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PubMed1988

Monitoring and evaluation: the Joint Commission's 9-step model.

In essence, the nine step model is a macro-description of the content of the program's structure and provides a brief description of the process. What it does not provide is a methodology for conducting the data-gathering and evaluation process (#6 and #7). Here is where the creativity of the QA coordinator is put to test. This methodology has not been formally prescribed by the Joint Commission, as QA is a rather new science which entails defining the concept in addition to determining consistent methodologies. We are thus left to explore other established disciplines, such as research and evaluation methodologies of education, for example, for the procedures and instrumentation to be employed in the data-gathering and analysis process. The application of the nine-step model is a helpful means of conceptualizing how each department's program should appear, including what to monitor, how to conduct the activity, who is to participate, and the frequency of activities. Hospitals are bastions of procedure manuals for everything from surgical draping to foley cath insertion. The establishment of a procedure manual for QA that is consistent with this model, however, is a necessary and effective means of taking a facility one step closer to compliance with established requirements.

Accreditation↗

PubMed2004

What happens in a psychoanalysis? A view through the lens of the analytic process scales (APS).

A group of experienced analysts has developed scales and a coding manual illustrated with clinical examples to evaluate recorded analyses and psychodynamic therapies. The analytic process scales (APS) assesses three dimensions: (1) the contribution of the analyst: helping to develop a relationship in which the analyst can provide clarification and interpretation of transference and resistance; (2) the contribution of the patient: the communication of experience and the expression of feeling in ways which provide information about needs, wishes and conflicts, accompanied by self-reflection; and (3) interactional characteristics of the emerging relationship, explored by studying sessions divided into psychoanalytically coherent segments. A preliminary study of nine sessions has established that the variables assessed by the APS can be rated reliably. Study of the analysts' contributions illuminated their varied and complex structure. Important differences emerged among the three patient-analyst pairs studied, and changes in scores over time tracked developments in the analytic work which would imply different treatment outcomes. The APS appears to be a reliable tool facilitating the systematic study of psychoanalyses.

Adult↗

PubMed1996

CancerNet redistribution via WWW.

CancerNet from the National Cancer Institute contains nearly 500 ASCII-files, updated monthly, with up-to-date information about cancer and the "Golden Standard" in tumor therapy. Perl scripts are used to convert these files to HTML-documents. A complex algorithm, using regular expression matching and extensive exception handling, detects headlines, listings and other constructs of the original ASCII-text and converts them into their HTML-counterparts. A table of contents is also created during the process. The resulting files are indexed for full-text search via WAIS. Building the complete CancerNet WWW redistribution takes less than two hours with a minimum of manual work. For 26,000 requests of information from our service per month the average costs for the worldwide delivery of one document is about 19 cents.

Computer Communication Networks↗

PubMed1991

Integrating medical images into hospital information systems.

The effective delivery of health care has become increasingly dependent on a wide range of medical data that includes a variety of images. Manual and computer-based medical records ordinarily do not contain image data, leaving the physician to deal with a fragmented patient record widely scattered throughout the hospital. The Department of Veterans Affairs is currently installing a prototype hospital information system workstation network to demonstrate the feasibility of providing image management and communications functionality as an integral part of an existing hospital information system. The core of this system is a data base management system adapted to handle images as a new data type. A general model for this network-based integration is discussed and various alternative architectures are examined.

Database Management Systems↗

PubMed1985

The Laboratory Information System (LIS): I-Application to the clinical chemistry laboratory.

The Laboratory Information System (LIS) was designed as a "turn-key" system. The main functions are operated interactively on a mini-computer which gives the laboratory complete control over daily processing. Collection of results from automated analyzers is accomplished via a micro-computer/micro-processor network. Links are provided with a central main frame computer for immediate patient identification and historical data processing. LIS is designed to manage all the operations involved in laboratory activities. The system has 14 major functions: registration of test requests, production of specimen collection sheets and identification labels, confirmation of specimen collection, production of aliquot labels, workload inquiry, production of worksheets, manual entry of test results, automated entry of test results, results inquiry, preliminary report, final report, daily activities reports, statistical reports, billing. System security is provided along three directions: data entry validation, system access control, and memory protection. The main advantages of LIS are: reduced clerical work, better evaluation of workload, faster communication, improvement of information given to the clinician: adapted reference values, interpretation, comments, improved retrieval operations, faster billing.

Autoanalysis↗

PubMed1999

A new way of building a database of EEG findings.

