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At least 127 records · Page 7Linked to original sources
PubMed2003

Sleep-disordered breathing in Michigan: a practice pattern survey.

OBJECTIVES: This survey sought to determine whether self-professed sleep specialists in the State of Michigan show practice variations in the diagnosis and management of sleep-disordered breathing (SDB), and whether such variations occur between pulmonologists and neurologists. METHODS: Questionnaires on practice volume and patterns during the prior 12 months were mailed to physician members of the Michigan Sleep Disorders Association ( n = 119); 67 were completed and returned. RESULTS: Respondents reported that they personally saw a median of 8 new patients each week for suspected SDB; estimates were that 86% of these patients were eventually confirmed to have SDB. Most patients (82%) had laboratory-based polysomnography after an initial clinic evaluation, and most (69%) of those treated for SDB received continuous positive airway pressure. However, practice patterns differed substantially among respondents, even when the analysis was limited to the 42 who reported board certification by the American Board of Sleep Medicine. For example, among all surveyed practices the likelihood that suspected SDB would be evaluated with a split-night diagnostic and treatment polysomnogram varied from 0 to 90%. The likelihood of SDB treatment with bilevel positive airway pressure varied from 0 to 50%, with automatically titrating devices from 0 to 100%, with surgery from 0 to 100% (0 to 50% among certified practitioners), and with oral appliances from 0 to 20%. The practice patterns of pulmonologists and neurologists did not differ significantly. CONCLUSION: Approaches to SDB vary widely in Michigan, though not according to clinician background in pulmonary medicine or neurology. A patient's experience, in both assessment and treatment, could differ substantially based on which clinician is consulted.

Humans↗
PubMed1989

Prevalence and treatment of asthma in the Michigan Medicaid patient population younger than 45 years, 1980-1986.

The prevalence and outpatient treatment of asthma were studied in the Michigan Medicaid patient population by use of computerized physician, hospital, and pharmacy reimbursement data to mark and track asthma-related medical transactions. Asthma cases were defined as patients with evidence of at least two diagnoses and prescription drug transactions consistent with asthma. More than 52,000 cases were thus identified. The period prevalence of asthma was estimated on a year-by-year basis. The prevalence of asthma in the population increased from 2.0 per 100 Medicaid patients in 1980 to 2.8 per 100 Medicaid patients in 1986. Prevalence decreased with age until the age of 20 years and increased thereafter, and was higher in male children than in female children. In contrast, asthma was more prevalent in female adults than in male adults. Prevalence was higher in black subjects than in other races and higher in urban residents than in rural residents. The total number of reimbursements for antiasthma medications increased from 60,000 per year to 120,000 per year, and the average number of antiasthma prescriptions per Michigan Medicaid asthma case increased at the rate of 6.6% per year during the study interval. Changes in the preferred types of asthma treatment consistent with changes that have occurred in the general population were observed. These data suggest that the relative and absolute occurrence of asthma and asthma treatment in the Michigan Medicaid population is increasing.

Adolescent↗
PubMed2004

Impact of FDA policy change on the reuse of single-use medical devices in Michigan hospitals.

BACKGROUND: Reuse of single-use devices (SUDs) was a common practice in many health care centers in the United States. In August 2000, the FDA presented a guidance document indicating their policy change that meant the FDA would regulate centers that reprocess SUDs. OBJECTIVE: Our objective was to survey Michigan health care centers to determine the level of action that has been taken regarding this policy change and determine whether there has been a shift in the extent of reuse of SUDs. METHODS: We developed a telephone survey tool and contacted the infection control personnel in the 54 Michigan hospitals that had more than 200 beds. RESULTS: The response rate to the telephone survey was 48 of 54 (89%). Prior to the FDA policy change, 46%, 17%, and 37% performed on-site, third-party, or no reprocessing of SUDs, respectively. Currently, 21%, 35%, and 44% performed on-site, third-party, or no SUD reuse, respectively. The major shift has been to utilization of third-party reprocessors as opposed to stopping reuse of SUDs. In the 27 centers that currently reprocess SUDs, the most common items included the following: compression sleeves, 13 of 27; pulse oximeters, 8 of 27; PTCA cardiovascular catheters, 7 of 27; and biopsy forceps, 5 of 27. There were 61% (11/18) that resterilized open but unused SUDs with an equal split between on-site versus third-party resterilization. There were 3 sites that stopped reprocessing SUDs completely as a result of the FDA policy change and 4 that previously did not reprocess SUDs that started using a third-party reprocessor. CONCLUSIONS: The FDA policy change has impacted how SUD reprocessing is being performed in Michigan. Few centers (1/48) reprocessing any high or medium-risk SUDs on-site at the time of the survey. There has been little overall reduction in SUD reprocessing, but there has been a shift to use of third-party reprocessors.

