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PubMed2004

Observations from a national multiple institution autotransfusion (ATS) quality indicator program.

A process to collect universal, mandatory autotransfusion (ATS) procedure quality indicators to measure and monitor ATS quality improvement was designed and implemented by Fresenius Medical Care Extracorporeal Alliance (FMCEA) an outsource provider of extracorporeal services. The indicator program collected and evaluated data that reflect real-world extracorporeal clinical practices and outcomes. The indicator reports provide our clinicians, client physicians, and partner institutions with confidential reports that allow comparison of their practice to evidenced-based performance standards. All ATS procedures reviewed were performed on non-open-heart surgery procedures (on pump or off pump), including vascular, thoracic, orthopedic, and general surgery. After continuous collection and analysis of the indicator data, a hospital is given a report with three components: 1) data analysis that reports summary results and benchmarks the hospital against the other reporting hospitals, 2) corrective action plan that allows the clinical manager to document their investigations and outline plans for continuous quality improvement; and 3) raw data tabulation that allows the clinical manager to identify individual cases that are outliers from the target goal to facilitate local chart reviews. This communication describes FMCEA's ATS Quality Indicator Program and presents the collective results for the first 13 months (January 2002--January 2003) of data collection. Physicians and ATS service client hospitals value the Quality Indicator Process Reports. ATS service managers use the reports and the subsequent process improvement to meet AaBB (American Association of Blood Banks) and JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards and guidelines for providing safe patient-care services.

Benchmarking↗
PubMed1982

Mandatory PKU screening: the other side of the looking glass.

The challenge that PKU screening programs face is to be effective without sacrificing individual liberty. Most states have assumed that this is impossible, and have enacted mandatory PKU screening tests. It now appears that in fact voluntary screening for PKU can be effective. Accordingly, it seems appropriate to reexamine existing mandatory screening statutes to determine if we can replace government coercion with voluntary informed consent. Focus should be placed on the proper role of the government in screening, and on improving the consent process, and not on those few couples who withhold consent.

Genetic Testing↗
PubMed1989

Mandatory assignment. What hath it wrought in Massachusetts?

The national precedent set in 1986--when Chapter 475, mandating Medicare assignment in Massachusetts, became law--has spread across the United States as other states seek to control physicians' incomes under the Medicare program. While some form of mandatory assignment is the law in at least a dozen states, the Bay State's law currently remains the most restrictive in the country. The effects of Chapter 475 continue to ripple through the health care system and are sure to intensify as the national debate heats up over the future of the Medicare program. The article explains the theoretical and practical reasons why mandatory Medicare assignment affects access to medical care, jeopardizes the number of physicians who will choose to treat Medicare patients, and ties the professional licensure process not to clinical expertise but to acceptance of a broad social-entitlement program.

Attitude of Health Personnel↗
PubMed2005

The perceived likelihood of dental hygienists to report abuse before and after a training program.

PURPOSE: The rise of abuse, mandatory reporting, and penalties for not reporting abuse make this study significant for oral health care personnel. The purpose of this research was to determine survey results pertaining to the likelihood of dental hygienists reporting abuse before and after a training program, in order to influence and encourage similar training programs in other locations and to impact dental hygiene curricula. METHODS: Exempt status was obtained from the University of New England Institutional Review Board for the Protection of Human Subjects. A convenience sample was taken of registered dental hygienists who attended a training program and who volunteered to complete a 10-item statement form. A three-category ordinal Likert-type scale was employed. The statement form was filled out before and after a tested training program for the recognition and reporting of abuse (violence) and neglect. The terms family violence, child abuse, and elder abuse were defined as umbrella terms to encompass all abuse, except where explicit. This study explores two research questions: Do dental hygienists perceive the likelihood to make a report if confronted with suspected abuse, and would training make a difference in the perceived likelihood to report? The 10 statements were grouped into three sets for analysis: 1) training and experience in reporting, 2) knowledge of responsibilities, signs, symptoms, and interviewing, and 3) likelihood of making a report. Data were analyzed using descriptive statistics to explain the population's knowledge characteristics and the likelihood of reporting abuse. RESULTS: Twenty-six surveys were administered and 25 surveys were returned for a 96% response rate (n=25). Survey results supported training to increase compliance with mandatory reporting. Of the subgroup having experience with reporting (n=5; 20%), over half (n=3) knew all aspects of abuse. The entire group knew more about child abuse than elder abuse. Prior to training, 40% definitely knew that they would likely report abuse, 40% somewhat knew that they would likely report it, and 20% didn't know or said it would be unlikely that they would report. Only 5% stated that they definitely knew how to make a report before the training. After training, 100% reported that they would be likely to make a report, an overall increase of 60%. In the pre-survey, 60% said they did not know how to make a report, compared to 96% indicating in the post-survey that they knew how to make a report after training. CONCLUSION: Evidence from the dental hygienists attending a continuing education program supports that training increases the self-perceived likelihood to report abuse. This study also acknowledged areas for investigation of curricular augmentation, such as providing more information on elder abuse and presenting a guide for filing a report of abuse to the appropriate agencies. It is imperative for educators to include adequate information in dental and dental hygiene curricula for training in reporting abuse. It is also incumbent upon dental hygiene clinicians to identify their own educational needs and to seek out appropriate continuing education. These identified outcomes are an important reinforcement to providing adequate instruction in dental hygiene curricula.

