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At least 955 records · Page 53Linked to original sources
PubMed1999

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.

Ambulatory Surgical Procedures↗
PubMed1990

[Occupational satire in Bernardino Ramazzini's 'De Morbis Artificum Diatriba'].

The classic work on occupational medicine, Ramazzini's 'De morbis artificum diatriba' (1700), is viewed from the perspective of literary history. The rhetorical term "diatribe" refers to the ancient traditions of Roman satire and Cynic moral philosophy. The literary model for Ramazzini's compendium is found in books of trade (Ständebücher) of the 16th and 17th century, in which the occupations of the time are characterized and satirized according to their individual vices. These literary traditions allow one to read Ramazzini's 'Diatriba' as a critical satire of social relations. In the course of interpreting selected chapters, it will become clear that the occupational illnesses of the working people, besides standing in a causal relationship to the moral illnesses of the privileged, are emblems and allegorical expressions of the Baroque view of life.

History, 18th Century↗
PubMed1981

The selection of patients at the Groote Schuur Maternity Hospital.

The Peninsula Maternity and Neonatal Service (PMNS) was established on 1 January 1980 as a result of the regionalization of obstetric and neonatal services in the Cape Peninsula. Some 20000 deliveries per annum occur in the 5 maternity hospitals and 3 Midwife Obstetric Units (MOUs) under the aegis of the PMNS. As part of the reorganization of the service the booking and referral criteria have been revised, taking into account the function of the Groote Schuur Hospital Maternity Block as the high-risk unit. The concept of risk in perinatology is discussed. The booking and referral criteria are detailed under the headings of booking criteria for hospital and for MOUs and referral criteria from the MOU to hospital -- antenatally, in labour, in the puerperium and for neonatal problems.

Ambulatory Care Facilities↗
PubMed2005

Overnight-stay patients in a day surgery unit to overcome shortage of inpatient beds.

A dedicated 23-h stay list was organised at the Addenbrooke's Hospital day surgery unit for elective cases in oral and maxillofacial surgery of minor or moderate severity that would normally be done as inpatients. The patients were selected by the two consultant oral and maxillofacial surgeons and the operations were done by a consultant surgeon (L.C.) and a consultant anaesthetist. Over a 14 month trial period 137 patients were admitted to our 23-h stay lists. One hundred and twenty seven of whom were operated on and stayed overnight, nine went home the same day, and one patient stayed beyond the 23-h limit as he was admitted to the medical ward after a grand mal seizure. The operations were for neoplastic, traumatic, salivary gland and jaw lesions. The reasons for using the overnight-stay facilities varied from social reasons to the need to monitor the airway. The fact that the theatre slots and overnight beds were guaranteed, and that the admissions were booked at outpatient consultation led to few cancellations by patients. This process reduced the inpatient waiting list and released the main operating theatre for major oral and maxillofacial operation, particularly for cancer.

Ambulatory Surgical Procedures↗
PubMed1986

A survey of elderly patients admitted to hospital for social reasons.

A random 4% sample of the over 65's discharged from general hospitals throughout Wales was selected from Welsh Office HAA returns. Included within the group were 101 patients admitted for social reasons (ICD code V600 to V6055). Such patients were predominantly very elderly, female and extremely disabled. Typically such patients lived with, and were being cared for, by relatives. The majority of admissions were booked or planned to provide relief to these carers. Geographical variations in the use of such care was demonstrated. Use of domiciliary medical services by these patients was extremely high in contrast to their use of domiciliary social services. Mortality and re-admission rates at 3 months and 12 months after the initial discharge were very high and hospital treatment had little influence upon patients' disability. However, the short mean length of stay suggests that such patients do not 'block beds'.

Aged↗
PubMed2006

Nutrition awareness and pregnancy: implications for the life course perspective.

