MedWorm: Health Management

Treating pain without fear

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

Federal regulators are less suspicious of doctors who prescribe opioids for patients, but barriers to adequate treatment remain. (Source: Medical Economics - Medical Economics magazine)

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Elements of malpractice: duty comes first

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

Once a patient requests medical services—and you agree to supply those services—you might be liable if something goes awry. (Source: Medical Economics - Medical Economics magazine)

Doctors hurt doctors, too

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

The author's quest to find out what went wrong with a "routine' needle biopsy was met by a stony wall of silence. (Source: Medical Economics - Medical Economics magazine)

Dangerous patients in the exam room

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

After a drug-seeking patient assaulted him, the author truly understood how vulnerable some doctors are. (Source: Medical Economics - Medical Economics magazine)

Borrowing money in a credit crunch

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

It's still possible—with a solid banking relationship, a sharp business plan, and ample collateral. (Source: Medical Economics - Medical Economics magazine)

Take your staff from good to great

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

Important as it is to find the right people, keeping them happy and productive is key to a successful practice. (Source: Medical Economics - Medical Economics magazine)

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The secrets of my successful medical practice

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

Small changes can make a big difference. This doctor learned to be a better physician—from his mistakes. (Source: Medical Economics - Medical Economics magazine)

Keys to a successful ehr rollout

Medical Economics - Medical Economics magazine — Fri, 04 Jul 2008 04:00:00 +0100

From timetables to training, implementing a new system is more about people than computers. (Source: Medical Economics - Medical Economics magazine)

Active living research - investigating policies and environments to support active communities

RWJF - Open Calls For Proposals — Thu, 03 Jul 2008 11:03:17 +0100

Active Living Research is a national program of the Robert Wood Johnson Foundation (RWJF) that supports research to identify promising policy and environmental strategies for increasing physical activity, decreasing sedentary behaviors and preventing obesity among children and adolescents. The program places special emphasis on strategies with the potential to reach racial/ethnic populations and children living in low-income communities who are at highest risk for obesity. Grants funded under this call for proposals (CFP) are expected to advance RWJF’s efforts to reverse the childhood obesity epidemic by 2015. This funding opportunity is for New Connections grants awarded through the Active Living Research program. The New Connections initiative brings new perspectives to RWJF grantmaking by supporting researchers and investigators from historically disadvantaged and underrepresented communities. Two types of New Connections grants will be funded under this CFP: research grants and publication grants.Deadline: Aug 28, 2008 (Source: RWJF - Open Calls For Proposals)

Ahip adopts guidelines for developing patient-centered medical homes

RWJF News Digest - Quality/Equality — Thu, 03 Jul 2008 11:03:13 +0100

America's Health Insurance Plans (AHIP), a trade group for health insurers, adopted new principles designed to guide the development of patient-centered medical homes, Modern Healthcare reports. (Source: RWJF News Digest - Quality/Equality)

Minnesota hospitals embrace healing design concepts

RWJF News Digest - Quality/Equality — Thu, 03 Jul 2008 11:03:13 +0100

Minnesota hospitals are incorporating architecture and other amenities grounded in healing design principles in an effort to improve the patient experience, the Minneapolis/St. Paul Business Journal reports. (Source: RWJF News Digest - Quality/Equality)

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Michigan hospitals step up recruitment, retention efforts

RWJF News Digest - Quality/Equality — Thu, 03 Jul 2008 11:03:13 +0100

As construction on several new Detroit-area hospitals draws to a close, area providers are ramping up their efforts to recruit and retain nursing talent, Crain's Detroit Business reports. (Source: RWJF News Digest - Quality/Equality)

Study exposes flaws in hospital use of barcode technology

RWJF News Digest - Quality/Equality — Thu, 03 Jul 2008 11:03:13 +0100

A study published online Monday in the Journal of the American Medical Informatics Association suggests that flaws in the design, implementation and workflow integration of barcoded medication administration systems encourage clinician workarounds that may increase the likelihood of errors, the Philadelphia Inquirer reports. (Source: RWJF News Digest - Quality/Equality)

