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  • 1
    Electronic Resource
    Electronic Resource
    Bingley : Emerald
    International journal of health care quality assurance 10 (1997), S. 31-34 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Examines excellence in three major pharmaceutical companies: Merck, Lilly, and Glaxo. Provides an overview of recent trends in the health care industry. Shows that, although all three companies are facing tough competition and strict cost-containment pressures, they continue to develop innovative strategies for increasing the quality of their product offering. Analyses Merck's recent acquisition of Medco and its implications; also highlights Merck's "Vital Interests" programme. Discusses Lilly's recent purchase of PCS from McKesson Drug and Lilly's recent efforts to concentrate on its core business. Introduces Helix, Glaxo's new computer network for pharmacists and explains the benefits of this unique service, both to its users and the sponsor.
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  • 2
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    Bingley : Emerald
    International journal of health care quality assurance 10 (1997), S. 73-75 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Presents an outline of a local pilot project on disease management in Ollerton, Nottinghamshire, UK. Disease management has been a staff college exercise at a national level: the alliance for health in Ollerton involved a purchaser, an acute trust and a practice. Secondary care expertise was used earlier in the disease process to identify patients and to treat them with a more continuous care programme. Disease management began with gastric illness - in examination, review and treatment for H Pylori eradication; extensions are planned to glaucoma and epilepsy. The project involved co-ordinated investment in building extensions, staff skills and records.
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  • 3
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    Bingley : Emerald
    International journal of health care quality assurance 10 (1997), S. 117-124 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA.
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  • 4
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    Bingley : Emerald
    International journal of health care quality assurance 10 (1997), S. 131-140 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Proposes a conceptual model of quality which incorporates an expectation framework. The model was prompted by a related empirical study examining effectiveness in a health care setting which highlighted the importance of quality measures in a contracting environment. The model attempts to understand the relationships between perceived service quality and patient expectations, experience and satisfaction. Makes recommendations which are considered to be relevant to NHS policy makers.
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  • 5
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    Bingley : Emerald
    International journal of health care quality assurance 10 (1997), S. 153-155 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Reviews the present contracting arrangements in general practice. Outlines recent Government White Papers, leading to a discussion of the future opportunities for general practice. Demonstrates the reality of primary-care- led NHS with quality of care plus cost containment.
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  • 6
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    International journal of health care quality assurance 10 (1997), S. 156-160 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Development and implementation of guidelines constitutes the basis of quality management systems for any organization. The authors have studied the internal documentation produced by professionals on 88 functional units of a university hospital. Reveals the existence of many documents concerning quality of care with an average of 102 available procedures or protocols per unit. However, this documentation is badly organized, making it difficult to consult and to put into practice. The results of this study were provided to other professionals at our hospital in order to make them aware of the necessity of rigorous document management. We have also written and sent recommendations for drawing up procedures and implementing an efficient documentary management system. This effort complements development of the hospital quality assurance plan.
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  • 7
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    Bingley : Emerald
    International journal of health care quality assurance 11 (1998), S. 90-95 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The quality of discharge letters has been evaluated in order to initiate a process of improved communications between the hospital and general practitioners. From each of 37 volunteer clinical departments of a French university hospital, a random sample of 30 stays was selected among the hospitalisations for one year. The quality of discharge letters was assessed according to recipients' needs and to French legislation. In total, 1,024 medical records were relevant and were analysed. This study showed deficiencies in management of discharge letters in the hospital. It constitutes the first step of a quality improvement process based on the awareness of concerned actors through information feedback and the follow-up of specific indicators.
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  • 8
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    International journal of health care quality assurance 11 (1998), S. 102-112 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: One hundred and thirty-one patients came to the Institute of Biological Psychiatry at Bangor, accompanied by 161 healthy blood relatives, spouses and friends. A history was taken and a diagnosis of schizophrenia was made using DSM IIIR criteria. The patients were examined to see if they had any concurrent physical disease. Venous blood samples were taken for measurements of chemical constituents believed to be involved in schizophrenia. The population of patients is described, and the views of the patients and their relatives were noted. Recommendations are made about how provision for patients might be improved.
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  • 9
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    International journal of health care quality assurance 11 (1998), S. 123-126 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Long waiting times are a serious problem for patients using urban health centres in developing countries. A block appointment system was introduced and evaluated in a large South African health centre. Waiting times of all patients were measured over a one-week period before and after the implementation of appointments. Focus group and individual interviews were conducted with staff and patients. After introducing appointments, patients with acute and chronic illnesses and having appointments had significantly shorter waits than similar patients without appointments (difference in median waits: 63 and 39 minutes respectively). Appointments had no benefits for patients not seeing doctors or collecting repeat medication. There was, however, an overall increase in patients' waiting times after introducing the system, mainly due to one atypical day in the follow-up study. Focus groups and interviews revealed that staff were sceptical at baseline but at follow-up were positive about the system. Patients were enthusiastic about the appointment system at all stages. The study shows that block appointments can reduce patient waiting times for acute patients, but may not be suitable for all patients. Staff and patients had different views, which converged with experience of the new system.
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  • 10
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    International journal of health care quality assurance 11 (1998), S. 137-142 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The development of managed care plans is the most dramatic change in the USA's health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations, and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers' rights, and ensure better quality health care from managed care programs.
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  • 11
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    International journal of health care quality assurance 11 (1998), S. 161-172 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Explains the conceptual framework behind and the foundation and implementation of the regulation, assessment, follow-up (RAF) method, and continuous improvement of quality of care in the Israeli Government surveillance of long-term care institutions. The RAF method has made crucial changes in the goals, tasks and tools of surveillance and in therapeutic approaches to the elderly. The "maintenance approach" has been replaced by a "rehabilitative approach" bringing about a real improvement in the quality of care in institutions. Presents selected findings from an evaluation of the RAF method's use in the surveillance system operated by the Israeli Service for the Aged of the Ministry of Labor and Social Affairs.
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  • 12
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    International journal of health care quality assurance 11 (1998), S. 181-187 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: States that rapid changes in the environment have exerted significant pressures on hospitals to incorporate patient satisfaction in their strategic stance and quest for market share and long-term viability. This study proposes and tests a five-factor model that explains considerable variation in customer satisfaction with hospitals. These factors include communication with patients, competence of the staff, their demeanour, quality 0of the facilities, and perceived costs; they also represent strategic concepts that managers can address in their bid to remain competitive. A probability sample was selected and a multiple regression model used to test the hypotheses. The results indicate that all five variables were significant in the model and explained 62 per cent of the variation in the dependent variable. Managerial implications of the proposed model are discussed.
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  • 13
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    International journal of health care quality assurance 11 (1998), S. 173-176 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: A report containing information about three of the top medical manufacturing companies in the world - Baxter Healthcare Corporation, Johnson & Johnson and Medtronic, Inc . Resources have been gathered and employees in key positions from each company have been interviewed to obtain the most current and accurate information. Interviewees were asked what factors contribute to their company's success. These factors were then explored more explicitly through a variety of publications, and the results are included in this report. In today's competitive market, companies must keep current with the market trends and be flexible and open to changing and/or improving their practices in order to remain successful. It has been found that although the main focuses of each company may be similar, the processes by which they strive to meet their goals are quite unique.
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  • 14
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    International journal of health care quality assurance 11 (1998), S. 193-203 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: As health care moves from a fee-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective quality care for the health care consumer
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  • 15
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    International journal of health care quality assurance 11 (1998), S. 204-210 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Two of the emerging issues for the health-care sector in the 1990s are occupational health and safety, and iatrogenic issues. Both of these issues are implicated in the use of pre-powdered latex gloves. Hospital healthcare workers are exposed to latex in many ways: gloves, intravenous sets, ventilator circuits, dental products, resuscitation equipment, anaesthetic equipment. Post-operative complications, delayed wound healing, scar formation, and the potential for misdiagnosis, in the presence of starch powder, have been well documented in the literature with the need for thorough glove rinsing prior to surgery. Another route for glove powder to enter wounds is through a barrier breach. For an institution to ensure it provides the most durable and effective barrier for health-care worker protection and patient safety, knowledge is needed regarding the various factors which lead to glove barrier failure. The primary aim of the study was to evaluate the in-use durability of the surgical gloves in current use against powder-free gloves. Descriptive statistics were used to analyse the data, in addition a cost analysis was calculated. The results of this study demonstrated clinically important differences between existing glove products in terms of barrier quality.
