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PubMed1985

Florida Legislature passes medical malpractice law.

The Florida Legislature recently adopted a medical liability tort reform package, a step toward what physicians hope is an eventual solution to the medical malpractice problem. In the August issue, Dr. Coleman chronicled the Florida Medical Association's efforts to pass a statewide constitutional amendment to accomplish similar reforms. Here, FMA's immediate past president tells how the previously unsuccessful efforts led to a promising legislative victory.

Florida↗
PubMed1988

How a south Florida hospital targeted Hispanic consumers.

Last month's "Case in Point" presented AMI Parkway Regional Medical Center, a 412-bed acute care hospital in North Miami Beach, Fla. The hospital's administration has recognized the ethnic make-up of the South Florida market (white, black and Hispanic) and wants to increase its penetration into the large and potentially lucrative Latin market. The hospital is one of six in South Florida that are owned by American Medical International Inc., Los Angeles. Parkway recently completed a modernization and development program that resulted in an expanded emergency department, state-of-the-art critical care units, a cost-saving ambulatory unit and facilities for outpatient and community education programs. Positioned in a fiercely competitive market, Parkway has adopted an aggressive marketing posture. The marketing function has been elevated to one of six hospital divisions, sharing equal footing with finance, professional services, administrative services, nursing and human resources. Given the hospital's reputation for action and the previous success of programs based on market research, the assistant administrator for marketing and business development secured support for research on the Latin market.

Florida↗
PubMed1999

Homicide or accident off the coast of Florida: trauma analysis of mutilated human remains.

In the many years Dr. William R. Maples served as a forensic anthropologist, he saw diverse sources of trauma presented in the victims of violent crime, accident and suicide in the state of Florida. In 1996 the District 18 Medical Examiner's Office of Florida requested the assistance of Dr. Maples in the analysis of human remains recovered by the U.S. Coast Guard. The deceased was in an advanced state of decomposition characterized by skin slippage and discoloration. The torso bore multiple lacerations, including nearly parallel lacerations in the skin of the back. Specimens were carefully macerated and the fractures reconstructed. The skeletal trauma was caused by a device capable of delivering robust cuts and blunt trauma in linear paths, as is consistent with propeller trauma. Unusual in this case were blows to the ventral and dorsal surfaces of the body. Based on the anthropological analysis and interviews with the family of the deceased, the F.B.I. proceeded with the case as a homicide investigation.

Accidents↗
PubMed1999

Fear and loathing in Florida--PPMC's, fee-splitting, and anti-kickback implications.

Many developments are occurring with respect to practice management agreements in Florida. These include the District Court of Appeal affirmance of the Bakarania decision, a bankruptcy court decision to the effect that the PhyMatrix Agreement evaluated in Bakarania constitutes illegal fee-splitting. There was also a new Board of Medicine decision permitting a percentage arrangement under a "management agreement." This article summarizes the recent developments in Florida, as well as some developments in other states, which are relevant for practice management agreements throughout the country.

Bankruptcy↗
PubMed1999

Performance evaluation and patient outcomes monitored by nurse practitioners and certified nurse-midwives in Florida.

In this descriptive survey study, four elements of performance evaluation of advanced practice nurses (APNs) currently in clinical practice were examined: evaluation frequency, evaluation responsibility, evaluation parameters, and monitored patient outcomes. Questionnaires were mailed to 2,093 APNs living in Florida and licensed by the Florida State Board of Nursing. Eight hundred twenty-two usable surveys were returned, for a 39% response rate. Of these respondents, 654 were in clinical practice as APNs, and comprised the final sample. The majority (56.9%) received formal annual evaluations, and most (75.9%) were evaluated primarily by physicians; only 17.5% reported peer evaluation. The most frequent evaluation parameters were appropriateness of care, patient satisfaction, patient outcomes, and patient volume. Patient outcomes fell into four categories: clinical endpoints, complications, compliance, and functional status. A need to increase the regularity, formality, and peer review elements of APN performance evaluation was concluded.

Adult↗
PubMed2000

The Frye hearing in Florida: an attempt to exclude scientific evidence.

