Thrombolysis "door-to-drug" interval.
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Critical Pathways↗
Biomedical subjects
J Teich
Publications and source records attributed to J Teich.
The future of clinical information systems: one hospital's perspective.
Developing advanced clinical information systems is a complex and arduous task. The pressures on the health care delivery system make the task imperative. Because of such a system's complexity, its potential to alter radically the practice of medical care, and the magnitude of the required investment, health care delivery organizations would be well served by a thoughtful determination of the perspectives, philosophies, and strategies that will govern the approach to this task. This article has presented a description of the results of the deliberations of the leadership of one organization, the Brigham and Women's Hospital. The ideas and activities described should prove useful to other organizations engaged in their own deliberations.
Academic Medical Centers↗
Prevention of neonatal macrosomia in gestational diabetes by the use of intensive dietary therapy and home glucose monitoring.
This study was undertaken to determine if intensive dietary therapy, home blood glucose monitoring, and the selective use of insulin can be effective in preventing fetal macrosomia. All patients were screened at 24 to 28 weeks' gestation using a modification of O'Sullivan's criteria. The 153 patients diagnosed as gestational diabetics by the study protocol were placed on a 1800 to 2000 Kcal American Diabetes Association diet and taught home glucose monitoring. Insulin therapy was initiated only if blood glucose control was inadequate. There were no significant differences (p greater than 0.05) between the study and reference populations in regard to mean birthweight or the incidence of macrosomia. Since our study criteria for diagnosing gestational diabetes were slightly different from those of the National Diabetes Data Group (NDDG), data from 99 patients meeting the NDDG criteria were analyzed in a similar manner. No significant differences were found between this subgroup and the reference population. Since only 7.2% of our study patients required insulin, we conclude that the incidence of fetal macrosomia in gestational diabetes can be kept equal to that of the general population by a program of intensive dietary therapy and home glucose monitoring, with insulin being used only therapeutically, not prophylactically.
Adult↗
United States citizens studying medicine abroad. Their backgrounds and test performance.
To acquire information about the characteristics of U.S. citizens who had recently studied medicine abroad, the Educational Commission for Foreign Medical Graduates (ECFMG) and the Association of American Medical Colleges merged independently collected data on a study group of 10,460 U.S. citizens who attended 359 medical schools in 75 foreign countries and who took their first ECFMG examination between 1978 and 1982. The study group was markedly heterogeneous: 21 percent were not U.S. citizens at birth, 32 percent did not have English as a native language, and 12 percent had two or more years of undergraduate college education in Puerto Rico. Sixty-seven percent resided in New York, New Jersey, California, Florida, or Puerto Rico, and 74 percent studied medicine in Mexico or the Caribbean. Forty-six percent passed the ECFMG examination on their first attempt, and 22 percent passed a subsequent examination. Only 45 percent had applied to a U.S. medical school, and 65 percent had taken the Medical College Admission Test. The means of the college grade-point averages, known for 39 percent of the study group, and of the scores on the admission test, known for 65 percent, were lower than those of both accepted and unaccepted applicants to U.S. medical schools in the 1976 and 1978 entering classes. The finding that 55 percent of the study group did not apply to a U.S. medical school does not support the widely held belief that most, if not all, U.S. citizens who attend foreign medical schools do so only after several unsuccessful attempts to gain admission to a U.S. school.
Adult↗
How to bring the impaired physician to treatment.
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Humans↗
Potential identifiability and preventability of adverse events using information systems.
STUDY OBJECTIVE: To evaluate the potential ability of computerized information systems (ISs) to identify and prevent adverse events in medical patients. DESIGN: Clinical descriptions of all 133 adverse events identified through chart review for a cohort of 3,138 medical patients were evaluated by two reviewers. MEASUREMENTS: For each adverse event, three hierarchical levels of IS sophistication were considered: Level 1--demographics, results for all diagnostic tests, and current medications would be available on-line; Level 2--all orders would be entered on-line by physicians; and Level 3--additional clinical data, such as automated problem lists, would be available on-line. Potential for event identification and potential for event prevention were scored by each reviewer according to two distinct sets of event monitors. RESULTS: Of all the adverse events, 53% were judged identifiable using Level 1 information, 58% were judged identifiable using Level 2 information, and 89% were judged identifiable using Level 3 information. The highest-yield event monitors for identifying adverse events were "panic" laboratory results, unexpected transfer to an intensive care unit, and hospital-incurred trauma. With information from Levels 1, 2, and 3, 5%, 13%, and 23% of the adverse events, respectively, were judged preventable. For preventing these adverse events, guided-dose algorithms, drug-laboratory checks, and drug-patient characteristic checks held the most potential.
Decision Making, Computer-Assisted↗