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PubMed2005

[Medication systems in hospitals and their evaluation by professional groups].

This study was aimed at analyzing the medication systems in hospitals based on the opinions of 107 professionals. With regard to medical prescriptions in the institutions, 74.8 percent were handwritten and 50.4 percent of the medication distribution systems were in individualized doses. Concerning the causes of medication errors, 91 percent were associated with the professionals. For 61.7 percent, the system was adequate, but had shortcomings. Few professionals suggested changes that would favor their work. The conclusion is that the culture of attributing responsibility to the professional for the error, as well as the practice of punishment without a substantial change of the cause that led to it, persists.

Medication Errors↗

PubMed1986

A method linking statistics and knowledge engineering for making medical consulting systems. A medical consulting system for electric response audiometry through auditory slow vertex response.

There are two methods of making medical consulting systems: the statistical method and the knowledge engineering method. Since both of these methods seem to be very different from each other, they have been recognized and applied separately. We contend, however, that a combination of statistics and knowledge engineering is a more effective and suitable way to create a medical consulting system than is the use of either method alone. In order to justify this contention, we created a medical consulting system, AUTSVR-V1.1, which detects auditory slow vertex responses (SVR) through observing and identifying background activities of the electroencephalogram (EEG) automatically during measurement of SVRs for the purpose of objective electric response audiometry (ERA), and compared it with AUTSVR-V1.0, which depends on statistics only.

Audiometry, Evoked Response↗

PubMed1984

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

Computers↗

PubMed1998

Coding medical information: classification versus nomenclature and implications to the Israeli medical system.

The efficient retrieval of medical information is essential for all functional aspects of a health system. Such retrieval is possible only by coding data (as it is produced or after it is produced) and entering it into a data-base. The completeness and accuracy of retrieved information depend, therefore, on the coding system employed. The main coding system that is in use in Israel is the ICD-9: International Classification of Diseases and its clinical modification (ICD-9-CM). Using such a statistical classification system for coding has met the basic needs for statistical and administrative purposes, but causes distortion and loss of information. With the recent growth and availability of information technology, more detailed data can be coded and processed than was possible before. A detailed nomenclature system such as SNOMED (the Systematized Nomenclature Of Human and Veterinary Medicine) can be used as a coding system that enables a more comprehensive and flexible medical information data base. This article discusses some aspects of coding medical information and suggests that a national revision of medical coding systems be considered as the computerized-patient-record is further developed and implemented.

Abstracting and Indexing↗

PubMed2005

What really happened? A validation study of rape survivors' help-seeking experiences with the legal and medical systems.

Much of what is known about rape survivors' experiences with the legal and medical systems has come from victims' accounts; rarely have researchers collected "the other side of the story" to find out what system personnel say did or did not happen in these interactions. In the current study, rape survivors who sought emergency medical care were interviewed before their hospital discharge about what services they received and how they were treated by social system personnel. Corresponding accounts were then collected from doctors, nurses, and police officers. There was significant interrater reliability between the survivors and legal and medical system personnel regarding what services were or were not provided ("service delivery") and if system personnel engaged in "secondary victimization" behaviors (i.e., statements/actions that could be distressing to victims). However, police officers and doctors significantly underestimated the impact they were having on survivors. Victims reported significantly more post-system-contact distress than service providers thought they were experiencing.

Adult↗

PubMed1982

Applications of multidimensional computer graphics in medical systems.

Multidimensional computer graphics are demonstrated in two medical systems applications in this paper. First, multidimensional computer graphics are utilized for descriptive purposes to show the differences among 10 physician specialty groups for multivariate data available at admission to medical school. Second, multidimensional computer graphics are demonstrated as a method that can be used for screening school applicants. The novel method utilized to represent multivariate data requires the plotting of a face. Each feature of a face--for example, face height or ear diameter-can be utilized to represent a different dimension of multivariate data. Each face then represents a vector whose elements are the mean values of multiple variables, or it represents a multivariate observation.

Career Choice↗

PubMed2003

Designation of a new training model of a local disaster medical system with tabletop exercises.

BACKGROUND: A new model of a local disaster medical system (LDMS) was proposed through the consensus method of expert panel meetings for county governments in Taiwan. This LDMS model adopts a local emergency medical response system (EMRS) for dealing with daily accidents as a basic structure by expanding its roles and functions. The objective of this study was to determine the feasibility of the new LDMS model by evaluating its initial phase response to simulated disasters using tabletop exercises. METHODS: Two tabletop exercises were held after the responders of the LDMS were trained according to the new model. Forty and 42 participants respectively joined the 2 tabletop exercises, which simulated an earthquake causing 400 casualties in 6 different locations in order to apply the new LDMS model. The outcome measurements of the tabletop exercises were the mean accuracy rate of victim triage and disposition, and medical interventions. RESULTS: About 92% of victims were correctly triaged, and 88% had a correct disposition. Moreover, around 86% of all victims received adequate medical interventions. All victims were dispatched to appropriate facilities or treatment areas within 45 min. CONCLUSION: The new EMRS-oriented model of this LDMS can respond quickly, efficiently, and adequately to the initial phase of a disaster during tabletop exercises. Further clinical investigations are required to prove the efficacy of the new LDMS model in real disasters or in full-scale drills.

