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PubMed1990

[Electronic data processing at the clinic].

Since 1 October 1986, all cataract, keratoplasty and glaucoma operations have been evaluated prospectively in the Department of Ophthalmology and Eye Hospital at the University of Erlangen-Nürnberg. The medical history data and preoperative status, intraoperative details and the postoperative course are standardized and stored. For each eye, the diagnosis is made according to the system called the "Erlanger Schlüssel." The present status of the Erlanger Ophthalmological Documentation System for Cataract, Keratoplasty and Glaucoma surgery is outlined. The difficulties encountered when the project was started are pointed out. The importance of electronic data processing in research, teaching and patient care is discussed.

Computer Systems↗
PubMed1988

Impact of the National Control of Diarrhoeal Diseases Project on infant and child mortality in Dakahlia, Egypt. National Control of Diarrheal Diseases Project.

The Egyptian National Control of Diarrheal Diseases Project (NCDDP) started in 1983. A field trial done in Dakahlia Governorate in 1980 to promote oral rehydration therapy showed that the mortality rate for the under-fives during the diarrhoea season was 18.1/1000 in control villages and 10.5/1000 in "outreach" villages (p less than 0.001). In 1986 mortality rates had become similar in the two areas and lower than in 1980 (6.5/1000 and 6.0/1000, respectively), even though there were no significant changes in diarrhoea incidence. Virtually all the reduction in mortality was due to a decline in diarrhoea-associated deaths. The principal differences between 1986 and 1980 were better case-management by mothers and doctors, in both outreach and control villages, and far greater television ownership. Village civil registers showed only slight changes in under-five mortality from all causes after 1980, but an accelerating decline from 1983. Governorate-wide civil registration data showed slowly falling infant death rates from 1970 onward, accelerating after 1982, with most of the decline corresponding to the seasonal pattern of diarrhoea-associated mortality throughout the year. Thus NCDDP promotion of better treatment seems to have been responsible for the decline in mortality.

Child, Preschool↗
PubMed1987

Quality improvement of patient care: some preliminary results of a hospital-wide quality-assurance project at the University Hospital of Maastricht.

Dutch hospitals have to design their quality-assessment programmes within the boundaries set by "indirect government legislation". At the University hospital of Maastricht a five-stage project was started in 1985 to construct a hospital-wide quality-assurance organisation that includes regular review of the quality of professional performance. This paper will describe intermediate results of the first stage and will discuss the results of different subsurveys undertaken to assess the current level of quality of care and several key-issues conditional to the implementation of such a hospital-wide structure in the existing organisation of a University hospital. Finally the results of the first stage will be contrasted with external legislative standards and internal needs of the University hospital recognised during assessment of the current situation.

Attitude of Health Personnel↗
PubMed1987

Planar stress thallium-201 scintigraphy. First experiences with a new circumferential programme.

A new computer programme was used in 22 patients referred for suspected ischaemic heart disease (IHD) or for assessment of the size of a suspected ischaemic or infarcted area. An interpolative method was used to construct the net myocardial images. Initial imaging in three projections was started at five minutes after thallium-201 injection and delayed imaging three hours after the injection. The data were presented as analog images, circumferential profile curves, and washout curves. The calculated delayed/initial count ratio is an important measure of redistribution. In the 12 patients referred to detect clinically or electrocardiographically suspected IHD, the diagnosis IHD was made by the cardiologists on the basis of current routine criteria and the thallium test. The technique was found useful in localising and assessing the size of a suspected ischaemic or infarcted area in nine of 10 patients. Our experience with the new programme confirms the experience of others that a combination of analog images and computer processed data gives much more precise information than the visual inspection of the analog pictures alone.

Adult↗
PubMedDate not supplied

Research in a busy family practice training program.

A newly designed framework for starting research projects in an Army family practice residency incorporates a timeline and a Family Practice Research Advisory Committee to stimulate research among residents and staff. Seventy-five percent of second- and third-year residents participated in approved projects compared to none two years ago. Sixty-six percent of the faculty have initiated research projects since implementation of the new guidelines. The combination of the committee and the timeline centralizes research within the family practice department and provides an academic environment for the department.

Curriculum↗
PubMed1985

[Personality characteristics of hypertensive patients. Study of subjects with essential hypertension compared to a control population].