State Supreme Courts require a minimum threshold of reliability and acceptance in the scientific community for all medical and similar evidence to be admitted at trial. In Florida and some other states, the courts adhere to what is known as the Frye standard, whereas in most states and in Federal Courts, it is the so-called Daubert standard. The jurisdiction of the present case is Hillsborough County (Tampa), Florida. Forensic pathologists seldom, if ever, are requested to participate in such hearings, unlike their toxicological and basic science colleagues who are more involved in research methodology and technical procedures. The burden is on the proponent of the evidence to prove the general acceptance of both the underlying scientific principle of the test and procedures used to apply that principle to the facts of the case at hand. The trial judge has the sole discretion to determine this question and general acceptance must be established by a preponderance of the evidence. The authors describe in detail a hearing in a case in which they were all involved. One author (WQS) had researched and documented the original scientific methodology in the literature. The situation involved a car and tractor trailer crash with the two occupants of the car dying of multiple trauma, whereas the truck driver was not injured. Autopsy of the auto driver revealed multiple injuries with exsanguination, and only vitreous humor and liver tissue, but not blood, were tested for ethyl alcohol. The estate of the driver of the automobile brought suit against the owner of the trucking company for wrongful death. The plaintiff requested a Frye hearing to question the reliability of testing other body specimens to translate to probable blood alcohol level. The testimony, submitted documents, and eventual decision by the judge are discussed.

Accidents, Traffic↗
PubMed2002

Rabies in a beaver--Florida, 2001.

On November 25, 2001, a beaver exhibited aggressive behavior by charging canoes and kayaks on the Ichetucknee River in Alachua County, Florida. The beaver was captured by park personnel and submitted to a Florida Department of Health (FDoH) laboratory for rabies testing. Park rangers contacted the Alachua County Health Department after they identified five persons who were in the vicinity of the animal before capture. These five persons were interviewed by county health department personnel, who reported that although the beaver had made aggressive actions, the animal had not bitten anyone. This report summarizes the investigation of this case of animal rabies. Mammals that exhibit aggressive or other unusual behavior should be reported promptly to local health officials and should not be approached or handled by the public.

Animals↗
PubMed2002

Laboratory bioassay studies to determine methoprene susceptibility in a natural population of Ochlerotatus taeniorhynchus from the Florida keys.

Larvae of Florida Keys Ochlerotatus taeniorhynchus collected from No Name Key were colonized and evaluated against technical S-methoprene in laboratory beaker tests. Glassware was treated with a silanizing reagent before testing to prevent methoprene attachment to the glassware. The No Name Key strain was compared with a susceptible laboratory strain of Oc. taeniorhynchus. Five serial dilutions (0.0100, 0.0050, 0.0010, 0.0005, and 0.0001 microg/ml) and an untreated control were evaluated. Tests were conducted in water baths with a constant water temperature of 27+/-1 degrees C and 250 ml of 3 per thousand salt water. Twenty-five late 3rd-stage larvae were placed in each beaker. Bioassay samples were analyzed by probit analysis and the median lethal concentration (LC50), 90% lethal concentration (LC90), and 95% lethal concentration (LC95) values; confidence limits; chi2 value; slope; and standard error were determined. The Florida Keys No Name Key strain exhibited no significant differences at the LC50, LC90, and LC95 levels from the laboratory strain in these studies.

Animals↗
PubMed1992

An evaluation of population forecast errors for Florida and its counties.

The authors evaluate the forecasting accuracy of population projections formulated at state and county levels for Florida. They find that "projections of Florida population made in the 1970s and 1980s had errors...of approximately 2-3 percent for 5-year horizons, 5-6 percent for 10-year horizons and 8-9 percent for 15-year horizons. County projections had errors averaging approximately 5, 10 and 15 percent for these three lengths of horizon, respectively. Based on comparisons with other studies of state and substate population projections, we believe this is a good record of forecast accuracy...."

Americas↗
PubMed2002

Probable variant Creutzfeldt-Jakob disease in a U.S. resident--Florida, 2002.

