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Europe has taken legislative measures to improve the management of packaging and packaging waste. This article outlines the arguments for excluding medical device packaging from the provisions of the recently published European Directive on packaging and packaging waste. Developments in a new barrier test method and further increases in the price of raw materials are also discussed.
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Disease management has been described as a comprehensive, integrated approach to care and reimbursement based on the natural course of a disease. It requires a management approach which brings together research evidence, best practice and inter-professional and inter-agency working. Starting with the ideal of continuity of care for individual patients, it implies structured co-ordination of care over time and across primary, secondary and tertiary settings. The appeal of disease management is that it promises reduced costs, combined with increased quality of care and patient satisfaction. But the concept is open to different definitions and interpretations and its effectiveness in improving UK healthcare is still largely untested. This Health Management Guide removes the mystique behind disease management and puts it in the context of existing knowledge and practice. Treating it as a concept, rather than a specific technique, it distinguishes between its different potential applications, offers practical guidance on implementation, and reports on how NHS organisations are taking it forward.
Part I of this series described a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a clear picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the process and the failure to clearly establish and maintain consensual goals. In Part 2, the consultation process is explored from a very different perspective. What are the issues that often trigger requests for consultation services, as well as the dynamics that can foreshadow success or failure before consultants are even engaged? What are the pitfalls and pointers for the successful use of consultation services?
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Extracorporeal immunoadsorption onto staphylococcal protein A replaces conventional plasmapheresis because its elimination efficiency is higher while less adverse reactions are seen. Experience in immunoadsorption is limited to specialized centers although recent technical developments make the procedure simple and safe to use. During a workshop held in Munich, September 1996, the application of immunoadsorption in various diseases was discussed. Goodpasture's syndrome, acquired autoimmune coagulopathy, HLA-sensitized transplantation and treatment-resistant life-threatening autoimmune diseases were accepted indications for immunoadsorption. Immunoadsorption in other immunoglobuline and immune complex mediated diseases is still under discussion.
This article is the first of a two-part series focusing on clinical consolidation in mergers. While the frequency of hospital mergers is growing at tremendous rates, the actual consolidation of services following mergers is slow. This article will explain why, despite the enormous benefits that can be achieved, clinical consolidation is not tackled. Finally, the resources and key issues for successful clinical consolidation will be shared. Part 2 of this article, which follows in the next issue, will focus on the structure and process for successful clinical consolidation.
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Key to purchasing any picture archiving and communications system (PACS) is the generation of a request for proposal (RFP), which defines the system's requirements. An RFP is not difficult to create and, in fact, one can follow simple rules such as outlined in Robert Fulghum's book, All I Really Need to Know, I Learned in Kindergarten. "Take time to look" is the first rule--don't jump into new adventures. Instead, start with a mission statement and clear objectives. Define the stakeholders and assemble the team. "Share everything" is the second rule to follow. This includes information, objectives and definitions of the problem. You'll want to define your specifications. What are the component requirements? How will you integrate information systems at your facility? What about performance--how is it defined and what is expected? Warm cookies and cold milk--or common sense--is another rule, particularly around issues that may seem obvious such as training and service. Who is going to do it, and what is required? "Watch out for traffic and hold hands." This rule, as applied to PACS and an RFP, means stick together. Create a partnership with your vendors. Talk to as many vendors and other users as possible. Last, "be aware of wonder." Fulghum's Rule, as applied here, means performance will speak for itself, particularly when there is significant improvement in the service you provide to your users.
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Guidelines for the management of obesity include recommendation about diet, exercise, behavioral modification, drug therapy and bariatric surgery in the comprehensive management of an obese patient. It is emphasized that the treatment of obesity should be individually tailored according to the age of the patient, degree and phase of obesity, body fat distribution and an expression of risk factors and comorbidities. The new realistic goals in obesity management do not focus on the weight loss per se but mainly on the risk factors reduction which accompanies even modest weight loss. The system of obesity management introduced in the Czech Republic includes obesity management centres attached to major teaching hospitals, obesity out-patient clinics (led by an obesity specialist), primary care physicians and weight reduction clubs. Postgraduate training in obesity management should be recognized by health authorities as a function specialty. A time demanding therapeutic strategy in obesity management should be taken into account by both health policy makers and health insurance companies.
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