Whereas computer-based electroencephalography (EEG) is widely applied, the EEG interpretations are usually not stored in a way that favours exploitation of modern computer technology. This paper reports an EEG description system facilitating categorization of EEG data in a computerized database. The system interactively communicates with the digital EEG system and also with the general patient administrative system. The main new quality of this system is the methods for data input and automatic data retrieval from several systems, rather than the establishment of a database of EEG data itself. The EEGs are visually analysed and categorized. Manually marked EEG events are automatically transferred to the database and such events as well as defined electrode positions within these epochs are directly linked to their corresponding descriptions. The database is updated without demand for filling in the events in the database in a second operation. Thereby, the EEG interpreter builds the database while analysing the EEG. This system provides an improved accessibility of EEG data for clinical, normative, educational and scientific use.

Brain↗

PubMed2004

Emergency management of the morbidly obese.

OBJECTIVES: To identify the difficulties encountered with the emergency management of morbidly obese patients and formulate recommendations to streamline care. METHODS: An English language literature search was undertaken using Medline (1966-2003) with key words 'morbid obesity' 'anaesthesia' 'imaging' 'obesity' 'emergency' 'transportation' 'retrieval' 'critical illness' and 'monitoring'. Potential articles were selected for content applicable to emergency medicine based on title and abstract and reviewed in detail. Reference lists were manually searched for further relevant articles. In view of the very limited systematic study in this area, all information deemed by the authors' to be of assistance to the emergency physician was included regardless of evidence level. Additional information was sought from standard critical care textbooks and their bibliographies and through personal communication with local ambulance and retrieval services. The authors' unpublished personal experience in providing emergency care to the morbidly obese was included for aspects of management not documented in medical literature. RESULTS: Obesity levels and associated health problems are rapidly rising in Australia. Few studies were identified dealing with critical illness in the morbidly obese and none specifically addressing ED management. Problems identified included size related logistical issues, and limitations of physical assessment, monitoring and routine investigations. Invasive procedures, intubation and ventilation can be particularly problematic, and modified techniques may be required. Limited data indicates a poorer outcome from critical illness most marked in the case of blunt traumatic injury. CONCLUSION: Very obese patients present a variety of logistical and medical challenges for EDs. A series of recommendations are made based on available data. Further studies in this area would be desirable to more specifically address ED issues.

Catheterization↗

PubMed2003

Negative pressure pulmonary oedema following tracheal tube obstruction in a paediatric patient: a preventable anaesthesia related morbidity.

The purpose of this study is to describe negative pressure pulmonary oedema due to undetected tracheal tube obstruction in a paediatric patient. A healthy 6 week-old scheduled for release of tongue-tie under general anaesthesia was noticed to be diagnosed at the preparation of the surgical site. The patient was quickly assessed, and ventilation with 100% oxygen was commenced. The heart sounds were still present. Two minutes later, pink frothy secretion was noticed in the lumen of the tracheal tube. Assisted manual ventilation was continued for about 3 hours in the intensive care unit (ICU). Clinical examination after 8 hours of oxygen therapy indicated stable vital signs and was discharged to the ward. Undetected tracheal obstruction due to unsupervised patient positioning may result in negative pressure pulmonary oedema in a paediatric patient. Improved communication between the surgical and the anaesthetic teams may prevent this morbidity.

Airway Obstruction↗

PubMed2003

Homecare: a telemedical application.

The advent of telecommunication and information technologies and the miniaturisation of technologies have enabled the evolution of telemonitoring systems. Early systems for hospitals and clinics, which usually required the patients to be wired to desktop devices, have evolved into homecare that requires devices to be lighter and simpler to use. In addition to miniaturisation and extended autonomy, further requirements for the telemonitoring system include local intelligence (that is, the system can take decisions without referring to external advice) and no moving parts to allow the patient to move freely during measurement periods. Body and local communication networks can prolong the connection of the homecare patient with a monitoring centre through the public networks. Additional medical functions and processing have been added to homecare equipment for telemedicine and patient discomfort is decreasing because of miniaturisation, autonomy and increased versatility of new systems. The applications have evolved rapidly from manually triggered alarms and single physiological parameter monitors to autonomous telemedical monitoring tailored to complete needs. This will eventually make telemedicine beneficial to patients, doctors and society.

Home Care Services↗

PubMedDate not supplied

Teaching the operation of medical equipment: the potential for misunderstanding.

