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Distribution by Scientific Domains
Business, Economics, Finance and Accounting60%
Medical Sciences40%

Selected Abstracts

Can early extubation and intensive physiotherapy decrease length of stay of acute quadriplegic patients in intensive care?

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2002
A retrospective case control study
Abstract Background and Purpose Respiratory complications remain a major cause of morbidity and mortality in the acute quadriplegic patient population. The literature has suggested that early insertion of a tracheostomy facilitated pulmonary management and an earlier discharge from the intensive care unit (ICU). Recently, a change in practice has meant that these patients are considered for extubation and intensive physiotherapy treatment, including an overnight on-call service, rather than tracheostomy. The aim of the present retrospective, case-controlled study was to determine if either practice resulted in a difference in length of stay in intensive care and if an on-call physiotherapy service for these patients was cost effective. Method A case control design was used. Between April 1997 and November 1999, seven patients who did not require a tracheostomy were identified; case control subjects were matched for severity with seven patients who did receive a tracheostomy. Length of stay in intensive care and on the acute ward, days from injury to fixation and the overall number of respiratory physiotherapy and night physiotherapy treatments were recorded. Results Five of the seven patients in the non-tracheostomy group received on-call overnight physiotherapy treatment, with an average of five sessions over a total of three nights. This group's length of stay in an ICU was significantly less than patients who were tracheostomized (p = 0.02). The overall number of physiotherapy treatments between the two groups was not significantly different. Conclusions The results of this study suggest that if extubation and intensive physiotherapy is undertaken for suitable patients, the length of stay in intensive care can be significantly reduced. This represents a considerable cost saving for ICUs and more than covers the added cost of providing an after hours on-call physiotherapy treatment service. A prospective evaluation is required to confirm these findings. Copyright © 2002 Whurr Publishers Ltd. [source]

Infrastructure and Rural Development: US and EU Perspectives Infrastruktur und Entwicklung des ländlichen Raums: Perspektiven aus den USA und der EU Infrastructures et développement rural : Perspectives aux États-Unis et dans l'Union européenne

EUROCHOICES, Issue 1 2008
David Blandford
Infrastructure and Rural Development: US and EU Perspectives Infrastructural development remains a cornerstone of rural development policy in both the United States and Europe. It is evident that rural development objectives differ, but similar policy measures are used. The economic rationale for infrastructure development centres on efficiency and creation of competitive advantage. Policy intervention is justified because of the added costs of infrastructure provision in remote, sparsely populated areas. Although this policy focus does not guarantee success, regions leading in economic development typically have better physical infrastructure. In the United States, policy must adapt to challenges posed by an ageing rural infrastructure and demographic change that will increase demands on social infrastructure such as housing and health facilities. There will be greater local responsibility for funding, and expanded use of public/private partnerships. In the European Union, the major challenge is in redirecting resources to new member states, where there is urgent need for both large new investments in transport networks and small investments to improve local access. Although two current options for funding these diverse needs focus on European policies only, investments in non-farm physical capital and public infrastructure cannot be sustained without active national policies to complement the European efforts, perhaps through co-financing requirements. Infrastructures et développement rural : Perspectives aux États-Unis et dans l'Union européenne Le développement des infrastructures demeure un pilier de la politique de développement rural aux États-Unis comme dans l'Union européenne. Les objectifs de développement rural diffèrent bien évidemment mais des mesures semblables sont employées. La justification économique du développement des infrastructures repose sur l'efficience et la création d'avantages concurrentiels. L'intervention publique est justifiée par les coûts supplémentaires des infrastructures dans les zones éloignées à population clairsemée. Bien que ce type de politique ne garantisse pas le succès, les régions en avance de développement économique ont en général de meilleures infrastructures physiques. Aux États-Unis, la politique soit s'adapter aux défis que posent le vieillissement des infrastructures rurales et l'évolution démographique qui va augmenter la demande d'infrastructures sociales telles que les services de santé et de logement. La responsabilité du financement local va augmenter et les partenariats public/privé vont se développer. Dans l'Union européenne, le principal défi est de réorienter les ressources vers les nouveaux pays membres qui ont un besoin urgent de nouveaux investissement d'ampleur dans les réseaux de transport et d'investissement de plus faible ampleur dans l'amélioration des accès locaux. Deux options actuelles de financement de ces divers besoins se concentrent sur les seules politiques européennes, mais les investissements dans le capital physique non agricole et dans les infrastructures publiques ne peuvent pas se poursuivre sans des politiques nationales actives complémentant les efforts fournis au niveau européen, peut-être à travers des mécanismes de co-financement. Infrastruktur und Entwicklung des ländlichen Raums: Perspektiven aus den USA und der EU Bei der Entwicklung der Infrastruktur handelt es sich nach wie vor sowohl in den USA als auch in Europa um einen Eckpfeiler in der Politik zur Entwicklung des ländlichen Raums. Es ist offensichtlich, dass sich die Ziele bei der Entwicklung des ländlichen Raums unterscheiden, die Politikmaßnahmen ähneln sich jedoch. Die wirtschaftliche Begründung für die Entwicklung der Infrastruktur zielt auf die Effizienz und das Schaffen von Wettbewerbsvorteilen ab. Politikeingriffe sind gerechtfertigt, da die Bereitstellung von Infrastruktur in entlegenen, dünn besiedelten Gebieten höhere Kosten verursacht. Obgleich dieser Schwerpunkt der Politik den Erfolg noch nicht garantiert, verfügen die wirtschaftlich am weitesten entwickelten Regionen typischerweise über eine bessere physische Infrastruktur. In den USA muss sich die Politik an die Herausforderungen anpassen, welche eine in die Jahre gekommene Infrastruktur im ländlichen Raum und der demografische Wandel mit sich bringen, und wodurch neue Anforderungen an die soziale Infrastruktur, wie z.B. Wohnungsbau und Gesundheitseinrichtungen, gestellt werden. Bei der Finanzierung werden die Kommunen stärker in die Verantwortung genommen, und öffentlich-private Partnerschaften werden an Bedeutung gewinnen. In der EU besteht die größte Herausforderung darin, Ressourcen zu den neuen Mitgliedstaaten umzuverteilen, wo sowohl neue Großinvestitionen in die Transportnetzwerke als auch kleinere Investitionen zur Verbesserung des lokalen Zugangs dringend benötigt werden. Obwohl sich die beiden im Moment vorhandenen Optionen zur Finanzierung dieser vielfältigen Bedürfnisse ausschließlich auf europäische Politikmaßnahmen konzentrieren, können die Investitionen in außerlandwirtschaftliches physisches Kapital und in die öffentliche Infrastruktur nicht ohne wirksame Politikmaßnahmen auf nationaler Ebene (z.B. die Pflicht zur Kofinanzierung) als Ergänzung zu den Bemühungen auf europäischer Ebene aufrecht erhalten werden. [source]

Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status?

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2007
A Canadian experience
Abstract The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity , the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity , the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P < 0.0001) of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES (P < 0.0001), and decreased with the proportion of recent immigrants in the region (P < 0.0001), after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care. [source]

Better product quality: When is it worth the added costs?

JOURNAL OF CORPORATE ACCOUNTING & FINANCE, Issue 3 2001
Ross L. Fink
Doing a cost/benefit analysis? Then you know that it's tough to estimate the value of improvements in product quality. When can you justify the added costs of better processes or materials? The authors have an answer: Use a value function to estimate the value of the improvement. And they show you how to do it. © 2001 John Wiley & Sons, Inc. [source]