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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↗
PubMed1995

Client interests in premarital counseling: a further analysis.

A survey was conducted of over 150 college students concerning their attitudes toward premarital preparation. In general, the students valued brief, high-quality, low-cost, voluntary programs led by well-trained clergy or mental health professionals. However, females, students with more supportive family backgrounds, and religious students were more willing to participate in longer-than-average programs. Students with more supportive family backgrounds were also willing to pay more for such programs and to participate earlier in their relationship's development and were more willing to accept mandatory programs. Religious students were more interested in those led by clergy and less interested in those led by mental health or social workers. Female students were more interested in in-depth programs that focus on awareness and skill-building.

Adolescent↗
PubMedDate not supplied

Documenting the scholarship of clinical teaching through peer review.

The essence of teaching is to make a positive difference in the lives of students. To this end, the nursing department at Kent State University developed and implemented a faculty-driven, voluntary program for peer review of clinical teaching. The authors describe the clinical peer review program and its positive outcomes.

Clinical Competence↗
PubMed1998

HIV prevalence in pregnant women in Europe: differences in assessment methods and prevalence levels across countries.

OBJECTIVE: To describe methods used to assess HIV prevalence and to assess prevalence levels and time trends among pregnant women in various European countries. METHODS: We used the European HIV Prevalence Database to examine annual HIV prevalence data in pregnant women for the years 1990 to 1996 (20 countries). RESULTS: In Western Europe, prevalences were generally obtained through unlinked anonymous surveys, whereas in most Central, and Eastern European countries, they were based on testing programs (voluntary or mandatory). Prevalences (per 10,000) were highest (i.e., 10-30/10,000) in large western urban areas including Amsterdam, Barcelona, London, Milan, Paris, and Rome; between 1 and 2 in Scandinavian countries; and down to 0.5/10,000 in Central and Eastern European countries (except Ukraine, 1996: 5/10,000). Prevalences decreased in Rome, whereas they increased in London, the Czech Republic, and since 1995 in Russia and Ukraine; elsewhere, no time trends were detected. CONCLUSIONS: Methodologic differences and potential biases should be considered when comparing these data. HIV prevalence in pregnant women is useful for monitoring the AIDS epidemic and for assessing and improving prevention. Efforts should be made to offer voluntary counseling and testing to women at risk for HIV and provide treatment to those who are infected.

Europe↗
PubMed1990

Standardization of image quality and radiation dose in mammography.

Image quality is the cornerstone to the practice of high-quality mammography. To ensure high quality in the practice of mammography, the American College of Radiology has established a voluntary program for the accreditation of mammographic screening sites. Between August 15, 1987, and February 1, 1989, 647 mammography units completed the accreditation program. Data collected from those units are presented, demonstrating that broad ranges of image quality and dose currently exist among mammographic screening sites. Reasons are discussed for the wide ranges observed, and steps are proposed to narrow the ranges of image quality and dose in the practice of mammography.

Accreditation↗
PubMed1995

Voluntary public health insurance for low-income families: the decision to enroll.

A dominant issue in the health reform debate is whether insurance coverage should be voluntary or mandatory. Clearly, the factors that determine who will seek voluntary coverage are relevant to this policy issue. This article uses experience from Washington State's Basic Health Plan to examine the enrollment choices of low-income families in a state-subsidized voluntary insurance plan offered through managed care organizations. We hypothesize that the decision to enroll, which encompasses the decisions to purchase insurance coverage and to select a particular plan, is influenced by four factors: the family's financial vulnerability, their risk perception, the price of coverage, and the transition costs of enrolling. Our enrollment model is supported by the data and has important implications for the design of voluntary programs. Families who choose to enroll are more likely to have a female head of household, young children, and a family member who has a part-time job and some college education. Higher premiums and availability of other insurance coverage decrease the probability of enrolling.

Adult↗
PubMed1989

Education for AIDS prevention: not our only voluntary weapon.

