Dr. Dullinger is the Vice President, Pharmacy Programs, Pharmacy Gold, Inc., a large pharmacy benefit management (PBM) company headquartered in St. Paul. An active player in the field of managed care pharmacy benefits and a keen observer of the recent spate of PBM-pharmaceutical company activity, the Journal sought her perspective ...

Biodiversity relates to sustainable development through a series of direct and indirect uses. These include direct harvest, nature tourism, wild genes improving domestic crops, wild species contributing to crop productivity, pest management, sources of medicine and bioremediation (biologically based environmental clean-up). Biodiversity relates through services, individual species indicating environmental change ...

The incorporation of aseptic technique into surgical practice can reduce the risk of nosocomial infections associated with surgery. The four principles of asepsis are: know what is sterile, know what is not sterile, keep these concepts separate, and remedy contamination immediately. This article details aseptic technique for operating room (OR) ...

The objective of this study was to record changes made by a wide body of general practices due to experience of, or concerns over, aggression. The study involved a retrospective survey of all general practitioners (GPs) in the West Midlands Health Authority region using a piloted postal questionnaire. A total ...

Academic medicine is once more face-to-face with health care reform, which this time is being seriously debated and will at least be the subject of legislation. There is the possibility that the coming changes could unintentionally injure academic medicine; that is why academic medicine's leaders must be participants and constructive ...

Materiel management personnel undoubtedly believe that in the past they have done all within their power to cut costs, increase efficiency and comply with their facility's productivity requirements. However, with healthcare reform and associated changes, it will be necessary for them to develop additional creative ideas--and implement innovative information system ...

AIM: The aim of this study was to determine the effectiveness and relative cost of three forms of information feedback to general practices--graphical, graphical plus a visit by a medical facilitator and tabular. METHOD: Routinely collected, centrally-held data were used where possible, analysed at practice level. Some non-routine practice data ...

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector ...

It was the purpose of this study to measure the relationship between hepatic venous O2 saturation (ShvO2) and mixed venous O2 saturation (SvO2) in septic patients (n = 21) following treatment with various catecholamines (epinephrine, norepinephrine, dopamine, dopexamine). At baseline mean SvO2 was 74 +/- 5% while mean ShvO2 was ...

Many public sector managers are facing fundamental organizational changes, as government macro reforms in health and education reach down to the managers' agenda. Cultural changes and a new set of values are demanding new management approaches and skills as managers seek to embrace an alternative organizational environment. Seeks to draw ...

Lee Gardenswartz and Anita Rowe extend our lead author's contributions to diversity management by suggesting a framework for organizational development that can create an "inclusive" environment for enhancing the productivity and service quality of its staff. The framework includes attention to (1) individual attitudes and beliefs, (2) organizational values and ...

In constructing this report, the author interviewed physicians to ask them how the practice of medicine has changed and what changes bother them most. She also talked to physician executives to find out how they were managing an increasingly disgruntled group of doctors. Four changes in the professional environment that ...

Professional recruiters often contact pharmacists about changing jobs. Through their relationship with employers and their knowledge of changing job trends, recruiters can place pharmacists into rewarding, uncommon positions. However, choosing a recruiter is like choosing a doctor or lawyer; you must ask the right questions. Finding a recruiter you enjoy ...

Our 1993 professional survey showed materiel managers gearing for change, as they expect to see their ranks decrease in number but gain influence. Central service managers seem to be warily watching CS contract services. Salaries increased more for materiel managers than CS managers, though both showed some losses in some ...

Countermeasures involving changes in management practices which are suitable for use in semi-natural ecosystems are described. Most of the relevant information relates to radio-caesium, but the applicability for some other radionuclides has also been evaluated. Improved live-monitoring techniques for radiocaesium, developed since the Chernobyl accident, allow the identification of animals ...

BACKGROUND: It has been contended that, during cardiopulmonary bypass at 27 degrees C, pH-stat management decreases cerebral metabolic rate for oxygen (CMRO2) more than alpha-stat management. In contrast, other studies have not found CMRO2 to differ between techniques. Using each animal as its own control, the authors assessed the effect ...