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  • 16
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    International journal of health care quality assurance 11 (1998), S. 222-231 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: This paper report the effectiveness of a nursing quality assurance program over three years, which demonstrates improvement in the incidence and severity of post-operative clean wound infections and the associated extended length of hospital stay and cost. General surgery categories included cardiovascular, orthopaedic, neurosurgery, kidney, abdominal, mammary and other. Cardiovascular categories included coronary artery bypass graft (CABG), heart transplant, and atrial valve replacement. Hip replacement and total knee replacement procedures were included in the orthopaedic category. Additional length of stay and concomitant hospital costs were calculated. Results show that early reporting of observations and implementation of appropriate treatment will decrease the incidence, severity and associated costs of post-operative clean wound infections.
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  • 17
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    International journal of health care quality assurance 11 (1998), S. 238-243 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The aim of this project was to compare the intentions with reported action of health Trusts in Scotland to prioritise and implement published SIGN clinical guidelines. All health Trusts in Scotland were asked about plans for implementation, and resurveyed 15-18 months later for confirmation. Specific guideline implementation groups led by medical doctors were the most common implementation structure. Implementation usually consisted of baseline audit, development of a local version, and reaudit. In one case a successful link between acute and primary care through an area level GP audit facilitator was thought to increase implementation. More research is required to: find out what influences the ability of an organisation to implement guidelines; identify particular facilitating factors or barriers; and on factors influencing the ability of a health organisation to implement guidelines.
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  • 18
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    Bingley : Emerald
    International journal of health care quality assurance 12 (1999), S. 143-148 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Recognising that changing culture is the most important role of a leader, the authors provide a diagnostic description of the culture within the nursing directorate of a National Health Service Trust. When the characteristics of the prevailing culture are compared with those associated with one that is ideal, many gaps are identified. In an attempt to address and overcome these gaps, the leaders within the organisation worked with the staff of the nursing directorate and in turn identified that learning and development was a priority if improvements were to be attained. Consequently two innovative development programmes were designed and the necessary steps taken to effect their implementation. The details of the programmes are provided along with the benefits and drawbacks attributed to this particular initiative.
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  • 19
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    International journal of health care quality assurance 12 (1999), S. 169-176 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The need to incorporate mental health service users in routine measurement of service effectiveness is included among recent policy proposals. However, mental health services pose particular problems of measurement and may prevent the acceptance of measures that are both comparable and meaningful. This paper outlines some of the major difficulties to be faced in routinely measuring quality of mental health services and taking users' views into account. It then proposes a minimum specification for any measure of quality that places mental health service users at the centre of the process.
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  • 20
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    International journal of health care quality assurance 12 (1999), S. 183-189 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: To a rapidly changing environment, health-care organizations are adopting a variety of value enhancement strategies. Typically characterized as quality improvement activities, these strategies generally include efforts to improve: clinical effectiveness; financial performance; consumer satisfaction; employee satisfaction; and risk management/quality assurance activities. Early efforts involved the use of continuous quality improvement (CQI) or total quality management (TQM) strategies with a focus on improving financial performance, while clinical effectiveness has been a greater emphasis more recently. This study examines the manner in which 14 US health-care systems, noted for innovation in quality improvement and value enhancement, are utilizing these activities to promote productive organizational change. An interview format, for use with key informants in each organization, was developed using a model with four dimensions - strategic, cultural, technical, and structural.
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  • 21
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    International journal of health care quality assurance 12 (1999), S. 210-213 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The implementation of clinical governance presents a major challenge for NHS Trusts. The article provides a summary of the background to implementing governance; the results of locally organised research in an NHS Trust reveals clinicians' perceptions and attitudes to implementing clinical governance and the lessons for NHS chief executives. The research provides a valuable insight into the implementation issues which Trusts need to address and the basis for trying to address these in their own organisation.
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  • 22
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    International journal of health care quality assurance 12 (1999), S. 254-266 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The results of a Q methodological study of professional understandings of the notion of risk in mental health services within the UK are discussed in relation to the relevance for staff training and quality assurance. The study attempted to access the diversity of understandings of risk issues amongst a multi-professional group of staff (n = 60) attending inter-agency risk training workshops in 1998. Q methodology is presented as both an appropriate means for such inquiry and as a novel experiential technique for training purposes. A tentative argument is advanced that the qualitative accounts generated by Q research could assist in systematic reviews of quality, complementing the singularly quantitative approaches typically represented in the audit process.
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  • 23
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    International journal of health care quality assurance 12 (1999), S. 279-286 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Primary care in the NHS changed substantially during the 1990s. In recent years, structural changes, most notably the introduction of primary care groups as an administrative centre for planning, have added impetus to the need for adopting meaningful measures of quality of the primary care service. This qualitative study reports the views of a sample of general practitioners, primary care nurses, and practice managers on the development and refinement of current performance indicators. Seven themes were identified as key areas for development of indicators of performance: patient experience, clinical activity, service development and innovation, access, health promotion, cost effectiveness, and quality of life outcomes. These themes are incorporated into a dynamic framework for development where improved outcomes (including quality of life measures) are seen as central to the evaluation of quality, and inter-professional collaboration in the delivery and evaluation of quality of the new primary care is called for.
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  • 24
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    International journal of health care quality assurance 12 (1999), S. 314-317 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Clinical practice guidelines are increasingly being recognised as integral to the clinical effectiveness agenda. According to the recent Scottish White Paper, Scotland "leads the way in clinical effectiveness". The Scottish Intercollegiate Guidelines Network (SIGN), established in 1993, has produced over 20 clinical practice guidelines, and plans to produce at least as many more, while reviewing existing guidelines at a minimum of every two years. This represents a substantial investment of NHS resources. This paper investigates whether this investment is being recouped in Scottish NHS acute trusts via the implementation of SIGN guidelines, and whether their implementation is being audited properly. It is argued that without clinical audit, guideline implementation is unlikely to succeed. This has important ramifications for the implementation of clinical governance.
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  • 25
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    International journal of health care quality assurance 9 (1996), S. 34-37 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Describes an audit of inter-profession communications among hospital, community health and social services concerning hospital admission. Information from 150 patient admissions (50 from each of three general practices after a target date) was gathered from both community and hospital sources. The results were used to audit the transfer policy operated by Airedale NHS Trust. The audit design incorporated an element of research, the results of which were used to inform the interpretation of the audit results and to suggest appropriate recommendations for change. Recommendations included the introduction of a pre-admissions checklist, specific changes to the nursing documentation, measures to improve the speed of information transfer, and the clarification of responsibilities for initiating contact across the hospital-community interface when patients with existing contacts in community services are admitted to hospital. Concludes that the introduction of supplementary research to an otherwise traditional audit cycle strengthened the resulting recommendations.
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  • 26
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    International journal of health care quality assurance 9 (1996), S. 9-14 
    ISSN: 0952-6862
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Traces the development of benchmarking in a number of UK National Health Service trusts, highlighting practical processes and the benefits of benchmarking but also identifying common pitfalls and ways of handling them when they arise or, better still, anticipating them. Several examples of successful benchmarking initiatives are given, emphasizing the advantages of using a systematic benchmarking approach, using benchmarking clubs and the need to develop ad hoc performance measures. Concludes by emphasizing the need for a new commitment to continuous improvement by senior managers to avoid the failures of previous drives for improvement.
