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S Houston

Publications and source records attributed to S Houston.

At least 55 records · Page 3Linked to original sources

The quality and outcomes management connection.

Measuring outcomes has become an essential part of quality improvement efforts. An outcomes management program can contribute to quality activities through the identification and quantification of outcomes and variances that can serve as performance measures. The COMIT model is highlighted as a process that can be used by multidisciplinary teams to promote outcome improvement. In addition, the Joint Commission on Accreditation of Healthcare Organizations functions and their relationship to an outcomes management effort are presented.

Humans↗

Case study. Outcomes management in orthopaedics.

Improving outcomes while maintaining quality and satisfaction in today's healthcare environment is a challenge. This article shares some of the foundation work and the results of an interdisciplinary team effort toward that goal. Changes in care practices and their impact on outcomes can promote the welfare of the patient, institution, and the nation's health.

Hospital Charges↗

Advanced practice nurse as outcomes manager.

Outcomes management as a patient management system has been designed to impact and improve select outcomes. Central to the development and implementation of best practice senario identified throughout outcomes management is the advanced practice nurse. SLEH has been in the forefront of development and implementation of an outcomes management program. This article describes the outcomes management position and shares the job description and performance evaluation used at this institution. The tools allow for measuring and quantifying the impact of the outcomes manager position on improving patient outcomes. The improvement of outcomes has increased the value of the advanced practice nurse and provided the institution with a solid future necessary for survival in a managed care market.

Benchmarking↗

Protective immunity to HIV-1 in SCID/beige mice reconstituted with peripheral blood lymphocytes of exposed but uninfected individuals.

Immunodeficiency typically appears many years after initial HIV infection. This long, essentially asymptomatic period contributes to the transmission of HIV in human populations. In rare instances, clearance of HIV-1 infection has been observed, particularly in infants. There are also reports of individuals who have been frequently exposed to HIV-1 but remain seronegative for the virus, and it has been hypothesized that these individuals are resistant to infection by HIV-1. However, little is known about the mechanism of immune clearance or protection against HIV-1 in these high-risk individuals because it is difficult to directly demonstrate in vivo protective immunity. Although most of these high-risk individuals show an HIV-1-specific cell-mediated immune response using in vitro assays, their peripheral blood lymphocytes (PBLs) are still susceptible to HIV infection in tissue culture. To study this further in vivo, we have established a humanized SCID mouse infection model whereby T-, B-, and natural killer-cell defective SCID/beige mice that have been reconstituted with normal human PBLs can be infected with HIV-1. When the SCID/beige mice were reconstituted with PBLs from two different multiply exposed HIV-1 seronegative individuals, the mice showed resistance to infection by two strains of HIV-1 (macrophage tropic and T cell tropic), although the same PBLs were easily infected in vitro. Mice reconstituted with PBLs from non-HIV-exposed controls were readily infected. When the same reconstituted mice were depleted of human CD8 T cells, however, they became susceptible to HIV-1 infection, indicating that the in vivo protection required CD8 T cells. This provides clear experimental evidence that some multiply exposed, HIV-1-negative individuals have in vivo protective immunity that is CD8 T cell-dependent. Understanding the mechanism of such protective immunity is critical to the design and testing of effective prophylactic vaccines and immunotherapeutic regimens.

Adoptive Transfer↗

A comparison of structured versus guided preheart catheterization information on mood states and coping resources.

A rapid growth in outpatient surgical procedures has been necessary to help alleviate expensive health care costs. Because procedures, such as heart catheterization, require a short patient stay, preparatory information is often structured and delivered concisely. The purpose of this study was to determine if heart catheterization patients who receive guided precatheterization information had reduced stress compared with heart catheterization patients who received structured precatheterization information. Using a two-group pretest/posttest design, 89 subjects were randomly assigned to two different preparatory nursing interventions. Data were collected on outpatients' coping resources and mood states, which served as measures of stress. No significant differences in stress were found between the guided and structured preparatory information groups. The results indicated that a variety of approaches can be used to prepare patients for outpatient heart catheterization procedures.

Adaptation, Psychological↗

Getting started in outcomes research.

