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At least 613 records · Page 34Linked to original sources
PubMed2000

The impact of a computerized physician reminder and a mailed patient reminder on influenza immunizations for older patients.

PURPOSE: To examine the impact of a computerized physician reminder in combination with a mailed patient reminder on the rate of influenza immunizations for older adults in a large family medicine office in Delaware. METHODS: In July of 1998, the Christiana Care Foulk Road Family Medicine Center (FMC) implemented an electronic patient record which included automated physician reminders for when influenza immunizations and other preventive interventions were due. In addition, FMC patients ages 65 years and older were sent a mailing urging them to receive an influenza immunization in 1998. Medical records were reviewed for active FMC patients ages 65 and older. Rates of receipt of influenza immunization were compared for the year before (1997) and after (1998) these two interventions were implemented. A secondary analysis compared influenza immunization rates for three different age groups (65-74 years, 75-85 years, over 85 years). RESULTS: For the 344 patients in the main study population, influenza immunization rates increased from 50.4 percent in 1997 to 61.6 percent in 1998 (p < 0.001). Immunization rates were lowest for persons over age 85 years, and rates increased significantly in the two younger groups but not in those over age 85 years. CONCLUSIONS: This study indicates that the use of a computerized physician reminder and a mailed patient reminder had a positive impact on influenza immunizations for older adults in a large family practice office. This combination strategy resulted in immunization rates that exceed published national goals, although there is still room for improvement, particularly for the oldest age group. These results support the notion that electronic patient records (EPRs) and other computerized reminder systems can significantly improve quality of care in office based settings.

Aged↗
PubMed2001

Impact of an electronic medical record on quality of care in a primary care office.

OBJECTIVE: To determine whether or not implementation of an electronic medical record (EMR) in a primary care office is associated with an increase in completion of preventive care for a general population of adults and children, and for adults with diabetes mellitus. DESIGN: Observational cohort study that compared the change in completion rate of recommended interventions from before to one year after implementation of an EMR. The EMR was designed for direct interaction by providers and included guidelines for preventive care as well as automated prompts for when interventions were due. MEASUREMENTS: Patients were selected from a family medicine teaching practice in Delaware that implemented an EMR in July of 1998. We examined completion of recommended interventions for adults (influenza and pneumococcal immunizations, mammograms and cholesterol screening), children (hepatitis B and varicella immunizations) and adults with diabetes mellitus (monitoring for glycosylated hemoglobin and cholesterol, influenza and pneumococcal immunizations). Completion rates were compared from before to one year after EMR implementation. RESULTS: The number of persons analyzed ranged from 117 for diabetes interventions to 1148 for cholesterol screening. Completion rates increased from before to after EMR implementation for all outcomes studied. The largest increases were seen for mammograms (28.7 percent to 52.5 percent), varicella immunizations (29.6 percent to 55.9 percent), glycosylated hemoglobin (53.0 percent to 80.3 percent) and influenza immunization for persons with diabetes (29.7 percent to 55.1 percent). CONCLUSION: Implementation of a primary care EMR was associated with a substantial increase in completion of recommended preventive care across a broad spectrum of interventions and populations.

Delaware↗
PubMed2000

School nursing practice today: implications for the future.

School nurses provide health care services to children in a complex environment. School nurses in Delaware established Strategic Planning and Research Committees to assist them in meeting the challenges of providing quality school health care. The small size of the state gave the researcher the opportunity to survey all currently practicing school nurses in public, private, and parochial settings. In this descriptive study, school nurses were asked to identify activities in their daily practice in five areas: administrative, educational, clerical, supportive, and physical. School nurses were asked to rate the frequency at which they performed these activities and to assess their perceived level of competence in the activities. Analysis of the surveys returned identified areas of common practice as well as areas of development and implementation of new school nursing skills.

Adolescent↗
PubMedDate not supplied

A hydrologic network supporting spatially referenced regression modeling in the Chesapeake Bay Watershed.

