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PubMed1997

Bio-ecological approach to cognitive assessment.

Because determining a child's educational program usually takes into consideration the child's cognitive functioning, it is vital that those who are involved in this enterprise recognize that many variables contribute to and explain performance. Thus, careful consideration, assessment, and planning are mandatory to plan a child's individual educational program. This article emphasizes that cognitive assessment is both a formal and an informal process that occurs in several contexts-the school, the home, and the community. Therefore, when psychological evaluators assess the cognitive performance of a child, it is necessary to analyze the complete of his or her social/emotional environments that have contributed to his/her current cognitive performance levels. Thus, it is vital to examine the orientation of family members, the academic assistance students receive at home, as well as the current and previous classroom environments in which the student has been educated. Six nonpsychometric measures (using item equivalency, test-teach-retest, and contextualization) were developed by the authors and are presented in recognition that there are many factors that one must consider when interpreting the performance of a child.

Child↗

PubMedDate not supplied

Shifts in medical student beliefs about AIDS after a comprehensive training experience.

We evaluated the beliefs of second-year medical students regarding critical issues in the AIDS epidemic before and after an intensive two-day training symposium. Paired responses, collected for three consecutive years, were available for 187 students. Our results indicate that, although the students generally held progressive beliefs on prevention and public policy prior to training, a significant minority held views that differ from expert opinion. After the training experience, we observed substantial shifts of opinion on several issues. For example, among those who initially believed that physicians should record results of HIV testing in patient charts without patient permission, 45% shifted to disagreement. On mandatory premarital testing, 43% of those initially supporting it shifted to disagreement. On some issues, such as contact tracing, where expert opinion is less clear, student opinion moved very little overall. Over the three-year period, we found evidence of a trend towards less concern over HIV transmission to men from causal sex with infected female partners and a trend towards acceptance of glove-wearing when handling all blood specimens. In conclusion, we demonstrate that the beliefs of medical students concerning difficult issues posed by the AIDS epidemic can be changed substantially in the short-term by a specially designed intensive educational program. Reinforcement and persistence of these changes should now be a concern for medical educators.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Elder abuse policy: considerations in research and legislation.

Elder abuse has become the most recently "discovered" form of intrafamilial violence. Most states have enacted elder abuse statutes or have amended their adult protection acts to specify the elderly. A majority of jurisdictions have included mandatory reporting requirements within their statutes. Commentary has been fiercely opposed to mandatory reporting for a variety of reasons. Compelled reporting does not appear to increase the number of reports filed, while enforcement of the schemes depletes much of the funds devoted to elder abuse. Definitions of elder abuse are contradictory and vague. Mandatory reporting requirements suggest that legislators believe elders are unable to determine whether reporting is in their own best interests and thus is an ageist response to the problem of elder abuse. Finally, few services are available to families in which elder abuse has been verified and even fewer program evaluations have been performed to assess these services. Mandatory reporting to identify elder abuse is not appropriate in the absence of programs found to be helpful.

Aged↗

PubMed1994

Hospital wage and price controls: lessons from the Economic Stabilization Program.

The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today.

Cost Control↗

PubMed2004

A survey evaluating the beliefs of radiology residency program directors regarding incorporation of numeric standards into accreditation standards.

RATIONALE AND OBJECTIVES: Numeric standards do not exist for the evaluation and comparison of radiology resident education. The Accreditation Council for Graduate Medical Education has recently proposed the evaluation and assessment of residents by using numeric values for films read in various radiology modalities. The purpose of this study was to evaluate radiology residency program directors' perceived need for numeric standards for radiology residency programs. MATERIALS AND METHODS: Program directors were surveyed via a three-part questionnaire. Initial contact was made by e-mail, with follow-up by telephone if necessary. The survey questions were: (1) Do you feel that a need exists for a set of numerical standards for the number of films read by radiology residents in each of the various subspecialties? (2) Specify the needs that you see. (3) What are the barriers and disadvantages to acquiring such data? RESULTS: Survey responses were received from 44 of 192 radiology residency programs (23% response rate). Overall, 34 (77%) of 44 program directors were against implementation of the Accreditation Council for Graduate Medical Education proposal, whereas 8 (18%) of 44 program directors were in favor of the proposal and 2 (5%) of 44 were undecided. A variety of reasons, both for and against the proposal, were provided by program directors. CONCLUSION: Among the program directors responding to the survey, there was strong opposition to implementation of mandatory standards for specific numbers of radiologic examinations by residents as the basis for program accreditation.

