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PubMed1993

Autotransfusion program: integrated use of different techniques.

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood. A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available. Results in 1992 in elective surgery: 98% enrollment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.

Blood Loss, Surgical↗

PubMed1996

Smoking among disadvantaged women: causes and cessation.

This study aimed to identify social-psychological factors associated with smoking and smoking cessation among disadvantaged women. Individual and group interviews were conducted with disadvantaged women in Atlantic Canada. Participants were predominantly poor, unemployed, geographically isolated, and single parents. The factors associated with smoking included coping with stresses, loneliness, powerlessness, low self-efficacy, social pressures, and addiction. Support from peers (i.e., women in similar circumstances) and partners was considered important. Health professionals and traditional cessation programs were not perceived as supportive. Participants viewed women's centres and women's agencies as appropriate deliverers of cessation programs. Methodological issues are discussed.

Adaptation, Psychological↗

PubMed1993

Automated linkage of free-text descriptions of patients with a practice guideline.

The process of applying a practice guideline to a patient requires a great deal of clinical data. AAPT (Appropriateness-Assessment Processing from Text) is an experimental computer program that can assess the appropriateness of coronary-artery bypass grafting surgery (CABG) in patients with coronary-artery disease (CAD) and chronic stable angina from the admission summaries of those patients. The AAPT architecture combines natural-language processing (NLP) and probabilistic inference. The NLP module identifies single clinical concepts of interest in the free-text document. The probabilistic inference module, a Bayesian belief network, estimates values for variables not specifically mentioned. AAPT produces a patient's summary of CAD that is similar to a manually generated clinical summary. Work is ongoing to improve AAPT and evaluate it as a tool to assist in the dissemination of guidelines and as a tool to encourage adherence to practice guidelines.

Angina Pectoris↗

PubMed1993

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices.

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.

Ambulatory Care↗

PubMed2004

Planning emergency medical services for children in Bolivia: part 1-the use of rapid assessment procedures.

OBJECTIVES: To describe an expedited process for collecting social and cultural data before program planning to develop emergency medical services for children in La Paz, Bolivia. The overall goal was to understand the relevant issues from the point of view of those most affected. METHODS: An interdisciplinary collaborative research team used several qualitative data collection tools in gathering and interpreting data. RESULTS: Information was collected from a wide variety of stakeholders that will allow for planning of programs that are Bolivian-driven, culturally appropriate, and socially feasible. CONCLUSIONS: By adhering to a systematic process of team building and data gathering from a variety of sources using a mix of methods, culturally appropriate information can be integrated into program planning.

Adult↗

PubMed2004

Clinical nurse specialist as leader of a bariatric program.

Bariatric surgery is an appropriate intervention for the treatment of morbid obesity. Using the National Association of Clinical Nurse Specialist's "spheres of influence" model, the clinical nurse specialist (CNS) is able to lead in the development and maintenance of an effective hospital-based bariatric program. The three spheres include the patient/client, the nurse/nursing practice, and the organization. The CNS is vital in guiding the education and support for patients and hospital staff. S/he is also instrumental as a leader in developing an environment that is conducive to supporting the bariatric patient population. By employing the three spheres in the program, everyone involved will benefit and positive patient outcomes can be expected.

Bariatrics↗

PubMed2002

[Infection control team].

Infection control(IC) is a quality-improvement activity that focuses on improving the care of patients and protecting the health of staff. The infection control committee(ICC) should function as the central decision-making and policy-making body for IC. The infection control team(ICT) is responsible for carrying out all aspects of the IC program. ICT should have appropriate access to medical relevant staff members who can provide information on the adequacy of the institution's compliance with regard to IC programs. Healthcare facilities should use ICT to assist in maintaining compliance with IC programs. Surveillance of hospital-acquired infections should be performed and surveillance data should be analyzed appropriately and used to monitor and improve IC and healthcare outcomes.

Cross Infection↗

PubMed2003

A multiobjective model for non-point source pollution control for an off-stream reservoir catchment.

