Voluntary attendance at a preventive dentistry instruction program.
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Health Education, Dental↗
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Trends in cardiac care: contractions, concentration, collaboration.
Cardiovascular services is entering an age of contraction and concentration. The number of programs and the growth in inpatient procedures have topped out and the presence of significant excess capacity has become apparent. During the next five years, there will be heightened pressures to simultaneously decrease the overall number of cardiac procedures performed and, on the part of individual providers, increase procedure volume in order to achieve economies of scale and high levels of quality. It is likely that the number of health care organizations with OHS programs and PTCA may be cut to 500 by the year 2000, significantly influencing the redistribution of cardiac services along regional lines. The public, government, and private payers have embarked on a quest for value; and in the future they will only purchase services from providers demonstrating high-quality outcomes and average, or below average, charges. HCFA's Cooperative Cardiovascular Project is typical of the direct continuous quality improvement and management initiatives that will be implemented to monitor appropriateness, outcome quality, and resource utilization through the application of clinical practice guidelines (CPGs) and data on the treatment of AMI, PTCA, and CABG surgery. A more indirect, managed care approach by purchasers to obtaining higher value can be seen in the Medicare Participating Heart Bypass Center Demonstration project, the federal government's first big step into selective specialty care contracting for clinical service on a package price basis. Several different types of private initiatives have been used to achieve wider distribution of service while maintaining high program volumes and high-quality care through collaboration and the formation of interhospital linkages. Although some of these have included collaborative programs to encourage voluntary community-based planning and discourage the duplication of services, the payers demand for value (cost/quality) and the organizational leverage of the regional health alliances will accelerate the process and spur the formation of a smaller number of high-volume invasive programs. Large invasive programs will continue to formalize interhospital linkages to provide an integrated set of services in a layered system of cardiac care.(ABSTRACT TRUNCATED AT 400 WORDS)
Cardiac Catheterization↗
Attrition from ophthalmology residency programs.
PURPOSE: To investigate the incidence of and reasons for voluntary resident attrition from ophthalmology training programs. DESIGN: Retrospective survey. METHODS: A survey was mailed to residency program directors of the 121 Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs asking them to report the number of residents who withdrew from training during 2001 to 2002 and the reasons for withdrawal. RESULTS: Of 102 responding programs, 13 (12.7%) had one resident withdraw from training in the academic year 2001 to 2002. These 13 residents represented 1.1% of all ophthalmology residents in training at the responding institutions during that academic year. The most frequent reason for withdrawing was to enter another medical specialty. CONCLUSIONS: Voluntary resident attrition from ophthalmology training programs is uncommon. The 1.1% attrition rate in this study is the lowest among published reports of attrition from other specialties.
Career Choice↗
Control of bovine viral diarrhea virus infection without vaccines.
Successful control and eradication of BVDV infection presuppose sufficient knowledge of its epidemiology, particularly sources of infection and ways of transmission. Furthermore, it is crucial to have tests that can be trusted to give the true infection of individual animals and indicate the infection status of herds. PI animals are considered to be the main source of infection. In preliminary experiments in Denmark, it was found that eradication in herds could be based on the identification and removal of PI animals. Actual and possible means of herd-to-herd transmission of importance for infection control are reviewed. Special attention is paid to the possibility of airborne transmission, which must be anticipated in areas with high BVDV prevalence and a high cattle population density. BVDV control programs have been initiated only in the Scandinavian countries including Finland, where the occurrence of BVDV varies from a very low prevalence in Finland to a very high prevalence in Denmark. The BVDV programs in Finland, Norway, and Sweden are basically the same. The primary aim of each is the identification of the herds free from infection and prevention of introduction of the infection to these herds. A secondary aim is to reduce gradually the number of infected herds. In Denmark, which has a high prevalence of BVDV, the program is a combined control and eradication program, and different tests are used. The control programs in Scandinavian countries and the eradication program in Denmark are described together with the tests involved. With respect to control, special emphasis is given to herd tests applied to bulk tank milk or to specially selected blood samples to indicate the infection status of individual herds. The initial bulk tank milk testings were the main basis for the conclusions that in Finland, Norway, and Denmark approximately 1%, 9%, and 39% of the dairy herds, respectively, seemed to have PI animals. With respect to eradication, an ELISA developed in Denmark for demonstration of virus in blood has proved to be extremely reliable for identification of PI animals. The BVDV programs are generally voluntary, although in Norway, where BVD is a notifiable disease, restrictions have been placed on infected herds to prevent a further spread of the infection. The annual losses in Denmark from BVDV have been calculated to be approximately 100 million DKr (17 million dollars), whereas the total costs of the control and eradication program for a 3-year period including testing of trade animals are estimated to be approximately 160 million DKr (27 million dollars).