On April 18, 2002, the Florida Department of Health and CDC announced the occurrence of a likely case of variant Creutzfeldt-Jakob disease (vCJD) in a Florida resident aged 22 years. This report documents the investigation of this case and underscores the importance of physicians increasing their suspicion for vCJD in patients presenting with clinical features described in this report who have spent time in areas in which bovine spongiform encephalopathy (BSE) is endemic.

Adult↗
PubMed2003

Cervical cancer rates and the supply of primary care physicians in Florida.

BACKGROUND AND OBJECTIVES: This study's aim was to determine if an increased supply of primary care physicians is associated with lower incidence and mortality rates for cervical cancer. METHODS: We determined cervical cancer incidence and mortality rates for each of Florida's 67 counties over the 3-year period of 1993-1995 using data from Florida's population-based tumor registry. Data on physician supply were obtained from the 1994 American Medical Association Physician Masterfile. We used multiple linear regression analysis to examine the relationship between physician supply and cervical cancer incidence and mortality rates, adjusting for other county-level characteristics. RESULTS: In regression analysis that adjusted for other county-level characteristics, each increase in the supply of family physicians of one physician/10,000 persons was associated with a corresponding drop in the incidence rate of 1.5 cases/100,000 persons and a corresponding drop in mortality rate of .65 cases/100,000 persons. CONCLUSIONS: Our results indicate that a greater supply of primary care physicians is likely associated with a lower incidence of cervical cancer and a lower cervical cancer mortality rate. More studies are needed at the individual patient level to confirm this association.

Confidence Intervals↗
PubMed1976

Progress report on the Charles River Breeding Laboratories' free-ranging rhesus monkey breeding colony on Key Lois, Florida.

The nucleus of a breeding colony of free-ranging rhesus monkeys (Macaca mulatta) free from tuberculosis, herpes-B virus, shigellosis, and salmonellosis has been established on Key Lois, Florida, USA. Standardized procedures for trapping, quarantine, and shipping from the wild in India to the island have been established. The monkeys seem to have adapted well to the Florida Keys' climate. Reproduction has proceeded according to expectations, and social groups have been formed with continual restructuring as each new group is placed on the island. The isolation of Key Lois from other inhabited keys by the open sea affords good isolation and has discouraged intrusion by unwanted visitors. The operational costs of this island breeding program are encouraging. It is projected that by 1976 or 1977, monkeys should be available from this colony at a lower price than for animals bred in indoor facilities; and their availability will be in excess of animals trapped in the forest and subjected to a conventional conditioning and quarantine period.

Animal Feed↗
PubMed2003

Bromeliad-inhabiting mosquitoes in south Florida: native and exotic plants differ in species composition.

At several locations in south Florida, water impounded by the leaf axils of native or exotic bromeliads was sampled for immature mosquitoes. Culex biscaynensis was the most commonly collected mosquito from exotic bromeliads at study sites in southeastern Miami-Dade County, whereas at nearby sites with native bromeliads, immature Wyeomyia mitchellii were more abundant than immature Culex biscaynensis. Aquatic habitat size and persistence may be important factors favoring Culex biscaynensis in exotic bromeliads. Leaf axils of exotic bromeliads had a greater water-holding capacity than those of the native bromeliads; and because the exotic bromeliads were located on the ground usually near lawn watering sprinklers, their aquatic habitats may persist longer than those of the native, epiphytic bromeliads that received only rainfall. In the exotic bromeliads, the frequency of occurrence of Culex biscaynensis was similar in tree-shaded and in open-sunlit areas. The distribution of Culex biscaynensis currently is limited to Miami-Dade County, and at sites in other south Florida counties, Wyeomyia spp. were the dominant mosquitoes in collections from exotic bromeliads. Aedes aegypti, Aedes albopictus and Culex quinquefasciatus were occasionally found in exotic bromeliads, usually in low numbers; however, these mosquitoes were not collected from native bromeliads.

Animals↗
PubMed2003

Surveillance results from the first West Nile virus transmission season in Florida, 2001.

