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At least 127 records · Page 7Linked to original sources
PubMed1993

The Avianca plane crash: an emergency medical system's response to pediatric survivors of the disaster.

OBJECTIVE: On January 25, 1990, a jetliner crashed on Long Island, New York. Twenty-two children survived the crash. The purpose of this study was to evaluate the emergency medical system's response to these pediatric survivors. METHODS: A questionnaire was sent to all local, acute care hospitals to determine their specific pediatric capabilities and to rank them as level I, II, or III pediatric centers; level I centers are tertiary care facilities. A second questionnaire was sent to all hospitals that received pediatric survivors to collect specific clinical information for each patient. Based on this clinical information a Pediatric Trauma Score (PTS) was assigned to each patient. Children with a PTS < or = 8 are considered to be at increased risk of trauma-related mortality. The assigned PTS was compared to the level of the pediatric center to which each patient was transported. RESULTS: Of 25 children on board the plane, 22 (88%) survived the crash; of 135 adults on board, 70 (52%) survived (chi 2 = 9.9, P = .002). Seven children had a PTs < or = 8; only 1 of these high-risk patients was transported directly to a level I pediatric center, and only 2 of the 5 high-risk children initially transported to level III facilities were transferred to higher level pediatric centers. CONCLUSIONS: Pediatric survivors were neither adequately triaged nor transported to appropriate facilities which could optimize their care. Possible explanations for this include: (1) unique features of the rescue operation, (2) limited pediatric training of prehospital personnel, and (3) deficiencies of the regional disaster plan. Emergency medical services systems and disaster plans can be made more responsive to children's needs by: (1) acknowledging that children have special needs requiring referral, (2) improving the training of prehospital personnel in pediatric emergency care, (3) classifying ill and injured children according to appropriate triage criteria, (4) recognizing existing tertiary care pediatric centers as the optimal location for the treatment of critically ill and injured children, and (5) designating these centers as the appropriate transport destination for critically ill and injured children.

Accidents, Aviation↗
PubMed2002

Mechanical failure of the American Medical Systems Ultrex inflatable penile prosthesis: before and after 1993 structural modification.

PURPOSE: The 700 Ultrex (American Medical Systems, Minnetonka, Minnesota) is the only penile prosthesis capable of length and girth expansion. Early experience with the 700 Ultrex showed an increased mechanical failure rate compared with the 700CX, mostly secondary to cylinder failure. In 1993 the Ultrex cylinders were modified. We examined the performance of the Ultrex device before and after modification. MATERIALS AND METHODS: We compared our results with the Ultrex prosthesis before (group 1) and after (group 2) the 1993 modification. We implanted 239 devices from October 1989 to December 1999. A total of 26 patients have died. Followup was obtained on the results of 137 of the remaining 213 implants (64%), including 85 pre-modification devices in 85 patients and 52 post-modification devices in 51, via a mailed questionnaire, telephone survey or chart review. The questionnaire and survey included a 5-point satisfaction scale. Groups 1 and 2 were compared in regard to 3 end points, namely cylinder, mechanical and overall failure. RESULTS: Followup was less than 1 to 136 months (median 92, 25th to 75th percentiles 43 to 108) in group 1 and less than 1 to 92 months (median 46, 25th to 75th percentiles 21 to 75) in group 2. The 5-year Kaplan-Meier estimates of overall, mechanical and cylinder survival in groups 1 and 2 were 64.7%, 70.7% and 80.2%, and 77.7% (p = 0.23), 93.7% (p = 0.017) and 96.2% (p = 0.008), respectively. Overall satisfaction was similarly high in groups 1 and 2 (mean 3.9 and 4 points). CONCLUSIONS: On long-term followup the 1993 modification of the Ultrex cylinders appears to have significantly decreased the propensity of cylinder failure of the pre-modification device.

Adult↗
PubMed1989

The role of smart medical systems in the Space Station.

