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PubMedDate not supplied

Using adaptive competency acquisition assessment for licensed practical nurse career mobility.

The purpose of this study was to examine the use of adaptive competency acquisition in Licensed Practical Nurse (LPN) graduate candidates as an assessment mechanism for career mobility. Participants completed the The results indicated that LPN graduate candidates developed adaptive competencies necessary for career transition. The results place value on career mobility, while providing educators insight into the basic competencies of one level of educational preparation, which can aid in service-based program development.

Career Mobility↗
PubMedDate not supplied

The Nursing Assistant to Licensed Practical Nurse Program: a collaborative career ladder experience.

The Department of Veterans Affairs (VA) is committed to providing cost-effective, quality care to veterans. Given an aging veteran population and common, multiple co-morbid illnesses, the needs of the typical patient cared for within the VA system are complex. Thus, caregivers meeting these needs require additional nursing education. To ensure the staff will have the skills necessary to care for patients experiencing more complex illnesses, the Battle Creek VA Medical Center (VAMC) designed a program giving experienced nursing assistants the opportunity to enroll in a nursing program leading to practical nurse licensure. The Nursing Assistant to Licensed Practical Nurse Program has been established by developing a collaborative agreement with an affiliating educational institution, defining the selection criteria, helping to prepare funding requests, developing a mentoring program, coordinating with Human Resources and Fiscal Services, and outlining the service obligation. After the first year of this program, the VAMC and the academic institution consider it a successful collaborative effort.

Career Mobility↗
PubMed2003

Teenage driver safety: should graduated drivers licensing be universal?

The number of motor vehicle deaths has decreased significantly in the last quarter century. However, there remain a disproportionate number of automobile crashes involving teenage drivers. Studies have shown these accidents are related to several, possibly behavioral, factors, including driver error, speeding, and increasing numbers of passengers. The injuries and fatalities also involve a disproportionate number of teenage passengers. A three-stage Graduated Drivers Licensure process has been adopted by 34 states to try to address this potentially preventable problem. The Graduated Drivers Licensure involves a very well-supervised permit period, a lengthened provisional period that includes advanced drivers' education and supervised practice, and finally a full license. Studies from Maryland, California, Oregon, Florida, Michigan, North Carolina, and Kentucky have shown significant decreases in the crash rates among teenage drivers. The Graduated Drivers Licensure, if adopted as a national standard, may be effective in decreasing the toll of teenage driving accidents.

Accidents, Traffic↗
PubMed2004

The effect of state motorcycle licensing laws on motorcycle driver mortality rates.

OBJECTIVE: The purpose of this study was to evaluate the association between motorcycle licensing and operation regulations and motorcycle mortality rates in the United States during 1997 through 1999. METHODS: A population-based ecologic study was used. RESULTS: Lower mortality rates were observed in states with the following motorcycling requirements: skill test for a motorcycle permit (rate ratio [RR], 0.76; 95% confidence interval [CI], 0.69-0.84), driver training (RR, 0.80; 95% CI, 0.74-0.86), longer duration of learner's permits (95-190 days [RR, 0.86; 95% CI, 0.79-0.95] and >190 days [RR, 0.87; 95% CI, 0.81-0.93], three or more learner's permit restrictions (RR, 0.78; 95% CI, 0.73-0.84), and a full helmet law (RR, 0.76; 95% CI, 0.71-0.81). CONCLUSION: Specific motorcycle licensure policies appear to be associated with lower mortality rates.

Accidents, Traffic↗
PubMed2005

Emergence of fluoroquinolone resistance in Campylobacter jejuni in chickens exposed to enrofloxacin treatment at the inherent dosage licensed in Japan.

