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Pang Y. A theory of fiscal policy response to an epidemic. Health Econ 2022; 31:2050-2071. [PMID: 35771194 PMCID: PMC9349544 DOI: 10.1002/hec.4564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/09/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Governments worldwide have issued massive amounts of debt to inject fiscal stimulus during the COVID-19 pandemic. This paper analyzes fiscal responses to an epidemic, in which interactions at work increase the risk of disease and mortality. Fiscal policies, which are designed to borrow against the future and provide transfers to individuals suffering economic hardship, can facilitate consumption smoothing while reduce hours worked and hence mitigate infections. We examine the optimal fiscal policy and characterize the condition under which fiscal policy improves social welfare. We then extend the model analyzing the static and dynamic pecuniary externalities under scale economies-the decrease in labor supply during the epidemic lowers the contemporaneous average wage rate while enhances the post-epidemic workforce health and productivity. We suggest that fiscal policy may not work effectively unless the government coordinates working time, and the optimal size of public debt is affected by production technology and disease severity and transmissibility.
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Affiliation(s)
- Yu Pang
- School of BusinessMacau University of Science and TechnologyTaipaMacau
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2
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Fang Z, Judelson D, Simons J, Steppacher R, Arous E, Sideman M, Schanzer A, Aiello FA. Vascular Surgeons Are Not Adequately Valued by Traditional Productivity Metrics. Ann Vasc Surg 2020; 73:446-453. [PMID: 33359694 DOI: 10.1016/j.avsg.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reimbursements for professional services performed by clinicians are under constant scrutiny. The value of a vascular surgeon's services as measured by work relative value units (wRVUs) and professional reimbursement has decreased for some of the most common procedures performed. Hospital reimbursements, however, often remain stable or increases. We sought to evaluate fistulagrams as a case study and hypothesized that while wRVUs and professional reimbursements decrease, hospital reimbursements for these services increased over the same time period. METHODS Medicare 5% claims data were reviewed to identify all fistulagrams with or without angioplasty or stenting performed between 2015 and 2018 using current procedural terminology codes. Reimbursements were classified into 3 categories: medical center (reimbursements made to a hospital for a fistulagram performed as an outpatient procedure), professional (reimbursement for fistulagrams based on compensation for procedures: work RVUs, practice expense RVU, malpractice expense RVU), and office-based laboratory (OBL, reimbursement for fistulagrams performed in an OBL setting). Medicare's Physician Fee Schedule was used to calculate wRVU and professional reimbursement. Medicare's Hospital Outpatient Prospective Payment System-Ambulatory Payment Classification was used to calculate hospital outpatient reimbursement. RESULTS From 2015 to 2018, we identified 1,326,993 fistulagrams. During this study period, vascular surgeons experienced a 25% increase in market share for diagnostic fistulagrams. Compared with 2015, total professional reimbursements from 2017 to 2018 for all fistulagram procedures decreased by 41% (-$10.3 million) while OBL reimbursement decreased 29% (-$42.5 million) and wRVU decreased 36%. During the same period, medical center reimbursement increased by 6.6% (+$14.1 million). CONCLUSIONS Vascular surgeons' contribution to a hospital may not be accurately reflected through traditional RVU metrics alone. Vascular surgeons performed an increasing volume of fistulagram procedures while experiencing marked reductions in wRVU and reimbursement. Medical centers, on the other hand, experienced an overall increase in reimbursement during the same time period. This study highlights that professional reimbursements, taken in isolation and without consideration of medical center reimbursement, undervalues the services and contributions provided by vascular surgeons.
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Affiliation(s)
- Zachary Fang
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Dejah Judelson
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Jessica Simons
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Robert Steppacher
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Edward Arous
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Matthew Sideman
- Division of Vascular Surgery, University of Texas at San Antonio, San Antonio, TX
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Francesco A Aiello
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA.
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3
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Duszak R, Maze J, Sessa C, Fleishon HB, Golding LP, Nicola GN, Hughes DR. Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work. J Am Coll Radiol 2020; 17:1453-1459. [PMID: 32682745 PMCID: PMC7332916 DOI: 10.1016/j.jacr.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines. METHODS Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed. RESULTS Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%). CONCLUSIONS Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.
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Affiliation(s)
- Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia.
| | - Jeff Maze
- Founder and CEO of Quinsite, LLC, Chapel Hill, North Carolina
| | - Candice Sessa
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia; Division Director, Community Radiology, Atlanta, Georgia
| | - Lauren P Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group PA, River Edge, New Jersey
| | - Danny R Hughes
- Executive Director, Harvey L. Neiman Health Policy Institute, Washington, DC; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
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Naidenova I, Nesseler C, Parshakov P, Chusovliankin A. After the Crimea crisis: Employee discrimination in Russia and Ukraine. PLoS One 2020; 15:e0240811. [PMID: 33112927 PMCID: PMC7592748 DOI: 10.1371/journal.pone.0240811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
This paper examines the issue of employee discrimination after a political crisis: the annexation of Crimea. The annexation, which resulted in a political crisis in Russian-Ukrainian relations, is a setting which allows us to test if a bilateral political issue caused employee discrimination. We use a quasi-experimental approach to examine how the political crisis influenced participation in major sports leagues in Russia and Ukraine. The results show that the employment conditions significantly worsened since the Crimea crisis started.
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Affiliation(s)
| | - Cornel Nesseler
- Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
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Abstract
Objectives: To analyze healthcare workers experiences in dealing with the Coronavirus (COVID-19) pandemic. Methods: An anonymous open web-based survey study was conducted among healthcare workers from the March 2020 to April 2020. A total of 24 relevant questions were asked based on participants’ characteristics, obligations, and preparedness in healthcare workers in the event of COVID-19 pandemic. Results: Approximately 1036 healthcare workers participated in this study with high response rate. Out of all the participants, 70% were women, 52% belonged to the 26-34 year age range, 50% were nurses, 33.7% were clinicians, 74.3% agreed to work overtime, 93.1% understand why they should stay past their shift end, 97.7% thought that preventing illness among healthcare workers and providing safety to family members, nearly 94% thought that personal protective equipment (PPE) for employees will enhance their willingness to report to work. Approximately 89.3% express a desire for incentives and financial support for family members. Conclusion: We recommend that providing PPE, reducing psychological stress, financial support and safety to family members of healthcare workers will increase the willingness to report to work.
