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PubMed2005

Stereoselective peptide analysis.

The stereochemistry of a peptide determines its spatial features and can profoundly influence its chemical properties and biological activity. Thus, the analysis of the stereochemical properties of a peptide is an important aspect of its characterisation. For such investigations a "selector" that engages in stereoselective interactions with the peptide analytes is often used. A substantiated knowledge of the underlying molecular recognition mechanism will therefore be helpful in understanding existing and developing new stereoselective analysis systems. After a short introduction concerning the fundamentals of peptide stereoisomers and their biological implications, the stereoselective peptide analysis methods described in the literature are comprehensively reviewed. The characteristics and applications of the employed methods based on various techniques including chromatography (pressure- and electrokinetically driven), capillary electrophoresis, nuclear magnetic resonance spectroscopy and mass spectrometry are discussed. The various selectors that have been utilised to discriminate peptide enantiomers and/or diastereomers are described concurrently. The review concludes with an overview of combinations and comparisons of techniques that have been applied to the analysis of peptide stereoisomers and constitute a trend for further developments.

Molecular Structure↗
PubMed2004

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: an anti-reflux procedure is required.

BACKGROUND: Controversy exists over the necessity of performing a concurrent antireflux procedure with a Heller myotomy. We therefore sought to objectively analyze gastroesophageal reflux following laparoscopic Heller myotomy where an antireflux procedure was not performed. METHODS: A prospective database of 66 cases of laparoscopic Heller myotomy performed between November 1996 and June 2002 was reviewed. Previous, concurrent, or subsequent fundoplication was performed in 12 patients; therefore 54 patients without antireflux procedures were available for analysis. Follow-up included symptomatic assessment in 50 patients (93%). Heartburn was assessed on a four-point scale with clinical significance defined as >2 episodes/week. Objective testing, including endoscopy, esophagogram, manometry, and 24-h pH monitoring, was offered to all patients. Objective evidence of reflux was defined as the composite endpoint of positive 24-h pH monitoring or esophagitis on endoscopy. RESULTS: Significant heartburn was reported in 15 of 50 patients (30%). Positive 24-h pH recordings were seen in 11 of 22 patients tested while esophagitis was seen in 13 of 21 patients tested, resulting in objective evidence of reflux in 18 of 30 patients tested (60%). Of these 18 patients, seven did not have significant heartburn. All 12 patients without objective reflux did not have significant heartburn. Therefore, of the 30 patients with objective testing, seven (23%) had objective reflux without subjective heartburn (silent reflux). CONCLUSION: Objective analysis reveals an unacceptable rate of gastroesophageal reflux in laparoscopic Heller myotomy without an antireflux procedure. We therefore recommend performing a concurrent antireflux procedure.

Adult↗
PubMed1991

Impact of medication profile review on prescribing in a general medicine clinic.

The effect of medication profile review by a clinical pharmacist on prescribing in a general medicine clinic was studied. Patients who were receiving five or more prescription or nonprescription medications were randomly assigned to an intervention group (n = 315) or a control group (n = 257). A clinical pharmacist reviewed the medication profile of each intervention group patient on the day before the patient's clinic visit and attached a written profile review to the medical record for study by the physician during the visit. After each clinic day, the pharmacist obtained updated records of patients in both groups and collected data on the number and cost of medications ordered before and after the visits. After the clinic visits, the average number of medications and the average monthly medication cost per patient decreased by 0.21 and $0.60, respectively, for the intervention group, compared with increases of 0.48 and $3.31 for the control group. The net result of a single profile review was a decrease of 0.69 prescription per patient, for a monthly medication cost savings of $3.91. The number and cost of medications that were discontinued were significantly higher in the intervention group. The intervention group also had significantly fewer drugs added for previously documented medical problems. Medication profile review by a clinical pharmacist reduced both the number and cost of drugs for patients receiving five or more medications.

Clinical Pharmacy Information Systems↗
PubMed2006

Tissue eosinophilia as an indicator of drug-induced cutaneous small-vessel vasculitis.