Outcomes research is being advocated as a means for providing information needed to support decision making in health care. In this article, the author defines terminology related to outcomes assessment, describes the process of outcomes measurement, and reviews suitable study designs for use in outcomes research.

Health Services Research↗

Fast Track recovery after aortocoronary bypass surgery: early extubation and intensive care unit transfer.

Fast Track is a practical method of delivering care to aortocoronary bypass (ACB) patients with minimal risks to the patients or their care providers. A prospective study designed by an interdisciplinary practice team will evaluate the effects of an accelerated recovery program on clinical and financial outcomes of ACB patients. Essential components of the accelerated recovery program include early extubation, accelerated activity, and appropriate patient selection. Preliminary results on early extubation are discussed.

Coronary Artery Bypass↗

Human immunodeficiency virus infection and porphyria cutanea tarda: coexistence of risk factors or causative association?

Several recent reports have described an association between human immunodeficiency virus (HIV) infection and porphyria cutanea tarda (PCT). We describe two HIV-infected patients who developed PCT and review 29 other reported cases of coexistent PCT and infection due to HIV. Recognized porphyrinogenic factors were identified in our patients and in 27 of the 29 cases described in the literature. Even in the two cases that lacked obvious precipitant factors for PCT, the possibility of hepatitis C was not excluded. This fact suggests that the co-occurrence of PCT and infection due to HIV may reflect the coexistence of risk factors for the two diseases rather than a causal association. Despite concern that exposure to sulfonamides might exacerbate porphyria, one of our patients and three patients described in the literature were safely treated with sulfonamides.

Adult↗

COMIT: improving patient outcomes.

The Continuous Outcomes Measurement Improvement Technique (COMIT) model of problem-solving focuses on the reduction of a variance or the improvement of a patient outcome. A specific variance, pain tolerance, is used to reflect application of the model. The steps are explained as the model is applied to a variance resulting in an improved patient outcome.

Humans↗

The association of tuberculosis and HIV infection in Harare, Zimbabwe.

SETTING: The tuberculosis (TB) service responsible for all TB treatment in Harare, Zimbabwe. OBJECTIVES: (1) To determine HIV seroprevalence among TB patients and controls. (2) To compare clinical and demographic characteristics of HIV-infected and uninfected TB patients. DESIGN: Cohort study. Entry criterion: TB diagnosed during the 18 month study period. Assessment included HIV serology. Matched community controls were HIV serotested. RESULTS: In 1434 TB patients tested, HIV seroprevalence was 48% in men and 44% in women, peaked in the 25-34 year age group and was higher than in controls (relative risk [RR] = 3.1, 95% confidence interval [CI] = 2.6-3.7). In adults, seroprevalence was 34%, 49% and 58% in successive 6 month periods. A history of entry of prior TB treatment was less common in the HIV-seropositive (RR = 0.57, CI = 0.37-0.88). In adults, tuberculin negativity, TB at 2 sites, lymph node, pericardial and miliary TB, hilar adenopathy and pleural effusion were significantly more common in HIV-seropositive patients; cavitation and upper lobe involvement were significantly less frequent. Pulmonary TB and sputum smear positivity had similar frequencies in the 2 groups. CONCLUSION: HIV was strongly and increasingly associated with TB in Harare and altered the clinical and radiologic features of TB. Failed standard TB treatment in HIV-infected individuals contributed minimally to new cases of TB.

AIDS-Related Opportunistic Infections↗

Tuberculous pericardial effusion associated with HIV infection: a sign of disseminated disease.

OBJECTIVE: To determine whether tuberculous pericardial effusion is associated with HIV infection. DESIGN: Retrospective cohort study. SETTING: Harare, Zimbabwe. SUBJECTS: 61 consecutive patients presenting with tuberculous pericarditis over an 18 month period. RESULTS: Tuberculous pericarditis was significantly associated with HIV seropositivity (odds ratio [OR] 2.46, 95% confidence interval [CI] 1.4-4.3, P = 0.001). The combination of tuberculous pericarditis and tuberculosis at another clinically obvious site (disseminated disease) was more common than pericarditis alone, and was significantly associated with HIV seropositivity (OR 6.1, CI 1.5-25, P = 0.007). Patients with disseminated disease were usually in CDC stage IV prior to the diagnosis of their tuberculosis.

Adult↗