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PubMed1998

Partnering to improve infant immunizations: The Arizona Partnership for Infant Immunization (TAPII).

The Arizona Partnership for Infant Immunization (TAPII) is a public-private partnership intended to achieve the year 2000 goal of 90% infant immunizations. Created in 1992 as a means to develop a statewide approach to improving infant immunization rates, TAPII is a broad-based partnership that includes public health departments, managed care plans, professional organizations, medical organizations, pharmaceutical companies, businesses, the faith community, the media, and many others. TAPII's organizational structure includes a steering committee and five subcommittees: advocacy and policy, community awareness, provider awareness, survey and assessment, and strategic planning. A key accomplishment of TAPII has been the development of a statewide infant immunization registry known as the Arizona Statewide Immunization Information System (ASIIS). This registry will facilitate up-to-date immunizations of children and improve statewide immunization assessment capability. Since the advent of TAPII, infant immunization rates within private managed care plans have increased. However, significant improvement in statewide rates will require long-term strategic efforts in provider and community awareness and a fully operational statewide registry, ASIIS, which is set to begin in January 1998. TAPII has been a successful partnership for a number of reasons: private sector participation, a single and measurable goal, vision and leadership, a strong emphasis on assessment, a broad-based membership, community ownership, Governor's Office participation, health plan involvement, and full-time project staffing. As resources to improve the health of communities diminish, public-private partnerships such as TAPII can effectively consolidate resources and expertise to improve the health of populations.

Arizona↗

PubMed1984

New JCAH standards affect medical staff, quality assurance.

Medical staff composition, credentialing procedures, governance, and quality assurance are the major areas affected by recent revisions in the Joint Commission on Accreditation of Hospitals' Accreditation Manual for Hospitals. The most controversial revision expands the definition of the medical staff to include not only physicians and dentists but also other nonphysician practitioners. Much of this controversy is unwarranted, however, because the standard is purely permissive; no hospital is required to change its medical staff composition if it chooses not to. Institutions are now permitted, if not encouraged, to examine specific classes or categories of providers and to determine the appropriateness of their practice within the hospital setting. Criteria for granting staff membership or clinical privileges must be developed for each category. Mechanisms for appointing medical staff members and for granting clinical privileges must be "hospital-specific"; each hospital; even those within the same system, chain, or geographic area, must have separate and distinct policies and guidelines for decision making in the credentialing process. The credentialing mechanism also must be "described to each applicant." The phrases "ethical criteria," "ethical pledge," and "ethical standards" have been completely dropped from the accreditation requirements. The previous standards subjected both the JCAH and the hospital to liability hazards. The newer standards not only eliminate the potential liability associated with the adoption of a particular code of ethics but also give the hospital greater latitude in enforcement, since the institution is not limited to a particular codification of principles or religious ethics. The medical executive committee's (MEC's) role and composition have also been redefined.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗

PubMed2003

The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology.

This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based upon modifications suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany, and derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. The document is not meant to override individual clinical considerations for problematic patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited and therefore the suggested treatments are impractical. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this version of the Consensus represents the best judgment of the ISL membership on how to approach patients with peripheral lymphedema as of 2003. We anticipate that the document will and should be challenged, debated in the pages of Lymphology (e.g., as Letters to the Editor), and ideally become a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this "living document" will undergo periodic revision and refinement.

Biopsy↗

PubMed1988

Reforming the law in action through empirically grounded civil commitment guidelines.

Some assumptions that guided the national task force in developing the Guidelines for Involuntary Civil Commitment are identified and discussed. The task force's multidisciplinary membership is seen as enhancing the credibility of the suggested reforms. The task force developed guidelines instead of a model law, avoiding disputes about the philosophical basis of commitment laws and providing local jurisdictions the liberty to adapt the task force's recommendations to suit local conditions. Both the problems identified and the suggestions offered by the guidelines were based on the empirical experience of local commitment systems. Communication among the components of civil commitment systems was seen as crucial to reform and as achievable through a recommended structural change.

Advisory Committees↗

PubMed2003

Voluntary accreditation of cellular therapies: Foundation for the Accreditation of Cellular Therapy (FACT).

