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PubMed2002

PGD training and its impact on general dentist practice patterns.

This study compares the practice patterns of general dentists with and without formal advanced training in AGED or GPR programs. The UCLA School of Dentistry surveyed a random selection of dentists from graduating years 1989, 1993, and 1997 as part of a Health Resources Services Administration (HRSA)-supported evaluation of the impact of federal funding on postgraduate general dentistry (PGD) programs. Using a sample drawn by the American Dental Association (ADA), 6,725 dentists were surveyed about their practice, advanced training, patients served, and services provided. Of the 2,029 dentists (30 percent) who responded, 49 percent were practicing dentists with no formal advanced training in general dentistry or one of the eight ADA specialties; 7 percent had Advanced Education in General Dentistry (AEGD) experience; 20 percent trained in a General Practice Residency (GPR); and 24 percent were specialists. Additionally, 7 percent of respondents had PGD training and a clinical specialty. GPR-trained dentists were significantly more likely to be on a hospital staff and to treat medically compromised patients even after ten years of practice. PGD dentists were less likely to seek specialty training. Major reasons for seeking PGD training were increasing treatment speed, learning to treat medically compromised patients, and wanting hospital experience. Primary reasons for not selecting training were starting a practice and having a great practice opportunity. Our conclusion is that PGD training has an enduring impact on practice patterns and improves access to dental care for underserved populations.

Analysis of Variance↗
PubMed2001

Behaviors, attitudes, and knowledge of low-income consumers regarding nutrition labels.

This exploratory study interviewed 130 participants in federal food assistance programs and 51 low-income nonparticipants to assess their behaviors and attitudes toward and awareness of the nutrition label. Regarding label use, 35.4 percent of participants and 45.1 percent of nonparticipants seldom/never read labels while grocery shopping, 31.5 percent of participants and 19.6 percent of nonparticipants sometimes read them, and 33.1 percent of participants and 35.3 percent of nonparticipants always/frequently read labels in the grocery store. In addition, 38.5 percent of participants and 41.2 percent of nonparticipants seldom/never read labels at home, 33.1 percent of participants and 27.5 percent of nonparticipants sometimes read them, and 28.5 percent of participants and 31.4 percent of nonparticipants always/frequently read labels at home. There were no significant differences between mean scores of participants and nonparticipants on how to use the nutrition label. Findings challenge nutritionists working with low-income individuals to develop more learning opportunities that teach how to use nutrition labels.

Adult↗
PubMed1994

International Federation of Clinical Chemistry. Use of artificial intelligence in analytical systems for the clinical laboratory. IFCC Committee on Analytical Systems.

The incorporation of information-processing technology into analytical systems in the form of standard computing software has recently been advanced by the introduction of artificial intelligence (AI) both as expert systems and as neural networks. This paper considers the role of software in system operation, control and automation and attempts to define intelligence. AI is characterized by its ability to deal with incomplete and imprecise information and to accumulate knowledge. Expert systems, building on standard computing techniques, depend heavily on the domain experts and knowledge engineers that have programmed them to represent the real world. Neural networks are intended to emulate the pattern-recognition and parallel-processing capabilities of the human brain and are taught rather than programmed. The future may lie in a combination of the recognition ability of the neural network and the rationalization capability of the expert system. In the second part of this paper, examples are given of applications of AI in stand-alone systems for knowledge engineering and medical diagnosis and in embedded systems for failure detection, image analysis, user interfacing, natural language processing, robotics and machine learning, as related to clinical laboratories. It is concluded that AI constitutes a collective form of intellectual property and that there is a need for better documentation, evaluation and regulation of the systems already being used widely in clinical laboratories.

Artificial Intelligence↗
PubMed2006

The third generation of therapeutic communities: the early development of the TC for addictions in Europe.

