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Biomedical subjects

D Wood

Publications and source records attributed to D Wood.

At least 109 records · Page 6Linked to original sources
PubMed1996

Season of birth and gender effects in children attending moderate learning difficulty schools.

This paper examines the effects of season of birth and gender on academic achievement and cognitive abilities in children attending moderate learning difficulty schools. Given the high preponderance of both boys and children born in summer attending special schools it is important to consider how well these children perform in relation to their peers. A multivariate analysis reveals that both boys and summer born children perform better on tests of intelligence, mathematical ability, and reading comprehension. Summer born children also perform better on a test of communication skills. Discriminant functions analysis reveals that for both gender and season of birth IQ is the major predictor variable followed by reading comprehension, mathematical ability and communication skill. For gender, IQ discriminates more successfully than the other variables, whereas with season of birth the relative sizes of the effects are more comparable. The results of the analysis are discussed in terms of the implications for the identification of children for placement in moderate learning difficulty schools.

Adolescent↗
PubMed1996

Economic aspects of lung volume reduction surgery.

OBJECTIVE: To investigate the economics of lung volume reduction surgery. DESIGN: Medical center and physician charges obtained from billing records. SETTING: Academic health center. PATIENTS: Twenty-three consecutive patients undergoing lung volume reduction surgery at a single institution who were discharged from the hospital prior to November 1, 1995. OUTCOME MEASURES: Length of hospital stay, mortality, medical center charges and professional fees, and sponsor reimbursement. RESULTS: Median hospital stay was 8.0 days and there were no deaths. The median charge was $26,669 (range, $20,032 to $75,561) of which 73% was for medical center services and 27% was for physician services. Fees for medical center rooms and operating suite time accounted for 71% of medical center charges. Charges by surgeons and anesthesiologists accounted for 77% of professional fees. Total charges were directly related to length of stay (r2 = 0.95). Median reimbursement for medical center services was $22,264 (114%; range, $13,333 to $123,362) and for physician services was $2,783 (34%; range, $2,597 to $11,265), resulting in a median total reimbursement that represented 94% of total charges. The median reimbursement-to-cost ratio was 1.22, compared with 1.05 for all medical services in fiscal year 1995. CONCLUSIONS: These data must now be assessed relative to outcomes such as quality of life, patient function, and long-term survival to determine cost-effectiveness of lung volume reduction surgery.

Cost Savings↗
PubMed1996

Inappropriately timed immunizations: types, causes, and their relationship to record keeping.

OBJECTIVES: This study examined inappropriately timed immunizations and their relationship to record keeping practices in Los Angeles public health centers. METHODS: Records of children's visits were reviewed at four public health centers maintaining separate records. RESULTS: One third of all children seen at both immunization-only and well child clinics were given inappropriately timed immunizations. Almost half of the immunizations were not transferred between sets of records. Children seen in both clinics were more than twice as likely to receive at least one inappropriately timed immunization as those seen only at the well child clinic. CONCLUSIONS: Keeping separate immunization records at separate clinics leads to inappropriately timed immunizations.

Community Health Centers↗
PubMed1996

The safety of antimalarial drugs in pregnancy.

Alternative drugs to chloroquine are required to prevent the deleterious effects of malaria in pregnancy. Fear of potential toxicity has limited antimalarial drug use in pregnancy. Animal toxicity studies have documented teratogenicity when antimalarials are administered at high dosages. Excepting the tetracyclines, there is no evidence to suggest that, at standard dosages, any of the antimalarial drugs are teratogenic. Primaquine is not recommended because of the potential risk of haemolytic effects in the fetus. Rates of spontaneous abortion and birth defects were comparable in pregnant women taking mefloquine, compared with chloroquine-proguanil, or pyrimethamine-sulfadoxine prophylaxis, in the first trimester of pregnancy. Standard doses of quinine do not increase the risk of abortion or preterm delivery. Therapeutic mefloquine does not provoke hypoglycaemia. There is no evidence in the literature to support the hypothetical risk of kernicterus in the newborn, following exposure to antimalarial drugs containing sulphonamides or sulphones prior to delivery. Documentation of the safety of doxycycline, halofantrine, and the artemisinin derivatives in the treatment of malaria in pregnant women is currently limited.

