company introduced a new Rapid Sequence Intubation standard operating procedure using a template from London's Air Ambulance. This replaced a previous ad-hoc and unsafe prehospital advanced airway management practice. It was hoped that this would increase clinical standards including internationally comparable results. All Rapid Sequence Intubations performed by the units of the Hungarian Air Ambulance under the new procedure between June 2011 and November 2013 were reviewed in a retrospective database analysis. During this period the air ambulance units completed 4880 missions with 433 intubations performed according to the new procedure. The rate of intubations that were successful on first attempt was 95.4% (413), while intubation was successful overall in 99.1% (429) of the cases; there was no failed airway. 90 complications were noted with 73 (16.9%) patients. Average on scene time was 49 minutes (ranging between: 15-110 minutes). This data shows that it is possible to effectively change a system that was in place for decades by implementing a new robust system that is based on a good template.

  14. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

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    Bencsik Gabor


    Full Text Available Abstract Background Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes. Methods We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459 admitted to ICUs between October 1st, 2009 and November 30th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs. Results The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4% had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%. The overall in-hospital mortality rate of AKI was 49% (55/112. The ICU mortality rate was 39.3% (44/112. The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3. Conclusions For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.

  15. [Hepatitis C: diagnosis, anti-viral therapy, after-care. Hungarian consensus guideline]. (United States)

    Hunyady, Béla; Gerlei, Zsuzsanna; Gervain, Judit; Horváth, Gábor; Lengyel, Gabriella; Pár, Alajos; Rókusz, László; Szalay, Ferenc; Telegdy, László; Tornai, István; Werling, Klára; Makara, Mihály


    Approximately 70,000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. Furthermore, these could from prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity, as a socioeconomic aspect. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antivirals and interferon-free combination therapies have been registered for the treatment of chronic hepatitis C with a potential efficacy over 90% and typically with a short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and/or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent

  16. Hand hygiene perception among health care workers in Hungarian hospitals: prior to a nationwide microbiological survey. (United States)

    Szabó, Rita; Böröcz, Karolina; Nagy, Orsolya; Takács, Mária; Szomor, Katalin N


    Transmission of pathogens via healthcare workers' (HCWs) hands is one of the most frequent means of spreading multi-resistant organisms and occurring healthcare-associated infections (HAIs) in hospitals. The role of contaminated hands in pathogen transmission was recognized by Hungarian physician, Ignác Semmelweis. Hand hygiene prevents cross-infections in hospitals, but numerous epidemiological and microbiology-based studies have documented low compliance of HCWs with this simple procedure. Furthermore, hand hygiene perception of HCWs plays an important role in determining hand hygiene compliance. Our aim was to describe the opinion of HCWs about their perception regarding hand hygiene practice. Our further goal was to strengthen a laboratory basis for bacterial backup control of nosocomial pathogens. A cross-sectional descriptive study was conducted between December 2010 and February 2011 in 13 participating hospitals in Hungary. HCWs know that there is correlation between contaminated hands and HAIs (83%), but neither the frequency (62%) nor the implementation (73%) of their hand hygiene performance are satisfying.We recommend that multimodal interventions - highlighted active microbiological surveillance of HCWs' hands - are the most suitable strategies to reduce the occurrence of HAIs and to determine their impact on cross-transmission of microorganisms and to overcome barriers of HCWs.

  17. [Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. (United States)

    Takács, Tamás; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Patai, Árpád; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Tiszlavicz, László; Szücs, Ákos


    Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.


    Directory of Open Access Journals (Sweden)

    Dorisz Talas


    Full Text Available This study analyses trends in the working capital management of those Hungarian dairy companies that feature the highest levels of sales revenues in the domestic market and diversified product structures. In view of the significance of food industry in the national economy, a particularly important question to examine in this context is to see what impacts the economic crisis has had on the business operations of the dominant companies of the sector, what processes it has triggered in working capital management. In 2012, 44 of the 500 companies with the largest amounts of sales were operating in the food processing sector. Within the group of these 44 enterprises, dairy companies had an 11% share. On the other hand, 82% of the total sales revenues of the dairy industry was given by the 15 companies where the individual amounts of registered capital are over HUF 250 million, which reflects a strong sales revenue concentration. Therefore, it has been an interesting aspect to study how in such a concentrated sector the leading companies shape their working capital management, what processes can be observed in this respect. This study has relied on the annual reports, i.e. the balance sheets and profit & loss accounts of the companies for the fiscal period of 2008–2012. The research methodology of the analysis is based on the review of financial indicators internationally accepted and used in connection with working capital management. Moreover, the study determines a cash conversion cycle, and in this context the inventory and receivables turnover, as well as the payables turnover. It has been assessed what changes the above-mentioned indicators of the competitors belonging to the target group of analysis have undergone, if there has been a general tendency of changes to be identified. For outstanding values it has been analysed what the large-scale changes could have been caused by. Fundamentally, I have aspired to reveal whether there has been

  19. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.


    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  20. Examination of Performance Management Targets in Case of an International Corporation’s Eastern Hungarian Operating Unit

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    Nemeth Zoltan


    Full Text Available Nowadays, due to the social and economic changes, the human is already the main resource which determines the successfulness of corporations. The expertise in managing the human resources is a key factor of competitiveness therefore it has become a strategic question. Primary aim of the treatise is to outline the most important principles, targets and peculiarities of performance management system, which is a central element of human resource management, as well as its interconnectedness with the individual performance evaluation and human resource development through the mirror of one of today’s biggest Hungarian economic corporations. We aimed to explore, by means of document analysis as well as methods of case study and interview, how the targets of performance management are used for increasing the economic productivity, preserving the competitiveness, retaining and enhancing the satisfaction of workers. It can be stated that the PM system was continuously improved in case of the organization examined because the corporate goals and the expected performances were adjusted to the changing market demands over time but, at the same time the goal of differentiation has remained unchanged. Each worker evaluates his/her performance individually, the base of which is the extent of contribution to the corporate results. Based on the results, it can overall be stated that such a well-functioning performance management system is applied in the operating unit of the corporation examined which is strongly supported by the organizational culture and which contributes to the joint fulfilment of personal as well as organizational goals.

  1. Managed health care. (United States)

    Curtiss, F R


    The fundamental components of managed-care plans are described; the development of managed-care programs is discussed; and the impact of managed care on pharmacy services and the price, quality, and accessibility of health care are reviewed. Health care can be considered to be managed when at least one of the following fundamental components is present: prospective pricing, "UCR" (usual, customary, and reasonable) pricing of services, peer review, mandatory use review, benefit redesign, capitation payments, channeling, quality criteria, and health promotion. The managed-care industry consists of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and managed fee-for-service plans. Managed-care reimbursement principles involve transferring some or all of the impetus for controlling use of services to the health-care provider. Means by which this is done include prospective pricing, services bundling, price discounts and negotiated fees, and capitation financing and reimbursement. Financial risk-sharing arrangements with providers--including hospitals, physicians, pharmacies, and home-care companies--are necessary for any managed-care plan to attain true control over its service costs. Use-review and use-management services are also fundamental to containing health-care spending. These include retrospective, concurrent, and prospective reviews of the necessity and appropriateness of medical services. Use management, like services bundling and prospective pricing, has been more effective in reducing costs of hospital inpatient services than costs associated with ambulatory care. Per case payments and services bundling have made individual charges for items irrelevant to hospital revenue. This has forced hospital pharmacy managers to become more sensitive to cost management. Drug formularies, improved productivity, and use of prescribing protocols are means by which hospital pharmacies have controlled costs. However, since shorter hospital

  2. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service

    National Research Council Canada - National Science Library

    Soti, Akos; Temesvari, Peter; Hetzman, Laszlo; Eross, Attila; Petroczy, Andras


    .... This replaced a previous ad-hoc and unsafe prehospital advanced airway management practice. It was hoped that this would increase clinical standards including internationally comparable results...

  3. Health care marketing management. (United States)

    Cooper, P D


    Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.

  4. [The most important obstacles of the development of Hungarian psychiatry]. (United States)

    Kalmár, Sándor


    A quarter of a century ago the change of the political system in Hungary precipitated a serious value-crisis and caused a lot of harmful effects in nurturing and the development of psychiatry. The author establishes that the attack against psychiatry is more intensive than previously but neither the education and health management nor the psychiatric leadership could cope with these difficulties. It can't be denied that the foundation of lifelong mental health begins in the early life years and about 75% of the first Mental Disorder manifests in adolescence and youth. We are not able to ensure the special rights of every child according to the Hungarian Constitution and the Declaration of the Rights of the Child by the United Nations. The large inequalities within the country, the lack of paramount mental education and nurturing, the lack of essential, consistent eternal values, the lack of required psychiatric care system are huge obstacles of the development of healthy individual and leads to self-destructive behaviour and several, serious physical and mental disorders. The purpose of the author is to call psychiatrists' attention to the main obstacles of the development of Hungarian Psychiatric Care System. The main obstacles of the present psychiatric care system: 1. Unclarified notions, confusion of ideas. 2. Somatic, neurologic, mental, cultural-social and spiritual ignorance. 3. Lack of organization in Mental Education and Psychiatric Care System. 4. Value-crisis in our society despite the fact that the "Council of Wise Men" created a "Scale of the Essential Consistent Eternal Values" for the Hungarian Education System in 2008. 5. Lack of mental health prevention both in education system and health care system. There is no teaching of hygiene lessons in the Hungarian schools. 6. Negligence and selfishness among the population. 7. Disinterest among competent authorities. 8. Leaving the most important possibilities out of consideration. The author establishes

  5. Evaluation of participatory planning: Lessons from Hungarian Natura 2000 management planning processes. (United States)

    Kovács, Eszter; Kelemen, Eszter; Kiss, Gabriella; Kalóczkai, Ágnes; Fabók, Veronika; Mihók, Barbara; Megyesi, Boldizsár; Pataki, György; Bodorkós, Barbara; Balázs, Bálint; Bela, Györgyi; Margóczi, Katalin; Roboz, Ágnes; Molnár, Dániel


    Stakeholder participation in nature conservation policies and especially in the management of protected areas has gained importance in the last decades. These changes are underlined by democratic principles and the perceived contribution of stakeholder involvement to the effectiveness of conservation management. Evaluating participatory processes is essential to learn about the past and thus increase the quality of future processes. The evaluation can be useful for the organisations responsible for planning and management, stakeholders and policy makers as well. The present paper shows the results of a systematic evaluation of 25 participatory processes related to the development of management plans for Natura 2000 sites in Hungary between 2007 and 2015. A conceptual framework was developed to evaluate the process and outcome of participatory management planning processes. Criteria were based on the scientific literature on public participation and tailored to conservation-related management planning and stakeholder involvement. Evaluated processes were grouped in three cases based on their time range and financial sources. Overall, the analysed processes scored at a medium level, showing better performance in the process criteria than in the outcome criteria. The best case scored significantly higher in four criteria compared to the other cases: representativeness, resource availability for facilitation, new, creative ideas and impact on the plan. The main factors behind the success were (1) embeddedness of the planning process in a larger project, where the plan was a tool for conservation, (2) carrying out only one process at a time, (3) previous experience of facilitators and planners with participatory planning and (4) the opportunity and capacity to propose a payment scheme as an incentive. But even this case received low scores in some criteria: conflict resolution, early involvement and well defined goals. Based on the results we suggest that more data is

  6. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians


    Rurik Imre; Torzsa Péter; Ilyés István (1943-) (gyermekgyógyász, gyermekendokrinológus, háziorvos); Szigethy Endre (1980-) (szociológus, epidemiológus); Halmy Lászlóné (orvos, Budapest); Iski Gabriella; Kolozsvári László Róbert (1977-) (háziorvos); Mester Lajos; Móczár Csaba (1966-) (háziorvos); Rinfel József; Nagy Lajos; Kalabay László


    Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In d...

  7. Managing as blended care. (United States)

    Mintzberg, H


    As part of a research project on managerial work based on a new model of the roles, the head nurse of a hospital unit was observed during a working day. Her work is described, with reference especially to the roles of leading, linking, controlling, and doing. Conclusions are drawn about the advantages of a craft style of management as opposed to the more traditional "boss" or professional styles. The author also discusses what those in general management can learn from those in nursing management, which seems best practiced out in the open, on one's feet, as a kind of blended care.

  8. Managed care and economic dynamics. (United States)

    Riggs, J E


    Over the past several decades, health care delivery in the United States evolved in an environment lacking marketplace constraints. The unforeseen result was the current health care crisis--uncontrolled costs, shrinking access, and redundant technological capabilities. Managed care is a strategy to impose fiscal constraints on health care delivery. A diagrammatic analysis of the economic dynamics between consumers and producers in an open marketplace is compared with that of patients, providers, and payers under the health care scheme that produced the health care crisis and under managed care. Patient demands, expectations, and needs for health care are not subject to fiscal constraint under managed care since the dislinkage between consumer and payer still exits. Managed care does not impose true open marketplace fiscal constraints on health care delivery. Furthermore, any solution to the US health care crisis that used true marketplace fiscal constraints would necessitate fundamental changes in societal values concerning individual rights to health care.

  9. Types of Managed Care Plans (United States)

    ... Size Email Print Share Types of Managed Care Plans Page Content Article Body ​Managed care plans have ... to any deductible you must meet. High Deductible Plans (HDP): HDPs, also known as consumer directed health ...

  10. Managed care under siege. (United States)

    Epstein, R A


    Managed Care Organizations (MCOs) are frequently criticized for their marketing mistakes. Often that criticism is leveled against an implicit benchmark of an ideal competitive market or an ideal system of government provision. But any accurate assessment in the choice of health care organizations always requires a comparative measure of error rates. These are high in the provision of health care, given the inherent uncertainties in both the cost and effectiveness of treatment. But the continuous and rapid evolution of private health care mechanisms is, in the absence of regulation, more likely to secure access and contain costs than any system of government regulation. State regulation is subject to the risk of capture and to the sluggish and acquisitive behavior of state run monopolies. The proposed fixes for the MCOs (rights to specialists, access to physicians outside the network, guaranteed emergency room access) are likely, when imposed from without, to cost more than they are worth. The long-term risk is that markets will fail under regulation, paving the way for greater losses from massive government control of the health care delivery system.

  11. Medicaid Managed Care Structures and Care Coordination. (United States)

    Gilchrist-Scott, Douglas H; Feinstein, James A; Agrawal, Rishi


    Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs. Copyright © 2017 by the American Academy of Pediatrics.

  12. Telicity marking in Hungarian

    Directory of Open Access Journals (Sweden)

    Éva Kardos


    Full Text Available This paper explores the encoding of telicity in Hungarian. While proposing a mereological, scalar semantic analysis, it shows that Hungarian uses a telicity-marking strategy in which it contrasts with English, where telicity is not the direct consequence of an overt marker but arises as a cumulative effect of specific, well-definable properties of various components of verbal predicates including the head verb and its argument(s. A major contribution of the analysis, which mainly addresses telicity marking in the class of non-creation/non-consumption predicates in neutral sentences, lies in the fact that it reveals important cross-linguistic differences with respect to the aspectual role of verbal particles and resultative/locative expressions and the referential properties of telic verbal predicates. As for the former, it is demonstrated that Hungarian verbal particles and resultative/locative expressions mark telicity by directly placing bounds on events by virtue of serving an event maximalizing function, whereas the English counterparts of these elements do not have such direct event-bounding effects. As for the latter, it emerges that in Hungarian quantized reference is a necessary and sufficient condition for telicity in cases where in English it is only sufficient.

  13. Managing acute care. (United States)

    Russell, J S


    In the last few years, much medical-facility construction has been driven by what insurers want. Hospitals have built facilities for well-reimbursed procedures and closed money-losing ones. Health-maintenance organizations increasingly expect to hold down costs by making prepayment arrangements with doctors and their hospitals. President Clinton has pledged early action on health-care reform, which will likely change planners' priorities. Whether the nation goes to Clintonian "managed competition" or a Canadian-style nationwide single-payer system (the two most likely options), the projects on these pages reflect two large-scale trends that are likely to continue: the movement of more procedures from inpatient to outpatient facilities and the separation of treatment functions from ordinary office and administrative tasks so that the latter are not performed in the same high-cost buildings as technology-intensive procedures. Various schemes that make care more "patient-centered" have been tried and been shown to speed healing, even for outpatients, but such hard-to-quantify issues get short shrift in an era of knee-jerk cost containment. The challenge in tomorrow's healthcare universe--whatever it becomes--will be to keep these issues on the table.

  14. Computerization of Hungarian reforestation manual with machine learning methods (United States)

    Czimber, Kornél; Gálos, Borbála; Mátyás, Csaba; Bidló, András; Gribovszki, Zoltán


    Hungarian forests are highly sensitive to the changing climate, especially to the available precipitation amount. Over the past two decades several drought damages were observed for tree species which are in the lower xeric limit of their distribution. From year to year these affected forest stands become more difficult to reforest with the same native species because these are not able to adapt to the increasing probability of droughts. The climate related parameter set of the Hungarian forest stand database needs updates. Air humidity that was formerly used to define the forest climate zones is not measured anymore and its value based on climate model outputs is highly uncertain. The aim was to develop a novel computerized and objective method to describe the species-specific climate conditions that is essential for survival, growth and optimal production of the forest ecosystems. The method is expected to project the species spatial distribution until 2100 on the basis of regional climate model simulations. Until now, Hungarian forest managers have been using a carefully edited spreadsheet for reforestation purposes. Applying binding regulations this spreadsheet prescribes the stand-forming and admixed tree species and their expected growth rate for each forest site types. We are going to present a new machine learning based method to replace the former spreadsheet. We took into great consideration of various methods, such as maximum likelihood, Bayesian networks, Fuzzy logic. The method calculates distributions, setups classification, which can be validated and modified by experts if necessary. Projected climate change conditions makes necessary to include into this system an additional climate zone that does not exist in our region now, as well as new options for potential tree species. In addition to or instead of the existing ones, the influence of further limiting parameters (climatic extremes, soil water retention) are also investigated. Results will be

  15. Austro-Hungarian Bank building in Subotica

    Directory of Open Access Journals (Sweden)

    Aladžić Viktorija


    Full Text Available During the negotiations between Austria and Hungary in 1867 when dual Austro-Hungarian Monarchy was formed, the question of the central bank was not touched to prevent further complications. In 1878, after years of prolonged negotiations, the central bank was successfully transformed into an institute in which Austria and Hungary had an equal share. The 'Austro- Hungarian Bank' acted as a central bank for both parts of the Empire. The dualistic character of the institute was characterized by two managements and two head offices in Vienna and Budapest. During first decade of 20th century it was built few dozens of bank buildings in Hungary and the most important: the central Austro-Hungarian Bank building in Budapest on Szabadsbg tjr 8. Bank building in Budapest was built according to the design made by Ignbc Alpbr who won the competition. Most of the other bank buildings built throughout Hungary were designed by architect Juzsef Hubert, but Austro-Hungarian bank building in Subotica was designed by architect Ferenc Juzsef Raichl in 1901. Main topic of this paper is research of architecture of Austro-Hungarian Bank Building in Subotica. It is obvious, although smaller in size, that the building was designed according to the main concept of the central bank building in Budapest. Compositions of the both facade applied similar architectural elements, like pillars, projections, attics, plinth and also decorative elements that symbolizes the function of a building. Inner organization of space also corresponds to each other, in both buildings: beside offices there were several apartments for renting. In contrast to other bank buildings in Hungary designed by Juzsef Hubert, bank building in Subotica, although made according to the concept of Central Bank building in Budapest represents remarkable and unique architectural masterpiece including all: architectural composition, decorative elements and function of a building.

  16. Managed Care, Ethics, and Counseling. (United States)

    Daniels, Jeffrey A.


    Addresses issues of managed care and ethics and how they relate to counseling. Specifically reviews a recent article published in "The Counseling Psychologist" (2000). Explores implications for counselors and counselor educators. (Author/GCP)

  17. Emotional Intelligence of Hungarian Teachers (United States)

    Baracsi, Ágnes


    The research focused on the personal and social competencies of Hungarian teachers as unexplored areas. The participants in the survey were 707 Hungarian teachers from elementary and secondary schools. In view of the expectations of the European Union related to new teacher roles, the following research question was formulated to guide the study:…

  18. Structuring managed care joint ventures. (United States)

    Williams, L


    Providers that undertake joint ventures to secure managed care contracts must understand the important governance, operational, legal, and political issues involved. Careful planning in all these areas can help ensure that the joint venture will meet its goals and avoid problems such as inappropriately negotiated contracts and legal violations.

  19. Total quality management issues in managed care. (United States)

    McLaughlin, C P; Kaluzny, A D


    The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services.

  20. Pain management in neurocritical care. (United States)

    Petzold, Axel; Girbes, Armand


    The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed.

  1. Managing the current and future supply of ecosystem services in the Hungarian and Romanian Tisza River Basin

    NARCIS (Netherlands)

    Petz, K.; Minca, E.L.; Werners, S.E.; Leemans, R.


    Ecosystem services that sustain human well-being depend on the continued functioning of ecosystems, proper management and supporting institutions. However, the interaction between these factors and ecosystem services is poorly understood. Therefore, we assessed how ecosystem services are represented

  2. Inadequate reimbursement for care management to primary care offices. (United States)

    Holtrop, Jodi Summers; Luo, Zhehui; Alexanders, Lynn


    Care management in primary care can be effective in helping patients with chronic disease improve their health; however, primary care practices are often challenged to identify revenue to pay for it. This study explored the impact of direct reimbursement on the provision of care management in a primary care physician organization. Using data on expenses and health plan reimbursement during the initial 16 months of care management implementation at 5 practices, we calculated the percentage of related costs that were covered by payments. Qualitative data from interviews with practice members were used to identify their perceived barriers to care management reimbursement and the impact of current reimbursement strategies on service delivery. Direct reimbursement for care management covered only 21% of the costs. Reimbursement varied by care manager background, patient diagnoses, insurer, and indication for the visit. Barriers to gaining reimbursement included patient resistance to copay, clinician hesitation to bill for care management visits (for fear the patient may receive a bill), differential reimbursement policies of insurers, and general lack of reimbursement for care management in many cases. Although practice-level quality improvement incentives were an alternative means of supporting care management, because these incentives were not directly tied to the service of care management, they were used for other activities ultimately supporting patient care. This study highlights the need for sufficient reimbursement to initiate and maintain care management for patients in primary care as proposed for service reforms under the Affordable Care Act. © Copyright 2015 by the American Board of Family Medicine.

  3. Legal implications of managed care arrangements. (United States)

    Knox, W A; Epstein, D M


    Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic-market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed.

  4. Nursing Care Management: Influence on Bundled Payments. (United States)

    Lentz, Shaynie; Luther, Brenda

    Fragmented and uncoordinated care is the third highest driver of U.S. healthcare costs. Although less than 10% of patients experience uncoordinated care, these patients represent 36% of total healthcare costs; care management interaction makes a significant impact on the utilization of healthcare dollars. A literature search was conducted to construct a model of care coordination for elective surgical procedures by collecting best practices for acute, transitions, and post-acute care periods. A case study was used to demonstrate the model developed. Care management defines care coordination as a model of care to address improving patient and caregiver engagement, communication across settings of care, and ultimately improved patient outcomes of care. Nurse-led care coordination in the presurgical, inpatient, and post-acute care settings requires systems change and administrative support to effectively meet the goals of the Affordable Care Act of reducing redundancy and costs while improving the patient experience. Nursing is the lynchpin of care management processes in all settings of care; thus, this model of care coordination for elective surgical admissions can provide nursing care management leaders a comprehensive view of coordinating care for these patient across settings of care during the predetermined time period of care. As bundled payment structures increasingly affect hospital systems, nursing leaders need to be ready to create or improve their care management processes; care coordination is one such process requiring immediate attention.

  5. Vajon in Translated Hungarian

    Directory of Open Access Journals (Sweden)

    Götz Andrea


    Full Text Available This paper presents an analysis of the structures the discourse marker vajon forms in translated Hungarian fiction. Although translation data has been deployed in the study of discourse markers (Aijmer & Simon- Vandenbergen, 2004, such studies do not account for translation-specific phenomena which can influence the data of their analysis. In addition, translated discourse markers could offer insights into the idiosyncratic properties of translated texts as well as the culturally defined norms of translation that guide the creation of target texts. The analysis presented in this paper extends the cross-linguistic approach beyond contrastive analysis with a detailed investigation of two corpora of translated texts in order to identify patterns which could be a sign of translation or genre norms impacting the target texts. As a result, a distinct, diverging pattern emerges between the two corpora: patterns of explicit polarity show a marked difference. However, further research is needed to clarify whether these are due to language, genre, or translation norms.

  6. Managed consumerism in health care. (United States)

    Robinson, James C


    The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.

  7. Managing depression in primary care (United States)

    Collins, Kerry A.; Wolfe, Vicky V.; Fisman, Sandra; DePace, JoAnne; Steele, Margaret


    OBJECTIVE To investigate family physicians’ practice patterns for managing depression and mental health concerns among adolescent and adult patients. DESIGN Cross-sectional survey. SETTING London, Ont, a mid-sized Canadian city. PARTICIPANTS One hundred sixty-three family physicians identified through the London and District Academy of Medicine. MAIN OUTCOME MEASURES Practice patterns for managing depression, including screening, pharmacotherapy, psychotherapy, shared care, and training needs. RESULTS Response rate was 63%. Family physicians reported spending a substantial portion of their time during patient visits (26% to 50%) addressing mental health issues, with depression being the most common issue (51% to 75% of patients with mental health issues). About 40% of respondents did routine mental health screening, and 60% screened patients with risk factors for depression. Shared care with mental health professionals was common (care was shared for 26% to 50% of patients). Physicians and patients were moderately satisfied with shared care, but were frustrated by long waiting lists and communication barriers. Most physicians provided psychotherapy to patients in the form of general advice. Differences in practice patterns were observed; physicians treated more adults than adolescents with depression, and they reported greater comfort in treating adults. Although 33% of physicians described using cognitive behavioural therapy (CBT), they reported having little training in CBT. Moderate interest was expressed in CBT training, with a preference for a workshop format. CONCLUSION Although 40% of family physicians routinely screen patients for mental health issues, depression is often not detected. Satisfaction with shared care can be increased through better communication with mental health professionals. Physicians’ management of adolescent patients can be improved by further medical training, consultation, and collaboration with mental health professionals

  8. Inflectional marking in Hungarian aphasics. (United States)

    MacWhinney, B; Osmán-Sági, J


    How do aphasics deal with the rich inflectional marking available in agglutinative languages like Hungarian? For the Hungarian noun alone, aphasics have to deal with over 15 basic case markings and dozens of possible combinations of these basic markings. Using the picture description task of MacWhinney and Bates (1978), this study examined the use of inflectional markings in nine Broca's and five Wernicke's aphasic speakers of Hungarian. The analysis focused on subject, direct object, indirect object, and locative nominal arguments. Compared to normals, both groups had a much higher rate of omission of all argument types. Subject ellipsis was particularly strong, as it is in normal Hungarian. There was a tendency for Broca's to omit the indirect object and for Wernicke's to omit the direct object. Across argument types, Wernicke's had a much higher level of pronoun usage than did Broca's. Broca's also showed a very high level of article omission. Compared to similar data reported by Slobin (this issue) for Turkish, the Hungarian aphasics showed an elevated level of omission of case markings. Addition errors were quite rare, but there were 14 substitutions of one case marking for another. These errors all involved the substitution of some close semantic competitor. There were no errors in the basic rules for vowel harmony or morpheme order. Overall the results paint a picture of a group of individuals whose grammatical abilities are damaged and noisy, but still largely functional. Neither the view of Broca's as agrammatic nor the view of Wernicke's as paragrammatic was strongly supported.

  9. [How to help and promote Hungarian medical publications?]. (United States)

    Rurik, Imre


    The journal impact factor (IF) is often recognized as a symbol of scientific prestige and relevance. However it is greatly influenced by the field or scope of journals, publisher, scientific, editorial, and economic background. Although there are many suggestions to modify the most important scientometric parameter, it is widely used to compare journals, individuals, departments, scientific outputs to judge academic promotions, grant allocations, awarding appointments. Most of the researchers use international database searching relevant publication, which will be cited in their own paper. Unfortunately these international databases refer only few Hungarian journals. It is recommended to develop and maintain a Hungarian Electronic Medical Bibliography, divided by the field of scientific interest (e.g., diabetology, gastroenterology, public health, urology etc.). Authors can upload the list or full text of publications, if copyright agreements allow, and search other Hungarian papers for citation, to promote each others. Organizer, manager, host and supporters of this database are very welcomed.

  10. [Hungarian psychiatry in the light of the Hungarian Presidency of the Council of the European Union]. (United States)

    Kurimay, Tamás


    In order to get an accurate picture of mental health and psychiatric care, the article reviews the relevant structures and functioning of the European Union. It examines a few, important professional events that reflect the gaining significance of the issue of mental health within the EU; the 2005 World Health Organization's European Ministerial Conference, the 2008 European Pact for Mental Health and Well-being, and the results of the so-called Thematic Conferences. For the future of the European Union, the articles stresses the crucial need for the continuing research and development, and highlights the benefits of the European Research Region an its framework programmes especially in the fields of brain research and mental health research. The issue of mental health, its care providing system, and the atmosphere of the work place, as the surveying of the Eurobarometer underscored, should be treated as priorities for the EU and during the Hungarian presidency. The programme of the Hungarian Presidency of the Council of the European Union provides priority to the presentation of the European Pact for Mental Health and Well-being to the Council Conclusion, as well as to the organization of a priority research presidential conference on the regions R and D, entitled "Discovery research in neuropsychiatry: depression, anxiety and schizophrenia in focus." The articles emphasizes the challenges of Hungarian psychiatry, first and foremost the difficulties of human resources, the theoretical context and determined perspectives for the establishment of the new National Psychiatry and Addictology Institute, the need of the move towards GP's and community care, and the importance of the cooperation with civil organizations, and scientific information gathering. The given tasks can only be achieved along with the professional development of psychiatry, with a change of perspectives towards EU since a concentrated multi level allocation of resources is only possible in the

  11. Primary care patient and provider preferences for diabetes care managers

    Directory of Open Access Journals (Sweden)

    Ramona S DeJesus


    Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care

  12. Managed care innovation and new product development. (United States)

    Clark, C S; Schuster, T B


    This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

  13. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira


    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  14. An overview of Medicaid managed care litigation. (United States)

    Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T


    Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of

  15. Multiple Operator Movements in Hungarian

    NARCIS (Netherlands)

    Surányi, L.B.


    In this thesis I argue for an approach to multiple operator constructions in Hungarian within a radically derivational model which heavily restricts the role of pre-fabricated functional A-bar projections and which holds that it is the verb in this language that carries and projects the relevant ope

  16. A managed care cycle provides contract oversight. (United States)

    Stevenson, Paul B; Messinger, Stephen F; Welter, Terri


    In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments.

  17. Spirulina in health care management. (United States)

    Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S


    Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management.

  18. Blogging and the health care manager. (United States)

    Malvey, Donna; Alderman, Barbara; Todd, Andrew D


    The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.

  19. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group]. (United States)

    Hritz, István; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Szücs, Ákos; Takács, Tamás; Tiszlavicz, László; Hegyi, Péter


    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary.

  20. Future developments in health care performance management

    Directory of Open Access Journals (Sweden)

    Crema M


    Full Text Available Maria Crema, Chiara Verbano Department of Management and Engineering, University of Padova, Vicenza, Italy Abstract: This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. Keywords: health care, lean management, clinical risk management, quality, health care processes

  1. Strategic management of health care information systems: nurse managers' perceptions. (United States)

    Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha


    The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

  2. Radiology education in Hungarian schools

    Energy Technology Data Exchange (ETDEWEB)

    Marx, G. [Department of Atomic Physics, Boetvoes Univ., Budapest (Hungary)


    Basic concepts of nuclear physics are not more abstract and more difficult than those of electricity. For the orientation of the citizens of the 21st century, the Hungarian school curriculum has made them compulsory for all teenagers. According to the teachers' experience, the students find nuclear issues more relevant and more interesting than the topics inherited from the schoolbooks of earlier centuries. (author)

  3. Primary care quality management in Uzbekistan.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.


    The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have

  4. Primary care quality management in Uzbekistan.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.


    The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have bee

  5. Managing Complaints in Multilingual Care Encounters (United States)

    Jansson, Gunilla; Wadensjö, Cecilia; Plejert, Charlotta


    Troubles-telling and complaints are common in contexts of care for older people and need to be managed by care staff in a respectful manner. This paper examines the handling of an older person's complaints in multilingual care encounters that involve participants who do not share a common language. The data consist of video-recordings and…

  6. Negotiating in a managed care world. (United States)

    Rubel, Barbara F; Roettele, Steve


    Medical managed care, once thought to be a passing influence affecting large urban markets only, has proven to be a dominating factor in virtually every medical practice in the country. Discounted rates, steerage, utilization management, pay for performance, and other managed care strategies are likely to be a provider's reality for the foreseeable future. It is imperative that physicians develop negotiating skills and educate themselves about how to negotiate not only rates but also the other components discussed herein that ultimately determine the economic viability of a managed care agreement.

