Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Sustainability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed2002

Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial.

BACKGROUND: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited. OBJECTIVE: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries. DESIGN: A cluster randomized, controlled, nonblinded trial. SETTING: 9 residential care facilities located in a northern Swedish city. PATIENTS: 439 residents 65 years of age or older. INTERVENTION: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff. MEASUREMENTS: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls. RESULTS: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models. CONCLUSION: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.

Accidental Falls↗
PubMed2001

Hospital policy on appropriate use of life-sustaining treatment. University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force.

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment.

Hospital Administration↗
PubMed1991

Sustained ventricular tachycardia associated with sarcoidosis: assessment of the underlying cardiac anatomy and the prospective utility of programmed ventricular stimulation, drug therapy and an implantable antitachycardia device.

The presentation, cardiac anatomy and utility of programmed ventricular stimulation in seven patients with sustained ventricular tachycardia associated with sarcoidosis are described. The mean patient age was 38 +/- 8 years. Pulmonary involvement was apparent in three patients and no systemic manifestations of sarcoidosis were present in one patient. All patients had electrocardiographic abnormalities at rest and six had a left ventricular ejection fraction less than 45%. All seven patients had left ventricular wall motion abnormalities and five had mitral valve dysfunction. Sustained ventricular tachycardia was easily induced in all patients. Spontaneous sustained ventricular tachycardia was not prevented with corticosteroid administration. Despite antiarrhythmic drug therapy, two patients had sudden cardiac death and an additional four had recurrence of ventricular tachycardia. Four patients had an automatic cardioverter-defibrillator implanted and received drug therapy; all four received appropriate shocks. This report represents the largest descriptive series of consecutive patients with sustained ventricular tachycardia associated with sarcoidosis. Antiarrhythmic drug therapy of ventricular tachycardia in patients with sarcoidosis, even when guided with programmed ventricular stimulation, is associated with a high rate of arrhythmia recurrence or sudden death, or both. Thus, implantation of an automatic antitachycardia device (cardioverter-defibrillator) should be considered as primary therapy in such patients. Furthermore, sarcoidosis should be excluded, with Kveim skin testing if necessary, in any patient with sustained ventricular tachycardia of unknown origin.

Adult↗
PubMed1994

[The prognostic stratification of the risk of sudden death and sustained ventricular tachycardia after an acute myocardial infarct: which patients should undergo programmed ventricular stimulation?].

BACKGROUND: Programmed ventricular stimulation performed early after acute myocardial infarction allows to identify patients at risk of sudden death and sustained ventricular tachycardia with high degree of predictive accuracy. This procedure, however, because of its invasive nature, is not desirable as a screening test for large numbers of patients. Therefore, it should be performed on a smaller group of postinfarction patients preselected on the basis of noninvasive testing. The aim of the present study was to identify, early after acute myocardial infarction, any procedure among noninvasive testing, able to selected with the highest sensitivity patients at risk of sudden death and sustained ventricular tachycardia to submit to programmed ventricular stimulation. METHODS: Two hundred and sixty four consecutive patients with recent myocardial infarction were evaluated and followed during a period of 12 months. In each patient 48 epidemiological, clinical and laboratory variables were evaluated. Laboratory variables were acquired between the 7th and the 12th day after the acute event. RESULTS: Multiple linear regression analysis showed that only Killip class, the number of ventricular premature depolarizations per hour and the presence of ventricular late potentials were significantly and independently related to the occurrence of sudden death and sustained ventricular tachycardia (F = 18.7; p < 0.00001). Combinations of these variables, determined at cut off levels best discriminating two subgroups of patients at different risk of the end-point events, proved to be able to accurately predict the outcome of our patients. The presence of at least one of the following conditions: Killip class > or = 2, ventricular premature depolarizations > or = 30 per hour, ventricular late potentials allowed to identify a first subgroup of patients at risk with a sensitivity of 100% (p = 0.00007), whereas the presence, at the same time, of all the above mentioned parameters allowed to identify a second subgroup of patients at risk with a 44% of positive predictive value (p = 0.00007). CONCLUSIONS: Our findings suggest that the first subgroup of postinfarction patients selected on the basis of noninvasive testing should undergo programmed ventricular stimulation, the second might be treated by adequate antiarrhythmic therapy without undergo any further investigation, whereas the remaining patients (without late potentials, in Killip class 1 and with ventricular premature depolarizations < 30 per hour) might be discharged without any antiarrhythmic therapy.

