O desperdício de materiais assistenciais percebido por graduandos de enfermagem / The waste of assistance material perceived by nursing students

O estudo teve como objetivo identificar a opinião dos graduandos de enfermagem sobre o desperdício de materiais assistenciais nas atividades práticas de ensino. Estudo exploratório, descritivo com abordagem quantitativa, cuja amostra foi composta por 186 graduandos que responderam a um instrumento com assertivas medidas pela escala de Likert. Mais da metade dos graduandos acreditaram que as instituições onde realizaram estágio têm desperdício de materiais; 76% dos graduandos da quarta série (p<0,001) reconheceram desperdiçar materiais durante os estágios e 89% da mesma série (p<0,001) atribuíram o desperdício à realização de um procedimento pela primeira vez. O estudo possibilitou a discussão do desperdício de materiais durante a graduação em enfermagem, alertando sobre a importância da gestão adequada desses recursos além da responsabilidade da enfermagem com o meio ambiente e práticas sustentáveis. Os achados indicam novas possibilidades para o desenvolvimento do tema e estratégias que podem ser testadas em futuros estudos.

The study aimed to identify the opinion of nursing students about the waste of assistance materials in practical learning activities. We conducted an exploratory, descriptive study with a quantitative approach. One hundred and eighty-six students composed the sample and they answered to an instrument with affirmatives measured by a Likert-type scale. More than half of students believed that institutions where they are interns waste materials; 76% of fourth grade students (p<0.001) acknowledged to waste materials during their internships and, 89% of the same year (p<0.001) attributed waste to conducting a procedure for the first time. The study allowed the discussion about waste materials during nursing training, alerting about the importance of adequate management of these resources besides the nursing responsibility with the environment and sustainable practices.

[Economy in intensive care medicine--a contradiction?]. / Ökonomie in der Intensivmedizin--ein Widerspruch?

BACKGROUND: Medical progress and demographic changes will lead to increasing budgetary constraints in the health care system in the coming years. With respect to economic, medical, and ethical aspects, intensive care medicine has a particular role within the health system. Nonetheless, financial restriction will be inevitable in the near future. MATERIALS AND METHODS: A literature review was performed. RESULTS: In an era of economic decline accompanied by widespread recognition that healthcare costs are on a consistent upward spiral, rationalization and rationing are unavoidable. Priorization models will play a pivotal role in allocation of resources. Individual ethics (respect for autonomy, nonmaleficence, beneficence) as well as justice are essential in daily practice. CONCLUSIONS: Economic thinking and acting as well as being ethically responsible are not mutually exclusive. On the contrary, acting in an ethically responsible manner will be of considerable significance given the pressure of increasing costs in intensive care medicine.

The share of people with high medical costs increased prior to implementation of the Affordable Care Act.

The percentage of Americans with high medical cost burdens--those who spend more than 10 percent of their family income on out-of-pocket expenses for health care--increased to 19.2 percent in 2011, after having stabilized at 18.2 percent during the Great Recession of 2007-09. The increase was driven primarily by growth in premium expenses in 2009-11 for people with employer-sponsored coverage. Out-of-pocket spending on health services, especially for prescription drugs, continued to decrease between 2007-09 and 2011. Medical cost burdens were highest for income groups most likely to benefit from the Affordable Care Act's coverage expansions, including people with private insurance coverage. Those who purchased nongroup coverage before the implementation of the health insurance Marketplaces in 2014 spent an especially high proportion of their income on health care, and over half of these people will qualify for premium subsidies in the Marketplaces. Federal subsidies will substantially reduce medical cost burdens for many people who do not obtain health insurance through their employers.

Avoiding unintended incentives in ACO payment models.

One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers.

[Surgery and the zeitgeist: what happened to ethics and moral?]. / Chirurgie und Zeitgeist: Wo bleiben Ethik und Moral?

Ethical and moral topics have always been an integral part of surgery. The rapid progress of highly advanced medicine has induced public discussions about medico-ethical problems as well as respective legislation. Interdisciplinary ethical committees, appointed by political as well as professional associations, have published guidelines concerning current ethical topics. However, what about the doctor's attitude and the influence of the ever changing "Zeitgeist"? With the surplus of unproven health information on the web, modern information technologies have changed the doctor-patient relationship. Active leadership of the doctor is still required. For the benefit of the patient the physician should confront increasing economic pressures and the requirements of higher performance levels with competence. Indications have to be based on the results of valid quality controls. Special moral standards should be applied for working within the surgical community and for the pursuit of a career in academic surgery. By strengthening mutual respect and the community spirit surgery will remain attractive for aspiring young doctors.