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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↗

PubMedDate not supplied

Changing health policy in the post-Mao era.

A shift away from Mao Zedong's concept of equality in the delivery of medical care is now taking place in The People's Republic of China. This change is evident in the emphasis now placed upon high technology, basic research, and hospital care. All of these changes are occurring against the backdrop of extremely scarce medical resources. Medicine seemingly is viewed as one of many material incentives to be provided high productivity and leadership groups; the "modernization" of medicine is seen as one visible manifestation of the success of the broader modernization effort itself. As well, population policy has become more stringent, with rewards being given to one-child families and sanctions being applied against couples having three or more children. Although these policy changes offer bright prospects for Sino-American cooperation in the biomedical field, foreigners must remain sensitive to the controversial nature of these alterations in the Chinese political setting.

China↗

PubMed1995

Dying of non-malignant diseases in general practice.

Recent policy changes within the British National Health Service have encouraged the provision of care within the community. The objective of this study was to explore the needs of informal caregivers of people with non-malignant diseases who wished to remain in their own homes until death. Semi-structured interviews with a non-random sample of 20 bereaved carers from 14 surgeries, their general practitioners, and district nurses were analyzed to discover the extent and quality of the care provided by the primary care team. One quarter of the doctors considered that palliative care applied exclusively to people with cancer. One half of the doctors felt that palliative care was primarily concerned with pain relief. Both doctors and nurses believed that their role was that of coordinating care for the patient. Carers were reluctant to criticize professional caregivers, but the results of this study suggest that carers need help with the burden of caring, including emotional support, advice and information regarding social services and financial benefits, and recognition of their caring role. Palliative care is not exclusive to people with cancer but should be extended to people with non-malignant diseases, encompassing not only symptom relief but also explicitly including emotional or spiritual support, care of the family, and support in preparing for the end of life.

Adult↗

PubMed1995

Vision impairment and corrective considerations of civil airmen.

BACKGROUND: Civil aviation is a major commercial and technological industry in the United States. The Federal Aviation Administration (FAA) is responsible for the regulation and promotion of aviation safety in the National Airspace System. To guide FAA policy changes and educational programs for aviation personnel about vision impairment and the use of corrective ophthalmic devices, the demographics of the civil airman population were reviewed. METHODS: Demographic data from 1971-1991 were extracted from FAA publications and databases. RESULTS: Approximately 48 percent of the civil airman population is equal to or older than 40 years of age (average age = 39.8 years). Many of these aviators are becoming presbyopic and will need corrective devices for near and intermediate vision. In fact, there has been approximately a 12 percent increase in the number of aviators with near vision restrictions during the past decade. Ophthalmic considerations for prescribing and dispensing eyewear for civil aviators are discussed. CONCLUSIONS: The correction of near and intermediate vision conditions for older pilots will be a major challenge for eye care practitioners in the next decade. Knowledge of the unique vision and environmental requirements of the civilian airman can assist clinicians in suggesting alternative vision corrective devices better suited for a particular aviation activity.

Adult↗

PubMed1995

Nurse practitioners in a teaching hospital.

The development of a model of care using acute care nurse practitioners in a teaching hospital and the integration of the nurse practitioner into an alternative model of care delivery are discussed. Issues in implementation include lack of understanding about the nurse practitioner role on the part of other members of the health care team, legislative constraints, and the administrative restrictions of teaching hospitals. Education of nurses and physicians regarding the scope of practice of the nurse practitioner role, departmental policy changes, and the development of protocols facilitate the efficiency and utilization of the nurse practitioner in this setting. Specific concerns surrounding costs of a nurse practitioner service and practice differences between the clinical nurse specialist and the acute care nurse practitioner are addressed. Nurse practitioner models of care delivery, which address quality, cost-effective care are on the forefront of tomorrow's health care.

Cost-Benefit Analysis↗

PubMed1995

Women's health as a priority.

