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PubMed1992

Digital archive center: implementation for a radiology department.

OBJECTIVE: In this article, we describe the implementation of a digital archive center for a radiology department in a 700-bed teaching hospital. MATERIALS AND METHODS: The archive center consists of two identical archive systems, each comprising five components: an archive server, a data-base server, an optical disk library, a stand-alone optical disk drive, and a communication network. An image management system controls the image traffic from acquisition devices to display stations. A fault-tolerant mechanism was built into the archive center to achieve a 100% uptime. RESULTS: The center has been in operation for over 6 months. We have not experienced a single total system failure during this period. It currently archives all digital images from three MR units and four CT scanners and selected images from three computed radiographic systems and two laser film digitizers. The center archives between 1.5 and 2.0 gigabytes of images per workday. CONCLUSION: With its built-in fault-tolerant mechanism, we believe that the implemented archive center is very reliable and is suitable for a radiology department to archive its digital images.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

Survey of behavior management teaching in pediatric dentistry advanced education programs.

PURPOSE: The purpose of this study was to survey pediatric dentistry advanced education program directors regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all (65) advanced education programs in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 54 programs. Two programs declined to respond because they had not yet accepted or certified residents. The final response rate was 86%. The mean percentage (+/- SD) of total didactic time devoted to behavior management was 13% (+/-9.5). Communicative techniques were taught as "acceptable" by 98% of programs, with the exception of the hand-over-mouth exercise (HOME), which was taught as "unacceptable" by 54% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 76% to 98% of programs. All programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that it is likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Most programs do not teach HOME as an acceptable behavior management technique. The amount of curricular time devoted to behavior management is not likely to change appreciably in the near future.

Anesthesia, Dental↗
PubMed1985

Statistical and research quality of the medical and pharmacy literature.

The statistical and research quality of reports published in two U.S. medical journals and two U.S. pharmacy journals over a 12-month period was determined. A 50% random sample of issues of New England Journal of Medicine, Annals of Internal Medicine, American Journal of Hospital Pharmacy, and Drug Intelligence and Clinical Pharmacy published in 1979 was reviewed, and all citable items were classified as one of nine types of communications. Items classified as original evaluative research reports were evaluated for experimental design and research goals and rated for appropriateness of statistical testing and overall research quality according to a set of objective criteria. Reports that were not immediately classifiable were reviewed by one additional person, and classifications or ratings were assigned by mutual consent. Of a total of 1506 citable items, 120 met the criteria for original evaluative research reports. The two medical journals had the highest percentages of reports for which statistical methods were rated as correct but also had the most reports for which statistical methods could not be rated as a result of incomplete documentation or publication errors. Reports in the medical journals had conclusions based on a logical progression of hypothesis, methods, and analysis of results more frequently than did reports in pharmacy journals. Reports in the medical and pharmacy journals differed greatly according to research design and research goals. Improvement is needed in the statistical quality and research quality of original research reports published in the pharmacy literature.

Pharmacy↗
PubMed1999

Investigation on SCH00013, a novel cardiotonic agent with Ca++ sensitizing action. 4th communication: influence on experimentally induced ventricular arrhythmia in dogs.

Influence of 4,5-dihydro-6-[1-[2-hydroxy-2-(4-cyanophenyl)ethyl]- 1,2,5,6,-tetrahydropyrido-4-yl]pyridazin-3(2H)-one (SCH00013) and vesnarinone (CAS 81840-15-5) on the arrhythmia experimentally induced by three different methods was investigated in dogs. In digitalis-induced arrhythmia, SCH00013 (3 mg/kg i.v.) showed a tendency to improve the arrhythmia with a decrease in the arrhythmic ratio and an increase in the conducted beats (CB), though these changes did not reach a significant level; it decreased significantly the blood pressure (BP) with no change in the total heart rate (THR) and atrial rate (AR). Vesnarinone (3 mg/kg i.v.) did not affect these parameters except for BP that was decreased significantly. In two-stage coronary ligation-induced arrhythmia, SCH00013 (1 and 3 mg/kg i.v.) did not change the arrhythmic ratio, CB, AR and BP, while the THR being slightly decreased; the arrhythmic ratio showed a tendency to decrease with SCH00013 when examined at 24 h after coronary ligation. Vesnarinone (3 mg/kg i.v.) did not affect these parameters at 24 and 48 h after ligation. In epinephrine (adrenaline)-induced arrhythmia, both SCH00013 and vesnarinone showed exacerbation of arrhythmia. SCH00013 at 1 mg/kg i.v. did not elicit ventricular fibrillation (VF) in five dogs examined, but at 3 mg/kg i.v. it elicited VF in two of three dogs. Vesnarinone at 1 mg/kg i.v. induced VF in all of three dogs examined. Incidence of VF induced by optical isomers of SCH00013 was not significantly different from each other: both isomers elicited VF in two of six dogs at 1 mg/kg i.v. and at 3 mg/kg i.v. each of them induced VF in two dogs examined. The present results indicate that SCH00013 is a cardiotonic agent that is equivalent to or less arrhythmogenic than vesnarinone in animal models of arrhythmia, such as adrenaline- and digitalis-induced arrhythmia and the two-stage coronary ligation-induced arrhythmia. Optical isomers of SCH00013 were essentially equieffective in eliciting exacerbation of adrenaline-induced arrhythmia in the dog.

