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PubMed1998

Estimating ancestral states of a communicative display: a comparative study of Cyclura rock iguanas.

In this study we describe the signature headbob displays of seven of the eight extant species of Cyclura iguanas using data collected from the field and from captive animals. We used phylogenetic comparative methods to estimate the ancestral states of several measures of the headbob displays, including number of headbobs and the duration of headbobs and inter-bob pauses. Divergence in the headbob display among species has been substantial, with some major changes occurring within only a few (about six) generations. Otherwise, results are consistent with those obtained previously for other lizards which suggest that there is an evolutionary limit on the total duration of headbob displays. Differences in the results obtained using different phylogenetic methods suggest that although estimates of ancestral states are reasonably robust to violations of evolutionary assumptions, we cannot determine the standard errors of those ancestral phenotypes accurately without more detailed information about the types of forces (e.g. selection, drift) underlying evolutionary change in these traits. In particular, within-species variation had a substantial impact on the standard errors of estimated ancestral states, and should be included in such estimations whenever possible. Finally, our results emphasize the importance of conserving behavioural as well as genetic diversity in trying to preserve endangered species for possible reintroduction into the wild. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed2005

Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study.

BACKGROUND: Satisfaction with care and quality of life (QoL) are indicative of the quality of care of cancer patients. The purpose of this study was to lay a cornerstone for patient-centred quality management by assessing the current status of satisfaction with care and QoL among oncological outpatients in Germany, and by identifying the key factors that determine a patient's willingness to recommend a medical facility. PATIENTS AND METHODS: A self-constructed and validated patient satisfaction questionnaire plus the SF-36 were distributed to a random sample of 3384 cancer patients who presented at 24 investigators' offices nationwide within a defined recruiting period and who met the inclusion criteria. The return rate was 81.9% (n=2772). A total of 2659 (78.6%) questionnaires were evaluable. The most common cancer types were breast (22.9%) and intestine (19.8%). RESULTS: Overall satisfaction was high, but specific reporting questions revealed many areas for improvement such as shared decision making, doctor-patient communication and organization of care. QoL was significantly impaired in many domains. Patient-provider relationship, facility setting and information on diagnosis and treatment options are major determinants of a patient's willingness to recommend a facility to a friend or relative if needed. CONCLUSIONS: This multicentre study focusing on patient perspectives highlights that, although the overall degree of satisfaction was quite high, there are numerous areas for improvement.

Adult↗
PubMed2005

Does instructor evaluation by students using a WEB-based questionnaire impact instructor performance?

BACKGROUND: Student feedback is a valuable method to evaluate the quality of education. Using a WEB-based questionnaire, the objective of this study was to evaluate the factors that may affect the ratings given by the students and the impact of those ratings on the instructor's teaching performance. METHODS: The questionnaire was organized into four areas: containment, presentation skills, measurement and assessment, and communication skills. In addition, there was a final area in which the students could express their opinions about their instructor. The students were asked to rank their instructors in each of the four areas using a scale of 1-5. In both May 2002 and 2003, the students ranked their instructors using the WEB-based questionnaire. RESULTS: In 2002, 468 students evaluated 146 instructors; while in 2003, 360 students evaluated 144 instructors. Of the total number of instructors evaluated, 140 were evaluated both in 2002 and 2003. The mean point scores for these 140 instructors were 3.64 +/- 0.51 in 2002 and 3.65 +/- 0.54 in 2003. There was no statistically significant difference according to the titles of the instructors. For both 2002 and 2003, regarding the last section in the questionnaire where students could present their opinions, 80 of the students, indicated the instructors had communication problems. All instructors with low scores were mentioned to have poor communication skills. The changes in the mean point scores were evaluated comparing results from 2002 and 2003. Fourteen professors, four associate professors, three assistant professors, two lecturers were found to have higher scores, three professors, seven associate professors, five assistant professors, and one lecturer were found to have lower scores. CONCLUSION: No significant improvement was found in the mean points of the total group. In the second year, only 16.4 of the instructors were affected positively.

Education, Medical, Undergraduate↗
PubMed2006

Cultural dissimilarities in general practice: development and validation of a patient's cultural background scale.

Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.

Adult↗
PubMed1985

Determination of depth distribution of internal mammary lymph nodes on lateral lymphoscintigraphy.

A method using a calibrated ruler for measuring lymph node depth on lateral lymphoscintigrams is described. The accuracy of the method was confirmed with a plexiglass phantom. At the time of internal mammary lymphoscintigraphy, lateral images were obtained in 201 patients. A total of 545 lymph nodes were visualised and categorised into 13 depth intervals. The average lymph node depth was 3.0 +/- 1.1 cm with a range of 1.0-7.1 cm. Average lymph node depth was classified according to body weight with an average depth of 2.5, 3.1 and 3.7 cm for patients weighing less than 60, 60-75 and more than 75 kg, respectively. Lateral lymphoscintigrams demonstrated normal anatomical communication between internal mammary and anterior mediastinal lymph nodes in 3.5% of patients.

Breast↗
PubMed2000

Students, tutors and relationships: the ingredients of a successful student support scheme.

BACKGROUND: Medical students suffer from stress and psychological morbidity. Much of this stress is related to uncertainty about course work and workload. Although several student support systems are on offer at various medical schools, few have been shown to meet the needs of students. OBJECTIVE: To evaluate one student support scheme and determine the factors which are essential for success. METHOD: A total of 144 second- and third-year medical students were randomly selected at the University of Dundee. They were asked to complete questionnaires regarding contact with their personal tutors, frequency of meetings, activities during meetings, opinions on how to improve the system and how satisfied they were with the present system. In addition 28 tutors were also asked to complete a questionnaire which matched as far as possible that for students. Qualitative data was collected from semi-structured interviews, free-text responses from questionnaires, email communications with student group representatives and telephone interviews. RESULTS: The scheme was rated as successful or very successful by 25 (18.4%) students and five (29.4%) tutors. A high success rating was associated with regular and frequent meetings, with tutors actively seeking their students and taking part in social as well as academic activities. CONCLUSIONS: The relationship that is formed between students and tutors is the most important factor contributing to the success of the scheme. Taking part in social activities encourages the relationship to develop, whilst addressing academic problems helps to meet the needs of students. Those students who fail exams appear to have the same needs as those who pass.

Education, Medical, Undergraduate↗
PubMed2005

Influence of number needed to treat, costs and outcome on preferences for a preventive drug.

BACKGROUND: The number needed to treat (NNT) has been widely recommended for communicating benefits from risk reductions. It has been claimed that NNT is easily understood and that it has intuitive meaning. There are, however, only few studies of lay people's understanding of NNT. OBJECTIVE: The objective of this study was to explore whether lay people are sensitive to the magnitude of treatment effectiveness as expressed in terms of NNT, and whether the sensitivity is influenced by variation in the type of health outcome, variation in patients' payment for the treatment or variation in the type of side effects. METHODS: In total, 2326 non-institutionalized Danes aged 18-91 years were interviewed face to face and asked whether they would consent to a treatment against a somewhat increased risk of death or heart attack. The respondents were allocated to different levels of effectiveness of treatment expressed as NNT of 10, 100, 200 or 400, different costs and different descriptions of adverse effects. RESULTS: The odds for consenting to therapy were little influenced by the magnitude of NNT, but were greater among married respondents and among those who had side effects presented in terms of headache and constipation. CONCLUSION: In this study, the respondents' choice of treatment was largely insensitive to the magnitude of NNT independently of variations in type of health outcome and costs. NNT may not be easily understood by lay people.

Adult↗
PubMed2001

Come talk with me: improving communication between nursing assistants and nursing home residents during care routines.

PURPOSE: We examined the effects of communication skills training and the use of memory books by certified nursing assistants (CNAs) on verbal interactions between CNAs (n = 64) and nursing home residents (n = 67) during care routines. DESIGN AND METHODS: CNAs were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities. A staff motivational system was used to encourage performance and maintenance of these skills. Formal measures of treatment implementation were included. RESULTS: Results were compared with those for participants on no-treatment control units. Trained CNAs talked more, used positive statements more frequently, and tended to increase the number of specific instructions given to residents. Changes in staff behavior did not result in an increase in total time giving care to residents. Maintenance of CNA behavior change was found 2 months after research staff exited the facility. Although an increase was found in positive verbal interactions between CNAs and residents on intervention units, other changes in resident communication were absent. IMPLICATIONS: Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care. The methodological advantages of including measures to assess treatment implementation are discussed.

