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PubMed1985

Mandatory continuing pharmacy education in Alberta, Canada: the response to live programs and correspondence courses.

This report briefly describes mandatory continuing pharmacy education in Alberta and provides survey data to determine the response of pharmacists to the program. The survey results indicate that most pharmacists exceeded the required number of education units and that more than 70 percent of the total acquired were obtained by completing correspondence courses. Females, those under 40 years of age and retail staff preferred correspondence programs. Managers, hospital staff and those over 40 years of age took somewhat fewer education units by correspondence, but attended more live programs than the former group. The popularity of correspondence is presumably due to the fact that most were provided free and because they are a more convenient method of obtaining education units. The freedom allowed to design their own educational program plus the modest costs involved are probably the two main reasons for the acceptability of Albert's continuing education program to pharmacists.

Alberta↗
PubMedDate not supplied

Injuries to emergency medicine residents on EMS rotations.

OBJECTIVES: To study the incidence and nature of injuries sustained by emergency medicine (EM) residents during EMS rotations, and steps taken at EM residency programs to increase resident safety during field activities. METHODS: An eight-question survey form was mailed to all 114 U.S. EM residency directors, with a second mailing to nonresponders eight weeks after the initial mailing. RESULTS: A total of 105 surveys were returned (92%). Six surveys were from new programs whose residents have not yet rotated on EMS. These were excluded from further analysis, leaving 99 programs. Of these, 91 (92%) reported no injuries. One EM resident died in a helicopter crash in 1985. Seven other injury events were reported: 1) facial lacerations, rib fractures, and a shoulder injury in an ambulance accident; 2) an open finger fracture (crushed by a backboard); 3) contusions and a concussion when an ambulance was struck by a fire engine; 4) a groin pull sustained while entering a helicopter; 5) bilateral metatarsal fractures in a fall; 6) rib fractures, a pneumothorax, and a concussion in an ambulance accident; and 7) "minor injuries" sustained in a crash while responding to a scene in a program-owned response vehicle. Actions taken at residency programs to reduce the risk of injury include the use of ballistic vests (four programs), requiring helmets on flights (five programs), and changing flight experience from mandatory to optional (two programs). Ten programs (10%) reported using ground scene safety lectures, and nine programs (15% of those offering flights) reported various types of flight safety instruction. Sixty-nine programs (70%) reported no formal field safety training or other active steps to increase resident safety on EMS rotations. CONCLUSIONS: Injuries sustained by EM residents during EMS rotations are uncommon but nontrivial, with several serious injuries and one fatality reported. The majority of EM residency programs have no formal safety training programs for EMS rotations.

Accidents, Occupational↗
PubMed1991

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--Department of Defense. Final rule.

This final rule establishes a mandatory preadmission authorization program for mental health services under CHAMPUS. Such a program is needed to promote quality assurance and contain rapidly increasingly costs in inpatient psychiatric care under CHAMPUS. By maintaining most of the procedures of the current voluntary preadmission authorization program, the final rule minimizes inconveniences for providers.

Adolescent↗
PubMed1982

The efficacy of second-opinion consultation programs: a cost-benefit perspective.

This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120,000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2,284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at $534,791. Of this amount, medical care utilization savings were $361,756 and productivity savings were $173,035. The cost of the program was $203,300, yielding a benefit-cost ratio of 2.63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.

Adolescent↗
PubMed2005

Public health and the politics of school immunization requirements.

Compulsory vaccination has contributed to the enormous success of US immunization programs. Movements to introduce broad "philosophical/personal beliefs" exemptions administered without adequate public health oversight threaten this success. Health professionals and child welfare advocates must address these developments in order to maintain the effectiveness of the nation's mandatory school vaccination programs. We review recent events regarding mandatory immunization in Arkansas and discuss a proposed nonmedical exemption designed to allow constitutionally permissible, reasonable, health-oriented administrative control over exemptions. The proposal may be useful in political environments that preclude the use of only medical exemptions. Our observations may assist states whose current nonmedical exemption provisions are constitutionally suspect as well as states lacking legally appropriate administrative controls on existing, broad non-medical exemptions.

