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PubMed1997

Creative inservices to meet mandatory education requirements.

To meet the mandates of federal and accreditation bodies, home care organizations must be prepared to conduct required education. There is a need to be creative and heighten the interest of the staff while doing more with shrinking education dollars. This article presents one agency's approach to the annual mandatory inservice program that allows the staff to have fun while learning.

Community Health Nursing↗
PubMed1997

Detention of persistently nonadherent patients with tuberculosis.

CONTEXT: Patients with tuberculosis (TB) who are persistently nonadherent to treatment present a public health risk. In 1993, California created a new civil detention process and allowed detention of noninfectious but persistently nonadherent patients. OBJECTIVES: To determine (1) which patients TB controllers attempt to detain, (2) how often and where patients are detained, and (3) how many of these patients complete TB treatment. DESIGN: Case series with cross-sectional comparison to other adult TB patients in the study counties. SETTING: Twelve California counties with the largest number of new TB cases reported in 1994. SUBJECTS: All patients whom TB controllers sought to detain during 1994 and 1995 because of persistent nonadherence to treatment. DATA SOURCES: Public health records, interviews with county TB officials, and Reports of Verified Cases of Tuberculosis to the California Tuberculosis Control Branch. RESULTS: Tuberculosis controllers sought the civil detention or arrest of 67 patients during the study period (1.3% of adult TB patients with the same disease sites). Forty-six percent of these patients were homeless, 81% had drug or alcohol abuse, and 28% had mental illness. Tuberculosis controllers sought civil detention of 15 patients. Fourteen patients were detained (median length of detention, 14.5 days). Tuberculosis controllers sought to arrest 62 patients during the study period. Fifty-three patients were arrested (median time in jail, 83 days). In 10 cases, both civil and criminal detention were attempted. We analyzed completion of therapy after excluding patients who were not detained or who died or moved. Overall, 41 (84%) of the remaining 49 detained patients completed therapy. Of the patients who completed therapy, only 17 were detained until treatment was completed. Compared with other TB patients in these counties, detained patients had 4 times the proportion lost to follow-up and half the proportion completing therapy within 12 months. CONCLUSION: Further improvements in the care of persistently nonadherent patients may require more psychosocial services, appropriate facilities for civil detention, and detaining patients long enough to assure completion of treatment.

Adult↗
PubMed1997

Substance abuse and maternity: the United States as a case study.

Two themes pervade the issue of women and addiction in the United States: anger and blame directed at women who use alcohol and other drugs; and neglect and a consequent lack of appropriate treatment. Often the focus is on the addicted pregnant woman and the debate posits a woman's right to autonomy and privacy in opposition to the future child's right to be born free from harm. Others emphasize the tension between blaming individuals and holding the state accountable for provision of services. These conflicts have impeded the diagnosis of women with substance abuse problems, the availability of services and women's access to appropriate care.

Federal Government↗
PubMed2005

Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination.

The authority of government to require participation in mandatory childhood vaccination programs may not target specific groups for either participation or exemption on a discriminatory basis. This poses difficulties when allowing religious or philosophical exemptions to mandatory vaccination, because certain groups are more likely to appeal for exemption. Avoiding loss of herd immunity, then, may require either discrimination against these groups by disallowing an exemption option that is available to others, or by denying the good of an exemption option to the entire population because of the action of certain groups. To avoid this unacceptable choice, steps must be taken now to more stringently enforce exemption requirements.

Guideline Adherence↗
PubMed1987

Periodic competency review. An assessment and policy model.

Periodic review of professional competence or performance is on the public agenda as a response to rising malpractice suits, iatrogenic morbidity, and mortality resulting directly from professional incompetence, and the inadequacy of current licensing and discipline systems. This article reviews several continuing competency programs, such as mandatory education, as well as recent experiments in selective performance evaluation. The evaluation literature suggests that mandatory continuing education and most peer review programs are not sufficiently related to improvement of performance. An Ontario experiment provides useful data and insight about a positive reinforcement (nonpunitive) independent peer review process. Policymakers should consider, as an alternative to mandatory continuing education, directing professional associations, professional schools, and regulatory boards to design cost effective review procedures which selectively monitor performance.