Equipment Contamination↗
PubMed2005

Field responses of Prunus serotina and Asclepias syriaca to ozone around southern Lake Michigan.

Higher ozone concentrations east of southern Lake Michigan compared to west of the lake were used to test hypotheses about injury and growth effects on two plant species. We measured approximately 1000 black cherry trees and over 3000 milkweed stems from 1999 to 2001 for this purpose. Black cherry branch elongation and milkweed growth and pod formation were significantly higher west of Lake Michigan while ozone injury was greater east of Lake Michigan. Using classification and regression tree (CART) analyses we determined that departures from normal precipitation, soil nitrogen and ozone exposure/peak hourly concentrations were the most important variables affecting cherry branch elongation, and milkweed stem height and pod formation. The effects of ozone were not consistently comparable with the effects of soil nutrients, weather, insect or disease injury, and depended on species. Ozone SUM06 exposures greater than 13 ppm-h decreased cherry branch elongation 18%; peak 1-h exposures greater than 93 ppb reduced milkweed stem height 13%; and peak 1-h concentrations greater than 98 ppb reduced pod formation 11% in milkweed.

Air Pollution↗
PubMed2005

Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan.

UNLABELLED: Little is known about physical barriers to adequate pain treatment for minorities. This investigation explored sociodemographic determinants of pain medication availability in Michigan pharmacies. A cross-sectional survey-based study with census data and data provided by Michigan community retail pharmacists was designed. Sufficient opioid analgesic supplies was defined as stocking at least one long-acting, short-acting, and combination opioid analgesic. Pharmacies located in minority ( or=70% white residents) zip code areas were randomly selected by using a 2-stage sampling selection process (response rate, 80%). For the 190 pharmacies surveyed, most were located in white areas (51.6%) and had sufficient supplies (84.1%). After accounting for zip code median age and stratifying by income, pharmacies in white areas (odds ratio, 13.36 high income vs 54.42 low income) and noncorporate pharmacies (odds ratio, 24.92 high income vs 3.61 low income) were more likely to have sufficient opioid analgesic supplies (P < .005). Racial differences in the odds of having a sufficient supply were significantly higher in low income areas when compared with high income areas. Having a pharmacy located near a hospital did not change the availability for opioid analgesics. Persons living in predominantly minority areas experienced significant barriers to accessing pain medication, with greater disparities in low income areas regardless of ethnic composition. Differences were also found on the basis of pharmacy type, suggesting variability in pharmacist's decision making. PERSPECTIVE: Michigan pharmacies in minority zip codes were 52 times less likely to carry sufficient opioid analgesics than pharmacies in white zip codes regardless of income. Lower income areas and corporate pharmacies were less likely to carry sufficient opioid analgesics. This study illustrates barriers to pain care and has public health implications.

Adult↗
PubMed2004

Molecular characterization of noroviruses detected in diarrheic stools of Michigan and Wisconsin dairy calves: circulation of two distinct subgroups.

Noroviruses have emerged as the leading worldwide cause of acute non-bacterial gastroenteritis in humans. The presence of noroviruses in diarrheic stool samples from calves on Michigan and Wisconsin dairy farms was investigated by RT-PCR. Norovirus-positive samples were found on all eight farms studied in Michigan and on 2 out of 14 farms in Wisconsin. Phylogenetic analyses of partial polymerase and capsid sequences, derived for a subset of these bovine noroviruses, showed that these strains formed a group which is genetically distinct from the human noroviruses, but more closely related to genogroup I than to genogroup II human noroviruses. Examination of 2 full and 10 additional partial capsid (ORF2) sequences of these bovine strains revealed the presence of two genetic subgroups or clusters of bovine noroviruses circulating on Michigan and Wisconsin farms. One subgroup is "Jena-like", the other "Newbury agent-2-like".

