Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Institutional Practice”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMed1994

Ethics in dental research. Publication of research: the ethical dimension.

If science is to achieve its goal, i.e., advancement of human well-being, the results of scientific research must be made available. When such results are presented, that presentation must be 'ethical'; it must conform to recognized standards of honesty, originality, and fairness. Unfortunately, not all such presentations conform to these standards; the public and scientific community alike are becoming ever more concerned about duplication in publication, about illegitimate claims to authorship, and about misleading use of statistics in presentation of experimental results. Certain of these 'unethical' practices can be eliminated or minimized by education, institutional practice, and requirements set by scientific journals. In the end, however, 'ethical publication' will depend on the 'ethical investigator'--an individual who has professed dedication to truth and the well-being of mankind.

Authorship↗
PubMedDate not supplied

Addressing infrequent cancer screening among women.

National health policies must be revised to support basic health services for all Americans, a breadth of cost-effective health practitioners, and a system that provides comprehensive, coordinated care in decentralized locations. State and local advocacy groups should increase consumers and policy-makers awareness about inadequate cancer screening. Educational institutions should address cancer prevention for practitioners in training. Practice institutions should employ nurses and nurse practitioners more effectively, as well as institute computerized feed-back and reminder systems. More rigorous research on the effect of educational messages on client beliefs, affect, and screening behavior are needed to guide interventions for cancer control.

Female↗
PubMed2001

Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness.

OBJECTIVE: Hospital care for children with viral lower respiratory illness (VLRI) is highly variable, and its relationship to severity and impact on outcome is unclear. Using the Pediatric Comprehensive Severity Index, we analyzed the correlation of institutional practice variation with severity and resource utilization in 10 children's medical centers. METHODS: Demographics, clinical information, laboratory results, interventions, and outcomes were extracted from the charts of consecutive infants with VLRI from 10 children's medical centers. Pediatric Component of the Comprehensive Severity Index scoring was performed at admission and at maximum during hospitalization. The correlation of patient variables, interventions, and resource utilization at the patient level was compared with their correlation at the aggregate institutional level. RESULTS: Of 601 patients, 1 died, 6 were discharged to home health care, 4 were discharged to rehabilitative care, and 2 were discharged to chronic nursing care. Individual patient admission severity score correlated positively with patient hospital costs (r = 0.48), but institutional average patient severity was negatively correlated with average institutional costs (r = -0.26). Maximal severity score correlated well with costs (r = 0.66) and length of stay (LOS; r = 0.64) at the patient level but poorly at the institutional level (r = 0.07 costs; r = 0.40 LOS). The institutional intensity of therapy was negatively correlated with admission severity (r = -0.03) but strongly correlated with costs (r = 0.84) and LOS (r = 0.83). CONCLUSIONS: Institutional differences in care practices for children with VLRI were not explained by differences in patient severity and did not affect the children's recovery but correlated significantly with hospital costs and LOS.

Bronchiolitis, Viral↗
PubMed1994

Umbilical arterial catheter use: report of an audit conducted by the Study Group for Complications of Perinatal Care.

The Study Group for Complications of Perinatal Care through 13 of its participating neonatal intensive care units conducted an audit of umbilical artery catheter (UAC) use over 3 months. Of 1941 patient admissions, 582 (30%) had a UAC inserted and left in place for a mean of 4.9 days. The mean supplemental oxygen concentration (FIO2) at removal was 0.35 with over 55% of UACs remaining in place until FIO2 was less than 0.26. Institutional practices varied widely for positioning the catheter tip, use of heparin, and types of infusates, as did the frequency of adverse events that prompted removal of the UAC. Most institutions with multiple physicians found less consistency in practice patterns within their own units than presumed prior to the audit. Just two institutions preferred catheter placement in the abdominal aorta (low) with the others selecting a low site only after detecting a malposition below the initially sought thoracic level. All but one group routinely used heparin, although in varying concentrations and total doses. Patient weight and catheter duration were inversely correlated, with smaller patients having catheters left in place for significantly longer periods (P < 0.01). Similarly, smaller patients had a higher likelihood of catheter removal because of an adverse event; the adverse events were not necessarily related to longer duration. A significant relationship existed between positioning a catheter tip in the abdominal aorta and removal for adverse events (P < 0.05).