Activities of Daily Living↗
PubMed1983

Utilization of physical therapy personnel in one hospital. A work sampling study.

The purpose of this study was to illustrate the adaptability and use of work sampling, an industrial engineering technique, as a dependable method for collecting personnel utilization data in the physical therapy department of a general hospital and to demonstrate the concept of work sampling to physical therapy supervisors and personnel unfamiliar with this approach. Over a six-week period, a total of 5,824 observations were made at randomly selected 15-minute intervals during the 40-hour work week. Percentages of total time used in observed activities for all physical therapy personnel were divided as follows: 1) direct care, 20.38 percent; 2) indirect care, 11.18 percent; 3) administration, 2.27 percent; 4) communication, 3.28 percent; 5) clerical, 9.56 percent; 6) personal time, 24.60 percent; and 7) out-of-department, 28.72 percent. Physical therapists were most likely to be involved in personal duties from 8 AM to 9 AM (35%) and from 4 PM to 4:30 PM (41%). They showed greatest productivity from 9 AM to 10 AM (59%) and spent time in out-of-department activities rather consistently throughout the day. A conclusion of this study was that work sampling may be used successfully to collect personnel utilization data in a physical therapy department.

Humans↗
PubMed2001

Type of inversion problem in physics: an inverse emissivity problem.

Inversion problems have recently drawn vast amounts of attention from the physics community due to their potential widespread applications. In this Rapid Communication, a different type of inversion problem in physics is proposed: an inverse emissivity problem, which aims to determine the emissivity g(nu) by measuring only the total radiated power J(T). Like other inverse problems, this one has potential for important practical applications. An exact solution is obtained for the proposed inverse problem. A unique existence theorem and techniques for eliminating divergences are also presented. A universal function set (UFS) suggested for numerical calculations is shown to be very useful in a numerical example. The UFS makes this inversion method practical and convenient for realistic calculations.

Journal Article↗
PubMed2006

Expression profiling of radiation-induced genes in radiodermatitis of hairless mice.

BACKGROUND: Radiation induces many cellular events leading to radiodermatitis. OBJECTIVES: The aim of this study was to establish a radiodermatitis model using experimental animals, and to examine the expression profile of radiation-induced genes. METHODS: Hairless mice were irradiated on the dorsal skin; then total RNAs were isolated and microarray hybridizations were performed. RESULTS: Irradiation with a total of 40 Gy (10 Gy day-1 for four consecutive days) provokes radiodermatitis in the hairless mouse. After microarray analysis, 130 genes that showed upregulation by radiation were selected and organized into four different clusters, depending on the time-kinetic pattern. Classification of these genes into several functional categories revealed that various biological processes were globally affected by radiation. These include transcription regulation, signal transduction, cell communication, cell death regulation and metabolism. CONCLUSIONS: These results demonstrate the complexity of the transcriptional profile of the radiation response, providing important clues on which to base further investigations of the molecular events underlying radiodermatitis.

Animals↗
PubMed2006

Defining pathways.

AIMS AND BACKGROUND: The term 'clinical pathway' is internationally accepted in all settings of healthcare management. The way in which clinical pathways have been developed in the United Kingdom differs from that in the USA. Besides the international differences in the purpose, many alternative names also can be found. These have led to confusion. There is no single, widely accepted definition of a clinical pathway. The aim of the study was to survey the definitions used in describing the concept and to derive key characteristics of clinical pathways. METHOD: Using the PubMed, we conducted a review of literature published between January 2000 and December 2003 using the following terms: critical pathway, clinical pathway, integrated care pathway, care pathway and care map. All reports reviewed had to use the concept, as defined by the Medical Subject Headings term, to be considered. To assess all definitions, the concept analysis method was used. RESULTS: In 82 of the 263 eligible articles, the definition of pathway was given. Totally, we found 84 different definitions. Each definition was rephrased by taking into consideration the following three features inherent to pathways: nouns, characteristics and aims and outcomes. Every feature was further divided into categories. CONCLUSIONS: A clinical pathway is a method for the patient-care management of a well-defined group of patients during a well-defined period of time. A clinical pathway explicitly states the goals and key elements of care based on Evidence Based Medicine (EBM) guidelines, best practice and patient expectations by facilitating the communication, coordinating roles and sequencing the activities of the multidisciplinary care team, patients and their relatives; by documenting, monitoring and evaluating variances; and by providing the necessary resources and outcomes. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction and increase the efficiency in the use of resources.