Amino Acid Sequence↗
PubMed2002

Practice variation among Michigan neurologists in the use of intravenous heparin.

BACKGROUND/OBJECTIVE: The indications for intravenous (IV) heparin use in acute ischemic stroke are uncertain. We sought to determine the current practice patterns of neurologists in Michigan with regard to IV heparin use, in view of the fact that several major multi-center trials evaluating heparin and related compounds have been completed in the last decade. METHODS: A survey was conducted of 180 active, practicing neurologists in Michigan. Five clinical scenarios were included and factors influencing heparin use were also determined. RESULTS: The vast majority of neurologists in Michigan would use IV heparin for patients with atrial fibrillation-related stroke (91% of those with a defined opinion). Heparin use was also popular for stroke-in-evolution (77%). There was a lesser degree of heparin use for patients with more than one transient ischemic attack (49%) or for patients with stroke and normal cardiac rhythm. Medicolegal factors at least sometimes influenced the selection of heparin as a therapy for 41% of physicians. CONCLUSIONS: Despite recent clinical trial data on heparin and related compounds which for the most part has been negative, IV heparin use remains popular for certain clinical scenarios, especially acute stroke with atrial fibrillation. Further studies are necessary to determine whether negative clinical trials have the same impact on neurologist behavior as positive studies.

Atrial Fibrillation↗
PubMed2003

Folic acid awareness in Michigan, 1996-1999.

OBJECTIVE: To evaluate the prevalence and trend of folic acid awareness among Michigan mothers during 1996-1999 and to identify maternal characteristics predictive of folic acid awareness. METHODS: We analyzed data from the Michigan Pregnancy Risk Assessment Monitoring System, a population-based survey of women with recent live births. A positive response to the question, "Before you became pregnant, did you know that folic acid could help prevent some birth defects?" was used as an indicator of folic acid awareness. Logistic regression was used to evaluate trends in folic acid awareness prevalence and the association between folic acid awareness and certain maternal characteristics. RESULTS: Of the women invited to participate, 7252 responded (67.3%). Overall, folic acid awareness increased from 1996 to 1999 (60.3-71.4%; P < .001). However, folic acid awareness decreased for women with no high school education from 1997 to 1999 (59.3-13.8%, P = .05). In addition, folic acid awareness was lower among black women (adjusted odds ratio [OR] 0.43; 95% confidence interval [CI] 0.4, 0.5, versus other races), women with unplanned pregnancies (adjusted OR 0.6; 95% CI 0.5, 0.8, versus those with planned pregnancies), and those with no high school education (adjusted OR 0.08; 95% CI 0.03, 0.2, versus women with college education). CONCLUSION: Although folic acid awareness has increased among Michigan mothers overall during 1996-1999, it has decreased among women with less than a high school education, and substantial gaps exist among socioeconomic subgroups. Continued efforts are needed to improve folic acid awareness and consumption of folic acid among women of reproductive age, with special attention focused on populations experiencing gaps or declines in folic acid awareness.

Adult↗
PubMed1991

Quality assurance in emergency medical service systems in Michigan: report of a survey.

To determine the characteristics and effects of quality assurance programs in emergency medical service (EMS) systems in Michigan, medical directors of all EMS medical control authorities in Michigan were mailed a survey consisting of 14 closed-ended and open-ended questions including 2 using a subjective continuum scale; the study included phone follow-up of nonrespondents. Twenty-nine (56%) of 52 authorities surveyed responded; 28 reported that they conducted quality assurance activities. Physicians were the most commonly reported reviewers and emergency medical technicians were the practitioners most frequently reviewed. Although 26 (92%) respondents reported that their quality assurance program made a difference in the quality of care delivered, lack of standards and resources were most frequently listed as program weaknesses. Survey findings prompted the EMS Division of the Department of Public Health, State of Michigan, to address quality assurance in statewide seminars and to develop guidelines for statewide implementation.