After West Nile virus (WNV) was first detected in Florida in July 2001, intensive surveillance efforts over the following five months uncovered virus activity in 65 of the state's 67 counties with 1,106 wild birds, 492 horses, 194 sentinel chickens, and 12 people found infected with the virus. Thirteen of 28 mosquito isolations came from Culex mosquitoes. As seen in the northeastern United States, wild bird mortality was the most sensitive surveillance method. However, unlike the predominantly urban 1999 and 2000 epizootics, the Florida transmission foci were rural with most activity detected in the northern part of the state. All human cases were preceded by the detection of WNV in animals; however, only eight of the twelve cases were preceded by reports of WNV activity in the county of residence. West Nile virus-positive animals detected by multiple surveillance systems preceded seven of these cases by two weeks or more.

Animals↗
PubMed2001

A population ecology study of hospital closures in Florida between 1965 and 1995.

The population ecology literature argues that, at the macro level, organizations experience various liabilities to their continued survival. This study examined the effect of size, age, and niche density on the closure of acute care hospitals in Florida between 1965 and 1995. The data for the study were created using information about Florida hospitals found in the annual reports of the American Hospital Association (n = 427). Using the technique of survival analysis, it was found that newer hospitals and hospitals originally established in organizationally dense areas (five or more hospitals within a five-mile radius) experienced a significantly greater incidence of closure than did those that were older or founded in less dense areas. Small hospitals (<100 beds) were also shown to be significantly more likely to close than large ones (>300 beds) as were hospitals located in organizationally dense areas (>five hospitals in a five-mile radius). The study concludes with an examination of the policy and management implications of the results.

American Hospital Association↗
PubMed2004

Multifocal autochthonous transmission of malaria--Florida, 2003.

The majority of malaria cases diagnosed in the United States are imported, usually by persons traveling from areas where malaria is endemic. However, small outbreaks of locally acquired mosquito-borne malaria continue to occur. During July-September 2003, an outbreak of malaria (eight cases of Plasmodium vivax malaria) occurred in Palm Beach County, Florida. During the same period, two patients were evaluated for malaria in neighboring Okeechobee County, approximately 75 miles from the Palm Beach County transmission area. One patient was thought to have acquired infection with the same parasite species (P. vivax), and concerns were raised about a possible link. To determine whether infection was acquired in Okeechobee County and whether a possible link existed to the Palm Beach County outbreak, the Florida Department of Health (FDOH) initiated an investigation. This report describes that investigation, which determined that although initial laboratory results suggested local transmission, subsequent evaluation and testing confirmed the case as imported malaria. These findings underscore the importance of a rapid and thorough investigation of any malaria case suspected to be acquired through local mosquito-borne transmission.

Adult↗
PubMed2002

The occupational, safety, and health of Florida farm workers: environmental justice in the fields.

This study involves a survey of farm workers in two South Florida counties questioning the workers about pesticide exposure, health problems, and laws and legal rights. A finding is that the federal and state laws which are currently in place to protect the workers from pesticide exposure are not adequately implemented. Several of the health problems farm workers noted match the symptoms of moderate and mild pesticide poisoning. The study concludes with policy recom mendations for federal and Florida officials to change and better enforce the current laws pertaining to farm workers.

Agricultural Workers' Diseases↗
PubMed1992

HIV infection, syphilis, and tuberculosis screening among migrant farm workers--Florida, 1992.

An estimated 2.7-4.0 million persons in the United States are classified as migrant and seasonal farm workers (1). Despite a high prevalence of tuberculosis (TB) and other conditions among migrant workers (2-4), approximately 13% have access to or receive care at federally funded migrant health clinics (5). During February-March 1992, to assess the prevalence of selected health conditions among migrant farm workers, the Florida Department of Health and Rehabilitative Services (FDHRS) conducted a voluntary screening for human immunodeficiency virus (HIV)-1 infection, syphilis, and TB among workers living in 14 migrant camps in Immokalee, Florida. This report summarizes the results of the screening and describes disease-prevention efforts developed by FDHRS for migrant workers.

Adolescent↗