NASA is developing a Health Maintenance Facility to provide medical equipment and supplies requisite for the Space Station to be launched in the late 1990s. An essential component of this medical facility is a computerized Medical Decision Support System which will expedite medical officers' efforts to maintain the crew's health. The computerized system includes four major functions: 1. A data collection and storage system with a self-contained medical expert scheme for performing treatment protocols. The expert system has 'data driven' and 'time driven' capabilities to facilitate automatic decision-making functions. 2. An integrated medical record and medical 'reference' information management component. 3. An inventory management system for medical supplies and pharmaceuticals. 4. Video, audio, and data communications between the medical officer in the Space Station and ground-based medical personnel. This paper discusses the design of such computerized data collection, communications and expert medical systems as will be developed for use in a Space Station Health Maintenance Facility.

Aerospace Medicine↗
PubMed1999

A unified framework for data modeling on medical information systems.

Medical Information Systems (MIS) are seen as a way of optimizing the use of existing health-care infrastructure, without resorting to new and costly hospital (re)construction. The qualitative (re)design of such an environment requires a basic understanding of patient and doctors related characteristics and capabilities. Patient care, patient education, medical education, and clinical research need to be considered to meet the basic requirements on the level of services desirable, determined on the basis of the patient's length of stay; i.e., used for modeling the significant entities of such a world. The aim is to extract conclusions for the level of services provided to the users. One's concept will capture, as well as will integrate, the basic design principles under which MIS may be set.

Artificial Intelligence↗
PubMed2002

"The less-than-perfect medication system": a systems approach to improvement.

The 1999 Institute of Medicine (IOM) report increased the focus by health care providers, regulators, and the public on the cause and effect of medical errors. The IOM report recognizes the complexity of the problem of medical errors and advocates a systematic approach to error reduction. Medication delivery systems in health care facilities are an excellent example of the complexity that exists. General Systems Theory (GST) provides a framework to evaluate system design and effectiveness. This article presents an example of the use of GST in the design and evaluation of medication systems with a focus on error reduction.

Humans↗
PubMed2005

Early experience with the American Medical Systems new tactile pump: results of a multicenter study.

INTRODUCTION: A new Tactile Pump for the American Medical Systems (AMS) 700 Inflatable Penile Prosthesis (IPP) had been developed in an effort to improve usability for the patient. Aim. To assess the ease of use of the new Tactile Pump. METHODS: A prospective, multicenter study was conducted at four investigative sites. Preoperatively, patients completed an evaluation of the new Tactile Pump vs. the current design 700 pump placed in scrotal models. Patients compared the ease of inflation and deflation of each model. All patients were implanted with the AMS 700 IPP including the new Tactile Pump. Patients returned at 6 weeks for activation of the device and for follow-up evaluation at 3 and 6 months. MAIN OUTCOME MEASURES: Preoperatively patients compared ease of use of the Tactile Pump vs. the current design. Postoperatively both physicians and patients assessed device functionality for inflation and deflation, ease of use of the pump, and time required to learn device operation. RESULTS: Thirty patients were implanted with the AMS 700 IPP and Tactile Pump. Thirty patients completed an activation visit, 20 patients completed the 3-month evaluation, and 9 patients completed the 6-month evaluation. The average age was 62.1 years. Primary erectile dysfunction etiologies included organic, nonspecific 10 (33.3%), vasculogenic 6 (20.0%), prostatectomy 6 (20.0%), diabetes mellitus 4 (13.3%), Peyronie's disease 3 (10.0%), and spinal cord injury 1 (3.3%). Preoperatively 93.3% (P < 0.001) of patients favored the Tactile Pump over the current pump on locating and working the inflation mechanism in the scrotal model. Patients also found the Tactile Pump deflation mechanism easier to find 100% (P < 0.001) and deflate 96.7% (P < 0.001). Most patients (86.7%) were trained to use their devices within 3 minutes. CONCLUSIONS: The AMS Tactile Pump provides benefit to patients and physicians by improving ease of use and training over the current IPP 700 pump.