Starting from projective situations--thematic apperception test (TAT) we have researched personality characteristics liable to be found in hypertensive subjects. With reference to a control group of 59 subjects we have studied 41 essential hypertensive subjects. They undergo a preliminary interview structured on the questionnaire type, are classically tested with the TAT, have one or several free interviews. These data are exploited on three levels and contents = manifest, latent, adaptive. It emerges that there are permanent biographical elements (elements of reactivation. Difficulty to put up with aggressiveness, object loss anxiety, use of operative thought back of adaptation = absence of solution to conflicts and possibilities of passage ?), personality patterns in between obsessional pole neurosis and limit state (Bergeret's nosography). These data partly overlap other research, they encompass a wider field than hypertension, given the structures involved (limit state, psychosomatic component). The lack of mentalization justifies the use of therapeutic techniques such as relaxation, biofeedback...

Adult↗
PubMed1979

Rationalisation of therapeutic diets in the Netherlands.

In 1976 a project was started by The Netherlands Education Bureau for Food and Nutrition to rationalise therapeutic diets and reorganise hospital catering departments. The first part of the work--rationalisation of therapeutic diets, including the introduction of a 'national dietetic instruction form'--is reported here.

Diet Therapy↗
PubMed1980

[Drug monitoring in psychiatry (author's transl)].

The Study Group for Drug Surveillance in Psychiatry (AMUP) has been working since July 1978 as a task force group of the "Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie" (AGNP). A protocol was designed for the initiation of drug monitoring in psychiatric hospitals. With support of the Bundesgesundheitsamt, Berlin, the first part of this project was started as a practicability study in the psychiatric hospitals of the Universities of Berlin, Göttingen, and Munich and in the municipal hospital of Schleswig. The study includes 7650 in-patients. It is based on the following methods: intensive drug monitoring, organized spontaneous monitoring of adverse drug reactions and registration of drug applications. This drug monitoring system in psychiatry will be expanded to other psychiatric hospitals, and eventually to out-patient clinics as well as private practices within the next two years.

Costs and Cost Analysis↗
PubMed1995

[Revision and optimization of processes: a fundamental timing for adequate use of the resources and technological innovation. An example of intervention in the cardiology field and considerations on "total quality" in medicine].

UNLABELLED: The Cardiology Unit of the Este General Hospital began its activity in 1988. We soon identified a mismatch between a good, up-to-date diagnostic instrumentation with growing customers' demand and an inadequate utilization of the instruments. Waiting lists were getting longer, customers were not satisfied, no-shows at the appointments increased and we had a progressive loss in image. We therefore decided to intervene on our processes, starting the project "TOTAL QUALITY IN CARDIOLOGY". We focused our attention on two main fields, namely (1) electrocardiography, (2) other diagnostic techniques, separately analyzed because of important differences. Point (1) is basically worked out by paramedical personnel, in high numbers and with stable demand, while point (2) is determinantly linked to medical activity, although with concomitant need for paramedical support. The figures are lower for point (2) but are steadily growing. In the two operating fields we further identified two separate adverse effects: 1). ELECTROCARDIOGRAPHIC EXAMINATIONS (ECG) ARE TOO TIME CONSUMING, 2) THE NUMBER OF DIAGNOSTIC PROCEDURES IS TOO LOW FOR THE INSTRUMENTS AVAILABLE. We used preliminary analysis with process flow diagrams and our interventional methods were policy deployment and daily routine work. ELECTROCARDIOGRAPHIC EXAMINATIONS ARE TOO TIME CONSUMING. From cause-effect diagram for cause classification and subsequent Pareto analysis we identified two groups of main causes: 1. the paramedical-patient team is not able to optimise usage of the instrument; in particular, total time for undressing of the patient, lead attachment, dressing of the patient, change in ECG conductivity cream and, if necessary, repetition of ECG for mistakes in procedure is much longer than operative time of the instrument; 2. the necessary copy of the ECG done by the instrument was too time consuming (2') as compared to total procedure time. Implementation plans have been as follows: activity was concentrated in one single room at constant temperature (20 degrees); we augmented the number of dressing rooms and nurses (from 1 to 2 unit); we substituted the ECG conductivity cream with a water-alcoholic solution and the copy with a photocopy. RESULTS: decrease in mean time for ECG from 6'52" to 3'25" (for example: total ECGs 1992: 14,827, total spared time: 852 working hours); reductions in dead times; capability to cope rapidly with high demand; consequent possibility to utilise paramedical personnel for other activities; reduction in copy costs from 156 to 50 Lit each (total reduction 1,571,662 Lit). EXPECTATIONS. further revision of the procedures to keep pace with new electrocardiographic instruments and to achieve shorter operative times.