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Affiliation(s)
- Rana H Almaghrabi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Narahari AK, Cook IO, Mehaffey JH, Chandrabhatla AS, Hawkins RB, Tyerman Z, Charles EJ, Tribble CG, Kron IL, Teman NR, Roeser ME, Ailawadi G. Comprehensive National Institutes of Health funding analysis of academic cardiac surgeons. J Thorac Cardiovasc Surg 2020; 159:2326-2335.e3. [PMID: 31604638 PMCID: PMC7546359 DOI: 10.1016/j.jtcvs.2019.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine trends in National Institutes of Health (NIH) funding for cardiac surgeons, hypothesizing they are at a disadvantage in obtaining funding owing to intensive clinical demands. METHODS Cardiac surgeons (adult/congenital) currently at the top 141 NIH-funded institutions were identified using institutional websites. The NIH funding history for each cardiac surgeon was queried using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER). Total grant funding, publications, and type was collected. Academic rank, secondary degrees, and fellowship information was collected from faculty pages. Grant productivity was calculated using a validated grant impact metric. RESULTS A total of 818 academic cardiac surgeons were identified, of whom 144 obtained 293 NIH grants totaling $458 million and resulting in 6694 publications. We identified strong associations between an institution's overall NIH funding rank and the number of cardiac surgeons, NIH grants to cardiac surgeons, and amount of NIH funding to cardiac surgeons (P < .0001 for all). The majority of NIH funding to cardiac surgeons is concentrated in the top quartile of institutions. Cardiac surgeons had a high conversion rates from K awards (mentored development awards) to R01s (6 of 14; 42.9%). Finally, we demonstrate that the rate of all NIH grants awarded to cardiac surgeons has increased, driven primarily by P and U (collaborative project) grants. CONCLUSIONS NIH-funded cardiac surgical research has had a significant impact over the last 3 decades. Aspiring cardiac surgeon-scientists may be more successful at top quartile institutions owing to better infrastructure and mentorship.
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Affiliation(s)
- Adishesh K Narahari
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Ian O Cook
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Anirudha S Chandrabhatla
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Robert B Hawkins
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Zachary Tyerman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Eric J Charles
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Curtis G Tribble
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Irving L Kron
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Mark E Roeser
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Cardiac Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Va.
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Spann A, Vicente J, Allard C, Hawley M, Spreeuwenberg M, de Witte L. Challenges of combining work and unpaid care, and solutions: A scoping review. Health Soc Care Community 2020; 28:699-715. [PMID: 31845451 DOI: 10.1111/hsc.12912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
The number of people who combine work and unpaid care is increasing rapidly as more people need care, public and private care systems are progressively under pressure and more people are required to work for longer. Without adequate support, these working carers may experience detrimental effects on their well-being. To adequately support working carers, it is important to first understand the challenges they face. A scoping review was carried out, using Arksey and O'Malley's framework, to map the challenges of combining work and care and solutions described in the literature to address these challenges. The search included academic and grey literature between 2008 and 2018 and was conducted in April 2018, using electronic academic databases and reference list checks. Ninety-two publications were mapped, and the content analysed thematically. A conceptual framework was derived from the analysis which identified primary challenges (C1), directly resulting from combining work and care, primary solutions (S1) aiming to address these, secondary challenges (C2) resulting from solutions and secondary solutions (S2) aiming to address secondary challenges. Primary challenges were: (a) high and/or competing demands; (b) psychosocial/-emotional stressors; (c) distance; (d) carer's health; (e) returning to work; and (f) financial pressure. This framework serves to help those aiming to support working carers to better understand the challenges they face and those developing solutions for the challenges of combining work and care to consider potential consequences or barriers. Gaps in the literature have been identified and discussed.
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Affiliation(s)
- Alice Spann
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
| | - Joana Vicente
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Camille Allard
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Mark Hawley
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
| | - Marieke Spreeuwenberg
- Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Luc de Witte
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
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Lee D, Lee J, Kim H, Kang M. Association of long working hours and health-related productivity loss, and its differential impact by income level: A cross-sectional study of the Korean workers. J Occup Health 2020; 62:e12190. [PMID: 33368803 PMCID: PMC7759721 DOI: 10.1002/1348-9585.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We aimed to explore the association between long working hours and health-related productivity loss (HRPL), due to either sickness, absenteeism or presenteeism, stratified by household income level. METHODS From January 2020 to February 2020, data were collected using a web-based questionnaire. A total of 4197 participants were randomly selected using the convenience sampling method. The nonparametric association between weekly working hours and HRPL was determined. Subsequently, a stratified analysis was conducted according to household income (1st, 2nd, and 3rd tertiles). Finally, the differences in HRPL of the different working hour groups (<40, 40, 40-51, and ≥52 hours) were investigated using a multivariate linear regression model. RESULTS Long working hours were more significantly associated with HRPL, as compared to the 'standard' working hours (40 hours/week). A larger proportion of productivity loss was associated with the presenteeism of workers, rather than absenteeism. The relationship between HRPL and weekly working hours was more prominent in the lower household income group. CONCLUSIONS The results of our study indicate that HRPL is associated with long working hours, especially in the lower household income group. Reducing the workload for the individual employee to a manageable level and restructuring sick leave policies to effectively counteract absenteeism and presenteeism may be a feasible option for better labor productivity and employee health.
