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Biomedical subjects

K W Kizer

Publications and source records attributed to K W Kizer.

143 records · Page 8Linked to original sources
PubMed1980

Ventricular dysrhythmia associated with serious decompression sickness.

A case of serious decompression sickness complicated by frequent, unifocal, premature ventricular contractions (PVC) is presented. Although no cardiac monitoring was available, a continuous lidocaine infusion was used during recompression treatment to treat the PVCs, and it appeared to produce no untoward side effects. The concerns about using lidocaine in the dysbaric patient subjected to a hyperbaric oxygen environment are discussed.

Adult↗
PubMed1980

Medical hazards of the water skiing douche.

Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices. A case of otitis media attributed to this phenomenon is described. The hazards of vaginal and rectal laceration, salpingitis, tubo-ovarian abscess with resultant infertility, induced abortion, and associated complications are reviewed. In addition to sinusitis, otitis media and tympanic membrane rupture, other potential upper airway and auditory complications are enumerated.

Adult↗
PubMed1979

Epidemiologic and clinical aspects of animal bite injuries.

During 1975, 332 animal bite injuries accounted for 1.2% of all surgical problems treated at the UCLA Hospital Emergency Department. Data on 307 bite injuries were available and analyzed for environmental, animal, human, interaction, and clinical factors. More than half of the dog bites and almost three fourths of the cat bites-scratches happened at or near the victims' homes. Dog bites were almost twice as common among men, while cat bites-scratches were twice as common among women. Of the incidents in which ownership information was available, 85% of dog bites and 80% of cat bites-scratches were from an animal belonging to the victim, his family or friends, or another known person. Forty-three percent of dog bites, and 52% of cat bites-scratches were provoked, that is, happened while the victim was interacting with the animal. Of bites of the head and/or neck, 38% injured the upper lip; 17% of dog bites injured the eye or adjacent tissues; 48% were in children less than ten-years-old. On fifth of cat bites-scratches involved the head and/or neck, 60% of these injured orbital or periorbital tissues. Over 2% of patients were hospitalized. Five percent of dog bite victims and 29% of cat bite-scratch victims returned with complications, mostly cellulitis or lymphangitis. Pasteurella multocida was the most common pathogen cultured, as evidenced by the 50% and 80% culture-positive rates for dog and cat bite-scratches respectively in this series.

Adolescent↗
PubMedDate not supplied

Pesticide food poisoning from contaminated watermelons in California, 1985.

Aldicarb, a carbamate pesticide, is the most potent pesticide in the market and has a LD50 of 1 mg/kg. In the United States it is illegal to use aldicarb on certain crops, e.g., watermelons, because it is incorporated into the flesh of the fruit. Once an accidental or illegal use of such a potent pesticide occurs, there is no easy way for the agricultural or public health system to protect the populace. This paper describes the impact of one such event upon the health of individuals and the institutions of California. On July 4, 1985, California and other western states experienced the largest known outbreak of food-borne pesticide illness ever to occur in North America. This was attributed to watermelons contaminated through the illegal or accidental use of aldicarb by a few farmers in one part of the state. Within California, a total of 1,376 illnesses resulting from consumption of watermelons was reported to the California Department of Health Services (CDHS). Of the 1,376 illnesses, 77% were classified as being probable or possible carbamate illnesses. Many of the case reports involved multiple illnesses associated with the same melon among unrelated individuals. Seventeen individuals required hospitalization. There were 47 reports of illness involving pregnant women, two of whom reported having subsequent stillbirths. Thirty-five of the remaining pregnant women were followed-up 9 mo after the epidemic; no additional stillbirths were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Kenneth W. Kizer on a national quality strategy. Interview by Lori Blades and Patricia A. Cholewka.