Critical Pathways↗
PubMed1997

The feasibility of automated voice messaging as an adjunct to diabetes outpatient care.

OBJECTIVE: To determine whether automated voice messaging (AVM) systems could be used as an adjunct to primary care for diabetic patients, we examined whether patients were able to respond to AVM queries for clinical information, whether sufficient numbers of problems were identified to warrant the implementation of the service, and whether patients found the system helpful. RESEARCH DESIGN AND METHODS: The AVM system we examined uses specialized computer technology to telephone patients, communicate messages, and collect information. Sixty-five diabetic patients participated. Based on a review of the literature and the input of diabetes clinician-researchers, we developed an AVM monitoring protocol to inquire about patients' symptoms, glucose monitoring, foot care, diet, and medication adherence. Patients also were given the option to listen to health promotion messages and to report their satisfaction with the calls. Patients responded by using their touch-tone telephone keypads. RESULTS: A total of 216 AVM calls were successfully completed, an average of 3.3 out of four calls per patient. Patients reported a variety of health problems that signaled the need for follow-up. Many patients reported not checking their blood glucose or their feet, and one in four reported problems with medication and diet adherence. Health and self-care problems varied across patient subgroups in ways suggesting that the AVM reports were reliable and valid. Overall, 98% of all patients reported that the calls were helpful, 98% reported that they had no difficulty responding to the calls, and 77% reported that receiving AVM calls would make them more satisfied with their health care. CONCLUSIONS: This study demonstrates that diabetic patients can respond to AVM queries and find the calls helpful. Such calls are a feasible strategy for identifying health and self-care problems that would otherwise go unnoticed by clinicians.

Aged↗
PubMed2004

An evaluation of emergency medicine resident interaction time with faculty in different teaching venues.

OBJECTIVES: To measure actual emergency medicine (EM) resident interaction time with faculty and to investigate the potential to use direct observation as an assessment tool for the core competencies. By 2006 all EM residencies must implement resident assessment techniques of the six Accreditation Council for Graduate Medical Education core competencies. Emergency medicine educators recommend direct observation as the optimal evaluation tool for patient care, systems-based practice, interpersonal and communication skills, and professionalism. Continuous faculty presence in the emergency department (ED) is widely believed to facilitate direct observation as an assessment technique. METHODS: Observational study of EM resident-faculty interaction time during two-hour periods. Study venues included two EDs, two trauma services, inpatient medicine, adult and pediatric intensive care units (ICUs), and a pediatric outpatient clinic. Using a priori definitions, the authors categorized faculty-EM resident interaction time as direct observation of patient care, indirect patient care, or non-patient care activities, and calculated total faculty interaction time. Subjects were blinded to the nature of the study, and data gathering was encrypted. RESULTS: Two hundred seventy observation periods of two hours each were conducted, sampling 32 EMR1, 33 EMR2-3, 41 EM, and 38 non-EM faculty. The mean total faculty interaction time ranged from a high of 30% (95% CI = 20% to 41%) in the pediatric ICU to a low of 10% (95% CI = 3% to 16%) on internal medicine wards. Overall, EM faculty interaction time was 20% (95% CI = 18% to 22%). Direct observation by faculty ranged from a high of 6% for EMR2-3s in the critical care areas of the ED (95% CI = 3% to 9%) to a low of 1% (95% CI = 0% to 2%) on internal medicine wards. Overall ED direct observation time was 3.6% (95% CI = 2.6% to 4.7%). Emergency department direct observation did not vary within EM resident training level or by ED site. Direct observation varied by treatment area within the EDs, with the critical care areas being substantially higher (6%) than the noncritical care areas (1%). CONCLUSIONS: Faculty direct observation time of EM residents was low in all training venues studied. Direct observation was the highest in ED critical care areas and lowest on medicine ward rotations. Emergency medicine faculty involved simultaneously in routine ED teaching, supervision, and patient care rarely performed direct observation, despite their continuous physical presence. This finding suggests that alternative strategies may be required to assess core competencies through direct observation in the ED.

