Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Medication Systems”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources
PubMed1984

Evaluation of a data base sheet in an A4 medical record system.

The medical record system used by the author's general practice is in the A4 format and includes a structured summary sheet of their own design. In an evaluation of this data base sheet, the aims were twofold: to measure the extra time required to complete the A4 data base sheet during an interview with a patient against the time for an inspection of existing medical records alone; to quantify the usefulness of the data base sheet to the doctor seeking immediate access to relevant information about the patient's medical, family and social history.Compilation of a structured A4 data base sheet took an average time of five and a half minutes per patient. Examination of NHS medical records took an average time of three minutes per record, and only 4 per cent of these records included any form of completed summary sheet. The data base sheet, which took only another two or three minutes to complete, was found to be a practicable document that provides immediate access to a wide range of relevant information for effective (and efficient) patient management.

Adult↗
PubMed1982

Relationship of size and payment mechanism to system performance in 11 medical care systems.

The performance of 11 medical care systems of varying size and payment mechanisms (consisting of six government owned and operated Indian Health Service units, three fee-for-service private practices and two HMOs) was studied. Performance was defined as the percentage of consumers in need of care who received adequate care according to predetermined standards for the process of care for various functions (i.e., prevention, screening, treatment, follow-up) and various health conditions (i.e., prenatal and infant care, hypertension, anemia, UTI). Size was found to have a strong negative relationship to the quality of treatment and follow-up care, but payment mechanism did not show such a relationship. Neither size nor payment mechanism was significantly related to prevention performance. In screening, the results depended on the health condition: size was inversely related to performance of screening for hypertension; HMOs performed significantly better in screening for prenatal anemia; and neither size nor payment mechanism was related to performance of screening for infant anemia.

Analysis of Variance↗
PubMed1978

An input-output model for resources planning in a medical care system.

As medical care delivery systems grow in complexity, the understanding of interaction between entities within the system becomes a key aspect in resource planning. The model presented in this paper is geared to aiding resource planning both at the community or regional level and at the medical facility level. At the regional level the problem is related to the elimination of duplication and the sharing of services. At the medical facility level the concern is the balancing of the supply and demand of services among the departments. The framework of the model is a directed graph with nodes representing the service entities and branches representing the interrelationships. At the regional level, entities are hospitals, clinics, and centralized supportive units, such as the data center or the central laboratory. At the medical center level, entities are generally departments within the facility. An iterative procedure is used to simulate the propagation effect of a change on all entities. The model at the medical center level, as implemented in a minicomputer system was applied to a real problem. The results strongly correlated with another, independent study.

California↗
PubMedDate not supplied

Sensitivity and specificity of the medical priority dispatch system in detecting cardiac arrest emergency calls in Melbourne.

INTRODUCTION: In Australia, cardiac arrest kills 142 out of every 100,000 people each year; with only 3-4% of out-of-hospital patients with cardiac arrest in Melbourne surviving to hospital discharge. Prompt initiation of cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac care greatly improves the chances of survival from cardiac arrest. A critical step in survival is identifying by the emergency ambulance dispatcher potential of the probability that the person is in cardiac arrest. The Melbourne Metropolitan Ambulance Service (MAS) uses the computerized call-taking system, Medical Priority Dispatch System (MPDS), to triage incoming, emergency, requests for ambulance responses. The MPDS is used in many emergency medical systems around the world, however, there is little published evidence of the system's efficacy. OBJECTIVE: This study attempts to undertake a sensitivity/specificity analysis to determine the ability of MPDS to detect cardiac arrest. METHODS: Emergency ambulance dispatch records of all cases identified as suspected cardiac arrest by MPDS were matched with ambulance, patient-care records and records from the Victorian Ambulance Cardiac Arrest Registry to determine the number of correctly identified cardiac arrests. Additionally, cases that had cardiac arrests, but were not identified correctly at the point of call-taking, were examined. All data were collected retrospectively for a three-month period (01 January through 31 March 2003). RESULTS: The sensitivity of MPDS in detecting cardiac arrest was 76.7% (95% confidence interval (CI): 73.6%-79.8%) and specificity was 99.2% (95% CI: 99.1-99.3%). These results indicate that cardiac arrests are correctly identified in 76.7% of cases. CONCLUSION: Although the system correctly identified 76.7% of cardiac arrest cases, the number of false negatives suggests that there is room for improvement in recognition by MPDS to maximize chances for survival in out-of-hospital cardiac arrest. This study provides an objective and comprehensive measurement of the accuracy of MPDS cardiac-arrest detection in Melbourne, as well as providing a baseline for comparison with subsequent changes to the MPDS.