Kenneth W. Kizer, MD MPH, is president and chief executive officer (CEO) of the National Forum for Health Care Quality Measurement and Reporting (National Quality Forum [NQF]), a not-for-profit membership organization created to develop and implement a national strategy for measuring and reporting healthcare quality. Dr. Kizer previously served as Under Secretary for Health in the U.S. Department of Veterans Affairs (VA) and is widely credited as being the chief architect of and driving force behind the greatest transformation of VA healthcare since its creation in 1946. NQF is a public-private partnership designed to involve all segments of the nation's healthcare system. The organization was proposed as part of the findings of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). Since the release of those findings, leaders from consumer, purchaser, provider, health plan, and health services research organizations, as well as from government, have met to define the mission, structure, and financing of NQF, and staff support has been provided by the United Hospital Fund of New York. NQF is primarily a membership dues- and grant-financed organization and has received significant public and private funding from foundation and corporate grants, including a $2.5-million founding grant from the Robert-Wood Johnson Foundation and a $1-million founding grant from the California Healthcare Foundation. NQF also received initial financial support from The Commonwealth Fund and United Hospital Fund.

Hospitals, Veterans↗
PubMedDate not supplied

Pulmonary air leaks resulting from outdoor sports. A clinical series and literature review.

The occurrence of pulmonary air leaks consequent to recreational sports is considered to be rare. We performed a retrospective records review for cases of pulmonary air leaks for the 5-year period 1993 to 1997 at a community hospital that serves a popular tourist destination area having intense year-round outdoor recreational activities. We identified 20 patients who had sustained a spontaneous or traumatic pulmonary air leak while engaged in an outdoor sport. All but one case (95%) were due to blunt chest trauma. A total of nine different sports were involved, but the majority of cases (11, or 55%) occurred during skiing or snowboarding. Three (15%) patients died. Nine (53%) of the surviving 17 patients sustained injuries serious enough to require hospitalization for tube thoracostomy and other trauma care. We concluded that pulmonary air leaks due to blunt chest trauma occur more frequently in outdoor sports than the literature suggests.

Adolescent↗
PubMedDate not supplied

The "new VA": a national laboratory for health care quality management.

In 1995, the Veterans Health Administration (VHA) initiated the most radical redesign of the veterans health care system since the system was formally created in 1946. One of the goals of this reengineering effort has been to ensure the consistent and predictable provision of high-quality care everywhere in the system. To accomplish this goal, the VHA has organized more than 100 different quality improvement activities according to a structure-, process-, and outcomes-focused quality management accountability framework (QMAF) that targets 10 interrelated dimensions of quality management (QM). Each of these dimensions utilizes a defined strategy and employs a menu of quality assessment and assurance tactics. Organizing these many different quality improvement activities into an accountability framework should facilitate the development of policies and procedures that will systematize the VHA's QM. The VHA's new operational structure and its approach to quality improvement provide a unique national laboratory for health care QM.

History, 17th Century↗
PubMedDate not supplied

The VA health care system: an unrecognized national safety net.

The dominance of local health care markets in conjunction with variable public funding results in a national patchwork of "safety nets" and beneficiaries in the United States rather than a uniform system. This DataWatch describes how the recently reorganized Department of Veterans Affairs serves as a coordinated, national safety-net provider and characterizes the veterans who are not supported by the market-based system.

Cost-Benefit Analysis↗
PubMedDate not supplied

Marine envenomations.

As man takes increasing advantage of the waters of the world for recreational, commercial and scientific purposes, the hazards of human contact with inhabitants must be appreciated. Many invertebrate and vertebrate animal species have developed natural defense mechanisms, some of which involve envenomation, with a few species posing the threat of serious injury or death. This paper discusses the more common and more serious marine envenomations encountered worldwide, including toxicology of the associated venoms and a discussion of current treatment recommendations.

Animals↗
PubMedDate not supplied

Lessons learned in public health emergency management: personal reflections.

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs); 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics. This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated. The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.

Communication↗
PubMedDate not supplied

Quality assessment in worksite health promotion.

