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Biomedical subjects

Judith Green-McKenzie

Publications and source records attributed to Judith Green-McKenzie.

13 recordsLinked to original sources
PubMed2006

Duration of time on shift before accidental blood or body fluid exposure for housestaff, nurses, and technicians.

BACKGROUND: Shift work has been found to be associated with an increased rate of errors and accidents among healthcare workers (HCWs), but the effect of shift work on accidental blood and body fluid exposure sustained by HCWs has not been well characterized. OBJECTIVES: To determine the duration of time on shift before accidental blood and body fluid exposure in housestaff, nurses, and technicians and the proportion of housestaff who sustain a blood and body fluid exposure after 12 hours on duty. METHODS: This retrospective, descriptive study was conducted during a 24-month period at a large urban teaching hospital. Participants were HCWs who sustained an accidental blood and body fluid exposure. RESULTS: Housestaff were on duty significantly longer than both nursing staff (P=.02) and technicians (P<.0001) before accidental blood and body fluid exposure. Half of the blood and body fluid exposures sustained by housestaff occurred after being on duty 8 hours or more, and 24% were sustained after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4% among housestaff, and 3% among phlebotomists. CONCLUSIONS: Housestaff were significantly more likely to have longer duration of time on shift before blood and body fluid exposure than were the other groups. Almost one-quarter of accidental blood and body fluid exposures to housestaff were incurred after they had been on duty for 12 hours or more. Housestaff sustained a higher rate of accidental blood and body fluid exposures than did nursing staff and technicians.

Accidents, Occupational↗
PubMed2006

Outcomes from the occupational physicians scholarship fund: private support for physician residency training.

The Occupational Physicians Scholarship Fund (OPSF) was established 20 years ago with the goal of helping to address the critical shortage of qualified physicians entering occupational and environmental medicine (OEM). We examined descriptive and outcome measures to evaluate its success. Information was obtained from members of the original board of directors, the OPSF office, and the American Board of Preventive Medicine (ABPM). Most of the scholars (88%) are diplomats of the ABPM, certified in OEM. Scholars represent 6% of board-certified OEM physicians, score higher on the certifying examination than other examinees, practice in all regions of the United States, and are represented in diverse practice settings. The OPSF has achieved its objectives, producing well-trained physicians who contribute to the growth and vitality of the specialty improving worker health, business productivity, and the environment.

Education, Medical↗
PubMed2005

Grand rounds: latex-induced occupational asthma in a surgical pathologist.

CONTEXT: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. CASE PRESENTATION: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. DISCUSSION: The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

Asthma↗
PubMed2005

Lowering the risk.

Explore the source record for details and available documents.

Blood-Borne Pathogens↗
PubMed2004

Workers' compensation: a historical review and description of a legal and social insurance system.

The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.

Humans↗
PubMed2004

Managing workers' compensation costs: success of initiatives to change outcomes.

The cost of workers' compensation health care has been a challenge during the past few decades. Various programs have been initiated on the local, state, and national levels to address this issue. The purpose of this article is to examine some of the programs that have initiated cost control measures. Most of those published claim successful outcomes. The initiatives reviewed herein were instituted at medical centers in Maryland and Pennsylvania, at casino hotels in Nevada, at an occupational health clinic in Ohio, at an electrical union in New York State, and at an insurance company. Initiatives in Minnesota and Washington State are also described. Sharing the outcomes of initiatives may allow such research to be translated into action on a broader scale.

Cost Control↗
PubMed2004

Workers' compensation costs: still a challenge.

The workers' compensation system in the United States, comprised of independent state based and national programs for federal workers, covers approximately 127 million workers and has evolved and grown since its inception in 1911. Coverage has significantly broadened in scope to allow for the inclusion of most occupational injuries and illnesses. The cost of workers' compensation care has also increased. Some of the cost drivers have been identified,and various approaches have been taken to address medical cost containment. There is a need to balance cost control with ensuring benefit adequacy and quality of medical care. It is likely that managing workers' compensation costs will continue to be a challenge in the foreseeable future. The cost of workers' compensation care affects all stakeholders including workers, employers,providers, state workers' compensation regulators, legislatures,and insurers. A continued commitment to quality, accessibility to care, and cost containment, and being alert to emerging issues that can affect these elements, will help ensure that workers are afforded accessible, high quality, and cost-effective care.

Cost Control↗
PubMed2004

Training African-American residents in the 20th century.

Bellevue Hospital, the oldest public hospital in the United States and a lineal descendant of an infirmary for slaves, accepted its first African-American resident, Dr. Ubert Conrad Vincent, in 1918. This occurred at a time when many medical centers were not accepting African-American residents. At the end of WWII, one-third of the accredited medical schools still barred African Americans. However, Bellevue Hospital continued to train African-American residents. Between the 1920s and 1940s four African Americans matriculated at Bellevue Hospital. There were six in the 1950s, four in the 1960s, and 25 in the 1970s. By the 1980s, 40 African Americans matriculated, and between 1990 and 1995, 61 matriculated. Despite its historic first, Bellevue lagged slightly behind the national average. While the number of African-American residents occupying U.S. residency slots increased from 2.8% in 1978 to 6.5% in 1996, African Americans comprised 3.6% of residency slots at Bellevue between 1985-1995. Currently, only 7% of practicing physicians and 5% in faculty positions are latino, African-American, and Native American. Increasing the number of under-represented minority (URM) physicians is important to the United States, as URM physicians are more likely to serve the poor and uninsured, therefore improving the overall healthcare of the underprivileged. A study by the Association of American Medical Colleges indicated that minority medical school graduates were five times more likely to report that they planned to serve minority populations than other graduates. In their position paper, the American College of Physicians expressed the belief that increasing the number of URM physicians will help reduce healthcare disparities that can hurt minority populations and lead to poor health outcomes. The Supreme Court acknowledged the importance of racial diversity by upholding the University of Michigan affirmative action admissions policy in its June 2003 ruling. URM physicians are needed not only to serve minority populations but also to serve as mentors and role models for prospective and current students. The first African-American resident to graduate from the Bellevue Residency Program did indeed treat the underserved, as Dr. Vincent founded the Vincent Sanatorium, dedicated to treating African-American patients, and training African-American nurses and doctors. Over the course of the 20th century, Bellevue Hospital has trained increasing numbers of African-American physicians. It is hoped that, like their predecessor, Dr. Vincent, they will provide care to underserved communities and to the community as a whole, as well as serve as role models for generations to come.

Black or African American↗
PubMed2002

The effect of a health care management initiative on reducing workers' compensation costs.

The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.

Costs and Cost Analysis↗