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PubMed2006

Developing a health and safety plan for hazardous field work in remote areas.

Developing health and safety plans (HASPs) is a common feature of occupational safety and health for many workplaces. Formal HASPs are a requirement for hazardous waste work, requiring the anticipation and identification of hazards and embodying the training, equipping, and evaluation of workers. Aside from OSHA, there are relatively few manuals or examples and virtually no papers that provide practical guidance in what a HASP should cover or how to create and implement one. Moreover, existing guidance refers to spatially circumscribed worksites. This article details development of a HASP to cover field researchers and ship personnel conducting scientific research in a remote area of the world (Amchitka Island in the western Aleutians), hundreds of kilometers from the nearest emergency room. It required characterizing the kinds of work to be performed and anticipating the hazards that could be encountered. It illustrates the meshing of a general HASP with a ship safety plan, a dive safety plan, and specialized topics, including stop-work authority, rock climbing, firearms, vehicle safety, and communication strategy. Remote area operations are a growing challenge facing the profession. An expedition of this sort requires extensive planning and experienced safety personnel and cannot rely on luck to ensure the safe return of participants.

Alaska↗
PubMed2002

Hearing impairment.

The purpose of this chapter is to review the literature on hearing impairment, specifically the impact of hearing impairment on the functioning of elders, interventions that minimize the impact of hearing loss on functioning, and identification of issues raised by the review for nursing research. Computerized (MEDLINE, PsychINFO, and CINAHL) and manual searches were used to obtain research reports from a range of disciplines. Research articles including elders (> or = 60) and published between 1989 and 2001 were included. Twenty-five articles were selected for critical review, four written by nurses. The diversity of methodologies, the criteria used to define hearing impairment, the range of sample characteristics, and the assessment measures make comparisons across studies difficult. Most studies, however, support the negative impact of hearing impairment, especially on psychosocial functioning. Measures that are condition specific are generally more effective in capturing the impact of hearing loss than generic measures. Findings related to physical disability are less consistent. The results of intervention studies suggest that hearing devices can improve psychosocial and communication outcomes, but behavioral interventions have not shown long lasting benefit. For nurses to assist elders and their families manage the impact of hearing impairment, further research is needed in several areas that have been poorly explored. These include the dyadic experience of hearing impairment, the way in which culture influences the experience of hearing loss, the needs of hearing impaired individuals across settings, the long-term impact of ototoxic medications, and strategies to assist elders in coping with hearing impairment and utilizing available technologies.

Aged↗
PubMedDate not supplied

Development of an internal dynamic web site to promote quality assurance in a clinical laboratory.

In clinical laboratories, one challenging quality assurance objective is to maintain standardized practices. Meeting this objective entails ensuring information flow, which is necessary to smooth running of the laboratory. To facilitate information flow, we developed an internal quality Web site on our local network. The dynamic generated pages of the site were constructed with EasyPHP v.1.6, a complete freeware package providing PHP dynamic language and databases. The site comprises various sections: general news, specific laboratory units news, documents (quality manual, guidelines, emergency processes), schedules, National Quality Control results, forum, etc. Five to 10 pages are updated each week. This work was facilitated by the use of PHP-written pages and data tables, which enable us to record in real time the operation of our assurance quality project and to improve traceability. This approach could be extended to other aspects of quality management and could help meet the future IS015189 standard requirements.

Computer Communication Networks↗
PubMed2006

The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research.

OBJECTIVES: The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice. METHODS: Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study. RESULTS: Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain. CONCLUSIONS: There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

Emergency Medicine↗
PubMed1994

Musculoskeletal clinic in general practice: study of one year's referrals.

