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Results for “Policy--changes”

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PubMed1989

Bone scintigraphy in the evaluation of ejection injuries.

The Royal Air Force (RAF) experience on local back injury with all ejection seats is that 50% have vertebral fractures on radiographic examination, with or without symptoms. These aviators are placed under the care of an orthopedic specialist and restricted from flying duties for 3 months or more. About half of the remainder demonstrate positive bone scans. Until recently, RAF policy was to treat these individuals the same as those with radiographically defined fractures. The author recommends this group of pilots be examined by orthopedic surgeons, and reviewed annually to assess long-term sequelae. Meanwhile, if asymptomatic, they are allowed to return to flying duties. The RAF recently incorporated most of these recommendations into a policy change.

Aerospace Medicine↗

PubMed1989

Emergency room visit time: changes over a 16-year period.

A one-week time and motion study was conducted at a large urban hospital replicating a study performed in 1969 in the same hospital, allowing a longitudinal study of emergency room utilization to be reported. Despite a 36% increase in the number of emergency room patients over the 16-year period, the findings from both studies replicate many of the patterns previously reported. Over time, both length of stay and wait times to see physicians have increased, although the values are still well within the ranges found in the literature. As competition increases, hospitals and their emergency room managers will have to determine what constitutes acceptable visit and waiting times in order to compete effectively for emergency room "clientele." Studies such as this one serve as a foundation for hospitals to implement policy changes that will improve health care delivery, and, in fact, this institution has already implemented changes based on this study.

Adult↗

PubMed1978

Health care in early infancy.

The pattern of illness and of health care during the first 16 weeks of life in a cohort of 1210 infants was examined. Children from families in the lower social strata had a significantly increased risk of respiratory illness and gastrointestinal disturbance and received less routine well baby care than children from more socially advantaged backgrounds. A number of policy changes which might improve the distribution of health care resources are examined.

Child Health Services↗

PubMed1988

Dynamics and clinical implications of the nursing home-hospital interface.

Nursing homes and hospitals are dynamically interrelated, and there is much that the clinician can do to optimize patient transitions between institutions. This article approaches this topic in three sections: epidemiology of movement between hospitals and nursing homes, impacts of policy changes and financial incentives on patient transfers, and clinical strategies to reduce unnecessary hospitalizations of nursing home patients.

Aged↗

PubMed1987

Control of nosocomial tuberculosis in New Zealand: a window into hospital occupational health?

A survey of six New Zealand hospitals, each of which employs at least one respiratory physician, demonstrated lack of uniformity and several deficiencies in measures to prevent nosocomial tuberculosis. Preemployment screening measures in particular were frequently suboptimal. Suggested improvements include upgrading tuberculosis control policies at a national level, with input from hospital boards, clinicians, and the Department of Health. Future policy changes should be based upon local and national experience and this requires the auditing of hospital control measures. The number of health workers amongst new cases of tuberculosis should also be recorded and taken into account.

Cross Infection↗

PubMedDate not supplied

Perinatal toxicology and the law.

New perinatal toxicology research findings not only extend scientific knowledge but they also produce legal changes as they reach public domain. This article examines the interaction between perinatal drug research and the law. The reactivity of the law in assimilating research on exposure of the developing organism to a broad range of neurotoxins, including both licit and illicit drugs, is illustrated. Outcomes of some cases depend to a great extent upon legal concepts invoked rather than upon the scientific evidence involved. Proposed policy changes and their implications for scientists are discussed.

Abortion, Induced↗

PubMed1985

The extent of physician participation in Medicaid: a comparison of physician estimates and aggregated patient records.

This article compares two measures of the extent of physician participation in Medicaid programs. The first, which has been used in most research to date on the subject, is based on physician estimates of the proportion of their patients who are Medicaid patients. The second derives from encounter forms for a sample of visits to the interviewed physicians. The comparison shows that physicians in the sample tended to overestimate by 40 percent the extent of their Medicaid participation. Because the two measures are highly correlated, the analysis of the determinants of Medicaid participation was not affected by the measure used. However, since physicians tended to overstate the proportion of Medicaid patients in their practices, interview data should not be used to measure the amount of physician participation or to calculate elasticities for the effects of policy changes on the extent of participation.

Data Collection↗

PubMed1985

Cost-effective use of laboratory tests: a joint responsibility of clinicians and laboratorians.

The successful attempts to achieve cost savings through improving the effectiveness of test utilization have several things in common. First, if the laboratory is to improve test ordering, it must thoroughly understand the clinical questions behind the test requests. Working with the appropriate clinical experts, the laboratory must establish standards and guidelines for appropriate test use. Then procedures must be developed to review and monitor test utilization to determine compliance with the standards and guidelines. Cost-effective improvements in the use of laboratory tests may require modifying clinicians' test ordering behavior through strategies such as problem-oriented request forms and administrative policy changes, but also the clinical laboratory's testing procedures where appropriate. Because laboratory tests are important elements of medical practice, the cost-effective use of laboratory tests and services is clearly the joint responsibility of clinicians and the clinical laboratory.

Clinical Laboratory Techniques↗

PubMed1985

Tuberculosis control practices in major metropolitan health departments in the United States. 3. Standard of practice in 1984.

