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At least 973 records · Page 54Linked to original sources
PubMed2005

The Auburn Elective Surgery Pilot Project.

BACKGROUND: The aim of this project was to increase rates of day surgery, reduce elective surgical waiting lists, give patients a guaranteed date of surgery and improve operating theatre utilization. The guiding principle behind the project was to treat the administration of elective surgery as a separate business unit, distinct from emergency surgery. METHODS: Elective surgical referrals for admission from throughout the Western Sydney Health Area Service were pooled. The procedure for surgical admissions was altered in three areas: (i) the use of a new booking and waiting list system administered by a dedicated nurse coordinator who generated the lists for surgery; (ii) restructuring the elective surgical operating sessions; and (iii) planning post-discharge care at the time of operation using model clinical pathways. RESULTS AND CONCLUSIONS: During the project period, the number of the selected surgical procedures performed doubled. Fifty-seven per cent of patients were discharged on the day of surgery. Surgeons took less time to perform procedures. By the end of the trial period, waiting lists for the selected procedures were eliminated. Operating costs as evaluated by the Centre for Health Economics Research and Evaluation were reduced by 25%. The administrative changes to surgical admissions resulted in improved cost and patient throughput for elective surgical admissions with no adverse patient outcomes.

Ambulatory Surgical Procedures↗
PubMed1997

Establishing outpatient cholecystectomy as a hospital routine.

OBJECTIVE: To determine the rate of outpatient cholecystectomies done voluntarily by surgeons and to identify any "correctable" factors leading to hospital admission, also to reassess the outpatient cholecystectomy rate after correcting the identified factors. DESIGN: A prospective analysis. SETTING: A 256-bed non-teaching acute-care community hospital on the outskirts of a major urban centre, served by 4 general surgeons. PATIENTS: All 515 patients booked for elective cholecystectomy at the hospital between Apr. 1, 1994, and Mar. 31, 1996, inclusive. INTERVENTION: Elective outpatient cholecystectomy. MAIN OUTCOME MEASURE: A successful procedure without compromise of safety. RESULTS: In the preliminary study, outpatient cholecystectomy was done in 75% of the patients. Variations in individual surgical practice, preoperative patient selection and inappropriate day surgery facilities were thought to be correctable factors leading to admission. After correction of the these factors (follow-up study), the rate of outpatient cholecystectomy rose to 95% (p < 0.001). Variations in individual surgical practice disappeared, and no patient required processing through inappropriate day surgery facilities. No patient suffered untoward effects from outpatient management. CONCLUSIONS: Outpatient cholecystectomy is a safe hospital routine for all elective procedures without selection. Voluntary acceptance of this routine leads to an initial 75% outpatient rate. Identifying and correcting modifiable factors led to a significant increase in the institutional outpatient rate, comparable to reported individual rates.

Adult↗
PubMedDate not supplied

Automation of the birth registry log book.

If available resources are limited, a computer novice with basic computer skills can develop and implement an electronic database management system. Commitment and determination to automate manual record keeping of birth registry data are crucial. Some of the database software systems available today were designed to be user friendly. Product reviews published in personal computer magazines will assist an end user to find such user-friendly programs. Once a system is selected and implemented, data can be easily retrieved and used for simple to advanced database functions. Hospital statistics, state-required maternity statistical reports, and research, quality assurance/quality improvement, staffing justification, market research, and critical path variance reports will benefit from the wide array of data manipulation techniques.

Birth Certificates↗
PubMed2006

Therapeutic transarterial embolisation in the management of benign and malignant renal conditions.

