This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis. / ADVANCED NURSING SCIENCES / D.Litt. et Phil.

Financail Accounting / D.Com. (Applied Accountancy)

Text in English / Little is known about the current practice of the nurse practising as an independent private practitioner in South Africa. There is also limited information available about his/her needs for establishing and maintaining a private practice. In this exploratory, descriptive study the AFFIRM model was applied and specific data regarding the practice and needs of the nurse in private practice was collected through a questionnaire. Based on the analysed data, it would appear that the majority of private nurse practitioners are married females and fall into the age group below 44 years. Although a variety of nursing services are offered, quality control appears to be minimal. It was found that private nurse practitioners have specific learning needs particularly regarding business management skills, quality control and current nursing practices. Recommendations were made for the maintenance of standards in private practices and the introduction of short courses for nurses in private practice. / Health Studies / M.A. (Nursing Science)

The objective of this research is to investigate the food security, food diversity and coping strategies used to access food in households in the Eastern Cape rural village of Timane in Idutywa, Eastern Cape, South Africa. A cross-sectional survey design was used in which a Coping Strategy Index questionnaire designed by Maxwell and Caldwell (2008) and a HDD questionnaire was used to gather data interviewing respondents. This study was conducted in the rural community of Timane which was divided into geographical groups from which household were randomly chosen. A total of 60 adults representing 60 selected households were interviewed to provide information on household dietary diversity. Data was collected on the socio-biographic and HHD parameters of households. Data was analyzed and presented as correlation, percentages, means and SDs. Up to 72% of household received state grants and the Spearman’s correlation between number of children and HDD score was r = 0.38 while that between number of adults in households and HDD score was r = -0.93. Food security in the Timane community largely depends on state grants and HDD increases moderately with the increase in children and decreases with the increase in adults per household. The majority of the households (72%) received state grants as a source of income within which old-age pensions constitute 28% and child grants 38%. The Spearman’s correlation coefficient between the number of children in households of respondents and CSI was 0.78 (P < 001) while that between the number of adults in households and CSIS was 0.2 (P < 001). Household in the rural community of Timane community were found to be food insecure and this gets severe with the increase in the number of children in households. / Life and Consumer Sciences / M. A. (Human Ecology)

Neste trabalho apresenta-se um procedimento de projeto para sistemas dinâmicos com não linearidades do tipo setor. Um sistema linear com incerteza estruturada é utilizado para descrever o sistema não linear, permitindo encontrar funções de Lyapunov, subconjuntos do domínio de atração e regiões invariantes do sistema não linear de forma relativamente simples. O controlador de ganho programado utiliza os estados do sistema para chavear controladores lineares robustos em subconjuntos do domínio de atração do sistema em torno do ponto de operação. O procedimento garante a estabilidade do sistema em malha fechada e reduz o conservadorismo que resulta quando uma grande região de atração é considerada. Além disto, também considera-se o problema de transição garantida entre pontos de operação, utilizando um caminho pré especificado no espaço de estado. Para o controle do sistema linear com incerteza, apresenta-se uma técnica de controle de custo garantido utilizando desigualdades de matrizes lineares. Um sistema de suspensão magnética e um sistema de bioxidação microbiana de sorbitol a sorbose são apresentados como exemplos de aplicação do controlador de ganho programado. / In this work a gain scheduling controller design procedure for dynamic systems with sector nonlinearities is given. An uncertain linear system with structured uncertainty is used to describe the nonlinear system, yielding an easy way to obtain Lyapunov functions, invariant sets and subsets of the system domain of attraction. The gain scheduling controller proposed uses the system state to switch linear robust controllers in subsets of the system domain of attraction around the operating point. The procedure guarantees the stability ofthe closed loop system and reduces the amount of conservatism that results when a large region of attraction around the operating point is considered. In addition, we also consider the problem of guaranteed transition between operating points by using a pre specified path in the state space for the system operating points. A guaranteed cost control law for uncertain linear systems using linear matrix inequalities is also presented. A magnetic suspension system and a sorbitol to sorbose microbial oxidation system are presented as applications of the gain scheduled controller.