Catheterization, Peripheral↗
PubMedDate not supplied

Academic misconduct: considerations for educational administrators.

Academic misconduct entails fraudulent behavior involving some form of deception whereby one's work or the work of others is misrepresented. Recently much attention has been paid to the problem of academic misconduct, and concern has been expressed that academic institutions have been slow to act and ineffective in policing themselves. Academic administrators have a responsibility to involve themselves in developing and implementing policies and procedures for handling allegations of misconduct. General principles and an outline of the stages of the investigational process are described, as are sources of information about developing institutional guidelines. Additionally, administrators are encouraged to examine their institutional practices for factors that may contribute to misconduct in an effort to develop norms and practices to help prevent misconduct, which undermines the basic integrity of academic institutions.

Biomedical Research↗
PubMedDate not supplied

Comparison of preventive care in Medicaid managed care and Medicaid fee for service in institutions and private practices.

OBJECTIVE: To compare preventive screening for children in Medicaid managed care (MMC) with children in Medicaid fee for service (M-FFS) in private and institutional settings. METHODS: The sample included randomly selected institutions and private practice physicians in New York City. Within setting, children in MMC and M-FFS were sampled randomly and charts reviewed for immunizations and lead and anemia screening. RESULTS: In both institutions and private practices, children enrolled in MMC appeared more likely to be up-to-date than their M-FFS counterparts for immunizations (institution, P <.01; private practice, P <.05), lead screening (institution, P <.01; private practice, P <.01), and anemia screening (institution, P <.01; private practice, P <.01). However, children in MMC had more visits (P <.01) and were followed up for a longer time (P <.01). After controlling for these variables, effects of MMC diminished and only remained significant for screening among private physicians. When considering 10 different attributes of managed care plans, no clear pattern of association with better preventive care services was observed. CONCLUSION: The positive effect of managed care on preventive care services was largely explained by more visits and longer follow-up time; however, there were differences between institutions and private practices, with enrollment in MMC associated with some positive effect on screenings in private practices.

Cross-Sectional Studies↗
PubMed1999

Pediatric clerkship experience and performance in the Nebraska Education Consortium: a community vs university comparison.

OBJECTIVE: To compare the reported experiences and performance on end-of-course examinations of students completing their pediatric clerkship at the University of Nebraska Medical Center (UNMC), Omaha, with that of students completing their clerkship in a community pediatrician's practice (CPP) outside the Omaha metropolitan area. DESIGN: Cohort study. SETTING: Private and/or institutional practices with both ambulatory and hospital components. PARTICIPANTS: For the academic year 1996-1997, all 113 students completing the 8-week third-year pediatric clerkship returned a questionnaire detailing their opinions of the experience. They also completed written (multiple-choice and essay questions) and oral (standardized parent interview) examinations, locally prepared and based on clerkship curriculum objectives provided to the students at orientation. Prior to student placement in the CPP, the clerkship goals, content, and evaluation methods as well as techniques for teaching in a busy office practice were reviewed with the CPP physicians. Eighty-one students performed their clerkship at UNMC while 31 spent all but the first week of the clerkship in the CPP. MAIN OUTCOME MEASURES: The students' opinions about their experiences and their performances on the end-of-course examinations were compared. Statistical analysis of the questionnaire was done using the Fisher exact test and the Mantel-Haenszel chi2 test while examination performance was compared using the t test and the Wilcoxon rank sum test. RESULTS: The UNMC and CPP groups reported similar opinions of their experiences in the newborn nursery and the inpatient portion of the clerkship, but the CPP students were much more positive about their learning experience in the clinic (P=.001). The CPP students reported more involvement in the patient's overall care (P<.001) and in other aspects of clinic operation (P<.001). The UNMC and CPP students had similar opinions of curriculum content, reading material, and didactic instruction. No group differences were found regarding interest in pediatrics as a career. Most importantly, no group differences were found in performance on any portion of the end-of-course examinations. CONCLUSIONS: Community-based education at the third-year clerkship level can be accomplished without a significant effect on student examination performance if students and faculty are aware of and adhere to a common set of goals. The end result is a much more robust experience for students who spend the clerkship in the practice of a community-based pediatrician.