Emergency Medical Services↗
PubMed2001

The seroprevalence of antibodies to Sarcocystis neurona in Michigan equids.

A cross-sectional study of serum antibodies to Sarcocystis neurona (the etiologic agent of equine protozoal myeloencephalitis, EPM) was performed on Michigan equids. Our objectives were to determine the seroprevalence of antibodies to S. neurona in Michigan equids and to identify specific risk factors for seropositivity. A random, weighted sample of Michigan horse farms (stratified by the state's opossum (Didelphis virginiana) population and the number of equids on each operation) was selected. Ninety-eight equine-operation owners agreed to participate, and blood collection occurred from late March through October of 1997. Data regarding the 98 farms' feeding and management practices were collected, as well as descriptive data for each of the 1121 individual horses. Serum samples were tested for antibodies to S. neurona using a Western blot test. The true seroprevalence of antibodies specific to S. neurona was estimated to be 60%. Chi-square analysis showed that seroprevalence was lowest in the colder parts of the state that had the fewest opossums (P<0.0001). In two multivariable logistic-regression analyses with random effects grouped by herd, age and exposure to pasture were associated with increased odds of seropositivity, and feeding of sweet feed (grains mixed with molasses) was associated with decreased odds of testing positive. No association was found between farm size, animal gender, hay types, horse-housing types or exposure to natural surface water and seropositivity.

Animals↗
PubMed1997

The Michigan equine monitoring system. I. Design, implementation and population estimates.

The Michigan equine monitoring system (MEMS) was designed and implemented in the State of Michigan, starting in 1991. The program was designed systematically to track the State's equine population, its health, and its economic implications to the equine industry. The MEMS was designed as a two-phase program. Phase I (the population and economic survey; the subject of this paper) was designed to provide new and statistically valid information describing the size, composition, location and economic characteristics of the Michigan equine industry. A standardized questionnaire was used to collect data via mail, telephone and personal interviews. Of the 3000 randomly selected list-frame samples, 2800 (93%) participated. However, 650 of these had no equids. There were 129,932 equids reported compared with 160,000 in 1984. The American Quarter Horse, Standardbred and Arabian breeds were the most numerous. Detailed results, including the size of equine operations/herds, uses, geographical distribution and the financial structure of the industry, are presented. A detailed account of the strategies used in designing and implementing the system is provided.

Animal Husbandry↗
PubMed2002

Taking the national guideline for care of acute myocardial infarction to the bedside: developing the guideline applied in practice (GAP) initiative in Southeast Michigan.

BACKGROUND: The Guideline Applied in Practice (GAP) program was developed in 2000 to improve the quality of care by improving adherence to clinical practice guidelines. For the first GAP project, the American College of Cardiology (ACC) partnered with the Southeast Michigan Quality Forum Cardiovascular Subgroup and the Michigan Peer Review Organization (MPRO) to develop interventions that might facilitate the use of the ACC/AHA Acute Myocardial Infarction (AMI) guideline in the practice setting. Ten Michigan hospitals participated in implementing the project, which began in March 2000. DESIGNING THE PROJECT: The project developed a multifaceted intervention aimed at key players in the care delivery triangle: the physician, nurse, and patient. Intervention components included a project kick-off presentation and dinner, creation and implementation of a customized tool kit, identification and assignment of local nurse and physician opinion leaders, grand rounds site visits, and measurement before and after the intervention. IMPLEMENTING THE PROJECT: The GAP project experience suggests that hospitals are enthusiastic about partnering with ACC to improve quality of care; partners can work together to develop a program for guideline implementation; rapid-cycle implementation is possible with the GAP model; guidelines and quality indicators for AMI are well accepted; and hospitals can adapt the national guideline for care into usable tools focused on physicians, nurses, and patients. DISCUSSION: Important structure and process changes--both of which are required for successful QI efforts--have been demonstrated in this project. Ultimately, the failure or success of this initiative will depend on an indication that the demonstrated improvement in the quality indicators is sustained over time.

American Heart Association↗
PubMedDate not supplied

An analysis of Michigan EMT licensure examination results as a predictor of paramedic licensure examination success.