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  • 27
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Electrokinetics (EK) is an emerging remediation technology for the in situ removal of heavy metals, volatile organic compounds, and radionuclides from soils and sediments. Naval Air Weapons Station Point Mugu, California will host an EK technology demonstration. The demonstration will consist of installing and operating an EK system, which is engineered to remove cadmium and chromium from former electroplating waste lagoons. The selected site is adjacent to and encroaches on an environmentally sensitive salt marsh are for a federally protected wildlife. The electrokinetic process will be used to mobilize and extract heavy metals from the metals-contaminated soil by applying a low amperage direct current across an array of electrodes placed in the contaminated soil. The demonstration will focus on the effectiveness of the EK process for removing heavy metals from the tidal marsh area. The EK demonstration will be used to collect cost-effective data necessary to address both the technical and economic feasibility of using this technology in areas where soils are porous, water is brackish, and the system is susceptible to tidal influences.
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  • 28
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    Environmental management and health 10 (1999), S. 52-63 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: This paper presents the results of laboratory experiments that investigate the removal of volatile organic compounds from saturated soils through the use of air sparging. Three series of experiments were performed in a column test apparatus using two different soils to represent actual field conditions, namely, a fine gravel and a medium-to-fine Ottawa sand (both obtained from sources near Chicago, Illinois, USA) contaminated with toluene, a major constituent of petroleum products. The results showed that toluene was removed from gravel very efficiently using air sparging; complete removal was achieved using a variety of air flow rates. However the toluene removal rates in tests using sand were significantly less. Even at the highest air flow rate used during testing, complete toluene removal took eight times longer than in comparable tests using gravel. With low air flow rates this was not achieved even after 17 hours of testing. It was further found that the injection of foams generated with surfactants, SDS and witconol SN70, at low air flow rates during the use of air sparging was found to accelerate the bulk removal of toluene in sand, but the use of surfactants did not facilitate the removal of residual levels of contamination.
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  • 29
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    Environmental management and health 10 (1999), S. 209-215 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The parallel Naples airshed model (PNAM) is a parallel software package for the numerical simulation of photosmog episodes in urban scale domains. It solves the atmospheric diffusion equations, which model the air pollution dynamics in a Eulerian approach, using a symmetric time-splitting, where the advection is separated from the (coupled) diffusion and chemistry. Presents some results of a numerical simulation of a severe photochemical smog episode, which occurred in the Naples area. A preliminary comparison with measured data is reported, as a first step toward the validation of PNAM. Some parallel performance results, obtained on an IBM SP machine, are also shown.
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  • 30
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Discusses computational challenges in air quality modelling (as viewed by the authors). The focus of the paper will be on Di, the "current" state-of-affairs. Owing to limitation of space the discussion will focus on only a few aspects of air quality modelling: i.e. chemical integration, sensitivity analysis and computational framework, with particular emphasis on aerosol issues.
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  • 31
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    Environmental management and health 10 (1999), S. 258-266 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Mesoscale air quality models are an important tool to forecast and analyse the air quality in regional and urban areas. In recent years an increased interest has been shown by decision makers in these types of software tools. The complexity of such a model has grown exponentially with the increase of computer power. Nowadays, medium workstations can run operational versions of these modelling systems successfully. Presents a complex mesoscale air quality model which has been installed in the Environmental Office of the Madrid community (Spain) in order to forecast accurately the ozone, nitrogen dioxide and sulphur dioxide air concentrations in a 3D domain centred on Madrid city. Describes the challenging scientific matters to be solved in order to develop an operational version of the atmospheric mesoscale numerical pollution model for urban and regional areas (ANA). Some encouraging results have been achieved in the attempts to improve the accuracy of the predictions made by the version already installed.
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  • 32
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    Environmental management and health 10 (1999), S. 282-289 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: Life-cycle analysis (LCA) provides a general framework for assessing and summarizing all of the information important to a decision. LCA has been used to analyze the desirability of replacing lead (Pb) with a composite of tungsten (W) and tin (Sn) in projectile slugs used in small arms ammunition at US Department of Energy (DOE) training facilities for security personnel. The analysis includes consideration of costs, performance, environmental and human health impacts, availability of raw materials, and stakeholder acceptance. Projectiles developed by researchers at Oak Ridge National Laboratory (ORNL) using a composite of tungsten and tin are shown to perform as well as, or better than, those fabricated using lead. A cost analysis shows that tungsten-tin is less costly to use than lead, since, for the current number of rounds used annually, the higher tungsten-tin purchase price is small compared with higher maintenance costs associated with lead. The tungsten-tin composite presents a much smaller potential for adverse human health and environmental impacts than lead. Only a small fraction of the world's tungsten production occurs in the USA, however, and market-economy countries account for only around 15 per cent of world tungsten production. Concludes that stakeholders would prefer tungsten-tin on the basis of total cost, performance, reduced environmental impact and lower human toxicity. However, lead is preferable on the basis of material availability. Life cycle analysis clearly shows that advantages outweigh disadvantages in replacing lead with tungsten-tin in small-caliber projectiles at DOE training facilities. Concerns about the availability of raw tungsten are mitigated by the ease of converting back to lead (if necessary) and the recyclability of tungsten-tin rounds.
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    Environmental management and health 6 (1995), S. 5-9 
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    Topics: Medicine , Economics
    Notes: Paint and dust samples were collected from a children's nursery ina London school. After chemical digestion using an available leadextraction method, lead concentrations were determined by atomicabsorption spectrophotometry. Most samples analysed were considered topose no hazard to the children. However, a few samples containedavailable concentrations in excess of 2,500ppm and were consideredpotentially hazardous. Such high concentrations were thought to be dueto remnants of old paint applied prior to the introduction ofregulations to limit the content of lead in paint. Although thelead-in-paint hazard has diminished in recent years, the possibility ofold lead paint still being a hazard should not be ignored.
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    Environmental management and health 6 (1995), S. 29-37 
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    Topics: Medicine , Economics
    Notes: Discusses environment and development improvement; the preventionand eradication of prevalent diseases and disabilities, as well asdrastic abatement in both severe and moderate malnutrition in Egypt. Thehealth of women and children in Egypt is a reflection of the generalhealth of the population. Simultaneously, the religious andenvironmental climate influences the socio-economic and healthsituation, as well as the living conditions of the citizens.
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    Environmental management and health 7 (1996), S. 11-15 
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    Topics: Medicine , Economics
    Notes: Aerosols play an important role in the radiative balance of the atmosphere. While sulphate aerosols are recognized as the dominant contributor of tropospheric aerosols over and near industrialized regions, smoke aerosols containing soot or elemental carbon are regarded with increasing importance on a global basis. The fate of carbonaceous aerosols is at present poorly understood as a result of various atmospheric processes. This paper examines the effect of morphology on the physical and chemical properties of atmospheric aerosols, in the context of fractal theory. The use of a fractal dimension to describe aggregate morphology enables more accurate modelling of sedimentation and optical characteristics.
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    Environmental management and health 7 (1996), S. 20-23 
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    Notes: Research over the last 20 years has had a major focus on the ecology of east coast estuaries, including the interaction between coastal seawater and saltmarshes. It is not possible to separate intertidal coastal saltmarshes from the rest of the coastal marine environment as they are involved in a truly interactive system. The significance of this system is attracting increasing attention as the effect of elevated nutrient concentrations on the ecology of the coastal zone has become apparent. It is only when we understand how the various chemical and biological processes influence the flux of nutrients through the estuarine interface between land and sea that any sensible management strategy can be developed.
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    Environmental management and health 7 (1996), S. 4-11 
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    Topics: Medicine , Economics
    Notes: Presents findings from an investigation of the adoption of different "abatement" technologies in 30 Danish firms, encompassing traditional iron manufacturers and electroplating firms. The abatement measures were all instigated to improve environmental or occupational safety and health conditions. Reasons and incentives for these measures were investigated. Finds that there are big differences between the different types of firms. Moreover public regulation is the most common incentive for adopting abatement technologies. Internal forces in the company - attitudes of management and employees - were also found to have an essential influence, while economic considerations play only a minor role.
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    Environmental management and health 8 (1997), S. 191-192 
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    Topics: Medicine , Economics
    Notes: Points to the contrast between traditional working life patterns and the demands of an increasingly industrialized and high technology society, for the increase in workplace psychological problems in Asia and the pacific rim countries. Lists and discusses ten literature references relating to the title material. Mentions the effects of pollution, cases of observed mass hysteria, the relationship between overtime and absenteeism and finally cultural factors on employee mental health and productivity.