Disaster Planning↗

PubMed1991

Liquid oxygen contaminants--increase in concentration during use of domiciliary liquid oxygen medical systems.

The quality of liquid oxygen in domiciliary medical systems used for oxygen therapy was investigated during the emptying cycle under simulated breathing conditions. The increase in the levels of contaminants during the use of these systems was evaluated by gas chromatography and two sampling methods. The quality of liquid oxygen from storage tanks located in hospitals and in the production or in distribution plants was also investigated.

Chromatography, Gas↗

PubMed1987

The Marton Lecture: Ocular manifestations of systemic medication.

The probability of ocular adverse reactions to systemic medication is low but when a reaction does occur it is often associated with one or more special factors relating to the condition being treated, to the patient, and to the nature of the drug itself. Nevertheless the role of the optometrist in the monitoring, detection and reporting of adverse reactions is important and is recognized by the College reporting scheme. A selection of the type of reactions that may be encountered in general optometric practice is reviewed. The reactions range from the relatively innocuous anticholinergic effects of the benzodiazepine tranquillizers to the more serious corneal, lens and retinal changes that may be associated with the corticosteroids, phenothiazines and chloroquine.

Age Factors↗

PubMedDate not supplied

Interprofessional referral patterns in an integrated medical system.

OBJECTIVE: To determine the interreferral patterns among physicians and complementary and alternative medicine (CAM) providers in an independent practice association integrated medical system. METHOD: Data from a 1-year period were collected on referral patterns, diagnosis, number of visits, cost, and qualitative aspects of patient care. The independent practice association provided care for approximately 12,000 patients. RESULTS: In the selected integrative network, there are those primary care physicians (PCPs) who refer and those who do not. Among those PCPs that refer to CAM, a preference is shown for a limited number of providers to whom they refer. Although doctors of chiropractic get more referrals, they are also more concentrated among selected providers than are doctors of oriental medicine. CONCLUSION: This study shows the interreferral patterns among the PCP and CAM providers working within an integrated medical system. One effect of being in the network for doctors of chiropractic and doctors of oriental medicine might be the possible interreferrals between each other.

Chiropractic↗

PubMed1989

The American dominative medical system as a reflection of social relations in the larger society.

Expanding upon Navarro's analysis of the American biomedical sector, I argue that the phenomenon of medical pluralism has historically and continues to reflect class, racial/ethnic, and gender relations in American society. The evolution of the American medical system is traced from a relatively pluralistic one in the nineteenth century to a dominative one in the twentieth century. While legitimation and even professionalization of various alternative medical systems supports the assertion that the dominance of biomedicine is delegated rather than absolute, these processes reflect the growing accommodation on the part of alternative practitioners to the reductionist disease theory which is compatible with capitalist ideology.

Chiropractic↗

PubMed1994

Evaluation of an emergency medical system. The prognosis in patients with an out-of-hospital cardiac arrest.

In a retrospective chart review, we evaluated the efficiency of the emergency medical system of the Leiden area in patients with an out-of-hospital cardiac arrest. A total of 309 adult patients were included. Two hundred patients (64.7%) died in the emergency department and 67 (21.7%) died during subsequent hospital stay. Finally, 42 patients (13.6%) survived after hospital discharge. Favourable prognostic factors were the presence of witnesses at the time of arrest, a short call-response interval, an initial cardiac rhythm of ventricular fibrillation or tachycardia, and adequate advanced cardiac life support provided by the emergency medical system. We detected several shortcomings in the system such as an unacceptably prolonged call-response interval for some patients at the periphery of the Leiden area and a delay in the first defibrillation attempt. Improvement of this "pre-hospital chain of survival" is likely to result in a better outcome for these patients.

Adolescent↗

PubMed2004

MITIS: a WWW-based medical system for managing and processing gynecological-obstetrical-radiological data.

In this paper a World Wide Web (WWW)-based medical system, called MITIS, is designed and developed for the management and processing of obstetrical, gynecological and radiological medical data. The system records all the necessary medical information in terms of patient data, examinations, and operations and provides the user-expert with advanced image processing tools for the manipulation, processing and storage of ultrasound and mammographic images. The system can be installed in a hospital's Local Area Network (LAN) where it can access picture archival and communication systems (PACS) servers (if available), or any other server within the radiology department, for image archiving and retrieval, based on the digital imaging and communication in medicine (DICOM) 3.0 protocol, over TCP/IP and also it is accessible to external physicians via the hospital's Internet connection. MITIS is composed as a set of independent WWW modules (ISAPI server extension dlls) and a Win32 application (COM+ server) for mammography image processing and evaluation.

Algorithms↗

PubMed2006

Effect of the Veterans Affairs Medical System on plastic surgery residency training.