Cardiology↗
PubMed1995

China: lowering maternal mortality in Miyun County, Beijing.

In Miyun County in China the medical authorities registered an elevated maternal mortality ratio which needed to be verified in order to design corrective changes. A decision was taken in 1988 to start a project of pilot interventions in the organization of maternal health services and access for obstetric emergencies. A control and pilot area were chosen in order to test the validity of the interventions. The reduction in maternal mortality from the main complications (postpartum haemorrhage and eclampsia) was impressive and no more maternal deaths were registered in the pilot area with reference to these causes. The overall maternal mortality ratio per 100,000 live births dropped by more than 75% in the pilot area throughout the three-year implementation period. It was therefore shown that the synergistic effect of additional training of medical workers and traditional birth attendants, improved health education, the provision of easier access to emergency care services, the establishment of obstetric rescue teams at the county level, generally improved MCH services, and strengthened management capacity for high risk pregnancies were the most appropriate interventions to lower maternal mortality.

Child Health Services↗
PubMedDate not supplied

The university/public health link in reducing infant mortality in a high-risk population.

The Greater Cleveland Healthy Family/Healthy Start (HF/HS) Project Consortium was established to combine various resources in the Cleveland community in an effort to reduce the infant mortality rate by 50% over five years. As part of HF/HS, an Infant Mortality Review Program (IMRP) was instituted. This program has two important facets: an in-depth review of the circumstances of each death, and the development of scientifically-based, community-oriented interventions based on these reviews. To conduct the IMRP, a "hot line" connection with each hospital and the coroner's office was established to provide prompt notification of infant deaths and to enable timely data collection. A core review group determines actual cause of death and preventability, and identifies appropriate interventions. Recommendations issued by a technical oversight panel are disseminated to groups with the authority to institute changes in an effort to foster continuous quality improvement. Complete reviews of 243 of 319 deaths reported to date have resulted in 11 recommendations for presentation to community groups. The public health department's cooperation with other agencies has facilitated a process which ensures timely implementation. Cleveland's strongly committed consortium was able to link university and public health expertise to activate community groups and health care providers to implement recommended solutions. Demonstration of a measurable decline in the community's infant mortality rate (IMR) should provide concrete evidence of the value of such linkages. We suggest that a similar review mechanism be considered for other communities with high infant mortality rates.

Cause of Death↗
PubMedDate not supplied

The characterization of Leishmania parasites and their vectors from Central America using molecular techniques.

The disfiguring cutaneous and mucocutaneous and often fatal visceral forms of leishmaniasis are an increasing public health problem in Central America. There are some evidences of a highest prevalence of L. braziliensis and L. mexicana in Guatemala; L. braziliensis, L. panamensis and L. infantum (L. chagasi) in Honduras and Nicaragua, and L. panamensis in Costa Rica and Panamá. Our research project, just starting, attempts to use molecular approaches for a more rapid and accurate diagnosis and to identify the parasites. The techniques include non-radioactive DNA probes, PCR, schizodeme, isoenzyme analysis and monoclonal antibodies; and specific recombinant peptides will be used to improve immunodiagnosis of the visceral form. Intra-specific heterogeneity in Leishmania isolates will be examined by pulsed field electrophoresis and random amplified polymorphic DNA. Using selected strains, the techniques will be compared on a regional basis leading to a better knowledge of parasite distribution and the related clinical entities. Furthermore, DNA probes for the identification of parasites in vectors and for sibling species of vectors, are also to be applied; chemical identification of sandfly male pheromones will be attempted possibly leading to potential novel control measures.

Animals↗
PubMed1994

A consultancy service that pays dividends. Setting up a pressure sore resource group.

1. The recognition that there may be a pressure sore problem in your hospital is important. 2. When starting a project, it is important to establish a baseline from which progress can be measured. 3. Better results will be achieved if the pressure sore problem is tackled by the multidisciplinary team. 4. It is important to realise that quality care costs money--the hospital may have to spend money in the first instance to provide a cost-effective service in the long run. 5. It is vital that medical and nursing staff are made aware of the cost-effectiveness of the wound care products they choose.

