bluuebunny/crossref_metadata_2025 huggingface dataset:
Frontal Lobe Seizures and Uveitis Associated With Acute Human Parvovirus B19 Infection
Authors: Hsu David , Sandborg Christy , Hahn Jin S.
Published: March 2008

We report a 5-year-old girl who developed repeated episodes of behavioral alterations shortly after human parvovirus B19 infection and uveitis. Video-electroencephalographic study demonstrated that these brief episodes were frontal lobe seizures. Seizures responded promptly to antiepilepsy medications. Further diagnostic testing did not reveal any rheumatologic disorders. Human parvovirus B19 infections in children are more commonly associated with febrile seizures and meningoencephalitis. Our case demonstrates that, rarely, it may be associated with the development of partial epilepsy. (J Child Neurol 2004;19:304-306).
Clinical Findings in Pelizaeus-Merzbacher Disease
Authors: Golomb Meredith R. , Walsh Laurence E. , Carvalho Karen S. , Christensen Celanie K. , DeMyer William E.
Published: March 2008

Pelizaeus-Merzbacher disease is a rare X-linked disease characterized by defective central nervous system myelination owing to a mutation in the proteolipid protein 1 gene. Few studies report detailed clinical findings in children with genetic confirmation of mutations in the proteolipid protein 1 gene. We reviewed the records of 10 boys with Pelizaeus-Merzbacher disease and one symptomatic carrier girl. Their median age was 2½ years (range 10 months to 20 years). Nine had proteolipid protein 1 gene duplications, one had a point mutation, and one had a single codon deletion. The families of eight patients reported perinatal complications, including maternal hypertension (three patients) and meconium aspiration (three patients). All of the patients were social and interactive, but all had difficulty with expressive speech. All patients presented with nystagmus and had hypotonia that progressed to spasticity, affecting the legs more than the arms; ataxia also contributed to motor impairment. Additional problems reported regarded feeding (eight patients) and sleep (three patients). Further work is needed to clarify the variations in disease course and the relationship of genotype to phenotype. (J Child Neurol 2004;19:328-331).
Frontal and Caudate Alterations in Velocardiofacial Syndrome (Deletion at Chromosome 22q11.2)
Authors: Kates Wendy R. , Burnette Courtney P. , Bessette Brandy A. , Folley Bradley S. , Strunge Leslie , Jabs Ethylin W. , Pearlson Godfrey D.
Published: March 2008

This study investigated the morphology of the frontal lobe and the caudate nucleus in velocardiofacial syndrome, a neurogenetic disorder caused by a microdeletion at chromosome 22q11.2 and frequently associated with severe psychiatric disturbances. Volumes of the caudate nucleus and subregions of the frontal lobe were compared on magnetic resonance images of 10 children with velocardiofacial syndrome and 10 age- and gender-matched controls. Frontal deep white matter was reduced significantly (by about 23%) in subjects with velocardiofacial syndrome relative to controls. Frontal and prefrontal volumes were also reduced in subjects with velocardiofacial syndrome, although not disproportionately to whole brain volume. The volume of the right caudate nucleus was increased in children with velocardiofacial syndrome. Associations between right caudate and right frontal regions were noted in controls but not in children with velocardiofacial syndrome. These findings suggest frontostriatal dysfunction in children with velocardiofacial syndrome. Insofar as up to 30% of adults with velocardiofacial syndrome (also known as chromosome 22q11 deletion syndrome) develop schizophrenia and frontostriatal dysfunction has been noted in schizophrenia, the findings support the hypothesis that velocardiofacial syndrome might represent a neurodevelopmental model of schizophrenia. (J Child Neurol 2004;19:337-342).
Combined Treatment With Vigabatrin and Topiramate in West Syndrome
Authors: Buoni Sabrina , Zannolli Raffaella , Strambi Mirella , Fois Alberto
Published: March 2008

The clinical and electroencephalographic (EEG) response to combined therapy with vigabatrin and topiramate was evaluated in five patients ages 7 to 15 months affected by West syndrome in an open-label trial. Four patients had cryptogenic and one patient had symptomatic (tuberous sclerosis) West syndrome. In cryptogenic patients who failed to respond to pyridoxine, vigabatrin was titrated to 80 to 100 mg/kg. Because control of infantile spasms or an EEG improvement was not obtained with vigabatrin treatment, topiramate was added (3-3.8 mg/kg/day). In all patients, the combined therapy with topiramate and vigabatrin achieved a rapid and complete normalization of infantile spasms, and in three patients with cryptogenic West syndrome, the EEG also became normal. In only one patient, transient anorexia was observed. This drug combination led to rapid neurodevelopmental normalization in cryptogenic patients. The results are promising and justify more trials in larger numbers of children with West syndrome. (J Child Neurol 2004 ; 19 :385-386).
Functional Brain Imaging in Sydenham's Chorea and Streptococcal Tic Disorders
Authors: Citak Elvan Caglar , Gücüyener Kivilcim , Karabacak Nese Ilgin , Serdaroglu Ayse , Okuyaz Cetin , Aydin Kursad
Published: March 2008

Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions. (J Child Neurol 2004;19:387-390).
Bilateral Decreased Oxygenation During Focal Status Epilepticus in a Neonate With Hemimegalencephaly
Authors: Alfonso Istrael , Vasconcellos Elza , Shuhaiber Hans H. , Yaylali Ilker , Papazian Oscar
Published: March 2008

Early surgical removal of a dysplastic hemisphere appears to be beneficial for neonates with hemimegalencephaly and medically resistant seizures. We analyzed the changes in the cerebral regional oxygen saturation index in a neonate with tuberous sclerosis and right hemimegalencephaly (1) during seven episodes of right hemisphere electroencephalographic status epilepticus with and without clinical manifestations and (2) after right hemispherectomy. The cerebral regional oxygen saturation index demonstrated marked fluctuations and progressive decline in both hemispheres during the episodes and normal values in the remaining hemisphere after surgery. We speculate that decreased oxygenation of the nonepileptic cerebral hemisphere in patients with hemimegalencephaly and medically resistant seizures can contribute to the production of global neurologic impairments in these patients and that the benefits of early hemispherectomy are due to the improved oxygenation of the nondysplastic hemisphere following surgery. (J Child Neurol 2004; 19:394-396).
A Boy With Spastic Paraparesis and Dyspnea
Authors: Kalkanoglu H. Serap , Dursun Ali , Tokatli Aysegül , Coskun Turgay , Karasimav Defne , Topaloglu Haluk
Published: March 2008

A 4½-year-old boy with signs and symptoms of spastic paraparesis and dyspnea is presented. Biotinidase deficiency was considered and was confirmed by both urine organic acid analysis and biotinidase activity measurement. The child recovered gradually on biotin therapy. Because other systemic signs and symptoms of the disease might not be present initially or might develop later, biotinidase deficiency should be considered in the differential diagnosis of a child presenting with acute or subacute spastic paraparesis. (J Child Neurol 2004; 19:397-398).
Toward a Definition of Roles for Physicians in Quality Assurance
Authors: Ziegenfuss James T.
Published: March 2008

This paper presents a role analysis of physicians working in the quality assurance field. Although spe cific activities vary from organization to organiza tion, eight roles seem to be generic. Four are defined as leading roles: fact finder, technical specialist, col laborator in problem solving, and alternative identi fier. Four roles are secondary: process specialist, re flector, trainer/educator, and advocate. Examples of role performance are presented. Additional concep tional and empirical research needs are identified.
Physician Practice Patterns: Why and How We Should Use Them
Authors: Schuch Rick J.
Published: March 2008

The author presents an historical overview of the development of physician practice pattern data. The value of this data, correctly presented, for comparing physician practice activity across geographical areas and for the same presenting clinical problems is dis cussed. In addition, variations in practice patterns have been used to probe questions of quality. The article argues for the use of practice pattern varia tions by utilization review physicians. The immense value of physician to physician interaction and its resultant value in motivating physician change are documented from recent literature.
Quality Assurance Concerns in Joint Ventures
Authors: Scheribel Karl W.
Published: March 2008

The demand for assurance of quality in the delivery of medical care increases every day. The forces influ encing these demands are diverse and numerous. Many operate from disparate points of view with decidedly different goals and methodology. The in formation presented here attempts to provide an ob jective, straightforward, easy to use, valid, and reli able approach to quantify two key elements that need to be evaluated when studying the adequacy of quality as it pertains to medical care. The first of these is the administrative structure and the second is the pa tient's medical care as reflected in the medical record. The procedures presented are adaptable to almost any setting and structure.
The Need for an Informed Credentialing Program
Authors: Balck Bruce
Published: March 2008

An informed credentialing process or the granting of physicians' privileges in an informed manner is one of the most important risk management functions performed in a health care facility today. Some of the objective information that should be integrated into the credentialing process to make it informed are such items as compliance with the medical staff bylaws, current licensure, professional liability coverage, malpractice experience, and results of medical staff quality assurance and committee activities. Failure to address problems that have been identified by the medical staff, administration, or governing board may constitute a breach of duty to patients. An in formed credentialing program helps maintain quali fied medical staff, promotes quality care, and avoids adverse publicity while minimizing the potential for individual and corporate liability.
Health Care Technology and Quality of Care
Authors: Schaffarzick Ralph W.
Published: March 2008

