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At least 1,063 records · Page 59Linked to original sources
PubMed1995

Computer-assisted surgery planning for lower extremity deformity correction by the Ilizarov method.

Starting in 1952, Prof. Gavril Ilizarov, a Russian orthopedic surgeon, devised a complex method of long bone deformity correction using an external bone fixation system consisting of rings and wires. We have developed a computer-assisted surgery planning system to aid in correction using the Ilizarov method. The hardware for the system is composed of an ultrasonic digitizer as input device, an HI plotter as output device, a 386/486 personal computer with super VGA monitor, and a mouse interfacing between user and computer. The software includes two separate programs. The main program is a menu-driven two-dimensional graphics program, which divides the planning procedure into several major stages, including preoperative planning and postoperative verification. The second program uses the information generated from the first program to create an image of the ideal three-dimensional frame construction to give a general impression of the appearance of the constructed frame.

Computer Simulation↗
PubMed1995

A new look at OEM (original equipment manufacturer) service agreements.

Next to personnel services, equipment maintenance is the second largest budgetary expense in large radiology departments. Because they are under constant pressure to contain costs, radiology administrators spend considerable time negotiating the best service at the lowest cost. Today, administrators have several options for imaging equipment maintenance: equipment maintenance insurance, in-house engineering, and various arrangements with original equipment manufacturers (OEMs) and independent service organizations (ISOs). In response to increased competition, OEMs have become more price-competitive with ISOs and have expanded their service menu and equipment maintenance insurance programs. OEM service menu options include: full service, tiered pricing, labor only, planned maintenance, full service with deductible, shared maintenance and extended warranty. Any type of service arrangement can be customized according to equipment age and sophistication, redundancy, income-producing potential, criticality of downtime and the strength and depth of the service organization. Even when vendor maintenance contracts are more expensive than purchasing service on a time-and-materials basis, they allow customers to budget accurately for the service of covered equipment. The authors' institution gets the best results for the best price from a judicious mix of maintenance options. Wise customers will explore many options before choosing a service agreement.

Budgets↗
PubMed2006

[Maintaining abstinence after alcohol detoxification].

"To quit drinking" is not the panacea of alcohol dependence treatment; it is only its first step. Abstinence should be considered more as a mean than a purpose of the after-withdrawal cares. The frequent resistance of the alcoholic patient to undertake in a long term abstinence can be by-passed by suggesting to fix himself renewable terms for periods during which he feels rather confident to raise the bet of a "most accomplished possible" abstinence. To facilitate the realization and the preservation of this abstinence in the best conditions (potentiation of the profits and minimization of the difficulties), a "therapeutic menu" will be proposed to the patient besides a "minimum plan" containing a medical follow-up over one year, with variable frequency of visits according to the evolution and the prescription of one or two anti-craving drugs registered. Psychotherapies using different techniques as Cognitive Behavioural Therapy, group therapy or psychoanalysis could be proposed after a necessary clarification to the patients of the mechanism of action of each and the waited profits. In the final, two thirds of the patients with alcohol dependence fire in one year a profit of their treatments; the practitioner takes, actually, no risk and should propose systematically a project to the only 20% of them who come to consult him.

Acamprosate↗
PubMed2001

Establishment of a clinical trials office at a children's hospital.

OBJECTIVE: To create a clinical trials office (CTO) at a children's hospital and assess its impact. METHODS: Meetings with faculty and clinical trials groups were undertaken to develop a conceptual plan for an exclusively pediatric CTO designed to be a 1-stop office for sponsors, contract research organizations, and investigators. Guiding principles, eg, use of the CTO would be voluntary and paid for on a fee-for-service basis, were defined, and a business plan was developed. RESULTS: The CTO opened in October 1997, offering a broad menu of services. Initial marketing efforts have been followed by steadily increasing use of the CTO, measured in a number of studies and investigators who use CTO services. Commensurate growth in CTO staffing has been required. Since the CTO's opening, the number of and revenues from industry-sponsored clinical trials performed at the hospital have been significantly greater than the pre-CTO baseline and have exceeded business plan projections. In addition, the proportion of industry-sponsored clinical research at the hospital that is administered by the CTO has expanded (now >50%). The increase in hospital revenues from industry-sponsored clinical trials has exceeded the cost of running the CTO. Studies performed by the CTO have involved a mix of general pediatric clinic/private office patients, subspecialty clinic patients, and hospitalized children. CONCLUSION: A CTO dedicated to pediatric clinical research can enhance the ability of a children's hospital to participate in the growing number of pediatric clinical trials.

