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At least 91 records · Page 5Linked to original sources
PubMed1996

Substance abuse and dependence in physicians: the Missouri Physicians' Health Program.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The average recovery rate in this study of 146 participants was 94%.

Female↗
PubMed1997

Implementing a quality assurance program using a risk assessment tool on dairy operations.

Concerns and perceptions about antibiotic residues in milk prompted the dairy industry to develop a voluntary program to support rational antibiotic use on dairy farms. One deficiency of this program is the inability of producers to identify easily the weaknesses in antibiotic management in order to develop control plans. To overcome this deficiency, an educational approach was designed. The program centered on an on-farm risk assessment tool used by the producer and an industry educator to determine the current risk for residue violation. The risk assessment tool was tested by 25 field personnel working with northeastern milk receivers and 250 producers in seven states. The participants in the study identified a lack of adequate treatment records as being the highest risk factor for antibiotic residues, followed by deficiencies in understanding how to use antibiotics and poor relationships between veterinarians and their clients. When field representatives utilized the risk assessment tool, for most producers, risk of antibiotic residue decreased by approximately 19%. In particular, more farms kept written records or more complete records. Finally, producers with reported histories of antibiotic residues were less likely to implement management changes to reduce the risk of antibiotic residue.

Animal Husbandry↗
PubMed1986

The impact of a drug information sheet on the understanding and attitude of patients about drugs.

A proposed Food and Drug Administration program to require written information with prescription drugs could cost $500 million annually; the American Medical Association has implemented a similar, voluntary program costing more than $3 million. However, the educational impact of written drug information has not been studied. We evaluated one-page drug information sheets using an objective examination. The baseline score of 71 patients was 3.9 of 6.0. Patients tested before and one day after receiving the drug sheet improved their score by +1.4. In the second phase, patients randomized to receive the drug sheet improved their score after one month by +1.1; those not given the sheet had no improvement. Changes in attitudes and incidence of reported adverse effects seemed to be random and unrelated to the information sheet. Thus, a drug information sheet may be a useful adjunct to patient education.

Attitude↗
PubMed1992

Reducing the number of uninsured by subsidizing employment-based health insurance. Results from a pilot study.

OBJECTIVE: To evaluate whether employers who do not provide health insurance would offer such benefits after a 50% reduction in the price of health insurance. DESIGN: Using a survey of 530 firms at two sites in New York State, we estimate the number of firms that added insurance during 1988 as a percentage of firms that were eligible for the subsidy. We use this proportion as an estimate for the number of firms that would have added insurance in the absence of the subsidy program. We then estimate the number of firms adding insurance during the initial year of the program, 1989. SETTING: The subsidized health insurance pilot projects were available in Brooklyn and in the Albany-Plattsburgh-Poughkeepsie region of New York State. INTERVENTION: New York State subsidized the price of health insurance, reducing it by 50%. Eligible employers were responsible for paying the remaining portion of the premium. RESULTS: The subsidized health insurance products increased the number of small firms (under 20 employees) offering insurance by a small amount, approximately a 3.5 percentage point increase. When fully implemented and assuming all eligible employers were aware of the program, the subsidy would increase the proportion of firms offering insurance by 16.5 percentage points. We view this as an upper boundary. CONCLUSIONS: Increased program visibility and allowing the employee to share in the premium payment may increase the number of employers offering insurance. Even under ideal conditions, however, the results highlight the limitations of voluntary programs to increase the number of employers offering health insurance.

Health Benefit Plans, Employee↗
PubMed1984

Future plans for quality assurance in radiation oncology in the United States.