PURPOSE: The aim of this study was to critically appraise the efficacy and complications of Therapeutic Transarterial Embolisation (TAE) in various benign and malignant renal conditions. MATERIAL AND METHODS: The records of all patients who underwent renal embolisation procedures, at a single institution, between March 1992 and March 2004, were reviewed. The patients were identified from hospital records via the procedure coding system and the radiology department procedures book and were analysed retrospectively. Twenty-nine patients were analysed, looking at indications, clinical outcome, complications and long-term results. RESULTS: Twenty-nine patients underwent 35 embolisation procedures during this period. Fourteen patients with benign diseases underwent 17 embolisation procedures for haematuria or intractable pain. In the haematuria group, selective embolisation was used to treat bleeding post percutaneous nephrolithotomy (PCNL) (n=4), angiomyolipoma (n=2), arteriovenous (AV) malformation (n=l1), renal artery aneurysm (n=1) and renal trauma (n=2). In the renal pain group (n=3), non-selective embolisation was done. Two of these patients had recurrence of pain despite repeat embolisation and subsequently underwent nephrectomy. Fifteen patients with advanced renal malignancy, who were deemed unfit for surgery, underwent 18 embolisation procedures for symptomatic haematuria. Twelve of the 15 patients had successful outcomes with cessation of haematuria. Three patients required repeat embolisation procedures for continuing haematuria with success. There were no major embolisation-related complications. Minor complications were self-limiting and settled with conservative management. CONCLUSION: Renal artery embolisation is effective in managing haematuria in benign and malignant renal conditions where indicated, with minor and easily treatable adverse effects

Adult↗
PubMed1992

Hypercard coding system for the ACR Index for Radiological Diagnoses.

We describe a computer version of the Index for Radiological Diagnoses of the American College of Radiology (ACR). This system combines a graphics interface with a search mechanism while preserving the hierarchical structure of the Index. The graphics interface allows easy selection of an anatomic part, while the search mechanism provides the code numbers associated with an entered term. The computer system and the paperback version of the ACR Index were compared by having 52 volunteers (21 radiology faculty members, 21 radiology residents, and 10 medical students) each code 30 cases with the book and a matched set of 30 cases with the computer. The average time to code cases was shorter when the computer was used (52.2 vs 64.5 sec; p less than .0001). Accuracy was higher when the computer was used (96.4% vs 90.4%; p less than .0001). The average confidence in the computer diagnosis was also higher (9.73 vs 9.51, on a scale of 1-10; p = .0016). This system demonstrates the ability of a computer program to outperform an analogous noncomputerized system.

Disease↗
PubMed1987

Diversification offers new opportunities for health care.

In this excerpt from the book, Market-Driven Strategies in Healthcare, healthcare diversification is explored. The various reasons, survival strategies, and expectations for a new venture are outlined. Although many new ventures are struggling and profits are being generated slowly, there are many potentially successful opportunities available to the aggressive healthcare system. With careful screening and selection, diversification efforts by an organization can present promising results.

Evaluation Studies as Topic↗
PubMed2006

Mapping the literature of nurse practitioners.

OBJECTIVES: This study was designed to identify core journals for the nurse practitioner specialty and to determine the extent of their indexing in bibliographic databases. METHODS: As part of a larger project for mapping the literature of nursing, this study followed a common methodology based on citation analysis. Four journals designated by nurse practitioners as sources for their practice information were selected. All cited references were analyzed to determine format types and publication years. Bradford's Law of Scattering was applied to identify core journals. Nine bibliographic databases were searched to estimate the index coverage of the core titles. RESULTS: The findings indicate that nurse practitioners rely primarily on journals (72.0%) followed by books (20.4%) for their professional knowledge. The majority of the identified core journals belong to non-nursing disciplines. This is reflected in the indexing coverage results: PubMed/MEDLINE more comprehensively indexes the core titles than CINAHL does. CONCLUSION: Nurse practitioners, as primary care providers, consult medical as well as nursing sources for their information. The implications of the citation analysis findings are significant for collection development librarians and indexing services.

Abstracting and Indexing↗
PubMed2000

Neuronal signal transduction pathways: wasteland or the promised land?

Proteins used in signal transduction pathways are commonly found in different cell types and organs. However, specific proteins whose expression is highly restricted are also utilized for allowing discrete responsiveness to signals that are otherwise ignored by other cells. How the brain uses common and specific signal proteins for communication within and beyond the cerebrum has been an area of intense study. A new book concentrates on the signaling that occurs in the brain under normal and pathological conditions--memory, apoptosis, neurodegeneration, depression, and drug dependence--and is filled with chapters written by experts in neurobiology and neurophysiology. Bryan Roth reviews the book and discusses in detail several chapters that may lead to promising future research.