The increasing costs and complexity of technologic advances in diagnosis and treatment have been ac companied by other important issues. They are often moral or ethical in nature; they include the public's desire and determination to have access to these "high-tech" advances; and the quality and equity with which those advances are apportioned and applied must be addressed. Seven criteria that can be applied to technology assessment are identified as is a process for that assessment. Together, these procedures can provide valuable information and assistance to those who make decisions about health benefits coverage— both in the public and the private sectors.
Ethical Issues Associated with Peer Review in Medicare
Authors: Schneider Kenneth C.
Published: March 2008

Delegation of Medicare peer review authority to hospital committees contributed to the failure of Professional Standards Review Organizations. The financial incentives of prospective payment under Diagnosis-Related Groups are associated with partic ularly aggressive hospital-based review and ethical tensions between attending physicians, medical staff committees, and hospital administration. Peer Re view Organizations (PROs) are expected to mediate as well as monitor in this environment, but PROs are harshly judged in turn by the "SuperPRO," which finds them too permissive, and by administrative law judges who overturn the majority of their denials on appeal. Although PRO deliberations are held confi dential, release of denial statistics and hospital-spe cific mortality information raises serious concerns.
Quality Assurance/Utilization Review as a Practice Option: The Influence of a Residency Program
Authors: Colvin Richard S.
Published: March 2008

The author examines the concept of a Quality As surance/Utilization Review residency program from the perspective of a program director in an estab lished specialty. Quality Assurance/Utilization Re view could develop into a specialty that is oriented heavily toward administration. In order to maintain a more appropriate orientation toward clinical med icine, the specialty must develop into an attractive practice option for the graduating medical student.
Impact of the Diagnostic-Related Group Prospective Payment Systexn on the Outcome and Quality of Care of Elderly Patients Hospitalized with Pneumonia
Authors: Simons Richard J. , Omundsen Beth A.
Published: March 2008

In order to determine whether the institution of the Medicare prospective payment system has led to poorer outcome and quality of care for patients hos pitalized with pneumonia at the Hershey Medical Center, a critical review of elderly pneumonia pa tients was performed for two time periods. The first time period was July 1981 through June 1982 (pre- diagnostic-related group era). The second time period was July 1984 through June 1985 (diagnostic-re lated group era). There were no significant differ ences between these two groups in terms of age, se verity of illness, and mean length of stay. The number of deaths was virtually identical for each group (ap proximately 27% mortality overall). We were unable to show any differences in the quality of care by a structured process of care review. Thus, we conclude that the prospective payment system has not had a negative impact on outcome or quality of patient care in patients hospitalized with pneumonia at this uni versity hospital.
Evaluating the Effectiveness of the Utilization Management Program
Authors: Connor Melody Drew
Published: March 2008

The cost of health care continues to be a matter of great concern to purchasers of service. In an effort to control their expenditures, many employers, insur ers, health maintenance organizations, and preferred provider organizations are assessing the effectiveness of their current cost-containment programs and im plementing more stringent approaches where indi cated. To respond to this situation, hospitals must develop effective utilization management programs that are designed to identify and resolve problems before they come to the attention of outside organi zations. Every aspect of the program should be eval uated periodically to assure that it is effective and continues to meet the needs of the hospital, its medical staff, and its patients. This paper describes the factors that make effective utilization management manda tory today and outlines a methodology for assessing effectiveness.
The Inspector General
Authors: Kusserow Richard P.
Published: March 2008

The Congress has increasingly added responsibili ties and authorities to the Office of Inspector General in the Department of Health and Human Services. The Inspector General's responsibilities extend be yond oversight of the monies spent by the Medicare and Medicaid programs to the assurance of the quality of care rendered to beneficiaries. His quality assur ance mandate includes the imposition of sanctions against health care providers and practitioners who fail to meet new patient care obligations under Sec tion 1156 of the Social Security Act.

The sanction processes followed by the peer review organizations (PROs) and the Inspector General have been subject to debate and change. Over the past year instructions and procedures have been strengthened by new PRO notice procedures, clearer instructions of PRO proceedings, and permitted use of expert wit nesses to provide evidence on cases in question. The Inspector General has received only 163 sanction recommendations from PROs from July 1985 through March 1988. Sixty-four physicians and one hospital have been excluded from the Medicare pro gram, and monetary penalties have been imposed on 25 physicians and 2 hospitals. Fifty-nine cases rec ommended for sanction have been rejected by the Inspector General.