The U.S. Geological Survey has developed a methodology for statistically relating nutrient sources and land-surface characteristics to nutrient loads of streams. The methodology is referred to as SPAtially Referenced Regressions On Watershed attributes (SPARROW), and relates measured stream nutrient loads to nutrient sources using nonlinear statistical regression models. A spatially detailed digital hydrologic network of stream reaches, stream-reach characteristics such as mean streamflow, water velocity, reach length, and travel time, and their associated watersheds supports the regression models. This network serves as the primary framework for spatially referencing potential nutrient source information such as atmospheric deposition, septic systems, point-sources, land use, land cover, and agricultural sources and land-surface characteristics such as land use, land cover, average-annual precipitation and temperature, slope, and soil permeability. In the Chesapeake Bay watershed that covers parts of Delaware, Maryland, Pennsylvania, New York, Virginia, West Virginia, and Washington D.C., SPARROW was used to generate models estimating loads of total nitrogen and total phosphorus representing 1987 and 1992 land-surface conditions. The 1987 models used a hydrologic network derived from an enhanced version of the U.S. Environmental Protection Agency's digital River Reach File, and course resolution Digital Elevation Models (DEMs). A new hydrologic network was created to support the 1992 models by generating stream reaches representing surface-water pathways defined by flow direction and flow accumulation algorithms from higher resolution DEMs. On a reach-by-reach basis, stream reach characteristics essential to the modeling were transferred to the newly generated pathways or reaches from the enhanced River Reach File used to support the 1987 models. To complete the new network, watersheds for each reach were generated using the direction of surface-water flow derived from the DEMs. This network improves upon existing digital stream data by increasing the level of spatial detail and providing consistency between the reach locations and topography. The hydrologic network also aids in illustrating the spatial patterns of predicted nutrient loads and sources contributed locally to each stream, and the percentages of nutrient load that reach Chesapeake Bay.

Delaware↗
PubMed2003

Does having an outpatient visit after hospital discharge reduce the likelihood of readmission?

OBJECTIVE: To determine whether or not having an outpatient visit after hospital discharge is associated with a lower likelihood of readmission for a statewide Medicaid population. DESIGN AND SETTING: A case-control study in the Delaware Medicaid program over a two-year period (7/1/93-6/30/95). PARTICIPANTS: 3,846 continuously enrolled patients aged 0-64 years who were hospitalized and were readmitted within 90 days (cases = 641) or not readmitted within 90 days (controls = 3,205). Subgroups included those readmitted for the same diagnosis (N = 720), for ambulatory care sensitive conditions (N = 906), or both (N = 276). MAIN OUTCOME MEASURE: Likelihood of readmission within 90 days of discharge. RESULTS: Readmission was significantly more likely when an outpatient visit was made after hospital discharge, both before and after controlling for demographic variables and case mix (adjusted odds ratio = 1.47, 95% confidence interval = 1.20-1.80). When readmission for the same diagnosis was examined, having an outpatient visit was associated with an increased likelihood of readmission before but not after controlling for demographics and case mix (adjusted odds ratio = 1.11, 95% confidence interval = 0.67-1.86). The same was for those admitted for ambulatory care sensitive conditions (adjusted odds ratio = 1.16, 95% confidence interval = 0.74-1.85) and for those readmitted for the same ambulatory care sensitive condition (adjusted odds ratio = 1.53, 95% confidence interval = 0.54-4.29). CONCLUSIONS: This study fails to demonstrate that outpatient visits after hospital discharge are associated with fewer readmissions for nonelderly Medicaid patients. This suggests that it may not be appropriate to use hospital readmission rates as an indicator of the quality of outpatient care.

Adolescent↗
PubMed1965

CONTINUOUS PRODUCTION OF FLOR SHERRY FROM NEW YORK STATE WINES.

