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PubMedDate not supplied

Consumer-directed services at home: a new model for persons with disabilities.

The past decade has produced a wave of new state programs that have introduced consumer direction into home-based services for persons with chronic impairments. Building upon earlier models developed for younger adults with physical disabilities, consumer-directed models are now being adapted to recipients of all ages with federal, state, and foundation support. These models shift responsibility for key service decisions from professionals to recipients and challenge the traditional home care agency model. Research evidence on the impact of consumer direction is just becoming available to policymakers. This paper reviews what we have learned from program and research activity so far, and what key issues and challenges remain.

Case Management↗
PubMed2006

Pharmaceutical marketing practices: balancing public health and law enforcement interests; moving beyond regulation-through-litigation.

Fraudulent or abusive sales and marketing practices by pharmaceutical companies can result in costly overutilization of products that are increasingly paid for by government healthcare programs and may result in adverse health and safety consequences to the patient-beneficiaries of those programs. Federal enforcement efforts in this area are largely modeled on those used to combat white-collar crime, with cases taking years to reach conclusion. This approach overlooks the impact on patients who receive unnecessary care or are denied access to appropriate care during the course of the investigation. Many states are beginning to regulate certain pharmaceutical sales and marketing practices, but state-by-state regulation ignores the importance of a uniform federal regulatory and enforcement approach in an area already occupied by federal law. This Article explores current federal and state efforts to limit overutilization, fraud, and abuse in the sale and marketing of prescription drugs, and illustrates the merits of an expanded role for the U.S. Food and Drug Administration (FDA) to regulate pharmaceutical sales and marketing practices. This approach borrows lessons learned from the FDA's efficient and effective regulatory and enforcement methods and maintains a careful balance between the interests of patient-beneficiaries, the government and industry.

Drug Industry↗
PubMedDate not supplied

[Clinical correlation of hypnagogic hypersynchrony during sleep in normal children and those with learning disability].

INTRODUCTION: One of the electroencephalographic (EEG) patterns that can be mistaken for paroxysmal clinical activity, when not taken into account and especially in children, is hypnagogic hypersynchrony (HH). This consists in generalised, paroxysmal, synchronic, symmetrical, slow, high voltage waves lasting 2 8 seconds, which appear in drowsiness and in stage I. It was observed that this pattern often appeared in children with learning disability (LD). AIMS. To correlate clinical data with the presence of HH during sleep in normal children and those with LD. PATIENTS AND METHODS: We assessed 180 children between the ages of 6 12 years with normal neurological development, 130 of which suffered LD and 50 who did not have LD. EEG was performed with sleep deprivation, following the International Federation of Clinical Neurophysiology guidelines. RESULTS: The presence or absence of HH, together with its characteristics, was assessed. Of the children with LD, 35.38% displayed HH and of the children without LD, only 4% displayed HH. Since the characteristics of HH in the children with LD were different to previous descriptions, we put forward criteria with which to evaluate those differences. CONCLUSIONS: HH appeared more often in children with LD than in normal children. Qualitative, quantitative (p< 0.05) and morphological changes were found in the paroxysmal activity of HH during the stages of sleep in children with LD.

Child↗
PubMed2000

[Characteristics of actual nutrition and health of children in regions of the Russian Federation].

In the article the problems of actual nutrition and state of Russian children health are considered. The carried out examinations of the vitaminous status have shown presence of a deficit of vitamins E, B1, B6, PP, and also calcium, phosphorus, iron lactate, zinc in daily ration of children. The inadequate organization of C-vitaminization of boiled food in children establishments, low supplying of learning schools by a hot food, insufficient use of products from suer milk, fish, juices, meat products, butter, vegetables, fruit, eggs in a nutrition of children is marked. In same of regions of Russia the inadequate nutrition organization of early age children is marked. The positive experience of areas (St.-Petersburg, Ul'yanovsk, Rostov, Smolensk, Kirov, Kurgan, Samara region, Republic Buryatiya) on organization of children and juveniles nutrition, development of the regional programs on a children's food industry evolution, on providing of early age children by food stuffs, on improvement of a schoolboys nutrition, on improvement a nutrition of children in children's preschool establishments is analyzed. The positive experience of nutrition organization of children on an example of the Ryazan and Arkhangel'sk regions surveyed. The actual information about a vitaminization, quality and safety of children's nutrition, ready dishes in the organized collectives on data of 1999 are given.

Adolescent↗
PubMed2002

[LaMedica. The medical education academy on the internet].

At present, "modern media" are still a novelty in medical education. The "LaMedica Project"--a program supported by the Federal Ministry for Education and Research--intends to provide an Internet-based education and training system for the entire field of medicine, using all available media resources. This online educational program will provide subjects for medical laypersons as well as medical experts. Various styles of learning and different learning requests will be promoted. The project presented mirrors the cutting edge of database technology, computer-based training and media didactics, critical content processing as well as supplying individual subjects. This report summarizes our 10 months of experience with this program at the Department for Urology and Pediatric Urology of the Johann Wolfgang Goethe University of Frankfurt Main.