Wisconsin hospital association introduces uniform color-coded patient wristbands

RWJF News Digest - Quality/Equality — Thu, 03 Jul 2008 11:03:13 +0100

Noting the potential for confusion when hospitals use different color-coding systems to communicate important information about patients, the Wisconsin Hospital Association is asking members across the state to adopt uniform standards for color-coded patient wristbands, the Wausau Daily Herald reports. (Source: RWJF News Digest - Quality/Equality)

Jun 26, 2008 - aarp, rwjf, labor department seek solutions to nursing and nurse faculty shortage

RWJF - News Releases — Thu, 03 Jul 2008 10:57:05 +0100

State teams convene to address nurse education capacity. (Source: RWJF - News Releases)

The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in hispanic women

Maternal and Child Health Journal — Thu, 03 Jul 2008 08:25:52 +0100

Abstract Objective To examine the association of gestational weight gain and dietary factors with abnormal glucose tolerance (AGT). Methods We conducted a prospective cohort study among 813 Hispanic prenatal care patients in Massachusetts. Gestational weight gain and oral glucose tolerance test results were abstracted from medical records. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Target weight gain was based on BMI-specific weekly weight gain rates established by the Institute of Medicine (IOM). Results We observed a statistically significant interaction between prepregnancy BMI and weight gain in relation to AGT (P < 0.01). Class II/III (BMI ≥ 35 kg/m2) obese women who had a high rate of weight gain (>0.30 kg/week) or who exceeded target weight were 3–4 times as likely to develop AGT compared to women who gained within IOM ranges (OR = 4.2, 95% CI 1.1–16.0, OR = 3.2 95% CI 1.0–10.5, respectively). Increasing levels of saturated fat and fiber and decreasing levels of energy-dense snack foods and polyunsaturated fat:saturated fat ratio were significantly associated with increased risk of AGT, independent of gestational weight gain. Conclusions Weight gain among class II/III obese women and certain dietary components may represent modifiable risk factors for AGT. Content Type Journal ArticleDOI 10.1007/s10995-008-0381-xAuthors Alison Tovar, Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy 136 Harrison Avenue Boston MA 02111 USAAviva Must, Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy 136 Harrison Avenue Boston MA 02111 USAOdilia I. Bermudez, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Department of Public Health and Family Medicine Boston MA USARaymond R. Hyatt, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Department of Public Health and Family Medicine Boston MA USALisa Chasan-Taber, The University of Massachusetts Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences Amherst MA USA Journal Maternal and Child Health JournalOnline ISSN 1573-6628Print ISSN 1092-7875 (Source: Maternal and Child Health Journal)

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Regional distribution effects of ‘needs planning’ for office-based physicians in germany and austria-methods and empirical findings