Flor sherry-like wines were produced continuously from New York State wines from Delaware or cold-pressed Concord grapes whose pigment contents were reduced with activated carbon. The course of flor fermentation was followed by total aldehyde analysis. Optimal flor production was observed at 18 to 20 C. Two continuous methods of fermentation were used. A glass column packed with ceramic saddles densely covered with yeasts gave good results, but required more careful management than the second method of submerged fermentation in a laboratory fermentor, which gave a higher sherry output and higher aldehyde production. With the laboratory fermentor, it was possible to obtain a sherry output of 22 liters per 24 hr with an aldehyde content of 300 to 500 mg per liter. The flor sherry produced by these methods required subsequent aging and fortification to the desired alcohol content.

Aldehydes↗
PubMed2004

Day care-related outbreaks of rhamnose-negative Shigella sonnei--six states, June 2001-March 2003.

During June 2001--March 2003, outbreaks of Shigella sonnei infections were reported in Delaware, Maryland, New Jersey, North Carolina, South Carolina, and Virginia. Five- to fortyfold increases in statewide shigellosis rates were observed during this period. These increases were attributed primarily to outbreaks in multiple day care settings that became prolonged and community wide. S. sonnei isolates from these states, as well as from New York City and Philadelphia, were similar genetically by pulsed-field gel electrophoresis (PFGE). Many of these isolates lacked the capacity to ferment rhamnose, which is unusual for S. sonnei. This report summarizes these outbreaks and describes the laboratory characteristics that link them. The findings underscore the importance of rapid and coordinated public health responses to isolated outbreaks of shigellosis.

Adolescent↗
PubMed2003

Reporting a health quality improvement project for reducing the disparity in screening mammograms among senior African-American women.

Despite intensive efforts by the established medical community to offer preventive health practices to minority populations, there remains a significant disparity in utilization of many of these services. Between African-American and Caucasian women there exists a significant disparity in the use of screening mammography. Under contract by the Centers for Medicare & Medicaid Services, Quality Improvement Organizations (QIOs) have been charged with reducing disparities in health care among identified minority populations within each state. Quality Insights of Delaware, the QIO for the state, has developed a project that utilizes a collaboration with African-American women and community resources in an effective outreach program to the targeted population.

Black or African American↗
PubMed1992

Video-assisted thoracic surgery: our first 20 cases.

Video-assisted thoracic surgery has been performed in 20 patients at the Medical Center of Delaware. Operations included seven pulmonary wedge resections, one mediastinal procedure, and 12 pleural procedures. In all cases, a definitive diagnosis was made or the lesion was removed. One postoperative atypical pneumonia occurred. One patient whose wedge resection proved to be squamous cell carcinoma on frozen section underwent a formal thoracotomy and lobectomy. Estimated savings in the eight patients who formerly would have undergone a thoracotomy incision is estimated at $30,000 for room cost alone. We foresee a markedly expanded role for this technique in major pulmonary resections, esophageal procedures, and cardiac surgery in the near future.

Aged↗
PubMed1991

Adenoid cystic carcinoma of the minor salivary glands.

Management of minor salivary gland adenoid cystic carcinoma is a controversial problem. Few clinicians obtain adequate experience in the treatment of this disease, which is often frustrated by early and late distant metastases. Fourteen cases of minor salivary gland adenoid cystic carcinoma recorded in the Delaware Registry over a 20-year period (1968 to 1988) were reviewed retrospectively. These cases were evaluated for their duration of symptoms; size, location, and histologic subtype of the lesion; perineural invasion; lymph node metastases; and treatment to determine the relationship of these factors to survival. Location and histologic subtype of the lesion and duration of symptoms were found to have a more significant impact on survival than size of the lesion, perineural invasion, or lymph node metastases. Surgery is the mainstay of therapy for minor salivary gland adenoid cystic carcinoma, with resection that includes disease-free margins but spares function being advocated. Although adjunctive radiation therapy has not been shown to increase survival, it is reasonable in lesions with perineural invasion and/or lymph node metastases.

