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Robert A Lowe

Publications and source records attributed to Robert A Lowe.

27 records · Page 2Linked to original sources
PubMed2003

The role of hazardousness and regulatory practice in the accidental release of chemicals at U.S. industrial facilities.

This article presents the results of an analysis of the accident history data reported under section 112(r) of the Clean Air Act Amendments. These data provide a fairly complete record of the consequences of reportable accidental releases occurring during the time frame 1995-1999 in the U.S. chemical industry and covering 77 toxic and 63 flammable substances subject to the provisions of section 112(r). As such, these results are of fundamental interest to the affected communities, regulators, and insurers, as well as to owners and managers in the chemical industry. The results show the statistical associations between accident frequency and severity and a number of characteristics of reporting facilities, including their size, the hazardousness of the processes and chemicals inventoried, and the regulatory programs (in addition to section 112(r)) to which these facilities are subject. The results are interpreted in light of economic drivers of protective activity and regulatory priorities for monitoring and enforcement.

Accidents, Occupational↗
PubMed2003

Researching racial and ethnic disparities in emergency medicine.

The recent Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" chronicles a growing body of literature describing racial and ethnic disparities in health care delivery. It suggests a research agenda designed to better understand and eventually eliminate these disparities. Prompted by this report, Academic Emergency Medicine convened a Consensus Conference on Disparities in Emergency Health Care on May 28, 2003, in Boston. One of the goals of that meeting was to develop a research agenda for emergency medicine researchers working on disparities in health care. This report describes the results of the consensus conference and suggests such a research agenda.

Aged↗
PubMed2003

Health care disparities in emergency medicine.

The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

Delivery of Health Care↗
PubMed2002

Researching quality in emergency medicine.

Research aimed at promoting quality of medical care must be quality research. This paper addresses issues of study design that can affect the validity of such research. The authors draw on previous research about medical errors-recognizing that issues of study design pertaining to medical errors apply to other research on quality of care and, indeed, to clinical research in general. The November 2000 Special Issue of Academic Emergency Medicine addressed medical errors in emergency medicine. In that issue, Kyriacou and Coben described three categories of research on medical errors: 1) research aimed at describing the magnitude of the problem; 2) research identifying causal factors for medical errors; and 3) research evaluating interventions aimed at improving quality of care. These three categories correspond to research methodologies that are, respectively, 1) descriptive; 2) qualitative; and 3) analytic. This article discusses challenges to the validity of each type of research and suggests some possible solutions to these problems. In addition, the article reviews projects that illustrate important issues in research quality. Three research projects are discussed: 1) a published project evaluating an intervention aimed at improving quality; 2) a quality improvement project that is transformed into a research project; and 3) a quality monitoring research project that exemplifies how a statistical technique borrowed from industry can offer a unique solution to quality challenges in medicine. Each of these projects demonstrates some of the challenges in researching quality and their solutions.

Emergency Medicine↗
PubMed2002

The effect of computer-assisted prescription writing on emergency department prescription errors.

OBJECTIVE: To determine whether computer-assisted prescription writing reduces the frequency of prescription errors in the emergency department (ED). METHODS: A pre-post retrospective analysis was used to compare errors between handwritten (HW) and computer-assisted (CA) ED prescriptions. Prescriptions were reviewed for pharmacist clarifications. A clarification was defined as an error if missing information, incorrect information, incorrect dose, non-formulary medication, or illegibility was the reason for clarification. The HW and CA error rates were compared using odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: During the pre-intervention period, there were 7,036 patient visits with 2,326 HW ED prescriptions filled for 1,459 patients. There were 91 clarifications, with a rate of 3.9%. There were 54 HW errors, for an error rate of 2.3%. During the post-intervention period, there were 7,845 patient visits with 1,594 CA prescriptions filled for 1,056 patients. There were 13 clarifications, with a clarification rate of 0.8%, and 11 errors, for a CA error rate of 0.7%. The CA prescriptions were substantially less likely to contain an error [OR 0.31 (95% CI = 0.10 to 0.36)] or to require pharmacist clarification [OR 0.19 (95% CI = 0.10 to 0.36)] than were the HW prescriptions. CONCLUSIONS: Computer-assisted prescriptions were more than three times less likely to contain errors and five times less likely to require pharmacist clarification than handwritten prescriptions.