Curriculum↗
PubMed1989

Reliability of white blood cell counting.

The Laboratory Proficiency Testing Program has successfully operated mandatory proficiency testing for 13 years in Ontario, Canada, using committees of volunteer peers. This is an alternative to gubernatorial proficiency testing. Using white blood cell (WBC) count determinations as a focus, we present our results. Ninety-six percent of participants attained WBC count results within +/- 10% of an all-methods mean and 77% attained results within +/- 5%. Ninety-six percent displayed satisfactory precision. Details of the program, ie, testing material, computer analysis, reference results, and scope of committee action, are discussed. In 1975, clinical expectations for WBC count determinations greatly exceeded most laboratories' capabilities. By 1987, participants were able to produce reliable, clinically useful WBC count results. The paramount reason for this improvement is the transition from manual to automated counting methods resulting from the stimulus of proficiency testing and the concomitant education.

Electronics, Medical↗
PubMed1999

Teaching residents about development and behavior: meeting the new challenge.

OBJECTIVE: To determine the teaching methods, materials currently used, and unmet needs for teaching developmental-behavioral pediatrics (DBP) at pediatric training programs in the United States. DESIGN: Cross-sectional survey of US pediatric residency training programs. The survey questionnaire consisted of 3 instruments: a program director survey, a developmental-behavioral pediatrics survey, and an adolescent medicine survey. PARTICIPANTS: Survey packets were mailed in January 1997 to 211 programs identified by mailing labels from the Association of Pediatric Program Directors. RESULTS: Data from 148 programs (70%) completing both the DBP survey and program director survey were analyzed. Ninety-five percent of programs reported a block rotation, and 95% of those stated that the rotation was mandatory. Eighty-seven percent had a formal curriculum. Most programs reported using articles, lecture outlines, and precepting for teaching DBP. Few programs used standardized case-based or computerized materials. Most programs, however, indicated a desire for these materials. Few programs felt that 4 topics were covered adequately: adoption (12%), violence (24%), substance use (28%), and conduct problems (41%). Programs that perceived that they covered these topics adequately were more likely to use written cases as part of their curriculum (Mann-Whitney test, 1373.5; P=.04). Barriers to teaching included lack of adequate faculty, time, money, and curricular resources. CONCLUSIONS: Pediatric residency programs have made significant gains in mandatory DBP training. However, many programs report a lack of adequate faculty, teaching materials, and methods. Responding programs indicated an interest in case-based materials. This approach may represent an alternative and underutilized resource for teaching DBP.

Adolescent↗
PubMed1993

College athletes and drug testing: attitudes and behaviors by gender and sport.

We surveyed varsity athletes at a Big East university to assess attitudes toward a mandatory drug education and testing program and examined whether there were differences in drug-related attitudes and behaviors based on gender or varsity sport. We found no statistically significant differences in personal drug use behaviors based on gender or team affiliation. Attitudes about drug use and knowledge of a teammate using drugs did show significant differences based on varsity sport. Tennis players were most likely to agree that drug use by college athletes is socially acceptable. Lacrosse players were most likely to know of atleast one teammate using drugs. Overall, attitudes towards the mandatory drug education and testing program were ambivalent. About half of our responding athletes believed drug testing was necessary and discouraged drug use. Only 17% believed that the program was an invasion of privacy.

Journal Article↗
PubMed1998

Gaseous emissions from vehicles in a traffic tunnel in Vancouver, British Columbia.

In August 1995, measurements of CO, NO(x') speciated nonmethane hydrocarbons (NMHC), and CO2 were made in Vancouver's Cassiar Connector, a 730-m-long level-grade highway traffic tunnel. Two characteristics of the Vancouver setting are the presence of many propane vehicles and a mandatory inspection and maintenance (I/M) program. Although the driving conditions and vehicle fleets are otherwise outwardly similar to those of recent Tuscarora-tunnel studies, CO/NO(x) ratios at the Cassiar Connector are significantly lower than those measured at Tuscarora. The Cassiar measurements are consistent with the MOBILE5A mobile emissions model predictions. The Canadian version of MOBILE5A--known as MOBILE5C--gives nearly identical results, indicating that differences in Canadian and U.S. emission standards cannot explain differences between Cassiar and U.S. tunnels. Considering the modeling results as well as measured ethene/acetylene ratios indicative of noncatalyst vehicles, it appears that vehicle deterioration remains the major issue in in-use vehicle emissions--even in Vancouver, where there is a mandatory loaded-mode I/M program. Uncertainties in determining the ages of the vehicles in the tunnel, however, have a significant impact on the model predictions.

