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At least 1,801 records · Page 100Linked to original sources
PubMed1998

[GSG (Structured Health Regulation)-conforming documentation of surgical interventions in a university clinic--3 years clinical experiences 1994-1996].

The cost increase in the public health sector is steadily mounting and hence politicians are forced to redefine the economic conditions for regulations. As a new quality in the area of inpatient hospital care the new German law of structural health care (GSG), valid as of January 1, 1993 replaces the principle of covering full costs. The GSG law required in our hospital an adjustment of existing EDP structures with integrated automatic remuneration estimate and the installation of a medical structure of the organisation for complete and correct documentation. Weakpoints of the prescribed obligatory ICPM codes and inadequate legal regulations result in a lack of separation or wrong integration of the lump sum payment in individual cases (FP) and special compensation (SE). The summary analysis of the compensation system with a subsequent medical control system showed a primarily inaccurate classification by 12%. There is as yet no proof for the usefulness of a lump sum payment system resulting in a selection of risks.

Cost Control↗
PubMed1998

[Structured documentation for quality management in patients with diabetes mellitus].

The medical services rendered by office-based physicians have to be assessed on the basis of valid, practicable, and reliable indicators. The necessity to implement such indicators follows from the fact that quality and economic efficiency have been combined. The indicators can be derived from already existing guidelines. The target is to define medical services according to their type, extent, frequency and their point of intervention with regard to the medical problems and the treatment goals. The aim is to implement measures that permit the qualitative and economic evaluation of medical services. On the basis of these indicators the Central Institute of Panel Physicians develops together with scientific groups data sets that are able to show if, and to which degree, physicians act guideline-conform. The data sets can be used as documentation modules for transmission purposes and will therefore be integrated into the standard interface for basic clinical data profiles of already existing practice computer systems. While the Centre of German Physicians for Quality Assurance in Medicine is responsible for guideline-development, the conversion of the guidelines into appropriate data set structures is accomplished by the Central Institute of Panel Physician. This close co-operation represents a useful division of the work to be done in connection with the implementation of quality management in physician offices.

Cost-Benefit Analysis↗
PubMed1998

[Variability of inpatient child and adolescent psychiatry--results of a multicenter documentation].

OBJECTIVE: For the first time in the German-speaking countries a complete evaluation of all 1236 inpatient treatment episodes within one year of investigation was carried out. METHOD: Case-related patient documentation at all of the 13 clinics for child and adolescent psychiatry in Lower Saxony and Bremen were evaluated. RESULTS: Data from all clinics agreed widely on the following: 1. the divergent family structures of the young patients compared to those of the general public, 2. a high degree of individual psychotherapy, and 3. the inclusion of the patient's social circumstances in the individual psychotherapy. Nonetheless, results for most of the variables assessed differed strongly. Inpatient child and adolescent psychiatric care thus seems to vary highly among clinics within the same epidemiological area. CONCLUSIONS: Hence, even when the reported number of episodes is high, no general conclusions on inpatient child and juvenile psychiatric treatment can be drawn on the basis of admissions data for individual clinics. Interinstitutional comparisons must be made on the assumption that there is no prototype clinic for child and adolescent psychiatry. Additional general conclusions include the lack of a disorder-specific approach to treatment. The entry of a large number of patients into foster or state homes following inpatient treatment reflects the impact upon them of abnormal psychosocial circumstances, as well as their decreased psychosocial adaption.

Adolescent↗
PubMed1998

Photography in bite mark and patterned injury documentation--Part 1.

Photography is an important means of collecting and preserving physical evidence as it relates to bite mark and patterned injuries in skin. Proper use and understanding of color, black-and-white, ultraviolet and infrared photography can greatly aid the collection and preservation of evidence. The techniques and equipment for the photo-documentation of this evidence are presented.

Bites, Human↗
PubMed1998

Photography in bite mark and patterned injury documentation--Part 2: A case study.

A case involving multiple bite marks is presented. The bite marks were photographed over a 31-day period to document the injuries and preserve their evidentiary value. The evidence recovered at each photography session is discussed and photographs are presented for review. Suggestions concerning the need for more research are presented.

Bites, Human↗
PubMed1998

[Conceptual aspects in development and implementation of basic psychiatric documentation].

