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Biomedical subjects

C Weir

Publications and source records attributed to C Weir.

34 records · Page 2Linked to original sources
PubMed1996

Overutilization of acute-care beds in Veterans Affairs hospitals.

The authors tested the hypothesis that the Department of Veterans Affairs (VA) hospitals would have substantial overutilization of acute care beds and services because of policies that emphasize inpatient care over ambulatory care. Reviewers from 24 randomly selected VA hospitals applied the InterQual ISD* (Intensity, Severity, Discharge) criteria for appropriateness concurrently to a random sample of 2,432 admissions to acute medical, surgical, and psychiatry services. Reliability of hospital reviewers in applying the ISD* criteria was tested by comparing their reviews with those of a small group of expert reviewers. Validity of the ISD* criteria was tested by comparing the assessments of master reviewers with the implicit judgments of panels of nine physicians. The physician panels validated the ISD* admission criteria for medicine and surgery (74% agreement with master reviewers, kappa > 0.4), whereas the psychiatry criteria were not validated (66% agreement, kappa 0.29). Hospital reviewers reliably used all three criteria sets (> 83% agreement with master reviewers, kappa > 0.6). Rates of nonacute admissions to acute medical and surgical services were > 38% as determined by the hospital and master reviewers and by the physician panels. Nonacute rates of continued stay were > 32% for both medicine and surgery services. Similar rates of nonacute admissions and continued stay were found for all 24 hospitals. Reasons for nonacute admissions and continued stay included lack of an ambulatory care alternative, conservative physician practices, delays in discharge planning, and social factors such as homelessness and long travel distances to the hospital. Using criteria that the authors showed to be reliable and valid, substantial overutilization of acute medicine and surgical beds was found in a representative sample of VA hospitals. Correcting this situation will require changes in physician practice patterns, development of ambulatory care alternatives to inpatient care, and modification of current VA policies determining eligibility for care.

Acute Disease↗
PubMed1996

The impact of physician order entry on nursing roles.

This study examines the impact of physician order entry (POE) on nurses perceptions of work, quality of care, and nurse/physician communication. Four hospitals that have implemented a computerized order-entry system with POE were compared with four similar hospitals using the same computerized system with clerk order entry only. Three factors were extracted from the 29 item survey using principal component extraction with varimax rotation that accounted for 16.5%, 12.4% and 8.7% of the variance respectively. Three scales were constructed from these factors measuring perceptions of impact of the information system on the quality of care, job, control, and nurse/physician communication. Nurses working in the POE environment rated their computer system as having greater impact on the quality of care and lower ratings of perceived control than those working in non-POE environments. No differences were found between nurses working in POE environments and those working in POE in terms of their ratings of frequency of contact and ease of access to physicians.

Attitude of Health Personnel↗
PubMed1995

Successful implementation of an integrated physician order entry application: a systems perspective.

Direct physician order entry is required for effective implementation of an integrated electronic medical record. This effort involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the findings of a follow-up study that quantified dimensions associated with successful implementation identified in a previous study. Results identified several implementation strategies associated with success. These include an interdisciplinary implementation group, involvement of large numbers of regular staff, early and intensive training and support, and 24 hour available assistance as important to success. In addition, attitudes of physicians and their level of involvement were found to be associated with success.

Attitude of Health Personnel↗
PubMed1994

Dimensions associated with successful implementation of a hospital based integrated order entry system.

Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.

Attitude of Health Personnel↗
PubMed1992

Once a boring task always a boring task? Interest as a self-regulatory mechanism.

A process was proposed through which individuals regulate their motivation to perform necessary but uninteresting activities over time. If committed to continuing, individuals may engage in interest-enhancing strategies that can change the activity into something more positive to perform. In Study 1 Ss performed novel tasks and generated strategies to make regular performance interesting. In Study 2 Ss actually used these strategies primarily in conditions indicating a self-regulatory attempt: The task was currently boring, there was a perceived reason to continue (alleged health benefit), and a relevant strategy was available. Strategy use was associated with a change in activity definition and greater likelihood of subsequently performing the activity. In Study 3 Ss beliefs about how to maintain motivation to perform more everyday activities emphasized the importance of regulating interest relative to other self-regulatory strategies.

Adult↗
PubMed1992

Patient and family satisfaction with discharge plans.

