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At least 1,531 records · Page 85Linked to original sources
PubMed1985

Preventive health and safety education in public hospitals: implementing a child restrainer carseat lend-lease program for indigent patients.

While the use of mandatory child restrainer car seats is evaluated by health professionals as in the domain of general public good, the implementation and prerequisite purchase may work a hardship on limited income individuals, especially those patients who deliver at city-county public hospitals. As legislation throughout the United States has begun to require mandatory car seat usage, the provision of such seats should also be addressed by public agencies who serve indigent populations. The purpose of this paper is to describe the establishment of an ongoing program for a lend-lease child restrainer car seat project in a public hospital setting. This paper also provides some suggestions to professionals who want to introduce and cultivate positive health care practices among populations which usually are non-responsive to primary prevention and health promotion.

Automobile Driving↗
PubMed1989

Medicaid utilization control programs: results of a 1987 study.

Medicaid agencies use both second surgical opinion programs (SSOP's) and inpatient hospital preadmission review programs to control utilization of services and thus program expenditures. This article reports on the 13 mandatory and 7 voluntary SSOP's and the 21 inpatient preadmission review programs, based on responses from 44 State Medicaid agencies.

Cost Control↗
PubMed2004

Assessment of the trauma evaluation and management (TEAM) module in Australia.

AIM: To assess the immediate effect on trauma-related knowledge of the trauma evaluation and management (TEAM) program applied to medical students in Australia. METHODS: 73 final year medical students from Melbourne were randomly assigned to two experimental groups (E1 and E2 who completed the TEAM program after a 20 item MCQ pre-test on trauma resuscitation and a second MCQ exam after the TEAM program) and two control groups (C1 and C2 who completed the pre- and post-MCQ exams before completing the TEAM module). All 73 students completed an evaluation questionnaire. Paired and unpaired t-tests were used for within and between groups comparisons. RESULTS: Groups C1 and C2 had similar mean scores in pre- and post-tests ranging from 57.2 to 60.5%. Groups E1 and E2 had similar pre-test scores but increased their post-test scores (pre-test range 53.8-57.1% and post-test 68.8-77.4%, P < 0.05). On a scale of 1-5 with five being the highest, a score of four or greater was assigned by over 74% of the students that the objectives were met, over 80% that trauma knowledge was improved, 25-40% that clinical skills were improved with over 74% overall satisfaction. Over 75% assigned a score of four or greater suggesting the module be mandatory. CONCLUSIONS: After the TEAM program there was significant improvement in cognitive skills. The students strongly supported its introduction in the undergraduate curriculum.

Clinical Competence↗
PubMed2006

Graduated driver licensing programs and fatal crashes of 16-year-old drivers: a national evaluation.

CONTEXT: Implementation of graduated driver licensing programs is associated with reductions in crash rates of young drivers, but graduated driver licensing programs vary in their components. The impact of programs with different components is unknown. OBJECTIVE: The purpose of this work was to determine which graduated driver licensing programs are associated with the greatest reductions in fatal motor vehicle crashes involving 16-year-old drivers. METHODS: We conducted a retrospective study of all 16-year-old drivers involved in fatal crashes in the United States from 1994 through 2004 using data from the Fatality Analysis Reporting System and the US Census Bureau. We measured incidence rate ratios of fatal motor vehicle crashes involving 16-year-old drivers according to graduated driver licensing programs, adjusted for state and year. RESULTS: Compared with state quarters with no graduated driver licensing program components, reductions of 16% to 21% in fatal crash involvement rates of 16-year-old drivers occurred with programs that included > or = 3-month mandatory waiting period, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction. Reductions of 18% to 21% occurred in state quarters with programs that included > or = 5 of the 7 components examined. Drivers aged 20 to 24 or 25 to 29 years did not experience significant reductions. CONCLUSION: Comprehensive graduated driver licensing programs are associated with reductions of approximately 20% in 16-year-old drivers' fatal crash involvement rates. The greatest benefit seems to be associated with programs that include age requirements and > or = 3 months of waiting before the intermediate stage, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction.

Accidents, Traffic↗
PubMed1998

Current list of laboratories which meet minimum standards to engage in urine drug testing for federal agencies, and laboratories that have withdrawn from the program--SAMHSA. Notice.

The Department of Health and Human Services notifies Federal agencies of the laboratories currently certified to meet standards of Subpart C of Mandatory Guidelines for Federal Workplace Drug Testing Programs (59 FR 29916, 29925). A similar notice listing all currently certified laboratories will be published during the first week of each month, and updated to include laboratories which subsequently apply for and complete the certification process. If any listed laboratory's certification is totally suspended or revoked, the laboratory will be omitted from updated lists until such time as it is restored to full certification under the Guidelines. If any laboratory has withdrawn from the National Laboratory Certification Program during the past month, it will be identified as such at the end of the current list of certified laboratories, and will be omitted from the monthly listing thereafter. This Notice is now available on the internet at the following website: http://www.health.org.

