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PubMed1995

A decision support database for nurse care planning as part of a hospital information system.

This paper, based on a doctoral thesis, describes the development and evaluation of a computerized care planning database at the Royal Hampshire County Hospital. It is part of an integrated Hospital Information System, the first to be installed in an United Kingdom. The research examines nurses' attitudes to the Nursing Process to the new care planning system before, three months after, and one year after its implementation. The quality of manual vs. computer care planning is compared in the same time periods using an existing quality assurance instrument and an audit tool, developed during the research. All data was analyzed in each time period in a framework of personal and organizational change theories. The proactive nature of the research allowed findings to be used as a basis for modifications during the process, which culminated in a further project to provide a database of standard based care plans. Results showed that an understanding of the Nursing Process was inadequate and that most nurses were ambivalent about paper care planning and the proposed computer care plans. Three months after implementation, attitudes became more unfavorable; however, after a year, attitudes showed a significant shift towards the positive pole. Conversely, the overall quality-of-care planning improved significantly.

Attitude to Computers↗
PubMed1991

National survey of state psychiatric hospital pharmacies.

The results of a winter 1990 nationwide mail survey of pharmaceutical services provided in state psychiatric hospitals are reported and discussed. The survey universe consisted of all 207 state psychiatric hospitals registered by the American Hospital Association. Private and federal and other government-operated psychiatric hospitals were not included. Questionnaires were mailed to the director of pharmacy at each institution. Two questionnaires were not deliverable. There were 117 usable replies, for a net response rate of 57.1%. Compared with community hospitals, state psychiatric hospitals had pharmacy departments that were open fewer hours per week, occupied more floor space, were less likely to have a complete unit dose distribution system and i.v. admixture program, had lower inventory turnover rates, and had fewer full-time positions. About 28% of the respondents employed pharmacists who spent at least two thirds of their time providing clinical services. Differences in the provision of pharmaceutical services between state psychiatric hospitals and community hospitals may be due in part to the fact that most of the former are long-term-care institutions rendering a specific class of therapies.

Formularies, Hospital as Topic↗
PubMed2001

Management and transmission of DICOM files using PC to PC multicasting methodology.

The PACS system built and used in hospitals nowadays has quite significant overload on its central server because of both treatment of very large data and full management of medical images. We suggest a distributed communication and management methodology using PC to PC multicasting strategy for efficient management of medical images produced by DICOM modalities. It is absolutely necessary for reducing strict degradation of PACS system due to large size of medical images and its very high transport rates. DICOM PC to PC component is composed a service manager to execute requested queries, a communication manager to take charge of file transmission, and a DICOM manager to manage stored data and system behavior. Each manager itself is a component to search for requested file by interaction or transmit the file to other PCs. Distributed management and transformation of medical information based on PC to PC multicasting methodology will enhance performance of central server and network capacity reducing overload on them.

Computer Communication Networks↗
PubMed1995

Evaluation of Community Care Network (CCN) system in a rural health care setting.

Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.

Attitude to Computers↗
PubMed1994

Automation support of patient-focused care.

The use of automation in hospital pharmacies is essential to support the concept of patient-focused care. Patient-focused care principles are defined, and the positive effect automation can have on supporting these principles is discussed. Automated technologies supporting drug distribution, sterile product production, prescription filling, and point of care information systems are summarized. Drug distribution technologies include distribution to and from the patient care area, distribution of medication to the patient, inventory control, controlled substance systems, and documentation of medication administration. Finally, a comprehensive automated technology system at a university teaching hospital is described.

Automation↗
PubMed1998

Integrating HIS-RIS-PACS: the Freiburg experience.

With the integration of different formerly isolated information systems, such as Hospital Information System (HIS). Radiology Information System (RIS), Picture Archiving and Communication System (PACS) and modalities, we evolve towards an architecture of distributed information processing in radiology, the data being stored in distributed databases. The frontier between the cooperative information systems becomes more subtle than in the past, and it seems more convenient to distinguish the different computer functionalities or services used in radiology than to detail the functions of RIS and PACS. This paper opens with a description of the different computer services used in radiology and how they relate one to another. It also shows how these functionalities could be integrated within a global Radiology Information and Archiving System. Finally, it shows the degree of systems interconnection that can be achieved presently, using the PACS-RIS installation at the University Hospital of Freiburg as an example.