Efficiency, Organizational↗
PubMed2002

Hemorrhagic complications of oculoplastic surgery.

PURPOSE: To determine the incidence and risk factors of hemorrhagic complications associated with selected oculoplastic procedures. METHODS: A prospective study was performed to document the severity of intraoperative hemorrhage and postoperative bruising in patients undergoing oculoplastic procedures. The use of anticoagulant or platelet-inhibiting medications, systemic medical conditions, patient age, patient sex, and type of procedure were examined to identify risk factors for hemorrhagic complications. RESULTS: Troublesome intraoperative bleeding prolonged surgery in 9.2% of cases. Severe bleeding with the potential to affect surgical outcome was encountered in 0.4% of procedures. There was little correlation between severity of bleeding and degree of postoperative bruising. Male sex, a history of heart disease, or age >60 years imparted a slightly greater risk of intraoperative bleeding. Age >60 years, hypertension, or recent cessation of aspirin may increase the risk of postoperative bruising. A history of previous stroke increased the risk of postoperative bleeding. There was no statistical difference in the incidence of hemorrhagic complications among patients currently treated with antiplatelet/anticoagulant agents, those who had stopped these medications before surgery, and those who were not treated with these agents. No patient had permanent sequelae related to hemorrhage. Two patients had postoperative systemic complications possibly attributable to withholding anticoagulant/antiplatelet medications in preparation for surgery. CONCLUSIONS: Although serious hemorrhagic complications may be associated with oculoplastic procedures, the incidence of these complications is low. The decision to withhold antiplatelet or anticoagulant medications before surgery should be individualized. Selected procedures can be safely performed without stopping these agents.

Adolescent↗
PubMedDate not supplied

Two tools for well-being: health systems and communities.

Medical systems and associative communities are two distinctive social tools. To promote health, tools of community are more significant than system tools. Medical systems were created to serve many needs efficiently and to produce standardized procedures and outcome. Clients are a necessary component of a medical system. Associative communities are formed with the active consent of the people they serve and require citizens rather than clients. If the promotion of health is the goal, the medical system is limited in what it can achieve by the nature of its design. Only when systems recognize the need for community building and work together with associations, focusing on citizens' capacities rather than clients' deficiencies, can health promotion be successful.

Awareness↗
PubMed2004

Physician and nurse satisfaction with an Electronic Medical Record system.

Electronic Medical Records (EMRs) are intended to support clinical activity, improve efficiency, and reduce error. Reluctance to use EMRs may exist among clinicians. The purpose of this study was to assess physician and nurse satisfaction with an Emergency Department (ED) EMR. We surveyed Emergency Medicine (EM) physicians and nurses at a large urban teaching hospital after implementation of an Emergency Department EMR. The questionnaire assessed: 1) computer background and experience; 2) perceptions regarding EMR use; and 3) concerns about impact upon quality of patient care. The clinicians find the EMR easy to use and are generally satisfied with the impact on their work. However, they report that the EMR has no positive impact on patient care. They report confusion in following the sequence of screens, and are concerned with the amount of time it takes to use the EMR and the confidentiality of patient information. Similar results were found between physicians and nurses. Nurses, but not physicians, report that they are able to finish work much faster than before implementation (p < 0.05). We were unable to correlate computer background and experience with satisfaction with an EMR. This survey suggests that EM physicians and nurses favor the use of an EMR and suggests opportunities for EMR enhancement.

Adult↗
PubMed1986

The changing medical care system: some implications for medical education.