OBJECTIVE: To determine whether tissue eosinophilia is a reliable indicator of a drug-induced etiology in biopsy samples demonstrating leukocytoclastic vasculitis. DESIGN: Retrospective medical record review with concurrent histopathologic analysis. SETTING: University-affiliated dermatology practice. PATIENTS: Sixty-three patients with cutaneous small-vessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non-drug-induced (n = 47) groups. MAIN OUTCOME MEASURES: Corresponding histopathologic material was reviewed by a dermatopathologist masked to the etiologic associations. An eosinophil ratio was calculated for each patient, derived from the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields), and expressed in relation to the intensity of inflammation in the histopathologic slides examined. Eosinophilia ratios were compared for both groups using the Mann-Whitney test. RESULTS: A significant difference was found in mean eosinophil ratios in the drug-induced vs non-drug-induced groups (5.20 vs 1.05; P = .01). Vascular fibrin deposition was present in both groups and was not found to be significantly different (P = .78). Clinical evidence of systemic vasculitis was present in 2 patients (13%) in the drug-induced group vs 15 (32%) in the non-drug-induced group. Fourteen patients (88%) in the drug-induced group had a short-term disease course vs 27 (57%) in the non-drug-induced group. CONCLUSIONS: Tissue eosinophilia is established as a reliable indicator of drug induction in cutaneous small vessel vasculitis. Drug-induced small-vessel vasculitis generally follows a short-term disease course without development of systemic involvement. This information may be useful for guiding management decisions, especially when the etiology is unclear.

Adolescent↗
PubMed2002

Use of measurement audit in outcomes management.

With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.

Child↗
PubMed2004

Embedding clinical indicators into nursing documentation.

The Methodist Healthcare System of San Antonio audits completeness and accuracy of nursing assessments. Between 1996 and 2001, regardless of software enhancements and education, completeness of risk assessments hovered at 80% or less. Accuracy of risk scores were in question due to paste functionality. In review, it became apparent that many risk assessment indicators were already an intrinsic part of nursing systems assessment. This project embedded weighted indicators invisibly within systems assessment. Risk scores then automatically calculate and display. This approach decreased documentation queries and increased accuracy of risk assessments. Results were validated using concurrent manual review. Skin assessment demonstrated a 96% accuracy rate with 100% completeness of documentation. Fall assessment resulted in a 2.5% miss rate and 100% completeness of record. 100% of high risk patients identified had appropriate care plan problems. Recommendations are to further explore embedded indicators in software design. The study demonstrated a) decrease in nursing documentation queries b) increase in completeness of record c) increase in accuracy of record and d) increase in accuracy of care plan.

Accidental Falls↗
PubMed1999

A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity.

OBJECTIVE: To evaluate the usefulness of repeated prevalence surveys to determine trends in the rates of nosocomial infections and to detect changes in risk factors (e.g., use of invasive devices) associated with nosocomial infections. PATIENTS AND METHODS: Ten annual prevalence surveys were conducted by trained infection control practitioners between 1985 and 1995 for acute-care patients on the medical, surgical, pediatric, and obstetric-gynecologic services at a 900-bed, tertiary-care, teaching hospital with 750 acute-care beds. The same methods of chart review and concurrent reporting from nursing, the microbiology and clinical laboratory, and the pharmacy were used each year to collect data on the prevalence of nosocomial infections, invasive-device utilization, and abnormal laboratory indicators. Although data were collected on a single day, a period-prevalence study approach was used, because charts were reviewed for any infection data occurring within the 7 days prior to the survey. RESULTS: The hospital census for acute care patients, as measured by the prevalence surveys, declined sharply over the 10 years, from 673 to 575 patients (P = .02). However, the medical service census increased from 150 to 188 patients (P = .01). During the same period, there was a significant decrease in the mean length of stay, from 7.3 to 6.0 days (P = .01), and a concomitant increase in the mean diagnosis related-group case-mix index, from 1.03 to 1.24 (P = .001). Overall, nosocomial infection rates remained unchanged over the study period (mean of 9.85 infections per 100 patients), but rates of nosocomial bloodstream infection increased from 0.0% in 1985 to 2.3% in 1995 (P = .05). Nosocomial infection rates were significantly higher on the medical and surgical services than on other services (P<.001). Utilization rates increased significantly for Foley catheters (9.0% to 16.0%, P = .002) and ventilators (5.0% to 8.0%, P = .05). CONCLUSIONS: Despite apparent increases in the severity of illness of our patients, overall rates of nosocomial infection remained stable during a decade of study. Rates of nosocomial bloodstream infection increased, in parallel with National Nosocomial Infection Surveillance System data. We found repeated prevalence surveys to be useful in following trends and rates of infection, device utilization, and abnormal laboratory values among patients at our institution. Such methodologies can be valuable and low-cost components of a comprehensive infection surveillance, prevention, and control program and other potential quality-improvement initiatives, because they enable better annual planning of departmental strategies to meet hospital needs.