Arkansas↗
PubMed1983

Employee rubella screening programs in Arizona hospitals.

One year after voluntary guidelines on rubella screening of hospital employees were issued by the Arizona Department of Health, a survey of 68 members of the Arizona Hospital Association was conducted, with an 81% response. Some form of employee rubella screening was present in only 49% of responding hospitals. Of the screening hospitals, 70% of programs had a mandatory aspect for selected employees. Administrative logistics, cost, problems encountered, and the quality and coverage of the program varied substantially among the different hospitals. Fewer than half of the screening hospitals had programs for physicians, students, or volunteers. Verbal histories of immunization or serological tests, although notoriously unreliable, were accepted by 14% of the screening hospitals. Half of the nonscreening hospitals plan to implement programs in the future. Reasons given for not establishing rubella screening programs include cost, no pediatric or obstetric service, liability issues, high turnover, and no previous case of rubella in an employee. Three hospitals (all screening) reported they had had a case of rubella in an employee. The data suggest slow partial compliance with recommendations for rubella screening in hospitals.

Adolescent↗
PubMedDate not supplied

Changes over time in audiometric thresholds in a group of automobile stamping and assembly workers with a hearing conservation program.

Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting between 7.4 and 10.2 million people who work in noise above 85 dBA. Although mandatory hearing conservation programs (HCPs) have been in effect since 1972, this problem persists, as hearing protectors are not consistently used by workers, or may not attenuate to manufacturer's estimates in real world conditions. In this study, information from noise and hearing protection use measurements taken at an automobile assembly plant were used to construct average lifetime noise exposure and hearing protection compliance estimates for use in modeling to predict both total hearing loss and onset of two accepted definitions of hearing loss. There were 301 males and females in this cohort; their mean age was 42.6 (7.2) years, and mean tenure was 14.3 (3.5) years. Average length of follow-up was 14.0 years. There were 16 members of this cohort who had hearing loss at the speech frequencies (defined as an average hearing level > or = 25 dB at 500, 1000, and 2000 Hz). In cross-sectional multivariate analyses, years of employment, male gender, and proportion of time wearing hearing protection were the factors most associated with hearing loss at the average of 2000, 3000, and 4000 Hz (p < 0.0001) controlling for age, transfer status (as a surrogate for previous noise exposure), race, and lifetime average noise exposure. The most consistent predictor of hearing loss in both univariate and multivariate analyses was percentage of time having used hearing protection during the workers' tenure.

Adult↗
PubMed1999

Practice management in obstetrics and gynecology residency curriculum.

OBJECTIVE: To establish the current level of instruction in practice management in obstetrics and gynecology residency programs; review recommendations of medical school practice management executives and current and former residents on design of practice management instruction programs; and develop recommendations for future management instruction by residency programs in obstetrics and gynecology. METHODS: A questionnaire was sent to 101 practice plan executives of obstetrics and gynecology departments at medical schools in the United States and Canada. A modified version was sent to 44 current obstetrics and gynecology residents and 72 former residents from the University of Tennessee, Memphis. RESULTS: The response rates were 71% (practice executives), 93% (current residents), and 81% (former residents). There were no formal management programs at 87% of responding institutions, although most respondents (62%) thought there should be mandatory participation in management programs, probably given by organizations outside the university. Potential subjects that received high ratings were current procedural terminology and diagnosis coding, managed care, billing procedures, contractual agreements between medical doctors, patient record management, and practice economics. CONCLUSION: Residency programs should establish formal practice management instruction programs and make participation mandatory. Funding should come from the medical school and university. Instructional help should come from extradepartmental organizations and individuals.

Canada↗
PubMed1990

Quality assurance and certification program for an aminoglycoside monitoring service.

