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PubMed2001

At least one class I gene in restriction fragment pattern-Y (Rfp-Y), the second MHC gene cluster in the chicken, is transcribed, polymorphic, and shows divergent specialization in antigen binding region.

MHC genes in the chicken are arranged into two genetically independent clusters located on the same chromosome. These are the classical B: system and restriction fragment pattern-Y (Rfp-Y), a second cluster of MHC genes identified recently through DNA hybridization. Because small numbers of MHC class I and class II genes are present in both B: and Rfp-Y, the two clusters might be the result of duplication of an entire chromosomal segment. We subcloned, sequenced, and analyzed the expression of two class I loci mapping to Rfp-Y to determine whether Rfp-Y should be considered either as a second, classical MHC or as a region containing specialized MHC-like genes, such as class Ib genes. The Rfp-Y genes are highly similar to each other (93%) and to classical class Ia genes (73% with chicken B: class I; 49% with HLA-A). One locus is disrupted and unexpressed. The other, YFV, is widely transcribed and polymorphic. Mature YFV protein associated with beta(2)m arrives on the surface of chicken B (RP9) lymphoma cells expressing YFV as an epitope-tagged transgene. Substitutions in the YFV Ag-binding region (ABR) occur at four of the eight highly conserved residues that are essential for binding of peptide-Ag in the class Ia molecules. Therefore, it is unlikely that Ag is bound in the YFV ABR in the manner typical of class Ia molecules. This ABR specialization indicates that even though YFV is polymorphic and widely transcribed, it is, in fact, a class Ib gene, and Rfp-Y is a region containing MHC genes of specialized function.

Alleles↗

PubMed2001

Short segment Barrett esophagus and specialized columnar mucosa at the gastroesophageal junction.

The rising incidence of adenocarcinoma of the esophagus and the gastric cardia has generated interest in the finding of intestinal metaplasia or specialized columnar mucosa in this location. Short segment Barrett esophagus is defined by the presence of columnar-appearing mucosa in the distal esophagus (<3 cm in length) with intestinal metaplasia on biopsy. In contrast, intestinal metaplasia may also be present if biopsy specimens are obtained from a normal-appearing squamocolumnar junction or from the gastric cardia (ie, immediately below the gastroesophageal junction) in the absence of columnar lining of the distal esophagus. This has been termed cardia intestinal metaplasia, gastroesophageal junction intestinal metaplasia, or specialized columnar mucosa at the gastroesophageal junction. This article reviews the currently available data on these rapidly evolving entities of short segment Barrett esophagus and specialized columnar mucosa at the gastroesophageal junction.

Barrett Esophagus↗

PubMed2004

Military deployment health surveillance policy and its application to Special Operations Forces.

An evaluation research methodology was used to determine whether deployment health surveillance for Special Operations Forces conformed with Department of Defense policy directives for the specified target population. Data for this methodology were based on pre- and postdeployment health assessments as well as patient encounters recorded during deployments. The data represented 1,094 individual and unique Special Operations Forces members deployed to 12 different countries from October 2000 through December 2001. Results from the study suggested that military deployment health surveillance policy goals for predeployment medical referrals, patient data capture, and documentation during the deployment and postdeployment medical referrals were being poorly met when Department of Defense and Joint Chiefs of Staff mandates were applied to Special Operations Forces in an unconventional operations environment. Preliminary evaluation indicates that deployment health surveillance implementation could be improved with the introduction of policy awareness education, training, and technology.

Health Plan Implementation↗

PubMed1989

Specialized testing after recent acute myocardial infarction.

A wide variety of specialized laboratory tests have been used to characterize prognosis and functional capacity soon after a patient has an acute myocardial infarction. Few attempts have been made to integrate the available data on these tests into clinically relevant guidelines for the clinician. This review evaluates the use of these tests, alone and in combination, throughout the course of recovery from acute myocardial infarction. The primary objective of these tests is to quantify myocardial ischemia and left ventricular dysfunction, the pathophysiologic basis of prognosis and functional capacity. The selection of one test over another depends on whether either test provides information on myocardial ischemia and left ventricular dysfunction not available through the standard clinical evaluation, and the risk, quality, and cost associated with each test. The stepwise application of specialized testing after acute myocardial infarction enables the identification of three groups of patients: approximately 20% at very high risk, due primarily to irreversible left ventricular dysfunction; approximately 30% at moderately high risk, due primarily to myocardial ischemia; and approximately 50% at low risk who are free of significant left ventricular dysfunction or myocardial ischemia. Accurate discrimination among these three groups enables the application of aggressive medical and surgical therapy to patients at moderate to high risk and accelerated recovery for patients at low risk. Specialized testing also helps to guide subsequent management after thrombolysis and revascularization procedures.

Coronary Angiography↗

PubMed2004

"Special scrutiny": a targeted form of research protocol review.

Research participants require ongoing protection of the kind already established in law and regulation. However, "special scrutiny" for certain types of research is also needed. Three criteria for special scrutiny are 1) research that involves initial experiences of translating new scientific advances into humans, especially when the intervention is novel, irreversible, or both; 2) research with a known or credible risk for significant harm (death or serious disability are the clearest examples) to research participants as a consequence of the experimental intervention and with no potential for offsetting direct medical benefit; or 3) research with a protocol that raises ethical questions about research design or implementation for which there is no consensus. Special scrutiny recognizes that not all research protocols are equally ethically challenging and aims to provide appropriate protection for all research participants.