Introdução: O atendimento nos Serviços de Emergência não está direcionado para a prevenção de agravos, como a ocorrência de úlceras por pressão (UP), visto que é centrado na manutenção da vida e na estabilização das condições hemodinâmicas dos pacientes. Contudo, há evidências de que poucas horas de permanência em leitos de observação são suficientes para o desenvolvimento de UP tornando fundamental a identificação dos pacientes de risco e a adoção precoce de medidas preventivas. Objetivo: Avaliar os custos e a eficácia da implantação de um protocolo de prevenção de UP na Unidade de Pronto Socorro Adulto (PSA) do Hospital Universitário da Universidade de São Paulo (HU-USP). Método: Trata-se de pesquisa quantitativa, exploratório-descritiva, na modalidade de estudo de caso único. Previamente a implantação do protocolo realizou-se o levantamento dos índices de prevalência e de incidência de UP. Em seguida foi desenvolvido um programa educacional teórico-prático, com ênfase na prevenção de UP, destinado à equipe de enfermagem. Três meses após a implementação do protocolo levantou-se, novamente, os índices de prevalência e de incidência de UP. Para a apuração dos custos diretos foram mapeadas as etapas relativas à aquisição de produtos, acessórios e equipamentos e levantamento dos índices de prevalência e incidência de UP antes e depois da implementação do protocolo. O salário hora/profissional foi multiplicado pelo tempo despendido em cada atividade e o custo unitário dos insumos multiplicado pela quantidade adquirida para a viabilização do protocolo. Resultados: Antes da implantação do protocolo de prevenção de UP, foi obtido o índice de prevalência de 6,67% e de incidência de 3%. Os custos diretos da implantação do protocolo totalizaram R$ 31.870,00 (100%) sendo R$ 11.650,93 (36,56%) relativos às atividades de implementação; R$ 10.102,90 (31,70%) referentes à MOD das enfermeiras que levantaram os índices de prevalência e incidência de UP antes da implantação; R$ 7.079,67 (22,21%) referentes à MOD das enfermeiras que levantaram os índices de prevalência e incidência de UP depois da implementação e R$ 3.036,50 (9,53%) para a aquisição de produtos, acessórios e equipamentos. Após a implementação evidenciou-se a diminuição nos índices de prevalência e de incidência para 0% e 1,38%, respectivamente. Conclusão: O investimento na capacitação teórico-prática dos profissionais de enfermagem e a aquisição de produtos, acessórios e equipamentos, necessários para viabilizar a exequibilidade do protocolo de prevenção, são fatores indissociáveis para o alcance de um resultado eficaz e, consequentemente, melhoria contínua da qualidade da assistência. / Introduction: The care in Emergency Services is not directed at the prevention of diseases, as the occurrence of pressure ulcers (PU), since its focus is based on the maintenance of life and stabilization of hemodynamic conditions of patients. However, there is evidence that a few hours spent in observation beds are sufficient for the development of PU, being important to identify risk patients and the early adoption of preventive measures. Objective: To evaluate the cost and effectiveness for the implementation of a PU prevention protocol in Adult Emergency Services (AES) at the University Hospital of the Universidade de São Paulo (UH-USP). Method: This is quantitative, exploratory and descriptive study, with a single case study design. Previously to the protocol implementation, a survey on the prevalence and incidence of PU was carried out. Next, theoretical and practical educational program, with emphasis on prevention of PU, was developed for the nursing staff. Three months after the protocol implementation, again, the prevalence and incidence of PU was assessed. For the calculation of direct costs, the stages related to the acquisition of products, accessories and equipment were mapped, and also a survey on the prevalence and incidence of PU before and after protocol implementation was performed. The hourly wage / professional was multiplied by the time spent on each activity and the unit cost of inputs multiplied by the amount acquired for the viability of the protocol. Results: Before the implementation of PU prevention protocol, the prevalence rate of 6.67% and incidence of 3% were obtained. The direct costs for implementing the protocol amounted to R $ 31.870.00 (100%) being R $ 11.650,93 (36.56%) regarding the implementation of activities; R $ 10.102,90 (31.70%) for the MOD of nurses who raised the prevalence and incidence of UP rate before implementation; R $ 7.079,67 (22.21%) for the MOD of nurses who raised the prevalence and incidence of UP rates after implantation and R $ 3.036,50 (9.53%) for the acquisition of products, accessories and equipment. After implantation it was observed a decrease in prevalence and incidence rates to 0% and 1.38% respectively. Conclusion: Investment in theory and practice training for nurses and the acquisition of products, accessories and equipment necessary to enable the feasibility of the prevention protocol, are factors inextricably linked to achieving an effectively outcome and consequently improving continuous quality of care.

