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PubMed1987

Evaluation of a microcomputer program (OPT) for parameter optimisation in clinical pharmacokinetics: gentamicin and tobramycin.

1. Several nomograms and computer programs are available to aid in aminoglycoside dosing. 2. Due to the variability in the relationship between dosage and serum drug levels, monitoring through the acquisition of serum drug levels is mandatory. 3. All clinical data, including serum drug levels, are subject to errors. 4. The program we have evaluated, OPT, calculates the most likely set of pharmacokinetic parameter estimates for individual patients by applying Bayes' theorem and the principle of Maximum Likelihood Estimation. Through a feedback process all available data are used, taking possible errors into account. 5. Our study shows that OPT is able to predict serum aminoglycoside levels accurately in the routine clinical setting. It may thus contribute to the quality of aminoglycoside therapy.

Adolescent↗
PubMed2002

Palliative care module within a required geriatrics clerkship: taking advantage of existing partnerships.

OBJECTIVE: LCME has recently required that all graduating medical students learn about end-of-life care. This program describes the design and integration into an existing geriatrics clerkship of a palliative care module that teaches the foundations of end-of-life and palliative care to medical students. DESCRIPTION: Faculty experts in geriatrics met during a series of weekly meetings in 1999 to design a mandatory four-week-long clinical clerkship in geriatrics. Since the palliative care program is based within the geriatrics department, faculty members with interest and expertise in both geriatrics and palliative care were invited to design a palliative care module that can be integrated into the clerkship. Since LCME does not specify details of what students must learn about end-of-life care, and our goal is to educate and prepare students for any chosen specialty, we wanted to design a basic core curriculum in palliative care that would be useful to any graduating student. After reviewing potential palliative care topics, and given limited curriculum time, we condensed the medical student core curriculum to the following sessions: (1) Systematic Pain Assessment Management, (2) Management of Distressing Symptoms, (3) Communicating Bad News, and (4) Advance Directives. We developed PowerPoint presentations, teaching case vignettes, and a set of reference articles, which can be distributed to students as well as to help faculty teachers prepare for the sessions. Teaching sessions occur in small groups, using case discussions and interactive lectures. Sessions 3 and 4 are co-facilitated by palliative care physicians and ethicists, who use role-plays, reflections, and discussions to teach the topics. At the end of the clerkship, students practice these communication skills with videotaped standardized patient encounters, and debrief with faculty members about their performances and ways to improve their communication skills. DISCUSSION: Palliative care sessions are welcomed by the students, who traditionally have not received much teaching in this area. Even though students have learned about mechanisms regulating pain and other symptoms in the past, they have not learned to assess or treat symptoms in a systematic way. Students often have good questions about the decision-making, legal, and ethical issues that emerge for patients near the end of life. Thus, co-facilitation of physicians with ethicists presents both the practical clinical and the theoretical perspectives, and provides a good model for team teaching. In terms of teaching style, students are more involved and participatory when teachers use case vignettes as compared with slide presentations, even if they are case-based. When using role-plays to teach students how to communicate bad news, we found that students need to feel safe in that environment, need to know they can call for time out when necessary, and want to have seen one done before they are asked to do one.

Clinical Clerkship↗
PubMed2004

The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.

BACKGROUND: Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups. METHODS: All 122 medical schools in the United States were surveyed in 2001 to determine whether they required dedicated course work in musculoskeletal medicine, defined as a preclinical module or clinical clerkship in orthopaedic surgery, rheumatology, or physiatry. Data from the Electronic Residency Application Service were obtained for the class of 2002. From these two sources, the rate of applications from students to orthopaedic surgery residency programs was calculated as a function of exposure to a required course in musculoskeletal medicine. Subgroup analysis was further carried out for women and for African Americans, Latinos, and Native Americans. RESULTS: In 2002, there were 16,294 graduates of American medical schools, of whom approximately 55% had mandatory instruction in musculoskeletal medicine. The rate of application to orthopaedic surgery residency programs was 5.7% among the students with required instruction compared with a rate of 5.1% for students without such required instruction. The rate of application for female students was 2.0% for those who had required courses and 1.1% for the female students who had not had the required courses. The rate of application for minority students in schools with required courses was 8.2% compared with a rate of 6.1% for those students without such exposure. CONCLUSIONS: Required instruction in musculoskeletal medicine was associated with a 12% higher rate of application to orthopaedic surgery residency programs among all students (5.7% of those who received required instruction compared with 5.1% of those who did not). The relative difference was more pronounced among women (a 75% difference in the rate of application) and minorities (a 35% difference in the rate of application). This study suggests that required instruction in musculoskeletal medicine can help to promote diversity in orthopaedic surgery residency programs.

