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PubMed1991

[Mandatory test for HIV infections in prison population: evaluation of the efficacy of a screening program].

The effectiveness of a screening programme for HIV infection among prisoners is discussed, in relation to validity of screening test, natural history ad modalities of transmission of the infection, hypothetical objectives of the programme, in comparison with alternatives prevention programmes. The association between HIV infection, e.v. drug abuse and sexual behaviours is analyzed. On the basis of available evidences the hypothesis of lack of effectiveness and possible harmfulness of this screening programme is proposed.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[Adjuvant systemic therapy in breast carcinoma in the 1990s: status of things and open questions].

Adjuvant systemic therapy of breast cancer has been shown to reduce relapses and prolong survival in the women treated. This is true of all subpopulations studied. Six-month multidrug chemotherapy in premenopausal patients, and tamoxifen or short-term chemotherapy in postmenopausal patients, are the treatments of choice in reducing the risk of relapse. In the near future ongoing research may answer some of the open questions surrounding the definition of populations for which the risk of relapse justifies therapy and the optimum manner of using available therapies. The modest but real improvement in prognosis of operable breast cancer was obtained solely by means of clinical trials. Participation in clinical research programs is becoming medically and socially mandatory.

Adult↗

PubMed1989

Cytopathology: new legislative, regulatory, and proficiency testing requirements.

In 1988, a combination of efforts by the press, the Maryland General Assembly, the Department of Health and Mental Hygiene (DHMH), and an advisory panel of pathologists and cytotechnologists led to broader and stricter regulation of cytopathology laboratories in Maryland. A new law called for standards covering the maximum number of slides a cytotechnologist may examine, unsatisfactory specimens, slide and records retention, a limitation on the use of out-of-state laboratories by Maryland physicians, and a mandatory, state-run proficiency testing program. Maryland's proficiency testing program is modeled on that of New York State but incorporates improvements in diagnostic definitions, testing mechanisms, and retraining requirements.

Laboratories↗

PubMed1987

Weaning from mechanical ventilation: successful use of modified inspiratory resistive training in muscular dystrophy.

An 18-yr-old man with Duchenne muscular dystrophy and ventilatory failure could not be weaned from mechanical ventilation using a T-piece method, despite repeated attempts over 3 months. Subsequently, we weaned the patient using inspiratory muscle resistive training (IRT), modified by the concurrent delivery of intermittent mandatory ventilation (IMV). During the training program, the sessions were gradually prolonged from 5 min to a maximum of 30 min, the IMV rate was gradually decreased, and the magnitude of the resistive load was gradually increased. After 45 days of training, his vital capacity had increased from 380 to 850 ml, his maximal inspiratory airway pressure from -28 to -50 cm H2O, and his tolerance of T-piece breathing, from less than 10 min to over 16 h. After an additional 2 wk of nocturnal mechanical ventilation, he was successfully weaned. We conclude that IRT with IMV can be an effective method of weaning patients who have severe ventilatory failure.

Adolescent↗

PubMed1995

First-year family medicine residents' use of computers: knowledge, skills and attitudes.

OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed.

Attitude to Computers↗

PubMed1997

[Cardiac pacing in general practice].

Cardiac pacemakers are used to maintain a sufficient cardiac rythm. The last generation may stimulate and sense both cardiac chambers, atrium and ventricule (physiologic pacemaker or dualchamber pacemakers). The rythm may also be adapted to the patient's activity (mode rate-adaptative or sensor-driven). All the pacemakers are multiprogrammable and a follow-up program in a pacemaker clinic is mandatory as every programmable parameter and pacing mode is adapted individually to the patient and also because complications are not uncommon. Despite high protection, pacemakers may be susceptible to certain sources of electromagnetic interferences. The maximal risk is present in medical environment and may easily be prevented (magnetic resonance imaging, defibrillation, electrosurgical cautery ...).

Aftercare↗

PubMed2006

Federal communication about obesity in the Dietary Guidelines and checkoff programs.