Aged↗
PubMed2004

Using community-based participatory research to reduce health disparities in East and Central Harlem.

OBJECTIVE: It is important to teach community members about the causes, magnitude and effects of health disparities that affect them, and to partner with them to develop, test and disseminate programs that they can sustain to improve health. East and Central Harlem are two underserved, predominantly minority, inner-city communities whose residents have disproportionately high morbidity and mortality from chronic conditions. We developed an approach to educate and work together with Harlem residents to study health disparities, and to use peer-led classes to improve chronic disease management and outcomes. METHODS: Researchers and community leaders formed a community-based research core ("Core") with funds from a large health disparities grant. We then assembled a community advisory board and partnered with them to start a community newsletter to explain the causes of local health disparities and suggest ways to eliminate them. Together, we also began to create a self-sustaining cadre of community-based peer educators to teach culturally acceptable chronic disease self-management skills. RESULTS: The recruited board consists of 33 leaders of community-based health and social service organizations, religious institutions, and tenant organizations, as well as local activists. We produced and distributed our first educational newsletter to more than 4,000 community leaders, members and community-based organizations. We also adapted an existing chronic disease self-management program for the Harlem population and developed strategies to recruit peer educators and sustain their efforts in the future. To help them attain expertise in teaching chronic disease self-management, the board selected four individuals to become master peer-education trainers. The board then helped recruit more than 60 community members and leaders for our first two peer-education courses. CONCLUSIONS: Researchers, clinicians and community leaders worked together to disseminate knowledge about health disparities and a peer-organized education program to address these disparities. This approach provides a foundation to attain a cadre of community-based experts to inform the community about ways to reduce health disparities. By pooling local and academic expertise and resources, we hope to develop programs that are workable, effective and sustainable without outside control or funding.

Black or African American↗
PubMed1995

Conflict resolution with end of life decisions in critical care settings.

This demonstration will present the key modules from an innovative videodisc-based program that was designed as an educational tool for health care professionals. It provides a resource for learning to deal with patients and families regarding the increasing problematic area of end-of-life-decisions. Tough Choices: Ethics, the Elderly, and Life-Sustaining Technologies is an interactive program that combines abstract ethical approaches with the realistic drama of a critical care setting. The format integrates scientific facts about the patient with value questions regarding the utilization of life-sustaining technologies. The unique program provides health care personnel with strategies on how to guide family decision-making as well as examples of the various interventions. This interactive multimedia program opens up an opportunity for health care providers to participate in a clinical case in which life and death decisions are made. Learners can explore various perspectives and treatment options within the framework of the dramatic case presentation without the usual time constraints or worries about causing harm to patients. The program involves learners in a variety of ethical and legal dilemmas that centers around a patient, her family, and a variety of health care professionals. Dramatic advances in the development of life-sustaining medical technologies have given hope to many people whose conditions would have meant certain death only a few years ago. As access to the technologies has expanded, concern for their appropriate utilization has become an issue worthy of increasing attention. Questions about the benefits of life-sustaining treatments are being raised in many quarters, particularly when the technology is viewed as a modern means of postponing death and prolonging suffering. Tough Choices brings to life the story of Irene Sullivan, an elderly widow who has an unexpected heart attack. Suddenly, her very existence depends on the life-support provided by mechanical ventilation and cardiopulmonary resuscitation (CPR). This is a growing area of concern since more than half of the patients who receive CPR and tube feedings and one third of the people receiving mechanical ventilation are 65 or over. Mrs. Sullivan's health care team is forced to deal with the opposing viewpoints of several close family members regarding the utilization of advanced medical technology. The interactive program invites viewers to explore the complex ethical and legal dilemmas involved in making life-and-death decisions about her care. It also permits immediate access to supportive resources in three areas: the clinical chart, abstracts of relevant research studies on life-sustaining technologies, and information from the professional literature on advance directives. The program incorporates practical steps involved in implementing the Patient Self-Determination Act as it follows the patient from the time of hospitalization through a series of life-threatening crises. Two very different aspects of the role of the health care professionals were explored: a crisis mode which covers the steps in managing a full-blown crisis situation, and a prevention mode which analyzes steps that could have been followed to keep an ethical crisis from occurring. The strong role models for practice display many of the characteristics that the helping professions need to foster in an atmosphere of healthcare reform.

