Dental fraud. A dental consultant's view

Since most plans today are based on "cost plus", employers and unions, whose plans were negotiated a long time ago, cannot afford to pay an increase of $13 per amalgam as they were asked to do when new codes for bonded amalgams were added to the provincial fee schedule. Similarly, demanding strains were placed on drug plans when a $16 per tablet medication for migraine headaches was placed on the market. The plan says that if a physician prescribed it, it will be covered. But by whom? And for how long? Dental insurance is not, and has not been for a very long time, a source of profit for the insurance carriers. One large company, for whom I worked for a number of years, just sold all their group dental insurance to a large carrier. Another well-known company has placed their group insurance on the market and is anxiously seeking a purchaser. It is too much to ask of a dental plan (and let's face it, without the plan, the patient may not seek dental treatment) to pay $100 or more for an "examination and one periapical radiograph resulting from the referral of a patient by a general practitioner to a specialist for endodontic treatment." In the case of a difficult diagnosis, this might be entertained, but why charge this fee in every case, even when the patient is holding a radiograph? I am not suggesting that fraud is being committed by a large number of practitioners on a regular basis. At the same time, I think that we must realize that this type of activity may result in the removal of dental "insurance" from the benefits provided by companies to their employees. Most dentists are extremely honest, but the backlash produced by the few who are involved in fraudulent practices is disturbing.     

The problem reader in the classroom.

Many children developed reading problems at the beginning stages because they were not ready for formal work or because they were put into the second book before they could read the first one accurately. Some reading problems can be prevented by recognizing the differences in rates in learning. Slow starters are not always slow learners. Many who are not ready for formal academic work in the first few months of school do have good ability. They refuse to be hurried, and if all adults working with them can be patient and gear the program to their needs, they can turn out to be our best producers in later life. Studies show that nearly all difficulties encountered by middle and upper grade children stem from lack of mastery of early level skills. We must concentrate our efforts more and more at the beginning stages, accepting each child where he is and arranging for him to go through each stage at the pace and in the manner best suited to him. We must start as early as possible to establish through good work habits a "learning how to learn" attitude, teaching the child how he can take an active part in his own learning process. We must help him to develop the ability to think, to plan, to get started, to keep on going and to complete a task. For some children it is not easy to learn to read. Confidence can be built through encouragement both at home and at school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Methods of research.

Reviews the book, Methods of Research (see record 1955-00057-000). The book is a lengthy volume addressed to "field workers, graduate students and members of the senior division of the undergraduate college who would evaluate the quality of conclusions, either as producers or consumers of research." The book has a number of collateral values which make it a useful reference work, including extensive bibliographies. The reviewer notes, though, that the work carries implications which will trouble many readers. It implies the primacy of data collection and treatment over the process of reflection from whence come the theories and hypotheses which direct the choice of data to be collected. It carries implications that all kinds of data collection are equally respectable, from an intellectual point of view, as indeed they are where only procedural questions arise. It implies that the student can be trained to "evaluate the quality of conclusions" on the basis of acquaintanceship and reference knowledge, i.e., knowledge of where to go in order to acquire the competency which will make one capable of asking the significant questions in the evaluation of the quality of conclusions. All of this seems to the reviewer to be likely to produce bystanders rather than participants in scientific work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New perspectives on equine stereotypic behaviour

As base closures accelerate and defense funds are reduced, it will become essential for the military engineer to have a strategic plan for military-facility reuse. At the core of this plan will be the need to have an extremely clear and definitive inventory and assessment of each facility's condition. Developing this data can be an arduous task, which can collapse under the shear weight of the information collected. Often a one-time audit is commissioned to develop this plan as a support to funding documents, but no method or system is put in place to keep the collected data current and updated. With the arrival of cost-effective relational database management systems linked through a structured query language to computer-aided drafting and design, it is possible to create a “living” facility-management system. This allows managers at all levels to benefit from current and accurate facility data in their daily decision-making process. An additional benefit is that the information is kept current as changes occur. This paper describes a condition-assessment survey process as well as how the results of this process can be used to develop information for long-term facility reuse planning and programming.     

Clinical and nonclinical aspects of program development consultation.

