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PubMed1990

Overhauling overtime standards. The Fair Labor Standards Act should be updated.

The minimum wage provisions of the Fair Labor Standards Act (1938) have drawn considerable attention through the years. But the act's overtime provisions have created some major problems yet generated little debate. As it now stands, the act stipulates that employees be paid overtime for hours worked in excess of 40 during a workweek. Certain employers, like hospitals and residential care facilities, have the additional option of paying overtime on the basis of a 14-day period for hours worked in excess of eight hours a day or of 80 hours during a two-week period. Recent amendments to the act have made it increasingly unresponsive to changes in employers' and employees' needs. The act reduces the scheduling flexibility many employers, like hospitals, need. Allowing more exceptions to the act's current provisions would create more flexibility. A workable plan would be to permit organizations open for business seven days a week to calculate overtime on the basis of a straight 80-hour work period. Such a change would not preclude management and labor from negotiating overtime pay for hours worked in excess of 8, 10, 12, or more a day.

Employment↗
PubMed2000

High standards. The formidable task of adopting HL7 standards is easier with the right tools.

PROBLEM: The hospital needed a strategy to integrate the HL7 standard into its facility. Because HL7 is flexible and subject to many interpretations, speaking HL7 is not a simple turnkey process. SOLUTION: Full HL7 functionality was achieved systematically and incrementally with the installation of an interface engine plus HL7 tools with end-point communication simulation. RESULTS: HL7 messaging simulation tools let technicians deliver better interfaces with fewer errors for less money. KEYS TO SUCCESS: A robust interface engine and third-party tools can lead the way for successful adoption of the protocol.

California↗
PubMed1975

Comparison of Type A and nutrient standard menus for school lunch. I. Development of the nutrient standard method (NSM).

Methodology was developed for planning school lunch menus which meet a specific nutrient standard. The method considered nine indicator nutrients plus calories and percentage of calories coming from fat. The nutrient composition of approximately 625 school lunch menu items were calculated using Agriculture Handbook No. 8 data. All nutrient data were converted to bead units which were summed on an abacus until the meal requirements were met. Preliminary testing of the method showed it to be usable by school lunch menu planners and provided menus meeting certain minimal nutrient constraints. After the test, suggested modifications were incorporated into the method to enhance its use. The method is described and a sample week's given.

Adolescent↗
PubMed2001

The reasonable physician standard: the new malpractice standard of care?

We are in the midst of a tremendous, but essentially unacknowledged, shift in the standard applicable in medical malpractice cases across the United States. The author provides a preliminary survey of this fluid area of the law, and provides rationales for the changes. At the same time, it is not yet clear whether the net impact of these changes will be for the better or for the worse--particularly in light of the simultaneous increase in societal emphasis of cost-conscious care.

Humans↗
PubMed1998

Demographics and medical care spending: standard and non-standard effects.

"In this paper, [the authors] examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high.... Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually.... Thus, changes in disability and mortality should, on net, reduce average medical spending on the elderly. However, these effects are not as large as the projected increase in medical spending stemming from increases in overall medical costs."

Americas↗
PubMed1992

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States.

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMedDate not supplied

Standards for monitoring quality of analgesic treatment of acute pain and cancer pain. American Pain Society Subcommittee on Quality Assurance Standards.

Hospital and chronic care facilities in the United States have active "quality assurance committees" that monitor selected outcomes of care, working toward steady improvement in results. In order to harness these existing mechanisms to improve pain treatment, the American Pain Society has drafted a set of standards that embody five key elements for favorably influencing behaviors of patients and clinicians: 1) ensuring that a report of unrelieved pain raises a "red flag" that clinicians cannot ignore; 2) putting information about analgesics conveniently at hand where orders are written; 3) promising patients responsive analgesic care and urging them to communicate pain; 4) providing policies and safeguards for the use of modern analgesic technologies; and 5) monitoring the facility's success in implementing these measures.

Acute Disease↗
PubMedDate not supplied

[Standardization of the study of maxillofacial roentgenology. II. Standardization of the methodology of orthopantomography].

The main factor of a good quality of orthopantomograms is a correct position of the occlusion plane and chin support, the straightening of the cervical vertebrae, head fixation and a choice of physicochemical conditions for exposure. All these conditions ensure the standardization of orthopantomography, reducing to the minimum errors in investigations.

