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PubMed2004

Progress toward paperless radiology in the digital environment: planning, implementation, and benefits.

A growing number of hospitals have installed PACS (Picture Archiving and Communications Systems) in order to improve patient care and to facilitate improved efficiencies. While eliminating films is commonly one of the first goals in planning a successful PACS implementation, eliminating the manual handling of paperwork can also produce a substantial benefit. We describe the process utilized at Maine Medical Center (MMC) to achieve a substantial degree of freedom from paperwork. Some of the benefits were expected, but some unexpected benefits also revealed themselves during this process.

Efficiency, Organizational↗
PubMed1989

BIOLAB--a computerized on-line system for physiological measurements in experimental animals.

An on-line system for the acquisition and analysis of physiological signals measured in experimental animals is described. The modular design makes it flexible and easily adaptable to various kinds of physiological measurements. Currently, the system includes support for hemodynamic and cardiac electrophysiological studies. The system is designed for intermittent recordings initiated either manually by the operator or automatically. The distributed computer system consists of three parts: the data acquisition subsystem, the on-line analysis subsystem, and the final data processing subsystem. The communication between the subsystem utilizes an Ethernet local area network, and the analysis and plot programs include support for RS/1 tables and graphs.

Animals↗
PubMed2001

Frequency of Alzheimer's disease and other dementias in a community outreach sample of Hispanics.

OBJECTIVES: To determine the proportion of Alzheimer's disease (AD) and other dementia types in a community sample of Hispanics. DESIGN: This is a descriptive diagnostic study of a nonrandom community outreach sample utilizing established criteria for the diagnosis of dementia type. Recruitment involved direct community outreach with diagnostic evaluations conducted at a university-affiliated outpatient clinic. SETTING: Hispanic Neuropsychiatric and Memory Research Clinic at the Olive View-UCLA Medical Center in Sylmar, California. PARTICIPANTS: One hundred community-dwelling Hispanics age 55 and older without prior diagnosis or treatment of their cognitive symptoms. MEASUREMENTS: Each subject underwent a complete medical diagnostic evaluation, in Spanish, including neuropsychological tests, neurological examination, laboratory tests, and brain imaging (computed tomography or magnetic resonance imaging) to establish dementia type. Presence of dementia was established according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Diagnosis for probable or possible AD and vascular dementia (VascD) was established using criteria from the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association for probable AD and by research criteria from the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences for VascD, respectively. Frontotemporal dementia was diagnosed using recommendations set forth by the Lund and Manchester groups. RESULTS: Subjects were poor, with low acculturation levels despite long years of U.S. residence. Forty percent of subjects had had undiagnosed cognitive symptoms for 3 or more years. Of those demented, 38.5% had AD and 38.5% met criteria for VascD. The best predictors of VascD were hypertension and cerebrovascular disease, whereas apolipoprotein E4 allele best predicted AD. Other forms of dementia were also present. Twenty percent of the sample was clinically depressed but not demented. CONCLUSIONS: In comparison with data from predominantly white populations, our proportion of AD cases was lower and that of VascD cases was considerably higher than anticipated. The percentage of clinically depressed older individuals was also high. These findings could have implications for differential cultural and genetic risk factors for dementia among diverse ethnic/racial groups. Further studies are needed to obtain accurate prevalence estimates of dementing disorders among the different U.S. Hispanic populations.

Aged↗
PubMed2002

Information-sharing strategies to support practising clinicians in their clinical teaching roles.

If the involvement of practising clinicians in undergraduate clinical teaching is to be retained, strategies that inform them of student expectations and show how their contribution can be integrated to the wider clinical teaching programme must be identified. A variety of information-sharing strategies has been designed and used to communicate with clinicians teaching in Phase 2 of the undergraduate medical curriculum in Dundee. Evaluation of these by the clinical teaching staff has indicated that briefing by students, posters and tutor manuals are more successful information-sharing strategies than formal staff-development sessions.

Cooperative Behavior↗
PubMed2000

Inferring quality of life from performance-based assessments.