Clinical Pharmacy Information Systems↗
PubMed2002

Radiology services in emergency medicine residency programs: a national survey.

OBJECTIVES: To determine who reads plain film radiographs, how quickly radiologists' interpretations are available, how many initial readings require correction, and how satisfied emergency physicians (EPs) are with radiology in emergency departments (EDs) with emergency medicine (EM) residency programs. METHODS: A questionnaire was sent to the chairs of all U.S. EM residencies, asking about EM radiology services. RESULTS: Of 120 sites surveyed, 97 (81%) responded. Respondents reported that, on weekday days, EM attendings or residents performed the radiograph interpretation used for clinical decision making at 66% of sites; on nights and weekends, EPs performed the clinically relevant readings at 79% of sites. Twenty-one percent of sites reported that no radiologist reviewed images before patients left the ED on nights and weekends. Only 39% of sites reported that all images were read within four hours on weekday days, and only 19% of sites reported readings within this time frame on nights and weekends. Median misinterpretation rates were reported as 1% on weekday days and 1.5% at other times. Overall, EPs were satisfied with their interactions with radiology at 63% of EDs. CONCLUSIONS: This study summarizes the perceptions of EPs regarding radiology services; the findings must be interpreted with caution, given the lack of external validation. Nevertheless, EPs report that many EM residency programs depend on EPs' interpretations of radiographs. Emergency physicians report that attending radiologists rarely read images on nights and weekends and that images are misread more frequently at these times. Although EPs were satisfied with many aspects of radiology, EPs expressed the most dissatisfaction with turnaround times and misreads.

Diagnostic Errors↗
PubMed2002

Predictable fixed prosthodontics: technique is the key to success.

This article reviews step-by-step clinical procedures for fixed prosthodontics that include a discussion of the following case parameters: (1) proper diagnosis and case selection; (2) tooth preparation; (3) soft tissue management; (4) impression making; (5) provisionalization; (6) additional laboratory diagnostic information; (7) case try in; and (8) case delivery. When the clinical principles of these procedures are faithfully followed, the success and predictability of any restorative endeavor will be greatly enhanced.

Cementation↗
PubMedDate not supplied

Use of photographs for the identification of pressure ulcers in elderly hospitalized patients: validity and reliability.

To evaluate the ability of research nurses to identify pressure ulcers, the authors assembled digital photographs of the skin of 160 consenting elderly patients (80% African American, 63% women). The series included 39 photos of pressure ulcers, 109 of normal skin, and 12 of other skin conditions, determined by consensus by two experts (D.J.M. and S.H.K.). Photos were packaged electronically into eight blocks of 20, with pressure ulcer prevalence ranging from 20% to 30% per block. The eight blocks were duplicated to create two sets of 160 photos each. Each of six raters (experienced clinical research nurses), working independently, evaluated the 320 photos as if each photo depicted a different patient. For analysis, the ratings were collapsed into binary determinations (any pressure ulcer vs. none). The overall sensitivity and specificity of the ratings were 0.97 (95% confidence interval: 0.94, 0.98) and 0.81 (95% confidence interval: 0.77, 0.86), respectively. Rater-specific prevalence (range: 31.8-47.5%) exceeded the true prevalence (24.4%). Inter- and intrarater reliability coefficients were 0.69 and 0.84, respectively. Trained research nurses can accurately classify pressure ulcers from photographs, even when patients are largely non-White and the photographs depict pressure ulcers spanning all pressure ulcer stages.

Aged↗