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At least 1,585 records · Page 88Linked to original sources
PubMed1999

Prevalence of alcohol problems among pediatric residents.

OBJECTIVE: To measure the prevalence of alcohol-related problems among pediatric trainees. METHODS: An alcoholism screening test was administered anonymously to participants at a mandatory substance abuse education and prevention program. SETTING: A large urban pediatric residency training program. SUBJECTS: One hundred fifteen pediatric residents attended the program during 3 consecutive years (1996-1998). Eighty-five (74%) screening tests were returned and 81 (70%) were analyzed MAIN OUTCOME MEASURE: The 25-item Michigan Alcoholism Screening Test (MAST). Differential MAST cutpoints have been established to "suggest" or "indicate" a lifetime diagnosis of alcoholism. RESULTS: Twelve residents (15%) had scores suggestive and 6 (7%) indicative of alcoholism. Twenty-eight (35%) admitted to having alcohol-associated amnesia (blackouts), 13 (16%) to "feeling bad" about their drinking, 9 (11%) to drinking before noon, 6 (7%) to getting into fights when drunk, and 2 (2%) to alcohol-related marital problems. However, only 1 (1%) had gone to anyone for help and none admitted to alcohol-related problems at work. CONCLUSIONS: These screening data suggest that alcohol abuse and related problems exist among pediatric trainees at troubling rates. While more than one third of the trainees had experienced a serious consequence from heavy drinking, only 1 had gone for help and problems were not apparent at work. Greater emphasis should be placed on alcohol prevention and early intervention programs as a routine part of pediatric training.

Adult↗
PubMed1997

Right-to-know training of workers with IQ less than 70: a pilot study.

Chemical emergencies occur frequently in the workplace. Laws and regulations have been enacted to reduce the risk of injuries to workers, including workers with an IQ less than 70. These regulations require employers to educate their workers about the nature and hazards of toxic substances in the workplace, about methods to reduce exposure, and about appropriate responses in case of an accident or an emergency. From May to August 1996, a project examined the responses of 58 Goodwill Industries employees before and after their attendance at a mandatory "Right-to-Know" training program. Responses to five questions relating to the safe use of chemicals were analyzed. A combination of quantitative and qualitative evaluations determined that for the 28 subjects with IQ < 70, the program did not achieve its goals. However, the program did provide fuller information for the 30 subjects with IQ > or = 70. The findings of this pilot study show the need to develop training programs tailored to meet the needs and conditions of workers with IQ < 70.

Accidents, Occupational↗
PubMed2004

[Adverse events following immunisation in Germany from 1.1.2001 to 31.12.2003].

The German Protection Act against Infection (Infektionsschutzgesetz) came into effect on 1 January 2001. Physicians must report complications after vaccination to local heath authorities according to Article 6 No. 3. . The local heath authorities send notifications to the Paul-Ehrlich-Institut (PEI). Between 1 January 2001 and 31 December 2003, a total of 941 reports from local public health authorities were registered in a central database and assessed. Compared to the number of reports of suspected adverse drug reactions sent to the PEI independently in the same time period by the pharmaceutical companies and the German Drug Commissions (Arzneimittelkommissionen) (n=2.338), underreporting has to be considered. Age distribution in the reports from local public health authorities revealed the following pattern: 33.8% of reports concerned adults (18-59 years old), 25.4% children aged 1-6 years, 16.9% infants, 11.3% adults (>60 years), 8.9% children aged 7-14 years and 1.9% adolescents aged 15-17 years. In 1.8% the age was not reported. The causal relationship was assessed by the PEI as proven in 0.2%, probable in 41.6%, likely in 27.5% and unlikely in 6.6%. In 11.9% assessment was not possible and in 11.8% of the reports follow-up information has been requested. Comparison to the reports from other sources revealed no major difference in respect to quality and content.

Adolescent↗
PubMed2006

Effects of a statewide physician-led quality-improvement program on the quality of cardiac care.

BACKGROUND: Several states have implemented mandatory public reporting of outcomes of cardiac revascularization procedures. Washington is the first to develop a nonmandatory, physician-led reporting program with public accountability and universal hospital participation. The purpose of this study was to determine whether quality improvement interventions resulted in the correction of data deficiencies and performance outliers for cardiac revascularization procedures. METHODS: From 1999 through 2003, there were 18 hospitals with coronary bypass surgery and interventional cardiology programs and 12 with only the latter. All patients > or =18 years undergoing 24372 isolated coronary bypass surgeries and 59,656 percutaneous coronary interventions were included. After 1999 to 2001 data were analyzed in early 2002, the Clinical Outcomes Assessment Program implemented a 6-step quality-improvement intervention to measure and remeasure data quality, process compliance, and performance. RESULTS: In 2003, 4 of the 18 surgery programs had 1 statistical outlier with respect to 4 performance measures, whereas 2 of 30 coronary intervention programs were mortality outliers. For bypass surgery, all programs maintained full compliance with program standards by adhering to timely and reliable submission of data, developing plans to address performance outliers, and demonstrating that outlier status did not persist from baseline to remeasurement. For coronary interventions, 1 program was a persistent outlier for mortality in 2002 and 2003. CONCLUSIONS: The Clinical Outcomes Assessment Program has successfully monitored cardiac care patterns in Washington State over a 5-year period. Most hospitals that perform coronary revascularization procedures meet acceptable performance standards.

