18 Feb
When early reports of increased mortality rates caused the premature discontinuation of the European Organisation for Research and Treatment of Cancer trial (EORTC 18961) of a post-surgical vaccine for patients with node-negative malignant melanoma, it cast a pall over the vaccine horizon, noted Dr. Eggermont. At a Pfizer-sponsored satellite symposium on cytotoxic T-lymphocyte antigen-4 (CTLA-4) agents, he described the situation for patients with advanced malignant melanoma, with three failed vaccine trials, as “quite disastrous.”
Continue Reading »
16 Feb
European Cancer Conference
The 14th meeting of the European CanCer Organisation (ECCO) took place in Barcelona, Spain, from September 23 to 27, 2007. Close to 14,000 attendees heard the latest scientific advances in cancer treatment. This article covers key sessions in breast cancer, prostate cancer, renal cancer, and melanoma.
Continue Reading »
12 Feb
To survive, “decent blacks of the ghetto” must wear many masks. But far too often, a mask becomes converted into a problematic self-esteem “face.” In other words, destructive “pretending” graduates into an unhealthy view of oneself. Anderson characterizes decent ghetto blacks as the “working poor” who value hard work, self-reliance, and other mainstream values of the African and Euro-American systems. They stay out of trouble, go to church, and emphasize schooling—all in contrast to their street-oriented ghetto neighbors.
Continue Reading »
10 Feb
TERMINOLOGY INADEQUACIES
Branden, who somewhat claims to have brought self-esteem to the public’s attention in the late 1950s, defines it as the estimate one individual passes on him/herself by way of a value judgment. Ayn Rand said it is reliance on one’s power to think. Sigelman refers to self-esteem as “your overall evaluation of your worth as a person, high or low, based on all the positive and negative self-perceptions that make up your self-concept.” Since these and other literature definitions do not seem to match, let us try to locate a “common ground” definition of self-esteem.
Continue Reading »
08 Feb
A review of the literature strongly suggests that providers who administer vaccines will benefit from monitoring their performance through assessment, including physicians in private practice. For those who work in public clinics, all states now require clinics to measure immunization coverage of 2-year-old children and the Advisory Committee on Immunization Practices recommends routine assessment by all providers. In addition, managed care organizations have begun to use immunization assessment as an indicator of the quality of health care services. Report cards or the Health Plan Employer Data and Information Set (HEDIS) measurements are becoming more important to MCOs. HEDIS was developed by the National Committee for Quality Assurance, an accrediting organization for MCOs. Many physicians in private practice do participate in one or more MCOs through an independent practice association. As we change to a more managed health care delivery system, documentation of the quality of services and care will become common. While providers who work directly as an employee of a “staff model” MCO similar to Kaiser Permanente or Prudential will be required to measure quality of services, all other providers receiving capitation or other forms of payment from MCOs will soon feel the pressure to assist MCOs in documenting the provision of quality care.
Continue Reading »
07 Feb
While we need to improve our immunization record, there is strong evidence that assessment of immunization coverage is an effective tool. In recent years, a few published studies have evaluated the effect of assessing immunization coverage on improving immunization levels; all have demonstrated improvement in coverage. One of the first studies was conducted in public health clinics in Georgia, where 70% of Georgian children received their immunizations. Annual assessments of coverage were conducted from 1987 to 1993 on nearly all of the 230 public clinics in Georgia. Immunization coverage and a diagnosis of the causes for suboptimal coverage were presented to the clinic staff and public health officials. Incentives were provided to encourage improvement in immunization rates. Information on coverage was shared between the clinics, strategies for improving immunization rates were shared at annual district and state meetings, and a peer-based incentive was created with peer pressure to improve coverage. This approach has been codenamed by the CDC as AFIX (Assessment, Feedback, Incentive, and Exchange). Improvement in coverage in Georgia public clinics was examined over a 7-year period. Coverage increased from less than 40% to 80% statewide with the incremental annual increases of 6%. During the same period, missed opportunities for immunization decreased from 18% to 0%.
Continue Reading »
06 Feb
There are at least three principal reasons for assessing immunization coverage: (1) national objectives for preventing childhood vaccine-preventable diseases exist; (2) suboptimal immunization coverage is a reality; and (3) effectiveness of the assessment strategy has been demonstrated.
Continue Reading »