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At least 19 recordsLinked to original sources
PubMed1990

Procedure-specific costs and savings in a mandatory program for second opinion on surgery.

Initial examination of the surgery experience of participants in a large employer-sponsored second opinion program revealed minimal savings in medical resource costs. But closer examination of relative savings for specific procedure categories showed that the greatest savings are for high-cost procedures: hysterectomy, prostatectomy, back surgery, and hip replacement. Furthermore, a nonconfirming second opinion does not dissuade patients from some procedures. Decisions about which procedures to include in a mandatory program should consider volume, costs, and effects of nonconfirmation, as well as the advantages of a mandatory second opinion for skeptical patients, or for patients for whom a controversial procedure has been recommended.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

A creative safety program.

Mandatory safety programs can be creative and fun using the instructional game approach. Games can be completed on the patient care unit when a free moment is available. Once the instructional games are developed, they can be used throughout the year to help the staff review safety policies, procedures, and standards.

Accident Prevention↗
PubMedDate not supplied

Self-learning packages in staff development.

Potential uses for self-learning packages in the nursing staff development setting include orientation programs, mandatory education programs, developmental programs, and review of infrequently used skills. The staff development educator can use pretest and posttest results obtained from the use of self-learning packages to document intervention with the learner. Benefits for both learners and staff development educators when this teaching strategy is used are described.

Education, Nursing, Continuing↗
PubMed1990

Cardiopulmonary resuscitation: a mandatory training program for nursing staff.

At Flinders Medical Centre, a 600 bed teaching hospital in Adelaide, South Australia, there are between eighty and one hundred cardiac arrests in the general wards areas each year. From the time an arrest occurs until the arrest team arrives, the patient's life will depend on the speed with which Cardiopulmonary Resuscitation (CPR) is initiated and the effectiveness of the CPR performed by ward staff. The outcome of cardiac arrest patients who receive promptly administered CPR is extensively documented in literature on the subject. When an arrest occurs in the ward at Flinders, staff activate an emergency call to the "cardiac arrest team", which consists of three medical staff members and one nursing staff member. The nurse, from the Intensive Care Unit, is responsible for coordinating the actions of the nursing staff during the arrest. Following the arrest an audit sheet is completed with details of the patient, the arrest, treatment, and any other pertinent information. Until 1985 it was not unusual at Flinders for arrest audit sheets to have comments such as: "CPR not performed by ward staff" or "CPR not being performed correctly by ward staff" or, even worse, "Ward staff disappeared when the arrest team arrived". In many hospitals throughout Australia this was, and may still be, a familiar problem. The nursing department at Flinders believed that if a program could be established in which nurses were given the opportunity to learn and practise CPR, they could gain the skills necessary to perform basic CPR in the ward until the arrest team arrived. In 1985 a coordinator of such a program was appointed, and it became mandatory at Flinders for all nursing staff to learn and be accredited annually in basic CPR skills. This article describes how the CPR Program started, its progress, and its results.

Cardiopulmonary Resuscitation↗
PubMed1985

Nosocomial rubella--consequences of an outbreak and efficacy of a mandatory immunization program.

An outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.

Adult↗
PubMed1990

Prevalence of psychiatric disorders in a mandatory screening program for infection with human immunodeficiency virus: a pilot study.

Ninety-five randomly selected human immunodeficiency virus (HIV)-seropositive Air Force personnel were psychiatrically examined during a routine medical evaluation. Of the 95, 95% did not have acquired immunodeficiency syndrome and were largely asymptomatic; 61.1% had clinical axis I diagnoses, which included simple phobia, adjustment disorders, hypoactive sexual desire disorder, alcohol use disorder, major depression, and organic mental disorders; 30.5% had personality disorders. Significantly higher frequencies (p less than 0.05) of simple phobia and hypoactive sexual desire disorder were noted with knowledge of HIV seropositivity. Disorders that occurred more commonly than in age-matched Epidemiologic Catchment Area (ECA) participants included: simple phobia, antisocial personality disorder, alcohol abuse, and organic mental disorders. The high prevalence of major psychiatric illness in this sample supports the notion that screening for psychiatric illness, and counseling where indicated, should be integral to HIV screening programs.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Determinants of provider selection or assignment in a mandatory case management program and their implications for utilization.

Mandatory managed-care programs for Medicaid beneficiaries typically require enrollees to select the provider who will act as gatekeeper to the medical care system. A substantial number of beneficiaries, however, do not exercise this choice and are assigned a gatekeeper. Using consumer survey data from the Missouri Managed Health Care Project, we examined characteristics and use experiences of assignees compared with selectors. We found that the assignees enjoyed better health than the selectors and were less likely to have had a regular source of care prior to the program. The utilization experience was similar for both groups. We conclude that the basis for not making a choice is one of indifference.

Adult↗
PubMed1986

Physical training programs for public safety personnel.

