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At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Randomized trial of geragogy-based medication instruction in the emergency department.

BACKGROUND: Medication adherence by older adults who are discharged from the emergency department (ED) is an essential attribute of effective treatment. Researchers have demonstrated that delivery of well-structured instructions increases the knowledge of discharge regimens and increases adherence among ED populations. OBJECTIVES: This study compared the level of medication knowledge of elderly ED patients receiving instruction by one of two teaching methods: the usual preprinted discharge instructions with handwritten medication information and individualized computer-generated discharge instructions designed within a geragogy framework. METHOD: The geragogy intervention included large-print, easily readable, specific information ordered within the elderly memory schema. This schema consists of purpose, administration, and emergency information in that order. The Knowledge of Medication Subtest by Horn and Swain (1977) was administered by telephone 48 to 72 hours after discharge. Sixty patients (38 women, 22 men) with a mean age of 76 years were randomly assigned to groups and completed the study at three rural ED sites. RESULTS: Subjects in the geragogy-based intervention group demonstrated significantly more knowledge of medications than did subjects experiencing the usual discharge teaching method (t = 2.19, p = .016). CONCLUSIONS: These findings suggest that a medication teaching intervention geared to the special needs of the elderly can be effective in increasing medication knowledge.

Aged↗
PubMedDate not supplied

Postoperative pain management in frail older adults.

PURPOSE: To evaluate the Frail Elder Pain Management Program (FEPMP) implemented for patients who had hip fracture repairs at a community hospital in 1995. Based on standards of geriatric and pain management practice, the FEPMP included education sessions, preprinted analgesic orders, pain flow sheets, written resources, and clinical support. A Logic Model reflected the program's conceptualization. DESIGN: Preexperimental pretest and posttest design. SAMPLE: A random sample of 50 charts of patients aged 75 and older who had hip fracture repairs were audited from each of two periods: the preimplementation period (1994-95) and the postimplementation period (1997-98). METHODS: A chart audit tool was developed, tested, and used. Data were analyzed using descriptive, parametric and nonparametric statistics. FINDINGS: Surgeons' prescriptions and nurses' pain management practices improved significantly (p = .0001). Pain assessment modestly improved. Patient outcomes also improved. IMPLICATIONS FOR PRACTICE AND EDUCATION: A programmatic approach to pain management is effective for improving practice and outcomes for frail elders.

Aged↗
PubMed2001

A technique for presenting risk and outcome data to potential living renal transplant donors.

BACKGROUND: Transplant centers have become increasingly interested in living donor kidney transplantation and have always had the obligation to counsel these donors fairly. Counseling techniques vary markedly among centers and can include overly qualitative or unintentional but covertly prescriptive presentation of risk and benefit. METHODS: We describe a simple technique using preprinted fields of stick figures for presenting important risk and benefit data to potential renal donors. We also suggest an approach to formulating basic statistics for donor counseling. RESULTS: Risk and benefit statistics can be presented visually and quantitatively in a way that minimizes the need for donor sophistication and also displays the "all or nothing" nature of adverse events in donor and recipient populations, as opposed to using of percentages or prescriptive phrases by the donor counselor. CONCLUSION: Such stick figure field counseling for living renal transplant donors accurately provides information to both donor and center, appropriately facilitates center impartiality, and may increase the center's and the donor's confidence in the counseling process.

Counseling↗
PubMedDate not supplied

Guideline attribute and implementation preferences among physicians in multiple health systems.

OBJECTIVES: Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments. SUBJECTS AND METHODS: Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences. RESULTS: Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence. CONCLUSIONS: Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.

Asthma↗
PubMedDate not supplied

Failure mode and effects analysis as a performance improvement tool in trauma.

