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Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE; partial implementation of Pharmacy Benefits Program; implementation of National Defense Authorization Act Medical Benefits for fiscal year 2001. Office of the Secretary, DoD. Interim final rule.

This interim final rule implements several sections of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001. The rule allows coverage of physical examinations for beneficiaries ages 5 through 11 that are required in connection with school enrollment; provides an additional two-year period for survivors of deceased active-duty members to remain eligible for TRICARE medical and dental benefits at active-duty dependent rates; extends eligibility for medical and dental benefits to Medal of Honor recipients and their immediate dependents in the same manner as if the recipient were entitled to retired pay; partially implements the Pharmacy Benefits Program establishing revised copays and cost-shares for the prescription drug benefit; implements the TRICARE Senior Pharmacy Program by establishing a new eligibility for prescription drug benefits for Medicare-eligible retirees; allows a waiver of copayments, cost-shares, and deductibles for all Uniformed Services TRICARE eligible active duty family members residing with their TRICARE Prime Remote eligible Active Duty Service Member Sponsor within a TRICARE Prime Remote designated area until implementation of the TRICARE Prime Remote for Family Member Program or October 30, 2001, whichever is later; provides for the elimination of TRICARE Prime copayments for active duty family members enrolled in TRICARE Prime; provides for the reimbursement of reasonable travel expenses for TRICARE Prime beneficiaries referred by a primary care provider to a specialty care provider who provides services over 100 miles away; and reduces the maximum amount which retirees, their family members and survivors would be liable from $7,500 to $3,000. The Department is publishing this rule as an interim final rule in order to meet statutorily required effective dates. Public comments, however, are invited and will be considered as to possible revisions to this rule.

Child↗

The Recruit assessment Program: a program to collect comprehensive baseline health data from U.S. military personnel.

Pilot testing has begun on the Recruit Assessment Program (RAP). The RAP is a proposed Department of Defense (DoD) program for the routine collection of baseline demographic, medical, psychosocial, occupational, and health risk factor data from all U.S. military personnel at entry into the armed forces. The RAP currently uses an optically scannable paper questionnaire, which will provide data for the first building block of an electronic medical record within the DoD and the Department of Veterans Affairs. The RAP will serve several important functions, including automating enrollment into the military health care system, improving patient care and preventive medicine efforts, and providing critical data for investigations of health problems among military personnel and veterans. If the feasibility of the RAP is demonstrated and the program is fully implemented throughout the DoD, it could provide a substantial improvement in health care delivery. For the first time, DoD and Department of Veterans Affairs physicians, public health officers, and researchers will have access to comprehensive baseline health status data.

Feasibility Studies↗

Comparison of a multivalent viral vaccine program versus a univalent viral vaccine program on animal health, feedlot performance, and carcass characteristics of feedlot calves.

A field study was conducted under commercial feedlot conditions at 2 sites in western Canada to determine the relative effects of a univalent viral vaccine (MLV 1) program versus a multivalent viral vaccine (MLV 4) program on animal health; feedlot performance; and carcass characteristic variables of fall-placed, auction market derived, feedlot calves. Five thousand one hundred and sixty-three calves were processed and randomly allocated to 1 of 2 experimental groups as follows: MLV 1, which received a modified live infectious bovine rhinotracheitis (IBR) virus vaccine upon arrival at the feedlot and again at approximately 70 days on feed (DOF); or MLV 4, which received a modified live IBR virus, parainfluenza-3 virus, bovine viral diarrhea virus, and bovine respiratory syncytial virus vaccine upon arrival at the feedlot and again at approximately 70 DOF. A total of 20 pens (10 pens at the site located near High River, Alberta and 10 pens at the site located near Vegreville, Alberta) were allocated to the study. On both a live and carcass weight basis, final weight, weight gain, and average daily gain (ADG) were significantly (P < 0.05) improved in the MLV 4 group as compared with the MLV 1 group. However, there were no significant (P > or = 0.05) differences in DOF, daily dry matter intake, dry matter intake to gain ratio (DM:G) live, or DM:G carcass between the experimental groups. In addition, there were no significant (P > or = 0.05) differences between the experimental groups in any of the carcass characteristic variables measured. The initial undifferentiated fever (UF) treatment rate was significantly (P < 0.05) lower in the MLV 4 group as compared with the MLV 1 group. There were no significant (P > or = 0.05) differences in the other measures of health between the experimental groups. In the economic analysis, there was a net advantage of $0.74 CDN per animal in the MLV 4 group as compared with the MLV 1 group due to lower initial UF treatment and improved ADG, even though the cost of the vaccine program was higher in the MLV 4 group.

