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PubMed2005

Comorbidities among Ohio's nursing home residents with diabetes.

OBJECTIVE: To determine the magnitude of diabetes mellitus among Ohio nursing home residents and the comorbid conditions affecting residents with diabetes. RESEARCH DESIGN, METHOD, AND SETTINGS: In certified Ohio nursing homes during 1999, 161,723 residents were eligible for this study because they had been admitted for at least 1 day that year, had been assessed using the Centers for Medicaid and Medicare's Minimum Data Set instrument, were 21 years old or older, and had a known sex and race. Eligible residents with diabetes were compared with those without diabetes with respect to comorbidity. RESULTS: The 25% of residents diagnosed with diabetes were younger, more often male, and more often black than residents without this disorder. Residents with diabetes were also more likely to have cardiovascular diseases; visual problems; foot conditions, including missing limbs; and kidney failure. Residents with diabetes were less likely to have oral problems than residents without diabetes. CONCLUSION: The Minimum Data Set instrument identifies important comorbidities among nursing home residents with diabetes and allows their disease course to be followed longitudinally. Nursing home residents in Ohio, and presumably in other states, bear a heavy burden from diabetes and significant comorbidities.

Adult↗
PubMedDate not supplied

Pediatric nurse practitioner practice patterns and compensation in Ohio.

INTRODUCTION: The purpose of the study was to describe practice patterns and compensation patterns of Pediatric Nurse Practitioners (PNPs) in Ohio. METHOD: A survey, including open-ended and forced choice questions, was sent to all members of Ohio's chapter of NAPNAP. The resultant sample included 200 female PNPs. Over half had practiced as NPs between 5-29 years, holding at least a Master's degree. RESULTS: Fifty percent worked full-time in a variety of practice settings; 71% held prescriptive privileges. Most saw patients with a physician on-site and billed for services with the physician's name; few had "on call" responsibilities. The majority spent most of their clinical time with acute visits and providing preventative services. Only 29% had a contract with a collaborating physician and the components of the contract varied greatly. Compensation for services mimicked national rates, annual salaries from $35,000-$90,000/year and hourly rates $19-$40/hour. Salary bonuses were reported by 23%. Two-thirds of the PNPs received benefits. DISCUSSION: Practice patterns of the Ohio PNPs were found to be consistent with the practice patterns of advanced practice nurses nationally. Most PNPs remain largely uninformed about reimbursement issues. Negotiation of employment contracts with potential employers will be enhanced by demonstration of the positive impact of the NP on the number and type of patients seen, reimbursement possibilities, and quality of care. Future studies need to focus on quantifying the value of the NP.

Adult↗
PubMed2000

Declining trends in cesarean deliveries, Ohio 1989-1996: an analysis by indications.

BACKGROUND: Similar to trends observed nationwide, the rates of cesarean deliveries declined in Ohio during the late 1980s and the early 1990s. This study examined the trends in cesarean deliveries in Ohio from 1989 through 1996, in the presence or absence of indications, and in relation to the use of obstetric procedures. METHODS: Birth certificate data for all singleton, liveborn infants in Ohio (n = 1,204,859) were used to analyze temporal trends in cesarean sections. RESULTS: The rates of primary and repeat cesarean deliveries declined, respectively, from 15.7 to 12.4 percent and from 83 to 63.3 percent during the 8-year study period. Significant declines in repeat cesarean deliveries were observed both in the presence and absence of documented medical conditions that could present a potential indication for the procedure. The rates of repeat cesareans remained comparable among women with and without documented indications for cesarean section (64% and 61%, respectively). In addition, 45 and 30 percent of repeat cesareans in 1989 and 1996, respectively, were performed in the absence of any documented indications, or on an elective basis. The declines in cesarean delivery rates during the 8-year study period occurred simultaneously with an increase in the use of electronic fetal monitoring, induction, and stimulation of labor. CONCLUSIONS: The findings suggest that a sizable proportion of repeat cesarean deliveries in 1996 may be unnecessary, even though a marked decline in the procedure has occurred between 1989 and 1996.

Adult↗
PubMed2003

Predominance of serotype V and frequency of erythromycin resistance in Streptococcus agalactiae in Ohio.