Air Pollutants↗
PubMedDate not supplied

The importance of continuing education for radiologic technologists.

A major thrust of health professionals now is the development of continuing education programs needed to maintain excellence in the services they render to the public. The question arises whether these new programs should remain voluntary or be mandatory. Radiologic technologists have a responsibility to develop their own quality programs that are reasonably inexpensive, diverse, comprehensive, accessible, and give the learner satisfaction in personal fulfillment. If it is not already too late, the profession should be sure that it uses education to the fullest possible extent.

Education, Continuing↗
PubMed2005

Vaccine information statements. Revolutionary but neglected educational advances in healthcare in the United States.

The purpose of this report is to provide further information about vaccine information statements (VISs) that are revolutionary but neglected educational advances in the United States. Because the use of VISs is mandated by the Federal Government in every individual being immunized, it is the goal of this report to further awaken health professionals and society to the mandatory use of these superb educational statements. With the passage of the National Childhood Vaccine Injury Act of 1986, the Federal Government required that VISs would be given to all vaccine recipients. As of September 2001, the VISs that must be used are diphtheria, tetanus, pertussis, (DTaP); diphtheria, tetanus (Td); measles, mumps, rubella (MMR); polio (IPV); hepatitis B; Haemophilus influenzae type b (Hib); varicella; and pneumococcal conjugate. Copies of the VISs are available at www.cdc.gov/nip/publications/VIS. The National Childhood Vaccine Injury Act of 1986 mandated that all health care providers report certain adverse events that occur following vaccination. As a result, the Vaccine Adverse Events Reporting System (VAERS) was established by the FDA and the Centers for Disease Control and Prevention (CDC) in 1990. In order to reduce the liability of manufacturers and healthcare providers, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program (NVICP). This program is intended to compensate those individuals who have been injured by vaccines on a no-fault basis. While the use of VISs has been mandated since 1996, a national survey of private practice office settings has revealed that many immunized patients do not receive the VISs. When these forms were used, physicians rarely initiated discussions regarding contraindications to immunizations or the National Vaccine Injury Compensation Program. Fortunately, the state boards of medical examiners, like the one in Oregon, are taking a strong stand for the use of VISs, with the warning that failure to use a VIS may result in disciplinary action. Our nation and practicing physicians must be awakened to the importance of the use of VISs to ensure that every vaccinated individual receives this statement at the time of vaccination.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Adjuvant therapy of breast cancer. International Breast Cancer Study Group.

Adjuvant systemic therapy has been shown to reduce relapses in treated women and to prolong their survival. This is true for all studied subpopulations. Multidrug chemotherapy for the duration of 6 months for the premenopausal patients, and tamoxifen or short-term chemotherapy with long-term tamoxifen for the postmenopausal patients represent the treatments of choice to reduce the risk of relapse. Some of the high priority questions relate to i) the definition of a population for which the risk of relapse is low enough to avoid the use of systemic adjuvant therapy, and ii) the definition of an optimal way of using available adjuvant therapies. These might find answers from ongoing research. The modest but real improvement of the prognosis in operable breast cancer was exclusively obtained only by means of clinical trials, and it is mandatory that participation in programs of clinical research becomes medically and socially the treatment of choice.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Pregnancy in women with arrhythmogenic right ventricular cardiomyopathy/dysplasia.

OBJECTIVES: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a cardiac disease characterised by myocardial necrosis followed by fibro-fatty substitution leading to the onset of ventricular arrhythmias. The aim of the present study was to analyse pregnancy in women affected by this condition. STUDY DESIGN: Six women affected by ARVC/D who underwent a pregnancy were studied with a follow-up programme, consisting of 12-lead ECG, signal-averaged ECG, 24-h ECG and two-dimensional and Doppler echocardiogram performed before the beginning of the pregnancy, at 3rd and 7th month of gestation and after the delivery. RESULTS: All women were on antiarrhythmic therapy during pregnancy; two complained of palpitations in the last 3 months. Delivery was performed at full terms in all, with caesarean section and epidural anaesthesia in four. Mean weight at birth was 3490g. No adverse reactions on the newborns were detected. All patients were advised against breast-feeding. No significant morphological changes were detected. During the period following the delivery (1-6years, mean 2,6years) one subject experienced a sustained ventricular tachycardia. CONCLUSIONS: Pregnancy seems to be well tolerated in patients affected by ARVC/D, but a programmed clinical protocol is mandatory particularly in the last trimester and puerperium, due to increased risk of ventricular arrhythmias.