Although program development can have therapeutic benefits for an organization and for its members, it is inappropriate to assume that consultation is simply therapy for groups; there are differences in goals and in methods. Organizational consultants can make errors if they work with organizations as therapists do with groups or treat organization members as if they were patients. On the other hand, both organizational consultants and psychotherapists need clinical sensitivity and skills at developing a setting of trust and openness. Both professionals encourage specificity and checking of assumptions and try to make explicit that which had been covert. Both groups find it effective to work with the "client system" rather than a specific "identical patient." Consultants working with groups can profit from clinical insight about the resistance of individuals and groups to change. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perforated duodenal ulcer: an alternative therapeutic plan

An alternative plan for the treatment of a perforated duodenal ulcer is proposed. We will focus on the now-recognized role of Helicobacter pylori in the genesis of the majority of duodenal ulcers and on the high rate of success of therapy with a combination of antibiotics and a proton-pump inhibitor or histamine2 blocker in treatment of such ulcers. Knowledge that half the cases of perforated duodenal ulcer may have securely sealed spontaneously at the time of presentation is incorporated in the therapeutic plan. Patients with a perforated duodenal ulcer who have already been evaluated for H pylori and are not infected or, if infected, have received appropriate therapy should undergo an ulcer-definitive operation if they are suitable surgical candidates. Most authorities recommend surgical closure of the perforation and a parietal cell vagotomy. The remaining patients should have a gastroduodenogram with water-soluble contrast medium. If the perforation is sealed, the patient can be treated nonsurgically. If the perforation is leaking, secure surgical closure of the perforation is necessary. Following recovery from the immediate consequences of the perforation, evaluation for H pylori should be conducted. If the patient is infected, combined medical therapy is recommended. If the patient is not infected, Zollinger-Ellison syndrome should be ruled out and medical therapy is recommended if the ulcer has not been treated previously. Elective ulcer-definitive surgery should be considered for the occasional uninfected patient who has already received appropriate medical therapy for the ulcer.     

Automated scheduling of radiologic procedures

The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.     

PAK-104P, a pyridine analogue, reverses paclitaxel and doxorubicin resistance in cell lines and nude mice bearing xenografts that overexpress the multidrug resistance protein

For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.     

Medical and technical compensation of disabilities

Thanks to technological advances handicaps can be treated in a better way by physicians. This real Metrology of Handicap constitutes a preliminary stage to medical decision. Functional repercussions of a lesion can thus be accurately assessed before the well adapted compensatory means are conceived, prescribed and applied. A better understanding of physiopathological mechanisms involving lesion, deficit and handicap and of compensatory procedures used by disabled people depends from this assessment. Some examples will be reported such as energy expenditure, 3-dimensional biomechanical analysis of daily activities and the correlation between both approaches. Likewise, efficiency of therapeutics can be assessed such as the analysis of gait with appliances with different types of prosthetic feet or effects on muscle of various training programs. Besides, sophisticated orthesis, prosthesis and living aids can be developed with the help of data processing, robotics and electrostimulation. This new type of devices will be added to the range of standard devices developed at little cost by occupational therapists. As for the future, caution is imperative. "Repaired" man turning "robotised" is an image provided by media that might bring disillusions. On one hand, numerous social, economic and personal factors intervene in the determination of the plan for life by the individual and his family. Thereby, all the possibilities offered by technological advances might not be studied in the choice of plan of life. On the other hand, priorities in aims of an increasingly demanding individual economy will be dictated by collective economy focused on cost management. However, the concept of increase in life expectancy without disability will be relevant in the determination of health policy and the role of rehabilitation physicians will be all the more important because they are the only one to be able to coordinate a team qualified to choose and apply the best therapeutics. Times are over when below-knee amputees were directly referred to the orthoprosthetist after segmentation, At the present time, psychologists cannot decide alone on the re-orientation of patients with brain trauma and, Domoticians will never organize the life place of tetraplegic subjects.     

Clinical monitoring for patients with severe craniocerebral injury

In references to an individual, agency refers to the capacity of the individual for meaningful action. Protecting and nurturing patient agency is a central feature of nursing work. The moral ideals and aim of nursing practice reflect a commitment to the patient that includes the patient as central to the determination of what happens to her or him. Whereas we most commonly think of the capacity to make these determinations as autonomy, I use the term agency because autonomy is a complicated and contested issue within philosophy and ethics. In an earlier issue, I suggested that an understanding of place is important to ethics. This is so because different places or institutions do different kinds of work, have different values, endow ethical concepts with different meanings, are structured by different visions, and are controlled and influenced by different kinds of knowledge and power. All these factors work together to determine a person's agency within a given place or environment. For example, home care providers cannot act in patients' homes in the same way they can act in a hospital, and providers cannot act in a school the way they act in a hospital. At the same time, patients' power to act is constrained in the hospital in ways that it is not in their homes. In the following narrative of an experienced home care nurse, I examine the ethical concern that can result from a commitment to patient agency by home care providers.     

Percutaneous drainage of pancreatic necrosis: is it ecstasy or agony?