In summary, the medical care system is undergoing the most widespread and significant changes in a generation. Individual hospitals, the basic delivery units of the past, may fast be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. Fee-for-service medicine and cost-based hospital reimbursement, each with its service-maximizing incentives, are being replaced--the former by prepaid capitation systems and the latter by discount pricing and all-inclusive admission charges. The hospital, until now a "farmer's market" of diverse programs and activities serving a broad patient population, increasingly has become a provider of intensive services to a narrowing and more ill patient base. The major teaching hospital, formerly a complete educational resource within itself, may soon become simply one of a number of educational settings, all of which are equally essential for providing a total medical education. Finally, after years of change driven by biomedical discoveries and centered in the academic medical centers, there is a new locus of innovation within the delivery system itself, and those in the forefront are not academicians. It is important, therefore, that just as in the past, when the academic medical center took the lead in bringing to the delivery system what it was learning in its laboratories, it must now take what is being learned in the marketplace and bring it back into the classroom.

Ambulatory Care↗
PubMed1993

Development of a portable information system: connecting palmtop computers with medical records systems and clinical reference resources.

The portability of palmtop computers makes them an ideal platform to maintain communication between busy physicians and medical information systems. In our academic FHC (Family Health Center) we have developed software that runs on a palmtop computer allowing access to information in the HIS (Hospital Information System) and our FHC's AAMRS (Automated Ambulatory Medical Record System). The resident physicians who staff the hospital and the FHC are frequently at home or otherwise off-site where terminal access is not available. Using a Hewlett-Packard 95LX palmtop computer as the base platform, custom software has been developed to access summary data on in-patients and out-patients. Data is downloaded into a database on a palmtop computer memory card. ASCII data from Medical Information Systems (MIS), is transformed into a database format readable on the palmtop. Our hospital MIS department transmits information daily on our in-patient service (20-30 patients). We also download, weekly, a patient summary on all of our active out-patients in our MUMPS-based AAMRS (2500-3000 patients). Each morning the resident in the Family Practice program updates his palmtop memory card at a central workstation. Palmtop computers with downloaded databases, can be valuable in care of patients when the physical or on-line chart is not easily accessible. They are particularly useful in multi-physician groups when the on-call physician provides care for the patients of other physicians. We have made the palmtop computer even more valuable to physicians by providing an integrated software package.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed2006

The challenge of mapping between two medical coding systems.

OBJECTIVE: Deployable medical systems patient conditions (PCs) designate groups of patients with similar medical conditions and, therefore, similar treatment requirements. PCs are used by the U.S. military to estimate field medical resources needed in combat operations. Information associated with each of the 389 PCs is based on subject matter expert opinion, instead of direct derivation from standard medical codes. Currently, no mechanisms exist to tie current or historical medical data to PCs. Our study objective was to determine whether reliable conversion between PC codes and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes is possible. METHODS: Data were analyzed for three professional coders assigning all applicable ICD-9-CM diagnosis codes to each PC code. Inter-rater reliability was measured by using Cohen's K statistic and percent agreement. Methods were developed to calculate kappa statistics when multiple responses could be selected from many possible categories. RESULTS: Overall, we found moderate support for the possibility of reliable conversion between PCs and ICD-9-CM diagnoses (mean kappa = 0.61). CONCLUSION: Current PCs should be modified into a system that is verifiable with real data.

Diagnosis-Related Groups↗
PubMed1999

Development of the local medical service network system. Integration of medical service with the network system between university hospital and other medical institutions.

Although every medical institution always make efforts to provide best services for the patients, it tends to be insufficient to send the patient's information and share them with other medical institutions. It is partly because in the Japanese medical care system there is no obligation to inform patients' medical information to other medical institutions. To provide effective and cost-effective medical service, we made a local network system between university hospital and other medical institutions. The system contributes to clarify the role of medical institutions and the continuity of medical service. For the next step, we must construct the home-care information service network towards the total service for the patients.

Community Networks↗
PubMed1997

[Local therapy in treatment of cytomegalovirus (CMV) retinitis in AIDS. The ganciclovir implant (pellet)].