Adolescent↗
PubMed1997

Final regulations for the nutrition labeling of raw fruits, vegetables, and fish.

In August 1996, the US Food and Drug Administration published regulations that revised the guidelines for voluntary nutrition labeling of raw fruits, vegetables, and fish; revised the criteria for retailers' compliance with the guidelines; and updated the nutrition labeling values for the 20 most frequently consumed raw fruits, vegetables, and fish. These actions were in response to the requirements of the Nutrition Labeling and Education Act of 1990 and make the voluntary nutrition labeling program more consistent with mandatory nutrition labeling of other foods. The provisions of the final rule are important for dietitians who develop nutrition education materials for retail stores and for dietitians who instruct patients and clients in selecting foods according to nutrition labeling information.

Animals↗
PubMed2003

Prevention of perinatal hepatitis B virus transmission by combined passive-active immunoprophylaxis in Iwate, Japan (1981-1992) and epidemiological evidence for its efficacy.

In a model area in Iwate, Japan, with a population of 1.4 million, the immunoprophylaxis of perinatal transmission of hepatitis B virus (HBV) was started in 1981 and covered >60% of all births already in 1986 when it became mandatory by the national program. Babies born to mothers who carried hepatitis B surface antigen (HBsAg) along with hepatitis B e antigen (HBeAg) in serum received hepatitis B immune globulin (HBIG) at birth and 2 months as well as vaccine at 2, 3 and 5 months after birth. In 1985, 39 of 45 (86.7%) babies who received immunoprophylaxis did not develop the HBV carrier state. During 1986-1992, 100286 of 104493 (96.0%) expecting mothers received tests for HBsAg, and it was detected in 1242 (1.2%) of them. Among the mothers carrying HBsAg, 257 (20.7%) were positive for HBeAg and their babies received immunoprophylaxis. Reflecting effects of immunoprophylaxis, the prevalence of HBsAg decreased from 0.75% (78/10437) in the children born during 1978-1980 to 0.23% (46/20812) in those during 1981-1985 (P<0.001), and further to 0.04% (12/32049) in those during 1986-1990 (P<0.001). The prevalence rates of antibody to HBsAg (anti-HBs) were 1.52, 0.79 and 0.85% in the three groups of children (P<0.001 between those during 1978-1980 and the others). The frequency of antibody to HBV core in the children with anti-HBs diminished remarkably from 76.7% (23/30) in those born in 1971 to 9.0% (6/67) in those born in 1990, thereby indicating a marked decrease in resolved infection and increase in acquired immunity to HBV as the results of immunoprophylaxis.

Journal Article↗
PubMed2004

Predicting sex offender institutional adjustment and treatment compliance using the personality assessment inventory.

This study examined the utility of the Personality Assessment Inventory (PAI) to identify prison inmates in a mandatory sex offender treatment program prone to engage in institutional misconduct. Archival PAI and institutional disciplinary data were coded for 137 inmates in treatment for an average of 1.59 years. The Antisocial Features scale predicted various forms of general and major infractions (e.g., verbal aggression), with no other scales providing any incremental validity beyond this measure. The Treatment Rejection scale was uniquely but modestly correlated (r=.14) with treatment noncompliance, even though such infractions were rare in this sample.

Adult↗
PubMed1989

Exercise in the elderly.

Regular physical activity in the elderly delays decline in physical abilities, improves quality of life, and enhances functional capacity. As medical costs rise, preventive measures such as exercise are attaining great importance. Physicians should encourage their patients to participate in routine exercise and assist them in selecting an appropriate program. Preexercise evaluation is mandatory and should include a history and physical examination, an exercise stress test, and appropriate laboratory tests.

Aged↗
PubMedDate not supplied

Infectious diseases fellowship training: another viewpoint.

According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent. More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down. However, once saturation is reached, it will persist longer in ID than in other, older subspecialties. In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease. Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents. Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs. A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs. Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.

Education, Medical, Graduate↗
PubMed1984

A community health education approach to occupant protection.

The goal of enhancing motor vehicle occupant protection is vital to the public's health. Controversies about passive versus active protection and voluntary versus mandatory measures continue. A program which employed a combination of positive reinforcements (incentives) and wide-scale community education succeeded in raising the community seat belt usage rate from 24 to 41% in 6 months. This rate was sustained at 36% at six-month follow-up. This article reviews the major features of the "Seat Belts Pay Off" campaign and its evaluation and considers both theoretical and pragmatic issues pertinent to replicating the program in other community settings.

Adult↗