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PubMed2000

Mammography in New Hampshire: characteristics of the women and the exams they receive.

New Hampshire (NH) is one of two states that has developed a population-based mammography registry. The purpose of this paper is to describe what we have learned about mammography use in New Hampshire. After collecting data for 20 months, the database contains almost 110,000 mammographic encounters representing 101,679 NH women, who range in age from 18 to 97 with a mean of 56.7 years (SD=10.91). Education levels are high with 92% having a high school education and 59% with some college. Forty-six percent report their primary insurance is private, 29% report HMO/PPO coverage, and 25% receive federal health care assistance. Risk factors represented in the database include (categories not mutually exclusive) advancing age (60% over age 50), hormone replacement therapy use by menopausal women (40.6%), and a family history of breast cancer (29%). Penetration of mammography relative to the NH population is higher for younger age groups (40-48% for those aged 44-64) than older age groups (34-39% for those aged 65-84). The majority of mammographic encounters are routine screening exams (86%), often interpreted as negative or normal with benign findings (88%). Use of comparison films to interpret either diagnostic or screening mammography occurred in 86% of encounters. We have matched 3,877 breast pathology records to these mammographic encounters. The distribution of pathology outcomes for diagnostic exams was very similar to that for screening exams (approximately 65% benign, 17% invasive breast cancer, and 6% noninvasive breast cancer). Overall, we have designed a system that is well accepted by the NH community. Challenges include careful monitoring of data for coding errors, and a limitation of linking variables in mammography and pathology data. Data represented in this registry are a critical resource for research in mammographic screening and breast cancer early detection.

Adolescent↗
PubMed2006

An approach to designing a national climate service.

Climate variability and change are considerably important for a wide range of human activities and natural ecosystems. Climate science has made major advances during the last two decades, yet climate information is neither routinely useful for nor used in planning. What is needed is a mechanism, a national climate service (NCS), to connect climate science to decision-relevant questions and support building capacity to anticipate, plan for, and adapt to climate fluctuations. This article contributes to the national debate for an NCS by describing the rationale for building an NCS, the functions and services it would provide, and how it should be designed and evaluated. The NCS is most effectively achieved as a federal interagency partnership with critically important participation by regional climate centers, state climatologists, the emerging National Integrated Drought Information System, and the National Oceanic and Atmospheric Administration (NOAA) Regional Integrated Sciences Assessment (RISA) teams in a sustained relationship with a wide variety of stakeholders. Because the NCS is a service, and because evidence indicates that the regional spatial scale is most important for delivering climate services, given subnational geographical/geophysical complexity, attention is focused on lessons learned from the University of Washington Climate Impacts Group's 10 years of experience, the first of the NOAA RISA teams.

Animals↗
PubMedDate not supplied

A personal exploration of the German hospice system.

While on vacation in Germany, I explored the German hospice system and its differences from that in the United States. I conducted an informal survey asking 10 individuals who were not associated with hospice work, about end-of-life issues. Knowledge of the hospice movement and of advance directives was found to be quite low. Through contact with German hospice associations, I learned that the modern German hospice movement was inspired by the British example. After a difficult beginning, the German hospice system is growing steadily. Professional providers of end-of-life care are paid according to the traditional fee-for-service system. As suggested by the World Health Organization, pain management is provided according to the three-step analgesic ladder. Physician-assisted suicide is illegal as it is in the United States. A federal self-determination law has not yet been enacted. Overall, the German hospice system has many similarities and a few interesting dissimilarities with that in the United States.

Adult↗
PubMedDate not supplied

Using the Resource Utilization Groups (RUG-III) system as a staffing tool in nursing homes.

Nurse managers working in nursing homes are challenged to develop strategies that maintain a balance among quality of care, nurse staffing levels, and workload within the context of federal and state nurse staffing requirements for nursing homes. One strategy to consider is the use of the Resource Utilization Groups (RUG-III) staffing benchmarks that are associated with each of the 44 resident classification groupings that comprise the RUG-III system. The RUG-III system is described. Three examples of the use of RUG-III as a staffing tool by nurses working in Veterans Health Administration nursing homes are described. The lessons learned about the advantages and limitations in using RUG-III as a staffing tool are summarized. These lessons are applicable to RUG-53, the January 2006 refinement of RUG-III.

Aged↗
PubMed1996

Children and adolescents with traumatic brain injury: reintegration challenges in educational settings.