OBJECTIVE: The purpose of this study was to test the serotype distribution and antibiotic sensitivity patterns of group B Streptococcus from three Ohio regions in comparison to other areas of the United States. STUDY DESIGN: Three hundred forty-nine group B Streptococcus isolates from three Ohio hospitals were serotyped specifically, and disk diffusion was used to determine antibiotic susceptibility. RESULTS: Serotype V was isolated most frequently (27%); major types Ia, Ib, II, and III had frequencies of 18%, 9%, 11%, and 17%, respectively. Erythromycin and clindamycin resistance was 12% (n = 200 isolates) and 8% (n = 49 isolates), respectively. CONCLUSION: The prevalence shift of resistant serotype V group B streptococci in Ohio reflects regional increases and suggests that alternative therapies for patients who are allergic to penicillin may be inadequate.

Anti-Bacterial Agents↗
PubMed2002

The impact of legislation and secular trends on newborn length of stay for Medicaid infants in Ohio.

OBJECTIVES: To examine the impact of state legislation mandating minimum maternal and newborn length of stay (LOS). STUDY DESIGN: By using Medicaid claims data linked to vital statistics files, LOS, and "short stay" (</=1 day after vaginal delivery, </=2 days after cesarean delivery) were determined for 151,464 term newborns born to mothers receiving Medicaid in Ohio from July 1, 1991 to June 30, 1998. Changes in LOS and "short stay" were examined for 4 periods that reflected events occurring in Ohio at the time. RESULTS: The proportion of newborns discharged after a "short stay" increased dramatically before legislation (7/1/91-8/31/95) but decreased after the introduction of legislation (9/1/95-6/30/96). In the 4 months after passage of the law, but before its effective date (Period III), the odds of a "short stay" decreased. This decrease continued in the 20 months after the law went into effect (Period IV). White, young, married mothers without a high school degree or with poor prenatal care and lower birth weight infants were more likely to be discharged early. CONCLUSIONS: LOS and "short stay" returned to near-1991 levels for Medicaid newborns in Ohio after legislative activity.

Delivery, Obstetric↗
PubMed2001

Pancreas transplantation in Ohio: a 15-year outcomes analysis.

BACKGROUND: Beginning in 1984, all pancreas transplantations performed in the state of Ohio have been tracked by the Ohio Solid Organ Transplantation Consortium (OSOTC). In this study the outcomes of these transplantations were compared across 3 eras to determine whether increasing experience has been beneficial. METHODS: Between July 1984 and December 1999, 765 kidney-pancreas (KPTx) and 76 pancreas only (Ptx) transplantations were performed. Outcomes measures for these 841 pancreas transplantations were compared over 3 eras, 1984 to 1989, 1990 to 1994, and 1995 to 1999. RESULTS: One-year patient survivals for KPTx patients were 87%, 92%, and 94% in the 3 eras, respectively. Graft survival at 1 year was also markedly improved between era 1 and era 3, increasing for PTx patients from 21% to 85% and for KPTx patients from 68% to 85%. Average waiting time increased from 132 to 318 days between era 1 and era 3. Conversely, average length of stay in hospital was significantly decreased from 34 to 18 days. The cost of the procedure, as measured by hospital charges, also decreased when compared in 1985 dollars as a technique to control for inflation. CONCLUSIONS: These data suggest that pancreas transplantation in Ohio has become a very successful and cost-effective therapeutic intervention for patients with type I diabetes with or without concomitant end-stage renal failure.

Aged↗
PubMed2000

Utilization of health and safety consulting services of the Ohio Bureau of Workers' Compensation by small businesses.

The Division of Safety and Hygiene (DSH) of the Ohio Bureau of Workers' Compensation (OBWC) provides health and safety consulting services to all businesses in Ohio insured by OBWC. It has been conceptualized that small companies in Ohio do not use health and safety consultative services to the same extent as non-small companies. To determine the validity of this belief, this study was conducted to analyze the records of the DSH for the years 1991-1995 in the Division's Southeast Region which contained a total of 281,041 insured companies. Of the 5977 companies utilizing the health and safety services of DSH and recording their number of employees, 65.3 percent were "small," defined as any company with less than 20 employees. Specific services used by businesses included industrial hygiene (small, 3.4% vs. non-small, 6.4%), ergonomics (0.7% vs. 2.8%), engineering such as ventilation or machine guarding (0.6% vs. 1.7%), construction safety (26.7% vs. 3.9%), and general safety such as implementing a safety program (31.4% vs. 22.4%). In conclusion, industrial hygiene, ergonomics, and engineering service utilization were significantly lower for the small businesses than for the non-small businesses, whereas safety service utilization was significantly higher for the small business. Improvement in the system of record-keeping and education/encouragement in the deployment of services are recommended.

