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PubMedDate not supplied

Physiotherapy and occupational therapy: a geriatric experience in the acute care hospital.

The continuously growing segment of the geriatric population with the high incidence and prevalence of comorbidity and disability suggests that enhanced preventive and rehabilitative programs will be mandatory. The early arrangement of comprehensive assessment and rehabilitation services is extremely important not only in preventing the decline of patients in the acute care settings and successive prolonged care before discharge, but also in improving functional status at discharge. We have considered the effectiveness of a rehabilitation program in acute medical care of the elderly. This article discusses a pilot project being carried out at Catholic University Hospital "A. Gemelli" of Rome.

Activities of Daily Living↗
PubMed1982

Efficacy of enforcement in an industrial hearing conservation program.

Relative efficacy of various levels of enforcement in the use of personal hearing protective devices was investigated among employees of a large industrial plant. The main variable was that each of four groups of employees worked during a different period of enforcement policy on the use of personal hearing protection. Analysis of variance of mean hearing levels using three different audiometric grading schemes with different levels of sensitivity, namely, the 0.5, 1, 2 kHz Hearing Level Index, the 1, 2, 3 kHz Hearing Level Index, and the 4000 Hz single puretone test indicate that the enforcement policy did have a dramatic effect on the efficacy of the hearing conservation program and should give similar results in other industrial settings. When and where the use of personal hearing protection was left to the employee it was found that hearing loss among the noise-exposed was very much in excess of that among a non-noise-exposed group. Mandatory use of personal protective devices was found to be much more effective in conserving hearing that the voluntary approach. Mandatory use of earmuffs exclusively proved to be less effective than mandatory use of personal hearing protection when the employee was given a choice of earmuffs or earplugs. Enactment of the Occupational Safety and Health Act did not result in greater hearing conservation over the existing company mandatory hearing conservation program which is quite effective.

Adult↗
PubMed2002

A hospital-based screening program for natural rubber latex allergy.

BACKGROUND: Natural rubber latex (NRL) allergy has become an important occupational health problem for health care workers, of whom approximately 10% are reportedly sensitized. Some medical facilities have chosen to convert entirely to NRL-free gloves, but others have found this to be financially or logistically unfeasible. OBJECTIVES: The goals of this study were 1) to devise a NRL allergy screening program that could identify sensitized (at-risk) employees for the purpose of providing them with a safe working environment; and 2) to develop a glove conversion plan that would lead to the removal of all NRL gloves from the institution. METHODS: A multidisciplinary University of Maryland Medical System NRL risk team developed a mandatory NRL screening program for all newly hired employees and any existing employees transferring into or within patient care positions. Employees were screened with a clinical questionnaire and a serology for immunoglobulin (Ig)E anti-NRL. Some employees voluntarily received an experimental NRL skin test to evaluate their skin reactivity to NRL. Each employee reporting respiratory or systemic symptoms associated with NRL exposure was evaluated by an allergist. RESULTS: During the 15-month study period from April 1998 to July 1999, 1,795 employees were screened for NRL allergy. Of the whole group, 8% (144 of 1,795) were NRL-specific IgE antibody-positive by CAP radioallergosorbent test (Pharmacia-Upjohn Diagnostics, Kalamazoo, MI) and/or NRL skin test, 57.3% of whom reported symptoms with powdered NRL glove exposure. The NRL IgE-positive rates of nonpatient-care employees (who did not use NRL gloves on a regular basis) and direct patient-care employees was 5.9% and 8.6%, respectively. Most NRL-sensitized employees were successfully accommodated with the use of synthetic gloves and continued to work in the positions for which they were hired. CONCLUSIONS: The University of Maryland Medical System NRL screening program has been successful in identifying at-risk employees and ensuring them a safe working environment during a progressive conversion of the hospital to a NRL-safe environment.

Adolescent↗
PubMedDate not supplied

Focus on: SUNY Health Center at Brooklyn Scientific & Medical Instrumentation Center.