OBJECTIVE: To explore the influence of a life event (pregnancy) on nutrition awareness and the motivations for nutrition behaviour. STUDY DESIGN: In-depth, face-to-face interviews with five groups of 12 women: women wishing to conceive a child, women in the first, second, and third trimesters of their first pregnancy, and women in the first trimester of their second pregnancy. As is common in qualitative research, participants were selected on the basis of diversity together with maximum representativeness within normal populations with respect to socio-demographic characteristics. RESULTS: With respect to nutrition awareness, three groups of women can be distinguished: (1) those who are 'going all the way'; these women try to live precisely by the book, (2) those who are 'taking the flexible way'; these women are more aware of their nutrition, but are more flexible in handling it, and (3) women who 'continue the same way'; these women have a no-nonsense mentality and do not experience essential shifts in their nutrition awareness. The extent and fluctuations in nutrition awareness throughout preconception and pregnancy are based on three types of motivations, the interest of (1) the child, (2) the mother, and (3) the social environment. CONCLUSIONS: This study provides indications that preconception and pregnancy could indeed be a life event leading to increased general nutrition awareness that might influence women's future nutrition-related behaviours.

Adult↗
PubMed1991

Contact allergens in registered chemical products.

A national database on chemical products (the Danish Product Register (PROBAS] was searched for products containing selected contact allergens. As of June 1990, a total of 47,400 products were registered in PROBAS. About 27,800 of these were fully computerized. A list of 43 allergens was established, based on the European standard patch test series, substances classified "May cause sensitization by skin contact", text books on contact dermatitis, and clinical experience. The number of products in which each of these allergens was registered varied from 30 to more than 1300. Formaldehyde was registered in all product categories included in the study. Benzyl alcohol, stearic acid, epoxy compounds, diethylenetriamine and butylated hydroxytoluene were registered in more than half of the product categories. Paints/lacquers and hardeners for two-component products (paints, glues, fillers, etc.), cleaning agents, binders, adhesives/glues and toiletries made up the most frequently registered product categories for the allergens listed. The possibilities and limitations of database information on chemical products are discussed.

Allergens↗
PubMedDate not supplied

[Possibilities of special correction in restoration of reading capacity in poorly sighted patients].

A total of 1012 patients aged 6-94 years (31.9% aged under 19 years, 25.2% aged 20-60 years, and 42.9% aged over 60) with poor sight, 83% of whom could not read book type, were examined. Corrected far visual acuity was 0.03-0.35, in 52.7% of these 0.1-0.2 and in 38.2% less than 0.1. The most incident diseases were retinal and optic nerve disease (40.6%), complicated myopia (15%), congenital ocular diseases (17.3%), aphakia (9.8%), and glaucoma (7.9%). In order to select correction, near visual acuity, reading acuity, and reading speed were evaluated. Optic magnifiers, such as hyperocular eyeglasses, magnifying glasses of different types (supporting, applied, special, manual, and telescopic) were used for correction. Four-fold magnifiers were prescribed most often (67.3%). Optic magnifiers allowed reading in 78% cases. The decisive factors of the device efficiency were reading acuity (no more than 48 points) and reading speed (at least 200 signs/min). Ocular disease, visual field status, patient's age and psychosomatic state, and technological characteristics of the device are also important factors.

Adolescent↗
PubMedDate not supplied

Establishment of a reference collection of substances and an analytical handbook of reference data to support enforcement of EC regulations on food contact materials.

A collection has been made of monomers and other starting substances that are required as analytical standards for enforcement of European Community legislation on food contact materials. The substances have been analysed by mass spectrometry and appropriate chromatographic methods to indicate the presence of impurities. The collection has been supplemented by a database of infra-red and mass spectra, and a handbook that collates various information to assist enforcement laboratories in the identification of plastics articles and the selection of appropriate methods of analysis where these are available.

Databases, Factual↗
PubMed1990

Applications of the International Classification of Diseases.

A brief outline is given of how various types of adaptation of the ICD for use in different situations have arisen. The application includes condensed lists, national adaptations, studies of morbidity, specialty adaptations (including for primary care), and augmentation by supplementary material. The major purposes of different applications are reviewed and an indication is given of factors influencing selection of the condition of primary interest in such situations. The article concludes by suggesting guidance for the development of applications and adaptations of the ICD.