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    Environmental management and health 8 (1997), S. 167-169 
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    Notes: Sheds light on emerging problems in occupational and environmental health in the Asia-Pacific region which include the changing employment structure, including the increased participation of women and ageing workers, hazards from new kinds of carcinogens and organic chemicals, reproductive hazards, AIDS, technology-related stress at work, and environmental problems resulting from industrial operations.
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    Environmental management and health 9 (1998), S. 6-9 
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    Notes: This article mainly aims at presenting the research and development of technologies of the Information Society applied to the environment, in the framework of the European Union (EU) policies and action plans. First of all, the link between telematics and environment is explained: although these two fields may seem contradictory, they finally prove to be complementary. Telematics can contribute to a better environmental management and protection. Besides this, the market and employment in Europe in the case of the above two mentioned fields is presented, together with the EU policies towards this direction. The Telematics Application Programme's main topics are also given in more detail. Last, the reflection task for the 5th RTD Programme (1998-2002) is presented and described.
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    Environmental management and health 9 (1998), S. 15-19 
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    Notes: Most public administrations have already some environmental management systems or subsystems in place, which are usually incompatible. An obvious way to remedy this patchwork of systems and information would be to redesign and implement a new IT system from scratch, taking all user requirements into account. The REMSSBOT project (EU DG XIII, Telematics Application Programme) aims at overcoming these disadvantages by offering integral management using an innovative telematic solution. Public administrations of the regions Piemonte (IT), Attica (GR) and Scheldt (NL, B) participate in the project. The REMSSBOT approach is based on a catalogue conforming to the guidelines of the European Environment Agency (EEA). The project-supporting tools and building blocks allow users to navigate through the catalogue and explore information sources, regardless of environmental topic and location. Based on such a design approach, three software applications (demonstrators) have been implemented in the participating regions, which prove the feasibility of using a catalogue-driven approach to implement worthy applications at relatively low cost and with reduced effort.
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    Environmental management and health 9 (1998), S. 20-21 
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    Topics: Medicine , Economics
    Notes: The User Analysis phase of the project, which consists of the user needs and requirements investigation and the functional specification for each of the participating regions, was one of the most important activities of the project. The article presents the procedures followed during this phase and describes the user needs and requirements for the REMSSBOT project, together with the partners involved in the project and their current IT situations.
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    Environmental management and health 9 (1998), S. 65-71 
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    Notes: Today's business world changes due to public demands, technology and global competition. Customers are considering environmental values into their supplier(s) selection and are increasingly buying products with identifiable environmental attributes. Therefore, to have a competitive leverage, companies should implement both ISO 9000 and ISO 14000 concurrently. In addition to the comparative analysis of both ISO 9000 and ISO 14000, zero defects (ZD) and clean (green) production concepts are clarified in this paper. The analogy of the fundamental thoughts behind them are highlighted. A practical strategy for implementing quality and environmental management scheme that copes with 21st century considerations is explored, emphasizing on three main elements i.e. methodology, competitiveness, and change effect.
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    Environmental management and health 9 (1998), S. 79-89 
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    Topics: Medicine , Economics
    Notes: Many countries all over the world are facing water shortages. As population increases, water is being perceived as a very valuable resource. Every effort is exerted to use water more efficiently and to make use of every drop of water to ensure the well being of future generations. New trends are developed and practiced in the area of water resources use and water saving. These trends vary from one country to another according to the degree of water scarcity, economic situations, and other factors. Developing non-conventional water resources is an example of the recent trends in developing new water resources and water savings. Unlike rainfall, rivers, and groundwater which are considered conventional freshwater resources, the non-conventional water resources include sea water desalination, agriculture wastewater reuse, and municipal wastewater reuse. This paper deals with the reuse of agriculture, municipal, and industrial wastewater as a new trend in developing additional water resources. Special interest is given to municipal wastewater, its characteristics and necessary treatment. Environmental and human health considerations for wastewater reuse, especially in agriculture, are also discussed. Possible consequences of wastewater reuse are introduced. Examples of wastewater reuse practices in some countries are also mentioned.
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    Environmental management and health 9 (1998), S. 130-135 
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    Notes: Large amounts of uranium, radium and radium products are redistributed throughout the environment owing to the use of phosphate fertilizers. Potential radiological impacts resulting from direct exposure, inhalation and ingestion of foods grown with fertilizers are discussed. This paper describes a simple method to measure exhalation rate of 222RN from phosphate fertilizers, clay and potatoes in a laboratory and in a more economical way. Three Egyptian factories of phosphate fertilizers were selected in this study (Assuit, Abu Zaable and Kafr El Ziat).
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    International journal of health care quality assurance 10 (1997), S. 7-19 
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    Notes: Explores the value of focus group methodology in a patient satisfaction initiative intended to identify quality improvement targets in a large general hospital. Analyses the transcripts from ten focus groups selected from hospital discharge lists, using simple cut-and-paste techniques. Finds that the focus group methodology was successful in amplifying feedback previously gleaned from surveys. Highlights patients' tolerance of shortcomings and their appreciation of staff providing high quality care while under pressure. Concludes that patients regard the National Health Service as deteriorating generally.
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    International journal of health care quality assurance 10 (1997), S. 27-30 
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    Topics: Medicine , Economics
    Notes: Examines the outcomes of attempts to improve health services in the former Communist countries of Eastern Europe and in the West European democracies. Discovers that while the East Europeans focused their efforts on increasing the numbers of doctors and beds per patient, while keeping to relatively low levels of investment in technological advances, West European countries have taken the opposite approach, emphasizing quality of care, particularly advanced care, reducing the numbers of physicians and hospital beds, acquiring advanced technological systems for diagnosis and treatment and spending ten times as much per patient as in Eastern Europe. Concludes that the West European approach has led to far better results.
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    International journal of health care quality assurance 10 (1997), S. 76-79 
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    Notes: Many different activities have been defined for the effective use of clinical audit. Proposes a method of linking the practice and outcome of audit with the Trust business people, setting out criteria methodology and background following a two-year research study.
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    International journal of health care quality assurance 10 (1997), S. 80-84 
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    Notes: Taking a philosophical approach, ancient Greek philosophers and Christians began to investigate the concept of quality of life. Later, such philosophical pursuit was replaced by the school of positivism, which indicated that science was and still is the only valid form of enquiry. Through such positivistic science the metaphysical nature of the concept of quality of life is thought to be uncovered. However, the later Wittgensteinian philosophical thoughts demonstrated that there is no metaphysical understanding of any concepts but there is only knowledge of playing language games. In the light of this philosophy, prior to any scientific investigations, researchers have already understood and agreed on the concept of quality of life by playing language games. From the above philosophical analyses, outlines some implications for health care research.
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    International journal of health care quality assurance 10 (1997), S. 107-116 
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    Notes: Describes a study designed to develop instruments for examining the quality of routine care of hypertension among the elderly and, using non-medical predictors of quality - such as elderly patient and doctor variables and doctor-patient interaction variables - to explain the variance in the quality of care. The study population comprised 352 elderly people (92 per cent) in one Jerusalem neighbourhood who were members of Israel's largest sick fund. Interviews, screening, observation and examination of records were the sources of information. Multivariate analysis was performed. The findings indicated a plethora of deficiencies in the quality of routine care, mostly in the quality of surveillance and the control of hypertension. It was found that the outcome of care is primarily a result of the physician-patient interaction, rather than of a lack of patient compliance. Proposes a national programme using the instruments developed.
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    International journal of health care quality assurance 10 (1997), S. 20-26 
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    Notes: Reviews the range of quality activity in a National Health Service hospital trust, using a staff questionnaire survey, self-assessment against the Baldrige Quality Award criteria, and the application of the SERVQUAL approach to service quality assessment. Reviews the acute health care quality programme literature. Finds that there are needs for greater integration of quality effort, to engage with patients in a more meaningful manner, and to achieve greater commitment and involvement from clinicians and managers. Identifies lack of time and resources as a major barrier to greater application of quality programmes. Explores ways of developing a more holistic and integrated programme of quality improvement. Describes the creation and implementation of a model for continuous improvement in health care quality.