Voluntary accreditation of cells, tissues, and cellular and tissue-based products intended for human transplantation is an important mechanism for improving quality in cellular therapy. The Foundation for the Accreditation of Cellular Therapy (FACT) has developed and implemented programs of voluntary inspection and accreditation for hematopoietic cellular therapy, and for cord blood banking. These programs are based on the standards of the clinical and laboratory professionals of the American Society of Blood and Marrow Transplantation (ASBMT), the International Society for Cellular Therapy (ISCT), and NETCORD. FACT has collaborated with European colleagues in the development of the Joint Accreditation Committee in Europe (jACIE). FACT has published standards documents, a guidance manual, accreditation checklists, and inspection documents; and has trained as inspectors over 300 professionals active in the field. All inspectors have a minimum of 5 years' experience in the area they inspect. Since the incorporation of FACT in 1996, 215 hematopoietic progenitor cell facilities have applied for FACT accreditation. Of these facilities, 113 are fully accredited; the others are in the process of document submission or inspection. Significant opportunities and challenges exist for FACT in the future, including keeping standards and guidance materials current and relevant, recruiting and retaining expert inspectors, and establishing collaborations to develop standards and accreditation systems for new cellular products. The continuing dialogue with the Food and Drug Administration (FDA) is also important to ensure that they are aware of the accomplishments of voluntary accreditation, and keep FACT membership alerted to FDA intentions for the future. Other potential avenues of communication and cooperation with FDA and other regulatory agencies are being investigated and evaluated.

Accreditation↗

PubMed2004

Bringing health policy issues front and center in the community: expanding the role of community health coalitions.

BACKGROUND: Systemic, environmental, and socioeconomic conditions create the context in which community members deal with their health concerns. Comprehensive, community-based chronic disease prevention interventions should address community-wide or regional policy issues that influence lifestyle behaviors associated with chronic diseases. CONTEXT: In two communities along the Arizona-Mexico border, community coalitions that administered a comprehensive diabetes prevention and control intervention expanded their membership to become policy and advocacy coalitions with broad community representation. These coalitions, or Special Action Groups (SAGs), identified and prioritized policy issues that directly or indirectly affect physical activity or nutrition. METHODS: Local schools were one focus of advocacy. The Centers for Disease Control and Prevention's School Health Index was implemented as part of the overall intervention; the SAGs supported schools in advocating for more physical education programs, removal of vending machines, substitution of more healthful options in vending machines, and changes in health education curricula. In the broader community, the SAGs promoted opportunities for walking and bicycling, long-term planning by their cities and counties, and healthy food choices in local grocery stores. Advocacy tactics included attending and making presentations at city council, school board, parks and recreation, and planning and zoning commission meetings; participating on long-range planning committees; organizing an annual community forum for elected and appointed officials; and presenting healthy food and cooking demonstrations in local markets. CONSEQUENCES: After three years, SAGs were able to document changes in local policies and practices attributable to their activities. INTERPRETATION: The SAGs contributed to systems changes in their communities and were able to obtain new resources that support protective behaviors. Also, the advocacy process itself provided strong positive reinforcement to all participants in this comprehensive diabetes intervention.

Arizona↗

PubMed2007

Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005.

OBJECTIVE: To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU. PARTICIPANTS: A multidisciplinary task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units. EVIDENCE: The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion. CONSENSUS PROCESS: The topic was divided into subheadings: decision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal. CONCLUSIONS: More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.

Critical Care↗

PubMed1993

Screening for human immunodeficiency virus: a survey of British clinical pharmacology units.

1. A survey of screening practices used to detect infection with the human immunodeficiency virus (HIV), covering the 12 months from June 1990 to May 1991, was carried out in 74 clinical pharmacology units performing phase I and II studies. Forty-five units were identified from the Technomark commercial register, and 29 units were identified from the clinical academic membership of the British Pharmacological Society. 2. An overall response rate of 92% was obtained: 41 replies from commercial units; 27 replies from academic units. Seventeen commercial units and 26 academic units reported involvement with healthy volunteer studies; these were the 43 questionnaires analysed. 3. The majority of clinical pharmacology units did not believe that it was necessary to perform HIV screening by HIV antibody testing. Six commercial units (35%) and three academic units (12%) did perform HIV antibody testing in healthy volunteers. 4. Reasons frequently given for testing were protection of clinical and laboratory staff, and the advantages to the volunteer of prophylaxis and treatment at an early stage of HIV infection. Reasons for not testing included the perceived low risk of a positive test, a lack of benefit from treatment, and the adverse implications in relation to health insurance. Advice from an Ethics Review Committee was not generally a reason for testing. 5. In future, screening patterns may change, depending on prevalence of HIV positivity in the community, the benefits of diagnosis and treatment, and the perceived or real disadvantages of having an HIV antibody test. For the present, we believe that indirect methods, such as an HIV risks questionnaire, are more appropriate than direct antibody testing.

