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At least 19 recordsLinked to original sources
PubMed1992

Costs and benefits of preemployment drug screening.

OBJECTIVE: This study provides a cost-benefit analysis of preemployment drug screening and evaluates the sensitivity of this analysis to variation in its underlying assumptions. DESIGN: Cost-benefit analysis, based on a cohort analytic study previously reported. SETTING: Employees of the US Postal Service in Boston, Mass. PARTICIPANTS: Estimates of costs and benefit are based on a cohort of 2533 postal workers in Boston and on average costs for the Postal Service in Boston and nationwide. RESULTS: Drug screening would have saved the Postal Service $162 per applicant hired. However, these results were sensitive to the assumptions in the model. If the prevalence of drug use in the population screened were 1% rather than 12%, the program would lose money. Similarly, if the cost per urine sample screened were $95 rather than the $49 assumed, then the program would lose money, even if the prevalence of drug positives was as high as 9%. CONCLUSIONS: Because of the sensitivity of this analysis to changes in its underlying assumptions, any company considering preemployment drug screening should carefully weigh the costs and benefits in its own industry.

Adult↗
PubMed1976

[Preventive screening in two factories. II. Exactitude of laboratory tests and questionnaire (author's transl)].

The exactitude of some widely used laboratory tests (triglycerids, cholesterol, glucose, uric acid, creatinine) is examined in a situation relevant for practising physicians. Different statistical methods for reporting errors are compared. Accuracy and precision are useful measures for the quality of analytic procedures. They are not sufficient for medical judgement for a single patient, since sampling procedures, type of sample or transport and storage of sample are not considered in accuracy and precision. Such sources of error can largely devaluate the quality of accuracy and precision and of the analytic procedures. Error coefficients are proposed as a new method of reporting laboratory errors. The mathematical model starts with an analysis of variance and total error, technical error and transport error are defined. The study shows that the error introduced by transporting serum via postal service compared to that conveyed in a cooled transport box by a special car is considerable. It is nearly impossible for a physican to use single laboratory value for a rational decision "normal-not normal" if the values are based on samples which are sent by postal service and if the values lie in the broad borderline between the normal and pathological area. This is especially true for creatinine (transport error 47.0 per cent) and uric acid (transport error 38.7 per cent), but not so much for cholesterol (22.9 per cent), triglicerids (14.3 per cent) and glucose (13.3 per cent). Variables with high transport error like creatinine should not be used in screening programs, as long as the transport is made by postal service and the method is not improved. The agreements between the answers of a questionnaire and of an interview are analysed with the same patients (n=235). These agreements lie between 98.7 per cent and 61.7 per cent depending on the single question. The exactitude of medical questionnaires is in the same size order as the exactitude of laboratory tests-at least when the sample is sent by postal service.

Clinical Laboratory Techniques↗
PubMed1976

Biomedical periodicals in Nigerian Medical Libraries: the medical librarian's dilemma.

The Nigerian medical librarian has an uphill task in his effort to satisfy the journal needs of users of his library. His problems stem from difficulties in the selection and acquisition of journals, delay in postal services, budgetary and other administrative controls, and the changing nature of medical education and health-care services in Nigeria. The librarian's attempts to solve these problems include increased subscriptions to journals and use of interlibrary loans, but the absence of union lists of holdings of other libraries, the heavy cost of photocopying services, and poor postal facilities present another dimension to his problems. Eventually his best solution seems to lie in the establishment of a national center for "least used" journals to serve as a source stock for the country's medical libraries.

Book Selection↗
PubMed1978

Follow-up methods to trace women treated for pulmonary tuberculosis, 1930-1954.

