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Procedure-specific costs and savings in a mandatory program for second opinion on surgery.

Initial examination of the surgery experience of participants in a large employer-sponsored second opinion program revealed minimal savings in medical resource costs. But closer examination of relative savings for specific procedure categories showed that the greatest savings are for high-cost procedures: hysterectomy, prostatectomy, back surgery, and hip replacement. Furthermore, a nonconfirming second opinion does not dissuade patients from some procedures. Decisions about which procedures to include in a mandatory program should consider volume, costs, and effects of nonconfirmation, as well as the advantages of a mandatory second opinion for skeptical patients, or for patients for whom a controversial procedure has been recommended.

Blue Cross Blue Shield Insurance Plans

Self-learning packages in staff development.

Potential uses for self-learning packages in the nursing staff development setting include orientation programs, mandatory education programs, developmental programs, and review of infrequently used skills. The staff development educator can use pretest and posttest results obtained from the use of self-learning packages to document intervention with the learner. Benefits for both learners and staff development educators when this teaching strategy is used are described.

Education, Nursing, Continuing

Cardiopulmonary resuscitation: a mandatory training program for nursing staff.

At Flinders Medical Centre, a 600 bed teaching hospital in Adelaide, South Australia, there are between eighty and one hundred cardiac arrests in the general wards areas each year. From the time an arrest occurs until the arrest team arrives, the patient's life will depend on the speed with which Cardiopulmonary Resuscitation (CPR) is initiated and the effectiveness of the CPR performed by ward staff. The outcome of cardiac arrest patients who receive promptly administered CPR is extensively documented in literature on the subject. When an arrest occurs in the ward at Flinders, staff activate an emergency call to the "cardiac arrest team", which consists of three medical staff members and one nursing staff member. The nurse, from the Intensive Care Unit, is responsible for coordinating the actions of the nursing staff during the arrest. Following the arrest an audit sheet is completed with details of the patient, the arrest, treatment, and any other pertinent information. Until 1985 it was not unusual at Flinders for arrest audit sheets to have comments such as: "CPR not performed by ward staff" or "CPR not being performed correctly by ward staff" or, even worse, "Ward staff disappeared when the arrest team arrived". In many hospitals throughout Australia this was, and may still be, a familiar problem. The nursing department at Flinders believed that if a program could be established in which nurses were given the opportunity to learn and practise CPR, they could gain the skills necessary to perform basic CPR in the ward until the arrest team arrived. In 1985 a coordinator of such a program was appointed, and it became mandatory at Flinders for all nursing staff to learn and be accredited annually in basic CPR skills. This article describes how the CPR Program started, its progress, and its results.

Cardiopulmonary Resuscitation

Prevalence of psychiatric disorders in a mandatory screening program for infection with human immunodeficiency virus: a pilot study.

Ninety-five randomly selected human immunodeficiency virus (HIV)-seropositive Air Force personnel were psychiatrically examined during a routine medical evaluation. Of the 95, 95% did not have acquired immunodeficiency syndrome and were largely asymptomatic; 61.1% had clinical axis I diagnoses, which included simple phobia, adjustment disorders, hypoactive sexual desire disorder, alcohol use disorder, major depression, and organic mental disorders; 30.5% had personality disorders. Significantly higher frequencies (p less than 0.05) of simple phobia and hypoactive sexual desire disorder were noted with knowledge of HIV seropositivity. Disorders that occurred more commonly than in age-matched Epidemiologic Catchment Area (ECA) participants included: simple phobia, antisocial personality disorder, alcohol abuse, and organic mental disorders. The high prevalence of major psychiatric illness in this sample supports the notion that screening for psychiatric illness, and counseling where indicated, should be integral to HIV screening programs.

Acquired Immunodeficiency Syndrome

Premarital screening for antibodies to human immunodeficiency virus type 1 in the United States. The Premarital Screening Study Group.

To evaluate premarital human immunodeficiency virus (HIV) screening as an approach to AIDS prevention in the United States, we determined the HIV antibody seroprevalence in marriage license applicants in eight areas by blinded testing of blood specimens routinely collected for syphilis serology. The seroprevalences were 0.0-0.4 percent in women and 0.0-1.1 percent in men. We also examined the impact of mandatory premarital HIV screening on marriage rates in Louisiana and Illinois. In 1988, after screening began, 9 percent and 16 percent fewer marriage licenses than in the previous two years were issued in Louisiana and Illinois, respectively. We estimated that mandatory premarital screening, if adopted nationally, would cost $167,230,000. We conclude that compared with other HIV prevention programs mandatory premarital screening would be expensive and would probably have a minor impact on the HIV epidemic.

AIDS Serodiagnosis

Cost effectiveness of laboratory improvement programs: the viewpoint from the private sector.

The costs of participating in laboratory improvement programs are categorized and presented from the viewpoint of the laboratory. These include: prevention costs, appraisal costs, and compliance costs. Costs of participating in voluntary vs. mandatory programs are compared. Reduction of costs could be achieved by reducing duplication and overlapping of programs. In conclusion, it is difficult to identify the exact costs in any program, but it is estimated that for the individual laboratory it may represent 10-15% of the operating costs.

Cost-Benefit Analysis

Individual advocacy as a governing principle.

Many case managers have two roles, that of gatekeeper and that of advocate, that often conflict. A true advocate adopts the client's perspective as the guide for activity. Many advocacy models exist, notably those of physician/patient and lawyer/client. The client's rights to an informed choice and to strict confidentiality are fundamental to these advocacy models and must be incorporated into any advocacy model of case management.