Accreditation↗

PubMed2003

Spirituality and religion in Canadian psychiatric residency training.

OBJECTIVE: Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. METHODS: We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. RESULTS: We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. CONCLUSION: Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.

Canada↗

PubMed1998

Drug testing as part of the war on drugs.

Drug testing programs in the United States may broadly be classified as mandatory (such as under DOT or Nuclear Regulatory Commission regulation) or nonmandatory. In the first group, a regulated employer is required by federal regulations to test. In the second, the employer chooses to test for reasons other than the federal requirements. It always was intended that the federal program would be the model for testing by private employers, and that mandatory testing would be extended to private employers who are regulated by various agencies of the federal government. This has happened. In addition, private employers who are not required to test under federal authority have instituted employee drug testing programs closely modeled on the federal program. Whether mandated or not, a well-designed and implemented drug testing program is a valuable tool in the effort to fight drugs in the workplace.

Government↗

PubMed1995

[The language and speech skills in 417 children with cleft formations].

Children with cleft palate often suffer from hearing, speech, and language articulation disorders. In order to design an efficient rehabilitation program for children thus affected, it is mandatory to acquire knowledge of the long term results achieved by the various therapeutical strategies including velopharyngoplasty and speech therapy. In this follow-up study 417 children with cleft palate (excluding isolated cleft lip) were examined in an interdisciplinary approach by maxillofacial surgeons, orthodontists, otolaryngologists, audiologists, and speech and language pathologists. The examinations determined that 93% of the children had speech or language disorders and 80% of these children suffered from mild to severe conductive hearing loss with or without clinical signs of otitis media with effusion. In 58 children (14%) with rhinolalia aperta, which had not been improved after one year of speech therapy, velopharyngoplasty with a cranial based pharyngeal flap was performed. The study showed that language skills do not correlate to the type of cleft palate, but rather to the frequency and degree of hearing loss. Using an interdisciplinary approach in early detection and the prompt clinical correction of cleft palate disorders resulted in only 49% of the affected children having to undergo speech and language therapy. In 51% of the affected children no speech therapy was necessary at all. The results presented in this study lead to the conclusion that our program for managing the rehabilitation of children with cleft palate is efficient.

Adolescent↗

PubMedDate not supplied

A public health response to emerging technology: expansion of the Massachusetts newborn screening program.

The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged governments worldwide to consider expanding universal newborn screening for rare metabolic disorders. In 1997 the Massachusetts Department of Public Health developed a public process to meet this challenge. After addressing significant medical, legal, ethical, and logistical issues raised by tandem MS, Massachusetts incorporated one new disorder into the mandatory newborn screen and developed an optional pilot program for 20 additional disorders. The Massachusetts experience has wide relevance for other nations and states. As screening protocols are contemplated for entire populations-for newborns and others- it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.

Ethics, Medical↗

PubMedDate not supplied

The role of free dental programs in care provision for the underserved.

UNLABELLED: Due to the shortcomings of the existing healthcare delivery system in general, and the dental field in particular, safety net programs are not simply optional; they are mandatory to help meet the overwhelming healthcare needs of the underserved. Free dental clinics are a vital part of this system, and indeed, millions of actual dollars, millions of dollars worth of services and thousands of hours of professional manpower are donated each year to provide free dental services for the needy. The short-term benefits of these clinics are obvious, the rendering of dental care to tens of thousands of individuals per year who would otherwise go without. The long-term advantages may be somewhat less than obvious, however. Given that most dental professionals have limited contact with the underserved, the free clinics offer the opportunity to bring in volunteer dentists, hygienists, and dental assistants who may then gain first-hand knowledge of the access crisis and work directly with North Carolina's growing population in greatest need of dental care. Additionally, the free clinics often offer the same benefit for dental students from the University of North Carolina at Chapel Hill, as well as for undergraduate pre-dental students. This is a key aspect, as for every one of these students who may eventually enter the dental profession with a willingness to provide for the underserved population, tens of thousands of individuals in need could potentially receive dental treatment over the span of a dental career. The challenges of beginning and maintaining a free dental program over the long term are daunting. However, for those willing to invest the time and effort, the resources are available for long-term success with a resultant significant, positive impact on the dental care access crisis now in existence. As stated by Dr. Franklin M. Boyar in describing his free dental program in Florida, " PROJECT: Dentists Care is simply an organization that brings together unmet health needs of indigent populations within our communities with the desire of individual dentists to help their fellow man, along with the responsibility of a profession to deliver needed care to the underserved." Inherent in consideration of itself as a profession is the understanding by the component members of dentistry that it is indeed a responsibility, not simply an option, to deliver needed dental care to all citizens, regardless of their ability to pay. At the heart of any successful resolution of the dental care access crisis is the ability of dental providers to accept this responsibility, significantly increase Medicaid acceptance, willingly participate in access initiatives, and provide the care for which they have been granted licensure by the citizens of North Carolina.

