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PubMedDate not supplied

A method for describing and evaluating naturopathic whole practice.

CONTEXT: Even though complementary and alternative medicine (CAM) is generally practiced as distinct systems of medicine, almost all CAM research has focused on single therapies. In order to more adequately evaluate the effectiveness of these medical systems, studies that evaluate the outcome of intact whole systems are needed. One challenge lies in defining the whole medical system (and any medical system it is compared to) in a way that ensures treatment fidelity. OBJECTIVE: This paper presents a proposed method to measure treatment fidelity (treatment criteria) in studies of the naturopathic medical system. DESIGN: Illustrative example of the theory-based development and post-hoc "testing" of treatment criteria against an existing database of actual treatments prescribed by a random sample of naturopathic physicians. MAIN OUTCOME MEASURES: Treatment criteria for 3 conditions--menopausal symptoms, bowel dysfunction, and fatigue/fibromyalgia--and their comparison to actual treatments prescribed. RESULTS: A set of meaningful, measurable treatment criteria based on the naturopathic practice principles were defined that could have generated the majority (82%-93%) of treatment prescriptions given at visits for these conditions. Several of the treatment criteria components are common across the 3 conditions studied, and might be appropriate for all visits to doctors of naturopathy (NDs). Others are specific to each condition. In addition to ensuring model validity, these criteria help identify critical components of care, enable study replication, provide a measure of quality of care, and are one step toward allowing CAM to be studied as it is generally practiced-as distinct systems of medicine. SETTING: Work was performed at Bastyr University and the University of Arizona.

Clinical Protocols↗
PubMed1989

Privacy Act of 1974; systems of records--HCFA. Notice of proposed modification to the "End Stage Renal Disease (ESRD) Program Management and Medical Information System (Registry)"--HCFA.

HCFA is proposing to modify the notice of system of records to update and clarify a number of sections. The modifications being proposed for this system include: The name of the system is being changed to "End Stage Renal Disease (ESRD) Program Management and Medical Information System (PMMIS)." The category of individuals is being revised to reflect ESRD patients treated by the Department of Veterans' Affairs (DVA) health care facilities. The retrievability section is being revised to include DVA personal identification numbers. The above changes clarify and update the system notice to include recent statutory requirements. In addition, the safeguard section is being expanded to include security-related contracts and current source documents for systems security policies.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Implementation of a computerized physician order entry system of medications at the University Health Network--physicians' perspectives on the critical issues.

There are many reasons why most hospitals have not adopted physician order entry systems for medications. It is a costly endeavour (Kuperman and Gibson 2003) that can cause major disruptions to workflow for physicians, pharmacists and nurses. Yet, the technology can reduce medication errors, especially with sophisticated decision support. We have presented many of the lessons learned from our successful implementation experience. To date, over 90% of medication orders are entered by physicians. The technology must be ready for the implementation. System issues such as errors, slowness and freezing give ready opportunity for critics who will claim the system is just not ready for real-time. Through rigorous testing, we were able to avoid issues previously seen in our pilot study. Usability testing with end-users was also critical in both guiding decision-making as well as validating that the system was ready for implementation. Proper training and support were also necessary. To ensure ready adoption, decision support was optimized to reduce the volume of less important alerts. Most importantly, we found that active physician involvement at multiple levels was key. This ensured that physicians understood from a high-level perspective that this change was necessary. Planning for specific implementation details had the benefit of input from physicians working in the area. Day-to-day issues of our residents and staff were also addressed promptly.

Attitude of Health Personnel↗
PubMed2000

[Prediction on the medical care system for the aged people in the new century].

Japan has become the country with the longest life expectancy in the world in about 25 years. Among many factors for this success, the medical care system, including the health insurance for everyone, played the important role, which has been evaluated as the best in the world. However, since the national economy in Japan has become recently suppressed it has become one of the big political problems to keep this system as same as before. In addition, the medical expenses for the elderly and aged people is now as high as 40% of all. In this meaning, we should create the better system by ourselves, based on ethical criteria, harmonized with the progress of medicine. In April of 2000, the new long term care system was introduced aiming the self independence of aged people. Now, the medical and long term care system has become unified into one toward the ideal society in the future. In this paper, the ideal medical care system, especially for the aged people was discussed. Needless to say, the medical care system should have widely view to the future. The progress of medicine, high technology and health promotion will play very important parts to create the ideal society in future. If any geriatric diseases including senile dementia will be settled in near future, the medical care system for the aged will change completely. In addition, the nationwide campaign of health promotion will induce excellent results. Thus the society in the future will become much brighter and happier. In this meaning, health promotion, medical care, and welfare systems should be unified into one system. The expenses for these systems should be regarded as the investments expecting the huge profit in health and happiness in the future.

Aged↗
PubMed1993

Impact of first-responder defibrillation in an urban emergency medical services system.

