Use of past care markers in risk-adjustment: accounting for systematic differences across providers

The European Journal of Health Economics - Risk-adjustment models are used to predict the cost of care for patients based on their observable characteristics, and to derive efficient and equitable...     

The supervisor's performance appraisal: evaluating the evaluator

The focus of much performance appraisal in the coming decade or so will likely be on the level of customer satisfaction achieved through performance. Ultimately, evaluating the evaluator--that is, appraising the supervisor--will likely become a matter of assessing how well the supervisor's department meets the needs of its customers. Since meeting the needs of one's customers can well become the strongest determinant of organizational success or failure, it follows that relative success in ensuring these needs are met can become the primary indicator of one's relative success as a supervisor. This has the effect of placing the emphasis on supervisory performance exactly at the point it belongs, right on the bottom-line results of the supervisor's efforts.     

The reality of perception in employee relations: "If it looks like a duck ..."

In employee relations, perception is as important as reality. What the employee perceives is generally what the employee believes and acts on. Employee perceptions are shaped by many factors, prominent among them organizational roles, supervisory styles, and communication styles. Employee perceptions cannot be ignored, even when they are known to be incorrect, because they are factual to the employees. Further, perceptions can be controlled to a considerable extent through effective supervision. The supervisor needs to become aware of the power of perception, learn what circumstances are likely to cause incorrect perceptions, learn how to manage employee perceptions to the extent possible, and always approach perception as the perceiver's reality.     

Supervising the health care professional

Those employees called professionals are in some ways little different from any other employees but in a few ways can be anywhere from subtly to dramatically different. As others, professionals are motivated by a unique mix of needs that can be used to gain insight into the appropriate supervisory techniques to apply. Different approaches to supervision are sometimes called for in the face of professionals' advantages, specifically their generally greater education and their external mobility owing to the presence of specific expertise used in other organizations, and their resulting loyalty to an occupation that frequently outweighs loyalty to an organization. The professional in short supply enjoys unique advantages that provide additional challenges for supervision. The conclusion eventually reached concerning supervising professionals is that honest, people-centered management is the key to success.     

Lipid monolayer image dipoles

A simple model is described for calculating the electrostatic energy of lipid domains at the air-water interface, taking account of dipole-dipole repulsions between the lipid molecules themselves, as well as interactions between the molecular dipoles and image dipoles in the subphase. The model assumes that the molecular dipoles within the monolayer arise from the terminal methyl groups of the hydrophobic hydrocarbon chains of the lipid molecules, and that on average they are oriented perpendicular to the plane of the monolayer. With this model the role of the subphase is to enhance rather than suppress the effects of dipole-dipole repulsions.     

Expanding access to coronary artery bypass surgery: who stands to gain?

OBJECTIVE--To determine the perceptions of general practitioners (GPs) about the benefits of coronary artery bypass surgery, in terms of gains in life expectancy, for different groups of patients. DESIGN--A questionnaire survey of all GPs in Northern Ireland. SETTING--A survey conducted collaboratively by the departments of public health medicine in each of the four health boards in the province, serving a total population of 1.5 million. MAIN OUTCOME MEASURES--The median and mean gain in life expectancy perceived by groups of doctors for smoking and non-smoking male and female 55 year old patients. The percentage of 50 year old and 70 year old non-smoking patients considered likely to have their lives extended with bypass surgery. Differences were assessed using the Mann-Whitney U test for unpaired samples and the Wilcoxon signed rank tests for paired. RESULTS--541 GPs replied (response rate 56%). The median (and mean) perceived gain in life expectancy after cardiac surgery for non-smoking 55 year old subjects was 120 (104) months for men and 120 (112) months for women (z = 6.42; P < 0.0001; Wilcoxon signed rank test). For male and female smokers of the same age, the perceived gains were 48 (47) and 60 (52) months respectively (z = 6.72; P < 0.0001; Wilcoxon signed ranks test), both figures being significantly different than for non-smokers. The median (and mean) percentage of patients that the doctors considered would have their lives extended by bypass surgery was 70 (64) of every 100 "young" patients and 40 (42) of every 100 "old" patients, (z = 16.2; P < 0.0001). CONCLUSIONS--These results point to a significant overestimation of the benefits of coronary artery bypass surgery by GPs in Northern Ireland and to a need to develop guidelines for referral.     

Screening methods for thyroid hormone disruptors

The U.S. Congress has passed legislation requiring the EPA to implement screening tests for identifying endocrine-disrupting chemicals. A series of workshops was sponsored by the EPA, the Chemical Manufacturers Association, and the World Wildlife Fund; one workshop focused on screens for chemicals that alter thyroid hormone function and homeostasis. Participants at this meeting identified and examined methods to detect alterations in thyroid hormone synthesis, transport, and catabolism. In addition, some methods to detect chemicals that bind to the thyroid hormone receptors acting as either agonists or antagonists were also identified. Screening methods used in mammals as well as other vertebrate classes were examined. There was a general consensus that all known chemicals which interfere with thyroid hormone function and homeostasis act by either inhibiting synthesis, altering serum transport proteins, or by increasing catabolism of thyroid hormones. There are no direct data to support the assertion that certain environmental chemicals bind and activate the thyroid hormone receptors; further research is indicated. In light of this, screening methods should reflect known mechanisms of action. Most methods examined, albeit useful for mechanistic studies, were thought to be too specific and therefore would not be applicable for broad-based screening. Determination of serum thyroid hormone concentrations following chemical exposure in rodents was thought to be a reasonable initial screen. Concurrent histologic evaluation of the thyroid would strengthen this screen. Similar methods in teleosts may be useful as screens, but would require indicators of tissue production of thyroid hormones. The use of tadpole metamorphosis as a screen may also be useful; however, this method requires validation and standardization prior to use as a broad-based screen.