BACKGROUND: A musculoskeletal clinic, staffed by a general practitioner trained in osteopathy, medical acupuncture and intralesional injections, was set up in an inner London general practice in 1987. AIM: A retrospective study was undertaken of one year's referrals to the clinic in 1989-90 to determine how general practitioners were using the clinic in terms of problems referred; consultation patterns of patients attending the clinic and 12 months after initially being seen; and how access to the clinic influenced referrals to relevant hospital departments. METHOD: Day sheets were studied which recorded information on demographic characteristics of patients referred to the clinic and their problems, diagnoses made, duration of symptoms, number and range of treatments given, and recurrence of problems. Use of secondary referral sources was also examined. RESULTS: During the study year 154 of 3264 practice patients were referred to the musculoskeletal clinic, and attended a mean of 3.5 times each. Of all the attenders 64% were women and 52% were 30-54 years old. Eighty one patients (53%) presented with neck, back or sciatic pain. A specific traumatic, inflammatory or other pathological process could be ascribed to only 19% of patients. Regarding treatment, 88% of patients received osteopathic manual treatment or acupuncture, or a combination of these treatments and 4% received intralesional injections. Nine patients from the clinic (6%) were referred to an orthopaedic specialist during the year, two with acute back pain. Referrals to orthopaedic specialists by the practice as a whole were not significantly lower than the national average, although the practice made fewer referrals to physiotherapy and rheumatology departments than national figures would have predicted. Seventeen patients (11%) returned to the clinic with a recurrence of their main complaint within a year of their initial appointment; second courses of treatment were usually brief. CONCLUSION: The clinic encouraged a relatively low referral rate to musculoskeletal specialists outside the practice. However, a need was identified for better communication about the potential of the approaches used in order that referrals to secondary specialists, particularly orthopaedic specialists, could be further reduced.

Acupuncture Therapy↗
PubMed1986

Symptoms of schizotypal personality disorder.

The authors examined the symptoms of 35 patients with schizotypal personality disorder. In contrast to the suggestion, based on studies of nonclinical, familial samples, that patients with schizotypal disorder are best characterized by the negative symptoms of social isolation and impaired functioning, they found that the positive symptoms of odd communication, ideas of reference, magical thinking, and illusions were equally valid discriminators of their clinically based group of patients. The findings argue against the idea that schizotypal personality disorder be redefined in the revision of DSM-III (DSM-III-R) to emphasize negative symptoms and suggest that clinical samples of schizotypal patients may differ from familial samples.

Adult↗
PubMedDate not supplied

Smart wheelchairs: A literature review.

Several studies have shown that both children and adults benefit substantially from access to a means of independent mobility. While the needs of many individuals with disabilities can be satisfied with traditional manual or powered wheelchairs, a segment of the disabled community finds it difficult or impossible to use wheelchairs independently. To accommodate this population, researchers have used technologies originally developed for mobile robots to create "smart wheelchairs." Smart wheelchairs have been the subject of research since the early 1980s and have been developed on four continents. This article presents a summary of the current state of the art and directions for future research.

Activities of Daily Living↗
PubMed2000

Common object request broker architecture (CORBA)-based security services for the virtual radiology environment.

The US Army Great Plains Regional Medical Command (GPRMC) has a requirement to conform to Department of Defense (DoD) and Army security policies for the Virtual Radiology Environment (VRE) Project. Within the DoD, security policy is defined as the set of laws, rules, and practices that regulate how an organization manages, protects, and distributes sensitive information. Security policy in the DoD is described by the Trusted Computer System Evaluation Criteria (TCSEC), Army Regulation (AR) 380-19, Defense Information Infrastructure Common Operating Environment (DII COE), Military Health Services System Automated Information Systems Security Policy Manual, and National Computer Security Center-TG-005, "Trusted Network Interpretation." These documents were used to develop a security policy that defines information protection requirements that are made with respect to those laws, rules, and practices that are required to protect the information stored and processed in the VRE Project. The goal of the security policy is to provide for a C2-level of information protection while also satisfying the functional needs of the GPRMC's user community. This report summarizes the security policy for the VRE and defines the CORBA security services that satisfy the policy. In the VRE, the information to be protected is embedded into three major information components: (1) Patient information consists of Digital Imaging and Communications in Medicine (DICOM)-formatted fields. The patient information resides in the digital imaging network picture archiving and communication system (DIN-PACS) networks in the database archive systems and includes (a) patient demographics; (b) patient images from x-ray, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US); and (c) prior patient images and related patient history. (2) Meta-Manager information to be protected consists of several data objects. This information is distributed to the Meta-Manager nodes and includes (a) radiologist schedules; (b) modality worklists; (c) routed case information; (d) DIN-PACS and Composite Health Care system (CHCS) messages, and Meta-Manager administrative and security information; and (e) patient case information. (3) Access control and communications security is required in the VRE to control who uses the VRE and Meta-Manager facilities and to secure the messages between VRE components. The CORBA Security Service Specification version 1.5 is designed to allow up to TCSEC's B2-level security for distributed objects. The CORBA Security Service Specification defines the functionality of several security features: identification and authentication, authorization and access control, security auditing, communication security, nonrepudiation, and security administration. This report describes the enhanced security features for the VRE and their implementation using commercial CORBA Security Service software products.