Certification↗
PubMed1993

Nonsanction seat belt law enforcement: a modern day tale of two cities.

This paper describes the implementation and evaluation of a nonsanction seat belt law enforcement program in two experimental communities of contrasting size in a state with a mandatory belt law. The main ingredients of the program were seat belt "salutes," public information and education, and limited use of inexpensive economic incentives. Driver shoulder belt use data collected before, during, and after the experimental programs, compared to similar data collected in a comparison community, showed the approach to be effective. While standard seat belt enforcement activities without incentives have been shown to be effective, many police departments, especially in smaller communities, are reluctant to make wholesale increases in seat belt citations. Although requiring some additional level of manpower and resources, a nonsanction approach to seat belt law enforcement can provide an alternate way of increasing belt use in these communities.

Ethnicity↗
PubMed2001

[A model for primary and secondary metastasis in breast cancer and the clinical consequences].

BACKGROUND: An adjuvant locoregional radiotherapy after radical surgery results in a survival advantage for breast cancer patients. The advantage starts with a delay and reaches about 10% 15 years after diagnosis. What could explain such a delayed efficacy? METHODS: A population-based cohort from 1996 to 1998 and the Munich Cancer Registry with courses of breast cancer disease since 1977 are the empirical basis. The analysis concerns survival rates and survival times in respect to metastases, local and lymph node recurrencies. A metastatic model is derived from the data. RESULTS: A cohort of 9,347 patients with a mean follow-up of 6.5 years and 2,587 courses with metastases and/or local recurrencies were registered. The overall survival after 15 years was for pT1 57.6%, pT2 37.9%, pT3 24.4% and for pT4 10.5%. Five years after metastasization 20.1 to 12.4% survived, 10 years 6% independent on pT. Ten years after local recurrencies the survival was dependent on pT of the primary tumor: pT1 36.3%, pT2 21.0%, pT3 13.1% und pT4 4.6%. A local recurrency is a prognostic factor for metastasization of the primary tumor, but local recurrencies can also cause metastases. The mean survival time after metastasization of the primary pT1 tumor is estimated about 61 months, after metastasization by local recurrencies about 99 months with a mean time to local recurrencies of 38 months. Further results of the metastatic model are: the development of metastasization is homogeneous and independent on pT-category, the metastatic initiation starts up to 5 years before diagnosis, metastatic-free survival time and progression survival time are independent and an impact of lymph node recurrencies on survival could not be detected. CONCLUSIONS: The reduction of local recurrencies by high-quality primary therapy with radiotherapy and also the early detection of local recurrencies may reduce secondary metastasization and therefore improve survival. The metastasization model also explains the limitation of the therapeutical strategies and the almost mandatory chance of early detection programs of breast cancer.

Aged↗
PubMed2006

Effects of long-term routine use of selective digestive decontamination on antimicrobial resistance.

OBJECTIVE: To assess the distribution of bacterial species and antimicrobial resistance in an ICU during long-term use of selective digestive decontamination (SDD) in the context of national reference data. DESIGN AND SETTING: Five-year prospective observational study in a 24-bed interdisciplinary surgical ICU of a university hospital (study ICU) participating in the project "Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units" (SARI; reference ICUs). PATIENTS: Resistance data were obtained from all patients; patients intubated for at least 2 days received SDD (colistin, tobramycin, amphotericin B). INTERVENTIONS AND MEASUREMENTS: SDD was performed in 1,913 of 7,270 patients. Antimicrobial resistance was examined in 4,597 (study ICU) and 46,346 (reference ICUs) isolates. RESULTS: Methicillin-resistant Staphylococcus aureus (MRSA) remained stable (2.76 and 2.58 isolates/1000 patient days) in the study ICU; this was below the German average (4.26 isolates/1000 patient days). Aminoglycoside- and betalactam-resistant Gram-negative rods did not increase during SDD use. Aminoglycoside resistance of Pseudomonas aeruginosa was 50% below the mean value of SARI (0.24 vs. 0.52 isolates/1,000 patient days). The relative frequency of enterococci and coagulase-negative staphylococci (CNS) was higher than in the SARI ICUs (23.2% vs. 17.3%, and 25.0% vs. 20.6%, respectively). CONCLUSION: Routine 5-year-use of SDD was not associated with increased antimicrobial resistance in our ICU with low baseline resistance rates. Vigorous surveillance and control measures to search and destroy MRSA were considered a mandatory component of the SDD program. The relative increase in enterococci and CNS is of concern requiring further investigation.

Amphotericin B↗
PubMed2005

Primary access-related complications with laparoscopy: comparison of blind and open techniques.

