Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden

We review and evaluate the international literature on activity-based funding of health services, focussing especially on experience in Australia (Victoria), Denmark, Norway and Sweden. In evaluating this literature we summarise the differences and pros and cons of three different funding arrangements, namely cost-based reimbursement, global budgeting and activity-based financing. The institutional structures of the four jurisdictions that are the main focus of the review are described, and an outline is provided about how activity-based funding has been introduced in each. We then turn to the mechanics of activity-based funding and discuss in detail how patients are classified, how prices are set and how other services are funded. Although concentrating on the four jurisdictions, we draw on wider international experience to inform this discussion. We review evidence of the impact of activity-based funding in the four jurisdictions on efficiency, activity rates, waiting times, quality and overall expenditure. Finally we conclude with a brief commentary of some of the challenges that would have to be faced if implementing activity-based funding.

Lääkehoidon toteuttaminen PEG-letkun kautta : Opetusvideo virtuaaliseen oppimisympäristöön

Käytännön työelämässä on kirjavia käytäntöjä lääkehoidon toteutuksessa perkutaanisen endoskooppisen gastrostooman eli PEG:n kautta. Huomasimme myös sairaanhoitajien tiedoissa olevan parantamisen varaa, joten halusimme olla mukana parantamassa lääkehoidon turvallisuutta. Opinnäytetyömme tarkoituksena oli tuottaa projektityöskentelynä laadukas opetusvideo lääkehoidon toteuttamisesta PEG-letkun kautta. Projektimme toteutettiin yhteistyössä VILHO-hankkeen kanssa ja video tulee osaksi VILHO-projektin toteuttamaa virtuaalista lääkehoidon peliä. Peli on tarkoitettu ammattikorkeakoulun käyttöön, sekä ammattihenkilökunnan täydennyskoulutukseen. Projektin suunnitteluvaiheeseen kuuluivat projektisuunnitelman ja käsikirjoituksen laatiminen. Videon kuvaukset suoritettiin oikeassa potilastilanteessa. Videon teknisestä toteutuksesta vastasi Ylivieskan ammattiopiston (YSO) kulttuurialan koulutusohjelman edustajat. Materiaalin editoimisen jälkeen tuote oli valmis testattavaksi kohderyhmällä. Projektin eri vaiheissa toteutettiin laaja-alaista yhteistyötä eri asiantuntijoiden kanssa. Projektimme tuloksena syntyi laadukas video, jota voidaan käyttää opetusmateriaalina osana virtuaalista lääkehoitopeliä. Videon avulla on helppo oppia oikea työskentelymalli. Videon laatua arvioimme esittämällä valmiin tuotoksen sekä työelämässä oleville henkilöille, että sairaanhoitajaopiskelijoille. Saamamme palautteen perusteella katsomme valmiin tuotteen olevan opetuksellisesti tarkoituksenmukainen ja täyttävän sille asetetut tavoitteet.In practical work field there is a variety of ways to give medical treatment by using the PEG-tube. We noticed that the nurses’ knowledge of PEG could be better so we wanted to participate in work that would enhance the safety of medical treatment. The purpose of our study was to produce a high-quality teaching video of how to give medication through a PEG-tube. Our project was made in co-operation with the VILHO-project. Our video will be a part of a virtual game about medical treatment that is developed by VILHO-project. The game is designed for students of universities of applied sciences or it can be used in updating education for health care professionals. The first part of our project was to plan and write a script. The video was filmed with a real patient. The students of Diploma in Audiovisual Communications, Ylivieska Vocational College (YSO), and their teacher were in charge of the technical implementation of the video. After editing the filmed material the product was ready to be tested by a test group. During the project there was co-operation with different specialists. As a result of this project we made a high-quality video which can be used as a learning material in the virtual medical treatment game. It is easy to learn the right model of working by watching the video. We estimated the quality of the video by showing the final version of it to both nurses in working life and students of nursing. On the basis of the given feedback we consider the product suitable for education and we think that it fills the goals we set for it.Opetusvideo joka on osa virtuaalista lääkehoidon peliä ( ei erikseen saatavilla

Predictors of Parental Contentment with the Amount of Encouraging Digital Feedback from Teachers in Finnish Schools

The Finnish National curriculum obligates teachers to give parents encouraging feedback about their children’s learning and development, the aim being to build a constructive relationship between homes and schools and to encourage close collaboration among all parties. Teachers in Finland nowadays use digital platforms that allow effective online communication. The frequency and quality of such communication vary a great deal. In particular, there seems to be a lack of clarity concerning the amount of encouraging feedback delivered in this way. The focus in this paper is on the extent to which Finnish parents (N = 1117) in both urban and rural areas are content with the amount of such feedback. We carried out a logistic regression analysis to predict parental contentment with the amount of encouraging messaging, with the pupil’s grade level, parental attitudes to digital communication, as well as parental educational level and gender as independent variables. In sum, parents who were less highly educated, with a neutral-to-positive attitude to digital communication and with a child in lower secondary school were most likely to be content with the amount of communication. These results have both research and practical implications in terms of enhancing the understanding of how best to deliver encouraging digital feedback between homes and schools. Furthermore, it seems that teacher education should focus on communicative competence early on. The current study completes our three-part series of studies on digital home–school communication in Finland

Introduction : Approaching the Dead

Peer reviewe

A-B-C – Shaping Alphabets with Methods of Outdoor and Multisensory Learning

In this study the development of literacy skills is connected to outdoor learning, visual arts, and the thinking skills method. The study represents design research where the teachers and the researchers actively work together pursuing for more child-centered and motivating pedagogical approaches for learning literacy. The teaching experiment described in this article consists of playing with the shapes of alphabets, creating the forms of alphabets, and trying to find those alphabets in the outdoor environment, and empathizing with imaginary characters living in the immediate surroundings of the school. The methods used in the experiment brought child-centeredness and playfulness to learning. The holistic approach encouraged children to be active and supported their achieving a range of learning goals simultaneously and effectively

Predictors of Parental Contentment with the Amount of Encouraging Digital Feedback from Teachers in Finnish Schools

The Finnish National curriculum obligates teachers to give parents encouraging feedback about their children’s learning and development, the aim being to build a constructive relationship between homes and schools and to encourage close collaboration among all parties. Teachers in Finland nowadays use digital platforms that allow effective online communication. The frequency and quality of such communication vary a great deal. In particular, there seems to be a lack of clarity concerning the amount of encouraging feedback delivered in this way. The focus in this paper is on the extent to which Finnish parents (N = 1117) in both urban and rural areas are content with the amount of such feedback. We carried out a logistic regression analysis to predict parental contentment with the amount of encouraging messaging, with the pupil’s grade level, parental attitudes to digital communication, as well as parental educational level and gender as independent variables. In sum, parents who were less highly educated, with a neutral-to-positive attitude to digital communication and with a child in lower secondary school were most likely to be content with the amount of communication. These results have both research and practical implications in terms of enhancing the understanding of how best to deliver encouraging digital feedback between homes and schools. Furthermore, it seems that teacher education should focus on communicative competence early on. The current study completes our three-part series of studies on digital home–school communication in Finland

Requirements for innovation policy in emerging high-tech industries

Peer reviewe

Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass?

Background: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux en -Y gastric bypass (RYGB). Objectives: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients. Setting: University hospital. Methods: We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016. Results: We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD. Conclusions: Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology. (C) American Society for Metabolic and Bariatric Surgery. All rights reserved.Peer reviewe