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Vendor questionnaire to evaluate product quality, service, and support.

A questionnaire was developed to obtain verifiable data on the quality of a manufacturer's product, availability and quality of service, qualifications of service personnel, availability of spare parts, availability of inservice training programs for users and clinical engineering staff, history and future support of product, and technical requirements for preventive maintenance and repair. The questionnaire was constructed on the premise that product quality, service, and support throughout the life of the instrument are of equal importance to the function and price in purchase decisions. They play an important role in determining the true cost of patient monitoring equipment and contribute to the quality, safety, and efficiency of patient care.

Commerce↗

Laparoscopic equipment troubleshooting.

1. A successful laparoscopy program requires dedicated personnel, standardized inventory, and ongoing inservice training. Members of the operating team must realize their individual responsibilities and establish accountability while providing safe, efficient care for their patients. 2. A standardized inventory and checklist of all laparoscopic equipment and instrumentation deemed necessary for the procedure by the physician must be maintained and checked on a daily basis. 3. Adequate primary and backup instrumentation must be readily available at all times.

Central Supply, Hospital↗

Reducing duplicate hand and wrist series in the emergency room: experience at Madigan Army Medical Center.

OBJECTIVE: To demonstrate that repetitive hand or wrist series could be minimized with minor refinements of triage. POPULATION: 2,119 consecutive trauma patients requiring hand or wrist series. METHOD: In baseline phase I, radiographs were ordered by triage corpsmen. In phase II, RNs or physicians performed triage and ordered films. Phase III followed inservice training on strategies to minimize duplicate studies. Phase IV required the RN or physician to provide written justification for duplicate studies. The number of duplications in each phase were compared to baseline using the chi-square test of homogeneity. RESULTS: The phase I duplication rate was 10.8%. In phase II, the percentage of duplicate studies was 8.1% (p = 0.12). Phase III decreased duplication to 6.2% (p < 0.01). Phase IV decreased duplicate studies to 5.8% (p < 0.01). CONCLUSION: In an emergency room generating over 180 hand and wrist studies monthly, minor changes in ordering practices reduced the duplication rate from 10.8% to 5.8%.

Emergency Medical Services↗

Inducing labor with a sustained-release PGE2 vaginal insert. Experience at a community hospital.

OBJECTIVE: To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital. STUDY DESIGN: Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought. RESULTS: Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert. CONCLUSION: This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.

Administration, Intravaginal↗

Rehabilitation of the expanded programme on immunization in Sudan following a poliomyelitis outbreak.

In 1993 a large outbreak of paralytic poliomyelitis occurred in Sudan as a result of an accumulation of large numbers of susceptible children that was accelerated by faltering immunization services. The extent of the outbreak led to the rapid rehabilitation of Sudan's Expanded Programme on Immunization (EPI); the government began financing vaccine purchase, operational aspects of EPI were decentralized, vaccine delivery was changed from a mobile to a fixed-site strategy, a solar cold chain network was installed, inservice training was resuscitated, and social mobilization was enhanced. National immunization days (NIDs) for poliomyelitis eradication were conducted throughout the country, including the southern states during a cease fire in areas of conflict. Measles immunization coverage was increased by offering measles vaccine during the second round of NIDs and subsequently through routine immunization services. Supplemental tetanus toxoid immunization of women of child-bearing age began in three provinces at high risk for neonatal tetanus. From 1994 to 1996 reported immunization coverage increased and the incidence of all EPI target diseases fell. Trends in coverage, disease incidence, financing, and the implementation of WHO-recommended disease-control strategies suggest that more sustainable immunization services have been re-established in Sudan.

Adult↗

Prevention training of paraprofessionals in the schools: an examination of relevancy and effectiveness.

Prevention training programs for paraprofessional school personnel are examined in this article. Prevention training for the reduction of student alcohol and other drug use, incorporating a student well-being model, is described and evaluated. The prevention training, entitled "Enhancing Student Well-Being," took place in two urban school districts with over 200 paraprofessional school personnel participating. The training was evaluated using measures of knowledge gained, self-efficacy, and participant satisfaction. Pre- and post-training differences showed consistent gains in participant efficacy expectations but less consistent gains in outcome expectations and knowledge. Participant satisfaction and self-reports of knowledge enhanced and skill improvement were uniformly high across all training programs. Implications for inservice prevention training of paraprofessionals are discussed.

Alcoholism↗

Youths' access to mental health services: the role of providers' training, resource connectivity, and assessment of need.

This paper posits that providers with training in and knowledge of mental health resources are more likely to recognize youths' mental health problems, and provide youths with services. In 1994 and 1996, we interviewed 792 adolescents who were involved with St. Louis public health, juvenile justice, child welfare. or education service sectors. Two hundred eighty-two youths had received some services, listing 533 providers. We could identify 364 of those providers, and 61% (222) responded concerning service need, service use, and provider knowledge and behavior. Structural equation models demonstrate that provider assessment of youths' mental health problems is the largest and provider knowledge of service resources the second largest determinant of service provision. Youths' self-reported mental health is not positively associated with increased services and is only minimally associated with provider assessment of their problems. Training (both professional and inservice) contributes to higher assessments of youths' problems and greater resource knowledge, which is associated with increased service provision. Providers from the mental health and child welfare sectors have more professional training in mental health and are more likely to receive inservice training. Inservice training should be offered to all who work with youths.

Adolescent↗