The Patterns of Care Study (PCS) is conducting continuing surveys in key disease sites that will monitor changes in processes and outcome of care from 1973 to 1985. The PCS will conduct a process survey in 1984 that will provide the baseline data for the quality assessment survey program available to individual facilities in the United States in 1985. This program will be conducted through the American College of Radiology and operated by the joint ACR-ASTR Quality Assessment Committee which includes representatives from the American Association of Physicists in Medicine. It will be a voluntary program that will be paid for by the facility requesting assessment. The feedback will be confidential and constructed in a manner as to maximally help the facility recognize areas where improvements can be made. We are continuing to work with licensing accrediting groups such as the Joint Commission on Accreditation of Hospitals (JCAH) and the American College of Surgeons' cancer accreditation program to advise them of the service we will be providing, and to obtain their recognition and recommendation of this service. This program will provide a means of meaningful quality assessment for the individual facility, and the opportunity for each facility to improve the quality of their care. In addition, through these surveys we will continue to monitor changes in the national benchmarks for processes and outcomes of care of key disease sites in which radiation therapy plays an important interventional role.

Female↗
PubMed1994

Mammography quality assurance programs.

A quality assurance program is an integral part of a department of radiology, but certain examinations require a more specialized approach than others. The need for greater quality control in mammography was recognized by the American College of Radiology in 1987. The voluntary program developed by this organization has greatly improved the overall quality of mammography in almost three fourths of the facilities in this country. The principles of this initiative now have been adopted by various state and federal agencies, but a uniform approach has not yet been finalized. Optimally, the best aspects of all of these programs will be integrated, resulting in satisfactory image quality, acceptable dosimetry, and an appropriate level of interpretive accuracy in all mammography installations.

Accreditation↗
PubMed1994

The impaired physician, Part II: Missouri State Physicians Health Program.

Missouri Physicians Health Program (MPHP) was established to help impaired physicians return to healthy personal and professional lives. One percent of Missouri physicians will suffer some sort of impairment; ie: substance abuse, or dependency of drugs or alcohol within a year. This is a confidential voluntary program. This program of early referral, intervention, treatment and monitoring advocacy has been highly successful. The average recovery rate in this study of 75 participants was 92%.

Female↗
PubMed1995

Who comes to a voluntary depression screening program?

OBJECTIVE: The purpose of this study was to describe who comes to a voluntary depression screening program by analyzing findings from the 1992 National Depression Screening Day. METHOD: Survey results from 5,367 adult volunteers at 345 facilities were analyzed. The authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and treatment history of the respondents. They also estimated the percentage of these individuals who would actually have a diagnosis of major depression (positive predictive value). The main assessment measure was the Zung Self-Rating Depression Scale. RESULTS: Of all participants, 76.6% (N = 4,109) had at least minimal depressive symptoms (score of at least 50 on the Zung depression scale), 53.3% (N = 2,859) had at least moderate symptoms (score of at least 60), and 22.6% (N = 1,214) had severe symptoms (score of at least 70). Few of the depressed respondents were currently in treatment for a mental health problem. The positive predictive value of a screening test diagnosis of depression was between 92.5% and 95.5% when a cutoff score of 60 was used to indicate depression and between 88.7% and 92.3% when a cutoff score of 50 was used. CONCLUSIONS: Voluntary screening tests, as exemplified by results from the National Depression Screening Day, provide a good opportunity for identifying previously unidentified and untreated individuals with depression.

Adolescent↗
PubMed1989

Feasibility study for neonatal neuroblastoma screening in the United States.

Urine was obtained from infants born at two large metropolitan Minneapolis/St. Paul, Minnesota hospitals to determine whether normal levels of urinary catecholamine metabolites in neonates can be used for subsequent neuroblastoma screening as well as to determine compliance with collecting such urine in a voluntary program. The results suggest that there are wide variations in raw values of urinary creatinine, homovanillic acid, and vanillylmandelic acid through the first 4 days of age, apparently because of maternal creatinine and catecholamine metabolite influences. Such maternal influences appear negligible by 3 weeks of age. Furthermore, the study suggests that voluntary compliance in the United States with collecting urine at home without rigorous public education and/or methods for reminding parents may be very poor.

Biomarkers, Tumor↗
PubMed1983

The current status of screening for uterine cancer.