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Affiliation(s)
- Dong‐Wook Lee
- Department of Preventive MedicineSeoul National University College of MedicineSeoulRepublic of Korea
| | - Jongin Lee
- Department of Occupational and Environmental MedicineSeoul St. Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hyoung‐Ryoul Kim
- Department of Occupational and Environmental MedicineSeoul St. Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Mo‐Yeol Kang
- Department of Occupational and Environmental MedicineSeoul St. Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Sarin S, Huddart S, Raizada N, Parija D, Kalra A, Rao R, Salhotra VS, Khaparde SD, Boehme C, Denkinger CM, Sohn H. Cost and operational impact of promoting upfront GeneXpert MTB/RIF test referrals for presumptive pediatric tuberculosis patients in India. PLoS One 2019; 14:e0214675. [PMID: 30933997 PMCID: PMC6443160 DOI: 10.1371/journal.pone.0214675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. Methods Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider’s perspective and expressed in 2015 USD. Results Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. Conclusions Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.
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Affiliation(s)
- Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Sophie Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | | | | | | | | | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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Abstract
OBJECTIVE The authors surveyed psychiatry residents to determine who participates in moonlighting and to understand their views and opinions on the necessity, importance, and educational value of moonlighting. METHODS An electronic survey was distributed to psychiatry residents at 16 programs nationally. Descriptive characteristics were calculated. Logistic and linear regressions were performed to determine differences between those who moonlight and those who do not and to assess differences in measures of financial distress, quality of life, and work-life balance. RESULTS A total of 173/624 (27.6%) residents participated. Within the subset allowed to moonlight, 50% (47/94) reported moonlighting during prior academic year, for an average of 17.4 ± 8.6 hoursh per month. Within those eligible to moonlight, there were no differences in perceived financial distress, quality of life, work-life balance, and confidence between residents who moonlighted and those who did not. Among moonlighters, 10.6% moonlighted overnight before working the next day, and only 68.1% included moonlighting when recording duty hours. 45% reported no supervision available while moonlighting. CONCLUSIONS In the study sample, 50% of psychiatry residents eligible to moonlight opted to do so. Though most programs have policies in place regarding moonlighting, programs may benefit from ensuring that residents are reporting moonlighting in duty hours and that supervision is available to those moonlighting.
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11
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Ajmal F, Probst J, Brooks J, Hardin J, Qureshi Z. Association between Freestanding Dialysis Facility Size and Medicare Quality Incentive Program Performance Scores. Am J Nephrol 2018; 49:64-73. [PMID: 30557871 DOI: 10.1159/000495262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medicare uses a quality incentive program (QIP) criteria to evaluate care in dialysis facilities and apply monetary penalties on underperforming facilities. Smaller dialysis facilities are likely to be rural and operate on lower profit margin; therefore, such facilities are likely to underperform and face Medicare penalties. The variation in QIP scores by facility size is not yet known. We investigated the association between freestanding dialysis facility size and QIP scores. METHODS Our cross-sectional analysis compared QIP scores across levels of facility size for 5,193 freestanding dialysis facilities that received QIP scores in 2015. We used Medicare facility data including Dialysis Facility Compare, Performance Scores, Facility-Level Impact, and Area Health Resource and United States Renal Data System files for the payment year 2015. We measured the facility size using the number of dialysis stations per dialysis facility. QIP scores were used to determine the quality of care. A generalized linear model was estimated at an alpha level of 0.05. RESULTS Facilities operating more than 10 dialysis stations scored higher than those operating fewer. Further, facilities in the South and Northeast, not offering peritoneal dialysis, affiliated with chains (except chain 3) and spending more hours per dialysis achieved higher QIP scores. Facilities reporting a higher proportion of Hispanic patients and of patients with access to pre-end-stage renal disease (ESRD) nephrologist care achieved higher QIP scores. Conversely, facilities with a higher Black patient population and higher patient travel distances scored lower. CONCLUSIONS The current study provides important finding about the performance of the dialysis facilities with ≤10 dialysis stations. Quality improvement strategies are needed, especially for the dialysis facilities with ≤10 stations, to prevent penalties and eventual closure of such facilities due to financial insolvency. Failure to address these issues will increase further disparities in ESRD care.
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Affiliation(s)
- Fozia Ajmal
- Department of Health Services Policy and Management, Columbia, South Carolina, USA,
| | - Janice Probst
- Department of Health Services Policy and Management, Columbia, South Carolina, USA
| | - John Brooks
- Department of Health Services Policy and Management, Columbia, South Carolina, USA
| | - James Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Zaina Qureshi
- Department of Health Services Policy and Management, Columbia, South Carolina, USA
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Tagliafico E, Bernardis I, Grasso M, D’Apice MR, Lapucci C, Botta A, Giachino DF, Marinelli M, Primignani P, Russo S, Sani I, Seia M, Fini S, Rimessi P, Tenedini E, Ravani A, Genuardi M, Ferlini A. Workload measurement for molecular genetics laboratory: A survey study. PLoS One 2018; 13:e0206855. [PMID: 30481188 PMCID: PMC6258511 DOI: 10.1371/journal.pone.0206855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/19/2018] [Indexed: 01/01/2023] Open
Abstract
Genetic testing availability in the health care system is rapidly increasing, along with the diffusion of next-generation sequencing (NGS) into diagnostics. These issues make imperative the knowledge-drive optimization of testing in the clinical setting. Time estimations of wet laboratory procedure in Italian molecular laboratories offering genetic diagnosis were evaluated to provide data suitable to adjust efficiency and optimize health policies and costs. A survey was undertaken by the Italian Society of Human Genetics (SIGU). Forty-two laboratories participated. For most molecular techniques, the most time-consuming steps are those requiring an intensive manual intervention or in which the human bias can affect the global process time-performances. For NGS, for which the study surveyed also the interpretation time, the latter represented the step that requiring longer times. We report the first survey describing the hands-on times requested for different molecular diagnostics procedures, including NGS. The analysis of this survey suggests the need of some improvements to optimize some analytical processes, such as the implementation of laboratory information management systems to minimize manual procedures in pre-analytical steps which may affect accuracy that represents the major challenge to be faced in the future setting of molecular genetics laboratory.