AIMS: It is the goal of this study to investigate the first development of the drug-free therapeutic community (TC) in Europe. The paper aims at systemizing information, scattered all over Europe and is the first stage in an ongoing study to record the development of the European TC movement and its influences. DESIGN: After a study of the grey (hidden) literature, TC pioneers and experts per country were contacted to further elaborate the first findings. Subsequently, a preliminary summary of our findings was published in the Newsletter of the European Federation of Therapeutic Communities (EFTC), inviting additional information and corrections. The authors completed the results for this article with relevant first-hand information, obtained through interviews with European pioneers. FINDINGS: The findings are summarized under three topics: chronology, interconnections and European identity. It was found that from 1968 until 1989, a new therapeutic approach arose all over Europe, modeled after Synanon, Daytop and Phoenix House, New York, through Phoenix House, London and Emiliehoeve in the Netherlands. Therapeutic communities were established in Belgium, Finland, Germany, Greece, Ireland, Italy, Norway, Spain, Sweden and Switzerland as well. These communities were closely-knit and interconnected in their reaction against psychiatric and methadone treatment. The European TCs developed an own identity compared to the American ones. CONCLUSIONS: The European TCs adapted the model of their American predecessors to their own culture, influenced more by milieu-therapy and social learning. Instead of harsh behaviorism, more emphasis was placed on dialogue and understanding. Professionals occupied a more pivotal role and took over the dominant position of ex-addicts. Research, executed by TC professionals gradually entered the TC. A generic network of TC connections, through which the development evolved, was uncovered, and clear regional trends can be observed.

Europe↗
PubMed1995

Historical perspective on risk assessment in the federal government.

This article traces the evolution of risk assessment as an essential analytical tool in the federal government. In many programs and agencies, decisions cannot be made without the benefit of information from risk assessment. Although this analytical tool influences important public health and economic decisions, there is widespread dissatisfaction with the day-to-day practice of risk assessment. The article describes the sources of dissatisfaction that have been voiced by scientists, regulators, interest groups and ordinary citizens. Problems include the use of arbitrary exposure scenarios, the misuse of the 'carcinogen' label, the excessive reliance on animal cancer tests, the lack of formal uncertainty analysis the low priority assigned to noncancer endpoints, the poor communication of risk estimates and the neglect of inequities in the distribution of risk. Despite these limitations, the article argues that more danger rests in efforts to make decisions without any risk assessment. Recent Congressional and Administration interest in risk assessment is encouraging because it offers promise to learn from past mistakes and set in motion steps to enhance the risk assessment process.

Animals↗
PubMed2004

Quality assurance: the key for amendments of the EU-directive/s regulating veterinary training in Europe.

The free movement of persons, goods and services within the European Union (EU) is one of the major principles established by the European treaties. This free movement shall now be reinforced through the full application of the new general system for the mutual recognition of professional qualifications, in which veterinary medicine is included. The success of this measure for internal market development imposes availability of professionals with the highest possible basic training and opportunities for continuing education and specialisation. Such benchmark definition requires the establishment of veterinary training throughout the EU to focus on the qualitative aspects of the basic training they impart. New production forms, new labour markets and a higher degree of consciousness of the producers and the consumers, together with an ever-increasing load of new information and knowledge in most veterinary fields had forced changes in veterinary education strategies. These changes have led to the adaptation of curricula and the application of new pedagogical concepts ultimately leading to the design of new, exciting programmes of veterinary training. Some of them use a combination of basic education and elective terms while others have focused training in species-oriented tracks already by the time students enter the clinical level. There is general consent that the quality of basal training must enable the student to achieve a level of confidence in life-long learning so he/she would be able to follow relevant CPD's and, eventually, pursue specialisation. At the same time, veterinary establishments are concerned with their ability to achieve these goals, mostly due to the usual high costs of veterinary training that constrain their chances to maintain equality of training levels through the EU. We need to find tools to harmonise veterinary training among the establishments of veterinary education in Europe, beyond the compulsory subject and training minimum requirements laid down by the Directive 78/1027. Harmonisation requires regulations but also awareness. Establishments of veterinary education must not only comply with regulations but also become aware of the advantages of quality assurance of their basic training. The present paper is a series of personal reflections by the author who ultimately addresses veterinary educators and interest organisations such as the European Association of Establishments for Veterinary Education (EAEVE) and the Federation of Veterinarians of Europe (FVE) to focus on strategies of quality assurance as the basis for claims of amendments of the EU-Directive/s regulating veterinary training in Europe.

Curriculum↗
PubMed2006

False alarms, real challenges--one university's communication response to the 2001 anthrax crisis.

Considerable research exists on how government agencies at the federal, state, and local levels communicated during the fall 2001 anthrax attacks. However, there is little research on how other institutions handled this crisis, in terms of their response to potential anthrax contamination (aka "white powder scares") and their approach to disseminating important health and safety information. In this article, we investigate a major university's communication response to the anthrax crisis. First, we describe its communication experiences relating to a large white powder scare that occurred in October 2001. Second, we describe the university's broader communication efforts in terms of several important elements of risk communication research, including influence of source attributes, key messages, preferred channels, responses to information requests, and organizational influences. This study underlines that an institution does not have to be directly affected by a crisis to find itself on the communication "front lines." Moreover, other institutions may find it useful to learn from the experiences of this university, so that they may communicate more effectively during future crises.

