Meaning vs. medical necessity: Can psychoanalytic treatments exist in a managed care world?

With more and more insured employees covered by behavioral managed-care organizations (MCOs), psychoanalytically oriented practitioners are confronted with the dilemma of trying to deliver meaning-based treatments in a medical-necessity setting. Like many psychoanalytic dilemmas, resolution requires an appreciation of the situation from the perspective of the other, that is, understanding health care from the perspective of the employer. On the basis of his experiences as a case manager, the author specifically suggests the importance of understanding (1) that the medical necessity standard requires distinguishing health care from growth experiences; (2) population as well as patient needs; (3) four reasons why psychoanalytically oriented clinicians are not popular with payers and vice versa. Supported by vignettes, clinical experiences, and literature, some specific recommendations are presented for analytic clinicians which might allow for less frustrating interactions with the healthcare system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond corporate-style downsizing: a better way for medical schools to succeed in a changing world

The previous years mean temperature of July, total solar radiation of July and August and the male flowering index were used to predict atmospheric pollen counts. We examined the adaptability of these predictions and we get following results: 1. Following good harvest years of male flower, atmospheric pollen counts predicted by previous year's mean temperature of July and the total solar radiation of July and August are higher than the actual atmospheric pollen count. 2. Prediction of atmospheric pollen counts by factors within the previous five years are more exact because matured Cryptomeria forests are increasing yearly. 3. There are few errors in prediction by the flowering index because the flower index reflects the actual harvest of male flower.     

Mental health staffing in managed care organizations: a case study

This paper examines temporal changes in staffing ratios and configuration of mental health providers per 100,000 members within two full-service staff-model health maintenance organizations (HMOs). Overall workforce reductions in all classes of mental health professionals occurred in the two HMOs from 1992 to 1995. Staffing ratios decreased in both HMOs for psychiatrists and psychologists. In one HMO, the ratio of clinical social workers also decreased over this period. Provider ratios from 1995 are benchmarked against state ratios per 100,000 population. Workforce mix for the two HMOs is contrasted with a single-year average for a large managed behavioral health (carve-out) organization. The authors discuss potential implications of the findings for training of several categories of mental health professionals.     

The limitations of decision trees and automatic learning in real world medical decision making

The decision tree approach is one of the most common approaches in automatic learning and decision making. The automatic learning of decision trees and their use usually show very good results in various "theoretical" environments. But in real life it is often impossible to find the desired number of representative training objects for various reasons. The lack of possibilities to measure attribute values, high cost and complexity of such measurements, and unavailability of all attributes at the same time are the typical representatives. For this reason we decided to use the decision trees not for their primary task--the decision making--but for outlining the most important attributes. This was possible by using a well-known property of the decision trees--their knowledge representation, which can be easily understood by humans. In a delicate field of medical decision making, we cannot allow ourselves to make any inaccurate decisions and the "tips," provided by the decision trees, can be of a great assistance. Our main interest was to discover a predisposition to two forms of acidosis: the metabolic acidosis and respiratory acidosis, which can both have serious effects on child's health. We decided to construct different decision trees from a set of training objects. Instead of using a test set for evaluation of a decision tree, we asked medical experts to take a closer look at the generated trees. They examined and evaluated the decision trees branch by branch. Their comments show that trees generated from the available training set mainly have surprisingly good branches, but on the other hand, for some, no medical explanation could be found.     

Recruiting and staffing in the electronic age: A research-based perspective.

Although the consulting psychology profession tends to focus on assessment and development, effectiveness in these domains is strongly influenced by how effective the recruiting process has been. The continuing widespread acceptance of Web-based recruiting systems presents both opportunities and challenges for consulting psychologists. An overview of recent research in this area, along with implications for the practicing consulting psychologists, is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of recruitment in staffing utility analysis.