The screening program for cervix cancer in the Province of British Columbia appears to have reached a stable state. It has achieved a reduction in incidence of clinical squamous carcinoma in women over 20 of about 75% and reduction in mortality of about two thirds. Data has been presented to suggest that no further improvement in these rates should be forthcoming in a voluntary program such as ours. There has been a real increase in the numbers of in situ carcinomas found in our population but despite this increase clinical invasive carcinoma has not risen and we attribute this to the success of the program in intercepting disease before it becomes invasive. Endometrial carcinoma has not increased in our population and we do not feel that the current methods for early detection of this disease are applicable to a province-wide study. We intend to continue to emphasize the earliest possible investigation of abnormal peri- and postmenopausal bleeding by fractional curettage, as our mainstay of detection.

Adult↗
PubMed1985

Improved perinatal knowledge in community hospitals through a self-instructional program.

The Perinatal Continuing Education Program (PCEP) was conducted throughout South Carolina. The program was well received and greatly valued; however, participants requested more information covering obstetrics. To meet this need, we developed the Perinatal Education Program for Community Hospitals (PEPCH), patterned after and similar to PCEP, and tested it in South Carolina and southern California. In the South Carolina trial, the posttest was found reliable (Kuder-Richardson index = .77). In the California trial, the pretest/posttest reliability was confirmed. Learning for nurses was documented (pretest = 30.8 +/- 5.3, posttest = 36.8 +/- 5.5, P less than .001). Completion rate for this voluntary program was 84%. We conclude that a self-study program based in the community hospital can improve knowledge of perinatal professionals.

California↗
PubMed1998

St. Joseph teams up wih EPA for big energy savings.

U.S government to the rescue? An energy savings program with the U.S Environmental Protection Agency is saving big bucks for plenty of health care facilities around the country. A good example is St. Joseph Hospital in Lancaster, PA, which is saving an estimated $175,000 each year from new lighting fixtures alone. And that's just the beginning. Here's the story, plus details on how you can tap into this voluntary program.

Conservation of Energy Resources↗
PubMed1980

Measurement of physicians' performance using existing techniques.

Existing techniques permit objective and valid measurement of limited elements of physicians' performance. These limited aspects, however, are of considerable importance to patients. The basic components of performance in medicine and surgery can be defined and used as the basis of organized programs for such evaluation. Interhospital comparisons can provide an effective impetus for assessing and improving performance of individual staff members when this is indicated. Professional auspices are needed for the development and application of methods that can provide continuing assurance that the clinical activity of physicians corresponds to contemporary standards.A system of incentives should be provided to physicians to promote their participation in voluntary programs of self-assessment. The incentives should be in the form of performance assessment credits, comparable in definition to continuing medical education credits, but granted for participation in an accredited program that objectively measures physicians' performance against national standards of the respective specialty.

Clinical Competence↗
PubMed1992

Strength increases from the motor program: comparison of training with maximal voluntary and imagined muscle contractions.

1. This study addressed potential neural mechanisms of the strength increase that occur before muscle hypertrophy. In particular we examined whether such strength increases may result from training-induced changes in voluntary motor programs. We compared the maximal voluntary force production after a training program of repetitive maximal isometric muscle contractions with force output after a training program that did not involve repetitive activation of muscle; that is, after mental training. 2. Subjects trained their left hypothenar muscles for 4 wk, five sessions per week. One group produced repeated maximal isometric contractions of the abductor muscles of the fifth digit's metacarpophalangeal joint. A second group imagined producing these same, effortful isometric contractions. A third group did not train their fifth digit. Maximal abduction force, flexion/extension force and electrically evoked twitch force (abduction) of the fifth digit were measured along with maximal integrated electromyograms (EMG) of the hypothenar muscles from both hands before and after training. 3. Average abduction force of the left fifth digit increased 22% for the Imagining group and 30% for the Contraction group. The mean increase for the Control group was 3.7%. 4. The maximal abduction force of the right (untrained) fifth digit increased significantly in both the Imagining and Contraction groups after training (10 and 14%, respectively), but not in the Control group (2.3%). These results are consistent with previous studies of training effects on contralateral limbs. 5. The abduction twitch force evoked by supramaximal electrical stimulations of the ulnar nerve was unchanged in all three groups after training, consistent with an absence of muscle hypertrophy. The maximal force of the left great toe extensors for individual subjects remained unchanged after training, which argues against strength increases due to general increases in effort level. 6. Increases in abduction and flexion forces of the fifth digit were poorly correlated in subjects of both training groups. The fifth finger abduction force and the hypothenar integrated EMG increases were not well correlated in these subjects either. Together these results indicate that training-induced changes of synergist and antagonist muscle activation patterns may have contributed to force increases in some of the subjects. 7. Strength increases can be achieved without repeated muscle activation. These force gains appear to result from practice effects on central motor programming/planning. The results of these experiments add to existing evidence for the neural origin of strength increases that occur before muscle hypertrophy.