Animals↗
PubMed1996

Should infection control practitioners do follow-up of staff exposures to patient blood and body fluids?

BACKGROUND: The purpose of this study was to determine the efficiency of a joint infection control/occupational health program for the follow-up of accidental blood or bloody body fluid exposures in health care workers. METHODS: A comprehensive staff follow-up program for all blood exposures with known patient sources was initiated in 1989, consisting of patient follow-up by the Infection Control Department (risk assessment for hepatitis B virus [HBV] and [HIV] infection and obtaining of consent for HIV testing) and staff follow-up by the Occupational Health Department. In 1992 a mailed survey was conducted to examine exposure follow-up policies and responsibilities in large teaching hospitals across Canada. RESULTS: A total of 924 blood exposures with known patient sources were reported between January 1989 and December 1993. HIV and HBV screening was obtained for 67.9% and 87.6% of patients assessed as at low risk and 82.3% and 92.2% of those assessed as at high risk for infection, respectively. Two previously unknown HIV-seropositive patients were identified, one of whom had been classified as at low risk (one of 530 [0.19%] patients at low risk who underwent screening). Primary reasons for screening being missed were patient discharge (46.3%) or communication problems (18.0%). The requirement for informed written consent before HIV screening accounted for the difference in completed HIV and HBV screens. Results of the hospital survey indicated that 40.8% of Canadian hospitals follow up all patients who are involved in blood exposures; however, most hospitals still rely on the physician to obtain consent (87.6%). CONCLUSIONS: Use of ICPs to screen patients involved in staff blood exposures during regular hours may be the most efficient method of follow-up, particularly if supplemented by a backup team of health professionals on nights and weekends. Although screening all patients for HBV/HIV may detect patients with undisclosed high-risk behaviors, institutions must decide whether the practice is cost-effective in areas of low prevalence.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior.

In 1972 the Stanford Heart Disease Prevention Program launched a three-community field study. A multimedia campaign was conducted for two years in two California communities (Watsonville and Gilroy), in one of which (Watsonville) it was supplemented by an intensive-instruction program with high-risk subjects. A third community (Tracy) was used as a control. The campaigns were designed to increase participants' knowledge of the risk factors for cardiovascular disease, to change such risk-producing behavior as cigarette smoking, and to decrease the participants' dietary intake of calories, salt, sugar, saturated fat, and cholesterol. Results of a sample survey indicate that substantial gains in knowledge, in behavioral modification, and in the estimated risk of cardiovascular disease can be produced by both methods of intervention. The intensive-instruction program, when combined with the mass-medica campaign, emerged as the most effective for those participants who were initially evaluated to be at high risk. The results after two years of intervention are reported for effects on knowledge and behavioral change for the total participant samples and for the high-risk subsamples in each of the three communities.

Attitude to Health↗
PubMed1994

Benchmarking in healthcare organizations: an introduction.

Business survival is increasingly difficult in the contemporary world. In order to survive, organizations need a commitment to excellence and a means of measuring that commitment and its results. Benchmarking provides one method for doing this. As the author describes, benchmarking is a performance improvement method that has been used for centuries. Recently, it has begun to be used in the healthcare industry where it has the potential to improve significantly the efficiency, cost-effectiveness, and quality of healthcare services.

Commerce↗
PubMed1995

How to monitor the effectiveness of an emergency medical dispatch system: the Houston model.

The use of priority dispatch systems for emergency medical services (EMS) is widespread throughout the United States and in several other countries. It is essential that any such system be monitored to prove that it is safe and effective. A study of the EMS system in Houston, Texas, USA, has previously reported that the priority dispatch system can safely and reliably identify EMS incidents requiring only basic life support; the methods by which this was achieved are outlined here. In addition, the current and pending revisions to the Houston Fire Department Dispatch Quality Management Programme are discussed.

Emergency Medical Service Communication Systems↗
PubMed2005

Patient expectations regarding eye care: development and results of the Eye Care Expectations Survey (ECES).

