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Biomedical subjects

J D Clark

Publications and source records attributed to J D Clark.

180 records · Page 10Linked to original sources
PubMedDate not supplied

Retinal haemorrhages and papilloedema due to benign intracranial hypertension in a pregnant diabetic.

A case of benign intracranial hypertension associated with generalized oedema is reported in a normotensive pregnant patient with long-standing insulin-treated diabetes mellitus. Following treatment with bed rest, chlorthalidone and dexamethasone the condition resolved and a healthy infant was delivered. This condition, not previously reported in a diabetic pregnancy, must be differentiated from other causes of bilateral optic nerve abnormalities associated with retinal haemorrhages and oedema, including diabetic retinopathy, diabetic optic neuropathy, accelerated hypertension and cerebral mass lesions. Treatment is required to prevent permanent visual impairment due to pressure on the susceptible optic nerve of the diabetic patient and to avoid the metabolic consequences to both mother and fetus of poor nutritional intake due to nausea.

Adult↗
PubMedDate not supplied

Are blood glucose reagent strips reliable in renal failure?

In vitro studies have suggested that a low packed cell volume may cause reagent strips to overestimate blood glucose concentration. The reliability of such strips has therefore been investigated in diabetic patients with end-stage renal failure, all of whom had low haematocrits (24 +2- 4 (4/- SD) %). Three brands of strips were evaluated and their results were compared with laboratory whole blood glucose concentrations determined on the same samples. All over-read compared with the laboratory (BM Glycemie 1-44 strips 118 +/- 1%, Glucostix 132 +/- 2%, ExacTech strips 163 +/- 4%) and the percentage overread was negatively correlated with the haematocrit for each strip (all p less than 0.001).

Blood Glucose↗
PubMedDate not supplied

Educating the provider community about the new role of the peer review organization.

This report suggests an educational format that has been used successfully in Michigan to introduce the Health Care Quality Improvement Initiative to the medical community. The activities related to pattern analysis and the Fourth Scope of Work will require a collaborative effort between the medical community and the peer review organization (PRO). To improve understanding by providers and practitioners of pattern analysis, the Fourth Scope of Work, and the new PRO requirements, a series of educational programs was designed. The first presentation in the educational series included information about the changes between the Third and Fourth Scope of Work as well as the new structure within the PRO responsible for the pattern analysis activities: the Center for Health Outcomes and Evaluation. Descriptions of the process to be followed in interactions between the Center and providers and practitioners also were included: For the second session, a hands-on exercise was created to introduce the concept of a pattern. The exercise included graphic representations of patterns and a worksheet format to encourage the user to find specific data points within tables and graphs, describe a pattern in hospital outcome data, and verify that the same outcome pattern appeared in subgroups of hospitals and physicians. The third component in the educational series was a demonstration of the interaction between the Center and a hospital participating in a cooperative improvement project. Hospital-specific and physician-specific data, with appropriate comparative data, were provided to an audience made up of hospital administrators, practicing physicians, and allied health personnel who then worked through the issues related to data validation, definition of a project, agreement on interventions, and remeasurement of the outcome under study.

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

Creation of hospital peer groups.

Hospital characteristics vary greatly across a geographic area such as a state. Hospital peer groups internally exhibit similar characteristics and can be used as a basis for the analysis of data, the dissemination of information, and the adoption of continuous quality improvement project results. This paper reflects the efforts made toward the identification of hospital peer groups within the state of Michigan. Hospital characteristics data for fiscal year 1992 were obtained from the American Hospital Association's Annual Survey of Hospitals and the Health Care Financing Administration's MEDPRO database. Thirteen peer group clusters have been identified, reviewed, and commented on by the state's hospital association and have met general approval by hospital administrators across the state. The established peer groups are being used to identify the differences in patterns of care among hospitals in the state. The peer groups also are being used for the feedback of comparable data and the identification of hospitals for participation in continuous quality improvement projects. The next research objective is to experiment with other clustering techniques and other inpatient populations. The consistency of the peer groupings across all clustering techniques and across both Medicare and total inpatient populations will be studied.

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

Surgery, growth modification or orthodontic camouflage? Brian's case.

A skeletal class II malocclusion can be dealt with in a number of ways. The preferred option is to use orthodontic treatment and growth modification if at all possible, but in cases where this is not possible the problem might be camouflaged or treated by surgery. In the case reported here the options are fully discussed and the opinions of the orthodontists expressed in the CASES project made clear. The actual treatment undertaken is also described.

Child↗