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PubMed1993

Preparing residents for Public Law 99-457. A survey of pediatric training programs.

Recent implementation of Public Law 99-457 has high-lighted the integral role of pediatricians in early intervention for infants and young children (birth to age 3 years) with disabilities and their families. Faculty representatives of all US pediatric residency programs were surveyed to determine the current status of resident education about issues in this content area. Of 219 surveys, 159 (73%) were returned and analyzed. Resident rotations in child development were offered in 89% of the programs. Of these, 73% were mandatory rotations. Generally, comprehensive resident exposure to a majority of important topics regarding Public Law 99-457 was reported. However, minimal teaching by parents and community agencies was used. Content areas perceived to be strengths in most programs included normal and atypical infant development and developmental assessment. Weaker areas included cultural aspects of family function, case management, and advocacy. Barriers to optimal teaching included time constraints of residents and faculty, inadequate resources and facilities, and insufficient resident interest. Respondents expressed strong interest in improving resident education in this area.

Child Development↗
PubMed1988

Comprehensive family practice clerkship in a minority institution.

A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas.

Black or African American↗
PubMedDate not supplied

Second skill educational development of personnel for a single-room maternity care system.

A modified cross-training approach was used to train nurses for a single-room maternity care unit. This cross-training program included development of a skills list for the labor/delivery and nursery/postpartum areas and an instruction program including formal lectures, independent study, and clinical experience. The clinical part of the program was a preceptor-based experience. The results of this program indicated that competency-based skills and objective selection criteria are mandatory for a successful cross-training program.

Female↗
PubMed1987

A comprehensive system for antimicrobial monitoring and review using a mandatory antimicrobial ordering sheet.

A comprehensive antimicrobial monitoring and review program using computer screening of information provided by antimicrobial order sheets (AOS) is needed to meet increasing pressures for ongoing review of all antibiotic use by indication. This article describes a program that has been successful in rapidly identifying areas of concern for further review and resolution. These multi-faceted programs passed JCAH scrutiny. Based on the authors experience, a system incorporating mandatory use of an AOS was preferred to a voluntary system. When used voluntarily, compliance to the use of an AOS was 84%. Compliance to use of parts of the form were stronger where check-off boxes were used instead of fill-in blanks. Surgical services personnel and first year residents were the most noncompliant. Admission orders lended themselves to noncompliance. Pharmacists using the forms were less compliant than physicians using them voluntarily, and gave different indications for use than did the physicians. Data documented on the AOS were verifiable with notes in the patient's medical record 92% of the time. Pharmacy coding and collection methods for AOS data presented problems in accurately determining compliance. When the use of the AOS became "mandatory," compliance increased to 97%. Trends in antimicrobial use were reported by an array of computer-generated reports of which several are illustrated. The system described here allows for the identification and monitoring of areas of concern in antimicrobial use, improves the efficiency of quality assurance activities, and can assess the effectiveness of a corrective action.

Anti-Bacterial Agents↗
PubMed1998

Process improvement program evolves into compliance program at an integrated delivery system.

An integrated delivery system discovered questionable practices when it undertook a process-improvement initiative for its revenue-to-cash cycle. These discoveries served as a wake-up call to the organization that it needed to develop a comprehensive corporate compliance program. The organization engaged legal counsel to help it establish such a program. A corporate compliance officer was hired, and a compliance committee was set up. They worked with counsel to develop the structure and substance of the program and establish a corporate code of conduct that became a part of the organization's policies and procedures. Teams were formed in various areas of the organization to review compliance-related activities and suggest improvements. Clinical and nonclinical staff attended mandatory educational sessions about the program. By approaching compliance systematically, the organization has put itself in an excellent position to avoid fraudulent and abusive activities- and the government scrutiny they invite.

Accounts Payable and Receivable↗
PubMed2003

Increasing resident research in a military internal medicine program.

The internal medicine residents from our training program rarely participated in scholarly activity prior to 1994. In an attempt to increase the quality and quantity of resident research, we initiated a research program that included: (1) a mandatory research project, (2) 2 months of dedicated research time, (3) appointment of a research director, (4) lectures on the critical appraisal of medical literature and research design, (5) technical support, (6) faculty mentoring, (7) a research meeting and competition involving five residency programs, and (8) military achievement awards. From 1994 to 1999, our house staff has had 134 research presentations and 21 manuscripts accepted for publication in peer-reviewed journals. Ninety percent of our residents presented at least one project at a scientific meeting by completion of their training between 1996 and 1999. Resident scholarly activity is significantly enhanced by a structured research program, an opportunity to present at a scientific meeting, and award recognition.