  7. Symptom management in palliative care and end of life care. (United States)

    Bookbinder, Marilyn; McHugh, Marlene E


    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  8. Functions of modal particles in Hungarian


    Marusynets, Marianna


    The article discusses the functions of Hungarian modal particles from the Relevance Theory perspective, which offers a cognitive account of utterance interpretation. It is argued that Hungarian modal particles govern the selection of context by guiding the hearer towards relevant interpretation.

  9. Ethnic Attitudes of Hungarian Students in Romania (United States)

    Ives, Bob; Obenchain, Kathryn M.; Oikonomidoy, Eleni


    Participants in this study were ethnic Hungarian secondary students attending high schools in Romania in which Hungarian was the primary language of instruction. Attitudes of participants toward ethnic and cultural groups were measured using a variation of the Bogardus (1933) Scale of Social Distance. Results were consistent with predictions based…

  10. No exodus: physicians and managed care networks. (United States)

    O'Malley, Ann S; Reschovsky, James D


    After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.

  11. Managed care in four managed competition OECD health systems. (United States)

    Shmueli, Amir; Stam, Piet; Wasem, Jürgen; Trottmann, Maria


    Managed care emerged in the American health system in the 1980s as a way to manage suppliers' induced demand and to contain insurers' costs. While in Israel the health insurers have always been managed care organizations, owning health care facilities, employing medical personnel or contracting selectively with independent providers, European insurers have been much more passive, submitting themselves to collective agreements between insurers' and providers' associations, accompanied by extensive government regulation of prices, quantities, and budgets. With the 1990s reforms, and the introduction of risk-adjusted "managed competition", a growing pressure to allow the European insurers to manage their own care - including selective contracting with providers - has emerged, with varying speed of the introduction of policy changes across the individual countries. This paper compares experiences with managed care in Israel, The Netherlands, Germany and Switzerland since the 1990s. After a brief description of the health insurance markets in the four countries, we focus comparatively on the emergence of managed care in the markets for ambulatory care and inpatient market care. We conclude with an evaluation of the current situation and a discussion of selected health policy issues. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Future developments in health care performance management. (United States)

    Crema, Maria; Verbano, Chiara


    This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance.

  13. Using care plans to better manage multimorbidity

    Directory of Open Access Journals (Sweden)

    Mark AJ Morgan


    Full Text Available Background The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs, each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. Methods A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control from 11 Australian general practices in regional and metropolitan areas. Results Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. Conclusion The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities.

  14. Using care plans to better manage multimorbidity. (United States)

    Morgan, Mark Aj; Coates, Michael J; Dunbar, James A


    The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control) from 11 Australian general practices in regional and metropolitan areas. Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities.

  15. Medicare Managed Care plan Performance, A Comparison... (United States)

    U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...

  16. Home Care Nursing Improves Cancer Symptom Management (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  17. Managed care and the infectious diseases specialist. (United States)

    Tice, A D; Slama, T G; Berman, S; Braun, P; Burke, J P; Cherney, A; Gross, P A; Harris, P; Reid-Hatton, M; Hoffman, R; Joseph, P; Lawton, S; Massanari, R M; Miller, Z I; Osheroff, W J; Poretz, D; Shalowitz, M; Simmons, B; Turner, J P; Wade, B; Nolet, B R


    There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

  18. Magyar Nemzeti Helynévtár [The Hungarian National Toponym Registry

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    Hoffmann, István


    Full Text Available The website of the Hungarian National Toponym Registry was launched in October 2015 ( The Hungarian National Toponym Registry is a digital database designed to store and manage the complete synchronic and diachronic place name stock of the Hungarian language area. The database consists of two units: the Hungarian Names Archives (, which stores place names in text and excel files (and incorporates approximately 450,000 data and the Hungarian Digital Toponym Registry (, the early and modern modules of which can be accessed as online databases (incorporating approximately 280,000 data. Data can be retrieved through a number of organisation and search options focusing on different features; the results can be projected to maps; detailed information is available with regard to each name form and indicated place. The paper presents the workings of the Hungarian National Toponym Registry, summarising the project’s progress, some further objectives, and the scientific and social significance of the research programme.

  19. Future developments in health care performance management


    Crema M; Verbano C


    Maria Crema, Chiara Verbano Department of Management and Engineering, University of Padova, Vicenza, Italy Abstract: This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to...

  20. Participative management in health care services

    Directory of Open Access Journals (Sweden)

    M. Muller


    Full Text Available The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalisation of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management.

  1. Total quality management in behavioral health care. (United States)

    Sluyter, G V


    The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.

  2. Primary care quality management in Slovenia.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.


    Of all GPs in Slovenia 86% are not interested in activities to systematically improve care. A clear national quality policy, further education for care managers and financial incentives for GPs could change the picture, as NIVEL research – done on the initiative of the World Health Organisation (WHO

  3. Using care plans to better manage multimorbidity


    Mark AJ Morgan; Coates, Michael J; Dunbar, James A


    Background The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the managemen...

  4. 42 CFR 440.168 - Primary care case management services. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary option...

  5. Producing Just Papers or Creating Added Value? Snap-Shot about Quality Systems at Hungarian SMEs

    Directory of Open Access Journals (Sweden)

    Emil NYERKI


    Full Text Available In this paper, a short historical review and the research results are presented, which are focused on the quality management systems used by the Hungarian SME’s. The research was based on an original empirical survey, conducted using a random sample of fifty managers from small and medium sized Hungarian enterprises. All of them use certified quality management systems. The paper presents their current state in the light of their responses, under several aspects. In conclusion, suggestions are given for the problems, such as measurement, development, and education on the research topic.

  6. Managing diversity in the health care workplace. (United States)

    Davidhizar, R; Dowd, S; Newman Giger, J


    Cultural diversity is increasing in the United States as increasing numbers of minorities enter the United States from abroad, and cultural diversity is especially prevalent in the health care workplace. In fact, the health care professions are particularly interested in the presence of minorities among caregivers because this often enhances the cultural competence of care delivery. Nevertheless, subtle discrimination can still be found, and managers must be alert that such behavior is not tolerated. Use of the Giger-Davidhizar Cultural Assessment Model can provide managers with information needed to respond to diversity among staff appropriately.

  7. Simulation modeling for the health care manager. (United States)

    Kennedy, Michael H


    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  8. Job redesign and the health care manager. (United States)

    Layman, Elizabeth J


    Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation.

  9. Leadership philosophy of care home managers. (United States)

    Rippon, Daniel; James, Ian Andrew

    Care home managers have a significant influence on staff morale and care delivery. Training methods underpinned by transformational leadership theory (TLT) have been used successfully to develop leaders in healthcare services. The aim of this preliminary study was to establish which aspects of TLT were apparent in care home managers' philosophies of leadership. A qualitative research design was used and 25 care home managers in the north-east of England took part. Participants were asked to provide their philosophies of leadership by completing a questionnaire; a thematic analysis of the responses was then conducted. Development of philosophy, enablement and interpersonal impact emerged as key themes. The findings suggested that elements of TLT were apparent in the participants' philosophies of leadership. However, the importance of gaining the support of senior management when attempting to apply a philosophy of eadership in practice was lacking. Aspects of TLT, such as supporting frontline employees to engage in education and establishing trust, were embedded in care home managers' philosophies. To develop leadership skills, managers may benefit from training programmes that involve both structured teaching and guided learning through experience.

  10. Total quality management in health care. (United States)

    McDonald, S C


    Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends.

  11. Improving managed care value through customer service. (United States)

    Tomczyk, Dennis J


    The ability of managed care providers to deliver high-quality customer service to managed care customers depends on their adoption of basic customer-service principles. To apply these principles effectively, providers need to understand and work to exceed the particular needs and expectations of these customers, which include boards of directors, senior executives, physicians, healthcare providers, clinical and patient financial services managers and staff, employers, brokers, and patients. Although these needs and expectations can be predicted to some extent, providers would be wise to implement regular surveys of customers and an open procedure for soliciting customer feedback about service issues. Better customer service for the broad range of managed care customers translates into higher levels of employer and patient satisfaction, which ultimately benefits providers.

  12. Hungarian climate change action plan

    Energy Technology Data Exchange (ETDEWEB)

    Molnar, S.; Takacs, T. [Systemexpert Consulting Ltd., Budapest (Hungary); Arpasi, M. [MOL, Budapest (Hungary); Farago, T.; Palvoelgyi, T. [Ministry for Environment and Regional Policy, Budapest (Hungary); Harnos, Z. [Univ. of Horticulture, Budapest (Hungary); Lontay, Z. [EGI-Contracting Engineering Co. Ltd., Budapest (Hungary); Somogyi, Z. [Forest Research Inst., Budapest (Hungary); Tajthy, T. [Univ. of Technology, Budapest (Hungary)


    In 1994--1996, within the framework of the US Country Studies Program, the Hungarian Country Study Team developed the national greenhouse gas emission inventory, and elaborated the mitigation options for the different sectors of the economy. In 1997, the development of a National Action Plan was begun as the continuation of this work. Results of the inventory study showed that greenhouse gas emissions decreased from the selected base level (i.e., from the yearly average emissions of 1985--1987) until 1994 by cca. 25%. However, this decrease was primarily caused by the deep economic recession. Therefore the policy makers have to face the problem of economic recovery without a relevant increase of greenhouse gas emissions in the near future. This is the main focus of the mitigation analysis and the National Action Plan.


    Directory of Open Access Journals (Sweden)



    Full Text Available Nowadays, the sustainability already goes far beyond the aspects of environmental protection; the knowledge and the education are also part of the sustainable development. In the field of education, a condition of realizing the sustainability is that the state should ensure a predictable and stable budget for the operation of institutions. Aim of the treatise, at first, is to examine the fulfilment of Europe 2020 Strategy objective affecting the higher education directly and then, based on statistical data, to present the trend in number of students of the Hungarian higher education and its composition by regions and to examine the change in the budgetary support.In order to retain the sustainability and competitiveness, the state and the institutions should make efforts to harmonise their sources and expenditures and to ensure a predictable, stable financial environment for the sector and its stakeholders.

  14. Hungarian repeat station survey, 2010

    Directory of Open Access Journals (Sweden)

    Péter Kovács


    Full Text Available The last Hungarian repeat station survey was completed between October 2010 and February 2011. Declination, inclination and the total field were observed using one-axial DMI fluxgate magnetometer mounted on Zeiss20A theodolite and GSM 19 Overhauser magnetometer. The magnetic elements of the sites were reduced to the epoch of 2010.5 on the basis of the continuous recordings of Tihany Geophysical Observatory. In stations located far from the reference observatory, the observations were carried out in the morning and afternoon in order to decrease the effect of the distant temporal correction. To further increase the accuracy, on-site dIdD variometer has also been installed near the Aggtelek station, in the Baradla cave, during the survey of the easternmost sites. The paper presents the technical details and the results of our last campaign. The improvement of the accuracy of the temporal reduction by the use of the local variometer is also reported.

  15. Multidisciplinary management of complex care. (United States)

    Schofield, Deborah; Fuller, Jeffrey; Wagner, Scott; Friis, Leanne; Tyrell, Bill


    Rural and remote areas of Australia are facing serious health workforce shortages. Multidisciplinary teams are one way of making the most of the rural workforce. In this paper, the advantages of multidisciplinary care in terms of patient outcomes, clinician satisfaction and system efficiency are considered with reference to an innovative rural multidisciplinary model that highlights how these positive outcomes can be achieved. Ways of developing the capacity of the future workforce for work in multidisciplinary teams are discussed.

  16. Dyspepsia management in primary care

    NARCIS (Netherlands)

    Thijs, JC; Arents, NLA; van Zwet, AA; Kleibeuker, JH


    Background: Dyspepsia is common in western society. Prompt endoscopy is imperative in all patients with sinister symptoms or if symptoms first appear after the age of 50-55 years, but the optimal management of younger patients with uncomplicated dyspepsia is still open to debate. Methods: The litera

  17. Strategic Planning in Hungarian Municipalities

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    Izabella BARATI-STEC


    Full Text Available The paper gives a summary of the most recent literature on strategic planning in local governments, while placing the fi ndings in a historical context. It focuses on planning in postsocialist countries, the impact of the heritage ofdecades of central planning and the relationship between decentralization and planning. The study concludes that while strategic planning improves the performance of local governments, special aspects, such as the fi nancial dependency of municipalities, focus on daily operation and on short-term results and enhanced need of institutional and personal capacity management must be taken care of while implementing strategic planning in local governments.

  18. Understanding performance management in primary care. (United States)

    Rogan, Lisa; Boaden, Ruth


    Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

  19. VHA Support Service Center Primary Care Management Module (PCMM) (United States)

    Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...

  20. The knowledge management on the elderly care (United States)

    Arve, Seija; Ovaskainen, Païvi; Randelin, I.; Alin, Jouni; Rautava, Païvi


    Purpose The elderly care pathway from the public health emergency unit to the university hospital and back home needs rationalising. Another purpose is to utilise the information of the electronic patient record system in care coordination. Theory The processed knowledge from the electronic patient record system enables the geriatric professionals to deal with the information of the elderly care pathway effectively and to develop the care in a patient-centred way. Methods All the 75-year-old or older patients who had visited the emergency unit of Turku health care centre were analysed. The data were collected from the Pegasos® electronic patient record system. The method used was time-series analysis. Statistical analyses were run on SAS System for Windows, release 9.1. Results Twenty-three thousand-three hundred and seventy-two older patients visited the emergency unit and 25% of them were referred to hospital, less to the Turku city hospital, more to the university hospital. The information of transitions into the local organisations could be followed, but there were many information gaps in transitions to the university hospital. Conclusion Older people are cared for in the university hospital too often. The expensive care begins at the emergency unit and leads to the long-term institutional care. The care pathway of older patients has to be based on professional capability, co-operation and knowledge management.

  1. 6th Congress of Croatian and Hungarian and 17th Congress of Hungarian Geomathematicians

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    Željka Tutek


    Full Text Available The theme of this year's 6th Congress of Croatian and Hungarian and 17th Congress of Hungarian Geomathematicians was Geomathematics – from theory to practice and its key topics were • Applied geomathematics (geosciences, environmental science • Geomathematics in reservoir characterization and modelling • Hydrological and hydrogeological modelling • Theoretical geomathematics (geostatistics, neural networks, statistics • Geoinformatics (including GIS.

  2. Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals. (United States)

    Dombrádi, Viktor; Csenteri, Orsolya Karola; Sándor, János; Godény, Sándor


    To investigate how International Organization for Standardization (ISO) 9001 and the Hungarian Health Care Standards (HHCS) certifications are associated with quality management, patient safety, patient rights and human resource management activities. A cross-sectional study was implemented using the 2009 Hungarian hospital survey's database. Hungary. Fifty-three general hospitals were included in the statistical analysis. No intervention was carried out in the study. The outcomes included the percentage of compliance in the dimensions of quality management, patient safety, patient rights, human resource management and the overall score for each hospital, and they were grouped according to the hospitals' certifications. Sixteen hospitals did not have either ISO 9001 or HHCS certifications, 19 had ISO 9001 certification only and 18 had both. Hospitals with ISO 9001 alone or in combination with the HHCS significantly outperformed hospitals with no certifications in terms of quality management and human resource management activities but not in terms of patient safety or patient rights activities. Combined, the two models provided the highest median levels in all cases. Nevertheless, no significant differences were observed when the hospitals with both certifications were compared with hospitals with ISO 9001 only. Although the combination of ISO 9001 and the HHCS showed the best results, the benefits were not decisive. Furthermore, although the HHCS include standards addressing patient safety, no direct association was found with regard to compliance. Thus, further investigation is required to understand this enigma.

  3. Managing the myths of health care. (United States)

    Mintzberg, Henry


    Myths impede the effective management of health care, for example that the system is failing (indeed, that is a system), and can be fixed by detached social engineering and heroic leadership, or treating it more like a business. This field needs to reframe its management, as distributed beyond the "top"; its strategy as venturing, not planning; its organizing as collaboration beyond control, and especially itself, as a system beyond its parts.


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    GR. P. POP


    Full Text Available The Szeklers and Hungarians from Romania. This study regards, as its main topic, the possibility of establishing at present, a geodemographical entity on Romania’s territory, since certain representatives of the Hungarian ethnical minority in our country, and with a particular insistence of those in the vicinity of the western border, always remember to bring into view the problem of establishing an autonomy, common to a Székely Land, located in the central area of our country, which would include Mureş, Harghita and Covasna counties. Without carrying out a detailed account of this situation, it needs to be mentioned, just as it will emerge of the following presentation, that such an approach has neither the most reduced geodemographical support, since the Szeklers, after being assimilated by the Hungarian ethnic group, are no longer present at the census of 20 October 2011. By taking into account the above mentioned aspects, in order to be able to respond to the insistent requests for autonomy in Transylvania, we proceeded to highlight, through a fairly detailed approach of the Hungarian ethnical minority, obviously in point of the number of inhabitants and of their distribution on Romania’s territory, resulting of this the fact that the number of Hungarians is of 1,227,623 people, value which related to those 20,121,641 inhabitants of Romania, means 6.10%. The total number of mentioned Hungarians is characterized by a pronounced concentration on Romania’s territory, standing out by creating a corridor with a diagonal aspect, on the northwestsoutheast direction, consisting of seven counties, the first four (Satu Mare, Bihor, Sălaj and Cluj being registered with 2.01% (404,561 inhabitants of those 6.10% Hungarians, the following three (Mureş, Harghita and Covasna accounting for 3.03% (609,033 inhabitants, and hence in the corridor are present 5.04% (1,013,594 Hungarians of 6.10% at the level of the entire country. The above mentioned

  5. Management of asthma in primary care

    NARCIS (Netherlands)

    Honkoop, Pieter Jacob


    Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of ‘Controlled asthma’, which means patients experience hardly any symptom

  6. Treatment-resistant depression: managed care considerations. (United States)

    Tierney, John G


    Treatment-resistant depression (TRD) presents a unique challenge in managed care, requiring review of both the clinical and economic components of care. To review the TRD disease state as well as data supporting the various therapeutic options available for the treatment of persistent depression in managed care. While there is no consensus on the definition of TRD, persistent disease can generally be defined as depression that fails to respond to adequate treatment. When initial treatment is not effective or tolerable after 6 to 8 weeks of therapy, the American Psychiatric Association (APA) treatment guidelines recommend dose titration, augmentation, or switching. In the case of a therapy switch, the body of evidence suggests that selection of an agent with a different mechanism of action than the initial agent may be the most effective treatment. Furthermore, when patients maintain continuous therapy for the recommended treatment duration, outcomes are improved compared with patients who discontinue therapy early. As a result, the most effective treatment strategies promote improved patient compliance as well as the use of agents associated with a reduced incidence of premature discontinuation and therapy change early in the treatment program. While data supporting these clinically effective components of therapy exist, few data are available demonstrating the most cost-effective therapeutic options for TRD. This analysis suggests that managed care providers could benefit from a model that they can customize to evaluate the overall costeffectiveness of different strategies in the management of depression.

  7. Management of asthma in primary care

    NARCIS (Netherlands)

    Honkoop, Pieter Jacob


    Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of ‘Controlled asthma’, which means patients experience hardly any symptom

  8. Knowledge management: organizing nursing care knowledge. (United States)

    Anderson, Jane A; Willson, Pamela


    Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

  9. Advances in migraine management: implications for managed care organizations. (United States)

    Dodick, David W; Lipsy, Robert J


    Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes. Triptans are selective 5-HT receptor agonists that are specific and effective treatments in the management of migraine, and they meet the acute treatment goal of rapid relief with minimal side effects. Triptans are associated with improved quality of life. Factors such as speed of onset, need for a second triptan dose, and patient satisfaction should be considered in the selection of a specific triptan treatment. Appropriate treatment can decrease costs. The patient's migraine history and response to prior therapy should be considered when selecting acute treatment. Cost-effectiveness models can be used to understand the effect of treatment choices on health care budgets. The direct cost per migraine episode, driven primarily by the need for rescue medications, is important to include in economic models. All aspects of effectiveness (efficacy, tolerability, and cost) should be considered to reduce overall managed care expenditures for migraine treatment. The improved clinical profiles of the triptans provide substantial value to managed care organizations.

  10. Should health care managers adopt Theory Z? (United States)

    Safranski, S R; Kwon, I W; Walker, W R; Unger, M


    Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

  11. Better team management--better team care? (United States)

    Shelley, P; Powney, B


    Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

  12. Landscape ethnoecological knowledge base and management of ecosystem services in a Székely-Hungarian pre-capitalistic village system (Transylvania, Romania). (United States)

    Molnár, Zsolt; Gellény, Krisztina; Margóczi, Katalin; Biró, Marianna


    Previous studies showed an in-depth ecological understanding by traditional people of managing natural resources. We studied the landscape ethnoecological knowledge (LEEK) of Székelys on the basis of 16-19(th) century village laws. We analyzed the habitat types, ecosystem services and sustainable management types on which village laws had focused. Székelys had self-governed communities formed mostly of "noble peasants". Land-use was dominated by commons and regulated by village laws framed by the whole community. Seventy-two archival laws from 52 villages, resulting in 898 regulations, were analyzed using the DPSIR framework. Explicit and implicit information about the contemporary ecological knowledge of Székelys was extracted. We distinguished between responses that limited use and supported regeneration and those that protected produced/available ecosystem services and ensured their fair distribution. Most regulations referred to forests (674), arable lands (562), meadows (448) and pastures (134). Székelys regulated the proportion of arable land, pasture and forest areas consciously in order to maximize long-term exploitation of ecosystem services. The inner territory was protected against overuse by relocating certain uses to the outer territory. Competition for ecosystem services was demonstrated by conflicts of pressure-related (mostly personal) and response-related (mostly communal) driving forces. Felling of trees (oaks), grazing of forests, meadows and fallows, masting, use of wild apple/pear trees and fishing were strictly regulated. Cutting of leaf-fodder, grazing of green crops, burning of forest litter and the polluting of streams were prohibited. Marketing by villagers and inviting outsiders to use the ecosystem services were strictly regulated, and mostly prohibited. Székelys recognized at least 71 folk habitat types, understood ecological regeneration and degradation processes, the history of their landscape and the management possibilities of

  13. Pulmonary Hypertension in Pregnancy: Critical Care Management


    Bassily-Marcus, Adel M.; Carol Yuan; John Oropello; Anthony Manasia; Roopa Kohli-Seth; Ernest Benjamin


    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Im...

  14. Alzheimer's disease care management plan: maximizing patient care. (United States)

    Treinkman, Anna


    Nurse practitioners have the potential to significantly impact the care of patients with dementia. Healthcare providers can now offer patients medications that will control symptoms and prolong functioning. As a result of ongoing contact with patients, NPs play an important role in assessing and screening patients for AD and educating the patients, families, and caregivers about the disease. Alzheimer's disease is a chronic, progressive illness that requires long-term management. Nurse practitioners should be familiar with available medications and appreciate the need to individualize therapy to maximize efficacy and minimize potential adverse drug reactions.

  15. Assessing the effect of increased managed care on hospitals. (United States)

    Mowll, C A


    This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

  16. Managed care: how economic incentive reforms went wrong. (United States)

    Powers, Madison


    In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.

  17. Fundamentals of pain management in wound care. (United States)

    Coulling, Sarah

    Under-treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient's total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.

  18. The development of care management systems to achieve clinical integration. (United States)

    Hill, M


    With development of managed care markets, health care delivery systems face increasing clinical and financial risk. For an integrated delivery system to survive, strategies for clinical integration and care management are essential. CareMap tools, collaborative practice groups, and case management serve as the foundation to accomplish care management over the health continuum. Coordination of care, within an institution and across traditional health settings, to achieve the best clinical and cost outcomes is the goal. The article discusses strategies for clinical integration, categories for measurement of performance, and the need to incorporate automated solutions into the strategic business plan.

  19. Online Testing of Hungarian Children's Prosocial Behavior (United States)

    Zsolnai, Anikó; Kasik, László


    The aim of our cross-sectional investigation was to explore prosocial behavior at the ages of 9, 11, and 13, and to reveal associations between this social behavior and some background variables such as age, gender, and parents' educational attainment. The participants were 185 Hungarian students and their teachers. Two Likert-type questionnaires…

  20. Community Cable Television--Hungarian Perspectives. (United States)

    Szekfu, Andras

    This paper argues that, although community cable television is one of the most dynamic (although experimental) elements of the Hungarian media structure, it is well on its way toward institutionalization. It is suggested that whether community cable television is able to retain the spontaneity, innovativeness, and elasticity of its early days may…

  1. The Hungarian car insurance cartel saga

    NARCIS (Netherlands)

    Cseres, K.J.; Szilágyi, P.; Rodger, B.


    his chapter discusses the landmark Hungarian case relating to the car insurance and repair markets, which involved both vertical and horizontal agreements. The case concerned the horizontal relationship between Hungary’s two largest insurance companies and their vertical relationships with car

  2. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus


    Full Text Available Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

  3. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities (United States)

    Kastner, Theodore A.; Walsh, Kevin K.


    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  4. Crafting the group: Care in research management. (United States)

    Davies, Sarah R; Horst, Maja


    This article reports findings from an interview study with group leaders and principal investigators in Denmark, the United Kingdom and the United States. Taking as our starting point current interest in the need to enhance 'responsible research and innovation', we suggest that these debates can be developed through attention to the talk and practices of scientists. Specifically, we chart the ways in which interview talk represented research management and leadership as processes of caring craftwork. Interviewees framed the group as the primary focus of their attention (and responsibilities), and as something to be tended and crafted; further, this process required a set of affective skills deployed flexibly in response to the needs of individuals. Through exploring the presence of notions of care in the talk of principal investigators and group leaders, we discuss the relation between care and craft, reflect on the potential implications of the promotion of a culture of care and suggest how mundane scientific understandings of responsibility might relate to a wider discussion of responsible research and innovation.

  5. Crew Management Processes Revitalize Patient Care (United States)


    In 2005, two physicians, former NASA astronauts, created LifeWings Partners LLC in Memphis, Tennessee and began using Crew Resource Management (CRM) techniques developed at Ames Research Center in the 1970s to help improve safety and efficiency at hospitals. According to the company, when hospitals follow LifeWings? training, they can see major improvements in a number of areas, including efficiency, employee satisfaction, operating room turnaround, patient advocacy, and overall patient outcomes. LifeWings has brought its CRM training to over 90 health care organizations and annual sales have remained close to $3 million since 2007.

  6. Loyalty in managed care: a leadership system. (United States)

    Kerns, C D


    Healthcare executives are given a comprehensive and integrated ten-step system to lead their organization toward stabilizing a financial base, improving profitability, and differentiating themselves in the marketplace. This executive guide to implementing loyalty-based leadership can be adapted and used on an immediate basis by healthcare leaders. This article is a useful resource for healthcare executives as they move to make loyalty an organizational resource. Effectively managing the often-fragmented forces of loyalty can produce a healthier bottom line and improve the commitment among key stakeholders within a managed care environment. A brief loyalty-based leadership practices survey is included to serve as a catalyst for leaders and their teams to strategically discuss loyalty and retention in their organization.

  7. The management of lipohypertrophy in diabetes care. (United States)

    Hambridge, Kevin

    Lipohypertrophy has been a recognized complication of insulin therapy for many years, yet research shows that its prevalence in insulin-injecting patients with diabetes remains high. The problem for the patient is that the injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of the insulin, with the potential for poor glycaemic control and unpredictable hypoglycaemia. Despite the important implications of this for diabetes control in insulin-injecting patients, there is a dearth of information and completed research into the condition. This article raises awareness of lipohypertrophy by reviewing the available literature on the prevention, identification and management of the condition from a nursing perspective. Recommendations for medical and nursing practice in diabetes care to improve prevention and management of lipohypertrophy are made.

  8. [Dental management of hemorrhage-prone patients]. (United States)

    Szalma, József; Joób-Fancsaly, Árpád


    The authors present a proposal of dental treatment and management of anticoagulated patients and of patients on antiplatelet therapy, with the approval by the Hungarian Association of Oral and Maxillofacial Surgeons and by the Dental Implantology Association of Hungarian Dentists. This current guide was based on recent Hungarian and on several foreign national guidelines and considers significant publications from international literature.

  9. The role of managed care organizations in obesity management. (United States)

    Schaecher, Kenneth L


    In the United States, obesity is characterized as this century's greatest healthcare threat. The American Medical Association and several other large organizations now classify obesity as a disease. Several federal initiatives are in the planning stages, have been approved, or are being implemented to address the disease. Obesity poses challenges for all healthcare stakeholders. Diet and exercise often are insufficient to create the magnitude of change patients and their attending healthcare providers need. Managed care organizations (MCOs) have 3 tools that can help their members: health and wellness programs focusing on lifestyle changes, prescription weight-loss drugs, and bariatric surgical interventions. MCOs are addressing changes with national requirements and are responding to the availability of new weight-loss drugs to help their members achieve better health. A number of factors either deter or stimulate the progress of weight loss therapy. Understanding how MCOs are key to managing obesity at the local level is important for healthcare providers. It can help MCOs and individual healthcare providers develop and coordinate strategies to educate stakeholders and better manage overall care.

  10. Does managed care make a difference? Physicians' length of stay decisions under managed and non-managed care.

    NARCIS (Netherlands)

    Jong, J.D. de; Westert, G.P.; Noetscher, C.M.; Groenewegen, P.P.


    BACKGROUND: In this study we examined the influence of type of insurance and the influence of managed care in particular, on the length of stay decisions physicians make and on variation in medical practice. METHODS: We studied lengths of stay for comparable patients who are insured under managed or

  11. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians. (United States)

    Rurik, Imre; Torzsa, Péter; Ilyés, István; Szigethy, Endre; Halmy, Eszter; Iski, Gabriella; Kolozsvári, László Róbert; Mester, Lajos; Móczár, Csaba; Rinfel, József; Nagy, Lajos; Kalabay, László


    Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. The knowledge about multimorbidity, a main consequence of obesity was balanced.Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue.There were wider differences regarding attitudes and practice, influenced by the the doctors' age, gender, known BMI, previous qualification, less by working location.GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients' waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors.Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for

  12. Patient care management as a global nursing concern. (United States)

    Bower, Kathleen A


    Effective and efficient patient management is important in all health care environments because it influences clinical and financial outcomes as well as capacity. Design of care management processes is guided by specific principles. Roles (e.g., case management) and tools (e.g., clinical paths) provide essential foundations while attention to outcomes anchors the process.

  13. Survival strategies in the era of managed care. (United States)

    Rudomin, M L; Spirakes, A S


    The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.

  14. Preparing Psychotherapy Students for the New Demands of Managed Care. (United States)

    Chambliss, Catherine

    The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care…

  15. New Concept of Hungarian Robotic Telescopes (United States)

    Hegedus, T.; Kiss, Z.; Biro, B.; Jager, Z.

    As the result of a longer innovation of a few Hungarian opto-mechanical and electronic small companies, a concept of fully robotic mounts has been formed some years ago. There are lots of Hungarian Automated Telescopes over the world (in Arizona, South Korea, Izrael and atop Mauna Kea, just below the famous Keck domes). These are cited as HAT telescopes (Bakos et al. 2002), and served thousands of large-frame time-series CCD images since 2004, and the working team found already 6 exoplanets, and a number of new variable stars, etc... The newest idea was to build a more robust robotic mount, hosting larger optics (D > 50 cm) for achieving much fainter celestial objects, than the HAT series (they are operating with Nikon teleobjective lenses) on a still relatively wide celestial area. The very first sample model is the BART-1, a 50cm f/6 telescope.

  16. The knowledge and practice of self-care management among ...

    African Journals Online (AJOL)

    Background: Self-care management in diabetic patients is crucial to control and prevent ... 4 levels of diabetes self-care knowledge and practices which are respectively diet, blood ..... glucose, improves insulin action, metabolism of proteins.