Centralized Hospital Services↗
PubMed1998

A standardized menu for Goal Attainment Scaling in the care of frail elders.

Goal Attainment Scaling (GAS), an individualized measurement approach, is particularly attractive for the evaluation and care planning of frail elders, who often experience multiple, complex problems. Some service providers find GAS too unwieldy for routine use. A modified version of GAS that uses a standardized menu of goals and attainment levels has been developed by the Geriatric Assessment and Rehabilitation Unit of a regional referral hospital in Nova Scotia, Canada. This article reviews the development, implementation, benefits, and challenges of the standardized menu, as well as the results of a retrospective descriptive study of its measurement properties. The standardized menu appears to be a feasible, valid, and responsive alternative to traditional GAS, while retaining much of its individualized nature.

Activities of Daily Living↗
PubMed2004

Assessment of executive dysfunction during activities of daily living in schizophrenia.

Many neuropsychological studies have described deficits of memory and executive functions in patients with schizophrenia, and the severity of these deficits seems to be determinant in predicting the community outcome of these patients [Schizophr. Bull. 26 (2000) 119]. However, neuropsychological evaluation does not provide valuable information about how the cognitive deficits directly affect daily living, that is, which cognitive deficit affects which behavior. The present study aimed at determining whether executive dysfunction in schizophrenia could be directly measured by analyzing three activities of daily living (ADL), in addition to assessing the ecological validity of commonly used neuropsychological tests. Within specific ADL (choosing a menu, shopping the ingredients, cooking a meal), the sequences of behaviors that have been performed by 27 control subjects and 27 patients with schizophrenia were both analyzed by using a preset optimal sequence of behavior. When compared with control subjects, patients with schizophrenia showed more omissions when choosing the menu, more sequencing and repetitions errors during the shopping task, and more planning, sequencing, repetition and omission errors during the cooking task. These behavioral errors correlated significantly with negative, but not with positive symptoms of the patients. Furthermore, they also correlated with the poor performances on executive neuropsychological tests, especially those sensitive to shifting and sequencing abilities, but not with memory tests. These results suggest that executive deficits in schizophrenia may specifically affect ADL and that such deficits can be quantitatively assessed with a behavioral scale of action sequences.

Activities of Daily Living↗
PubMed1981

[Value of tomodensitometry in the diagnosis of lumbar disk hernias].

The authors relate their experiences concerning tomodensitometric examination to evaluate the herniation of a disk. 45 patients and 50 herniations of a disk have been studied. 39 herniations have sustained surgical procedures. The tomodensitometric examination and the radiculosaccography have been performed among these patients in order to compare the findings. The fact that there has only been 3 failures prove the reliability of tomodensitometric examination; among these failure there is 2 post-operative recurrences and one L4 L5 herniation. The radiculosaccography fails 5 times (1 L4 L5 herniation and 4 L5 S1 herniations). There is not any common negative in the two methods. Because of its total innocuity (no injection of any kind) the tomodensitometric examination seems to be the first exploration to prescribe when an herniation of a disk is resistant to clinical treatment and when a surgery is planned.

Diagnosis, Differential↗
PubMed2000

Effects of using recommended coping strategies on drinking outcome following a brief intervention.