The objective of the present study was to determine whether selection of fluoroquinolone resistance could be easily induced in Campylobacter jejuni-colonized chickens by treatment with enrofloxacin of representative fluoroquinolones at the inherent dosage licensed in Japan (50 ppm in drinking water for 3 days). In the case of isolates from chickens of study 1, an increase in the population of susceptible isolates appeared after the cessation of treatment and maintained throughout the experiments. On the contrary, our results of study 2 demonstrated that administration of enrofloxacin generated a rapid increase of fluoroquinolone resistance in C. jejuni showing the mutation of Asp-90-Asn in the gyrA gene. Present results indicate that the enrofloxacin treatment for broilers at the inherent dosage is able to select fluoroquinolone resistance in C. jejuni. We conclude that whatever enrofloxacin dosage is used, an emergence of fluoroquinolone resistant of C. jejuni occurs.

Animals↗
PubMed2005

Pharmacological properties and clinical efficacy of a recently licensed systemic antifungal, caspofungin.

Caspofungin, a semisynthetic derivative of the pneumocandin B(0), is the first licensed compound of a new class of antifungal agents, the echinocandins. It attacks the fungal cell by selective inhibition of the beta-(1,3)-d-glucan synthase, which is not present in mammalian cells. In vitro studies have indicated a potent fungicidal effect on Candida species, and in vivo studies in immunocompromised animals with invasive candidiasis demonstrated a favourable outcome. In randomized clinical trials in patients with oropharyngeal/oesophageal and invasive candidiasis, caspofungin was at least as effective as amphotericin B deoxycholate, yet showed a significantly superior safety profile. Of patients with invasive aspergillosis refractory to or intolerant of other antifungal agents, 45% showed a partial or complete response to caspofungin given as a salvage treatment. Also, it demonstrated comparable clinical efficacy but superior tolerability in the empirical antifungal therapy in neutropenic patients compared with liposomal amphothericin B. Caspofungin has an excellent tolerability and a low potential for drug interactions. Thus, caspofungin represents an interesting and clinically valuable new antifungal drug that broadens the available therapeutic armamentarium for the treatment of invasive fungal infections.

Antifungal Agents↗
PubMed1998

Out of sight, out of mind? Licensed clubs in remote aboriginal communities.

Most Aboriginal communities in the Northern Territory have used provisions under the NT Liquor Act to impose total or partial bans on alcohol and only eight (as of 30 June 1995) had established licensed clubs. This article examines (a) patterns of alcohol consumption in communities with clubs, and (b) economic, social and political aspects of the place of clubs in these communities. Alcohol consumption was estimated on the basis of 'purchase into store' figures for 1994-95 provided by the NT Liquor Commission. Among male drinkers, consumption of absolute alcohol in 1994-95 was estimated at 42.5 litres a head, 76% higher than the figure for the NT as a whole, which in turn was 42% above the national level. Similar differences were found for female drinkers. Combined retail turnover of the seven clubs that traded throughout the year was estimated at $8.1 million. It is argued that many clubs are able to use their monopolistic control of a valued resource to become powerful political institutions in communities, sometimes leaving non-drinkers effectively disenfranchised. It is also argued that the health consequences of these high consumption levels have received far less attention than the effects of Aboriginal public drunkenness in urban areas. It is concluded that, while the rights of Aboriginal communities to establish community-controlled clubs should be respected, the notion that they are under some sort of obligation to do so should be exposed as a measure likely to add to the health burdens of people already inadequately served by health, education and other services.

Adolescent↗
PubMed2000

Liquor licensing and community action in regional and remote Australia: a review of recent initiatives.

OBJECTIVE: To review the effectiveness of community-based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and to assess their implications for other communities or towns contemplating similar measures. METHODS: Findings from evaluations of community initiatives in Tennant Creek (NT), Derby (WA), Halls Creek (WA), Elliott (NT) and Curtin Springs (NT) are compared with respect to impact on alcohol consumption, and on indicators of alcohol-related harm relating to public order, health and well-being, and economic activities. The extent of community support for these initiatives is also examined. RESULTS: Restrictions were found to have a modest but real impact on alcohol consumption, and a significant impact on indicators of alcohol-related harm, especially violence. Restrictions were also found to have widespread community support, often qualified by a belief that other measures were also required. CONCLUSIONS: Restrictions on availability are an effective means of reducing alcohol-related harm at a local level and, depending upon the processes involved in their introduction, are likely to have strong community support, provided that other measures are also pursued. IMPLICATIONS: Five issues are identified that are likely to arise in other settings where restrictions are contemplated. These are: the issue of representativeness ('who speaks for the community?'); selection of particular kinds of restrictions on availability; selection of most appropriate additional measures; universal vs. selective restrictions; and the role of liquor licensing authorities in imposing or facilitating restrictions.