Cultural Diversity↗
PubMed2005

Mandatory alcohol intervention for alcohol-abusing college students: a systematic review.

Most colleges and universities in the United States have programmatic responses for alcohol policy violators that commonly include some form of mandatory alcohol education or counseling. The purpose of this study was to conduct a review of intervention programs for college students who are required to attend alcohol education or counseling. MEDLINE, PsycINFO, and ERIC databases were searched for reports of college-based mandatory interventions offered on American campuses. When possible, within-group and between-group effect sizes were calculated. Sixteen reports were identified, including three randomized controlled trials. Most of the reviewed studies used qualitative or quasi-experimental designs, did not include comparison or control groups, had small or selective sample sizes, lacked behavioral measures of alcohol consumption, and/or had no follow-up, low follow-up rates, or short follow-up intervals. Recommendations for future research include testing different modes and types of interventions and sanctions, evaluating long-term efficacy, and establishing cost-effectiveness.

Alcoholism↗
PubMedDate not supplied

Criteria for organized cervical screening programs. Special emphasis on The Netherlands program.

Based on the criteria of Wilson and Jungner and experiences in the population-based organized cervical screening program in the Netherlands, conditions for efficient and effective population screening for cervical cancer are described. The purpose of this paper is to determine if these criteria are met for cervical cancer screening and to give recommendations for improvement. Cervical cancer is still an important health problem; the present incidence reflects both background risk and screening activity during previous decades. A positive effect of screening is reached because of the long development time of the disease and the ability of the Pap smear test to detect precancer and early, symptomatic disease. Considerable reduction in the incidence and mortality of cervical cancers can be reached if all women attend and all detected lesions are adequately followed up. Common terminology and classification criteria for histology and cytology should be used. Whether newly developed techniques that may improve or replace cytology can be used in screening programs should be a multidisciplinary decision after clinical trials have given evidence-based information on the performance, cost-effectiveness and need of these techniques. When cervical cancer screening is undertaken, it should be offered in organized programs at the medical level closest to the patients, the general practitioner. High compliance is the most important factor in reducing cervical cancer incidence. Quality control and assurance must be performed at all levels. In the case of limited resources, the program should use a five-year interval and concentrate on the age range 25-60 years, with special attention to women who have never been screened or were screened > 10 years previously. Evaluation of medical and organizational aspects is mandatory. Cooperation between all involved parties is a prerequisite of creating a successful screening program.

Cost-Benefit Analysis↗
PubMed1989

Mandatory testing for the AIDS antibody.

The appearance of Acquired Immune Deficiency Syndrome (AIDS) has brought suffering and death to those who are afflicted. At the same time, this disease has posed enormous challenges to those who care for the sufferers, to biomedical scientists, and to those responsible for public health and social policy. The issue addressed in this article is whether the implementation of mandatory testing for the AIDS antibody is an appropriate and effective strategy to use in coping with the AIDS epidemic. The goal of an AIDS prevention program is to prevent transmission of Human Immunodeficiency Virus (HIV) infections. The pro and con aspects of using mandatory AIDS antibody testing to achieve this goal are given in issue statements. The opinions of leading authorities are presented, followed by a general review of the literature. The literature is then reviewed concerning the issue as it effects the nurse as an individual, the nursing profession, and the health-care delivery system. A position is taken and specific recommendations are proposed for the profession in the areas of practice, legislation, and research.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Survivor training challenge. . . A creative approach to safety education program in a long term care facility.