Adrenergic Uptake Inhibitors↗
PubMed2000

Tyrosine supplementation for phenylketonuria.

BACKGROUND: Phenylketonuria is an inherited disease for which the main treatment is the dietary restriction of the amino acid phenylalanine. The diet has to be initiated in the neonatal period to prevent or reduce mental handicap however the diet is very restrictive and unpalatable and can be difficult to follow. A deficiency of the amino acid tyrosine has been suggested as a cause of some of the neuropsychological problems exhibited in PKU. Therefore, this review aims to assess the efficasy of tyrosine supplementation for phenylketonuria. OBJECTIVES: To assess the effects of tyrosine supplementation alongside or instead of phenylalanine restricted diet for patients with phenylketonuria who commenced on diet at diagnosis and either continued on the diet or relaxed the diet later in life. To assess the evidence that tyrosine supplementation alongside, or instead of phenylalanine restricted diet improves intelligence, neuropsychological performance, growth and nutritional status, mortality rate and quality of life. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Trials Register which is a specialist trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Additional studies were identified from handsearching the Journal of Inherited Metabolic Disease (from inception, 1978, to 1998). The manufacturers of prescribable dietary products used in the treatment of phenylketonuria were also contacted for further references. Date of the most recent search of the Group's specialised register: November 1999. SELECTION CRITERIA: All randomised or pseudo-randomised trials investigating the use of tyrosine supplementation versus placebo in patients with phenylketonuria in addition to, or instead of, a phenylalanine restricted diet. Patients treated for maternal phenylketonuria were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trial eligibility, methodological quality and extracted the data. MAIN RESULTS: Two trials were included with a total of 47 patients. The blood tyrosine concentrations were significantly higher in the patients receiving tyrosine supplements than those in the placebo group (weighted mean difference 22.526, 95% Confidence interval (CI) 12.182 - 32.870). No significant differences were found between any of the other outcomes measured. REVIEWER'S CONCLUSIONS: From the available evidence no recommendations can be made about whether tyrosine supplementation should be introduced into routine clinical practice. Further randomised controlled studies are required to provide further evidence.

Dietary Supplements↗
PubMed2006

Life story work in health and social care: systematic literature review.

AIM: The aim of this paper is to review the literature on life story work in health and social care practice. BACKGROUND: Life story work as an intervention has been used with a number of health and social care clients, such as children people with learning disabilities, older people on medical wards and with older people who have dementia. It may help challenge ageist attitudes and assumptions, be used as a basis for individualized care, improve assessment, assist in transitions between different care environments, and help to develop improved relationships between care staff and family carers. However, to date there has been no attempt to collate the findings from published accounts. METHODS: A systematic search of the literature on life story work was conducted in February 2004, using nursing, medical and social science databases and a combination of thesaurus and free text search terms. This revealed over 1000 publications; the use of carefully constructed inclusion and exclusion criteria identified 51 relevant items. Fourteen were subsequently selected and reviewed using a set of reflective critical appraisal questions. FINDINGS: A range of methodological approaches has been adopted to explore the use of life story work with no one specific methodology prevailing. The work has been most frequently used with older people and people with a learning disability and life story books are the most common approach. Staff perceptions of life story work have been explored, but patient and carer views are less frequently reported. The findings of the studies are discussed in broad themes, offering some tentative recommendations for using life story work in practice. CONCLUSION: Evidence on the use of life story work is immature, leading to the recommendation for more research. Although appraising literature from a range of approaches is complex, there are some potentially far-reaching benefits of life story work in health and social care practice.

Aged↗
PubMed1994

Family welfare and health practices increase after exposure to population education.

