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At least 919 records · Page 51Linked to original sources
PubMed1989

Drinking water microbiology--new directions toward water quality enhancement.

Drinking water microbiology has emerged from decades of relative complacency to recognize there can be major concerns with potable water quality. Many of these issues are a result of an explosion of information on new waterborne agents, treatment problems with raw-source water qualities, biofilm development in some distribution systems and specialized requirements in water quality unique to hospitals and industries. Protozoan cyst survival after some disinfection practices involving surface water impoundments and virus occurrence in poorly protected groundwaters have provided reasons for expanding minimum treatment of surface waters and for requiring disinfection of all groundwaters unless there is a demonstrative data base to support exceptions in treatment requirements. Official monitoring of small water supplies must be increased on a monthly basis and a rapid alert established to inform water plant operators of unsatisfactory water qualities. As an option, application of operational tests to analyse water quality in terms of chlorine residual, turbidity, total coliforms and heterotrophic bacterial counts in small water plant operations should be encouraged. This would provide the operator at remote locations with the opportunity to utilize the information to make necessary treatment adjustments or corrections in water distribution deficiencies promptly and be a supplement to the official regional monitoring program. Application of drinking water alternative sources (bottled water and water from point-of-use treatment devices) should be viewed by the health authorities as only a temporary solution, not as a permanent fix for a public water supply known to present some established health risk to consumers. The public must also recognize that bottled water is not frequently monitored by health laboratories for acceptable quality and the use of home treatment devices places the responsibility of proper maintenance on the user. Microbial quality improvements in drinking water to hospitals and food industries can frequently be achieved through a routine, systematic flushing program for building plumbing networks and associated attachment devices. In other situations, use of booster disinfection or point-of-use devices may provide the important special water quality requirements for certain industrial applications. In any event, these supplemental treatment measures will require careful in-plant monitoring and maintenance to prevent reversals in water quality enhancement.

Animals↗
PubMed2006

Computer based medication error reporting: insights and implications.

BACKGROUND: Despite the growing use of error reporting tools, the healthcare industry is inexperienced in receiving, understanding, and analyzing these reports. OBJECTIVE: To assess the accuracy and define the epidemiology of medication error reports. DESIGN, SETTING, AND PATIENTS: A retrospective cohort study of 581 error reports containing 1010 medication errors reported between July 2001 and January 2003 at a large academic children's institution. MAIN OUTCOME MEASURES: Correct classification and types of medication errors. RESULTS: Of the 1010 medication errors reviewed, 298 (30%) were prescribing errors, 245 (24%) were dispensing errors, 410 (41%) were administration errors, and 57 (6%) involved medication administration records (MAR). Following expert review, 208 errors (21%) were deleted because they had been inappropriately coded as errors and 97 (10%) were added as they were not initially coded despite having occurred. In addition, 352 medication error reports needed to have the subtype of error reclassified; 207 (59%) of these involved the reporter choosing the non-descript "other" category on the reporting tool (such as "Prescribing other") which was able to be reclassified by expert review. The overall distribution of error type categories did not change significantly with expert review, although only MAR errors were underreported by the reporters. The most common medications were anti-infectives (17%), pain/sedative agents (15%), nutritional agents (11%), gastrointestinal agents (8%), and cardiovascular agents (7%). CONCLUSIONS: Despite clear imperfections in the data captured, medication error reporting tools are effective as a means of collecting reliable information on errors rapidly and in real time. Our data suggest that administration errors are at least as common as prescribing errors in children. Further research is needed, not only in the area of computerized physician order entry (CPOE) for children, but also on ways to make the dispensing and administration of medications safer.

Academic Medical Centers↗
PubMed1987

Pharmacy: a profession in transition or a transitory profession?