Humans↗
PubMed2001

A study of quality assessment in clinical microbiology performance of independent laboratories in Tokyo: 18-year participation in the Tokyo Metropolitan Government External Quality Assessment Program.

We evaluated the performance of independent microbiology laboratories in Tokyo over an 18-year period of participation in the external quality assessment (EQA) program, and we estimated the impact of the EQA program. The study design was a longitudinal retrospective analysis of performance, including isolation, identification, and antimicrobial susceptibility testing of bacteria from simulated patients' samples, in "open" surveys compared with "blind" surveys. Independent microbiology laboratories, licensed by the Tokyo Metropolitan Government, have been subject to mandatory evaluation by the EQA program since 1982. Survey reports, correspondence, annual guidance meetings, and inspections are used as quality improvement strategies. The performance for identification in "blind" surveys was significantly worse than that in "open" surveys (P < 0.001). Poorly performing laboratories had common features, including inadequate supervision by physicians and lack of familiarity with the impact of variations on the use of the standards. However, there were improvements in the performance of identification of some pathogens. The performance of susceptibility testing has not yet reached the relatively high level seen for identification. Some of the smaller laboratories have been gradually acquired by commercial chains operating outside Tokyo. The EQA program has established a role both in regard to laboratory improvement and as an educational tool. However, the program lags behind these of other developed countries in regard to the practical sciences. The main problems in regard to laboratory improvements are a shortage of human resources in clinical microbiology, lack of standardization of laboratory methods, and the pressures of financial constraints in the Japanese medical insurance system.

Data Collection↗
PubMedDate not supplied

[Social participation in health. An experience in Simojovel, Chiapas].

One of the basic foundations for the operation of health programs is the social participation of the population in actions going from planning to evaluation, promotion and control of actions related with their own health. In the work, we present the results of a preliminary and partial evaluation of an ongoing autopromoting health project in the communities of Lázaro Cárdenas and Las Limas, in the Municipality of Simojovel, Chiapas, México. The basic goal of this work is to identify factors derived from the relations of localities with the State and, on the other hand, from socioeconomic conditions of the populations, which favor or hinder the development of social participation in their own health projects. This is a comparative study, type before and after, within and between localities, intended to measure the effect of a health program with community participation in two communities having divergent relations with the State. For this, we carried out a socioeconomic and prevalent morbidity survey before and after the implementation of social participation in health actions. We also characterized social participation in health actions and identified the type of State intervention in the localities through governmental programs and institutions. The results convey the notion that the health program contributes to enhance hygienic sanitary conditions of the population and decrease the frequency of such ailments as diarrhea and parasitic diseases; social participation is more active in Lázaro Cárdenas than in Las Limas. State interventions in the communities are given through social programs and institutions in a mandatory way, with no opportunity for community participation in decision-making. The conclusion is that the demographic organization of the community and autopromotion favor the participation in health actions, while the presence of the State through political repression and actions delivered through social programs promote dependence and paternalism, hindering the ample social participation in actions for health.

Adolescent↗
PubMed1989

Pharmacists' attitudes toward and use of cardiopulmonary resuscitation training received in pharmacy school.

Recent graduates of a pharmacy school were surveyed to determine their attitudes toward and use of cardiopulmonary resuscitation (CPR) and basic life support (BLS) training received as part of their pharmacy school instruction. Questionnaires were mailed to 215 pharmacists who had completed the mandatory CPR-BLS training; only those who had practiced pharmacy for at least 6 of the previous 12 months were asked to respond. Usable questionnaires were received from 187 of the pharmacists surveyed. Of the respondents, 134 (72%) believed that the CPR-BLS program should continue to be mandatory for graduation; 131 (70%) believed their training to be of value in their current practices, and 174 (93%) believed it would be of value in the future. Nine (5%) of the pharmacists had actually performed CPR since their graduation. Pharmacists practicing in small and large hospitals were more likely to participate in CPR than pharmacists in medium-sized hospitals, and such participation was associated with the presence of decentralized and clinical pharmacy services. Recent pharmacy graduates who had received mandatory CPR-BLS training in school had positive attitudes about the value of this training in their professional practices.