  17. Managing chronic conditions in a South African primary care context ...

    African Journals Online (AJOL)

    Managing chronic conditions in a South African primary care context: ... is an approach to motivating behaviour change in general health care settings. ... They had mixed experiences with skills for agenda setting and reducing resistance.

  18. Managed care contracting issues in integrated delivery systems. (United States)

    Stewart, E E


    This article is a checklist for use by health care providers in reviewing proposed managed care contracting agreements. This checklist is not an exhaustive list, but is intended to be used as a framework for review.

  19. Influences on Case-Managed Community Aged Care Practice. (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen


    Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

  20. Hungarian space research 1981-1985: Lectures and review articles (United States)

    Benko, G. (Editor)


    This monograph presents an overview of Hungarian space research from 1981 to 1985. Topics discussed in the original report include the development of space research centers, the flight of the first Hungarian astronaut, Hungarian participation in international space programs such as the Vega/Halley's Comet mission and the BEALUCA materials science experiment, advances in astronomical research, and activities of the Cosmic Geodetic Observatory. Other topics discussed incude space biomedical studies, meteorological applications of space research, satellite communications, and satellite power supply systems.

  1. El + verb complex predicates in Hungarian

    Directory of Open Access Journals (Sweden)

    Éva Dékány


    Full Text Available This paper investigates the structure of complex predicates comprising the verbal particle el- (`away' and a verb in Hungarian. I show that el- has different meaning contributions to the predication when combined with different types of verbs. I argue that despite the three seemingly unrelated meanings of el-, two uses involve the same lexical item. In these unifiable cases I analyze el- as a measure function that can measure in both the spatial and the temporal domains.

  2. Competitiveness of the Hungarian elite sport system


    Gulyás, Erika


    This paper presents the initial results of significant research conducted under the IOC PhD Student Research Grant Programme with the support of the Hungarian Olympic Committee. The main objectives of the research were to understand why Hungary is successful in specific sports and to explore the relationship between elite sport policy systems and success in international competitions. The increasing international sporting competition forces governments to invest more money in elite sport deve...

  3. Playing the Part: Hungarian Boy Scouts and the Performance of Trauma in Interwar Hungary

    Directory of Open Access Journals (Sweden)

    Steven Jobbitt


    Full Text Available In 1920, the historic Kingdom of Hungary was dismembered according to the dictates of the Treaty of Trianon. Resulting in the loss of two-thirds of the nation’s pre-World War I territory, and one-third of its prewar population, Trianon has long stood as a symbol for Hungarian suffering and trauma in the twentieth century. Historians of modern Hungary have given much consideration to Trianon, with serious attention being paid to what some have called the Trianon syndrome, or the Trianon trauma. Arguing that interwar Hungarian culture and politics need to be understood in light of the menacing psychological shadow cast by Trianon, a number of historians have suggested that the people of Hungary were traumatized spontaneously and universally by the dismemberment of the nation and the suffering that followed. This paper argues that, though this may indeed have been the case on a raw emotional level, careful consideration needs to be given to the overlapping political and pedagogical functions of the Trianon trauma, especially as this trauma found expression in repeated public “performances” of the Trianon tragedy. Focusing on the revisionist performances of Hungarian boy scouts between the wars, and in particular on the personal papers of the Hungarian geographer and boy scout leader Ferenc Fodor, this paper draws a direct link between trauma and performance in the interwar period, and argues that, though trauma was indeed central to Hungarian cultural politics, it functioned as much as a pedagogical strategy as it did a psychological reality.

  4. Research on Relative Age in Hungarian Swimming

    Directory of Open Access Journals (Sweden)

    Nagy Nikoletta


    Full Text Available In 2017, the 19th World Swimming Championship will be organized in Hungary. Up to now, many people have already been working with swimmers to achieve good results. However, in the next period they must work even harder to ensure that the national swimmers of a country as small as Hungary can achieve the outstanding results of their predecessors. Since high-level competitions in swimming have become more intense, innovations including scientific studies are needed during preparation for the event. The purpose of this paper is to present the major results of an independent study carried out by the authors about the relative age of the best Hungarian swimmers with the aim of contributing to their preparation. The research population consisted of selected age groups of swimmers registered by the Hungarian Swimming Association (N=400. The method for data collection was an analysis of documents. To evaluate the data, the Chi-square and Kruskal-Wallis tests were used. The results are presented according to the period of the competitor’s date of birth, gender, and age group. The results confirm only partly the hypothesis that people born in the first quarters of the year play a dominant role in Hungarian national swimming teams. In the conclusion, the authors recommend further research on relative age in swimming and in other sports.

  5. Managing care in an integrated delivery system via an Intranet. (United States)

    Halamka, J D; Hughes, M; Mack, J; Hurwitz, M; Davis, F; Wood, D; Borten, K; Saal, A K


    The CareGroup Provider Service Network is a managed care contracting organization which provides central administrative services for over 1800 physicians and 200,000 managed care lives. Services include utilization management, disease management and credentialing for the entire network. The management model of the Provider Service Network empowers local physician groups with information and education. To meet the managed care information needs of the network, we implemented an intranet-based executive information system, PSNWeb, which retrieves data from a managed care data warehouse. The project required the integration of diverse technologies and development of a complex security/confidentiality infrastructure to deliver information to 8 major clinician groups, each with different information needs.

  6. Health information technology: transforming chronic disease management and care transitions. (United States)

    Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B


    Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Does managed care make a difference? Physicians' length of stay decisions under managed and non-managed care

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P


    Full Text Available Abstract Background In this study we examined the influence of type of insurance and the influence of managed care in particular, on the length of stay decisions physicians make and on variation in medical practice. Methods We studied lengths of stay for comparable patients who are insured under managed or non-managed care plans. Seven Diagnosis Related Groups were chosen, two medical (COPD and CHF, one surgical (hip replacement and four obstetrical (hysterectomy with and without complications and Cesarean section with and without complications. The 1999, 2000 and 2001 – data from hospitals in New York State were used and analyzed with multilevel analysis. Results Average length of stay does not differ between managed and non-managed care patients. Less variation was found for managed care patients. In both groups, the variation was smaller for DRGs that are easy to standardize than for other DRGs. Conclusion Type of insurance does not affect length of stay. An explanation might be that hospitals have a general policy concerning length of stay, independent of the type of insurance of the patient.

  8. How managed care growth affects where physicians locate their practices. (United States)

    Polsky, D; Escarce, J J


    Managed care has had a profound effect on physician practice. It has altered patterns in the use of physician services, and consequently, the practice and employment options available to physicians. But managed care growth has not been uniform across the United States, and has spawned wide geographic disparities in earning opportunities for generalists and specialists. This Issue Brief summarizes new information on how managed care has affected physicians' labor market decisions and the impact of managed care on the number and distribution of physicians across the country.

  9. Assessment, authorization and access to medicaid managed mental health care. (United States)

    Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T


    Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

  10. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.


    BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the


    Directory of Open Access Journals (Sweden)

    Camila Dubow


    Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.

  12. Pharmacist credentialing in pain management and palliative care. (United States)

    Juba, Katherine M


    A credential is documented evidence of a pharmacist's qualifications; while credentialing is the method used to acquire, confirm, determine, and document a pharmacist's qualifications to practice. Voluntary credentials are important in clinical pharmacy specialties to ensure proficiency in caring for patients with complex pharmacotherapy needs. This article discusses current and future pharmacy pain management and palliative care credentialing opportunities. Pharmacists wishing to pursue voluntary pain management and palliative care credentialing may elect to take a multidisciplinary pain credentialing exam offered by the American Society of Pain Educators (ASPE) or American Academy of Pain Management (AAPM) and/or complete an American Society of Health System Pharmacists (ASHP) Postgraduate Year 2 (PGY2) pain management and palliative care pharmacy residency. A palliative care credentialing exam is not currently available to pharmacists. Efforts are underway within the pharmacy profession to standardize the board certification process, design a pain and palliative certificate program, and create a specialty pain management and palliative care board certification examination.

  13. Care management actions in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Marcelo Costa Fernandes


    Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.

  14. Pain management improves care and revenue: an interview with ProCare Systems. (United States)

    Davis, F N; Walsh, C


    As provider and managed care organizations continue to look for better ways to control costs and improve patient outcomes, disease management programs are getting an increasing share of their attention. One often-over-looked area with significant potential to improve outcomes, reduce costs, and enhance revenues is pain management. It has been estimated that at least 40 percent of senior citizens suffer from chronic pain, and as the population ages, the number of chronic pain sufferers will only increase. Pain management companies have been forming to meet the current and future demand for comprehensive pain management programs. One such company is ProCare Systems, a single-specialty physician practice management company based in Grand Rapids, Michigan. HFM spoke with Fred N. Davis, MD, president and cofounder of ProCare Systems, and Cyndy Walsh, ProCare System's CEO, about pain management programs and the patient care and financial impact they can effect.

  15. Federal Nursing Service Award. Impact of TriCare/managed care on total force readiness. (United States)

    Ray, M A; Turkel, M C


    Mission readiness is dependent on a healthy total force and the response of military medical and nursing services. Managed care has become the norm in U.S. health care, including the Department of Defense Military Health System. Cost management, health maintenance organizations, and other health plans are defined as "managed care," an aggressive cost-control effort by health care purchasers and insurers to limit health care spending and services and advance a market-oriented, profit-driven system. The impact of managed care on mission readiness and retention of active and reserve personnel is and will continue to be profound. The purpose of this research was to conduct a qualitative, phenomenological study (life experiences) of TriCare/managed care to explore the impact and the meaning of the experience on total force mission readiness of the U.S. Air Force and how managed care has changed nursing practice. The results reveal the significance of the impact of TriCare/managed care on total force readiness by identifying, through themes, meta-themes, and a representative model, the negative effect that economics is having on active duty and reserve force health and well-being.

  16. Primary care referral management: a marketing strategy for hospitals. (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J


    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  17. Effective population management practices in diabetes care - an observational study

    DEFF Research Database (Denmark)

    Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis


    Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices...

  18. Ethical Issues in Managed Care: Perspectives in Evolution. (United States)

    Belar, Cynthia D.


    Presents a reaction to Cooper and Gottlieb's (this issue) article titled, "Ethical Issues with Managed Care: Challenges Facing Counseling Psychology." Challenges that many issues addressed by Cooper and Gottlieb have been longstanding in the profession. Argues against the belief that the managed care environment is fraught with more ethical…

  19. Psychotropic Medication Management in a Residential Group Care Program (United States)

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.


    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  20. Nurse leaders as managers of ethically sustainable caring cultures. (United States)

    Salmela, Susanne; Koskinen, Camilla; Eriksson, Katie


    The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. The study has a quantitative design with elements of a qualitative research approach. Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence. © 2016 John Wiley & Sons Ltd.

  1. Managing conscientious objection in health care institutions. (United States)

    Wicclair, Mark R


    It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient's/surrogate's timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient's timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector's reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards' assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors' reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine.

  2. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N


    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.


    NARCIS (Netherlands)



    This study reports on the application of the principles of the lexical approach to a non-Indo-European language, namely Hungarian. This language is a Uralic island surrounded on all sides by Indo-European languages. In addition, the Hungarians are, in terms of cultural features, Europeans. These con

  4. Competition assignment problem algorithm based on Hungarian method

    Institute of Scientific and Technical Information of China (English)

    KONG Chao; REN Yongtai; GE Huiling; DENG Hualing


    Traditional Hungarian method can only solve standard assignment problems, while can not solve competition assignment problems. This article emphatically discussed the difference between standard assignment problems and competition assignment problems. The kinds of competition assignment problem algorithms based on Hungarian method and the solutions of them were studied.

  5. Hungarian University Students' Misunderstandings in Thermodynamics and Chemical Kinetics (United States)

    Turanyi, Tamas; Toth, Zoltan


    The misunderstandings related to thermodynamics (including chemical equilibrium) and chemical kinetics of first and second year Hungarian students of chemistry, environmental science, biology and pharmacy were investigated. We demonstrated that Hungarian university students have similar misunderstandings in physical chemistry to those reported in…

  6. Hungarian University Students' Misunderstandings in Thermodynamics and Chemical Kinetics (United States)

    Turanyi, Tamas; Toth, Zoltan


    The misunderstandings related to thermodynamics (including chemical equilibrium) and chemical kinetics of first and second year Hungarian students of chemistry, environmental science, biology and pharmacy were investigated. We demonstrated that Hungarian university students have similar misunderstandings in physical chemistry to those reported in…

  7. Check list of the Hungarian Salticidae with biogeographical notes

    Directory of Open Access Journals (Sweden)

    Szüts, Tamás


    Full Text Available An updated check list of the Hungarian jumping spider fauna is presented. 70 species are recorded from Hungary so far. Four species are new to the Hungarian fauna: Hasarius adansoni, Neon valentulus, Sitticus caricis, Synageles subcingulatus. With 12 original drawings.

  8. Measuring the savings from managed care: experience at Citibank. (United States)

    Reiff, M G; Sperling, K L


    In a leap of faith, Citibank in 1989 designed a point-of-service plan aimed at containing health care costs in the long term without sacrificing quality of care. In 1994 a study was undertaken to empirically evaluate whether these goals had been achieved. The study supported Citibank's overall managed care strategy, providing objective, quantifiable data that can lead to greater efficiencies.

  9. COPD self-management supportive care: chaos and complexity theory. (United States)

    Cornforth, Amber

    This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

  10. Challenges for Managed Care from 340B Contract Pharmacies. (United States)

    Fein, Adam J


    The federal 340B Drug Pricing Program has expanded rapidly, with important yet still unmeasured impact on both managed care practice and policies. Notably, providers increasingly rely on external, contract pharmacies to extend 340B pricing to a broad set of patients. In 2014, 1 in 4 U.S. retail, mail, and specialty pharmacy locations acted as contract pharmacies for 340B-covered entities. This commentary discusses crucial ways in which 340B growth is affecting managed care pharmacy through formulary rebates, profits from managed care paid prescriptions, disruption of retail pharmacy networks, and reduced generic dispensing rates. Managed care should become more engaged in the discussion on how the 340B program should evolve and offer policy proposals to mitigate the challenges being encountered. There is also an urgent need for objective, transparent research on the 340B program's costs, benefits, and implications for managed care pharmacy and practice.

  11. Price elasticity and pharmaceutical selection: the influence of managed care. (United States)

    Domino, Marisa Elena; Salkever, David S


    State Medicaid programs are turning increasingly to managed care to control expenditures, although the types of managed care programs in use have changed dramatically. Little is known about the influence of the shifting Medicaid managed care arena on treatment decisions. This paper investigates factors affecting the selection of treatments for depression by providers participating in either of two Medicaid managed care programs. Of particular interest is the influence of medication price on the choice of treatment, since one vehicle through which managed care organizations can reduce total expenditures is by increasing the price sensitivity of participating providers. We take a new approach by phrasing the problem as a discrete choice, using a nested multinomial logit model for the analyses. Contrary to earlier literature, we find some evidence that physicians in both programs do take price into consideration when selecting among treatment options. HMO providers in particular demonstrate increased price sensitivity in the two most commonly prescribed categories of antidepressants.

  12. Guidelines for Management Information Systems in Canadian Health Care Facilities


    Thompson, Larry E.


    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations.

  13. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.


    diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning......Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...

  14. Health care managers' views on and approaches to implementing models for improving care processes. (United States)

    Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta


    To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.


    Directory of Open Access Journals (Sweden)

    Andras Toth


    Full Text Available The Hungarian model was heralded as one of the most successful post-socialist way of integration into the globalised world economy and European economic area in the nineties. Currently, Hungary is suffering from a full-blown crisis 1996 onwards. Increasingly large number of Hungarians is losing their faith in political parties, institutions, democracy and in market economy. The government, elected in 2010 by supermajority and still enjoying a broad support despite the deepening recession, condemns the development path taken after 1989 and openly rejects the wrong model of the last 20 years. The government intends to build a new economic model following a model, which one can call a model of economic nationalism as the only way out of the crisis. The paper intends to portray, through the case of Hungary, how economy and politics is interconnected, and why political elites are choosing a credit fuelled development path. The paper intends to portray how a credit fuelled growth was induced by politics and ended up in tears. Moreover, the paper describes the consequences of pro-etatist shift in the public sentiment due to the alleged “market-failure”, which was in reality a crisis, at first place, created for political purposes by political means. This article, based on the Austrian business cycle theory, argues that the tragedy of Hungary was that it went through a government inspired spending binge in the first half of the 2000s. The deficit spending of the government was accompanied by the expansion of credit by the commercial banks, mostly denominated in Swiss francs. The combined effect of deficit spending and credit expansion was the build-up of debt and loss of cost competitiveness. The 2008 crisis ended the credit fuelled development path and has started the long and painful period of deleveraging crisis. On the other hand, the Hungarian crisis is a post-Keynesian crisis. It had broken out when the state was already heavily indebted and

  16. Outlook for developing the Hungarian oil industry

    Energy Technology Data Exchange (ETDEWEB)

    Zsengeller, I.


    Reports from the 72nd general meeting of the Hungarian state society of miners and metallurgists are presented. Half of the need for energy supply is provided by oil and natural gas. The annual extraction is 2 million T of oil and 7 billion mT of natural gas. The discovered reserves guarantee extraction for 10-30 years. The need is stressed for using new methods in oil refining to extract more valuable products. World Bank credit also has to be used for development of the industry.

  17. The Hungarian Peculiarities of National Remembrance: Historical Figures with Symbolic Importance in Nineteenth-century Hungarian History Paintings

    Directory of Open Access Journals (Sweden)

    Zsuzsanna Tóth


    Full Text Available In order to place nineteenth-century Hungarian art into international context, this article calls for the theoretical discourse of cultural memory, when a suppressed community turns to their past and insists on their antecedents’ traditions for the survival of their culture. When, in the 1850s and 1860s, the leaders of the Habsburg Austrian Empire retaliated against Hungary for its 1848-49 “Fight for Freedom”, Hungarian visual art of the era rediscovered long-honoured figures of the historical past as the essential components of Hungarian national identity. This article argues that the successful visualization and memorialization of outstanding historical characters with symbolic values for the Hungarian nation was due to history painting itself as medium. The Hungarian painters’ choice of characters vigorously reacted to the changing political relationship between the Austrians and the Hungarians from the failure of the 1849 Hungarian Fight for Freedom until the 1850s and the 1870s involving the 1867 Austro-Hungarian Compromise. Keeping it in mind, the display and the reception of four great paintings, Bertalan Székely’s The Discovery of the Body of King Louis II (1860, Viktor Madarász’s Péter Zrínyi and Ferenc Frangepán in Prison at Wiener-Neustadt (1864, Székely’s The Women of Eger (1867 and Gyula Benczúr’s The Baptism of Vajk (1875 are analysed.

  18. Pain management: lessons from palliative care. (United States)

    Langlois, John P


    Reducing suffering and helping patients to control their symptoms are key components of palliative care. This commentary will offer a comprehensive definition of palliative care and will present a case history to illustrate how palliative care can benefit patients with chronic pain.

  19. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner


    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  20. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner


    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  1. Is managed care restraining the adoption of technology by hospitals? (United States)

    Mas, Núria; Seinfeld, Janice


    As health care costs increase, cost-control mechanisms become more widespread and it is crucial to understand their implications for the health care market. This paper examines the effect that managed care activity (based on the aim to control health care expenditure) has on the adoption of technologies by hospitals. We use a hazard rate model to investigate whether higher levels of managed care market share are associated with a decrease on medical technology adoption during the period 1982-1995. We analyze annual data on 5390 US hospitals regarding the adoption of 13 different technologies. Our results are threefold: first, we find that managed care has a negative effect on hospitals' technology acquisition for each of the 13 medical technologies in our study, and its effect is stronger for those technologies diffusing in the 1990s, when the managed care sector is at its largest. If managed care enrollment had remained at its 1984 level, there would be 5.3%, 7.3% and 4.1% more hospitals with diagnostic radiology, radiation therapy and cardiac technologies, respectively. Second, we find that the rise in managed care leads to long-term reductions in medical cost growth. Finally, we take into account that profitability analysis is one of the main dimensions considered by hospitals when deciding about the adoption of new technologies. In order to determine whether managed care affects technologies differently if they have a different cost-reimbursement ratio (CRR), we have created a unique data set with information on the cost-reimbursement for each of the 13 technologies and we find that managed care enrollment has a considerably larger negative effect on the adoption of less profitable technologies.

  2. Managed care and its impact on American urology. (United States)

    Holtgrewe, H L


    America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.

  3. [Nursing management of wound care pain]. (United States)

    Chin, Yen-Fan


    Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject.

  4. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.


    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with bette

  5. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.


    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with

  6. Essential case management services for young children in foster care. (United States)

    Zlotnick, C; Kronstadt, D; Klee, L


    A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care. The purpose of this study was to identify the services needed by foster care families and determine which services require the most case manager effort. Consistent with other research, many foster care children in this study exhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it was services aimed at the foster care parents, rather than the foster care children, that required the most labor-intensive case management services.

  7. Embedding care management in the medical home: a case study. (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D


    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.


    Directory of Open Access Journals (Sweden)

    A. CSÍK


    Full Text Available The significant lead time resulting from the use of the OLSER system of the Hungarian Hydrological Forecasting Service is of key importance in making timely preparations for flood defence. Due to continuous improvements to the quantitative meteorological forecast models (primarily the generally used ECMWF model and the OLSER system over the past years, we have by now reached a point where the previously separately managed flood peak forecasting and continuous forecasting can no longer be interpreted independently. Continuous forecasting taking into account precipitation forecasts and monitoring spatial changes of the complex physics-based concentration process also offers a level of accuracy suitable to identify peak values. The flood wave of June 2013 along the Hungarian Danube section exceeded the ever observed highest high water levels everywhere (except for gauge Mohács. The forecasts prepared by HHFS played a crucial role both in terms of lead time and the forecasted water levels.

  9. Corporate social responsibility and the future health care manager. (United States)

    Collins, Sandra K


    The decisions and actions of health care managers are oftentimes heavily scrutinized by the public. Given the current economic climate, managers may feel intense pressure to produce higher results with fewer resources. This could inadvertently test their moral fortitude and their social consciousness. A study was conducted to determine what corporate social responsibility orientation and viewpoint future health care managers may hold. The results of the study indicate that future health care managers may hold patient care in high regard as opposed to profit maximization. However, the results of the study also show that future managers within the industry may continue to need rules, laws, regulations, and legal sanctions to guide their actions and behavior.

  10. Prevalence of malocclusions in Hungarian adolescents. (United States)

    Gábris, Katalin; Márton, Sándor; Madléna, Melinda


    The aim of this epidemiological study was to assess the prevalence of malocclusion, associated caries experience, and level of oral hygiene in the Hungarian population using the World Health Organisation (WHO) questionnaire designed to assess dentofacial anomalies. A total of 483 adolescents (289 girls, 194 boys), aged 16-18 years, were assessed. Orthodontic anomalies were detected in 70.4 per cent of the sample. Crowding and spacing were observed in 14.3 and 17 per cent, respectively, with the latter being more prevalent in the maxilla than in the mandible (10.4 and 2.9 per cent, respectively). A Class I occlusion was found in 52.8 per cent of the subjects. A half cusp anomaly in the antero-posterior molar relationship was more prevalent than a full cusp anomaly (26.9 and 20.3 per cent, respectively). The decayed, missing, and filled teeth (DMFT), the decayed, missing, and filled surfaces (DMFS), and the visible plaque indices scores (VPI) of the 340 adolescents with malocclusion were significantly higher (P adolescents who displayed no anomalies. The prevalence of malocclusion in the Hungarian population seems to be comparable with other European communities.

  11. Ottoman-Hungarian Conflict through Venetian Eyes

    Directory of Open Access Journals (Sweden)

    N. Zeynep YELÇE


    Full Text Available The new phase in Ottoman-Hungarian relations starting with the ascension of Süleyman I and the following period of conflict have been thoroughly examined by scholars; causes and effects have been analyzed; and the process has been evaluated in a wide array of perspectives ranging from evaluations as a process of glorious conquest to a process of tragic enslavement. This paper moves away from such grand narratives to explore the way the process was perceived by contemporaries as they lived through the conflict. As such, this paper focuses on the letters of Lorenzo Orio, the Venetian ambassador in Buda between 1519-1523. From his arrival in Buda on June 5, 1519, to his presentation of his report to the Pregadi on December 22, 1523; Orio has been a close witness of the relations and conflicts between the Ottomans, Habsburgs, and the Hungarians. The information offered by Orio in these tumultuous times, as he tried to present a neutral stance for Venice, has not only added to the soft power of Venice but presents us the experience and perception of an era. In other words, it opens a window to the rumors, gossip, fears, and hopes in the daily lives of the contemporaries.

  12. The "Battle" of Managing Language Barriers in Health Care. (United States)

    Steinberg, Emma M; Valenzuela-Araujo, Doris; Zickafoose, Joseph S; Kieffer, Edith; DeCamp, Lisa Ross


    Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging. Reports of parent perspectives on navigating language discordance in health care are limited. We analyzed portions of 48 interviews focused on language barriers from 2 qualitative interview studies of the pediatric health care experiences of LEP Latina mothers in 2 urban US cities. We found mothers experienced frustration with health care and reported suboptimal accommodation for language barriers. Six themes emerged relevant to health care across settings: the "battle" of managing language barriers, preference for bilingual providers, negative bias toward interpreted encounters, "getting by" with limited language skills, fear of being a burden, and stigma and discrimination experienced by LEP families. Parents' insights highlight reasons why effective language accommodation in health care remains challenging. Partnering with families to address the management of language barriers is needed to improve health care quality and safety for LEP patients and families.

  13. Managed care, consumerism, preventive medicine: does a causal connection exist? (United States)

    Rizzo, John A; Xie, Yang


    Managed care plans, and HMOs in particular, have long touted that their emphasis is on preventive care, to avoid expensive illness later in life. However, few articles in the contemporary literature adequately address this claim. The available evidence seems to support that HMOs do, in fact, provide greater access to preventive services, but the limitations of this research are substantial. This article discusses the scientific evidence on the relationships between managed care arrangements and the implications for preventive care in the current era, emphasizing consumer choices and less-restrictive plan structures.

  14. Toward population management in an integrated care model. (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R


    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative.

  15. Managing high-risk patients: the Mass General care management programme


    Dennis L. Kodner


    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusett...

  16. Nostalgia and Sentimentality Among Minority Elderly People (Bulgarian Roma People and Hungarians Living in Romania

    Directory of Open Access Journals (Sweden)

    Stanislava Stoyanova


    Full Text Available Nostalgia and sentimentality are very typical for the old age. There are some characteristics that are perceived as typical for the elderly people in the different cultures, such as being dependent, and needing long-term care. There are also some similarities between the population tendencies in Bulgaria and Romania. The simultaneously acceptance in European Union of both countries also suggests the existence of some similar attitudes towards the past among elderly minority people in both countries. The hypothesis of the study was that together with some similarities, the elderly people from both ethnic minorities in the two countries would differ cross-culturally in their sentimentality and nostalgia related to the past. Sentimentality and nostalgia in elderly minority people (26 Roma people in Bulgaria and 21 Hungarians in Romania were measured by means of a questionnaire created by Gergov & Stoyanova (2013. The results indicated that the Hungarian minority in Romania was more sentimental and nostalgic than the Roma minority in Bulgaria. More thoughts about the past reported the minority young elders than the minority oldest old. The females from the minority groups were more sentimental than the males from the minority groups. Higher sentimentality and nostalgia among elderly Hungarians could be explained by their higher conservatism and more satisfaction with the hystorical past than Roma people. Roma people living in institutions felt a sense of stability in their present and they shared some positive expectations for the future.

  17. People deliver eye care: managing human resources

    Directory of Open Access Journals (Sweden)

    Kayode Odusote


    Full Text Available People deliver health. Effective health care needs an efficient and motivated health workforce, which is the totality of individuals who directly or indirectly contribute to the promotion, protection and improvement of the health of the population.Community eye health is about providing eye health care to the people as close as possible to where they live and as much as possible at a price they can afford. It promotes people-centred care rather than the traditional disease-centred eye care services. In order to provide effective and efficient eye care services, we need an adequate number of well-qualified, well-motivated and equitably distributed eye health workers (EHWs.

  18. Becoming nursing manager in the nested and complex border of caring and management dimensions

    Directory of Open Access Journals (Sweden)

    Gabriela Marcellino de Melo Lanzoni


    Full Text Available The study aimed to understand the experience of managing medical-surgical inpatient units in a general hospital, highlighting the meaning of being a nursing manager, with the intention to qualify and instrument nurses for caring management practice in this scenario. This is a Grounded Theory research, conducted from August 2010 to August 2012, through interviews with 19 participants from the nursing team, distributed in 3 sampling groups. From the analysis emerged the phenomenon “Becoming a nursing manager in the nested and complex border of caring and management dimension”. To exercise caring management, nurses use management instruments as essential tools, they become capable theoretically and enhances, based on his experience, professional skills and personal characteristics.  We conclude that competency mobilization beyond the clinical aspect is needed; allowing the use of management instruments to make caring viable and to improve relational and interactive processes.

  19. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M


    are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated......Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians...... affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD...

  20. Disabling health care? Medicaid managed care and people with disabilities in America

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder


    Medicaid, America's largest government-funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid-1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using...... business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle-aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services...... research. This qualitative research examined the implications of Medicaid managed care by conducting in-depth interviews with a total of thirty respondents with physical disabilities in the age range of 45-64 years enrolled in a mandatory managed care program in the eastern seaboard of United States...

  1. Staged diabetes management. Toward an integrated model of diabetes care. (United States)

    Mazze, R S; Etzwiler, D D; Strock, E; Peterson, K; McClave, C R; Meszaros, J F; Leigh, C; Owens, L W; Deeb, L C; Peterson, A


    This paper introduces a new and innovative approach to diabetes management in the primary-care setting. Staged diabetes management (SDM) represents a four-year effort to develop and test a data-based approach to diabetes management that could be easily adapted to a variety of health-care settings in which diabetes management is principally under the direction of primary-care physicians was limited access to specialists. After testing under controlled circumstances at the International Diabetes Center (Minneapolis, MN), SDM was subjected to substantial field trials under conditions that represent the scope and variety of primary-care practices in diabetes. The following represents the work of several investigators who independently undertook a review of SDM.

  2. Effects of managed care contracting on physician labor supply. (United States)

    Libby, A M; Thurston, N K


    We examine the effect of managed care contracting on physician labor supply for office-based medical practices. We extend the standard labor supply model to incorporate choices regarding the patient base. Empirical tests use data from the 1985 and 1988 national HCFA Physician Practice Costs and Income Surveys and InterStudy Managed Care Surveys. We use physician-level information on participation in managed care contracting to estimate changes in work hours. Managed care contracting is generally associated with lower physician work hours. However, accounting for motivations to participate in contracts and the extent of contracting, the effect on hours is reduced in magnitude and significance. We conclude that relying on broad aggregate measures for policy analysis will likely be misleading as underlying motivations and contracting incentives change over time.

  3. Medicaid Managed Care Penetration Rates and Expansion Enr... (United States)

    U.S. Department of Health & Human Services — The Medicaid managed care penetration rates and expansion enrollment by state charts are composed annually by the Data and System Group (DSG) of the Centers for...

  4. Identifying and managing patients with delirium in acute care settings. (United States)

    Bond, Penny; Goudie, Karen


    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  5. Disabling health care? Medicaid managed care and people with disabilities in America

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder


    Medicaid, America's largest government-funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid-1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using...... business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle-aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services....... The purpose of the study was to understand their experiences in accessing physical health care services and to ascertain the effects of managed care on their health and well-being. This study found beneficiaries encounter numerous barriers in accessing preventative, treatment, and acute care services. Overall...

  6. Managing palliative care for adults with advanced heart failure. (United States)

    Kaasalainen, Sharon; Strachan, Patricia H; Brazil, Kevin; Marshall, Denise; Willison, Kathleen; Dolovich, Lisa; Taniguchi, Alan; Demers, Catherine


    The purpose of this study was to explore the care processes experienced by community-dwelling adults dying from advanced heart failure, their family caregivers, and their health-care providers. A descriptive qualitative design was used to guide data collection, analysis, and interpretation. The sample comprised 8 patients, 10 informal caregivers, 11 nurses, 3 physicians, and 3 pharmacists. Data analysis revealed that palliative care was influenced by unique contextual factors (i.e., cancer model of palliative care, limited access to resources, prognostication challenges). Patients described choosing interventions and living with fatigue, pain, shortness of breath, and functional decline. Family caregivers described surviving caregiver burden and drawing on their faith. Health professionals described their role as trying to coordinate care, building expertise, managing medications, and optimizing interprofessional collaboration. Participants strove towards 3 outcomes: effective symptom management, satisfaction with care, and a peaceful death.