Changes in federal law have paved the way for students with traumatic brain injury (TBI) to receive special educational services. Although not all students with TBI need special education, many will need careful planning for reintegration into the classroom. The present article presents information about the range of services that need to be considered for these students and the problems that can affect students' academic and social functioning. Characteristics that distinguish this group of students from peers with special learning needs are highlighted and specific suggestions are made to help educators work more effectively with these students when they return to school. A case study is used to highlight the issues discussed.

Adolescent↗
PubMed1996

Diagnosis-related group system. Can we still earn a living caring for sick people?

Medicare and Medicaid patients are starting to enroll in managed care organizations, as government tries to lower costs of caring for the elderly, disabled, and poor. Because they are the most likely to be sick, taking care of them imposes serious risks on hospitals and medical groups. The federal government uses the diagnosis-related group (DRG) system to reimburse hospitals. The system depends on physicians documenting diagnoses and complications. Physicians see illness as unpredictable, and so feel that detailed documentation of severity is futile. The government and health plans nevertheless follow case mix index and create hospital and physician profiles, relying on the existing imperfect system. For providers to be recognized for the value they add to the care of the sick, physicians must learn to use the DRG system to best advantage, or risk being driven out of business.

Aged↗
PubMed2004

Residents' working hours in a consortium-wide surgical education program.

Traditional work schedules of surgical residents have been cited as a factor that negatively influences education and the quality of patient care. Demands by federal and state legislators as well as the general public have forced a re-evaluation of the issue. Long working hours and resulting sleep deprivation affect the lives of residents profoundly, but the question remains does it lower the quality of medical care? The justification for the long hours is that they are vital to medical education, but residents are so drained by their schedules that they are rarely in the best state of mind to learn from their experiences. Under the scrutiny of the Resident Review Committee (RRC), many programs and institutions have been cited in the recent past in violation of resident working hour requirements. As a result, many institutions have implemented reforms, thereby reducing the number of citations they received. In spite of having the highest number of citations, the field of general surgery has failed to show any improvement. The Oakland Health Education Programme Center for Medical Education (OHEP), a consortium of 16 teaching hospitals in the State of Michigan, set out to review the components of general surgery residency training in order to be able to make recommendations that might assist program directors in making appropriate changes where necessary to enhance resident education and the quality of patient care as well as to meet the personal demands of residents. Questionnaires on residents' attitudes concerning their working hours and possible reforms were sent to all general surgery residency programs in the OHEP consortium. The questionnaire consisted of 25 questions divided into three major sections: the first section encompassed demographic information including current work hours and on-call schedules. The second section consisted of questions relating to attitudes toward work hours and the options for change. The third section consisted of questions that viewed the perceived effects of limited work hours. From the seven participating hospitals with surgery residency programs in OHEP, 92 residents responded to our survey. The majority of residents were in the first 3 years of postgraduate training. The mean age of residents was 30 years old. Sixty-four per cent of respondents were male, and 18 per cent were female. Residents reported an average of 56 with a range of 0 to 110 hours on call. Variations in the number of hours had to do with the various rotations residents were on, in that during certain elective rotations, residents were not assigned to any call. The on-call schedule varied; alternate nights were reported by 11 per cent, every third night by 33 per cent, and every fourth night or more by 53 per cent. The majority of surgical residents did express the need for reform and did not feel that reforms would affect the quality of resident education. However, residents did not want to lengthen residency training beyond the 5 years. The results of our study indicates that the majority of residents in general surgery programs in Michigan perceive a need for reform of work schedules. Surgical educators may have underestimated this need in the past. Most residents thought that long hours impaired their educational experience and at times compromised their clinical care.

Attitude of Health Personnel↗
PubMed1989

[Adjustment to occupational reorienting within the scope of preparatory rehabilitation measures].

A phase II facility in the meaning of the federal government's action programme for the advancement of rehabilitation of disabled persons, the Ulm rehabilitation hospital offers a full therapy chain from acute treatment through to vocational rehabilitation measures. The range of services provided by the "vocational rehabilitation" department are oriented on the rehabilitees' individual potential, and are supported by a multitude of follow-along medical-therapeutic services. Experience over several years has lead to the conclusion that, obviously, comprehension and integration of the learning contents presented are not contingent on the individual's physical and intellectual capacities alone. A central determining factor for successful programme participation seems to be the personal coping strategy, closely linked with the rehabilitees' fundamental convictions and character. An attitude that attributes success to personal achievement can be contrasted with an attitude that views personal performance as being dependent on inapproachable outside influences, and an underlying optimistic attitude was found to correlate with successful outcome.

Adaptation, Psychological↗
PubMed1992

Rapid detection methods for bacterial identification in urologic office laboratory.