Twenty-eight metropolitan health departments in the United States reporting more than 200 cases annually were surveyed to determine the standard of practice in the control of pulmonary tuberculosis. The results were compared to previous surveys done in 1978 and 1980 to determine the impact of policy changes recommended by the American Thoracic Society, American College of Chest Physicians, and Centers for Disease Control and recent reports of innovative chemotherapeutic methods. A high degree of uniformity in chemoprophylaxis practices again was demonstrated. In contrast to our previous survey of 1980, most programs now use rifampin-containing regimens with short (less than 12 month) course chemotherapy as the primary initial treatment regimen for tuberculosis. Mean duration of treatment for tuberculosis decreased from 20.2 +/- 2.1 months in 1980 to 11.7 +/- 1.0 months in 1984. Intermittent chemotherapeutic regimens also were used more frequently in 1984. However, substantial variance from other recommended guidelines still is prevalent among the major metropolitan programs in the United States.

Adolescent↗

PubMed1978

External examinations for internal evaluation: the National Board Part I Test as a case.

The appropriateness of the Part I examination of the National Board of Medical Examiners to evaluate second-year curricular performance of students at Case Western Reserve School of Medicine was examined. Review of the June 1974 examination by 37 faculty members revealed that 85% of the items reflected the content of the second-year curriculum and that 60% could be answered from information provided in the second-year teaching. Two-thirds of the items were related to the content of the first-year curriculum, and half could be answered on the basis of first-year material. The school's faculty used the study data in making policy-changing decisions.

Curriculum↗

PubMed1983

Intravenous methylprednisolone at the time of renal transplantation.

Ninety-five consecutive transplants performed prior to the introduction of methylprednisolone bolus at transplantation were compared to 136 consecutive transplants performed after the policy change. No difference was found in the incidence of reversible or irreversible rejection in the two groups. The treated group were exposed to a higher total dose of steroid than the non-treated group. Routine bolus methylprednisolone therapy at transplantation is not recommended.

Adult↗

PubMed1984

Competency to stand trial among adolescents.

Both adolescents and adults were administered a standardized measure of competency to stand trial. Results suggested that competency to stand trial does increase through the adolescent years, but that even older adolescents, aged 15 to 17, received lower scores than did adults. These results have implications for the continuing policy changes that have made the juvenile court increasingly adversarial.

Adolescent↗

PubMed1983

The impact of physical fitness evaluation on behavioural intentions towards regular exercise.

The Fishbein model was used to assess the impact of physical fitness evaluation with subsequent counselling by professional staff on individual intentions to exercise regularly. The subjects for this study were 172 self-selected adults seeking an evaluation of their current physical fitness. Experimental subjects were given a sequence of fitness testing and counselling; however, this did not significantly change the intention to exercise relative to control subjects. The only significant differences in intentions to exercise regularly were found (i) between subjects differing in fitness level (p less than .002), and (ii) between subjects differing in current exercise behaviour (p less than .001). Thirty-five percent (35%) of the variance in intentions to exercise were explained by a combination of (i) the two components of the Fishbein model (attitude and social norm) and (ii) an index of current physical activity. Since most of our subjects reported a positive intention to exercise, the most appropriate tactic for an increase of community activity may be to initiate policy changes facilitating behaviour in accordance with existing attitudes.

Adult↗

PubMed1982

High rate of tuberculin conversion in Indochinese refugees.

From January 1979 through December 1980, a total of 664 Indochinese refugees were screened for tuberculosis in Monroe County, New York; 307 (46%) had positive 5-tuberculin unit PPD Mantoux tests. When 217 refugees with initially negative tests were retested at 60 days, 94 (43%) had converted from a negative to a positive test. Although none of the converters had evidence of active tuberculosis disease, 90 (96%) were given isoniazid preventive therapy. This conversion phenomenon has continued over time, discounting an effect of local, national, or international policy changes. The conversions do not seem to be a function of antigen, tester, or reader; criteria for testing, retesting, or reading; home country, camp country, or length of time in camp; or history of prior BCG vaccination, tuberculosis, or immunization exposure, current illness, or testing intervals since arrival in the United States and subsequent testing. Further studies to evaluate boosting or anergy are in progress to assess this potential public health problem.

Adolescent↗

PubMed1975

Equal treatment and unequal benefits: the Medicare program.

This paper analyzes the distribution of Medicare benefits among elderly persons on the basis of income, race, and geographical location. It first presents available statistical evidence from Medicare on the distribution of benefits and the magnitude of differentials among these elderly. It then sorts out the contribution to differentials arising from differences in the availability of medical resources. prices of medical services, and other demographic factors. The importance of various Medicare program features on remaining differentials--such as the cost-sharing provisions of Medicare, reimbursement policies, and nondiscrimination enforcement procedures--are then investigated. The effect of health status on utilization of medical services by the elderly is also analyzed, and the distribution of Medicare benefits by income for elderly persons of similar health status is presented. The paper concludes with recommendations for reducing differentials in Medicare benefits and indicates those policy changes which would result in a distribution of benefits more closely related to health care needs of the elderly.

Aged↗

PubMed1983

Public policy and female sterilization in Costa Rica.

For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.

Adolescent↗

PubMed1989

Perinatal mortality in rural Tanzania.

Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).

Delivery, Obstetric↗

PubMedDate not supplied

Fertility intentions and subsequent behavior: a longitudinal study in rural India.

This report compares fertility and family planning intentions of rural Indian women in 1975 with actual outcomes in 1987. Ninety-four of 103 respondents who had fewer children than they wanted in 1975 and had stated definite intentions with respect to future fertility and contraceptive use were reinterviewed in 1987. Overall, women had fewer children than desired and stopped childbearing when they reached or closely approximated their ideal number of sons. Since sons were clearly the determinant of "reproductive success," it is argued that only a significant change in the status of rural women can bring about widespread compliance with the official family planning program's two-child norm.

Adolescent↗