  7. [Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]. (United States)

    Erdei, Gergő; Kovács, Viktória Anna; Bakacs, Márta; Martos, Éva


    The Hungarian Diet and Nutritional Status Survey examines the obesity prevalence, dietary habits and, since 2014, physical activity in Hungarian adults in every 5 years. The survey provides national data representative by age and gender, based on anthropometric measurements and international standards. In 2014, nearly two-thirds of adults were overweight or obese. 28.2% of men and 31.5% of women were obese. Prevalence of morbid obesity were 2.6% and 3.3% in men and women, respectively. Abdominal obesity was more prevalent among women than men (55% vs. 38%), and the rate was increasing with age in both genders. In elderly, 55% of men and almost 80% of women were abdominally obese. In conclusion, the prevalence of overweight, obesity, and abdominal obesity is high in Hungarian adults. In order to tackle obesity, we need to obtain representative and measured data, which form the basis of targeted interventions and the assessment of their impact. Orv. Hetil., 2017, 158(14), 533-540.

  8. Trends in managed care contracting among U.S. hospitals. (United States)

    Gautam, K; Campbell, C; Arrington, B


    This article describes the changing profile of hospitals initiating managed care contracts as of 1992. Based on statistical tests, early contractors rank higher on profitability, case mix, bed size, affiliation, and urban location. In contrast, recent and noncontractors are predominantly rural, freestanding hospitals with low case mix, low profitability, high subacute services, and government ownership. A number of lessons for the future are drawn and a stage-by-stage approach to studying managed care issues is proposed.

  9. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers (United States)

    Roberts, James R.; McCurdy, Leyla Erk


    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  10. Ethics of managed care. Implications for group practice. (United States)

    Philip, D J


    The advent of managed care and the impact of an increasingly pluralistic, postmodern society need not mean abandoning standards of medical ethics embraced since Hippocrates. The time-honored relationship between patients and physicians remains of paramount importance. Ethical issues surrounding "universal" access and financial models that directly incentivize practices to withhold care are both addressed from a historical perspective.

  11. Relationship between chronic conditions and patient satisfaction with managed care. (United States)

    Gines, M D; Pinto, L A; Gocka, L T; Legorreta, A P


    The objective of this study was to compare the level of satisfaction among members with and without chronic health conditions (asthma, diabetes, hypertension, and elevated plasma lipoprotein) in a large California managed care organization. One year's worth of member satisfaction survey data was analyzed. Results showed that a high percentage of members were satisfied with the health plan and with their access to care. Members with chronic conditions were significantly more satisfied with their access to care than were members without such conditions.

  12. Headache in primary care: how important is diagnosis to management?


    O'Flynn, Norma; Ridsdale, Leone


    Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evid...

  13. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process. (United States)

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret


    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.


    Directory of Open Access Journals (Sweden)

    Toth Jozsef


    Full Text Available In this paper we estimate the impact of different factors on creditability of agricultural farms. According to the literature the collateral (tangible assets, the farm size, productivity, and subsidies should have significant effects on farm loans. We use data from the Hungarian Farm Accountancy Data Network to test our two hypotheses and theoretical assumptions for the period 2001-2010. Because of using panel data, we do our estimations using fixed effects econometrics model to test our assumptions. The results indicate that the chosen factors have significant influence on total liabilities and short- and long-term loans as well. With specially interest of subsidies the growing level of supports decrease the need of other financial tools. At output factors (inclusive farm size have significant and positive effect, same as collateral (tangible assets.

  15. Progressive Dyslexia: Evidence from Hungarian and English (United States)

    Druks, Judit; Aydelott, Jennifer; Genethliou, Marios; Jacobs, Helen; Weekes, Brendan


    We report a patient with non-fluent Primary Progressive Aphasia who was premorbidly literate in two alphabetic scripts, Hungarian (L1) and English (L2). Testing was performed over a two-year period to assess the impact of progressive illness on oral reading and repetition of single words. Results showed significant decline in oral reading in both languages, and an effect of language status in favour of oral reading in L1. Phonological complexity was a significant predictor of oral reading decline in both languages. Of interest, we observed an effect of language status on task performance whereby repetition was better in L2 than L1 but oral reading was better in L1 than L2. We conclude that language status has an effect on repetition and oral reading abilities for bilingual speakers with non-fluent Primary Progressive Aphasia. PMID:22713383

  16. Hodgkin disease therapy induced second malignancy susceptibility 6q21 functional variants in roma and hungarian population samples. (United States)

    Varszegi, Dalma; Duga, Balazs; Melegh, Bela I; Sumegi, Katalin; Kisfali, Peter; Maasz, Anita; Melegh, Bela


    Patients treated successfully for pediatric Hodgkin's lymphoma are known to develop secondary malignancies; care is already taken in treatment to prevent this adverse effect. Recent GWAS study identified rs4946728 and rs1040411 noncoding SNPs located between PRDM1 and ATG1 genes on chromosome 6q21 as risk factors for secondary malignancies in patients formerly treated with radiotherapy for pediatric Hodgkin disease. We investigated the allele frequencies of these two SNPs in biobanked, randomly selected DNA of average, apparently healthy Hungarians (n = 277) and in samples of Roma (n = 279) population living Hungary. The risk allele frequency for rs4946728 was 79.4 % in Hungarian and 83.5 % in Roma samples, while for rs1040411 it was 56.4 % in Hungarian and 55.8 % in Roma samples. These values are quite similar in the two populations, and are rather high. The values are higher than those frequencies observed in the controls (rs4946728: 59.1 % and rs1040411: 39.6 %, p < 0.05), and are in the range of the cases (86 % and 68.2 %, respectively) of the above original GWAS study. Our findings suggest, that beside the already taken precautions, genetic characterization of Hungarian pediatric Hodgkin patients seems to be advantageous prior to the treatment of their disease.

  17. How to manage burns in primary care.


    Waitzman, A. A.; Neligan, P C


    Burns are common injuries; more than 200,000 occur in Canada annually. Nearly all burn injuries can be managed on on outpatient basis. Appropriate treatment depends on burn depth, extent, and location. Special types of burns, such as chemical, tar, and electrical injuries, need specific management strategies. Prevention through education is important to reduce the incidence of burns.

  18. Water cycle investigations in Hungarian forest ecosystems

    Institute of Scientific and Technical Information of China (English)

    Judit Sitkey


    From the biological point of view the value of autotrophy plant association is determined by the carbon fixation and the carbon cycle. Among the plant associations of Hungary, forest has the largest biological carbon fixation and carbon cycle. In general,the annual water cycle is the key factor in the organic material production of the Hungarian forests. The most intensive water consumption and organic material production take place from May till July, which period is named main water consumption and respectively main growing period. In Hungary the categories of the forest climate are characterized by main tree species and based on the forest climate covers 8% of the forest area, hornbeam-oak forest climate covers 22%, sessile oak-Turkey oak forest climate covers48% and forest steppe climate covers 22%. Partly in the frame of ICP-Forests, the Department of Ecology in the Forest Research Institute carries out long term, complex ecophysiological investigations on several sample plots (so-called basic plots) throughout the whole country. The organic material production (growth), the nutrient and water cycle, the measurements of air pollutants and meteorological parameters, as well as chemical analyses are all part of the investigations. As a comparison the figure of two basic plotsforest steppe climate in the hydrological year of 2001-2002. In the Hungarian forest 60%-70% of the precipitation is used for interception, evaporation, and in the vegetation season, for the transpiration both in beech and forest steppe climate. From other point of view, only 30%-40% of the open air precipitation infiltrates into the soil and can be utilized by the forest.

  19. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography. (United States)

    Hales, Caz; de Vries, Kay; Coombs, Maureen


    Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

  20. Care management: agreement between nursing prescriptions and patients' care needs. (United States)

    Faeda, Marília Silveira; Perroca, Márcia Galan


    analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. analisar a concordância entre prescrições de enfermagem, registradas nos prontuários, e as necessidades de cuidados dos pacientes; investigar a correlação entre o perfil profissional dos enfermeiros e a concordância das prescrições. estudo descritivo com abordagem quantitativa e documental, realizado em unidades de clínica médica, cirúrgica e especializada de um hospital de ensino, no interior do Estado de São Paulo. Foi aplicada a nova versão validada do Instrumento de Classificação de Pacientes e, posteriormente, investigadas 380 prescrições de enfermagem no momento da admissão e alta hospitalar. foi identificado que 75% dos itens das prescrições de enfermagem estavam compatíveis com as necessidades cuidativas dos pacientes. Encontrou-se baixa correlação entre a concordância da prescrição de enfermagem e o perfil profissional. as prescrições de enfermagem não estão sendo realizadas, em sua totalidade, em consonância com as necessidades dos pacientes. Para

  1. Regional Disparities along the Romanian-Hungarian Border Region

    Directory of Open Access Journals (Sweden)



    Full Text Available The paper presents the actual state and condition of territorial inequalities at the Romanian-Hungarian border region, which shows - at present - an evident advantage of the Hungarian side, from the point of view of complex socio-economical aspects. This advantage is especially outstanding for the Hungarian side in the field of infrastructural supply (drinking water, natural gas, and public sewage networks, but it is valid for some characteristics of human capital, too, (above all, with regard to the illiteracy rate and the proportion of highly skilled persons with bachelor degree. Despite these difficulties, these inequalities are not insurmountable and should not affect efficient cross-border cooperation between the two countries. This regional inventory facilitates the evaluation of the starting-point of this kind of cooperation and also depicts some aspects of the interregional cooperation of the four counties north of the Romanian-Hungarian border region which belong to the Carpathian Euroregion.

  2. New Features of Educational Media Development in Hungarian Secondary Education. (United States)

    Benedek, Andras


    The development of educational technology media in Hungarian secondary education is discussed in terms of changing general pedagogical requirements; the influence of interactivity on teaching procedures; training teachers and developing educational media; and new statutory frameworks. (AEF)

  3. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Erikssen Lars


    Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact

  4. Emotion management in children′s palliative care nursing

    Directory of Open Access Journals (Sweden)

    Eryl Zac Maunder


    Full Text Available This article explores the emotional labor involved for nurses providing palliative care for children/young people living with life-limiting illnesses/conditions, and their families. It highlights the challenges nurses face in managing their emotion when caring for children/young people and their families, and explores strategies to enable nurses to cope with this aspect of their role without compromising their personal wellbeing. It suggests that emotional labor within nursing goes largely unrecorded, and remains undervalued by managers and health care services.

  5. Care for the case manager: balancing your wheel of life. (United States)

    Crowell, D M


    The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

  6. Hypertension management in primary care in Belarus and The Netherlands.

    NARCIS (Netherlands)

    Schellevis, F.G.; Rusovich, V.; Egorov, K.N.; Podpalov, V.P.; Boerma, W.G.W.


    Both in Belarus and in the Netherlands, guidelines on the management of hypertension in primary care have been developed, including recommendations about detection, treatment and follow-up. These guidelines are meant to harmonize actual practice management of hypertension of improve the quality of c

  7. Audit Trail Management System in Community Health Care Information Network. (United States)

    Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio


    After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

  8. Innovation and Internationalization of Hungarian SMEs in the IT Industry

    Directory of Open Access Journals (Sweden)

    Csonka László


    Full Text Available The aim of this paper is to look at the extent and type of internationalization among Hungarian information technology (IT small- and medium-sized enterprises (SMEs and the possible relationship between the degree of innovativeness and the internationalization of these companies. Information technologies play an important role in the Hungarian economy: this sector is one of the most R&D intensive industries in which many SMEs are active.

  9. Excise Tax Overshifting in the Hungarian Beer Market


    Bakó, Barna; Berezvai, Zombor


    We conduct this paper on excise tax shifting in the Hungarian beer market. Using a regression model we show that tax overshifting occurs in this market. We present a model with oligopolistic competition to explain how tax overshifting can occur because of the separated vertical structure. Our results suggests that Hungarian beer producers compete in Bertrand fashion and the hypothesis of collusion between beer producers can be rejected.

  10. Anticoagulated patient management in primary care service

    Directory of Open Access Journals (Sweden)

    Marco Antonio Zapata Sampedro


    Full Text Available Out-patients undergoing anticoagulant treatment are attended by nursing staff, working with doctors.To be able to provide adequate medical care, nurses must have the minimum knowledge and skills needed to work with the programme described in this article. These include basic and specific knowledge of anticoagulation. The correct functioning of the service will help provide an optimum control of the INR (International Normalized Ratio and reduce the complications of bleeding, both of which are the main objectives of the nursing care of these patients.

  11. Optimizing cardiothoracic surgery information for a managed care environment. (United States)

    Denton, T A; Matloff, J M


    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  12. What are purchasers looking for in managed care quality? (United States)

    Lipson, E H


    Spurred by competition and the growth of managed care, providers are seeking new approaches for satisfying the needs of health care purchases. Increasingly, these purchasers are focusing on the value of managed care arrangements, especially the degree to which they manage quality. Underlying the emerging focus on quality are concerns about "undercare," potential legal liability, and the economics of quality. Purchasers are sensitive to the quality of service and the experience of their patients, as well as the clinical quality of the care they receive, and many employers are now engaged in a systematic effort to assess both of these dimensions of quality. The emergence of national data banks, practice standards, and accreditation programs offers additional tools for strengthening provider accountability for quality.

  13. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David


    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe....... The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility...... study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide...

  14. Nutrition services in managed care: new paradigms for dietitians. (United States)

    Laramee, S H


    Managed care systems are transforming the health care system in the United States. Dietitians will need to review practice opportunities in new and different settings, and develop additional skills to make a successful transition to the transformed health care environment. The shift in health care financing from a fee-for-service model to a capitated system will have the most dramatic impact on the profession. Not all the answers are available, but the focus for the future is clear--customer satisfaction, outcomes research, and cost-effective nutrition services.

  15. [Organizational context and care management by nurses at emergency care units]. (United States)

    dos Santos, José Luis Guedes; Pestanab, Aline Lima; Higashi, Giovana Dorneles Callegaro; de Oliveira, Roberta Juliane Tono; Cassetari, Sônia da Silva Reis; Erdmann, Alacoque Lorenzini


    The purpose of this study was to understand the meanings attributed to the organizational context and the role of nurses in care management at emergency care units.This study was based on qualitative research and the Grounded Theory methodological framework. Data were collected from September 2011 to June 2012 by means of semi-structured interviews with 20 participants from two emergency care units (UPA) in southern Brazil, divided into three sample groups. The context is marked by constraints that hinder communication and interaction between professionals and the search of assistance by patients with demands that are not resolved at other levels of care. This scenario highlights the performance of nurses in the managerial dimension of their work, who assume the responsibility for managing care and coordinating professional actions in favour of improved care practices.

  16. Program management of telemental health care services. (United States)

    Darkins, A


    Telemedicine is a new adjunct to the delivery of health care services that has been applied to a range of health care specialties, including mental health. When prospective telemedicine programs are planned, telemedicine is often envisaged as simply a question of introducing new technology. The development of a robust, sustainable telemental health program involves clinical, technical, and managerial considerations. The major barriers to making this happen are usually how practitioners and patients adapt successfully to the technology and not in the physical installation of telecommunications bandwidth and the associated hardware necessary for teleconsultation. This article outlines the requirements for establishing a viable telemental health service, one that is based on clinical need, practitioner acceptance, technical reliability, and revenue generation. It concludes that the major challenge associated with the implementation of telemental health does not lie in having the idea or in taking the idea to the project stage needed for proof of concept. The major challenge to the widespread adoption of telemental health is paying sufficient attention to the myriad of details needed to integrate models of remote health care delivery into the wider health care system.

  17. A guide to wound managment in palliative care. (United States)

    Naylor, Wayne A


    Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

  18. What health care managers do: applying Mintzberg's structured observation method. (United States)

    Arman, Rebecka; Dellve, Lotta; Wikström, Ewa; Törnström, Linda


    Aim The aim of the present study was to explore and describe what characterizes first- and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first- and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.

  19. An Application of Business Process Management to Health Care Facilities. (United States)

    Hassan, Mohsen M D

    The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

  20. Health care units and human resources management trends. (United States)

    André, Adriana Maria; Ciampone, Maria Helena Trench; Santelle, Odete


    To identify factors producing new trends in basic health care unit management and changes in management models. This was a prospective study with ten health care unit managers and ten specialists in the field of Health in São Paulo, Southeastern Brazil, in 2010. The Delphi methodology was adopted. There were four stages of data collection, three quantitative and the fourth qualitative. The first three rounds dealt with changing trends in management models, manager profiles and required competencies, and the Mann-Whitney test was used in the analysis. The fourth round took the form of a panel of those involved, using thematic analysis. The main factors which are driving change in basic health care units were identified, as were changes in management models. There was consensus that this process is influenced by the difficulties in managing teams and by politics. The managers were found to be up-to-date with trends in the wider context, with the arrival of social health organizations, but they are not yet anticipating these within the institutions. Not only the content, but the professional development aspect of training courses in this area should be reviewed. Selection and recruitment, training and assessment of these professionals should be guided by these competencies aligned to the health service mission, vision, values and management models.

  1. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care. (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus


    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.

  2. Improving Chronic Care: Developing and testing disease-management interventions applied in COPD care

    NARCIS (Netherlands)

    K.M.M. Lemmens (Karin)


    textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of dis

  3. Nursing management and organizational ethics in the intensive care unit. (United States)

    Wlody, Ginger Schafer


    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  4. [Administrative and reporting tasks of family physicians in Europe. Comparison with the Hungarian system]. (United States)

    Rurik, Imre; Kalabay, László


    Administrative tasks are continuously increasing in the different health systems worldwide and also in the primary care. The administrative and reporting tasks of family physicians in Hungary are regulated by laws and rules. The aim of the study was to compare the recent Hungarian administrative tasks to those of other European countries in the primary care. Family physicians from 22 countries of the European General Practice Research Network were asked to fill a questionnaire regarding their countries. The results of their answers were presented and analyzed. Doctors are paid by capitation or fee for services, sometimes by the combination of both. They are obliged to prepare reports which depend on the respective countries, contain identification data of patients, diagnoses to be set up, and treatments. Administrative duties and the national characteristics of drug-prescriptions, referral systems to specialist or hospital were also analyzed. Conclusions were made in comparison with the European and Hungarian regulations. Reports needed by the Hungarian authorities are more complex and detailed, with many overlaps. The reasons why data are needed are often not clear and do not fit for the purpose. The time available for medical treatment is decreased by administrative duties making the gate-keeper function ineffective. There is no time for real prevention. Without official (governmental) version of primary care softwares, family physicians use too many softwares with different quality, which are not compatible with each other. It is suggested to check and modify the data obliged in reporting systems. Only data relevant in epidemiological or economical points of view should be reported with more focus to personal protection of privacy rights.

  5. Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014. (United States)

    Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N


    State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1

  6. [Management of pain in palliative care]. (United States)

    Heiskanen, Tarja; Hamunen, Katri; Hirvonen, Outi


    Palliative pain management is usually successful, if the medication is strengthened in a stepwise manner in accordance with pain intensity, and initiation of a strong opioid is not delayed. Finding of a sufficiently effective dose of the opioid drug with simultaneous management of adverse effects requires continuous pain assessment and patient monitoring. In many cases it is possible to enhance analgesia by supplementing the medication with an antidepressant or an antiepileptic along with the opioid and paracetamol or the analgesic. Palliative radiotherapy will relieve tissue injury pain caused by bone metastases and soft tissue tumors as well as pain due to the possible nerve entrapments caused by them.

  7. Dementia Care: Confronting Myths in Clinical Management. (United States)

    Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W


    Every day, patients with dementia, their families, and their physicians face the enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting.

  8. Hospital marketing orientation and managed care processes: are they coordinated? (United States)

    White, K R; Thompson, J M; Patel, U B


    The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.

  9. Psycotherapy, managed care, and the economy of interaction. (United States)

    Metzl, J M


    This paper examines the disclosure over the value of long-term psychotherapy in a managed-care system. Many managed-care companies define extended psychotherapy as superfluous. Those who defend psychotherapy respond that the restrictions imposed by managed care are misguided and potentially harmful. After briefly discussing the relevant literature, the points of contention between psychotherapy and managed care are examined from the perspective of narrative literary theory. The analysis highlights the contrasting narrative assumptions implied about the importance of the clinical interaction. Pointing out each side's use of point-of-view, narrative structure, and informational exchange, it is posited that beneath arguments that often focus on the commodities of time and money lie larger, conceptual differences. These stealthily serve to undermine the possibility of a rational debate. The paper concludes by asserting that psychotherapy and managed care assume incommensurate narratives of interaction when discussing the value of therapy. The terms of discourse must be expanded in order to account for the philosophical differences described. Several ways this might be accomplished are proposed.

  10. The European initiative for quality management in lung cancer care. (United States)

    Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul


    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

  11. Exploring Space Management Goals in Institutional Care Facilities in China (United States)

    Zhang, Jiankun


    Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities.

  12. Introducing managed care to the medical school curriculum: effect on student attitudes. (United States)

    Field, T S; Baldor, R A; Casey, L M; Chuman, A; Lasser, D; Ehrlich, A; Gurwitz, J H


    In order to assess the effect of clinical training and didactic instruction on medical student attitudes toward managed care, we conducted a survey of all medical students at the midpoint of their third year clerkships at the University of Massachusetts Medical School. The students were exposed to clinical training in managed care settings and a 2-day required course on the principles underlying managed care. The main outcome measures were student attitudes toward the concepts of managed care, managed care organizations, and future careers in managed care. Students also assessed the attitudes of medical faculty toward managed care. Attitudes of students with previous clinical training in managed care settings did not differ from those of students without such exposure toward the concepts underlying managed care or managed care organizations and were less positive about careers in managed care. Student responses before and after the 2-day course on managed care demonstrated that attitudes moved in a significantly positive direction. Seventy-one percent of students reported that the opinions they had heard from medical faculty about managed care were negative. Preparing medical students to practice medicine effectively in managed care settings will require focused attention on managed care issues in the medical school curriculum and the combined efforts of academic health centers and managed care organizations.

  13. Managing mechanistic and organic structure in health care organizations. (United States)

    Olden, Peter C


    Managers at all levels in a health care organization must organize work to achieve the organization's mission and goals. This requires managers to decide the organization structure, which involves dividing the work among jobs and departments and then coordinating them all toward the common purpose. Organization structure, which is reflected in an organization chart, may range on a continuum from very mechanistic to very organic. Managers must decide how mechanistic versus how organic to make the entire organization and each of its departments. To do this, managers should carefully consider 5 factors for the organization and for each individual department: external environment, goals, work production, size, and culture. Some factors may push toward more mechanistic structure, whereas others may push in the opposite direction toward more organic structure. Practical advice can help managers at all levels design appropriate structure for their departments and organization.

  14. Pricing specialty carve-outs and disease management programs under managed care. (United States)

    LaPensee, K T


    The drive toward improved efficiency and effectiveness in health care has spawned disease management programs to address the needs of patients with certain conditions. These programs parallel traditional case management programs in monitoring patients, but disease management differs from case management in early assessment of patient risk, with proactive clinical interventions and educational efforts. The most comprehensive programs include a coordinated delivery system that can be "carved out" from other health care benefits. Pricing disease management can benefit from the analysis of detailed, disease-specific and community-specific data from public or private sources.

  15. Conflict across organizational boundaries: managed care organizations versus health care providers. (United States)

    Callister, R R; Wall, J A


    This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.

  16. Administration to innovation: the evolving management challenge in primary care. (United States)

    Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J


    The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

  17. Time based management in health care system: The chosen aspects

    Directory of Open Access Journals (Sweden)

    Joanna Kobza


    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  18. [Time based management in health care system: the chosen aspects]. (United States)

    Kobza, Joanna; Syrkiewicz-Świtała, Magdalena


    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.

  19. Hypertension management: the primary care nursing role. (United States)

    Khan, Ehsan Ullah


    Hypertension is a prevalent chronic illness that is implicated in many cardiovascular diseases. Practice nurses and the district nursing team have a major role to play in its management. In this article, current British Hypertension Society guidelines are presented and discussed with regards to their evidence base. Implications for nursing practice are highlighted.

  20. Managed care or managed inequality? A call for critiques of market-based medicine. (United States)

    Rylko-Bauer, Barbara; Farmer, Paul


    This review article critiques the growing dominance of market-based medicine in the United States against the background of existing problems with quality of care, rising costs, devaluation of doctor-patient relationships, and, especially, persistent inequalities of access and outcomes. It summarizes the present state of health care delivery by focusing on the concurrent trends of growth in managed care, expanding profits, increasing proportion of those uninsured, and widening racial, ethnic, and class disparities in access to care. Allowing market forces to dictate the shape of health care delivery in this country ensures that inequalities will continue to grow and modern medicine will become increasingly adept at managing inequality rather than managing (providing) care. The article challenges anthropology to become more involved in critiquing these developments and suggests how anthropologists can expand on and contextualize debates surrounding the market's role in medicine, here and abroad.

  1. Health care managers learning by listening to subordinates' dialogue training. (United States)

    Grill, C; Ahlborg, G; Wikström, E


    Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. Only eight managers participated in the intervention, but data afforded a basis for further research. Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

  2. [Management of technology and its influence on nursing care]. (United States)

    Palacios-Ceña, Domingo


    Currently, much nursing care adheres to a specific biomedical paradigm within the positivist framework. However, sometimes nursing care cannot be adapted to numerous human or vital conditions affecting our patients, their families or the environment in which nurses work. An specific example of these nursing interventions are those applied in intensive care units (ICU) where there is a large amount of technology and nursing care is specialized. Several questions that arise are whether the above-mentioned specialization is inherent to nurse care, whether technology management forms part of nursing care, whether this care has a non-nursing origin, and what is the source of nursing knowledge. The present article aims to provide basic knowledge to distinguish the nursing care performed in the ICU within the 2 predominant paradigms in current nursing: the biomedical and the holistic paradigms. The characteristics of nursing care in both paradigms are described and an integrated vision of these 2 paradigms and of nursing care with and without the use of technology is provided.

  3. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records. (United States)

    Monroe, C Douglas; Chin, Karen Y


    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  4. Development of a chronic care ostomy self-management program. (United States)

    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert


    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

  5. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost


    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  6. Physician directed networks: the new generation of managed care. (United States)

    Bennett, T; O'Sullivan, D


    The external pressure to reduce cost while maintaining quality and services is moving the whole industry into a rapid mode of integration. Hospitals, vendors, MCOs, and now, physicians, are faced with the difficult decisions concerning how their operations will be integrated into the larger health care delivery system. These pressures have forced physicians to consolidate, build leverage, and create efficiencies to become more productive; thereby better positioning themselves to respond to the challenges and the opportunities that lie before them. This initial phase of consolidation has given many physicians the momentum to begin to wrestle back the control of health care and the courage to design the next generation of managed care: Physician Directed Managed Care. What will be the next phase? Perhaps, the next step will be fully-integrated specialty and multi-specialty groups leading to alternate delivery sites. "Everyone thinks of changing the world, but no one thinks of changing himself." - Leo Tolstoy

  7. Management considerations in the care of elderly heart failure patients in long-term care facilities. (United States)

    Heckman, George A; Boscart, Veronique M; McKelvie, Robert S


    Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.

  8. Multidisciplinary care and management selection in prostate cancer. (United States)

    Aizer, Ayal A; Paly, Jonathan J; Efstathiou, Jason A


    The management of prostate cancer is complicated by the multitude of treatment options, the lack of proven superiority of one modality of management, and the presence of physician bias. Care at a multidisciplinary prostate cancer clinic offers patients the relative convenience of consultation with physicians of multiple specialties within the confines of a single visit and appears to serve as a venue in which patients can be counseled regarding the risks and benefits of available therapies in an open and interactive environment. Physician bias may be minimized in such an environment, and patient satisfaction rates are high. Available data suggest that low-risk patients who are seen at a multidisciplinary prostate cancer clinic appear to select active surveillance in greater proportion. However, relatively few studies have investigated the other added value that multidisciplinary clinics provide to the patient or health care system, and therefore, additional studies assessing the impact of multidisciplinary care in the management of patients with prostate cancer are needed.

  9. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao


    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  10. Facilities Management and Health Care at Home


    Lundberg, Stefan


    The topic of this thesis is the new requirements that will be put upon the facilities management when the elderly are living longer in their own homes, in spite of illness, impairment and old age. For many reasons, especially demographic ones, this issue has come to the fore and since it has substantial political impact and considerably affects our living conditions, it will most certainly appear on the agenda of most Swedish housing companies in the near future. The growing number of inhabit...

  11. [The hospital perspective: disease management and integrated health care]. (United States)

    Schrappe, Matthias


    Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

  12. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care



    Abstract Use of Chinese herbal medicines (CHM) in symptom management for cancer palliative care is very common in Chinese populations but clinical evidence on their effectiveness is yet to be synthesized. To conduct a systematic review with meta-analysis to summarize results from CHM randomized controlled trials (RCTs) focusing on symptoms that are undertreated in conventional cancer palliative care. Five international and 3 Chinese databases were searched. RCTs evaluating CHM, either in comb...

  13. Marketing a managed care plan: achieving product differentiation. (United States)

    Romeo, N C


    The health care marketplace is changing dramatically, even without federal reform measures. This is a volatile, yet promising, time to market a managed care plan. Before marketing the product, it is critical that the competition is thoroughly evaluated and consumer and employer needs are researched. The final product should be distinguishable from the competition and address market needs. Promotion can then begin, utilizing a proactive public relations and advertising campaign in addition to traditional methods of marketing.

  14. Breast Cancer Screening in a Low Income Managed Care Population (United States)


    the morbidity and mortality of breast cancer among the population of low income women who have incomes less than 200% of the national poverty level...34Journal for Health Care for the Poor and Underserved" (see appendix). Entitled "Difficulty in Reaching Low Income Women for Screening Mammography...useful insights for future program planning and research design. Keywords: screening mammography, low income , managed care and barriers Poverty is

  15. Managing organizational change: strategies for the female health care supervisor. (United States)

    Davies, G


    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Overcoming resistance against managed care ? insights from a bargaining model


    Ehlert, Andree; Wein, Thomas; Zweifel, Peter


    Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SH...

  17. Myasthenic crisis patients who require intensive care unit management. (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto


    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.

  18. Manager traits and quality-of-care performance in hospitals. (United States)

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke


    This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

  19. [Organization of health services and tuberculosis care management]. (United States)

    Barrêto, Anne Jaquelyne Roque; de Sá, Lenilde Duarte; Nogueira, Jordana de Almeida; Palha, Pedro Fredemir; Pinheiro, Patrícia Geórgia de Oliveira Diniz; de Farias, Nilma Maria Porto; Rodrigues, Débora Cezar de Souza; Villa, Tereza Cristina Scatena


    The scope of this study was to analyze the discourse of managers regarding the relationship between the organization of the health services and tuberculosis care management in a city in the metropolitan region of João Pessoa, State of Pernambuco. Using qualitative research in the analytical field of the French line of Discourse Analysis, 16 health workers who worked as members of the management teams took part in the study. The transcribed testimonials were organized using Atlas.ti version 6.0 software. After detailed reading of the empirical material, an attempt was made to identify the paraphrasic, polyssemic and metaphoric processes in the discourses, which enabled identification of the following discourse formation: Organization of the health services and the relation with TB care management: theory and practice. In the discourse of the managers the fragmentation of the actions of control of tuberculosis, the lack of articulation between the services and sectors, the compliance of the specific activities for TB, as well as the lack of strategic planning for management of care of the disease are clearly revealed. In this respect, for the organization of the health services to be effective, it is necessary that tuberculosis be considered a priority and acknowledged as a social problem in the management agenda.