This study explored factors affecting patient and family satisfaction with discharge plans, an outcome of discharge planning provided by the hospital department of social work. Adequacy of discharge plans was rated by 126 patients and 130 family members within 24 hours before hospital discharge. Patient ratings of discharge plans were related to their degree of involvement in decision making, social support networks (sex and marital status), and physical condition (diagnosis and functional ability). Three types of factors were important to family members: 1) factors related to the discharge planning process, 2) the patient's discharge destination, and 3) length of patient hospital stay. Findings are discussed in terms of their implications on maximizing consumer satisfaction in the cost-conscious environment.

Aged↗
PubMed1992

Dyspnea and pulmonary function in the L-tryptophan-associated eosinophilia-myalgia syndrome.

We reviewed the pulmonary history, dyspnea ratings, and pulmonary function test results in 16 patients with L-tryptophan-induced eosinophilia myalgia syndrome to determine the correlation between reported pulmonary complaints and pulmonary function abnormalities. All patients reported pulmonary symptoms. Dyspnea, seen in 14 of 16 (87 percent) patients, was the most common symptom. The severity of dyspnea was graded by the baseline dyspnea index and the oxygen cost diagram. Pulmonary function testing including maximal static inspiratory and expiratory pressures were measured. The DCO was diminished in 12 of 16 (75 percent) patients. The MSIP was decreased in seven out of ten (70 percent) and the MSEP was decreased in nine out of ten (90 percent) of those patients tested. There was a statistically significant correlation between the severity of dyspnea as graded by the BDI and OCD, and the decrease in DCO. These results and a review of the literature of the pulmonary manifestations of EMS lead us to conclude that patients with EMS have a high prevalence of dyspnea, and it appears to be caused by both lung parenchymal involvement, as well as respiratory muscle weakness.

Adult↗
PubMed1989

Effects of instruction on intrinsic interest: the importance of context.

Two studies examined how contextual cues influence the impact of receiving instructions for improving performance on intrinsic motivation. The authors proposed that whether instruction enhances or decreases motivation depends on the salience of performance goals. Goal salience was proposed to be a function of how an individual defines the activity, which, in turn, may be influenced by contextual features. To test this hypothesis, the authors used a computer game that emphasized fantasy in addition to skill, and they varied the presence of contextual cues highlighting performance. In Study 1, the authors varied the presence of prior performance feedback, and found that instruction decreased interest only when no prior performance feedback (positive or negative) was received. In Study 2, the authors explicitly manipulated contextual salience by describing the activity's goals as either skill- or fantasy-related. Instruction decreased interest in the fantasy-emphasis context, but increased interest in the skill-emphasis context. Furthermore, when instruction matched perceived goals Ss experienced greater positive affect while performing the task. The implications for models of intrinsic motivation are discussed.

Achievement↗
PubMed1989

Mineral deficiency in the pathogenesis of enamel hypoplasia in prematurely born, very low birthweight children.

Although it is well known that enamel hypoplasia commonly is observed in prematurely born, very low birthweight (VLBW) children, its pathogenesis is not understood clearly. One likely mechanism may be related to mineral deficiency, which may be diagnosed as radiological demineralization of the long bones. In this study, we compared the cortical area of the humerus as measured from neonatal radiographs in 31 VLBW children with enamel hypoplasia and 14 VLBW children without enamel hypoplasia. The results showed that children with enamel hypoplasia had a lower mean cortical area of 10.1 +/- 1.9 mm2 compared with 13.9 +/- 1.4 mm2 in children without enamel hypoplasia (P less than 0.001). It was also found that intubated children with a lower cortical mass may be more predisposed to develop localized enamel hypoplasia caused by the laryngoscope (P less than 0.001).

Bone and Bones↗
PubMed1981

Validation of the auditory response cradle with sound and tactile stimuli.

The usefulness of the auditory response cradle as a device to test perception of neonates was extended to include tactile as well as sound stimuli. Newborns received three types of trials: white noise, von Frey hair (heavy and light) or no stimulus (control) presentations. The motor and respiration response probabilities were calculated for each type of trial. There was roughly equivalent responding for auditory and tactile stimuli whilst the control response rate was significantly lower. The heavy von Frey hair was more likely to evoke a response than the light one. These results were taken as evidence that the auditory response cradle can be used to test neonatal perception in more than one modality.

Acoustic Stimulation↗