OBJECTIVE: To develop an instrument (the Eye Care Expectations Survey [ECES]) that can identify and quantify the expectations of patients visiting eye care providers. METHODS: A total of 202 patients attending 4 ophthalmology practices affiliated with Duke University Eye Center enrolled in the study. All participants completed the pilot version of the ECES, which was developed through a review of the expectations literature and a multicondition focus group process. Factor analysis of patients' responses was used to identify the performance characteristics of the ECES. RESULTS: Factor analysis yielded factors that describe 4 distinct types of expectations: patient involvement in eye care, interpersonal manner, information about diagnosis and prognosis, and communication and clinical competence. These 4 factors explained 89% of the total variance. The factor analysis identified a subset of 27 questions (of the original 37) to represent the 4 factors. Estimates of internal consistency and test-retest reproducibility indicate that the ECES is reliable. In addition, tests of association with clinical variables support the construct validity of the survey. The psychometric properties of the ECES were influenced by the severity of the underlying eye condition as well as other demographic and clinical variables, including the patient's rating of his or her own vision, best corrected visual acuity, sex, education, race, and household income. CONCLUSIONS: Based on this cross-sectional study, the 27-item ECES appears to be a useful tool for better understanding patients' expectations regarding eye care.

Attitude to Health↗
PubMed1988

Reconstruction of the larynx and trachea.

This article involves an analysis of 43 patients who underwent 64 reconstructive procedures for laryngeal and/or tracheal defects at The Ohio State University (Columbus). The purpose of this report is to analyze the results of a variety of reconstructive techniques in order to formulate a recommended therapeutic approach. Utilizing this therapeutic approach, 77% of the reconstructions were totally successful in providing an airway not requiring a tracheotomy tube and a voice capable of communication. Another 16% of the reconstructions were considered partially successful, requiring a permanent airway tube due to limitations created by coexisting health problems. There have been no patients where airway reconstruction was totally unsuccessful. A generalized approach to reconstruction is presented.

Adolescent↗
PubMed2004

Advance directive use among patients undergoing high-risk operations.

BACKGROUND: The Patient Self-Determination Act requires that patients entering hospitals be asked if they have an advance directive. This has led to increased awareness of advance directives, yet surgeons have paid little attention to their use among patients undergoing even major surgery. We sought to evaluate the use of advance directives in patients undergoing pancreaticoduodenectomy and esophagectomy. METHODS: Patients undergoing these operations between 1996 and 2001 at a university teaching hospital were identified and reviewed for statement of advance directive, its presence in the chart, and impact on patient care. RESULTS: A total of 252 patients met inclusion criteria. The number of patients with an advance directive increased, but had little impact on patient care. CONCLUSIONS: More patients having major surgery have advance directives, but the number present in the medical record remains low. Further attention to advance directives would foster increased communication between surgeons and patients and extend patient autonomy.

Advance Directives↗
PubMed2000

Minimally invasive limited pericardiectomy: the hybrid approach.

This communication describes our clinical experience with the hybrid method, a video-assisted anterior minithoracotomy approach developed for minimally invasive limited pericardiectomy to treat 8 patients with massive pericardial effusion. The average operating time was 37.2 minutes, and there was no procedure-related morbidity or mortality. The mean follow-up period was 5.6 months, and there have been no recurrences. The hybrid approach can be accomplished irrespective of pleural adhesions. It eliminates the need for hemipulmonary collapse, making it more advantageous than the totally port-access thoracoscopic approach.

Aged↗
PubMed2006

A multifaceted intervention improves patient satisfaction and perceptions of emergency department care.

OBJECTIVE: . We aimed to evaluate the effectiveness of a multifaceted intervention, targeting staff-patient communication, in improving emergency department patient satisfaction. METHODS: We undertook a pre- and post-intervention study in a university-affiliated emergency department, over a 12-month period. The intervention included communication workshops, a patient education film, and a patient liaison nurse. At the patient level, the patient liaison nurse ensured optimal staff-patient community communication and played a role in staff communication education. The intervention was evaluated using patient surveys (containing general and communication-specific satisfaction items scored out of 100), complaint rates, and patient liaison nurse activity data. RESULTS: A total of 321 and 545 patients returned questionnaires in the pre- and post-intervention periods, respectively. Significant improvements were observed in patients' perceptions of being 'informed about delays' [score difference, 5.3; 95% confidence interval (CI), 0.6-10.0], that 'staff cared about them as a person' (difference, 4.4; 95% CI, 0.7-8.1), the overall emergency department facility assessment (difference, 3.9; 95% CI, 0.4-7.5) and overall emergency department care (difference, 3.8; 95% CI, 0.3-7.3). Non-significant improvements were seen in all other satisfaction items. In the post-intervention period, there was a 22.5% (95% CI, 14.6-32.8) decrease in the number of complaints received and a decrease in the complaint rate of 0.7 (95% CI, -0.3 to 1.6) complaints per 1000 patients. The patient liaison nurse activities included orientation of the patient including (i) explanation of tests, procedures, and delays; (ii) communication with a range of hospital staff; and (iii) general comfort measures including analgesia quality control. CONCLUSION: Significant improvements in a variety of patient satisfaction measures were achieved with an intervention comprising staff communication workshops, a patient education film, and a patient liaison nurse.