Dental Clinics↗

PubMed2005

Decreasing latitude and increasing regulation in transplantable tissue programs.

ADVANCED TECHNOLOGY and improved surgical techniques have led to new therapeutic uses for allografts. DISEASE TRANSMISSION via allograft tissue transplants has prompted federal intervention in the tissue banking industry and resulted in federal regulations. NEW STANDARDS from the Joint Commission on Accreditation of Healthcare Organizations became effective July 1, 2005, and apply to all hospitals that store or implant allograft tissues. These standards include mandatory policies on all aspects of hospital transplantation programs, including tissue ordering, receipt, storage, issuance, and record keeping.

Federal Government↗

PubMed1999

Florida's bicycle helmet law and a bicycle safety educational program: did they help?

INTRODUCTION: This research studied the effectiveness of Florida's mandatory helmet law for children and a community bicycle safety campaign promoting helmet use. Children's use of helmets before and after the law's enactment and the type and extent of head injuries sustained in bicycle crashes were evaluated. METHODS: The trauma and medical records from Broward General Medical Center's Pediatric Referral Trauma Center provided demographic data, injury severity scores, and information on the type and extent of head injuries sustained. Data were compared using independent sample t tests and Pearson chi(2) statistics with.05 as the significance level. RESULTS: Each group consisted of 72 children, predominantly 7- to 12-year-old boys. Known helmet use rose from 5.6% to 20.8%, with children aged 10 to 12 years having the greatest increase in helmet use (27%). Helmet use rose in urban and suburban areas. Changes in the type and extent of head injuries were mixed. Injury severity scores were higher for nonhelmeted children in the after-law group. DISCUSSION: Although helmet use increased, especially among the 7- to 12-year-olds targeted during the bicycle safety campaigns, bicycle helmet use remains too low, and nonhelmeted children continue to have a higher risk for serious injuries. Community bicycle safety programs that promote helmet use remain an important adjunct to mandatory helmet use laws.

Attitude to Health↗

PubMed2000

Teaching scientific integrity and research ethics.

Cases of misconduct in scientific research have enforced a lively public and scientific discussion. The international scientific community has been engaged during the last years in the search for adequate responses to fraud and misconduct. Most of the new guidelines emphasize the responsibility of researchers and scientific institutions for preventive measures; the teaching of research ethics should be included in undergraduate and postgraduate academic education. At the Universities of Ulm and Marburg members of the 'Study group Ethics in Medicine' are developing a teaching program in Research Ethics. They now offer courses: teaching in small groups (7-15 participants) with structured case discussions. These courses are not mandatory. The first steps in the development of the teaching program for young scientists in medicine, biology, chemistry, and physics have been taken. The fields of conflicts in these different fields of science are very similar. We offered five case discussion sessions with mixed groups (postgraduate students, postdocs, head of departments) and the first results are very positive: high acceptance, high motivation, high demand for next courses.

Attitude of Health Personnel↗

PubMedDate not supplied

A national survey of state maternal and newborn drug testing and reporting policies.

The prevalence rate of drug use by pregnant women in the United States has been shown to range from 7.5 percent to 11 percent. Drug exposure in utero has been associated with deleterious effects on the fetus and newborn. Public health officials are currently confronted with difficult policy decisions with regard to testing and reporting of pregnant and post-partum women and the provision of appropriate services. The widespread lack of consistent policy on the State level has led to bias in testing and reporting procedures and to the inappropriate use of the legal system as a deterrent to drug use during pregnancy. A survey of the 50 States and the District of Columbia found that no State currently has enacted legislation regarding testing. Thirteen States have mandatory reporting policies for drug-exposed newborns. Eleven of these States require reporting to social service agencies, at least 3 States routinely report to criminal justice agencies, and 10 require that reports be filed as child abuse or neglect. Many States without mandatory reporting statutes indicate that reports are made to social service agencies at the discretion of the health care provider. During fiscal year 1990, only 22 States specifically allocated funds for programs that address perinatal substance use. In States with mandatory reporting policies, reports should be made only to social service agencies in conjunction with the provision of appropriate preventive, medical, and social services to the woman and her infant. Interagency coordination is necessary to standardize testing and reporting practices within States and to effectively allocate resources.