Ethical Review↗

PubMed1989

In-shoe casting technique for specialized sports shoes.

The use of vacuum casting to create better-fitting orthoses for special athletic shoes has been discussed. By vacuum-forming a negative cast within the confines of special athletic shoes, such as bicycling cleats or fencing shoes, a better-fitting orthosis can be fabricated with little or no special adjustments or modifications necessary to create the best fit and function.

Adult↗

PubMed1999

[7 reasons for hospitalizing stroke patients in special treatment units].

THE HELSINGBORG DECLARATION: One of the primary objectives of the Helsingborg declaration was that all patients should have access to care in a neurovascular unit. However to date, only a few specialized facilities are available in Europe. SEVEN GOOD REASONS: There are seven good reasons why patients suffering cerebral vascular events should be hospitalized in specialized care units. 1. Improve chances of survival and recovery: mortality at 3 and 12 months is 25% lower in patients hospitalized in specialized units and the combined risk of death and institutionalization is reduced by one-third. The beneficial effect in terms of survival and function persists at 5 years. 2. Provide optimal management for emergency conditions which may be confounded with cerebral vascular events and which require emergency care. 3. Optimize health care organization. 4. Favor research and teaching. 5. Reduce health expenditures related to cerebral vascular events. 6. Inform health authorities of the needs of this population. 7. Prepare for the possible development of intravenous thrombolytic therapies. OUTDATED ATTITUDE: Fatalism and nihilism is no longer an acceptable attitude. Cerebral vascular events must be considered as an emergency condition and our health care system must change, adapting health care facilities to this new situation. Neurovascular units provide one of the most effective tools to meet this challenge.

Adult↗

PubMedDate not supplied

Interdisciplinary collaboration in the special care unit--Part I.

Quality improvement (QI) activities in special care units can serve as a model of interdisciplinary problem identification and resolution for organizations that are moving from service-specific QI activities to organizational-wide activities. The transition from distinct unit-based QI activities to an interdisciplinary collaborative model at the Carl T. Hayden Veterans Administration Medical Center began with recognition of problems that were identified during a Joint Commission survey of the special care units. Process improvements were made that resulted in improved interdisciplinary collaboration between the special care units, and a successful follow-up Joint Commission survey.

Accreditation↗

PubMed1995

Publication of OIG Special Fraud Alerts: home health fraud, and fraud and abuse in the provision of medical supplies to nursing facilities--HHS. Notice.

This Federal Register notice sets forth two recently issued OIG Special Fraud Alerts concerning fraud and abuse practices in the home health industry and in the provision of medical supplies to nursing facilities. For the most part, the OIG Special Fraud Alerts address national trends in health care fraud, including potential violations of the Medicare anti-kickback statute. These two Special Fraud Alerts, issued directly to the health care provider community and now being reprinted in this issue of the Federal Register, specifically address fraud and abuse in the provision of (1) home health services and (2) medical supplies to nursing facilities, including the submission of false claims and anti-kickback violations.

Equipment and Supplies↗

PubMed1995

Clinical specialization programs for dietitians: a needs assessment.

This needs assessment was conducted to identify the perceived need for advancement and specialization through practicum programs in clinical dietetics. A questionnaire was developed and validated through a pilot study. It was mailed to a randomized sample of 950 dietitians (52%) registered with the ODA. Fifty two per cent responded, representing 27% of ODA members. Of those surveyed 89% were currently employed. The most current area of practice was clinical nutrition (55%) followed by foodservice (22%) and community nutrition (14%). Seventy two per cent of the respondents identified that they would consider enrolling in a specialized practicum. Most cited reasons for enrolling were increased knowledge/expertise (44%) and increased professional profile (25%). Areas of greatest interest were: nutrition assessment (9%), critical care/nutrition support (8%) and gerontology (7.5%). Sixty two per cent preferred the program to be offered part-time, 27% full-time and 9% were impartial. The most frequently cited length and cost per week for the program within specified part or full-time categories was: two weeks full-time (36.5%) at S200-299.00 (33%), four weeks full-time (25%) at S100-199.00 (31%) and two weeks part or full-time (23.5%) at S200-299.00 (57%). Desired ODA regions for program availability were: Toronto (34%), Kitchener/Waterloo/Hamilton (17.5%) and London (14%). Lastly, 92% of the respondents felt the program should be CDA and ODA approved and continuing education points be provided. These results indicate that dietitians are interested in pursuing professional self-development through specialized practicums.

Attitude of Health Personnel↗

PubMed1997

Medicare program: special payment limits for home oxygen--HCFA. Proposed notice.

