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Biomedical subjects

G Franklin

Publications and source records attributed to G Franklin.

At least 37 records · Page 2Linked to original sources
PubMed1999

Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project II: medical and disability costs.

OBJECTIVES: This study examined the effect of managed care on medical and disability costs as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot (MCP). METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: experience- rated capitation and a primary occupational medicine delivery network. The FFS control group included injured workers employed at 392 firms (12,000 employees). Medical and disability costs were compared for 1,058 injuries in the managed care group and 1,159 injuries in the FFS group occurring between April 1995 and June 1996. Univariate and multivariate statistical methods were used to analyze the effects of managed care on medical and disability costs. RESULTS: The mean unadjusted medical cost per injury ($587) for the managed care group was 21.5% lower (P = 0.06) than for the FFS group ($748). Adjustment for differences in worker and firm-level characteristics through multivariate analysis had little effect on the unadjusted results, except that the difference in costs between managed care and FFS groups became statistically significant (P<0.01). The major cost differences were for outpatient surgery (cost per surgery) and ancillary services (pharmacy, x-ray, physical therapy, and all other costs). In addition, disability costs, particularly percent on time loss and time-loss cost per injury, were significantly lower (P<0.01) in the managed care group. CONCLUSIONS: The results from the MCP suggest that substantial savings in workers' compensation medical and disability costs may be realized using the type of managed care intervention designed for this study. Delivering occupational health services through managed care arrangements whose design is based on an integrated, occupational health-centered delivery model may offer a viable approach for improving delivery systems, reducing costs and encouraging greater attention to disability prevention.

Adult↗
PubMed1999

Controlling workers' compensation medical care use and costs through utilization management.

Little is known about the performance of utilization management (UM) programs, which are now widely used within the workers' compensation system to contain medical costs and improve quality. UM programs focus largely on hospital care and rely on preadmission and concurrent reviews to authorize hospital admissions and continued stays. We obtained data from a large UM program representing a national sample of 9319 workers' compensation patients whose medical care was reviewed between 1991 and 1993. We analyzed these data to determine the denial rate for hospital admission and outpatient surgery and the frequency of length-of-stay restrictions among hospitalized patients. The denial rate was approximately 2% to 3% overall, but many of the denials were later reversed. On average, the UM program reduced the length of stay by 1.9 days relative to the number of days of care requested. The estimated gross cost savings resulting from reduced hospitalization time and decreased outpatient care was approximately $5 million. UM programs may offer a viable approach to cost containment within the workers' compensation system. Their value as a tool to improve the quality of care for workers' compensation patients remains to be demonstrated.

Adult↗
PubMed1999

A potpourri of parasitic infestations.

Ectoparasitic infestations are common cutaneous problems. The vast majority of these are attributable to scabies and pediculosis. While these are usually readily recognizable, infestations caused by other ectoparasites, such as nonscabetic mites, may pose difficulty in diagnosis. In this article, we present a variety of ectoparasitic infestations that initially eluded diagnosis and review the gamut of ectoparasites that can cause eruptions in the skin.

Aged↗
PubMed1998

The H19 transcript is associated with polysomes and may regulate IGF2 expression in trans.

The imprinted H19 gene produces a fully processed transcript that does not exhibit any conserved open reading frame between mouse and man. Although transcriptional control elements associated with the mouse H19 locus have been shown to control the neighboring Igf2 gene in cis, the prevailing view is that the cytoplasmic H19 transcript does not display any function. In contrast to earlier reports, we show here that the H19 transcript is associated with polysomes in a variety of cell types, in both mouse and man. A possible trans-function of the H19 gene is suggested by a reciprocal correlation in trans between cytoplasmic H19 and IGF2 mRNA levels, as well as IGF2 mRNA translatability. We discuss these results in terms of their challenge to the prevailing dogma on the function of the enigmatic H19 gene, as well as with respect to the ontogeny of the Beckwith-Wiedemann syndrome, and propose that the human H19 gene is an antagonist of IGF2 expressivity in trans.

Animals↗
PubMed1998

The limited state of technology assessment for medical devices: facing the issues.

Medical devices are an integral part of clinical practice and account for a substantial proportion of the national health budget. Clinical testing and regulation of medical devices, however, is vastly different from and inferior to the testing and regulation of drugs. As managed care organizations begin to exert controls on device use, providers are being caught between the policies of their organizations and the demands of device manufacturers and patients, who want wider access to devices. We outline several reasons for the poor state of medical device evaluations and the dangers of using devices without adequate information, and include the recently developed device assessment and reporting guidelines created by the Task Force on Technology Assessment of Medical Devices.

Device Approval↗
PubMed1998

Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.

Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status.

Carpal Tunnel Syndrome↗
PubMed1997

Reliability and validity of medical outcome and patient satisfaction measures among injured workers in Washington State: a pretest.

Several existing measures of medical outcomes and some newly constructed measures of patient satisfaction were tested for reliability and validity on a sample of 100 subjects who had suffered work-related injuries and illnesses in Washington State. Included in the measures of medical outcome were the SF-36 and the upper body mobility subscale of the Health Assessment Questionnaire. The newly constructed measures of patient satisfaction assessed areas such as satisfaction with the attending physician and with access to referrals. Also administered were assessments of job satisfaction, both prior to and since the injury, and a measure of chance health locus of control. The patient satisfaction and medical outcomes measures demonstrated good reliability and validity for use with this population. However, neither the measures of job satisfaction nor chance health locus of control were related to either patient satisfaction with medical care nor to medical outcomes.

Accidents, Occupational↗
PubMed1997

Surveillance of nasal and bladder cancer to locate sources of exposure to occupational carcinogens.