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Affiliation(s)
- Enrico Tagliafico
- Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena ad Reggio Emilia, Modena, Italy
- * E-mail: (AF); (ET)
| | - Isabella Bernardis
- Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena ad Reggio Emilia, Modena, Italy
| | - Marina Grasso
- Laboratory of Human Genetics, Galliera Hospital, Genoa, Italy
| | | | - Cristina Lapucci
- Medical Genetics and Molecular Biology Unit, Synlab Italy, Brescia, Italy
| | - Annalisa Botta
- Dept. Biomedicine and Prevention, Medical Genetics Section, Tor Vergata University of Rome, Rome, Italy
| | - Daniela Francesca Giachino
- Medical Genetics, University of Torino, Dept. Clinical &Biological Sciences, Torino, Italy
- Medical Genetics, San Luigi University Hospital, Orbassano, Italy
| | - Maria Marinelli
- Genetics Laboratory Unit, Department of Obstetrics and Pediatrics, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Paola Primignani
- Department of Laboratory Medicine, Medical Genetics, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvia Russo
- Cytogenetics and Molecular Genetics Laboratory, Istituto Auxologico Italiano, I.R.C.C.S., Milan, Italy
| | - Ilaria Sani
- Genetica Medica—AOU "A. Meyer" di Firenze, Florence, Italy
| | - Manuela Seia
- Medical Genetics Laboratory; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Fini
- Unit of Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Rimessi
- Unit of Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Elena Tenedini
- Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena ad Reggio Emilia, Modena, Italy
| | - Anna Ravani
- Unit of Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maurizio Genuardi
- Istituto di Medicina Genomica, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alessandra Ferlini
- Unit of Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- * E-mail: (AF); (ET)
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Mehta A, Efron DT, Canner JK, Manukyan MC, Dultz L, Burns C, Stevens K, Sakran JV. Surgeon variation in operating times and charges for emergency general surgery. J Surg Res 2018; 227:101-111. [PMID: 29804841 DOI: 10.1016/j.jss.2018.02.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients and hospitals face significant financial burdens from emergency general surgeries (EGSs), which have been termed a public health crisis in the United States. We evaluated hospitalization charges, operating charges, and variations in operating time by surgeon volume for three common EGS procedures. METHODS Using Maryland's Health Services Cost Review Commission database, we performed a retrospective study of laparoscopic appendectomies, laparoscopic cholecystectomies, and open bowel resections performed by general surgeons among adult patients from July 2012 to September 2014. We compared operating charges to total hospitalization charges and quantified variations in operating time for each procedure. We then divided patients into quartiles based on their surgeon's procedure-specific case volume and used hierarchical linear regressions to calculate differences in both operating time and charges between quartiles. RESULTS We identified 3194 appendectomies, 4143 cholecystectomies, and 1478 bowel resections. Operating charges accounted for one-quarter (26.9%) of total hospitalization charges and widespread variation existed in operating time (appendectomies: median 79 min [interquartile range 66-100 min], cholecystectomies: 96 min [76-125 min], bowel resections: 155 min [117-209 min]). After adjustment, low-volume surgeons relative to high-volume surgeons did not operate statistically longer for appendectomies (+1%, 95% confidence interval [CI]: -2% to 5%) but operated +16% (95% CI: 12%-20%) longer for cholecystectomies (+14 min) and +40% (95% CI: 30%-50%) longer for bowel resections (+59 min). Adjusted median operating charges from low-volume surgeons relative to high-volume surgeons were $554 (26.7%), $621 (22.0%), and $1801 (47.0%) greater for appendectomies, cholecystectomies, and bowel resections, respectively. CONCLUSIONS Operating charges contributed substantially to total EGS hospitalization charges, where low-volume surgeons operated longer and had higher operative charges relative to high-volume surgeons. Reducing variations in operating times and charges represents an opportunity to alleviate the financial burden from EGS procedures.
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Affiliation(s)
- Ambar Mehta
- Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David T Efron
- Johns Hopkins Department of Surgery, Baltimore, Maryland
| | | | | | - Linda Dultz
- Johns Hopkins Department of Surgery, Baltimore, Maryland
| | | | - Kent Stevens
- Johns Hopkins Department of Surgery, Baltimore, Maryland
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Pawlak H, Petkowicz B, Maniak B, Kuna-Broniowska I, Petkowicz J, Buczaj A, Maksym P, Nowakowicz-Dębek B, Gawda P. Severity of work in opinions of rural women living in the Bieszczady region of south-eastern Poland. Ann Agric Environ Med 2018; 25:145-150. [PMID: 29575860 DOI: 10.26444/aaem/75595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of the study was recognition of the opinions of rural women living in the Bieszczady region of south-eastern Poland, concerning their perception of the degree of severity of work. The study was conducted among the inhabitants of the Cisna commune. MATERIAL AND METHODS The basic research instrument was a questionnaire form containing 15 items. The study covered 101 women living in the Cisna commune in the Bieszczady. The self-reported degree of work load on a farm was analyzed among women who were occupationally active, and those who were not occupationally active. The effect of assistance from family members on the severity of work perceived by women was considered. RESULTS The women in the study focused on agro-tourism, a few of them were engaged in agricultural work and the majority worked in household gardens. The study showed that occupationally active women work considerably longer, on average, and are the most loaded, compared to those not engaged in occupational activity. The mean daily time devoted to duties on a farm did not significantly differ between occupationally active and non-active women, and amounted to 380 and 320 minutes, respectively. The majority of women who were non-active occupationally evaluated their household chores as the highest work load. In turn, the women who undertook occupational activity assessed them as most burdensome, despite great help from their family. The body positions assumed while performing field work were: standing, standing-bent-over, and walking. The mean evaluations of work load while standing and standing-bent-over did not significantly differ, but affected the work load among women who, however, could not assess the severity of their work resulting from the body position assumed.