Aged↗
PubMed1987

Intranasal drug delivery for systemic medications.

This article is designed to provide a critical literature review on the scientific advances in intra- and transnasal drug delivery for systemic medication. The article discusses the fundamentals, developmental concepts, and biomedical assessment of the transnasal administration of systemically effective drugs which are either easily inactivated when taken orally, due to the extensive hepatic first-pass elimination, or too large in molecular size to be absorbed efficiently, except by i.v. administration.

Absorption↗
PubMed1997

Identifying the physical demands of Army Reserve personnel during deployable medical systems training.

The purpose of this investigation was to (1) assess the physical demands of soldiers involved in Deployable Medical Systems (DEPMEDS) activities, and (2) evaluate the incidence of musculoskeletal injuries among reserve military personnel involved in these tasks. The primary study group consisted of 190 soldiers participating in a 2-week annual field training exercise. Information regarding the DEPMEDS construction was obtained by performance of an ergonomic analysis, administration of a physical exertion questionnaire, and collection of injury data reported during daily sick call. The neck, shoulders, and low back were the most frequently reported sites of musculoskeletal injury. Soldiers involved in DEPMEDS construction were 7.6 times more likely to sustain a musculoskeletal injury than soldiers not involved in this aspect of the field training exercise. Current methods of DEPMEDS construction that utilize medical personnel for erecting and dismantling equipment may reduce the unit's mission readiness.

Ergonomics↗
PubMedDate not supplied

Evaluating process changes in a pediatric hospital medication system.

This article describes a process change designed to increase the safety of prescribing and interpreting complex order sets. All chemotherapy orders written for pediatric oncology patients at a major teaching hospital in the Eastern United States and the affiliated ambulatory clinic from June 1998 through February 2000 (n = 1792) were reviewed to evaluate a new process for communication of chemotherapy orders. The multidisciplinary check (MDC) is a forum where all disciplines simultaneously review and change complex order sets. Evaluation of the MDC included monthly completion rate and classification of changes made to orders at MDC. Over the study period, 96% of eligible orders received a multidisciplinary check, and 44% were changed. The most common change was to clarify discrepancies between the order and the protocol. Changes were made to avoid medication errors in 99 of 451 orders. Changes to avoid medication errors were more likely to involve nonchemotherapy medications. The MDC is an efficient and feasible process to increase safety at the beginning of the medication system.

Antineoplastic Agents↗
PubMed1995

The transition to medication system performance indicators.

Economic and competitive pressures in the health care market are causing hospitals and other health care providers to seek more effective ways to improve the quality of care and to decrease costs. Integrating total quality management and continuous quality improvement techniques into traditional drug use evaluation methodology allows for the development of critical performance indicators. These indicators integrate the selection, use, delivery methods, and outcomes of drug therapy with other operational therapeutic modalities. The article describes the development of medication system performance indicators using heparin dosing as a model.

Clinical Protocols↗
PubMed1998

Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study.

STUDY OBJECTIVE: To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems. METHODS: This study was performed in lle de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptive study involved completion of a questionnaire by the operator just after endotracheal intubation was performed. RESULTS: Six hundred eighty-five (99.1%) of 691 consecutive prehospital intubations were performed successfully in the field. The orotracheal route was used in 96.0%, and no surgical approaches such as cricothyroidotomy were used. Mechanical complications occurred in 84 patients, at a rate of 15.9% for nonarrest patients and 8.1% for arrest patients. A wide variety of sedation protocols were used. Difficult intubations (10.8%) were comparable in incidence to the number seen in US emergency departments, not US prehospital systems. By the same token, intubation success rates (99.1%) were comparable to US EDs and much higher than US prehospital results. CONCLUSION: The characteristics of French prehospital airway management differ significantly from those of other countries. These differences may be explained by differences in approach to prehospital management rather than differences of skill.