Since 1987, the State Resource Center of Jamia Millia Islamia of New Delhi has been implementing a program which integrates population education contents into its literacy education classes for adult learners. Using the core messages on family size, spacing of children, responsible parenthood, right age of marriage, population-related beliefs and customs and population and development, the Center undertook many activities such as: i) integrating population contents in literacy primers, readers and supplementary reading books; ii) development of teaching aids and instructor's resource materials; iii) organization of training for instructors and iv) holding outreach activities such as street corner plays, fairs, etc. To evaluate the impact of the program, the Center undertook an impact survey to measure the level of knowledge, attitude and practices of randomly selected beneficiaries of the project, i.e. 934 learners from 85 literacy learning centers, 5 years after the introduction of the population education program. The study used pre-test and post-test method for collecting data and to compare results. In terms of practice, the study has shown that the respondents having knowledge about family planning methods increased from 67 to 87%, after being exposed to the project's activities. There was also an increase of 61% in cases adopting family planning methods over the pre-measurement level. More importantly, there was not only an increase in awareness of public health and family welfare services but a 137% increase was registered in the use of public health and family welfare facilities for family planning counseling and services. With regard to knowledge and attitude on the various population education messages promoted by the project, the study has shown a 40% increase in "high" knowledge category and 25% increase in favorable attitude after the exposure to the project.

Asia↗
PubMed2004

Equity of access to elective surgery: reflections from NZ clinicians.

OBJECTIVES: To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. METHODS: A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. RESULTS: General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. CONCLUSIONS: The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

Attitude of Health Personnel↗
PubMed2005

Reasons for attending dental-care services in Ouagadougou, Burkina Faso.

OBJECTIVE: To determine why patients attend dental-care facilities in Ouagadougou, Burkina Faso and to improve understanding of the capacity of oral health-care services in urban west Africa. METHODS: We studied a randomly selected sample of patients attending 15 dental-care facilities in Ouagadougou over a 1-year period in 2004. Data were collected using a simple daily record form. FINDINGS: From a total of 44,975 patients, the final sample was established at 14,591 patients, of whom 55.4% were new patients and 44.6% were "booking patients". Most patients seeking care (71.9%) were aged 15-44 years. Nongovernmental not-for-profit dental services were used by 41.5% of all patients, 36% attended private dental-care services, and 22.5% of patients visited public services. The most common complaint causing the patient to seek dental-care services was caries with pulpal involvement (52.4%), and 60% of all complaints were associated with pain. The patients' dental-care requirements were found to differ significantly according to sex, health insurance coverage and occupation. CONCLUSION: Urban district health authorities should ensure provision of primary health-care services, at the patients' first point of contact, which are directed towards the relief of pain. In addition to the strengthening of outreach emergency care, health centres should also contribute to the implementation of community-based programmes for the prevention of oral disease and the promotion of oral health. Exchange of experiences from alternative oral health-care systems relevant to developing countries is urgently needed for tackling the growing burden of oral disease.

Adolescent↗
PubMed2001

Primary care services promoting optimal child development from birth to age 3 years: review of the literature.

OBJECTIVE: To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years. DATA SOURCES: Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. STUDY SELECTION: Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English. DATA EXTRACTION: A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion. DATA SYNTHESIS: Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems. CONCLUSIONS: The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.

Child Development↗
PubMed2000

[Review of several different forms of psychotherapy in treatment of depression].