Female↗

PubMed1994

Confirmatory tests for drugs in the workplace by gas chromatography-mass spectrometry.

The Mandatory Guidelines for Federal Workplace Drug Testing Programs require the use of gas chromatography-mass spectrometry (GC-MS) for the confirmation of presumptive positive urine specimens. This review focuses upon GC-MS methods developed specifically for forensic confirmation of amphetamine, methamphetamine, 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (THC-acid), benzoylecgonine, morphine, codeine and phencyclidine in urine for purposes of workplace drug testing. In addition, current laboratory issues pertaining to each drug class are reviewed. Generally, drug assays utilized either liquid-liquid or solid-phase extraction methods, derivatization if necessary, and GC-MS detection operating in the selected ion monitoring mode or by full scan acquisition.

Amphetamines↗

PubMedDate not supplied

Introducing baccalaureate student nurses to gerontological nursing.

The faculty at the University of Missouri-Columbia Sinclair School of Nursing (MUSSON) developed and implemented a gerontological nursing care course, with support from the Health Resources and Services Administration, the American Association of Colleges of Nursing, and the John A. Hartford Foundation. The course, with both didactic and clinical components, was mandatory for all students in the baccalaureate program. The course drew on two resources unique to the MUSSON: Senior Care, the school's home care agency, and TigerPlace, a retirement community closely linked to the school. Goals of the course were to increase knowledge of gerontology and gerontological nursing and to promote more positive student attitudes toward older adults. Evaluation of six semesters of pretest and posttest data found that knowledge increased although attitudes toward older adults did not become more positive. However, despite the lack of quantifiable improvement in attitudes, some students wrote positive comments on end-of-semester course evaluations about experiences and interactions with older adults during the course.

Adolescent↗

PubMed2005

A comprehensive grassroots model for statewide safety improvement.

BACKGROUND: The Maryland Patient Safety Center (MPSC) a collaboration of the Maryland Hospital Association and Delmarva Foundation for Medical Care, Inc., was designated by the State of Maryland in June 2004. A voluntary, nonregulatory initiative, the MPSC complements the state's regulatory efforts in mandatory reporting and support for performance improvement. PROGRAMS: The MPSC's mission is to bring health care providers together to understand causes of unsafe practices and to put practical, evidence-based improvements in place. Using a multifaceted approach, the MPSC implements its mission through education and training, safety culture collaboratives, adverse-event and near-miss reporting, research, and special projects. Participation in these initiatives is provided at no cost to Maryland providers. Early results show that health care leaders and front-line workers are embracing the MPSC's vision to make Maryland's health care the safest in the nation. More than 2,500 health care providers have participated in the MPSC's programs in its 15 months. Eighty percent of the state's hospitals are taking part in the intensive care unit (ICU) Safety Culture Collaborative, which has already yielded a 36% decrease in catheter-related blood stream infections and a 20% decrease in ventilator-associated pneumonia. A MODEL FOR OTHER STATES: The MPSC's approach can serve as a model for other states to emulate.

Adverse Drug Reaction Reporting Systems↗

PubMed2006

[Ultrasound techniques in anesthesiology--guided vascular access using sonography].

In anaesthetic practise ultrasound can facilitate cannulation of veins and arteries not only in adults but also in children. It is the main advantage and safety feature of this technique, that the targeted vessels and the surrounding anatomical structures are visualized and that the needle is advanced under continuous observation. Moreover, its systematic use can reduce the rate of unsuccessful cannulation attempts, which can be caused by anatomical variations or thrombi, occluding the targeted vessel. Ultrasound guided vascular cannulation can decrease complication rates and might improve patients safety e.g. by avoiding puncture of the carotid artery. However, in order to pass on these potential benefits to the patient and justify the increased expenses related to the purchasing of preferably portable ultrasound systems, it is mandatory to offer an appropriate ultrasound training programs for physicians using this technique.

Anesthesia↗