PURPOSE: Performance based measures have been suggested as an approach to estimate quality of life, but the associations have not been extensively evaluated. This study's purpose was to determine the associations between quality of life and performance based assessments of disablements in community dwelling individuals post-stroke. METHODS: Forty five people were evaluated in a cross-sectional pilot study. The subjects' quality of life (SF-36), ability in basic and instrumental activities of daily living (ADL), manual dexterity, mobility, neurological impairment, and perception of lateral neglect were evaluated. Multiple regression was employed to find the strongest associations. RESULTS: Neurological impairment explained 34% of the variation in the women's physical health summary score (PCS) of the SF-36. Instrumental ADL and neurological impairment together explained 66% of the women's mental health summary score (MCS) of the SF-36. Manual dexterity of the hemiplegic hand explained 39% of the variation in the men's PCS. CONCLUSION: Performance based measures may be useful to estimate quality of life in non-communicative individuals.

Aged↗
PubMed1999

Incidence of very mild to severe dementia and Alzheimer's disease in Denmark: the Odense Study.

OBJECTIVE: Calculation of incidence of dementia and AD, including cases in the earliest phases of the diseases. BACKGROUND: Establishment of incidence estimates is important for the future planning of the health care system, and incidence studies can offer insights into risk factors. METHODS: A total of 5,237 persons age 65 to 84 years were randomly drawn among people living in the municipality of Odense, Denmark. Of this sample 3,086 persons were eligible for the incidence study. All participants were examined with CAMCOG, the cognitive section of The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), and the follow-up period was 2 years. Using multiple linear regression, the CAMCOG cutoff score was individualized to detect even minor cognitive decline with optimal precision. Possibly demented persons were further examined with the remaining part of the CAMDEX and neuropsychological tests. AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD, and vascular dementia and dementia of other types were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for dementia. Finally, the severity of dementia was determined according to the Clinical Dementia Rating scale. RESULTS: The incidence rate for very mild to severe dementia was 29.5 per 1,000 person-years and 20.9 for AD, and the rates were similar for men and women. CONCLUSION: Application of an individualized cutoff for the screening instrument resulted in detection of a substantial number of cases with very mild dementia, which subsequently resulted in higher incidence rates than those reported in most other studies.

Age Distribution↗
PubMed2006

Governing the surgical count through communication interactions: implications for patient safety.

BACKGROUND: Intermittently, the incidence of retained surgical items after surgery is reported in the healthcare literature, usually in the form of case studies. It is commonly recognised that poor communication practices influence surgical outcomes. AIM: To explore the power relationships in the communication between nurses and surgeons that affect the conduct of the surgical count. METHODS: A qualitative, ethnographic study was undertaken. Data were collected in three operating room departments in metropolitan Melbourne, Australia. 11 operating room nurses who worked as anaesthetic, instrument and circulating nurses were individually observed during their interactions with surgeons, anaesthetists, other nurses and patients. Data were generated through 230 h of participant observation, 11 individual and 4 group interviews, and the keeping of a diary by the first author. A deconstructive analysis was undertaken. RESULTS: Results are discussed in terms of the discursive practices in which clinicians engaged to govern and control the surgical count. The three major issues presented in this paper are judging, coping with normalisation and establishing priorities. CONCLUSIONS: The findings highlight the power relationships between members of the surgical team and the complexity of striking a balance between organisational policy and professional judgement. Increasing professional accountability may help to deal with the issues of normalisation, whereas greater attention needs to be paid to issues of time management. More sophisticated technological solutions need to be considered to support manual counting techniques.

Adult↗
PubMed1996

OpenLabs services for ordering laboratory investigations.

An automated system is described that screens requests for laboratory investigations from GPs and delivers feedback with respect to the adequacy of the requests. The system has to replace and extend the current system in which feedback is provided on a manual basis each half year, based on the tests requested during a period of one month, randomly selected from the previous half year. It has been reported elsewhere that the manual system reduced the number of tests requested considerably. The criteria used by the automated system and the manual system are based on guidelines and work agreements that GPs have agreed to follow when requesting investigations. It is concluded that the automated system is very user-friendly and that in the order of 4-17% of the requested tests could be identified as unnecessary, with a false negative rate in between 4% (for hyperthyroidism) and 23% (for hypothyroidism). The achieved reduction in the number of tests is in addition to the reduction obtained in the manual system.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

A cystic fibrosis handbook for teachers.