Advance Directives↗
PubMed1996

Nonsustained ventricular tachycardia in coronary artery disease: relation to inducible sustained ventricular tachycardia. MUSTT Investigators.

BACKGROUND: Many physicians believe that electrocardiographic characteristics of nonsustained ventricular tachycardia correlate with the risk for sudden death in survivors of myocardial infarction. Sustained ventricular tachycardia induced by programmed electrical stimulation has also been shown to predict sudden death. OBJECTIVE: To determine whether electrocardiographic characteristics of spontaneous nonsustained ventricular tachycardia can predict the inducibility of sustained ventricular tachycardia by programmed electrical stimulation in patients with coronary artery disease having abnormal ventricular function. DESIGN: Observational cohort study. SETTING: 70 clinical electrophysiology laboratories in the United States and Canada. PATIENTS: 1480 consecutive patients with coronary artery disease, left ventricular ejection fraction of 0.40 or less, and asymptomatic nonsustained ventricular tachycardia. INTERVENTION: Electrophysiologic study attempting to induce sustained monomorphic ventricular tachycardia. MEASUREMENTS: Daily frequency, duration, and cycle length of spontaneous episodes of nonsustained ventricular tachycardia, measured by standard electrocardiographic recordings. RESULTS: No statistically significant difference in the frequency or duration of spontaneous nonsustained ventricular tachycardia was seen between patients with and those without inducible sustained ventricular tachycardia. Rates of spontaneous tachycardia were slightly slower in patients with inducible ventricular tachycardia than in patients without inducible ventricular tachycardia (P = 0.047), but the difference was not clinically significant. CONCLUSION: Electrocardiographic characteristics of spontaneous nonsustained ventricular tachycardia do not predict which patients with coronary artery disease will have inducible sustained ventricular tachycardia.

Coronary Disease↗
PubMedDate not supplied

Electrophysiologic effects of bepridil in normal and infarcted canine myocardium.

The electrophysiologic effects of bepridil, 10 mg/kg i.v., were determined in normal noninfarcted and in infarcted ventricular myocardium in 8 urethane-anesthetized dogs 4-6 days after anterior myocardial infarction. At drive cycle lengths of 400 and 333 ms, bepridil significantly increased relative (RRP) and effective (ERP) refractory periods in both normal ventricular tissue (mean increases, RRP 7-14%, ERP 5-6%, p less than 0.05-0.01) and in infarcted ventricular tissue (mean increases, RRP 12-15%, ERP 13-14%, p less than 0.01). Bepridil also selectively prolonged the local activation delay in infarcted ventricular myocardium (mean increases 37.5-45.1%, p less than 0.01), while ventricular excitation thresholds were not altered by bepridil in either normal or infarcted myocardium. Before bepridil administration, programmed ventricular stimulation initiated sustained ventricular tachycardias in 6 of the 8 postinfarction dogs tested. After bepridil, 2 of the 6 previously responsive animals were rendered noninducible, 3 animals responded to programmed stimulation with nonsustained tachyarrhythmias of relatively slower rates, and the one remaining dog responded with sustained ventricular tachycardia (VT). These data suggest that increases in refractoriness in both normal noninjured and in ischemically injured ventricular tissue, with a selective delay in conduction in ischemically injured tissue, contribute to the antiarrhythmic actions of bepridil in the setting of myocardial infarction.