Clinical Clerkship↗
PubMed2000

Integrated institution--community rehabilitation in developed countries: a proposal.

PURPOSE: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. METHODS: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries; presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. RESULTS: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. CONCLUSION: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

Community Health Services↗
PubMed2006

Prognostic parameters of metastatic adrenocortical carcinoma.

CONTEXT: Prognostic parameters of metastatic adrenocortical carcinoma (ACC) are poorly characterized. OBJECTIVE: The objective of the study was to describe the clinical presentation of metastatic ACC and determine prognostic factors for survival. DESIGN: This was a retrospective cohort study (1988-2004). SETTING: The study was conducted in an institutional practice. PATIENTS: Participants included 124 consecutive patients with metastatic ACC, 70 from Gustave-Roussy Institute (main cohort) and 54 patients from the Cochin Hospital (validation cohort). Clinical data concerning all patients, histopathologic slides of primary tumors (44 in the main cohort and 40 in the validation cohort), and molecular biology data on 15 primary tumors (main cohort) were analyzed. INTERVENTION: There was no intervention. MAIN OUTCOME: The main outcome was the specific survival after discovery of the first metastasis (Kaplan-Meier method). This included univariate analysis on the main cohort, confirmed on the validation cohort and then analyzed in a multivariate analysis. RESULTS: In the main cohort, overall median survival was 20 months. In univariate analysis, the presence of hepatic and bone metastases, the number of metastatic lesions and the number of tumoral organs at the time of the first metastasis, a high mitotic rate (>20 per 50 high-power field), and atypical mitoses in the primary tumor predicted survival (P = 0.05, 0.003, 0.046, 0.001, 0.01, and < 0.001, respectively). The number of tumoral organs and a high mitotic rate were confirmed on the validation cohort (P = 0.009 and 0.03, respectively). These two parameters were confirmed in multivariate analysis (P = 0.0058 and 0.049). CONCLUSION: Metastatic ACC is a heterogeneous disease with poor outcome. The combination of the number of tumoral organs at the time of the first metastasis and the mitotic rate can predict different outcomes.

Adolescent↗
PubMed1996

Descending necrotizing mediastinitis. Surgical drainage and tracheostomy.

OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. DESIGN: Case series. SETTING: General community, institutional practice, hospitalized care. PATIENTS: Five consecutive cases of descending necrotizing mediastinitis that were treated at our institution from 1983 to 1995. Selection criteria included clinical manifestations of severe cervical infection, characteristic radiographic features, documentation of the mediastinal infection at operation, and establishment of the relationship of the oropharingeal infection with the mediastinal process. Cases of mediastinitis due to perforation of the cervical esophagus were excluded. A cervicothoracic computed tomographic scan was obtained in the last 4 patients on admission. In the first case, computed tomographic scanning was not yet available at our institution. INTERVENTIONS: All patients underwent drainage of the cervical infection through a cervical incision. Mediastinitis was drained by thoracotomy in 2 patients, since the lower mediastinum was involved, whereas 3 patients underwent cervicomediastinal drainage alone. Tracheostomy was performed in 2 patients. RESULTS: All patients survived, with a short hospital stay (mean, 35 days). CONCLUSIONS: Cervicomediastinal drainage is adequate when the descending mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed only when the process has diffusely spread below the carina. Early diagnosis is crucial, and we strongly recommend a cervicothoracic computed tomographic scan in every patient with deep cervical infection. We consider tracheostomy not always necessary. Adequate early drainage, with the cervical wounds left open, and antibiotic and anti-inflammatory therapy should prevent upper airway obstruction.

Adult↗
PubMed2001

[Determinants of psychotropic drug utilization in homes for the elderly and in nursing homes].