BACKGROUND: Severe or fatal complications attributable to gas embolus, major vascular injury, or visceral injury are rare but have been reported after blind access to the abdominal cavity in laparoscopy. The open access technique has been introduced with the aim to reduce these injuries. This report evaluates access-related complications with both blind and open access techniques in a teaching hospital using standardized techniques for both methods. METHODS: Two groups of patients at different times from a prospective database were compared. A retrospective analysis of 2,297 patients treated using blind access between 1992 and 1996 were compared with 2,066 patients treated using open step-by-step access between 1999 and 2001 regarding access-related complications. An accreditation program for both techniques was mandatory for the 67 surgeons involved. RESULTS: No case of gas embolus or major vascular injury was seen in either group. Four cases of visceral injuries (0.17%) in the blind access group and one case (0.05%) in the open group were seen (p = 0.337). All the injuries were recognized and repaired intraoperatively with no further postoperative complications. CONCLUSION: Our educational efforts to make both techniques as safe as possible were successful, as evidenced by a minimum of access-related complications. Because no evidence exists to show that the blind access technique is superior in any aspect, the open technique is recommended for access to the abdominal cavity in laparoscopy.

Adolescent↗
PubMed2006

Certification from the American Board of Pathology: getting it and keeping it.

In the last 5 years, there have been significant changes in the process of obtaining (and maintaining) certification in anatomic and/or clinical pathology and in pathology subspecialties. These changes include the elimination of the requirement for a "credentialing year" with its attendant "double class" of residents; the implementation of a mandatory maintenance-of-certification program for all persons certified by the American Board of Pathology, Tampa, Fla, on or after January 1, 2006; and the alterations in format and manner of grading for the certifying examinations. This article updates the pathology community regarding these changes and provides references where candidates and diplomates can find the most recent information regarding all aspects of certification and maintenance of certification.

Certification↗
PubMed2001

A functional assay for paralytic shellfish toxins that uses recombinant sodium channels.

Saxitoxin (STX) and its derivatives are highly toxic natural compounds produced by dinoflagellates commonly present in marine phytoplankton. During algal blooms ("red tides"), shellfish accumulate saxitoxins leading to paralytic shellfish poisoning (PSP) in human consumers. PSP is a consequence of the high-affinity block of voltage-dependent Na channels in neuronal and muscle cells. PSP poses a significant public health threat and an enormous economic challenge to the shellfish industry worldwide. The standard screening method for marine toxins is the mouse mortality bioassay that is ethically problematic, costly and time-consuming. We report here an alternative, functional assay based on electrical recordings in cultured cells stably expressing a PSP target molecule, the STX-sensitive skeletal muscle Na channel. STX-equivalent concentration in the extracts was calibrated by comparison with purified STX, yielding a highly significant correlation (R=0.95; N=30) between electrophysiological determinations and the values obtained by conventional methods. This simple, economical, and reproducible assay obviates the need to sacrifice millions of animals in mandatory paralytic shellfish toxin screening programs.

Animals↗
PubMed2000

Teaching cardiopulmonary resuscitation to CEGEP students in Quebec--a pilot project.

In order to increase CPR training in Quebec, we designed a pilot study to test out the efficacy of training CEGEP (junior college) students in CPR. We tried out four different methods of teaching CPR on students (Group A 'control', 4 h course, manikin to student ratio 1:4; Group B, 4 h course, manikin to student ratio 1:1; Group C, 2 h course, manikin to student ratio 1:1; Group D, video-assisted CPR instruction, manikin to student ratio 1:1). CPR skills were tested on a computerized manikin at the end of the initial course and again at the end of the semester in order to evaluate short and long-term retention of skills. There were no significant differences between the test groups and the control group in terms of compressions or ventilations at the beginning and end of the semester, however groups C and D performed significantly better primary surveys (Airway, Breathing, Circulation - ABC sequences) during the initial testing. The most common reasons reported by students for not taking CPR courses were the cost of courses (49.2%) and the inconvenience of courses (26.2%), similarly the two most common incentives which could get students to take CPR courses were; free courses (65.6%) and greater accessibility of courses (54.1%). Video-assisted CPR training appears to be feasible, enjoyable and as, if not more effective than traditional CPR courses. Instituting a mandatory video-assisted CPR program in the CEGEP system in Quebec and in high schools and colleges throughout the world, would be a cost-effective way to train massive amounts of young people in CPR.

Adult↗
PubMed2003

[New modalities of mechanical ventilation].

