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At least 1,009 records · Page 56Linked to original sources
PubMed1993

Meeting the urgency for document delivery in clinical medicine.

A Document Delivery library project was designed to improve delivery of information to health professionals in the Washington DC/Baltimore area. The project goals were to enhance delivery of full text documents and accelerate interlibrary loan services. The aim was to provide direct library services in the clinical arena by facilitating access to the articles needed by practitioners and clinical investigators. The objectives were to (1) design, develop and implement a comprehensive Document Delivery System (DDS) for the Library Information System (LIS) which included interlibrary loan, photocopy services and facsimile transmission capabilities; (2) establish a multi-university Library Knowledge Network for resource sharing; and (3) evaluate the project. The DDS and facsimile service are described and project data and outcomes are reported. Today, the participating libraries can use electronic means to share interlibrary loans. Georgetown users have responded favorably to the DDS and Fax services.

Clinical Medicine↗
PubMed1993

A review of documentation requirements for preclinical sections, for marketing submissions in the European Community, Japan and the USA.

Standardization of the documentation requirements for preclinical sections, for marketing submissions in the European Community (EC), Japan and the USA is proposed. It is unnecessary to standardize the leading summaries of submissions as their format is predicated by the way in which the regulatory authorities review applications. Harmonization of the technical sections will reduce the duplication of effort expended by pharmaceutical companies to produce documentation specific for each regulatory authority. Elimination of requirements specific to individual authorities will further reduce the resource requirements. The proposals made in this paper are aimed to increase the 'user-friendliness' of the preclinical documentation and therefore expedite the review process.

Animals↗
PubMed1993

[Experience of the quality program of the clinical documentation department of the Hospital of Galdacano].

BACKGROUND: The management of quality is a key tool to improve efficacy of Spanish hospitals. Hospital quality programs and those of each department/unit are based on self-evaluation with the principle of there being things to be improved and have demonstrated their efficacy. The aim of the present study was to demonstrate the applicability of the methodology of quality in a Department of Clinical Documentation. METHODS: Four indicators of quality in the quality program were measured in the form of indexes over 18 months in a department of clinical documentation of a general hospital. RESULTS: Index of filing errors: 0.1%, index of history availability: 98%, index of histories not in place: 6.4 to 11.1, index of reclaimable histories: 3.1 to 5.2. CONCLUSIONS: The methodology of quality is applicable to a department of clinical documentation with its development being useful in detecting problems as the first step in improving quality.

Hospitals, General↗
PubMed1996

[Techniques of iconographic documentation].

The Authors describe modalities of photography and videorecording that should be used in stapes surgery and report the solutions they adopted to get iconographic documentation of high quality standard. As regards videorecording systems, the authors used both S-VHS and U-Matic equipment; with both types high fidelity shootings are obtained in the active documentation of each phase of the operation. Moreover, U-Matic master copying guarantees a final copy of higher quality. Technical difficulties that the authors met in videorecording are connected to the restricted field of view, limited by the speculum, which may itself cause dazzling phenomena or light refraction. A 2/3 inch CCD Sony camera, with a modified ELC(Electronic Light Control), was used to get round these problems, so as to eliminate the reflection of surgical instruments. In order to build up a photographic archive, it is also possible to get slides from single pictures of the recorded tapes, although their definition quality is lower than the one obtained foff photos; these, however, must be taken with reference to precise optical parameters and in particular: for shooting view pictures low enlargements (1,6x) were used with an intermediate aperture (f44), while, to better visualize details(footplate hole, stapedial tendon), it was considered right to u se restricted frames (2,5x) and a low aperture (f22). Such a technical solution, in fact, gives a better relation between depth of field and brightness. Finally the Authors underline that the constant use of the intraoperative videorecording system allows: greater participation of every member of the team in the operation; a delayed critical revision of th e operation; medico-legal documentation of possible intraoperative complications; iconographic material available both for scientific and didactic purposes.

Humans↗
PubMedDate not supplied

Pain management documenting the decision making process.