Artificial Intelligence↗
PubMed2004

Family-focused treatment for adolescents with bipolar disorder.

BACKGROUND: Research has begun to elucidate the optimal pharmacological treatments for pediatric-onset bipolar patients, but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment. This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents (FFT-A). The adult version of FFT has been shown to be effective in forestalling relapses in two randomized clinical trials involving bipolar adults. METHODS: FFT-A is administered to adolescents who have had an exacerbation of manic, depressed, or mixed symptoms within the last 3 months. It is given in 21 outpatient sessions of psychoeducation, communication enhancement training, and problem solving skills training. We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients. RESULTS: An open treatment trial involving 20 bipolar adolescents (11 boys, 9 girls; mean age 14.8+/-1.6) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms, mania symptoms, and behavior problems over 1 year. LIMITATIONS: These early results are based on a small-scale open trial. CONCLUSIONS: Results from an ongoing randomized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder. If the results are positive, then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community.

Adolescent↗
PubMed1992

Eight year's experience with automated anesthesia record keeping: lessons learned--new directions taken.

For the past eight years, an automated anesthesia record keeping system, COMANDAS (COMputerized ANesthesia Data Acquisition System) has been used in the cardiovascular operating rooms at Mayo Clinic. The automated anesthesia record is designed to match the traditional hand-written record and becomes part of the official medical record. COMANDAS is interfaced with the physiologic monitor and mass spectrometer in each OR, and a number of other computers within the Mayo Medical Center. Since the introduction of COMANDAS over 24,000 surgical procedures have been charted. The anesthesia record is more complete, consistent in organization, and legible when compared to a hand-written record. Recently, it was determined that the computers and peripherals that make up COMANDAS were wearing out and that the vendors would no longer support or replace the equipment. A process to find a replacement for COMANDAS was then begun. Although the cardiovascular anesthesia group was satisfied with the automated anesthesia record, there were a number of areas in which improvement was desired. A systematic evaluation of the system was begun with a survey of the users. The majority of those surveyed felt that COMANDAS was a useful system which made parts of their job easier. The user interface, method of manual data entry, time to produce the record and difficulty learning the system were the source of the greatest dissatisfaction. Artifacts, networking, interfacing with other devices and computers were also issues for the replacement system. Most commercial systems were found wanting in one or more areas of significance. The most practical solution appeared to be the modification of a currently available intensive care unit patient data management system.

Anesthesiology↗
PubMed2000

Can improving quality decrease hospital costs?

PURPOSE: To determine whether the concept of 'cost of quality' and the techniques used for its study in the industrial sector are also applicable to hospitals. DATA SOURCES: We undertook a systematic review of the literature published since 1992 (five electronic databases and a manual search) using keywords relating to quality of health care and costs. STUDY SELECTION: We selected all articles relating cost and quality, providing indicators for quality failure, determining the cost of failure, and itemizing the cost of quality. Twelve articles met these criteria (USA, nine; UK, one; Australia, one; France, one); six referred to total quality management, three to hidden costs, and three to adverse events. DATA ABSTRACTION: For each article, we recorded the test hypothesis, the focus of the study and the main results on costs and quality. RESULTS OF DATA SYNTHESIS: Preventing failure by applying total quality management to a variety of projects (managed care project, setting-up a standard procedure . . .) led to financial savings; quality was maintained, even enhanced. Better communication and co-ordination reduced hidden costs and also increased quality. Adverse events prolonged hospital stays by 1.74-4 days and increased costs. CONCLUSION: Very few detailed articles related cost and quality and, although they all noted a positive impact of an emphasis on quality, they nevertheless had their shortcomings. Study periods were too short, the indirect aspects of costs and savings were not taken into account, economic reference values were omitted. We conclude that more precise and strict methods for quantifying costs are needed.