Phosphorus loads from agricultural non-point source pollution (NPSP) significantly degrade reservoir water quality, making adequate control of agricultural NPSP necessary for improving the water quality. Controlling NPSP is generally accomplished using various Best Management Practices (BMPs). The present study applies the Agricultural Non-Point Source Pollution (AGNPS) model to simulate NPSP loading and BMP efficiencies and establishes an enhanced multiobjective mixed-integer programming model for NPSP control strategy analyses based on these results. Cost, phosphorus load, sediment load and equity are the four major objectives considered. A case study for the Posan reservoir is presented. Four commonly proposed and applicable BMPs are chosen. Non-inferior solutions obtained using the constraint method and trade-off relationships among different control objectives are described and discussed. Compared with a previously proposed fertilizer control model, results show that the model established herein is more cost-effective and achieves better phosphorus and sediment loading reduction and equity goals. Furthermore, the current model is expected to facilitate decision-making analysis for development of an appropriate cost-sharing program to encourage adoption of appropriate BMPs by farmers.

Agriculture↗

PubMedDate not supplied

Software review: Dioptimum.

UNLABELLED: BEST FEATURES: The software screens all preoperative measurements to detect those likely to be in error. This data screening function is based on statistical analysis of the distribution of eye measurements within the human population. If measurements are input that are far from the average value, the program will identify those cases with a message on the screen and a large warning sign. Nevertheless, the program will perform the requested lens power calculations. The program will also compare measurements between right and left eyes, if both are entered, and a test is performed on the asymmetry between the eyes. WORST FEATURES: The lack of a written owner's manual is probably the most glaring defect of the program, even though most of the important information is present on a disk. Only users familiar with running software programs will be able to easily obtain the data. The program can be installed on a hard disk only two times. For physicians with multiple offices or multiple computers that are not on-line, this is a significant handicap. HARDWARE REQUIREMENTS: Two floppy disk drives, 256K RAM and printer, DOS 3.0 or higher are required. One floppy drive plus a hard drive can also be used. The program will run a TTL monochrome or color monitor but the type of color monitor is not specified. LIST PRICE: $495 COPY PROTECTION: Yes USER SUPPORT: 800 number available EASE OF USE: Good ON SCREEN HELP: Yes CONSUMER VALUE: Very expensive PERFORMANCE: Excellent PUBLISHED BY: Storz Ophthalmics, Inc. 1365 Hamlet Avenue Clearwater, FL 34616 (818)-443-2606 or (800)-237-5906 A defective disk can be returned for replacement at no charge within 1 year of the date of purchase. Beyond that date, disks can be replaced at a cost of $10.00. In summary, this is a very well thought out software program for calculating and printing IOL powers using a second-generation lens implant power formula. With appropriate written documentation, the program will become extremely easy to use, even for novices. Because it is so simple to use, surgeons will continually update their personalized surgeon factors and patient data in order to provide patients with the best possible refractive results. A discussion of the use of the Holladay formula in comparison to other formulas is found in reference 2.

Humans↗

PubMed1995

The impact of legislation designed to reduce infant mortality.

In response to the slowing improvement in the nation's infant mortality rate in the mid-1980s, Congress passed a series of bills aimed at increasing women's access to prenatal care and enhancing available services through the Medicaid program. Other programs also received increased appropriations targeted at infant mortality reduction. Since then, dramatic changes have been made in state Medicaid and maternal and child health programs. Only a few evaluations of these initiatives have been completed, and the preliminary results seem to show that although Medicaid eligibility expansions improved access to appropriate prenatal care, enhanced services are needed to improve birth outcomes.

Female↗

PubMed1996

School health in pediatric residency training: 1994.

OBJECTIVE: To explore efforts of pediatric residency programs to provide future pediatricians with appropriate school health skills (given the growing recognition that school health programs have a positive effect on child health). DESIGN: A survey was mailed to the directors of all 214 accredited pediatric residency programs in the United States. RESULTS: Based on an overall response rate of 72%, a defined clinical experience in school health is required in only 34% of programs and offered by 43%. It usually consists of occasional half days during block rotations. Content included consultation on children with chronic illness, classroom observations, and participation in school-based clinics, health education classes, and multidisciplinary team meetings. Many residency programs viewed core topics in school health as appropriate for pediatric residency curriculum, and many of them included such instruction. In the programs that offered school health, dollars were generated only 16% of the time, and the funding level was seldom significant (>$50 000). CONCLUSIONS: Tomorrow's pediatricians will need training in comprehensive school health (including education, service provision, and the assurance of a medical home for some children in the school), but school health is a minor part of the curricular experience for today's pediatric residents. Future investigations should target barriers to comprehensive school health training (including financial impediments) and look at alternative school and community experiences and their effect on trainees, schools, and school-aged children.