Animals↗
Progress of control and prevention programs for bovine viral diarrhea virus in Europe.
In Europe, nationwide BVD control programs based on the TC principle have been running for up to 10 years in the Nordic countries. The results have shown that BVD eradication by removal of PI animals without use of vaccines is effective and that today's diagnostic tests, when used by experienced diagnosticians, are suitable for this task. Furthermore, to avoid control programs becoming Sisyphean tasks, adherence to strict biosecurity guide-lines to minimize infection of susceptible herds is a crucial additional measure. Efficient organization of testing, with sufficient capacity of diagnostic laboratories, is also important to minimize the period of overlap when remaining infected and recently emerged naive herds coexist close to each other. Control programs based on voluntary participation are possible, but when approaching final clearance of a national herd, significant delays can easily be suffered if any herd owners are allowed not to clear their herds. The control schemes used in the Nordic countries were tailored to fit the structure of the cattle production in each country. If BVD control programs based on the same principles are to be set up for other bovine populations,it is important to recognize and take into account for differences in the epidemiology of BVD and in the structure of the animal production,including cattle density and husbandry practices. To ensure optimal performance of the diagnostic tests, the diversity of BVDV in the region to be tested should also be considered.
Animals↗
Refusing HIV testing in an urgent care setting: results from the "Think HIV" program.
Efforts to increase HIV case identification through routine, voluntary HIV testing are hindered by high refusal rates. Our objective was to identify patients most likely to refuse routine HIV testing. We developed a new HIV testing program at four Massachusetts urgent care centers. Patients were asked if they were interested in routine HIV testing. We performed analyses to assess differences in characteristics between those who refused testing and those who accepted it. Data were available for 9129/10,354 (88%) patients offered routine HIV testing from January to December 2002. Of these 9129 patients, 67% refused testing. In the crude analysis, HIV test refusal was associated with female gender, white race, older age, and higher educational level. In multivariate analysis, non-English-speaking patients who were Hispanic, Haitian, and other race were more likely to refuse testing than their English-speaking counterparts. Among all patients, "not at risk" and "already tested" were the most common reasons for test refusal. Two thirds of patients refused routine HIV testing when it was offered in a statewide urgent care-based program. If routine HIV testing programs are to be successful, strategies must be developed to increase HIV test acceptance among patients most likely to refrain from testing.
AIDS Serodiagnosis↗
The role of biological monitoring in the health management of lead-exposed workers.
In 1967, the problem of occupational lead exposure came to public attention in Korea. Since then, regular progress has been made in lowering workplace lead exposures, instituting new workplace controls, and implementing health examinations of exposed workers. Serious lead poisoning episodes led to the introduction of biological monitoring programs on a voluntary basis in high lead exposure facilities in Korea. Occupational health services for lead workers in Korea during the last 10 years could be categorized into three phases. During the first phase (1988-1993), effort was directed at increasing awareness among workers concerning the hazards of lead exposure, biological monitoring was commenced with zinc protoporphyrin (ZPP), and a respiratory protection program was introduced. During the second phase (1994-1996), a computerized health management system of lead workers was developed, blood lead measurement was added for biological monitoring, and engineering controls were introduced in the workplace to lower air lead levels to comply with air lead regulations. Finally, during the third phase (1997-present), bone lead measurement by X-ray fluorescence was introduced to evaluate total body lead burden. During the period 1988-1998, air lead levels have remained generally steady and above the permissible exposure level (PEL), but ZPP and blood lead levels have shown a steady decline. It was discovered that in a developing country like Korea, which cannot introduce engineering controls quickly to protect lead workers, biological monitoring was very useful in identifying and lowering excess lead absorption. In the future, as average exposure duration continues to rise, bone lead measurement may be recommended to adequately protect the long-term health of lead workers.
Air Pollutants, Occupational↗
Quality assurance in nuclear medicine facilities; availability of final recommendations--FDA. Notice.
The Food and Drug Administration (FDA) is announcing the availability of final recommendations prepared by its Center for Devices and Radiological Health (CDRH) on quality assurance programs in nuclear medicine facilities. The final recommendations include the agency's rationale for the recommendations as well as references that can be used as well as references that can be used as guides in conducting quality control monitoring. These final recommendations are available as a technical report in CDRH's radiation recommendations series. They are intended to encourage and promote the development of voluntary quality assurance programs in nuclear medicine facilities.
Hospital Departments↗
The mandate project: institutionalizing a system of patient care quality assurance.
