Support for ethical dilemmas in individual cases: experiences from the Neu-Mariahilf Hospital in Goettingen. (1/10)

Prompted by a recommendation of the two Christian hospital associations in Germany, the Neu-Mariahilf Hospital in Gottingen set up a health ethics committee in autumn 1998. It is the committee's task to give support to staff members, patients and their relatives in individual cases where ethical dilemmas arise. The following article describes the committee's work by means of three cases.  (+info)

Political contributions from the health and insurance industries. (2/10)

During a major election year, interest surges in discovering the sources of campaign funds for influential members of Congress and presidential candidates. This study traces the contributors from the health and insurance industries during the 1990 campaign and presents preliminary figures for the 1992 campaign. Health interests contributed $16.3 million to congressional candidates in 1990, many of whom sit on influential committees and subcommittees. The insurance industry gave $10.9 million that same year. In either case, more than half of the funds came from political action committees (PACs); the rest, from individuals. As of 30 June 1992 health industry PACs had given more than $8.3 million to candidates for federal office in the 1992 campaign; insurance PACs had contributed $6.4 million.  (+info)

Scurvy in the British Mercantile Marine in the 19th century, and the contribution of the Seamen's Hospital Society. (3/10)

When long voyages in sailing vessels were commonplace, scurvy was a major health hazard in mariners of all nations. The observations of James Lind (1716-94) and others indicated that citrus fruits had both a preventive and curative role in this disease. In the light of this work, by 1800 the disease had been virtually eliminated from Britain's Royal Navy. However, it continued in the merchant navies of all nations until the latter half of the 19th century. In 1867, the Merchant Shipping Amendment Act was passed by the British Parliament largely as a result of a concerted effort by the Seamen's Hospital Society (SHS), one of whose physicians, Harry Leach (1836-79) was the major proselytiser for improved conditions in the merchant service. Examination of the SHS records before and after this event demonstrate a marked reduction in the prevalence of scurvy in the Port of London. Although other factors-such as the introduction of steam ships, which resulted in faster voyages-were clearly important, the compulsory administration of genuine lime juice under supervision in the merchant service seems to have exerted a significant effect.  (+info)

Patient safety culture and leadership within Canada's Academic Health Science Centres: towards the development of a collaborative position paper. (4/10)

Currently, the Academy of Canadian Executive Nurses (ACEN) is working with the Association of Canadian Academic Healthcare Organizations (ACAHO) to develop a joint position paper on patient safety cultures and leadership within Academic Health Science Centres (AHSCs). Pressures to improve patient safety within our healthcare system are gaining momentum daily. Because AHSCs in Canada are the key organizations that are positioned regionally and nationally, where service delivery is the platform for the education of future healthcare providers, and where the development of new knowledge and innovation through research occurs, leadership for patient safety logically must emanate from them. As a primer, ACEN provides an overview of current patient safety initiatives in AHSCs to date. In addition, the following six key areas for action are identified to ensure that AHSCs continue to be leaders in delivering quality, safe healthcare in Canada. These include: (1) strategic orientation to safety culture and quality improvement, (2) open and transparent disclosure policies, (3) health human resources integral to ensuring patient safety practices, (4) effective linkages between AHSCs and academic institutions, (5) national patient safety accountability initiatives and (6) collaborative team practice.  (+info)

Public reporting and pay for performance in hospital quality improvement. (5/10)

BACKGROUND: Public reporting and pay for performance are intended to accelerate improvements in hospital care, yet little is known about the benefits of these methods of providing incentives for improving care. METHODS: We measured changes in adherence to 10 individual and 4 composite measures of quality over a period of 2 years at 613 hospitals that voluntarily reported information about the quality of care through a national public-reporting initiative, including 207 facilities that simultaneously participated in a pay-for-performance demonstration project funded by the Centers for Medicare and Medicaid Services; we then compared the pay-for-performance hospitals with the 406 hospitals with public reporting only (control hospitals). We used multivariable modeling to estimate the improvement attributable to financial incentives after adjusting for baseline performance and other hospital characteristics. RESULTS: As compared with the control group, pay-for-performance hospitals showed greater improvement in all composite measures of quality, including measures of care for heart failure, acute myocardial infarction, and pneumonia and a composite of 10 measures. Baseline performance was inversely associated with improvement; in pay-for-performance hospitals, the improvement in the composite of all 10 measures was 16.1% for hospitals in the lowest quintile of baseline performance and 1.9% for those in the highest quintile (P<0.001). After adjustments were made for differences in baseline performance and other hospital characteristics, pay for performance was associated with improvements ranging from 2.6 to 4.1% over the 2-year period. CONCLUSIONS: Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs.  (+info)

Legislative change to permit direct access to physical therapy services: a study of process and content issues. (6/10)

The purpose of this study was to examine process and content issues related to legislative change to permit direct access to physical therapy services. Data sources were survey questionnaires sent to the presidents of the 52 chapters of the American Physical Therapy Association (APTA), APTA publications, state statutes, and personal contacts. Results were based on the experiences of 35 chapters, 17 in direct-access states and 18 in non-direct-access states. The majority of direct-access states obtained their status in a single legislative campaign; the majority of non-direct-access jurisdictions attempting legislative change have been unsuccessful for 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists. The following limitations on practice in a direct-access mode are found in the various practice acts: diagnosis requirements, eventual referral requirements, physical therapist qualifications, patient consent requirements, and practice setting restrictions.  (+info)

Joint statement on resuscitative interventions (update 1995). CMA policy summary. (7/10)

This joint statement includes: guiding principles for health care facilities when developing cardiopulmonary-resuscitation (CPR) policy; CPR as a treatment option; competence; the treatment decision, its communication, implementation and review; and palliative care and other treatment. This joint statement was approved by the Canadian Healthcare Association, the CMA, the Canadian Nurses Association and the Catholic Health Association of Canada and was developed in cooperation with the Canadian Bar Association.  (+info)

Quebec hopes to overcome province's surgical-delay problem. (8/10)

The Quebec government has released an action plan for eliminating delays in surgery in the province. One of the main goals is to increase the amount of day surgery, thus reducing the demands on hospitals. While most physician groups appear to support the plan, the Quebec Hospital Association wonders whether the follow-up community care needed to support the day surgery will be available.  (+info)