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    International journal of health care quality assurance 10 (1997), S. 35-41 
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    Notes: Addresses the severe criticism by the Health Service Commissioner of NHS trusts for their handling of patient complaints, particularly the attitude of managers and the new NHS trust culture, which emphasized that patients should be considered as more than just customers. Argues that the word "customer" should not be thrown out because managers are uncomfortable with it; takes the view that, while they may have tried to adopt the term, they have failed to appreciate its meaning. Makes a comparison between customer and consumer and presents a case for regarding patients as customers. Concludes that lessons can be learned from private business in developing the provider-customer relationship and that attitude and behaviour changes can be brought about by a long-term cultural change programme.
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    International journal of health care quality assurance 10 (1997), S. 61-66 
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    Topics: Medicine , Economics
    Notes: Pathways of care define in detail the individual components of treatment for a group of patients. A well written pathway can give rise to consistent care of the highest quality. There are both educational and audit advantages to the approach. Details the means by which groups are selected and the care pathways written. Gives an example of the benefits that can accrue, based on the authors' experience at Ashford Hospital, UK of running a pathway for patients having prostate surgery. The pathways are appreciated by patients, nurses, doctors and managers. Care is improved and costs contained.
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    International journal of health care quality assurance 10 (1997), S. 67-72 
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    Notes: Presents the results of a study which investigated whether the quality of information provided by GP referral letters to a community mental health team (CMHT) was sufficient to determine an appropriate response and the allocation of professional resources. A random sample of GP referral letters received over a six-month period was analysed. The presenting problem, diagnosis and the indication of severity of symptoms were rated. Perusal of the CMHT members' replies to the GPs allowed a rough analysis of the extent of agreement with the GPs' diagnoses, description of presenting problems and severity of symptoms. Discusses the results of the study with regard to the implications of GP fundholding and the employment of GP-based counsellors.
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    International journal of health care quality assurance 10 (1997), S. 94-106 
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    Topics: Medicine , Economics
    Notes: Discusses the characteristics of health care accreditation schemes, especially the implications of their voluntary status. Singles out the Trent small hospital accreditation scheme (TSHAS) for detailed and systematic evaluation. Describes the quantitative and qualitative evaluation methods, which involved a meta-analysis of the literature, interviews with key staff and questionnaires completed by other participants in TSHAS. The main findings, divided into ten themes, confirm much of the published work on accreditation. The findings also provide new insights into the nature and value of health care accreditation, notably about the direction in which accreditation needs to go if both community and larger hospital accreditation is to survive.
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    International journal of health care quality assurance 10 (1997), S. 125-130 
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    Topics: Medicine , Economics
    Notes: Reports on a study which aimed to initiate a quality assurance process among health care personnel in Sweden. An epidemiological survey concerning treatment of leg ulcers in a defined region in Sweden was conducted and the costs of treating leg ulcers at different levels of care were analysed. The epidemiological survey provided the data necessary to calculate the socio-economic costs for the treatment of leg ulcers. The weekly cost was found to be about 24 times higher for hospital in-patients than it was for patients treated at home. The quality assurance process has continued through an interdisciplinary regional consensus conference and the establishment of a consensus programme in the region, with targets and general suggestions for the care and treatment of leg ulcers. To maintain high quality in leg ulcer treatment in the region, an interdisciplinary reference group has been established with members from different clinics at the hospital and members from the primary health care.
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    International journal of health care quality assurance 10 (1997), S. 149-152 
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    Topics: Medicine , Economics
    Notes: Clinicians in chronic pain services are facing the need to develop meaningful and methodologically adequate measures, not only to evaluate the effectiveness of interventions and to assure quality, but also to support the continued funding and future development of such services. Explores the problems inherent in assessing outcomes in chronic pain. These include the complexity of the chronic pain syndrome itself, the multidimensional nature of interventions and the challenges of defining outcomes in the chronic illness syndrome. The complexity and challenges of assessing outcomes may lead to some reticence in facing the challenges but it is the responsibility of the clinicians to continue developing measures and to communicate to purchasers and other stakeholders the complexity of assessing outcomes in chronic pain.
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    International journal of health care quality assurance 10 (1997), S. 166-172 
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    Topics: Medicine , Economics
    Notes: The aim of this project was to develop a reliable and valid consumer satisfaction questionnaire for users of the District Nursing Service in Clwyd. During the qualitative phase 18 quality themes were identified. These were used to construct a draft questionnaire. Respondents were to rate their experience of the service (experience scale) as well as the importance to them of each service feature listed (importance scale). Following pilot testing and item analysis the importance scale was dropped. Factor analysis of the resulting 11-item questionnaire yielded four factors, similar to those identified in other studies. Makes some suggestions to improve the reliability and practical utility of the questionnaire, and describes its use in Clwyd.
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    International journal of health care quality assurance 10 (1997), S. 197-201 
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    Topics: Medicine , Economics
    Notes: To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The simulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. Examines the effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance. Finds that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.
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    Notes: Notes that with health care reform moving at tremendous speed throughout Canada, a great deal of interest in outcomes research has been generated. States that the research team consisted of 17 professional practice leaders from eight disciplines. Proposes, through the research, to identify from the perspective of former patients what results they hoped to achieve prior to discharge from hospital and what facilitated and hindered them in achieving these results. Reports that a representative sample was selected for the study. Forty-one former patients each participated in up to two focus groups, with a total of 16 focus groups conducted. Hierarchical analysis revealed themes that fell within the framework of structure, process and outcomes. The findings will assist in ensuring that more appropriate and effective care is offered to patients by a variety of disciplines.
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    International journal of health care quality assurance 10 (1997), S. 236-240 
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    Topics: Medicine , Economics
    Notes: Presents a study which investigates how it was planned to implement guidelines from the Scottish intercollegiate guidelines network (SIGN). The study aimed to describe the activity in planning the implementation of SIGN guidelines in Scottish Health Service Trusts in 1996, and to provide a baseline for evaluation. A postal questionnaire was sent to the Clinical Audit lead person in 46 Scottish Health Service Trusts. The response rate after two reminders ranged from 60-72 per cent across different categories of Trust. The questionnaire asked for plans to implement individual guidelines, adaptation, professions involved, timeframes, dissemination, and evaluation methods. Reveals that local consensus was the main factor in deciding priorities. Most Trusts wished to see other local versions of guidelines produced, and to evaluate implementation collaboratively. Most expected to have reviewed baseline practice before implementation.
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    International journal of health care quality assurance 10 (1997), S. 267-276 
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    Topics: Medicine , Economics
    Notes: Explores the tensions between cost and quality, need and market, and the effects on patient care and service providers within today's NHS. Builds on research carried out in two hospitals during 1993 to 1995, focusing on perceptions of quality and its management in the context of the nursing discipline. Indicates a divergence of perspectives on "customer requirements" and the emergence of a cultural divide within the total care process. Identifies and illustrates the significant potential for cost savings in health care, which may be achievable while simultaneously improving quality, and suggests that the "prize" for bridging the cultural divide might include a substantial financial gain as well as improved standards of care. In the context of health care, need, expectation, and finite resources are inextricably linked. A shared understanding of the interdependence between the three, and of the balance to be struck, is essential in health care provision today and into the twenty-first century. Suggests that there is some way to go.
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    International journal of health care quality assurance 9 (1996), S. 5-14 
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    Notes: States that health systems globally are in transition, for which also a correspondingly reformed education is required, involving new - and renewed - basic sciences, principles, skills and methods. To that end, demonstrates how problem-based learning in general practice is almost ideal, although still sparsely implemented, and has much in common with health care quality assurance. Contends that primary care in many ways comprises the most important platform and vehicle of modern health services and their interaction with the population. Uses the example of the Faculty of Health Sciences in Linköping, where all curricula are integrated, community-oriented, problem-based and have a focus on primary care and general practice. Represents a useful and hitherto insufficiently recognized widening of the overall field of health care quality assurance, and summarizes some of the experiences therein. Also provides a brief overview of the literature.
