Informal in-hospital care in a rehabilitation setting in Greece: An estimation of the nursing staff required for substituting this care

Purpose. To explore: (a) the type and frequency of care-giving activities provided by family members in the Rehabilitation Setting (RS), (b) opportunities for family members to receive training in care-giving activities, (c) to what extent caregivers feel free to ask the nursing staff for help and (d) to estimate the number of nursing staff required to substitute this care and thus to estimate the money saved by the RS due to the in-hospital informal care.

Method. A convenience sample of 80 family members was selected. A questionnaire was developed to investigate several aspects of informal in-hospital care. Data was analysed using SPSS for Windows (Release 10.1).

Results. Cultural reasons and nursing staff shortage led 78.8% (n = 63) of the sample to provide informal in-hospital care. Oral and facial care (67.5%), help with getting dressed (62.5%), help with feeding (61.25%, n = 49), making patients' beds (57.5%, n = 46) and assistance with transferring patients from one hospital department to another (56.25%, n=45) was provided on a daily basis by the subjects. 48.75%, (n=39) changed sheets 1-2 times per week, while assistance with transfers from bed to wheel-chair and vice-versa (43.75%, n = 35) was provided 3-4 times per week. The estimated total time spent per week by the subjects on care-giving activities was 34,034 minutes that corresponds to a total of 75.6 working days or 15.12 working weeks. In order to substitute this care, the RS would need to hire 17 more assistant nurses, entailing a cost of from e14,450 to e20,060 per month.

Conclusions. Informal in-hospital care is provided by Greek families in the RS. Nursing care staff shortage combined with cultural factors are the main reasons for this phenomenon. However, it saves the RS and the Greek State money and policy makers should be looking for ways to overcome the nursing shortage.     

Predictive model to determine cost/benefit of early detection and intervention in occupational low back pain

Low back pain related to work injury has major socioeconomic implications. Theoretically, the early detection of patients at risk for continued work disability after 6 months of work absence, and of those with a recurrence of pain (RP) and leave work once again, should be cost-effective if combined with effective intervention. The objective of this prospective research was to analyze the cost-effectiveness of a detection-intervention system (DIS) developed from a logistic predictive model of work status. A sample of newly injured workers (N=135 males) were assessed following a first episode of compensated low back pain. A predictive biopsychosocial profile was obtained from a series of univariate and multivariate regression analyses. Structural diagnosis, pain rating, length of inactivity before treatment, negative life changes, and self-efficacy expectancies were found to be best predictors. With a correct classification rate of 72% the predictive model parameters (sensitivity and specificity) were chosen in order to reduce the number of false negatives (recurrence of pain or chronic patients not detected). The calculation of the cost/benefit proportions reveals that the detection-intervention system generates savings of up to $39,595 Can./100 patients a year. By combining low treatment expenses ($250 Can to $1,000 Can.) and increasing the success rates (40–75% return to work), the detection-intervention system is potentially more cost effective than the current approach without detection-intervention.     

Breast Fine-Needle Aspiration in the Socialist Republic of Vietnam: First-Year Experience in the Ho Chi Minh City Cancer Center

Abstract: In the Socialist Republic of Vietnam, breast cancer is the second leading cause of cancer death in women. Prior to 1994, in certain regions of Vietnam, such as the South, the only diagnostic modalities for breast lesions were clinical examination and open surgical biopsy, a procedure prohibitively expensive for many women. In January 1994, two American cytopathologists conducted a 3-day breast fine needle aspiration (FNA) seminar at the Ho Chi Minh City Cancer Center, Ho Chi Minh City. After the seminar, 754 breast FNAs were performed from January 1994 to January 1995. The sensitivity and specificity of breast FNA were 96% and 83%, respectively, and there were nine false positive and seven false negative diagnoses. The overall diagnostic accuracy of breast FNA is within the range of previously reported accuracies, indicating that breast FNA can be learned quickly and practiced proficiently. A main role of breast FNA in Vietnam is in the diagnosis of high-stage, inoperable breast tumors. The relative af-fordability of breast FNA enables many women with breast lesions to undergo a diagnostic procedure. The introduction of inexpensive, diagnostically accurate procedures, such as breast FNA, may prove to be of great benefit in countries with scant medical resources.     