Anthrax↗
PubMedDate not supplied

The state of EMS education research project: characteristics of EMS educators.

OBJECTIVES: The preparation of emergency medicine practitioners occurs at a variety of levels, via individuals with various levels of experience and training, and through a variety of oversight organizations. The purpose of this study was to quantify the characteristics of those recognized as prehospital emergency medical services (EMS) educators, the type and amount of infrastructure available to facilitate the learning process, and what attributes and common practices the profession values. METHODS: The respondents (n = 1,691) were generated randomly from a nationwide systematic sample of all known EMS instructors. The sample was adequate to generalize to the 15,000 EMS educators. Face validity and content validity were assured through use of a 24-member focus group of EMS educators, practitioners, and administrators, who reviewed the questionnaire. Reliability estimates were generated via Cronbach's alpha and Kuder-Richardson 20 and 21 and ranged from 0.59 to 0.83, with a grand mean for the seven study constructs of 0.70. Factor analysis with varimax rotation explained 40% to 66% of the respective construct variance, with a grand mean of 56% of the response variance explained. RESULTS: The respondents were satisfied with their teaching experience (98%), expected to continue (80%), and taught because of a perceived dearth of qualified instructors. Only half of the respondents utilized federally generated curricular materials, and approximately 20% were uncomfortable in assessing psychomotor skills. The relationship of testing to assessment and skill performance appeared to be the most significant pedagogic challenge. CONCLUSIONS: The respondents were a senior group of educators committed to the training of new providers who will comprise the foundation of future EMS educational efforts at the national level.

Adult↗
PubMed1996

Blood safety decisions, 1982 to 1986: perceptions and misconceptions.

Although blood bankers and those who treat persons with hemophilia are supportive of most of the recommendations of the Report, the manner in which the analysis was conducted and some of the general conclusions that were reached appear flawed. The flaws may reflect the deficiencies in the process by which the Committee gathered data more than any bias on the part of its members themselves. The Report may accurately reflect the testimony heard, but it is biased by the committee's acceptance as fact the opinions of critics who claim the AIDS epidemic was mismanaged by the blood-collecting agencies, professional organizations, hemophilia organizations, and the federal government. Countervailing views on the various issues are ignored or incompletely discussed. Much testimony was taken from the victims of the transfusion-associated AIDS epidemic. Reliance seems to have been placed upon hindsight testimony (taken 10 years after the events), rather than on documentation of what was known at the time when events unfolded. The Report states that "[t]he Committee's charge did not include the development of assertions about what should have been done at the time,"l(pl:4) yet that is precisely what was done. These comments address just a few of the misconceptions we perceive in the Report. They are based on our understanding of the state of knowledge--or ignorance--at the time that decisions about the safety of the blood supply were made. If we are to avert future threats to the blood supply from emerging infectious diseases, a goal that is universally embraced, we must learn the lessons the past can teach us, as painful as they may be. However, the hazards of judging history in hindsight should be avoided. Neither allegations nor opinions should be accepted as facts without critical examination and without placement in the context of contemporary knowledge; to accept a lesser standard does a great injustice to all who were touched by this tragedy.

Blood Banks↗
PubMed1993

Teaching scientific integrity and the responsible conduct of research.

Since 1990, federal guidelines have required "instruction about the responsible conduct of research" for science trainees who are supported by certain National Research Service Award (NRSA) training grants. This article reports how one school, The University of Chicago, responded to this requirement by developing a two-year "scientific integrity" program, targeted for but not limited to trainees on NRSA grants. The program features lectures the first year and seminars the next on a variety of topics related to the responsible conduct of research. This arrangement allows trainees to benefit both from the presentations of important university and outside speakers and from the intimate exchange possible only in smaller group settings. The program is an ongoing course rather than an intensive one- or two-day effort, and is intended not as an effort to reform dishonest persons who are likely to commit outright fraud but to serve the large group of honest trainees by helping them learn the important ethical issues and norms in the practice of good science, recognize areas of ethical conflict in research and scientific training, and understand their own values better. The authors discuss some major structural, procedural, and philosophical questions that had to be faced as the program was developed. They report the difficulties of evaluating such a program but believe that it and programs like it can have a variety of benefits, which they describe, for both the trainees themselves and the larger research community.(ABSTRACT TRUNCATED AT 250 WORDS)

Chicago↗
PubMedDate not supplied

Special education in Russia: historical aspects.