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    International journal of health care quality assurance 9 (1996), S. 29-33 
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    Topics: Medicine , Economics
    Notes: Describes how a consumer satisfaction survey was carried out at a community mental health centre and the improvements that occurred as a result. A questionnaire was designed to be delivered as a semi-structured interview to elicit the views and opinions of the clients. Their responses highlighted a number of positive areas about the centre, especially in terms of the staff and the therapeutic support they provide. The feedback also revealed a number of areas where improvements were needed. Reports on six recommendations which were made in terms of medication, activities, privacy, reviews, social service issues and complaints. The staff worked hard to implement a number of changes to improve the quality of the service they provide. The end result is that users' views and opinions have been integrated with the service design and delivery, making the centre a more user-friendly place.
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    International journal of health care quality assurance 9 (1996), S. 38-43 
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    Topics: Medicine , Economics
    Notes: Introduces an African perspective to existing research and scholarship on the relationship between western medical technology and health care planning in Africa. Examining the broader issues of development and underdevelopment, contends that the present health care system, fashioned after western medical systems (focusing on hospital and curative care), has failed to make significant impact by reducing mortality rates in Africa. Describes the already precarious health conditions in Africa and argues that, while Africa can benefit from the application of western medical technology, the irrelevance of current strategies to people's needs and the widespread abuse of medical resources have rendered western technology ineffective in Africa. Concludes by calling for the creation of a council of technological assessment in Africa to review requirements and recommend to African governments appropriate and efficient medical technologies to meet the health needs of Africans.
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    International journal of health care quality assurance 9 (1996), S. 15-19 
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    Topics: Medicine , Economics
    Notes: Discusses attempts to meet in an accessible, equitable and high-quality way, the health needs of 35,000 South Australians in 1.68 million square kilometres. Illustrates innovative work practices, developing teams and responses to regionalization.
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    International journal of health care quality assurance 9 (1996), S. 28-30 
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    Topics: Medicine , Economics
    Notes: Implementation and maintenance of a quality system in radiotherapy organization is discussed in the context of the Wessex Radiotherapy Centre, Southampton (UK). Examines the various development stages, staff attitudes, financial implications and identifies the positive and negative benefits.
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    International journal of health care quality assurance 9 (1996), S. 20-27 
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    Topics: Medicine , Economics
    Notes: Presents and discusses the results of a monitoring programme instituted to comply with the objectives laid down in The Patient's Charter. Explores the dangers inherent in attempting to assess the quality of out-patient clinics by the use of single, simplistic indicators such as a waiting time. Examines the ways in which total quality management has been deployed in a health-service context and pays particular attention to the way in which the concept of "the customer" may need considerable refinement. Suggests incorporating more user-centred approaches into evaluations of quality in the National Health Service, such as the patient satisfaction survey and the application of the SERVQUAL model of consumer satisfaction. Refines the concept of "ecological validity" in an attempt to capture the perceptions and world views of all of the participants in episodes of out-patient care in order to derive more complete measures of quality.
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    International journal of health care quality assurance 9 (1996), S. 20-31 
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    Topics: Medicine , Economics
    Notes: Describes a methodological framework for evaluating intervention programmes to establish and develop quality assurance systems in general hospitals, based on the authors' experience in participating in a specific intervention programme in quality assurance. Both the approach and the design of the evaluation programme were shaped by the unique characteristics of this intervention programme. The evaluation programme was based on a model of organizational behaviour and change developed especially for the introduction of quality assurance systems into hospitals. With modification, the programme can also be used to evaluate other intervention programmes.
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    International journal of health care quality assurance 9 (1996), S. 4-9 
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    Topics: Medicine , Economics
    Notes: One aspect of the Clinton Healthcare Reform programme is to assist health maintenance organizations (HMOs) in collecting and analysing data for the purpose of continuous quality improvement. The HEDIS 2.0 quality performance measurement model is currently in use and endorsed by the National Committee for Quality Assurance (NCQA). Outlines a process using HEDIS 2.0 by which an HMO can identify crucial problem areas and track the success of the solution process. Discusses the use of other relevant statistical tools.
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    International journal of health care quality assurance 8 (1995), S. 34-39 
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    Topics: Medicine , Economics
    Notes: Reports on an inter-agency initiative in Wakefield that used aneeds-led case management approach for the resettlement of 32 formerusers of long-term hospital mental health services. Reviews theprogramme using headings provided by the values which underpinned localmental health services, namely, that services should endeavour to beappropriate, acceptable, accessible, effective/efficient and equitablefor service users. The main objective of the programme was achieved– 32 former users of hospital mental health services wereresettled. Issues were, however, raised concerning the extent to whichthe programme could be described as needs-led. Concludes that there isstill much to learn about the application of case management within theBritish health context.
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    International journal of health care quality assurance 8 (1995), S. 4-7 
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    Topics: Medicine , Economics
    Notes: Describes the clinical audit forum of anaesthetists in North TeesNHS Trust with particular reference to patients' peri-operativeexperience. Shows that a designated waiting room in theatre has improvedthe effectiveness and efficiency of the service provided.
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    International journal of health care quality assurance 8 (1995), S. 8-12 
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    Topics: Medicine , Economics
    Notes: Substantial investments are now being made in quality assuranceprogrammes throughout the developed world. Proposes that economicevaluation is one approach to justifying these in terms of value formoney. Three key elements are: comparison with some alternative courseof action; measurement of costs; and measurement of consequences.Illustrates the difficulties of addressing these by a case-study –an audit programme aiming to increase the use of intravenousthrombolysis for acute myocardial infarction. Discusses the productionof accurate costings; the wide confidence limits associated withregression analysis; and the numerous assumptions required in themodelling of effectiveness. Economic evaluation of quality assuranceprogrammes may be useful in future, if the required data can becollected.
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    International journal of health care quality assurance 8 (1995), S. 17-23 
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    Topics: Medicine , Economics
    Notes: Introduces the Complaints Manager program from Health-TEC toaddress the problems involved in complaints management and control inthe health service. Shows the main screens available for data input.Demonstrates the wide range of reports which can be generated. Suggeststhat the Complaints Manager program provides an efficient and low-costmeans of keeping complaints under control.
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    International journal of health care quality assurance 8 (1995), S. 4-13 
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    Notes: Presents an evaluation of a TQM initiative which was designed tohelp the general level of awareness and knowledge within generalpractices and to encourage the implementation of TQM in primary care.The purposes of the initiative were to assess the effectiveness of theTQM approach used, not only in terms of tangible results but also interms of cost effectiveness suitability and workability; and to checkthe transferability of the model used and its replicability with similarlevels of benefits in other general practices on a nationwide basis.
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    International journal of health care quality assurance 8 (1995), S. 14-22 
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    Topics: Medicine , Economics
    Notes: In The Patients' Charter, a standard is laid down that allpatients who attend out-patient clinics should be seen within 30 minutesof their appointment time. Discusses how a statistical monitoring systemusing a "low technology" approach was implemented atLeicester General Hospital during 1992-93. This was instrumental inraising the proportion of patients seen within 30 minutes from under 50per cent to over 80 per cent in 15 months. Points to the fact thatstatistical monitoring alone is not sufficient to deliver qualityimprovements. Suggests that only enlightened management action whichbrings both management and clinicians into a quality improvementprogramme is likely to be effective. Discusses some of the measurementproblems involved. Warns against the fact that over-reliance on purelyquantitative measures (as indicated in "Charter" standards)to the neglect of more qualitative measures may be counterproductive.Suggests that qualitative approaches need to complement the normalstatistical monitoring.
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    International journal of health care quality assurance 8 (1995), S. 23-28 
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    Topics: Medicine , Economics
    Notes: Total quality management (TQM) must become a part of corporatestrategy if it is to become a way of life in health care. TQM should beunderstood in the context of a cultural transformation. The greatestchallenge for top management is to create an organization in which everyemployee, department and function is linked inextricably to theorganization's mission and vision. One of the key benefits of TQM is theuse of teams to work on and achieve organizational objectives. Healthcare managers must understand motivation in order to carry the workforcewith them to attain those objectives.
