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A survey of mailroom practices at Providence Medical Center, Seattle, revealed inadequate working conditions and a lack of supervision. This article explains how careful planning and management enabled the mailroom to control copying costs and to improve services to patients, physicians, and hospital staff.
A series of 1720 roentgen examinations consisting of 5178 roentgen films were copied with the Delcomat (de Oude Delft) copying apparatus. The copies were re-examined after some months, and the diagnoses were compared with the original ones made of normal size films. The diagnostic accuracy was in most examinations not significantly reduced. There was some extraneous variation not depending on the copying method in complicated pulmonary and cardiologic problem cases, and the lack of immediate screening information also caused some reduction in the diagnostic accuracy. The presumption that there would be some information loss in the miniaturized copies led to false positive statements in some cases. The diagnoses were made by a group of radiologists consisting of one specialist (staff member) and two registrars (residents).
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Medical students participating in the Rural Physician Associate Program in Minnesota enjoy a unique educational experience, but local library resources are not adequate to support the program. To rectify this deficiency a library service program has been initiated, with the computer-based bibliography and photoduplication the principal service elements. Because of positive evaluation by the students, the service will be continued and expanded.
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Diagnostic imaging is becoming more and more important and effective in modern medicine. The author describes a quick, inexpensive and simple technique suitable for reproducing immediately colour images of surgical specimens (recovered from the operating room) by means of a colour photocopying machine. Untrained people too are able to run this method that allows the production of well defined images helpful for a closer and more careful real time communication between the surgeon and the pathologist. This document can also be part of the patient's record, and it's useful for the discussion with other physicians involved in diagnostic or therapeutic procedures. The method saves the specimen from every injury and allows its investigation by the pathologist.
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At a public office with a staff of 129, twenty people work for short periods with large amounts of self-copying paper. A controlled study has shown a significantly higher incidence of pruritus and nasal congestion amongst staff exposed to large amounts of self-copying paper or its components, no drying of the skin after working with the paper and no increased degree of irritation of the skin were found in the study group at dermatological examination. No differences were found between the study group and the control group with respect to allergy or skin status or working conditions apart from the contact with self-copying paper. The study confirms that contact with fresh self-copying paper may result in pruritus and skin irritation, but allergy to the paper or microcapsule contents could not be demonstrated in this study.
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An analysis of paper-based charting was carried out at Sunnybrook Health Sciences Center as a prelude to developing a strategic plan to implement an electronic patient record. A relational model of the Sunnybrook paper chart was developed, describing each of its forms in terms of specific data fields. Three hundred and forty nine different forms are in current use at Sunnybrook, containing 64 types of data fields such as Patient Demographics, Vital Signs, and Doctor's Orders. The extent of data field duplication at the level of hospital forms was significant. A Patient Demographics field was present on all forms and on all pages of a patient's chart, as would be expected. Twenty seven other fields were duplicated on more than ten different forms, including Working Diagnosis which was present on 110 forms, History of Past Illness on 42 forms, and History of Present Illness on 32 forms. Current Medications were recorded on 32 forms and Allergy fields were present on 29 separate forms. Only five data fields of the total 64 were present on only one form. The duplication of data fields within complete patient charts was then examined to confirm that data field duplication was occurring within the actual healthcare delivery process. Using the relational model of the charting system, 143 acute care in-patient encounters were abstracted into the database. The charts were selected randomly from each of the hospital inpatient services. The numbers and types of forms within each chart were recorded, amounting to 18,654 physical pages and using 165 of the different forms. The average in-patient encounter within the model was 130.4 pages long, with a minimum of 27 pages, a maximum of 559 pages, and containing on average 25.8 different forms. The duplication of data fields within actual charts followed a pattern similar to the duplication found on the forms. Initial diagnosis was present on an average of 20.4 pages within the charts, with a minimum of 2 pages and a maximum of 152 pages containing this data field. Other frequently occurring data fields included History of Past Illness present on an average of 12.2 pages per chart, History of present illness on 10.2 pages per chart, and allergies on an average of 9.1 pages per chart. The results obtained through the examination of Sunnybrook charts should be generalizable to most paper-based systems. This study did not measure the workload associated with duplicating chart data. however, the magnitude of the duplication seen in this study leaves little doubt that significant amounts of time could be saved with appropriate modification of health care delivery processes. Multiple copies of the same data field within a database are referred to as aliases of each other. This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care. A growing recognition of the costs and risks of data replication within paper-based charting systems is driving the healthcare industry toward Electronic Patient Record systems. Better quality patient care data, provided by computerized records, is likely to be necessary but not sufficient to improving the efficiency and effectiveness of the healthcare system. Intelligent application of this information will be essential.
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Immediate postoperative radiographs confirm the quality of reduction and fixation of fractures. This information is already available from the image intensifier and can be saved as hard copy thermal prints. If thermal prints give the surgeon the necessary patient and clinical information them immediate postoperative radiography should not be required. In this retrospective study of 20 hip fractures treated by dynamic hip screw (DHS) fixation, plain radiographs and thermal prints were compared for the patient and clinical information they contained. Thermal prints were found to be deficient in some areas but, nevertheless, can potentially replace postoperative radiographs in many orthopaedic procedures saving time, money and radiation exposure.
We have studied the use of image intensification in a trauma theatre over a period of 6 months with particular reference to the acquisition of intraoperative image intensifier thermal prints instead of formal radiographs. The quality of the prints and the savings generated have been assessed. During the study period, 476 patients underwent orthopaedic trauma procedures. The image intensifier was used for intraoperative screening in 280 patients. In 278 of these a thermal print was obtained. This was used, instead of formal check radiographs, to plan further management in 210 patients (75%). In 68 patients, the printout was insufficient in its coverage of the operated area, and a check radiograph was also obtained. In no case did the clarity of the thermal image hinder accurate interpretation. We believe that thermal images are a useful substitute for formal postoperative radiographs in many trauma cases, and that, with notable exceptions, their use could decrease costs, reduce patient discomfort and radiation dose and spare overloaded radiology services.
Polaroid photography has been used as a method for assessing and recording certain plastic surgery cases. It has the advantage of being easily and immediately available. Photocopies, in black and white or in colour, can be obtained and can be enlarged. Either the originals or photocopies can be sent to clinicians for rapid appraisal or for their own records. This technique is useful whether silhouette or contrast changes are important, and it allows immediate presentation to the patient for discussion and illustration. Several clinical pre- and post-operative examples demonstrating these facts are given in photographic form. The possible advantages of using Polaroid cameras, which rival the quality and cost of conventional photography, are raised.
In this review are presented the different aspects and problems to which the edition of a journal like "Cellular and Molecular Biology" is submitted as well as all the incidences happening in the organization and editorial matter. There are presented the most frequent dysfunctions hampering the editorial and organisatorial activities, striking frontally all Ethical Rules and some of them constituting true criminal mafia activities from the side as well of authors and scientists as of a rival publishing company like Elsevier and of well established scientific organizations, like the IFCB and the CSBMCB, demonstrating as so far how lobbies exert inadmissible dictatorial pressures on the activity as well of individuals as of a journal like CMB and on a congress organization like our group, the Founders of the World Congresses of Cellular and Molecular Biology. Many examples are mentioned, most of them without indication of names and places for evident Ethical reasons but other ones with full names and places, particularly to obtain their condemnation by the Justice of particular countries and essentially by the High Court of the Human Rights for having used and for continuing to use mafiosi methods.
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