The main conceptual prerequisites for the development and introduction of a standardised documentation system in psychiatry (in this case: psychosocial rehabilitation) are discussed. These will help to improve the acceptance of the system and optimise the quality of the data. Since the positive motivation of the staff is decisive, it is essential to meet their needs and demands.

Confidentiality↗
PubMed1998

[Who is dangerous? Problems of validity and reliability in assessment and documentation of socially aggressive behavior].

Records of violent behaviour and its sequels gain increasing interest as a matter of quality assurance. The paper presents scales and instruments applied in psychiatric institutions until now. While problems of reliability are solved sufficiently, there are major problems of validity in the measurement of violence. To be usable for quality management, a documentation has to provide a clear cut-off for the severity of violent incidents that should be reported. Otherwise uncomparable data and underreporting will result.

Adult↗
PubMed1976

[Documentation of obstetric case reports by means of video-terminals as a part of the Vienna General medical information system "WAMIS" (author's transl)].

A report is given on the introduction of a complete documentation system of obstetric case reports by means of video-terminals and printer-terminals in both departments of Obstetrics and Gynaecology of the 1niversity of Vienna. The special routine for the admission of patients, which produces the heading of the case report is demonstrated, as well as the sheets of collecting the data in respect to case history, antenatal examinations, labour room reports and details of obstetric operations. The computer prints the case history using the collected data. These computer-printed case reports replace the customary handwritten reports. Laboratory data, therapeutic measures and final diagnosis are computed in the same way. The advantages of this form of organization of data collection for clinical purposes and research work are discussed.

Austria↗
PubMed1998

Reimbursement and documentation issues in an ambulatory ECT program.

In this era of decreased health resources and the strong influence of third-party payers, the financial advantages of ambulatory electroconvulsive therapy (ECT) should be well recognized by all concerned parties. However, to a large degree, third-party payers are only minimally aware of the availability and potential cost savings associated with this treatment modality. Also, documentation has been problematic, because reviewers unfamiliar with ECT have not been able to find the necessary data even when they are present in the chart. This article illustrates some of these problems and how they have affected our ambulatory ECT program.

Ambulatory Care↗
PubMed1999

Diffuse bilateral subacute neuroretinitis: first patient with documented nematodes in both eyes.

OBJECTIVE: To describe the first patient with documented evidence of diffuse unilateral subacute neuroretinitis (DUSN) in both eyes. METHODS: A 10-year-old healthy Brazilian girl was first seen with signs of late-stage DUSN in both eyes. A careful search for a nematode was performed in each eye. RESULTS: A motile 550- to 660-microm nematode was found in the inferotemporal retina of the left eye. A similar-sized motile nematode was found in the superotemporal retina of the right eye. Both nematodes were treated with argon green laser applications with bilateral improvement of visual function. CONCLUSION: Although most patients with DUSN do not develop the disease in the fellow eye, this case demonstrates that DUSN can occasionally affect both eyes.

Acute Disease↗
PubMed2001

Spontaneous regression of optic gliomas: thirteen cases documented by serial neuroimaging.

OBJECTIVE: To demonstrate spontaneous regression of large, clinically symptomatic optic pathway gliomas in patients with and without neurofibromatosis type 1 (NF-1). METHODS: Patient cases were collected through surveys at 2 consecutive annual meetings of the North American Neuro-Ophthalmology Society (NANOS) and through requests on the NANOSNET Internet listserv. Serial documentation of tumor signal and size, using magnetic resonance imaging in 11 patients and computed tomography in 2 patients, was used to evaluate clinically symptomatic optic pathway gliomas. All tumors met radiologic criteria for the diagnosis of glioma and 4 patients had biopsy confirmation of their tumors. In 3 patients, some attempt at therapy had been made many years before regression occurred. In one of these, radiation treatment had been given 19 years before tumor regression, while in another, chemotherapy had been administered 5 years before signal changes in the tumor. In the third patient, minimal surgical debulking was performed 1 year before the tumor began to shrink. RESULTS: Spontaneous tumor shrinkage was noted in 12 patients. Eight patients did not have NF-1. In an additional patient without NF-1, a signal change within the tumor without associated shrinkage was detected. Tumor regression was associated with improvement in visual function in 10 of 13 patients, stability of function in 1, and deterioration in 2. CONCLUSIONS: Large, clinically symptomatic optic gliomas may undergo spontaneous regression. Regression was seen in patients with and without NF-1. Regression may manifest either as an overall shrinkage in tumor size, or as a signal change on magnetic resonance imaging. A variable degree of improvement in visual function may accompany regression. The possibility of spontaneous regression of an optic glioma should be considered in the planning of treatment of patients with these tumors.