Alberta↗

Medicaid program; time limitation on price recalculations and recordkeeping requirements under the drug rebate program. Final rule with comment period.

On September 19, 1995, we published a proposed rule in the Federal Register that introduced requirements for States and manufacturers pertaining to the Medicaid drug rebate program. We received several comments from States and manufacturers regarding recordkeeping requirements and drug price recalculations. This final rule with comment period finalizes separately, in an accelerated timeframe, two specific provisions of the September 1995 proposed rule. It establishes new recordkeeping requirements for drug manufacturers under the Medicaid drug rebate program. It also sets forth a 3-year time limitation during which manufacturers must report changes to average manufacturer price and best price for purposes of reporting data to us. In addition, it announces the pressing need for codification of fundamental recordkeeping requirements. Furthermore, it announces our intention to continue to work on finalizing the complete drug rebate regulation for the Medicaid drug rebate program.

Drug Costs↗

[A program for continuous infusion of cardiovascular agents (CIRCULATION)--how to derive the algorithm and how to use the mathematical formula in this program].

Recently, many cardiovascular agents came to be administered to serious or perioperative cases continuously, and difficult calculation became necessary. For continuous infusion of cardiovascular agents, we devised a personal computer program (CIRCULATION) to avoid difficult calculation for PC-9801 series (NEC) by a C language (Turbo-C, Version 2.0). It is easy to use the program, and it calculates the algorithm for many cardiovascular agents in a second. The program is very useful for anesthesiologists and for other doctors when they administer various cardiovascular agents.

Algorithms↗

The Athletic Prevention Programming and Leadership Education (APPLE) Model: Developing Substance Abuse Prevention Programs.

Alcohol and other drug (AOD) abuse affects every sector of society, and student-athletes are no exception. Because many factors affecting athletes do not affect other students, athletic departments commonly approach prevention through AOD education. Different educational approaches are described in this article, particularly the Athletic Prevention Programming and Leadership Education (APPLE) model. Project APPLE is designed to enable an athletic department to systematically analyze its AOD prevention in seven areas: recruitment practices, expectations and attitudes, education and AOD programs, policies, drug testing, discipline, and referral and counseling. Because athletic trainers often are involved in this process, this article should help them to design more effective AOD programs.

Journal Article↗

Medicare program; rural health clinics: amendments to participation requirements and payment provisions; and establishment of a quality assessment and performance improvement program; suspension of effectiveness. Interim final rule with comment period; partial suspension of effectiveness.

This interim final rule with comment period revises the rural health clinic (RHC) regulations to revert to those provisions set forth in regulations before publication of the December 24, 2003 RHC final rule. That final rule implemented certain provisions of the Balanced Budget Act (BBA) of 1997 to establish a process and criteria for disqualifying from the RHC program clinics that no longer meet basic location requirements (rural and medically underserved), and to require RHCs to establish quality assessment and performance improvement programs. That rule also prohibited "commingling" (the use of the space, professional staff, equipment, and other resources) of an RHC with another entity. [In addition, it addressed comments on the February 28, 2000 proposed rule. Since the publication of the RHC final rule exceeded the 3-year timeline for finalizing proposed rules set by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, we are suspending the effectiveness of the current provisions by removing the RHC provisions set forth in the December 2003 final rule and reverting to those RHC provisions previously in effect.] We intend to reissue new proposed and final RHC rules to reinstate the current provisions. However, these revisions do not impact the effectiveness of the self-implementing provisions of the BBA or any provisions we had previously implemented or enforced through program memoranda.

Ambulatory Care Facilities↗

Cardiovascular risk factor prevalence in African-American adult screenees for a church-based cholesterol education program: the Northeast Oklahoma City Cholesterol Education Program.