The new Dietary Guidelines for Americans focus on obesity prevention. They recommend increased consumption of whole grains, fruits, vegetables, fish, and low-fat dairy products, within a balanced diet whose total calories have been moderately reduced. Meanwhile, other well-known and well-funded federally sponsored consumer communications promote increased total consumption of beef, pork, and dairy products, including energy dense foods such as bacon cheeseburgers, barbecue pork ribs, pizza, and butter. These latter communications are sponsored by the federal government's commodity promotion programs, known as "checkoff" programs. The programs are established by Congress, approved by a majority of the commodity's producers, managed jointly by a producer board and the U.S. Department of Agriculture, and funded through a tax on the producers. The federal government enforces the collection of more than 600 million US dollars annually in mandatory assessments, approves the advertising and marketing programs, and defends checkoff communication in court as the federal government's own message-in legal jargon, as its own "government speech." Federal support for promoting fruits and vegetables is small by comparison. The checkoff programs recently have become more clearly identified as federal programs. After a recent decision by the U.S. Supreme Court upholding the constitutionality of the checkoff programs, calls for consistency with the Dietary Guidelines may get louder. The current inconsistencies in federal communication undermine the effectiveness of the Dietary Guidelines as an antidote to the shortcomings of the private sector market for information about weight and obesity.

Advertising↗

PubMed2004

Fifty years of general anesthesia in California oral and maxillofacial surgery.

In summary, the advances of the last half of the 20th century in general anesthesia delivery by oral and maxillofacial surgeons are the following: 1. Oral and maxillofacial surgeons in training are exposed to significantly more hospital general anesthesia training and in addition spent much of their residency training performing general anesthesia on outpatient dental patients undergoing dentoalveolar surgery. Training programs increased from one year to three years, then to four years and finally, many six-year programs were developed that award the MD degree during or following completion of the residency program. 2. Self-evaluation programs were initiated in the late 1960s and evolved into mandatory in-office evaluation by peer practitioners and later into state-regulated evaluation. These programs began in Southern California and spread to encompass the entire United States. 3. Intravenous ultra-fast acting barbiturate office anesthesia became very refined and several combination drug "balanced" techniques developed. 4. Benzodiazepines, first diazepam then midazolam were introduced and gained wide acceptance by the dental profession. 5. New synthetic narcotic agents were introduced, which give the oral surgeon another pain control and anesthesia supplement. The new agents were short acting but very effective for the period necessary to complete most office surgical procedures. Fentanyl is the prototype for these agents. 6. Monitoring devices were incorporated into practice, and currently all oral surgeons use the pulse oximeter, the electrocardiograph, and blood pressure monitoring devices. All of these monitors are required by the California general anesthesia regulations. 7. Propofol, an entirely new type of intravenous agent, was introduced and is used by more than half of oral surgeons reporting in a survey of drugs used in 2003. Propofol may be used by incremental injection or by continuous infusion incorporating an automatic infusion pump. 8. Sevoflurane, a potent inhalation anesthetic that has many properties of an ideal agent - rapid onset, potent, easily delivered by calibrated vaporizers, rapid emergence, infrequent postoperative nausea, and favorable acceptance by almost all patients about to undergo general anesthesia - is gaining acceptance and use by oral and maxillofacial surgeons.

Anesthesia, General↗

PubMed1999

Alcohol risk reduction for fraternity and sorority members.

OBJECTIVE: The primary objective of this study is to evaluate the effectiveness of "Talking about Alcohol and Drugs... Among Greeks" (TAAD), a lifestyle risk reduction program that is research- and theory-based, protocol-driven, and targeted for fraternity and sorority members. METHOD: One fraternity and two sororities on five campuses participated in the program. A total of 780 participants completed pre- and posttest questionnaires. Posttest data were collected 1 academic year after pretest data collection. RESULTS: Results indicate that the program decreased positive attitudes toward alcohol consumption among program participants, with participants in the true experimental condition indicating greater disagreement than control participants (F = 3.05, 2/701 df, p < .05). Belief in myths about the etiology of alcoholism was reduced among experimental participants who did not actually attend the program, with those participants indicating greater disagreement than control or true experimental participants (F = 10.92, 2/702 df, p < .0001). The program had no apparent effect on alcohol consumption by experimental participants. CONCLUSIONS: The program's ability to influence behavior was hindered by systemic problems, such as trainer credibility and implementation infidelity, and probable participant psychological reactance. Training by professionals and mandatory attendance would set the stage for improved program effectiveness. Beyond that, an approach that emphasized how high-risk drinking norms jeopardize the goals of the fraternities and sororities might be better received than the current approach, which focuses on how individual attitudes, beliefs and behaviors lead to alcohol-related problems and alcoholism.

Adolescent↗

PubMed1991

An academic medical center's experience with mandatory managed care for Medicaid recipients.