  20. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    Directory of Open Access Journals (Sweden)

    Luis Rafael Moscote-Salazar


    Full Text Available Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

  1. NHS direct: managing demand for primary care? (United States)

    Mark, Annabelle L; Shepherd, Ifan D H


    This paper considers how NHS Direct is affecting demand for primary care in particular out-of-hours services from GPs. This is reviewed through a 3-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question 'Has NHS Direct increased the workload for HARMONI doctors?'. The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups notably the elderly and children, and in individual GP practices may be significant. In addition, the changes in organizational arrangements may influence significant changes in referral patterns such as GP out-of-hours visits. This was confirmed in the interview data indicating a link between the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24 hours, 7 days a week NHS Direct service. The conclusions drawn are that behavioural and organizational changes are at least as significant as the evidence-based computerized decision support software in changing the demand for primary care. Further evidence cited is that a different demand pattern of calls was experienced by those local GPs not integrated into out-of-hours provision at NHS Direct West London at the time of the study.

  2. Influences on the career commitment of health-care managers. (United States)

    Myrtle, Robert C; Chen, Duan-Rung; Liu, Caroline; Fahey, Daniel


    The health-care field is undergoing rapid and significant transformation. This transformation has led to the breakdown of traditional career paths for managers in the patient care segment of the industry. To our knowledge, there has not been a systematic examination of how these changes have impacted on the career commitment of managers in this segment of the industry. Building on previous research, we examine the effects of employment-related conditions and career experiences on the career commitment of these managers while controlling for the influence of individual characteristics. Specifically we assess the relationship between employment-related conditions, such as job security, position tenure, industry segment, management level and the extent to which their current position meets their career expectations, and their career experiences, including moving from a non-health-care management position, moving from a different health-care sector, their career stage, career patterns and their satisfaction with their career progression. We found that measures associated with the different employment-related experiences had a more significant influence on career commitment than those measures associated with different career experiences.

  3. Continuity in health care: lessons from supply chain management. (United States)

    Meijboom, Bert R; Bakx, Saskia J W G C; Westert, Gert P


    In health care, multidisciplinary collaboration is both indispensable and complicated. We discuss organizational problems that occur in situations where multiple health care providers are required to cooperate for patients with complex needs. Four problem categories, labelled as communication, patient safety, waiting times and integration are distinguished. Then we develop a supply chain perspective on these problems in the sense of discussing remedies according to supply chain management (SCM) literature. This perspective implies a business focus on inter-organizational conditions and requirements necessary for delivering health care and cure across organizational borders. We conclude by presenting some strategic and policy recommendations.

  4. Soil-atmosphere relationships: The Hungarian perspective (United States)

    Ács, Ferenc; Rajkai, Kálmán; Breuer, Hajnalka; Mona, Tamás; Horváth, Ákos


    This study discusses scientific contributions analyzing soil-atmosphere relationships. These studies deal with both the biogeophysical and biogeochemical aspects of this relationship, with biogeophysical aspects being in the majority. All of the studies refer either directly or indirectly to the fundamental importance of soil moisture content. Moisture has a basic influence on the spatiotemporal pattern of evapotranspiration, and so 1) on cloud formation and precipitation events by regulating the intensity of convection, and 2) on the trace-gas exchanges in the near-surface atmosphere. Hungarian modeling efforts have highlighted that soils in the Pannonian Basin have region-specific features. Consequently, shallow and deep convection processes are also, to some extent, region-specific, at least in terms of the diurnal change of the planetary boundary layer height and the spatial distribution of convective precipitation. The soil-dependent region-distinctiveness of these two phenomena has been recognized; at the same time the strength of the relationships has not yet been quantified.

  5. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices. (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick


    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  6. Brahms J. Hungarian Dances. London Symphony Orchestra, Neeme Järvi / Jonathan Swain

    Index Scriptorium Estoniae

    Swain, Jonathan


    Uuest heliplaadist "Brahms J. Hungarian Dances. London Symphony Orchestra, Neeme Järvi. Chandos MC ABTD 1496; CD CHAN 8885 (57 minutes). Brahms J. Hungarian Dances. Staatskapelle Berlin. Otmar Suitner." Denon CD CO- 74597 (53 minutes)

  7. Brahms J. Hungarian Dances. London Symphony Orchestra, Neeme Järvi / Jonathan Swain

    Index Scriptorium Estoniae

    Swain, Jonathan


    Uuest heliplaadist "Brahms J. Hungarian Dances. London Symphony Orchestra, Neeme Järvi. Chandos MC ABTD 1496; CD CHAN 8885 (57 minutes). Brahms J. Hungarian Dances. Staatskapelle Berlin. Otmar Suitner." Denon CD CO- 74597 (53 minutes)

  8. Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts (United States)

    Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica


    Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

  9. Critical care management of severe traumatic brain injury in adults


    Haddad Samir H; Arabi Yaseen M


    Abstract Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP...

  10. Guidelines of care for the management of acne vulgaris. (United States)

    Zaenglein, Andrea L; Pathy, Arun L; Schlosser, Bethanee J; Alikhan, Ali; Baldwin, Hilary E; Berson, Diane S; Bowe, Whitney P; Graber, Emmy M; Harper, Julie C; Kang, Sewon; Keri, Jonette E; Leyden, James J; Reynolds, Rachel V; Silverberg, Nanette B; Stein Gold, Linda F; Tollefson, Megha M; Weiss, Jonathan S; Dolan, Nancy C; Sagan, Andrew A; Stern, Mackenzie; Boyer, Kevin M; Bhushan, Reva


    Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

  11. [New model of professional self-management in primary care]. (United States)

    Anguita-Guimet, A; Ortiz-Molina, J; Sitjar-Martínez de Sas, S; Sisó-Almirall, A; Menacho-Pascual, I; Sebastian-Montal, L


    To analyse the benefits of a new organisational model in Primary Care based on the empowerment of professional management compared to standard model (team led by medical director). To improve the quality of care, and patient and professional satisfaction. In February 2009 six family physician (FP) and four administrative staff met to create a self-management group to care for the 10,281 population assigned to them. The total catchment population of the Primary Care (PC) centre was 32,318. Additionally, between March and December 2010 three FP, seven nurses and two administrative staff, were included in the self-management group making the total population served by the self-management group of 16,368, compared to 15,950 patients seen using the standard model. The model gave priority to self-demand management, professional self-coverage, to reduce clinic bureaucracy, greater efficiency and participation in research and teaching. 1) Milestone in Pilot Phase (December-2008 to December-2009): increase in attended population, reduction in clinic visits, significant reduction in delay to be visited by a doctor; significant reduction of complementary tests (x-rays, laboratory tests); increase in use of generic drugs and reduction of expensive and new drugs without added value, and active participation in teaching and clinical trials. 2) Consolidation Phase (December-2010, compared to other professionals working in a standard model in the same centre): self-management group reported a lower percentage of clinic visits and a higher percentage of visits resolved through telephoning the clinic. Furthermore, the self-management group achieved better financial results than the control group (additional medical tests, pharmacy budget). The self-management group had improved job satisfaction compared to control group (measured by Professional Questionnaire QoL-35). The new model has increased professional satisfaction and may improve results in some health indicators

  12. [Geertz' Interpretive Theory and care management: visualizing nurses' social practice]. (United States)

    Prochnow, Adelina Giacomelli; Leite, Joséte Luzia; Erdmann, Alacoque Lorenzini


    This paper presents a theoretical reflection on hospital nursing care management and Geertz' Interpretive Theory of Culture. We discuss some significant elements of culture in management, based on the theoretical reference frameworks of nursing, administration and anthropology. In these, the importance of cultural diversity is highlighted as an innovative resource to expand the vision of human integrity, valuing divergences, respect and sharing, which are important for nurses in the construction of their social practice.

  13. Language disparities and timely care for children in managed care Medicaid. (United States)

    Galbraith, Allison A; Semura, Jeanne I; McAninch-Dake, Rebecca J; Anderson, Nancy; Christakis, Dimitri A


    To examine the relationship of race/ethnicity, language, communication with providers, and interpreter use with timeliness of illness and routine care for children in managed care Medicaid. Cross-sectional study using data from the Consumer Assessment of Health Plans Survey, which was administered to parents of children less than 15 years of age in Washington State managed care Medicaid in 2000. Predictors of interest were child's race/ethnicity, parent's primary language at home, difficulty communicating with the child's providers because of language, and need and use of interpreters. The primary outcomes were how often (always, usually, sometimes, or never) the child received illness and routine care as soon as wanted. Analyses used multivariate ordered logistic regression and model-based direct adjustment. A total of 5142 children were included. In adjusted analyses, children received illness and routine care significantly less often than wanted if the parent's primary language at home was not English; the parent ever had difficulty communicating with the provider; and the parent needed but did not always get an interpreter. Language barriers were associated with decreased timeliness of care for children in managed care Medicaid.

  14. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care. (United States)

    Penney, Christine; Henry, Effie


    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  15. Quality of management in the health care system. (United States)

    Borgenhammar, E


    Quality of management is a necessary, yet not sufficient, prerequisite in quality of care. There are two main approaches to improved quality. One is the individualist approach, where the role of the manager is emphasized. The other is the contextual approach. Focus is on managerial prerequisites such as organizational structure, culture, participation in decision making, and use of management time. Individualist as well as contextualist approaches are presented. Each decade during the 20th century has had its own "pet theory" regarding what problems the manager should allocate time on. A study of 41 Nordic public health researchers illustrates that cost-benefit analysis is the best known of ten theories. Management ethics, with the manager as ideologist, is seen as particularly demanding on managerial creativity.

  16. Management strategies for palliative care: promoting quality, growth and opportunity. (United States)

    Herbst, L H; Cetti, J


    Over 20 years ago, hospice in the United States evolved to provide end-of-life care for terminally ill patients. However, three major barriers exist, which limit access to hospice care. The first two, cultural and regulatory barriers, are not under the direct control of hospices, although programs can be adapted to minimize their influence. The third, management focus, is controlled by hospice programs and has the greatest influence on access to care and quality of care. Under the influence of the Medicare Hospice Benefit and the peer pressure of managed care, many hospice programs use reimbursability as at least one criterion for determination of coverage of services. The fear is that limited reimbursement will cause some services and therapies to bring the programs to financial ruin. This case study shows the outcome of changing management focus away from restrictive policies about therapies and patient selection toward management of productivity and working capital. Some programs have contributed to growth and stability; the revenue thus produced has supported the new innovations. San Diego Hospice is now growing more than 30 percent per year in spite of competition and a fairly flat death rate in the community. This growth is attributed to finding and meeting unmet needs and making all decisions based on the right thing to do. Every staff member understands and supports the mission. The many programs within the agency contribute to fulfillment of the goal to transform end-of-life care. They are presented here as an example of what can be done with mission-based management.

  17. Palliative care in cancer: managing patients' expectations. (United States)

    Ghandourh, Wsam A


    Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.

  18. International Equity Portfolios and Currency Hedging: The Viewpoint of German and Hungarian Investors


    Bugár, Gyöngyi; Maurer, Raimond


    In this paper we study the benefits derived from international diversification of stock portfolios from German and Hungarian point of view. In contrast to the German capital market, which is one of the largest in the world, the Hungarian Stock Exchange is an emerging market. The Hungarian stock market is highly volatile, high returns are often accompanied by extremely large risk. Therefore, there is a good potential for Hungarian investors to realize substantial benefits in terms of risk redu...

  19. Development of an allergy management support system in primary care (United States)

    Flokstra - de Blok, Bertine MJ; van der Molen, Thys; Christoffers, Wianda A; Kocks, Janwillem WH; Oei, Richard L; Oude Elberink, Joanne NG; Roerdink, Emmy M; Schuttelaar, Marie Louise; van der Velde, Jantina L; Brakel, Thecla M; Dubois, Anthony EJ


    Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients. PMID:28352197

  20. The health-care manager's guide to managing change in challenging times. (United States)

    Lombardi, D N


    Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management.

  1. The transfer of a health insurance/managed care business. (United States)

    Gavin, John N; Goodman, George; Goroff, David B


    The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations.

  2. Evolving strategies for optimal care management and plan benefit designs. (United States)

    Cruickshank, John M


    As a prevalent, complex disease, diabetes presents a challenge to managed care. Strategies to optimize type 2 diabetes care management and treatment outcomes have been evolving over the past several years. Novel economic incentive programs (eg, those outlined in the Patient Protection and Affordable Care Act of 2010 that tie revenue from Medicare Advantage plans to the quality of healthcare delivered) are being implemented, as are evidence-based interventions designed to optimize treatment, reduce clinical complications, and lower the total financial burden of the disease. Another step that can improve outcomes is to align managed care diabetes treatment algorithms with national treatment guidelines. In addition, designing the pharmacy benefit to emphasize the overall value of treatment and minimize out-of-pocket expenses for patients can be an effective approach to reducing prescription abandonment. The implementation of emerging models of care that encourage collaboration between providers, support lifestyle changes, and engage patients to become partners in their own treatment also appears to be effective.

  3. Update on the critical care management of severe burns. (United States)

    Kasten, Kevin R; Makley, Amy T; Kagan, Richard J


    Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition have produced appropriate protocols that aid the healing process in severely injured patients with burn. As more patients survive larger burn injuries, the early diagnosis and successful treatment of secondary and tertiary complications are becoming commonplace. While advances in this area are exciting, much work to elucidate immune pathways, diagnostic tests, and effective treatment regimens still remain. This review will provide an update on the critical care management of severe burns, touching on accurate diagnosis, resuscitation, and acute management of this difficult patient population.

  4. Medicaid Managed Care and Individuals with Disabilities: Status Report. (United States)

    Hemp, Richard; Braddock, David


    Summarizes information presented in the American Association on Mental Retardation's 1998 publication, "State of the States in Developmental Disabilities" (Braddock, Hemp, Parish, and Westrich), which reports data on the implementation of managed care for persons with developmental disabilities. A table summarizes information about enrollment of…

  5. The knowledge and practice of self-care management among ...

    African Journals Online (AJOL)

    Background: Self-care management in diabetic patients is crucial to control and ... knowledge and practice among 80 participants attending a diabetes clinic in ... problems 88.7% (n=71); retinopathy 15% (n=12); hypertension 23.7% (n=19) ...

  6. The Nurturing Teacher: Managing the Stress of Caring (United States)

    VanSlyke-Briggs, Kjersti


    This book tackles the concerns of stressed teachers. Whether from nurturance suffering (stress related to caring for students) or from the piles of paperwork yet to be tackled, this text helps the reader sort through the causes of stress, the emotional, physical and social reactions to stress and how one can begin to plan a stress management plan.…

  7. Care-managers' professional choices: ethical dilemmas and conflicting expectations. (United States)

    Tønnessen, Siri; Ursin, Gøril; Brinchmann, Berit Støre


    Care-managers are responsible for the public administration of individual healthcare decisions and decide on the volume and content of community healthcare services given to a population. The purpose of this study was to investigate the conflicting expectations and ethical dilemmas these professionals encounter in their daily work with patients and to discuss the clinical implications of this. The study had a qualitative design. The data consisted of verbatim transcripts from 12 ethical reflection group meetings held in 2012 at a purchaser unit in a Norwegian city. The participants consist of healthcare professionals such as nurses, occupational therapists, physiotherapists and social workers. The analyses and interpretation were conducted according to a hermeneutic methodology. This study is part of a larger research project. Two main themes emerged through the analyses: 1. Professional autonomy and loyalty, and related subthemes: loyalty to whom/what, overruling of decisions, trust and obligation to report. 2. Boundaries of involvement and subthemes: private or professional, care-manager or provider and accessibility. Underlying values and a model illustrating the dimensions of professional responsibility in the care-manager role are suggested. The study implies that when allocating services, healthcare professionals need to find a balance between responsibility and accountability in their role as care-managers.

  8. The Exnovation of Chronic Care Management Processes by Physician Organizations. (United States)

    Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M


    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

  9. Managing information technology human resources in health care. (United States)

    Mahesh, Sathiadev; Crow, Stephen M


    The health care sector has seen a major increase in the use of information technology (IT). The increasing permeation of IT into the enterprise has resulted in many non-IT employees acquiring IT-related skills and becoming an essential part of the IT-enabled enterprise. Health care IT employees work in a continually changing environment dealing with new specializations that are often unfamiliar to other personnel. The widespread use of outsourcing and offshoring in IT has introduced a third layer of complexity in the traditional hierarchy and its approach to managing human resources. This article studies 3 major issues in managing these human resources in an IT-enabled health care enterprise and recommends solutions to the problem.

  10. The Care management Information system for the home Care Network (SI GESCAD): support for care coordination and continuity of care in the Brazilian Unified health system (SUS). (United States)

    Pires, Maria Raquel Gomes Maia; Gottems, Leila Bernarda Donato; Vasconcelos Filho, José Eurico; Silva, Kênia Lara; Gamarski, Ricardo


    The present article describes the development of the initial version of the Brazilian Care Management Information System for the Home Care Network (SI GESCAD). This system was created to enhance comprehensive care, care coordination and the continuity of care provided to the patients, family and caretakers of the Home Care (HC) program. We also present a reflection on the contributions, limitations and possibilities of the SI GESCAD within the scope of the Home Care Network of the Brazilian Unified Health System (RAS-AD). This was a study on technology production based on a multi-method protocol. It discussed software engineering and human-computer interaction (HCI) based on user-centered design, as well as evolutionary and interactive software process (prototyping and spiral). A functional prototype of the GESCAD was finalized, which allowed for the management of HC to take into consideration the patient's social context, family and caretakers. The system also proved to help in the management of activities of daily living (ADLs), clinical care and the monitoring of variables associated with type 2 HC. The SI GESCAD allowed for a more horizontal work process for HC teams at the RAS-AD/SUS level of care, with positive repercussions on care coordination and continuity of care.

  11. Primary care management of opioid use disorders (United States)

    Srivastava, Anita; Kahan, Meldon; Nader, Maya


    Abstract Objective To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance. Sources of information PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included. Main message Both methadone and buprenorphine-naloxone are substantially more effective than abstinence-based treatment. Methadone has higher treatment retention rates than buprenorphine-naloxone does, while buprenorphine-naloxone has a lower risk of overdose. For all patient groups, physicians should recommend methadone or buprenorphine-naloxone treatment over abstinence-based treatment (level I evidence). Methadone is preferred over buprenorphine-naloxone for patients at higher risk of treatment dropout, such as injection opioid users (level I evidence). Youth and pregnant women who inject opioids should also receive methadone first (level III evidence). If buprenorphine-naloxone is prescribed first, the patient should be promptly switched to methadone if withdrawal symptoms, cravings, or opioid use persist despite an optimal buprenorphine-naloxone dose (level II evidence). Buprenorphine-naloxone is recommended for socially stable prescription oral opioid users, particularly if their work or family commitments make it difficult for them to attend the pharmacy daily, if they have a medical or psychiatric condition requiring regular primary care (level IV evidence), or if their jobs require higher levels of cognitive functioning or psychomotor performance (level III evidence). Buprenorphine-naloxone is also recommended for patients at high risk of methadone toxicity, such as the elderly, those taking high doses of benzodiazepines or other sedating drugs, heavy drinkers, those with a lower

  12. Diagnosing and managing psychosis in primary care. (United States)

    Saunders, Kate; Brain, Susannah; Ebmeier, Klaus P


    Psychosis is broadly defined as the presence of delusions and hallucinations. It can be organic or functional. The former is secondary to an underlying medical condition, such as delirium or dementia, the latter to a psychiatric disorder, such as schizophrenia or bipolar disorder. The identification and treatment of psychosis is vital as it is associated with a 10% lifetime risk of suicide and significant social exclusion. Psychosis can be recognised by taking a thorough history, examining the patient's mental state and obtaining a collateral history. The history usually enables a distinction to be made between bipolar disorder, schizophrenia and other causes. Early symptoms often include low mood, declining educational or occupational functioning, poor motivation, changes in sleep, perceptual changes, suspiciousness and mistrust. The patient's appearance, e.g. unkempt or inappropriately attired, may reflect their predominant mental state. There may be signs of agitation, hostility or distractibility. Speech may be disorganised and difficult to follow or there may be evidence of decreased speech. Mood may be depressed or elated or change rapidly. Patients may describe abnormal thoughts and enquiry into thoughts of suicide should be routine. Disturbances of thought such as insertion or withdrawal may be present along with perceptual abnormalities i.e. illusions, hallucinations. Insight varies during the course of a psychotic illness but should be explored as it has implications for management. All patients presenting with first episode psychosis for which no organic cause can be found should be referred to the local early intervention service. In patients with a known diagnosis consider referral if there is: poor response or nonadherence to treatment; intolerable side effects; comorbid substance misuse; risk to self or others.

  13. The effect of managed care on hospital marketing orientation. (United States)

    Loubeau, P R; Jantzen, R


    Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short

  14. Hollywood on the Danube: Hungarian Filmmakers in a Transnational Context

    Directory of Open Access Journals (Sweden)

    Catherine Portuges


    Full Text Available Exile, emigration and displacement have marked the trajectories of Hungarian filmmakers over the past century. Michael Curtiz, the Korda brothers—Alexander, Vincent and Zoltán—André de Toth, Emeric Pressburger, Vilmos Zsigmond, Miklós Rózsa, Peter Lorre, Géza von Radvány and other talented artists have crossed borders, cultures and languages, creating such classics as Casablanca, Somewhere in Europe, The Red Shoes and The Lost One. The legendary sign posted in Hollywood studios read: "It is not enough to be Hungarian, you have to have talent, too!" Accompanied by film extracts, rare footage, personal interviews, archive photographs, and documentary materials, my presentation explores the transnational odysseys of these Hungarian directors, producers, cinematographers, composers, actors and screenwriters whose artistic contributions became an indispensable part of international cinema, suggesting that the challenges of emigration may also offer opportunities for critique, self-examination and artistic creativity.

  15. Development of the security system of the new Hungarian banknotes (United States)

    Peterfi, Sandor


    The more than 75 year old Hungarian Banknote Printing Corporation is an enterprise with a rich history. It is located in the very center of the capital, only some blocks away form the Parliament. Most people on this side of the Atlantic may not even have heard about the Hungarian currency, the Forint. Some may remember that after the WWII it was Hungary, where the severest hyperinflation in the world took place. As we come from a manufacturing company , we can give you information about deliberation and experiences of application of optically variable features on banknotes and some observations made in the past two years since the new Hungarian bank note series is ins circulation.

  16. An evaluation of a managed care project from the patients perspective.

    NARCIS (Netherlands)

    Groenendijk, J.J.; Delnoij, D.


    Background: The American concept of managed care has found its way into European health care since the late nineties. The ultimate goal of managed care is to improve the efficiency of health care through promoting the quality of care and controlling the costs. A large Dutch health insurer initiated


    Directory of Open Access Journals (Sweden)

    Pasztor Szabolcs


    Full Text Available Thanks to the all pervasive globalisation trends previous state borders have become more permeable and subject to change. As borders disappear previously separated borderlands can unite and form a spatial unit where more increased economic interactions could integrate both sides to the global economy.The European continent is such a case which previously had been puctuated by strong state borders. Today the continent sees the physical and intellectual disappearance of borders. Regional integrations – like the European Union – spur this process and helps the integration of borderland inside and outside of the common market. The creation of a common market was a huge success and still a great deal of benefits are anticipated from the fulfillment. We are not taken by surprise when we see a massive increase in the number of border related studies and researchers. This field is very popular today. However the difference between Western and Eastern Europe is huge because eastern state borders are still strong or they link peripheral regions. There - under the communist times- border crossings were restricted and trade links were quite poor. No wonder that the tendencies of the past are still determining. This paper focuses on of one the most peripheral external borderland of the Schengen zone: the Hungarian-Ukrainian borderland. Expectations are running high and the disappearance of the border is a long-awaited hope. First I take into consideration the relevant economic theory in connection with more intense borderland dynamics. In the literature the trade theory, new economic geography and the traditional location theory approach this question. The approaches do not give coherent and clear-cut answers so I have to turn my attention to different empirical approaches. These show huge heterogeneity depending on the nature and character of the borderlands. In the mentioned case, settlement-level data are not fully available so I conduct a

  18. [Multimodal neuromonitoring for the critical care management of acute coma]. (United States)

    Ltaief, Z; Ben-Hamouda, N; Suys, T; Daniel, R T; Rossetti, A O; Oddo, M


    Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase. The aim of this review is to describe the utility of multimodal neuromonitoring for the critical care management of acute coma.

  19. Care guides: employing nonclinical laypersons to help primary care teams manage chronic disease. (United States)

    Adair, Richard; Christianson, Jon; Wholey, Douglas R; White, Katie; Town, Robert; Lee, Suhna; Britt, Heather; Lund, Peter; Lukasewycz, Anya; Elumba, Deborah


    Lay persons ("care guides") without previous clinical experience were hired by a primary care clinic, trained for 2 weeks, and assigned to help 332 patients and their providers manage their diabetes, hypertension, and congestive heart failure. One year later, failure by these patients to meet nationally recommended guidelines was reduced by 28%, P < .001. Improvement was seen in tobacco usage, blood pressure control, pneumonia vaccination, low-density lipoprotein cholesterol levels, annual eye examinations, aspirin use, and microalbuminuria testing. Care guides served an average of 111 patients at an annual per patient cost of $392. Further testing of this model is warranted.

  20. Integrative care for the management of low back pain: use of a clinical care pathway

    Directory of Open Access Journals (Sweden)

    Legendre Claire G


    Full Text Available Abstract Background For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial. Methods A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study. Results Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans. Conclusion This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting. Trial registration NCT00567333

  1. Acute stroke: postprocedural care and management of complications. (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio


    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  2. Implementing an integrated care management program in community pharmacies: A focus on medication management services. (United States)

    Smith, Megan G; Ferreri, Stefanie P; Brown, Patrick; Wines, Kristen; Shea, Christopher M; Pfeiffenberger, Trista M

    To describe the initiation of a community pharmacy medication management service within a statewide integrated care management program. One hundred twenty-three community and community health center pharmacies in 58 counties of North Carolina. Independent and community health center pharmacies offering medication management as part of an integrated care management program to Medicaid, Medicare, dually eligible Medicare-Medicaid, and NC Health Choice beneficiaries in North Carolina. Community pharmacies joined an enhanced service network created by Community Care of North Carolina to provide medication management services as part of an integrated care management program. During the first 3 months of the program, 41% of pharmacies consistently documented the medication management services. Interviews were conducted with pharmacists from the inconsistent pharmacies to drive program improvements. Pharmacists at 73 community and community health center pharmacies were interviewed. The majority of pharmacists reported that challenges in "initiating services" and "documenting" were due to increased intensity of service and documentation compared with Medicare Part D medication therapy management requirements. Program changes to improve participation included revision of documentation requirements, authorization of technicians to transcribe pharmacists' interventions, additional documentation templates, workflow consultations, and feedback on documentation quality. Community pharmacies are capable of providing medication management integrated with care management. Some pharmacies have more difficulty initiating new services in the current workflow landscape. To facilitate implementation, it is important to minimize administrative burden and provide mechanisms for direct feedback. Pharmacy owners, managers, and leaders in pharmacy policy can use these findings to aid implementation of new services in community pharmacies. Copyright © 2016 American Pharmacists Association

  3. Managing Organized Insecurity: The Consequences for Care Workers of Deregulated Working Conditions in Elderly Care

    Directory of Open Access Journals (Sweden)

    Lene Ede


    Full Text Available Part-time work is more than twice as common among women than men in Sweden. New ways of organizing working hours to allow for more full-time jobs have been introduced for care workers in elderly care, which means unscheduled working hours based on the needs of the workplace. The aim of the study is to analyze how the organization of the unscheduled working hours affect employees’ daily lives and their possibility to provide care. The Classic Grounded Theory method was used in a secondary analysis of interviews with employees and managers in Swedish municipal elderly care. The implementation of unscheduled working hours plunged employees into a situation of managing organized insecurity. This main concern for the care workers involved a cyclic process of first having to be available for work because of economic and social obligations to the employer and the co-workers, despite sacrifices in the private sphere. Then, they had to be adaptable in relation to unknown clients and co-workers and to the employer, which means reduced possibilities to provide good care. Full-time jobs were thus created through requiring permanent staff to be flexible, which in effect meant eroded working conditions with high demands on employee adaptability. Solving the part-time problem in elderly care by introducing unscheduled working hours may in effect be counter-productive.

  4. Named Entity Recognition in a Hungarian NL Based QA System (United States)

    Tikkl, Domonkos; Szidarovszky, P. Ferenc; Kardkovacs, Zsolt T.; Magyar, Gábor

    In WoW project our purpose is to create a complex search interface with the following features: search in the deep web content of contracted partners' databases, processing Hungarian natural language (NL) questions and transforming them to SQL queries for database access, image search supported by a visual thesaurus that describes in a structural form the visual content of images (also in Hungarian). This paper primarily focuses on a particular problem of question processing task: the entity recognition. Before going into details we give a short overview of the project's aims.

  5. Abstracts of the 27th Hungarian conference on rabbit production

    Directory of Open Access Journals (Sweden)

    Abstracts, Conferences, Congresses, Symposiums...


    Full Text Available About 100 participants took part in the 27th Hungarian Conference on Rabbit Production at Kaposvár, organised by the Kaposvár University, the Hungarian Branch of the WRSA and the Rabbit Production Board. This is the largest and most popular event for rabbit breeders in Hungary. Thirteen papers were presented by senior and young scientists. Topics of the papers covered almost all fields of rabbit research (production, housing and welfare, reproduction, genetics, nutrition. Full papers are available from the organiser ( on request.

  6. A comprehensive approach to quality management of intensive care services. (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar


    The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

  7. Cold chain management practices of health care workers in primary health care facilities in Southern Nigeria (United States)

    Ogboghodo, Esohe Olivia; Omuemu, Vivian Ossaidiom; Odijie, Oisedebame; Odaman, Ofure Jennifer


    Introduction Vaccination has caused a dramatic reduction in the threat of diseases that were once widespread and often times fatal. The efficient practice of cold chain management is therefore key to ensuring that the benefits of vaccination are sustained. The objective of this study is to assess the practice of cold chain management among health workers in primary health care facilities in Benin City, Edo State. Methods A descriptive cross-sectional study design was employed in this study. The study population consisted of registered nurses, auxiliary nurses and community health extension workers in primary health care facilities in Benin City, Edo State. The tool for data collection was pre-tested, structured self-administered questionnaire. Bivariate analysis between socio-demographic variables and practice of cold chain management was done. Binary logistic regression was also done to determine significant predictors of practice of cold chain management. The level of significance was set at p cold chain management. Significant determinants of practice of cold chain management were cold chain management training (p = 0.004), presence of functional refrigerators (p = 0.016), NPI supervision (p cold chain management among respondents was fair. All stakeholders should ensure they work collectively towards ensuring that favorable environments which would improve the practice among health workers are put in place. PMID:28761610

  8. Innovation in health service management: Adoption of project management offices to support major health care transformation. (United States)

    Lavoie-Tremblay, Mélanie; Aubry, Monique; Cyr, Guylaine; Richer, Marie-Claire; Fortin-Verreault, Jean-François; Fortin, Claude; Marchionni, Caroline


    To explore the characteristics that influence project management offices acceptance and adoption in healthcare sector. The creation of project management offices has been suggested as a promising avenue to promote successful organisational change and facilitate evidence-based practice. However, little is known about the characteristics that promote their initial adoption and acceptance in health care sector. This knowledge is important in the context where many organisations are considering implementing project management offices with nurse managers as leaders. A descriptive multiple case study design was used. The unit of analysis was the project management offices. The study was conducted in three university-affiliated teaching hospitals in 2013-14 (Canada). Individual interviews (n = 34) were conducted with senior managers. Results reveal that project management offices dedicated to project and change management constitute an innovation and an added value that addresses tangible needs in the field. Project management offices are an innovation highly compatible with health care managers and their approach has parallels to the process of clinical problem solving and reasoning well-known to adopters. This knowledge is important in a context where many nurses hold various roles in project management offices, such as Director, project manager, clinical expert and knowledge broker. © 2017 John Wiley & Sons Ltd.