In 1970, prior to present-day requirements for quality assurance programs, a project was undertaken to institute such a program voluntarily in ten hospitals. Five hospitals succeeded in fully implementing the program which was based on the "Bi-Cycle Process" and each documented improvements in desired patient care behaviors. Two hospitals partially implemented the process and demonstrated no significant changes in desired patient care behaviors. Two hospitals failed to provide the data upon which assessments could be made and one hospital never got beyond preliminary efforts at instituting the process. The project demonstrates that a voluntary quality assurance program is feasible and has important implications for PSROs and continuing medical education. It also provides evidence that attention to psychosocial factors is essential in the institutionalization of programs designed to produce desired changes in patient care behaviors.
Education, Medical, Continuing↗
Bedside glucose monitoring. Comparison of performance as studied by the College of American Pathologists Q-Probes program.
OBJECTIVE: To measure changes in practice characteristics and accuracy of bedside glucose monitoring between studies performed in 1991 and 1994. DESIGN: Participants in a 1991 and a 1994 bedside glucose monitoring study of the College of American Pathologists Q-Probes program were compared using data collected by a questionnaire for 15 quality variables and data from paired specimens for accuracy. Accuracy goals of bedside testing were those defined by the American Diabetes Association as within 10% of the laboratory value. Accuracy was estimated using a daily paired comparison of patient specimens for 30 days, one bedside glucose instrument, and individuals who commonly performed these measurements. SETTING: Institutions subscribing to the College of American Pathologists' voluntary quality improvement program, Q-Probes. PARTICIPANTS: In 1991 and 1994, 605 and 544 institutions collected data about performance characteristics, whereas 171 and 242 institutions participated in the accuracy components, respectively. MAIN OUTCOME MEASURE: Changes in accuracy between 1991 and 1994. RESULTS: When compared, improvement occurred for 12 of 15 quality variables. However, no significant changes were found for the percentage of values within stated accuracy goals. CONCLUSIONS: Although the process of bedside glucose testing improved between the 1991 and 1994 studies, the testing accuracy remained unchanged.
Blood Chemical Analysis↗
Are you ready to carry out smallpox vaccine plans?
New recommendations for smallpox vaccination have addressed key concerns of emergency department (ED) managers. The program would be voluntary. Vaccinated staff would not be quarantined. Fifteen or more ED staff members at each hospital would receive the vaccine as part of a total team of 40 or more, with the exact number varying according to individual needs.
Centers for Disease Control and Prevention, U.S.↗
Voluntary newborn HIV-1 antibody testing: a successful model program for the identification of HIV-1-seropositive infants.
Harlem Hospital in New York City has one of the highest HIV-1 newborn seroprevalence rates in the United States. We report the results of a program introduced in 1993 and designed to identify HIV-1-seropositive (HIV+) newborns at birth. All new mothers, independent of risk, received HIV counseling that emphasized the medical imperative to know the infant's HIV status as well as their own. Consent was obtained to test the infant; discarded cord blood samples were tested by enzyme-linked immunosorbent assay (ELISA), and when positive, Western Blot confirmation. We compared the number of HIV+ infants identified through voluntary testing with the number reported by the anonymous New York State Newborn HIV Seroprevalence Study. In 1993, 97.8% (91 of 93) of the number of HIV+ infants identified by the anonymous testing were identified through voluntary maternal and newborn testing programs. Eighty-five HIV+ infants were identified before nursery discharge: 50% (42/85) through newborn testing; 14% (12/85) through prenatal testing; 13% (11/85) presented to care knowing their status; 23% (20/85) were known because of a previous HIV+ child. Six additional HIV+ children were diagnosed after hospital discharge (mean age, 5.5 months; range 1.5 through 17 months); four presented with symptomatic disease. The optimal time for identification of the HIV+ pregnant woman is before or during pregnancy, but when this does not occur, voluntary newborn testing can identify many HIV+ infants who would otherwise be discharged undiagnosed from the nursery.
Blotting, Western↗
Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants: the place of voluntary counseling and testing.
Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to "opt out," universal treatment (mass treatment for those whose HIV status is not determined by voluntary counseling and testing), universal testing with women having the right to "opt out" of learning their test results, and mass treatment for all without testing.
AIDS Serodiagnosis↗
Seroepidemiology study of rubella antibodies among pregnant women from seven Asian countries: evaluation of the rubella vaccination program in Taiwan.
During 2003-2004, approximately 13% of birth in Taiwan was given by foreign-born females. The aims of this study were to compare the seroprevalence of rubella antibodies between Taiwan-born and foreign-born pregnant women and evaluate the effect of rubella vaccination program in Taiwan. We reviewed the rubella antibody test results of 5007 women during routine pregnancy check-ups at Fooyin University Hospital during 1999-2002. In Taiwan-born women, rubella antibody was undetectable in 29.2%, 7.3%, and 8.3% of the cohorts born before 1971, between 1971 and 1976, and after 1976, respectively. In the cohorts born between 1971 and 1976 and after 1976, pregnant women born in China, Vietnam, Indonesia, and Philippines had significant higher chances of being susceptible. Our results suggested that the voluntary adult vaccination program was not as effective as the school or wipe-out programs. Both Taiwanese women born before 1971 and foreign-born women were more likely to be susceptible to rubella. The introduction of 'catch-up' immunization program and enforcement of the checking of immunization record and/or blood test before pregnancy for these women are necessary in preventing CRS.