Computer-Assisted Instruction↗
PubMed2000

Clinical infection control in gene therapy: a multidisciplinary conference.

Gene therapy is being studied for the treatment of a variety of acquired and inherited disorders. Retroviruses, adenoviruses, poxviruses, adeno-associated viruses, herpesviruses, and others are being engineered to transfer genes into humans. Treatment protocols using recombinant viruses are being introduced into clinical settings. Infection control professionals will be involved in reviewing the safety of these agents in their clinics and hospitals. To date, only a limited number of articles have been written on infection control in gene therapy, and no widely available recommendations exist from federal or private organizations to guide infection control professionals. The goals of the conference were to provide a forum where gene therapy experts could share their perspectives and experience with infection control in gene therapy and to provide an opportunity for newcomers to the field to learn about issues specific to infection control in gene therapy. Recommendations for infection control in gene therapy were proposed.

Congresses as Topic↗
PubMed2003

The Arkansas River Valley Rural Health Cooperative: building a three-pronged approach to improved health and health care.

This paper describes the Arkansas River Valley Rural Health Cooperative (ARVRHC), one of the Arkansas networks jump-started with support from the Southern Rural Access Program (SRAP). The initial goal of the network was to develop a subsidized health insurance program to provide affordable medical services for the uninsured population (23%) in the 3-county service area. When planning efforts called for the network to address broader needs, the ARVRHC crafted a more comprehensive 3-pronged program model consisting of 3 interrelated programs: (1) the Health Care Access Program (HCAP), (2) the Health Education and Disease Management Program (HE&DMP), and 3) the Information and Assistance Program (I&AP). The HCAP is designed to address the financial barriers to access through a community-based health plan. The HE&DMP focuses on improving the health of individuals through education, counseling, and preventive care. The I&AP links low-income families to existing public assistance programs (e.g., Medicaid) and social support services. The Prescription Drug Assistance Program is one of the I&AP programs that helps individuals without prescription coverage obtain drugs at no cost. A key lesson learned is the importance of combining technical assistance with funding. The ARVRHC has been successful in leveraging funding, having received over $1.7 million in grant funds since 1999. A critical challenge facing the network today is the need for ongoing subsidy funding. Proposed legislation for a federal demonstration of the HCAP and similar programs would enable full implementation and evaluation of this model.

Arkansas↗
PubMedDate not supplied

Points to consider about prescription drug prices: an overview of federal policy and pricing studies.

Pharmaceutical prices in the United States are under evaluation as policy makers decide how to reduce health care expenditures and public subsidy of the pharmaceutical industry. Furthermore, evidence of higher drug prices in the United States, compared with those in other countries, fuels the prescription drug price debate. These issues are not new to the public forum and much can be learned from prior debates and policies. This paper begins by reviewing the pricing debate with the Kefauver hearings on monopolies held during the late 1950s and early 1960s and continues with the current price debate. Government reports and academic studies are discussed, addressing the methodological differences and their implications to policy makers. Finally, the literature review includes foreign government prescription drug programs with their respective prescription drug expenditures. Evidence provided by academics about the pricing practices of the drug manufacturers indicates product quality and price information would force firms to compete on the price level, thus reducing pharmaceutical product pricing to the "true" market price.

Drug Costs↗
PubMed2003

Responding to nursing's agenda for the future. Where do we stand on recruitment and retention?

How can the nursing profession address the escalating shortage of registered professional nurses? A multifaceted approach is important to ensure success. One domain of Nursing's Agenda for the Future (American Nurses Association [ANA], 2002) is recruitment and retention. Through the Agenda, creative strategies are being sought to attract and retain qualified nurses. This article describes one institution's response to addressing this critical shortage. Strategies were developed to present a continuum of learning and advancement opportunities across the career span of the professional nurse. They include recruiting student nurses, increasing NCLEXRN pass rates, providing financial support for further education or specialty certification, and using shared governance to increase retention. Institutions must look to their own resources as well as federal and state resources to offer these opportunities to nursing staff. The goal is to build an environment that both attracts nurses and supports them in their career and life goals.

Career Mobility↗
PubMed2005

Local coverage initiatives: solution or band-aid for the uninsured?

This issue brief surveys health coverage expansion initiatives that are operating on the county or local level, often without the benefit of federal funding. The paper explores the circumstances that have made these initiatives possible and considers the ongoing barriers that local policymakers face in sustaining the programs. Descriptions of four initiatives illustrate the range and variety of programs in operation today and offer both best practices and lessons learned for other communities. The paper also includes a brief analysis of the key elements that make up a successful coverage initiative. Finally, this issue brief considers the role of local and county-based initiatives in the context of overall health care delivery in the national policy framework, highlighting the prospects for sustainability and replication on a broader scale.

California↗
PubMed1984

A synopsis of federal-state sponsored preventive child health.