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Affiliation(s)
- Halina Pawlak
- Department of Ergonomics, Department of Technology Faculty of Engineering, University of Life Sciences in Lublin, Poland
| | | | | | - Izabela Kuna-Broniowska
- Department of Applied Mathematics and Computer Science, University of Life Sciences, Lublin, Poland
| | | | - Agnieszka Buczaj
- Department of Ergonomics, Department of Technology Faculty of Engineering, University of Life Sciences in Lublin, Poland.
| | - Piotr Maksym
- Department of Ergonomics, Department of Technology Faculty of Engineering, University of Life Sciences in Lublin, Poland
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Jackson JB, Vincent S, Davies J, Phelps K, Cornett C, Grabowski G, Scannell B, Stotts A, Bice M. A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident. J Grad Med Educ 2018; 10:91-94. [PMID: 29467980 PMCID: PMC5821009 DOI: 10.4300/jgme-d-17-00277.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/31/2017] [Accepted: 09/17/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Funding for graduate medical education is at risk despite the services provided by residents. OBJECTIVE We quantified the potential monetary value of services provided by on-call orthopedic surgery residents. METHODS We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services. RESULTS In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort. CONCLUSIONS The potential monetary value generated by on-call orthopedic surgery residents is substantial.
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Laquintana D, Pazzaglia S, Demarchi A. [The new methods to define the staffing requirements for doctors,<BR>nurses and nurses aides: an example of their implementation in an Italian hospital]. Assist Inferm Ric 2017; 36:123-134. [PMID: 28956868 DOI: 10.1702/2786.28221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
. The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. AIM To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. METHODS The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. RESULTS The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of € 1.828.562,00. CONCLUSIONS The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.
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Rimmer A. Workload pressure would not be a defence against clinical negligence, barrister warns. BMJ 2017; 357:j2053. [PMID: 28442460 DOI: 10.1136/bmj.j2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Roberts HW, Ni MZ, O'Brart DPS. Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a 'hub and spoke' model for the delivery of high-volume cataract surgery. BMJ Open 2017; 7:e013616. [PMID: 28302635 PMCID: PMC5372035 DOI: 10.1136/bmjopen-2016-013616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS). METHODS FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties. RESULTS The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%. CONCLUSIONS The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency.
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Affiliation(s)
- H W Roberts
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - M Z Ni
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - D P S O'Brart
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
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Abstract
Increasing workloads and the current austerity measures are putting UK radiology departments under considerable stress. We need to look at the most efficient ways to manage radiology departments in order to cope with increasing demand. Consequently, a system is needed that can compare productivity between radiologists with different jobs. We measured workload in a UK radiology department and compared the productivities of consultants working different numbers of sessions, which are called programmed activities (PAs), to identify the optimal job plan structure for reporting productivity. Reporting data was gathered from electronic records for 14 consultants working different numbers of PA during the period April 2010-March 2011. These were converted into relative value unit (RVU) scores using a modified RCSI RVU system. Crude and net workloads were calculated for each consultant by dividing their total RVU score by the number of PAs they were contracted for and how many they spent reporting. The consultants reported 118,001 imaging studies. There was statistically significant variation in productivity between consultants working different numbers of PAs on χ (2) analysis (p < 0.05). Consultants working 12 PAs were more productive than consultants working 11 PAs, with net workloads of 7636 RVU/PA/year versus net 6146 RVU/PA/year, p < 0.05. Although UK consultants working 12 PAs per week are more productive than their colleagues, the reasons why are unclear. We have identified a method that can be developed further to identify efficient working practices in UK radiology departments. However, a UK-specific RVU system would make this productivity analysis more accurate.
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Affiliation(s)
- Shah H M Khan
- East Lancashire Hospital NHS Trust, Royal Blackburn Hospital, Blackburn, Lancashire, BB2 3HH, UK
| | - William P Hedges
- Medical School, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, Fife, KY16 9TF, UK.
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21
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Scott G. Unsocial hours pay is a question of fairness. Nurs Stand 2017; 29:3. [PMID: 25921983 DOI: 10.7748/ns.29.35.3.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Should you be paid extra for working weekends? What about nights, or public holidays? Unsocial hours go with the job for most nurses, but the issue of whether and how staff should be rewarded is currently being scrutinised by the NHS Pay Review Body. In the past week there has also been a heated political discussion, as the parties vie for nurses' votes.
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22
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Lewis DM, Dove S, Jordan RE. Results of the 2015 Perfusionist Salary Study. J Extra Corpor Technol 2016; 48:179-187. [PMID: 27994258 PMCID: PMC5153304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Abstract
Presently, there exists no published valid and reliable salary study of clinical perfusionists. The objective of the 2015 Perfusionist Salary Study was to gather verifiable employee information to determine current compensation market rates (salary averages) of clinical perfusionists working in the United States. A salary survey was conducted between April 2015 and March 2016. The survey required perfusionists to answer questions about work volume, scheduling, and employer-paid compensation including benefits. Participants were also required to submit a de-identified pay stub to validate the income they reported. Descriptive statistics were calculated for all survey questions (e.g., percentages, means, and ranges). The study procured 481 responses, of which 287 were validated (i.e., respondents provided income verification that matched reported earnings). Variables that were examined within the validated sample population include job title, type of institution of employment, education level, years of experience, and geographic region, among others. Additional forms of compensation which may affect base compensation rates were also calculated including benefits, call time, bonuses, and pay for ancillary services (e.g., extracorporeal membrane oxygenation and ventricular assist device). In conclusion, in 2015, the average salary for all perfusionists is $127,600 with 19 years' experience. This research explores the average salary within subpopulations based on other factors such as position role, employer type, and geography. Information from this study is presented to guide employer compensation programs and suggests the need for further study in consideration of attrition rates and generational changes (i.e., perfusionists reaching retirement age) occurring alongside the present perfusionist staffing shortage affecting many parts of the country.