This notice would establish special payment limits for home oxygen. Currently, payment under the Medicare program for home oxygen and other items of durable medical equipment is equal to 80 percent of the lesser of the actual charge for the item or the fee schedule amount for the item. Based on our experience and after consulting with representative of home oxygen suppliers, we have determined that the Medicare fee schedule amounts for home oxygen are grossly excessive and are not inherently reasonable because they are excessively high relative to the payment and amount for similar services by the Department of Veterans Affairs which uses a true competitive payment methodology. This notice would replace the use of fee schedule amount and proposes that payment for home oxygen be equal to 80 percent of the lesser of the actual charge or a special payment limit set by HCFA, which would vary by locality. It is intended to prevent continuation of excessive payment. The special limit would be based on the average payment amount for home oxygen services by the Department of Veterans Affairs.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1991

Testing the limits: special treatment procedures for child and adolescent partial hospitalization.

How does a child and/or adolescent partial hospitalization program structure care for patients who are suicidal, assaultive, or combative or using drugs? Special treatment procedures designed for use in child and adolescent partial hospitalization programs must adequately address the issue of safety and involve the family and the community, while maintaining the patient in the least-restrictive environment. This paper deals with management of child and adolescent partial hospitalization patients whose behavior and level of impulsivity have escalated to the point where they require special programs. Special treatment procedures for dealing with patients displaying aggressive, acting-out behaviors, noncompliance with program rules, suicidal or runaway ideation, and drug usage are described.

Adolescent↗

PubMed1993

State Medicaid health maintenance organization policies and special-needs children.

Little research has been done to ascertain what enrollment in a health maintenance organization (HMO) may mean for the care of Medicaid recipients who regularly require specialty health services. This article presents the results of a survey of all State Medicaid agencies regarding their policies for enrolling and serving special-needs children in HMOs. The survey revealed that many States have implemented one or more strategies to protect special-needs Medicaid recipients enrolled in HMOs. The survey results suggest, however, that such strategies are too limited in scope to ensure appropriate access to specialty services for all children with special health needs.

Child↗

PubMed1998

The politics of Alzheimer's special care units: lessons to be learned from the demented?

The development of nursing home special care units for Alzheimer's Disease is linked to the political emergence of the disease in the past two decades. This article will explore the response of the nursing home industry to Alzheimer's Disease in the way of special care programs. Similarities and differences between the demented population and other groups served in nursing homes will be highlighted. Issues to be addressed before special care programs are developed for other populations will be suggested.

Aged↗

PubMed1998

Publication of OIG Special Fraud Alert: fraud and abuse in nursing home arrangements with hospices--OIG. Notice.

This Federal Register notice sets forth a recently issued OIG Special Fraud Alert concerning fraud and abuse practices involving nursing home arrangements with hospices. For the most part, OIG Special Fraud Alerts address national trends in health care fraud, including potential violations of the Medicare anti-kickback statute. This Special Fraud Alert, issued to the health care provider community and now being reprinted in this issue of the Federal Register, specifically identifies and highlights some vulnerabilities in nursing home arrangements with hospices and instances of potential kickbacks between nursing homes and hospices to influence the referral of patients.

Fraud↗

PubMed1983

Specialized services for the non-institutionalized patient with epilepsy: developments in the US and the UK.

Services for the non-institutionalized patients with epilepsy have been the subject of a number of government sponsored reports. The recommended expansion in specialized services (for example, the special centres and the hospital-based epilepsy units) has not come about, and, as a result, services for epilepsy in the UK do not conform to the highest international standards. This paper reviews recent US findings with regard to the cost of epilepsy: contrasts recent developments in the US with those in the UK: emphasizes the need for further audit of the hospital facilities in this country: outlines the role of specialized epilepsy services and the structure these services might take in the UK.

Epilepsy↗

PubMed1986

Sterile supply needs for specialized units.

Sterile supply to specialized units means providing those items which cannot be safely obtained in the form required from other sources, e.g. commercial supplies. Items can be great or small, simple or complex, but are more likely to be the latter. While the service is available to any user within the hospital or community, I have attempted to identify those areas which might generally be regarded as special. The list below highlights the mix of specialized areas catered for by the average central service department, where provision of basic dressings, instruments and utensils would be insufficient to provide the quality of service required. Central service is more internationally acceptable as a term for the department which supplies reprocessing facilities, e.g. sterilization or disinfection services to a whole variety of health care users: Bone marrow assessment/treatment; burns and plastic surgery; cardiac catheterization; chiropody; dental; dialysis; endoscopy; ear, nose and throat; intensive therapy (including coronary care); isolation (source and protective); medical research; operating theatres; ophthalmology; radiology; radiotherapy/oncology; respiratory therapy.

Central Supply, Hospital↗

PubMed1997

The provision of primary dental care for patients with special needs.

The Community Dental Service (CDS) has increasingly become associated with providing primary dental care for those people who are unable to access care by the usual means. The work reported here examines the provision of primary dental care by using the notion of a dental service continuum to demonstrate that in the treatment of patients with special needs the CDS acts as a safety net service. One hundred and twenty-four General Dental Service (GDS) practices and 33 CDS practices took part in the survey. The results suggest that both services provide primary dental care for a wide range of patients with special needs. Dentists in the GDS and CDS treat and care for different populations of patients with special needs. It is proposed that a continuum of service provision exists.

Dental Care for Persons with Disabilities↗