Contends that previous utility models have focused either on selection activities or on human resource activities that follow the hiring decision (e.g., performance appraisal or training). A more complete staffing model incorporating the effects of recruitment activities that precede selection is proposed by the present authors. A numerical example is presented that illustrates that recruitment decisions can substantially alter selection utility values and conclusions. The model provides a more complete and integrative perspective for future recruitment and staffing research. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in childhood cancer mortality as indicators of the quality of medical care in the developed world

BACKGROUND: Mortality from childhood cancer in general and childhood leukemia in particular has sharply declined in economically developed countries over the last 30 years, whereas the incidence of these diseases has remained essentially unaltered. Therefore, childhood malignancies can be used as tracers of accessibility to and effectiveness of medical care. The objective of this study was to compare the reduction of mortality from childhood cancer in general, and childhood leukemia in particular, in four economically developed areas of the world, to assess accessibility to and effectiveness of technologically advanced medical care. METHODS: The authors used data from the World Health Organization to compare the evolution over time of gender specific, age-adjusted mortality from childhood cancer in general and childhood leukemia in particular in the childhood (birth to age 14 years) populations of North America, western Europe, Japan, and Australia and New Zealand during the period 1960-1993. They assessed the evolution over time and the cumulative percentage representing the decline in mortality from childhood cancer and childhood leukemia in the four aforementioned areas of the world. RESULTS: The decline in mortality from both the disease entities considered and for both genders has been more pronounced in North America than in other economically developed areas of the world. CONCLUSIONS: When disease control depends on technologically advanced medical care, as in the case of cancer, the North American population is benefited by earlier and effective introduction of new therapeutic approaches. This conclusion does not apply to other childhood diseases, the incidence of which is higher among low-income groups and control of which depends on prevention rather than treatment.     

Of dirty sheets and worse: administration costs and staffing matters

A retrospective study was done of 22 patients with complex femoral (11) and tibial (11) shaft fractures treated with static interlocking nailing followed by dynamization, which was carried out on average 7.8 months later. The success rate was 54% with no significant difference between the healing of femoral and tibial fractures. The follow-up was at least 2 years. The interval from nailing to dynamization did not correlate with the success rate; the longest interval associated with successful healing was 20 months. The authors found that static interlocking nailing without dynamization can still produce a high union rate, and if there is sparse callus formation during the healing process, indicating low osteogenesis, dynamization will result in fracture union in only half the cases. To improve the union rate, cancellous bone grafting may be necessary.     

Nurse staffing and quality of care in nursing facilities

A study of 198 nursing facilities in Maryland tested the hypotheses that: 1) the presence of more RNs improves the quality of nursing care; and 2) increased numbers of all types of nursing staff improve the quality of nursing care, based on a multidimensional measure of quality of nursing care. Findings indicate that the ratio of RNs to residents is directly related to a measure of resident rights deficiencies. In addition, the ratio of total nursing staff to residents is directly related to a lower overall deficiency index and a higher quality of care score.     

Rehabilitation and staffing levels in a 'new look' hospital-hostel

The present study examined the utility of a new hospital-hostel with low staffing levels. Results showed that the hostel was able to maintain 9 of the 10 initially transferred patients and has been able to provide some improvements in their quality of life. However, unlike highly staffed hospital-hostels, it was not able to decrease patients' disabilities. Implications of this are discussed in relation to staffing levels and practices.     

Tomorrow''s world: atherosclerosis in the year 2000

Sheep were immunized with a protective recombinant antigen (45W) from the cestode parasite Taenia ovis using three different vaccine delivery systems, either alone or in different combinations. The DNA encoding 45W was cloned into the expression plasmid pcDNA 3 and an ovine adenovirus to create nucleic acid and recombinant viral vector vaccines, respectively. Sheep received two vaccinations with various combinations of these two delivery systems and/or purified recombinant 45W protein in a conventional vaccine formulation containing Quil A as adjuvant (protein/Quil A vaccine). Sheep receiving two inoculations of either the nucleic acid or the recombinant adenovirus alone, demonstrated only low levels of 45W-specific antibody. However, immunization with either nucleic acid or recombinant adenovirus primed animals to mount an enhanced immune response after a subsequent vaccination with the protein/ Quil A vaccine. The most striking result was that sheep initially immunized with the nucleic acid vaccine and boosted with the recombinant adenovirus, mounted IgG1 responses > 65 fold higher than those of sheep receiving either vaccine alone. The level of antibody in these sheep was commensurate with that observed in animals vaccinated twice with the protein/Quil A adjuvanted vaccine. In both cases, host-protection from experimental challenge infection with T. ovis was obtained.     