Adolescent↗

PubMed1979

The pharmacist's role as a member of the institutional review board.

Since World War II, concern about the protection of human subjects in biomedical research has increased considerably. The Nuremberg Code and the Helsinki Declaration have been published. The United States Department of Health, Education, and Welfare (DHEW) has developed and published regulations that specify a review process which research institutions must follow in order to receive DHEW funds for research involving human subjects. Part of this process includes a review of research projects by an Institutional Review Board (IRB). Membership on the IRB must be varied and should include allied scientists. Because many of the projects include investigational drugs, the inclusion of a pharmacist as a member is logical. The pharmacist, if properly selected and prepared, can play a vital role in the review of research projects by assisting in the evaluation of the scientific merit of the plan, the appropriateness of the volunteer agreement, and the regulatory compliance of the project. The selected pharmacist should view the duty as another opportunity to practice clinical pharmacy.

Human Experimentation↗

PubMed2005

18th International Conference on Antiviral Research.

The 18th International Conference on Antiviral Research (ICAR) was held at the Princess Sofia Hotel in Barcelona, Spain, from 11th-14th April, 2005. This is a yearly international meeting sponsored by the International Society for Antiviral Research (ISAR). The current president of ISAR is John A Secrest 3rd of the Southern Research Institute. The scientific programme committee was chaired by John C Drach from the University of Michigan. ISAR was founded in 1987 to exchange prepublication basic, applied and clinical information on the development of antiviral, chemical and biological agents as well as to promote collaborative research. The ISAR has had a major role in the significant advances of the past decade in the reduction of the societal burdens of viral diseases by the focus of ICAR on the discovery and clinical application of antiviral agents. The 18th ICAR was organised as a series of focus presentations on specific viral groups consisting of oral and poster presentations of original research findings. In addition, the conference included plenary speakers, award presentations, a minisymposium on bioterrorism, and a satellite symposium on clinical antiviral drug developments. The size of the conference (> 50 oral and 250 poster presentations) necessitates limitation to the most noteworthy in the judgment of this reviewer. The current membership of the ISAR is approximately 700 with approximately 50% the membership in attendance.

Antiviral Agents↗

PubMed2001

A brief history of the Japan Society for Cell Biology.

The Japan Society for Cell Biology (JSCB) was first founded in 1950 as the Japan Society for Cellular Chemistry under the vigorous leadership of Seizo Katsunuma, in collaboration with Shigeyasu Amano and Satimaru Seno. The Society was provisionally named as above simply because cell biology had not yet been coined at that time in Japan, although in prospect and reality the Society was in fact for the purpose of pursuing cell biology. Later in 1964, the Society was properly renamed as the Japan Society for Cell Biology. After this renaming, the JSCB made great efforts to adapt itself to the rapid progress being made in cell biology. For this purpose the Society's constitution was created in 1966 and revised in 1969. According to the revised constitution, the President, Executive Committee and Councils were to be determined by ballot vote. The style of the annual meetings was gradually modified to incorporate general oral and poster presentations in addition to Symposia (1969-1974). The publication of annual periodicals in Japanese called Symposia of the Japan Society for Cellular Chemistry (1951-1967) and later Symposia of the Japan Society for Cell Biology (1968-1974) was replaced by a new international journal called Cell Structure and Function initiated in 1975. This reformation made it possible for the Society to participate in the Science Council of Japan in 1975 and finally in 1993 to acquire its own study section of Cell Biology with grants-in-aid from the Ministry of Education and Science, Japan. The JSCB hosted the 3rd International Congress on Cell Biology (ICCB) in 1984 and the 3rd Asian-Pacific Organization for Cell Biology (APOCB) Congress in 1998, thus contributing to the international advancement of cell biology. Now the membership of JSCB stands at approximately 1,800 and the number of presentations per meeting is 300 to 400 annually. Although a good number of interesting and important findings in cell biology have been reported from Japan, the general academic activity of the JSCB is far less than one might expect. This is simply due the fact that academic activity in the field of cell biology in Japan is divided among several other related societies such as the Japan Society for Molecular Biology and the Japan Society for Developmental Biology, among others.

Biology↗

PubMedDate not supplied

Committee on Natural Toxins and Food Allergens. Marine and freshwater toxins.

