Reengineering health care materials management

Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.     

Quality management for psychology services in health care facilities.

Describes a model of quality management, designed by a task force of the Canadian Psychological Association, to meet revised standards of the Canadian Council on Health Facilities Accreditation for psychology services. The incorporation of aspects of Continuous Quality Improvement, Total Quality Management, Indicators, and Benchmarking are discussed in relation to their application to psychology services in health care facilities. The Quality Management Model is based on the assumptions that everyone wants to do their job well and improve in their job performance; that the improvement in the quality of services is everyone's responsibility; and that psychological service provision in a health care facility involves complex linkages between providers, suppliers, and customers. The model also assumes that the major problems affecting quality of service are usually those same linkages, or the customers themselves; and that identifying and monitoring these linkages is crucial to understanding how to improve quality. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Total quality management in behavioral health care

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.     

Diagnostic validity of tests--binary tables or multidimensional statistical methods?

The authors criticize the use of concepts of sensitivity and specificity calculated by means of a binary table in differential diagnostic reflections pertaining to more than one disease or several, i.e. more than one diagnostic test. On examples they present possibilities of different ways for calculating these concepts with different not correlating results. They indicate the justification of using multidimensional statistical methods in those instances and their better diagnostic yield.     

Manifestation and management of stress in health care workers

The inescapable nature of stress and its effects both positive and negative are thoroughly examined in this article by Jan Howells-Johnson. Major theories of stress, physiological and psychological effects, as well as coping mechanisms and benefits are all included. Working through the activities gives the reader an opportunity to examine stress in a very personal way, by reflecting on and relating to their own experiences of it. As stress is never going to go away, knowledge gained from this extensive work may prove the pathway to effective self help or a more cheerful acceptance of what cannot be changed.     

Modern techniques for quality control and quality management in gynecological health care

Information technologies may contribute in many effective ways to total quality management. Their supporting capacity concerns areas such as clinical documentation and quality control as well as problem analysis, quality assurance and improvement and knowledge management. Here however, a great deficit of the available departmental information systems must be stated.     

Observations on database design for improving clinical care

Many people with HIV use complementary or alternative therapies, often without the knowledge of their doctors. To encourage open communication with their patients, doctors need to be aware of what complementary therapies are available and willing to discuss their use. They are then in a better position to defend their patients against exploitation or unsafe treatment.     

AIDS: the statistical basis for public health

Inhibition of the Na-Ca exchange at the beginning of rest in isolated myocytes of the guinea-pig heart by means of superfusion with Na,Ca-free solution or 5.0 mM Ni2+ resulted in appearance of multiple phasic contractures. Contractures could not be initiated when the sarcoplasmic reticulum (SR) Ca2+ had been depleted by short (1 s) or steady state exposure to 10 mM caffeine, 0.1 microM ryanodine or due to rapid spontaneous release of the SR Ca2+ occurring sometimes at the beginning of rest. Superfusion with 2 x 10(-7) M thapsigargin, which blocked the SR Ca2+ uptake, prevented contractures otherwise initiated by superfusion with the Na,Ca-free solution. The frequency of spontaneous contractures was positively related to the rate of stimulation before rest and negatively related to the duration of rest before superfusion with the Na,Ca-free solution. It is proposed that in guinea-pig myocardium Ca2+ taken up by the SR from sarcoplasm or other cellular compartments like mitochondria, is released during diastole and rest to the subsarcolemmal space from which it is extruded by means of Na-Ca exchange. The release is a primary event not dependent on decrease of the resting sarcoplasmic free [Ca2+] by the outward Ca2+ transport. Inhibition of the Na-Ca exchange at the beginning of rest did not initiate any contractile response in rat myocytes. If the spontaneous contractures were already present, they were inhibited by superfusion with the Na,Ca-free solution. The result reflects the basic difference in the properties of SR of guinea-pig and rat.     

Preventive health care for children

This article discusses immunization, development, vision, blood pressure, dentition, behavioral, and environmental screening for preschool children. The authors then discuss screening for children in the early school years. Injury and violence prevention and topics of sexuality for the preadolescent are also presented.     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.     

HRA model for hypercholesterolemia based on a longitudinal health database

OBJECTIVE: To examine the use, effectiveness, acceptability, and continuation rates of the copper T 380 A intrauterine device (IUD) among women attending an inner-city family planning clinic. DESIGN: A 1-year prospective cohort study. SETTING: The family planning clinic of Grady Memorial Hospital, which serves the inner-city indigent population of Fulton and Dekalb counties in metropolitan Atlanta, Ga. PARTICIPANTS: A total of 115 women with 1 or more live births who were in a mutually monogamous relationship for the previous year had the copper T 380 A IUD inserted between December 20, 1990, and June 28, 1991. MAIN OUTCOME MEASURES: Follow-up, consisting of history and a pelvic examination, was done 2, 6, and 12 months after IUD insertion to determine the status of the IUD and to detect any complications related to its use. At the end of the study, the continuation rates, reasons for removal, and complications related to IUD use were assessed. RESULTS: Thirty-seven women were unavailable for follow-up. Eight of those were seen in other clinics at Grady Memorial Hospital, but no mention was made of their IUD status. Fifty-six of the remaining 78 women were known to continue IUD use without any complications at the end of the 12 months. Among the 22 women known to have the IUD removed, 8 women cited no problems. Pelvic pain, menometrorrhagia, desire for permanent sterilization, and expulsion of the device were mentioned as reasons for other IUD removals. Pelvic inflammatory disease was not documented in any of the patients during the year of follow-up. CONCLUSION: With proper screening and counseling, the IUD may be used successfully in selected patients in inner-city family planning clinics.     

Living dangerously: risk-thinking and risk management in mental health care

Behind today's fixation on risk assessment and risk management in the care of people with mental health problems in the community lies a more sinister regime, argues NIKOLAS ROSE. Clinical judgement is now less about care and treatment; much more about the control of those who might pose a threat to the community in which, with the closure of the long-stay hospitals, they now must live.     

Creating a population-based linked health database: a new resource for health services research

Cytologically, the distinction between bronchioalveolar carcinoma and reactive/reparative processes of respiratory epithelium can be difficult. Retrospectively, we have identified 11 consecutive cases of bronchioalveolar carcinoma from the cytology files of University Missouri-Kansas City/Truman Medical Center. On average, a combined 5.71 cytologic/histologic procedures were performed before reaching a definitive diagnosis for this group. An additional seven random cases of reactive/reparative respiratory cases of adult respiratory distress syndrome patients were used as a control. Cytomorphometric analysis was performed. The mean average nuclear diameter for the carcinoma group was 13.76 microns and for the reactive/reparative group was 13.29 microns. There was no statistical difference between the two groups (paired student t test, P > .05). It appears from our data that mean nuclear diameter is not a discriminator for the cytologic distinction between bronchioalveolar carcinoma and reactive/reparative respiratory epithelium and that the accepted cytologic parameters of for bronchioalveolar carcinoma are more valid.     

A preventive health paradigm for health care psychologists.

Developed a preventive health paradigm for health care psychologists by building on public health and preventive mental health models of primary, secondary, and tertiary prevention. Adoption of a "biopsychosocial" perspective on health and illness is basic to the preventive health paradigm. Examples of preventive health programs are considered along with a wide range of preventive health activities by psychologists in health care settings. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)