INTRODUCTION: Performance improvement (PI) in the multiple systems injured patient frequently highlights areas for improvement in overall hospital care processes. Failure mode effects analysis (FMEA) is an effective tool to assess and prioritize areas of risk in clinical practice. Failure mode effects analysis is often initiated by a "near-miss" or concern for risk as opposed to a root cause analysis that is initiated solely after a sentinel event. In contrast to a root cause analysis, the FMEA looks more broadly at processes involved in the delivery of care. The purpose of this abstract was to demonstrate the usefulness of FMEA as a PI tool by describing an event and following the event through the healthcare delivery PI processes involved. DESCRIPTION: During routine chart abstraction, a trauma registrar found that an elderly trauma patient admitted with a subdural hematoma inadvertently received heparin during the course of a dialysis treatment. Although heparin use was contraindicated in this patient, there were no sequelae as a result of the error. This case was reviewed by the trauma service PI committee and the quality improvement team, which initiated FMEA. EVALUATION: An FMEA of inpatient dialysis process was conducted following this incident. The process included physician, nursing, and allied health representatives involved in dialysis. As part of the process, observations of dialysis treatments and staff interviews were conducted. Observation revealed that nurses generally left the patient's room and did not involve themselves in the dialysis process. A formal patient "pass-off" report was not done. Nurses did not review dialysis orders or reevaluate the treatment plan before treatment. We found that several areas of our current practice placed our patients at risk. 1. The nephrology consult/dialysis communication process was inconsistent. 2. Scheduling of treatments for chronic dialysis patients could occur without a formal consult or order. 3. RNs were not consistently involved in dialysis scheduling, setup, or treatment. 4. Dialysis technicians may exceed scope of practice (taking telephone orders) when scheduling of treatment occurred before consult and written orders. OUTCOMES: Near-miss events may be overlooked as opportunities for improvement in cases where no harm has come to the patient. As a result of our FMEA investigation, the following recommendations were made to improve hospital care delivery in those trauma patients who require inpatient dialysis: 1. Education of RNs about the dialysis process. 2. Implementation of a formal reporting process between the RN and the dialysis technician before the procedure is initiated. 3. RN supervision of dialysis treatments. 4. Use of a preprinted inpatient dialysis form. 5. Education of dialysis technicians regarding their scope of practice. 6. Improve notification process for scheduling dialysis procedures between units and dialysis coordinator (similar to x-ray scheduling). Our performance improvement focus has broadened to include all reported "near-miss" events in order to improve our healthcare delivery process before an event with sequelae occurs. We have found that using FMEA has greatly increased our ability to facilitate change across all services and departments within the hospital.

Algorithms↗
PubMed2005

Suicidal bus bombing of French Nationals in Pakistan: physical injuries and management of survivors.

BACKGROUND: Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation. METHODS: The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry. RESULTS: Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary receiving hospitals. The average number of injuries per patient was eight. The mean Injury Severity Score was 10.8. The majority of patients had secondary and tertiary blast injuries. Most of the survivors had calcaneal injuries; these have not been reported in the literature in similar terrorist attacks. Twelve operative interventions were undertaken. All of the 12 patients were stabilized and evacuated within 24 h of admission. CONCLUSIONS: All of the 12 patients transferred to the Aga Khan University Hospital survived. Unlike the reported injuries, calcaneal fractures were most commonly encountered in the survivors.

Adult↗
PubMed2004

Assessing medication prescribing errors in pediatric intensive care units.

OBJECTIVE: To evaluate a matrix for determining the predominant type, cause category, and rate of medication prescribing errors, and to explore the effectiveness of hospital-based improvement initiatives among pediatric intensive care units (PICUs). DESIGN: This study involved the prospective identification of medication errors for categorization and evaluation by using a matrix methodology. A pretest-posttest design without a control group was used to explore the impact of initiatives employed to reduce medication error rates and severity. SETTING: PICUs in nine freestanding, collaborating tertiary care children's hospitals that participated in both baseline and postintervention analyses. METHODS: We evaluated 12,026 PICU medication orders at baseline and 9,187 orders postintervention for prescribing errors, excluding resuscitation orders. A standardized tool and process captured error type, cause category, and severity for 2 wks before and after intervention. Three levels of error detection were used and included pharmacy order entry, PICU nurse order transcription, and team-based overview. Site-specific interventions were implemented, which included predominantly provider education as well as informational (47%) and dosing "assists" via preprinted orders, forcing functions, or prompts (39%). RESULTS: Of baseline orders, 11.1% had at least one prescribing error. The interception of prescribing errors improved 30.9% (1.6% of all orders at baseline, 2.0% post intervention). Preventable adverse drug events were uncommon (0.6% of all medication errors) and of low severity at baseline; most were wrong dose errors. The implementation of improvement initiatives, specific for each facility, resulted in a 31.6% reduction in prescribing errors from 11.1% to 7.6%. However, site results varied considerably. CONCLUSIONS: A benchmark for medication prescribing errors in the PICU was identified among nine children's hospitals. The methodology was successful in accounting for site-specific differences with regard to identifying and documenting errors as well as reporting results of improvement initiatives. Furthermore, the methodology employed was generalizable in the identification of predominant prescribing error types, which helped to track individual hospital improvement initiative development and implementation. Overall improvement in prescribing error rates was noted; however, considerable variation in the success of improvement initiatives was noted and bears further attention.

Drug Therapy, Computer-Assisted↗
PubMed2004

Assortative model for social networks.

In this Brief Report we present a version of a network growth model, generalized in order to describe the behavior of social networks. The case of study considered is the preprint archive at cul.arxiv.org. Each node corresponds to a scientist, and a link is present whenever two authors wrote a paper together. This graph is a nice example of degree-assortative network, that is, to say a network where sites with similar degree are connected to each other. The model presented is one of the few able to reproduce such behavior, giving some insight on the microscopic dynamics at the basis of the graph structure.

