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PubMed2005

The impaired and disruptive physician: the Missouri Physicians' Health Program--an update (1995-2002).

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 recovery rate in this study of 197 participants was 90%. New concepts of the "Behaviorally Disruptive Physician" and the Joint Commission on the Accreditation of Health Care Organization requirements regulating physician impairment are also discussed.

Humans↗
PubMed2002

Substance abuse and dependence in physicians: the Missouri Physicians Health Program--an update (1995-2001).

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 recovery rate in this study of 168 participants was 89%. New concepts of the "Behaviorally Disruptive Physician" and the Joint Commission on the Accreditation of Health Care Organization requirements regulating physician impairment are also discussed.

Alcoholism↗
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↗
PubMed2006

[French sanitary cooperation in developing countries].

In the face of a worsening public health situation throughout the world, French know-how in the field of sanitary cooperation warrants a far more active commitment from our country. Instead there have been only a few initiatives and we are witnessing a programmed decline of our presence. The statement issued by the Economic and Social Council in 2006--the highlights of which will be presented at this meeting--strongly advocates a voluntary program to revive sanitary cooperation by encouraging civic-spirited young people to express international solidarity through public service in impoverished areas. By compensating the shortage of human resources in developing countries, this program would allow immediate implementation of measures to promote action, training and research not as a replacement operation but rather as a genuine partnership. Deployment of our public aid for development in the field of health-care must not have a detrimental effect on the bilateral dimension of the relationship that indeed requires urgent strengthening. In addition tighter coordination of all parties involved in cooperation activities is needed to ensure greater efficiency and consistency. New funding sources (starting with the airline ticket tax) and greater mobilization of the European Union is necessary to ensure that developing countries have more financial resources to wage the "health-care battle". Reducing the "health-care gap" that cripples development and destabilizes societies must be the first priority of French Cooperation.

Developing Countries↗
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↗
PubMed2000

Controlling on-farm inventories of bulk-tank raw milk--an opportunity to protect public health.

Hazard Analysis Critical Control Point programs provide a systematic approach for the reduction of food safety problems through preventive measures. On-farm programs similar to Hazard Analysis Critical Control Point, which target pathogen reduction and screening can provide assurance to processors and consumers that on-farm food safety is a high priority. Additional voluntary oversight of farm practices, including monitoring of and controlled access to raw milk supplies on the farm could further contribute to public food safety. Off-farm sales of raw milk directly to the public have resulted in foodborne outbreaks of multidrug resistant salmonellosis in California and Washington when raw milk was used for unlicensed cheese production. If dairy producers in those cases had voluntary programs in place to inventory, monitor, and control access to raw milk supplies, the outbreaks probably could have been prevented.

Animals↗
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↗
PubMed2001

A labor perspective of workplace violence prevention. Identifying research needs.

BACKGROUND: During the past decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard. Research by the National Institute for Occupational Safety and Health and the U.S. Department of Justice have bolstered these efforts. This research revealed that workplace violence is the second leading cause of traumatic-injury death on the job for men, the leading cause of traumatic-injury death on the job for women, and accounts for some 2 million nonfatal injuries each year in the United States. LABOR PERSPECTIVE: Ten years ago, the debate focused on whether workplace violence is an occupational hazard or strictly a police and criminal justice issue. Labor unions have joined with occupational safety and health professionals in recognizing that workplace violence is a serious occupational hazard that is often predictable and preventable. They have advocated that employers establish multidimensional violence-prevention programs. CONCLUSION: Although the nature of workplace violence varies from industry to industry, implementation of the federal Occupational Safety and Health Administration (OSHA) Violence Prevention Guidelines for Health Care and Social Service Workers and for Late-Night Retail Establishments is a high priority to unions in the affected industries. Labor wants employers to invest in protecting workers from violence through voluntary programs and state legislation, and it supports the promulgation of a mandatory federal OSHA standard. To that end, intervention research can play a key role in demonstrating effective, technically and economically feasible prevention strategies

Homicide↗
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↗
PubMed1999

Neonatal screening for congenital hypothyroidism and phenylketonuria at Siriraj Hospital, Mahidol University, Bangkok, Thailand--a pilot study.

A newborn screening program for congenital hypothyroidism (CH) and phenylketonuria (PKU), a pilot study, was initiated at the Medical Genetics Unit, Department of Pediatrics, Siriraj Hospital Faculty of Medicine, Mahidol University in Bangkok, Thailand from January 1994 to December 1998, using dried blood spots (DBS). A total of 18,739 infants (out of 85,150 livebirths) were screened (22 % coverage). Three cases of congenital hypothyroidism (CH) were identified (incidence of 1: 6,246, livebirths), by enzyme linked immunosorbent (ELISA) and fluoroimmunoassays using a cut-off level of TSH >20 microlU/ml: the recall rate of 0.24%. The screening for PKU was done by fluorometric (Guthrie) and enzyme linked immunosorbent (ELISA) methods; using cut-off levels of phenylalanine > 4 mg/dl and > 3.6 mg/dl respectively, with a recall rate of 0.13%. There was no PKU found. Our study, a voluntary program, emphasizes the importance of parental education and consent; specimen collection and handling; appropriate follow-up and referral to specialists for treatment and counseling. Routine newborn screening for CH and PKU is being established to ascertain the maximum coverage, using recommendations and guidelines from this pilot study.

Congenital Hypothyroidism↗