OBJECTIVE: To evaluate the impact of adding first-responder defibrillation by fire-fighters to an existing advanced life-support emergency medical services system. DESIGN: Nonrandomized, controlled clinical trial with periodic crossover. SETTING: Memphis, Tenn, a city of 610,337 people, which is served by a fire department-based emergency medical services system. All city ambulances provide advanced life support. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: Twenty of 40 participating engine companies were equipped with an automated external defibrillator and ordered to apply it immediately in all cases of cardiac arrest. The other 20 companies were ordered to start cardiopulmonary resuscitation (CPR) immediately and wait for paramedics to arrive. Every 75 days, group roles were reversed. Care otherwise proceeded according to 1986 American Heart Association guidelines. MAIN OUTCOME MEASURES: Return of spontaneous circulation in the field, survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: During the 39-month study interval, 879 patients were treated by a project engine company. Four hundred thirty-one (49%) of these were found in ventricular fibrillation. Bystander CPR was started in only 12% of cases. Overall, firefighters reached the scene a mean of 2.5 minutes faster than simultaneously dispatched paramedics. Although our automated external defibrillators proved to be reliable and efficacious for terminating ventricular fibrillation and pulseless ventricular tachycardia, patients treated by an automated external defibrillator-equipped engine company were no more likely than CPR-treated controls to be resuscitated (32% vs 34%, respectively), to survive to hospital admission (31% vs 29%), or to survive to hospital discharge (14% vs 10%). Neurological outcomes were also similar in the two treatment groups. CONCLUSIONS: In a fast-response, urban emergency medical services system served by paramedics, the impact of adding first-responder defibrillation appears to be small. Early defibrillation alone cannot overcome low community rates of bystander CPR. Careful attention to every link in the "chain of survival" is needed to achieve optimal rates of survival after cardiac arrest.

Aged↗
PubMed2003

A tool for sharing annotated research data: the "Category 0" UMLS (Unified Medical Language System) vocabularies.

BACKGROUND: Large biomedical data sets have become increasingly important resources for medical researchers. Modern biomedical data sets are annotated with standard terms to describe the data and to support data linking between databases. The largest curated listing of biomedical terms is the the National Library of Medicine's Unified Medical Language System (UMLS). The UMLS contains more than 2 million biomedical terms collected from nearly 100 medical vocabularies. Many of the vocabularies contained in the UMLS carry restrictions on their use, making it impossible to share or distribute UMLS-annotated research data. However, a subset of the UMLS vocabularies, designated Category 0 by UMLS, can be used to annotate and share data sets without violating the UMLS License Agreement. METHODS: The UMLS Category 0 vocabularies can be extracted from the parent UMLS metathesaurus using a Perl script supplied with this article. There are 43 Category 0 vocabularies that can be used freely for research purposes without violating the UMLS License Agreement. Among the Category 0 vocabularies are: MESH (Medical Subject Headings), NCBI (National Center for Bioinformatics) Taxonomy and ICD-9-CM (International Classification of Diseases-9-Clinical Modifiers). RESULTS: The extraction file containing all Category 0 terms and concepts is 72,581,138 bytes in length and contains 1,029,161 terms. The UMLS Metathesaurus MRCON file (January, 2003) is 151,048,493 bytes in length and contains 2,146,899 terms. Therefore the Category 0 vocabularies, in aggregate, are about half the size of the UMLS metathesaurus.A large publicly available listing of 567,921 different medical phrases were automatically coded using the full UMLS metatathesaurus and the Category 0 vocabularies. There were 545,321 phrases with one or more matches against UMLS terms while 468,785 phrases had one or more matches against the Category 0 terms. This indicates that when the two vocabularies are evaluated by their fitness to find at least one term for a medical phrase, the Category 0 vocabularies performed 86% as well as the complete UMLS metathesaurus. CONCLUSION: The Category 0 vocabularies of UMLS constitute a large nomenclature that can be used by biomedical researchers to annotate biomedical data. These annotated data sets can be distributed for research purposes without violating the UMLS License Agreement. These vocabularies may be of particular importance for sharing heterogeneous data from diverse biomedical data sets. The software tools to extract the Category 0 vocabularies are freely available Perl scripts entered into the public domain and distributed with this article.

Algorithms↗
PubMed1999

Multimedia electronic medical record systems.

A wide range of imaging technologies are becoming increasingly important to the practice of medicine. In addition, many medical specialties are highly visual, independent of their use of new imaging modalities. Because today's medical record contains text, images, and physiologic signals, it is inherently multimedia in nature. However, most electronic medical record systems handle only the textual portion of the patient record, resulting in a fragmentation of the database that physicians need to make timely, effective clinical decisions. Advances in database-, storage-, data-compression, and networking technologies will facilitate the development of multimedia electronic medical record systems for the 21st century. These systems will become widely used over the next decade, and in addition to enhancing patient care, will also present new opportunities for using clinical imaging data for biomedical research and education.

Forecasting↗
PubMedDate not supplied

Implementation of an enteral nutrition and medication administration system utilizing oral syringes in the NICU.