Journal Article↗
PubMed2000

Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. Program of All-Inclusive Care for the Elderly.

OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life-Sustaining Treatment (POLST), a preprinted and signed doctor's order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes. DESIGN: Retrospective chart review. SETTING: ElderPlace, a Program of All-Inclusive Care for the Elderly (PACE) site in Portland, Oregon. PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n = 58). Reasons for exclusion were no POLST (1), missing POLST (1), and insufficient documentation of care (2). MEASUREMENTS: POLST instructions for each participant and whether or not each of the treatments addressed by the POLST was administered in the final 2 weeks of life. RESULTS: The POLST specified "do not resuscitate" for 50 participants (93%); CPR use was consistent with these instructions for 49 participants (91%). "Comfort care" was the designated level of medical intervention in 13 cases, "limited interventions" in 18, "advanced interventions" in 18, and "full interventions" in 5. Interventions administered were at the level specified in 25 cases (46%); at a less invasive level in 18 (33%), and at a more invasive level in 11 (20%). Antibiotic administration was consistent with POLST instructions for 86% of 28 subjects who had infections in the last 2 weeks of life, and less invasive for 14%. Care matched POLST instructions in 84% of cases for IV fluids and 94% for feeding tubes. CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, IV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life-sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.

Advance Directives↗
PubMed1997

Predictive value of letters of recommendation vs questionnaires for emergency medicine resident performance.

OBJECTIVE: To evaluate the predictive value of standard letters of recommendation (LORs) vs preprinted questionnaires (PPQs) for resident performance at one emergency medicine (EM) residency program. METHODS: A retrospective association of LORs and PPQs with in-training residents performance ratings was done at one EM residency program. The residency application files of EM residents who completed the program were reviewed to locate files that had LORs and PPQs written by the same author. Seventeen resident files contained 32 LOR/PPQ pairs. These LORs and PPQs were submitted in a blinded fashion to 3 outside EM residency directors. Each LOR and PPQ was evaluated for the applicant's suitability for the specialty of EM, medical knowledge, procedural skills, interpersonal skills, motivation, and overall rank. The scores given by the outside reviewers were compared with resident performance ratings determined by 5 EM attending physicians who evaluated the residents along the same 6 dimensional ratings. RESULTS: Statistically, no differences were found between the LORs and PPQs in predicting resident performance. CONCLUSIONS: PPQs may substitute for LORs in the evaluation of resident applicants.

Achievement↗
PubMed1976

MORLUC numeric system for the identification of Enterobacteriaceae.

Foul hundred eighty-six members of the Enterobacteriaceae representing nine genera were identified by conventional methods, and the results were compared with MORLUC (Biotrol Company Inc., Jamaica, N.Y.). MORLUC, an acronym for melibiose, ONPG (o-nitrophenyl-beta-galactopyranoside), rhamnose, lysine decarboxylase, urease, and citrate, are six prepackaged reagent-impregnated paper loops which are sealed within a plastic packet. The hydrogen sulfide reaction obtained from a triple sugar iron slant is coupled with MORLUC results and is readily converted into a three-digit numerical code, which is referenced on a preprinted single page listing. Additionally, the triple sugar iron is used to confirm the glucose fermentation by an unknown isolate. Comparisons of individual MORLUC tests and standard methods results in a better than 92% agreement, except for unrease. Four hundred sixty-six of the 486 bacterial isolates, or 96% of the strains which were numerically identified by MORLUC, agreed with conventional diagnoses.

Carboxy-Lyases↗
PubMed2007

Oral chemotherapy safety practices at US cancer centres: questionnaire survey.

OBJECTIVE: To characterise current safety practices for the use of oral chemotherapy. DESIGN: Written questionnaire survey of pharmacy directors of cancer centres. SETTING: Comprehensive cancer centres in the United States. RESULTS: Respondents from 42 (78%) of 54 eligible centres completed the survey, after consulting with 89 colleagues. Clinicians at 29 centres used handwritten prescriptions, two used preprinted paper prescriptions, and six used electronic systems for most oral chemotherapy prescribing. For six commonly used oral chemotherapies, on average 10 centres required a diagnosis on the prescription, 11 required the protocol number, four required the cycle number, nine required double checking by a second clinician, 14 required a calculation of body surface area, and 14 required a calculation of dose per square metre of body surface area. Only a third of centres requested patients' written informed consent when oral chemotherapy was given off protocol. Nearly a quarter (10) of centres had no formal process for monitoring patients' adherence. In the past year respondents at 10 centres reported at least one serious adverse drug event related to oral chemotherapy, and respondents at 13 centres reported a serious near miss. CONCLUSION: Few of the safeguards routinely used for infusion chemotherapy have been adopted for oral chemotherapy at US cancer centres. There is currently no consensus at these centres about safe medication practices for oral chemotherapy.