INTRODUCTION: Predicting paramedic candidate performance on the written licensure examination is of considerable importance to educators, students, employers, and state regulators. There has been little investigation of the available statistical data regarding examinee pass rate and examination score. No studies have measured an examinee's sequential success pattern on the basic emergency medical technician (EMT) or paramedic examinations. There has been no analysis of the relationship between the number of examinations required for successful paramedic licensure and examination score. OBJECTIVE: The purpose of this study was to determine the frequency with which paramedic licensure examinees successfully pass the State of Michigan written examination on the first or subsequent attempts; to determine the frequency with which the paramedic examinees pass the prerequisite basic EMT licensure examination; to determine whether the frequency of paramedic examination attempts is related to examination score; and to determine whether there is a relationship between successfully passing the basic EMT examination and successfully passing the paramedic examination. METHODS: A retrospective study of Michigan paramedic licensure examination results for 1994 was done on the basis of a review of reports prepared for Michigan Department of Public Health Emergency Medical Services (MDPH-EMS) by Professional Examination Services. Analysis of paramedic examination score and the number of examination attempts is correlated to EMT score and number of attempts required to pass. Success in the first or subsequent paramedic examinations is correlated to paramedic score, and success in passing the first or subsequent EMT examination is then related to success in passing the paramedic examination. RESULTS: Paramedic examinees (n = 869) generated a 72.1% pass rate in 1994 (mean score = 82.2%). The minimum passing score is 80%. The average score for examinees who passed (n = 627) was 86.2% (95% confidence interval [CI] = 85.8-86.6%); those who failed (n = 242) averaged 71.9% (95% CI = 71.1-72.6%). Paramedic examinees successful on the first attempt (n = 500) had higher average scores (mean = 87.1%; 95% CI = 86.7-87.5%) than did those who required multiple attempts (mean = 82.8%; 95% CI = 82.3-83.3%; n = 127). A total of 702 (90.5%) paramedic examinees passed the EMT examination on the first attempt. Examinees who passed the EMT examination the first time averaged fewer attempts on the paramedic examination (mean 1.5; 95% CI = 1.4-1.6) than did those who required multiple EMT examinations (mean 2.3; 95% CI = 2.0-2.6). Paramedic examinees passing the EMT examination in one attempt had higher average paramedic scores (82.6%; 95% CI = 82.1-83.2%) than those needing multiple EMT attempts (75.5%; 95% CI = 73.4-77.5%). CONCLUSION: Paramedic examinees who pass their EMT licensure examination on the first attempt have a significantly better chance of passing the paramedic licensure examination. Paramedic licensure examinees who pass the paramedic examination on the first attempt score significantly higher than do examinees who require additional attempts. Paramedic programs should incorporate EMT examination performance into their student selection criteria. Further study of variables predictive of success is needed.

Clinical Competence↗
PubMed2003

Polychlorinated dibenzo-p-dioxin and dibenzofuran concentration profiles in sediments and flood-plain soils of the Tittabawassee River, Michigan.

Concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) in sediments and flood-plain soils collected along the Tittabawassee River in Michigan ranged from 102 to 53,600 pg/g, dry wt. Mean PCDD/PCDF concentrations in downstream sediment and soil were from 10- to 20-fold greater than those found at locations upstream of Midland, Michigan. Concentrations of PCDD/PCDF in sediments and flood-plain soils from the Tittabawassee watershed were comparable to those found in industrialized areas such as the Housatonic and lower Passaic Rivers in the U.S. Concentrations of PCDDs/PCDFs in soil and sediment were not correlated with total organic carbon (TOC) in sediments or soils. OCDD and 2,3,7,8-TeCDF were the predominant congeners in sediment/soil collected from locations downstream of Midland, Michigan. Principal component analysis of the PCDD/PCDF congener profile suggested the presence of sources originating from a mixture of chlorophenol and other chlorinated compound production. Mass balance analysis of TCDD equivalents (TCDD-EQs) derived from H4IIE-luc bioassay of sediment extracts and 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TEQs) estimated from instrumental analysis suggested that PCDDs/PCDFs were the major dioxin-like compounds present in sediments. A significant correlation existed between bioassay-derived TCDD-EQs and instrumentally measured TEQs (r2 = 0.94).