Adolescent↗
PubMed1997

Beyond restructuring. Futuristic rapid-cycle change to improve patient care.

Rapid changes in the healthcare environment provide an impetus to look closely at the way patient care is delivered. It is increasingly important to be both patient focused and cost effective in the delivery of care. No longer can tradition, organizational structures, or poor communication impede effective and efficient patient care. A rapid-cycle change process is one method that involves staff members in identifying and implementing needed change to improve patient care and to remove waste from the system.

Efficiency, Organizational↗
PubMed2006

The perioperative specialist practitioner: developing and evaluating a new surgical role.

INTRODUCTION: This paper describes the design, implementation and evaluation of a new professional role in surgery. The role of the perioperative specialist practitioner (PSP), conceived as a response to the Working Time Directive, provides integrated preoperative and postoperative care to patients undergoing surgery in hospital. METHODS: A 1-year training programme was designed, dealing with a wide range of knowledge, skills and attitudes. Effective communication was a key component. Nine intensive 5-day modules at Imperial College London (London, UK) alternated with supervised experience of the surgical team at each participant's home trust. Detailed evaluation of the role and the training programme was provided by an independent research team, using an interview-based qualitative approach. Observational data were provided by the project team. Data were analysed using standard qualitative methods. RESULTS: 27 PSPs across 12 National Health Service trusts took part in two PSP training programmes. A total of 124 interviews (94 individual and 30 group) were carried out with PSPs and their colleagues. Overall, the role was seen as successful and positive, with great potential for dealing with reductions in junior medical cover. Each site encountered different opportunities and problems. Lack of mentorship was a key issue, and the role provoked considerable opposition in trusts. The training programme was viewed as highly successful. DISCUSSION: PSPs can provide high levels of expertise, but within clear limits. Our training programme has been effective and is perceived to be of high quality. However, introducing a new role requires time and sensitivity if opposition is to be minimised.

Adult↗
PubMed2006

An audit of the quality and content of periodontal referrals and the effect of implementing referral criteria.

AIMS: This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital. METHODS: Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations. RESULTS: There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31-34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department. CONCLUSIONS: Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.

Communication↗
PubMedDate not supplied

Student perceptions of a problem-based learning course.

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students' role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.

Curriculum↗
PubMed2002

[What messages did the Norwegian tobacco industry communicate to consumers in its advertising?].

BACKGROUND: A Norwegian official report, NOU 2000: 16, Tort liability for the Norwegian tobacco industry, concludes that Norwegian law and judicial practice allows lawsuits against the tobacco industry for damages. A crucial claim in such suits would be that the industry withheld information on health risks and addiction and instead used advertising messages that undermined the information campaigns initiated after the reports on smoking and health from the U.S. Surgeon-General and the Norwegian Board of Health in 1964. This article reports a study of differences in tobacco advertising in Norway before and after 1964. MATERIAL AND METHODS: A total of 1,945 photographs of advertisements in two popular weekly family magazines over the 1955 to 1975 period were stored in a database along with information on date of publication, size, copy and message, presumed target group, and characteristics of persons and situations shown. RESULT: Up until 1964, advertisement space per year in these magazines totalled 100 dm2 (11 sq. feet). The amount of advertising space then increased up until 1973, to 2,033 dm2 (219 sq. feet). The share featuring women went up from 33 in the 1955-64 period to 62% in 1965-75, when 51% of advertisements showed women smoking while 31% showed men smoking. Pre-1964 advertisements primarily contained information to smokers on price, type of tobacco, packaging and country of origin; after 1964 the advertisements developed a more universal appeal associating smoking with various social situations marked by style, well-being and comfort. The tobacco was said to be pure, fresh, mild and natural, and the filter was claimed to have protective properties. INTERPRETATION: It is probable that the cognitive dissonance created by more health information on smoking after 1964, i.e. the necessary motivation to quit, was reduced as a result of strategic changes in the amount and content of advertising.

Advertising↗