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PubMed1980

Complications associated with ambulatory surgery.

The interest in ambulatory surgery has grown substantially during the past ten years. To evaluate the medical aspects of ambulatory care objectively, there must be accurate, reliable, and pertinent complication data. A prospective study of 13,433 patients at a freestanding ambulatory surgical center was performed. Ninety-nine and eight-tenths percent of the patients were followed up through the first two postoperative weeks. One hundred six medical, surgical, or anesthetic complications were identified in the patient population. No deaths occurred in the center, and there was no instance of cardiovascular collapse. Sixteen patients were transferred to a general hospital. Surgery and anesthesia performed in either the inpatient or outpatient setting may be associated with serious complications. Many surgical procedures can be performed as safely in the outpatient setting as in the hospital inpatient setting.

Ambulatory Surgical Procedures↗
PubMed1995

Quality assessment and improvement of transfusion practices.

A successful quality assessment program simultaneously creates, sustains and documents excellence in patient care. As clinical practices evolve, it helps to assure their continuing improvement. The program strives to eliminate unnecessary transfusions as the cornerstone of transfusion safety. It should be conducted in a professional, nonadversarial, and educational manner.

Adult↗
PubMed1994

Patient weights: from physician complaints to improved nursing practice through quality improvement.

Identification of a patient-centered problem led the Quality Improvement Committee to the development of a standard of care and a concurrent clinical monitor. This project focused on nurses making an assessment when a patient's daily weight fluctuated more than 1 kg. Although the problem was patient oriented, the indicators of the concurrent monitor reviewed the nursing practice.

Humans↗
PubMed1993

Informed decision making in persons acquitted not guilty by reason of insanity.

Deciding to raise an insanity defense carries serious consequences. This is especially true for persons charged with minor offenses, for whom an acquittal not guilty by reason of insanity (NGRI) might lead to a longer period of incarceration than would conviction. Before raising an insanity defense, a defendant should be provided with information necessary to make an informed decision and should be competent to understand the consequences of the verdict. This study attempted, through retrospective review and concurrent evaluation, to determine the degree to which trial courts in Virginia attended to these important aspects of informed decision making before finding defendants charged with misdemeanors NGRI. The study also attempted to assess the degree to which defendants were competent and informed at the time of adjudication. In most instances, trial courts did not consider defendants' competence to make decisions regarding the insanity defense and did not consider whether defendants were informed about the consequences of a successful insanity defense at the time of adjudication. The average length of stay for these patients was (at least) 21 months; most would have been released earlier had they been committed civilly rather than committed as a result of insanity pleas. We stress the need to educate judges, attorneys and forensic evaluators to the importance of considering defendants competence to plead insanity and of providing information about the consequences of a successful plea. We also propose that laws be changed to recognize the importance of these elements in the decision making process regarding pleas of insanity.

Adult↗
PubMed1993

Relationship of physician ratings of severity of illness and difficulty of clinical management to length of stay.

In a concurrent prospective study, medical and surgical residents rated the severity of illness and difficulty of clinical management of each of their patients within 24 hours of admission, and on a daily basis throughout the patient's stay. Data were collected on consecutive admissions resulting in 661 admissions with complete data for analysis. Results indicate that difficulty and severity are correlated, each explaining variations in length of stay (LOS), and together explaining up to 44 percent. Four alternative measures are tested, first-day values, average values over the stay, peak or highest values, and a zero-one measure indicating whether or not the severity or difficulty fluctuated over the stay. First-day and average measures of severity and difficulty explain little variation in LOS; peak and fluctuating measures are highly explanatory. After adjusting for diagnosis-related groups (DRGs), fluctuating severity adds 34 percent, and adjusting for both DRGs and severity, fluctuating difficulty adds 10 percent for a total of 53 percent variance explained. In comparable results, peak severity adds 21 percent, and peak difficulty 4 percent, for a total of 34 percent variance explained. Findings indicate that difficulty had independent value as a predictor, and the high explanatory power of the fluctuating measures suggests that a third dimension, instability, may be as important as severity and difficulty in explaining LOS.

Baltimore↗
PubMed1976

[Association of Posner-Schlossman-syndrome with Adisson's disease (author's transl)].