There have been major developments this past year in the Marine and Freshwater Toxins topic area (formerly Phycotoxins). These include AOAC approval and inauguration of a new AOAC Presidential Task Force on Marine and Freshwater Toxins to accelerate methods validation, and the appointment of several new Topic Advisors. A joint FAO/IOC/WHO group addressing biotoxins in molluscan bivalves is also relevant to this report and to the new Task Force. The AOAC Presidential Task Force on Marine and Freshwater Toxins is an international group that, in late November 2004, consisted of 90 world experts and stakeholders. Chaired by this General Referee, the group establishes methods priorities based on analytical methods criteria, determines fitness for purpose, identifies and reviews available methodologies, recommends methodologies for validation, and identifies complementary analytical tools. Once appropriate analytical methodology has been identified or developed, the Task Force is able to identify financial and technical resources necessary to validate the methods. The first two formal meetings of the Task Force were held in Bethesda, MD, on May 19, 2004 and in St. Louis, MO, on September 22, 2004. These meetings were held in conjunction with the XI International IUPAC Symposium on Mycotoxins and Phycotoxins and the 118th AOAC INTERNATIONAL Annual Meeting and Exposition, respectively. The Bethesda meeting served to introduce members of the group to the AOAC Community/Task Force model and to discuss objectives, concerns, general workings, and communications. The meeting concluded on an encouraging note, with a commitment from AOAC to help provide financial resources for the review of nonproprietary methods deemed high priority by the Task Force. This development was seen as an important step toward reaching methods validation objectives. The terms of reference for the Task Force were approved by the AOAC Board of Directors in late June, 2004. They described the Task Force membership as composed of voting and nonvoting members, with the voting members consisting of 13 members (12 plus the Chair). Voting members comprise of a balance of government regulators, academics, and industry members. No single agency has more than 2 voting members. Task Force members serve as experts in the field and agree to identify other experts; recommend individuals who can serve on the Task Force and as Chair; develop and prioritize a list of marine and freshwater toxins that need validated methods; assist in identifying existing methods for validation through AOAC validation programs; and recommend to the AOAC INTERNATIONAL Board of Directors policies and procedures necessary to accomplish the mission of the Task Force. They endeavor to actively support the work of the Task Force through garnering of sources of funding (except where prohibited by employer); identifying potential participating laboratories, sample identification and acquisition; and increasing program awareness among stakeholders. They assist AOAC in the identification of study directors and in the development of quality measurement tools by participating in the validation of methods and by identifying venues for members of the Task Group or the community to gather and assist with meeting content. Prior to the September 2004, AOAC Annual Meeting, the Task Force approved a set of Analytical Methods Selection Criteria, which are critical to the mission of the Task Force. They can be found, along with the Terms of Reference, roster of members, and other information, on the Task Force Web site at http://www.aoac.org/marine toxins/task_force.htm. The September 22, 2004 Task Force meeting in St. Louis included discussion of 2 interlaboratory studies, a proprietary kit for domoic acid by enzyme-linked immunosorbent assay (ELISA; Biosense Labs AS, Bergen, Norway) and also a nonproprietary liquid chromatography (LC) method for paralytic shellfish poisoning (PSP) toxins by precolumn oxidation (James F. Lawrence, Health Canada). These 2 methods were recommended by the Task Force for review by AOAC in September 2004. The group also discussed future priority directions, aspects of interlaboratory studies and official methods of analysis, other methods validation issues, future meetings, and funding. In addition to the Task Force meeting, 2 subgroup meetings were held. One subgroup addressed strategies to replace the mouse bioassay for brevetoxins with alternative modern methods based on ELISA or LC/mass spectrometry (MS). Brevetoxin metabolites, toxicity issues, and extraction conditions as well as future field studies were addressed in detail. The receptor binding assay (RBA)/saxitoxins subgroup addressed several aspects of the methodology, radiolabeled saxitoxin, and comparisons of mouse bioassay and RBA response. Both subgroups were productive and were seen as very useful by the participants. Task Force attendees generally agreed that subgroups are the most effective means of progressing towards validation of new methods and of ensuring thorough discussions of methods under consideration. By the time of their next meeting (April 2005) at the "Marine and Freshwater Toxins Analysis: 1st Joint Symposium and AOAC Task Force Meeting" in Baiona, Spain, the Task Force will have several well developed new subgroups in the areas of okadaic acid and dinophysis toxins, yessotoxins, domoic acids, and ciguatoxins. Some of the subgroups will hold face-to-face meetings in Spain and others will meet at future symposia or joint meetings. It is likely that training sessions will be associated with multiple Task Force meetings planned for 2005. Details on these meetings can be found on the Task Force Web site. Although the Task Force has experienced rapid growth, the addition of new members to the group, especially industry and government stakeholders, is encouraged. Task Force member Michael Quilliam, NRC Canada, provided the information given below on a joint CODEX group of special relevance to the new Task Force. This group met in late September 2004. For more information, see http://www.who.int/foodsafety/chem/meetings/biotoxin/en/.