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using TV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double-check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Administration, Oral↗
PubMed2005

Prevalence of dementia among Veterans Affairs medical care system users.

OBJECTIVES: In an aging population, the number of veterans diagnosed with dementia is likely to increase. Knowledge of existing dementia prevalence will be beneficial in planning for future patient care needs. Our objectives were to assess the prevalence of the dementia diagnosis among those treated at Veterans Affairs (VA) medical centers and determine how it varies across race and Veterans Integrated Service Network (VISN). MATERIALS AND METHODS: Data were collected on all veterans seen within the VA medical system from 1997 through the first half of 2001. Only veterans aged 65 and over were included in the study. Veterans were included if they had one of the following dementia ICD-9 codes: 290.XX, 291.2, 294.XX, 331.XX, 046.1, or 046.3. RESULTS: The overall prevalence of dementia was 7.3%. The prevalence of dementia was similar among white patients and patients of other races, except African-American patients, in whom it was 50% higher. Across VISNs, the prevalence of dementia ranged from 5.8 to 9.4%. Alzheimer's disease was the most frequently diagnosed type of dementia within the VA, and inpatient service utilization and outpatient psychiatry visits by individuals with dementia were high relative to other VA patients. DISCUSSION: The overall prevalence identified is consistent with that reported in the literature, as is the elevated prevalence in African-Americans versus whites. The data on prevalence by VISN may identify regional variation in either the types of dementia present or the diagnostic criteria used. The dementia diagnosis is clearly associated with substantial service use.

Age Factors↗
PubMed1993

Relativism and the social scientific study of medicine.

Does the social scientific study of medicine require a commitment to relativism? Relativism claims that some subject (e.g., knowledge claims or moral judgments) is relative to a background (e.g., a culture or conceptual scheme) and that judgments about the subject are incommensurable. Examining the concept of success as it appears in orthodox and nonorthodox medical systems, we see that judgments of success are relative to a background medical system. Relativism requires the social scientific study of medicine to be value free in the sense that a medical system must be described without evaluating its elements. When social scientists do evaluate the successfulness of a nonorthodox medical system, they give a crucial role to the nonorthodox conception of success. This strategy does not vitiate value-freedom and it entails a relativism about success. The social scientific study of medicine, therefore, does require relativism in the form of a relativism about success.

Christianity↗
PubMed1993

Patients' reactions to physician use of a computerized medical record system during clinical encounters.

BACKGROUND: As physicians begin to use computer technology in front of patients during clinical encounters, concern has been raised that such computer use may exert a dehumanizing effect on the physician-patient relationship. To investigate this concern, we measured patient reactions to physician use of a computerized medical record system during clinical encounters. METHODS: Adult patients who presented for clinical care were randomized into three groups. With the first group, the physician used a standard paper-and-pencil charting system during the encounter. With the second group, the physician used a computerized medical record system with keyboard input. With the third group, the physician used the computerized medical record system with voice input. Patient reactions were measured with a questionnaire that the patients completed after the clinical encounter. RESULTS: For most components of the physician-patient relationship studied in this report, questionnaire scores did not differ significantly among the three study groups. Patients in the voice input group rated physician explanations of patient problems significantly higher than patients in the other two groups. There was a trend for patient confidence in the physician to be higher in the keyboard input group. Although measured encounter durations were significantly shorter in the computer groups, there were no differences in patient satisfaction with encounter duration among the three groups. CONCLUSIONS: Physician use of computers during clinical encounters was not associated with a decline in the perceived quality of the physician-patient relationship.

Adult↗
PubMedDate not supplied

Three-dimensional helical CT for treatment planning of breast cancer.

PURPOSE: The role of three-dimensional (3D) helical CT in the treatment planning of breast cancer was evaluated. METHODS: Of 36 patients examined, 30 had invasive ductal carcinoma, three had invasive lobular carcinoma, one had DCIS, one had DCIS with minimal invasion, and 1 had Paget's disease. Patients were examined in the supine position. The whole breast was scanned under about 25 seconds of breath-holding using helical CT (Proceed, Yokogawa Medical Systems, or High-speed Advantage, GE Medical Systems). 3D imaging was obtained with computer assistance (Advantage Windows, GE Medical Systems). RESULTS: Linear and/or spotty enhancement on helical CT was considered to suggest DCIS or intraductal spread in the area surrounding the invasive cancer. Of 36 patients, 24 showed linear and/or spotty enhancement on helical CT, and 22 of those 24 patients had DCIS or intraductal spread. In contrast, 12 of 36 patients were considered to have little or no intraductal spread on helical CT, and eight of the 12 patients had little or no intraductal spread on pathological examination. The sensitivity, specificity, and accuracy rates for detecting intraductal spread on MRI were 85%, 80%, and 83%, respectively. CONCLUSIONS: 3D helical CT was considered useful in detecting intraductal spread and planning surgery, however, a larger study using a precise correlation with pathology is necessary.

Breast Neoplasms↗