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PubMed1991

Surgeons and HIV.

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Ethics, Medical↗
PubMed1990

Legal and ethical issues relating to AIDS.

The worldwide AIDS epidemic has posed an extraordinary array of ethical and legal challenges. The work presented here reviews three issues at the heart of the matter: discrimination against HIV-infected people, the limits of confidentiality, and the exercise of coercive government powers to limit spread of the disease. Because the authors are most familiar with the U.S. experience, the review deals primarily with the history of the epidemic in the United States and public responses to it in that country.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The costs of employee smoking. A computer simulation of hospital nurses.

A computer simulation model of the economic impact of employee smoking on an employer was developed with a population of hospital nurses as the example. Net economic impact was calculated by estimating cumulative costs borne by the employer under various scenarios and comparing them with projected costs estimated from baseline data. The model included the following: baseline number of staff, baseline percentage of smokers, annual employee turnover rate, number of smokers interested in quitting, the cost of a smoking cessation program, expected success rate of a voluntary cessation program, smokers quitting spontaneously without a program, and employer-borne costs related to employee smoking. A variety of scenarios were constructed to generate a range of employer net economic impact figures and resulting percentages of smoking employees. Results showed that the benefits of a cessation program would be eliminated over several years, unless the prevalence of smoking in incoming employees was reduced. The most favorable scenario, combining a hospital cessation program and reduced smoking among new employees, generated cumulative savings, discounted at 5%, of $358,000 to $684,000 over an eight-year period.

Computer Simulation↗
PubMed1993

Leadership development for medical students--beyond the prescription pad.

BACKGROUND: Physicians are often perceived as leaders in their communities and are expected to participate in politics, business, and volunteer activities. Medical students receive little guidance about becoming effective community leaders. PROGRAM DESCRIPTION: We developed a leadership training program for medical students. Participation in the program was voluntary. The principal forum for this program was a dinner seminar series, which emphasized presentations by current community leaders and identification of leadership opportunities in which medical students could participate. PROGRAM EVALUATION: Information collected at the onset of the program identified the students' concern and priorities regarding leadership activities. Seventy-seven percent of participating students identified good communication skills as the most important quality of a leader. In identifying an issue in which physicians might become involved, students noted only medically related issues, such as access to health care. No long term evaluation data are available to assess the effect of this program. CONCLUSION: Medical school curricula should teach students the leadership skills they will need to participate in community activities.

Community Participation↗
PubMedDate not supplied

A balancing act: the tension between case-finding and primary prevention strategies in New York State's voluntary HIV counseling and testing program in women's health care settings.

This study sought (1) to identify factors that influence women's willingness to accept voluntary HIV counseling and testing at New York State Family Planning Programs (FPPs) and Prenatal Care Assistance Programs (PCAPs) and (2) to evaluate the effectiveness of such a voluntary counseling and testing program. Telephone interviews elicited organizational-level data from 136 agencies; a combination of telephone and face-to-face interviews was used to gather provider data from 98 HIV counselors; and client data were gathered from 354 women in face-to-face interviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were tested returned for their results and posttest counseling. Clients' recall of pretest counseling content was relatively poor. Bivariate and regression analyses suggest that client, provider, and organizational factors are all associated with rates of pretest counseling and testing. The current voluntary counseling and testing program is achieving only moderate success. Although a substantial number of clients accept HIV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall important informational content, which suggests variation may exist in the quality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Headings (MeSH): AIDS, HIV serodiagnosis, women's health, patient education.

AIDS Serodiagnosis↗
PubMed1994

Closing the loop of patient care--a clinical trial of a computerized discharge medication program.

A frustrating time for hospitalized patients and their primary care providers is after discharge from the hospital, because of changes in patients' medications. We developed a computer program to improve the discharge process, by providing guidance to the physician writing the prescriptions, offering educational material to the patients, and providing electronic notification of medication changes to the primary care providers. During a one-year clinical evaluation of this system, in which use of the program was voluntary, 1000 patients were discharged through the program. House officers tended to use the program more often for patients who were older and in the hospital longer. Both house officers and primary care physicians found the program extremely useful, and the process took no longer than the manual method of creating discharge medication lists. Patients who were discharged using this program may have had better adherence to medication regimens. We conclude that computer-assisted compilation of a discharge medication list is a useful method for improving the discharge process.

Boston↗
PubMed1998

Consolidated billing and compliance program--Part 2.

On February 11, 1998, the Department of Health and Human Services Office of Inspector General (OIG) released guidelines to assist hospitals and their agents and subproviders to comply with Medicare and Medicaid regulations. While adopting and implementing a compliance program is voluntary, the OIG believes that such a program prevents fraud, abuse, and waste while simultaneously furthering providers' fundamental mission--to provide quality care.

Fraud↗
PubMed1989

Umbilical cord blood serosurvey for human immunodeficiency virus in parturient women in a voluntary hospital in New York City.

The potential spread of the human immunodeficiency virus (HIV) to childbearing women in areas of high acquired immunodeficiency syndrome (AIDS) endemicity is a major public health concern. As a private institution providing obstetric care to such a population of women, we undertook an anonymous HIV cord blood serosurvey to estimate the number of childbearing women at our institution at risk for perinatal transmission of the virus and to assess the success of our voluntary screening program to identify seropositive women. Between November 1987 and January 1988, cord blood samples from all clinic deliveries were analyzed for the presence of HIV antibody. For each sample obtained, the mother's age and site of prenatal care were known. Overall, 2.7% (six of 224) of the samples tested were seropositive; two of the 34 samples (5.9%) from teenage mothers were seropositive. All positive samples were from women who received prenatal care; none were identified through a voluntary screening program based on patient self-acknowledged risk-behavior assessment. This confirms that risk factor history elicited by personal interview is not a reliable screening tool for initiating HIV antibody counseling and testing. The high seropositive rate in teenagers is disturbing and needs further assessment.

AIDS Serodiagnosis↗
PubMed1992

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.

Adult↗
PubMed1995

Home health agencies: targets of anti-fraud and abuse investigations.

Increased health care fraud and abuse investigations could result in home health agencies, and other targets, becoming politically acceptable casualties of war in the battle to balance the federal budget. To protect themselves, home health agencies would be well advised to conduct internal fraud and abuse audits on an annual basis and to develop corporate compliance plans (see Newsletter, Vol. 9, No. 7, July 1994, at 16, and next month's issue, which will discuss corporate compliance programs as well as the OIG's new voluntary disclosure program). In addition, purchasers of home health agencies should be especially vigilant of fraud and abuse problems during the due diligence phase of the acquisition and, if problems are discovered, should consider whether voluntary disclosure to the OIG and settlement of any resulting claims is an appropriate condition of closing.

Aged↗