This paper reports on The Hospital of the University of Pennsylvania's experience and concerns as a participating primary care site in a Medicaid managed care program (HealthPASS), which was established in 1986. Enrollment is mandatory for approximately half of Philadelphia's medical assistance population. Participating primary care sites receive monthly capitation for enrollees and serve as "gatekeepers" for specialty and inpatient services. The report discusses why the academic medical center chose to participate in the program and how existing activities were modified to meet both increased demand for primary care and increased administrative requirements. It also identifies characteristics of the HealthPASS program and of the medical center that have impeded effective case management of care for the urban poor population that the program serves. Improving the quality of care for the medically indigent while controlling costs is essential, but political realities and the special needs of the Medicaid population must be acknowledged. Increased attention must be given to the impact that political compromises have on the design and effectiveness of a managed care program.

Academic Medical Centers↗

PubMed2005

Cost and utilization analysis of a pediatric emergency department diversion project.

OBJECTIVE: States are struggling to find effective means to decrease Medicaid costs. The objective of this pilot study was to compare emergency department (ED) cost and utilization by members who were enrolled in a pilot program (designed to reduce the use of hospital EDs) with the costs and utilization incurred by a control group. METHODS: A large, private, primary care pediatric practice launched a pilot ED diversion program that provided extended office hours, multiple access locations, and care coordination. Participants in the program were Medicaid recipients who were younger than 18 years. Enrollment in the program was through either patient self-selection or mandatory assignment by the state Medicaid agency. A total of 17,382 children who were enrolled in the enhanced access program (intervention group) and 26,066 Medicaid-eligible children who received services from other local community primary care providers (control group) were included in the study. Children who had chronic health conditions and were receiving Supplemental Security Income benefits were excluded from this analysis. Regression analyses and t tests were applied to analyze the medical claim data that were collected for this project. Three variables were used as dependent variables to measure different aspects of the ED cost and utilization: per member per month cost, per thousand member per month encounter frequency, and per encounter cost. These variables were used to compare the intervention group with the control group for ED claims, as well as for the overall cost of care during the study period. RESULTS: In the 12-month period subsequent to program initiation, the average per member per month cost for ED utilization of the intervention group was 1.36 dollars less than that of the control group. However, there was no significant difference in terms of per-visit cost related to ED utilization. Therefore, the savings seemed to come as a result of a reduction in ED visits, not from reduced cost per visit. On average, children in the intervention group visited the ED approximately 8 fewer times per thousand members per month than the control group, yet there was no significant difference in the overall (ED and non-ED) cost of care between the intervention and control groups. CONCLUSION: Analysis from the first year of this pilot program demonstrates that by providing enhanced, coordinated, primary care access to Medicaid children, the utilization of the ED was significantly lowered among healthy children, whereas the overall cost of care remained the same.

Child↗

PubMed1995

A framework to develop a sexual abuse prevention program.

In 1993, the Province of Ontario proclaimed the Regulated Health Professions Act (RHPA) and 21 health profession acts, including the Medical Radiation Technology Act. Under the RHPA, 21 health care regulatory colleges were created to ensure that Ontario patients receive safe, competent and quality care. Programs administered by the colleges ensure that all patients are treated with dignity and respect, and include measures for preventing or dealing with the sexual abuse of patients. This article sets out a framework and discusses issues related to the development and implementation of a sexual abuse prevention program. Key components include: establishing a patient-relations committee, preparing a statement of philosophy, defining sexual abuse, setting guidelines for professional behaviour, and educating members, staff and the public. Other aspects of such programs include procedures for complaints and discipline, mandatory reporting and penalties, and funding for therapy and counselling for patients who have been sexually abused by members.

Communication↗

PubMed1981

The faculty and continuing medical education: an attitude study.

Meager or nonexistent faculty reward systems hamper continuing medical education (CME) programs conducted by U.S. medial schools. In light of a growing number of mandatory CME regulations and a consequent increase in physician attendance of CME programs, the need for a competent faculty is apparent. A survey of faculty members designed to ascertain the importance of a faculty reward system was conducted by the University of Washington Division of Continuing Medical Education. Results reveal that faculty members are twice as likely to teach in CME programs outside of the university system as within the system. Survey respondents of nonprofessor rand considered faculty advancement the single greatest source of encouragement to participate in CME programs, yet this participation is seldom considered by the university in evaluations for promotion or tenure. If medical schools are to accept a responsibility for the continuing education of medical professionals, a commitment to provide adequate faculty incentive is imperative.

Attitude↗

PubMedDate not supplied

Mandatory pharmacosurveillance--a Canadian model for access to therapy and research.

