An assessment of selected performance outcomes associated with the DOD capitation budgeting demonstration (pilot) project (1978-1981).

In the early 1970's, rising military health care costs led to congressional interest in alternative health care delivery systems wherein efficiency and cost containment had been successfully demonstrated. As a result of a recommendation of the Military Health Care Study (1975) , DOD developed and implemented a pilot capitation budgeting (CB) resource allocation system during 1978-81. During the subsequent evaluation, a contractor determined that the tested methodology did not result in significant improvements over the traditional budgeting system. Consequently, the demonstration was terminated.http://archive.org/details/assessmentofsele00orloLieutenant, Medical Service Corps, United States NavyApproved for public release; distribution is unlimited

A Review of Events That Expose Children to Elemental Mercury in the United States

Concern for children exposed to elemental mercury prompted the Agency for Toxic Substances and Disease Registry and the Centers for Disease Control and Prevention to review the sources of elemental mercury exposures in children, describe the location and proportion of children affected, and make recommendations on how to prevent these exposures. In this review, we excluded mercury exposures from coal-burning facilities, dental amalgams, fish consumption, medical waste incinerators, or thimerosal-containing vaccines. We reviewed federal, state, and regional programs with data on mercury releases along with published reports of children exposed to elemental mercury in the United States. We selected all mercury-related events that were documented to expose (or potentially expose) children. Primary exposure locations were at home, at school, and at others such as industrial property not adequately remediated or medical facilities. Exposure to small spills from broken thermometers was the most common scenario; however, reports of such exposures are declining. The information reviewed suggests that most releases do not lead to demonstrable harm if the exposure period is short and the mercury is properly cleaned up. Primary prevention should include health education and policy initiatives

African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings

Background International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Methods Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Results Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Conclusions Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources

A preliminary analysis of educational needs for Navy health care executives

The Bureau of Medicine and Surgery and the Naval Postgraduate School have initiated the development of an innovative program in management education for senior Naval health care executives. The first phase of the development was based on interviews with 80 executives to determine their perceptions of the skills needed to effectively manage military treatment facilities. The interview findings became the basis of a survey-based needs analysis, which is the focus of this report. Data analyses were focused on the requirements for specific management skill areas, needs for education in these domanins, and how these perceptions differ as a function of rank, position, and corps of the respondents.Bureau of Medicine and Surgery, Department of the Navyhttp://archive.org/details/preliminaryanaly00crawN0619A93P000014Approved for public release; distribution is unlimited