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M Defever

Publications and source records attributed to M Defever.

10 recordsLinked to original sources
PubMed1998

Urinary incontinence among elderly persons who live at home: a literature review.

Urinary incontinence affects many older persons and is a problem with considerable physical, psychosocial and economic consequences. Urinary incontinence among elderly persons living at home often goes undetected by health care professionals. Nurses as well as other health care professionals have an important role in the development of a systematic approach for the detection of urinary incontinence and in the enhancement of the quality of incontinence care for elderly persons living at home. This article reviews aspects of epidemiology, impact on quality of life, self-care, and treatment possibilities of urinary incontinence in this cohort of elderly persons. As a result of the findings of the literature review, the role of nurses in incontinence care is discussed.

Aged↗
PubMed1995

Health care reforms: the unfinished agenda.

A number of similar trends emerge in the development of major reform programs in all Western societies: (1) convergence and divergence: whether intentionally or not, the reform programs follow the proposed general directions across countries. This convergence is challenged by an opposite trend towards divergence through regionalization; (2) politics: the interference of the political process and of government coalitions is manifest in health policy making; (3) competition: the movement away from the public integrated model towards the public contract model is occurring in National Health Service type systems as well as in Health Insurance Systems; (4) privatization: the increase of the private sector is encouraged in all European countries by a variety of mechanisms such as opting-out and tax concessions; (5) inequity: gains in efficiency entail a decrease in availability and accessibility of high quality care among the different population groups; (6) management costs: cost-containment efforts lead to an increase in management costs especially of management information both in real money and human resources; (7) power shifts: there is a reorientation of the flux of money throughout the system with shifts in authority away from the traditional power groups; and (8) public deficits: concern about the reduction of public deficits prevails over cost-effectiveness, or macro-efficiency prevails over micro-efficiency.

Economic Competition↗
PubMed1991

Long term care: the case of the elderly.

Health care for the elderly in industrialized countries has been characterized by a variety of persistent myths, nurtured by an amazing blindness for facts, and pertaining to their number, the related morbidity, the models of care, the unbearable costs and the financial situation of the elderly. Today a more optimistic perspective about the elderly is emerging emphasizing an older person with a remarkable physical and mental fitness and living in satisfying housing and income conditions. There is a less alarming prognosis about the increase of the elderly population and the share of elderly in the increase of health care budgets seems to be incremental. A wide spectrum of models of care has unfolded over Europe and the plausible explanations for the differences relate to the North-South gradient, the cultural patterns, the history of the health care system and the level of economic development. Europe is focusing on community care: in northern Europe to substitute for institutional care and in southern Europe as a response to changing family patterns. There is a danger of overshooting with policies for the aged, but more than special attention is to be given to the vulnerable risk groups which are the octogenarians, suffering from dementia and poor in housing assets.

Aged↗
PubMed1990

The policies of organ transplantation in Europe: issues and problems.

Transplantation has evolved from an experiment to a routinely performed procedure for a widening range of organs. Transplantation in Europe is dominated by the scarcity of organs from deceased donors leading to problems of selection criteria for recipients, of legal protection for donors and of the empowerment of agencies for allocative decisions. Although public involvement is very emotional, there has been a benign neglect in several European countries by policy makers, accepting implicitly organ transplantation leading to a variety of programs for diffusion, organization, and financing of transplantation. Non-transplanting hospitals play a key role in organ procurement and transplant centers are increasingly subject to quality assessment, whereby the issue of the relation between improved outcome at higher volumes comes to the forefront. International cooperation is critical for the development of effective transplant programs in Europe.

Europe↗
PubMed1984

Medical staff organization in three European multi-hospital systems: an exploratory study.

Multi-hospital systems have increased rapidly in number in recent years. This development is based primarily on hoped-for economies of scale, better access to the capital market, and more expert management. The place and the role of doctors in this process has, to judge from the literature, been passed by almost unnoticed. Is this also a case of the "benign neglect" that prevailed with respect to the medical organization when management structures were established in the separate hospitals? The present article reports on an exploratory study of the situation of doctors and the medical staff organization in three European multi-hospital systems. Two important structural elements, the strengthening of management and the medical staff organization, appear to be of fundamental importance for the determination of the place and the role of doctors in multi-hospital systems and of the way the doctors themselves experience the system. There are a number of factors that one may assume affect the situation of doctors in such systems: the process of system formation, the size of the system, the influence of the general environment, cost-consciousness of the doctors, and the force of strong personalities.

France↗