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At least 91 records · Page 5Linked to original sources

Cancer education in Viet Nam: a need for foreign input.

In Viet Nam cancer education has a low priority because of political and social factors. Knowledge about cancer staging and basic management principles is stagnated by restricted communication with foreign colleagues and by limitations of available techniques. Participation in either formal residency programs or conferences for continuing education outside Viet Nam is restricted to select individuals of high rank. Most foreign experience is gained from Russia or from the former Eastern-bloc nations. Available foreign textbooks and journals are limited to those published more than 20 years ago. Infectious diseases are the most significant health problem in Viet Nam and they indirectly contribute to the incidence of cancer, including the occurrence of hepatocellular carcinoma. A widespread epidemic of acquired immune deficiency syndrome (AIDS), acquired both outside and within the medical system, is another potential consequence of current health care practices. The need for an international exchange of scientific knowledge is dramatically reinforced through the identification of significant deficits in available medical care and the patterns of mortality in this restricted society.

Curriculum↗

Desktop telemedicine in vascular surgery: some preliminary findings.

OBJECTIVE: Surgical specialists have generally underutilized telemedicine technologies. This report describes the use of real-time interactive-video telemedicine to augment the care of vascular surgical patients in underserved rural areas within our region. MATERIALS AND METHODS: The telemedicine system at Fletcher-Allen Health Care (FAHC) and the University of Vermont in Burlington utilizes desktop video conferencing technology with terrestrial transmission at 384 kbps. The current system was initiated in January 1996, and there are at present 18 external sites and multiple locations at FAHC, including the vascular laboratory, angiography suites, operating rooms, and the home of one vascular surgeon. During the first 12 months of operation, the vascular surgeons were asked to complete a questionnaire to evaluate the technology and its usefulness in clinical care. The use of the telemedicine system by the vascular surgeons was monitored by the questionnaires, phone bills, and a special "no charge" billing code. Telemedicine events were classified as clinical or educational. RESULTS: In the 26 months since implementation, 107 events have taken place, including both clinical and educational uses. There were 103 clinical uses by three vascular surgeons, including five emergency uses. A joint Vermont-Maine vascular educational conference has taken place four times. Overall, use by vascular surgery represented 14.2% of all telemedicine events in the first year or 30.9% of all clinical events during that time period. Use of telemedicine was reported to have improved patient care in 96% of the cases. Eighty percent of the telemedicine uses in the first year saved patient travel. There were no diagnostic errors, as determined by in-person clinical follow-up, attributable to the telemedicine system use. CONCLUSIONS: Use of a real-time video telemedicine has great potential for vascular surgeons, but cost-effectiveness studies may be needed prior to its widespread adoption.

Angiography↗

Can subspecialty cancer consultations be delivered to communities using modern technology?--A pilot study.

The objective of this project was to evaluate patient and physician acceptance of subspecialty oncologic teleconsultation for distant communities. Many newly diagnosed cancer patients have to travel several hours and long distances to attend specialty medical oncology consultations at our regional cancer center in Victoria, BC. Difficulties in recruiting of oncologists in Vancouver Island have prompted the search for other means to deliver subspecialty consultation closer to home. Teleconsultation seemed a possible model. Hence, 30 sequential patients with gastrointestinal (GI) malignancy referred from the Central Island region were seen after an informed consent via videoconferencing and 30 sequential patients were seen face to face in Victoria by one oncologist. Patients and the oncologist filled out a satisfaction questionnaire. The age, sex, proportion of patients who subsequently received chemotherapy, and the number of other co-morbid conditions were similar in both groups. No difference was observed in patient satisfaction whether patients were seen via videoconference or in person. However, the oncologist felt the video did not go as well as face-to-face consultation. Patients were very satisfied with teleconsultation, and it saved them hours of travel.

Aged↗

The components of hospital quality: a nursing perspective.

The first stage of a larger investigation intended to define objective and standardized measures of the quality of care provided by hospitals included the conduct of focus groups with registered nurses, eliciting their opinions as to the merit of a number of potential indicators of hospital quality. The registered nurses in the focus groups settled on the ratio of registered nurses to beds, the percentage of board-certified physicians, the presence of discharge planning services, service mix, the number of technological services, and Council on Teaching Hospitals membership as the best indicators of high-quality care delivery.

Attitude of Health Personnel↗

A work sampling study of midlevel health professionals in a rural medical clinic.