Cost Savings↗
PubMed2000

Collection of process data after cardiac surgery: initial implementation with a Java-based intranet applet.

BACKGROUND: Using a Java-based intranet program (applet), we collected postoperative process data after coronary artery bypass grafting. METHODS: A Java-based applet was developed and deployed on a hospital intranet. Briefly, the nurse entered patient process data using a point and click interface. The applet generated a nursing note, and process data were saved in a Microsoft Access database. In 10 patients, this method was validated by comparison with a retrospective chart review. In 45 consecutive patients, weekly control charts were generated from the data. When aberrations from the pathway occurred, feedback was initiated to restore the goals of the critical pathway. RESULTS: The intranet process data collection method was verified by a manual chart review with 98% sensitivity. The control charts for time to extubation, intensive care unit stay, and hospital stay showed a deviation from critical pathway goals after the first 20 patients. Feedback modulation was associated with a return to critical pathway goals. CONCLUSIONS: Java-based applets are inexpensive and can collect accurate postoperative process data, identify critical pathway deviations, and allow timely feedback of process data.

Computer Communication Networks↗
PubMed2002

[Use of bar codes of biomedical products in a catheterization laboratory. A required step to improve quality and reduce costs].

The technology of bar coding has been recommended because of the ability to increase efficiency. The relative widths of both the bars and spaces code the data stored in the bar code. The Health Industry Business Communications Council (HIBCC) is a non-profit organization aimed at developing appropriate standards to improve exchange among all health care trading partners. According to these recommendations all health care products should be labeled with a primary symbol identifying the labeler and the product code and a secondary one that is useful to distributors and providers. The efficacy of bar code technology depends on the ease of use and the incorporation of user workflow into the system. Despite problems depending on industry factors as well as the lack of standards, resource factors associated with costs for the implementation of the new technology and human factors for cultural exchange that facilitate adoption, it is outstanding that bar code technology improves patient safety and increases organization productivity reducing manual-consuming steps and allowing for more accurate and complete data collection.

Cardiac Catheterization↗
PubMed2004

Design and implementation of a hands-free electrolarynx device controlled by neck strap muscle electromyographic activity.

The electrolarynx (EL) voice prosthesis is widely used, but suffers from the inconvenience of requiring manual control. Therefore, a hands-free EL triggered by neck muscle electromyographic (EMG) activity was developed (EMG-EL). Signal processing circuitry in a belt-mounted control unit transforms EMG activity into control signals for initiation and termination of voicing. These control signals are then fed to an EL held against the neck by an inconspicuous brace. Performance of the EMG-EL was evaluated by comparison to normal voice, manual EL voice, and tracheo-esophageal (TE) voice in a series of reaction time experiments in seven normal subjects and one laryngectomy patient. The normal subjects produced voice initiation with the EMG-EL that was as fast as both normal voice and the manual EL. The laryngectomy subject produced voice initiation that was slower than with the manual EL, but faster than with TE voice. Voice termination with the EMG-EL was slower than normal voice for the normal subjects, but not significantly different than with the manual EL. The laryngectomy subject produced voice termination with the EMG-EL that was slower than with TE or manual EL. The EMG-EL threshold was set at 10% of the range of vocal-related EMG activity above baseline. Simulations of EMG-EL behavior showed that the 10% threshold was not significantly different from the optimum threshold produced through the process of error minimization. The EMG-EL voice reaction time appears to be adequate for use in a day-to-day conversation.

Adult↗
PubMed2000

MedIDok--an Intranet tool for XML-based data modelling in medicine.