Clinical Protocols↗
PubMed1979

Cost containment: medical system rehabilitation or reform.

Cost containment is considered the premier goal for improvement of the medical care system. Before any other steps can be taken to improve availability, accessibility, or quality, or before introduction of any governmental programs for the removal of economic obstacles to obtaining medical care,--in other words, before any effort to make the medical care system more equitable--the rapid hyperinflation of medical care costs must be arrested. It is argued here that the defects of the system as currently operating are such that no cost control effort can be effective without radical change and reorganization of the system itself: methods of practice, methods of reimbursing providers, and methods of assuring accountability and supervision. And it is further argued, that if only cost control measures are instituted, not only will inflation not be stemmed, but it will be further aggravated and at the same time, the poor and minorities now suffering the consequences of an inadequate, ineffective, and unresponsive medical care system will be further deprived.

Cost Control↗
PubMed2004

The association of periodontal disease parameters with systemic medical conditions and tobacco use.

OBJECTIVES: The objective of this study was to determine if an association existed between periodontal disease and various systemic medical conditions and tobacco use. MATERIAL AND METHODS: The study design was a case-controlled, retrospective chart review. Patient charts (n=2006) were selected from more than 13,000 active patients attending the University of Minnesota dental clinics. These charts were examined to determine patient's self-reported systemic condition and smoking history. In addition, the number of missing teeth and bone loss were recorded. Two examiners collected the data. One examiner abstracted patient's medical history from the standard clinic medical questionnaire. The second examiner assessed the radiographs and dental charts to determine bone loss and number of missing teeth. Each examiner was blind to the findings of the other. RESULTS: After adjusting for age, sex, diabetes and smoking (yes/no) status, seven conditions were significantly (p=0.0003-0.04) related to bone loss or number of missing teeth (vascular disease, heart surgery, vascular surgery, heart attack, thyroid problems, arthritis, stomach ulcers). From these conditions, thyroid problems and arthritis had a negative association with bone loss. CONCLUSIONS: These findings support the results from previous investigators that a number of systemic conditions and smoking are closely associated with missing teeth or bone loss.

Aged↗
PubMed1991

Hematopoietic and lymphoproliferative cancer among male veterans using the Veterans Administration Medical System.

Hematopoietic and lymphoproliferative cancer risk among the 3.7 million United States male veterans who use the Veterans Administration (VA) medical system annually was assessed using age-specific incidence curves and cumulative incidence rates. Relative risk comparing the VA with general population risk estimates from the Surveillance, Epidemiology, and End Results (SEER) data were increased significantly for all malignancies examined. The VA sample showed risk increases of 93% for Hodgkin's disease, 20% for non-Hodgkin's lymphomas, 51% for multiple myelomas, and 40% for all leukemias. Among the leukemia subtypes, the observed risk increases were 54%, 23%, 80%, and 46% for lymphocytic, granulocytic, monocytic, and other forms of leukemia, respectively. The large size of the sample and the consistency of risk estimates with two different methods confer validity and strength to these findings. The possible relevance of the high prevalence of tobacco and alcohol use in this population sample to the current findings is discussed and the need for further analytic investigations to explain the increases in risk is emphasized.

Adult↗
PubMed1975

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis↗
PubMed2004

End-user perceptions of a computerized medication system: is there resistance to change?

Public mandate to control cost, while improving quality of service, leads health care administrators to look to information technology for innovative solutions. This case study of acute care registered nurses in a public hospital focuses on experiences of the end-users of a computerized medication system. Data was obtained by in-depth interviews and observation performed in the clinical setting. Findings fell into five challenging issues to the end-user and health care administration: end-user perceptions of inadequate training, negative experiences of implementation, perceived deficiencies in quality of technology, perceptions of lack of participatory design and a ensuing circumvention of the new system. Emphasis is on the relationship of the findings to the quality of public health care administration.

Attitude to Computers↗