Attitude of Health Personnel↗
PubMedDate not supplied

Hospitalist programs: are they good for your practice?

With the changes brought about in health care delivery by the growth of Managed Care, the attractions of hospitalist programs are becoming increasingly evident. As the programs have grown in usage, and program models have evolved from mandatory to voluntary, primary care physicians (PCPs) and independent practice organizations (IPAs) have begun to recognize their positive impact on their practices, from both financial and logistic perspectives, as well from those of patient care. This article discusses that effect and reviews the procedures and ramifications of one of the newer program models. Quality of patient care and the provision of successful outcomes via clinical guidelines are addressed as indications of successful hospitalist programs.

Attitude of Health Personnel↗
PubMedDate not supplied

[Problems in managing the newborn infant with lumbosacral meningomyelocele: basis for comprehensive care].

Newborns affected by spina bifida with myelomeningocele has been managed in Bologna by a team of neurosurgeons and neonatologists, whose experience is described here. Among the main problems faced during a ten years period are: selection of infants for surgical correction, treatment schedule and follow up program, nursing protocol in an intensive care unit. Basing on their personal work and an exhaustive literature's revision, the authors emphasize the opportunity of delaying surgery until local and general conditions are improved and a careful evaluation of the patient has been achieved. An appropriate pre and post operative nursing is mandatory. But the whole therapeutic program and furthermore any rehabilitation chance has their cornerstone in a full cooperation among the several specialists involved. The neonatologist first, the family pediatrician later can act as the pivot for the team, in order to achieve a comprehensive approach and an "overall" management for the individual affected child.

Critical Care↗
PubMed1992

Cost-sharing and the future of fees for service for frail elders in state programs.

Although Congress has rejected the concept of mandatory cost-sharing under the Older Americans Act, many states already use client fee systems under state-funded home and community-based services programs. This research included a survey of actual state experiences and a review of earlier studies. States are compared on issues concerning policy and experience with fee systems, including income verification, fee schedules, termination policies, and costs of administration. Although policy and practice differ markedly across states, certain states are close to operationalizing comprehensive policies in this area. The author concludes that there is a need to conduct additional state-level demonstrations that address policy issues identified in the research. Evaluation research is needed to determine program effectiveness and efficiency, particularly concerning whether cost-sharing increases the amount of services available and ensures a high level of services to minorities.

Aged↗
PubMed2006

Reflections of medical students on visiting chronically ill older patients in the home.

The expanding number of Americans living with chronic illness necessitates educating future physicians about chronic illness care. Weill Cornell Medical College's Chronic Illness Care in the Home Setting Program (CIC-HSP), a mandatory part of the primary care clerkship, exposes medical students to persons with chronic illness via a half day of house calls with a geriatrics team. The investigators sought to qualitatively assess the effect of the CIC-HSP on medical students and recent medical graduates. Fifty-two prospective participants were approached, and 50 (96%) with varying training levels and time since completing the program were interviewed. Most respondents (63%) found that the home visits taught them important approaches to caring for the chronically ill, such as individualizing care to meet patients' individual needs and improving quality of life as a goal of care. Students remarked that the experience enhanced their empathy (18%) and sensitivity (20%) toward chronically ill patients and increased their appreciation for chronic illness care (35%). Many participants reported that patients were more empowered in the home (55%) and perceived greater rapport and warmth between the doctor and patient (57%) in the home (vs office) setting. The vast majority of recent medical graduates (84%) related that this educational exposure continued to positively influence their approach to patient care. A home visit experience with a geriatrics team can help foster medical students' understanding of the psychosocial and medical aspects of chronic illness, teach relevant approaches to patient care, and improve students' attitudes toward caring for the chronically ill.

Adult↗
PubMed1989

Shoot out at the RBRVS corral.