This article discusses the balancing of beneficiary and provider interests in the sanctions process and other quality assurance activities carried out by the Inspector General.
The Utilization Review Program
Authors: Castillo Jose J. , Bennett Kari E.
Published: March 2008

The survival of a health care institution in today's economic climate is dependent on, among other things, the efficiency of its utilization review pro gram. The purpose of this article is to serve as a basic guideline for an institution to develop an adequate utilization review program. It emphasizes that a uti lization review program is essential for the economic survival of any health care industry. The utilization review program should be an integrated organization with the support of administration, and the partici pation of staff physicians, physician advisors, review nurses, and important hospital departments, such as social service, laboratory, medical records, preplan ning, and so forth. Following the format presented in this paper, an institution may easily develop a utili zation review program. The ideas presented in this paper have been time-proven at our institution.

There must be educational programs for physicians on the basics of managing patients according to the prospective payment system and the economic impact physicians can make on the hospital's economic sta tus. These educational presentations must take place as often as necessary to reinforce policy and proce dure, and to carry out effective patient management.

The utilization review department, as well as the medical staff, must work in close harmony with ad ministration to assist the facility in surviving trying economical times.
Organizational Control of Hospital Infrastructure Determines the Quality of Care
Authors: Grujic Stevan D. , O'Sullivan Donal D. , Wehrmacher William H.
Published: March 2008

Hospital personnel and their performance un derlie all hospital facilities and patient services (the hospital infrastructure). Hence, quality pa tient care is not exclusively in the domain of the medical staff and must be regarded as a compre hensive responsibility of the hospital. Hospitals must establish behavioral quality systems and teach employees not only how to do their job well to meet technical quality standards, but also how to fulfill patient expectations. Critical and life threatening problems are thereon pre vented or minimized, and protection of physi cians and hospitals from litigation improves as a result. Governing boards must provide a role model and demand excellence of everyone, in order to improve the performance of the hospital infrastructure.
Guest Editorial: Reflections of a Chairman
Authors: Spratt Charles E.
Published: March 2008

In December 1988, Dr. Charles Spratt retired as chairman of the journal committee. Few people probably know, as we do, how much of the creation of Quality Assurance and Utilization Review and its continued growth are a credit to Dr. Spratt. We invited him to write the editorial which follows. Charlie's insight, good humor, commitment, and hard work have been gifts to us all. With a full measure of gratitude, we wish him and his wife full measures of good health and rewarding years ahead.
Quality Assurance and Utilization Review in a Health Insuring Organization
Authors: Nash David B. , Goldstein Philip , Kron Samuel
Published: March 2008

HealthPASS is a Philadelphia-based health insur ance organization (HIO), owned and operated by the Penn Health Corporation, a subsidiary of Maxicare, the large for-profit health maintenance organization (HMO) company based in California. In a contractual agreement with the Pennsylvania Department of Public Welfare (DPW), Maxicare contracts primary care physician services on a capitated basis, and other services on a fee basis, to about 96,000 Medicaid enrollees in certain zip codes in Philadelphia. Al though HealthPASS does not provide care directly, it contracts with providers for these medical services. HealthPASS serves a primarily poor, minority, and inner city population with high rates of drug abuse, alcoholism, and mental illness. Currently, the enrol lees are served by a network of providers including more than 40 participating hospitals and over 500 primary care providers (PCPs) in the community. HealthPASS is unique as previous HIOs in Kentucky and Arizona both failed.

This paper describes the quality assurance and uti lization review (QA-UR) system implemented by HealthPASS with specific examples of case discus sions and a detailed look at the structure and function of the internal review process. Before outlining the QA-UR system, a brief history is provided of the recent controversial trend toward managed care for Medicaid recipients, as there have been marked fail ures in this arena nationally. The HealthPASS system is described—what it is, how it is staffed, who it serves, and the health services it offers. Discussion of the QA-UR system follows. Lastly, some of the thorny political issues that remain, such as the effort by HealthPASS to educate physicians about managed care, to develop protocols of care, and to coordinate QA-UR for so many physicians and hospitals, are examined.
Assessing Peer Review in the Quest for Improved Medical Services
Authors: Hershey Nathan , Bontempo Lea C.
Published: March 2008

The increased concern about the quality of medical services evidenced by, inter alia, the growing atten tion to quality of Peer Review Organizations. the purchasing and implementation of sophisticated med ical data systems by hospitals, and the growing clamor from private health insurers and employers about the rapidly rising costs of health services has made determining the effectiveness of medical inter ventions a priority subject for many authorities in the field of medical care assessment. At the risk of over simplification, the view that a greater focus on qual ity of health services is overdue has begun to energize healthcare institutions, the health professions, pay ers, and the general public.