Adult↗
PubMed1980

Initiation of a goal-directed movement in the monkey. Role of the cerebellar dentate nucleus.

The participation of the dentate nucleus (DN) in the initiation of a voluntary movement was investigated in five baboons (Papio papio). In these experiments, we have analyzed the effects of excluding the DN on the latency (reaction time, RT) of a learned goal-directed movement. Two techniques were for excluding the DN. In three animals, the structure was cooled with a probe, stereotaxically implanted on the side ipsilateral to the active hand. In two others, a partial electrolytic destruction of the DN ipsilateral to the operant hand was undertaken. In one further animal, both DNs were destroyed electrolytically. A comparison was made of the effect of DN inactivation on the latency of stereotyped goal-directed movements of constant amplitude and direction, and of goal-directed movements whose amplitude and/or direction were varied in random fashion. The exclusion of DN brought about a prolongation of RTs in all animals. This prolongation was not accentuated by variation of different characteristics (amplitude and/or direction) of the impending goal-directed movement. A recovery of the RTs to their prelesion values was observed after irreversible unilateral DN lesion, but no so easily after bilateral destruction. These results show that in the monkey DN is concerned with the initiation of a goal-directed movement, but is not critically implicated in the encoding of direction and amplitude parameters. These findings are discussed in view of the role that is usually attributed to the neocerebellum in programming voluntary movements.

Animals↗
PubMed1978

Nonprofessionals in the rehabilitation of mentally disordered sex offenders.

Eighty-six sex offenders were exposed to a 6-month voluntary program of either group encounters (experimental group) or hobbies and games (control group) led by nonprofessionals. Pre- and posttests included a personality test, an introspective report, and a behavior rating scale. Written ward records were assessed as were the results of a postexperimental prisoner evaluation of the experience. Significant changes were evidenced by encounter subjects in improved feelings of approval of the prison-hospital experience, lessened hostility, and better attendance at the meetings. Encounter subjects were improved in the predicted direction on 55 of the 74 treatment dimensions. Community volunteers were judged moderately successful as lay therapists.

Adult↗
PubMed1993

The Australian development of national quality indicators in health care.

BACKGROUND: The Australian Council on Healthcare Standards (ACHS) conducts a voluntary program of health facility accreditation modeled along the lines of the Joint Commission. To increase clinician involvement in the accreditation process and in quality assurance programs and to enable some assessment of the outcome of care in a facility at the time of survey, the ACHS, together with the medical colleges, is developing objective measures of care (clinical indicators). METHODS: Ten medical colleges are now involved in the program. The first set of measures, the Hospital-Wide Medical Indicators (HWMIs) developed in conjunction with the Royal Australian College of Medical Administrators, was formally introduced into the accreditation process in January 1993. These indicators were developed by a combined working party of the Care Evaluation Program and the Royal Australian College of Medical Administrators. The HWMIs address the areas of trauma, postoperative pulmonary embolism, readmissions to hospital, returns to the operating room, hospital-acquired infection, medication errors, and hospital throughout. CONCLUSION: It is hoped that the development of objective measures of care (clinical indicators) will facilitate the accreditation process. The development of these measures also enables Australian physicians to compare patient care throughout the hospital with national indicators of quality of care.

Accreditation↗