The Scientific and Medical Instrumentation Center (SMIC) is the clinical engineering program serving the State University of New York's Health Science Center at Brooklyn. SMIC is a separate department within the center's 354-bed University Hospital, and provides many instrumentation support services for the hospital and the center's Basic Sciences Division. Now in its 24th year, SMIC developed the nation's first mandatory initial checkout program for patient care equipment, and in 1973 published the results of a funded pilot preventive maintenance program; this served as a model for the start-up of other PM programs in hospitals across the country and overseas. Today, this 35-person department is primarily responsible for some 7,000 units used in over 60 University Hospital departments and clinics. With its interdisciplinary expertise, SMIC also provides the hospital with many other instrumentation services, including prepurchase evaluation and review, and on-site emergency instrumentation service. SMIC also develops unique devices and instruments for the center's researchers, from the prototype stage through to final construction, and may modify instruments for increased safety and efficacy.

Biomedical Engineering↗
PubMed2002

Active surveillance for scrapie by third eyelid biopsy and genetic susceptibility testing of flocks of sheep in Wyoming.

Control of scrapie, an ovine transmissible spongiform encephalopathy or prion disorder, has been hampered by the lack of conventional antemortem diagnostic tests. Currently, scrapie is diagnosed by postmortem examination of the brain and lymphoid tissues for PrP(Sc), the protein marker for this group of disorders. For live, asymptomatic sheep, diagnosis using tonsil or third-eyelid lymphoid tissue biopsy and PrP(Sc) assay has been described. To evaluate the feasibility and efficacy of third-eyelid testing for identification of infected flocks and individual infected sheep, 690 sheep from 22 flocks were sampled by third-eyelid lymphoid tissue biopsy and immunohistochemistry. Sheep were further evaluated for relative genetic susceptibility and potential contact exposure to scrapie. Third-eyelid testing yielded suitable samples for 80% of the sheep tested, with a mean of 18.1 lymphoid follicles (germinal centers) per histologic section. Three hundred eleven of the sheep were sampled through passive surveillance programs, in which only sheep with potential contact with an infected sheep at a lambing event were tested, regardless of their scrapie susceptibility genotype. In addition, 141 genetically susceptible sheep with no record of contact with an infected animal at a lambing event were sampled through a targeted active surveillance program. Ten PrP(Sc)-positive sheep were identified through the passive surveillance program, and an additional three PrP(Sc)-positive sheep, including two from flocks with no history of scrapie, were identified through the active surveillance program. All PrP(Sc)-positive sheep had the highly susceptible PrP genotype. Third-eyelid testing is a useful adjunct to flock monitoring programs, slaughter surveillance, and mandatory disease reporting in a comprehensive scrapie eradication and research program.

Animals↗
PubMed1985

Residents' knowledge of behavioral pediatrics.

Four groups of residency programs (4433 residents) were compared regarding performance on the In-Training Exam of the American Board of Pediatrics and a 30-item addendum assessing behavioral knowledge: 10 programs funded to provide mandatory training, 6 not funded but requiring training, 4 control programs not requiring training but participating in an evaluation of behavioral training, and all other programs (221) whose residents took the exam. Three measures were calculated for each resident: percent correct on "organic" items; percent correct on "behavioral" items; and a ratio (behavioral to organic). Moderate positive correlations were found between organic and behavioral scores. There were no significant differences in organic performance related to program type. Ratio scores were higher for PL-1-funded residents than for any other PL-1 group. For PL-2s, Funded, Not Funded, and Control residents performed better than the All Other group. By the 3rd year, Funded residents performed better than All Other residents; Not Funded and Control scores fell in between. These data suggest that: (1) behavioral knowledge is only moderately related to organic knowledge; (2) requiring behavioral training increases behavioral knowledge but does not decrease the level of organic knowledge; and (3) funded programs attract residents more knowledgeable about behavior who, during their training, remain more knowledgeable than residents in programs not participating in an evaluation of behavioral training.

Child Behavior↗
PubMed1996

Mandatory CPR training for students may improve cardiac-arrest survival rate, MDs say.

A mandatory cardiopulmonary resuscitation (CPR) program that started as a pilot project in Ottawa-area high schools is expanding to other Canadian schools. Besides CPR techniques, Grade 9 students are being taught about healthy lifestyles and how to recognize cardiac arrest. Emergency physician Justin Maloney, the program's principal architect, believes that in a decade this mandatory training will translate into increased bystander-initiated CPR and improved chances of survival for victims of cardiac arrest.

Cardiopulmonary Resuscitation↗
PubMed1994

Cardiovascular health and disease in children: current status. A Special Writing Group from the Task Force on Children and Youth, American Heart Association.