Aged↗
PubMedDate not supplied

Leukoreduction and acute rejection in liver transplantation: an interim analysis.

BACKGROUND: Little is known about the effect of blood transfusions and leukoreduction on acute rejection in liver transplantation. The purpose of this study was to assess the impact of leukoreduction on the occurrence of early rejection episodes in liver transplantation. METHODS: In 1999, mandatory leukoreduction was implemented in our program. Data from 339 consecutive liver transplant recipients were analyzed with attention to the time period as a proxy for leukoreduction, the number of transfusions, the wait list status, the hepatitis B or C status, the recipient age, and the type of immunosuppression. RESULTS: Using an early (6-month) rejection-free graft survival model, we observed that introduction of leukoreduction was independently associated with fewer rejection episodes (P =.001). Despite the lower rejection rate, due to a regimen of tacrolimus and antithymocyte globulin, the effect of implementation of leukoreduction remained significant (P =.021). CONCLUSION: The use of leukoreduction is associated with fewer early rejections, irrespective of the type of immunosuppression. These data support an exploration of the immunomodulatory effect of leukoreduction.

Disease-Free Survival↗
PubMed1983

The physician's role in sports medicine. Serving the athlete, school, and team.

Increased interest in and opportunities for participation in recreation and sports have brought sports medicine into physicians' offices as another phase of health care. At one time considered to be limited to treatment and rehabilitation of injuries, sports medicine today includes many other medical aspects of sports. A preparticipation health appraisal is mandatory before entry into strenuous activity programs. Annual physical appraisals are not necessary, however, when continuing health supervision and periodic reviews of illness and injury are used to reveal needs for prompt medical attention. Cardiopulmonary and musculoskeletal capabilities must be included in the health examinations of athletes. School health personnel are important components of a scholastic sports medicine program because of their availability, their interest in all athletes, and the usefulness of their cumulative health records. Many physicians are sufficiently interested and qualified in sports medicine to serve as team physicians and be advisors on the health aspects of school or community youth sports programs.

Female↗
PubMed1998

Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes.

OBJECTIVES: Reliable prevalence data would be useful in assessing the impact of sudden cardiac death in young competitive athletes on the community and designing effective preparticipation screening strategies. BACKGROUND: The frequency with which these catastrophes occur is largely unknown. METHODS: We utilized a circumstance unique to Minnesota in which the precise number of participants and deaths due to cardiovascular disease could be ascertained over a substantial period of time based on a long-standing insurance program for catastrophic injury or death, mandatory for all student athletes engaged in interscholastic sports. RESULTS: Over the 12-year period, 1985/1986 to 1996/1997, inclusive, three sudden deaths due to cardiovascular disease occurred in competitive high school athletes (grades 10-12) during competition or practice. At autopsy, 1 each proved to be due to anomalous origin of the left main coronary artery from the right sinus of Valsalva, congenital aortic valve stenosis (with bicuspid valve) and myocarditis. All three athletes were white and male, 16 or 17 years of age; two competed in cross-country/track and one in basketball. During the study period there were 1,453,280 overall sports participations and 651,695 student athlete participants among the 27 high school sports. The calculated risk for sudden death was 1:500,000 participations and 1:217,400 participants per academic year (or 0.46/100,000, annually). Over a 3-year high school career for a student athlete the estimated risk was 1:72,500. CONCLUSIONS: The risk of sudden cardiac death in a population of high school student athletes was small, in the range of one in 200,000 per year, and was higher in male athletes. The rare occurrence of sudden cardiac death in competitive sports underlines the limitations implicit in structuring productive and cost-effective broad-based preparticipation screening strategies for high school athletes.

Adult↗
PubMedDate not supplied

Tumor biology and experimental therapeutics.

Recent research using multicellular tumor spheroids has resulted in new insights in the regulation of invasion and metastasis, angiogenesis and cell cycle kinetics. The onset and expansion of central necrosis in tumor spheroids has been characterized to be a complex interaction of several mechanisms; in a number of cases, necrosis is not a consequence of hypoxia or anoxia, but emerges as secondary necrosis following an accumulation of apoptosis in spheroids. Recent therapeutically oriented studies have been directed towards novel hypoxic markers, targeted therapy, multicellular-mediated drug resistance, and heavy ion irradiation of spheroids. Research efforts should be enhanced mainly in the fields of tumor tissue modeling by heterotypic three-dimensional (3D) cultures and of apoptotic versus necrotic cell death. Based on the fundamental differences between monolayer and 3D cultures, spheroids should become mandatory test systems in therapeutic screening programs.