Emergency Medicine↗
PubMed1991

[International research in family dynamics].

The purpose of this study is to describe the family dynamics of families expecting their first or second child. The aim is to describe how mothers and fathers differ in their views on family dynamics and what differences there are between families expecting their first or second child. The study forms part of an international comparison study which is currently under way in the United States, Estonia and in the Nordic Countries. In the theoretical part of the study family dynamics is examined using the framework developed by Barnhill (1979). The study was carried out in the Turku and Rauma regions where a total of 136 families were involved. The families were clients of maternity clinics and were expecting their first or second child. Family dynamics was studied during the third trimester of pregnancy. A family dynamics questionnaire and measure developed by the Family Research Group in the United States were used in the study. Both instruments were based on Barnhill's (1979) conceptual framework of the functioning of healthy families. As statistical methods frequencies, correlations and the T-test were used. Both mothers and fathers reported moderate individuation and flexibility, clear communication, mutuality and role reciprocity. Mothers reported more role conflict than fathers who reported more isolation, rigidity and distorted communication than mothers. There were no significant differences between families expecting their first or second child in terms of individuation, flexibility, stability and communication. After childbirth the latter reported more isolation and role conflict.

Child Rearing↗
PubMed2005

Brief communication of the Residency Review Committee-Surgery (RRC-S) on residents' surgical volume in general surgery.

BACKGROUND: The Residency Review Committee-Surgery (RRC--S), 1 of 10 surgical specialties of the Accreditation Council for Graduate Medical Education (ACGME) has monitored the surgical volume of all general surgical residents closely. As a consequence of the reduction of duty hours with the limitation of an 80-hour work-week (averaged over 4 weeks), we were interested in the impact of these restrictions on surgical (volume) experience since its first year of implementation (2003--2004). Therefore, we evaluated the surgical volume of general surgical services since the implementation of the ACGME duty-hour restrictions and compared this volume with that of previous years without these duty limits. METHODS: The Biostatistical Management Section of the ACGME implemented prospective analysis of categorized data for total surgical procedures and Chief Resident cases. The study interval included all resident surgical procedures completed from 1997 to 2004. We were interested particularly in evaluating trends and outcomes after the first year of successful full compliance of the 80-hour work week. Specific evaluations included the impact on surgical programs for total major procedures and Chief Resident cases requisite for application to the American Board of Surgery. RESULTS: The average number of total major procedures for both resident and program averages were noted to increase steadily through the academic years of evaluation (1997--2001). A sharp decrease was evident in the total major procedures for the academic year 2001--2002 that relates to a correction of the biostatistical database implemented by the ACGME to correct a system conversion that began in the academic year 2001--2002. Despite significant changes to the system data mappings, beginning in the academic year 2001, this reduction is explained by the total counted surgeries as major that were eliminated in a revised counting methodology. It was evident on evaluation of the average (of averages) for major surgical procedures per resident (per program) in academic years 1997 to 2004 that the number of procedures was not statistically different in the academic years evaluated when compared with the year for implementation of duty-hour standards (2003--2004). Data analysis further indicates that the average procedures (per resident) performed as Chief Resident in general surgery remained stable from 1997 to 2004; the use of tiered t tests comparing Chief Resident averages (per program) for the academic years 2002--2003 versus 2003--2004 indicated that data remained consistent and confirmed no statistical variance in volumes during this interval (P=0.43). Because some general surgery programs have exceptions for duty-hour requirements (n=15) to allow an 88-hour week averaged over 4 weeks, these differences were of interest to evaluate programs with and without these duty-hour exceptions. Preliminary data with these limited parameters of evaluation suggest no detrimental outcomes related to the duty-hour restrictions for total major procedures per resident or for surgical procedures as Chief Residents for programs with and without these approved exceptions. CONCLUSIONS: RRCs that evaluate general surgery and surgical specialties have responded aggressively and professionally to implement the duty-hour standards per the ACGME. This brief report should be considered an interim communication to evaluate the surgical experience impact for programs currently under the restriction of duty-hour limits. The data provided in the first year of evaluation since the implementation of the 80-hour work-week restriction policy suggest that there has been no significant change in the overall surgical experience for major procedures (per resident), nor has there been a negative impact on Chief Resident surgical experience. A continuum of the prospective evaluation process is required by the RRC-S and other surgical specialties to ensure that requisite surgical volume is maintained throughout the entire 5 years of clinical surgery.

