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PubMed1996

Firearm-related deaths and hospitalizations--Wisconsin, 1994.

Firearm-related injuries are a major cause of premature deaths in the United States. Although state-based vital records systems monitor fatal injuries, few surveillance systems exist to monitor nonfatal firearm-related injuries. Wisconsin is one of seven states funded by CDC cooperative agreements to establish firearm-related injury surveillance systems. Wisconsin's system, which links hospital discharge records and vital records, uses external cause of injury codes (E-codes) for case identification. This report describes the surveillance system and findings for 1994.

Accidents↗
PubMed1992

Implementation and analysis of a non-floor stock controlled substance unit dose system in a pediatric hospital.

The purpose of this study was to evaluate the implementation of a modified unit dose dispensing system for schedule II controlled substances. Each dose is signed out of stock for the intended patient. Changes in the system required revision of dispensing records and procedures in pharmacy and nursing. After implementation the error rate for controlled substances was reduced to a level equivalent to non-controlled substances. A workload study was conducted in the pharmacy and on two general medical-surgical units. Small increases in workload occurred. Although this system is a modified unit dose system it does provide some of the safety features found in unit dose systems. Patient care benefits may decrease hospital liability in high-risk patients to offset cost factors.

Arkansas↗
PubMedDate not supplied

SEPs in two patients with localized lesions of the postcentral gyrus.

Scalp distributions of median nerve SEPs were studied in normal controls and 2 patients with localized lesions of the postcentral gyrus. In controls, parieto-occipital electrodes registered N20-P27 while frontal electrodes registered P20-N27. Other small components, parieto-occipital P22 and frontal N22, were recognized in about half of the control records. The wave forms at a frontal and a parieto-occipital electrode, both distant from the central region, formed exact mirror images of each other concerning N20-(P22)-P27 and P20-(N22)-N27. Electrodes near the central region contralateral to the stimulation registered cP22-cN30 (central P22 and central N30). When the postcentral gyrus was damaged, N20/P20-P27/N27 and cP22-cN30 were eliminated and the only remaining components were a frontal negative wave (frN) and a contralateral parieto-occipital positive wave (poP). Digital nerve stimulation also evoked poP and frN in both cases. In case 2, poP coincided with P22 of the non-affected side. The following generators were proposed; N20/P20-P27/N27: area 3b, cP22-cN30: areas 1 and 2, poP/early frN (= P22/N22): area 4 at the anterior wall of the central sulcus (due to direct thalamic inputs to motor cortex), late frN: uncertain (SMA?, SII?).

Adult↗
PubMed1997

Role of appendectomy and tonsillectomy in pathogenesis of ulcerative colitis.

We wished to determine the effect of appendectomy and tonsillectomy on the subsequent risk for development of ulcerative colitis (UC). We conducted a case-control study at the University of Oklahoma Hospital and VA Medical Center gastroenterology clinics, as well as at the offices of private physicians. Subjects being followed for UC formed the study group. Patients being followed at Internal Medicine Associates of the University of Oklahoma clinics formed the controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. The study group consisted of 193 patients, and there were 394 controls. The prevalence of appendectomy was lower (17.8% vs 5.2%) among patients with UC (P < 0.01). The prevalence of tonsillectomy was similar in the two groups (20.6% vs 18.1%; P = NS). We conclude that appendectomy is associated with a decreased risk for subsequent development of ulcerative colitis.

Adult↗
PubMed1996

Streamlining documentation: an opportunity to reduce costs and increase nurse clinicians' time with patients.

Clinical documentation can take up to 25 percent of a nurse's time in an acute care setting, not to mention the time spent by other clinicians and ancillary caregivers on documentation. Institutions can reduce documentation time by systematically determining what information is crucial to the provision of patient care across all disciplines and then using a redesign process that mirrors work redesign. By following a structured process that challenges the philosophy and function of the documentation system, a hospital's multidisciplinary staff members can use their expertise to design alternatives that achieve documentation's original intent-to document diagnoses and treatment accurately-in a more efficient and useful way.

Cost Control↗
PubMedDate not supplied

Sexual partner networks in the transmission of sexually transmitted diseases. An analysis of gonorrhea cases in Sheffield, UK.