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Affiliation(s)
| | - Steven Dove
- Trident Health Resources, Inc., Dunedin, Florida
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23
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de Araújo TR, Menegueti MG, Auxiliadora-Martins M, Castilho V, Chaves LDP, Laus AM. Financial impact of nursing professionals staff required in an Intensive Care Unit. Rev Lat Am Enfermagem 2016; 24:e2818. [PMID: 27878219 PMCID: PMC5173300 DOI: 10.1590/1518-8345.1274.2818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/12/2016] [Indexed: 12/02/2022] Open
Abstract
Objective to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. Method a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. Results the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. Conclusion the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution.
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Affiliation(s)
- Thamiris Ricci de Araújo
- MSc, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Ribeirão Preto, SP, Brazil
| | | | | | - Valéria Castilho
- PhD, Associate Professor, Escola de Enfermagem, São Paulo, Universidade
de São Paulo, São Paulo, SP, Brazil
| | - Lucieli Dias Pedreschi Chaves
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
| | - Ana Maria Laus
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Oriowo BA, Hoffman K, Evans J, Haurani MJ, Satiani B. Comparison of time utilization in an academic inpatient versus an outpatient vascular laboratory. J Clin Ultrasound 2016; 44:540-544. [PMID: 27351720 DOI: 10.1002/jcu.22375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Efficient, cost-effective services in vascular laboratories (VLs) will be required in tomorrow's health care environment. Inpatient VLs (IPVL) are burdened with complex patients, excessive workload, and a high percentage of bedside tests. Outpatient VLs (OPVL) are therefore presumed to be more productive and efficient. We compared time utilization in OPVLs and IPVL to test this hypothesis. METHODS Vascular sonographers at an academic IPVL and OPVL were asked to track their daily activities during five consecutive weekdays. Test type, scan time, delays in patient arrival, preparation for the test, computer entry, and administrative time (patient- and non-patient-related) were logged. RESULTS Delay in patient arrival and non-patient-related administration activities were both significantly greater in the OPVL (p < 0.01 and 0.03, respectively). Actual scan time occupied only 38.8% of the technologist's day, with the rest spent on patient- and non-patient-related activities. CONCLUSIONS No appreciable differences were noted between IPVL and OPVL in most of the efficiency parameters measured. General administration time and delay in patient arrival were greater in the OPVL. Thus, OPVL were not more efficient than IPVL. In order to maximize efficiency in the OPVL, non-patient-related activities, which occupy over a quarter of the daily workday, must be shifted from technologists to support staff. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:540-544, 2016.
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Affiliation(s)
- Babatunde A Oriowo
- Division of Vascular Diseases and Surgery, Vascular Laboratory, Heart and Vascular Center, Wexner Medical Center at The Ohio State University, 376 West 10th Avenue, 7th floor, Prior Hall, Columbus, OH, 43210
| | | | | | - Mounir J Haurani
- Division of Vascular Diseases and Surgery, Vascular Laboratory, Heart and Vascular Center, Wexner Medical Center at The Ohio State University, 376 West 10th Avenue, 7th floor, Prior Hall, Columbus, OH, 43210
- VeinSolutions Columbus, Columbus, OH, 43210
| | - Bhagwan Satiani
- Division of Vascular Diseases and Surgery, Vascular Laboratory, Heart and Vascular Center, Wexner Medical Center at The Ohio State University, 376 West 10th Avenue, 7th floor, Prior Hall, Columbus, OH, 43210.
- VeinSolutions Columbus, Columbus, OH, 43210.
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Abstract
Government data on 1,039 job titles in Taiwan were analyzed to assess possible relationships between job attributes and compensation. For each job title, 79 specific variables in six major classes (required education and experience, aptitude, interest, work temperament, physical demands, task environment) were coded to derive the statistical predictors of wage for managers, professionals, technical, clerical, service, farm, craft, operatives, and other workers. Of the 79 variables, only 23 significantly related to pay rate were subjected to a factor and multiple regression analysis for predicting monthly wages. Given the heterogeneous nature of collected job titles, a 4-factor solution (occupational knowledge and skills, human relations skills, work schedule hardships, physical hardships) explaining 43.8% of the total variance but predicting only 23.7% of the monthly pay rate was derived. On the other hand, multiple regression with 9 job analysis items (required education, professional training, professional certificate, professional experience, coordinating, leadership and directing, demand on hearing, proportion of shift working indoors, outdoors and others, rotating shift) better predicted pay and explained 32.5% of the variance. A direct comparison of factors and subfactors of job evaluation plans indicated mental effort and responsibility (accountability) had not been measured with the current job analysis data. Cross-validation of job evaluation factors and ratings with the wage rates is required to calibrate both.
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Affiliation(s)
- Chia-Fen Chi
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan.
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Abstract
We have a natural experiment emerging, with different UK countries looking at different approaches to NHS nurse staffing. For example, in June, Scotland first minister Nicola Sturgeon announced that Scotland will enshrine the use of existing local nurse workforce planning tools in law. This was misrepresented in some media coverage as being about legislated staffing levels, but it actually legislates what was already common local practice: flexibility framed by tested workforce tools, underpinned by professional judgement.