Animals↗
PubMed1999

Elusive locus of control in biological development: genetic versus developmental programs.

Taken as a composite, the meaning of the composite term "genetic program"-widely taken to suggest an explanation of biological development - simultaneously depends upon and underwrites the particular presumption that a "plan of procedure" for development is itself written in the sequence of nucleotide bases. Is this presumption correct? I want to argue that, at best, it must be said to be misleading, and at worst, simply false: To the extent that we may speak at all of a developmental program, or of a set of instructions for development, in contra-distinction to the data or resources for such a program, current research obliges us to acknowledge that these "instructions" are not written into the DNA itself (or at least, are not all written in the DNA), but rather are distributed throughout the fertilized egg. I will argue that the notion of genetic program depends upon, and sustains, a fundamental category error in which two independent distinctions, one between "genetic" and "epigenetic," and the other, between program and data, are pulled into mistaken alignment. The net effect of such alignment is to reinforce two outmoded associations: on the one hand, between "genetic" and active, and, on the other, between "epigenetic" and passive. J. Exp. Zool. (Mol. Dev. Evol.) 285:283-290, 1999.

Animals↗
PubMed1986

Electrophysiologic evaluation of pirmenol for sustained ventricular tachycardia secondary to coronary artery disease.

The efficacy and electrophysiologic effects of pirmenol were evaluated in 21 patients with a history of sustained ventricular tachycardia (VT) and coronary artery disease. Intravenous pirmenol (0.7- to 1.1-mg/kg bolus, followed by a 35- to 40-micrograms/kg/min infusion) significantly prolonged the PR, QRS, QT and corrected QT intervals, HV interval and right ventricular effective refractory period, and shortened the sinus cycle length and atrioventricular nodal block cycle length. All 21 patients had inducible VT (20 sustained, 1 nonsustained) during programmed stimulation in the control state. After intravenous pirmenol, 5 patients (24%) no longer had inducible VT. In those in whom VT was still inducible, the VT cycle length was prolonged significantly. The 5 patients who responded to intravenous pirmenol were given oral pirmenol (200 to 250 mg every 8 hours) for 1 to 3 days and retested with programmed stimulation. In 4 of these 5, VT could not be induced with oral pirmenol administration; in 1 patient sustained VT was induced and pirmenol therapy was discontinued. Oral pirmenol suppressed recurrent VT during a follow-up of 315 +/- 133 days in 4 patients. However, pirmenol therapy was discontinued in 2 patients because of possible deleterious effects (worsened heart failure in 1 patient and elevated liver function test results in 1). Thus, pirmenol, a type IA antiarrhythmic drug, had an overall efficacy of approximately 19% in patients with sustained VT secondary to coronary artery disease.

Adult↗
PubMed2003

Maternal mental health and parenting in poverty.

Maternal mental health is a key factor affecting the quality of parenting and, ultimately, a child's developmental outcomes. Thus, the persistence of mental health problems such as chronic depressive symptoms or addiction in low-income mother-child dyads may be the critical determinant of their collective future. This review examines the research conducted by nurses that focuses on maternal mental health, mothering, and child outcomes in the context of rearing children in poverty. Multiple methods were used for the search. Four programs showed evidence of sustained, related studies focused on the mental health of low-income mothers and their parenting. Two of these programs included intervention studies aimed at improving the mental health of mothers and developmental outcomes for their children. There were four newer programs of research in which the research teams had begun to focus on mothers rearing children in poverty and five other researchers who conducted single studies of maternal mental health. Additionally, two investigators focused on mothers who were prisoners, one team focused on homeless mothers, and another on mothers with HIV. Studies were critiqued using a developmental science framework. Studies varied widely in the degree to which they used developmentally based conceptual frameworks, designs, and measures. While nurse scientists have made progress in conducting research with mothers rearing children in poverty, there is an urgent need for more developmentally sensitive research aimed at strengthening maternal mental health and assisting mothers to be more effective parents in the midst of the challenges of poverty and welfare reform. By doing so, nursing interventions can improve the child's developmental outcomes.