Antineoplastic Agents↗
PubMed2000

Blame, shame, and community: justice responses to violence against women.

Justice processing for crimes against women is reviewed. The data reveal conviction rates for partner violence and rape by known acquaintances are miniscule; mandatory arrest, protection orders, and diversion programs inadequately deter rebattering; few losses are compensated; and the adversarial justice process is retraumatizing, exacerbating survivor's self-blame. To better address crimes against women, several nations and tribal communities use communitarian approaches, forms of restorative justice. The offense is framed to include the perpetrator, victim, and community. The process forgoes incarceration to have family, peers, and advocates design perpetrator rehabilitation, victim restoration, and social reintegration of both victim and perpetrator. Evaluations suggest communitarian justice may increase victim satisfaction, raise the social costs of offending, multiply social control and support resources, and open a new avenue to targeted prevention.

Female↗
PubMed2003

Transjugular intrahepatic portosystemic shunts: an update.

Transjugular intrahepatic portosystemic shunts (TIPS) have been used in the treatment of complications of portal hypertension. TIPS is used for the control of acute variceal bleeding and for the prevention of vericeal rebleeding when pharmacologic therapy and endoscopic therapy have failed. Patients with refractory ascites with adequate hepatic reserve and renal function who fail to respond to large volume paracentesis may be reasonable candidates for TIPS. Promising indications for TIPS are Budd-Chiari syndrome uncontrolled by medical therapy, severe portal hypertensive gastropathy, refractory hepatic hydrothorax, and hepatorenal syndrome. TIPS cannot be recommended for preoperative portal decompression solely to facilitate liver transplantation. Special care should be taken to insure proper placement of the stent to avoid increasing the technical difficulty of the transplantation procedure. The major limiting factors for TIPS success are shunt dysfunction and hepatic encephalopathy. Because shunt stenosis is the most important cause of recurrent complications of portal hypertension, a surveillance program to monitor shunt patency is mandatory. The MELD score may be useful in predicting post-TIPS survival, and also in counseling patients and their families.

Budd-Chiari Syndrome↗
PubMed1975

A successful respirator program.

This discussion covers the successful implementation of a respirator program on a voluntary basis in a large industrial plant. The program had the stated objective of mandatory usage at the end of a specified period of time. It was successfully implemented in an 1100-man department. This practical approach is applicable to large and small plants.

Attitude↗
PubMed2002

State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets.

OBJECTIVE: To develop national and state level estimates for preventable bicycle related head injuries (BRHIs) and associated direct and indirect health costs from the failure to use bicycle helmets. METHODS: Information on the effectiveness and prevalence of use of bicycle helmets was combined to estimate the avoidable fraction, that is, the proportion of BRHIs that could be prevented through the use of bicycle helmets. The avoidable fraction multiplied by the expected number of BRHIs gives an estimate of the number of preventable cases. Direct and indirect health costs are estimated from a social perspective for the number of preventable BRHIs to assess potential cost savings that would be achieved if all riders wore helmets. RESULTS: Approximately 107,000 BRHIs could have been prevented in 1997 in the United States. These preventable injuries and deaths represent an estimated $81 million in direct and $2.3 billion in indirect health costs. Estimates range from 200 preventable BRHIs and $3 million in health costs in Wyoming (population 480,000) to 13,700 preventable BRHIs and $320 million in health costs in California (population 32.3 million). CONCLUSIONS: A number of successful approaches to increasing bicycle helmet use exist, including mandatory use laws and community based programs. The limited use of these strategies may be related to the fact that too little information is available to state agencies about the public health and economic burden of these preventable injuries. In conjunction with information on program costs, our estimates can assist state planners in better quantifying the number of preventable BRHIs and the costs and benefits of helmet promotion programs.

Bicycling↗
PubMed1979

Medical management of hypertension.

In a paper like this, with such diverse information, it is impossible to summarize the content completely. Suffice it to say that a stepwise approach to the management of essential hypertension has been presented, beginning with a diuretic agent as the cornerstone of management for most patients. Recommendations for the addition of a second, third, or even a fourth agent have been offered based on a discussion of the site of action of various therapeutic agents. The common side effects and toxicity of various drugs have also been discussed. It cannot be overemphasized that the physician's knowledge of his patient and a thorough understanding of drug actions, interactions, and reactions are mandatory if highly effective, individualized therapeutic programs are to be implemented. Likewise, educating the patient about his disease and eliciting his maximal cooperation are keys to therapeutic success.