Adolescent↗
PubMed2005

Improving the readability and processability of a pediatric informed consent document: effects on parents' understanding.

OBJECTIVE: To examine whether a consent document modified to conform with the federal guidelines for readability and processability would result in greater parental understanding compared with a standard form. DESIGN: Randomized clinical study. SETTING: The preoperative waiting area of a larger tertiary care children's hospital. PARTICIPANTS: A total of 305 parents of children scheduled for minor elective surgical procedures. INTERVENTIONS: Parents were randomized to receive information about a clinical study in 1 of 4 ways: (1) standard consent form alone, (2) standard consent form with verbal disclosure, (3) modified form alone (standard form modified to meet the federal guidelines for readability and processability), and (4) modified form with verbal disclosure. MAIN OUTCOME MEASURES: Parents were interviewed to determine their understanding of 11 elements of consent, including study purpose, protocol, risks, benefits to child (direct), benefit to others (indirect), freedom to withdraw, alternatives, duration of study, voluntariness, confidentiality, and whom to contact. Their responses were scored by 2 independent assessors. RESULTS: Understanding of the protocol, study duration, risks, and direct benefits, together with overall understanding, was greater among parents who received the modified form (P<.001). Additionally, parents reported that the modified form had greater clarity (P = .009) and improved layout compared with the standard form (P<.001). When parents were shown both forms, 81.2% preferred the modified version. CONCLUSIONS: Results suggest that a consent form written according to federal guidelines for readability and processability can improve parent understanding and thus will be important in enhancing the informed consent process.

Adult↗
PubMed1997

Documenting the educational content of morning report.

OBJECTIVES: To document the educational content of a pediatric morning report and to determine if it represents a curriculum. SETTING: A midwestern, tertiary care, pediatric training program. DESIGN: A prospective, observational study was conducted of case presentations discussed during pediatric morning report from July 1995 through July 1996. Presented cases were analyzed for demographics, clinical venues where patients were encountered, case diagnoses, and ensuing discussion. RESULTS: Morning report by study criteria was considered a curriculum. A wide variety of patient ages (aged from birth to 41 years) and all clinical venues were represented. A broad spectrum of diagnoses covered 30 of 31 Pediatrics Review and Education Program (American Academy of Pediatrics, Elk Grove Village, Ill) Content Specification headings and most (72%) of the Educational Objectives listed (N = 977 [72%]). The most common topic areas were infectious diseases (n = 137 [18.2%]), disorders of the blood/neoplasms (n = 85 [11.2%]), neurological disorders (n = 57 [7.5%]), genetics or dysmorphology (n = 56 [7.4%]), and gastrointestinal tract disorders (n = 44 [5.8%]). Top discussion categories were patient clinical presentation (n = 399 [19.6%]), evaluation (n = 375 [18.4%]), and management (n = 377 [18.5%]). CONCLUSIONS: Morning report represents a curriculum in a pediatric residency training program. It can be used effectively to address nontraditional or rarely discussed topics that are important to the overall professional development of pediatric residents.

Adolescent↗
PubMed2001

Parathyroid autotransplantation during thyroidectomy: documentation of graft function.

HYPOTHESIS: Biochemical function of normal parathyroid tissue grafted during thyroidectomy can be documented. DESIGN: An intervention study in which devascularized or inadvertently removed parathyroid glands are reimplanted in forearm muscle pockets during thyroidectomy. Postoperative serum parathyroid hormone levels were evaluated by venous sampling from both forearms on postoperative days 1, 3, 14, 28, 56, and 84. SETTING: Tertiary care teaching hospital. PATIENTS: Seven patients undergoing thyroidectomy at risk for postoperative hypocalcemia. RESULTS: A 1.5-fold gradient of parathyroid hormone measurements between grafted and nongrafted arms was demonstrated in all patients on postoperative day 28. A maximal parathyroid hormone gradient was reached on day 56, and biochemical function persisted in 6 patients on day 84. CONCLUSIONS: Biochemical function of parathyroid glands reimplanted during thyroidectomy can be demonstrated objectively. The application of parathyroid autotransplantation may preserve parathyroid function for inadvertently removed or devascularized parathyroid glands during thyroid surgery.