Alcohol Drinking↗
PubMed1995

To drive or not to drive: neuropsychological assessment for driver's license among stroke patients.

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception, (II) spatial attention, (III) visuospatial processing, and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.

Adult↗
PubMed2005

Relative sensitivities of licensed nucleic acid amplification tests for detection of viremia in early human immunodeficiency virus and hepatitis C virus infection.

BACKGROUND: Screening donors for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) RNA is primarily performed on minipools (MPs) with one of two commercial nucleic acid amplification tests (NAT; Roche Molecular Systems; or Gen-Probe/Chiron). We compared these assays with respect to detection of RNA in early HIV and HCV infection. STUDY DESIGN AND METHODS: Twelve HIV plasma donor panels (116 serial samples) and 12 HCV panels (180 serial samples) were selected to optimally represent early viremia. Initial testing was performed in singlicate or triplicate on separately coded aliquots, both neat and at dilutions corresponding to MP screening (1:16 for Gen-Probe; 1:24 for Roche); 20 additional replicates were performed when discordant results were observed. Odds ratios (ORs) comparing detection of RNA by different assays were derived with logistic regression models. Differences in window-period closure and yields of assays in MP or individual-donation (ID) format were estimated. RESULTS: Differences in detection rates between Roche and Gen-Probe NAT assays were small and only observed with samples with very-low-level viremia. ORs for detecting RNA by the Gen-Probe versus the Roche assay were significant for HIV if conducted on MPs (1.8; 95% confidence interval [CI], 1.3-2.5) but not neat (1.0; 95% CI, 0.72-1.4). Odds of detecting HCV RNA were higher if the Gen-Probe assay was conducted either neat (2.3; 95% CI, 1.6-3.2) or on MPs (4.0; 95% CI, 2.8-5.8). These differences translated to <1 day window-period closure and <or=1 infection per 20 million donations. In contrast, comparisons of ID versus MP assays were highly significant for both viruses (ORs for ID vs. MP ranged from 45.3 to 93.4), with projected yields of one to two additional infections per 10 million donations. CONCLUSIONS: Differences in sensitivities of licensed NAT assays for HIV and HCV are very small and clinically insignificant, particularly when compared to differences of MP versus ID NAT screening.

Blood Banking↗
PubMed1993

Should persons with diabetes be licensed to drive trucks?--Risk management.

How should a regulatory agency interpret a risk analysis that concludes there is a small increase in risk? The agency must decide on behalf of society whether the increased risk is large enough to justify banning the risky activity or taking some other step to lessen the risks. In a companion paper (Songer et al.), we conclude that licensing insulin using persons to drive commercial motor vehicles in interstate commerce would result in 42 additional crashes each year. Here we address risk management issues by interpreting the number of additional crashes and the relative risks of the prospective handicapped drivers. Are the number of additional crashes (42) significant? Is the increase in the annual crash risk (from 0.00785 to 0.032 for non-insulin dependent and 0.048 for insulin dependent persons) significant? Are the relative risks significant for all insulin using drivers (4.7)? For drivers with a history of severe hypoglycemic reactions (19.8)? How should society tradeoff risk increases for increases in opportunity for these handicapped persons? We review other social decisions concerning highway safety: Accepting the increasing risks of letting 16 year olds drive, allowing extremely light cars, allowing some unsafe highways, and allowing extremely unsafe driving conditions at some times of day. We conclude that the additional risks from insulin using persons are well within the current accepted range of risks.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1997

A prospective study of injuries in licensed floorball players.