This synopsis presents data on the impact of services and evaluation issues for the nation's largest preventive child health program, the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). The information is drawn from a series of six EPSDT demonstration/evaluation (D/E) projects sponsored by the Health Care Financing Administration between 1972 and 1979. These projects were implemented in order to learn how to provide preventive services for children participating in the Medicaid program. The results of D/E activities are revised in a methodological framework as defined by principles of epidemiology and evaluation research. Consideration of the major threats to valid interpretation of the D/E findings shows self-selection to be the most serious methodological problem. Data pertaining to the history of use of preventive services, number of children found to have problems in screening, the treatment status and subjective seriousness of these problems, and the resolution of conditions referred to diagnosis and treatment are presented within the context of this methodological critique. The information thus assembled also provides the basis for further, more rigorous assessments of EPSDT program accountability.

Child↗
PubMed2002

In focus. Life after BioethicsLine: a reply to Joyce Plaza.

The recent closure and removal of BioethicsLine led many researchers to wonder where to turn for their research needs. Joyce Plaza wrote that the closure is a mistake. In this essay I maintain, contra Plaza, that due to its cross-disciplinary nature researchers can find bioethics literature in other databases. In developing the search strategy the researcher needs to consider what the problem is about. If the researcher has a philosophical approach in mind, a wise choice would be to use Philosopher's Index; a legal approach suggests using Academic Universe, Westlaw, Lexis or legal databases freely available through state and federal websites. Further, in so far as the National Library of Medicine is integrating citations in BioethicsLine into the NLM Gateway databases (PubMed and LOCATORplus) I point out suggestions on using the latter databases effectively. There is a wealth of information readily available and researchers have much to learn by trying the alternatives.

Abstracting and Indexing↗
PubMedDate not supplied

Management of conventional mass casualty incidents: ten commandments for hospital planning.

The successful management of mass casualty incidents (MCIs) requires standardization of planning, training, and deployment of response. Recent events in the United States, most importantly the Hurricane season in 2005, demonstrated a lack of a unified response plan at local, regional, state, and federal levels. A standard Israeli protocol for hospital preparedness for conventional MCIs, produced by the Office of Emergency Preparedness of the Israeli Ministry of Health, has been reviewed, modified, adapted, and tested in both drills and actual events at a large university medical center in the United States. Lessons learned from this process are herein presented as the10 most important steps (ie, Commandments) to follow when preparing hospitals to be able to respond to conventional MCIs. The standard Israeli emergency protocols have proved to be universally adaptable, flexible, and designed to be adapted by any healthcare institution, regardless of its size and location.

Clinical Protocols↗
PubMed1999

Final thoughts on IMPACT: a federally funded, jail-based, drug-user-treatment program.

A federal demonstration project in the Cook County Jail, called IMPACT (Intensive Multi-phased Program of Assessment and Comprehensive Treatment), provided residential drug-user treatment to more than 3,000 inmates during its 5 years of operation between January 1991 and October 1995. In that time, much was learned about initiating and conducting a complex, intensive, longer-term drug-user-treatment program in a jail setting. This article describes IMPACT and summarizes the results of a process and an outcome evaluation of the program and a series of focus groups. Based on these studies, we recommend ways to improve the design and implementation of drug-user treatment programs in jails.

Decision Trees↗
PubMed2000

The American experience: lessons learned.

This paper discusses ten lessons learned since 1989 about handling allegations of scientific misconduct involving biomedical and behavioral research supported by the U.S. Public Health Service.

Artificial Intelligence↗
PubMed1990

Rationing health care: the choice before us.

Rapid technological advances and upward pressure on wages of hospital personnel are leading to a steady increase in health care spending that is absorbing an ever-larger fraction of gross national product. Eliminating inefficiencies in the system can provide brief fiscal relief, but rationing of beneficial services, even to the well-insured, offers the only prospect for sustained reduction in the growth of health care spending. The United States, which has negligible direct experience with rationing, can learn about choices it will face from the experience of Great Britain where health care has been rationed explicitly for many years.

Cost Control↗
PubMed2003

Should consensus be 'the commission method' in the US? The perspective of the Federal Advisory Committee Act, regulations, and case law.

This paper examines the drive for consensus from the perspective of the good government framework for federal advisory commissions in the United States. Specifically, the paper examines the Federal Advisory Committee Act (FACA)--the statute, its regulations, and case law. It shows that the FACA was intended to be an antidote to abuses in consensus-making processes, including the failure to fully include competing views on commissions. The index of suspicion in the FACA scheme rises when a group work product--including a consensus report--is to be the basis of recommendations to federal officials. Once FACA's requirements regarding committee composition are satisfied, the index of suspicion drops and FACA is indifferent to consensus-making; but the conditions for informed, meaningful participation apply to members who dissent from, as well as those who participate in, consensus. In negotiated rulemaking, the push for consensus and closure creates unacceptable tension with the good government goals of openness and accountability. Proponents of consensus-only bioethics commissions can learn from FACA-related legislative, agency, and judicial insights that consensus-seeking is not always desired by government officials; is rarely cost free; and that diversity and dissent enhance openness, accountability, and fairness. The burden of proof is therefore on proponents of a consensus-only standard for bioethics commissions to demonstrate that a drive for consensus furthers sound decision-making by government officials more than it sets back openness and accountability to a diverse public.

Advisory Committees↗