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Eberth B, Elliott RF, Skåtun D. Pay or conditions? The role of workplace characteristics in nurses' labor supply. Eur J Health Econ 2016; 17:771-785. [PMID: 26453574 DOI: 10.1007/s10198-015-0733-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
Empirically rigorous studies of nursing labor supply have to date relied on extant secondary data and focused almost exclusively on the role of pay. Yet the conditions under which nurses work and the timing and convenience of the hours they work are also important determinants of labor supply. Where there are national pay structures and pay structures are relatively inflexible, as in nursing in European countries, these factors become more important. One of the principal ways in which employers can improve the relative attractiveness of nursing jobs is by changing these other conditions of employment. This study uses new primary data to estimate an extended model of nursing labor supply. It is the first to explore whether and how measures of non-pecuniary workplace characteristics and observed individual (worker) heterogeneity over non-pecuniary job aspects impact estimates of the elasticity of hours with respect to wages. Our results have implications for the future sustainability of an adequately sized nurse workforce and patient care especially at a time when European healthcare systems are confronted with severe financial pressures that have resulted in squeezes in levels of healthcare funding.
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Affiliation(s)
- Barbara Eberth
- Newcastle University Business School, 5 Barrack Road, Newcastle upon Tyne, NE1 4SE, UK.
| | - Robert F Elliott
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Diane Skåtun
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Affiliation(s)
- Veronica Wilkie
- Institute of Health and Society, University of Worcester, Worcester WR2 6AJ, UK
| | - Alwyn Ralphs
- School of Medicine, Keele University, Staffordshire, UK
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Rimmer A. Sixty seconds on . . . the consultant contract. BMJ 2016; 352:i1233. [PMID: 26935491 DOI: 10.1136/bmj.i1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chang LY, Yu HH. The Relationship Between Nursing Workload, Quality of Care and Nursing Payment in Intensive Care Units. Stud Health Technol Inform 2016; 225:871-872. [PMID: 27332385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nursing workload adversely affects patient safety in intensive care units, the higher nursing care hours were lower incidence rate of bedsores.
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Affiliation(s)
- Li-Yin Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiu-Hui Yu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
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Weinrebe W, Johannsdottir E, Karaman M, Füsgen I. What does delirium cost? An economic evaluation of hyperactive delirium. Z Gerontol Geriatr 2016; 49:52-8. [PMID: 25801513 PMCID: PMC4715123 DOI: 10.1007/s00391-015-0871-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 01/30/2015] [Accepted: 02/11/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Demographic changes have resulted in an increase in the number of older (> 75 years) multimorbid patients in clinics. In addition to the primary acute diagnoses that lead to hospitalization, this group of patients often has cognitive dysfunctions, such as delirium. According to clinical experience, delirium patients are more time-consuming for clinicians and their function is often poor. The costs caused by delirium patients are currently unknown. In the present study, a retrospective examination of a database was carried out to calculate the costs that arise during the clinical treatment of documented delirium patients. SETTING AND METHODS The purpose of this retrospective analysis was to collect information recorded by nursing personnel trained in the treatment of delirium and information from a manual documentation matrix for additional time expenditure. In the database analysis anonymous data of previously discharged patients for a time window of 3 months were analyzed. Documented additional expenditure for patients with hyperactive delirium at hospitalization were analyzed by personnel. Material costs, the duration of hospitalization by main diagnosis and age clusters during hospitalization until discharge were also examined. The analysis was performed in a hospital with internal wards. RESULTS Data for 82 hyperactive delirium patients were examined and an average of approximately 240 min of additional personnel expenditure for these patients was found. These patients were approximately 10 years older (p < 0.01) and were hospitalized for an average of 4.2 days longer (p < 0.01) than non-delirium patients. Hyperactive delirium usually developed within the first 5 days of hospitalization and lasted 1.6 days on average. Patients for whom hyperactive delirium was detected early were hospitalized for significantly less time than those for whom it was detected late (6.85 versus 13.61 days, p = 0.002). Additionally, calculated personnel and material costs, including costs affecting the hospitalization period, amounted to approximately 1200 € per hyperactive delirium patient. This corresponds to approximately 0.3 CMP (casemix points) per patient. CONCLUSION The calculations of personnel and material costs and duration of hospitalization in patients with hyperactive delirium demonstrated significant additional costs. Early routine detection of delirium can be achieved through training and this approach leads to a shortening of the hospitalization period and lower costs.
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Affiliation(s)
- W Weinrebe
- Innere Medizin, Hohenloher Krankenhaus gGmbH, Krankenhaus Künzelsau, Universität Witten-Herdecke, Am Sonnenrain 28, 74909, Meckesheim, Deutschland.
| | - E Johannsdottir
- Innere Medizin, Hohenloher Krankenhaus gGmbH, Krankenhaus Künzelsau, Universität Witten-Herdecke, Am Sonnenrain 28, 74909, Meckesheim, Deutschland
| | - M Karaman
- Institut für Biomathematik Berlin, Berlin, Deutschland
| | - I Füsgen
- Geriatrische Medizin, Marien Hospital Bottrop, Universität Witten-Herdecke, Herdecke, Deutschland
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Iacobucci G. Junior doctors' dispute goes beyond pay, Tory MP says. BMJ 2015; 351:h5363. [PMID: 26443617 DOI: 10.1136/bmj.h5363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Bart AI. 'White Collar' Overtime Eligibility May Broaden. Provider 2015; 41:37-40. [PMID: 26571632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Current outpatient delivery systems have been problematic in their ability to effectively schedule appointments and grant patients access to care. A better appointment system has demonstrated improvement on these issues. The objective of this study is to develop a grid appointment system to further improve the scheduling flexibility by determining the minimum length of appointment slots that optimizes the total costs of patient waiting, physician idling, and overtime. This minimum length is used for the patient type requiring the least amount of treatment time such as return visit (RV), and multiplications of the minimum length are for patient types with longer treatment such as new patients (NP). The results indicated that the proposed grid system adjusts to demand changes at least 15% more cost-effective when grouping two RVs into an NP or dividing an NP into two RVs compared to the base-line scheduling approaches that build around the mean treatment time.