Humans↗
PubMedDate not supplied

[Standardization of examinations in maxillofacial roentgenology. I. Standardization of methods in intraoral roentgenography].

Typical errors in teeth roentgenography reproduced in experiment, indicate that considerable disproportional distortions of images of anatomical structures which are decisive for radiodiagnosis, may occur in these cases. These distortions influence the accuracy of assessment of the condition of periapical tissues, marginal parts of the alveolar process, cavity sizes, and the actual end of the root of the canal. Standardization of intraoral roentgenography is based on a strict position of the patient's head, angle of inclination and alignment of a tube. Specialized P3-1 film should be used. Its processing should strictly correspond to the instructions of a manufacturing factory otherwise the quality of an image is deteriorated and an effective equivalent dose on the vital organs is increased.

Humans↗
PubMed1973

Standardization of diagnostic materials. 2. Problems of standardization in clinical chemistry.

If analytical results in clinical chemistry are to be made meaningful, i.e., accurate, precise, and specific, a systematic approach to their attainment is necessary. Furthermore, because this system is so complex in scope and the need for it is so widespread, it will require international coordination. Agreement on the units of measurement, the production and certification of standard reference materials, and the development of reference methods of demonstrated accuracy will require the support of all segments of clinical chemistry.

Chemistry, Clinical↗
PubMed1978

[Standardization of the methods of determining microorganism sensitivity to antibiotics. The effect of the size of the inoculate on the results of determining microorganism sensitivity to antibiotics and its standardization].

The literature data and personal observations of the authors on the effect of the inoculate amount on the results of determination of microbial sensitivity to antibiotics by the methods of serial dilutions in the liquid and solid nutrient media and agar diffusion are discussed. It was shown that the inoculate of the density of 3.6.10(7) to 4.25.10(7) microbial bodies per 1 ml was optimal for the methods of agar diffusion and serial dilutions in agar. Recommendations for simplifying standardization and dilution of the inoculate are presented.

Anti-Bacterial Agents↗
PubMed1994

Bioengineering and the skin: from standard error to standard operating procedure.

Bioengineering techniques for examination of the skin, measuring principles and sources of error relative to technique, study design, measuring conditions and variability related to test subjects and preconditioning are reviewed. Principles of validation and standard operating procedures (SOP) are discussed, including guidelines for measurement of transepidermal water loss (TEWL) and laser Doppler cutaneous blood flow. Today typical errors are not related to a measuring device but to the way it is used.

Biomedical Engineering↗
PubMedDate not supplied

High-dose versus standard-dose epinephrine treatment of cardiac arrest after failure of standard therapy.

STUDY OBJECTIVE: To assess the efficacy of high-dose epinephrine (HDE) compared with standard-dose epinephrine (SDE) in emergency department patients in cardiac arrest after SDE failed to improve asystole or ventricular fibrillation. DESIGN: Prospective, multicenter, blinded, controlled trial. SETTING: Eight academic center emergency departments. PATIENTS: One hundred forty patients treated for cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were either improvement in cardiac rhythm or return of spontaneous circulation (ROSC). Of the 140 patients enrolled, 78 received HDE and 62 received SDE. Of the 34 patients with ventricular fibrillation, 3 were resuscitated with HDE and 2 with SDE (p = 0.60). Of those with asystole, ROSC occurred in 12 of HDE and 5 of SDE recipients (p = 0.11). No patient had return of significant neurologic function and none survived to hospital discharge. Overall, there was no advantage to HDE after failure of SDE. CONCLUSION: Our results are similar to those of controlled clinical trials comparing HDE with SDE in cardiac arrest.

Adrenergic alpha-Agonists↗
PubMed1998

[A standard method for reporting ramdomized medical scientific research; the 'Consolidation of the standards of reporting trials' (CONSORT)].

The 'Consolidation of the standards of reporting trials' (CONSORT) statement was published in 1996. From that time on all manuscripts reporting randomized controlled trials (RCTs) submitted to JAMA, The Lancet or the British Medical Journal, must include a flow diagram and all the information in the CONSORT checklist. The Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) will follow suit. The manuscripts must be accompanied by this checklist together with the page numbers where each item may be found. The completed checklist will be sent to the editors and the reviewers but will not be published. This method of publication is also applicable to longitudinal or cross-sectional studies. By making the process of publishing trials controllable it is hoped that the quality of these manuscripts will improve and with it their use and the quality of scientific research.

Clinical Trials as Topic↗