Each year, the state of Wisconsin requires nursing homes to hold mandatory training sessions on several safety-related topics. These training sessions must include an update on infection control, a review of blood borne pathogens, techniques in accident prevention and information on bio-hazardous materials. This article outlines an inservice developed at Attic Angel Place in Madison, Wisconsin. Using the popular television show Survivors, the facility developed an obstacle course-like survivor training program dealing with accident prevention and bio-hazardous materials. 130 of the facility's 150 full and part time employees attended the "Survivor's Challenge".

Accident Prevention↗
PubMed1998

AIDS control and the workplace: the role of occupational health services in South Africa.

AIDS interventions typically fail to address the disjuncture between private behaviors and the social determinants of HIV infection. Data from a telephone survey of manufacturing companies and a postal survey of occupational health nurses in the Western Cape, South Africa, were used to explore the possible role of occupational health services in prevention and control of AIDS. The author found limited evidence of worker involvement in AIDS programs, particularly in companies with occupational health professionals. The management of sexually transmitted diseases was incomplete. Mandatory pre-employment testing of workers for HIV was not widespread. Respondents' opinions on priorities for AIDS prevention and control reflected a preoccupation with knowledge transfer. To ensure their effectiveness, workplace AIDS programs must improve worker participation and integrate AIDS prevention in general workplace health and safety programs. In addition, education programs must develop objectives within a critical theoretical understanding of the behavioral issues relevant to AIDS prevention, and must emphasize the empowerment of women in the workplace. In the context of the present restructuring of health services in South Africa, occupational health services, using the strategies outlined, can make a major contribution to national AIDS prevention and control.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Paedophilia: a review of the evidence.

OBJECTIVE: The aim of this study was to critically review the literature concerning the nature ane prevalence of paedophilia. METHOD: The literature of the past 30 years was examined in relation to the author's clinical experience and with emphasis on methodologically appropriate empirical studies. RESULTS: Concern and reporting of child-adult sexual activity has increased markedly in the last decade, although its prevalence has not increased at least since the 1960s. The prevalence in women can be as high as 60%, depending on the definition and method of enquiry used, and female compared to male victims report more negative effects, although a percentage of both men and women report the experience as positive. Validation of effects requires multivariate statistical analysis. Current pro-active procedures to identify paedophiles detect those who victimise boys but do not detect the much greater number of paedophiles who victimise girls. Perpetrators are known to the majority of their female and male victims, and those reported are almost all male; most boys do not consider their prepubertal experiences with older women abusive. Relapse prevention, the current most popular treatment, has been shown to be ineffective for incarcerated child molesters. CONCLUSIONS: Child-adult sexual activity should be opposed as an infringement of children's rights rather than requiring a false belief that it is invariably harmful; whether it should be mandatory for therapists to report it requires examination. Scientifically appropriate evaluation should be an essential component of current treatment programs.

Adult↗
PubMed1972

Compulsory sterilization. (Letter to the editor).

Angela R. Holder's conclusion (221: 229, 1972) that a decline in forced sterilization cases exists because "any system of compulsory sterilization is too near naziism to be acceptable in a democratic society" ignores present realities. At no time in American history has there been greater acceptance of the idea that human procreation must be regulated by coercive means. Many leaders of the movement for population control, for example, openly advocate mandatory sterilization, abortion, and birth control as part of their crash program for population stabilization. Simultaneously, a growing number of those concerned with genetic "quality" demand that individual rights be subordinated or destroyed for the good of society and the species. Meanwhile, the increasing minimization of the enormous complexities of the abortion issue to a morally and medically neutral therapeutic procedure, threatens to make abortions, as well as sterilization, innocu ous public health measures that could be forced on society if circumstan ces dictate. Moreover, as the public is conditioned to believe that these measures lack ethical ramifications, the day is hastened when they can be imposed without significant opposition.

Coercion↗
PubMed2001

A labor perspective of workplace violence prevention. Identifying research needs.