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36
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Sprinks J. Hands off our unsocial hours pay, college congress tells government. Nurs Stand 2015; 29:9. [PMID: 26135995 DOI: 10.7748/ns.29.44.9.s7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Butlet A. Fighting for our rights. Aust Nurs Midwifery J 2015; 22:56. [PMID: 26255423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Osborne K. Scrap unsocial hours payments and nurses will retaliate, warns RCN. Nurs Stand 2015; 29:7. [PMID: 25921984 DOI: 10.7748/ns.29.35.7.s2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Vogel K, Karltun J, Yeow PHP, Eklund J. Increased work pace is unprofitable: a beef-cutting case study. Meat Sci 2015; 105:81-8. [PMID: 25828161 DOI: 10.1016/j.meatsci.2015.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022]
Abstract
The beef industry worldwide is showing a trend towards increased cutting pace aimed at higher profits. However, prior research in the duck meat industry suggested that a higher cutting pace reduced quality and yield, leading to losses. This study aimed to test this hypothesis by investigating the effects of varying beef-cutting paces on yield, quality and economy. A field experiment was conducted on six workers cutting beef fillet, sirloin and entrecôte. Three types of paces were sequentially tested: Baseline (i.e., status quo), 'Quantity focus' (i.e., pace required to maximise quantity) and 'Quality focus' (i.e., pace required to minimise errors). The results showed a significant drop in yield, increased rate of quality deficiency and economic losses with the change to 'Quantity focus' (from Baseline and 'Quality focus') for all meat types. Workers supported these results and also added health problems to the list. The results confirmed that an increased cutting pace is unprofitable.
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Affiliation(s)
- K Vogel
- KTH Royal Institute of Technology, STH, Unit of Ergonomics, Alfred Nobels allé 10, SE-141 52 Huddinge, Sweden.
| | - J Karltun
- School of Engineering, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden.
| | - P H P Yeow
- School of Business, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya 46150, Selangor, Malaysia.
| | - J Eklund
- KTH Royal Institute of Technology, STH, Unit of Ergonomics, Alfred Nobels allé 10, SE-141 52 Huddinge, Sweden.
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College aims to end culture of working beyond shifts. Nurs Manag (Harrow) 2015; 21:7. [PMID: 25727419 DOI: 10.7748/nm.21.10.7.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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41
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Booth TC, Boyd-Ellison JM. The current impact of incidental findings found during neuroimaging on neurologists' workloads. PLoS One 2015; 10:e0118155. [PMID: 25723558 PMCID: PMC4344225 DOI: 10.1371/journal.pone.0118155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 01/08/2015] [Indexed: 12/21/2022] Open
Abstract
Objective Neuroimaging is an important diagnostic tool in the assessment of neurological disease, but often unmasks Incidental Findings (IFs). The negative impacts of IFs, such as ‘patient’ anxiety, present neurologists with management dilemmas, largely due to the limited knowledge base surrounding the medical significance of these IFs. In particular, the lack of evidence-based clinical trials investigating the efficacy of treatments for subclinical IFs makes management protocols challenging. The objective was to determine the impact IFs may have on neurologists’ workloads and healthcare budgets and to examine neurologists’ concerns regarding the clinical management of these ‘patients’. Methods Qualitative research based on constructivist grounded theory. Data was collected through semi-structured interviews of purposively sampled neurologists, coded, and concurrent comparative analysis performed. A substantive theory of the ‘IF impacts’ was developed after concept saturation. Results Neurologists managed the escalating workload caused by an increased number of referrals of ‘patients’ with IFs found during neuroimaging; however it was unclear whether this was sustainable in the future. Neurologists experienced IF management dilemmas and spent more time with ‘patients’ affected by anxiety. The lack of information provided to those undergoing neuroimaging by the referring clinician regarding the possibility of discovering IFs was highlighted. Conclusion The impact of IFs upon the neurologist, ‘patient’ and the health institution appeared considerable. Further research determining the natural history of subclinical IFs and the efficacy of intervention will help to alleviate these issues.
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Affiliation(s)
- Thomas C. Booth
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- * E-mail:
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Wierz V. [Blessing or curse?]. Pflege Z 2015; 68:104-107. [PMID: 25895181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kleebauer A. NHS faces staff exodus if unsocial hours payments are withdrawn. Nurs Stand 2015; 29:11. [PMID: 25563090 DOI: 10.7748/ns.29.19.11.s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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44
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Leversidge A. Seven-day services. Midwives 2015; 18:17. [PMID: 25961104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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45
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RCN asks members to record any overtime worked. Nurs Stand 2014; 29:8. [PMID: 25492745 DOI: 10.7748/ns.29.15.8.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The RCN is calling on its members to record the hours they work and to request payment or time off in lieu for overtime as part of its pay campaign.
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Kelm R. [An important management tool]. Pflege Z 2014; 67:728-731. [PMID: 25632589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Édeleva AN, Proĭdakova EV. [The mathematical methods for the estimation of the workload on the personnel of the Bureau of Forensic Medical Expertise]. Sud Med Ekspert 2014; 57:45-48. [PMID: 25764903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of the present study was to analyse the financial support of forensic medical research with the application of mathematical methods based at the Nizhni Novgorod Regional Bureau of Forensic Medical Expertise. The authors elaborated the prognosis of the expenses for the forensic medical expertise of the corpses of the elderly and senile subjects.
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Your entitlement toolkit. Qld Nurse 2014; 33:20-3. [PMID: 25453155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kazemier S. [Profit sharing with differences in work week and capital income]. Tijdschr Diergeneeskd 2014; 139:16. [PMID: 24701782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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50
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Dyer C. UK doctor who charged for unworked shifts is allowed to resume practice after repaying hospital and showing remorse. BMJ 2014; 348:g1185. [PMID: 24474425 DOI: 10.1136/bmj.g1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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