Cost Control

Optical identification and traceability potentials.

This brief outline of optical identification potentials alerts law enforcement agencies to the early developments in the field. The present elective system of I.D. classification may become a mandatory program for universal traceability in the future.

Classification

Impact of a mandatory Medicaid case management program on prenatal care and birth outcomes. A retrospective analysis.

This study examined the impact of Philadelphia's mandatory Medicaid case management program (HealthPASS) on adequacy of prenatal care and birth outcomes among enrollees. A sample of 217 deliveries for HealthPASS patients at the Hospital of the University of Pennsylvania (HUP) during 1988 was compared with a matched sample of 1988 deliveries at HUP for whom the payor was Pennsylvania's traditional fee-for-service Medicaid program. Inpatient charts for all 434 subjects were abstracted for information on sociodemographic characteristics, substance use during pregnancy (cigarettes, alcohol, and drugs), course and extent of prenatal care, and birth outcomes including birth weight, gestational age, and mortality. No significant differences were detected between HealthPASS and Medicaid groups, suggesting that the mandatory managed care program neither improved nor impeded access to needed services. These results were not surprising in view of the fact that HealthPASS actually did little to change provider or patient behavior with respect to obstetrical care. Both the HealthPASS and Medicaid groups experienced low rates of adequate prenatal care (39%) and high rates of low birth weight (20%). Also disturbing was the finding that at least 46% of women smoked during pregnancy, at least 20% drank alcohol, and at least 17% used cocaine. These findings support the need for continued efforts to improve both access to, and content of, prenatal care for the urban poor.

Adolescent

Mandatory exercise and heart disease risk in fire fighters. A longitudinal study.

After undergoing initial assessments of percentage of body fat (% fat), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and maximal oxygen consumption (VO2Max), a group of 24 paid male fire fighters (mean age, 30.1 +/- 7.7 years) began a mandatory exercise program. The physiological variables mentioned above were assessed once a year for the subsequent 5 years. A repeated-measures multivariate analysis of variance followed by univariate post hoc techniques showed a minimal but statistically significant improvement in % fat (-1.43% +/- 0.66%) and TG (-27.54 +/- 10.44 mg/dl) over the 5-year period. Significant differences in TC, HDL-C, LDL-C, and VO2Max were noted over the years, but their magnitudes were small and no pattern was demonstrated. Each of the 5-year means for TC, LDL-C, % fat, and VO2Max were outside the desirable ranges. We concluded that mandatory exercise programs do not significantly alter the risk factor status or the aerobic fitness levels of fire fighters and that a significant number of the latter demonstrate a higher than average risk for cardiovascular disease.

Adult

Arguments against mandatory screening for HIV in low-prevalence areas.

With heightened awareness that healthcare professionals may be a potential source of infection for the human immunodeficiency virus, calls for serial, mandatory testing and reporting are increasing. Fear and hysteria are particularly noticeable in rural settings, which are only now experiencing marked increases in the incidence of AIDS cases. While arguments for and against the merits of serial mandatory testing programs can be constructed, this paper presents support to oppose mandatory testing. Evidence for this stance is drawn from several sources, including epidemiologic, economic, and clinical research; as well as medical ethics literature.

AIDS Serodiagnosis

Industry's voluntary program: Community Awareness and Emergency Response Program and the Emergency Planning and Community Right-to-Know Act.

This paper describes the chemical industry's Community Awareness and Emergency Response (CAER) Program, and voluntary and mandatory actions by the chemical industry to comply with the major environmental legislation. The chemical industry started the voluntary CAER Program soon after the Bhopal Disaster in 1984; it is coordinated through the Chemical Manufacturer's Association. This program, which began in March 1985, is a long-term industry commitment to develop a community outreach program and to improve local emergency response planning. The Congress of the United States began, in 1985, to consider proposals for mandatory programs. This led to enactment of the Superfund Amendments and Reauthorization Act of 1986, known as SARA. A portion of this Act, entitled Title III is also known as the Emergency Planning and Community Right-to-Know Act. Although this legislation has many mandatory requirements, it should be emphasized that a significant degree of voluntary industrial participation is needed if the purposes of the statute are to be achieved. Title III has created an intricate and still evolving system that ties together the EPA, industrial plant managers, state emergency response commissions, local emergency planning committees and fire departments with jurisdiction over the facility. Each of these groups has a different role and responsibilities but must work cooperatively with other participants. Because of the intricate network of participants, the magnitude of the information flow, and the continuing evolution of the system, unique public relations problems exist in order to comply with Title III.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness

[Morbidity among mothers and infants after ambulatory deliveries].

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

Ambulatory Care

AIDS prevention: legislative options.

This article reviews legislative options to prevent the transmission of HIV infection. It distinguishes between pre-exposure measures designed to prevent initial exposure, and post-exposure measures aimed at preventing infected individuals from exposing others. Part I identifies education as the key component of a comprehensive prevention program, and reviews options for pre-exposure education programs designed to avoid or minimize exposure. Part II reviews post-exposure prevention measures, focusing on reporting and contact tracing provisions. Mandatory reporting by name of individuals testing HIV positive and mandatory contact tracing are opposed as counterproductive prevention measures; voluntary partner notification is supported. Part III examines various prevention efforts for settings where there may be either a real or perceived risk of transmission of HIV infection. Part IV sets out conclusions.

Acquired Immunodeficiency Syndrome