A regulatory era is taking shape under the Health Care Financing Administration (HCFA) which eventually will be implemented under the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88). Sweeping changes are planned for all laboratories, including physician's office and group practice offices. Both of these groups have previously been exempt from federal controls. Though many urologists have been doing urine cultures and colony counts in their offices for a long time, it is important that precise bacterial identification also be done for good patient care, to control quality and cost, and for more rapid results. Herein, we review many commercial kits now available for precise bacterial identification in the office laboratory. These are largely unknown to most practicing urologists but have been available to microbiologists. They easily can be learned and used in an office or group practice Urologists are competent to perform these tests, especially with a review course or with assistance from their local hospital microbiology laboratory.

Microbial Sensitivity Tests↗
PubMedDate not supplied

A framework for selecting performance measures for opioid treatment programs.

As a result of new federal regulations released in early 2001 that move the monitoring and evaluation of opioid treatment programs from a government regulation to an accreditation model, program staff members are now being challenged to develop performance measurement systems that improve care and service. Using measurement selection criteria is the first step in developing a performance measurement system as a component of an overall quality management (QM) strategy. Opioid treatment programs can "leapfrog" the development of such systems by using lessons learned from the healthcare quality industry. This article reviews performance measurement definitions, proposes performance measurement selection criteria, and makes a business case for Internet automation and accessibility. Performance measurement sets that are appropriate for opioid treatment programs are proposed, followed by a discussion on how performance measurement can be used within a comprehensive QM program. It is hoped that through development, adoption, and implementation of such a performance measurement program, treatment for clients and their families will continuously improve.

Accreditation↗
PubMed2001

Promoting the health and social care of older people: gaining a perspective from outside the UK.

With people living longer, getting sicker and entering nursing home care later in their lives, the global trends point to preventing premature institution as a major public health and social care goal. Compared with the UK--Australia, Canada and the USA have a longer track record for introducing government Acts, policies and strategies which contribute to supporting older people in maintaining their health, safety and independence. They also have government Ministers for the Aged. In the UK, it is only very recently that we are witnessing new Government programmes such as the NHS Plan and Modernizing Social Services that begin to demonstrate its more determined approach to improve the life of the older person. An ageing population brings new challenges to policy-makers and planners in the statutory sectors. Various international conferences have been held to address ways in which countries are providing or developing their services, and their research regarding older people. Yet, whatever country one considers, nursing home care continues to give rise to many concerns. Developments in the USA managed care programmes have recently come under even more scrutiny from the Federal and State governments, insurance agencies, nursing home owners and, of course, older people themselves. This article raises issues that still need to be addressed in the UK. It reports briefly on an international conference (attended during the undertaking of a Winston Churchill Fellowship) which had some forward-thinking presentations addressing existing and future care needs of older people. It then concentrates on highlighting some of the current developments in the USA care system that might be learning lessons for UK policy-makers. It concludes with some additional considerations for delivering a National Service Framework for Older People in order that "The needs of older people are at the heart of the reform programme for health and social services."

Aged↗
PubMed2001

[Teaching training: an important skill for undergraduate students].

This work describes the structure of the course "Pedagogical Training" introduced in the new Nursing Curriculum of Minas Gerais Federal University College of Nursing. We believe that attending this pedagogical course provides students with the opportunity to be the active subjects and architects of their own knowledge, which will make it possible for them to deliberately develop their roles as educators and perform in a critical manner in view of the reality of those involved. It can be said that pedagogical training constitutes one of the possibilities to think about, reflect on and construct the teaching-learning process during both the moments experienced in class and those in the fields of clinical practice.

Curriculum↗
PubMed1990

Managing organizational change: strategies for the female health care supervisor.

In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗
PubMed1999

Croatia and Bosnia: the imprints of war--I. Consequences.

As Serbia and Kosovo emerge from yet another European war, their people's health and the region's health care, scientific research, and medical education have been seriously damaged and disrupted. There are lessons to be learned from recent Balkan wars, lessons that might help doctors, international relief organisations, and governments to do better than they have done elsewhere during the long reconstruction period that will follow this recent savage conflict. An analysis of the medical legacies of war may also raise issues for doctors worldwide to consider as part of their role in a larger public-health community. For a week in May, 1999, I travelled to Croatia and the Croat-Muslim Federation of Bosnia-Herzegovina to meet doctors working in peace but next to war. In the first part of this essay, I briefly survey some of the medical consequences of the Croatian and Bosnian conflicts. In the second part, to be published in the June 26 Issue, I consider plans for and limitations to restoration, and try to identify possible opportunities for prevention of the adverse health effects of war in a newly enlarged Europe.

