Commitment and cost control in the health care system.

Suggests that government has contributed to an escalation of health costs that is pushing quality health care out of reach of many Americans. The Health Care Financing Administration is seeking to correct this problem by replacing inappropriate incentives with ones that reward efficiency while assuring access to care. Provisions in the law that change benefits, encourage innovative service delivery, and provide incentives for cost-effective delivery and management are discussed. Coalitions of business, labor, and providers and consumers of health care are becoming more active in reducing health care costs by promoting alternative delivery systems and stimulating more cost-conscious behavior. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Balancing respect for autonomy with competing values with the use of principle-based ethics.

Psychologists sometimes find themselves in situations in which they need to balance respect for patient autonomy with other competing values and neither the laws nor ethics codes provide clear direction on how they are to do so. With the use of a model from principle-based ethics, this article recommends a strategy for resolving those dilemmas in a manner that promotes patient autonomy as much as possible, even when respect for autonomy may be temporarily trumped by other values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Balancing elder care responsibilities and work: Two empirical studies.

It was hypothesized that workers with elder care responsibilities, compared with noncaregiving workers, would be more likely to suffer physical symptoms of stress and to be absent more days. In Study 1, 67 employees (32 noncaregivers, 35 caregivers) of a financial institution were interviewed. In Study 2, 169 employees (118 noncaregivers, 51 caregivers) of a health care institution completed a questionnaire. In Study 1, caregivers were absent more days than noncaregivers, and caregiver status was related to the incidence of weight loss or gain, drowsiness, and inability to sleep. In Study 2, caregiver status was related to the incidence of weight loss or gain, drowsiness, inability to sleep, frequent headaches, and nervousness. Caregivers were not significantly different from noncaregivers in absenteeism. Results indicate that caregivers' responsibilities may negatively affect work performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Palatability and foraging cost interact to control caloric intake.

The combined effects of meal cost and food flavor on meal size were studied with a method that avoided the covariation of nutrient composition and caloric density with palatability. As rats (Rattus norvegicus) drank flavored fluids (unpalatable 0.05% sucrose octaacetate [SOA], neutral 0.05% saccharin, and palatable 2% Polycose?+?0.2% saccharin [P?+?S]), liquid diet was infused intragastrically. Relative to saccharin, rats with free access ate 10% more calories in larger meals while consuming P?+?S and initially ate fewer calories in smaller but more frequent meals while drinking SOA. Other rats lever-pressed to begin meals, which halved meal number and doubled meal size relative to the free-access group. Although foraging rats also ate larger P?+?S meals and smaller SOA meals, the changes did not affect total intake. Without the usual differential postingestive effects of foods that differ in palatability, making food more costly blunts rats' response to its flavor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental ethics and medical ethics: some implications for end-of-life care, Part I

Heterotrimeric G proteins, consisting of alpha, beta, and gamma subunits, transduce environmental signals through coupling to plasma membrane-localized receptors. We previously reported that the filamentous fungus Neurospora crassa possesses a Galpha protein, GNA-1, that is a member of the Galphai superfamily. Deletion of gna-1 leads to defects in apical extension, differentiation of asexual spores, sensitivity to hyperosmotic media, and female fertility. In addition, Deltagna-1 strains have lower intracellular cAMP levels under conditions that promote morphological abnormalities. To further define the function of GNA-1 in signal transduction in N. crassa, we examined properties of strains with mutationally activated gna-1 alleles (R178C or Q204L) as the only source of GNA-1 protein. These mutations are predicted to inhibit the GTPase activity of GNA-1 and lead to constitutive signaling. In the sexual cycle, gna-1(R178C) and gna-1(Q204L) strains are female-fertile, but produce fewer and larger perithecia than wild type. During asexual development, gna-1(R178C) and gna-1(Q204L) strains elaborate abundant, long aerial hyphae, produce less conidia, and possess lower levels of carotenoid pigments in comparison to wild-type controls. Furthermore, gna-1(R178C) and gna-1(Q204L) strains are more sensitive to heat shock and exposure to hydrogen peroxide than wild-type strains, while Deltagna-1 mutants are more resistant. In contrast to Deltagna-1 mutants, gna-1(R178C) and gna-1(Q204L) strains have higher steady-state levels of cAMP than wild type. The results suggest that GNA-1 possesses several Gbetagamma-independent functions in N. crassa. We propose that GNA-1 mediates signal transduction pathway(s) that regulate aerial hyphae development and sensitivity to heat and oxidative stresses, possibly through modulation of cAMP levels.     

Rehabilitation psychology practice, ethics, and a changing health care environment.

Rapid changes in the health care environment have brought about ethical and professional challenges for rehabilitation and rehabilitation psychology. The response of rehabilitation psychologists to the threats and opportunities of these challenges will have an impact on the welfare of persons with disabilities and the future of the profession. Managed care organizations have focused their efforts on the management of acute illness. Ethical concerns are being raised about patient access to care, self-determination, confidentiality, provider accountability, and marketing in managed care systems. Rehabilitation psychologists' skills in program development and outcome evaluation place them in a key position to influence the changes in the health care environment. To be effectual, however, fundamental changes must be made in research psychology practice, education and training, research focus, and professional activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethics on the job. A survey. Quality vs. cost

In this third installment in our series, nurses tell us how hospital cost-cutting measures have taken a bite out of quality of care, affecting everything from staffing levels to patient discharge to the availability of supplies. Depending on where you work, though, the news isn't all bad.     

Quality of informal care is multidimensional.

Purpose: To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are routinely satisfied. We investigated the extent to which potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are empirically distinct dimensions of quality of care. Design: 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of their own depression, life events, cognitive status, and perceptions of pre-illness relationship quality. Results: Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing additional evidence for the distinction between these measures of quality of care. Conclusions: ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ethics of language and the language of ethics.

Responds to the comments of M. P. Nichols (see record 1989-40699-001) on the work of the present authors (see record 1989-40685-001), asserting that therapists work toward understanding the correctness of the view explained by the client in a never-ending process that changes both therapist and client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laboratory cost control and financial management software

Event-related potentials (ERPs) evoked by light flashes and auditory tones in a standard odd-ball procedure were recorded from Fz, Cz and Pz scalp sites. Tonic pain was evoked by immersion of the hand in cold water (5 degrees C). Significant effects of pain were found in responses to target stimuli but not in responses to non-target stimuli. P300 wave was affected more than the earlier P200 component. The reduction of P300 amplitude was the strongest effect, both in auditory and visual tests. P300 latency was not significantly affected. Difference curves (target minus non-target ERPs) showed the additional effects: latency of P200 component was elongated and its amplitude enlarged but only in auditory experiments. In control experiments with warm water stimulation no significant alterations of P300 or P200 components were found. The results show that the effect of tonic pain is specific: it predominantly affects the processes that manifest themselves as amplitude changes of P300 components in responses to target stimuli.