Integration of administrative, clinical and scientific documentation in medicine is a challenge because of the complexity and dynamics of the underlying data models. At least 50 items per procedure are necessary for clinically adequate documents. Extensive fine tuning is required to achieve acceptance by physicians, thus rapid prototyping is important. The results of this modelling process should be provided independently of specific implementations for reasons of portability. To address these needs we developed MedIDok (Medical Intranet-based Documentation), a set of intranet tools to generate and maintain specific documentation systems (generated programs, no manual coding) and the associated data models. The data structures are provided in XML format and therefore can be reused with other software architectures. The feasibility of non-redundant Intranet systems for both clinical and scientific information management is assessed covering the following domains at a major university hospital: hip ultrasound, endoscopic cholecystectomy, ESWL (extracorporeal shock wave lithotripsy) and implantable cardiac defibrillators. With the programs generated by MedIDok so far more than 10,000 patient contacts have been documented.

Computer Communication Networks↗
PubMed2004

Assessment and management of personality disorders.

Patients with personality disorders are common in primary care settings; caring for them can be difficult and frustrating. The characteristics of these patients' personalities tend to elicit strong feelings in physicians, lead to the development of problematic physician-patient relationships, and complicate the task of diagnosing and managing medical and psychiatric disorders. These chronic, inflexible styles of perceiving oneself and interacting with others vary widely in presentation. In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., these styles are categorized into three clusters based on their prominent characteristics: cluster A, the odd or eccentric (e.g., paranoid, schizoid, schizotypal); cluster B, the dramatic, emotional, or erratic (e.g., antisocial, borderline, histrionic, narcissistic); and cluster C, the anxious or fearful (e.g., avoidant, dependent, obsessive-compulsive). Knowledge of the core characteristics of these disorders allows physicians to recognize, diagnose, and treat affected patients. The goal of management is to develop a working relationship with patients to help them receive the best possible care despite their chronic difficulties in interacting with physicians and the health care system. Effective interpersonal management strategies exist for these patients. These strategies vary depending on the specific diagnosis, and include interventions such as the use of specific communication styles, the establishment of clear boundaries, limit setting on the patients' behavior and use of medical resources, and provision of reassurance when appropriate. Additionally, medications may be useful in treating specific symptoms in some patients.

Adaptation, Psychological↗
PubMed2001

Reliability and validity of the Digigraph 100 in orthodontic diagnosis.

Cephalometric analyses of lateral cephalograms allow important statements to be made on diagnosis and treatment planning. Such radiographs should, however, be taken with a considerable reduction in radiation exposure. With the Digigraph 100 (Dolphin Imaging Systems Inc., USA) a cephalometric technique based on distance measurements of emitted sonic signals is now available. This study was aimed at determining the degree to which this procedure can cope with the requirements of reliability and validity in the field of orthodontics. For this purpose 50 volunteers were examined by conventional cephalometry with manual tracing of lateral cephalograms as well as by sonic cephalometry, with Jarabak analysis in both cases. In addition an option was available for reading lateral cephalograms into the Digigraph by means of a radiograph evaluation program. The 31 evaluated parameters were subjected to modified statistical analysis. Good reliability was recorded in the range between 0.96 and 0.99 for eleven sonic cephalometric measurements, whereas 26 values were between 0.69 and 0.95. The validity was significantly lower in comparison to radiocephalometry. In particular, measurements related to landmarks which were difficult to access or could be only indirectly determined, such as the sella point, the articulare point or the apices of the incisors, proved to be weak points of sonic cephalometry. The device is thus indicated rather in the field of communication with the patient or for intermediate examination without radiation exposure. Cephalometry without radiation exposure would represent decisive progress in orthodontic diagnostics. However, some developmental work on the processing software or even the development of a specific sonic cephalometry which deliberately dispenses with parameters that are difficult to record with this procedure is still needed.

Adolescent↗
PubMed2005

Service-oriented science.

New information architectures enable new approaches to publishing and accessing valuable data and programs. So-called service-oriented architectures define standard interfaces and protocols that allow developers to encapsulate information tools as services that clients can access without knowledge of, or control over, their internal workings. Thus, tools formerly accessible only to the specialist can be made available to all; previously manual data-processing and analysis tasks can be automated by having services access services. Such service-oriented approaches to science are already being applied successfully, in some cases at substantial scales, but much more effort is required before these approaches are applied routinely across many disciplines. Grid technologies can accelerate the development and adoption of service-oriented science by enabling a separation of concerns between discipline-specific content and domain-independent software and hardware infrastructure.

Algorithms↗