The objective of this paper and those that will fol low is to examine medical peer review. Medical peer review involves peer appraisal in at least two stages: in criteria and standard setting (1, 2), and in deter mining whether criteria and standards have been met by practitioners in the rendering of services (2). This first article describes some difficulties with the infor mation available to facilitate effective medical peer review, and examines the processes that provide the knowledge base upon which medical peer review de pends.
The Effect of Precertification on the Rate of Hospitalization of Patients with Low Back Pain
Authors: Grable Harvey R.
Published: March 2008

This report is a study of the rates of hospitalization of two similar groups of patients with a diagnosis of medical low back pain resulting from an injury. It is based on a 7-year experience with utilization review. None of the patients had met the minimal criteria for hospitalization described by the "Reference Criteria for Short-Stay Hospital Review" of the American Medical Association (1). One of these two groups was required to undergo a preservice review (precertifi cation) before hospitalization. The other group did not undergo this precertification. This study tests the hypotheses that there is a significant incidence of unnecessary hospitalization of patients with medical low back pain and that precertification does reduce this rate of hospitalization. It also tests the hypothesis that race, age, and gender correlate with this unnec essary hospitalization. Further, it examines the rela tionship between the precertification process and the time of admission and the length of stay once admit ted. The methods used are defined, and the contro versy surrounding precertification and unnecessary hospitalization in general, and for low back pain in particular, is described.
Efficiency Gains in Utilization Review
Authors: Paranjpe Nitin , Strumwasser Ira , Ronis David L. , Bartzack Charlotte , Zech Charles
Published: March 2008

A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge- Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentra tions of nonessential admissions were found in medi cal, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitaliza tion. Focusing utilization review on MDCs with non essential rates exceeding 15% results in an examina tion of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.
Special Problems in Adolescent Health Care
Authors: Imai Walter K.
Published: March 2008

Health care providers caring for adolescent pa tients are faced with problems unique to this age group due to their evolving developmental stages of growth. Serious problems with psychosocial as well as biological bases causing major morbidity and mor tality are encountered. Purely biomedical approaches and quality standards are likely to be inadequate. Age and developmental stage appropriate approaches to treatment and prevention are required, with atten tion to environmental stresses and risk-taking behav iors. Adolescent development, current hazards, and preventive strategies are reviewed.
Conservative Management of Temporomandibular Joint Disease: A Case Study
Authors: Pfitzinger Walter R.
Published: March 2008

Although temporomandibular joint (TMJ) prob lems are difficult to diagnose and evaluate, treatment today centers on conservative methods, not surgery. Many dentists lack the knowledge to adequately di agnose and treat TMJ, and many insurers as well as managed care plans have often refused to pay for conservative therapy, now known as Phase 1 TMJ treatment. This treatment consists of appliance or intraoral splint placement, along with physical ther apy. Ultimately, this therapy is far less expensive than either joint or orthognathic surgery.

Since there is no recognized specialty in TMJ dis ease, managed care programs need to establish dis cernible criteria for the selection of providers to di agnose and treat their TMJ patients. By carefully selecting providers and monitoring the outcome of treatment rendered to patients, costs and time of treatment could be drastically reduced, benefiting the patient and the managed care program.
Physician Reimbursement and the Resource-Based Relative-Value Scale
Authors: Grossman Joel
Published: March 2008

This article assesses the situation that led to the development of the Resource-Based Relative-Value Scale (RBRVS), describes the scale and how it might be applied, and compares it to other reimbursement schemes. Potential weaknesses of the RBRVS are also discussed.
A Managed Care Approach to Outpatient Review
Authors: Lawless Grant D.
Published: March 2008

The recent growth in outpatient services has been the result of both increased use of new and improved technology, along with a shift to an ambulatory set ting for many previously performed inpatient tests and procedures. Employers have seen an almost un checked rapid growth in this portion of health care costs, with no signs of slowing down. This article attempts to show a basic step-by-step approach to identifying and reviewing some of the major cost generators through a managed care program.
Assessing Peer Review in the Quest for Improved Medical Services: Part III
Authors: Hershey Nathan
Published: March 2008