OBJECTIVE: To locate sources of occupational exposure to nasal and bladder carcinogens for surveillance follow up in British Columbia, Canada. METHODS: Incident cases of nasal cancer (n = 48), bladder cancer (n = 105), and population based controls (n = 159) matched for sex and age, were interviewed about their jobs, exposures, and smoking histories. Odds ratios (ORs) were calculated for 57 occupational groups with stratified exact methods to control for age, sex, and smoking. RESULTS: Occupational groups at increased risk of nasal cancer included: textile workers (six cases, OR 7.6); miners, drillers, and blasters (six cases, OR 3.5); welders (two cases, OR 3.5); pulp and paper workers (three cases, OR 3.1); and plumbers and pipefitters (two cases, OR 3.0). Nasal cancer ORs were not increased in occupations exposed to wood dust, possibly due to low exposures in local wood industries. Strongly increased risks of bladder cancer were found for sheet metal workers (four cases, OR 5.3), miners (19 cases, OR 4.5), gardeners (six cases, OR 3.7), and hairdressers (three cases, OR 3.2). Among occupations originally considered at risk, the following had increased risks of bladder cancer: painters (four cases, OR 2.8); laundry workers (five cases, OR 2.3); chemical and petroleum workers (15 cases, OR 1.8); machinists (eight cases, OR 1.6); and textile workers (three cases, OR 1.5). CONCLUSIONS: Occupational groups with increased risks and three or more cases with similar duties were selected for surveillance follow up. For nasal cancer, these included textile workers (five were garment makers) and pulp and paper workers (three performed maintenance tasks likely to entail stainless steel welding). For bladder cancer, these included miners (12 worked underground), machinists (five worked in traditional machining), hairdressers (three had applied hair dyes), and laundry workers (three were drycleaners).

Aged↗
PubMed1995

Normal development and neoplasia: the imprinting connection.

The observation that a number of autosomal genes are expressed in a parent of origin-dependent monoallelic manner has fuelled a frantic research effort into the underlying mechanisms and biological functions of this phenomenon, termed genomic or parental imprinting. The level of intrigue associated with this subject has been heightened by the discovery that the "transcriptional phenotype" of some imprinted genes shows developmental and tissue-specific variation, and that some imprinted genes are expressed biallelically in tumors. Here we describe some further examples of variation in the allele-specific transcription of an imprinted gene, human IGF2. Analysis of different sub-clones of an established tumor cell line (Jeg-3) revealed examples of both a switch from monoallelic to biallelic expression, as well as monoallelic expression from the opposite parental allele. Examination of IGF2 expression in adult human liver clearly demonstrated that the functional imprinting is manifested in a promoter-specific manner. The P1 promoter produced biallelically derived transcripts, whereas the remaining three promoters were utilized in a complex pattern of mono- and biallelic expression which varied from sample to sample. These observations emphasize the need to re-examine the imprinting phenomenon and its plasticity in terms of the cis elements and trans-acting factors involved in the transcriptional regulation of these genes both in the normal and pathological contexts.

Adult↗
PubMed1994

Factors influencing the duration of work-related disability: a population-based study of Washington State workers' compensation.

OBJECTIVES: The purpose of this study was to examine factors predictive of duration of work-related disability. METHODS: Multivariate survival analysis techniques were used to conduct a population-based, retrospective cohort study on a random sample of 28,473 workers' compensation claims from Washington State filed for injuries occurring in 1987 to 1989. The principal outcome measure was length of time for which compensation for lost wages was paid, used as a surrogate for duration of temporary total disability. RESULTS: The findings suggest that, even after adjusting for severity of injury, older age, female gender, and a diagnosis of carpal tunnel syndrome or back/neck sprain significantly predict longer duration of disability. Other predictors that were stable and significant, but involved lower magnitudes of effect included divorced marital status, firm size of fewer than 50 employees, higher country unemployment rates, and construction and agricultural work. CONCLUSIONS: Greater disability prevention efforts targeting these higher risk subgroups could have significant economic and public health effects. The greatest impact may be on claimants who remain disabled at 6 months after an injury that did not require hospitalization.

Actuarial Analysis↗
PubMed1994

Dual therapy: personality change in the therapist while working with patients.

This paper promotes a recognition that it is often necessary for therapists to engage in an extended therapeutic process of working on their own personality difficulties which arise in the course of treating various patients in order to help them more effectively. Although gradually it has become increasingly accepted that countertransferences frequently occur in the work of all therapists, such impediments to the therapeutic process almost inevitably have been considered to be overcome as soon as the therapist becomes aware of them. The focus of this paper is not on countertransference per se, about which much has already been written. Rather, it emphasizes the necessity for two parallel therapeutic processes which I have termed "dual therapy" in order to facilitate the benefits of psychotherapy.

Adult↗
PubMed1992

Occupational injuries among minors doing farm work in Washington State: 1986 to 1989.

BACKGROUND: There is growing evidence that many children are injured while engaged in agricultural work. However, little specific information on farm work-related injuries among minors is available, probably because employment or workers' compensation data for children are hard to obtain. METHODS: Workers' compensation data were used to evaluate occupational injuries among children in Washington State from 1986 through 1989. The frequency and severity of injuries among minors doing farm work were compared with the distributions of injuries among minors working in food service and all other occupations by year of injury, age of injury, and month and hour of injury. RESULTS: A total of 16,481 claims filed by children under age 18 were evaluated. Although farm workers accounted for only 7% of all claims, they made up 36% of claims filed by children under age 14, and 17% of claims filed by children aged 14 or 15. Injuries classified as serious accounted for 26% of farm worker claims compared with only 16% of all claims filed by children. CONCLUSIONS: Although injury rates could not be developed owing to the lack of denominator data, this study demonstrates that farm work is dangerous for young children.

Accidents, Occupational↗