Benzofurans↗
PubMed1997

Harbinger. II: Deployment and evolution of assertive community treatment in Michigan.

Assertive Community Treatment (ACT) is now recognized as the model proven to be most successful in working with clients with long-term, severe mental illness. The first documented research replication study of ACT was Harbinger of Grand Rapids, in Kent County, Michigan. The Harbinger program influenced significant programmatic changes throughout the public mental health system in Michigan. This paper describes this evolution in community mental health locally and why these changes came about. The state-level strategy to implement replications of Harbinger is described, as well as funding and monitoring mechanisms that have now resulted in over 100 successful ACT programs in Michigan. For mental health administrators, the implications discussed include the future of ACT promotion and implementation, within the reality of a managed care framework.

Community Mental Health Services↗
PubMed2001

Microbiological, molecular biological and stable isotopic evidence for nitrogen fixation in the open waters of Lake Michigan.

We have used a combination of microbiological, molecular biological and stable isotope methods to relate specific microbial populations to elemental cycling at an offshore site in Lake Michigan. Several lines of evidence suggest that atmospheric N2 may be a significant source of nitrogen to the lake. Particulate organic nitrogen (PON) at approximately equals 10-15m depth in July and October had a delta15N of 0.5-1.5%o. These values closely reflect the 15N composition of atmospheric N2, suggesting biological nitrogen fixation. Historical data show a developing late-summer N:P minimum at approximately equals 15 m; low abundance of inorganic nitrogen relative to phosphorus favours species able to acquire atmospheric nitrogen. Microscopic examination of October water samples revealed abundant heterocystous cyanobacteria, including Nodularia sp. Potentially nitrogen-fixing Anabaena spp. have been found in Lake Michigan before but, to our knowledge, this is the first report of Nodularia. Finally, we have amplified both cyanobacterial and non-cyanobacterial nifH sequences (encoding the nitrogenase iron protein) from lakewater samples, evidence for the presence of bacteria capable of nitrogen fixation. The surface waters of Lake Michigan are considered to be phosphate limited in the stratified season and, under these conditions, energetically expensive nitrogen fixation is expected to be uncompetitive with assimilation of combined nitrogen. Our results suggest that, from both microbiological and biogeochemical perspectives, this may be an oversimplification.

Animals↗
PubMed1996

A study of preventable trauma mortality in rural Michigan.

OBJECTIVE: To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan. DESIGN: A prospective study of all deaths caused by injury during a 1-year period. METHODS: Preventability of death and appropriateness of care were determined using a structured implicit review process and expert panel. A second panel was convened to confirm the reliability of the review process. MAIN RESULTS: One hundred fifty-five injury-related deaths underwent panel review. Four deaths (2.6%) were found to be definitely preventable and 16 (10.3%) possibly preventable, for a combined preventable death rate of 12.9%. Sixty-five deaths (41.9%) occurred in the emergency department or hospital; 18 of these (27.7%) were judged to be definitely preventable or possibly preventable. Forty-three episodes of inappropriate care were identified in 27 (17.4%) of the 155 cases reviewed. These occurred primarily in the emergency department and hospital rather than during prehospital care or transfer. CONCLUSIONS: A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.

Accidents, Traffic↗
PubMed1994

Uniting the past and the future in public health nursing: the Michigan Oral History Project.

In 1987 a group of Michigan public health nurses recognized the need to capture the richness of the lives of renowned public health leaders by collecting and preserving their oral histories. With the assistance of the Bentley Collection at the University of Michigan, the Michigan Oral History Project found a home. In this paper, the process of designing and implementing the oral history project is described within the framework of McBride's Orchestrating the Stages of a Career, adapted from the Dalton/Thompson/Price career development model. The steps in selecting interviewers and leaders, conducting the interviews, and keeping track of the completed work are outlined. Finally, the early results and potential uses for the collected data are discussed. This project has special significance in this year for the celebration of the centennial of public health nursing.

Biographies as Topic↗