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Biomedical subjects

D Wilson

Publications and source records attributed to D Wilson.

At least 595 records · Page 33Linked to original sources
PubMedDate not supplied

Quality improvement through review of inpatient deaths.

Emphasis on hospital mortality as a monitoring tool has raised concerns about the validity of mortality rates as a measure of quality of care. An indepth review of all mortalities at Beth Israel Medical Center was conducted from 1988 through 1993. Clinical issues identified from chart review were referred for departmental physician peer review, and quarterly reports of trends and issues were disseminated to all levels of the institution. Mortality rates declined 21% over the 6 years, from 3.3% to 2.6% of all discharges. Clinical quality issues were identified in less than 3% of all mortalities. The majority of problems were related to delays and appropriateness of treatment (57% of quality issues). The review program identified specific hospital processes for improvement, and, more importantly, created a "watchful concern" about quality-of-care issues throughout the hospital.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Comparative efficacy of nicardipine hydrochloride and propranolol in the treatment of hypertension.

Nicardipine hydrochloride and propranolol were compared for antihypertensive efficacy and safety in a 14-week randomized, double-blind, crossover study. After taking placebo for 4 weeks, patients received either nicardipine (30 mg three times a day) or propranolol (40 mg three times a day) for 4 weeks, then placebo for 2 weeks and, finally, were crossed over to the alternative active medication for 4 weeks. Both drugs substantially reduced blood pressure. Statistically significant treatment effects favouring nicardipine were observed for supine and standing diastolic and systolic blood pressures. As expected, heart rate decreased significantly with propranolol, but not with nicardipine. Of the 33 patients evaluated for safety, 18 reported adverse experiences (two while taking placebo) that were assessed as probably related to the drugs under study. Symptoms related to vasodilation were reported more frequently during nicardipine treatment and respiratory complaints were more frequent in patients given propranolol.

Aged↗
PubMedDate not supplied

The effect of the Medicare regulations on hospice practice: enhancing staff performance.

The purpose of this paper is to examine the federal hospice regulations (42 CFR 418.50-.100) and identify from these standards key characteristics that help define important aspects of palliative hospice care. The other purpose will be to examine these requirements to determine what these standards say or imply about the functioning of the hospice staff within the certified program. We assert that in order for a certified program to function in the capacity outlined in the federal hospice requirements, both the administration and staff need to understand, and then practice, the complex role delineated within the Congressional Law and ensuing regulations. The Medicare hospice regulations are a recognized program standard throughout the nation. These requirements, finalized in 1983, were developed by the Health Care Financing Administration (HCFA) as a result of the Congressional Tax Equity and Fiscal Responsibility Act (TEFRA, 1982). Since the promulgation of these regulations, hospices wishing to gain certification have had to adapt and mold their program focus and clinical procedures to meet this legislative mandate. Although some hospice administrators may perceive the Medicare requirements simply as hoops to be jumped through in order to gain funding, in truth, these regulations stand as a benchmark in the history of American hospice care. In their totality, the rules set forth a system of health care that is singular in program design.

Certification↗
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Hospice care versus home health care: regulatory distinctions and program intent.

A significant percentage of community health care agencies have both a certified hospice and home health program component. These agencies commonly utilize many of the same "cross-trained" staff in both programs. However, these programs are not identical in focus, scope and regulatory practice. This paper examines both certified hospice and certified home health care practice from the standpoint of the Code of Federal Regulations (CFR). The distinctions made in these two sets of regulations (hospice, 42 CFR 418.50-.100 and home health, 42 CFR 484.10-.52) point to important differences in program and management practice.

Certification↗
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Relationship between acute diarrhoea and low plasma levels of vitamin A and retinol binding protein.

The objective of this study was to assess vitamin A status and association between acute diarrhoea and plasma levels of vitamin A through cross-sectional comparison in children. Plasma vitamin A was measured by colorimetric method of Neeld & Pearson and RBP by radial immunodiffusion technique. Seventy eight children (aged 18-119 months), 26 with current history of diarrhoea and 52 children as controls (outpatient from the Santa Casa de Misericórdia Hospital in metropolitan area of São Paulo City, Brazil) were studied. Children with history of diarrhoea showed significant low levels (mean +/- s.e.) as compared to controls, vitamin A (15.87 +/- 1.4 micrograms/dl vs. 21.14 +/- 1.15 micrograms/dl, p < 0.007) and RBP (1.70 +/- 0.2 mg/dl vs. 2.52 +/- 0.11 mg/dl). Multivariate logistic regression adjusted by sex, age, nutritional status and mother education revealed association between diarrhoea and inadequate levels of vitamin A and RBP.

Acute Disease↗
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The new look of health facility design.

Recent changes to our health care system are affecting priorities in the design of hospital facilities. Architects are now more often consulted to renovate or retrofit facilities than to design and build new ones. Using case studies, this article outlines the principal points to consider when renovating or retrofitting a health care facility.

Architecture↗
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Recruitment strategies used by an allied health education program to increase student enrollment.

OBJECTIVE: To increase student enrollment in and public awareness of a Clinical Laboratory Science (CLS) program so that the program would not be eliminated by the University. SETTING: The Medical Technology (MT) program at the University of Delaware (UD). PRACTICE DESCRIPTION: The MT program is a 2 + 2 university-based program established in 1948. The program is accredited for 26 students. PRACTICE INNOVATIONS: Various recruitment activities were used to increase enrollment including presentation at high schools, and panel discussions and open houses held on campus. Extensive publicity on and off campus was used to inform the community about CLS. MAIN OUTCOME MEASURE: Student enrollment in the program and the results of a survey administered to students enrolled in a CLS introductory course. RESULTS: There were 22 students in the 1993-1994 graduating class compared to 10 in the 1992-1993 class. The enrollment also increased for the junior, sophomore, and freshman classes. Because of increased student enrollment and public awareness, the University decided not to eliminate the MT program. CONCLUSION: No single recruitment activity contributed to the increased numbers; rather, it appears that all of the activities contributed to the rise in enrollment of MT majors at UD.

Delaware↗
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Equine vaccination.

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Animals↗
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Review of the effect of early amniocentesis on foot deformity in the neonate.

A recent publication by the Canadian Early and Mid-Trimester Amniocentesis Trial Group reported an increase in orthopaedic foot deformities in infants whose mothers underwent an amniocentesis from 11 to 12 + 6 gestational weeks versus a group sampled between 15 to 16 + 6 gestational weeks. Because the sampling of the former group was at the time of maximum foot growth and maximum acquisition of amniotic fluid, the authors hypothesize that the foot deformities are secondary to decreased fetal movement during a key phase in foot and ankle development.

Amniocentesis↗
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York Medical Society.

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Education, Medical↗