Biomedical subjects

M M Morgan

Publications and source records attributed to M M Morgan.

60 records · Page 4Linked to original sources

PubMed1984

Improving physician performance through peer comparison feedback.

A project to improve physician performance in colorectal cancer screening was evaluated as part of an ambulatory quality assurance program. A minimum standard was adopted requiring a digital examination and stool test for occult blood at annual check-ups of patients aged 40 years and older. During a 31/2-year period, three different intervention strategies for improved compliance with the standard were sequentially implemented and assessed: educational meeting, retrospective feedback of group compliance rate, and retrospective feedback of individual compliance rate compared with that of peers. A pretest/posttest design was employed in evaluating the first two intervention strategies. Neither strategy resulted in significant improvement in compliance. Monthly feedback of individual performance ranked with that of peers was then implemented in a randomized clinical trial utilizing a crossover design. During the first 6-month period, the physicians receiving feedback (group 1) improved from 66.0% to 79.9% (P less than 0.001), while the control group (group 2) also improved, from 67.5% to 76.6% (P less than 0.001), suggesting a spillover effect. During the second 6-month period, group 2 received feedback and group 1 did not. Group 1 stabilized at approximately 80% while group 2 continued to improve from 76.6% to 84.0% (P less than 0.001). Behavior changes persisted at 6 and 12 months after intervention.

Boston↗

PubMed1984

Lidocaine-pancuronium bromide retrobulbar injection: experimental studies of simultaneous neural and myoneural blockage for profound akinesia.

The akinesia of the superior rectus muscle after retrobulbar administration of lidocaine was quantitatively compared to the akinesia after retrobulbar administration of a mixture of lidocaine and pancuronium bromide. Adult cats were given halothane general anesthesia and a limited orbitotomy was performed to facilitate exposure of the superior rectus muscle and its branch of the superior division of the oculomotor nerve. The superior rectus muscle was disinserted and connected to a myograph. A suprathreshold stimulus of 3 volts was then applied to the branch of the oculomotor nerve innervating the superior rectus muscle. The strength, measured in grams, of the superior rectus muscle contraction was then quantitated with the myograph. Subsequently, retrobulbar administration of the drug was given and at 10 minute intervals thereafter the suprathreshold electrical stimulus of 3 volts was reapplied to the nerve innervating the superior rectus muscle, and the strength of the contraction was recorded with the myograph. Retrobulbar administration of 0.5 cc of 2% lidocaine was compared with retrobulbar administration of a mixture of 0.5 cc of lidocaine 2% and 0.2 mg of pancuronium bromide at a dosage of 0.04 mg per kilogram. For the first 30 minutes of the experiment, each retrobulbar administration provided profound akinesia with a total absence of measurable muscular contraction, despite suprathreshold stimulation of the nerve. From 40 to 120 minutes following the retrobulbar administration, the combination of lidocaine 2% and pancuronium bromide was associated with persistent absence of measurable superior rectus contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Local↗

PubMed1983

A computer-based monitoring system for follow-up of elevated blood pressure.

An automated surveillance system utilizing a computer-based medical record system (COSTAR) was designed to improve the follow-up of patients with newly identified elevated diastolic blood pressure. A population of patients was selected where, in the 6-month period following the initial measurement of an elevated diastolic blood pressure, there were fewer than two visits during which blood pressure was recorded. In a randomized controlled clinical trial, this poor follow-up population was divided into two groups, with computer-generated reminders being automatically generated for only patients in the experimental group. Follow-up was significantly improved in the group receiving the reminders, both in terms of rate of follow-up attempted or achieved by the responsible physician and in the repeated recording of blood pressure. We conclude that a computer-based reminder system improves follow-up of newly discovered elevation in diastolic blood pressure.

Adolescent↗

PubMed1978

Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system.

A computer-based medical information system (COSTAR) has been used to support a quality assurance program where the data collection is an integral part of the patient care recording activity and, therefore, does not require a separate abstracting or encoding process. This program utilizes concurrent audit to detect deficiencies in patient care, and automatic rapid feedback to the responsible provider in time to allow the provider to correct the deficiency. This system has been demonstrated to improve follow-up of throat cultures, positive for Group A Beta hemolytic streptococcus. It is well accepted by the medical staff whose practice is being audited. Because the data are collected as part of the routine operation of COSTAR, the computer monitoring and feedback have only a small incremental cost.

Boston↗

PubMed1977

A computerized prenatal record.

An entirely computerized ambulatory medical record system is operational in a large health maintenance organization. A unique subsystem was designed for use in prenatal care, in which the provider's completion of a single encounter form at the time of visit meets all the information requirements of care delivery, administration, and quality assurance. Instead of using a conventional paper chart, computer-generated summaries and flow charts are automatically provided for scheduled visits and for use as a hospital preadmission record, significantly reducing the provider effort expended on record keeping. On-line inquiry function is also available using terminals at the ambulatory center and the hospital. The computer data base has been used for quality assurance studies in prenatal care. The system is well accepted by providers, is reliable, and is cost effective.

Computers↗

PubMedDate not supplied

Do resident and staff physicians differ in the types and costs of antihypertensive drugs they select?

OBJECTIVE: To compare the types and costs of drugs prescribed by resident and staff physicians treating patients with uncomplicated essential hypertension. DESIGN: Cross-sectional study, using a computer-based medical record database. SETTING: Primary care internal medicine clinic in a large teaching hospital. PATIENTS/PARTICIPANTS: Hypertensive patients seen by ten postgraduate year-1 (PGY-1) and PGY-2 primary care internal medicine residents and four staff physicians practicing in the same clinic. MEASUREMENTS AND MAIN RESULTS: The types and costs of antihypertensive drugs prescribed for the patients treated by resident and staff physicians were compared. A larger proportion of patients of resident physicians than of staff physicians were treated with calcium channel blockers [19(15%) vs. 40(4%), p less than 0.001]; residents prescribed thiazide diuretics less frequently and beta-blockers more frequently than did staff physicians, although these differences were not significant. The estimated average wholesale price of antihypertensive drugs for patients cared for by residents was 35% higher than that for patients cared for by staff physicians ($0.73 vs. $0.54, p = 0.048). This difference was not fully explained by differences in practice composition. CONCLUSIONS: Resident physicians in this study selected more expensive medications to treat hypertension than did their faculty preceptors, even when differences in practice composition were considered.

Antihypertensive Agents↗