The above comments are meant to help the reader further analyze the fine study of Freeny et al. [1]. To my knowledge, this is the first series to specifically define its patients correctly as having pure pancreatic necrosis. This work represents a thorough analysis of a difficult problem and points out how to treat these patients if one wants to be successful. This template is important to radiologists who wish to get involved with this type of patient. What Freeny et al. truly describe is the agony and ecstasy involved with this difficult undertaking. Radiologists can obtain a lot of satisfaction in taking care of this type of patient, but they and the referring physicians must be committed. The patient, the referring physician, and the radiologist must also face the agony in dealing with the illness. They must be ready to handle the number of catheters, the number of catheter changes, the number of CT scans, and the duration of drainage. In some cases percutaneous drainage will work; in some cases it is the only alternative for a patient with this disease. In other cases a catheter or two can be placed, but they might not be as beneficial to the patient as surgery. Clearly, percutaneous drainage of pancreatic necrosis can be done, and radiologists must work with their clinical colleagues to decide whether it is in the patient's best interest.     

Reducing the risk of needlestick injury associated with implanted ports

Implanted ports give many of our patients a sense of freedom that they have not known since they have been sick. Between infusions, they do not have to be reminded constantly of their illness through an external vascular access device. However, this patient advantage does carry some degree of risk for the nurse working with the patient and the device. Needlestick injuries are serious and expensive. There is a financial and emotional toll that cannot be measured. Each employer is required by OSHA to have an exposure control plan for eliminating or minimizing employee exposure to bloodborne pathogens (OSHA, 1991, 1994). Inventions such as the HuberLoc meet the criteria for devices that can reduce the risk of injury through engineering controls. Agencies need to know that OSHA-mandated worker protection can be both easy to use and cost effective. Home care nurses need to be more proactive in informing agencies about such devices and lobbying for their use.     

Advanced marketing strategies to build the esthetic dental practice

Esthetic dentistry is truly a major part of the future of the fee-for-service practice. There are still many patients who seek high-quality elective care and these individuals need to be swayed to make an initial appointment with you. Whether you reach them through your present patients or through outreach to the community, the important key is your method of handling each of these patients as they join your practice. Customer service needs to be stronger and more obvious than ever before in order to differentiate your practice from others and to attract more referrals. The days of waiting for patients to arrive have clearly come to an end. Managed care and a decline in the need for traditional services has eroded a significant component of the dental market. When you combine that with the realization that only 50% of the population visits the dentist even once a year (and far less in many countries outside the United States), then it becomes obvious that the total available market for the elective services of esthetic dentistry has declined. Esthetic dentistry programs must be better defined, with an ongoing focus to educate present patients and to attract new patients. As I state in my seminars, I firmly believe that any practice today can still be highly successful. I do not feel that I will be making that statement three to five years from now. The time to begin positioning your practice for future growth of esthetic dentistry is now. As managed-care programs increase, it will become more difficult to turn around a declining practice. Having a quality marketing program already in place will make the difference for your esthetic practice. The new patient phone call is critical. It is there that you will begin to help patients understand fully the overall attitude and policies of your office. Successful management of new patients is to win their trust by giving them ultimate customer service while convincing them to fit your present system and schedule. When a new patient calls the practice, you want to get them scheduled within a reasonable time frame while their motivation is still positive. Remember, you only get one first chance to make a great impression. Each office should decide which questions are appropriate to ask. The front desk coordinator should ask these questions calmly and clearly so that the new patient has an opportunity to answer them without feeling that they are going through the inquisition. At the same time, the more information you have about this patient, the easier it will be to gain treatment acceptance because of your understanding of the new patient's needs. Many offices will ask new patients how they came to choose their particular office. Since many practices gain new patients from existing patients, it is appropriate to know when this has occurred and properly thank the referral patient. By thanking the patient who referred the new patient, you will encourage further referrals.     

企业竞争力的核心--市场营销

对中国加入WTO后企业面临的新市场环境下的市场营销策略进行了分析探讨,认为企业必须全面地应用现代化市场营销的观点和理念对现有营销模式进行改造和完善,转变观念,紧紧抓住企业竞争力的核心——市场营销,才能与用户构建互利互赢的长期稳定的销售伙伴关系。     