Animals↗
PubMed1996

Improving the accuracy of total quality management instruments.

Total quality management (TQM) instruments are essential tools in defining concepts identified in an Ishikawa or ¿cause-and-effect¿ diagram. Collecting meaningful and accurate data using TQM instruments is imperative if productivity and quality of care are to be enhanced. This article provides managers with techniques and guidelines that will enhance the reliability and validity of TQM instruments, thereby promoting organization efficiency and customer satisfaction.

Efficiency, Organizational↗
PubMed1996

Quality improvement of diagnostic microbiology through a peer-group proficiency assessment program. A 20-year experience in Ontario. The Microbiology Committee.

OBJECTIVE: To evaluate the microbiology laboratory performance in Ontario over a 20-year period of participation in a quality assessment program and to assess the impact of quality improvement strategies. DESIGN: Longitudinal review of isolation, identification, and antimicrobial susceptibility testing of bacteria from lyophilized, simulated patient samples. SETTING: Ontario medical laboratories, licensed by the Ministry of Health, have been subjected to mandatory testing by the Laboratory Proficiency Testing Program of the Ontario Medical Association since 1974. Survey reports, information bulletins, correspondence, on-site consultations, educational assistance tutorials, and teleconference education are used as quality improvement strategies. PARTICIPANTS AND INTERVENTIONS: Laboratories were subjected annually to 20 external quality assessment challenges. Performance was assessed against consensus reference values. Single survey and cumulative profiles were reviewed by a peer-group panel for acceptable or unacceptable performance. Specific interventions are used to improve collective and individual laboratory performance. RESULTS: The number of microbiology laboratories declined from 335 in 1974 to 190 in 1994. Twenty-one percent failed expected performance standards on initial review. One hundred forty-two on-site consultations and 61 educational assistance tutorials have been provided. Twenty-five laboratories were declared nonproficient. Since 1989, 50% of the laboratories have scored at or above 80% for isolation and identification, but 25% have scored at or below 50% on susceptibility testing, and 10% or fewer have scored at or above 80%. Poor susceptibility testing performance is due to inappropriate agent selection, not testing errors. CONCLUSIONS: The emphasis of the Laboratory Proficiency Testing Program is on quality improvement, not punishment. Performance has improved, but poor performers have the same characteristics as in 1974. Identification to species is common owing to the use of commercial systems. Automated susceptibility testing has increased to 45% of participants.

Bacterial Infections↗
PubMed1996

Inhibition of vascular smooth muscle cell proliferation and arterial intimal thickening by a novel antiproliferative naphthopyran.

Smooth muscle cell proliferation plays an important role in neointimal thickening after vascular injury and may contribute to restenosis after angioplasty. Development of suitable pharmacological agents modulating smooth muscle cell proliferation is critical for further investigation of vascular hyperplasia and its prevention. In the present study, we report a novel series of compounds that inhibit smooth muscle cell proliferation and arterial intimal thickening after balloon angioplasty. LY290181 (2-amino-4-[3-pyridyl]-4H-naphtho [1, 2-b]pyran-3-carbonitrile) and LY290293 (2-amino-4-[3-pyridyl]-4H-naphtho [1, 2-b]pyran-carbonitrile) produced a dose-dependent inhibition of DNA synthesis and proliferation of vascular smooth muscle cells in culture. Fifty percent inhibition (IC50) of cell proliferation was produced by 20 nM LY290181 or LY290293. Cell growth inhibition was not due to cell death, as demonstrated by the release of intracellular lactate dehydrogenase and by the reversibility of inhibition upon washing. Inhibition of smooth muscle cell proliferation was achieved in cells stimulated by either serum or individual growth factor such as platelet-derived growth factor, fibroblast growth factor or epidermal growth factor. In the rat model of balloon injury to carotid artery, LY290181 and LY290293 produced 61% (P < .005) and 48% (P < .005) inhibition of intimal thickening when administered p.o. at 100 and 120 mg/kg/day, respectively, over a 2-week period. Inhibition of intimal thickening (70%, P < .005) by LY290293 was also demonstrated when the compound was administered s.c. at 10 mg/kg/day. These studies demonstrate that naphthopyrans LY290181 and LY290293 are potent inhibitors of smooth muscle cell proliferation in vitro and that they produce substantial reduction in arterial intimal thickening in a balloon injury model when administered systemically.