More than 600,000 children in the United States have a congenital or acquired cardiac abnormality, and millions more are at risk of developing atherosclerotic disease in adulthood, a risk made particularly evident by the prevalence of cardiovascular risk factors in the young. There are barriers to optimum prevention and treatment of these conditions in children and youth. The AHA's Task Force on Children and Youth has described these barriers and outlined a series of recommendations and strategies to meet the challenges they impose. More research is needed, and research initiatives will be developed at scientific conferences designed to review critical areas of cardiac development and etiology of disease in children. Financial support for such research initiatives must be increased. Educational programs on cardiovascular risk factors will be extended to children and their families. When these programs are coordinated with efforts in the community and in schools, they will reduce the prevalence of cardiovascular risk factors. The task force recommends that various departments and committees of the AHA use their resources for the benefit of children: for example, by developing more research initiatives for funding by the AHA or NHLBI and increasing legislative and regulatory efforts in the areas such as mandatory school health programs and tobacco advertising. It is hoped that in the next decade, through research and educational efforts, many advances in the prevention and treatment of cardiovascular diseases in the young will be realized.

Cardiovascular Diseases↗
PubMed1987

Compulsory premarital screening for the human immunodeficiency virus. Technical and public health considerations.

The effectiveness of a mandatory premarital screening program was examined as a means of curtailing the spread of the human immunodeficiency virus (HIV) infection in the United States. The epidemiology of the HIV, the technical characteristics of tests for antibodies to HIV, and the logistic, economic, and legal implications of such a program were considered. In one year, universal premarital screening in the United States currently would detect fewer than one tenth of 1% of HIV-infected individuals at a cost of substantially more than +100 million. More than 100 infected individuals would be told that they were probably not infected, and there would likely be more than 350 false-positive results. Public education, counseling of individuals, and discretionary testing can be important tools in reducing the spread of HIV infection, but mandatory premarital screening in a population with a low prevalence of infection is a relatively ineffective and inefficient use of resources.

Acquired Immunodeficiency Syndrome↗
PubMed1994

HIV screening of surgeons and dentists: a cost-effectiveness analysis.

OBJECTIVE: To assess the cost-effectiveness of human immunodeficiency virus (HIV) screening strategies of surgeons and dentists. DESIGN: We constructed a model to project costs and HIV transmissions prevented over 15 years for four screening scenarios: 1) one-time voluntary screening, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in the first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of practitioner-to-patient transmission are eliminated for all practitioners testing positive. Voluntary screening assumes 90% of HIV-positive and 50% of HIV-negative practitioners are tested, and risks of transmission in the clinical setting are eliminated for 90% of HIV-positive surgeons and dentists. All costs and benefits are discounted at 5% per annum over 15 years. RESULTS: Using "best-case" scenario assumptions, we find for surgeons that a one-time voluntary screening program would be most cost-effective, at $899,336 for every HIV transmission prevented. For dentists, the one-time voluntary program also is the most cost-effective, at $139,571 per transmission prevented. Annual mandatory programs were least cost-effective for both surgeons and dentists, at $63.3 million and $2.2 million per transmission prevented, respectively. CONCLUSIONS: HIV screening of surgeons and dentists ranks among the more expensive medical lifesaving programs, even using liberal assumptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transmission prevented; these features should be considered carefully in designing specific HIV screening programs.

AIDS Serodiagnosis↗
PubMed1985

The Army Weight Control Program: a comprehensive mandated approach to weight control.

The Army Weight Control Program is a comprehensive, multidisciplinary, and mandated approach to weight control, designed to assist, educate, and motivate overweight individuals to reach their ideal body weight. The program objective is to ensure that Army personnel are able to meet the physical demands of their duties under combat conditions and is based on the assumption that the individual is ultimately responsible for exhibiting high standards of professional appearance. The history and the program philosophy are described. The Army Weight Control Program utilizes height-weight tables as an initial screen, followed by skinfold measurements, to identify overweight soldiers. Individuals who exceed established age and sex adjusted body fat standards (20% to 26% for men and 28% to 34% for women) and who do not have a pathological cause for their obesity are enrolled in the mandatory Army Weight Control Program. Entry into the program results in the withholding of favorable personnel actions. Noncompliance with established monthly weight-loss goals for a period of 6 months may result in separation from the Army. The rationale for the procedures and the methodologies of the program are reviewed and discussed. It is concluded that studies are required to evaluate the effectiveness of mandatory weight-control programs.