Consultants↗
PubMedDate not supplied

[A future path toward cooperation: hospital partnership].

Development agencies have been promoting hospital programs in developing countries for several years. Although they have placed the accent on reorganising the management of these hospitals, most funds have been used for investment in buildings and equipment. This policy has failed, for several reasons. In many cases the field of intervention is too narrow, and involved too few professionals. There is also an erroneous belief that management restructuring can solve all the problems of running an hospital. Indeed, practitioners themselves, who are the cutting edge, are often ignored. Many projects are started without evaluating the resources of the hospital team. And a training program is not always the best solution when there is a lack of motivation or poor basic knowledge. Development agencies are often simply regarded a funding sources, yet money is not the answer to all hospital problems. Clearly development agencies cannot enter partnerships directly with hospitals in developing countries, but the solution may be to get these hospital more involved. For example, French hospitals are legally authorized to undertake international cooperation programs, free from time limits and political pressures, contrary to development agencies. What is more, hospitals in the developed countries can learn much about cost rationalization from their counterparts in the developing countries. Development agencies should thus encourage this sort of hospital "twinning" initiative and provide financial support, but it is important that the hospitals involved should be fully independent to avoid excessive bureaucracy.

Capital Financing↗
PubMed1993

Dr Max Kamien. Academic general practitioner and champion of rural practice.

"I did not set out to be either a general practitioner or an academic. However, three personality traits helped to point me in that direction. A consciousness of the difficulties of minority groups and a desire to help them fight their battles, a valuing of the generalist role and a streak of idealism that incorporates a world view that nearly everything could and should be better than it is. "The position of academic general practice in medical schools is akin to that of Aborigines in Australian society. Things are nowhere near as hard as they were 15 years ago, but they are still not easy. Many things I have tried to do have come to fruition but with a lead time of five to 15 years. If I had know how hard the struggle for academic general practice would be, I would have thought once and still have taken the same career path. "In the future I would like to spend more time making professional and social contact with general practitioners throughout Western Australia and helping medical students and vocational trainees to achieve their intellectual and professional potential. I would like to encourage more young doctors to start research projects within their own practices and become a helper rather than an initiator. I want to be the third or fourth name on a paper not the first. In five to ten years I will bow out of academia, but I can't imagine ever giving up clinical medicine, one to one practice teaching and patient care."

Faculty, Medical↗
PubMedDate not supplied

[The behavior of mothers at the appearance of fever and cough in small children].

The Social Cooperative Progetto Popolare of Montescaglioso (Matera) organized some health education meetings on common health problems. Since information on treatment of cough and fever are very frequently sought, a survey was conducted interviewing the mothers with children of 6 months-10 year of age. The health visitors, social workers and teachers members of the Cooperative, interviewed, using a structured interview, 220 mothers (45% of all the eligible mothers resident in the area). 157 mothers (71.3%) had children with cough or fever the month before the interview. 25% of children were not administered any drug while the remaining 117 received 1 to 5 drugs. 45 children (28.6%) were administered an antibiotic (13 different active principles!). Non farmacologic treatments were associated to drugs for 17 children with fever and 39 children with cough. Results were presented in public and discussed with Montescaglioso inhabitants. Altough some of the results were expected, it should be stressed that this project demonstrated that it is possible to actively involve professionals and lay people in collaborative projects and start a two way communication and collaboration.

Adult↗
PubMed1997

[The intervention center at the Rikshospital. Experiences from the first year of activity].

In order to co-ordinate and promote the development of new clinical applications by structuring collaboration and communication across traditional specialty boundaries, a first of its kind hospital department was opened at Rikshospitalet in June 1996. The Interventional Centre is a multidisciplinary centre for research and development, teaching and quality management of imaging-guided minimally invasive therapy, endoscopic surgery and interventional radiology. The department is a full fusion of state-of-the art operating theatre with an advanced radiology department and with fully up-to-date ultrasound and endoscopy facilities for integrated use in the treatment of the patient. The department is cross-disciplinary organised. A small staff of 14 persons are responsible for the day-to-day running of the centre. Specialists from other hospital departments work together with the centre's permanent staff to develop new procedures. During the first year, 19 research projects were started and a total of 510 procedures performed within the fields of Radiology, Neurosurgery, Gastroenterology, Cardiology, Cardiovascular surgery and Paediatric cardiology, and also within the fields of image processing and telecommunication.

Centralized Hospital Services↗