Aged↗
PubMed1997

Injury prevention capacity building in New York State: federal support played a significant role.

Federal funds contributed substantively to an expanded infrastructure for injury prevention (IP) in New York State at all levels. Indicators of capacity building included increased recognition of injury as a priority public health (PH) issue, enhanced interagency collaboration around IP, stimulation of planning around preventive strategies, training of more PH practitioners in IP, improved use of injury surveillance data, increased local IP projects, development of a PH approach to violence prevention, and broadened statutory authority for IP. Practical "lessons learned" offer generalizable insights. Specific funding strategies to support IP infrastructure and to link research with application can maximize the effectiveness of future injury capacity building efforts.

Allied Health Personnel↗
PubMed2007

The Family Medicine Curriculum Resource Project: implications for faculty development.

Faculty development implications related to implementing the Family Medicine Curriculum Resource (FMCR) Project provide an opportunity to look at the recommendations of the Society of Teachers of Family Medicine's federally funded Faculty Futures Initiative (FFI) and the recent Future of Family Medicine (FFM) project. Implications for faculty development include the importance of the clerkship setting, originally defined in 1991, with new features added in today's practice environment as outlined by the FFM and the changing assumptions in approaching faculty development. Previously, faculty development focused on teaching learners to master current knowledge. Now, faculty must teach learners how to master new competencies throughout their lives; learners need to learn how they and others learn now. Teaching must focus on how to learn in the future as well as what to learn for the present. Competence ("what individuals know or are able to do in terms of knowledge, skills, and attitudes") has become the focus of curriculum development efforts over the last few years and most appropriately serves as the focus of curriculum development in the FMCR Project. Implications for developing teachers and preceptors focus on the skills and circumstances required to teach and evaluate all types (cognitive, metacognitive, and affective) of competence. In the new culture, novel teaching methods will serve as the focus of faculty development in teaching and of educational ("best practices") research.

Clinical Clerkship↗
PubMed2004

Funding medical education research: opportunities and issues.

Medical education research is underfunded. Little research focuses on basic issues of learning and teaching in medicine, and few educational innovations are tested across institutions to insure their generalizability. Despite repeated calls for the development of research organizations that would deal with substantial issues in medical education, funding remains a miniscule portion of the total budget for medical education. The author discusses how medical education research is supported in the present economic environment. The majority of published research is accomplished during the course of the researcher's employment. Many universities support pilot studies that lead to larger grants. Faculty development programs and career or academic awards support some research. Small to moderate amounts of funding are available through a variety of sources including medical specialty associations and private foundations. The author lists a variety of resources and strategies for finding foundations to fund research. Funding for larger research projects, particularly those that require more than a few years to accomplish or that involve multiple institutions, is more difficult to obtain. Federal training grants provide the laboratory for innovation and education research, but include inadequate funds to accomplish in-depth evaluation or research. The lack of emphasis on theory building and failure to prove the usefulness of innovations across schools cannot be overcome with current levels of funding. Medical educators must be advocates for the research support needed to move medical education research from a field with limited influence on practice to one that is able to connect sound insights and ideas with actual practices in education and improved patient health.

Career Mobility↗
PubMed2001

Parent management training.

As the estimates of prevalence and cost of mental health problems in our children continue to rise, it is incumbent on our society to have an effective and cost-efficient means to address this health crisis. Consistently, the research literature indicates that PMT offers great promise as an efficacious treatment of conduct-disordered children. There are recent studies of PMT's benefits as a preventive intervention that not only improves children's conduct but also positively affects parent-child relationships, mood, social competence, and school adjustment or performance. Although relatively untested, there are indications that PMT also could play an important adjunctive role in the treatment of internalizing disorders. As a curriculum-driven and didactic form of treatment, PMT is highly adaptable to various treatment and prevention contexts, and from a managed care perspective, PMT's structure allows its costs to be well defined and managed. Despite these positive attributes, however, few clinics systematically offer PMT as a treatment option, and third-party payers have been reluctant to cover its costs. Although it is conceded that much needs to be learned about the scope of PMT's effectiveness and the modifications that are necessary to improve its adaptability to high-risk families, it is proposed that PMT should join the mainstream of broadly available health care provisions for children and their families. This broad inclusion of PMT requires mental health educators to include PMT training as a standard part of provider training, requires that third-party payers include PMT as a covered service, and requires that local and federal governments support the proliferation of PMT in treatment and prevention initiatives.

Adolescent↗