Areas in pharmacy that are in transition are described, and ways to prevent the perception of pharmacy as a transitory profession are detailed. Pharmacy has adapted itself over the past 75 years to changes in the health-care system and in societal demands of the profession. The evolution of pharmacy functions has included drug product preparation, establishment of standards, drug distribution, and clinical pharmacy. The profession is continuing to change in reaction to economic and social forces. Hospital pharmacy flourished when it shifted from a profit to a cost center because pharmacy practice researchers documented the contribution of clinical pharmacy to patient care and because hospital pharmacy administrators developed sound management procedures to maintain efficient inventories. Current controversies in pharmacy practice are discussed, including pharmacist prescribing, physician dispensing, and therapeutic substitution. These terms inadequately describe the concepts, especially when they are taken out of context of the total health-care process involving a physician-pharmacist team. Because of the success of this teamwork in acute-care institutions, ambulatory pharmaceutical services should involve cooperative activities of pharmacists in professional service administrative organizations (PSAOs) and physicians in independent practice associations. The cost-effectiveness of PSAOs is discussed. Marketing of drug products is changing as the physician-pharmacist interaction becomes integral to the drug therapy decision-making process. Drug distribution should not be viewed as less professional than clinical activities. Although the pharmacy profession is reorienting itself toward patient care and the rational use of drugs in society, it must maintain its authority over the drug distribution system.

Drug Prescriptions↗
PubMed2000

Integration of medical applications: the 'mediator service' of the SynEx platform.

Interoperability is a key issue and a long-term domain of research for distributed healthcare information systems. The SynEx European project provides open and standard integration platform for both new and legacy medical applications. It aims to provide access to hospital information services, patient records, and to medical knowledge, in a seamless way, hiding the distribution aspects and the heterogeneity of the underlying systems. In this study, we describe the SynEx 'mediator service', a software engineering component, that is used to facilitate the development of mediators between any pair of SynEx components and to manage the corresponding interchange messages. Both a C++ library and a Java package of a generic mediator model are provided with several ready-to-use specialisations for well-defined use. The use of the XML technology as a powerful data interchange format and as an efficient data structure converter is proposed and discussed.

Computer Communication Networks↗
PubMed1995

Evaluation of diffuse technologies: the case of digital imaging networks.

There have been significant developments in recent years in the methodologies and methods for the evaluation of a wide range of health technologies. There remain, though, many technologies which are difficult to evaluate. Often the difficulty stems from the complexity of the technologies themselves, which are in effect hybrids, comprising combinations of several distinct elements. In this paper these are termed 'diffuse' technologies, because the different elements exert different costs and effects, often across several different services. Computer networks are one, increasingly important, example of such technologies in health care. While it is possible to evaluate individual elements of such technologies, it is not clear how to evaluate the technology as a whole, where the whole may be greater (or less) than the sum of the parts. The paper outlines a seven-stage framework for the evaluation of diffuse technologies. The general principles of evaluation are illustrated using the example of picture archiving and communication systems (PACS), which are computer systems designed to capture, store and distribute electronic radiological images within a hospital.

Cost-Benefit Analysis↗
PubMed1999

[Interventional radiology and the medical applications of information systems: what consequences for the radiology department?].

The French health care system reform has introduced some changes in the distribution of hospital budgets according to the distribution of admitted patients in diagnosis related groups (DRGs). This new model of budget allocation does not take into account the more technical nature of some medical procedures and services and does not promote the implementation of new technologies. Using four simulated clinical cases, we studied the length of stay in different DRGs and the number of associated points (points d'indice synthétique d'activité, ISA). The addition of the interventional radiologic procedures did not modify the DRG (which remained unchanged from the initial DRG). In order to achieve recognition of the specific nature of interventional radiology procedures, a database should be created and an economical evaluation conducted.

Age Factors↗
PubMed1990

Effect of an admission monitoring and scheduling system on productivity and employee satisfaction.

This article develops and evaluates an admission monitoring and scheduling system designed to reduce fluctuation of work load on nursing units. Effects of the system on work-load distribution, full-time equivalents, labor cost, and employees are assessed in a 235-bed hospital. The system provided more stable work loads and had a potential for improving productivity by about 3 percent, and reducing by about 40 percent the number of days nurses are asked to take off without pay during low-census periods.

Admitting Department, Hospital↗
PubMedDate not supplied

[The participation of hospital pharmacy services in enteral nutrition].