Adolescent↗
PubMed1990

Meeting JCAHO drug usage evaluation requirements in a small hospital.

Our hospital successfully implemented a drug review program which met JCAHO standards. This was accomplished by analyzing our current situation to identify opportunities for improvement and then developing a drug review plan consistent with JCAHO requirements. The establishment of a DUE pharmacist to coordinate the program and the cooperation of the medical staff has been crucial to the success of our program.

Accreditation↗
PubMed1985

DRG clinical surveillance: an approach to internal control.

In the present healthcare environment, internal control of hospital resources is becoming increasingly important. One hospital's approach to instituting internal control is the development of a DRG clinical surveillance program. This program uses utilization review in conjunction with quality assurance to provide the hospital with a working framework for determining whether hospital admission is appropriate or whether an alternative method of healthcare delivery should be used.

Concurrent Review↗
PubMed1988

Using treatment plans for quality assurance monitoring in a residential center.

Treatment plans for children in residential centers are required for accreditation and reimbursement, and they can provide important insights to the quality of care. One residential center has developed a system for reviewing treatment plans as part of its quality assurance (QA) monitoring. QA staff use checklists to review plans to assure that they are complete and technically correct and to evaluate the quality and appropriateness of care as revealed in the treatment strategy.

Adolescent↗
PubMed2006

Active surveillance using electronic triggers to detect adverse events in hospitalized patients.

BACKGROUND: Adverse events (AEs) occur with alarming frequency in health care and can have a significant impact on both patients and caregivers. There is a pressing need to understand better the frequency, nature, and etiology of AEs, but currently available methodologies to identify AEs have significant limitations. We hypothesized that it would be possible to design a method to conduct real time active surveillance and conducted a pilot study to identify adverse events and medical errors. METHODS: Records were selected based on 21 electronically obtained triggers, including abnormal laboratory values and high risk and antidote medications. Triggers were chosen based on their expected potential to signal AEs occurring during hospital admissions. Each AE was rated for preventability and severity and categorized by type of event. Reviews were performed by an interdisciplinary patient safety team. RESULTS: Over a 3 month period 327 medical records were reviewed; at least one AE or medical error was identified in 243 (74%). There were 163 preventable AEs (events in which there was a medical error that resulted in patient harm) and 138 medical errors that did not lead to patient harm. Interventions to prevent or ameliorate harm were made following review of the medical records of 47 patients. CONCLUSIONS: This methodology of active surveillance allows for the identification and assessment of adverse events among hospitalized patients. It provides a unique opportunity to review events at or near the time of their occurrence and to intervene and prevent harm.

Academic Medical Centers↗
PubMed1991

Charge reviews can beef up bottom lines.

Traditionally, healthcare organizations have been reluctant to pursue charge reviews until pressed to do so by third-party challenges to their charges. But a hospital pursuing either a concurrent or retrospective review may realize significant revenue enhancement--and not only from correcting undercharges on charge-based accounts. Charge reviews can lead to smoothed patient documentation, better cost accounting, more appropriate Medicare payment, and, ultimately, an improved bottom line.

Concurrent Review↗
PubMed1990

Generic screening as an integral part of quality management.

Comprehensive quality management programs are vital to the evaluation and improvement of the delivery of health care today and in the future. These programs must address issues which include quality assurance, risk management, and utilization management. The programs should be designed to promote and assist in the safe delivery of patient care as well as the provision of a safe environment for all patients, visitors, and employees. Various methodologies have been advocated to ensure quality care, the majority of which are retrospective evaluations. One of the more recent methodologies developed is generic screening. The Boston Veterans Medical Center has utilized generic screening since 1986 in its Quality Management Program. Our generic screening program has been successful as a result of multidisciplinary collaboration, commitment, and support from the medical center's top management, both administrative and clinical. We have developed a credible system that may be used to fulfill many requirements of both internal and external reviews. The program is easily reproducible and provides a basis for trend analysis within specific groups in order to better plan and meet patient care needs, minimize risk, and maximize outcome.

Boston↗
PubMed1992

A successful community hospital program for monitoring adverse drug reactions.