Adolescent↗
PubMed1998

Preparing for rural practice. Enhanced experience for medical students and residents.

PROBLEM ADDRESSED: Recruitment and retention of physicians appropriately trained for rural practice in Canada continues to be a serious challenge. We describe three integrated educational programs at the University of Alberta that aim to increase students' and residents' participation in rural health care and encourage them to take up practice in rural areas. OBJECTIVES OF PROGRAM: To expand and enrich rural educational experiences at undergraduate and postgraduate levels and to supplement family medicine postgraduate education with a third-year special-skills program for rural practice. MAIN COMPONENTS OF PROGRAM: Main components are sustained, reliable funding from the Government of Alberta for the Rural Physician Action Plan; adequate infrastructure to support the program; and commitment by university faculty, rural physicians, and communities. CONCLUSION: The rural-based educational programs have allowed more than 95% of medical students to gain experience in rural areas. The number of family medicine residents doing rural rotations has doubled, and the length of experiences in rural practice has increased fourfold. The third-year special-skills training for rural practice has expanded greatly, and at least 26 of 49 participants have gone on to enter rural practice. In more than 30 rural Alberta communities, 56 physicians have had an important influence on the training of medical students and family medicine residents.

Alberta↗
PubMed1999

A randomized, controlled trial of exercise and education for individuals with fibromyalgia.

OBJECTIVE: To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia. METHODS: Forty-one subjects were randomly assigned to the program or served as waiting list controls. Program outcome was assessed with a 6-minute walk test, the Fibromyalgia Impact Questionnaire, a Self-Efficacy Scale, and a "knowledge" questionnaire (based on information provided during the educational sessions). Waiting list control subjects subsequently completed the program. Program outcome was reassessed 3 or 6 months post-program. RESULTS: The program produced significant improvements in 6-minute walk distance, well-being, fatigue, self-efficacy (for controlling pain and other symptoms), and knowledge. At followup, immediate gains in walk distance, well-being, and self-efficacy were maintained, but gains in fatigue and knowledge were lost. CONCLUSION: Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia. The benefits of our program may be due to exercise or education since both interventions were given.

Adult↗
PubMed2005

Management and performance of Taiwan's waste recycling fund.

Taiwan's resource recycling program was formally established in 1989, starting with the mandatory recycling of polyethylene terephthalate bottles. The number of mandatory regulated materials was extended to 8 categories with 27 items by 2002. Because of false data reporting, financial scandal, lack of transparency of the system, and the demand from parliament, the recycling policy has gradually changed from entirely privatized to being nationalized. Currently, the structure is built on six main bodies: fund management committee, consumers, industries responsible, recyclers, fee reviewing committee, and auditing agents. The industries that are responsible submit a fee, which is set by the fee reviewing committee, to the waste recycling fund (WRF), which is operated by the fund management committee. The auditing agents routinely check the responsible industries by documentation review as well as on-site counting to ensure that the fee is correctly submitted. The WRF provides initiatives to collect and dispose of the end-of-life products. The fund is split into a trust fund and a nonbusiness fund to deal with the collection, disposal, and treatment of the listed materials. The latter deals with the supporting works and ensures that the system runs effectively. The ratio of trust fund to nonbusiness fund is 80-20%. It is no doubt that the current practice achieves some improvements. Household waste has been reduced by 22%. And, most importantly, the benefit-to-cost ratio was as high as 1.24. However, similar to other state-owned systems, the resource recycling program has been criticized for false reporting from the responsible industries, a rigid system, and complicated procedures. To build a sustainable enterprise, the recycling program should be privatized as the recycling market and operating procedures are well established and fully mature.