Carcinoma, Adenoid Cystic↗
PubMed2006

Nursing admissions process redesigned to leverage EHR.

Among the challenges facing nurses in acute care facilities are duplicate documentation, complex rules for coordinating care, and pressure to accelerate patient discharge. Christiana Care, a two-hospital, 900-bed health system in Delaware, redesigned its nursing admissions process to address these issues and provide a centralized source of assessment information. An interdisciplinary team redesigned the assessment process to leverage the clinical documentation, decision support, and workflow tools of Christiana Care's evolving electronic health record. Nurses use a wireless device at the patient's bedside to enter admission information. A series of decision-support rules evaluate the information and send electronic referrals to appropriate ancillary departments. Departments electronically document interventions that can be tracked by nursing, closing the loop.A dedicated rollout coordinator and system-generated audit reports were critical to early identification and resolution of several implementation problems. The new process has not only simplified the work of nursing but led to more appropriate referrals to the ancillary departments. More than 25 percent of the patients have information imported from a previous encounter, eliminating duplicate documentation and improving patient satisfaction. Admission information also is being used to monitor and support a variety of quality efforts, including core measures.

Delaware↗
PubMed2000

Epidemiology of spinal cord injury after acute odontoid fractures.

OBJECT: Cervical spinal cord injury (SCI) after odontoid fracture is unusual. To identify predisposing factors, the authors evaluated a consecutive series of patients who sustained SCI from odontoid fractures. METHODS: A consecutive series of 5096 admissions to the Delaware Valley Regional Spinal Cord Injury Center were reviewed, and 126 patients with neurological impairment at the C1-3 levels were identified. Seventeen patients had acute closed odontoid fractures with neurological deficit. Various parameters including demographics, mechanisms of injury, associated injuries, fracture types/displacements, and radiographic cervical canal dimensions were compared between "complete" and "incomplete" spinal cord injured-patients as well as with neurologically intact patients who had suffered odontoid fractures. There were similar demographics, mechanisms of injury, associated injuries, fracture type/displacement, and canal dimensions in patients with complete and incomplete SCIs. However, only patients with complete injury were ventilator dependent. In comparison with patients with intact spinal cords, spinal cord-injured patients were more commonly males (p = 0.011) who had sustained higher velocity injuries (p = 0.027). The computerized tomography scans of 11 of 17 neurologically impaired patients were compared with those of a random sample of 11 patients with intact spinal cords. Although the anteroposterior diameter (p = 0.028) and cross-sectional area (p = 0.0004) of the cervical spinal canal at the C-2 level were smaller in impaired patients, the displacement of the fragment was not different. CONCLUSIONS: Odontoid fractures are an infrequent cause of SCI. Patients with these injuries typically are males who have smaller spinal canals and have sustained high velocity injuries.

Adult↗
PubMed1992

Parental occupation and childhood astrocytoma: results of a case-control study.

Parental occupations were investigated as possible risk factors for astrocytoma, the most frequently occurring brain tumor in children. A case-control study of 163 pairs was performed. Cases under 15 years of age at diagnosis in 1980-1986 were identified through the tumor registries of eight hospitals in Pennsylvania, New Jersey, and Delaware. Controls were selected by random-digit dialing and were matched to cases on age, race, and telephone area code. Occupations before the child's conception, during the pregnancy, and after the child's birth were studied separately. We did not observe any strong associations. Significantly more fathers of cases were electrical or electronic repairmen, a subgroup of an occupational category previously associated with increased risk. An excess of case mothers employed as nurses was observed, which was significant for mothers of children diagnosed before 5 years of age. Elevated although not significant odds ratios were observed for some white collar and professional occupations in case parents; for paternal exposure to paint and paternal occupation in the paper and pulp mill industry, both in the period after the child's birth; and for maternal occupation as a hairdresser. The lack of strong associations may have resulted from low statistical power for some job groupings. Our study, unlike previous studies, focused on a single type of brain tumor: childhood astrocytoma. Thus our results suggest that some parental occupations associated with childhood brain tumors in previous studies may not be risk factors for childhood astrocytoma.

