Biomedical subjects
H Jones
Publications and source records attributed to H Jones.
Improving outcomes in therapeutic drug monitoring--a case history.
A case history describes quality improvement initiatives undertaken by the Laboratory, the Pharmacy, and the Department of Nursing at Children's Medical Center in Dallas, Texas, a 266-bed pediatric teaching hospital affiliated with the University of Texas Southwestern Medical School. The initial purpose of the study was to correct problems identified by a retrospective review of randomly selected patient charts. The problems included laboratory schedules for drug assays, the timing and documenting of blood collections, the reporting of toxic results to physicians, and the interpreting of serum drug concentrations. The major changes in the program included increased frequency of testing in the laboratory, educating nurses as to sample collection guidelines, introducing a clinical pharmacy consultation service, daily reporting of all drug levels to the pharmacy from the laboratory computer, and reporting toxic levels to the clinical pharmacist who then notified the physician and offered a consult. The study then began to focus on attempting to monitor the service related to outcome indicators. Outcome data included a comparison of test volumes (15.7% decrease), tests per adjusted patient day (15.4% decrease), and tests per patient day of therapy for aminoglycosides (gentamicin decreased 6.8%) before and after the changes were implemented. Data also included aminoglycoside tests reported as therapeutic and as toxic. Plans for further improvement have been identified and include differentiating peak and trough serum drug concentrations for aminoglycosides, possibly developing protocols for vancomycin and cyclosporine monitoring, continuing to educate laboratory technologists and nurses, and continuing to monitor usage and outcome indicators.
Putting employees under the microscope.
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Bayesian analysis: an objective, scientific approach to better decisions.
An important responsibility for managers is to see that good decisions are made, which includes training other decision makers in how to make them. In our rapidly changing health-care environment, it is important that the best decisions be made based on cost-effectiveness (tests we perform or outsource), productivity (employees we hire), service quality (how we organize services), technology (equipment and methods we purchase), and outcomes (what we accomplish for patients). A decision analysis method is described that uses an objective, scientific approach to decision making. Bayesian analysis is a statistical method that allows researchers (decision makers) to take into account data as well as prior beliefs to calculate the probability that an alternative (decision, treatment) is superior. Developing criteria, prior rating, of options, and calculating assessments and final assessment are included in the analysis. An example is provided to show how our laboratory compared routine hematology automation alternatives (automated cell counter, automated microscope, and automated flow cytometry cell counter) using the Bayesian analytical technique. Discussion follows related to how the technique is effective in managing team decisions by allowing different opinions, past experiences, and beliefs to be expressed and evaluated.
Rebuilding morale after downsizing.
Motivating employees is one of a manager's most important roles, but it is a challenge in today's shifting health-care market. Decreasing funding and a changing patient population are forcing hospitals to either cut costs or go out of business. In such a tense environment, the possibility of layoffs continually looms over our heads. Whether your laboratory is contemplating job cuts or you already have been through them, you know there is no worse threat to employee morale. A March 1996 Strategic Management survey reported that poor morale is the worst human resource problem among 81% of 691 U.S. hospitals. Ronald Henkoff said it best in the January 1994 issue of Fortune Magazine: "A distressing 80% of downsizers admit that the morale of the remaining employees has been mugged. These sullen, dispirited, hunkered-down folks, lest we forget, are the very people who are supposed to revitalize our enterprise and delight our customers." Many times, when we focus on cost constraints and customer service, we overlook what we might do to improve trust among our staff. Rather than letting bad feelings run their course after 1999 job cuts, we decided to intervene. We developed new management tools and recovery interventions at Children's Medical Center to ward off discontent after the changes.
Cancer patients use unconventional medical therapies far more frequently than standard history and physical examination suggest.
BACKGROUND: Studies with questionnaires have suggested that many cancer patients utilize unconventional medical therapies (UMT). There are few data evaluating directed questions about the use of UMT. This study was performed to determine if careful directed questioning about UMT reveals a higher rate of utilization compared to standard history and physical examination. MATERIALS AND METHODS: A prospective evaluation of 196 consecutive patients presenting for initial consultation at the University of Pennsylvania was performed. Each patient underwent standard history and physical examination, including questions regarding prescription and over-the-counter medications. At the completion of standard questioning, patients were asked an explicit set of directed questions regarding the utilization of UMT. The median age of the patient population was 61 years (range = 28-80 years). Cancer diagnoses included breast (19%), lung (28%), prostate (26%), and other (27%). Females constituted 32% of the patient population. RESULTS: Initially, only 13 patients (7%) revealed they were using UMT during a standard history and physical. Evaluation of the remaining 183 patients with directed questioning revealed an additional 66 patients (36%) were utilizing these therapies. Of the 79 patients taking UMT, 84% were identified by directed questioning and 16% by standard history and physical examination (P < 0.0005). Forty-one patients (52%) were using > or = 2 of these therapies (mean = 2.5; range 1-17 therapies). A total of 48 different UMT were used by this patient population. Patients utilizing multivitamin supplementation were significantly more likely to be using an UMT than those who were not (68% vs. 31%; P < 0.0001). Females were more likely to use UMT than males (49% vs. 35%; P = 0.08). CONCLUSIONS: The addition of explicitly directed questioning to the standard history and physical examination significantly increases the oncologist's ability to identify cancer patients who utilize UMT. Some of these therapies may interact with conventional cancer treatments and/or cause significant side effects; consequently, it is important for oncologists to detect those patients utilizing these therapies.
Proceedings: Measurement of total and regional lung water in vivo.
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3rd party payment for nurses.
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Organizational support of the clinical nurse specialist role: a nursing research and professional development directorate.
Administrative support is essential for optimal utilization of the Clinical Nurse Specialist (CNS) resource. It has been linked to successful role implementation, role efficacy and job satisfaction. The article addresses how a Nursing Research and Professional Development Directorate (NRPD) provides administrative support of the CNS role. The impact of the directorate on the role functions of practitioner, consultant, educator and researcher is delineated. Specific challenges to the CNS role and organizational benefits are described. A model of organizational support of the CNS, based on the concepts of collaboration and peer mentorship, is proposed. The model emphasizes mutual goal setting to achieve both organizational and professional objectives.
Nursing abroad: serving in the armed forces.
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The impact of the "scream": to use or not to use.
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Colostomy care. Maintaining an active life.
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Cause for complaint. A question of priorities.
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Preventing cancer with education.
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Beliefs of Indiana public school policymakers on the role of the school in education about sexuality: its responsibility, its quality, its direction.
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Me and my ward: organised chaos. Interview by Laurence Dopson.
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