Female↗
PubMed1995

Environmental tobacco smoke. The Brown and Williamson documents.

OBJECTIVE: To examine the tobacco industry's public and private responses to rising concern over the health effects of environmental tobacco smoke (ETS). DATA SOURCES: Documents from Brown and Williamson Tobacco Corporation (B&W), the British American Tobacco Company (BAT), and other tobacco interests provided by an anonymous source, obtained from Congress, and received from the private papers of a former BAT officer. STUDY SELECTION: All available materials, including confidential reports regarding research and internal memoranda exchanged between tobacco industry lawyers. CONCLUSIONS: Privately, B&W and BAT began conducting research related to ETS in the mid 1970s. BAT researchers appear to have determined that sidestream smoke produces irritation, that it contains toxic substances including N-nitrosamines, and that it is "biologically active" (eg, carcinogenic) in laboratory tests. During the 1980s, the primary purpose of BAT's research related to ETS was to develop a new cigarette that emitted less irritating and less biologically active sidestream smoke. Publicly, the tobacco industry has denied that exposure to ETS has been proven dangerous to health. It has criticized the methodology of published research on ETS, even when some of its own consultants have privately acknowledged that the research was valid. In addition, the industry has funded scientific research with the stated purpose of anticipating and refuting the evidence against ETS. The tobacco industry's strategy regarding passive smoking has been remarkably similar to its strategy regarding active smoking. It has privately conducted internal research, at least some of which has supported the conclusion that passive smoking is dangerous to health, while it has publicly denied that the hazards have been proven.

Humans↗
PubMed2000

Isolated superior oblique palsies with electrophysiologically documented brainstem lesions.

Over a 13.5-year period, we observed 10 patients with isolated superior oblique palsies in whom electrophysiological abnormalities indicated brainstem lesions. In 7 patients unilateral masseter reflex abnormalities were seen, and were located on the side of the superior oblique palsy in 2 patients and on the opposite side in 5 patients. Two patients had slowed gain of following eye movements to the side contralateral to the superior oblique palsy. Slowed adduction saccades in the eye contralateral to the superior oblique palsy were seen in 1 patient. Clinical improvement was frequently (in 7 of 10 patients) associated with improvement or normalization of electrophysiologic findings. Magnetic resonance imaging (MRI) was normal, showing no evidence of brainstem lesions in 6 patients. Unilateral superior oblique palsy may be the only clinical sign of a brainstem lesion. Although such a cause may be underdiagnosed if based on MRI-documented lesions only, it remains a rare condition.

Adult↗
PubMed1975

Documented hyperparathyroidism of thirty-six years' duration.

The fascinating history of the first Memorial Hospital patient who was diagnosed as having hyperparathyroidism is reviewed. The illness presented as a cystic mass in a femur in 1929, which was treated with radiation. When the patient was first seen at Memorial Hospital in 1931, the diagnosis of osteitis fibrosa cystica was made; serum calcium was 14 mg/100 ml. In 1932, 6 years after Mandl performed the first parathyroidectomy ever for osteitis fibrosa cystica, this patient's neck was explored, and a right hemithyroidectomy was done, with removal of two normal parathyroid glands. The parathyroid tumor was finally located and partially removed in 1937 after a second failure at neck exploration in 1936. Correspondence between Dr. Edward D. Churchill at the Massachusetts General Hospital and Dr. Bradley Coley at Memorial Hospital indicated the concern at that time about uncontrollable tetany, which had been fatal in some contemporary cases and which had led to the practice of only partially removing the tumor. Following this, the patient was observed with documented hypercalcemia and chemical evidence of hyperparathyrodism until age 79. The physical and chemical abnormalities over the years up to and including her last exam are presented. The case is important not only from the historical viewpoint, but because it lends a perspective to long-term parathyroid disease, which is becoming less appreciated in this day of the routine serum calcium by SMA-12 screening. The question of partial parathyroidectomy for adenoma or hyperplasia is reviewed, and the question of observation of patients with mild hypercalcemia who probably have parathyroid tumors is discussed.

Adenoma↗

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