The treatment of Parkinson's disease: current concepts and rationale

The recent advances in the treatment of Parkinson's disease have made for significant improvements in the quality of life and mortality rate of those who suffer from this neurodegenerative disease. At the same time, the number of options and the complexity of multi-drug regimens have posed a great challenge for the clinician caring for the patient with Parkinson's disease. Though there are still many questions to be answered in regard to the potential neuroprotective effects of several medications, a few general rational treatment plans can be outlined. In patients requiring treatment in the early stages of the disease, especially with a predominance of tremor, anticholinergics or amantadine should be considered initially. At this point, it would be reasonable to add selegiline for both therapeutic and possible neuroprotective effects. As a patient becomes more affected by the disease and additional therapy is necessary, starting either a dopamine agonist or levodopa would be a rational choice. Continuation of selegiline and, possibly, amantadine for neuroprotective reasons should be contemplated. Titration in levodopa therapy (with controlled-release or standard levodopa) to higher levels should prompt addition of a dopamine receptor agonist if one has not been started previously. Conversely, if a patient is receiving only a dopamine receptor agonist and is becoming progressively disabled, levodopa should be added to the regimen. Fluctuations in motor abilities may be improved further by the use of a COMT inhibitor. Patients with uncontrollable motor fluctuations should be considered for surgery. Undoubtedly, the coming years will bring more treatment options and more evidence on which sequences and combinations of therapies are the most beneficial. Differences in efficacy and adverse effects for each patient must be taken into consideration when outlining and carrying out a treatment plan. By using a rational approach to the treatment of Parkinson's disease, with the above guidelines in mind, the patient should be able to enjoy a good quality of life and level of function for many years.     

Obesity: evaluation and treatment

Obesity as a chronic condition among large numbers of people is a disease of recent origin, often but by no means always associated with dietary habits and sedentary lifestyle. Many obese people want to lose weight, and may have tried to do so numerous times with self-help or proprietary weight-loss programs. When they seek a physician for help in losing weight-or when a physician advises an obese patient to lose weight as part of a clinical strategy-care must be taken to "match" the patient to an appropriate therapeutic program with appropriate therapeutic goals. History and physical examination and psychologic evaluation are essential elements of patient screening. Complications of obesity must be taken into account in any treatment plan. The multidisciplinary management strategy is most likely to succeed in helping the patient lose weight. It also avoids untoward events associated with complications or concomitant disease. The multidisciplinary approach is especially important when the patient does not lose weight, and alternative strategies must be considered, such as surgical approaches.     

Review of The psychology of successful selling.

Reviews the book, "The psychology of successful selling," by Richard W. Husband (see record 1954-03433-000). The reviewer notes that this book is directed to all salesmen to aid them in their daily work. Its emphasis is on sales tactics, from finding your prospects through approaching him and overcoming his resistance to closing the sale. There is also a short section concerning the selection of salesmen, helping him to compare his traits with those of successful salesmen. This book is not intended to be a professional book for psychologists; rather it is deliberately designed to be easy, informal reading without technical language or reference to experiments or statistics. In general, there is little in the book to recommend it even to sales managers or salesmen over the many other volumes written in this field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing suicidal emergencies: Recommendations for the practitioner.

All practicing psychologists with an active caseload occasionally encounter a patient or client whom they consider to be a suicidal emergency. Few psychologists, however, have had education or training focused on managing such cases. The current article conceptualizes what a "behavioral emergency" is, gives recommendations for containing the emergency client's emotional turmoil, and sets forth an evidence-based approach, using diagnosis-specific risk factors, for improving the clinician's ability to estimate suicide risk. Recommendations are also given for appropriate responses to the patient or client on the basis of the level of estimated risk. Having such an algorithm or plan for dealing with the suicidal client is essential to good practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical Issues in Recording.

There has been considerable discussion about wire tapping and bugging in the newpapers and professional journals. A recent article (Amer. Psychologist, 1956, 11, 54-60) stated that there exists "a vaguely defined but strongly felt uneasiness about man's learning too much about man." This report went on to say that "those who wish to study behavior, either individual or group, will have to be keenly aware of what 'sanctities' they threaten as they go about their business." The current author contends that the whole purpose in covert recording, if such be indicated as required by the data, is to enable one to obtain more information, to facilitate rapport, and in the long run (it is hoped) to be of benefit to the individual therapeutically. To say that the procedure of covert recording (which may help the patient) is unethical, can only stem from a failure to recognize the dynamics that are present in therapy. He then considers a number of other questions raised by proponents of both overt and covert recording. The author concludes that whether research is concerned with the nature of the behavior involved in jury decisions or how best to aid a patient requesting therapy, the best method for eliciting such data should be used. Doing this is both proper and needed. Covert recording can respect the patient's confidence and can be constructive. Values should not be confused or lost to sight because of the present climatological atmosphere. (PsycINFO Database Record (c) 2010 APA, all rights reserved)