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PubMed2006

A brief review of concurrent activation potentiation: theoretical and practical constructs.

Enhancing the acute quality of the resistance training stimulus is the goal of many research and applied professionals. To that end, many methods have been proposed and a variety of training strategies and ergogenic supplements have been investigated. Postactivation potentiation is one phenomenon that has been frequently examined, offering some promise in this regard. Though never previously applied in the strength and conditioning profession, dental research on jaw clenching, studies examining the Jendrassik maneuver and remote voluntary contractions and research on motor overflow together make a compelling case for the existence of a concurrent activation potentiation phenomenon and the acute ergogenic advantage associated with the simultaneous activation of muscles other than the prime mover or synergists. Evidence demonstrates that this advantage is accrued via activation of the H reflex and through cortical overflow. Ultimately, through research and practical application, athletes may be taught to optimize the type, timing, and magnitude of remote muscle actions in order to gain an ergogenic advantage and increase the acute response of the prime movers. This strategy may be especially useful during the most difficult portion of a resistance training repetition and during the most difficult repetitions of a resistance training set.

Adaptation, Physiological↗
PubMed1995

Introduction to special section: prediction and prevention of antisocial behavior in children and adolescents.

The growing concern about antisocial behavior and violence by children and adolescents has prompted several scientific reviews. Concurrently, 2 major scientific reviews of prevention have published reports. In addition, there has been an increase in the amount, complexity, and coordination of research on prediction and prevention of youth antisocial behavior. This special section is prompted by the co-occurrence of these developments, and it includes studies that focus on longitudinal prediction, testing of methods of risk screening, and evaluating interventions.

Adolescent↗
PubMed1998

Do treatment restrictions imposed by utilization management increase the likelihood of readmission for psychiatric patients?

OBJECTIVES: The use of utilization management as a cost-containment strategy has led to debate and controversy within the field of mental health. Little is currently known about how this cost-containment approach affects patient care or quality. The aim of this investigation was to determine whether treatment restrictions imposed on privately insured psychiatric patients by a utilization management program affected the likelihood of readmission. METHODS: The utilization management program included three review activities: preadmission certification, concurrent review, and case management. During a 5-year period (1989-1993), 3,073 inpatient reviews were performed on 2,443 privately insured psychiatric patients. Using logistic regression, restrictions imposed by utilization management on length-of-stay in relation to 60-day readmission rates were investigated. RESULTS: The most common diagnoses among the psychiatric patients whose care was reviewed were alcohol dependence (22.9%), recurrent depression (22.5%), and single-event depression (20.8%). On average, 22.4 days of inpatient psychiatric treatment was requested through the review procedures, and 15.5 days of care were approved by the utilization management program. Of the 2,443 patients reviewed, 7.9% had a readmission within 60 days of their initial admission. Patients whose length-of-stay was restricted by utilization management were more likely to be readmitted. For each day that the requested length-of-stay was reduced, the adjusted odds of readmission within 60 days increased by 3.1% (P = 0.004). CONCLUSIONS: The utilization management program restricted access to inpatient psychiatric care by limiting length of stay. Although this approach may promote cost containment, it also appears to increase the risk of early readmission. Continuing attention should be paid to investigating the effects on quality of utilization management programs aimed at containing mental health costs.

Adult↗
PubMed1976

PSRO: current status of the professional standards review organization program.

Since Public Law 92-603 was enacted in October 1972 considerable progress has been made in the establishment of Professional Standards Review Organizations (PSROs) for the purpose of determining the necessity, appropriateness, and quality of medical care provided beneficiaries of the major programs authorized in the Social Security Act. Sixty-five conditional PSROs are implementing review in acute care hospitals in their geographic area, and 55 planning groups are developing plans to qualify for conditional PSRO designation. The PSRO hospital review system is based on three interrelated review mechanisms. These are concurrent review, which includes admission certification, and continued stay review through discharge; medical care evaluation studies; and analysis of hospital, practitioner, and patient profiles. This article describes the review system in some detail and the potential opportunities the PSRO program offers to occupational therapists.

Hospitals↗
PubMed1986

Response to environment changes and challenges.