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    International journal of health care quality assurance 8 (1995), S. 14-18 
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    Notes: Describes how Lifecare NHS Trust established core values and an ISO9000 quality framework as the foundation for patient care qualityimprovement. Discusses a procedural approach to ensure that Lifecaredefines clearly the requirements of the management of every aspect ofits care system. Presents a framework for total quality management andprocess improvement of care delivery.
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    International journal of health care quality assurance 8 (1995), S. 4-8 
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    Topics: Medicine , Economics
    Notes: Presents the results of a medical audit of the records of 199children diagnosed as diabetic and admitted to Al-Amiri Hospital,Kuwait. Uses the measurement of glycosylated haemoglobin (HbA1) toindicate the levels of control achieved. Finds that the degree ofglycaemic control compares favourably with studies done in otherhospitals, but unfavourably with specialized diabetic clinics. Proposesthat glycaemic control could be improved by provision of the services ofspecialized support staff such as dietitian, educator, psychologist andhealth visitor.
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    International journal of health care quality assurance 8 (1995), S. 23-26 
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    Topics: Medicine , Economics
    Notes: Examines the concept of patient-focused care and how it fits intohospital process re-engineering. Describes the project undertaken at theDerbyshire Royal Infirmary, to implement patient-focused care and carepathway development in accident and emergency, and trauma andorthopaedics. Concludes with an insight into how care pathways have beenused to improve hospital documentation, reduce duplication ofinformation and provide a rich source of data for effective clinicalaudit.
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    International journal of health care quality assurance 8 (1995), S. 32-35 
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    Notes: Presents Path.Finder, a locally managed health care informationsystem built in response to the need for better communication of currentresearch evidence and clinical practice guidelines. Concludes that thissystem will improve patient care by providing up-to-date, clinicallyuseful information which is relevant locally. The technology and theinformation management system have been developed in parallel.
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    International journal of health care quality assurance 9 (1996), S. 15-28 
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    Topics: Medicine , Economics
    Notes: Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality with NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely; tangibility; reliability: responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.
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    International journal of health care quality assurance 9 (1996), S. 28-38 
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    Topics: Medicine , Economics
    Notes: One of the key objectives in the Patient's Charter was to reduce the amount of time typically spent waiting for treatment in NHS out-patient clinics, a documented source of discontent. Presents the results of a quality improvement programme instituted at Leicester General Hospital. Discusses some of the techniques and problems encountered in the measurement exercise. While the results of the monitoring exercise indicated that waiting times were being radically reduced, doubt is expressed as to whether this one simplistic indicator is sufficient to measure the overall quality of out-patient clinics. There is a danger that measurement systems have concentrated on that which is measurable rather than that which is significant. In particular, the voice of the patient is not incorporated into the league table approach to out-patient quality. Discusses several approaches to the measurement of overall quality and the problems and dangers inherent in adopting a league table approach to quality measurement.
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    Environmental management and health 10 (1999), S. 96-104 
    ISSN: 0956-6163
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    Topics: Medicine , Economics
    Notes: Electrostatic precipitators (ESP) and fabric filters (FF) are the main air pollution control equipment utilized to clean dust laden fumes from utility boilers. The choice among these systems depends on specific site conditions such as dust characteristics, required efficiency, gas flowrate and temperature. ESP are generally characterized by higher capital investments and lower operating charges, while the opposite may be said for FF baghouses. As a consequence, ESP present higher total costs when high specific collection areas are required, as happens in the case of low-sulfur high-resistivity dust. However, significant reductions in both capital investment and operating charges may be obtained with pulsed energization of precipitators working in severe back corona conditions. This possibility greatly enlarges the field of applications in which ESP are a lower cost option compared to fabric filters. In the paper an economic comparison of pulse energized ESP, with conventional ESP, reverse-air, shaker, and pulse-jet baghouses is performed. A mapping of the operating conditions in which the adoption of each examined control technology is economically convenient is also defined.
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    Environmental management and health 10 (1999), S. 155-164 
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    Topics: Medicine , Economics
    Notes: The gas emissions towards the atmosphere are one of the main and most actual environmental problems in the world. The effects of greenhouse gas emissions have been studied and treated recently in the Climate Change Conference in Kyoto. In the approved Kyoto Protocol, the European Union will reduce emissions by 8 per cent, the USA by 7 per cent, and Japan by 6 per cent. The data for each country are used to implement policies and make global decisions regarding the level of emissions allowed in the future. For this reason, a study more in depth about the origin and level of emissions from a regional perspective becomes necessary, due to the implications on regional development. The study provides detailed information regarding atmospheric emissions in Spanish regions. Shows that in many cases the atmospheric emissions are not directly related to the economic situations of each region. For this reason, environmental policies should pay attention to the regional differences within a country.
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    Environmental management and health 10 (1999), S. 177-191 
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    Notes: Proposes two concepts for the empirical analysis of society-nature interrelations: first, socio-economic metabolism - the material and energy flows between societies and their natural environment and second, the colonization of nature - the sum of deliberate interventions into natural systems aimed at their "improvement" with respect to socio-economic goals. Discusses empirical examples for sustainability indicators, focusing on landscape processes, and relates land use to the analysis of material and energy flows.
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    Environmental management and health 10 (1999), S. 105-111 
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    Topics: Medicine , Economics
    Notes: Employee involvement is essential to improving pollution control. Organizations like Dow Chemical have been able to use employee involvement to reduce pollution. It begins by understanding, as Dow does, that "If pollution is a cost to you (my competitor) and a cost to me, I win if my costs are lower". Controlling these costs requires people to think about it - a lot. Everyone must accept ownership for pollution. All the pieces must fit together. Unfortunately, even the most advanced companies are still struggling with these issues. An anonymous survey was sent to some of the top pollution-reducing companies in the world. Responses to the questionnaire that focused on a wide range of issues often proved surprising to disturbing. Executives in charge sometimes felt they had employee involvement but few of the operational conditions for it to exist. Dow Chemical provides a rare example of being able to connect all the pieces, through its three keys.
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    Environmental management and health 6 (1995), S. 25-28 
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    Topics: Medicine , Economics
    Notes: Discusses the concept of waste management as opposed to wastedisposal - as the way in which organizations deal with their waste– through the introduction of the Environmental Protection Act(EPA) 1990 Part II which replaced the Control of Pollution Act (COPA)1974. Examines the problems of the COPA and defines the benefits of theEPA which gives the new waste regulation authorities (WRAs) extensivepowers such as the granting/revoking of licences to operators, the aimbeing the control of the waste management process. Also examines otherfeatures of the Act such as public registers and environmental auditing,and takes a look at the future prospects of waste management.
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    Environmental management and health 6 (1995), S. 4-6 
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    Topics: Medicine , Economics
    Notes: In less developed countries there are chronic food shortages andscarcity of arable land and water, coupled with increasing population.Widespread irrigation permits more intensive agriculture, but fertilityis decreased and outbreaks of fluorosis and arsenic poisoning haveoccurred. Use of modern fertilizers causes soil mineral deficiency,including that of zinc. Iodine deficiency has caused outbreaks ofgoitre. Increased fertilizer use leads to an unacceptably highconcentration of nutrients and potential toxins in rivers and lakes.Industrial effluent also poses a serious problem.
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    Environmental management and health 6 (1995), S. 14-16 
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    Topics: Medicine , Economics
    Notes: Argues that a substantial amount of nutrition should be included inthe curriculum for all health-care professionals, including nurses,osteopaths, physiotherapists, podiatrists and retail pharmacists. TheDepartment of Health has set up a Nutrition Task Force, charged withensuring nutrition education of consumers, food manufacturers andretailers, and also adequate nutrition training in the curriculum forhealth professionals. The Task Force lists eight learning outcomes, and18 subject areas that should be covered. Discusses who should teachnutrition.