From patient admission to discharge, pain is a critical symptom of concern to the nurse case manager. This descriptive study examined nurses' decision-making regarding pain management as documented in clinical records of patients after orthopedic surgery. Using a Nurses' Pain Management Audit Tool, data analysis revealed that during the first 24 hours after emergence from the Post-Anesthesia Care Unit, these patients received less than 50% of the narcotic doses available for their pain relief. Nurses documented less than 25% of the "ideal occurrences" possible for pain assessment, as described in the Agency for Health Care Policy and Research Guidelines. Incomplete databases for guiding patient outcomes of effective pain management were perpetuated by insufficient documentation. Nurse case managers could stimulate increased commitment and quality improvement in pain management as a crucial aspect of patient care.

Adult↗
PubMed1997

Type II diabetes mellitus clinical guidelines at primary health care level. A SEMDSA Consensus Document, 1997, in association with DESSA, ADSA.

OBJECTIVE: To develop effective education and management programmes for all aspects of diagnosis, treatment and prevention of complications of type II diabetes mellitus in the primary care setting. OPTIONS: The approach suggested is intended to be adaptable to both optimal and minimal health care settings and to individual patient differences both in the public and the private sectors. OUTCOMES: Few long-term studies are currently available worldwide comparing patient outcome (In terms of macrovascular morbidity and overall mortality) with the various treatment regimens or the clinical and biochemical targets recommended. As complications cannot be totally prevented with our current state of knowledge and therapeutics, attention must still be focused on secondary and tertiary prevention to slow the progression of complications after they have been detected. EVIDENCE: Working groups of diabetologists, epidemiologists, gynaecologists, primary care physicians, nurse specialist educators, dieticians, podiatrists and patient-interest organisations reviewed and discussed the current scientific knowledge and clinical recommendations as reflected by the latest overseas position and consensus statements on the subject. The format and spirit of the document are based on the 'Guidelines for the management of non-insulin-dependent diabetes in Africa, 1996' and adapted through local clinical experience to the needs and realities of our country at a primary health care level setting. RECOMMENDATIONS: These include details on the provision of information for early detection, effective management and integration of clinical services for type II diabetes into a multidisciplinary chronic (non-communicable) diseases programme within the existing and evolving national health care system, emphasis on lifestyle modification, appropriate education and medication, the prevention and treatment of complications and timely referrals to a higher level of health care, and the concept of the patient charter of rights and responsibilities in the hope of achieving an optimal level of self-management within the constraints of the disease. VALIDATION: Relevant organisations involved in the education and care of people with diabetes were asked to select representatives to participate in the guidelines working group of the National Diabetes Advisory Board (SEMDSA). Draft documents on 12 topics were produced, amended and widely circulated for comments, criticisms, consensus and endorsement. SPONSORS: The consensus conference and the complication and publication of this document were supported by a generous educational grant from Servier Laboratories (SA).

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

A comparison of nursing activities associated with manual and automated documentation in an Australian intensive care unit.

This article describes a comparative study that examined the frequencies of nursing activities, when using a clinical information system (CIS) and a paper-based documentation system in an Australian intensive care unit. The study unit had half the beds equipped with a CIS, and the remaining beds used paper documentation. Work sampling methodology was used to observe nurses working with both systems. Though there were differences for all activities between the environments and the directions of the differences were logical, none were statistically significant using a chi-square test (P = .11-0.65), probably because of the small sample size. This study established that work sampling methodology using a random timer is a valid and relatively easy method to capture work activity in the clinical area. Although this article does not provide definitive information regarding the benefits of a CIS over manual documentation, a number of important methodological issues are discussed, including the study design, procedure, use of dedicated observers, and the distinction between basic versus fully optioned systems. Future research should evaluate the efficiency, impact on patient outcomes and nursing practice, and cost effectiveness of fully optioned systems.

Australia↗
PubMed1997

Documenting 'what nurses do'--moving beyond coding and classification.

A variety of strategies for knowledge representation have been applied to the texts from a number of medical domains. Many of the techniques rely on the well-defined ways in which medical terms are used within a given domain, a phenomenon referred to as 'sublanguage.' Because much of nursing documentation involves the use of 'everyday' language, the viable application of sublanguage-based approaches to knowledge representation of nursing documentation is not a forgone conclusion. We propose an approach utilizing semantic markup of nursing notes as a strategy for determining whether the documentation of 'what nurses do' is a sublanguage Results of an initial feasibility study utilizing the approach are presented.