  9. Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management

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    Muhammad Saiful Ridhwan


    Full Text Available The importance of managing medical information has become very critical in the healthcare delivery system. Medical information nowadays are optimized towards serving different areas such as; diagnosing of diseases, planning and administration, treatment and monitoring of patient outcomes, services and costs. This article provides a review into various Health and Social Care systems which encompasses the Knowledge Management value. For analysis, more than 30 systems that are related to Health and Social Care were gathered via Internet research, only 20 of these systems were finally selected based on recent system development and popularity of the system.Keywords: Health Care, Knowledge, Knowledge Management, Social Care, systemdoi:10.12695/ajtm.2013.6.2.4 How to cite this article:Ridhwan, M.S., and Oyefolahan, I.O. (2013. Knowledge Management System in Health & Social Care: Review on 20 Practiced Knowledge Management. The Asian Journal of Technology Management 6 (2: 92-101. Print ISSN: 1978-6956; Online ISSN: 2089-791X. doi:10.12695/ajtm.2013.6.2.4


    Directory of Open Access Journals (Sweden)

    Kanellopoulos Dimitros


    Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes

  11. Management of liver cirrhosis between primary care and specialists

    Institute of Scientific and Technical Information of China (English)

    Ignazio Grattagliano; Enzo Ubaldi; Leonilde Bonfrate; Piero Portincasa


    This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: "ascites", "liver fibrosis","cirrhosis", "chronic hepatitis", "chronic liver disease","decompensated cirrhosis", "hepatic encephalopathy","hypertransaminasemia", "liver transplantation" and "portal hypertension". Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology,Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications.Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.

  12. ESRD in the geriatric population: the crisis of managed care and the opportunity of disease management. (United States)

    Steinman, Theodore I


    The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.

  13. Nurses in abortion care: identifying and managing stress. (United States)

    Lipp, Allyson; Fothergill, Anne


    The psychological impact of abortion on the women undergoing the procedure is well researched, but little is known about the potential psychological impact on nurses working in abortion care. The proportion of medical abortions in the UK is rising compared to surgical abortions. A recent research study found that being more directly involved in the procedure places more emotional demands on the nurses. This emotional labour required by nurses working in abortion care may increase their stress levels. This paper examines the potential increase in stress in nurses caused by medical abortions. A model of stress comprising stressors, moderators and stress outcomes was used as a framework for this examination. Research on abortion and mental health nursing was applied to managing stress in abortion care; this included coping mechanisms, prevention and intervention strategies. This showed that stress, burnout and coping are important issues in abortion care. On this basis, recommendations for practice have been formulated to inform practice for nurses and managers in abortion care.

  14. Nurse case managers: patient care implications at a Pakistani university. (United States)

    Walani, Laila

    The role of the nurse in hospital is varied and some are choosing to incorporate more managerial and administrative skills into their clinical role. One such role is that of the nurse case manager (NCM). This particular role concentrates on involving the family and the patient in his or her own care, facilitation of the care plan, and open discussions between the patient, medics and nursing staff. NCMs in the author's hospital have made a remarkable contribution to patient care. It is a challenging and exceedingly demanding role in both developing and developed countries, but one that is increasingly important. The NCMs are involved in coordination, facilitation of core process and mobilization of resources, not only in hospital but at the patient's home. In this short introductory article the role of NCM is highlighted and the author discusses how this diverse role is concerned with patient care. NCMs work with multidisciplinary teams to enhance the patient's care process. Their attention is also given to cost reduction and clinical pathway management.

  15. A need for managed care in Saudi Arabia. (United States)

    Mufti, M H


    Is the Kingdom of Saudi Arabia getting value for money invested in health? Quality care is being provided throughout health facilities in the Kingdom, however there is minimal control of utilization in all health sectors, consequently leading to abuse and over utilization, particularly in the public sector. Managed care programs have proven effective in reducing unnecessary inpatient and ancillary service utilization by reducing use of expensive procedures and unnecessary, highly specialized services, and shifting to less expensive care options. Health maintenance organizations are the best example of a managed health care model; tracking good performance and cost savings averaging between 20-40% compared to more traditional health plans. Key features of health maintenance organizations include serving a defined population voluntarily enrolled in the health plan; assumption of contractual responsibility and financial risk by plan to provide a range of services, and payment of a fixed periodic payment by the enrollee, independent of the actual use of services. The key characteristic that distinguishes health maintenance organizations from other delivery systems is prepayment for the care that is provided. Preferred Provider Organizations offer discounts for services received from a selected set of physicians and hospitals. Services received by enrollees are not fully reimbursed from this selected list of providers. Preferred Provider Organizations use health maintenance organizations administrative processes for controlling costs but do not include some of the intrinsic cost and quality controls of health maintenance organizations. Review of several studies indicate that patients enrolled in prepaid group practices (managed care organizations) were hospitalized 15-40% less often than those enrolled in fee-for-service health plans.

  16. Obesity, weight management, and health care costs: a primer. (United States)

    Bachman, Keith H


    Rational decision-making regarding health care spending for weight management requires an understanding of the cost of care provided to obese patients and the potential cost-effectiveness or cost savings of interventions. The purpose of this review is to assist health plans and disease management leaders in making informed decisions for weight management services. Among the review's findings, obesity and severe obesity are strongly and consistently associated with increased health care costs. The cost-effectiveness of obesity-related interventions is highly dependent on the risk status of the treated population, as well as the length, cost, and effectiveness of the intervention. Bariatric surgery offers high initial costs and uncertain long-term cost savings. From the perspective of a payor, obesity management services are as cost-effective as other commonly offered health services, though not likely to offer cost savings. Behavioral health promotion interventions in the worksite setting provide cost savings from the employer's perspective, if decreased rates of absenteeism are included in the analysis.

  17. Targeted temperature management in neurocritical care: Boon or bust

    Directory of Open Access Journals (Sweden)

    Ashish Bindra


    Full Text Available Temperature management in neurocritical care is important and has gained due importance in recent years. Targeted temperature management (TTM includes deliberate reduction of core body temperature to a range of 32–34°C in comatose survivors of cardiac arrest after return of spontaneous circulation and also therapeutic hypothermia (33–35°C in normothermic patients or controlled normothermia (cooling patients to 37°C in hyperthermic patients. This review focuses on the practical aspects of cooling and temperature management in neurocritical care. An electronic search of Google Scholar, MEDLINE (OVID, EMBASE and the Cochrane library was performed. The physiological changes, potential side effects along with significant research and clinical applications in the field of temperature management are main highlights. Currently, the research evidence is available for TTM in adults following cardiac arrest, neonatal hypoxic ischaemic encephalopathy and raised intracranial pressure. Controlled normothermia in neurocritical care population is rapidly gaining popularity. However, data on disease specific therapeutic markers, therapeutic depth and duration and prognostication of this modality are limited. Overall in experienced hands, the technique is safe to execute without the major morbidity and a potential to improve the outcome. Though over the years, clinical applications are unable to consistently demonstrate its benefits, but TTM in neurological insult has become an established and promising concept.

  18. Chronic disease management: improving care for people with osteoarthritis. (United States)

    Brand, Caroline A; Ackerman, Ilana N; Tropea, Joanne


    Chronic disease management (CDM) service models are being developed for many conditions; however, there is limited evidence to support their effectiveness in osteoarthritis (OA). A systematic review was undertaken to examine effectiveness, cost effectiveness and barriers to the use of osteoarthritis-chronic disease management (OA-CDM) service models. Thirteen eligible studies (eight randomised controlled trial (RCTs)) were identified. The majority focussed on delivery system design (n = 9) and/or providing self-management support (SMS) (n = 8). Overall, reported model effectiveness varied, and where positive impacts on process or health outcomes were observed, they were of small to moderate effect. There was no information about cost effectiveness. There is some evidence to support the use of collaborative care/multidisciplinary case management models in primary and community care and evidence-based pathways/standardisation of care in hospital settings. Multiple barriers were identified. Future research should focus on identifying the effective components of multi-faceted interventions and evaluating cost-effectiveness to support clinical and policy decision-making.

  19. Management of health care expenditure by soft computing methodology (United States)

    Maksimović, Goran; Jović, Srđan; Jovanović, Radomir; Aničić, Obrad


    In this study was managed the health care expenditure by soft computing methodology. The main goal was to predict the gross domestic product (GDP) according to several factors of health care expenditure. Soft computing methodologies were applied since GDP prediction is very complex task. The performances of the proposed predictors were confirmed with the simulation results. According to the results, support vector regression (SVR) has better prediction accuracy compared to other soft computing methodologies. The soft computing methods benefit from the soft computing capabilities of global optimization in order to avoid local minimum issues.

  20. Expanded managed care liability: what impact on employer coverage? (United States)

    Studdert, D M; Sage, W M; Gresenz, C R; Hensler, D R


    Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.

  1. [Management of onychocryptosis in primary care: A clinical case]. (United States)

    Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E


    Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.

  2. Intelligently Managed Data: Achieving Excellence In Nursing Care. (United States)

    Kerfoot, Karlene M


    Much information and clinical data are available in health care. Unfortunately, much of it is not available for clinical decision making and management support. Analytics within the context of health information technology (HIT) will provide a framework to bring better reasoning and intelligence to HIT and nursing care. The missing link is the people who will bring this forward into the everyday lives of clinical nurses and nurse executives. With better competencies among staff and leaders in nursing and more credentialed nursing informatics leaders in influential positions, nursing will be a full participant in the digital revolution which, along with analytics, will lead to intelligent and effective systems.

  3. Using customer input to improve managed care performance. (United States)

    Kairey, M S; Baumruk, R W


    How do you get the information you need to manage your company's health care plans effectively? Consider a "customer satisfaction survey" that gathers data from the people who use the plans every day: employees. Make the data work for you when you negotiate costs, communicate key plan features, and look for ways to improve health care quality and upgrade the service you and your employees get from your health plans. American Express and the Chicago Health Plan Value Project (a unique group of 14 companies and 7 health plans) tried this approach, and they now expect a "win-win-win" situation all around.

  4. Total quality management and the Army health care system. (United States)

    Jeffer, E K


    Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of quality care to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain.

  5. Defense Health Care: Acquisition Process for TRICARE’s Third Generation of Managed Care Support Contracts (United States)


    Selection Team Roles and Responsibilities for TRICARE’s Contract Award Process 11 Figure 3: Timeline of Bid Protest Events for TRICARE’s North Region...14-195 TRICARE Managed Care Support Contracts Figure 2: Source Selection Team Roles and Responsibilities for TRICARE’s Contract Award Process

  6. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools. (United States)

    Ung, Brian L; Mullins, C Daniel


    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.

  7. Bayesian inference of genetic parameters on litter size and gestation length in Hungarian Landrace and Hungarian Large White pigs

    Directory of Open Access Journals (Sweden)

    Zoltán Csörnyei


    Full Text Available Genetic parameters of number of piglets born alive (NBA and gestation length (GL were analyzed for 39798 Hungarian Landrace (HLA, 141397 records and 70356 Hungarian Large White (HLW, 246961 records sows. Bivariate repeatability animal models were used, applying a Bayesian statistics. Estimated and heritabilitie repeatabilities (within brackets, were low for NBA, 0.07 (0.14 for HLA and 0.08 (0.17 for HLW, but somewhat higher for GL, 0.18 (0.27 for HLA and 0.26 (0.35 for HLW. Estimated genetic correlations between NBA and GL were low, -0.08 for HLA and -0.05 for HLW.

  8. Bayesian inference of genetic parameters on litter size and gestation length in Hungarian Landrace and Hungarian Large White pigs


    Zoltán Csörnyei; László Csató; János Farkas; Ino Curik; István Nagy


    Genetic parameters of number of piglets born alive (NBA) and gestation length (GL) were analyzed for 39798 Hungarian Landrace (HLA, 141397 records) and 70356 Hungarian Large White (HLW, 246961 records) sows. Bivariate repeatability animal models were used, applying a Bayesian statistics. Estimated and heritabilitie repeatabilities (within brackets), were low for NBA, 0.07 (0.14) for HLA and 0.08 (0.17) for HLW, but somewhat higher for GL, 0.18 (0.27) for HLA and 0.26 (0.35) for HLW. Estimated...

  9. Nurses' adherence to the Kangaroo Care Method: support for nursing care management

    Directory of Open Access Journals (Sweden)

    Laura Johanson da Silva


    Full Text Available OBJECTIVE: construct an explanatory theoretical model about nurses' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management.METHOD: qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed.RESULTS: four main categories emerged that composed the analytic paradigm: Giving one's best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (demotivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method.CONCLUSIONS: the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (discontinuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model.

  10. [Inefficient management of personal health in oral anticoagulation. Home nursing care in primary health care]. (United States)

    López Castañón, Lorena


    This case report describes an 83 year-old immobilised patient with multiple diseases and on polypharmacy. Nursing care is developed at home. The patient is included in patient care programs for the anticoagulated and polymedicated patient. Nursing assessments were made using the Marjory Gordon functional health patterns, by which we identified, among others, problems related to non-compliance with the pharmacological treatment. The Nurse's Diagnosis was: Ineffective Management of own health. With the support of NANDA, NOC and NIC taxonomy we determined the nursing objectives and interventions. The expected results of the Care Plan were achieved. Polypharmacy in the elderly can lead to treatment problems, increasing hospital admissions, morbidity and mortality and health expenditure Nursing care at home is a continuous development process and is increasing due to aging of the population, the prevalence of chronic diseases, as well as the increased life expectancy. It is estimated that in 2030, 24% of the Spanish population will be over 64 years. The physical, sensory, cognitive and chronic disabilities of aging make this type of care necessary. It is a major element in the comprehensive care of these patients, by checking the correct use of medication, symptom control, helping them to be autonomous in managing their disease and establishing a fluid relationship between the patients and their family.

  11. Difficult airway management from Emergency Department till Intensive Care Unit. (United States)

    Pradhan, Debasis; Bhattacharyya, Prithwis


    We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  12. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala


    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  13. Operations research in intensive care unit management: a literature review. (United States)

    Bai, Jie; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O


    The intensive care unit (ICU) is a crucial and expensive resource largely affected by uncertainty and variability. Insufficient ICU capacity causes many negative effects not only in the ICU itself, but also in other connected departments along the patient care path. Operations research/management science (OR/MS) plays an important role in identifying ways to manage ICU capacities efficiently and in ensuring desired levels of service quality. As a consequence, numerous papers on the topic exist. The goal of this paper is to provide the first structured literature review on how OR/MS may support ICU management. We start our review by illustrating the important role the ICU plays in the hospital patient flow. Then we focus on the ICU management problem (single department management problem) and classify the literature from multiple angles, including decision horizons, problem settings, and modeling and solution techniques. Based on the classification logic, research gaps and opportunities are highlighted, e.g., combining bed capacity planning and personnel scheduling, modeling uncertainty with non-homogenous distribution functions, and exploring more efficient solution approaches.

  14. [Case management. The nursing business of care or cost]. (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L


    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

  15. Pain management in the acute care setting: Update and debates. (United States)

    Palmer, Greta M


    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  16. Utilizing patient satisfaction surveys to prepare for Medicaid managed care. (United States)

    Fields, T T; Gomez, P S


    To prepare for Medicaid managed care, a community health center incorporated the business principle of continuous quality improvement, often used in the private sector to improve customer service, into its planning process. The initial endeavor was to create a patient satisfaction survey that was appropriate for the uniqueness of the community. The survey, taken monthly, resulted in both staff and patients making active improvements in the clinic environment. Staff showed more enthusiasm, and patients were more assertive in their attitudes toward the clinic. The empowerment of the patient to take ownership in the clinic will be coupled with the next step of the formalized plan, that of educating patients on the steps necessary to ensure that their Medicaid managed care facility will be the local community health center.

  17. Case Marking in Hungarian Children with Specific Language Impairment (United States)

    Lukács, Ágnes; Kas, Bence; Leonard, Laurence B.


    This study examines whether children with specific language impairment (SLI) acquiring a language with a rich case marking system (Hungarian) have difficulty with case, and, if so, whether the difficulty is comparable for spatial and nonspatial meanings. Data were drawn from narrative samples and from a sentence repetition task. Suffixes were…

  18. "Unraveling Intercultural communication in an Hungarian cookie Company"

    DEFF Research Database (Denmark)

    Baca, Susan


    This paper presents a case study of a Hungarian company going through the double transition of having been recently acquired by a foreign corporation and, at the same time, reorienting its business approach from east to west. This juncture in time for Central and Eastern European companies, namel...

  19. Media Literacy and Cigarette Smoking in Hungarian Adolescents (United States)

    Page, Randy M.; Piko, Bettina F.; Balazs, Mate A.; Struk, Tamara


    Objective: To assess smoking media literacy in a sample of Hungarian youth and to determine its association with current smoking and susceptibility to future smoking. Design: Quantitative cross-sectional survey. Setting: Four elementary and four high schools in Mako, Hungary. Method: A survey form was administered in regularly-scheduled classes to…

  20. US-Hungarian Relations Ten Years After 1956

    Directory of Open Access Journals (Sweden)

    Tibor Glant


    Full Text Available 1966, the tenth anniversary of the 1956 Revolution, was a key year in US–Hungarian relations. Diplomatic relations were raised from the lowest to the highest level, but suspicion and tension remained. Neither side knew what to expect from the other on account of the anniversary, the Vietnam War, economic and cultural negotiations, and the fate of Cardinal Mindszenty. A traditional diplomatic historical approach is supplemented here with cultural materials to present the full scale of contacts ranging from high political issues to the visit of Hollywood movie star Kirk Douglas in Budapest. First Secretary of the Legation for Press and Cultural Affairs Edward Alexander receives special attention, because he played a crucial role in the events of 1966. As press secretary, he helped calm Hungarian fears over what American journalists might report about the anniversary, while as cultural affairs officer he worked on documenting and expanding American cultural presence in Hungary. In the latter capacity, he opened the USIA Library at the Legation, fraternized with blacklisted painters of the Zuglói Kör [‘Zugló Circle’], monitored the Hungarian stage production of My Fair Lady, and reported on the publication of American literature in Hungarian.

  1. Medical Liability in the Light of New Hungarian Civil Code (United States)

    Barzó, Tímea


    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since the change of regime. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades.

  2. Long memory in the Croatian and Hungarian stock market returns

    Directory of Open Access Journals (Sweden)

    Silvo Dajčman


    Full Text Available The objective of this paper is to analyze and compare the fractal structure of the Croatian and Hungarian stock market returns. The presence of long memory components in asset returns provides evidence against the weak-form of stock market efficiency. The starting working hypothesis that there is no long memory in the Croatian and Hungarian stock market returns is tested by applying the Kwiatkowski-Phillips-Schmidt-Shin (KPSS (1992 test, Lo’s (1991 modified rescaled range (R/S test, and the wavelet ordinary least squares (WOLS estimator of Jensen (1999. The research showed that the WOLS estimator may lead to different conclusions regarding long memory presence in the stock returns from the KPSS and unit root tests or Lo’s R/S test. Furthermore, it proved that the fractal structure of individual stock returns may be masked in aggregated stock market returns (i.e. in returns of stock index. The main finding of the paper is that both the Croatian stock index Crobex and individual stocks in this index exhibit long memory. Long memory is identified for some stocks in the Hungarian stock market as well, but not for the stock market index BUX. Based on the results of the long memory tests, it can be concluded that while the Hungarian stock market is weakform efficient, the Croatian stock market is not.

  3. Media Literacy and Cigarette Smoking in Hungarian Adolescents (United States)

    Page, Randy M.; Piko, Bettina F.; Balazs, Mate A.; Struk, Tamara


    Objective: To assess smoking media literacy in a sample of Hungarian youth and to determine its association with current smoking and susceptibility to future smoking. Design: Quantitative cross-sectional survey. Setting: Four elementary and four high schools in Mako, Hungary. Method: A survey form was administered in regularly-scheduled classes to…

  4. "Great Expectations:" The Motivational Profile of Hungarian English Language Students (United States)

    Kormos, Judit; Csizer, Kata; Menyhart, Adrienn; Torok, Dora


    In this article we investigate what characterizes the language learning motivation of Hungarian English language students in terms of Dornyei and Otto's process model of motivation ("Motivation in Action," 1998). We used a mixed-method research design, in which qualitative interviews conducted with 20 students were supplemented with questionnaire…

  5. Linguistics in Language Teaching: The Case of Finnish and Hungarian (United States)

    Tarsoly, Eszter; Valijarvi, Riitta-Liisa


    This paper discusses the role of various linguistic sub-disciplines in teaching Finnish and Hungarian. We sketch the profile of the two languages, including difficulties in learning and teaching them, and the context in which they are taught in the UK. Using examples from our own teaching, we argue that a linguistically oriented approach is well…

  6. Medical Liability in the Light of New Hungarian Civil Code (United States)

    Barzó, Tímea


    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since the change of regime. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades.

  7. Behaviour Profile of Hungarian Adolescent Outpatients with a Dual Diagnosis (United States)

    Dinya, Elek; Csorba, Janos; Suli, Agota; Grosz, Zsofia


    The behaviour dimensions of 244 Hungarian adolescent psychiatric outpatients with a dual diagnosis (intellectual disability and psychiatric diagnosis) were examined by means of the adapted version of the Behaviour Problem Inventory (BPI, Rojahn, Matson, Lott, Esbensen, & Smalls, 2001). Four IQ subgroups were created: borderline, mild, moderate…

  8. Establishing Normative Reference Values for Handgrip among Hungarian Youth (United States)

    Saint-Maurice, Pedro F.; Laurson, Kelly R.; Karsai, István; Kaj, Mónika; Csányi, Tamás


    Purpose: The purpose of this study was to examine age- and sex-related variation in handgrip strength and to determine reference values for the Hungarian population. Method: A sample of 1,086 Hungary youth (aged 11-18 years old; 654 boys and 432 girls) completed a handgrip strength assessment using a handheld dynamometer. Quantile regression was…

  9. Pathologists' roles in clinical utilization management. A financing model for managed care. (United States)

    Zhao, J J; Liberman, A


    In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

  10. Dynamic cardiomyoplasty: perspectives on nursing care and collaborative management. (United States)

    Vollman, M W


    Historically, heart transplantation has served as the definitive treatment of choice for patients with end-stage heart failure. Unfortunately, heart transplantation is not available to all patients because of the scarcity of donor allografts and strict patient selection criteria. Dynamic cardiomyoplasty is an experimental alternative to heart transplantation for the treatment of severe congestive heart failure and dilated cardiomyopathy. The procedure involves the use of an autologous latissimus dorsi muscle graft that is wrapped around the ventricles by pericardial attachment. The muscle graft is then stimulated by specialized synchronous train impulses from a cardiomyostimulator; the resultant muscle graft contractions provide support for ventricular function. This article describes collaborative, preoperative, immediate postoperative, and long-term management of patients receiving dynamic cardiomyoplasty. As members of the health care team, nurses are in a unique position to develop care standards and facilitate multidisciplinary collaboration for the care of this complex patient population.

  11. [Management and organization of ambulatory medical care in a district]. (United States)

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B


    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  12. Do-it-yourself managed care. Case study I: Randall's Medical Network. Case study II: Hershey's Managed Care Plan. (United States)


    Employers, who pay for much of the healthcare in this country, are not waiting for government to restructure the healthcare system. In this cover story, PROFILES examines how two firms formed their own managed care networks to control healthcare cost and quality, and what hospitals did to become players. By understanding the employer' point of view, hospital marketers can better anticipate their needs and develop a marketing strategy to form closer relationships with employers, provide quality care at a lower cost, and increase their market share.

  13. Patterns of care in the management of seminoma stage I

    DEFF Research Database (Denmark)

    Vossen, Carla Y; Horwich, Alan; Daugaard, Gedske


    -orchidectomy strategies in seminoma stage I patients has led to debates about whether the three strategies are equally effective and safe. The differences in interpretation of the data as well as the debates are likely to result in differences in treatment after orchidectomy in seminoma stage I patient management...... and countries that indicate the need for research into long-term relapse rates and long-term adverse effects to standardize and optimize care for seminoma stage I patients....

  14. New Public Management, Care and Struggles about Recognition

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene


    New Public Management (NPM) is usually perceived as a homogeneous discourse. However, when we examine it by looking at micro-politics in municipalities and understand its consequences drawing on the voices of home helpers, the picture is more complex and ambiguous. NPM is seen as disciplining paid...... of resistance. The analysis applies feminist theories of recognition and care, and its findings are based on focus group interviews and feminist discourse analysis...

  15. Primary care diabetes bundle management: 3-year outcomes for microvascular and macrovascular events

    National Research Council Canada - National Science Library

    Bloom, Jr, Frederick J; Yan, Xiaowei; Stewart, Walter F; Graf, Thomas R; Anderer, Tammy; Davis, Duane E; Pierdon, Stevem B; Pitcavage, James; Steele, Jr, Glenn D


    To determine whether a system of care with an all-or-none bundled measure for primary-care management of diabetes mellitus reduced the risk of microvascular and macrovascular complications compared with usual care...

  16. [Evaluation of Nurse Demand Management in Primary Care]. (United States)

    Brugués Brugués, Alba; Peris Grao, Antoni; Pavón Rodríguez, Francisca; Mateo Viladomat, Enric; Gascón Ferret, Jordi; Flores Mateo, Gemma


    to evaluate the health outcomes of nurse demand management on unscheduled patients in a Primary Care Centre, following a clinical guide designed by the whole primary care team. Cross-sectional study. A primary care team from Castelldefels. Barcelona, Spain. A random sample of 558 patients requesting a consultation for the same day in a Primary Care setting, attended between May 1st, 2011 and January 31st, 2012. The guide includes 23 health problems that can be dealt by a nurse autonomously, 18 of them possibly requiring an emergency intervention, and shared decision with the physician. Each health problem is divided into three sections: a) a brief definition of the problem; b) an intervention algorithm; and c) nursing diagnoses of North American Nursing Diagnosis Association for each health problem and a description of the possible nursing interventions. We studied 558 patients with a mean age of 42.5 years old (SD 17.7). The most commonly consulted problems were upper respiratory tract symptoms (19.4%), followed by nausea/vomiting (16.5%), and burns/wounds (12.5%). 73.3% of the problems were resolved autonomously by a nurse. 65,8% of the patients attended received health advice. Nurse demand management has shown to be highly effective at handling the conditions attended, while it provides a high percentage of health advice and education during consultations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model. (United States)

    Delon, Sandra; Mackinnon, Blair


    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

  18. [Psychometric properties of the Hungarian version of the Codependence Questionnaire]. (United States)

    Nagy, Anikó; Knapek, Éva; Balázs, Katalin; Kuritárné Szabó, Ildikó


    The purpose of this study is to assess the internal consistency of the subscales of the Hungarian Version of the Codependent Questionnaire (CdQ, Roehling & Gaumond, 1996). Thus, a reliable measurement of codependency for professionals become available in Hungary. The Hungarian Version of the Codependent Questionnaire enables professionals to identify codependent individuals. Our sample (N=137) was recruited from the general population and from self-help groups (82 individuals); and patients with borderline personality disorder (55 individuals) were recruited as clinical control group. The reliability of the questionnaire was assessed by Cronbach's alfa and principal component analysis. In addition, in order to investigate the latent structure, factors analyses and hierarchical cluster analysis were used. Based on our results, the Cronbach's alfa values of the subscales of 'control', 'reliability' and 'intimacy' indicate appropriate reliability, however, the subscale of 'enmeshment' indicates poor reliability. The originally assumed factor structure is not supported by the results of the statistical analyses. The subscales are not separate from each other, which is also indicated by the correlations of the total scores of the subscales. The reliability of the Hungarian Version of the Codependent Questionnaire is nearly identical to the original data, except for one subscale ('enmeshment subscale'). Based on these results the Hungarian Version of the Codependent Questionnaire is considered to be reliable. Besides the Hungarian adaptation, the strength of this study is the investigation of a clinical sample. The use of the questionnaire is recommended without the subscale of 'enmeshment' and further 5 items, and it is suggested to use as one scale.

  19. Issues in Business and Medical Education: Brief Literature Review on Strategic Management of Health Care Institutions. (United States)

    Smith, Alan D.

    The literature on the use of strategic management principles by health care organizations is reviewed. After considering basic concepts of strategic management and managerial problems in nonprofit organizations, strategic planning and management of health care organizations are covered. Attention is directed to the health care environment,…

  20. Minnesota's fifteen-year romance. Managed care: lessons learned and survival approaches for hospitals and physicians. (United States)

    Reece, R L; Coombes, D H


    For the last 15 years, Minnesota has lived with managed care. The Minnesota story is important because it is a singularly unique example of the natural history of managed care in the United States, from the indemnity response to HMOs to PPOs to "open-ended" HMOs to comprehensive managed care.

  1. Integrated Pest Management: A Curriculum for Early Care and Education Programs (United States)

    California Childcare Health Program, 2011


    This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early…

  2. Managing the physics of the economics of integrated health care. (United States)

    Zismer, Daniel K; Werner, Mark J


    The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles

  3. Risk Management for Point-of-Care Testing (United States)


    Point-of-care testing (POCT) is growing in popularity, and with this growth comes an increased chance of errors. Risk management is a way to reduce errors. Originally developed for the manufacturing industry, risk management principles have application for improving the quality of test results in the clinical laboratory. The Clinical and Laboratory Standards Institute (CLSI), EP23-A Laboratory Quality Control based on Risk Management guideline, introduces risk management to the clinical laboratory and describes how to build and implement a quality control plan for a laboratory test. A simple, unit-use blood gas analyzer is utilized as an example for developing a laboratory quality control plan. The US Centers for Medicare and Medicaid Services (CMS) has revised the Clinical and Laboratory Improvement Amendments (CLIA) interpretive guidelines to provide a new quality control option, individualized quality control plans (IQCP), for decreasing the frequency of analyzing liquid controls from two levels each day of testing to manufacturer recommended frequencies in conjunction with a device’s built-in internal control processes and the risk of error when testing with that device. IQCPs have the advantage of allowing laboratories the flexibility to adopt alternative control processes in concert with traditional liquid controls to improve efficiency and cost effectiveness while providing optimal quality POCT results for patient care. PMID:27683462

  4. The effect of multidisciplinary team care on cancer management. (United States)

    Abdulrahman, Ganiy Opeyemi


    Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.

  5. An innovative national health care waste management system in Kyrgyzstan. (United States)

    Toktobaev, Nurjan; Emmanuel, Jorge; Djumalieva, Gulmira; Kravtsov, Alexei; Schüth, Tobias


    A novel low-cost health care waste management system was implemented in all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model include mechanical needle removers, segregation using autoclavable containers, safe transport and storage, autoclave treatment, documentation, recycling of sterilized plastic and metal parts, cement pits for anatomical waste, composting of garden wastes, training, equipment maintenance, and management by safety and quality committees. The gravity-displacement autoclaves were fitted with filters to remove pathogens from the air exhaust. Operating parameters for the autoclaves were determined by thermal and biological tests. A hospital survey showed an average 33% annual cost savings compared to previous costs for waste management. All general hospitals with >25 beds except in the capital Bishkek use the new system, corresponding to 67.3% of all hospital beds. The investment amounted to US$0.61 per capita covered. Acceptance of the new system by the staff, cost savings, revenues from recycled materials, documented improvements in occupational safety, capacity building, and institutionalization enhance the sustainability of the Kyrgyz health care waste management system. © The Author(s) 2015.

  6. Managing managed care: habitus, hysteresis and the end(s) of psychotherapy. (United States)

    Kirschner, S R; Lachicotte, W S


    In this paper we examine how clinicians at a community mental health center are responding to the beginnings of changes in the health care delivery system, changes that are designated under the rubric of "managed care." We describe how clinicians' attitudes about good mental health care are embodied in what sociologist Pierre Bourdieu calls their habitus, i.e., their professional habits and sense of good practice. Viewed in this light, their moral outrage and sense of threat, as well as their strategic attempts to resist or subvert the dictates of managed care agencies, become a function of what Bourdieu terms the hysteresis effect. The paper is based on ethnographic fieldwork conducted by a team of researchers at the mental health and substance abuse service of a hospital-affiliated, storefront clinic which serves residents of several neighborhoods in a large northeastern city. Data consist primarily of observations of meetings and interviews with staff members. We describe four aspects of the clinicians' professional habitus: a focus on cases as narratives of character and relationship, an imperative of authenticity, a distinctive orientation towards time, and an ethic of ambiguity. We then chronicle practices that have emerged in response to the limits on care imposed by managed care protocols, which are experienced by clinicians as violating the integrity of their work. These are discussed in relation to the concept of hysteresis.

  7. Home-based Self-care: Understanding and Designing Pervasive Technology to Support Care Management Work at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    practices are investigated to (a) further understand the self-care management work in nonclinical settings, and (b) inform future design of pervasive healthcare technology that accounts for people’s perspectives on self-care and everyday life. First, we explore two selfcare practices of medication...... management and preventive self-monitoring to further study people’s perspectives on self-care both for health and illness. Second, we combine our initial studies with three additional studies of self-care practices: self-monitoring of pregnant women with pre-eclampsia and heart patients as well as home...... the self-care management work at home. People need to know which care activities to perform, when to perform them, how to proceed and why these are important. While at home, an active lifestyle and comorbidity not only challenge self-care activities but also the use of self-care technologies in non...