In training users to operate medical equipment, there exists the potential for a failure to communicate completely what the instrument's capabilities are and how it operates. The knowledge must be transferred through many contact points, each increasing the possibility for misunderstanding or failure to understand. Major contact points are: designer and builder with sales staff; and sales staff and hospital personnel. Primary teaching methods are: instruction manual, in-service training presentation, videotape, film, and hands-on experience. Knowledge and competence in equipment use are basic to avoid liability if a problem should arise.

Equipment and Supplies↗

PubMed1997

Picture archiving and communication system-asynchronous transfer mode network in a midsized hospital.

This article describes the pathway to full implementation of a hospital information system-picture archiving and communication system-wide area network (HIS-PACS-WAN) in a 300-bed acute care hospital, and the linking of that system to two other off-site medical centers. The PACS included direct digital capture of computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine, and ultrasonography images into an Olicon archive. Plain radiographs and fluoroscopy images were digitized manually and archived into an Olicon system. The active archive included current images on each Olicon workstation and the juke box. Long-term archiving of the images on removable optical discs, which would be loaded manually by an operator every time a request for one of these studies appeared on the operator's monitor, also was implemented. Ability to store, retrieve, and display simultaneously the physician's report of each procedure along with the images was an ultimate goal. The WAN is to be used for teleradiology and teleconferencing among the three medical centers involved in this study as well as other off-site locations. Phase I included the design and installation of the local area network (LAN) in the Department of Radiology at Olive View-UCLA Medical Center. This included the clinics and the inpatient and hospital-wide fiber-optic network and its linkage to the local telephone company. Phase II involved linkage of the Olicon workstations to imaging equipment. This implementation has been delayed significantly because of inadequate needs assessment, absence of planning for forward-compatibility to imaging equipment, and incompatibilities in DICOM conformance among vendors. Every PACS project must include an in-depth needs analysis, which should be updated yearly because of rapid turnover of technology. Although this analysis should have a heavy emphasis on clinical needs, it must incorporate the hospital-wide needs for an integrated information systems network. Integration of PACS, HIS, RIS, and a dictation/transcription system is a complex task that requires a full-time, clinically oriented project officer for successful completion.

Computer Communication Networks↗

PubMed1995

Sexual health, teenage responsibility.

The Planned Parenthood Association of South Africa in 1992, published a manual on ¿Responsible Teenage Sexuality¿. It deals comprehensively and frankly with issues of teenage sexuality in an easy-to-use module format. With increasing emphasis on the need for sex education at school and in the home, this manual provides essential information for teachers, youth leaders, and health professionals. The modules take cognizance of the sensitive issues that concern young people. The open approach enables counselors to provide the answers that young people seek in an honest and comfortable way. Compiled by the youth counselors of the Cape Town Planned Parenthood Association of South Africa, the manual is based on their knowledge and experience of providing sex education to young people from all communities over the past 10 years.

Adolescent↗

PubMed1991

The new FAA national automated ECG network: some aviation medical examiner experiences.

The Federal Aviation Administration (FAA) has required, since August 1, 1987, that aviation medical examiners (AMEs) transmit by telephone all electrocardiograms (ECGs) necessary for airman "Class I" medical certification. This relatively new airman certification requirement is centralized at the Civil Aeromedical Institute (CAMI) in Oklahoma City. In calendar year 1989, the FAA received 69,000 electronically transmitted electrocardiograms. CAMI uses Marquette Electronics software to interpret the ECG signals that are received from multi-channel equipment. The single-channel transmitted ECGs are hand screened at present. The FAA "automated" screening program is unique among governmental airman medical certification programs throughout the world. This paper presents, for potential future users, the authors' experiences with the new airman automated electrocardiographic certification requirement, and covers positive and negative features involved in the implementation and operation of the program. We conclude that while the new FAA automated ECG screening program has satisfactorily replaced the former "physician-intensive" manual screening process, the new system increases the AME's equipment and operation costs. These are passed on to the airman who is seeking certification.

Aerospace Medicine↗

PubMed2006

Role of risperidone in children with autism spectrum disorder.