California↗
PubMed2001

Determining adjusted income in HUD programs serving persons with disabilities: requiring mandatory deductions for certain expenses; and disallowance for earned income. Office of the Secretary, HUD. Final rule.

This final rule amends HUD's regulations in part 5, subpart F, to include additional HUD programs in the list of programs that must make certain deductions in calculating a family's adjusted income. These deductions primarily address expenses related to a person's disability, for example medical expenses or attendant care expenses. The purpose of this amendment is to expand the benefits of these deductions to persons with disabilities served by HUD programs not currently covered by part 5, subpart F. Second, this rule adds a new regulatory section to part 5 to require for some but not all of these same programs the disallowance of increases in income as a result of earnings by persons with disabilities. HUD believes that making these deductions and disallowance available to persons with disabilities through as many HUD programs as possible will assist persons with disabilities in obtaining and retaining employment, which is an important step toward economic self-sufficiency. This rule follows publication of a August 21, 2000 proposed rule, and takes into consideration public comments received on the rule.

Persons with Disabilities↗
PubMed2000

Resource document on mandatory outpatient treatment.

Mandatory outpatient treatment, or outpatient commitment, refers to court-ordered treatment for patients who suffer from severe mental illness and who are unlikely to be compliant with such treatment without a court order. Many states already have commitment statutes that permit mandatory outpatient treatment, and others are considering enacting new legislation or amending existing statutes. This Resource Document was prepared under the auspices of the American Psychiatric Association's Council on Psychiatry and Law to provide information to those who are drafting mandatory outpatient treatment legislation. It begins with a review of the history of mandatory outpatient treatment and recent empirical findings, followed by a detailed discussion of the salient issues in mandatory outpatient treatment. The document concludes with a statement of recommendations concerning key provisions in statutory schemes of mandatory outpatient treatment programs. This Resource Document endorses the view that mandatory outpatient treatment can be a useful intervention for a small subset of noncompliant patients with severe and chronic mental illness who go in and out of psychiatric hospitals through the so-called "revolving door."

Chronic Disease↗
PubMed1987

Substance-abuse policies and guidelines in amateur and professional athletics.

Substance-abuse policies and guidelines in amateur and professional athletic organizations are described. Amateur athletic organizations, which are governed by the U.S. Olympic Committee or the National Collegiate Athletic Association (NCAA), have developed programs that include mandatory drug testing. Drugs banned by the two organizations include psychomotor stimulants, sympathomimetic amines, narcotic analgesics, anabolic steroids, miscellaneous central nervous system stimulants, and, in the case of the NCAA, certain street drugs. Professional organizations have been somewhat slower to follow and, with the exception of tennis, do not allow mandatory drug testing. Each formal drug-screening program includes penalties for violators. The enforcement practices of the organizations representing tennis, baseball, basketball, and football are described. One aspect unique to professional sports is the employee-assistance program, which allows the impaired athlete to receive treatment while continuing to play and receive a salary. As drug-control programs become more common in athletics, opportunities may arise for pharmacists to participate in the areas of drug information and educational services.

Doping in Sports↗
PubMed2006

[Roadside observation on the use of safety belt in Guangzhou and Nanning cites of China].

OBJECTIVE: To determine the rates of correct use of safety belt (CUSB) among drivers and front seat passengers in Guangzhou and Nanning through roadside observation and to provide scientific evidence for the development of intervention plan and to strengthen road safety law enforcement. METHODS: Observational sites were randomly selected from three road types (Highway, Main Street and Subordinate Street). Targeted automobiles were observed at each site at four different times and uniformed checklists were used to record safety belt use during observations. Within each vehicle, belt use by drivers of different sex, road type, workday/weekend, day/night and seating position were calculated. Data was analyzed, using Chi-square tests to compare the statistic significance. RESULTS: (1)The rate of CUSB and non-use rate among drivers were higher in Nanning than in Guangzhou (P= 0.00) but the rate of incorrect use was on the contrarary. (2) The rate of CUSB by front seat passengers in Guangzhou was higher than that in Nanning (P = 0.04); as well as the rate of (P = 0.00) incorrect use while the non-use rate was on the contrarary. (3)In general, the rate of CUSB was higher on highways than on local streets (P = 0.00). (4) The CUSB rate of drivers and front seat passengers was higher at daytime than at night (P = 0.00), and the rate of incorrect use was higher at working days than weekends (P = 0.00). (5) The CUSB rate was higher for female drivers than for males in Guangzhou (P = 0.00), but there no statistical significance was found in Nanning (P = 0.21). CONCLUSION: Results suggested that intervention actions should be undertaken to raise the awareness of the importance of safety belt use. Effective public information and education programs, law enforcement and mandatory safety belt use, prioritizing programs on people neglegent to the importance are necessary to increase the safety belt use and to decrease the mortality and injuries caused by traffic accidents.