Authorities frequently state that education is the "only" method we have to stop the AIDS (acquired immunodeficiency syndrome) epidemic until a vaccine and/or curative therapy is available. We suggest that education, while critically important to our efforts to stop transmission of the human immunodeficiency virus (HIV), needs to be bolstered by additional voluntary approaches. Control of parenteral drug use, prevention of ulcerative sexually transmitted diseases, provision of expanded contraceptive services to seropositive reproductive age women, and reinforcement of risk-reduction behaviors through extended follow-up interventions are required as well. The support of these voluntary programs is a necessary complement to educational approaches which impact on HIV transmission and eventually on the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Peer instruction of home glucose monitoring.

During a 2-wk summer camp for insulin-dependent children aged 9-15 yr, a voluntary program of home glucose monitoring using an Ames' Dextrometer was offered. The primary instructors were campers who had mastered the procedure and who, with limited staff assistance, tutored naive campers. By camp's end, 96% of all naive campers had practiced this new home glucose monitoring procedure. Procedural errors were infrequent and decreased as a function of practice. No significant differences were found in error rates as a function of either the age or sex of the user. The data suggest that home glucose monitoring could be incorporated into the treatment regimen of many young patients and that peer instruction is an effective method of introducing the procedure to young children.

Adolescent↗
PubMed1981

Medicare program; Medigap--certification of Medicare supplemental health insurance policies: Health Care Financing Administration. Proposed rule.

This proposal would establish a program of certification, by the Secretary, of Medicare supplemental health insurance policies (so-called Medigap policies) voluntarily submitted by insurers for review. It would implement, in part, section 507 of the Social Security Disability Amendments of 1980. HCFA will administer the certification program. The voluntary certification program would go into effect July 1, 1982, and would apply only to policies issued in those States that do not have in effect a program for regulating Medigap policies equal to or more stringent than the one to be described in these regulations. A Supplemental Health Insurance Panel, consisting of the Secretary or a designee and four State Commissioners of Superintendents of Insurance appointed by the President, will determine the adequacy of a State's program in relation to the standards contained in the regulations. These regulations would: (1) set standards for policies voluntarily submitted to HCFA for certification, (2) establish procedures for the certification program, and (3) promulgate the statutory requirements that the Supplemental Health Insurance Panel would use to approve State regulatory programs.

Certification↗
PubMed2000

Infection rates drop at hospitals participating in reporting system.

Data Benchmarks: The rates of nosocomial and surgical-wound infections have plummeted at hospitals participating in the National Nosocomial Infections Surveillance, a voluntary program of the federal Centers for Disease Control and Prevention. Compare your hospital's performance with the top benchmarks in a new report and learn what organizers say are the essential components of the program's success.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

[Quantification of menstrual bleeding in women using intrauterine devices (IUDs)].

A study in the changes of menstrual blood loss produced by the of 11 different intrauterine devices (IUDs) in 319 voluntary women attending a voluntary program for Family Planning at the Instituto Mexicano del Seguro Social (IMSS). The results showed that two IUDs increased bleeding above 80 mL in the case of Lippes Loop D and the copper T 380. The following IUDs: Cu T 200 and 220, as well as ML-250 increased blood loss moderately; copper 7 produced a slightly higher blood loss (not statistically significant) "T" IUDs liberating progesterone or progestagens (Nor 8; Nor 2; Net 10) all produce a significant decrease of the menstural flow, reaching 93.5% (of the control value) in women using "T" IUDs liberating 8 micrograms of Levonorgestrel. Excessive bleeding in women with IUDs (over 80 ml) is checked significantly by the use of non-steroid anti-inflammatory prostaglandin synthesis' inhibitors such as 500 mg of mefenaminc acid or 250 mg of Naproxen thrice daily for 5 days.

Female↗
PubMed1992

The HIV epidemic. Ethical issues for the next decade.

The HIV epidemic and ethical issues will continue to be a major topic of discussion over the next decade. It is now evolving into a new phase and we are experiencing a change or shift in the populations that are affected. This article focuses on the issues of early intervention, access to care, and the continuum of care including a discussion of case management, the changing populations, drug trials, and issues surrounding confidentiality.

Clinical Trials as Topic↗