Conservation of Natural Resources↗
PubMed1992

Lack of prognostic implications of spontaneously occurring or stimulation induced atrial tachyarrhythmias in patients with dilated cardiomyopathy.

A prospective study was undertaken in 102 patients with idiopathic dilated cardiomyopathy to assess the significance of spontaneous and inducible atrial tachyarrhythmias (ATA). Twenty-six patients were in chronic atrial fibrillation (group I) and 76 patients were in sinus rhythm (group II); 14 patients in group II had a clinical history of ATA or episodes of ATA during Holter monitoring. An electrophysiological study was systematically performed. Programmed atrial stimulation was carried out in group II, and used up to two atrial premature stimuli from the right atrium at 2 cycle lengths (sinus cycle length--10%, 600 ms) and then one atrial extrastimulus under infusion of 1 to 4 micrograms. min-1 of isoproterenol. Programmed ventricular stimulation was performed in groups I and II. Sustained atrial tachyarrhythmia (ATA) was induced in 33 patients in group II (42%); isoproterenol infusion facilitated the induction of ATA in only one other patient, who had exercise-related ATA. Eleven patients in group II with spontaneous ATA had inducible sustained ATA. The sensitivity of programmed atrial stimulation to reproduce an ATA was 78.5% and its specificity 64.5%. Inducible ATA was related to a shorter atrial effective refractory period (209 +/- 25 ms vs 228 +/- 32, P less than 0.02). Inducible and spontaneous ATAs were related to older age but not to the existence of spontaneous or inducible ventricular tachycardia; they did not have prognostic significance: the left ventricular ejection fraction and the prognosis were similar in patients with spontaneous or inducible ATA and those without ATA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2007

Creating a successful school-based mobile dental program.

BACKGROUND: Dental disease is one of the leading causes of school absenteeism for children. This article describes the creation and evolution of the St. David's Dental Program, a mobile school-based dental program for children. METHODS: The dental program is a collaboration of community partners in Central Texas that provides free dental care to low-income children in schools without relying on reimbursements or government funding. RESULTS: Since 1998, the program has provided 132,791 screenings for oral health treatment needs and 38,634 encounters for sealants or treatment. In 2005, the program provided $2.1 million worth of services at a cost of $1.2 million (not including donated services). Factors important to the program's success included sustained funding for general operating costs; well-compensated clinicians to deliver care and experienced human service workers to manage program operations; the devotion of resources to maximize consent form return rates; and the development of strong relationships with school district and individual school staff. CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers, the program was able to reach more children than fixed-site clinics. The program was a merging of private and public health dentistries. This model can be useful to other communities in light of the unmet need for dental care and tighter federal, state, and local government budgets.

Adolescent↗
PubMed1997

Medicare program; physician fee schedule conversion factor for calendar year 1998 and sustainable growth rate for fiscal year 1998--HCFA. Final notice.

This final notice announces the calendar year 1998 Medicare physician fee schedule conversion factor and the fiscal year 1998 sustainable growth rate for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1846(d) and (f), respectively, of the Social Security Act. The 1998 Medicare physician fee schedule conversion factor is $36,6873. The sustainable growth rate for fiscal year 1998 is 1.5 percent.

Aged↗
PubMed2004

The role of enforcement programs in increasing seat belt use.

Seat belt laws by themselves led to increased belt use in the United States and Canada, but initial effects were limited. Canadian provincial officials launched highly publicized enforcement campaigns in the early 1980s that resulted in substantially increased belt use. Canadian-style enforcement programs subsequently were adopted in the United States, and the use of such programs has grown in recent years. Lessons from these efforts include the importance of police leadership, focused publicity about enforcement, and sustained rather than single-shot efforts. What is needed in the United States to achieve a national belt use rate of 90% or greater is widespread, methodical, and sustained application of enforcement programs augmented by creative publicity. Enhanced penalties-in particular drivers license points-likely will be needed to reach hard-core nonusers.

Accident Prevention↗