Disease↗
PubMed2005

Official USP Reference Standards: metrology concepts, overview, and scientific issues and opportunities.

The United States Pharmacopeia (USP) is a private standards-setting body created in 1820 by practitioners who wished to promote the quality of therapeutic products in commerce. The principal product of USP, then and now, is the United StatesPharmacopeia (USP), to which was added the National Formulary (NF) in 1975. The two compendia are published as a combined text annually (USP-NF). Originally a book of process standards, USP-NF evolved over time into compendia containing primarily product standards that are expressed in monographs for therapeutic ingredients, products, and excipients. As a public health service, USP supplies official USP Reference Standards to manufacturers and others who wish to test an article according to selected procedures of a monograph or General Chapter. During the past decade, understanding of USP monographs and official USP Reference Standards as a means of controlling the quality of a therapeutic article has evolved, based on advances in metrology, on activities in the International Conference on Harmonization of Technical Requirements for the Registration of Pharmaceuticals for Human Use (ICH), and on considerations by the USP Council of Experts and its Expert Committees and USP staff. This article discusses the evolution of this understanding, focusing on drug substances and excipients for well-characterized small molecules and their corresponding dosage forms.

Adverse Drug Reaction Reporting Systems↗
PubMed1976

Guide to research on the Rosenzweig Picture-Frustration (P-F) Study, 1934-1974.

Research on and with the Rosenzweig Picture-Frustation (P-F) Study and its precursors, 1934-1974, is presented. Investigations with the original versions of the P-F in English and the parallel, standardized versions in Europe, Asia and the Americas are covered. More than 500 articles and books are organized by topic in a Citation Index giving authors and dates. The available references for a given topic can then be readily located. The major topics include basic (construct) research, reliability, validity, and pragmatic applications. These applications pertain to developmental and individual differences, clinical disorders, antisocial behavior, personnel selection, counseling and therapy, educational and school psychology, cultural and socioeconomic differences, and experimental psychodynamics.

Aggression↗
PubMed1999

A comparative study of pregnancy outcome in teenage girls and mature women.

The objective was to compare the pregnancy outcome of teenage girls and mature women. The design was a retrospective study of births from January to December 1990, based on the antenatal clinic and the labour ward, University Hospital of the West Indies, Jamaica. Teenage mothers, 13 to 19 years old, and a control group of mothers, 22 to 23 years old, were selected from the records of 2,394 live, singleton births between 200 and 305 days' gestation. The main outcome measures were birth weight, crown heel length, head circumference, head circumference:length ratio, ponderal index and placental weight. The results showed that in the teenage group, weight, body mass index at booking, haemoglobin concentration in each trimester, and minimum haemoglobin level during pregnancy were lower than in the control group. Systolic blood pressure in the first and the second trimesters was lower than in controls, but there was no significant difference in the third trimester nor in the delivery systolic blood pressure. Babies of teenage mothers had lower birth weights and smaller head circumferences than the babies of the control group, but there was no significant difference between the groups in crown heel length, ponderal index, head circumference:length ratio, and placental weight. These data support the hypothesis that teenaged girls are not physically mature and, as a consequence, their offspring have lower birth weights and smaller head circumferences.

Adolescent↗
PubMedDate not supplied

Indigenous practices of Saudi girls in Riyadh during their menstrual period.

The objective of this study was to identify the indigenous menstrual hygiene practice of Saudi girls in Riyadh. A total of 600 girls aged from 11 years to 18 years were selected from outpatient clinics at three different hospitals in Riyadh. Data were collected using a structured interview. The results revealed that nearly two-thirds of the girls avoided certain foods, drinks and activities, including showering and performing perineal care, and practised several indigenous rituals during the period. Mother, religious books and sisters were the main sources of the girls' infomation. The study suggests that nurses and health care providers should use all available opportunities to educate young girls about menstruation.

Adolescent↗
PubMed1995

Clinical research in ancient Babylon: methodologic insights from the book of Daniel.