1. If one understands and believes what has been noted above, then the conclusion is that some new system must be devised for payment of medical services. 2. While the Board of Trustees report in evaluation and recommendations of the RBRVS study was ultimately acceptable to the delegates, the Hsiao study was not. (It is incomplete and flawed in many ways and is to be reviewed further and ruled upon.) 3. The problems of rural v urban differential will be addressed. 4. A gradual phasing in of this entire program to avoid disruptions is mandatory. 5. The acceptance of a "balance billing concept" will be necessary and only fair to allow full access to medical care. There seems to be some "inherent reasonableness" to the fact that the well-to-do senior citizen would expect to be balance billed, and on the other hand, the indigent elderly person would receive excellent medical care, as proposed by our present "courtesy card program." 6. Ongoing surveillance by medical authorities will be needed to avoid the subversion that so often happens to well-intentioned programs. Dr. Russell Roth (past president of the AMA) has helped lighten the atmosphere among many of our stormy debates over the years. He has done this by well designed and appropriate limerics. The one that he concocted for this particular problem goes as follows: "It is true that our health depends, On our congressional friends, To grant this convention, this brief intervention, Remember Jesus saves and Congress spends." It can thus be seen from all of the above, that this "shoot out" wound up not being a deadly and divisive affair. A note of harmony allowed all of the factions to "spike their guns." Great credit for this belongs to not only the excellent report AA of our Board of Trustees but also to the long range perceptiveness of our membership who realized the necessity for this approach.

Fees and Charges↗
PubMed2002

Electroconvulsive therapy training in Canada: a call for greater regulation.

OBJECTIVE: A national survey of senior psychiatric residents' experience of electroconvulsive therapy (ECT) training was undertaken in Canada in 1989. Since then, guidelines have been published in Canada and the US with respect to ECT training in psychiatry residency programs. This study examines whether there has been any change in the Canadian resident ECT training experience through a second national survey. METHODS: Confidential questionnaires assessing the training in and the attitudes toward ECT were sent to all 133 psychiatric residents-in their final year of training in Canadian medical schools. RESULTS: We attained a response rate of 68.3%. Of respondents, 88% felt that theoretical and practical ECT training should be a mandatory component of psychiatric residency programs. No marked improvements have occurred with respect to didactic and bedside training in ECT, compared with the original 1989 study. Only 18% of respondents reported that they feel completely competent administering ECT. Despite this, 59.3% anticipate working in an inpatient setting. CONCLUSIONS: The publication of training guidelines has made little impact on training in and attitudes toward ECT in senior psychiatric residents in Canada. Despite senior residents' acknowledgement of ECT's value, few feel competent to administer ECT after completing their training.

Canada↗
PubMed1977

Laboratory support of drug abuse control programs: an overview.

Labeling an individual a drug abuser has serious sociologic and legal implications that only laboratory testing can effectively allay. A proper specimen (both qualitatively and quantitatively) must be obtained for analysis. Positive identification of specimen with subject is of paramount importance. The problems of specimen substitution--other people's urine, tap water, apple juice--directly impinge here, as does the possibility of drug degradation by heat, light, and microbial attack and of drug adsorption by the container and urinary sediment. Confirmation of postives indicated by screening tests (thin layer chromatography and immunoassays) by gas chromatography and/or ultraviolet spectrophotometry is, in most situations, mandatory. An effective quality control program is an absolute requirement. Even under ideal circumstances, laboratory results can sometimes wrongly indicate the abuse of drugs; and conversely, drug abuse can take place without detection by the laboratory. As in any clinical situation, laboratory tests are only a part (albeit an important one) of the entire evaluation of the individual involved.

Chemistry, Analytic↗
PubMed1988

A pilot outreach program for small quantity generators of hazardous waste.

The Massachusetts Department of Environmental Management initiated a pilot project to improve compliance with hazardous waste regulations and management of hazardous wastes with auto body shops around the state. The program consisted of mass mailings, a series of workshops throughout the state, a coordinated inspection program by the state regulatory agency, and technology transfer. At the start of the program in January 1986, approximately 650 of the estimated 2,350 auto body shops in the state had notified EPA of their waste generating activities; by January 1987, approximately 1,200 shops had done so. Suggestions for improving program efforts include tailoring the outreach effort to the industry, government-sponsored research and development directed at the needs of small firms, mandatory participation in hazardous waste transportation programs, and better coordination by EPA of its information collection and distribution program.

Automobiles↗