Benzothiadiazines↗
PubMed2006

Support for immunization registries among parents of vaccinated and unvaccinated school-aged children: a case control study.

BACKGROUND: Immunizations have reduced childhood vaccine preventable disease incidence by 98-100%. Continued vaccine preventable disease control depends on high immunization coverage. Immunization registries help ensure high coverage by recording childhood immunizations administered, generating reminders when immunizations are due, calculating immunization coverage and identifying pockets needing immunization services, and improving vaccine safety by reducing over-immunization and providing data for post-licensure vaccine safety studies. Despite substantial resources directed towards registry development in the U.S., only 48% of children were enrolled in a registry in 2004. Parental attitudes likely impact child participation. Consequently, the purpose of this study was to assess the attitudes of parents of vaccinated and unvaccinated school-aged children regarding: support for immunization registries; laws authorizing registries and mandating provider reporting; opt-in versus opt-out registry participation; and financial worth and responsibility of registry development and implementation. METHODS: A case control study of parents of 815 children exempt from school vaccination requirements and 1630 fully vaccinated children was conducted. Children were recruited from 112 elementary schools in Colorado, Massachusetts, Missouri, and Washington. Surveys administered to the parents, asked about views on registries and perceived utility and safety of vaccines. Parental views were summarized and logistic regression models compared differences between parents of exempt and vaccinated children. RESULTS: Surveys were completed by 56.1% of respondents. Fewer than 10% of parents were aware of immunization registries in their communities. Among parents aware of registries, exempt children were more likely to be enrolled (65.0%) than vaccinated children (26.5%) (p value = 0.01). A substantial proportion of parents of exempt children support immunization registries, particularly if registries offer choice for participation. Few parents of vaccinated (6.8%) and exempt children (6.7%) were aware of laws authorizing immunization registries. Support for laws authorizing registries and requiring health care providers to report to registries was more common among parents of vaccinated than exempt children. Most parents believed that the government, vaccine companies or insurance companies should pay for registries. CONCLUSION: Parental support for registries was relatively high. Parental support for immunization registries may increase with greater parental awareness of the risks of vaccine preventable diseases and utility of vaccination.

Adult↗
PubMedDate not supplied

Structured continuous objective-based assessment of resident's performance at point of care (SCOPA).

The assessment of the clinical performance of physicians-in-training is an important task. The critical care rotation is a mandatory rotation for most residency training programs and is designed to ensure the graduation of trainees who are able to initiate lifesaving management during medical emergencies. Ensuring that each resident fulfills the objectives of the rotation is of paramount importance. Unfortunately, the current assessment methods are subjective and suffer from many threats to validity and reliability that make the assessment inaccurate. In this review, the current assessment method is analyzed, and causes for inaccuracy are identified. A new model for assessment that is continuous, structured, objective-based and at the point of care (SCOPA) is proposed based on the best available assessment methods. Such a model might be useful for the assessment of trainee's performance in critical care as well as non-critical care rotations.

Attitude of Health Personnel↗
PubMedDate not supplied

Using administrative data to assess child safety in out-of-home care.

This article describes efforts to produce useful safety measures from administrative data. A measure similar to that proposed by the U.S. Department of Health and Human Services is presented and compared to a measure that takes into account the length of time children are in placement. These measures are also reported for out-of-home care placement types. The challenges posed in constructing such measures from extant data are discussed.

Child↗
PubMed2006

Nonalcoholic fatty liver disease and the metabolic syndrome.

In the last 15 years evidence has been accumulating suggesting that hepatic steatosis may be the starting point for a progressive liver disease. Nonalcoholic steatosis (nonalcoholic fatty liver disease, NAFLD) is now considered a metabolic pathway to advanced liver disease, cirrhosis and hepatocellular carcinoma. Liver disease of other etiology, namely hepatitis C virus, may interact with NAFLD, although the underlying mechanism(s) have not been fully elucidated. Type 2 diabetes mellitus, obesity and dyslipidemia are the principal factors associated with NAFLD, which is now considered the hepatic expression of metabolic syndrome (MS). Several studies have dealt with the relationship of NAFLD and MS, the risk of liver disease associated with the classical features of MS, the importance of insulin resistance as the common soil of different diseases. We still need to clarify the mechanism(s) responsible for liver disease progression from pure fatty liver, to steatohepatitis and to cirrhosis, and the reason(s) why only a few NAFLD cases progress to terminal liver failure while others (the majority) will have a cardiovascular outcome. The epidemics of obesity and diabetes of Western countries is expected to produce a significant increase of metabolic liver disease in the next years. Prevention and intervention programs based on lifestyle are therefore mandatory to reduce the burden of metabolic liver disease.

Fatty Liver↗