This article explores the challenges in today's hospital environment for professional growth and is also the second article in this issue which discusses concurrent review activities on the units. The author advocates that one stop reviewing effectively serves many purposes.

Concurrent Review↗
PubMed1993

Potential impact of managed care on national health spending.

Illustrative estimates suggest that if all acute health care services were delivered through staff- or group-model health maintenance organizations (HMOs), national health spending might be almost 10 percent lower. If the delivery of all such services (except those now provided by staff- or group-model HMOs) were subject to utilization review arrangements incorporating precertification and concurrent review of inpatient care, spending might be 1 percent lower. The estimates assume no changes in the health care system apart from expansion of these two forms of managed care to cover all insured persons. They also assume that moving to universal managed care would produce a one-time drop in the level of national health spending with no subsequent effect on spending growth.

Health Expenditures↗
PubMed1987

Toward meaningful blood usage review: comprehensive monitoring of physician practice.

During a one-year period, all blood transfusions at an acute care Veterans Administration hospital were concurrently reviewed. Inappropriate transfusion episodes represented less than 2% of the total according to clinical criteria established for purposes of screening cases. The percentage of episodes reviewed that did not meet the screening criteria decreased progressively (3.6% to 0.3%) during the study period. Episodes in which red blood cells (RBC) or fresh frozen plasma (FFP) alone and RBC and FFP together were transfused comprised almost all of the cases that were unjustified by peer review. The findings indicated that, although comprehensive review may document the overall appropriateness of clinical transfusion practice, more detailed profiling of clinical circumstances of each episode is necessary to provide convincing arguments for major revisions in hemotherapy practice.

Blood Transfusion↗
PubMed2002

A comparison of diagnosis capture from medical records, self-reports, and drug registrations: a study in individuals 80 years and older.

BACKGROUND AND AIMS: Reports of diseases and health problems vary as a function of the information source. In the present study we compared the capture of information on morbidity using medical records, self-reports, and drug registrations. METHODS: A concurrent review of medical records, self-reports, and registration of marker drugs was conducted to determine diagnosis for 44 common diseases. Diagnoses from the various sources were uniformly classified according to ICD-10. The study included a sample of 702 individuals, aged 80 and older, enrolled in population-based longitudinal studies. RESULTS: The morbidity rates differed considerably across the used sources. Although medical records captured most of the morbidity, self-reports offered supplemental information especially for less objective health problems. Marker drugs typically confirmed information in the records, but only for a limited number of diseases. DISCUSSION: In studies of aging and health, a thorough review of medical records and a concurrent evaluation of self-reports and marker drugs represent a valuable strategy for portraying morbidity. This strategy goes beyond the use of a single source like self-reports, and provides better estimates of health conditions in the elderly.

Aged↗
PubMedDate not supplied

Psychiatric hospitalization and managed care in conflict.

The managed-care concurrent review process often results in denied or limited coverage of psychiatric inpatient care due to reviewers' misconceptions about psychiatric hospitalization and in an effort to achieve savings. For employers, such decisions may cost more in the long run.

Adult↗
PubMed1998

Effects of utilization management on patterns of hospital care among privately insured adult patients.

OBJECTIVES: This study examined the effects of utilization management review activities on patterns of hospital care among a sample of adult patients insured through a managed fee-for-service plan. METHODS: The study was a retrospective analysis of insurance administrative data representing a case series of patients for whom utilization management review was performed. Two review activities were analyzed: pre-admission review and concurrent (continued stay) review. Patients were 49,654 privately insured adult patients reviewed for care between January 1989 and December 1993. Review outcomes included inpatient or outpatient care denied, site of treatment shifted (from inpatient to outpatient), or reduction in requested hospital days (total days requested - total days approved). RESULTS: Few patients (<1%) were denied care at time of admission or were required to obtain outpatient instead of inpatient care. More common was action taken to limit length of stay by concurrent review, which accounted for 83% of the total reduction (25,197 requested days) in inpatient care. Utilization management became more restrictive with time: the number of days approved declined by 15% to 50% from 1990 to 1993, depending on the type of admission. Utilization management was most forceful in restricting care for mental health patients, who represented 5.7% of the study population but accounted for 54.7% of the total reduction in requested days. CONCLUSIONS: The utilization management program appeared to limit hospital care by managing length of stay once patients were admitted. The effects of restricting length of stay in this manner on quality and health outcomes should be investigated.