Tracing the history of special education services in Russia from its beginnings in the early nineteenth century through the rapid expansion of both private and government-supported programs and institutions until the restrictive Soviet period provides both understanding and appreciation of current Russian special education services and institutions. Theoretical principles guiding special education formulated by L. Vygotsky, and sources outside the USSR, were officially suppressed, as were testing and statistical data on handicapped individuals. Official mandates to bring students with handicaps up to state-approved standards resulted in the development of creative, effective approaches. The framework of special education changed little until the breakdown of the USSR. The new Russian Federation ratified UN resolutions protecting the rights of children. Categorical language is a recent development, and terms such as defective, retarded and pedologist are gradually being replaced. The final decade of this century is witnessing rapid change at the initiation of the Ministry of Education that is beginning to produce needed reform. One of the major initiatives is to provide LD specialists in all schools so that students will not need to be a great distance from home to receive needed services.

Child↗
PubMed2005

Developing effective interuniversity partnerships and community-based research to address health disparities.

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date.

Academic Medical Centers↗
PubMed1987

Judgment, 28 January 1987.

The plaintiff, who was pregnant with twins, underwent an abortion. Subsequently she learned that only one of the twins had been aborted and, after giving birth to a healthy child, sought damages for pain and suffering and for the loss of income after the delivery of the child. The Court held that the physician who performed the abortion had a duty to accomplish a successful abortion, which was not negated by medical exams after the abortion that failed to discover the continuing pregnancy. It remanded the case to a lower court to determine damages, including loss of income during the period in which the plaintiff was required to devote herself to the care of the child.

Abortion, Induced↗
PubMed2002

Cancer screening practices from National Health Interview Surveys: past, present, and future.

The National Health Interview Survey (NHIS) has provided data about health behaviors at the national level since 1957. The 1987 and 1992 Cancer Control Supplements to the NHIS, along with other supplemental surveys administered intermittently on self-reported cancer-related behaviors, have contributed to important research and public health purposes. In this article, we reviewed 73 papers published between 1980 and 2001 that used NHIS data, including the first report from the 1998 NHIS, to examine what has been learned from past surveys. Our goal was to facilitate future analyses of recently released data on cancer screening practices from the Cancer Control Supplement to the 2000 NHIS, which is now known as the Cancer Control Module. We categorized the papers according to which of the following three study approaches they used: trends in screening rates, correlates of these rates with factors that may influence screening, and linkages or comparisons of NHIS data with other surveys or sources of information. We summarize knowledge gained in cancer screening for each of these three categories and identify areas that could benefit from more research. We highlight some of the new information available for the first time on the Cancer Control Module of the 2000 NHIS as fresh opportunities for cancer control research. Finally, we describe how the Cancer Control Supplements to the NHIS are integrated with the objectives of and developments in national cancer surveillance research that have emerged from federal planning efforts and collaborations with national partners in cancer surveillance in recent years.

Attitude to Health↗
PubMed1994

Medicaid policies for HIV-related drug therapies: perspectives of the state affiliates of the American Pharmaceutical Association.

OBJECTIVES: To determine how Medicaid prescription drug policies differ by state, and to assess how these policies affect pharmacies and the drug therapies available to Medicaid patients with HIV infection or tuberculosis. EVALUATION PROCESS: The state affiliates of the American Pharmaceutical Association (APhA) were surveyed to learn how state Medicaid policies impact the provision of prescription drugs to Medicaid patients within their state. The survey focused on Medicaid payment level incentives, Medicaid payments compared with private payments, Medicaid utilization policies, and incentives and disincentives in each state's Medicaid payment system. RESULTS: Approximately two-thirds of the APhA affiliates reported that the Medicaid payment levels in their states for drugs used to treat HIV-related illnesses were at least moderately below private payment levels; in 11 states these Medicaid payments were substantially below those of private payers. Many APhA affiliates responding to the survey stated that the Medicaid program in their state limited the number of reimbursed drugs that Medicaid patients can receive. Eight APhA affiliates reporting that these utilization limits created restrictions on the ability of Medicaid patients with AIDS and HIV-related infections to receive needed medications. CONCLUSIONS: With Medicaid programs becoming the major payers of AIDS-related healthcare, federal policies should standardize Medicaid coverage, payment, and utilization policies for prescription drugs needed by Medicaid recipients with HIV-related conditions. This would enable Medicaid patients to receive necessary and adequate drug therapies regardless of their state of residence. These federally mandated policies also would require an increased federal role in financing this expanded Medicaid drug coverage.