Child↗

PubMed2000

Benchmarking in health-system pharmacy: experience at MeritCare Medical Center.

The experience of MeritCare Medical Center (MMC) with the Benchmarking Program coordinated by The Clinical Pharmacokinetics Laboratory at Millard Fillmore Hospital is described. MMC is a community-based teaching institution in Fargo, North Dakota, that serves patients in North Dakota, South Dakota, and Minnesota. MeritCare began participating in the Benchmarking Program in 1997. Data from the individual hospital report raised concern about the high cost of antimicrobials at MMC relative to peer-group institutions. The staff conducted an evaluation of antimicrobial prophylaxis for noncardiovascular surgery, concluded that cefazolin use was suboptimal, and attempted to encourage more cost-effective utilization. MMC's participation in the Benchmarking Program also prompted more appropriate use of various other antimicrobial agents, including i.v. and oral ciprofloxacin. An i.v.-to-oral switching program was begun for various agents. Preliminary analysis after 15 months demonstrated direct cost savings for drug acquisition of $60,000 to $80,000 per year and a reduced length of stay. Initiatives undertaken by MeritCare on the basis of data obtained through the Benchmarking Program resulted in substantial estimated savings in drug acquisition costs.

Anti-Bacterial Agents↗

PubMed2005

A model to identify direct costs of nursing education: the Colorado experience.

During spring 2003, national, state, and local economic factors converged in a manner that propelled us to better identify the costs of the educational programs offered within the University of Colorado Health Sciences Center School of Nursing (SON). Two factors prompted analysis of direct costs of the nursing education programs: a shrinking state appropriation and a 36.7% rescission of state funds during that academic year. The SON supports 618 students in four programs (baccalaureate, master of science, doctor of nursing, and doctor of philosophy). During summer 2003, the SON leadership team met numerous times in an iterative process to clarify assumptions and make recommendations in an attempt to cost out academic programs. Data were obtained from a variety of sources. The SON Office of Budget and Finance provided revenue and expense data. The Office of Academic Affairs provided course schedules, the course offering plan, and projected student enrollment in courses. The Division Chairs provided data concerning faculty workload and faculty areas of expertise. The data were compiled in Access tables and arrayed in a series of Excel spreadsheets that captured course data and faculty data. A "what-if" analysis was completed to determine cost of a pilot accelerated baccalaureate program. This method provides a dynamic analytic system shown to be prospectively and retrospectively effective. As a result of this analysis, the following metrics are available: direct cost per student per course/program; revenue per student per course/program; faculty teaching FTE; and faculty-to-student ratio.

Budgets↗

PubMed2001

Surgical patients' fear of addiction to pain medication: the effect of an educational program for clinicians.

OBJECTIVE: The appropriate and optimal use of analgesics is essential for the adequate management of postoperative pain. Concern that use of opioid analgesics contributes to the development of addiction is a barrier to effective pain relief. The purpose of this study was to determine the prevalence of fear of addiction in postoperative patients in relation to surgical outcomes and staff participation in an educational program. DESIGN: Two treatment levels (program vs. control) and three data collection periods (before program, immediately after the program, and 6 months after the program). SETTING: Six community hospitals with 100-500-bed capacities in a southeastern state. PATIENTS: Seven hundred eighty-seven patients who had undergone orthopedic or laparotomy procedures. INTERVENTIONS: Staff at three of the six hospitals received an educational program to promote implementation of Agency for Health Care Policy and Research acute pain management guidelines. OUTCOME MEASURES: Patient report of preoperative and postoperative fear of addiction, satisfaction with pain treatment, communication with clinicians, and pain intensity. RESULTS: Only 10.8% of the sample reported preoperative or postoperative fear of addiction. Staff participation in the educational program was found to decrease fear of addiction in this sample. Fear of addiction was also related to surgery type, with disc surgery patients more likely to report fear of addiction as compared with patients undergoing other types of surgery. Fear of addiction was not related to other outcomes in this sample. CONCLUSIONS: Fear of addiction is not prevalent among postoperative patients, yet clinician education can further decrease the proportion of surgical patients who fear of addiction to pain medication.