The purposes of this project were to (1) develop a handbook on cystic fibrosis for elementary school teachers and to (2) pilot this handbook with a group of teachers and school nurses. The project used a descriptive survey design in which parents, teachers, and school nurses of 14 elementary-age children with cystic fibrosis were recruited from one cystic fibrosis clinic. Interest in using the handbook with their child's teachers was elicited from parents; also, interest in using the handbook was obtained by open-ended questions in a mailed survey sent to teachers and school nurses. Levels of teacher and school nurse knowledge were measured with a true/false pretest and posttest instrument. All parents expressed a desire to use the handbook with their child's teachers. Sixty-seven percent of the teachers and 89% of the school nurses returned the survey, and all endorsed the use of the handbook in their classrooms or schools. Comparison of the pretest and posttest scores from the teachers revealed an increase in teachers' knowledge. Scores on pretest and posttest measures from school nurses were high at each testing time. Results support the use of a printed handbook to promote knowledge of cystic fibrosis in teachers and to support communication among nurses, parents, and teachers.

Child↗
PubMed1995

Nationwide EDI system can trim administrative costs.

Administrative costs related to the healthcare industry can be reduced dramatically through implementation of a nationwide electronic data interchange (EDI) system. Estimates suggest that such a system could trim $73 billion from the $220 billion spent annually in the United States on healthcare administrative costs by automating 11 transactions traditionally performed manually. The greatest potential for cost savings lies in the electronic conversion of enrollments, submissions, and payments.

Computer Communication Networks↗
PubMed1994

Severe impairment battery. A neuropsychological test for severely demented patients.

OBJECTIVE: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. DESIGN: Case series. SETTING: Geriatric long-term facility. PATIENTS: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99 +/- 5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71 +/- 6.14. MAIN OUTCOME MEASURE: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. RESULTS: The mean score on the SIB was 92.52 +/- 31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11, 12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. CONCLUSION: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up.

Aged↗
PubMed2006

Teaching young nonverbal children with autism useful speech: a pilot study of the Denver Model and PROMPT interventions.

This single subject design study examined two models of intervention: Denver Model (which merges behavioral, developmental, and relationship-oriented intervention), and PROMPT (a neuro-developmental approach for speech production disorders). Ten young, nonverbal children with autism were matched in pairs and randomized to treatment. They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents. Fidelity criteria were maintained throughout. Eight of the ten children used five or more novel, functional words spontaneously and spoke multiple times per hour by the conclusion of treatment. There were no differences in acquired language skills by intervention group. Initial characteristics of the best responders were mild to moderate symptoms of autism, better motor imitation skills, and emerging joint attention skills.

Attention↗
PubMedDate not supplied

A theoretical model for coordinating and documenting patient education.

The Joint Commission on Accreditation of Healthcare Organizations' patient and family education standards pose a challenge to large medical centers. Prior to 1994, Joint Commission standards required all healthcare disciplines to instruct their patients about issues relevant to their health. There was no requirement that the information that was given to patients by providers in various disciplines, units, or clinics be coordinated. Now that education is a functional chapter in the Joint Commission's Accreditation Manual for Hospitals, an integrated approach to providing such education is necessary. This article proposes a theoretical model intended to help medical centers meet the new standards, improve patient education, and improve communication among healthcare providers.

Family↗
PubMedDate not supplied

Training of health care personnel towards the implementation and use of electronic health care records using integrated imaging technology.

The hospital of the future will be a place in which Health Care providers of various disciplines will have access to all information about a patient in a timely fashion, and where the communication system will be able to cope with all information representations ranging through data, text, images and voice. Multimedia systems offer the facilities to cope with the specific problems of the mainly manual approach for the effective and efficient organization of information related to facts and findings in medical care. In this article we outline the training needs for future users of such systems.

Computer User Training↗
PubMed1994

The development of graphic symbols for medical symptoms to facilitate communication between health care providers and receivers.