Accidents, Occupational↗
PubMed2006

The influence of gender on colorectal cancer stage: the state of Ohio, 1996-2001.

PURPOSE: The authors sought to determine if colorectal cancer stage at diagnosis varies by gender in the state of Ohio. METHODS: We conducted a retrospective cohort study. Included in the cohort were patients diagnosed with colorectal cancer from 1996 to 2001 who had their data reported to the State of Ohio Tumor Registry. We collected data on gender, stage of cancer, and three potential confounding variables: age, location of colon cancer, and race. The colorectal cancer was determined to be at one of four stages: (1) carcinoma in situ, (2) local disease, (3) regional disease, and (4) distant disease. In addition, we combined stages 1 and 2 to create a good prognosis category, and we combined stages 3 and 4 to create a bad prognosis category. RESULTS: Our cohort consisted of 27,041 patients [13,807 women (51%) and 13,234 men]. The women with colon cancer were significantly older and had more right-sided colon cancer, (p < 0.05). With the use of logistic regression, the women were significantly less likely to have carcinoma in situ compared with the men (OR = 0.82, 95% CI 0.75-0.89). The women also had a significant decrease in local disease (OR = 0.94, 95% CI 0.89-0.99). In contrast, the women showed significantly more regional disease than men (OR = 1.11, 95% CI 1.05-1.16). The women were less likely to have a good prognostic stage (OR = 0.89, 95% CI 0.85-0.94) and more likely to have a bad prognostic stage (OR = 1.12, 95% CI 1.07-1.18). CONCLUSIONS: In the State of Ohio from 1996 to 2001, women had more advanced colon cancer at diagnosis than men.

Adult↗
PubMed1998

Attitudes of Ohio hospital pharmacy directors toward national voluntary pharmacy technician certification.

Ohio pharmacy directors' attitudes about national voluntary pharmacy technician certification were surveyed. In May 1996 a questionnaire was mailed to all 224 hospitals in Ohio. The questionnaire contained 29 attitudinal statements constructed as forecasts of the effects of certification; pharmacy directors were asked to rate their level of agreement or disagreement with each statement using a 7-point Likert scale. The response rate was 61.4% (137 questionnaires returned). Respondents indicated modest agreement with 21 of 27 attitudinal statements and therefore had a generally positive view of certification. For example, they agreed that certification will improve technicians' knowledge, image, confidence, skills, and job satisfaction. They disagreed that certification will allow technicians to function independently, result in the replacement of pharmacist positions with technicians, or eliminate the need for on-the-job training of technicians. There were significant differences in scores between directors working at hospitals employing certified technicians and directors working at hospitals not employing certified technicians for only three statements. Overall, Ohio hospital pharmacy directors had positive attitudes about pharmacy technician certification.

Adult↗
PubMed1989

The Medical Education Evaluation Program of the state of Ohio.

In October 1988, seven foreign medical graduates participated in the first administration of the examination devised by the Medical Education Evaluation Program (MEEP) mandated by the State Medical Board of Ohio. The MEEP was established to provide an objective evaluation of an applicant's clinical competencies; passing the MEEP examination was intended to certify that the applicant's clinical skills were comparable to those of a medical student graduating from a school accredited by the Liaison Committee on Medical Education. An applicant who successfully passed the MEEP examination and fulfilled the other Ohio licensure requirements would be eligible to take the Federation Licensing Examination (FLEX) and apply for an unrestricted license to practice medicine in Ohio. The paper describes the origin and development of the MEEP examination and the testing modalities selected (multiple-choice examinations and the use of standardized patients). Four fundamental areas were tested; these are named and described, along with the method for calculating scores for each area and the criteria for passing the different components of the examination. Although the small sample size prohibited meaningful data analysis for the performance of the first group of MEEP candidates, the MEEP examination appears to meet psychometric standards of certifying and licensing examinations, based on data from comparable tests taken by beginning fourth-year medical students in New England and NBME Part III examination examinees. Some potential pitfalls of the MEEP examination are mentioned, as well as the fact that it presents a challenge to boards of medical examiners of other states to implement performance-based assessments of physicians who graduate from non-accredited medical schools.

Clinical Competence↗
PubMed1999

Support programs for minority students at Ohio University College of Osteopathic Medicine.