Abstracting and Indexing↗
PubMed1997

Immediate eradication of Helicobacter pylori in patients with previously documented peptic ulcer disease: clinical and economic effects.

OBJECTIVES: The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost-effectiveness of H. pylori eradication in the large cohort of asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer disease. METHODS: A decision analytic model estimated the clinical and economic effects of two management strategies for asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, and strategy 2-continued-maintenance antisecretory therapy, with H. pylori eradication therapy reserved for the first symptom recurrence. RESULTS: At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36.8 ulcer months/100 patient years), 10% fewer months with ulcer symptoms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per-patient expenditures ($587 vs. $767/patient year) than maintenance antisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more months with upper gastrointestinal symptoms from all causes (37.9 vs. 33.2 symptom months/100 patient years) than strategy 2, because maintenance antisecretory therapy was effective in treating symptoms due to causes other than peptic ulcer disease. CONCLUSIONS: Ulcer-related outcomes of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori eradication at reduced cost. Therefore, H. pylori eradication should be aggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.

Anti-Ulcer Agents↗
PubMed1998

GP documentation of obesity: what does it achieve?

BACKGROUND: Obesity is a major and increasing health problem in the United Kingdom, and, until recently, the government health promotion package for general practice reimbursed general practitioners for documenting obesity. Despite poor evidence for effectiveness of interventions in primary care, documentation of obesity could possibly improve patient awareness and knowledge, or provide public health information. AIM: To assess patient perception of obesity and its health risk, and the accuracy of estimating obesity using patient information. METHOD: Subjects were consecutive attenders to a general practitioner (GP) at a single urban practice in the South and West Region. Outcome measures were 'measured' body mass index (BMI) calculated from measured weight and height, 'estimated' BMI using patient information, and patient perception of obesity and the health risks of obesity. RESULTS: There is good correlation between 'estimated' and 'measured' BMI (intraclass correlation 0.91). Estimated BMI is lower than measured BMI (mean 0.77 lower), and the difference increases with age and level of BMI: for BMIs of < 20, 20-24.99, 25-29.99, and > or = 30 the mean differences (estimated-measured) were -0.06, -0.46, -0.98 and -1.72 respectively. Estimated obesity (BMI > 30) is reasonably sensitive (70%), specific (99%), and predictive (93% positive predictive value) of measured obesity (kappa 0.78). All obese subjects are aware that they are overweight, and most of them (78%, 95% confidence interval 66-88%) are aware that their weight is a health risk. CONCLUSION: Obese patients attending GPs' surgeries are likely to know if they are overweight, or could easily estimate from their knowledge of height and weight that they were overweight with reasonable accuracy. Obese subjects also know that their weight carries health risks. Thus, measurement of obesity in the general population is not likely to improve risk assessment or patient knowledge significantly. Without evidence for effective intervention or improved decision-making in primary care, reimbursement guidelines linked to the documentation of obesity in the population are probably an inefficient use of resources.

Adolescent↗
PubMed1998

[Quality assurance of image documentation systems. Acceptance test, constancy control].

For the documentation of digital images from computer-assisted imaging apparatus by means of an image documentation system (IDS) there exists in Germany a standard for the acceptance test with description of characteristic parameters and definition of reference values for later constancy controls. The acceptance test should be performed after installation of the image documentation system by the manufacturer/specialists while constancy controls should be carried out weekly by the user. In this report we give a short report on the test images and procedures described in the German standard (DIN 6868-56) and provide additional practical tips for the performance of the acceptance test and constancy controls.

Diagnostic Imaging↗
PubMed1998

The opinions of district nurses regarding the knowledge, management and documentation of patients with chronic pain.

This is the first of two studies investigating district nurses' opinions regarding the knowledge, management and nursing documentation of patients with chronic pain conditions, before and after the introduction of 'pain advisers' in one health care region in Stockholm. Seventy (97%) district nurses at 12 selected primary health care centres (PHCCs) answered a questionnaire. The study showed that 85% of the district nurses met patients with chronic pain conditions at least once a week. None of the 12 PHCCs had any written information/policies on pain control. Many district nurses did not perform any individual analysis of the patients' pain and very few used any tool, such as VAS, to assess or evaluate the patients' pain. The district nurses reported insufficient pain documentation. A number of district nurses were dissatisfied with the present management of patients with chronic pain at their PHCCs, their own knowledge of pain control, their own preparedness to meet these patients, their own follow-ups and their own documentation. The study also showed that the district nurses' attitudes to pain and pain control varied, depending on how satisfied they were with their own management of patients with chronic pain conditions.