The rapid expansion of worksite health promotion programs and the proliferation of service providers have resulted in increased concern about the quality of such programs. And while employers may view health promotion programs as a service to be purchased, in general, quality standards, price, and outcomes are less well established for primary prevention programs than for other medical services. This trend creates substantial potential for inappropriate expenditures, undermining the general credibility of such programs. Recognizing the limits of epidemiologic data and the potential for misuse of health promotion activities in the workplace, the California Department of Health Services (CDHS) undertook the development of guidelines for employers' use in assessing the quality of the numerous employee health promotion or chronic disease risk reduction programs available to them. To make the use of such programs as productive as possible, the CDHS developed recommendations in two main areas: (1) general recommendations for six fundamental program planning and development activities that underlie sound health promotion programs, and (2) specific criteria for seven types of health promotion programs commonly implemented in work settings. Optimally, worksite-based health promotion programs should be part of a comprehensive effort that provides for appropriate medical oversight, referral, and follow-up procedures. These programs should be complemented by appropriate changes in the work environment and in organizational policies. Programs should also include strategies to assist employees in initiating healthier behaviors and maintaining the new behaviors once they are established. Preventive medicine and occupational medicine practitioners and medical directors should be familiar with the issues addressed by these recommendations.

California↗
PubMedDate not supplied

Guidelines for community-based screening for chronic health conditions.

Preventive measures for many chronic diseases depend upon identification of asymptomatic individuals who have the disease or who may be at risk for developing it. A screening biochemical test can identify such individuals. Mass screening for biochemical markers or risk factors for chronic conditions, especially for elevated serum cholesterol and blood glucose, has been advocated in recent years and has become increasingly common in various nonmedical community settings. Although generally well intentioned, such programs may fall short of their goals and may even be counterproductive. In recognition of the use of biochemical screening in nonmedical community settings, and in an attempt to make such efforts as productive as possible, the California Department of Health Services (CDHS) has developed state guidelines for these screening programs. These guidelines make recommendations regarding: (1) the criteria for judging the effectiveness of biochemical screening tests; (2) the qualifications and training of screening program staff; (3) the proper use and maintenance of equipment used in screening programs and other quality control measures; (4) referral procedures for persons with abnormal test results; and (5) the lawful implementation of screening programs. Optimally, as pointed out by these guidelines, all community-based screening programs should complement a larger health education or risk-reduction program that guarantees appropriate medical follow-up and management. Preventive medicine practitioners and organizations embarking on such activities should be familiar with the issues addressed by these guidelines and may find adherence to them useful in developing effective community screening programs.

California↗
PubMedDate not supplied

California's "5 a day--for better health!" campaign: an innovative population-based effort to effect large-scale dietary change.

The annual toll of diet-related diseases in the United States is similar to that taken by tobacco, but less progress has been achieved in reaching the Public Health Service's Healthy People 2000 objectives for improving food consumption than for reducing tobacco use. In 1988, the California Department of Health Services embarked upon an innovative multi-year social marketing program to increase fruit and vegetable consumption. The 5 a Day--for Better Health! Campaign had several distinctive features, including its simple, positive, behavior-specific message to eat 5 servings of fruits and vegetables every day as part of a low-fat, high fiber diet; its use of mass media; its partnership between the state health department and the produce and supermarket industries; and its extensive use of point-of-purchase messages. Over its nearly three years of operation in California, the 5 a Day Campaign appears to have raised public awareness that fruits and vegetables help reduce cancer risk, increased fruit and vegetable consumption in major population segments, and created an ongoing partnership between public health and agribusiness that has allowed extension of the campaign to other population segments, namely children and Latino adults. In 1991 the campaign was adopted as a national initiative by the National Cancer Institute and the Produce for Better Health Foundation. By 1994, over 700 industry organizations and 48 states, territories, and the District of Columbia were licensed to participate. Preventive medicine practitioners and others involved in health promotion may build upon the 5 a Day Campaign experience in developing and implementing efforts to reach the nation's dietary goals.

California↗
PubMedDate not supplied

Internal practice barriers for non-physician practitioners in the veterans healthcare system.

As a consequence of the re-engineering of the veterans healthcare system initiated in 1995, non-physician clinicians are functioning with new levels of autonomy and expanded scopes of practice, but they are not consistently being utilized to their optimal potential. A work group appointed by the Under Secretary of Health in 1996 found various barriers to improving this situation: 1) lack of clarity regarding the roles of the non-physician clinicians; 2) lack of understanding of the basis of their credentialing; 3) lack of uniformity of their credentials; 4) non-acceptance by physicians and managers; 5) rigidity of administrative policies; and 6) salary, benefit, and career-advancement issues. The authors recommend ongoing management attention to addressing these barriers both within and outside the VHA system.

Allied Health Personnel↗