by Lee Sui-Hing Rean, Yip Chui-Ling. / Thesis (M.B.A.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 50-52). / ABSTRACT --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF FIGURES --- p.vi / LIST OF TABLES --- p.vii / ACKNOWLEDGEMENTS --- p.ix / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Research Objectives --- p.3 / Significance of Study --- p.3 / Chapter II. --- LITERATURE REVIEW --- p.5 / Chapter III. --- HYPOTHESES --- p.10 / Chapter IV. --- RESEARCH METHODOLOGY --- p.11 / Research Design --- p.11 / Data Collection Methods --- p.11 / Secondary data --- p.11 / Primary data --- p.12 / Sampling Methods --- p.13 / Sample Characteristics --- p.14 / Data Analysis Method --- p.15 / Chapter V. --- RESULTS --- p.16 / Common Cost-Cutting Measures Adopted by Hong Kong Companies --- p.16 / Communication Between Employers and Employees --- p.16 / Employees' Attitude Towards Cost-Cutting Measures --- p.17 / Relationship Between Employers and Employees --- p.18 / Effects of Cost-Cutting Measures --- p.18 / Staff Morale --- p.18 / Stress at Workplace --- p.19 / Job Security --- p.19 / Work Passion --- p.20 / Popular Remedial Measures Taken by Employers and Their Effectiveness --- p.20 / Willingness to Stay at the Company in the Coming Two Years and the Reasons --- p.22 / Chapter VI. --- ANALYSES AND IMPLICATIONS --- p.23 / Hypothesis 1: Cost-Cutting Measures Negatively Affect Employer-Employee Relationship --- p.23 / Implications --- p.23 / Company Size --- p.25 / Demographic Factors --- p.26 / Hypothesis 2: Cost-Cutting Measures Have Negative Psychological Effect(s) on Employees --- p.27 / Hypothesis 2a: Cost-Cutting Measures Reduce Staff Morale --- p.27 / Hypothesis 2b: Cost-Cutting Measures Increase Job Stress --- p.27 / Hypothesis 2c: Cost-Cutting Measures Decrease Job Security --- p.28 / Hypothesis 2d: Cost-Cutting Measures Decrease Work Passion --- p.28 / Implications --- p.29 / Effects of Different Cost-Cutting Measures --- p.29 / Company Size --- p.31 / Hypothesis 3: Employers are Concerned About the Post-Effect(s) of Cost-Cutting Measures on Employees --- p.32 / Implications --- p.32 / Employers' Attitude to Different Post-Effects --- p.32 / Company Size --- p.34 / Hypothesis 4: Remedial Measures Done by Employers can Effectively Reduce the Negative Effects on Employees --- p.35 / Implications --- p.35 / Other Implications From the Survey --- p.37 / Reasons to Stay in Current Companies --- p.37 / Demographic Factors and Intention to Stay --- p.38 / Importance of Communication --- p.39 / Chapter VII. --- LIMITATIONS --- p.42 / Chapter VIII. --- CONCLUSIONS AND RECOMMENDATIONS --- p.44 / APPENDIX I --- p.46 / APPENDIX II --- p.49 / BIBLIOGRAPHY --- p.50

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.

University of Macau / Institute of Chinese Medical Sciences

No description available.