In the last few years new mechanical ventilation modalities have been developed that aim to improve the characteristics of mechanical ventilation and its adaptation to the patient. Volume-programmed and pressure-controlled ventilation (volume-controlled pressure-adjusted, adaptable pressure ventilation, autoflow ventilation) attempt to combine the advantages of volume and pressure ventilation by controlling volume but with decelerated flow. These types of ventilation can be programmed in controlled, assisted, intermittent mandatory ventilation, or support ventilation mode. Other modalities offer pressure ventilation with continuous flow during the respiratory cycle (BIPAP, DUOPAP, APRV) and allow the patient to breathe spontaneously. Some ventilators have new modalities (adaptable support ventilation) that calculate the best minute ventilation according to the patient's weight and the level of support required. The ventilator provides support according to spontaneous respiratory frequency and tidal volume. Other modalities (proportional assist ventilation) provide support according to the patient's respiratory efforts. These new modalities can improve the adaptation of mechanical ventilation to the patient. None of these modalities are superior to the others. The choice of ventilation mode should be individualized according to each patient's characteristics.

Child↗
PubMed1980

Cardiovascular side effects of phenothiazines and tricyclic antidepressants. A review with precautionary measures.

A well-documented association exists between the phenothiazines and the tricyclic antidepressants and such alarming side effects as cardiac arrhythmias, ECG changes, and even sudden death. Most disturbing is the fact that major and possibly fatal arrhythmias can occur in young adults without antecedent heart disease who are receiving therapeutic dosages of these psychotropic drugs (especially thioridazine). Further study of the cardiovascular side effects of psychotropic drugs is needed to clarify the association. In the meantime, it is mandatory that physicians individualize treatment programs that include these drugs and carefully monitor patient response.

Antidepressive Agents, Tricyclic↗
PubMed1991

Consumption of fish: benefits and perceived risk.

Fish, a useful source of protein, may be polluted by microbes, natural toxins, and/or synthetic chemicals. However, based on a review of the U.S. General Accounting Office, "There does not appear to be a compelling case to implement a mandatory comprehensive federal seafood inspection program." Although earlier studies showed higher body burdens of polychlorinated biphenyls (PCBs) in populations who consumed a lot of fish from polluted waterways, a recent study refutes these observations. No information is available in the United States on the levels of polychlorinated dibenzodioxins (PCDDs) and dibenzofurans (PCDFs) in anglers who consume a great deal of fish presumed to be contaminated by these chemicals.

Animals↗
PubMed1981

Monitoring personnel exposure to stainless steel welding fumes in confined spaces at a petrochemical plant.

This paper documents exposure to stainless steel welding fumes at a petrochemical plant. The situation evaluated may be separated into three categories: 1) evaluation of background concentration levels in a maintenance shop (area monitoring), 2) evaluation of personnel exposures during open air welding in a maintenance shop (personal monitoring), 3) evaluation of personnel exposures in confined space welding (personal monitoring). Thirty-five area samples and seventy-six personal samples were collected and analyzed for chromium (VI), total chromium, nickel, iron, copper, and total particulates. The background concentrations in the maintenance shop were found to be far below those felt to be harmful. Personnel exposures found in the maintenance shop during open air welding were also low, especially when compared to current OSHA permissible exposure levels. Contaminant levels found during confined space welding, as in distillation towers, were considered excessive. After several possible solutions to the problem were considered, it was decided to implement a mandatory air-line respirator program for all employees entering confined spaces during stainless steel welding operations.

Air Pollutants↗
PubMed1990

Hearing conservation programs in Massachusetts' vocational/technical schools.

A survey of vocational/technical schools in Massachusetts was performed to evaluate the prevalence of and need for hearing conservation programs. The surveys were sent to the superintendents or principals of all 27 regional schools in Massachusetts. Surveys consisted of questions in the areas of shop noise exposure, use of safety equipment, and hearing conservation education. Results indicate that (1) many teachers and students may be exposed to hazardous noise levels (2) hearing protection is not required in one-third of the schools and is used less frequently than other safety equipment, and (3) teachers desire additional training in hearing conservation and would welcome the assistance of an audiologist. These results point out the need for obtaining measurements of noise levels in the school shops, designing hearing conservation programs for school settings, implementing mandatory use of hearing protection, and providing education in hearing conservation for students and teachers.

Ear Protective Devices↗
PubMed2006

The public health imperative for a neonatal herpes simplex virus infection surveillance system.

About 1 in 5 sexually active adults in the United States has serologic evidence of genital herpes caused by herpes simplex virus type-2. Neonatal herpes simplex virus infection is a serious consequence of genital herpes infection. Herpes infection in neonates causes significant morbidity and neurologic damage and generally has a case-fatality ratio untreated of 60%. It is estimated that 440 to 1,320 cases of neonatal herpes infections occur in the United States per year (11-33 cases occur per 100,000 live births). Given the challenges in surveillance for genital herpes due to the large number of asymptomatic infections and infrequent laboratory-based diagnosis, we recommend that to begin an effective national control program for herpes infections, a mandatory national surveillance system for neonatal herpes be implemented. Such a system would help assure appropriate therapy, help monitor trends and understand the burden of disease, identify risk determinants, and evaluate prevention efforts.

Adult↗