A retrospective cohort study, designed to examine the relationship between multiple chest fluoroscopies and subsequent breast cancer risk, was conducted in which 93.6% of 1764 former sanatorium patients were successfully located. The methodology used to trace former female patients who were treated for pulmonary tuberculosis between 1930 and 1954 (20-45 years before the study began) is presented. Extensive use of city directories and telephone resulted in locating the majority of study subjects. Outpatient medical records and state vital statistics departments were also of value. Searching for death certificates of parents was helpful as the informant named on the certificate was often the woman being traced or her husband. The Postal Service was of limited use. No difference in the proportion of breast cancer cases was found between the more easily traced patients and the last 9.7% of patients who were difficult to locate. Fewer of the last patients located had died, however, than those located without intense effort. Patients lost to follow-up were younger at the time of sanatorium admission, had a higher proportion of Protestants and non-white women, had shorter lengths of hospitalization and had less severe tuberculosis requiring less aggressive treatment than patients located.

Adolescent↗
PubMed1992

Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.

Consumer Behavior↗
PubMed1992

Research project shows importance of pre-employment hearing testing.

Forty employees received pure-tone baseline hearing tests at the time they began employment as LSM operators for the U.S. Postal Services; the workplace eight-hour average sound level (TWA) was 85 dBA. Nineteen operators from the original group had their hearing retested three years later. None of the retested subjects showed large or systematic changes in hearing sensitivity over the three-year period. For the audiometric frequencies most susceptible to noise exposure (3000, 4000, 6000 Hz), only 5 percent of the operators showed a bilateral change in threshold greater than 5 dB at any frequency, and none of them showed more than a 10 dB threshold change in both ears. None of the operators displayed a Standard Threshold Shift as described by OSHA. The data further suggested that many workers began their LSM work assignment with a pre-existing hearing loss and, based upon audiometric and history information, the impairment probably resulted from prior occupational and/or nonoccupational noise exposure. The importance of hearing-conservation programs for employees is emphasized.

Adult↗
PubMed1992

Preemployment drug screening. The epidemiologic issues.

Deciding to test applicants for employment for drugs raises complex, legal, moral, economic, and technical issues. However, we focus here on three epidemiologic issues germane to this decision. In one industry, the United States Postal Service, two recent studies suggest associations between positive preemployment drug screens and turnover, absenteeism, accidents, injuries, and discipline, but these associations are weaker than had been assumed. Cost-benefit analyses show that whether drug screening saves money depends both on the costs associated with adverse outcomes such as accidents and on the prevalence of drug use in the population screened. Finally, the predictive value of a positive drug screen also depends crucially on the prevalence of drug use. In populations with low prevalence of drug use, a large proportion of the positives may be false positives.

Absenteeism↗
PubMed1991

Dog bites.

Although our canine companions can provide us with many hours of unyielding love and faithfulness, it is important to remember that these same loving creatures inflict 500,000 to one million bites per year, accounting for one percent of all emergency room visits nationwide. Ten percent of these injuries require suturing, one to two percent require hospitalization, and approximately one-third of dog bite injuries cause lost time from work or school. The United States Postal Service spends more than $250,000 annually just for prevention and treatment of dog bite injuries involving letter carriers! Still think that adorable pooch is harmless? Read on.

Animals↗
PubMed1992

Consultants' views of a district's services.

A postal questionnaire survey of consultants in the Bath Health District was conducted to establish a means for individual consultants to express their views about the provision of health services in the district, so that by working together a new relationship between the District Health Authority (DHA) as purchaser and the clinicians as providers of services could commence. A response rate of 84 per cent was achieved. The survey sought views on clinical and management issues to be used in the development of service agreements (contracts) and views on topics identified by general practitioners (GPs) as areas in need of improvement. Detail is given of results relating to out-patient services, issues of communication and the continuing role of community hospitals. Most consultants sanctioned the appropriateness of referrals by GPs to out-patient services but they identified some out-patient referrals as inappropriate. This justifies a further review of the out-patient services to be purchased by the DHA. Consultants were in agreement that there was scope for review of out-patient follow-ups. They agreed with GPs that discharge summaries could be provided within 24 hours of patient discharge to improve communication with GPs and that consultants should be available by pager to be contacted by GPs, but disagreed with GPs about the feasibility of giving patients on waiting lists a firm admission date at the time of going on the waiting lists. The majority of consultants were in favour of continuing support for community hospitals. They identified overall social value of community hospitals and greater clinical value of out-patient services than in-patient services in community hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