Two generations have passed since Pakistan changed constitutionally from being under the rule of the British monarchy to becoming an independent Islamic-based democratic republic. Its medicolegal system, including the administration of justice, the academic basis of its medical and scientific expertise, and the practical investigation of crime, is thus a ...

This article is part of a series written for those who wish to bring about broad, permanent improvements in their organization; those who are "change managers." The subject is change management: Why is change necessary? How to approach it from an overall systems point of view? What are the most ...

Constant change is the norm rather than the unusual, and all indications are that the rate, volume, and complexity of change will only escalate in the future. The issue for managers is more about coping with the responses that they and their staff have to change rather than the change ...

The objectives of the study was to investigate the effects on general practitioners' activities of a change in their remuneration system from a capitation-based system to a mixed fee-per-item and capitation-based system. It was our hypothesis that the effect of the change in remuneration varied between subgroups of doctors and ...

Radical change, often referred to as a paradigm shift, will occur in the wake of the United States healthcare reform effort currently underway. It will be value-based, community-oriented and patient- and family-centered. These changes will pose great challenges for materiel management. The future will call for integrated healthcare delivery networks ...

Today's successful materiel managers must possess a wide range of skills. They must above all be highly adaptable to change and influence others to accept rather than resist change. The role and responsibility of the materiel manager have expanded significantly, requiring higher levels of formal education. In conjunction with this, ...

BACKGROUND: Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught. OBJECTIVE: To update internists on recent changes in anesthetic management and how they affect the preoperative evaluation. SUMMARY: Recent advances in anesthetic ...

OBJECTIVE: To describe the experiences of 10 fundholding practices in the Northern region during 1991-2 and to elicit subjective assessments of the impact of their change in status on practice management and patient care. DESIGN: Semistructured interviews were conducted with clinicians and practice managers; other staff in the practices were ...

Medicine is developing at an extraordinary rate in all clinical specialties, the pace largely driven by science and technology. General practice is developing professionally at a similar pace, but in addition is experiencing a huge change in the management of primary care, generated by the engine of policy and organisational ...

To successfully implement total quality management (TQM), management must embrace change. Mr. Hage explains that managers face the challenge not only of learning new information, but of changing the way they think, if they are to take full advantage of TQM. In addition to learning new techniques, a commitment to ...

Continuous QI requires our hospitals to undergo a fundamental change in values, beliefs, and ways to manage. Process improvement changes must start with senior managers, who create the environment for continuous improvement and then enable department managers and employees to improve their processes. Persistent poor quality does not respect organizational ...

This paper is intended for physicians not directly responsible for transfusion medicine in their everyday practices. The field has changed dramatically in the last decade. This paper attempts to outline these changes, and detail factors that will be of practical use in general, medical, and surgical practices. Topics include available ...

For the general manager moving to the position of chief executive, it means more than a superficial change of title: it brings changes to organisational relationships, increased public exposure and personal accountability, and pressure to use time more effectively. Neil Goodwin explores the personal changes for general managers becoming chief ...

As chairman and CEO of the Xerox Corporation, Paul Allaire leads a company that is a microcosm of the changes transforming American business. With the introduction of the first plain-paper copier in 1959, Xerox invented a new industry and launched itself on a decade of spectacular growth. But easy growth ...

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, ...

The academic leadership of internal medicine is considering fundamental changes in the curriculum for internal medicine residency training. The impetus to change the curriculum is derived from various socioeconomic changes during the past 10 years. These changes have resulted in a drastically shortened length of stay of patients in hospitals, ...

Recurrent parotitis is characterized by a cyclic swelling of the parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppuration. Recurrent parotitis is hardly a common problem, but when it does present itself, it is most perplexing. Its etiology and the ...

Physicians are finding themselves in increasing numbers in significant management roles. Physician managers interviewed about their experiences in changing careers identified six critical transitions, three involving psychological adjustments and three requiring development of new skills. A framework is developed in this two-part article that relates career events that trigger transitions, ...