Adolescent↗
Effectiveness of community-based screening for depression.
OBJECTIVE: The effectiveness of a voluntary depression screening program was assessed by determining 1) whether participants in the 1994 National Depression Screening Day went for recommended follow-up examinations and 2) the characteristics that differentiated those who did and did not return. METHOD: Randomly selected participants (N = 1,169) from 99 facilities completed a follow-up telephone survey. RESULTS: Of 805 people for whom follow-up was recommended, 56.5% (N = 455) went for an appointment. The severity of depressive symptoms in these subjects ranged from severe (33.4%, N = 152) and marked (41.3%, N = 188) to minimal (17.1%, N = 78) and normal (8.1%, N = 37). Subjects with marked or severe depression were more likely to respond to the screening recommendation than were those with minimal depressive symptoms. However, at each level of symptom severity, subjects who had received previous treatment were more likely to adhere to the screening recommendation than were those with no previous treatment. Of those who returned for a recommended follow-up, 72.1% were diagnosed with depression. Of those who did not return, 29.5% cited lack of insurance, under insurance, or inadequate finances, and 38.0% felt they could "handle" depression on their own. CONCLUSIONS: Voluntary screening for depression is an effective way to bring certain untreated depressed individuals to treatment. Inadequate insurance and the belief that individuals can manage depression on their own continue to be barriers to seeking treatment among some depressed individuals who attend a depression screening program.
Adolescent↗
On-farm quality assurance programs: a survey of producer and industry leader opinions.
To assess interest in implementing a California dairy quality assurance program, practices and opinions of dairy producers and industry leaders were surveyed by a mailed questionnaire and by focus groups. The majority of the 55 participants in the focus group were dairy producers; processor marketing executives, extension dairy advisors, packinghouse executives, and dairy veterinarians were represented. The consensus among the focus groups was that a quality assurance program should be voluntary, be managed by creameries, and confer an economic advantage to participants. Focus group members listed chemical and microbial food safety (in both meat and milk), environmental health, and animal welfare as issues that should be addressed. Of the 1440 questionnaires mailed with producers' milk checks, 413 were returned. Information was collected regarding opinions and practices pertaining to administration of drugs to animals, medical records and animal identification, culling practices, manure management, cow welfare, and feeding of animal protein. An overwhelming 99% of producers believed they were responsible for the safety of meat and milk leaving the farm. Sixty percent of producers said that they would consider joining a California-specific quality assurance program, whereas 9% indicated that they would not. Producers would be more likely to join if their processor believed it would impart a market advantage and if the program standards were controlled by producers.
Animals↗
Development, implementation, and results of a successful multidisciplinary adverse drug reaction reporting program in a university teaching hospital.
The development and implementation of an active adverse drug reaction reporting program in a university teaching hospital is described. The progression from a solely voluntary system to a multidisciplinary program consisting of both voluntary and involuntary components is discussed. A total of 1,011 adverse reactions were reported between July 1, 1988 and July 22, 1992. The most common reaction reported was rash. Antibiotics were most commonly implicated in the reactions reported. As a single agent, digoxin was involved most frequently. Voluntary reporting by physicians, nurses, and pharmacists accounted for approximately 24% of the adverse reactions reported. Occurrence screening by the Quality Assurance department produced approximately 76% of the reports.
Adverse Drug Reaction Reporting Systems↗
Comprehensive program for handling hazardous drugs.
Development and implementation of a comprehensive program for safe handling of hazardous drugs is described. A comprehensive, multidisciplinary program for handling hazardous drugs was developed at a 1000-bed tertiary care, university teaching institution. Hazardous drugs were identified by a hazardous-drug working group consisting of occupational health professionals, pharmacists, and an industrial hygienist. The Occupational Safety and Health Administration (OSHA) 1986 handling guidelines were used as a template, with input solicited from pharmacy staff and from other institutions. A new system for receiving, storing, and transporting hazardous drugs--which also included new labeling for such drugs--was implemented. The new guidelines were discussed with the staff, with emphasis placed on absolute compliance and incorporation of the guidelines into standard operating procedures and daily pharmacy practices. All pharmacy employees underwent retraining to ensure complete understanding. A voluntary medical surveillance program for pharmacy employees was developed concomitantly to monitor exposure to genotoxic hazardous drugs. Implementation of a comprehensive program for safe handling of hazardous drugs increased employee understanding of the need for such a program and improved the hospital's compliance with recent OSHA regulations.
Baltimore↗