  8. Managing corporate governance risks in a nonprofit health care organization. (United States)

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J


    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves.

  9. Choices: anger and anger management in rehabilitative care. (United States)

    Pierce, Linda L; Pierce, Scott W; Gies, Cheryl E


    Violent acts are on rise and rehabilitation providers as caregivers may encounter anger on a daily basis. The purpose of this article is to discuss anger and describe anger management strategies based on behavioral interventions grounded in Choice Theory. Applying choice theory to anger is the belief that people are internally, not externally motivated, and that outside events do not make people do anything. Thus, what drives people's anger behaviors are internally developed notions of what is important and satisfying for them. Anger becomes a choice along with its management. Choosing strategies to manage anger are key to reducing the potential for angry emotions to escalate to the point of aggressive and violent acts that threaten caregivers and clients safety. Anger-free environments promote mental/physical health and establish elements of safe living and working environments in a variety of rehabilitative care settings. © 2013 Association of Rehabilitation Nurses.

  10. The Water Pricing Effects on the Water Use of the Hungarian Households

    Directory of Open Access Journals (Sweden)

    László VASA


    Full Text Available Hungary has remarkable surface and subsurface water resources which result in important comparative benefits. In Hungary, before the political change, the water prices were determined by the state. According to the underlying principles of the communism, the water prices were very low as well. After the political and economical change in Hungary, from 1990 the water market started to be oligopoly-like: today the water supply is managed by regional water-work companies which are operating under state coordinated frames (e.g. price allowance, state-fixed prices containing profit. The consequences of the changeover to the capitalism have several effects; there is a need for the validating of the real costs and the environmental aspects in the water prices. This new approach led to the increased water-prices. In this study, the reaction of the Hungarian households to the growing of the water-rates is examined. The research work is based on primary statistical data. The analysis shows that the water consumption is hardly decreased and the sparing of water became more important. The study overviews the Hungarian water consumption structure as well.

  11. Infectious disease management in primary care: perceptions of GPs

    Directory of Open Access Journals (Sweden)

    Röing Marta


    Full Text Available Abstract Background It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing. Methods Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach. Results Five qualitatively different perceptions of infectious disease management were identified. They were: (A the GP must help the patient to achieve health and well-being; (B the management must meet the GP's perceived personal, professional and organisational demands; (C restrictive antibiotic prescribing is time-consuming; (D restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E patients benefit personally from restrictive antibiotic prescribing. Conclusions Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning.

  12. Forging community partnerships to improve health care: the experience of four Medicaid managed care organizations. (United States)

    Silow-Carroll, Sharon; Rodin, Diana


    Some managed care organizations (MCOs) serving Medicaid beneficiaries are actively engaging in community partnerships to meet the needs of vulnerable members and nonmembers. We found that the history, leadership, and other internal factors of four such MCOs primarily drive that focus. However, external factors such as state Medicaid policies and competition or collaboration among MCOs also play a role. The specific strat­egies of these MCOs vary but share common goals: (1) improve care coordination, access, and delivery; (2) strengthen the community and safety-net infrastructure; and (3) prevent illness and reduce disparities. The MCOs use data to identify gaps in care, seek community input in designing interventions, and commit resources to engage community organiza­tions. State Medicaid programs can promote such work by establishing goals, priorities, and guidelines; providing data analysis and technical assistance to evaluate local needs and community engagement efforts; and convening stakeholders to collaborate and share best practices.

  13. Managing evidence-based health care: a diagnostic framework. (United States)

    Newman, K; Pyne, T; Cowling, A


    This paper proposes a diagnostic framework useful to Trust managers who are faced with the task of devising and implementing strategies for improvements in clinical effectiveness, and is based on a recent study incorporating clinicians, managers, and professional staff in four NHS Trusts in the North Thames Region. The gap framework is inspired by the gap model developed by Zeithaml, Parasuraman and Berry from their research into service quality and incorporates Dave Sackett's schema as well as a personal competency profile needed for the practice of evidence based health-care (EBHC). The paper highlights the four organisational and personal failures (gaps) which contribute to the fifth gap, namely the discrepancy between clinically relevant research evidence and its implementation in health care. To close the gaps, Trusts need to set the goal and tackle the cultural, organisational, attitudinal and more material aspects such as investment in the information infrastructure, education and training of doctors. Doctors need to go through a process from awareness to action facilitated through a combination of personal and organisational incentives and rewards as well as training in the requisite skills. Researchers should take steps to improve the quality of the evidence and its accessibility and purchasers should reinforce the use of EBHC by withdrawing funding for care which has proved to be ineffective, inappropriate or inferior.

  14. Managed care in workers' compensation: analysis of cost drivers and vendor selection. (United States)

    Daiker, B


    1. Managed care for employee benefits provides a model of cost containment for workers' compensation; however, significant differences must be understood. 2. Purchasers of managed care services must perform an internal assessment to determine the cost drivers for workers' compensation. Managed care does not address all cost drivers. 3. A model for evaluating managed care vendors places them on a continuum of risk, similar to insurance risk, where a variety of cost containment strategies may be used together. 4. By reviewing seven key aspects of a managed care vendor, a purchaser can rate the vendor's ability to meet their needs.

  15. Technical elements, demonstration projects, and fiscal models in Medicaid managed care for people with developmental disabilities. (United States)

    Kastner, T A; Walsh, K K; Criscione, T


    We presented a general model of the structure and functioning of managed care and described elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to service delivery for people with developmental disabilities. A number of technical elements of managed care systems were delineated and reviewed in relation to the inclusion of people with developmental disabilities. Several managed care demonstration projects were described and, finally, a multi-year hypothetical budget model, including long-term care, was presented as a framework for considering how managed care affects specific service structures. Implications for people with developmental disabilities were discussed.

  16. Integrated obesity care management system -implementation and research protocol

    Directory of Open Access Journals (Sweden)

    St-Cyr-Tribble Denise


    Full Text Available Abstract Background Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals. Methods We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs. This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be


    Directory of Open Access Journals (Sweden)

    Ye. G. Totskaya


    Full Text Available The paper reviews topical issues of organization and management of innovative activity in the regional health care system.Objective. Development and scientific substantiation of a conceptual model of managing innovation in the regional health care system, introduction of institutional mechanisms for its implementation, and evaluation of their efficacy in using diagnosis and treatment technologies. Objectives of the study included reviewing the organization status and problems hampering the development, identification of prospects, and justification for appropriate changes in innovation in healthcare system and medical science at the regional level.Material and methods. To conduct a comprehensive assessment of the status and meet challenges of innovation promotion, a methodology for social-hygienic research was worked out including bibliographic and analytical methods, situational analysis, sociological and economic methods, expert assessment, methods for quality management system audit in accordance with ISO 19011:2002, IDEFO function modeling (RD IDEF0-2000, and organizational modeling. The study was based on the analysis of foreign and domestic literature, statistics, methods for managerial modeling, as well as management experience (including innovative methodological approaches gained by Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan which meets the requirements for a platform for research and innovative product reproduction, including research, clinical, organizational, and managerial aspects. Other facilities were considered in conjunction with the leading innovative platform.Results. The paper presents a scientifically based model of innovative medical environment with its elements as subjects, each with a set of functions. Conceptual model for management includes structuring (resource, processes, and quality management; application of international standards and strategic management mechanisms

  18. Medicaid Managed Care and the Health Care Utilization of Foster Children. (United States)

    Palmer, Makayla; Marton, James; Yelowitz, Aaron; Talbert, Jeffery


    A recent trend in state Medicaid programs is the transition of vulnerable populations into Medicaid managed care (MMC) who were initially carved out of such coverage, such as foster children or those with disabilities. The purpose of this article is to evaluate the impact of the transition of foster children from fee-for-service Medicaid coverage to MMC coverage on outpatient health care utilization. There is very little empirical evidence on the impact of managed care on the health care utilization of foster children because of the recent timing of these transitions as well as challenges associated with finding data sets large enough to contain a sufficient number of foster children for such analysis. Using administrative Medicaid data from Kentucky, we use retrospective difference-in-differences analysis to compare the outpatient utilization of foster children transitioned to MMC in one region of the state with foster children in the rest of the state who remained in fee-for-service coverage. We find that the transition to MMC led to a 4 percentage point reduction in the probability of having any monthly outpatient utilization. We also estimate that MMC leads to a reduction in outpatient spending.

  19. Telemedicine and telepresence for trauma and emergency care management. (United States)

    Latifi, R; Weinstein, R S; Porter, J M; Ziemba, M; Judkins, D; Ridings, D; Nassi, R; Valenzuela, T; Holcomb, M; Leyva, F


    The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.

  20. The effect of managed care on use of health care services: results from two contemporaneous household surveys. (United States)

    Deb, Partha; Li, Chenghui; Trivedi, Pravin K; Zimmer, David M


    This paper estimates treatment effects of managed care plans on the utilization of health care services using data from two contemporaneous, nationally representative household surveys from the USA. The paper exploits recent advances in simulation-based econometrics to take the endogeneity of enrollment into managed care plans into account and identify the causal relationship between managed care enrollment and utilization. Overall, results from the two surveys are remarkably similar, lending credibility to their external validity and to the econometric model and estimation methods. There is significant evidence of self-selection into managed care plans. After accounting for selection, an individual enrolled in an health maintenance organization (HMO) plan has 2 more visits to a doctor and has 0.1 more visits to the emergency room per year than would the same individual enrolled in a nonmanaged care plan.

  1. How technology in care at home affects patient self-care and self-management: a scoping review.

    NARCIS (Netherlands)

    Peeters, J.M.; Wiegers, T.A.; Friele, R.D.


    The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence fo

  2. The management of health care service quality. A physician perspective. (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L


    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

  3. Targeted temperature management: Current evidence and practices in critical care

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    Saurabh Saigal


    Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

  4. Management of health-care waste in Izmir, Turkey

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    Ahmet Soysal


    Full Text Available The aim of this study was to evaluate health-care waste in the 18 districts of metropolitan municipality of the third biggest city in Turkey. This cross-sectional study was carried out with 825 health institutions established in the 18 districts of Izmir metropolitan municipality, in 2007. The total amount of health-care waste collected was 4841 tons and 621 kilograms per patient's bed in 2007. Most of the medical wastes were collected from Konak, Karsiyaka and Bornova districts and were 2308, 272 and 1020 tons, respectively. Regarding to overpopulation, the number of health institutions in these districts are more than the number of health institutions in the other administrative districts. There was a statistically significant, positive correlation between the amount of health-care waste collected and population of the 18 districts (r = 0.79, p < 0.001, and number of beds/patients (r = 0.83, p < 0.001. To provide a safe health-care waste management metropolitan municipality must provide hazardous waste separation in health institutions, establish sterilization units for infectious waste, and provide the last storage of medical waste in completely different, safe and special areas apart from the municipal waste storage areas.

  5. Overcoming resistance against managed care - insights from a bargaining model. (United States)

    Ehlert, Andree; Wein, Thomas; Zweifel, Peter


    Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed. In a "three-player/three-cake" game the coalitions {SHI, MCO}, {MCO, RI}, and {SHI, RI} can form. Players' possibility to switch between coalitions creates new outside options, causing the conventional bilateral Nash bargaining solution to be replaced by the so-called von Neumann-Morgenstern triple. These triples are compared to the status quo (where the RI has no threat potential) and related to institutional conditions characterizing Germany, the Netherlands, and Switzerland.

  6. Severe ovarian hyperstimulation syndrome: Intensive care management of two cases

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    Praveen Talawar


    Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.

  7. Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery. (United States)

    Cole, L; Houston, S


    Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

  8. Survey among critical care nurses and physicians about delirium management. (United States)

    Nydahl, Peter; Dewes, Michael; Dubb, Rolf; Hermes, Carsten; Kaltwasser, Arnold; Krotsetis, Susanne; von Haken, Rebecca


    Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines. To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians. The study used an open online survey with multiple-choice responses. An invitation for participation was spread via journals and electronic resources using a snowball system. Apart from recording socio-demographical characteristics, the survey collected data on delirium assessment, delirium-related processes, non-pharmacological prevention and treatment and barriers for implementation. Differences between nurses and physicians were tested by Fisher's exact test with sequential Bonferroni correction. The survey was conducted in autumn 2016, and 559 clinicians participated. More nurses than physicians reported screening for delirium. The majority of clinicians reported screening for delirium when this was suspected; more than 50% used validated instruments. Half of the clinicians had delirium-related structures implemented, such as two thirds reporting delirium-related processes. Most cited barriers were lack of time and missing knowledge about delirium and its assessment. With significant difference, physicians recommended more than nurses early removal of catheters and daily interprofessional goals for patients. In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians. Nurses and physicians in this survey reported similar perceptions and attitudes towards management of delirium. Both professions need more knowledge and inter-professional training on when and how to use validated assessment instruments. © 2017 British

  9. Effect of care management program structure on implementation: a normalization process theory analysis. (United States)

    Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A


    Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship

  10. Total quality in acute care hospitals: guidelines for hospital managers. (United States)

    Holthof, B


    Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

  11. Wound healing and treating wounds: Chronic wound care and management. (United States)

    Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J


    In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. A computer science approach to managing security in health care. (United States)

    Asirelli, P; Braccini, G; Caramella, D; Coco, A; Fabbrini, F


    The security of electronic medical information is very important for health care organisations, which have to ensure confidentiality, integrity and availability of the information provided. This paper will briefly outline the legal measures adopted by the European Community, Italy and the United States to regulate the use and disclosure of medical records. It will then go on to highlight how information technology can help to address these issues with special reference to the management of organisation policies. To this end, we will present a modelling example for the security policy of a radiological department.

  13. Emerging trends in cancer care: health plans' and pharmacy benefit managers' perspectives on changing care models. (United States)

    Greenapple, Rhonda


    Cancer care in the United States is being transformed by a number of medical and economic trends, including rising drug costs, increasing availability of targeted therapies and oral oncolytic agents, healthcare reform legislation, changing reimbursement practices, a growing emphasis on comparative effectiveness research (CER), the emerging role of accountable care organizations (ACOs), and the increased role of personalization of cancer care. To examine the attitudes of health plan payers and pharmacy benefit managers (PBMs) toward recent changes in cancer care, current cost-management strategies, and anticipated changes in oncology practice during the next 5 years. An online survey with approximately 200 questions was conducted by Reimbursement Intelligence in 2011. The survey was completed by 24 medical directors and 31 pharmacy directors from US national and regional health plans and 8 PBMs. All respondents are part of a proprietary panel of managed care decision makers and are members of the Pharmacy and Therapeutics Committees of their respective plans, which together manage more than 150 million lives. Survey respondents received an honorarium for completing the survey. The survey included quantitative and qualitative questions about recent developments in oncology management, such as the impact on their plans or PBMs of healthcare reform, quality improvement initiatives, changes in reimbursement and financial incentives, use of targeted and oral oncolytics, and personalized medicine. Respondents were treated as 1 group, because there were no evident differences in responses between medical and pharmacy directors or PBMs. Overall, survey respondents expressed interest in monitoring and controlling the costs of cancer therapy, and they anticipated increased use of specialty pharmacy for oncology drugs. When clinical outcomes are similar for oral oncolytics and injectable treatments, 93% prefer the oral agents, which are covered under the specialty tier by 59

  14. Patient care and management: reduced skin integrity of the foot. (United States)

    Bateman, Sharon

    The development and deterioration of pressure ulcers are a frequent occurrence across all healthcare settings and specialties, posing daily challenges to the healthcare worker and unnecessary suffering to the patient. Reduced skin integrity occurs within those patients deemed high risk, particularly to the vulnerable areas such as the heel and ankle (American Physical Therapy Association (APTA), 1996). The incidence of pressure ulcers, alongside diabetes, vascular insufficiency and obesity, is on the increase, posing additional demands on current clinical resources; specialist clinics, debridement therapies and appropriate dressing management regimes. This article will focus on the heel and ankle in regards to reduced skin integrity and the positive introduction of an innovative dressing product as an adjunct to the overall care and management of this patient group.

  15. Management of Patients with Subclinical Hypothyroidism in Primary Care. (United States)

    McCarthy, E; Russell, A; Kearney, P M


    Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels.

  16. [Community health in primary health care teams: a management objective]. (United States)

    Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex


    To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.


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    Full Text Available The aim of the study was to rank and classify Hungarian cities and counties according to their environmental quality and level of environmental awareness. Ranking of the Hungarian cities and counties are represented on their „Green Cities Index” and „Green Counties Index” values. According to the methodology shown in Part 1, cities and counties were grouped on different classification techniques and efficacy of the classification was analysed. However, they did not give acceptable results either for the cities, or for the counties. According to the parameters of the here mentioned three algorithms, reasonable structures were not found in any clustering. Clusters received applying algorithm fanny, though having weak structure, indicate large and definite regions in Hungary, which can be circumscribed by clear geographical objects.

  18. Breeding value estimation in the Hungarian Sport Horse population. (United States)

    Posta, János; Komlósi, István; Mihók, Sándor


    The aims of this study were to estimate phenotypic and genetic parameters for a range of traits in Hungarian Sport Horses, and to compare several methods of estimating breeding value (BV) in this breed. The analyses were based on the Hungarian Sport Horse Studbook, results of self-performance tests (SPTs) and show-jumping competition results. An SPT comprises subjective judgement of conformation traits, movement analysis traits and free-jumping performance, assessed via ordinal scores. Genetic parameters of SPTs were estimated with an animal model. Different measurements of the competition performance were compared using the same repeatability model. Estimates of BV for sport were made with random regression models using a first-order Legendre polynomial. Heritability was found to increase and permanent environmental variance to decrease continuously with age. BVs can be estimated at different ages and from these a composite BV index can be computed. It is possible to weight BVs for the specific age of a horse.

  19. Translating Family Names in Hungarian: A Diachronic Survey

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    Tamás Farkas


    Full Text Available In our paper we focus on the translating practice and translatability of surnames used in Hungarian, from the problems of translating the immediate predecessors of surnames to the questions of translating surnames today. Our main interest is in how multilingualism, language contact situations, language prestige considerations, customs, fashion and other potential factors affect the use of these names in different languages, and the translatability in a wider sense in the actual practice in Hungary and other countries. We shall look at name translation practice in medieval documents, the relevant questions of spontaneous and conscious surname changes, the changes of Hungarian surnames used outside of Hungary, and finally the questions of translating surnames occurring in fiction.

  20. The management of care: a social and legal function of chilean nursing

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    Paula Ceballos-Vásquez


    Full Text Available Introduction: The objective of this article is to reflect on the implication of the concept of management of nursing, making Latin-American countries that have incorporated the management of care aware of its norms and the chilean experience and the legal aspects that regulate the management of care are specifically presented.Development: To achieve this objective, a bibliographic revision of diverse mainstream magazines, texts and laws related to administration and Management of Care was carried out.Initially, the concept of management is analyzed with the purpose of comprehending why the nursing integrate it in its field of performance. To visualize later how some of the countries of Latin-America have incorporated it in their legal frameworks of management of Care care of nursing, and subsequently the experience of the Chilean chilean nursing with regard to the Management management of Care care is analyzed extensively.Conclusions: As final considerations it is indicated that the Management management of Care care is part of the social function of the nurses, for the daily work they are to perform incorporating the management, it would provide managing competencies and would permit the autonomous caretaking to these professionals. 

  1. 匈牙利香肠%Hungarian sausage

    Institute of Scientific and Technical Information of China (English)



    英文名:Hungarian sausage原产地:匈牙利行走匈牙利,从来不用为食物烦恼。这个国家从草原到城市,没有哪里找不到香肠摊子,在小摊上付出少许银两,匈牙利妈妈就会笑盈盈递过来一段香肠。

  2. What Influences the Savings Decisions of the Hungarian Population?


    Annamária Horváthné Kökény; Zsuzsanna Széles


    We created a theoretical model of the main factors that influence household savings based on our secondary research, then conducted a questionnaire survey involving 4106 Hungarian households in the scope of primary research. The examined households had a low level of financial knowledge. They believe that financial literacy needs to be developed, since in general it is true that they are not adequately familiar with the various financial services and state aid options related to them. We came...

  3. ADRIAN HATOS, School Performance and Language of Hungarian Ethnic Pupils

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    Full Text Available One of the thorniest issues of the linguistic policies in North-Western Transylvania was the establishment of linguistic arrangements in the mandatory education system. Supported also by arguments which refer to the equal opportunity rule, native language education for ethnic minority children, concerning especially the Hungarian language, has flourished both in mixed schools, and in schools that are segregated in terms of the teaching language. This article assesses the effects that the various linguistic contexts in which a Hungarian teenager in the region studies can have on his/her performance in school, compared to the performance of his/her colleagues who study in Romanian. I start from two hypotheses: linguistic shortcoming and opposition culture. The hierarchical linear regression modeling of the average of school results scores in the seventh grade, on a sample of over 3 700 pupils in the eighth grade in Bihor County, indicates a significant and systematic disadvantage of Hungarian pupils, although small as an absolute value, irrespective of the linguistic arrangement. Moreover, both the linguistic disadvantage thesis and the opposition culture model can be supported, although the results are not conclusive from this point of view.

  4. The Greek charter of the Hungarian King Stephen I

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    Stojkovski Boris


    Full Text Available The first Hungarian Christian ruler, King Stephen I (997-1038 issued several charters that have survived to this day. One of them is the charter issued on behalf of the nuns from the Monastery of the Holy Theotokos in Veszprémvölgy. The charter was written in the Greek language, and has been the subject of many studies. The original has not been preserved; what remains is a copy from the time of King Coloman, dated to 1109. The charter has not been published in a critical edition in any language other than Hungarian and even though it has been examined by numerous Hungarian scholars, many questions remain open. The aim of the author is to provide a critical edition and an English translation of the charter, but also to clarify some remaining doubts about the charter and its contents. Furthermore, some comparisons will be made with the Byzantine charters issued at the beginning of the 11th and during the 12th century.

  5. What do the Hungarian young people think about the nuclear?

    Energy Technology Data Exchange (ETDEWEB)

    Pazmandi, T.; Aszodi, A.; Boros, I.; Hanti, A.; Legradi, G.; Petofi, G. [Budapest University of Technology and Economys, Institute of Nuclear Techniques, Budapest (Hungary)


    During the last few years new challenges and opportunities appeared on the nuclear agenda, like the improvement of the economic competitiveness, enhancing radiation and waste safety, strengthening of the role of the public acceptance. It seems that the future of the nuclear industry depends on several things. On the one hand the scientific and technical development in the last decades worked up sufficient nuclear safety and radiation protection, and nuclear methods are widely used in the industry, agriculture and medical systems, as well. On the other hand there are some other interesting questions, like Human Relations and the public acceptance of the nuclear energy still lying ahead of us. The Hungarian Youth for Nuclear (FINE) was established in 1998 as the Hungarian branch of the Young Generation Network. Our purpose is to remove the misbelieves and fears arisen around the nuclear techniques and mainly the nuclear energetics and to answer the questions brought up by the Hungarian youth in this topic. In this paper our experience what we have drawn with the help of our programmes about the attitude and the knowledge of the youth is summarised. (author)

  6. Educational Implications of Nurse Practitioner Students and Medical Residents' Attitudes toward Managed Care. (United States)

    Breer, M. Lynn; Pohl, Joanne M.; Stommel, Manfred; Barkauskas, Violet H.; Schillo, Barbara; Oakley, Deborah


    Attitudes toward managed care of 431 medical residents and 153 advanced practice nursing students were compared. Medical students were more likely to agree that managed care emphasizes cost over quality and threatens autonomy. Nursing students were more likely to agree that it encourages preventive care. Medical students were less enthusiastic…

  7. Study on the Hungarian algorithm for the maximum likelihood data association problem

    Institute of Scientific and Technical Information of China (English)

    Wang Jianguo; He Peikun; Cao Wei


    A specialized Hungarian algorithm was developed here for the maximum likelihood data association problem with two implementation versions due to presence of false alarms and missed detections. The maximum likelihood data association problem is formulated as a bipartite weighted matching problem. Its duality and the optimality conditions are given. The Hungarian algorithm with its computational steps, data structure and computational complexity is presented. The two implementation versions, Hungarian forest (HF) algorithm and Hungarian tree (HT) algorithm, and their combination with the na(i)ve auction initialization are discussed. The computational results show that HT algorithm is slightly faster than HF algorithm and they are both superior to the classic Munkres algorithm.

  8. Developing a Total Quality Management Model for Health Care Systems

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad


    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on

  9. Critical Care Management of Cerebral Edema in Brain Tumors. (United States)

    Esquenazi, Yoshua; Lo, Victor P; Lee, Kiwon


    Cerebral edema associated with brain tumors is extremely common and can occur in both primary and metastatic tumors. The edema surrounding brain tumors results from leakage of plasma across the vessel wall into the parenchyma secondary to disruption of the blood-brain barrier. The clinical signs of brain tumor edema depend on the location of the tumor as well as the extent of the edema, which often exceeds the mass effect induced by the tumor itself. Uncontrolled cerebral edema may result in increased intracranial pressure and acute herniation syndromes that can result in permanent neurological dysfunction and potentially fatal herniation. Treatment strategies for elevated intracranial pressure consist of general measures, medical interventions, and surgery. Alhough the definitive treatment for the edema may ultimately be surgical resection of the tumor, the impact of the critical care management cannot be underestimated and thus patients must be vigilantly monitored in the intensive care unit. In this review, we discuss the pathology, pathophysiology, and clinical features of patients presenting with cerebral edema. Imaging findings and treatment modalities used in the intensive care unit are also discussed.

  10. Collaborative care management for a pregnant woman with an ostomy. (United States)

    Aukamp, Virginia; Sredl, Darlene


    Pregnant women with an ostomy face many challenges during the prenatal period. Although these challenges may be present, pregnancy in the ostomate is presented as a continuum of health and wellness in this article. Collaborative care professionals, especially nurses and midwives, are often the most accessible professional sources for health care information, but current research and information on this topic is sparse. Ostomy-related problems that may occur during pregnancy, include: intestinal obstruction, peristomal hernia, pouching problems, including the effect of nausea and vomiting on pouch hydration, stomal retraction, stenosis, or laceration, and stomal prolapse. Three types of ostomies are discussed: continent ileostomies, urostomies and colostomies. A description of the normal characteristic appearance of each is also included. Collaborative care from pre-conception through the post partum period is described with emphasis on teaching self-help techniques such as: special nutritional considerations, how to recognize potential problems, and how to fit and adapt appliances to the changing body form of the patient as the pregnancy progresses. Phenomenologic information about the pregnant ostomate's perceptions about her pregnancy experience is also presented. Psycho-prophylaxis methods of complementary therapy alternatives alleviating nausea and vomiting within pregnancy, as well as the pain of childbirth are also presented. Although nursing/midwifery management of a pregnant ostomy patient is a challenge, those challenges are surmountable and outcomes resemble those found in the general population.

  11. [Intercultural competence. Management of foreignness in intensive care medicine]. (United States)

    Bein, T


    Living in a multicultural society is characterized by different attitudes caused by a variety of religions and cultures. In intensive care medicine such a variety of cultural aspects with respect to pain, shame, bodiliness, dying and death is of importance in this scenario. To assess the importance of cultural and religious attitudes in the face of foreignness in intensive care medicine and nursing. Notification of misunderstandings and misinterpretations in communication and actions. An analysis of the scientific literature was carried out and typical intercultural conflict burden situations regarding the management of brain death, organ donation and end of life decisions are depicted. Specific attitudes are found in various religions or cultures regarding the change of a therapeutic target, the value of the patient's living will and the organization of rituals for dying. Intercultural conflicts are mostly due to misunderstandings, assessment differences, discrimination and differences in values. Intercultural competence is crucial in intensive care medicine and includes knowledge of social and cultural influences of different attitudes on health and illness, the abstraction from own attitudes and the acceptance of other or foreign attitudes.

  12. Informal care givers’ experiences with support in primary palliative care when a case manager is involved: a descriptive study in the Netherlands.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.


    Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and gen

  13. Making it local: Beacon Communities use health information technology to optimize care management. (United States)

    Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A


    Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

  14. Integrating digital image management software for improved patient care and optimal practice management. (United States)

    Starr, Jon C


    Photographic images provide vital documentation of preoperative, intraoperative, and postoperative results in the clinical dermatologic surgery practice and can document histologic findings from skin biopsies, thereby enhancing patient care. Images may be printed as part of text documents, transmitted via electronic mail, or included in electronic medical records. To describe existing computer software that integrates digital photography and the medical record to improve patient care and practice management. A variety of computer applications are available to optimize the use of digital images in the dermatologic practice.

  15. [Hungarian Diet and Nutritional Status Survey - OTÁP2014. II. Energy and macronutrient intake of the Hungarian population]. (United States)

    Sarkadi Nagy, Eszter; Bakacs, Márta; Illés, Éva; Nagy, Barbara; Varga, Anita; Kis, Orsolya; Schreiberné Molnár, Erzsébet; Martos, Éva


    The aim of the study was to assess and monitor the dietary habits and nutrient intake of Hungarian adults. Three-day dietary records were used for dietary assessment, the sample was representative for the Hungarian population aged ≥18ys by gender and age. The mean proportion of energy from fat was higher (men: 38 energy%, women: 37 energy%), that from carbohydrates was lower (men: 45 energy%, women: 47 energy%) than recommended, the protein intake is adequate. Unfavorable change compared to the previous survey in 2009 was the increase of fat and saturated fatty acid energy percent in women, the decrease in fruit and vegetable consumption, which explains the decreased fiber intake. An increasing trend in added sugar energy percent in each age groups of both genders was observed compared to 2009. Interventions focusing on the promotion of fruit and vegetable consumption and decreasing of saturated fat and added sugar intake are needed. Orv. Hetil., 2017, 158(15), 587-597.

  16. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana


    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  17. Management training of physician executives, their leadership style, and care management performance: an empirical study. (United States)

    Xirasagar, Sudha; Samuels, Michael E; Curtin, Thomas F


    To examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. Cross-sectional national survey. Executive directors of community health centers (269 respondents; response rate = 40.9%) were surveyed regarding their perceptions of the medical director's leadership, and for quantitative information on the center's achievement of clinical (mostly disease management) goals. The dependent variables were the medical director's scores (as perceived by the executive director) on transformational, transactional, and laissez-faire leadership, effectiveness, satisfaction with the leader, and subordinate extra effort, using an adapted Multifactor Leadership Questionnaire (43 items; 5-point Likert scale). The independent variable was the medical director's management training status. Compared with medical directors with or =30 days of in-service training, had 0.32, 0.35, 0.30, 0.36, and 0.37 higher scores on transformational leadership, transactional leadership, rated effectiveness, satisfaction, and subordinate extra effort, respectively, and 0.31 lower score on laissez-faire leadership (all P management degrees but with > or =30 days of in-service training had 0.34, 0.36, 0.50, and 0.47 higher scores on transformational leadership, transactional leadership, rated effectiveness, and satisfaction with the leader (all P leadership significantly influences achievement of disease management goals. Training may enable physician executives to develop leadership styles that are effective in influencing clinical providers' adoption of disease management guidelines under managed care.

  18. Exploring self-care and wellness: a model for pharmacist compensation by managed care organizations. (United States)

    Srnka, Q; Portner, T S


    Self-care and wellness are rapidly becoming mainstays of practice for many pharmacists. Consumer confidence and trust in pharmacists provides continuing opportunities for pharmacists to create products and services to satisfy consumer demands related to disease prevention and healthcare delivery. We outline two pharmacy wellness programs designed to meet consumer needs, and offer them as models for pharmacists. Issues related to the program and extent of involvement by pharmacists are raised, including the role of the pharmacists in behavior modification efforts; selecting areas of focus (e.g., smoking cessation); working with physicians for referrals; enlightening community business leaders and managed care organizations to the economic benefits of the program; and developing strategies for fair purchase of services to achieve program goals and provide adequate compensation in return.

  19. [Essentials for transition of palliative care patients to palliative home care and for management of their cancer pain]. (United States)

    Koshikawa, Takafumi; Shimoyama, Naohito


    Multi-disciplinary team work among visiting doctors, nurses, care managers and pharmacists located close to the patient's home is essential for smooth transition of a palliative care patient from hospital care to palliative home care and should be set up prior to the patient's discharge from the hospital. Palliative home care physicians should have knowledge of the fundamental support by the government to spare excessive cost to the patients. As for cancer pain management, opioid-centered analgesic therapies have lead to better quality home care for patients. In Japan, although oxycodone SRs and fentanyl patches are available besides morphine, there is no rescue opioid other than morphine. On the other hand, some cancer pain refractory to opioids such as neuropathic cancer pain should be carefully treated by adjuvant analgesics in conjunction with non-pharmacological treatments.