After introductory remarks concerning the Posner-Schlossman-syndrome (syndrome of glaucomatocyclitic crises) a case is reviewed. The concurrence with Addison's disease in this patient gives rise to speculations as to possible connections between the two conditions, but the conclusion is that the simultaneous occurrence of the two diseases at present must be regarded as coincidental.

Addison Disease↗
PubMed1990

Asbestos review and update.

Concurrent with the widespread use of asbestos in buildings were noticeable increases in the incidence of certain types of lung disease and cancer among workers who mined, milled, manufactured, and applied asbestos containing products. OSHA and EPA initiated efforts to reduce exposure to asbestos in 1971 and 1973, respectively. The approach taken by these agencies can best be understood through knowing the epidemiology of asbestos. The role of the occupational health nurse is centered around prevention of exposure to asbestos by educating employees on the risks of exposure, implementing engineering controls, and enforcing OSHA standards.

Asbestosis↗
PubMed1981

Physicians measure up. A study of 13 surgical procedures.

The Colorado Foundation for Medical Care Professional Standards Review Organization performed a six-month study in the latter half of 1978 to determine if the following surgical procedures were performed in accordance with the appropriate indications: primary appendectomy, cataract surgery, cholecystectomy, coronary arteriography, uterine dilation and curettage, surgical repair of hiatal hernia, abdominal hysterectomy, vaginal hysterectomy, lumbar disk excision, meniscectomy, tonsillectomy, adenoidectomy, and tonsillectomy and adenoidectomy. Data were collected concurrently by nurse reviewers on 4,850 hospitalized Medicare and Medicaid patients in Colorado hospitals. Cases that did not meet explicit indications were referred to physician reviewers for final determination. The 4,728 cases (97%) either met indications for these procedures or were justified by physician review. The conclusion from the study was that Colorado physicians are performing these procedures appropriately.

Colorado↗
PubMed1997

Refractory anaemia with ringed sideroblasts concurrent with multiple myeloma--a brief review of the recent literature.

The report describes a patient in whom myelodysplastic syndrome and multiple myeloma (MM) were simultaneously present. This patient manifested an IgA-lambda type of MM concurrent with a refractory anaemia with ringed sideroblasts (RARS) without prior therapy. His bicytopenia could not be improved by vitamin B6 regardless of a reduced serum vitamin B6 concentration. A review of the literature suggests that myelodysplastic syndrome (MDS), chronic neutrophilic leukaemia (CNL) and idiopathic myelofibrosis (IMF) are the most frequent disorders associated with MM. The IgA type seems to be associated more commonly with these disorders. The mechanisms responsible for the development of plasma cell proliferation are diverse; the neoplastic transformation of a common progenitor, the involvement of the lymphoplasmacytic system and/or chronic reticuloendothelial stimulation may play a role in the occurrence of such hybrid haematological disorders.

Aged↗
PubMed2003

Extreme lymphoplasmacytosis and hepatic failure associated with sulfasalazine hypersensitivity reaction and a concurrent EBV infection--case report and review of the literature.

We present an unusual case of a patient with extreme lymphoplasmacytosis and hepatic failure in association with a reaction to sulfasalazine and a concurrent Epstein-Barr virus (EBV) infection. Sulfa drugs can cause a wide range of allergic and hypersensitivity reactions and occasionally can lead to a fulminant illness. In the case under discussion the patient had hepatotoxicity, skin rash, fever, and peripheral blood atypical lymphocytosis. Initial impressions suggested the possibility of a malignant lymphoproliferative disorder. Flow cytometry of peripheral blood and a bone marrow biopsy provided clear evidence for a reactive, polyclonal process as opposed to a malignant disorder. Cessation of the offending drug and administration of steroids led to dramatic improvement. This case illustrates that drug hypersensitivity reactions can be manifested by an extreme lymphocytoid leukemoid reaction.

Adult↗
PubMed2004

Spironolactone use in patients with heart failure.