The present article endeavours to introduce, in a concise form, selected forms of psychotherapy for the treatment of depressions. In particular behaviour therapy (BT), cognitive therapy (CT), interpersonal psychotherapy (IPT) and a psychoanalytically oriented and inspired therapy, subsequently named psychodynamic therapy (PT), are described. The attempt to offer a brief presentation of these treatment methods follows essentially the descriptions of Elizabeth Schramm in her book "Interpersonelle Psychotherapie". We thank the author for giving her kind consent to our publication. Our main concern is to enable the reader to recognize the essential characteristics and differences between these treatment forms, so that he can give the depressive patient advice on the choice of an adequate treatment. The first three brief psychotherapies have been developed specifically for the treatment of depressions. The psychodynamically (psychoanalytically) oriented approach is the most frequently used. CT, BT and IPT in particular have in common that they offer a temporally limited, clearly structured treatment programme in the sense of a manual, and are thus teachable and conveyable and efficient with respect to costs. We would point out, however, that combinations between the different treatment forms are possible and that a strict distinction between the separate methods is chiefly of didactic value. Essential to all treatment methods is the empathic and supporting relation to the patient. The therapist should play an active role and should convey the hope that the patient can be helped. All the described treatment forms are suited for the treatment of light to moderately severe depressions, with or without concomitant psychopharmacological therapy. In psychodynamic therapy the tendency is to dispense with medication, whereas CB, CT and IPT tend to integrate the use of psychoactive drugs in their treatment schedules. In our opinion psychopharmacological treatment should on no account be renounced to in severe depressions and where there is risk of suicide. We would also point out that IPT and CT offer specific group programmes for the in-patient treatment of depressive patients. The four treatment forms are briefly reviewed (theoretic background, treatment indications, monitoring, effectiveness), followed by a short overview of the most essential characteristics and differences between the separate treatment forms and by contact addresses.

Combined Modality Therapy↗
PubMed1998

Presentation and reading level of sleep brochures: are they appropriate for sleep disorders patients?

OBJECTIVE: Sleep-disorders patients must be given information and health education they understand. The purpose of this study was twofold: (1) to assess suitability of American Sleep Disorders Association and National Sleep Foundation patient education brochures; and (2) to assess one widely used brochure, using patient input and patient literacy level, as a model for development of future materials. DESIGN: Twelve American Sleep Disorders Association and National Sleep Foundation brochures were assessed for reading level using Grammatik, and for design, presentation, and motivating qualities using the Suitability Assessment of Materials (SAM). Patient literacy level was assessed using the Rapid Estimate Of Adult Literacy in Medicine (REALM). SETTING: The Louisiana State University Medical Center sleep clinic, faculty private sleep clinic, and in the sleep center laboratory. PATIENTS OR PARTICIPANTS: During the months of February-May 1997, 170 sleep disorders patients, 39% African American, 59% white participated in the study. Participants ranged in age from 18-73 years, with a mean age of 46. MEASUREMENTS AND RESULTS: Suitability scores for the 12 brochures indicate that none scored in the superior range, 83% scored adequate, and 17% scored not suitable. Ninety-four percent of the brochures were written on a 12th grade level or higher, yet 37% of the sleep patients tested were reading at less than a 9th grade level. Low-level readers were significantly more likely than their higher-reading-level counterparts to report that a brochure was too long (22% vs 12%; p < .05), and that they would need help reading it (44% vs 3%; p < .001). CONCLUSIONS: Patients need sleep information given to them on a level they understand. When developing and selecting appropriate materials, reading level, length, and suitability of written material should be considered.

Adolescent↗
PubMed1984

The Maryland plan for recruiting psychiatrists into public service.

A joint initiative by the University of Maryland and the Maryland Mental Hygiene Administration succeeded in recruiting 116 university-trained psychiatrists into state employment in a period of 7 years. The program emphasizes the creation of an academic environment in state treatment facilities, integration of university and state residency training programs, part-time faculty status for state psychiatrists, and rapid promotion of talented young psychiatrists to positions of authority. The program has been successfully implemented at no cost to either the university or the state.

Foreign Medical Graduates↗
PubMed2003

Smallpox vaccine: the good, the bad, and the ugly.

Smallpox inarguably shaped the course of human history by killing countless millions in both the Old World and the New World. Dr. Edward Jenner's discovery of vaccination in the late 18th century, and the global eradication of smallpox in the 1970s, rank among the greatest achievements in human history. Amidst recent growing concerns about bioterrorism, smallpox vaccination has resurfaced from the history books to become a topic of major importance. Inoculation with vaccinia virus is highly effective for the prevention of smallpox infection, but it is associated with several known side effects that range from mild and self-limited to severe and life-threatening. As the United States moves forward with plans to vaccinate selected health care workers and the military, and perhaps offer the vaccination to all citizens in the future, it is important to fully understand and appreciate the history, risks, and benefits of smallpox vaccination.

Humans↗