BACKGROUND: During the past decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard. Research by the National Institute for Occupational Safety and Health and the U.S. Department of Justice have bolstered these efforts. This research revealed that workplace violence is the second leading cause of traumatic-injury death on the job for men, the leading cause of traumatic-injury death on the job for women, and accounts for some 2 million nonfatal injuries each year in the United States. LABOR PERSPECTIVE: Ten years ago, the debate focused on whether workplace violence is an occupational hazard or strictly a police and criminal justice issue. Labor unions have joined with occupational safety and health professionals in recognizing that workplace violence is a serious occupational hazard that is often predictable and preventable. They have advocated that employers establish multidimensional violence-prevention programs. CONCLUSION: Although the nature of workplace violence varies from industry to industry, implementation of the federal Occupational Safety and Health Administration (OSHA) Violence Prevention Guidelines for Health Care and Social Service Workers and for Late-Night Retail Establishments is a high priority to unions in the affected industries. Labor wants employers to invest in protecting workers from violence through voluntary programs and state legislation, and it supports the promulgation of a mandatory federal OSHA standard. To that end, intervention research can play a key role in demonstrating effective, technically and economically feasible prevention strategies

Homicide↗
PubMed2002

The Medical Event Reporting System for Transfusion Medicine: will it help get the right blood to the right patient?

The Medical Event Reporting System for Transfusion Medicine (MERS-TM) collects, classifies, and analyzes events that potentially could compromise the safety of transfused blood to facilitate system improvement. This system is designed to collect data on near misses as well as actual events. Near-miss events are a valuable source of data because they occur more frequently than, but share many characteristics and causes of, actual events. Further, although most current reporting efforts describe only what has occurred with little attention to what caused the event, MERS-TM includes a standardized method of causal analysis. The standardization provided by MERS allows users to compare their experience with that of other organizations, which speeds learning across the entire transfusion medicine community. Important features of the MERS-TM system are that it is able to capture threats, hazards, near misses, injuries, and deaths; characterizes failures and recoveries systematically; identifies and provides causal codes for the entire range of system defects including technical, organizational, cultural, and human factors; raises staff awareness about error management; is easily integrated with existing quality assurance programs; has a consistent and straightforward classification method; enables compliance with mandatory Food and Drug Administration reporting and accreditation requirements; has features to deal with a high volume of reports; supplies Web-based training, data entry, and analysis; and provides comparative benchmarks from comparable institutions.

Blood Transfusion↗
PubMed1999

Newborn screening for human immunodeficiency virus infection in the Bronx, NY, and evolving public health policy.

New advances in the diagnosis and treatment of HIV infection continue to propel changes in public understanding of HIV infection and the administration of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory HIV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pregnant women and newborns (whose HIV status is unknown at the time of delivery) began in the summer of 1999. To better understand the impact this program might have on the patients who receive health care at Lincoln Medical and Mental Health Center (Lincoln Hospital), we evaluated our experience with the current NBS program prior to inauguration of the new expedited testing program. We evaluated the NBS program from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected infants born, mother's HIV status (if known) at the time of delivery, amount of time between blood sampling and return of the test results to the Hospital, and medical follow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patients who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with positive NBS screening test results were born to mothers who were known to be HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-infected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS program. The average time between sampling and receipt of results for all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV status was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing program for New York State will facilitate early diagnosis, prevention and treatment of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the time of delivery.

Female↗
PubMed2005

Models of interprofessional learning in Canada.

This article provides an overview of interprofessional education in Canada, with a view to defining programs at all levels in terms of what models have been employed. The available information implies that the lack of convincing evidence of the effectiveness of existing programs is probably the most serious problem for the expansion of interprofessional education. The objectives of the programs are both to increase the knowledge about the other professions and their scope of practice, and to improve team function, and there are a number of well-established interprofessional programs in Canada that are designed to achieve these objectives, and many other examples of programs that are partial or planned. Despite this, the present interprofessional education initiatives tend to involve only a small proportion of the total health work trainees. There is a need for programs that are more widespread. The most frequent model involves a mandatory experience, which is case-based, involves all the students registered in Health Faculties, and where the students form interprofessional student teams. In addition to examining believable cases, the students also learn some specific information about interacting with the other professions and gain knowledge about the roles, knowledge and contributions that can be made by professions other than their own.

Canada↗
PubMed2004

Analysis of outpatient surgery center safety using an internet-based quality improvement and peer review program.