BACKGROUND: The addition of spironolactone, an aldosterone antagonist, to standard therapy can reduce the risk of both morbidity and mortality in patients with severe heart failure. OBJECTIVE: To evaluate the use of spironolactone in class III and IV heart failure patients in four urban teaching hospitals. METHODS: We conducted a concurrent medical record review of 163 patients with documented heart failure admitted to a general medicine service over a 5-week period. Data retrieved included patient demographics, heart failure class, left ventricular ejection fraction, spironolactone contraindications, spironolactone use, dose and frequency, and other heart failure medication use, dose and frequency. All data reflected patients' baseline status. RESULTS: Our patient population was 80% white people, 61% male, with a mean age of 70 years (35-99). A total of 114 had class III or IV heart failure (70%). Angiotensin-converting enzyme inhibitors or appropriate alternative were prescribed in 117 (72%) patients, whereas beta-blockers were used in 121 (74%) patients. Fifty-seven patients met spironolactone ideal candidate criteria. Of these, eight (14%) were appropriately prescribed spironolactone. CONCLUSIONS: Three years after publication of the Randomized Aldactone Evaluation Study, spironolactone is underutilized in the treatment of heart failure. Results of this study indicated that the majority of patients in class III or IV heart failure were not prescribed spironolactone. Improvements in spironolactone prescribing are needed.

Adult↗
PubMed1997

Comparing results of concurrent and retrospective designs in a hospital utilization review.

Hospital utilization reviews are performed on the basis of lists of explicit criteria, such as the Appropriateness Evaluation Protocol, both concurrently and retrospectively, in an increasing number of settings as part of efforts to improve the performance of hospitals and to reduce health care costs. Retrospective data collection has advantages in terms of expenses and ease of sampling, but relies on the quality of medical records. We report on a comparison between concurrent and retrospective data collection performed simultaneously and independently by two reviewers on the same hospital stays in the regional St-Loup Hospital. Results suggest that retrospective data collection produces higher rates of inappropriate hospital utilization, due to a limited number of criteria that are recorded concurrently, but are not found in the retrospective reading of medical records. These results should encourage a further investigation of the comparability between concurrent and retrospective designs in other settings.

Concurrent Review↗
PubMed1985

Warfarin: a quality assurance model for concurrent drug monitoring.

Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.

Concurrent Review↗
PubMed1986

More on concurrent interval-ratio schedules: a replication and review.

It has been suggested that the failure to maximize reinforcement on concurrent variable-interval, variable-ratio schedules may be misleading. Inasmuch as response costs are not directly measured, it is possible that subjects are optimally balancing the benefits of reinforcement against the costs of responding. To evaluate this hypothesis, pigeons were tested in a procedure in which interval and ratio schedules had equal response costs. On a concurrent variable time (VT), variable ratio-time (VRT) schedule, the VT schedule runs throughout the session and the VRT schedule is controlled by responses to a changeover key that switches from one schedule to the other. Reinforcement is presented independent of response. This schedule retains the essential features of concurrent VI VR, but eliminates differential response costs for the two alternatives. It therefore also eliminates at least one significant ambiguity about the reinforcement maximizing performance. Pigeons did not maximize rate of reinforcement on this procedure. Instead, their times spent on the alternative schedules matched the relative rates of reinforcement, even when schedule parameters were such that matching earned the lowest possible overall rate of reinforcement. It was further shown that the observed matching was not a procedural artifact arising from the constraints built into the schedule.

Animal Feed↗
PubMed2002

Nicotine concentrations with concurrent use of cigarettes and nicotine replacement: a review.

This paper reviews the data on blood nicotine or saliva cotinine concentrations with concomitant smoking and use of nicotine replacement (NR) products. Eleven studies that provided data on blood nicotine concentrations, carbon monoxide in exhaled air, and number of cigarettes smoked were reviewed. At least one day had to be spent on concurrent use of cigarette and NR products. With simultaneous use of smoking and acute NR products (gum and inhaler) the nicotine concentrations were unchanged, whereas they increased (+54%) with nicotine patches. With both types of NR products, the number of cigarettes smoked per day was reduced by approximately 50% and carbon monoxide (CO) by 30%. Where smokers had the intention or received instructions to reduce smoking, a greater reduction in cigarettes smoked and exhaled CO was observed. Despite substantially increased nicotine concentrations (e.g., up to 3 times the approved dose) there were no significant adverse reactions. Concurrent use of NR products and cigarette smoking appears to be safe.

Humans↗