The status of selected cardiovascular risk factors was ascertained in a consecutive sample of 661 (222 men and 439 women) African-American adults who were screened for the Northeast Oklahoma City Cholesterol Education Program, a church-based cholesterol intervention program. Hypertension was present in 48.4% and 44.7% of men and women, respectively. Average systolic blood pressure levels were similar in men and women (132.0 vs 131.5 mm Hg, P = 0.40) although average diastolic blood pressure levels were higher in men (84.0 vs 81.1 mm Hg; P < .0001). A substantial proportion of the screenees were unaware of their hypertension, and blood pressure normalization (SBP < 140 and DBP < 90 mm Hg) was uncommon in drug-treated hypertensives. Average cholesterol levels were slightly higher in women compared to men (206.0 vs 199.6 mg/dL, P = 0.11). The majority of persons with elevated cholesterol levels (> or = 240 mg/dL) were unaware of their condition and were infrequently treated with cholesterol-lowering drugs. Overweight was highly prevalent, was more common with advancing age, and was related to the presence of hypertension in both men and women. In addition, a strong linear relation between overweight and blood pressure was present in both sexes. Overweight was more common in young men (< 35 years old) compared to age-matched women; however, women were increasingly more overweight than men after 35-44 years of age. In fact, by age 65, 90% of the women were overweight. These data indicate an excessive prevalence and high mean levels of modifiable cardiovascular risk factors in these church-attending African-American adults. Because churches are a central institution in most African-American communities, and their congregations appear to have an excessive cardiovascular disease risk factor burden, churches may be appropriate sites for the implementation of community-based risk factor control programs.

Adult↗

Current and future perspectives regarding the framework for nurse anesthesia education: a freestanding academic program within a regionalized program framework.

In 1987, Pittsburgh's LaRoche College advanced its baccalaureate level nurse anesthesia program to the master's degree level. The coordinator of the didactic program collaborated with directors of two affiliated hospitals of nurse anesthesia to develop a program in which scientific concepts, theory and clinical applications have been well-integrated.

Curriculum↗

Educational program evaluation: the University of Vermont family nurse practitioner program.

Graduates of the Family Nurse Practitioner (FNP) Program at the University of Vermont, Burlington, were surveyed to determine if the FNPs had enlarged their nursing roles following completion of the program. A sample of Vermont nurses served as a control group. Results of a questionnaire, used to obtain information about the nurses' training, functions, and attitudes, indicated that FNPs performed activities associated with an expanded nursing role more frequently than did their nonpractiioner counterparts. There was evidence that the two groups differed in their attitudes toward various aspects of their nursing roles. The evaluation is an ongoing study; as the number of program graduates increases, further characterization of their roles will be possible.

Attitude of Health Personnel↗

Instructional computing in Alberta nursing programs as perceived by program leaders.

This paper summarized data from a survey which was conducted to establish the status of computing in Alberta's professional nursing programs. It describes the hardware and software applications in use and identifies barriers to the growth of instructional computing. The study reveals a range of activity in Alberta's nursing programs and definite progressive trends. Future directions as perceived by program leaders are reported.

Alberta↗

The role of physicians in a community-wide program for prevention of cardiovascular disease: the Minnesota Heart Health Program.

The Minnesota Heart Health Program (MHHP) aims to reduce cardiovascular disease (CVD) morbidity and mortality by reducing risk factors among the mass of residents in three midwestern communities. A major aspect of the program is the involvement of community physicians because they have high credibility as citizen leaders, especially on health issues. In the MHHP, physicians contributed in a number of ways. The initial contacts with physicians resulted in their providing support and introductions to other community leaders, whose active support was also gained. Physicians sit as members of the central Community Advisory Borads of MHHP and serve on the executive committees of these boards. All MHHP issues related to medical practice are brought before Physicians' Advisory Groups in each community for resolution. Primary care physicians attend MHHP continuing education programs. In a survey of 109 physicians in one of the MHHP communities, 95 percent of respondents believed cigarette smoking to be an important risk factor for CVD, but only 15 percent judged themselves to be effective in dealing with patients who smoked. Forty-one percent of respondents said that elevated blood cholesterol is an important risk factor, but only 20 percent felt effective in treating the condition. Only 18 percent of the physicians in the sample believed that a poor eating pattern plays a substantial role in CVD, and 9 percent felt effective in counseling patients about eating habits. This pattern of results indicates the need not only for continuing education about risk factors for CVD, but also for training to improve patient counseling skills.