Journal of Public Health — Thu, 03 Jul 2008 08:18:26 +0100

Abstract Aim To identify effects of ‘needs planning’ for doctors under contract with statutory health insurance in Austria and in Germany on the evenness of doctors’ geographical distribution. Subjects and methods Based on a description of ‘needs planning’ methods in both countries, the uneven regional distribution of general practitioners (n=59.724), ophthalmologists (n=5.789), otorhinolaryngologists (n=4.326) and urologists (n=2.903) is evaluated at the NUTS-3 level by ascertaining the respective Gini coefficients as well as by presentation of the Lorenz curve and cartographic analysis for ophthalmologists to serve as an example. Results The regional distribution disparity in all four specialities is less pronounced in Germany than in Austria. This difference can be seen most clearly for ophtalmologists (Gini coefficient 0.166 in Germany, 0.226 in Austria). However, a different result is obtained when ratios in Germany are compared with those of the contract specialists in Austria. In this comparison the regional distribution disparity for the general practitioners and otorhinolaryngologists in Germany is more pronounced than for the equivalent contract specialists in Austria. For ophthalmologists and urologists the situation is reversed, the difference for the urologists being the most striking (Gini coefficient 0.177 in Germany, 0.202 in Austria). Conclusion Practice planning for contract statutory health insurance doctors in Austria has an effect on the evenness of geographical distribution similar to that of needs planning in Germany. The role of needs planning in promoting an even geographical distribution of office-based doctors in Germany and Austria thus appears clear. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10389-008-0187-8Authors Gerhard Fülöp, Health Austria Ltd/Division of the Austrian Federal Institute for Health GÖG/ÖBIG (Gesundheit Österreich GmbH/(Österreichisches Bundesinstitut für Gesundheitswesen) Vienna AustriaThomas Kopetsch, National Association of Statutory Health Insurance Physicians KBV (Kassenärztliche Bundesvereinigung) Herbert-Lewin-Platz 2 10623 Berlin GermanyGerhard Hofstätter, Health Austria Ltd/Division of the Austrian Federal Institute for Health GÖG/ÖBIG (Gesundheit Österreich GmbH/(Österreichisches Bundesinstitut für Gesundheitswesen) Vienna AustriaPascal Schöpe, National Association of Statutory Health Insurance Physicians KBV (Kassenärztliche Bundesvereinigung) Herbert-Lewin-Platz 2 10623 Berlin Germany Journal Journal of Public HealthOnline ISSN 1613-2238Print ISSN 0943-1853 (Source: Journal of Public Health)

The migration of doctors to and from germany

Journal of Public Health — Thu, 03 Jul 2008 08:18:25 +0100

Abstract Aim To analyse the role of Germany in the context of the strong international migration of doctors. In doing so, the migration of German doctors abroad and foreign doctors to Germany is qualitatively and quantitatively presented. Subjects and methods The annual statistical reports from the country's medical associations given to the Federal Medical Association were investigated on migratory movements. Furthermore, a survey on how many German doctors are working in these countries was done within relevant organisations in some European countries and the US. Results Germany is affected by an international migration of doctors in two directions. German doctors are emigrating and as well foreign doctors are immigrating. The exchange is not balanced, Germany loses more doctors every year to foreign countries than it gains through immigration. Discussion and conclusions The increasing emigration of German doctors reinforces the shortage of doctors in Germany. In addition, the functioning of the German health system increasingly depends on the immigration of foreign doctors. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s10389-008-0208-7Authors T. Kopetsch, KBV (Kassenärztliche Bundesvereinigung)–National Association of Statutory Health Insurance Physicians Herbert-Lewin-Platz 2 10623 Berlin Germany Journal Journal of Public HealthOnline ISSN 1613-2238Print ISSN 0943-1853 (Source: Journal of Public Health)

Metabolic syndrome in children and adolescents in crete, greece, and association with diet quality and physical fitness

Journal of Public Health — Thu, 03 Jul 2008 08:18:24 +0100

Abstract Aim To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. Subjects and Methods A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Results Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Conclusions Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10389-008-0191-zAuthors Manolis Linardakis, University of Crete School of Medicine Preventive Medicine and Nutrition Clinic Heraklion Crete GreeceGeorge Bertsias, University of Crete School of Medicine Preventive Medicine and Nutrition Clinic Heraklion Crete GreeceKaterina Sarri, University of Crete School of Medicine Preventive Medicine and Nutrition Clinic Heraklion Crete GreeceAngeliki Papadaki, University of Crete School of Medicine Preventive Medicine and Nutrition Clinic Heraklion Crete GreeceAnthony Kafatos, University of Crete School of Medicine Preventive Medicine and Nutrition Clinic Heraklion Crete Greece Journal Journal of Public HealthOnline ISSN 1613-2238Print ISSN 0943-1853 (Source: Journal of Public Health)