A small sample of recent developments in local speed management and safety in Australia is outlined to illustrate conclusions about practice and assessment. This experience seems to support the effectiveness of devices in lowering speeds and reducing accidents, but there is still generally a lack of adequate monitoring and evaluation. ...

This article examines the lessons learned about implementation and management from the closing of six large institutions for people with mental retardation in New York State. Unanticipated problems occurred, despite special attention to implementation issues in policy design and demonstrated management capacity in similar circumstances. A study of the closure ...

Two of the industry's prominent management experts and authors explain that the Information Systems Department can take a leading role in reengineering the management infrastructure of a healthcare organization. Change is no longer the enemy of management if the infrastructure is set up to accommodate and promote change from within.

Simply stated, understanding how hospitals receive money enables materiel managers to save money. Reimbursement in the health care industry is a complex phenomenon, and the rules and regulations change annually, so that it is sometimes difficult to budget appropriately and estimate the hospital's bottom line accurately. The savvy materiel managers ...

At the Eastern Section Meeting of the Triological Society January 26, 1990, Levinson et al reported outstanding success with ciprofloxacin in the treatment of malignant otitis externa. Moreover, several of the individuals so managed had been refractory to conventional therapy with semisynthetic penicillin and aminoglycoside protocols. This new class of ...

This study examines practice mobility among young physicians, based on a large nationwide 1987 survey of physicians under age 40 years and in their second through fifth years of practice. Averaged across all physicians, there is a 10% to 12% chance of changing practices for each of the first 3 ...

The manager's role is changing due to the changes in the environment. The major change in this role is a move from process management to ensuring outcomes. Assisting staff to achieve outcomes in a constantly changing environment may now be the major contribution of the manager. Five ideas are presented ...

To change from punitive and legalistic QA to positive and productive CQI, both attitudes and methods must change. This is a difficult challenge, but potential rewards for both the organization and its individual members suggest that the effort is worthwhile and deserves high priority. Members of the executive/management team will ...

The Internal Change Consultant Development Programme is designed to equip senior NHS managers in Scotland with the appropriate skills, knowledge and attitudes to enable them to support organisational initiatives in pursuit of the new agenda for the Scottish NHS. John Edmonstone and Maggie Havergal describe the programme and attempt to ...

Management of febrile seizure involves diagnosis and treatment of the underlying cause and assessment of risk factors for recurrence. What should physicians tell anxious parents about this frightening occurrence? Is prophylaxis with anticonvulsant agents appropriate? The authors address these questions and discuss the changing approach to management of febrile seizure.

Cows that produce large quantities of milk require more management and higher quality of management than cows producing smaller quantities of milk. This is true whether improvements in milk production occur through genetic selection, increased milking frequency, or use of bovine somatotropin (bST). The milk response to use of bST ...

In an outpatient protocol for management of the abnormal Pap smear, it is crucial that physicians rule out the presence of invasive disease. To that end, it is essential to acquire thorough knowledge of cervical cancer risk factors, including human papilloma virus. Physicians must also be familiar with Pap smear ...

To the supervisor, self-management is an essential part of management within the organization, and self-improvement, the process of changing one's self for the better, is an unending part of self-management. To enjoy long-term success in changing the way you approach the supervisory job, follow these guidelines: Do not try to ...

Changes in circulating lipid status were studied in a 70-year-old woman during management of chylothorax that included chest drainage, pleuroperitoneal shunting, and a successful thoracic duct ligation. Hypolipidemia with a relative decline in high-density lipoprotein (HDL) cholesterol was apparent at presentation. Following recovery, serum HDL cholesterol rose to the upper ...

Insuring the quality of practice in our work environments is a concern shared by nurse managers and staff members alike. As in other areas of practice, improving quality involves changing practice to overcome problems of effectiveness and efficiency. In the following review article, change is defined, its salient characteristics are ...

Diabetes has no known cure and is a leading source of morbidity and mortality. Clinical management involves patients managing a complex and variable regimen. This article reviews the determinants of effective self-management and the methods of promoting better self-management. Trait variables (e.g., personality and demographics) have been presumed to affect ...