Part I of this article explored flaws in the operation of peer review in the selection of articles for journal publication and decision-making in the award of re search grants, and Part II described medical peer review, its practitioners, and the distinctions between medical peer review and other activities and proc esses aimed at improving the quality of medical per formance in hospitals. This part of the article directs attention to how the courts respond when a physician, aggrieved by an adverse determination with regard to appointment, reappointment, or clinical privileges (credentialing) by the hospital based on medical peer review, seeks redress in the courts.
Accuracy of ICD-9-CM Codes in Identifying Reportable Communicable Diseases
Authors: Campos-Outcalt Doug E.
Published: March 2008

Billing records from the outpatient clinics of a uni versity medical center were used to identify report able communicable diseases. Patient charts were re viewed to check the accuracy of all cases of commu nicable diseases not reported to the local health department. Thirty-three percent of the cases iden tified as one of 20 communicable diseases, using the ICD-9-CM system, were found to be incorrectly coded. This study documents a lack of specificity (nu merous false positives) when using encounter form data and ICD-9-CM codes to identify communicable diseases in an outpatient setting.
The Fellowship Program in Quality Assurance and Utilization Review
Authors: Trautlein J. , Ziegenfuss J.T. , Pelberg A. , Wenner W. , Casale T.
Published: March 2008

This article reports on the progress of a fellowship program for physicians in quality assurance and uti lization review (QA/UR). The article begins with a description of the initial program concept and pre sents the "program-in-action" including: academic coursework, site rotations, learning experiences of the fellow/resident, funding, outcomes to date, strengths and weaknesses analysis, current require ments, and future research and development needs. By presenting design and operations this 2-year progress report is intended to assist other developing programs as QA/UR education increases nationally.
Assessing Peer Review in the Quest for Improved Medical Services and The Implications for Education in Quality Assessment: Part IV
Authors: Hershey Nathan
Published: March 2008

Three court decisions reviewing medical peer re view conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning med ical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion.

Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals.

The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the rela tive lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer re view ; and (4) to describe the changes that should be anticipated in review of medical services in the fu ture.

Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care. If the care is below the desired level, then steps to modify practitioner professional conduct by provid ing information about the effectiveness of diagnostic and therapeutic interventions, and imposing limits on practice if necessary, are warranted. Thus, while adverse credentialing decisions may follow medical peer review, they should not be viewed as its objec tive.
The Rational Ordering of Blood Cultures in the Emergency Department
Authors: Salluzzo Richard , Reilly Kevin
Published: March 2008

A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and pa tients.

Generally speaking, as the number of blood cul tures obtained increases so does the number of false positive results. Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and ad mission to the hospital.

This study reviews the manner in which blood cul tures were ordered before and after the introduction of general guidelines for their use. It outlines a proc ess whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other labo ratory and diagnostic studies.
Formatting Departmental Quality Assurance Minutes to Meet Internal and External Needs
Authors: Coldiron John S. , Wieler Doris
Published: March 2008

This article presents a method that is helpful in achieving compliance with the JCAHO medical staff monitoring standards. Since the QA activity of the medical staff is of great importance to the institution, it is imperative that monitoring activities are clearly documented and easily evaluated. Through the use of a standardized departmental minutes format, each clinical department is prompted to address the monthly activity relating to each of the basic quality assurance functions. These minutes can be "scored" using an evaluation tool suitable for review by the Medical Executive Committee. This enables the com mittee to track the status of each department's use of the "Ten Step Process." This method has successfully met the challenge of a recent JCAHO accreditation visit. The use of the standardized departmental min utes format and the evaluation tool provide a method to successfully meet the JCAHO medical staff quality assurance standards.
Small Area Analysis Shows Differences in Utilization
Authors: Richardson Steven L. , Renz Kathleen K. , Vogel Thomas T. , Graham John E. , Kaufman Jeffrey
Published: March 2008

Adjusted admission rates for respiratory distress (COPD, asthma, bronchitis, and pneumonia) varied up to 3.09-fold between the highest and lowest hos pital market areas in 1986 for the state of Ohio. Reasons for the variability can be determined through small area analysis techniques with the help of area physicians. Substantial improvements in the availability, delivery, and cost of respiratory care would reasonably be anticipated as a result of such analysis and feedback.
Hospital Variations in Adverse Patient Outcomes
Authors: Wan Thomas T. H.
Published: March 2008