Advisory Committees↗

PubMed2006

Rural and non-rural differences in membership of the American Society of Bioethics and Humanities.

OBJECTIVE: To determine whether bioethicists are distributed along a rural-to-urban continuum in a way that reflects potential need of those resources as determined by the general population, hospital facilities and hospital beds. METHODS: US members of a large, multidisciplinary professional society, the American Society of Bioethics and Humanities (ASBH), the US population, hospital facilities and hospital beds were classified across a four-tier rural-to-urban continuum. The proportion of each group in rural settings was compared with that in urban settings, and odds ratios were calculated with 95% confidence intervals. RESULTS: Although 91% of ASBH members live or work in urban settings, only 66% of the US population did so. In contrast, 2% of ASBH members live or work in rural settings compared with 13% of the population. ASBH members were 10.7 times (95% CI 6.6 to 17.3) as likely to be represented in urban than in rural settings when compared with the general population, 25.6 times (95% CI 15.8 to 41.5) and 6.9 times (95% CI 4.3 to 11.1) as likely with regard to hospital facilities and hospital beds, respectively. CONCLUSIONS: Using various comparisons it was found that ASBH members are under-represented in rural as compared with urban settings. Although not all bioethicists are ASBH members, these findings suggest that the availability of professional bioethical resources may be inadequate in rural America. The disparities that were found may have considerable effect on ethics scholarship, research, ethical committees and education, and adds to the argument that rural American communities are under-served.

Beds↗

PubMed1993

Informed consent for clinical anaesthesia research.

Most surgical patients are first seen by an anaesthetist after admission to hospital, either the evening before or on the day of surgery. Some medical ethicists believe that an approach by an anaesthesia researcher made after admission is unethical because the hospital itself is a coercive environment, and patients have insufficient time for reflection or consultation. Others believe that an approach prior to admission may be an invasion of the patient's privacy and confidentiality. The implications of these views for anaesthesia researchers may not be apparent to research ethics boards (REBs). To determine current practice, a questionnaire concerning the membership and function of REBs and the time of obtaining informed consent was sent to each research representative of the 16 Canadian university departments of anaesthesia. Membership of REBS was similar, but not identical, in all centres. Most representation was from medical disciplines. Consent was generally obtained following the patient's admission to hospital. In one centre, the REB always requested informed consent to be obtained before the patient's admission to the hospital. Surgeons had no involvement with consent for anaesthesia research in 14 centres while in the other two they gave permission for their patients to be studied and informed patients of the potential approach by anaesthesia researchers. We conclude that it is ethically acceptable to obtain informed consent for most low-risk clinical anaesthesia research after the patient's admission to hospital.

Anesthesiology↗

PubMed1993

Long-term recovery from alcoholism.

AA has demonstrated success in steadily increasing membership, with no loss of the proportion of those with over 5 years of sobriety. It has been recognized as effective long-term treatment for alcoholism by psychiatrists and psychoanalysts experienced in treatment of the addictions. The triennial membership surveys of AA have shown stability in 1. A 50% dropout rate within the first 3 months of starting AA. Only 41% of those in the first year will remain in the Fellowship for another year. 2. Roughly equal numbers of those with less than 1 year, 1 to 5 years, and over 5 years of sobriety, with an average length of sobriety of about 4 years. 3. Members having a sponsor (85%) and belonging to a home group (88%). 4. Attendance by members of about three meetings a week, regardless of duration of sobriety. 5. Members telling their doctor that they are in AA, but not helping him or her learn about the program. The survey data also indicate that AA is changing in the following ways: 1. The number of women members has increased to more than one third the total membership. 2. An increasing number of young people, under 30 years of age, to more than one fifth the total. 3. A decreasing number of older people, over 50 years of age, to just under one fourth the total. 4. An increasing number of members who were also addicted to other drugs (46%). Psychiatrists can use these data and knowledge of AA to 1. Increase the effectiveness of referrals of alcoholic patients to AA regardless of age, sex, race, or other characteristics. All are welcome and can benefit. 2. Deal with resistance, which occurs when patients begin to make contact with AA. 3. Help alcoholic patients through the difficult first year of sobriety. 4. Encourage their alcoholic patients to use AA as a program for personal growth and development. 5. Helping dually addicted patients use AA's singleness of purpose to facilitate their recovery. 6. Cooperate with alcohol and drug treatment programs in helping patients transfer to AA and work on an effective program of recovery. 7. Work with members of the local AA Treatment Facilities and Cooperation with the Professional Community Committees in helping alcoholic patients enter and use AA. 8. Provide psychiatric treatment for AA members in ways that support and sustain their program of recovery, especially by avoiding dependence-producing medications.