Automobile Driving↗
PubMed2004

Criminal recidivism in three models of mandatory drug treatment.

Although research has generally been supportive of compulsory treatment programs for drug abusers, findings remain mixed, and few studies have assessed the impacts of different coercive program elements. This study compared criminal recidivism outcomes of 350 clients mandated to the same long-term residential treatment facilities from three different legal sources. On several measures of recidivism, including long-term re-arrest rates that controlled for time at risk, clients mandated from two highly structured programs were found to recidivate at less than half the rate of comparison group clients. This group effect was upheld in multivariate models that controlled for pre-treatment differences and other factors related to recidivism. Combined with results of a previous retention study involving these clients, the findings provide support for the use of structured protocols for informing clients in mandatory programs about legal contingencies of participation and enforcing contingencies through frequent contact between legal agents and treatment staff.

Adult↗
PubMed1994

Mandatory training in geriatric psychiatry: can programs deliver the goods?

There have been a number of recent attempts to establish guidelines and curricula for training of general psychiatry residents in geriatric psychiatry. However, concerns have arisen as to whether or not many training programs have the resources necessary to train residents using these guidelines. In an attempt to determine how closely training guidelines are adhered to, the Division of Geriatric Psychiatry at the University of Toronto anonymously surveyed all general psychiatry residents completing their mandatory training in geriatric psychiatry between June 1992 and July 1993 (N = 30). The supervisors of these residents were surveyed anonymously as well (N = 15). The response rate was 83% for the residents and 80% for staff. In general, the training guidelines were closely adhered to except possibly for the required number of patient contact hours per week. The author concludes that when training guidelines are developed which include consideration of appropriate program resources and the number of residents required to train, residents and supervisors adhere closely to these guidelines.

Aged↗
PubMed2002

The Professional Development Program of the Australian College of Rural and Remote Medicine.

BACKGROUND: The case for doctors' performance and maintenance of competence are issues of increasing importance for the profession, governments and communities. There is also increasing public expectation that the profession will be pro-active in protecting patients from under performing doctors. The Australian College of Rural and Remote Medicine (ACRRM) positions itself as the arbiter of standards for rural and remote medical practice and has assumed responsibility for providing a mandatory Professional Development Program (PDP) for its Fellows. OBJECTIVE: This paper outlines the steps taken by the ACRRM to design and develop a PDP. DISCUSSION: The PDP aims to enable doctors to participate in a range of continuing education activities that enhance their clinical, management and professional skills. Participation is mandatory but the program is designed to be flexible and responsive to the range of practice characteristics in rural Australia as well as to individual needs. The PDP includes categories on continuing medical education, quality assurance and clinical assessment (with minimum compulsory requirements), practice assessment, educator activities and educational development activities. The PDP will evolve over time to meet the needs of doctors and communities in rural and remote Australia.

Australia↗
PubMed1987

The ethical dimensions of policy for prenatal diagnostic technologies: the case of maternal serum alpha-fetoprotein screening.

New technologies have dramatically increased the number of fetal abnormalities that can be detected and, in some cases, effectively treated during the prenatal period. Considering the potential health benefits to children and parents from early detection of fetal abnormalities, various forms of mandatory prenatal screening programs have been suggested. In order to explicate the ethical dimensions of mandatory screening in general and to demonstrate the role of nurses in prenatal screening programs, maternal serum alpha-fetoprotein screening is analyzed. The benefits, risks, and potential consequences from the broad use of this technology are discussed in conjunction with the rights of fetuses and pregnant women. An active role in the formation of health policy that might regulate new technologies affecting maternal-fetal-newborn health is suggested as a fundamental responsibility of the nursing profession.

Amniotic Fluid↗