All health care professionals are responsible for reporting ADRs. The physician records these events in the patient's medical record. In the monitoring program at Meriter Hospital, pharmacy responsibilities include review and assessment of all reported ADRs. When appropriate, the ADR is reported to the FDA. The pharmacy department maintains ADR statistics, reports quarterly to the P&T committee, and disseminates information to appropriate hospital committees and departments. The P&T committee supports the ADR monitoring program and policy. This committee reviews all ADRs and recommends action plans. The ADR monitoring program has successfully increased the number of ADRs reported, and actions resulting from ADR reports have had a positive impact on patient care.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Women's emotional adjustment to IVF: a systematic review of 25 years of research.

This review provides an overview of how women adjust emotionally to the various phases of IVF treatment in terms of anxiety, depression or general distress before, during and after different treatment cycles. A systematic scrutiny of the literature yielded 706 articles that paid attention to emotional aspects of IVF treatment of which 27 investigated the women's emotional adjustment with standardized measures in relation to norm or control groups. Most studies involved concurrent comparisons between women in different treatment phases and different types of control groups. The findings indicated that women starting IVF were only slightly different emotionally from the norm groups. Unsuccessful treatment raised the women's levels of negative emotions, which continued after consecutive unsuccessful cycles. In general, most women proved to adjust well to unsuccessful IVF, although a considerable group showed subclinical emotional problems. When IVF resulted in pregnancy, the negative emotions disappeared, indicating that treatment-induced stress is considerably related to threats of failure. The concurrent research reviewed, should now be underpinned by longitudinal studies to provide more information about women's long-term emotional adjustment to unsuccessful IVF and about indicators of risk factors for problematic emotional adjustment after unsuccessful treatment, to foster focused psychological support for women at risk.

Anxiety↗
PubMed2001

Concurrent opioid dependence and mental health problems: a review of the issues for general practice.

The literature is reviewed on the issue of concurrent opioid dependence and mental health problems within the general practice setting. People with such problems have poorer personal, clinical and social outcomes than people with either mental health or drug and alcohol (D&A) problems alone. Mental health and drug services operate from different policy systems and are generally not co-ordinated with each other, leaving the onus on the patient to move effectively through health systems. The common statement that GPs are ideal health professionals to manage concurrent problems is contrasted with the evident barriers in general practice such as lack of time, knowledge, skills and confidence. Models for managing concurrent problems tend towards shared care. However, these models either have received mixed evidence (e.g. consultant-liaison psychiatry) or are amenable to development but remain untested (e.g. co-ordinated care, community health centre programs). The Enhanced Primary Care items introduced in 1999/2000 may provide an incentive for GPs to participate in shared care arrangements with other health professionals. However, there is a need for mechanisms to increase the links between GPs and other health services.

Australia↗
PubMed1993

Utilization care plans and effective patient data management.

This article introduces the concept of a utilization care plan (UCP) for supporting the communication of data required for effective utilization review and utilization management. Utilization review is a process of measurement that compares the performance of a ward, department, or entire facility against accepted criteria to identify resource use shortfalls. Utilization management is the deliberate action by third party payers to ensure that shortfalls in resource utilization are minimized. Critical to the success of utilization management is effective data communication; utilization review data must be accurate, complete, accessible, timely, and coordinated. Computer-based UCP systems can remind caregivers when and what services should be provided to patients and also monitor the portion of those services that should be administered during each phase of a patient's therapy. Deviations from the UCP system template constitute variances that can be documented and highlighted in a friendly automated system that ensures highly accurate and extremely timely concurrent utilization information. Some implications of using UCP systems for future research and practice are also discussed.

British Columbia↗
PubMed1988

Emergency department daily record review: a quality assurance system in a teaching hospital.

A system of daily patient chart review of 11 categories of physician documentation and patient care was implemented over a 36-month period at Allegheny General Hospital in Pittsburgh. A total of 108,317 charts of emergency patients were reviewed. Feedback on errors in all categories were given to the physicians responsible, and necessary corrective actions were taken as soon as possible. All new resident physicians rotated in two-month blocks and received orientation to patient care and chart documentation expectations prior to starting the service. All physicians' charts underwent the same thorough chart review. Not only did the percentage of errors decrease from the first months to the second months of the residents' rotations, but the yearly percentage of total errors decreased as the study progressed, from 5.47% to 3.57%.

Concurrent Review↗