An approach to steady-state staffing in a psychology department.

Discusses the budgetary and academic consequences of the decrease in growth of university and college psychology departments and the mobility of department members. A model of staffing used in one university psychology department is presented which minimized the difficulties described and helped the department reach a stable staffing conception. In this model, staff members are employed on 1- or 2-yr contracts until steady-state staffing can be implemented. Advantages and disadvantages of the model are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Third world medicine in first world cities: capital accumulation, uneven development and public health

This paper addresses issues of public health and access to care for the urban poor in the context of current U.S. urban, economic and industrial policy. The pathologies that threaten "inner city" neighborhoods are the result of decades of political neglect, economic exploitation and resource withdrawal, which themselves stem directly from public and corporate sector strategies to facilitate capital accumulation and consolidation. The resulting conditions of uneven development between wealthy and impoverished local sectors mirror similar relationships between First and Third World countries. These same patterns are reflected and reproduced in the health care "industry" itself, where growing corporate dominance has developed alongside a concomitant reduction in support for public sector and community-based care. These trends create and exacerbate conditions that place poor and minority populations at risk. Community development and political empowerment, as well as the overall corporate hegemony that increasingly characterizes the political economy of the U.S.A., are essential public health considerations that must be included in any meaningful health policy or health care reform proposals.     

The place of facts in a world of values: Subject and object in a postmodern world.

The value-fact or subject-object split (S-0) recently defended by H. H. Kendler (1999) as necessary for a scientific psychology to establish facts, was rejected by Gestalt psychology as reducing the person to object status. The Gestalt solution correlating principles of perceptual organization with corresponding features of the object world (S/0) has however answered poorly to the vast cultural differences found in values. Communal/dialectical psychology in agreement with a postmodern worldview, treats facts as intrinsically value-laden social constructions mediated by a society's particular social relations (S?0). Examples of fact ambiguity are illustrated, and S?0 is recommended as ontologically preferable for psychology as social science and for turn-of-the-millenium psycho-ecology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health and human resource mobilization: an assessment of staffing pattern in NLEP at operational level

In this paper the staffing pattern, training and infrastructural facilities of the National Leprosy Eradication Programme (NLEP) at operational level as well as the attendant problems in mobilising human resources are discussed. The study shows that the major portion of the work of the NLEP is being shared by the PMWs (72%), followed by NMS (14%) and Medical Officers (5%). The population served by the PMW in all the high and moderate endemic regions is more than the prescribed limit except in Nagaland and Sikkim. In the same areas, the Medical Officer serves a population more than the norm in Andhra Pradesh, West Bengal, Maharashtra, Karnataka and Bihar. Regarding case load, in no state the M.O. serves more than 2500 cases except in Bihar and Kerala, in moderate endemic and low endemic regions respectively. The PMW in Haryana and Punjab states attends more than 250 cases. In NLEP every one out of four sanctioned posts is vacant. There is also an urgent need to rationalize the training programme so that there is optimal utilization of the training centres.     

Pregnancy-associated Sweet's syndrome: world literature review

Sweet's syndrome (acute febrile neutrophilic dermatosis) is a steroid-responsive dermatosis characterized by pyrexia, neutrophilia, and painful erythematous plaques that histologically show a dense dermal infiltrate of neutrophils. Pregnancy-associated Sweet's syndrome is defined as the initial appearance or recurrent episode of Sweet's syndrome in a pregnant woman. Sweet's syndrome occurring during pregnancy has only been described in four women. The clinical characteristics of the women with pregnancy-associated Sweet's syndrome are reviewed and the differential diagnosis of pregnancy-associated dermatoses that clinically mimic Sweet's syndrome are discussed.