A large proportion of the residential and nursing home population is mentally ill. The causes for increased prescription of psychotropic drugs other than mental disorders have been discussed. This study presents data on the role of the individual's characteristics and institutional conditions on psychotropic drug use in residents of residential and nursing homes. Therefore the psychotropic drug use of 4 old-people's homes in Leipzig (Germany) was reviewed. Sociodemographic characteristics and a number of behavioral patterns of the residents were examined. Regression analysis revealed associations of age, gender and certain behavioral patterns (e.g., agitation, insomnia with nightly disturbances) and psychotropic drug use. Beyond that, psychotropic drug use varied among the 4 institutions' practices. Further research should be aimed at gaining insight into the interplay of these individual and institutional influences on psychotropic drug use in order to develop specific interventions to optimize treatment.

Aged↗
PubMedDate not supplied

Establishment of a central laboratory serum tumor marker service on a consolidated immunodiagnostic platform: development of practice standards, service improvements, and operational efficiency.

BACKGROUND: Laboratory testing for serum tumor markers traditionally has been performed in low volume in most hospitals. Many markers are sent out to reference laboratories. Over the past decade, serum tumor marker testing in patient management has become more defined, resulting in increasing test volume and wider availability of assays on automated immunodiagnostic platforms. METHODS: A retrospective review of laboratory operations, test volumes, and budgets over a 10-year period. Results of utilization initiatives as part of a clinical practice management team also were reviewed. RESULTS: The volume of serum tumor marker requests in our institution increased 2.25-fold over an 8-year period. In contrast, total laboratory test volume increased only 1.3-fold. Implementation of an on-site tumor marker laboratory using a consolidated platform (Elecsys 2010) decreased the average unit cost per test from $12.36/test to $6.79/test. This was accomplished by a combination of insourcing and by consolidation of multiple semi-automated instruments. Total savings were $219,972 per year, including direct budget reductions and cost avoidance due to volume increases. Various institutional practice standards were implemented, and turnaround time was markedly reduced for selected tests. CONCLUSIONS: Testing for serum tumor markers is becoming more established in large hospital laboratories. Increasing test volumes and the availability of consolidated instrument platforms with a broad menu of tumor marker tests (such as the Elecsys 2010) facilitates consolidation and insourcing of many tumor marker assays. This permits the laboratory to reduce unit and overall cost, to leverage excess capacity on existing instrumentation, and to create an opportunity to add value to the service by reducing turnaround time and implementing practice standards.

Academic Medical Centers↗
PubMed1986

Intervention in the psychiatric hospital in the era of deinstitutionalization.

This article, written following a survey of staff in a psychiatric hospital, analyzes how the trend toward deinstitutionalization has influenced institutional practice. Interviews reveal that intervenors support the objective of social reintegration, even if they find it a source of contradictions. In their daily activities, the staff are concerned mainly with improving their patients' quality of life, but this concern is also accompanied by the apprehension of encouraging dependency on the institution. Thus intervenors experience difficulty in focusing their practice on a system of representation capable of reconciling the ideal of rehabilitation with the characteristics of their clientele. Recognizing the paradoxes associated with work in the institutional setting does, however, make it possible to start a process of clarification that is likely to support intervenors and improve the quality of their relationship with chronic psychiatric patients.

Activities of Daily Living↗
PubMed1993

Amygdala atrophy in Alzheimer's disease. An in vivo magnetic resonance imaging study.

OBJECTIVES: To study the ability of magnetic resonance imaging to measure the volume of the amygdala and detect amygdala atrophy in patients with early Alzheimer's disease. DESIGN: Prospective case-control study and "blind" measurements. SETTING: Subjects were ambulatory outpatients selected from an institutional practice in Paris, France. PATIENTS: We studied 11 patients with probable Alzheimer's disease according to National Institute of Neurologic and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) inclusion and exclusion criteria, as well as six age-matched control subjects. INTERVENTION: None. MAIN OUTCOME MEASURE: A 1.5-T magnetic resonance imager was used to acquire the images. Two neuroradiologists independently and blindly measured the volume of the right and left amygdalas on high-resolution contiguous slices. In addition, other cerebral structures, ie, the sylvian fissures, temporal lobes, lateral and third ventricles, corpus callosum, and hippocampal formation, were measured on a single slice. RESULTS: The values obtained by the two observers correlated highly (r = .90), and interrater variability was 13%. The Alzheimer's disease group showed significant (33%, P < .0001) atrophy of the amygdala when compared with the control group. The other structures showed less variation. CONCLUSION: Significant amygdala atrophy can be detected in vivo in patients with early Alzheimer's disease by means of standard magnetic resonance imaging. This technique may be useful in the early diagnosis of Alzheimer's disease.