The Ohio University College of Osteopathic Medicine ranks high among the nation's 19 osteopathic medical schools with respect to the percentage of underrepresented minorities (URMs) in the entering class. The college has strong recruitment and retention programs for URM and disadvantaged students. URM enrollment rose steadily from 11% in 1982-83 to 22% in 1997-98, despite the school's location in a rural, residential public university with few minorities as students or town residents. The college has six programs to support minority students through both undergraduate and medical school: the Summer Scholars Program (1983 to present), an intensive six-week summer program to prepare rising under-graduate seniors and recent graduates to apply to medical school; Academic Enrichment (1987 to present), to support first- and second-year medical students; the Prematriculation Program (1988 to present), an intensive six-week summer program for students who will matriculate in the college; Program ExCEL (1993 to present), a four-year program for undergraduates at Ohio University; the Summer Enrichment Program (1993 to present), an optional six-week program for students who will enter the premedical course at Ohio University; and the Post-baccalaureate Program (1993 to present), a year-long, individually tailored program for URM students who have applied to the medical college but have been rejected. The medical college first focused on supporting students already in the medical school curriculum, then expanded logically back through the undergraduate premedical programs, always targeting learning strategies and survival strategies, peer and faculty support, and mastery of the basic science content. The college plans to create an on-site MCAT preparation program and perhaps expand into secondary education.

Curriculum↗
PubMed1999

An application of the NCRP screening techniques to atmospheric radon releases from the former feed materials production center near Fernald, Ohio. National Council on Radiation Protection and Measurements.

The National Council on Radiation Protection and Measurements has published a series of screening models for releases of radionuclides to the environment. These models have been used to prioritize radionuclides being considered in environmental dose reconstructions. The NCRP atmospheric models are also accepted by the U.S. Nuclear Regulatory Commission for demonstrating compliance with the constraint on releases of airborne radioactive materials to the environment from licensees other than power reactors. This study tested the NCRP atmospheric techniques by comparing annual average predicted air concentrations of radon with measured radon concentrations at 14 locations 43 m to 598 m downwind of the former U.S. Department of Energy Feed Materials Production Center (FMPC) near Fernald, Ohio, for the period 2 July 1985 to 2 July 1986. Predictions were made using five different sets of meteorological data as input: (1) NCRP default values; (2) composite FMPC site data; (3) data from the Greater Cincinnati Airport; (4) data from the Dayton, Ohio, airport; and (5) data collected at Miami University, located near Oxford, Ohio. Following are the respective medians and ranges of the ratio of the predicted to observed annual radon air concentrations for each of these sources of meteorological data: (1) 5.2, 0.9-54; (2) 1.4, 0.1-8.2; (3) 0.7, 0.1-7.2; (4) 0.7, 0.1-8.4; and (5) 0.6, 0.1-10. The stated goal of the NCRP models is to predict doses that do not underpredict actual doses by greater than a factor of 10. In this comparison, all of the meteorological data produced air concentration predictions that meet this criteria. However, to ensure that final doses meet this criterion, one would need to carefully evaluate all assumptions used to calculate dose from each of these air concentrations.

Air Pollution, Radioactive↗
PubMed2000

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

BACKGROUND: Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. METHODS: All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. RESULTS: In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. CONCLUSIONS: In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Humans↗
PubMed2005

The frequency of dilated diabetic eye examinations by optometrists in the state of ohio.

PURPOSE: The purpose of this study was to assess optometric care of diabetic patients. The American Optometric Association recommends dilated eye examinations at least once a year for people with diabetes. METHODS: Onsite chart reviews of 1497 diabetic patient charts were performed at a volunteer sample of Ohio-based optometric practices (n = 82). Four percent of all optometrists in the state of Ohio were surveyed. Data were collected from a 10-year period and included doctor age, membership in the Ohio Optometric Association (OOA) Diabetes Initiative, patient age, date of examinations, chief complaints, and dilation at examination. The primary outcome of the study was the frequency of dilated eye examination for diabetic patients by optometrists. RESULTS: Optometrists dilated 85.8% of diabetic patients at their last comprehensive examination. The percentage of diabetic patients dilated by optometrists increased from 40.0% in 1994 to 91.5% in 2003. The average time since last comprehensive eye examination for diabetic patients was 1.0 +/- 1.8 (mean +/- standard deviation) years. Diabetic patients who were dilated at a comprehensive eye examination returned to care on average 0.7 years sooner than those who were not dilated. Doctor-level factors related to a higher average percentage of dilations were younger doctor age (beta = -6.1%/10 years of doctor age; 95% confidence interval [CI], -10.1 to -2.1) and membership in the OOA Diabetes Initiative (beta = 11.6%; 95% CI, 2.3 to 20.8). CONCLUSIONS: There is variability in diabetic eye care by optometrists. However, the majority of optometrists surveyed in this study provided dilated eye examinations for their diabetic patients. Programs desiring to increase compliance to diabetic standard of care guidelines may benefit by targeting both doctors and patients.