Injuries occurring among 457 licensed floorball players in the Swedish National League were analysed prospectively during the season from 1993 to 1994. Fifty-one (11%) players sustained 58 injuries. The majority (76%) of the injuries were due to trauma mostly during the gama (55%). Twenty-three (52%) of the traumatic injuries were caused by an opponent or a stick. Ankle sprain (35%) was the most common diagnosis. Injury severity classified with regard to time of absence from sport participation were similarly distributed for minor (36%), moderate (29%) and major (35%) injuries. The total rate of injury was 2.5 per 1000 hours for female and 2.6 for male players. Although this rate is lower than for contact sports like soccer and ice-hockey, we feel that further investigation of floorball injuries and improvement of protection devices would be valuable.

Adult↗
PubMed1999

First rotavirus vaccine licensed: is there really a need?

The first rotavirus vaccine was licensed in the United States on 31 August 1998 for the prevention of severe rotavirus diarrhea in children. Despite this landmark in new vaccines, many pediatricians and public health professionals in Europe are uncertain of the need for this vaccine for the routine immunization of infants. In Europe, ample evidence suggests that rotavirus is the most common cause of hospitalizations for severe diarrhea among children, but proper studies documenting the disease burden of rotavirus or the cost-effectiveness of a rotavirus immunization program have only been conducted in the United Kingdom following epidemiologic models used in the United States. All children are infected with rotavirus during their first few years of life, 30-50% of diarrheal hospitalizations among children <5 years are due to this agent, and, by the age of 5 years, between 1 in 40 and 1 in 77 children in Europe and the United States may be hospitalized for rotavirus. The first vaccine is a live, oral preparation combining four different serotypes of rotavirus and administered in three doses with other childhood immunizations. The good efficacy against severe rotavirus diarrhea, the low risk of adverse side effects and the positive cost-effectiveness equation have led the two major immunization advisory groups in the U.S. to recommend this vaccine for routine use in American infants. European physicians and policy-makers should re-examine the epidemiology and disease burden of rotavirus diarrhea now that an effective method of prevention is at hand.

Child↗
PubMed1991

Barriers to the retention of registered and licensed practical nurses in small rural hospitals.

The availability of nursing resources is one of the most critical issues facing health care organizations in the country. The study investigated the potential factors that relate to the desire of registered nurses (RNs) and licensed practical nurses (LPNs) to continue practicing in rural hospitals of North Dakota. All RNs and LPNs who worked in North Dakota hospitals with fewer than 100 beds (490 hospitals) were mailed survey questionnaires. Approximately eight weeks later, responses were received from 291 respondents for an overall return rate of 59 percent. Correlational analyses were used to examine the subjects' responses. A moderate relationship was found among the work-related variables. Overall job satisfaction and performance constraints were the only variables to make significant contributions to the prediction of turnover intention for both RNs and LPNs. Overall job satisfaction accounted for the largest percentage of the variance (R2 = 0.42 and R2 = 0.44) for RNs and LPNs, respectively. Satisfaction with promotion was the only work-related variable to make a significant contribution to the prediction of turnover intention for RNs (R2 = 0.23). Performance constraints, role ambiguity, and shift worked were the only work-related variables contributing to the prediction of turnover for LPNs. These results are discussed in terms of their implications for the management of RNs and LPNs in rural hospitals. Clinical ladders for promotions, the identification of potential performance constraints, and supervisory training are suggested as target areas in which rural hospitals might focus attention for managing turnover in RNs and LPNs.

Attitude of Health Personnel↗
PubMed2002

Veterinarian perception of the intentional misuse of veterinary medications in humans: a preliminary survey of Idaho-licensed practitioners.