Adult↗
PubMed1997

Implementation of total quality management after reconfiguration of services on a general hospital unit.

In 1992 the New York State Office of Mental Health issued a statewide plan for mental health services to reduce the number of inpatient beds in state-run facilities from approximately 11,000 to between 6,000 and 8,000 by the year 2000. This reduction resulted in at least a 25 percent increase in psychiatric beds at local general hospitals. In 1992 Albany Medical Center Hospital's department of inpatient psychiatry established an interdisciplinary committee to address changes resulting from the reconfiguration of services to chronic mentally ill persons. The committee established procedures to use the principles of total quality management to respond to problems and to continuously improve the therapeutic milieu. The authors describe how these principles were used to create a patient satisfaction survey, to examine and improve part of the hospital admissions procedure, and to review and revise treatment planning documentation. A concurrent review committee reviews patients' records to ensure accuracy of documentation and quality of care.

Chronic Disease↗
PubMed1993

Use of i.v. cimetidine, ranitidine, and famotidine in 40 hospitals.

The drug experiences of 1200 patients receiving i.v. histamine H2-receptor antagonists were studied. Forty hospitals in five southeastern states participated in a drug-use evaluation (DUE). In addition to supplying background information, a pharmacist at each hospital used a standardized form to perform a concurrent review of 30 consecutive adult patients who had been started on i.v. cimetidine, ranitidine, or famotidine. In addition to the patient's age and the prescriber's medical specialty, specific DUE criteria included the reason given in the medical record for use; dosage regimen and adjustments made on the basis of the patient's renal function; other GI drugs taken concurrently; pharmacist intervention; simultaneous use of oral medications; occurrence of adverse events; H2-antagonist use with specified drug products known to affect serum drug concentrations of one or both medications; and use of gastric pH monitoring. Therapy with i.v. H2 antagonists was usually started by internal medicine specialists or surgeons, and most of the evaluated patients received such therapy for prevention of stress-related mucosal damage. According to estimated creatinine clearance, 34% of patients were in need of dosage adjustments, but such adjustments were made in only 49% of these. Forty percent of patients began therapy while taking at least one medication orally, and almost one fourth of patients were receiving an additional drug for the treatment of an acid-peptic or related indication. The occurrence of adverse events was similar for the three H2 antagonists studied. The findings identify several problematic areas in the way H2 antagonists are used in clinical practice.

Adolescent↗
PubMed2002

A nurse practitioner intervention model to maximize efficient use of telemetry resources.

BACKGROUND: Telemetry monitoring is widely used in hospitals; the importance of being able to monitor and examine dysrhythmias has been universally accepted. Yet it is often used for patients who do not actually require this technology. A model to improve the efficiency of telemetry use entailed the use of an advanced practice nurse (APN; identical to a nurse practitioner) to provide concurrent review and intervention of floating telemetry, which is available for patients independently of the floor location and who do not need an intensive care unit bed. ADDRESSING OVERUSE: The demand for floating telemetry at Hackensack University Medical Center had equaled or exceeded the telemetry availability virtually 100% of the time, even after local guidelines had been disseminated in 1998. The APN carried out concurrent monitoring and intervened with the attending physician when patients were on telemetry for longer than 48 hours and did not meet the local telemetry guidelines. RESULTS: The mean number (standard error [SE]) of hours per patient declined from 65.2 +/- 0.7 hours (95% confidence interval, 63.8 to 66.6 hours) for the 11 months before the intervention to a mean of 49.6 +/- 0.4 hours (95% confidence interval, 48.7 to 50.2 hours) for the 29 months after intervention--representing a decrease of 34% (p < 0.0001). This decrease led to an increase in the number of patients per month put on telemetry. DISCUSSION: The APN model, an aggressive approach that induced change almost immediately, was then applied to other quality improvement projects.

Adult↗