BACKGROUND: Cytomegalovirus (CMV) retinitis with AIDS has been treated either systemically or locally by weekly intravitreous injections. An intraocular device now offers a new therapeutic approach. We investigated its efficacy in preventing progression of CMV retinitis without additional systemic therapy. Conversely, we also studied the risks and disadvantages of this method of drug administration. PATIENTS AND METHODS: In our study 46 devices were implanted in 28 patients. All patients were pretreated with systemic medication. Systemic treatment was stopped on the day of surgery. RESULTS: Severe perioperative complications occurred in one patient, who developed retinal detachment after surgery. Most patients showed no relapse of retinitis with the implant, though they did not receive systemic treatment for 8.1 months on average. Only 20% of our patients presented with extraocular CMV disease. Thirty-five percent (n = 17) of patients with unilateral retinitis developed CMV retinitis in the primary uninvolved fellow eye. After implantation of a device into this eye also progression could be stopped without additional systemic treatment. Two patients showed progression of retinitis due to an empty ganciclovir reservoir. A second device was implanted without removal of the first. CONCLUSIONS: The intraocular ganciclovir device appears to be an effective treatment for CMV retinitis with few disadvantages. Time to progression of retinitis tends to be prolonged compared to systemic treatment.

AIDS-Related Opportunistic Infections↗
PubMed1989

Protein composition of human aqueous humor: SDS-PAGE analysis of surgical and post-mortem samples.

We analyzed the protein composition of human aqueous humor. Samples were obtained by paracentesis from 25 human eyes (age range 64-92 years) at elective cataract surgery, and from 20 age-matched post-mortem eyes within 1.5 to 18 hr after death. Individual samples were assayed for total protein, and the polypeptides were separated by qualitative SDS-PAGE into high-, medium- and low-molecular-weight ranges and then silver-stained. The clinical samples showed a remarkable consistency in the total protein values (mean +/- SEM: 12.4 +/- 2.0 mg per 100 ml) and no detectable variations in the profiles of the silver-stained proteins. Twelve major protein fractions, with apparent molecular weights of 140, 80 (doublet), 67, 60 (doublet), 35, 27, 25, 17, 14.6 and 9 kDa, were present. A preliminary analysis showed that the 17 kDa band contained a molecule resembling basic fibroblast growth factor. Two additional samples of aqueous humor from patients whose blood/aqueous barrier was compromised during paracentesis showed a quantitative and qualitative increase in the polypeptides that were present. Compared with the samples of aqueous humor obtained at surgery, the post-mortem samples exhibited a greater variability in total protein content (56.1 +/- 11.6 mg per 100 ml) and an increased number of high- and low-molecular-weight protein fractions. In view of wide differences in the clinical parameters, including ocular and systemic medications, systemic illness, surgical premedications, anesthesia and total serum protein values, the similarity in the protein profiles of the carefully drawn surgical samples is most remarkable. Our results indicate that, in patients who underwent elective cataract surgery, the levels of major proteins in human aqueous humor are not affected by wide individual variations in the clinical parameters. We attribute this finding to the care taken in the collection of aqueous humor samples.

Aged↗
PubMed2002

Distortion of olfactory perception: diagnosis and treatment.

Clinically, olfaction can fail in any of three ways: (i) decreased sensitivity (hyposmia, anosmia) and two types of distortion (dysosmia); (ii) distorted quality of an odorant stimulation (troposmia); (iii) perceived odor when no odorant is present (phantosmia, hallucination). The distortions are usually much more upsetting to a person's quality of life than a simple loss. An ipsilatersal loss of olfactory sensitivity is often identified in the nostril with any type of olfactory distortion. The pathophysiology of a stimulated distortion (troposmia) is likely a decreased number of functioning olfactory primary neurons so that an incomplete characterization of the odorant is made. In phantosmia, two possible causations include an abnormal signal or inhibition from the primary olfactory neurons or peripheral olfactory or trigeminal signals that "trigger" a central process. The clinician's goal is to carefully define the problem (e.g. taste versus smell, real versus perceived, one versus two nostrils), to perform the appropriate examination and testing and to provide therapy if possible. Treatment includes assurance with no active therapy (because many of these will naturally resolve), topical medications, systemic medications, anesthesia to parts of the nose and, rarely, referral for surgical excision of olfactory neurons. Endoscopic transnasal operations have the advantage of treating phantosmia and sometimes allowing a return of olfactory ability after the operation.

Humans↗