Funding for the NIH Women's Health Initiative is allocated by Congress on an annual basis. Since the 1994 elections, which dramatically changed the balance of power and priorities in the U.S. Congress, some individuals have voiced concern over the future of this project. Pharmacists can ensure that funding for this research continues by contacting their congressional representative to express their views directly. They can also join forces with other pharmacists through their national and state pharmacy associations. Law makers and persons responsible for funding decisions are interested in and responsive to the positions taken by professional groups. Pharmacists can improve the health of their female patients by encouraging them to make healthy lifestyle changes (e.g., stop smoking, exercise regularly, reduce fat intake, maintain recommended body weight, obtain a Pap test annually, have mammograms at recommended intervals, and perform monthly breast self-examinations). Pharmacists should urge women who might benefit from HRT to talk about it with their physicians. Pharmacists are a valuable source of information about the advantages and disadvantages of HRT. The exclusion of women from clinical and epidemiologic studies has left clinicians with inadequate information about the best approach to preventing and treating many women's health problems. During the past decade, the efforts of various individuals, government agencies, and professional organizations have brought about policy changes that broaden opportunities for inclusion of women in clinical trials as well as increased funding for women's health research. The Women's Health Initiative and other research currently being conducted will yield valuable information that can be used to improve the health of women.

Cause of Death↗

PubMed1995

Emergency cardiac care. Moral, legal, and ethical considerations.

According to the American Heart Association, "Successful completion of an ACLS course means in accordance with the cognitive and performance standards of the American Heart Association. It does not warrant performance, nor does it, per se, qualify or authorize a person to perform any procedure. It in no way related to licensure, which is a function of the appropriate legislative, health or educational authority." The same can be said for BLS; however, with the recent revisions in ECC programs, even this disclaimer has been eliminated from the most recent textbooks in BLS and ACLS. This is in keeping with "...the American Heart Association's reaffirmation of its role as an educational resource rather than as a certifying agency." Lay public course participants in BLS (which technically includes dentists) will now receive course participation cards. Health care provider course participants will continue to receive "course completion cards" if all criteria have been satisfied by the student. The trend is to categorize what was previously termed testing as evaluation. Certification has become a thing of the past. It is unclear at this time what the impact this policy change will have on agencies who rely upon documentation from the American Heart Association to satisfy requirements that have been imposed upon dentists and other health professionals for initial licensure and relicensure. Semantics aside, one thing that remains clear is the expectation of the dentist with regards to emergency management. Expertise (for lack of a better term) in specific aspects of ECC remains a standard. For all dentists, expertise in BLS is that standard. For dentists administering deep sedation and general anesthesia, expertise in ACLS is the community standard. Although there is some ambiguity for those dentists administering conscious sedation, at the very least, they should have expertise in BLS. In addition, they are strongly encouraged to have expertise in ACLS, particularly because the limited hours of training in conscious sedation provide less medical background than is acquired during training in deep sedation and general anesthesia. In addition, the dentist is ultimately responsible for the demeanor of his or her office and staff. In the prehospital dental office setting, the matter of converting a dental office team geared to efficient delivery of dental procedures, into a team primed to perform emergency cardiac care seems daunting. This is especially so if the dentist has little undergraduate or clinical preparation for managing life-threatening emergencies. Therefore, an emergency management plan (with oversight for its implementation by the dentist) is of paramount importance.

Anesthesia, Dental↗

PubMed1995

Research in adolescent suicide: implications for training, service delivery, and public policy.

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.

Adolescent↗

PubMedDate not supplied

MADD rates the states: a media advocacy event to advance the agenda against alcohol-impaired driving.

The "Rating the States" (RTS) Program of Mothers Against Drunk Driving (MADD) is designed to bring public attention to the status of State government efforts to combat alcohol-impaired driving. MADD's 1993 report, which evaluated each State with a grade from A to D, brought renewed visibility to MADD's fight for new prevention policies and helped to advance key State legislation. Because of MADD's national press conference and other media activities, more than 60 million Americans saw or heard a news story related to the program. This article outlines the program's objectives and methodology, efforts to publicize the results, and what was achieved in terms of news media coverage and in advancing public policy change. The RTS Program is a proven media advocacy strategy for prompting State legislatures and Governors to enact new policies. The article concludes with guidelines for other public health advocacy groups that may want to emulate this strategy.

Accidents, Traffic↗

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↗