The effects of a monetary reward and self-monitoring on reducing interdialytic weight gain (IWG) were compared for 6 hemodialysis patients in an outpatient setting. A single-subject experimental design (A-B-BC-B-BC) was used to examine each variable individually and in combination, with alternating phases to control for possible sequencing effects. Monetary reward (50 cents - $3) was administered in a titrated manner according to standardized criteria, ranging from 3 % and 4% of patients' dry weight on weekdays and weekends, respectively, to 3.5% and 4.5% for weekdays and weekends. Self-monitoring involved recording daily fluid and diet intake. Results indicated that by the end of the treatment program, the 6 participants averaged a 14% reduction in weekday IWG and a 15.45% reduction in weekend IWG; however, due to significant variability, it cannot be concluded that the reductions are treatment effects. Four out of 6 participants reduced their average IWG for both weekends and weekdays by .75 kg (1.65 lb.). The average weekend reduction for these 4 participants was .85 kg (1.87 lbs.) while the average weekday reduction was .65 kg (1.43 lb.). All 6 participants showed reductions in weekday IWG that averaged .53 kg (1.17 lb.). However, only 2 participants demonstrated IWG reductions that could be attributable to either of the 2 treatment variables. The standardized dry weight criterion for assessing fluid adherence may have posed excessively stringent demands on participants, as only 1 of the 6 participants actually met the criterion. Future research should address the role of nonspecific treatment factors, as well as patient characteristics and responsivity to particular treatment components in an effort to identify those factors responsible for behavior change in this population.

M.A. / Modern health-care services in general hospital settings are often characterised by mUltidisciplinary and interdisciplinary approaches to patient care. The underlying rationale of these approaches lies in the potential pooling of specialised medical resources from a variety of medical fields. Consequently there is usually an increase in the diagnostic procedures available, theoretically offering a more comprehensive health service. Whilst the above approach is seen to be effective when the health-car~ team specialists subscribe to one encompassing paradigm, it is hypothesised that the existence of other alternative paradigms may affect the efficacy of team work. Using the interface between the Psychology and Renal units of J.G. Strijdom Hospital as an example, this study describes the effect of paradigmatic differences within a team approach on the conceptualisation of problems and treatment choices. The traditional medical approach is contrasted against a systems based psychological approach. The existence of the two approaches within a single team encounters difficulty in the gaining of consensus regarding the level of focus.