  20. Managing between the agendas: implementing health care reform policy in an acute care hospital. (United States)

    Sorensen, Roslyn; Paull, Glenn; Magann, Linda; Davis, JanMaree


    This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance. A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units. This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised. The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect. While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation. This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

  1. Considerations for developing chronic care system for traumatic brain injury based on comparisons of cancer survivorship and diabetes management care. (United States)

    Heiden, Siobhan M; Caldwell, Barrett S


    Experts in traumatic brain injury (TBI) rehabilitation recently proposed the framing of TBI as a chronic disease rather than a discrete event. Within the framework of the Chronic Care Model (CCM), a systematic comparison of three diseases - cancer survivorship, diabetes management and TBI chronic care - was conducted regarding chronic needs and the management of those needs. In addition, comparisons of these conditions require comparative evaluations of disease management characteristics and the survivor concept. The analysis found diabetes is more established within the CCM, where care is integrated across specialists and primary care providers. No single comparison provides a full analogue for understanding the chronic care health delivery system for TBI, indicating the need for a separate model to address needs and resources for TBI survivors. The findings from this research can provide practitioners with a context to develop a robust continued care health system for TBI. Practitioner Summary: We examine development of a chronic care system for traumatic brain injury. We conducted a systematic comparison of Chronic Care Model elements of decision and information support. Development of capabilities using a benchmark of diabetes care, with additional insights from cancer care, provides insights for implementing TBI chronic care systems.


    Directory of Open Access Journals (Sweden)

    Gábor LUKÁCS


    experience and the regularities regarding animals and plants discovered by the developing sciences. His main source is ’Elementa rei rusticae’ by Mitterpacher but he also mentioned 51 different books as sources, (34 of them in the section about plant cultivation. Plant cultivation had the same importance and number of pages as in the work of Mitterpacher but animal husbandry had twice as many pages. He wrote about the breeding of all farm animals but it was not the chapters on animal husbandry that pointed ahead but his remarks to help the rationalization of farming and the fact that he wrote about plant cultivation and animal husbandry as a whole. The book made him well-known in the country. He was offered the post of a land steward by Széchenyi Ferenc and Festetics György. Accepting the latter he moved to Keszthely and he took over the management of the domain of 162ooo acres. The earl left the army at that time and started to restore his neglected domain. Nagyváthy’s main task was to improve farm management. He introduced strict accountancy and applied double-entry book-keeping for the first time and Hungary and his main principle was to put down all farming activities in writing. The farm managers were not suitable for this task so he convinced Festetics to found a school for them and an other secondary grammar school in the other centre of the domain in Csurgó. By 1797 the condition of the domain improved significantly and the Earl founded ’Georgikon’ the first agricultural college in Europe though without the land steward who favoured the idea of enlightment (the court in Vienna would not approve it. After the expiration of his contract he retired and moved to Csurgó, where he inspected the secondary grammar school as a secular inspector. He spent the last 22 years of his life here ’hard working in respectable poverty’. He died on 13th February 1819 (according to other sources on 24th. His posthumous books are as follows: ’Hungarian housewife on the farm

  3. Impact of chronic kidney disease management in primary care. (United States)

    Meran, S; Don, K; Shah, N; Donovan, K; Riley, S; Phillips, A O


    The introduction of eGFR reporting and publication of national CKD guidelines has led to major challenges in primary and secondary care, leading to an increase in the number of referrals to nephrology clinics. We have shown that introduction of a renal patient care pathway reduces nephrology referrals and enables managed discharges of CKD patients to primary care. The aim of this article is to examine the outcome of patients discharged to primary care to find out if there is an associated risk with increased discharge supported by the patient pathway. The study was carried out within a single NHS Trust covering a population of 560,000. All patients discharged from the trust's renal outpatient clinic between June 2007 and July 2008 were identified. Patient notes and the local laboratory database systems were used to determine the source and timing of tests. A total of 31 new referrals and 57 regular follow-ups were discharged during this period. The median age of discharge was 67.5 years. Most subjects (60%) had CKD stage 3 at the time of discharge. A total of 23% of discharges were categorized as CKD stages 1, 2 or normal and 17% of patients had CKD stage 4. Overall, 93% had stable eGFRs prior to discharge, 77.5% of patients had blood pressure within threshold (140/90 according to UK CKD guidelines) and 97.7% of patients had haemoglobins >10 g/dl. Post-discharge 83% of patients had eGFRs recorded by their general practitioner and 92.6% of these were measured within appropriate time frames as per CKD guidelines. The majority of patients (82%) had either improved or stable eGFR post-discharge and only three patients had a significant decline in their eGFR. These data indicate that selected CKD patients can be appropriately discharged from secondary care and adequately monitored in primary care. Furthermore, we have shown that this was a safe practice for patients.

  4. Diabetes management patterns in a palliative care unit in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Sami Ayed Alshammary


    Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients' individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

  5. [Outsourcing in long-term care: a risk management approach]. (United States)

    Guimarães, Cristina Machado; Carvalho, José Crespo de


    This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

  6. Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions. (United States)

    Carrier, Emily; Reschovsky, James


    Use of care management tools--such as group visits or patient registries--varies widely among primary care physicians whose practices care for patients with four common chronic conditions--asthma, diabetes, congestive heart failure and depression--according to a new national study by the Center for Studying Health System Change (HSC). For example, less than a third of these primary care physicians in 2008 reported their practices use nurse managers to coordinate care, and only four in 10 were in practices using registries to keep track of patients with chronic conditions. Physicians also used care management tools for patients with some chronic conditions but not others. Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools. The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level care management resources, such as nurse managers, that could be shared among smaller physician practices.

  7. Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability. Final rule. (United States)


    This final rule modernizes the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The final rule aligns, where feasible, many of the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It also ensures appropriate beneficiary protections and enhances policies related to program integrity. This final rule also implements provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes.

  8. How technology in care at home affects patient self-care and self-management: a scoping review. (United States)

    Peeters, José M; Wiegers, Therese A; Friele, Roland D


    The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients' role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients' self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.

  9. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity (United States)


    ... memorandums are available on the FNS Web site at . Finally, after publishing each of the interim rules, the...

  10. Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures. (United States)

    Kimura, Joe; DaSilva, Karen; Marshall, Richard


    The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c system integrated these disease management functions into the front lines of primary care and the positive impact of those changes on overall diabetes quality of care.

  11. Complementary medicine in palliative care and cancer symptom management. (United States)

    Mansky, Patrick J; Wallerstedt, Dawn B


    Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.

  12. Marriage and family therapists evaluate managed mental health care: a qualitative inquiry. (United States)

    Christensen, L L; Miller, R B


    This study examined the experiences of 26 marriage and family therapists working in managed mental health care. A qualitative strategy was used to explore therapists' perspectives regarding practice in a managed care environment. Using an open-ended, semi-structured, mailed questionnaire four themes emerged from the data. These are the adaptations of clinical practice, issues of treatment duration/abandonment, effects of managed care on the therapeutic relationship, and issues of diagnosis. Recommendations are drawn from the findings and discussed.

  13. The importance of human resources management in health care: a global context


    Soriano Mark A; Howard John M; Orchard Carole; Kabene Stefane M; Leduc Raymond


    Abstract Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is esse...

  14. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day


    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  15. Epilepsy in the dental office: concern, care and management. (United States)

    Haller, Jerome S


    Epilepsy, also known as seizure disorder, encompasses several different modes of presentation. Patients of all ages, from early childhood to the elderly, who present for dental care may be taking anticonvulsants or may have an unanticipated seizure in the dental office. Dentists should be familiar with the varied manifestations of seizures, the medications used in their treatment and management of a seizure in the dental office. It is estimated that 1% of the population of the United States are afflicted with epilepsy. There is indication that the elderly are becoming included in that number because of their affliction with cardiovascular disorders. The word "epilepsy" raises anxiety in many people because they fear that such an event is life threatening. However, the term epilepsy applies primarily to prolonged or repetitive seizures requiring intervention by trained individuals.

  16. [Management of the esophageal candidiasis by the primary care physician]. (United States)

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas


    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  17. [Risk management in anesthesia and critical care medicine]. (United States)

    Eisold, C; Heller, A R


    Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.

  18. Health insurance in India: need for managed care expertise. (United States)

    Thomas, Thomas K


    Health insurers in India currently face many challenges, including poor consumer awareness, strict regulations, and inefficient business practices. They operate under a combination of stifling administrative costs and high medical expense ratios which have ensured that insurers operate under steep losses. External factors (eg, onerous regulations, lack of standards, high claims payouts) and internal factors (eg, high administrative costs, dependence on indemnity models that cover inpatient treatment costs only) have forced the health insurance industry into a regressive spiral. To overcome these challenges, health insurers need to innovate in their product offerings and tighten their existing processes and cost structures. But as a long-term strategy, it is imperative that health insurers deploy managed care concepts, which will go a long way toward addressing the systemic issues in the current operational models of health plans.

  19. Building trust: The influence of mentoring behaviors on perceptions of health care managers' trustworthiness. (United States)

    Fleig-Palmer, Michelle M; Rathert, Cheryl; Porter, Tracy H


    In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers' evaluations of their managers' trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon Kram's (1988) seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support. The aim of the study was to investigate the influence of health care managers' informational and interpersonal mentoring behaviors on workers' perceptions of their managers' trustworthiness and the mediating role of trustworthiness on trust in the managers. Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest. Results showed that managers' mentoring behaviors influenced worker perceptions of their managers' trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers. Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers' ability, integrity, and benevolence.

  20. Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions. (United States)

    Robinson, Monica; Fisher, Thomas F; Broussard, Kim


    Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

  1. The importance of human resources management in health care: a global context. (United States)

    Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond


    This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. We explored the published literature and collected data through secondary sources. Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

  2. The importance of human resources management in health care: a global context

    Directory of Open Access Journals (Sweden)

    Soriano Mark A


    Full Text Available Abstract Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Conclusion Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

  3. New models of integrated health care management in nephrology. (United States)

    Ramos, Rosa; Molina, Manolo


    Chronic kidney disease (CKD) is becoming a worldwide major public health problem that is rapidly approaching epidemic proportions due to its high prevalence, as well as the associated increase of cardiovascular morbidity and mortality in these patients. Early detection and prevention may have an impact on both slowing the progression of CKD and reducing cardiovascular morbidity and mortality. CKD prevention programmes can be more cost-efficient over time without negative impacts on quality of care. Until now, reimbursement in CKD has been segmented and usually focused on the end of the process (dialysis) when cost is higher, whereas new models focused on provider integration, while balancing quality and costs, are needed to respond to today’s challenges. Traditionally, “pay for services” has been used in state-assisted dialysis centres, but this model has the risk of inducing an increase in demand. Integrated management would respond to this challenge with comprehensive solutions that manage kidney disease at all levels of health care risk. It is based on a comprehensive model that typically includes several products and services, often including pharmacological treatments. The rate of reimbursement directly depends on the achievement of previously defined quality control parameters. The third model is based on a “capitation” model that consists of the provider receiving a set amount of resources per population for a particular time regardless of the volume of services provided. The complexity and the progressive nature of CKD along with the associated morbidity rates in these patients force us to consider a global approach rather than a sum of different services. In our opinion, the first method of reimbursement in CKD that should be considered is a bundle rate, and when this model has been consolidated, tending toward a global capitation model.

  4. Exploring valid and reliable assessment methods for care management education. (United States)

    Gennissen, Lokke; Stammen, Lorette; Bueno-de-Mesquita, Jolien; Wieringa, Sietse; Busari, Jamiu


    Purpose It is assumed that the use of valid and reliable assessment methods can facilitate the development of medical residents' management and leadership competencies. To justify this assertion, the perceptions of an expert panel of health care leaders were explored on assessment methods used for evaluating care management (CM) development in Dutch residency programs. This paper aims to investigate how assessors and trainees value these methods and examine for any inherent benefits or shortcomings when they are applied in practice. Design/methodology/approach A Delphi survey was conducted among members of the platform for medical leadership in The Netherlands. This panel of experts was made up of clinical educators, practitioners and residents interested in CM education. Findings Of the respondents, 40 (55.6 per cent) and 31 (43 per cent) participated in the first and second rounds of the Delphi survey, respectively. The respondents agreed that assessment methods currently being used to measure residents' CM competencies were weak, though feasible for use in many residency programs. Multi-source feedback (MSF, 92.1 per cent), portfolio/e-portfolio (86.8 per cent) and knowledge testing (76.3 per cent) were identified as the most commonly known assessment methods with familiarity rates exceeding 75 per cent. Practical implications The findings suggested that an "assessment framework" comprising MSF, portfolios, individual process improvement projects or self-reflections and observations in clinical practice should be used to measure CM competencies in residents. Originality/value This study reaffirms the need for objective methods to assess CM skills in post-graduate medical education, as there was not a single assessment method that stood out as the best instrument.

  5. [Management of adult secondary insomnia in primary health care]. (United States)

    Cavadas, Luís Filipe; Ribeiro, Lúcia


    Insomnia is the most common sleep disorder in adults, with secondary insomnia being the most prevalent. This sleep disorder is associated with important medical and social consequences. The General Practitioner (GP) plays a key role in the diagnosis of insomnia, which may affect about 69% of their patients in the PHC (Primary Health Care). Recognize the differential diagnosis of secondary insomnia in adults, evaluate and manage these patients in the PHC, appropriately use the treatments available and meet the criteria for referral. Bibliographic search in MEDLINE databases, and evidence based review databases, using the MeSH terms: Primary Health Care, Sleep Disorders, Insomnia, for articles published since January 2000 until July 2009, in English, Portuguese, French and Spanish. Index de Revistas Médicas Portuguesas and scientific societies dedicated to sleep disorders were searched. Mood and anxiety disorders are the main co-morbidities associated with secondary insomnia, being present in 30% to 50% of patients with insomnia. The medical pathology and substance abuse are present respectively in 10% of patients. It is essential a proper clinical history, with a history of sleep, sleep diary and the partner information. There is evidence that the combination of specific pharmacological treatments (benzodiazepines and the benzodiazepine receptor agonists) with the nonpharmacological (cognitive-behavioral therapy) may be useful in secondary insomnia, as co-adjuvant treatment of the underlying disease. There are several treatment options with their indications and adverse effects. The criteria for referral should be defined according to the availability of human resources. Due to the high prevalence and the serious consequences of secondary insomnia in adults, it must be systematically managed by the GP. It is important to know and to use non-pharmacological therapy in GP consultation, because this therapy was shown to be important in treating this type of insomnia

  6. Gold standards for primary care of burn management

    Directory of Open Access Journals (Sweden)

    Fatih Zor


    Full Text Available Every year, about 2.5 million people are affected from burns in the world. In our country there is no reliable database related to this subject. There are ongoing studies about the epidemiology of burns in Turkey. After burn injury had represent many various complications, such as myocardial infarction, cardiac deficiency, acute hypertension, endocarditis, thromboembolism, pulmonary edema, pneumonia, respiratuar failure, renal failure, gastric ulcus, ileus, sepsis, coagulopathy and anemia. Such complications can preventable or treatable. In this respect, preventive management in the first step burn treatment had very importantly in burn cases. Skin is a barrier which protects evaporative heat loss. In cases of acute burn, hypothermia occurs related to skin loss. For these cases, care must be taken to keep the patient warm. In addition fluid resuscitation is very important in these cases. Furthermore, the damaged tissues are highly susceptible to infection in burned patients. Burn care and rehabilitation includes challenging and complex procedures. Briefly, treatments of burn cases require a multidisciplinary and meticulous approach.

  7. The ethics of managed care: a dose of realism. (United States)

    Hall, M A; Berenson, R A

    This article examines the ethics of medical practice under managed care from a pragmatic perspective that gives physicians more useful guidance than existing ethical statements. The article begins by stating the authors' starting premises and framework for constructing a realistic set of ethical principles: namely, that bedside rationing in some form is permissible; that medical ethics derive from physicians' role as healers; that actual agreements usually trump hypothetical ones; that ethical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The authors then articulate the following concrete ethical guides: financial incentives should influence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements that they would be embarrassed to describe accurately to their patients or that are not in common use in the market; physicians should treat each patient impartially, without regard to source of payment, and in a manner consistent with the physician's own treatment style; if physicians depart from this ideal, they must tell their patients honestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by having physicians to advocate for recommended treatment that is not covered.

  8. Managing health care decisions and improvement through simulation modeling. (United States)

    Forsberg, Helena Hvitfeldt; Aronsson, Håkan; Keller, Christina; Lindblad, Staffan


    Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.

  9. Comprehensive environmental management of asthma and pediatric preventive care. (United States)

    Roy, Angkana; Downes, Martin J; Wisnivesky, Juan P


    Indoor environmental triggers can increase asthma morbidity. National guidelines recommend comprehensive use of environmental control practices (ECPs) as a component of asthma management. The purpose of this study was to examine the association between preventive asthma care and comprehensive ECP use among children with asthma. We used data from the National Asthma Survey, including 1,921 children with asthma. Comprehensive use was defined as using at least five of eight ECPs: (i) air filter, (ii) dehumidifier, (iii) mattress cover, (iv) pillow cover, (v) pet avoidance, (vi) smoke avoidance, (vii) removing carpets, and (viii) washing sheets in hot water. Univariate and multiple regression analyses were conducted to examine the association between comprehensive use of ECPs and receipt of preventive asthma care, as measured by number of routine asthma visits in the prior year and physician advice to modify the environment. Overall, 17% (95% CI: 14-19%) of participants had comprehensive ECP use. The most commonly used practices were 'smoke avoidance' (85%), 'pet avoidance' (59%), and 'washing sheets in hot water' (46%). Comprehensive use of ECPs was associated with having received physician advice [odds ratio (OR) 3.1, 95% CI: 2.2-4.4] and increased asthma visits (1-2 visits: OR 1.5, 95% CI: 1.0-2.4; 3-4 visits: OR 2.2, 95% CI: 1.3-3.8; ≥5 visits: OR 2.7, 95% CI: 1.5-4.8). Only a minority of parents implement comprehensive ECPs, and receipt of preventive asthma care is associated with comprehensive use. Further research is needed to determine the factors mediating these associations in order to inform more effective asthma counseling.

  10. Nurses’ Experiences of Managing and Management in a Critical Care Unit

    Directory of Open Access Journals (Sweden)

    K. Robyn Ogle


    Full Text Available In this article, we describe the major findings of an ethnographic study undertaken to investigate nurses’ experiences of managing nurses and being managed by nurses in an Australian critical care unit. Our purpose was to valorize and make space for nurses to speak of their experiences and investigate the cultural practices and knowledges that comprised nursing management discourses. Subjugated practices, knowledges, and discourses were identified, revealing how nurses were inscribed by, or resisted, the discourses, including their multiple mobile subject positions. Informed by critical, feminist, and postmodern perspectives, nine mobile subject positions were identified. Direct participant observation, participant interviews, and reflective field notes were analyzed for dominant and subjugated discourses. The major finding described is the subject position of “junior novice.” Nurses informed by dominant patriarchal and organizational discourses participated in constructing and reinscribing their own submissive identity reflected in interprofessional relations that lacked individual valuing and undermined their self-esteem.

  11. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit. (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M


    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  12. The chronic care model versus disease management programs: a transaction cost analysis approach. (United States)

    Leeman, Jennifer; Mark, Barbara


    The present article applies transaction cost analysis as a framework for better understanding health plans' decisions to improve chronic illness management by using disease management programs versus redesigning care within physician practices.

  13. Virgin Islands: Coral Bay Watershed Management (A Former EPA CARE Project) (United States)

    The Coral Bay Watershed Management is a recipient of the Level II CARE cooperative agreement to continue and expand its collective efforts to stop erosion, sediment, and storm-water pollution of Coral Bay, improve solid waste management,

  14. The Oral Health Care Manager in a Patient-Centered Health Facility. (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley


    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The new system of the talent development program in Hungarian soccer

    Directory of Open Access Journals (Sweden)

    Csáki István


    Full Text Available Study aim: due to a series of failures and the drastic reduction in the quality of Hungarian soccer, greater emphasis should be put on coaches’ professional development and talent development programs. The aim of this study was to present the newly established Hungarian Soccer Development Program that focuses on the development of youth talent.

  16. Health-Related Physical Fitness in Hungarian Youth: Age, Sex, and Regional Profiles (United States)

    Welk, Gregory J.; Saint-Maurice, Pedro F.; Csányi, Tamás


    Purpose: The purpose of this study was to examine region, age, and sex profiles of physical fitness in Hungarian youth. Method: A sample of 2,602 Hungarian youth aged 10 to 18 years old completed a series of physical fitness field tests: the Progressive Aerobic Cardiorespiratory Endurance Run (PACER) fitness test, body mass index (BMI), percent…

  17. The National Union Catalog and Its Role in Reference and Research in the Hungarian Field. (United States)

    Oroszlan, Judith B.

    The National Union Catalog (NUC), a repository of the cataloged holdings of major research libraries of the United States and Canada, has significance in the area of Hungarian studies despite special problems encountered in the separation of these cards from those in other languages and in editing Hungarian names and the use of accents. The Union…

  18. The Hungarian ICT sector – a comparative CEE perspective with special emphasis on structural change


    Balázs Lengyel


    This paper analyses the Hungarian ICT sector from a Central European and Estern European perspective. It outlines the position of the ICT sector in Central European and Eastern European states. Furthermore, it describes the impact of ICT on structural improvement in the regiuon. In conclusion, it gives an overview of the Hungarian ICT policy.

  19. The acquisition of Hungarian high front unrounded short vs. long vowels

    NARCIS (Netherlands)

    Zajdó, K.; Wempe, T.G.; van der Stelt, J.; Pols, L.C.W.


    This study examined spectral properties of the Hungarian vowel pair /i/ vs. /i:/ with contrasting phonemic vowel lengths in 2;0 and 4;0 years old boys acquiring Hungarian as their native language. Results were obtained by an automated pitch-synchronous bandfilter analysis method that estimates the

  20. Health-Related Physical Fitness in Hungarian Youth: Age, Sex, and Regional Profiles (United States)

    Welk, Gregory J.; Saint-Maurice, Pedro F.; Csányi, Tamás


    Purpose: The purpose of this study was to examine region, age, and sex profiles of physical fitness in Hungarian youth. Method: A sample of 2,602 Hungarian youth aged 10 to 18 years old completed a series of physical fitness field tests: the Progressive Aerobic Cardiorespiratory Endurance Run (PACER) fitness test, body mass index (BMI), percent…

  1. Fluorescence Technology for Point of Care Wound Management. (United States)

    Anghel, Ersilia L; Falola, Reuben A; Kim, Paul J


    As the prevalence of chronic wounds continues to rise, the need for point of care wound assessment has also increased. While a variety of technologies have been developed to improve diagnostic abilities and monitoring of wounds, none have proven completely effective in all settings. Further, many of the stalwart wound management techniques remain costly, time consuming, and technically challenging. The two key pivotal events of ischemia and infection can lead to limb loss. A relatively new crop of fluorescence-based technologies, including devices that measure pathogenic auto-fluorescence, fluorescence angiography, or map cutaneous oxygenation, are increasingly being utilized for adjunct wound assessment-both clinical and operative settings can address these events. These technologies offer rapid, efficient, visual, and quantitative data that can aid the wound provider in evaluating the viability of tissues, ensuring adequate perfusion, and optimizing wound bed preparation. In the following review, pathogenic auto-fluorescence is compared to gross evaluation of wound infection and culture based diagnostics, indocyanine green fluorescence angiography is compared to various methods of visual and physical assessments of tissue perfusion by the practitioner, and cutaneous oxygenation is compared to clinical signs of ischemia. We focus on the current applications of fluorescence technologies in wound management, with emphasis placed on the evidence for clinical and operative implementation, a safety analyses, procedural limitations, and the future direction of this growing field of wound assessment.

  2. The management of diabetes in indigenous Australians from primary care

    Directory of Open Access Journals (Sweden)

    Thomas Merlin C


    Full Text Available Abstract Background Indigenous Australians have high rates of diabetes and its complications. This study examines ethnic differences in the management of patients with type 2 diabetes in Australian primary care. Methods Diabetes management and outcomes in Indigenous patients enrolled in the NEFRON study (n = 144 was systematically compared with that in non-Indigenous patients presenting consecutively to the same practitioner (n = 449, and the NEFRON cohort as a whole (n = 3893. Results Indigenous Australians with diabetes had high rates of micro- and macrovascular disease. 60% of Indigenous patients had an abnormal albumin to creatinine ratio compared to 33% of non-Indigenous patients (p 1c ≥ 8.0%, observed in 55% of all Indigenous patients, despite the similar frequency use of oral antidiabetic agents and insulin. Smoking was also more common in Indigenous patients (38%vs 10%, p Conclusion Although seeing the same doctors and receiving the same medications, glycaemic and smoking cessation targets remain unfulfilled in Indigenous patients. This cross-sectional study confirms Aboriginal ethnicity as a powerful risk factor for microvascular and macrovascular disease, which practitioners should use to identify candidates for intensive multifactorial intervention.

  3. Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida

    Directory of Open Access Journals (Sweden)

    Jungwon Park PhD


    Full Text Available This study examines the patterns of length of stay (LOS and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care patients had 7% shorter LOSs and a 1.9% lower inpatient cost than did Medicaid fee-for-service (FFS patients. Medicaid managed care patients had shorter LOSs in the Medicaid managed care market with high competition. High managed care penetration generates a cost-decreasing spillover to Medicaid FFS patients.

  4. Lay and health care professional understandings of self-management: A systematic review and narrative synthesis


    Euan Sadler; Charles DA Wolfe; Christopher McKevitt


    Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions.Methods: Systematic review and narrative synthesis of qualitative stud...

  5. Current management of diabetes mellitus and future directions in care. (United States)

    Chatterjee, Sudesna; Davies, Melanie J


    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  6. Attributes of effective managers and implications for health care management education in the Asia-Pacific region. (United States)

    Jain, S C; Boldy, D; Chen, G


    This paper explores the perceptions of managers and students from 11 countries in the Asia-Pacific region regarding the attributes needed for becoming effective managers and the broad implications of these findings for health care management education. The study forms part of a wider international project aimed at exploring the role of national culture in managerial behavior and effectiveness.

  7. Effect of work environment on care managers' role ambiguity: an exploratory study in Japan. (United States)

    Yoshie, Satoru; Saito, Tami; Takahashi, Miyako; Kai, Ichiro


    Previous literature pointed out that the role of care managers is ambiguous. In 2000, Japan instituted a new policy for long-term care of the elderly (the National Long-Term Care Insurance Policy), within which the work of care managers was recognized as a new profession providing care management services for the elderly needing care. We conducted a random-sampled mail survey on 530 care managers in 268 organizations to clarify the association between role ambiguity and care managers' work environments, including role clarification, organizational profit-seeking climate, and the utilization of professional and personal support. The results showed that fewer opportunities for role clarification and increased organizational profit-seeking climate were associated with greater role ambiguity for care managers. Furthermore, emotional and instrumental support from colleagues and external resources were positively associated with role ambiguity, while informational support from superiors was negatively associated with role ambiguity. Role clarification and the utilization of support within and outside of work organizations would be beneficial to reduce the role ambiguity of care managers.

  8. Managed behavioral health care: an instrument to characterize critical elements of public sector programs. (United States)

    Ridgely, M Susan; Giard, Julienne; Shern, David; Mulkern, Virginia; Burnam, M Audrey


    To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and "unmanaged" care and among managed care arrangements. The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary.

  9. Chronic disease management and the home-care alternative in Ontario, Canada. (United States)

    Tsasis, Peter


    The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

  10. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.


    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients


    Directory of Open Access Journals (Sweden)

    Rozsa Andrea


    The preliminary sample for the analysis is framed on the basis of three criteria: amount of the subscribed capital, sales revenues and product structure. Those companies are regarded as competitors that have subscribed capitals in excess of HUF 250 million, consistently high levels of sales revenues and diversified product structures. The preliminary sample consists of 7 companies. In 2012, their total sales revenues were as high as about 50% of the overall amount of sales revenues in the sector. Three of the 7 companies are possessed by foreign owners in full or part, whereas 4 of them belong to Hungarian owners. In 2012, Hungarian-owned companies covered more than one-third of the combined sales revenues of the 7 leading companies. Hence, the competitive positions of these 4 companies based on their financial positions are examined. These calculations have relied on the annual reports for the period of 2008–2012 (balance sheets, income statements, cash flow statements. The research has implemented a comprehensive and comparative financial analysis. The main question is what the key financial characteristics of the Hungarian-owned companies are. Financial indicators are calculated and their time-series analysis is accomplished to describe the sample companies’ capital structures, liquidity and profitability. Using comparative analysis of the applied financial ratios the study determines (1 which company has the most advantageous financial conditions for the successful operation; (2 which companies have disadvantageous financial situation; and (3 which companies are in potential financial distress situation. Potential bankruptcy positions are examined by the applications of Altman and Springate models.

  12. Contextualizing History in Hungarian Films of the New Millennium


    Clara Orban


    Hungarian films produced after the year 2000 build on the historical reality of the fall of communism and anticipate, or come to terms with, entry into the European Union.  This article will explore six films that deal with history through multiple perspectives to dramatize the dynamic between historical events and human responses to them.  These films reference history, or efface it, as a way of problematizing the relationship between human behavior and history.  Colossal Sensation [Világszá...

  13. The impact of health information technology on collaborative chronic care management. (United States)

    Marchibroda, Janet M


    Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. Those engaged in chronic care management should seek to leverage health IT and health

  14. Improving the effectiveness of health care innovation implementation: middle managers as change agents. (United States)

    Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Schaefer, Cynthia T


    The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers' commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers' commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers' influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.

  15. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care. (United States)

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein


    Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

  16. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study. (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki


    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  17. The effect of managed care on quality: a review of recent evidence. (United States)

    Hellinger, F J


    This article reviews recent evidence about the relationship between managed care and quality. With one exception, the studies reviewed represent observation periods that extend through 1990 or a more recent year. The review has led to the conclusion that managed care has not decreased the overall effectiveness of care. However, evidence suggests that managed care may adversely affect the health of some vulnerable subpopulations. Evidence also suggests that enrollees in managed care plans are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan.The findings of the studies reviewed do not provide definitive results about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the newer types of health maintenance organizations that invest heavily in information systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is applied identically by all health plans, and research studying the different dimensions of managed care also is needed.

  18. Experiences of Emotion Management in Medical Care (Case Study: Toronto

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour


    Full Text Available Introduction   This study lies at the intersection of the sociology of emotions and medical sociology, investigating emotion management among a rather unknown category of medical personnel –Hospital Chaplains. Sociologists of emotions seek to understand how emotions can be socially influenced in terms of both experience and expression. They believe emotions can be influenced by such institutions as culture and religion. As a result, not only do societies and subcultures have different patterns of expressing emotions according to their own norms and characteristics, but there are also different ways of managing emotions in social institutions. For example, in North American healthcare system, hospital chaplaincy is institutionalized, like other members of the medical team, to provide spiritual and religious care, which is often accompanied with emotional support, requiring therefore emotion management. In order to explore emotional experiences that chaplains undergo as a result of working in hospital and dealing with people who are emotionally overwhelmed, the author utilized insights from interactional and symbolic interactionist, phenomenological, and ethnomethodological approaches within the sociology of emotions and spoke with different chaplains from five faith traditions. The aim was to understand how chaplains perform interpersonal emotion management, what techniques, strategies and skills are involved in dealing with people’s emotions, and how performing emotion management in healthcare institutions brings religion and spirituality at the forefront of a secular society.       Material and Methods   This is a qualitative study based on in-depth interviewing with hospital chaplains working in different hospitals in the Toronto area. Toronto has a large number of hospitals and medical/healthcare institutions, most of which have a spiritual care department in which a number of full-time and part-time chaplains work to provide

  19. Introduction to the special issue on advances in clinical and health-care knowledge management. (United States)

    Bali, Rajeev K; Feng, David Dagan; Burstein, Frada; Dwivedi, Ashish N


    Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

  20. The need for hospital care of patients with clinically localized prostate cancer managed by noncurative intent

    DEFF Research Database (Denmark)

    Brasso, Klaus; Friis, S; Juel, K;


    We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....