Careful review of the literature suggests that the conceptual problem in analyzing hospitals' quality of care is the difficulty of identifying problem domains of hospital care. An appropriate measurement model using multiple indicators of hospital quality problems is developed and evaluated. Adverse patient outcomes reflecting the quality problems are compiled from a peer review organization's generic screen indicators for 85 acute care hospitals. Predictor variables of adverse outcomes include bed size, number of high- technology services offered, case mix, severity of pa tients treated, ownership, net profit, market share, efficiency, teaching status, and metropolitan size. The findings show that hospital characteristics exert lim ited effects on adverse outcomes. Efficiency and av erage length of stay are the only statistically signifi cant factors that explain the variation in adverse outcomes.
Measurement of Dollar Value of Services in a Capitated Dental Plan
Authors: Schoen Max H. , Atchison Kathryn A.
Published: March 2008

A number of attempts have been made to develop measures of the cost of resources expended to produce specific services that are more equitable than fees. Two conceptually different relative value methods (RVU and RTCU) and UCR fee-for-service were used to measure the dollar value of care produced in three consecutive years under a network-type capitation dental plan. While each yielded a different total, the values were relatively close in the first year. How ever, they diverged in the second and third years even when an inflation factor was kept constant for all three. In addition, the dollar value of specific services varied markedly over the three methods. The relative merits of the different systems are discussed, as well as possible reasons for the divergence. It is concluded that the RTCU system is preferable, but that great care must be taken to keep any system current, regardless of specific derivation.
Green Spring Criteria for Medical Necessity of Outpatient Treatment and Its Use in a Mental Health Utilization Review Program
Authors: Nyman Gary , Harbin Henry , Book Jonathan , Wiegand Diane , Lizanich-Aro Suzanne , Krajewski Thomas , Yuhas Michael , Shoffeitt Paul
Published: March 2008

The authors have developed a two-tiered method for utilization review of outpatient mental health services. The methodology looks at initial and contin ued treatment evaluation and uses diagnosis, symp toms, plan of treatment, and the Global Assessment Scale (GAS) among other indicators to determine ap propriateness of treatment. Preliminary program ex perience has been positive and is included.
Determining Medical Necessity of Outpatient Physical Therapy Services
Authors: Moorhead Joel F. , Clifford Joanne
Published: March 2008

A patient referred for physical therapy may attend one or several therapy visits or may continue to re ceive ongoing therapy services several times weekly for several months. The question of the continued medical necessity of those services arises often.

Determination of medical necessity for continued therapy services requires knowledge of the natural history of diseases that may require therapy services, familiarity with the effectiveness of treatment alter natives for those diseases, and awareness of commu nity practice patterns. Accurate and complete docu mentation from the therapist or referring physician is required for the physician advisor or utilization review consultant to make an accurate determination of medical necessity. A structured format for provid ing this documentation is suggested.
Promoting Quality through Managed Care
Authors: Coleman Roger L.
Published: March 2008

Managed care organizations will be able to promote quality care as well as control costs by utilizing qual ity management approaches and practice guidelines. By so doing, organized systems of care could promote adherence to standards of quality and appropriate ness. Focusing on systems of care is a major compo nent of the quality improvement process and fits well with the development and utilization of practice guidelines. Practice guidelines, as well as risk man agement, quality assurance, and quality improvement techniques, can help reduce undesirable variation in practice patterns and prevent problems from occur ring. Guidelines may be based on different levels of explicitness ranging from subjective judgment to spe cific outcomes and patient preferences. The use of guidelines and quality improvement mechanisms will enhance the effectiveness of clinical decision making and enable managed care organizations to work pro ductively with physicians to promote quality.
Effect of Clothing Masculinity on Perceptions of Managerial Traits: Does Gender of the Perceiver Make a Difference?
Authors: Forsythe Sandra M.
Published: March 2008

Four groups of marketing students (N=91) viewed color videotapes of four women interviewing for a middle management position, rated each applicant on five management characteristics, and made hiring recommendations for each applicant. The four applicants were videotaped in each offour costumes representing four levels of masculinity. Analysis of variance was used to estimate the effect of costume, person, gender of the respondent, and possible interactions on perception of management characteristics and on hiring decisions. The results showed that masculinity of clothing had a positive effect on (a) the perception of management characteristics, and (b) favorability of hiring decisions. Although gender differences were not statistically significant, females tended to rate the applicants as more forceful and self-reliant and were more likely to hire than were males.
Attractiveness of Men's Suits: The Effect of Aesthetic Attributes and Consumer Characteristics
Authors: Eckman Molly
Published: March 2008

The objective of this study was to explore aesthetic aspects of clothing design. Evaluations of the attractiveness of men's tailored clothing by men and women were analyzed, focusing on the influence of aesthetic attributes and consumer characteristics. An individual-subject analysis of variance, based on a conjoint model with interactions, showed evaluations were affected by aesthetic attributes, configurations of aesthetic attributes, and consumer characteristics. Theoretical and managerial implications of the results for retailers and fashion marketers are discussed.
Appearance Retention of Carpets Using Image Analysis; Correlation with Subjective Method
Authors: Presley Ann Beth
Published: March 2008

This study compares a new objective method for measuring texture retention in carpets to the usual subjective technique. The effect of mechanical wear on the texture of a range of nylon cut-pile carpets is examined using the image analysis techniques of covariance and co-occurrence analysis, and the results correlated with the subjective method.