OBJECTIVE: To review the clinical trials investigating the efficacy and safety of risperidone in the treatment of children with autism spectrum disorder (ASD). DATA SOURCES: Searches of MEDLINE/PubMed (1992-February 2006) were conducted, as well as an extensive manual review of journals, using the key words autism and risperidone. STUDY SELECTION AND DATA EXTRACTION: Only double-blind, placebo-controlled trials were included for review. DATA SYNTHESIS: ASD is the most common of the pervasive developmental disorders. The main characteristics (core symptoms) of autism are impairment in social skills, problems communicating, and stereotypical movements. Behavioral manifestations or maladaptive behaviors include aggression, irritability, hyperactivity, inattention, impulsivity, tantrums, and self-injurious behavior. CONCLUSIONS: Based on the data examined, risperidone appears efficacious and safe for treating certain behavioral aspects of autism including irritability, aggression, hyperactivity, and stereotypy. It does not appear to be as effective for the treatment of the core symptoms of autism.

Antipsychotic Agents↗

PubMed2002

Interrelations among social-cognitive skills in young children with autism.

Typically developing infants show a reliable developmental sequence of emergence of early social-cognitive skills, such as joint attention, communicative gestures, gaze and point following, imitation, and referential language. First infants share others' attention, then they follow others' attention and then behavior, and then they direct others' attention and then behavior. The current study used a series of tests from a study of typically developing infants (Carpenter, Nagell, & Tomasello, 1998) to investigate interrelations among these social-cognitive skills in young children with autism and children with other developmental delays. Tests of object permanence, spatial relations, facial and manual imitation, and executive function also were included. We found that for most children with autism, unlike other children, tests involving others' attention were more difficult than tests involving others' behavior. However, within the domains of attention and behavior, the typical pattern of sharing, then following, and then directing was evident. There were several positive intercorrelations among the social-cognitive skills (as there were for typically developing infants), but there also was some evidence of individual differences in patterns. Implications for theories of social-cognitive and language development are discussed.

Autistic Disorder↗

PubMed1991

Using Monte Carlo simulations in public health risk assessments: estimating and presenting full distributions of risk.

With desktop computers as powerful as mainframes were just a few years ago, analysts can now use commercial software to estimate full probability distributions for--not just point estimates of--health risks experienced by people chronically exposed to toxic chemicals at or near hazardous waste sites. Even though probability is the central concept in risk assessment, and even though probabilistic methods offer strong advantages and insights as compared to the "deterministic" methods now required by U.S. Environmental Protection Agency's guidance manuals, analysts have only begun to use probabilistic methods at Superfund sites. In this paper, we examine a simplified case study using Monte Carlo methods to estimate full distributions of public health risk. We demonstrate the use of "toggles" to isolate the contributions of different inputs, and we also offer new graphical methods to communicate the results to risk managers and concerned citizens.

Child↗

PubMed2000

Processing of multiple kinematic signals in the cerebellum and motor cortices.

The cerebellum and motor cortices are hypothesized to make fundamentally different but synergistic contributions to the control of movement. Richly interconnected, these structures must communicate and translate salient parameters of movement. This review examines the similarities and differences in the encoding of multiple limb movement parameters in the cerebellum and motor cortices. Also presented are recent data on direction and speed coding by cerebellar Purkinje cells and primary motor and dorsal premotor cortical neurons during a visually-instructed, manual tracking task. Both similarities and differences have been found in the way that these two motor areas process movement parameters. For example, the two motor control structures encode direction with almost identical depths of modulation, which may simplify the exchange of directional signals. Two major differences between the cerebellum and motor cortices consist of the distribution of the preferred directions and the manner in which direction and speed are jointly signaled within the discharge of individual neurons. First, an anterior-posterior distribution of preferred directions has been shown for both reaching and manual tracking, consistent with an intrinsic reference frame and/or the structure of afferent input. In contrast, neurons in the motor cortices have uniformly distributed preferred directions, consistent with general purpose directional calculations. Secondly, Purkinje cells in the cerebellum and motor cortices combine movement direction and speed information differently. For example, Purkinje cell discharge encodes combinations of direction and speed, a 'preferred velocity', while the motor cortical neurons use a temporal parcellation scheme to encode multiple parameters of movement. These results demonstrate that the cerebellum and motor cortices process and use kinematic information in fundamentally different ways that may underlie the functional uniqueness of the two motor control structures.

Animals↗

PubMed2001

Selective mutism: how a successful speech and language assessment really is possible.

A speech and language assessment of children with selective mutism is often difficult because these children are silent in most situations. In Australia, a study was designed to assess the children in their homes, the place where they usually speak. Five children who met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria for selective mutism participated in the study. Assessment included audio-taping extracts of the children's conversations with members of their family and the administration of a number of standardised speech and language tests. The study found that four of the five children had a communication disorder. This paper outlines these communication disorders and describes how a successful speech and language assessment of children with selective mutism is possible.

Child↗