Around 600 BC, Daniel of Judah conducted what is widely regarded as the earliest recorded clinical trial. His trial compared the health effects of a vegetarian diet with those of a royal Babylonian diet over a 10-day period. The strengths of his study include the use of a contemporaneous control group, use of an independent assessor of outcome, and striking brevity in the published report. Weaknesses include probable selection bias, ascertainment bias, and confounding by divine intervention. Although Daniel probably never achieved tenure, he did get "learning and skill in all letters and wisdom ... and understanding in all visions and dreams" (well before Freud). Despite the trial's dramatic findings, over 4 centuries elapsed before publication of Daniel's results. Daniel apparently perished, then published.

Bible↗
PubMed1975

Breast cancer in patients with Hashimoto's thyroiditis.

The case records of four groups of women over thirty on the books of a thyroid clinic were used to explore a possible association between breast cancer and Hashimoto's thyroiditis. The index group consisted of 1810 women (10 160 person-years of observation) with Hashimoto's thyroiditis, and the three control groups, matched by sex, age, marital status, and residency, were selected from patients with myxoedema (essential hypothyroidism), benign nodular goitre, or hyperthyroidism. The incidence of breast cancer for the index group, though not for control groups, was significantly higher than that expected from data for the general population, suggesting that patients with Hashimoto's thyroiditis are one high-risk population for breast cancer.

Adenocarcinoma↗
PubMed1980

Fragmin: a calcium ion sensitive regulatory factor on the formation of actin filaments.

Physarum actinin previously isolated [Hatano, S., & Owaribe, K. (1976) in Cell Motility (Goldman, R., Pollard, T., & Rosenbaum, J., Eds.) Vol. 3, Book B, p 499, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY] was found to be a 1:1 complex of actin and fragmin which is a regulatory factor in the formation of actin filaments. Since fragmin did not contain a cysteine residue, it was purified from the complex by the selective cleavage of actin with 2-nitro-5-thiocyanobenzoic acid, followed by column chromatography. Fragmin had nearly the same molecular weight as actin, but had a quite different amino acid composition. When added to G-actin before polymerization, fragmin accelerated the initial viscosity increase of actin solutions induced by salts, but kept the final viscosity much lower than normal F-actin. When added to F-actin after polymerization, fragmin drastically reduced the viscosity of actin solutions. In both cases, the final products of reaction of fragmin with actin were short F-actin filaments. The number average length of the filaments decreased with the increasing molar ratio of fragmin to actin, and the length distribution was always exponential. Fragmin required for its activity a concentration of free Ca2+ higher than 10(-6) M. When the concentration of free Ca2+ was lower than 10(-7) M, fragmin affected neither actin polymerization nor F-actin. The regulation by Ca2+ was reversible.

Actinin↗
PubMed2000

Neurocognitive dysfunction after coronary artery bypass surgery: a systematic review.

OBJECTIVE: Substantial, albeit scattered, evidence suggests that coronary artery bypass grafting may impair cognitive function. As methods and definitions differ greatly across studies, the reported incidence of cognitive decline after coronary bypass surgery varies widely as well. The aim of the present study was to systematically review those studies on cognitive decline that are relatively comparable and meet with certain quality criteria. METHODS: Four electronic databases and the references of several abstract books and earlier reviews were used to identify relevant literature. Stringent criteria, based in part on the 1994 consensus meeting on assessment of neurobehavioral outcomes after cardiac surgery, were used to assess the studies that were found. In total, 256 different titles were found, of which 23 met with the formulated selection criteria. RESULTS: Twelve cohort studies and eleven intervention studies were evaluated. A pooled analysis of six highly comparable studies yielded a proportion of 22.5% (95% confidence interval, 18.7%-26.4%) of patients with a cognitive deficit (a decrease of at least 1 standard deviation in at least two of nine or ten tests) 2 months after the operation. CONCLUSIONS: Neurocognitive dysfunction is a frequently occurring complication of coronary artery bypass grafting. The etiologic contribution of cardiopulmonary bypass to this complication will remain unclear until a randomized trial that directly compares off-pump and on-pump bypass surgery is carried out.

Cardiopulmonary Bypass↗