Aged↗
PubMed2001

Long-term follow-up of unoperated macular holes.

OBJECTIVE: To investigate the anatomic and visual acuity outcomes among patients with unoperated macular holes and at least 5 years of follow-up. DESIGN: Retrospective, noncomparative case series from an institutional practice setting. PARTICIPANTS: All patients with unoperated full-thickness macular holes evaluated at Bascom Palmer Eye Institute between January 1, 1968 and December 31, 1993 and observed for at least 5 years. METHODS: Demographic and clinical data were abstracted from patients' medical records and ophthalmologic photography records. For patients with bilateral macular holes, only one eye was included. MAIN OUTCOME MEASURES: Visual acuity and clinical features on initial examination, at 5 years, and at final follow-up. RESULTS: The study included 65 eyes of 65 patients with a median age of 65 years (range, 52-85 years) and a median follow-up of 9.3 years (range, 5-29 years). On initial examination at Bascom Palmer Eye Institute, the macular hole was stage 2 in 15 eyes (24%), stage 3 in 23 eyes (37%), and stage 4 in 25 eyes (40%). At final follow-up, the macular hole was stage 3 in 10 eyes (16%) and stage 4 in 53 eyes (84%). Visual acuity was 20/200 or worse in 35 eyes (54%) on initial examination, in 43 eyes (74%) at 5 years, and in 53 eyes (82%) at final follow-up. Poorer visual acuity on initial examination was a significant predictor of poorer final vision (P < 0.01). Other accompanying clinical features such as the presence of operculum, posterior vitreous detachment, and epiretinal membrane were not significantly associated with final vision. Throughout follow-up, there was a redistribution and reduced number of yellow nodular opacities at the level of the retinal pigment epithelium at the base of the macular holes and the development of retinal pigment epithelial atrophy around the macular holes. CONCLUSIONS: Long-term follow-up of unoperated macular holes demonstrates progression in hole size and stage, vision loss which generally stabilizes at the 20/200 to 20/400 level, a redistribution and reduced number of yellow nodular opacities at the level of the retinal pigment epithelium, and the development of retinal pigment epithelial atrophy surrounding the macular hole, resulting in a "bull's-eye" macular appearance.

Aged↗
PubMed2007

The relationship between cultural competence education and increasing diversity in nursing schools and practice settings.

This article attempted to examine the relationship between cultural competence education and increasing diversity in nursing schools and practice settings. In addition to the review of the literature, a panel of experts was interviewed regarding institutional practices in response to the challenge of increasing diversity and cultural competence education. Evidence of positive outcomes of cultural competent care and impact of race and ethnic concordance between patients and providers are presented. The challenge of increasing underrepresented minorities in health care professions remains elusive. An ecological analysis is recommended to address the social and cultural barriers that transcend the micro system of the school and the macro system of the society. The challenge of increasing diversity and realizing outcomes of cultural competence education requires social and comprehensive remedies to level life inequities that perpetuate a history of disadvantages in some groups.

Acculturation↗
PubMedDate not supplied

Ethical conflicts reported by certified registered rehabilitation nurses.

The purpose of this study was to identify the types of ethical conflict reported by certified registered rehabilitation nurses (CRRNs) and their relationship to demographic, educational, and practice-setting variables. Ethical conflicts expressed by CRRNs in active practice in Maryland, Virginia, and the District of Columbia were analyzed according to four themes. Disagreements about medical or institutional practice, patients' rights, and payment issues were the most frequent practice contexts for ethical conflicts, reflecting these nurses' considerable underlying concerns about resource allocation in rehabilitation practice. Participants believed that 60% of the ethical conflicts were resolved, frequently through discussions with other team members and patients' family members. Ethics committees and consultants were used infrequently. There were no statistically significant relationships between the kinds of conflicts or their resolution and the participants' demographic, educational, and practice-setting variables.

Adult↗