Computer Communication Networks↗
PubMed1997

Reliability and validity of hospital pharmacists' clinical intervention data.

The reliability and validity of pharmacist intervention data documented at a hospital in England were studied. The study involved intervention data recorded from September 1 to December 31 in 1990 (a pilot study), 1991, and 1992 by a total of 23 pharmacists. The interventions in 1990 were coded by a single pharmacist manager and compared with coding by pharmacists of their own interventions during 1991 and 1992. To test for internal reliability of the intervention data, 25% (584) of the 2342 interventions recorded in 1991 and 1992 were randomly sampled after interventions by the 11 pharmacists no longer at the site were eliminated. In September 1993 the 12 remaining pharmacists were asked to recode the interventions they had previously entered. In March 1994 a panel of 12 pharmacists recoded 62 interventions randomly selected from the 684 recoded interventions. Each panel member also assigned financial values to interventions. Medical records corresponding to the 62 recoded interventions were inspected for evidence of the interventions. The distribution of interventions among the drug-use-process (DUP) indicators used in the coding differed significantly between 1990 (when a manager assigned all codes) and 1991 plus 1992 (when pharmacists coded their own interventions). There were similar differences between 1991 and 1992. Results from code-recode and panel testing showed the DUP indicators to be reliable. Clinical outcome indicators were unreliable, as were financial indicators. Medical records verified the occurrence of 50 (81%) of the 62 interventions selected, but in only one case was there evidence that the change in drug therapy was initiated by a pharmacist. The capacity of pharmacists at a British hospital to reliably code interventions was poor.

Chi-Square Distribution↗
PubMed1984

Analysis of hospital infection surveillance data.

How often infection rates should be calculated and how large a change is required for "significance" are pertinent questions in nosocomial infection surveillance programs. A method is presented which establishes outbreak threshold infection frequencies. Comparison is direct and immediate: computation of rates or use of electronic data processing is not required. We have validated this method, using computer systems, by comparing the distributions of mean weekly incidence and prevalence statistics for each ward by nosocomial infection site in an acute care general hospital against both our theoretical outbreak threshold limits and the distribution of proven infection outbreaks. Sensitive and specific distinction between random variation or sporadic cross-infection and true persisting outbreaks requiring intervention is obtained. This approach provides a simple and timely alternative to intuitive after-the-fact interpretation of infection patterns which is applicable to infection surveillance and cost-effective infection control in hospitals of all sizes.

British Columbia↗
PubMed1995

Medicare funding of nurse education. The case for policy change.

OBJECTIVES: To determine the magnitude and distribution of US Medicare funding for nursing education and to assess the extent to which Medicare funding contributes to meeting national health care workforce priorities. DATA SOURCES: Medicare Hospital Cost Report Information System, American Hospital Association Annual Survey of Hospitals, and National League for Nursing national surveys of schools of nursing. DATA ANALYSIS: Using hospital identifiers, data from three data sets were merged and analyzed to estimate percentage distributions of Medicare funding according to types of educational programs, hospital characteristics, and student enrollment. RESULTS: Fifteen percent of direct Medicare graduate medical education funding goes to hospitals for the training of nurses and paramedical personnel. Totaling approximately $174 million in 1991, 71% of these funds went to hospitals for nursing education costs. Most of the nation's teaching hospitals (289 of 381 Council of Teaching Hospitals member hospitals) and nurse education programs (1112 of 1484) do not qualify under existing policies for Medicare nursing education reimbursement. Sixty-six percent of Medicare nurse training funds, totaling $114 million in 1991, went to 145 hospitals operating diploma nursing programs; these programs produce less than 10% of nurse graduates. Three states (Pennsylvania, New Jersey, and Ohio) received nearly one half (48%) of the $114 million for diploma nursing education. CONCLUSIONS: Medicare is the largest single source of federal support for nursing education. Yet, the majority of Medicare nursing education funding goes to hospitals affiliated with an increasingly smaller, idiosyncratic subset of nurse training programs. Unlike graduate medical education, Medicare supports primarily preprofessional education in nursing. Graduate education, including the preparation of nurse practitioners, does not generally qualify for reimbursement. Medicare reimbursement for nursing education must be retargeted.