Administration, Oral↗
PubMed1999

A risk management audit: are we complying with the national guidelines for sedation by non-anaesthetists?

OBJECTIVES: To assess the effect of a preprinted form in ensuring an improved and sustained quality of documentation of clinical data in compliance with the national guidelines for sedation by non-anaesthetists. DESIGN: The process of retrospective case note audit was used to identify areas of poor performance, reiterate national guidelines, introduce a post-sedation advice sheet, and demonstrate improvement. SETTING: Emergency Department, Musgrove Park Hospital, Taunton. SUBJECTS: Forty seven patients requiring sedation for relocation of a dislocated shoulder or manipulation of a Colles' fracture between July and October 1996 and July and October 1997. MAIN OUTCOME MEASURES: Evidence that the following items had been documented: consent for procedure, risk assessment, monitored observations, prophylactic use of supplementary oxygen, and discharging patients with printed advice. Case note review was performed before (n = 23) and after (n = 24) the introduction of a sedation audit form. Notes were analysed for the above outcome measures. The monitored observations analysed included: pulse oximetry, respiratory rate, pulse rate, blood pressure, electrocardiography, and conscious level. RESULTS: Use of the form significantly improved documentation of most parameters measured. CONCLUSIONS: Introduction of the form, together with staff education, resulted in enhanced documentation of data and improved conformity with national guidelines. A risk management approach to preempting critical incidents following sedation, can be adopted in this area of emergency medicine.

Procedural Sedation↗
PubMed2001

A descriptive study of managed-care hassles in 26 practices.

OBJECTIVES: To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem. METHODS: 16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship. RESULTS: Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both. CONCLUSIONS: The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.

Attitude of Health Personnel↗
PubMed1969

Punch card data processing in haematology.

A method of processing haematological laboratory data based on the IBM 870 system is described. As the cards are being punched with the identification particulars of the patient and source of the sample, a worksheet is automatically generated on which the tests are indicated. The results of the laboratory tests are recorded by the technician on the worksheet and reproduced on the punch cards which are subsequently used for the automatic printout of the results on self-adhesive preprinted labels. The resulting report is clear and legible and is transferred onto the request/report document. The data processing is carried out by clerk/typists who have been trained as punch card operators. The present workload of approximately 2,000 items of information obtained from some 170 samples per day is handled by one punch card operator in less than three hours. The punch cards are manipulated in a sorter for quality control purposes and are stored for subsequent retrieval of information.

Hematology↗
PubMed2005

Dissipative flows of 2D foams.

We analyze the flow of a liquid foam between two plates separated by a gap of the order of the bubble size (2D foam). We concentrate on the salient features of the flow that are induced by the presence, in an otherwise monodisperse foam, of a single large bubble whose size is one order of magnitude larger than the average size. We describe a model suited for numerical simulations of flows of 2D foams made up of a large number of bubbles. The numerical results are successfully compared to analytical predictions based on scaling arguments and on continuum medium approximations. When the foam is pushed inside the cell at a controlled rate, two basically different regimes occur: a plug flow is observed at low flux whereas, above a threshold, the large bubble migrates faster than the mean flow. The detailed characterization of the relative velocity of the large bubble is the essential aim of the present paper. The relative velocity values, predicted both from numerical and from analytical calculations that are discussed here in great detail, are found to be in fair agreement with experimental results from the preprint Experimental evidence of flow destabilization in a 2D bidisperse foam by the present authors (2005).

Journal Article↗
PubMed1993

Advanced applications of personal computers in the radiologist's office.

The author's department has found various advanced applications for the computer to be useful in daily practice. They use a data-base program to track interesting cases for later retrieval. The program automatically generates an American College of Radiology code based on the body part and diagnosis. The program is also used to track radiographic film quality. A barcode scanner attached to a computer at the film alternator is used to enter the accession number generated by the radiology information system. If any deficiencies are present, they are entered from a preprinted bar-code sheet. The bar-code scanner allows rapid entry of all examinations during the read-out session. Reports generated from the data base have been helpful in identifying and quantifying radiographic examination deficiencies. Department computers are also connected to the campus Ethernet network. This network allows radiologists to electronically verify radiology reports and to conduct electronic literature searches on the computers in their offices.

Database Management Systems↗
PubMedDate not supplied

Characterizing and developing strategies for the treatment of community-acquired pneumonia at a community hospital.

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community-acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP. OBJECTIVE: To characterize and provide recommendations for the management of CAP. METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000. RESULTS: Fifty-one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step-down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step-down, and step-down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step-down criteria and promoting early discharge criteria was estimated to be $220,000. CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.

Aged↗