HIV Infections↗
PubMed2003

North Carolina Association challenges the state Medicaid agency and wins!

After Judge Beecher Gray ordered parties to attempt to settle before re-appearing on September 29, AHHC Executive Vice-President Tim Rogers and staff met with DMA officials as well as members of the General Assembly and Governor's office. Using a comprehensive approach, AHHC launched an immediate political and press campaign to help convince DMA in addition to its legal actions. Articles and testimony from affected PDN patients and their parents began appearing in North Carolina newspapers, and ultimately the state was persuaded to settle this issue out of court. At press time, DMA has finally instructed the state Attorney General to proceed with legal settlement papers that will in essence support all the issues AHHC was fighting for. North Carolina will maintain the current (higher) PDN reimbursement rate; will NOT recoup any funds from providers: and will file a state plan amendment and repay CMS the federal share. Due to AHHC's action, North Carolina providers have been spared nearly $4 million in recoupments and potential agency closure and shut-down of the PDN program ... which serves only 380 North Carolina residents. After nearly two years of having to react and advocate for its members, the North Carolina association can now rejoice in the fact that "you can fight city hall..." and win! Rogers reports "the North Carolina association has entered into a new era of stature and respect and advocacy on behalf of its record 570 agency members. This was truly a team effort and stands as a great legacy for AHHC." AHHC now enjoys a much improved, collaborative relationship with the North Carolina Department of Health and Human Services and DMA. AHHC has entered into a whole new era of cooperation and dialogue with the new Medicaid administration in North Carolina. DMA has been tremendously supportive and has expressed renewed interest in learning more about the state's growing home care and hospice industry. AHHC has a staff of five and a contract staff of three. Rogers rejoined the AHHC staff in 2001 after seven years in private home health and hospice employment. He states, "It was my dream to ultimately rejoin AHHC as its EVP and staff, like long-time AHHC regulatory expert Sherry Thomas. That dream materialized in 2001, and I must say--it's so good to be back HOME. "The last two years have been memorable for our great association, its staff, and its board of directors. But two special people who helped maintained our very existence during these lawsuits were attorney Renée Montgomery and Judge Jack L. Cozort. I always knew that Renee and Jack were among the state's health care legal experts, but never did I dream that they would envelop such passion, devotion, and vigor during this process." At the 2003 AHHC Annual Meeting, AHHC formally recognized Montgomery, Cozort, and Thomas as its "Home Care and Hospice Heroes."

Home Care Services↗
PubMed1983

Recent supreme court antitrust rulings in health care.

Three recent U.S. Supreme Court antitrust rulings that influence the health-care delivery system are examined. Historically four defenses protected the health-care system from antitrust law. They are the learned-profession exemption, the fact that health-care systems have little effect on interstate commerce, the state-action defense, and the business-of-insurance exemption under the McCarran-Ferguson Act. These defenses and Supreme Court cases that have weakened or eliminated them are described. The cases are Arizona v. Maricopa County Medical Society, Union Labor Life Insurance Co. v. Pireno, and Blue Shield of Virginia v. McCready. Health-care providers will be subject to increased antitrust scrutiny as a result of these cases.

Arizona↗
PubMed1996

[The Ulm emergency medicine training course. 1: Concept].

The course in emergency medicine was introduced by the German Federal Government to meet the requirements of the curriculum of the 4th year of medical education in 1992. The Department of Anaesthesiology of the University Hospital Ulm drew up a course consisting of one week of practical instructions (Table 3) for groups of 24 students, case presentation and accompanying lectures that cover the topics of emergency medicine (Table 2). The course is part of continuous education in emergency medicine. It starts with courses in "first aid" and "first medical attendance to emergencies" followed by the "course"in emergency medicine" and further training weeks on the "mobile intensive care unit (MICU)" during the "internship" as well as a course on emergency medicine for ambulance doctors and the training on he job by an emergency physician during residency (Table 1). The aim of the course is training competence (psychomotoric skills and clinical competence) for the primary care of life-threatening emergencies. The following educational methods were included in the concept: problem oriented learning, situation-oriented learning, learning by doing (cognitive apprenticeship).

Anesthesiology↗