Assessing the quality of care delivered in office-based outpatient surgery centers is difficult because formerly there was no central data collection system. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), in its ongoing effort to assess and improve patient care, has developed an Internet-based quality improvement and peer review program to analyze outcomes for surgery centers it accredits. Reporting is mandatory for all surgeons operating in AAAASF-accredited facilities. Each surgeon must report all unanticipated sequelae and at least six random cases reviewed by an accepted peer review group biannually. A total of 411,670 procedures were analyzed during a 2-year period (from 2001 to 2002). There were 2597 sequelae reported during this period. The most common sequela was hematoma formation following breast augmentation. Infection occurred in 388 cases. Deep vein thrombosis, pulmonary embolism, and intraoperative cardiac arrhythmias were found to occur in a frequency consistent with previous reports. Significant complications (hematoma, hypertensive episode, wound infection, sepsis, and hypotension) were infrequent. A total of 1378 significant sequelae were reported for 411,670 procedures. This calculates to one unanticipated sequela in 299 procedures (an incidence of 0.33 percent). Seven deaths were reported. A death occurred in one in 58,810 procedures (0.0017 percent). The overall risk of death was comparable whether the procedure was performed in an AAAASF-accredited office surgery facility or a hospital surgery facility. This study documents an excellent safety record for surgical procedures performed in accredited office surgery facilities by board-certified surgeons.

Accreditation↗
PubMed1995

Health care concerns related to lifting: an inside look at intervention strategies.

As members of injury prevention and injury management teams, physical therapists and occupational therapists have the opportunity to evaluate back stress associated with patient-lifting activities. In this study, three mathematical formulas are presented that can be used to objectively assess health care workers' maximum safe lifting capacity for moving patients. Recommendations to reduce the rate of back injury in health care workers include the use of lifting machines for moving patients, mandatory in-service education on body mechanics, and employee assistance programs that improve job satisfaction and worker morale.

Accidents, Occupational↗
PubMed1999

The role of medical organizations in supporting doctor-patient communication.

The clinical competence of physicians depends largely on the education, accreditation, certification and licensing programs offered by the various Canadian medical organizations. In virtually all of these, doctor-patient communication is a required element. Educational programs at all levels are subject to accreditation by a number of different organizations including undergraduate medical programs (Committee on Accreditation of Canadian Medical Schools), residency training (College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada) and continuing medical education (CFPC and RCPSC). Doctor-patient communication is a key element in teaching at all levels. The two colleges also emphasize communications in the certification process. The provincial licensing authorities are aware of the importance of effective communication between physicians and patients. Several of the them have physician assessment programs, and recently they have started to assess a model of mandatory performance review. Both of these approaches assess physician-patient communication. There is increasing pressure, with strong support from consumers, that some level of communication skills competency should be imposed by the licensing authorities. Most approaches to exposing physicians to communications focus on rewards rather than coercion but a number of possible schemes could be considered to promote communication skills.

Accreditation↗
PubMed1992

[Quality control in the allergy laboratory--4 years "Allergy Ring Trial" in Austria].

In 1988 the Austrian Society for Allergology and Immunology initiated an external quality control program for the in vitro allergy diagnosis. In 12 mailings, 62 sera from allergic patients were sent to selected laboratories in order to determine total and antigen specific IgE according to the laboratory-specific methods. The values for total IgE varied considerably (73.9% were within +/- 1 SD, 94.3% within +/- 2 SD and 99.1% within +/- 2 SD, but only 0.9% beyond that). Sources of error were mainly attributable to inappropriate equipment and low quality reagents, but also bad test performance, with respect to personnel and the routines. In contrast, antigen specific IgE against pollen, mites, moulds, insect venoms, animal danders, drugs, parasites, environmental and food antigens revealed quite homogeneous results. Out of 1492 data, only 46 (3.1%) had to be declared as "wrong", and the variability of the RAST-classes was low. Whereas the quality of the reagents from all the different suppliers was not absolutely reliable at the beginning of the study, it improved considerably with time, as consequence of our complaints. The comparability of the methods for detecting total-IgE were non-satisfactory, whereas those for antigen specific IgE were generally good. The variety of methods employed (radio- and enzyme immunologic, fluoro- and nephelometric methods, etc.) should entail appropriate consequences, especially critical comparisons within one and the same laboratory; in addition, international standardization of the "normal" values should replace company-standards, and quality control programs for each test system before it is marketed should be mandatory. Our results confirm, that external control should be obligatory for any laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