BACKGROUND: Teaching hospitals within the Veterans Affairs Health System perform the majority of complex and high-risk surgical procedures in the veteran patient population. Residency positions in the Veterans Affairs Medical System are usually part of a rotational educational system within a university-based residency, and plastic surgeons in training are a major work force and health care provider. The purpose of this study was to evaluate the current effect of the Veterans Affairs Medical System on plastic surgery residency training. METHODS: A 6-year (January of 1998 to December of 2003) review was performed of procedures completed at the Durham Veterans Affairs Medical Center, Section of Plastic Surgery. Procedures were divided into the following categories: extremities and trunk; breast and cosmetic; head and neck, including excision of skin lesions; hand surgery; craniomaxillofacial surgery; and other. Only procedures performed in the main operating room were reviewed and analyzed. In addition, a detailed review was performed of major head and neck reconstructions with free tissue transfer. RESULTS: A total of 1655 operative procedures were performed in 1290 patients. The ratio of men to women was 6:1 (1112 men and 178 women). Patients ranged in age from 26 to 97 years (average age, 62.7 years). Procedures in the extremities and trunk (n = 193, 11.7 percent), breast and cosmetic (n = 228, 13.8 percent), hand surgery (n = 155, 9.4 percent), and other (n = 275, 16.6 percent) categories were comparably distributed. Although the head and neck category accounted for the highest number of procedures (n = 766, 46.3 percent), the majority of these procedures were simple excisions of skin tumors (n = 612). There were significantly fewer major craniomaxillofacial cases (n = 38, 2.3 percent). CONCLUSIONS: Data from the retrospective analysis reveal that a broad spectrum of plastic surgical procedures is performed within the Veterans Affairs Health System, serving as a tremendous resource for resident training. The fact that approximately 260 procedures per year are performed demonstrates an active service. Craniomaxillofacial surgery is currently underrepresented compared with other categories at the authors' particular institution. By their definition, nonspecific plastic surgical procedures ("other") account for 275 (16.6 percent) of all 1655 procedures performed. This demonstrates that plastic surgery "overlaps" with other specialties, such as dermatology. The Veterans Affairs Health System will continue to play a significant role in the future training of plastic surgeons. Now, more than ever, a strong Veterans Affairs surgical service, including plastic surgery and its modern techniques, will be needed.

Adult↗

PubMed1995

Cognitive computer-based video analysis: its application in assessing the usability of medical systems.

This paper describes a methodology, based on cognitive research, for assessing the usability of medical computing systems. The issue of developing appropriate evaluation tools, both for use in the design process and for analysis of end products, is beginning to be recognized as being of great importance. In this paper, the use of video recording for collecting empirical data on system usability is detailed. The techniques described allow for the collection of an integrated data set consisting of the transcripts of physicians as they "think aloud" in interacting with a medical system, along with video records of user-computer interaction. The use of coding methodologies and a computer-based annotation system for the analysis of video data are described. Our preliminary experience indicates that this methodology offers a powerful way for assessing physicians' informational needs. Implications for the development and evaluation of medical information systems are discussed.

Computer Systems↗

PubMed1989

Factors associated with the decline of the Cooperative Medical System and barefoot doctors in rural China.

The Cooperative Medical System (CMS) and its barefoot doctors have been in decline in rural China for nearly a decade. In order to explore the reasons for this, in 1987 we carried out a survey of villagers, barefoot doctors, and local administrators in Fengxian, Shanggoa, and Loaan counties, where incomes are good, fair, and low, respectively. The state of the CMS in these counties was contrasted and the situations which prevailed in 1978, 1982, and 1985, when the system was, respectively, at its peak, had begun to decline, and had declined markedly, were compared. A random sample of villages was selected and all the barefoot doctors and administrators as well as a random sample of households were surveyed. The results indicate that health status (as measured by infant mortality, immunization coverage, and rate of infectious diseases) has decreased in areas where the CMS has declined, while per capita incomes increased. Concomitantly, villager's expenditures on health care have increased. Barefoot doctors and their patients were, however, reasonably happy with the system, and in its absence the doctors are no longer able to obtain ongoing training. The CMS was fiscally sound, and did not decline to the same extent in all areas--it continues to thrive in Fengxian, which is relatively affluent. It is concluded that the system probably declined because many local administrators perceived that it no longer enjoyed the backing of the central government.

China↗

PubMed1992

HMO versus private care medical systems: a study to determine the aging consumers' satisfaction with medical care under these two systems.

In one community, 175 aging persons (44 HMO and 132 private medical care patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status were collected to determine whether these variables would relate to HMO membership. Satisfaction scores were compared between HMO and private care medical groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private medical care group, whereas satisfaction with cost was higher in the HMO group. Furthermore, the HMO group evaluated private medical care and HMO care similarly. The private medical care group rated HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.

Aged↗

PubMed1989

Learning from the past, improving upon the present: traditional and western medical systems at the juncture.

Each cultural group has a reality which consists of a formal multi-centuried tested system of beliefs and practices. That system potentially inhibits or facilitate the acceptance of newly introduced technology and ideas. Among the critical beliefs and practices are those related to health and well-being. This article compares and contrasts "western" and "traditional" medical systems located both in the United States and other parts of the world. It discusses health and policy related postures concerning the "traditional medical system" taken by several countries and organizations. It, further, provides an overview of some current trends related to the recognition and acknowledged value of traditional medicine world-wide.

Attitude to Health↗