The expected impact of new vaccines and vaccination policies

Journal of Public Health — Thu, 03 Jul 2008 08:18:23 +0100

Abstract Aim The purpose of this paper is to outline the potential of newly available vaccines and highlight the evolution of tools required for correctly assessing the impact of immunisation policies. Subjects and methods We review an entire range of critical factors in the evaluation of the impact of new vaccines and vaccinations, including herd immunity, immunological memory, epidemiology and indirect effects of immunisation on vaccine-preventable diseases and illnesses. Results The impact of newer vaccines on public health has become as complex as it is promising: the benefits of vaccinating according to aged-based rather than at-risk-based recommendations (e.g. influenza vaccine); societal benefits going beyond the mere avoidance of death and hospitalisation (e.g. rotavirus vaccine); prevention of associated pathological states, of many confirmatory tests following a positive result of screening and psychological distress (e.g. human papillomavirus vaccine); or reduction of serious sequelae and associated chronic suffering (e.g. zoster vaccine). Conclusion The changing context of vaccinology offers new challenges for research methods and orientations. Clearly, we must shift from the concept of prevention of disease to that of prevention of illness. Developing tools for the precise measurement of these phenomena involves multidisciplinary co-operation in the development of dynamic models; at the same time, we must improve our communication skills for explaining complex issues to the larger public. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10389-008-0203-zAuthors Paolo Bonanni, University of Florence Department of Public Health Viale G.B. Morgagni 48 - 50134 Florence ItalySara Boccalini, University of Florence Department of Public Health Viale G.B. Morgagni 48 - 50134 Florence ItalyAngela Bechini, University of Florence Department of Public Health Viale G.B. Morgagni 48 - 50134 Florence Italy Journal Journal of Public HealthOnline ISSN 1613-2238Print ISSN 0943-1853 (Source: Journal of Public Health)

The relationship between state capacity measures and allocations to children and youth with special needs within the mch services block grant

Maternal and Child Health Journal — Wed, 02 Jul 2008 15:32:55 +0100

Abstract Objectives To examine the association between state economic, political and health services capacity and state allocations for Title V capacity for Children and Youth with Special Health Care Needs (CSHCN). Methods Numerous datasets were reviewed to select 13 state capacity measures: per capita Gross State Product (economic); governor’s institutional powers and legislative professionalism (political); percent of Children with Special Health Care Needs, percent of uninsured children, percent of children enrolled in Medicaid, state health funds as a percent of Gross State Product, ratio of Medicaid to Medicare fees, percent of children in Medicaid enrolled in managed care, per capita Medicaid expenditures for children, ratios of pediatricians/family practitioners and pediatric subspecialists per 10,000 children, and categorical versus functional state definition of CSHCN (health). Five measures of Title V capacity were selected from the Title V Information System, four that reflect allocation decisions by states and the fifth a state assessment of the role of families in Title V decision-making: ratio of state/federal Title V spending; per capita state Title V spending; percent of state Title V spending on CSHCN; state per child spending on CSHCN; and, state Title V Family Participation Score. OLS regression was used to model the association between state and Title V capacity measures. Results The percentage of the state’s gross state product (GSP) accounted for by state health funds and the per capita GSP were positively associated with the per capita expenditures on all children. The percentage of CSHCN in the state was negatively associated with the ratio of state to federal support for Title V and the per child expenditures on CSHCN. Lower family participation scores were associated with having a hybrid legislature; however, higher family participation scores were found in states using a functional definition of special needs. Conclusions Measures of state economic, political and health services capacity do not demonstrate consistent and significant associations with the Title V capacity measures that we explored. States with greater economic capacity appear to devote more financial resources to Title V. Our finding that per capita CSHCN expenditures are negatively associated with the percentage of CSHCN in the state suggests that there is an upper limit on what states devote to CSHCN. Our current understanding of what state factors influence Title V capacity remains limited. Content Type Journal ArticleDOI 10.1007/s10995-008-0378-5Authors Lewis H. Margolis, University of North Carolina at Chapel HIll Department of Maternal and Child Health Rosenau Hall Chapel Hill NC 27599-7445 USAMichelle Mayer, University of North Carolina at Chapel Hill Department of Health Policy and Administration, Cecil G. Sheps Center for Health Services Research Chapel Hill USAKathryn A. Clark, University of North Carolina at Chapel HIll Department of Maternal and Child Health Rosenau Hall Chapel Hill NC 27599-7445 USAAnita M. Farel, University of North Carolina at Chapel HIll Department of Maternal and Child Health Rosenau Hall Chapel Hill NC 27599-7445 USA Journal Maternal and Child Health JournalOnline ISSN 1573-6628Print ISSN 1092-7875 (Source: Maternal and Child Health Journal)