Adult↗
PubMedDate not supplied

Intensive care unit bedside documentation systems. Realizing cost savings and quality improvements.

Automating intensive care unit (ICU) documentation saves time and assists in interpreting data and planning care. The current economic climate makes the cost of ICU computer systems prohibitive for many institutions. Any expenditure without a measurable return on investment will be scrutinized carefully. The literature describing ICU computer system benefits often is difficult to interpret. No two implementations, hospitals, or benefit study designs have been the same. Each implementation has many unique variables. These variables make study comparison and replication potentially impossible. The authors have concluded that replicating previous studies may not be relevant if the goal is to justify system cost. The objective is met by designing a study that evaluates changes in data management activities as well as issues unique to the study unit or institution. The purpose of this article is to review the findings of previous benefits studies related to ICU documentation systems and to suggest other measures to support cost justification for expensive bedside documentation systems.

Cost Savings↗
PubMedDate not supplied

Community-based obstetrical ultrasound reports: documentation of compliance with suggested minimum standards.

The objective of this study was to determine the degree of documented compliance of community-based ultrasound reports with suggested standards/guidelines for basic ultrasound examinations as published by the American College of Obstetricians and Gynecologists (ACOG) and the American Institute of Ultrasound in Medicine (AIUM). First trimester reports from obstetric offices (n = 20) had complete compliance with ACOG guidelines in 35% and AIUM standards in 15% of the cases (p = NS). Radiological reports (n = 26) had complete compliance with ACOG guidelines in 11.5% and AIUM standards in 3.9% of the cases (p = NS). None of the second/third trimester reports from either the obstetrical offices (n = 35) or from radiological facilities (n = 94) had complete compliance with either ACOG or AIUM standards/guidelines. Ultrasound reports generated by community-based obstetricians and radiologists from our referral sources demonstrate significant omissions in documentation of components suggested by AIUM and ACOG for minimum standards of basic ultrasound examinations.

Congenital Abnormalities↗
PubMed2003

Documentation and three-dimensional modelling of human soleus muscle architecture.

The purpose of this study was to visualize and document the architecture of the human soleus muscle throughout its entire volume. The architecture was visualized by creating a three-dimensional (3D) manipulatable computer model of an entire cadaveric soleus, in situ, using B-spline solid to display muscle fiber bundles that had been serially dissected, pinned, and digitized. A database of fiber bundle length and angle of pennation throughout the marginal, posterior, and anterior soleus was compiled. The computer model allowed documentation of the architectural parameters in 3D space, with the angle of pennation being measured relative to the tangent plane of the point of attachment of a fiber bundle. Before this study, the only architectural parameters that have been recorded have been 2D. Three-dimensional reconstruction is an exciting innovation because it makes feasible the creation of an architectural database and allows visualization of each fiber bundle in situ from any perspective. It was concluded that the architecture is non-uniform throughout the volume of soleus. Detailed architectural studies may lead to the development of muscle models that can more accurately predict interaction between muscle parts, force generation, and the effect of pathologic states on muscle function.

Cadaver↗
PubMedDate not supplied

Sticking together! A creative approach to documenting insulin double checks.

Patient care and family teaching are the heart of the rehabilitation staff nurse's role. Documentation of the various aspects of patient care and family teaching is a necessary but time-consuming process. In this article you will learn how the nurses of one rehabilitation center welcomed a creative time-saving method of working together to improve documentation compliance for double checking insulin administration. The development of the process, education of the staff and the outcomes are included.

Documentation↗
PubMed1995

[Requirements for a surgical documentation system and its realization].

Adequate documentation of all surgical procedures is now essential. High demands in terms of quality and quantity mean that computerized databases and evaluation procedures are required. In the Department of Abdominal and Transplantation Surgery within Hanover Medical School a standardized but individually adaptable documentation system has been greated using standard hardware and software. A hierarchical code system has been established for surgical procedures, and this also offers the options of automatic online coding and translation into the coding used in the International Classification of Procedures in Medicine. The advantages and limitations of this system are discussed.

Database Management Systems↗