Effects of altitude on top speeds during 1 h unaccompanied cycling

The present world record for 1 h unaccompanied cycling (55.291 km) was set by T. Rominger in November 1994 at sea level (Bordeaux, France). However, maximal aerobic cycling performances can be expected to increase at altitude because, for a given air temperature, air density decreases more than VO_2max. The combined effect of these opposite trends results in an improvement of performances. In this study, based on the aerodynamics of track cycling, and assuming an average decrease of VO_2max with altitude as from the literature, we show that the ideal altitude for Rominger is 4000 m where he could cover 60.1 km in 1 h. To our knowledge, only two cyclists attempted at close time intervals to set the 1 h record at sea level and at altitude (Mexico, 2230 m above sea level): F. Moser and J. Longo. Their increase of performance with altitude was only about 50% of that predicted on the basis of similar calculations as performed on Rominger. This suggests that the decrease of VO_2max resulting from altitude is greater for athletes than for average trained subjects and/or that the fraction of VO_2max that can be maintained throughout 1 h decreases with altitude.     

Economic effects of community versus hospital-based faculty pneumonia care

To compare the length of stay and charges for patients with pneumonia admitted in 1995 to the teaching and nonteaching services of a Northeastern teaching hospital, we reviewed the charts of 237 patients. Patients cared for by hospital-based generalists working with housestaff (teaching service) were discharged more quickly and with lower or equivalent charges than patients cared for by community-based attending physicians working either with housestaff (private teaching service) or alone (nonteaching service). Academic teaching services staffed by general medicine faculty may provide efficient inpatient pneumonia care.     

医院成本管理之我见

目前,医院之间的竞争日益激烈,医院要在市场中生存和发展,加强成本管理十分重要.本文认为应从全员成本意识、组织保障、成本核算基础工作、院科两级核算、采购管理和本量利分析等方面工作,管理医院成本.     

Direct medical costs associated with Parkinson's disease: a population-based study.

The objective was to provide population-based estimates of incremental medical costs associated with Parkinson's disease (PD) from onset forward. All Olmsted County, Minnesota, residents with confirmed PD onset from 1987 through 1995 (n = 92) and one age- and sex-matched non-PD referent subject per case were identified with retrospective record review and followed in provider-linked billing data for direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before index (i.e., year of symptom onset) through 10 years after index. Costs for each referent subject were subtracted from those for his/her matched case. Tests for statistical significance used Wilcoxon signed ranks. Preindex costs were similar [median difference in annual costs (MD) = -3 dollars; P = 0.59]. One year post index, PD subjects exhibited borderline significantly higher costs compared to referent subjects (MD = 581 dollars; P = 0.052); the difference diminished over 5 years (MD = 118 dollars; P = 0.82). By 5 to 10 years, however, PD subjects exhibited significantly higher costs (MD = 1,146 dollars; P = 0.01). Over the full 10 years, excess costs were concentrated among PD subjects without rest tremor (MD = 2,261 dollars, P < 0.01, for those without tremor and -229 dollars, P = 0.99, for those with tremor). These population-based estimates of PD-associated direct medical costs from onset forward can uniquely inform policy decisions and cost-effectiveness research.     

Aerobic exercise capacity at sea level and at altitude in Kenyan boys, junior and senior runners compared with Scandinavian runners

The aim of this study was to characterize Kenyan runners in regard to their oxygen uptake and blood and ammonia responses when running. Untrained Kenyan boys (14.2±0.2 years) and Scandinavian runners were included for comparison. The studies were performed at altitude (～2.000 m.a.s.l.) and, for several Kenyan and Scandinavian runners, at sea level as well. At altitude sedentary adolescent Kenyan boys had a mean maximal oxygen uptake (Vo_2max) of 47 (44–51) ml · kg^?1· min^?1, whereas similarly aged boys regularly walking or running but not training for competition reached above 62 (58–71) ml · kg^?1· min^?1 in Vo^2max. Kenyan runners in active training had 68±1.4 ml · kg^?1· min^?1 at altitude and 79.9±1.4 ml · kg^?1· min^?1 at sea level, with individuals reaching 85 ml · kg^?1· min^?1. The best Scandinavian runners were not significantly different from the Kenyan runners in Vo_2max both at altitude and at sea level, but none of the Scandinavians reached as high individual values as observed for some Kenyan runners. The running efficiency, determined as the oxygen cost at a given running speed, was less in the Kenyan runners, and the difference became more pronounced when body weight was expressed in ml · kg^?0.75 min^?1. Blood lactate concentration was in general lower in the Kenyan than in the Scandinavian runners, and the Kenyans also had extremely low ammonia accumulation in the blood even at very high exercise intensities. It is concluded that it is the physical activity during childhood, combined with intense training as teenagers that brings about the high Vo_2max observed in some Kenyan runners. Their high aerobic capacity, as well as their good running economy, makes them such superior runners. In addition, their low blood lactate and ammonia accumulation in blood when running may also be contributing factors.