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Life satisfaction in a sample of empty-nest elderly: a survey in the rural area of a mountainous county in china

Quality of Life Research — Wed, 02 Jul 2008 15:29:39 +0100

Abstract Objective To estimate the life satisfaction and its predictors between the empty-nest and not-empty-nest elderly. Methods A semi-structured questionnaire including socio-demographic characteristics, physical health, and the Life Satisfaction Index (LSI), UCLA Loneliness Scale (UCLA-LS), and Geriatric Depression Scale (GDS) was administered to 275 empty-nest and 315 not-empty-nest rural elderly in a Chinese county. Linear regression analysis was used to examine the predictors of LSI score. Results The empty-nest elderly had lower life satisfaction, lower income, poorer relationships with children, less social support, higher prevalence of chronic diseases, and more feelings of depression and loneliness compared to the not-empty-nest elderly. “Empty-nest status” was negatively related with life satisfaction. Depression was the strongest predictor of life satisfaction in both groups. The second strongest predictor was loneliness among the empty-nest group, while it was chronic diseases among the not-empty-nest group. Marital status and income were correlated with life satisfaction only among the empty-nest elderly. Conclusions The empty-nest elderly were likely to have mental health problems and to feel unsatisfied with their life. These findings also emphasize the importance of mental health as the determinant of life satisfaction among the empty-nest elderly. Content Type Journal ArticleDOI 10.1007/s11136-008-9370-1Authors Li-Juan Liu, The Second Military Medical University The Training Department 800 Xiangyin Road Shanghai 200433 People’s Republic of ChinaQiang Guo, The Second Military Medical University The Training Department 800 Xiangyin Road Shanghai 200433 People’s Republic of China Journal Quality of Life ResearchOnline ISSN 1573-2649Print ISSN 0962-9343 (Source: Quality of Life Research)

Ama releases toolkit to spur assessments of, improvements to physician-patient communication

RWJF News Digest - Quality/Equality — Wed, 02 Jul 2008 11:22:02 +0100

The American Medical Association (AMA) has launched a toolkit designed to help health care providers assess physician-patient communication, particularly for individuals with limited English proficiency or low health literacy, AMNews reports. (Source: RWJF News Digest - Quality/Equality)

Report explores ways to boost capacity at u.s. nursing schools

RWJF News Digest - Quality/Equality — Wed, 02 Jul 2008 11:22:02 +0100

The Robert Wood Johnson Foundation, AARP Foundation and U.S. Department of Labor have released a white paper outlining solutions for increasing capacity at the nation's nursing schools, AHA News Now reports. (Source: RWJF News Digest - Quality/Equality)

Physicians not taking steps to ensure patient comprehension of medical instructions, study finds

RWJF News Digest - Quality/Equality — Wed, 02 Jul 2008 11:22:02 +0100

A study published online in the Journal of General Internal Medicine suggests that physicians frequently fail to ensure that patients understand medical instructions, United Press International reports. (Source: RWJF News Digest - Quality/Equality)

Book review: epidemiology: concepts and methods by william a oleckno. published by waveland press inc, illinois 2008. paperback 649pp. isbn 1 57766 522 8. price $51.95