Angioplasty, Balloon↗
PubMed1995

The proficiency testing of platelet counting.

Ontario's laboratory professionals have shown that they are able to successfully operate a proficiency testing program by making use of volunteers. The program serves and assists the laboratory directors in their own quality assurance program. The two prime reasons for the success of LPTP are that it is not seen by the professions to be regulatory and that it emphasizes education, not punitive action. Whereas platelet performance below 100 x 10(9)/L is not as accurate as the remainder of the clinical range, most Ontario laboratories seem to perform platelet determinations at clinically acceptable levels.

Blood Platelets↗
PubMed1995

CQI action team: responding to the detoxification patient.

BACKGROUND: The management of detoxification patients is a complex interdisciplinary effort requiring involvement, cooperation, and understanding from staff at all levels of the facility. In 1992-93, alcohol-related diagnoses were the highest admission diagnosis at the Royal C. Johnson Veterans Affairs Medical Center (VAMC). Yet only 44% of the detoxification patients admitted to the VAMC were placed in beds specifically designed for detoxification. Initially, the action team believed that the issues were apparent and that the problems were the result of uncooperative and noncompliant providers who were not following established policy. METHODS AND RESULTS: Data analysis of admission and discharge trends, laboratory results, and bed census revealed discrepancies with several widespread myths held by local health care workers. These misperceptions and attitudes often interfered with treatment. CONCLUSIONS: Recommended changes included the development of a clinical pathway for the detoxification patient, implementation of an alcohol withdrawal assessment tool to manage and treat the patient at risk for experiencing alcohol withdrawal, and hospitalwide education on management of the detoxification patient.

Alcoholism↗
PubMed1995

A case study of nursing case management in a rural hospital.

This article describes the process of implementing a New England model of case management in a rural hospital and the modifications necessary in adapting an urban model to a rural setting. Nursing case management at this institution has been associated with a decrease in the length of stay by 1.7 days at an estimated cost savings of $65,932 for the 16-month study period. Case management has also been instrumental in improving quality of care through a program of continuous quality improvement and in redesigning the RN role. The vision for the future is to extend the nurse case manager role outside the hospital walls to the community in a collaborative plan that would bill nursing services through physicians' offices.

Cost-Benefit Analysis↗
PubMed1995

Evidence that the National Committee for Clinical Laboratory Standards disk test is less sensitive than the screen plate for detection of low-expression-class methicillin-resistant Staphylococcus aureus.

A low-expression-class methicillin-resistant Staphylococcus aureus strain (strain 9302-2) was sent to 207 laboratories as part of the bacteriology component of the Laboratory Proficiency Testing Program of Ontario. An incorrect (susceptible) result was reported by 16 of 76 (21%) of laboratories that used the National Committee for Clinical Laboratory standards disk test, whereas 1 of 104 laboratories that used other methods reported an incorrect result (P < 0.05). Experiments showed discrepancies in the disk test results given by Mueller-Hinton agars from three manufacturers. We advise that laboratories should use a low expression-class methicillin-resistant S. aureus isolate as a control for the National Committee for Clinical Laboratory Standards disk test.

Humans↗
PubMed1995

Nonfinancial barriers to care for children and youth.

Public health and medical care interventions have produced dramatic changes in the health of children in the United States. Emerging new morbidities such as behavioral and learning disorders, and child abuse and neglect, highlight the lack of an integrated system of health. Children's developmental vulnerability, dependency, and unique morbidities have been underemphasized in the organization and delivery of health care. The Andersen and Aday model of health care utilization is used to describe financial and nonfinancial barriers to care for children that include family characteristics and organizational characteristics of the health system. Case studies of immunization delivery, children with chronic illness, and mobile populations of children reveal the mismatch between the health care system and children's basic health needs. Integrated service models for high-risk populations of children represent an essential mechanism for coordinating the delivery of medical, developmental, educational, and social services needed by children and families. Universal, coordinated public health and medical services of adequate scope and quality should be assured for children through market and health system reform.

Adolescent↗