Regulatory authorities in Canada have expressed a vital need for pharmacoepidemiological data on long-term effectiveness, safety, and cost-benefit of new therapies, particularly in comparison to currently available therapies, in routine clinical practice to allow informed decision making in listing new therapies on formulary. We describe the evolution of a new model of pharmacosurveillance involving a partnership between academic and community rheumatologists, government, and industry whereby access to therapy is conditional on participation in an industry-funded pharmacosurveillance study that assesses long-term effectiveness, safety, and cost-benefit. Though funded by industry, the program is administered by government and designed and operated at arms length from industry. The clinic data sheets are available at www. altarheum.com. The program also provides a sustainable model for promoting observational research on therapeutics in general.

Antirheumatic Agents↗

PubMed2004

Ethics of research involving mandatory drug testing of high school athletes in Oregon.

There is consensus that children have questionable decisional capacity and, therefore, in general a parent or a guardian must give permission to enroll a child in a research study. Moreover, freedom from duress and coercion, the cardinal rule in research involving adults, is even more important for children. This principle is embodied prominently in the Nuremberg Code (1947) and is embodied in various federal human research protection regulations. In a program named "SATURN" (Student Athletic Testing Using Random Notification), each school in the Oregon public-school system may implement a mandatory drug-testing program for high school student athletes. A prospective study to identify drug use among student-athletes, SATURN is designed both to evaluate the influence of random drug testing and to validate the survey data through identification of individuals who do not report drug use. The enrollment of students in the drug-testing study is a requirement for playing a school sport. In addition to the coercive nature of this study design, there were ethically questionable practices in recruitment, informed consent, and confidentiality. This article concerns the question of whether research can be conducted with high school students in conjunction with a mandatory drug-testing program, while adhering to prevailing ethical standards regarding human-subjects research and specifically the participation of children in research.

Adolescent↗

PubMed1986

A descriptive analysis of pharmacy continuing education offerings in 1985.

This study reports the results of a national survey of ACPE-approved provider continuing education offerings during 1985. The study was designed to identify frequently-presented topics, characterize types of programs offered, describe the providers offering programs and detail continuing education activities on a regional basis. Data were requested through the mail and the ACPE "program description form" was used as the source of the study data. Two hundred and one (84.1%) ACPE-approved providers from eight regions of the country and Puerto Rico participated and data from 2,461 programs were analyzed. Differences and similarities among programs offered and characteristics of providers were reported. Additional information was generated on when programs were offered, methods of presentation, average tuition charged and average credit hours offered. Significant differences were noted. Comparisons with previous national studies were made where possible. Among the findings was: an impact by mandatory continuing education requirements on the number of programs available; an increase in average program tuition charges; a decrease in the average number of credit hours per program; and an increase in competition among providers. Programs provided a rich variety of offerings, required a moderate tuition charge, were offered in every month, and used many different formats and delivery methods.

Data Collection↗

PubMed2006

Heterozygote carrier testing in high schools abroad: what are the lessons for the U.S.?

The main value of carrier detection in the general population is to determine reproductive risks. In this manuscript I examine the practice of providing carrier screening programs in the school setting. While the data show that high school screening programs can achieve high uptake, I argue that this may reflect a lack of full understanding about risks, benefits, and alternatives, and the right not to know. It may also reflect the inherent coercion in group testing, particularly for adolescents who are prone to peer pressure. The problem of carrier screening in the schools is compounded when the condition has a predilection for certain groups based on race, ethnicity or religion. I examine programs around the world that seek to test high school students for Tay Sachs and Cystic Fibrosis carrier status. I argue that carrier programs should be designed so as to minimize stigma and to allow individuals to refuse. The mandatory school environment cannot achieve this. Rather, I conclude that screening programs should be designed to attract young adults and not adolescents to participate in a more voluntary venue.

Adolescent↗

PubMed2005

The legal and governmental response to domestic elder abuse.

Older Americans constitute the fastest growing segment of the United States population and may account for 20% of the Unites States population by 2050. The federal government has taken minimal action to identify and solve their problems. Due to the federal government's inaction, states have become the primary engine for combating abuse. This is most often seen through adult protective services, which primarily consist of mandatory reporting laws, involuntary interventions, and educational programs. Funding is the primary roadblock to the successful execution of state laws targeting domestic elder abuse. The proposed federal Elder Justice Act of 2003, if passed, may fill in the gaps of current federal legislation by implementing a uniform method of response to domestic elder abuse and providing funding to the states to rectify instances of abuse.

Aged↗