The intentional administration of veterinary medications to humans is a form of medication misuse that has not been systematically studied. Veterinarians are the health practitioner group most likely to have knowledge about this problem and to be approached by the public for advice. For this preliminary study, questionnaires were mailed to 1,077 veterinarians registered with the Idaho Board of Veterinary Medicine regarding their knowledge and perceptions of this type of misuse; 392 (36.4%) completed surveys were returned. The most frequently reported veterinary medications misused in humans were analgesic, anti-inflammatory medications, anti-arthritis medications, or both; systemic antibiotics, topical anti-infectives; and topical corticosteroids. People involved with rodeo, horse racing, and health care; rural area residents; and those lacking health insurance were perceived to be the groups most likely to misuse veterinary drugs. Veterinarians rated the following as likely reasons for misuse: having an independent self-sufficient attitude, convenient availability of veterinary medications, lower cost, and belief that veterinary medications are stronger than comparable human medications. Human misuse of veterinary drugs may be more common than many health practitioners realize. Limitations of this study include the response rate, sampling of veterinarians licensed in only one rural state, and reliance on veterinarians' recall of relevant instances of misuse and their perceptions of groups most likely to misuse these drugs and why. These limitations make it difficult to determine if the problem is being under- or over-represented relative to the general population. However, regardless of the magnitude of the problem in the rural population, the general population, or both, the potential for harm is great. Patients with risk factors for this form of misuse should be questioned by their physician in a nonthreatening manner to detect use of veterinary medications and to provide an opportunity to inform them of the risks.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Modeling the mental health workforce in Washington State: using state licensing data to examine provider supply in rural and urban areas.

CONTEXT: Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying provider types, practice locations, and practice productivity. PURPOSE: To identify mental health shortage areas using existing licensing and survey data. METHODS: The 1998-1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Census data, and the results of the 1990-1992 National Comorbidity Survey were used to calculate supply and requirements for mental health services in 2 types of geographic units in Washington state-61 rural and urban core health service areas and 13 larger mental health regions. Both the number of 9 types of mental health professionals and their full-time equivalents (FTEs) per 100,000 population measured supply in the health service areas and mental health regions. FINDINGS: Notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio (10.4 FTEs per 100,000 and 306.5 FTEs per 100,000, respectively). Ten of the 13 mental health regions were more than 10% below the state ratio of psychiatrist FTEs per 100,000. CONCLUSIONS: States gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.

Geography↗
PubMed2006

Graduated drivers license programs and rural teenage motor vehicle fatalities.

CONTEXT: Graduated drivers license (GDL) programs have been shown to reduce motor vehicle fatalities among 15- to 17-year-olds. However, the 20 most rural states have been the least likely to enact more stringent GDL policies. PURPOSE: Estimate the relationship of GDL programs and the number of traffic fatalities among 15- to 17-year-olds on rural interstate and noninterstate roadways. METHODS: Analysis of 1992-2002 Fatality Analysis Reporting System data and a compendium of state laws using a conditional negative binominal regression model with full fixed effects to control for unobservable differences across states and years. FINDINGS: Overall, GDL programs were associated with a 7.8% reduction in rural traffic fatalities among 15- to 17-year-olds. Virtually all of this reduction took place on noninterstate roadways. The most stringent GDL programs were associated with a nearly 22% reduction in this age group and were the only programs associated with reductions in fatalities among 15- to 17-year-old drivers. CONCLUSIONS: Rural states should consider enacting stringent GDL programs. Had the 19 of the 20 most rural states without such programs all adopted the most stringent GDL programs in 2002, the analysis suggests that 64 traffic deaths among 15- to 17-years-olds could have been prevented.

Accidents, Traffic↗
PubMed2005

CpG oligodeoxynucleotides adsorbed onto polylactide-co-glycolide microparticles improve the immunogenicity and protective activity of the licensed anthrax vaccine.

To reduce the biothreat posed by anthrax, efforts are under way to improve the protection afforded by vaccination. This work examines the ability of immunostimulatory CpG oligodeoxynucleotides (ODN) adsorbed onto cationic polylactide-co-glycolide (PLG) microparticles (CpG ODN-PLG) to accelerate and boost the protective immunity elicited by Anthrax Vaccine Adsorbed (AVA, the licensed human anthrax vaccine). The results indicate that coadministering CpG ODN-PLG with AVA induces a stronger and faster immunoglobulin G response against the protective antigen of anthrax than AVA alone. Immunized mice were protected from lethal anthrax challenge within 1 week of vaccination with CpG ODN-PLG plus AVA, with the level of protection correlating with serum immunoglobulin G anti-protective antigen titers.

Animals↗