AIMS: To explore the unique contribution to outcome drinking of clients' use of six strategies for moderating drinking, after statistically accounting for variance explained by some client and intervention variables. DESIGN: An exploratory hierarchical regression analysis assessed the contributions to variance in drinking outcome of pre-intervention (client characteristics, baseline drinking), assignment (level of assessment, therapist experience) and early follow-up variables. Data came from an experimental trial which evaluated the effect of adding assessment to provision of a self-help book to heavy drinkers. SETTING: Diverse Ontario communities. PARTICIPANTS: Heavy drinkers (99 males, 56 females) were selected from 185 media-recruited applicants who were screened by telephone to exclude cases with severe alcohol-related problems. Their mean (+/- SD) pre-admission weekly quantity of alcohol consumed was 22 +/- 15 drinks. Follow-up rates at 3 and 12 months were 92% and 88%. MEASUREMENTS: Regressed onto weekly quantity at follow-up were: client characteristics, previous measures of weekly quantity, experimental condition and use of the menu of strategies (setting goals for drinking, keeping track of drinking, pacing drinking, planning ahead to avoid heavy drinking, developing free-time activities and coping with problems without drinking). FINDINGS: At 3 months the variables predicting lower weekly quantity were: pre-intervention weekly quantity, developing free-time activities, setting goals for drinking and condition. Lower weekly quantity at 12 months was predicted by lower 3-month and pre-intervention weekly quantity, and regular use of: coping with problems without drinking, setting goals for drinking and keeping track of drinking. CONCLUSIONS: This descriptive study revealed a positive association between level of use of recommended coping strategies at follow-up and drinking outcome. Controlled studies of the effects of strategy use on drinking outcome are therefore warranted.

Adaptation, Psychological↗
PubMed1997

The Medicare mall. Will Washington like what it built?

"Shopping spree" doesn't begin to describe it. Next year, 38 million seniors will begin choosing their health care coverage from a menu crammed with options. Medicare Plus Choice means just that: HMOs, provider-sponsored plans, private-pay options, medical savings accounts, and more. It also means a bevy of new rules--and risks--for everyone.

Aged↗
PubMed1986

An incentive management plan for hospital-based physicians.

Arthur D. Little, Inc., has developed an incentive management program for salaried, hospital-based physicians. The program is based on the tracking of physician productivity through the assignment of work units for both routine inpatient care and all medically performed tests and outpatient procedures. A monetary pool based on increases in the hospital's profitability over a base year is divided among physicians on the basis of their relative productivity throughout the year. Administratively assigned work units can be used to give physicians credit for activities which benefit the institution but which are not revenue producing. The system puts incentives in place for physicians to increase revenues while holding down costs. The main feature of the incentive system is a bonus pool, the size of which is based on hospital net income. A reporting application was developed that downloads data from the hospital's service bureau data-processing vendor, preprocesses the data through a C program, and produces reports through an extremely user-friendly, menu-driven, spreadsheet-based program.

Efficiency↗
PubMed1988

Curbing the cost of interdisciplinary care plans.

Interdisciplinary care plans, if done properly, become not only a cost-effective form of planning patient care but can also be the most efficient and holistic form of care giving. The key person in the team is the coordinator. The coordinator must ensure timely care plan reviews, notify members of upcoming conferences, enforce conference rules, and ensure proper documentation and efficient utilization of time at the conference. The administrator is ultimately responsible for seeing that each discipline is held accountable for its part of the care plan process. The administrator must encourage the provision of high-quality care through the care planning process, as well as motivate and reinforce to all team members the importance of this holistic concept of patient care. The person actually writing the care plans during the conference can be chosen by the coordinator but should be someone who has a good concept of proper care plan form and medical terminology and who can write quickly. A productive care conference is only part of the answer to an effective interdisciplinary approach. Care plans must be specific, individualized and realistic, with measurable and obtainable goals. They must be made available to all personnel in such a manner that they become a precise menu of the care giving process. All care givers must be keenly aware of the value and usefulness of this patient care tool to ensure high quality in a coordinated, holistic approach.

Cost Control↗
PubMedDate not supplied

Role of exercises and drills in the evaluation of public health in emergency response.

INTRODUCTION: Public health agencies have been participating in emergency preparedness exercises for many years. A poorly designed or executed exercise, or an unevaluated or inadequately evaluated plan, may do more harm than good if it leads to a false sense of security, and results in poor performance during an actual emergency. At the time this project began, there were no specific standards for the public health aspects of exercises and drills, and no defined criteria for the evaluation of agency performance in public health. OBJECTIVE: The objective of this study was to develop defined criteria for the evaluation of agency performance. METHOD: A Delphi panel of 26 experts in the field participated in developing criteria to assist in the evaluation of emergency exercise performance, and facilitate measuring improvement over time. Candidate criteria were based on the usual parts of an emergency plan and three other frameworks used elsewhere in public health or emergency response. RESULTS: The response rate from the expert panel for Delphi Round I was 74%, and for Delphi Round II was 55%. This final menu included 46 public health-agency level criteria grouped into nine categories for use in evaluating an emergency drill or exercise at the local public health level. CONCLUSION: Use of the public health-specific criteria developed through this process will allow for specific assessment and planning for measurable improvement in a health agency over time.