A Quality Assurance Program (QAP) should both evaluate and improve the quality of a service. In order to train newly employed pharmacists and ensure provision of a consistently high level of clinical service, a pharmacist training program for an Aminoglycoside Monitoring Service (AMS) and a QAP involving pharmacist certification was established. The certification program consists of a pretest, a reading/information package, an "on the job" training requirement and a posttest which pharmacists work through at their own speed. Certification requires completion of 45 hours of supervised AMS activity and a score of 90 percent on the posttest. Yearly recertification is required. As an integral part of the QAP, the clinical coordinator reviews the AMS monitoring forms monthly for specific performance standard indicators. Problems are identified and dealt with on an individual basis. The program is not mandatory, however, all pharmacists have elected to complete certification. Seven pharmacists and three pharmacy residents have participated in the certification program. All seven pharmacists and one resident received certification. A questionnaire completed by the pharmacists indicated that all felt certification was necessary and contributed to standardization and consistency of the AMS.

Aminoglycosides↗
PubMed1989

HIV testing in prisoners: is mandatory testing mandatory?

We studied 977 newly incarcerated Oregon inmates to compare voluntary versus mandatory human immunodeficiency virus antibody (HIVAb) testing in the prison setting. All inmates were offered HIVAb counseling and testing. Blood drawn for routine syphilis serology from those who declined this offer was also tested for HIVAb after personal identifiers had been removed. Only 1.2 percent (12) prisoners were HIV positive. However, 62.5 percent (611) inmates were at risk for HIV infection by being an intravenous drug user, a male homosexual, or hepatitis B core antibody (HBcAb) positive. The ratio of at-risk, as yet uninfected inmates to those already HIV infected was 53 to 1. Two-thirds of all inmates including those at-risk chose to receive counseling and testing. In areas where most at-risk inmates are not yet infected, it may be more appropriate for HIV prevention activities in prison to focus on voluntary programs that emphasize education and counseling rather than mandatory programs that emphasize testing.

Adolescent↗
PubMedDate not supplied

Commercial plans in Medicaid managed care: understanding who stays and who leaves.

Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial plans to the program, by the late 1990s commercial plan participation in Medicaid had begun to decline. This study examines the role of Medicaid policies, plan characteristics, and local health care market conditions in a commercial plan's decision to exit. We find that many of the factors that influence commercial plans' decisions to exit Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan.

Capitation Fee↗
PubMed2002

Critical issues for dentistry: PGD program directors respond.

Discussion of critical issues facing postgraduate education in general dentistry (PGD) and dental education in general has been intense in the past decade. This study reports on critical issues raised by directors of PGD programs that may help direct future research and action within dental education and the larger profession. The analysis reports responses to an open-ended question sent to all U.S. PGD program directors regarding critical issues facing their training programs. Of 212 surveys, 169 program directors submitted written responses regarding critical issues. Twelve unique themes were identified: lack of postdoctoral applicants (two subthemes were high student debt and students' preference for private practice); student quality; professionalism and attitudes; number of postdoctoral positions; lack of funding; quality of facilities; special patient care; program curriculum; educator issues; mandatory or encouraged PGD year; value of dental program; and dentist shortage. Significant differences between AEGD and GPR directors were observed for two of the twelve areas: high student debt and value of dental program. The study provided insight into the thoughts of a large proportion of the U.S. PGD program directors "in the trenches." Some consideration of allowable expenses may be needed to align federal training support to best address program director needs.

Administrative Personnel↗
PubMedDate not supplied

Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada.