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    Environmental management and health 6 (1995), S. 27-33 
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    Topics: Medicine , Economics
    Notes: Evaluates the effect of bioaugmentation on the activated sludgetreatment of food wastewaters including those containing potato, starch,sugar and milk. Parameters of study include live liquid microorganisms,dosage, aeration time and wastewater strength. Concludes thatbioaugmentation with addition of live liquid micro-organisms improvestotal organic carbon (TOC) removal efficiency and reduces sludgeproduction. Aerobic bioaugmentation is effective in TOC removal frompotato, sugar and milk wastewater but not effective in the case ofstarch wastewater.
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    Environmental management and health 6 (1995), S. 19-28 
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    Topics: Medicine , Economics
    Notes: Describes a computational environment based on cellular automataand genetic algorithm principles. This kind of approach is useful in alarge set of applications, particularly in biological models, includingthose related to theoretical ecology. The program runs on an IBMcompatible personal computer with a visual genetic algorithm display. Itwould be preferable to have at least a 80386-based machine to takeadvantage of its speed of processing. It is menu-based oriented tofacilitate its use by non-experts, and permits the interference by theresearcher in many environmental and behavioural parameters, allowingmany kind of studies. Illustrates the program's capabilities by applyingit to a set of simulations in order to demonstrate their effect on theevolution of the biological population.
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    Environmental management and health 6 (1995), S. 7-13 
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    Topics: Medicine , Economics
    Notes: Presents the measured concentrations of iron, zinc, cobalt,chromium, nickel, lead, manganese and sodium in atmospheric inhalablecoarse and fine particles for the period September 1984-April 1986 inJedda, Saudi Arabia. The results show that iron and sodium have thehighest concentrations, indicating that inhalable particles are of soiland sea origin. The metal concentrations of fine inhalable particles aremuch smaller than those of coarse inhalable particles, so that humanhealth is hardly affected.
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    Environmental management and health 10 (1999), S. 7-17 
    ISSN: 0956-6163
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    Topics: Medicine , Economics
    Notes: Pesticides have been detected in groundwater in many areas of the State of Washington over recent years. Laws and regulations of federal and state environmental protection and argicultural agencies have developed in response to concern over the public health risk to pesticide exposure. Prevalent views about health risk from pesticide exposure tend to emphasize either the economics and food availability, while downplaying risk of pesticide exposure, or the risk to people, while downplaying economic and food availability issues. The Aquifer Vulnerability Project of the Washington State Department of Ecology is using the Environmental Agency's PATRIOT model to screen the State of Washington for susceptibility to pesticide leaching to groundwater. PATRIOT models the pesticide loading at the top of the water table when the user selects parameters to run in the model, including the crop and the pesticide.
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    Environmental management and health 10 (1999), S. 41-51 
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    Topics: Medicine , Economics
    Notes: This paper looks at the potential implications of land use and climate change for replenishment of the five aquifers which lie beneath the Upper Guadiana catchment in central Spain. The impacts of scenarios for climate and land use change on groundwater recharge are explored using a physically based hydrological model. (Research is the downward flux of water from the base of the root zone, beyond which water is no longer available for evapotranspiration and forms part of the groundwater resource.) The model is integrated for a series of climate change scenarios spanning the range of predictions from general circulation models. Aquifer replenishment through recharge from the main four cover types is examined for each scenario and the implications for groundwater resources are examined. These climate scenarios are then coupled with a scenario for change in irrigated land use in the Guadiana derived from a cellular automata model based on historical change. The implications of coupled climate and land use change are discussed. The results indicate that current climatic variability has greater impacts on groundwater recharge than a number of extreme scenarios for climatic change. Although the impact of the land use change scenario is greater than that of the climate change scenarios, it is still significantly less than current vairability and represents a relatively small change at the catchment scale. This change is too small to significantly affect groundwater resources but may impact surface flows.
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    Environmental management and health 6 (1995), S. 10-13 
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    Topics: Medicine , Economics
    Notes: The radiological consequences on the population of a borax accidentin 1994 in the Tammuz 2 nuclear reactor have been postulated. Doseequivalents resulting from the atmospheric release of radionuclidesduring the accident have been estimated for distances ranging from theexclusion zone to 100km from the reactor. Gamma submersion, betasubmersion doses from the plume, inhalation doses and surface exposuredoses have been estimated for various exposure times. Dose equivalentsestimated for the site boundary for an exposure time of 24 hours were1.42 - 10mSv. Accordingly, it seemed that the consequences of theaccident on the population living around Tuwaitha site could only takethe form of stochastic radiation, such as the induction of cancers, andheredity.
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    Environmental management and health 6 (1995), S. 6-15 
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    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: An environmental impact assessment, EIA, was carried out before thefinal development and implementation of an irrigation project with atotal area of 118,853 ha. in the Konya Plain located in Central Anatoliaof Turkey, by the General Directorate of State Water Works (DSI). Theobjectives of the project are to supply water for irrigation andmunicipal demands by developing the Beysehir Lake, Sugla LakeGembos basin and other water sources in the region, by conveying theexcess water through an improved BSA channel to the Cumra-Konya plainsand to increase the irrigated agriculture. Evaluates six sub-projects byconsidering construction and operation phases with respect toagricultural environmental problems, possible water quality impact,ecological changes and, finally, water budget and meteorologicalconditions. In order to reduce the possible adverse environmental impactof the originally considered design values, some significant changeswere adopted according to results of this EIA study. Presents only thewater quality aspect of the work.
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  • 98
    Electronic Resource
    Electronic Resource
    Bingley : Emerald
    Environmental management and health 6 (1995), S. 28-33 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: In this study tannery industrial wastewater was supplied from aleather industry plant in the south of Germany. An anaerobic pilot plantwas erected for the treatment of this wastewater. Discusses the effectof such an anaerobic process with special reference to the fate ofchronium and the other associated heavy metals throughout the process.The studied metals were Cr, Cd, Pb, Ni, Cu, Fe and Zn. The eliminationrate of these metals throughout the anaerobic processes from thewastewater and the increasing rate of metal correlations in the sludgewere studied extensively. Levels of Cr, Cu, Fe, Cd, Ni, Pb and Zn in theraw wastewater after acidification were 33.72, 0.13, 1.82, 0.06, 0.19,0.21 and 1.07 mg/l respectively. In the sludge the levels were 6,296,16, 141, 31, 12.4, 23 and 94 mg/kg dry weight respectively. The levelsof these metals were decreased by stabilization. The overall resultsrevealed that a remarkable decrease has been achieved in the reductionlevel of metals in the final wastewater. The elimination of such metalsreached 98 per cent for Cr, 53.8 per cent for Cu, 81.3 per cent for Fe,16.7 per cent for Cd, 21.1 per cent for Ni, 72.9 per cent for Zn. On theother hand, such metals were concentrated in the sludge, on the dryweight basis, up to the levels of 13,193 mg Cr/kg, 27.7 mg Cu/kg, 348 mgFe/kg, 3.2 mg Cd/kg, 13.7 mg Ni/kg, 28 mg Pb/kg and 110 mg Zn/kg.Meanwhile, the studied anaerobic process exhibited significantimprovement in the quality of the tannery wastewater to meet theguideline characteristics. However, the partial high level of Cr (III)and the other associated metals in the produced sludge strongly militateagainst the use of such tannery sludges as manure in agriculture.
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  • 99
    Electronic Resource
    Electronic Resource
    Bingley : Emerald
    Environmental management and health 6 (1995), S. 17-18 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: The growth of population is outstripping our ability to preventirreversible degradation of the natural environment and continuedpoverty for much of the world. Discusses possible solutions to theproblem, including artificial photosynthesis which uses purely chemicalmethods and can be carried out on barren lands. The aim of currentresearch is to devise chemical means of photolysis of water.
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  • 100
    Electronic Resource
    Electronic Resource
    Bingley : Emerald
    Environmental management and health 6 (1995), S. 19-22 
    ISSN: 0956-6163
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Medicine , Economics
    Notes: New industries associated with food altered the face of the foodindustry in the 1950s. Food research has continued since then. Discussesthe Delphi and brainstorming and debate approaches to technologicalforecasting. Presents food research forecasts carried out between 1966and 1986 and discusses their accuracy in the light of actualdevelopments. Also presents current opinions of likely futuredevelopments.
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