Attitude of Health Personnel↗

Extramural programs of theNational Library of Medicine: program objectives and present status.

The National Library of Medicine Extramural Program, utilizing the authorities of the Medical Library Assistance Act of 1965 and the Public Health Service Act, includes support for library construction, improving and expanding basic library resources, research and development, man-power development, publications, and support for the operation of regional health sciences libraries. The program objectives relating to these various activities have been outlined. A $4,000,000 supplement has been appropriated by the Congress for fiscal year 1966 to implement the authorities of the Act. With the construction provision available in fiscal year 1967, over $13,000,000 has been requested for the second year of the program. The Medical Library Assistance Act is intended to catalyze and stimulate expanded support of medical libraries by their host institutions. Bold and imaginative plans by the medical library community are essential to the full success of the endeavor.

Legislation, Medical↗

Teaching effectiveness in coordinated undergraduate program in dietetics. Assessments of students, graduates, and program directors.

The effect of practitioner experience on teaching effectiveness of faculty in coordinated undergraduate programs in dietetics (CUPs) was studied on the basis of ratings from program directors, students, and program graduates. Instruments to measure teaching effectiveness were developed that contained 36 items common to all teaching situations and 6 each related to teaching in clinical/community dietetics and to food service management. Four dimensions of effective teaching were identified using factor analysis: interpersonal skill, dietetic expertise, organizational focus, and clinical or practical orientation. Extensive practitioner experience did not contribute to teaching effectiveness.

Clinical Competence↗

Petro-Canada Heart Health Program: successful program.

1. The economic impact of cardiovascular disease is significant, requiring 8.3 million annual inpatient days for treatment. Disability accounts for 25% of disability pensions paid by Canada Pension Plan to individuals less than 65 years of age. 2. Management of risk factors provides an opportunity to reduce the likelihood of coronary heart disease (CHD) and to mitigate the effects of non-modifiable risks. 3. There is an increased risk for CHD with elevated cholesterol. The best return on the value of a cholesterol program comes from testing work groups comprised mainly of males and older employees. 4. The goal of promoting and maintaining high levels of physical, mental, and social well being for workers can be achieved through programs such as the cholesterol screening and education programs.

Adolescent↗

Therapeutic walking program: an alternative to a formal vascular rehabilitation program.

A formalized 3-day-a-week structured exercise program proved unsuccessful in a regional, inner-city referral center. However, a large number of patients who needed exercise training were seen. In response to this demand, a "Therapeutic Walking Program" was designed. This article describes the nurse's role, the exercise program, patient screening, and indications for future research.

Exercise Therapy↗

Employee assistance programs: history and program description.

1. The history and development of Employee Assistance Programs (EAPs) can be traced back to the 1800s. There are currently over 10,000 EAPs in the United States. 2. Standards for program accreditation and counselor certification have been established for EAPs. The "core technology of Employee Assistance Programs" includes identification of behavioural problems based on job performance issues, expert consultation with supervisors, appropriate use of constructive confrontation, microlinkages with treatment providers and resources, macrolinkages between providers, resources, and work organizations, focus on substance abuse, and evaluation of employee success based on job performance. 3. Some EAPs take a broad brush approach, and incorporate health promotion and managed care functions.

Accreditation↗

Programming for recognition and programming for response. Separate developmental subroutines in the murine thymus.

Pre-T cells become programmed with the capacity to make functional responses to activating stimuli in a process that occurs prior to, and independently of, T-cell receptor gene rearrangement and T-cell receptor-dependent positive selection. In spite of this early programming, as differentiation proceeds further the cells enter a stage in which they appear to be unable to make any functional responses. This 'eclipse' phase begins when the cells undergo successful T-cell receptor beta-chain rearrangement and ends, with the return of their functional competence, only when they successfully traverse positive selection. These results suggest that pre-T cells are subject to two distinct subroutines of differentiation, which cannot operate at the same time: one which confers function and one which confers and selects recognition specificity. To provide a possible molecular basis for the relationship between these two processes, we consider specific alterations in response-associated transcription factors that may cause the changes in responsiveness observed during programming for recognition. The interplay of the two differentiation subroutines is proposed to be a consequence of the use of common transcription factors in different combinatorial contexts for functional responses, assembly of T-cell receptor complexes, and selection.

Aging↗