We present the results of a study done in the departments of hospital pharmacy of our country with the aim of knowing their participation in the use and clinical follow up of patients with enteral nutrition. 293 questionnaires were sent out, and 121 were filled out and returned (41.3%). The responses were classified into three groups, according to the number of hospital beds, considering > or = 1000 (large), 500-1000 (medium), and < or = 500 (small). The data were analyzed by means of a statistical program (R-Sigma Horus). 79% (68) of the small hospitals have a unitary dose drug dispensation system, and the Enteral Nutrition was distributed through this system in 53% (50) of them; only 29% (27) of them have a stock of these preparations on the wards. 93% (14) and 65% (54) of the large and small hospitals respectively, prefer the use of enteral nutrition as opposed to parenteral nutrition. 85% (11) of the large hospitals have protocols for the use of enteral nutrition, this being 62% (10) and 59% (47) in medium and small hospitals. The committees for artificial nutrition are present in 75% of the large hospitals, in addition to which, in 66% of these there is a nutritional support team. A pharmacist from the department of pharmacy participates in both multidisciplinary groups. If it is necessary to manipulate the enteral nutrition preparations, in 30% of the departments of pharmacy of the smaller hospitals, this is centralized, being done by personnel of the department itself; in 59% of them (19) there is a specific area for the elaboration, which is not the case in large hospitals. Drugs are mixed with the enteral nutrition in 25% (1), 12% (1), and 9% (4) of the large, medium and small hospitals respectively. There is great, active participation of the hospital pharmacists in the activities of the multidisciplinary nutritional support systems, although at the present time, the involvement of the departments of pharmacy in the centralization of the manipulation of the enteral nutrition is reduced. It is necessary therefore, to implement the development of enteral nutrition programs with a quality guarantee from the departments of pharmacy.

Enteral Nutrition↗
PubMed2001

A preliminary assessment of two hospital food service systems using parameters of food safety and consumer opinion.

The goal of any hospital caterer should be to provide food that meets nutritional requirements, satisfies the patient, improves morale and is microbiologically safe. Food distribution to hospital wards plays a critical role. The aim of this study was to compare two hospital food service systems using parameters of food safety and consumer opinion. An NHS hospital was selected where food delivery was due to change from a plated system to a cafeteria trolley system. Samples (50 g) of dishes (n = 27) considered to be high-risk were collected for three consecutive days from breakfast, lunch and supper meals. The samples were taken from a pre-ordered tray (similar to that of a patient) in the plated system and from the trolley on the ward in the cafeteria system of meal delivery (approximately six months after its introduction). Consumer opinions cards (n = 180) were distributed and interviews also conducted. Microbiologically, the quality of food items delivered by both systems was satisfactory. However, concern was raised with the plated system, not for hot foods cooling down but for chilled foods warming up and being sustained in ambient conditions. Overall consumer satisfaction and experience was enhanced with the trolley system. Food was hotter and generally perceived to be of a better quality. Satisfaction with cold desserts was not dependent on the delivery system.

Anecdotes as Topic↗
PubMed1996

Integrated computerized patient records: a two-year Geneva experience.

The UNIDOC system of computer-based medical records that was developed and made operational within the DIOGENE-2 Hospital Information System (HIS), is based upon a fully standardized and distributed open systems architecture. It should also be emphasized that UNIDOC illustrates a feasible marriage of the two technologies, UNIX and MS-DOS, is in many respects successful enough to be recommended as a sound general solution to medical office integration into a HIS.

Abstracting and Indexing↗
PubMed1989

Prospective payments to hospitals: should emergency admissions have higher rates?

Systematic variation in patient resource use can be a significant problem for a system based on diagnosis-related groups (DRG's) if this variation is not evenly distributed across hospitals. If certain hospitals routinely treat patients who require more services than average under DRG's, the long-run financial viability of these hospitals will be threatened. In this study, the authors examine whether patients who are admitted on an emergency or urgent basis represent an identifiable group of patients whose costs are systematically higher than those of electively admitted patients, controlling for DRG. Alternative approaches for incorporating admission status into a DRG payment system are developed and tested.

Costs and Cost Analysis↗