Since there are a variety of communication barriers in health care settings in Japan, a study was designed to improve communication by the use of graphic symbols. At the beginning of this study, graphic symbols were developed to correspond to 26 basic symptoms. Seventy-six subjects voluntarily evaluated the comprehensibility of these symbols: nursing students (n = 29), manual sign language interpreters (n = 24), hearing impaired subjects with normal (n = 10), limited (n = 11), and minimal (n = 2) literacy abilities. The comprehension by each respondent of each symbol was compared with that of the authors. On the average, numbers of the matching meanings were 24.9 +/- 1.36 (mean +/- S.D.) for students, 24.5 +/- 1.77 for interpreters, 23.4 +/- 2.22, and 21.5 +/- 3.01 for the first two groups of the hearing impaired. Among the 26 symbols, 10 showed high levels of the matching rates (> 90%) for all groups. These symbols were considered to be effective alternatives to verbal expression. Further refinements of the graphic symbols were suggested to suppress the differences in interpretation of the remainder of the symbols. During this study, colleagues and subjects suggested cognitive strategies to clarify and enhance the meaning of the graphic symbols such as (a) the subtraction of excessive information, (b) the addition of further information, and (c) the simplification of the setting by minimizing social and cultural bias.

Adult↗
PubMedDate not supplied

Development of a teaching file by using a DICOM database.

A teaching file of Digital Imaging and Communications in Medicine (DICOM) images was developed. Selected computed tomographic, magnetic resonance, angiographic, nuclear medicine, and ultrasonographic images were transferred to a personal computer (PC) with a 75-GB hard drive. The database created from the DICOM header information was modified to include American College of Radiology (ACR) Learning File categories. Database modification allowed cases to be searched by diagnosis, by findings, and by patient age, sex, and demographics. Technologists inputted ACR codes into the DICOM headers before the images were acquired, thereby reducing database maintenance time. Images were manipulated and reviewed and were used for case presentations, board review, and conferences. Selected images were transferred via a hospital network to workstations for consultation, saving time for referring clinicians. The teaching file is reliable, cost-effective, and easy to install and takes advantage of recent technologic advances in computer hardware and software. Rapid cost reductions and increases in PC storage capacity allow maintenance of the teaching file in DICOM format without intermediate steps involving automation or manual conversion. This setup rivals any of the proprietary software currently available from other vendors.

Computer Communication Networks↗
PubMed1995

[Medical emergency service. Descriptions of a one-year activity at an emergency communication center].

The emergency medical communication centre, Vestfold Central Hospital, receives emergency medical calls (phone 113), from 200,000 citizens in Vestfold county. Calls are categorised by urgency (red, yellow or green) according to the Norwegian Index to Emergency Medical Assistance, a criteria-based dispatch manual. In 1993, 2,440 red (suspected life-threatening conditions), 3,502 yellow and 6,505 green calls were received. The frequency of red and yellow calls did not differ much through the day, but varied between different municipalities in the county. The cause of emergencies varied by month. Acute illness increased in May and December, accidents in June, July and December. Psycho-social emergencies (violence, suicide, drug abuse) seemed to vary in a circadian manner. Efforts were made 628 times to give basic life support instruction by telephone. An ambulance was the most frequent response, general medical practitioners were called upon relatively seldom. The response was estimated to adequate in 79% of the incidents, exaggerated in 9% and inadequate in 3%.

Emergency Medical Service Communication Systems↗
PubMed1989

Sequence initiation performance by stutterers under conditions of response competition.

Male stutterers and nonstutterers were compared on their performance of a task that required tapping keys as rapidly and accurately as possible to reproduce different sequences of finger movements as soon as they had been demonstrated on a visual display panel. Testing using the right hand alone confirmed previous findings that stutterers are significantly slower than nonstutterers in initiating new movement sequences and make significantly more errors on initial sequences. Subjects were also tested on this sequence reproduction task while they performed concurrently a manual task with the left hand that required turning a knob in response to signal tones. The hypothesis underlying the study was that associated with stuttering is a dysfunction in the mechanisms regulating interhemispheric communication, and it was predicted that the concurrent task would interfere more with the sequence reproduction task performance of stutterers than with that of nonstutterers. A joint analysis of the speed and accuracy aspects of performance of the two tasks confirmed the prediction. Additional research required to clarify whether the effects are in fact due to the hypothesized interhemispheric mechanisms or to a generally greater susceptibility of stutterers to interference from any concurrent motor or cognitive activity is discussed.

Adult↗