Adult↗
PubMed2006

Knowledge and practices of Ohio nurse practitioners regarding food access of patients.

PURPOSES: To assess the self-identified food security knowledge and practices of nurse practitioners (NPs) in Ohio and the relationships of food security knowledge and practices to NP characteristics. DATA SOURCES: This study utilized a survey approach for data collection. Participants were licensed NPs with prescriptive authority in Ohio who were randomly selected from the Ohio licensure list and responded to a questionnaire (n= 288) with demographic and food security-related questions. CONCLUSIONS: Less than one third of respondents agreed or strongly agreed that they were knowledgeable about the topic of food security. Education of NPs about food insecurity and about incorporation of food security principles into the healthcare process is needed. IMPLICATIONS FOR PRACTICE: Food insecurity can negatively impact compliance to prescribed treatments. NPs should address food security issues in order to provide specialized, individualized care to patients in order to achieve positive outcomes. Through evaluation of patients' food access, and factors that are related to food insecurity, this can be achieved.

Adult↗
PubMed1999

Professional preparation of elementary teachers in Ohio: status of K-6 health education.

Improving the health status of children and youth depends to an extent on the adequate preparation of elementary teachers to teach health education. This survey: 1) examined the status of health education preparation that preservice elementary education majors receive from Ohio colleges and universities (n = 50); 2) determined the type of health education courses that Ohio colleges and universities require for elementary education majors; and 3) assessed the extent to which Ohio colleges and universities incorporate health and pedagogy-related content in their courses for elementary education majors. Results showed that 40 of the 50 institutions offered a health course. Twelve different textbooks were used in the courses. Coverage of course content ranged from much to none for 10 survey items ranging from the National Health Education Standards to the K-6 Health Instruction Responsibilities and Competencies.

Curriculum↗
PubMed1982

Epidemiological study of tumors of the central nervous system in Ohio.

Historically, the first epidemiological lead of an excess risk of death due to malignancies of the brain and central nervous system among the former employees of the rubber industry was in 1949, in a study correlating causes of death with prior employment designated on the death certificates for the state of Ohio in 1947. The geographical distribution of deaths (1955) due to histologically confirmed tumors of the CNS identified one county, Summit, of the 88 counties of Ohio, as having significantly more deaths than expected for ages 25-64. Summit County represents the principal rubber manufacture center in the U.S. A series of analyses were carried out which identified a higher death risk among rubber workers compared to nonrubber worker residents of Summit County according to histologically confirmed diagnoses of tumors of the CNS in 1963. Longitudinal employee cohort studies of four different companies engaged in the manufacture of rubber products, in the same state, Ohio, indicated a higher death rate due to tumors of the central nervous system. Epidemiological leads were cited in a broad industry survey comparison in which higher death rates due to neoplasms of the central nervous system were observed among workers in electrical machinery and paper and allied products as well as the rubber industry. Potential chemical linkage of the excess of CNS neoplasm deaths among rubber workers and workers in the rayon industry was explored.

Adult↗
PubMed1990

The distribution and dynamics of Rickettsia in the tick population of Ohio.

A five-year survey of ticks and associated rickettsia in Ohio shows a partitioning of spotted fever group rickettsia (namely, Rickettsia montana and R. rickettsii) into three areas of the state where the majority of human spotted fever cases occur. The percentage of ticks infected, even in areas with a high incidence of disease, is remarkably low, less than 1%. The statewide infection rate for R. bellii approaches 3%, and this organism appears to be more evenly distributed throughout the state. Dermacentor variabilis, which accounts for 97% of Ohio ticks received for testing, is the only species which has been found to harbor rickettsia. Ohio's tick testing program is not an effective surveillance tool and is of no use in diagnosing tick-borne disease. However, the program does function as an excellent means of increasing public awareness of tick-borne disease.

Animals↗