OBJECTIVE: Canada introduced a mandatory folic acid food fortification program in November 1998. We investigated whether the rate of folate and vitamin B12 insufficiency among adults has changed since this mandatory fortification program was implemented. METHODS: We conducted a retrospective cross-sectional study using a large Ontario laboratory database. We included all individuals who underwent evaluation of their serum folate, red cell folate and serum vitamin B12 between April 1, 1997 to July 31, 1998 (Period A), August 1, 1998 to January 30, 1999 (Period B) and February 1, 1999 to March 31, 2000 (Period C). RESULTS: A total of 8,884 consecutive samples were analyzed during the period of study. Mean age was 57.4 years (SD 21.1), and 63.2% were female. The prevalence of serum folate insufficiency (below 3.4 nmol/L) fell from 0.52% in Period A to 0.22% in Period C [prevalence ratio (RR) 0.41, 95% confidence interval (CI) 0.18-0.93)]. The prevalence of red cell folate insufficiency (below 215 nmol/L) declined from 1.78% during Period A to 0.41% in Period C (RR 0.23, 95% CI 0.14-0.40). No significant difference was observed between periods in the prevalence of B12 insufficiency below 120 pmol/L (3.93% versus 3.11%, respectively; RR 0.79, 95% CI 0.62-1.01). CONCLUSIONS: There has been a significant decline in the prevalence of folate, but not vitamin B12 insufficiency, following Canadian folic acid food fortification. These changes may have important implications for the prevention and detection of folate and vitamin B12 insufficiency, including identifying the benefits of folic acid food fortification and the need to further consider fortification or supplementation with vitamin B12.

Adult↗
PubMed1989

Experience with mandatory continuing education in a teaching hospital.

Mandatory continuing education (MCE) has the potential to create unwilling learners who, if given a choice, may not participate in continuing education programs. Participants of two MCE programs conducted at a large teaching hospital responded to a survey assessing their perception of and attitudes toward MCE and their perceptions of program effectiveness. Results of the study indicated that mandating the programs did have adverse effects on participants' perceived outcomes and on the likelihood of their voluntarily attending future programs. Descriptions of the two programs, design and results of the study, and suggestions on how to approach mandatory programming are presented.

Attitude of Health Personnel↗
PubMed1997

[The on-line simulation of blood propofol concentration by personal computer transmitting settings of the syringe pump via a digital port].

A program for on-line simulation of blood propofol concentration was developed. Various pharmacokinetic model programs are available for the estimation of intravenous anesthetic concentration. But manual entry of data such as body weight, rate of infusion and the timing of changing the flow rate is mandatory in these programs. This limited the use of these programs for investigational use only. In a new program, the data required such as total dose, flow rate, body weight and time were collected automatically on-line via the digital outlet of the syringe driven pump (Terumo STC525X, Japan and Graseby 3500, UK) to a personal computer (Apple Macintosh Power Book Duo230 or Power Book 520, USA). Based on the obtained data, pharmacokinetic model was solved with personal computer. Calculated blood concentrations of propofol were displayed in a numeric form and a trend graph was obtained. This program provides useful information for maintainance of anesthesia with propofol.

Anesthesia, Intravenous↗
PubMed1995

HIV infection and AIDS: attitudes and knowledge of Arizona pharmacists.

OBJECTIVE: To assess Arizona pharmacists' attitudes and knowledge regarding HIV infection and AIDS. METHODS: Mailing of a 7-page survey, which included demographic and attitudinal items, as well as preparedness, comfort, and knowledge scales. SETTING: Randomly selected pharmacists registered and residing in Arizona. PARTICIPANTS: Of the 479 pharmacists surveyed, 41 were removed from the sample because they had moved with no forwarding address, were retired or not practicing, or had died. The response rate was 46% for the remaining 438 pharmacists. A final sample size of 199 was obtained. RESULTS: The respondents had a high level of preparedness and comfort in addition to positive attitudes. Overall, their knowledge level was low. Inpatient pharmacists had a higher level of therapeutic knowledge (p < 0.0001) and were more willing to work with a person infected with HIV than were outpatient pharmacists (p = 0.05). Pharmacists who had attended at least 1 HIV/AIDS-related continuing education (CE) program had higher levels of preparedness (p < 0.0001), comfort (p = 0.01), and knowledge (p < 0.0001) than those who had not. The majority of respondents believed that an HIV/AIDS CE program should be mandatory. CONCLUSIONS: Although Arizona pharmacists feel prepared, are comfortable, and have positive attitudes regarding patients with HIV/AIDS, their level of knowledge is low. The results of this study may be used by CE providers to design programs to meet the educational needs of pharmacists.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[A handling program for resistant pneumococci. Physicians sometimes neglect mandatory notification].

Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly. Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem. In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996. In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs. With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994. To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L. An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.

Disease Notification↗