Biomedical subjects

F M LaForce

Publications and source records attributed to F M LaForce.

96 records · Page 6Linked to original sources

PubMedDate not supplied

A target-based model for increasing influenza immunizations in private practice. Genesee Hospital Medical Staff.

OBJECTIVE: To measure the impact of a population-based tracking system on influenza immunization rates. DESIGN: Thirteen practices with 45 physicians were randomized to a control and two intervention groups. SETTING: Private practices. PATIENTS: All patients aged 65 years and over who were seen in participating physicians' practices within the preceding two years. INTERVENTION: In both intervention groups influenza immunization rates for physicians were recorded weekly as cumulative percentages of their target populations, using a specially prepared poster. In addition, postcard reminders were sent to all the patients in one of the intervention groups. MEASUREMENTS AND MAIN RESULTS: Immunization rates in the two intervention groups were 30% higher than in the control group; the control group immunized 50% (2,405/4,772) of its target population, while the poster and poster/postcard groups immunized 66% (1,420/2,149) and 67% (2,427/3,604), respectively. CONCLUSION: A population-based strategy that monitors performance can significantly improve rates of influenza immunization in private practices.

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PubMedDate not supplied

Adult immunizations: are they worth the trouble?

There are good data to recommend routine use of vaccines against measles, rubella, tetanus, influenza, and pneumococcal infections in adults. An adolescent or an adult born after 1956 is considered to be susceptible to measles unless he or she has received two doses of live measles vaccine or has suffered a physician-diagnosed case of measles. Tetanus is largely a disease of the elderly, and there is a universal need for immunizations with tetanus toxoid. Influenza continues to be a major public health problem, and influenza vaccine should be given annually to the elderly and to those at high risk. The efficacy of pneumococcal vaccine in American adults is still being debated. Results from case-control studies show that the vaccine is about 60% effective in reducing the incidence of disease due to vaccine-related strains. Its use in the elderly and in those at higher risk for pneumococcal infection is recommended.

Adult↗

PubMedDate not supplied

Local anesthetics and tracheal ring ciliary activity.

The effects of local anesthetics on ciliary activity were studied using ferret tracheal rings maintained in vitro. Ciliary activity was quantitated visually after exposure to varying concentrations of mepivacaine, lidocaine, procaine, chloroprocaine, and bupivacaine. The recovery of ciliary activity was determined after tracheal rings were washed free of the local anesthetic agent. Mepivacaine was the least toxic, with no effect on ciliary activity at a 1.0% concentration. Bupivacaine was the most toxic, with irreversible damage to respiratory epithelium at a concentration of 0.13%. Lower concentrations caused ciliostasis, with some recovery after removal of the anesthetic. Licocaine, procaine, and chloroprocaine also depressed ciliary activity which, in general, was reversible after removal of the anesthetic.

Anesthesia, Local↗

PubMedDate not supplied

Impairment of tracheal ring ciliary activity by halothane.

The effects of varying concentrations of halothane on tracheal ciliary activity were studied using a ferret tracheal organ culture technique. Using 1% and 2% halothane produced no impairment of ciliary activity, while 3% halothane caused some ciliostasis; 4% and 5% halothane produced rapid cessation of ciliary activity. Recovery was prompt and complete after exposure to 4% halothane for as long as 3 days, but after 4 days of exposure recovery was incomplete and after a week of exposure death of ciliary cells occurred.

Anesthesia, Inhalation↗

PubMedDate not supplied

Pulmonary antibacterial defense mechanisms are depressed by halothane.

Pulmonary antibacterial activity was determined by challenging halothane-exposed and control mice to radiolabeled (32P) Staphylococcus aureus produced by an aerosol generator and by determining the relative changes in viable bacterial and radioisotope counts in ground lung immediately after exposure and 4 hours later. Mice that were anesthetized for 4 hours with 1 or 2 MAC halothane and allowed to recover for 1 hour showed higher 4-hour bacterial counts when compared to controls, while radioisotope counts were the same in both groups. These data indicate that 1 and 2 MAC halothane anesthesia is associated with depressed lung bactericidal activity but that physical clearance mechanisms are not depressed.

Aerosols↗

PubMedDate not supplied

A performance-based incentive program for influenza immunization in the elderly.

Our objective was to implement and evaluate performance-based reimbursement for influenza immunization of the elderly in physician offices. We performed a community-based quasi-experiment with historic and concurrent comparisons, using primary care physician offices in Monroe County, New York. Participants in the intervention group included 53 primary care physicians admitting to one hospital, and the comparison group included 82 primary care physicians admitting to other hospitals. All physicians participated in a Medicare-sponsored demonstration to increase influenza immunization rates, and, during the 1990-1991 immunization season, used a target-based poster to track immunization rates. Physicians in the intervention group were enrolled in a performance-based financial incentive program that rewarded immunization rates above 70%. A survey concerning influenza immunization practices and opinions was sent to all physicians. The average physician-specific immunization rate in the incentive group was 73.1% versus 55.7% in the comparison practices (P < .001). Eligibility for incentives, practice size, sex of physician, medical specialty, reminder postcards, and practice populations including medically indigent patients were associated with immunization level. Controlling for the above variables, we completed a regression analysis showing that eligibility for the incentive was still significant (P = .003). The survey responses were not predictive of performance or significantly different between the two groups, except for the negative influence of sending postcards. This study in a community setting suggests that linking reimbursement to performance may be a successful strategy to increase influenza immunization levels for the elderly.

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