Adolescent↗
PubMed2004

Teaching communication skills: an AACE survey of oncology training programs.

BACKGROUND: The extent of communication skills training (CST) in American oncology fellowship programs is unknown. METHODS: A survey was sent to program directors of medical oncology, radiation oncology, gynecologic oncology, and surgical oncology training programs regarding (1) the presence and method(s) of CST in their programs, (2) their attitude about mandatory CST, and (3) their attitude about a mandatory assessment of communication skills competence as a prerequisite for specialty certification. RESULTS: Only a third of programs contained some form of CST. Surgical oncology programs were particularly lacking. Lack of faculty time was cited as the major barrier to implementing CST. A majority of program directors support mandatory CST but not a core competence requirement for certification. CONCLUSIONS: There is a current deficiency in CST in American oncology fellowship training. Given the importance of communication skills in the provision of high-quality cancer care, initiatives to address this deficiency are a priority.

CD-ROM↗
PubMed1998

Proposal to institutionalize criteria and quality standards for cervical cancer screening within a health care system.

The uterine cervix is the most common cancer site for females. Approximately 52,000 new cases occur annually in Latin America, thus the need to improve efficiency and effectiveness of Cervical Cancer Screening Programs (CCSP) is mandatory to decrease the unnecessary suffering women must bear. This paper is addressing essential issues to revamp the CCSP as proposed by the Mexican official norm. A general framework for institutionalizing CCSP is outlined. Furthermore, strategies to strengthen CCSP performance through managerial strategies and quality assurance activities are described. The focus is on the following activities: 1) improving coverage; 2) implementing smear-taking quality control; 3) improving quality in interpretation of Pap test; 4) guaranteeing treatment for women for whom abnormalities are detected; 5) improving follow-up; 6) development of quality control measures and 7) development of monitoring and epidemiological surveillance information systems. Changes within the screening on cervical cancer may be advocated as new technologies present themselves and shortcomings in the existing program appear. It is crucial that these changes should be measured through careful evaluation in order to tally up potential benefits.

Adult↗
PubMed1999

Medicaid recipients' experiences under mandatory managed care.

OBJECTIVE: To describe Medicaid recipients' experiences with the outcomes of access, quality, and satisfaction in a mandatory managed care (MC) program. STUDY DESIGN: A qualitative case study design with content analysis of narrative focus group (FG) data, which was part of a comprehensive program evaluation that also involved pre- and postsurveys and analyses of cost and utilization data. PATIENTS AND METHODS: Six FG interviews were conducted in the autumn of 1997 with 31 women on the Aid to Families with Dependent Children program. Participants were recruited from a randomly ordered list of women who had responded to a 1996 premanaged care survey regarding their or their child's healthcare experiences under traditional Medicaid. RESULTS: There was general consensus across all focus groups on a range of issues, including improvements in access to primary care and continuity of care. Overall, few participants expressed discontent with restriction of choice of provider and on MC policies regarding use of the emergency room. There was no consensus on what factors influenced choice of MC plan, although convenience of location was named most frequently. An unanticipated outcome was the recurrent theme across all focus groups of disrespectful treatment by healthcare personnel, especially under traditional Medicaid, which had declined somewhat under managed care. CONCLUSIONS: These contextual accounts identify specific features of a mandatory Medicaid MC program that are viewed as improvements over traditional Medicaid. Specific features that were dissatisfying can be addressed to improve both enrollee satisfaction and the transition to managed care for Medicaid recipients.

Aid to Families with Dependent Children↗
PubMedDate not supplied

Social security reform in Central and Eastern Europe: variations on a Latin American theme.