The image analysis methods provide reliable measurements of the retention of carpet texture. Such a consistent and reliable instrumental method could play an important role in product design, performance evaluation and quality control in carpet manufacture.
Uniforms for Collegiate Female Golfers: Cause for Dissatisfaction and Role Conflict?
Authors: Wheat Kaiya L. , Dickson Marsha A.
Published: March 2008

Female collegiate athletes (N = 71 ) from Big Ten Conference golf teams were surveyed about their satisfaction with team uniforms and the factors influencing satisfaction. Players rated their satisfaction with team uniforms as neutral. Both quantitative and qualitative responses indicated positive relationships between having well-fitting, aesthetically attractive uniforms and uniform satisfaction. Men's clothing, worn by a majority of the female golfers, was often bulky and ill-fitting, associated with greater uniform dissatisfaction. Although wearing a recognizable apparel brand name product gave players satisfaction, the actual product produced by these manufacturers did not. Contrary to our hypothesis, role conflict experienced by the athlete did not significantly affect uniform satisfaction. Implications for sport clothing manufacturers are discussed.
Interviewing and Selection at Hewlett-Packard Laboratories
Authors: Joyce Gwenda
Published: March 2008

This is a description of a rigorous selection process which proves the case for time and care to be taken if excellent staff are to be recruited and retained
Removing Discrimination in Recruitment
Authors: Dowson JO
Published: March 2008

Steps in selection which can help remove discrimination and promote equal opportunities in education
Local Management of Schools
Authors: Hill David
Published: March 2008

How will the roles of the various groups of people who work in education be affected by LFM?
Make That Bid! Money for Development
Authors: Tilling Michael
Published: March 2008

Schools and colleges are being asked to find their funding from a variety of sources. The practice of bidding for these funds is now commonplace. This article looks at some of the advantages and drawbacks of this system and offers advice as to how institutions might maximise their chances of success.
Too Much Too Quickly: Primary Curriculum Reform
Authors: Ferris Robert , Mifsud Joseph , McEwen Alexander
Published: March 2008

The last decade could be described as a period requiring simultaneous, major and multiple innovations in both school internal administration and curriculum. How these changes have been managed and what has been their impact on school managers, are the subjects of this article. The findings are discomforting, showing work overload, high stress levels, low morale and failure to develop 'ownership' of reforms.
School Electronic Mail
Authors: Brown Rosalie
Published: March 2008

Managing rapid contacts with schools abroad helps to make international links a reality for students. This article recounts one school's experience of using electronic mail to make contacts - the article reached me by electronic mail (as have several others for this issue) and is printed with its email heading to give an idea of what email looks like for those who've never used it. If you can access email, the editor's address is Athody@uk.ac.luton.vax2- give it a try!
Developing a Nurse-Led Education Program to Enhance Self-Care Agency in Leg Ulcer Patients
Authors: Herber Oliver R. , Schnepp Wilfried , Rieger Monika A.
Published: March 2008

Patients with leg ulceration face changing self-care demands associated with the consequences of the disease and treatment. Often patients can manage their self-care for some time, but new therapeutic self-care demands may emerge that require more complex self-care actions. The purpose of this article is to describe the development of a nurse-led education program in North-Rhine Westphalia, Germany, that aims to help patients with leg ulcers to meet their therapeutic self-care demands. Orem's self-care deficit nursing theory is used as a framework to provide the conceptual context for this supportive—educative nursing system that is being tested in a multi-site clinical trial.
Ethical Implications for Living with Adversity: The Ever-Present Experience in the Global Nursing Community
Authors: Milton Constance L.
Published: March 2008

The discipline of nursing is experiencing the ever-present phenomenon of living with adversity or opposition. As a global nursing community, what are the possible ethical implications for global health in view of professional nursing practice and education? Professional nurses worldwide struggle with choosing and doing what is right while abiding with contexts or situations incarnated with conflict. With a global shortage of nursing faculty and practitioners, this column begins a nursing ethical discussion for pondering the need for community change. Ethical implications for the possibilities of faithfulness in adversity will be discussed from a human becoming nursing theoretical perspective.