Alcoholics Anonymous↗

PubMed1988

Life-saving therapy for newborns: a questionnaire survey in the state of Massachusetts.

The attitudes of Massachusetts pediatricians concerning life-saving therapies for newborns were surveyed. The sample was drawn from the membership list of the Massachusetts Chapter of the American Academy of Pediatrics. Of the sample population of 801 physicians, 449 (56%) responded. Three hypothetical cases were presented with treatment options: (1) An infant with Down syndrome and duodenal atresia, (2) an infant with meningomyelocele and microcephaly and, (3) an extremely low birth weight infant of 700 g and 28 weeks' gestation suffering from birth asphyxia. For case 1, 73% of the physicians recommended surgical correction of the duodenal atresia. Of these, 68% would seek a court order if the parents did not consent to surgery. For case 2, 53% of the physicians recommended surgical repair of the meningomyelocele. For case 3, 90% of the physicians recommended continued resuscitation of the infant and referral to an intensive care unit. Religious affiliation and age were factors influencing these clinical recommendations, with Catholic and younger physicians tending to opt for more aggressive medical intervention. The great majority of physicians (93%) indicated that the economic situation of the family should not affect a decision regarding life-saving therapy. A majority (62%) of the physicians approved of infant care review committees with a primary advisory role. Comparison with earlier attitudinal surveys suggests that pediatricians today are more willing to intervene medically on behalf of infant patients than previously.

Down Syndrome↗

PubMed1999

Assurance opportunities for local health departments.

CONTEXT: Widespread changes in health care in the United States, especially the growth in the number and membership of health maintenance organizations (HMOs), provide increasing opportunities for collaboration, especially through contracts, between local health departments (LHDs) and HMOs to achieve public health goals. OBJECTIVES: (1) To identify, through a review of the literature, the areas in which HMOs and LHDs can collaborate to their mutual benefit and (2) for the leadership of an LHD in Florida to engage HMOs in its county in Florida in collaboration. DESIGN: University faculty reviewed the relevant literature; the Director of Medical Services for the Duval County Health Department developed the relationships with Duval County HMOs. SETTING: The setting for the study was Duval County. PARTICIPANTS: The participants in the study included faculty from the College of Public Health at the University of South Florida, State and county public health officials, and representatives of 10 HMOs. MAIN OUTCOME MEASURES: The main outcome measures were a literature review to identify feasible areas for collaboration and successful collaboration with HMOs in areas of mutual interest. RESULTS: The director of medical services for the county health department initiated a variety of collaborative activities with 10 HMOs. These led to agreements, participation on committees and task forces, provision of services, and improved communication. CONCLUSIONS: Collaboration between LHDs and HMOs to achieve public health assurance goals is feasible. Other organizations can encourage such collaboration through public and private policies.

Community Health Services↗

PubMedDate not supplied

The "hospital epidemiologist" in U.S. hospitals, 1976-1977: a description of the head of the infection surveillance and control program. Report from the SENIC project.

As part of the first two phases of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control), information was collected from the heads of the infection surveillance and control programs (ISCPs) in U.S. hospitals. The data were analyzed to describe these respondents and to determine whether differences among them were related to their areas of professional training or to characteristics of the hospitals where they were located. The findings indicate that the ISCP heads constitute a very heterogeneous group, with substantial differences in age, professional training (40% are pathologists), characteristics of their medical practices, memberships in professional organizations related to infection control, time spent in ISCP activities, approach to epidemiologic problems, and opinions on the preventability of nosocomial infections and the seriousness of infection problems in their hospitals. These differences are related strongly to the ISCP heads' professional training, size of hospital, and, to a lesser extent, medical school affiliation, but there is little evidence that the differences are related to regional or urban-rural location or type of ownership of the hospitals. The average ISCP head estimates that about half of all nosocomial infections are preventable, but these estimates vary inversely with tenure in the position and the tendency to approach a clinical problem epidemiologically.

Administrative Personnel↗