The nature of public safety jobs often reflects sudden strenuous exertion at a moment's notice. In the 1970s, police and fire departments became acutely aware of high numbers of on-the-job injuries and illnesses related to coronary heart disease. Disability payments for premature cardiovascular problems were being linked to cardiovascular risk factors accrued while on the job. This prompted public safety departments to initiate fitness programs for their employees. The fitness level of public safety personnel is not high. Job-related benefits have been linked to consistent physical training; high aerobic capacity, high muscular strength and endurance, above-average lean body weight, and minimal body fat are necessary for efficient job performance. In light of the physical benefits gained through regular exercise, pioneer departments began exercise programs for their personnel. These included the fire departments in Lawrence, Kansas, Alexandria, Virginia and Los Angeles, and the Dallas police department. Mealey documents psychologic improvements with exercise. Pioneer fitness programs such as that of the Los Angeles fire department have noted evidence of risk-factor reduction following institution of a mandatory program. The Alexandria department has instituted mandatory entrance requirements for their recruits, such as a no-smoking policy while on the job and mandatory exercise participation. Many community departments are not able to justify the institution of fitness programs. They may cite cost, lack of space, or lack of administrative support for the inability to initiate these programs. Legal and union ramifications may also deter the effort of program implementation. Considerations when implementing programs should involve cost of equipment, space, employee input, and determination of mandatory versus voluntary status. Preliminary medical screening and fitness evaluations should reliably evaluate an employee's physical ability to perform job-related tasks. The tests should be performed on a regular basis during employment. It is important, therefore, to convey the benefits of exercise to administrators. Frequent exercise testing should record progress of participants during exercise training and goals should be constantly updated. Pioneer programs should be used as models to follow when implementing a public safety physical training program. However, individual departments should evaluate the needs of their own personnel with respect to equipment, exercise schedule and type, and place of training.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Occupational↗
PubMed1990

Premarital screening for antibodies to human immunodeficiency virus type 1 in the United States. The Premarital Screening Study Group.

To evaluate premarital human immunodeficiency virus (HIV) screening as an approach to AIDS prevention in the United States, we determined the HIV antibody seroprevalence in marriage license applicants in eight areas by blinded testing of blood specimens routinely collected for syphilis serology. The seroprevalences were 0.0-0.4 percent in women and 0.0-1.1 percent in men. We also examined the impact of mandatory premarital HIV screening on marriage rates in Louisiana and Illinois. In 1988, after screening began, 9 percent and 16 percent fewer marriage licenses than in the previous two years were issued in Louisiana and Illinois, respectively. We estimated that mandatory premarital screening, if adopted nationally, would cost $167,230,000. We conclude that compared with other HIV prevention programs mandatory premarital screening would be expensive and would probably have a minor impact on the HIV epidemic.

AIDS Serodiagnosis↗
PubMed1977

Cost effectiveness of laboratory improvement programs: the viewpoint from the private sector.

The costs of participating in laboratory improvement programs are categorized and presented from the viewpoint of the laboratory. These include: prevention costs, appraisal costs, and compliance costs. Costs of participating in voluntary vs. mandatory programs are compared. Reduction of costs could be achieved by reducing duplication and overlapping of programs. In conclusion, it is difficult to identify the exact costs in any program, but it is estimated that for the individual laboratory it may represent 10-15% of the operating costs.

Cost-Benefit Analysis↗
PubMed1989

Multidisciplinary response of San Francisco General Hospital to the AIDS epidemic.

Acquired immunodeficiency syndrome (AIDS)-related services offered by San Francisco General Hospital (SFGH); programs to protect employees who are at occupational risk for infection with human immunodeficiency virus (HIV); and the legal, ethical, and economic implications of such infection are discussed. Support from public officials, health-care professionals, and the community has enabled SFGH to develop an extensive program of AIDS-related services. The program consumes 10% of SFGH's budget and was responsible for treating 1693 patients between January 1981 and June 1988. The hospital has two internationally recognized units dedicated to the care of AIDS patients. Many of the medical and support departments at SFGH contribute expertise directly; clinical and basic research are also conducted. Other services sponsored by the hospital include HIV testing and counseling; special training for physicians and nurses; assisting patients with finances, housing, and home care; emotional support; and community education. Expenses per patient are lower at SFGH than nationally because of contributions from the private and public sectors, but costs are not fully recovered. Hospital employees are protected by a body substance precautions program, a comprehensive needle-stick program, mandatory reporting and evaluation of all exposures, and enrollment in a study to document seroconversions. Confidentiality and compensation remain major concerns. San Francisco General Hospital has a model program of caring for patients with AIDS and protecting its workers, but the issue of compensating those employees who do become infected with HIV has not yet been resolved.

AIDS Serodiagnosis↗
PubMed1992

Individual advocacy as a governing principle.

Many case managers have two roles, that of gatekeeper and that of advocate, that often conflict. A true advocate adopts the client's perspective as the guide for activity. Many advocacy models exist, notably those of physician/patient and lawyer/client. The client's rights to an informed choice and to strict confidentiality are fundamental to these advocacy models and must be incorporated into any advocacy model of case management.

Cost Control↗
PubMed1979

Optical identification and traceability potentials.

This brief outline of optical identification potentials alerts law enforcement agencies to the early developments in the field. The present elective system of I.D. classification may become a mandatory program for universal traceability in the future.

Classification↗