BACKGROUND AND OBJECTIVES: Routine contact tracing data on patients with gonorrhea are used to identify sexual partner networks. These are combined with gonococcal typing data to study patterns of transmission. The role of persons in transmission is discussed. STUDY DESIGN: Contact tracing data on patients with gonorrhea attending the Royal Hallamshire Hospital in Sheffield in 1988 and 1989 are analyzed. Gonococcal strains identified by auxotype/serovar (A/S) class are combined with these data to identify transmission paths. RESULTS: The network contained 1,272 persons, 724 (77%) of whom had gonorrhea during the study period. Four hundred two clusters of linked cases were identified. The largest cluster, containing 35 persons connected over 16 months, is discussed in greater detail to illustrate how these data may help identify patterns of transmission and the role of persons. CONCLUSION: Contact tracing data can be used to identify sexual partner networks and to study transmission patterns. Microbiologic data can aid interpretation. An person's risk of acquiring infection depends on indirect links as well as direct links. To understand patterns of transmission it may be important to distinguish between those involved in transmission and those only acquiring infection. Networks established through gonococcal transmission are also relevant to the transmission of other sexually transmitted diseases.

Adolescent↗
PubMed2000

Notification of infectious diseases by general practitioners: a quantitative and qualitative study.

OBJECTIVE: To examine general practitioners' knowledge and practices concerning reporting of notifiable conditions, and to examine barriers to notification of infectious diseases by general practitioners and identify strategies for improving the notification process. DESIGN AND SETTING: Audit of the 100 most recent notifications received by the South Eastern Sydney Public Health Unit of cases of each of hepatitis A, pertussis and measles; and focus groups with GPs practising in Sydney's eastern and southern suburbs, some of whom were selected on the basis of their notification practices. RESULTS: Although these diseases are notifiable on clinical suspicion, only about 40% of the hepatitis A and pertussis cases and 80% of measles cases (54% overall) had been notified by GPs. Delays between doctor and laboratory notifications were an average of seven days for hepatitis A, 19 days for pertussis and seven days for measles. Focus groups showed that at least some GPs have poor understanding of the process of notification, most felt uncomfortable notifying an unconfirmed case, many preferred to leave notification to the laboratory because of concerns about damaging the doctor-patient relationship, and that there is need for financial or other incentives. CONCLUSIONS: There are deficiencies in the completeness and timeliness of notification by GPs which may adversely affect the timing of prophylaxis and outbreak control. Notification by GPs may be improved by such strategies as better notification forms and better feedback to doctors on the outcomes.

Attitude of Health Personnel↗
PubMed1998

Effect of antibiotic order form guiding rational use of expensive drugs on cost containment.

New injectable antimicrobial agents are generally costly and broad-spectrum. Overusage results in unnecessary economic loss and multi-drug resistant organisms. Effective strategies for decreasing costs without compromising patient care are required. This study aimed to evaluate the economic impact of a system using an antimicrobial order form to assist rational usage of expensive antimicrobial agents. The study was performed during 1988-1996 at a 900-bed, tertiary-care, medical school hospital in Bangkok. The target drugs were 3 costly, broad-spectrum antibacterial drugs, namely imipenem, vancomycin, and injectable ciprofloxacin. The restriction of these 3 drugs was started in 1992 and was extended to netilmicin and ceftazidime in 1995. A filled antimicrobial order form (AOF) was required by pharmacists before dispensing the drugs. The AOF guided the physicians to give explicit information about anatomic diagnosis, etiologic diagnosis, and suspected antimicrobial resistance patterns of the organisms. It also contained information about indications of the restricted drugs. The filled forms were audited daily during working days by the chairman of The Hospital Antibiotic Committee. Feedback was given to the prescribers by infectious disease specialists at least twice a week. The strategy was endorsed by the executive committee of the hospital. Impact of AOF without endorsement, audit and feedback, was evaluated in 1996. The expenditures of the drugs were adjusted to the average admitted patient-days per fiscal year of the study period. The system with endorsement was well accepted and could be maintained for 4 years. The adjusted expenditures per year of the 3 restricted antibiotics were 1.41-1.87 million baht less (22-29%) in 1992-1994 than the pre-intervention year 1991. The cost reduction of imipenem and injectable ciprofloxacin could also be maintained for 1995 but not vancomycin for which use increased. The costs of these 3 restricted drugs increased very sharply (69%) in 1996 when there was loss of endorsement and capacity to perform auditing and feed back by infectious disease specialists. The system did not work with ceftazidime which was commonly used for febrile neutropenia and nosocomial infections.

Anti-Bacterial Agents↗