A work sampling study was initiated to provide a comprehensive description of the tasks performed by midlevel health personnel in the rural component of an experimental medical care delivery system. The investigation determined the proportion of time spent on various activities by the staff members of a rural clinic which is linked to supervisory physicians in a distant urban medical center. Over 800 observations were recorded during ten randomly selected days in a two-month period on each of the three staff members. The family nurse practitioner spent one-third of her time in direct patient care activities with almost one-half of the day devoted to indirect patient care tasks. The laboratory aide allocated one-half of her day to providing direct patient services whereas the clerk-receptionist spent over 40 per cent of her day on patient records and billing. Work sampling results were considered within a comparative framework to qualitatively assess performance. The findings were coupled with proposed changes in administrative and medical policy to provide a quantitative basis for developing cost-reducing alternative staffing configurations.

Allied Health Personnel↗

Patients as reliable reporters of medical care process. Recall of ambulatory encounter events.

This study explores the reliability of a data source on the quality and content of care rarely used in studies comparing the performance of health care organizations, that is, patient reports obtained from surveys. Evidence of patient survey reliability and validity and report data on patient reporting accuracy were reviewed for ten events that may have occurred during an initial health assessment for new adult enrollees of a health maintenance organization (HMO). Reports of 380 patients obtained through telephone survey were compared with medical records. For chest radiograph, mammogram, and electrocardiogram (EKG), patient reports exhibited both sensitivity and specificity. For serum cholesterol test, patients proved to be sensitive but not specific reporters. For blood pressure measurement, stool kit, and rectal examination, false negative rates were low (less than or equal to 0.10); they were somewhat higher for breast self-examination instruction and pelvic examination (0.21 and 0.22, respectively). Only for testicular self-examination instruction did patient reports fail to confirm medical record documentation (false negative rate = 0.53). Multivariate analysis showed a small association between increasing patient age and decreasing confirmation. Gender did not affect reporting ability, and agreement did not deteriorate over a 2- to 3-month postencounter interval. Patient reports appear to merit greater use in comparative studies of technical quality of care. Key words: quality of health care; quality assurance; health care; ambulatory care; patient recall; patient reports.

Ambulatory Care↗

Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico.

BACKGROUND: The traditional system for esophageal 24-h pH monitoring requires transnasal introduction of the catheter with pH sensors; this technique produces discomfort, inconvenience, and interference with daily activity. Recently, a catheter-free pH monitoring system (Bravo) has been proposed as an alternative and promising method for 24-h pH. AIM: To evaluate performance, tolerability, and symptoms related to this new technology in our population. METHODS: Consecutive patients with gastroesophageal reflux disease (GERD) with indication for 24-h pH were included. pH Bravo capsule was placed 6 cm above the squamocolumnar junction using endoscopic measurement. Symptoms associated were evaluated daily in a personal diary until 7 days after the capsule attachment. Severity of symptoms was assessed by a 5-point Likert scale. Capsule detachment was assessed by chest X-ray. RESULTS: Eighty-four patients were included. Forty-nine were female (mean age 44 +/- 12 yr). Indications for pH monitoring were: nonresponse to proton pump inhibitor therapy in 38 (45%), preoperative evaluation for anti-reflux surgery in 36 (43%), previous failed transnasal 24-h pH monitoring in 6 (7%), and extra-esophageal manifestations of GERD in 4 (5%). The capsule was successfully attached in 95% of patients. At day 7, capsule detachment occurred spontaneously in all cases. Symptoms related to capsule attachment were: chest pain in 26 (33%), foreign body sensation in 11 (14%), nausea in 5 (6%), and 9 (11%) patients had more than one symptom. Severities of those symptoms were mild, and no patient required removal of the capsule. Women and younger patients had more symptoms related to the procedure (p < 0.05). CONCLUSIONS: Esophageal pH monitoring with Bravo capsule is a safe, reliable, and tolerable method in patients with GERD.

Adult↗

Health care delivery and advanced technology.

Remedying the deficiencies in the current health care delivery system and effectively using advances in biomedical research require that a significant effort be organized to develop advanced technology in this field. The time is ripe and development personnel are available; hence, what are needed are simply a dedication to solving the problem, a commitment of resources toward this end, and an organizational mode that will allow the effective participation of developmental personnel.

Chromatography↗