After Chile reformed its social security system in 1981, several other Latin American countries and certain Central and Eastern European (CEE) countries implemented the Chilean model, with some variations: either a single- or multitier system, or with a period of transition to take care of those in the labor force at the time of the change. The single-tier version consists of individual accounts in pension fund management companies. Multi-tier systems retain some form of public program and add mandatory individual accounts. Most of the CEE countries did not want to incur the high transition costs associated with the Chilean model. The switch to a market economy had already strained their economies. Also, the countries' desire to adopt the European Union's Euro as their currency--a move that required a specific debt ceiling--limited the amount of additional debt they could incur. This article describes the CEE reforms and makes some comparisons with the Latin American experience. Most of the CEE countries have chosen a mixed system and have restructured the pay-as-you-go (PAYGO) tier, while the Latin American countries have both single- and multi-tier systems. Some CEE countries have set up notional defined contribution (NDC) schemes for the PAYGO tier in which each insured person has a hypothetical account made up of all contributions during his or her working life. Survivors and disability programs in CEE have remained in the public tier, but in most of the Latin American programs the insured must purchase a separate insurance policy. Issues common to both regions include: Administrative costs are high and competition is keen, which has led to consolidation and mergers among the companies and a large market share controlled by a few companies. Benefits are proportionately lower for women than for men. A large, informal sector is not covered by social security. This sector is apparently much larger in Latin America than in the CEE countries. Issues that are unique to some of the CEE countries include: Individual accounts in Hungary and Poland have proved more attractive than originally anticipated. As a result, contributions to the public PAYGO system in Hungary and Poland fell short of expectations. In several countries, laws setting up the programs were enacted without all the details of providing benefits. For example, in some countries laws must now be drawn up for establishment of annuities because they do not yet exist. Setting up a coherent pension policy has been difficult in some countries because of frequent and significant changes in government. This situation has affected the progress of reform in various stages of development. In general, a definitive assessment of individual accounts in these countries will not be possible until a cohort of retirees has spent most of its career under the new system.

Aged↗
PubMed2003

The utility of mandatory depression screening of dementia patients in nursing homes.

OBJECTIVE: Current methods for enhancing the recognition and treatment of depression in nursing home patients have been unsuccessful. This study examines the process, outcome, and impact of instituting a mandatory depression screening program for depressed dementia patients in nursing homes. METHOD: The experimental and comparison groups each consisted of two nursing homes of 519 and 363 patients, respectively. Two of the experimental group and one of the comparison group homes were more traditionally staffed facilities; one of the comparison group homes had an enriched staff of psychologists. The Cornell Scale for Depression in Dementia was administered to the residents with dementia. In the experimental group, the patients who scored > or =5 were referred for psychiatric assessment. RESULTS: In the experimental group, 100% of the referred dementia patients who met screening criteria for depression were seen by a psychiatrist. This resulted in a significant increase in the percentage of individuals given antidepressants. This was greater than the percentage of patients receiving antidepressants in the "typical" comparison group home but not the "staff-enriched" comparison group home. White patients were significantly more likely to receive antidepressants; however, screening significantly increased the proportion of depressed nonwhites receiving antidepressants. At the 12-week follow-up, there was a significant difference in scores between patients receiving antidepressants in each group. CONCLUSIONS: Mandatory depression screening can significantly increase the proportion of depressed dementia patients receiving antidepressants, lead to dose adjustments, diminish potential ethnic biases in treatment, and affect the depressive symptoms of treated individuals.

Aged↗
PubMedDate not supplied

Establishing standards for intranet on-line education.

Following a clear set of on-line programming standards assists educators with consistency the training expectations from participants. Placing staff educational materials and health information online is an effective way to disseminate information and an efficient method of providing ongoing staff education. The presentation of on-line programming should be organized, comprehensive, and up-to-date. In addition, on-line programming should also be appealing, dynamic, and, above all practical. Today's clinical staff are pushed to the limits of time and resources. On-line training is one way to help staff meet their learning needs in today's reality. The inception of the UWMF on-line educational programs began in January 2002. Since that date employee participation has increased steadily. The time for Intranet on-line program development is part of the staff education department. For example, one area of programming is the mandatory educational credits needed for the organizations 100 certified medical assistants (CMAs). Figure 1 shows the nearly 3.5 years (January 2002 through May 2005) of participation. The 912 sessions made available 1,870 CEs for the CMAs. If the organization's CMAs were to pay for the continuing education credits (CEs) outside of the clinic setting, it could cost on average of dollar 10.00 per CE, or dollar 18,700 during the same 3-year period. Another aspect of economics is the cost in time away from work. On-line education allows employees to participate when time is available, versus having to leave work when traditional educational inservices are being held. This flexibility in participation can lead to better staff coverage.

Computer Communication Networks↗