Adolescent↗
PubMed1991

Are your retirement plan assets safe from malpractice judgments?

In conclusion, there is a reasonable chance that retirement plan assets in Delaware qualified plans are insulated from judgment creditors, but the best course is to maintain adequate insurance protection and follow an aggressive prejudgment strategy in serious cases so you don't have to resolve the issue in a bankruptcy proceeding.

Delaware↗
PubMed1989

Cardiac transplantation: goals and two-year results.

Results of cardiac transplantation have improved steadily following the first successful operation in 1967. However, rejection, infection, hypertension, hypercholesterolemia and accelerated coronary artery disease remain important late problems after successful heart transplantation. Facilitated patient access to the transplant center based upon geographic proximity to the home, family, and primary care physicians leads to enhanced care by allowing the original transplant team to remain actively involved with ease in the long-term follow-up. With this goal in mind, a cardiac transplantation center was developed with emphasis on developing an organized approach to providing care for patients with refractory congestive heart failure in the Virginia, West Virginia, Washington, D.C., Maryland, and Delaware area. Twenty-one of the 22 patients (95.4 per cent) survived and resumed active lives one to 26 months following heart transplantation. Forty-four rejection episodes occurred and were treated successfully, primarily on an outpatient basis. Only six infections were serious enough to require readmission to Fairfax Hospital, but all responded completely to treatment. Cardiac transplantation at a center focusing on regional patient care is not only less costly and more comfortable for patients and their families, but the continuity of care and comprehensive management of late complications can lead to improved long-term survival rates.

Delaware↗
PubMedDate not supplied

The effect of a required residency based student clerkship on resident selection.

Over the past decade, the Department of Family Medicine at Jefferson Medical College has used a network of seven residency-based family practice centers each year to teach 223 third-year medical students in their required family medicine clerkship. A comparison of these affiliated residency programs with a control group of the other family medicine residency programs in Pennsylvania and Delaware (with minimal third-year teaching responsibilities) from 1976 to 1984 has shown that the affiliated programs had a significantly higher National Residency Matching Program (NRMP) fill rate (92% v. 77%), had a higher percentage of programs with fill rates above the national average (71% v. 41%), and filled their full complement of residents more often (82% v. 52%) than the control programs. This success in residency recruitment was due in part to the fact that the affiliated programs filled one-third of their positions with Jefferson graduates, three times the percentage found in the control programs. For family medicine residency programs, teaching third-year medical students in a required clerkship offers a major opportunity to improve their residency selection results in the NRMP.

Clinical Clerkship↗
PubMed1985

Documentation of hospice care plan development and team meetings.

The interdisciplinary team meeting documentation system as described in this article meets the documentation requirements specified by JCAH and Medicare. The goal of the system is to provide necessary documentation in a format that is easy to use. Because of the generic content and format of this system, hospices in any setting or from any provider can adapt the forms to their particular needs. Delaware Hospice has shared this documentation system together with the interdisciplinary care plan form with numerous hospices who have also found them practical and instrumental in providing high-quality patient care.

Delaware↗
PubMedDate not supplied

Influenza viruses related to A/Shearwater/Australia/1/72 (Hav6 Nav5) in domestic and feral birds.

One influenza-A virus isolated from domestic turkeys in California in 1964 and two from migrating ducks in Delaware in 1973 were classified as Hav6 and Nav5, i.e., antigenically the same as A/Shearwater/Australia/1/72. The detection of antigenically related viruses in three different species over a ten-year period suggests a broad host range, contributing to continued circulation in nature. The turkeys suffered severe respiratory disease although infected migratory birds have not revealed signs of disease. These results suggest migratory birds, which travel over vast areas, as a source of influenza viruses infecting domestic species.

Animal Population Groups↗