Adolescent↗

PubMed1996

Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes.

OBJECTIVE: The authors investigated the clinical feasibility and the outcome for patients of a program designed as an alternative to acute hospitalization. METHOD: This was a random-design study comparing a conventional inpatient program for urban, poor, severely ill voluntary patients who usually require hospitalization to an alternative experimental program consisting of a day hospital linked to a crisis residence. Patients were assessed with standardized measures of symptoms, functioning, social adjustment, quality of life, and satisfaction with clinical services upon admission to the study, at discharge from the index admission, and at follow-ups 2, 5, and 10 months after discharge. RESULTS: One hundred ninety-seven patients were enrolled in the 2-year research program and followed for 10 months. Of the voluntary patients who would have been admitted to the hospital, 83% were appropriate for the experimental program. The clinical, functional, social adjustment, quality of life, and satisfaction outcome measures were not statistically different for the patients in the two treatment conditions; however, there was a slightly more positive effect of the experimental program on measures of symptoms, overall functioning, and social functioning. CONCLUSIONS: The experimental condition, a combined day hospital/crisis respite community residence, seems to have had the same treatment effectiveness as acute hospital care for urban, poor, acutely ill voluntary patients with severe mental illness.

Community Mental Health Services↗

PubMed1990

Physicians' attitudes toward substance abuse and drug testing.

Responding to a survey, 303 physicians provided opinions about permissibility of substance use among eight occupational groups, appropriateness of drug-screening programs by employers, and the role of physicians in managing substance abuse problems. The majority felt that neither drugs nor alcohol should be used at lunch by any individuals, but that alcohol and to some degree marijuana use was permissible after work or on weekends. Physicians could not agree about reliability or use of drug-testing programs. However, most believed that employee drug screening was more appropriate after evidence of poor job performance rather than screening all employees or applicants.

Attitude of Health Personnel↗

PubMedDate not supplied

Family characteristics and sexual risk behaviors among black men in the United States.

CONTEXT: Past research indicates that family characteristics are associated with sexual risk-taking behaviors in adolescence and adulthood Because the prevalence of sexually transmitted diseases is higher among black males than among males of other races, it is important to understand factors associated with sexual risk in this group. METHODS: Data from 1,125 black men participating in the 1991 National Survey of Men were used in structural equation modeling to examine the association of individual and family characteristics with age at sexual initiation and the lifetime number of sexual partners. RESULTS: Men whose mothers worked were likely to have first intercourse at a younger age than others (beta, -.104), whereas those raised by both parents were likely to delay sexual initiation (.072) and to have fewer partners during their lifetime (-.062). Men who were married or had had first intercourse at an old erage were likely to have a lower total number of partners than others (-.297 and -.369, respectively). CONCLUSIONS: School and community programs should provide culturally appropriate and accessible activities for black youth, and should reach black males early, while they are still in elementary school. Programming targeted at parents mayhelp them learn skills for communicating effectively with children about sexuality-related issues.

Adult↗

PubMed1988

Lean meats make the grade--a collaborative nutrition intervention program.

Lean Meats Make the Grade is a collaborative nutrition intervention program involving the Minnesota Heart Health Program (MHHP), the Minnesota Beef Council, and the Pork Producers Council. The purposes of this program were to educate consumers about identification of leaner cuts of meat, low-fat preparation methods, and selection of appropriate meat portion size. Program components included training for meat managers, taste testing for consumers, recipes and customer information brochures, and labels on individual meat packages to assist in the identification of leaner cuts of meat. The program was implemented through grocery stores in two of the towns selected for MHHP intervention. Population-based telephone surveys indicated that respondents in the intervention towns were more aware of the lean meats program than those in the comparison communities. Knowledge of lean cuts of meat and low-fat preparation methods also increased as a result of the program. Independently collected sales data from five participating and two control stores provided some indications of a greater interest in lean cuts and 80% lean ground beef as a result of the intervention program. Programs such as this have potential for community-wide nutrition education.

Animals↗