Allied Health Personnel↗
PubMed1995

The Australian Capital Territory Injury Surveillance and Prevention Project.

OBJECTIVE: To identify the representativeness and sensitivity of the data collected by the Australian Capital Territory Injury Surveillance and Prevention Project (ACTISPP) for ED injury cases seen in the Australian Capital Territory (ACT). METHODS: A retrospective descriptive study was conducted using a systematic sample of people injured in the ACT between January 20 and September 19, 1992, and who received their first treatment for this injury in an ACT ED. The ACTISPP surveillance system is dependent on ED patient or family completion and return of a comprehensive injury survey. The following population variables in the ACTISPP database were compared with those of the injured ED population, as determined by ED and hospital record review: age, gender, postal code of residence, nature of injury, body part injured, and whether the patient had been admitted to hospital. RESULTS: The sensitivity of the surveillance system for injuries seen in the ED was 31% (95% CI = 30-32%). The distribution of the ACTISPP sample did not differ from the expected distribution for sex or socioeconomic status. The distributions differed by age only in the 5-14-year age group (p < 0.001). With respect to the nature of injury and body part injured, the difference was significant (p < 0.001) but was no greater than 7% for any of the categories. Two percent of the surveillance sample were admitted to hospital, compared with an estimated 4% of the target population (p < 0.001). CONCLUSIONS: Approximately one-third of all incident injuries managed in the EDs of the ACT are included in the ACTISPP database. Although some sampling bias is introduced in the surveillance process, it does not appear to be of sufficient magnitude to compromise the project's goals.

Adolescent↗
PubMed2002

Etiology and weekly occurrence of alcohol-related seizures.

OBJECTIVES: 1) To determine the prevalence of identifiable causes of alcohol-related seizures other than alcohol withdrawal. 2) To test the hypothesis that patients with alcohol-related seizures present with greater frequency following Sundays when alcohol is not commercially available. METHODS: This was a retrospective chart review of 140 consecutive patients presenting with alcohol-related seizures during a six-month period. Identifiable causes of seizures other than alcohol withdrawal and the day of the week of presentation were documented. RESULTS: One hundred forty individual patients were eligible for study. Identifiable causes of seizures other than alcohol withdrawal were found in 53.6% of patients, and they were distributed as follows: 1) current or past history of significant head trauma 25.7%, 2) idiopathic seizure disorder 15.7%, 3) cerebrovascular accident 5.7%, 4) nontraumatic intracranical lesion 3.6%, and 5) toxic/metabolic abnormalities 2.9%. Alcohol is not available for purchase on Sundays because of the "Blue Laws" in Massachusetts. A total of 34.5% of patients with alcohol withdrawal seizures presented on Mondays (p < 0.001). Of patients with identifiable causes of seizures other than alcohol withdrawal, only 16% presented on Mondays (p > 0.10). CONCLUSIONS: Approximately 50% of seizures in alcohol-dependent patients are potentially unrelated to alcohol withdrawal. Patients with alcohol withdrawal seizures presented with greater frequency on Mondays following the 24-hour period when alcohol was not commercially available in Boston. This suggests that patients with alcohol withdrawal seizures may present with greater frequency following periods of decreased availability of alcohol.

Adult↗
PubMed1986

Phenotypic characteristics of coliform and noncoliform bacteria from a public water supply compared with regional and national clinical species.