Accreditation↗
PubMed2004

Systems approaches to surgical quality and safety: from concept to measurement.

OBJECTIVE: This approach provides the basis of our research program, which aims to expand operative assessment beyond patient factors and the technical skills of the surgeon; to extend assessment of surgical skills beyond bench models to the operating theater; to provide a basis for assessing interventions; and to provide a deeper understanding of surgical outcomes. SUMMARY BACKGROUND DATA: Research into surgical outcomes has primarily focused on the role of patient pathophysiological risk factors and on the skills of the individual surgeon. However, this approach neglects a wide range of factors that have been found to be of important in achieving safe, high-quality performance in other high-risk environments. The outcome of surgery is also dependent on the quality of care received throughout the patient's stay in hospital and the performance of a considerable number of health professionals, all of whom are influenced by the environment in which they work. METHODS: Drawing on the wider literature on safety and quality in healthcare, and recent papers on surgery, this article argues for a much wider assessment of factors that may be relevant to surgical outcome. In particular, we suggest the development of an "operation profile" to capture all the salient features of a surgical operation, including such factors as equipment design and use, communication, team coordination, factors affecting individual performance, and the working environment. Methods of assessing such factors are outlined, and ethical issues and other potential concerns are discussed.

General Surgery↗
PubMedDate not supplied

[Joint effort to improve quality in a Brazilian pediatric public hospital through cross-infection control]

OBJECTIVES: To examine the role of the laboratory in nosocomial infection control from January 1993 to December 1996 in Centro Geral de Pediatria of Hospital Foundation of Minas Gerais state. METHODS: Follow -up of 101,139 patient-days (11,147 discharges + deaths + transfers) in the wards and intensive care unit by using the National Nosocomial Infection Surveillance (NNIS) system proposed by the Centers for Disease Control and Prevention (CDC- Atlanta). Prospective surveillance of nosocomial infections at all sites was performed according to the hospital - wide (since 1992) and intensive care unit (since 1996) NNIS components. The CDC definitions since 1988 and Brazilian Ministry of Health regulation number 930 since 1992 were used to diagnose the nosocomial infections. RESULTS: The five most frequent nosocomial pathogens (from a total of 139 isolates) were Klebsiella sp = 24.5%; S. aureus = 18%; P. aeruginosa = 13.7%; E. coli = 12.9%; S. epidermidis = 12.2%. The percentage of identification of pathogens isolated from nosocomial infection sites has increased from 6.2% in 1993 to 13.3% in 1995 and 28.2% in 1996 (p< 0.001) and so has the attempt to isolate the pathogens: 7.5% in 1993, 16.1% in 1995, 33.8% in 1996 (p< 0.001). The time interval taken for lab results (from specimen collected to microbiology result) has decreased from the average of ten days in 1993 to six days in 1996 (p = 0.001). CONCLUSIONS: The continuing education and improved communication among infection control personnel, pediatricians, surgeons and members of the laboratory have proven to play a key role in the epidemiology of nosocomial infections by defining their etiologies in the Centro Geral de Pediatria. A task force to determine the microbiology has been achieved by the understanding of all clinicians that it is important to treat their patients specifically. The NNIS method applied to Brazilian hospitals has shown its impact on the microbiology lab role in nosocomial infection control as well.

Journal Article↗