Delphi Technique↗
PubMed1986

Design and analysis considerations for a longitudinal study of periodontal disease.

Perception and concern for the health changes in our aging population led the Veterans Administration to initiate an interdisciplinary and longitudinal investigation of the aging process, the Veterans Administration Normative Aging Study, in 1963. A cohort of the 2,280 healthy men of this study self-selected to enroll in the dental longitudinal study, an investigation of oral health in these healthy males. In 1968, 1,221 men between the ages of 25 and 75 began with a baseline cycle of 5 general series of examinations, including an interim health history and survey of dietary habits; masticatory performance and taste thresholds; salivary analyses; oral cytologic and radiographic survey and comprehensive clinical data on caries and periodontal status. Design considerations for the Dental Longitudinal Study included prospective planning of specific oral variables to be recorded, and provision of collection techniques to allow for additional analyses based on a wide menu of retrospective data. The volunteer cohort was screened to obtain men who met stringent general health criteria, who represented wide socioeconomic ranges and would likely remain geographically stable. Importantly, enrollment in the parent study was without regard for dental status or oral health. Administrative design considerations included orderly transfer for exam data to machine-readable format by use of optical scan forms designed to register specific oral variables, with security preserved for the primary source records and rapid record retrieval. Additional data collection requiring manual coding was designed to transfer spreadsheets of clinical impressions and diagnoses to computer retrieval protocols. Provisions for recording of exceptional circumstances, i.e., salient oral pathology, were recognized and the optical scan forms modified to index and retrieve such cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Using patient focus groups for new patient services.

BACKGROUND: This article is intended to illustrate the usefulness of patient input in the strategic planning process and to demonstrate in particular the use of focus groups in concept development, concept testing, and program evaluation. INTERACTIVE PLANNING: Three areas of patient services were designed partly on the basis of patient input. "Service Teams with Appropriate Resources" (STARs) were conceived as basic organizational units to deliver interdisciplinary care to meet the needs of specific groups of patients. A patient services "menu" was envisioned to allow the patient or caregiver to decide which service would most appropriately and efficiently meet patient needs. The "Service Expectation Program" was formulated to ease entry into the hospital by providing information on what patients should expect from the hospital experience. CONCEPT TESTING: Focus groups were used again to test and refine the concepts developed during the interactive planning stage. General themes included the need for improved communication, the desire to be treated with respect and dignity (personhood), the need for coordination across the continuum of care, and the desire for more personal choice and control. ONGOING EVALUATION: Sources of patient feedback used in the ongoing evaluation process included a patient satisfaction survey and a telephone survey. Additional focus groups and telephone surveys are planned. MANAGEMENT ISSUES: The focus group discussions with patients introduced useful data into the quality improvement and interactive planning process. Findings were disseminated to all levels of hospital management and program staff through newsletters, reports, and in-service training sessions. Data were useful in interactive planning, program concept testing, and the development and implementation of new services.

Focus Groups↗
PubMed2000

Continuous quality improvement for patients with back pain.

Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence. This project sought to merge scientific evidence about back pain and knowledge about behavior change to help organizations improve care for back pain. Participating insurance plans, HMOs, and group practices focused on problems they themselves identified. The year-long program included quarterly meetings, coaching for rapid cycles of change, a menu of potential interventions, and recommendations for monitoring outcomes. Participants interacted through meetings, e-mail, and conference calls. Of the 22 participating organizations, 6 (27%) made major progress. Typical changes were reduced imaging, bed rest, and work loss, and increased patient education and satisfaction. Specific examples were a 30% decrease in plain x-rays, a 100% increase in use of patient education materials, and an 81% drop in prescribed bed rest. Despite the complexity of care for back pain, rapid improvements appear feasible. Several organizations had major improvements, and most experienced at least modest improvements. Key elements of successful programs included focus on a small number of clinical goals, frequent measurement of outcomes among small samples of patients, vigilance in maintaining gains; involvement of office staffs as well as physicians, and changes in standard protocols for imaging, physical therapy, and referral.

Back Pain↗