During the summer and fall of 1984, elevated total coliform counts were observed in the distribution system of a public water supply serving 350,000 people in south central Connecticut. As part of an investigation of possible health risks associated with the presence of bacteria in the water supply, bacterial isolates from the distribution system were compared with bacterial isolates of the same species obtained from a large regional teaching hospital and from a national compendium of clinical isolates. Characteristics analyzed included phenotypic metabolic activity, antimicrobial susceptibilities to clinically utilized antibiotics, temperature tolerance at 44.5 degrees C, and beta-glucuronidase activity in single-test form and on a selective medium. Environmental isolates lacked known plasmid-mediated characteristics, with the exception of one Escherichia coli isolate which showed some antibiotic resistance. Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, and Enterobacter agglomerans from all sources were temperature tolerant and yielded positive fecal coliform tests. Only E. coli showed beta-glucuronidase activity (both in a single biochemical test and on a selective medium). No single characteristic analyzed was sufficient to establish an organism as either environmental or clinical in origin.

Anti-Bacterial Agents↗
PubMed2006

Knowledge, attitudes and practice of medical students at the Cave Hill Campus in relation to ethics and law in healthcare.

OBJECTIVES: The purpose of this study is to assess the knowledge, attitudes and practices among medical students in relation to medical ethics and law. The results of the study will be a useful guide to tutors of medical students and curricula designers. METHODS: A thirty-item self-administered questionnaire about knowledge of law and ethics, and the role of an ethics committee in the healthcare system was devised, tested and distributed to all levels of students and staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) in 2003. The data from the completed questionnaires were entered into an SPSS database and analyzed using frequency and multiple cross-tabulation tables. RESULTS: Completed responses were obtained from 55 (96%) of the medical students. Medical students generally attested to the importance of ethical knowledge but felt that they knew little of the law. Students varied widely as regards the frequency with which they saw ethical or legal problems, with a quarter seeing them infrequently, but another quarter seeing them every day. They received their knowledge from multiple sources and particularly from lectures/seminars, and found case conferences the most helpful. Only a few students felt that text books had been helpful. Students were generally knowledgeable about most ethical issues, but many had uncertainties on how to deal with religious differences in treating patients, on the information to be given to relatives, and how violent patients should be treated. CONCLUSIONS: The results of the study highlight that medical students felt an inadequacy of knowledge of law as it pertains to their chosen career Since most of their knowledge of law was obtained from lectures, these should be reviewed and other avenues of tuition explored. The study also highlights the need to identify the minority of students who have problems with their ethical knowledge and to devise means whereby any deficiencies can be discussed and modified.

Adult↗
PubMed1999

Quantitative image analysis of estrogen and progesterone receptors as a prognostic tool for selecting breast cancer patients for therapy.

OBJECTIVE: To assess estrogen and progesterone receptor presence in human breast tumors using immunocytochemical analysis. STUDY DESIGN: For both estrogen (ER) and progesterone (PR) receptor assay, percent of stained cells and intensity of staining were estimated on a series of 251 consecutive breast cancer cases from the M. Ascoli Cancer Hospital Center in Palermo using the CAS 200 image analysis system. RESULTS: Cytochemical assay revealed a differential distribution of both ER and PR, by menopausal status of the patients; premenopause (PreM) was mostly ER negative (63%), and postmenopause (PostM) > 10 years was mostly ER and PR positive (64%). The percent of cells stained for ER was significantly different between PreM and PostM patients when they were considered as a whole. By contrast, no difference emerged for PR staining among menopausal groups. Overall, patients whose tumors were PR positive showed a significantly (P < .03) longer interval free of relapse. CONCLUSION: The present results suggest that PRs behave as better indicators than ERs of early relapse in breast cancer patients. Further studies, with longer follow-up, are needed, however, to validate this concept.

Adenocarcinoma↗
PubMed1986

Why the traditional hospital won't survive.

The demand for hospital services is declining, and this is changing the role of the hospital in health care. The authors contend that to be part of the health systems of the future hospitals must adopt new strategies that will fundamentally change the traditional hospital and the distribution of health services.

Delivery of Health Care↗
PubMed1999

Converting customer expectations into achievable results.

It is not enough in today's environment to just meet customers' expectations--we must exceed them. Therefore, one must learn what constitutes expectations. These needs have expanded during the past few years from just manufacturing the product and looking at the outcome from a provincial standpoint. Now we must understand and satisfy the entire supply chain. To manage this process and satisfy the customer, the process now involves the supplier, the manufacturer, and the entire distribution system.

Commerce↗