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At least 145 records · Page 8Linked to original sources
PubMed2006

Preoperative surgical case review program in a community-based, academic medical center: a feasibility study.

OBJECTIVE: To assess the feasibility of applying postoperative objective criteria for preoperative evaluation of scheduled gynecologic cases. STUDY DESIGN: A preoperative evaluation program was introduced in which all surgeons were asked to voluntarily submit a 1-page case summary questionnaire for each elective gynecologic surgical procedure. A committee of departmental peers reviewed each submission for appropriateness of indications and completeness of preoperative evaluation. Cases were evaluated against quality assessment criteria sets created by the American College of Obstetricians and Gynecologists. Reviewed summaries were categorized as either meeting criteria, not meeting criteria but appropriate, not meeting criteria or no pertinent criteria available for the procedure planned. RESULTS: In all, 2,005 elective gynecologic surgical procedures were performed by 70 active surgeons during the 1-year study period; 1,166 procedures (58%) were reported. Of 70 surgeons, 57 reported at least 1 procedure, but only 6 were 100% compliant with their surgical submissions. In total, 1,008 procedures (86% of reported cases) met the criteria or were deemed appropriate by committee review. In 166 instances, additional information was requested from and provided by the surgeon before the case could be adjudicated. CONCLUSION: A voluntary program of preoperative surgical case review for scheduled gynecologic procedures appeared feasible but resulted in only modest initial participation.

Academic Medical Centers↗
PubMed1980

Initiation of a goal-directed movement in the monkey. Role of the cerebellar dentate nucleus.

The participation of the dentate nucleus (DN) in the initiation of a voluntary movement was investigated in five baboons (Papio papio). In these experiments, we have analyzed the effects of excluding the DN on the latency (reaction time, RT) of a learned goal-directed movement. Two techniques were for excluding the DN. In three animals, the structure was cooled with a probe, stereotaxically implanted on the side ipsilateral to the active hand. In two others, a partial electrolytic destruction of the DN ipsilateral to the operant hand was undertaken. In one further animal, both DNs were destroyed electrolytically. A comparison was made of the effect of DN inactivation on the latency of stereotyped goal-directed movements of constant amplitude and direction, and of goal-directed movements whose amplitude and/or direction were varied in random fashion. The exclusion of DN brought about a prolongation of RTs in all animals. This prolongation was not accentuated by variation of different characteristics (amplitude and/or direction) of the impending goal-directed movement. A recovery of the RTs to their prelesion values was observed after irreversible unilateral DN lesion, but no so easily after bilateral destruction. These results show that in the monkey DN is concerned with the initiation of a goal-directed movement, but is not critically implicated in the encoding of direction and amplitude parameters. These findings are discussed in view of the role that is usually attributed to the neocerebellum in programming voluntary movements.

Animals↗
PubMed2001

Startle response of human neck muscles sculpted by readiness to perform ballistic head movements.

1. An acoustic startle stimulus delivered in place of a 'go' signal in a voluntary reaction time (RT) task has been shown previously to advance the onset latency of a prepared distal limb movement without affecting the amplitude of the muscle response or movement kinematics. The primary goal of this study was to use muscles with a larger startle response to investigate whether the startling stimulus only triggered the RT movement or whether some form of interaction occurred between a startle response and a temporally advanced RT movement. 2. Twenty healthy male or female subjects were instructed to react as quickly as possible to an acoustic 'go' stimulus by performing a ballistic head flexion or right axial rotation. The 'go' stimulus was periodically replaced by an acoustic stimulus capable of eliciting a startle reflex. Separate startle-inducing stimuli under relaxed conditions before and after the movement trials served as control trials (CT trials). Bilateral surface electromyography of the orbicularis oculi, masseter, sternocleidomastoid and cervical paraspinal muscles, and head-mounted transducers were used to measure the muscle response and movement kinematics. 3. Muscle activation times in startled movement trials (ST trials) were about half those observed in RT trials, and were not significantly different from those observed in the startle CT trials. The duration of head acceleration was longer in ST trials than in RT trials and the amplitude of both the neck muscle electromyogram (EMG) and head kinematics was larger during ST trials than during RT trials. The EMG amplitude of ST trials was biased upward rather than scaled upward compared with the EMG amplitude of RT trials. 4. Over the 14 ST trials used in this experiment, no habituation of the reflex response was observed in the muscles studied. This absence of habituation was attributed to a combination of motor readiness and sensory facilitation. 5. The results of this experiment indicated that the neck muscle response evoked by a startling acoustic stimulus in the presence of motor readiness could be described as a facilitated startle reflex superimposed on a temporally advanced, pre-programmed, voluntary RT movement. Parallel reticular pathways to the neck muscle motoneurones are proposed as a possible explanation for the apparent summation of the startle and voluntary movement responses.

Adult↗
PubMed1978

Nonprofessionals in the rehabilitation of mentally disordered sex offenders.

Eighty-six sex offenders were exposed to a 6-month voluntary program of either group encounters (experimental group) or hobbies and games (control group) led by nonprofessionals. Pre- and posttests included a personality test, an introspective report, and a behavior rating scale. Written ward records were assessed as were the results of a postexperimental prisoner evaluation of the experience. Significant changes were evidenced by encounter subjects in improved feelings of approval of the prison-hospital experience, lessened hostility, and better attendance at the meetings. Encounter subjects were improved in the predicted direction on 55 of the 74 treatment dimensions. Community volunteers were judged moderately successful as lay therapists.

Adult↗
PubMed2004

The laboratory is a key partner in assuring patient safety.

Medical errors have a great impact on patient outcomes. They can cause serious injury to patients or even result in their deaths. However, morbidity and mortality can sometimes be prevented by the timely and effective action of health care workers. Several IOM Reports have focused on the problem of errors in the United States health care system and identified gaps that need to be addressed. As part of the overall health care system, clinical laboratories are vulnerable to medical errors. Because of significant efforts on the part of both the laboratories and the manufacturers of laboratory equipment and reagents, the errors in the analytic phase of the total testing process now represent the smallest portion of testing errors. Currently, laboratory testing errors occur most frequently in the preanalytic phase. The primary reason for the high prevalence of preanalytic errors is that, at the present time, it is difficult to monitor all preanalytic variables and to implement necessary improvement processes, particularly when some of the variables (like phlebotomy) are not under the control of the laboratory. Considerable efforts have been made by laboratory professionals and other stakeholders to decrease testing errors. Minimal quality requirements have been set through regulations for both laboratory testing and the manufacture of medical equipment and reagents. At the same time, nonregulatory approaches have greatly affected the quality of laboratory testing. These include laboratory standards, various quality improvement programs, voluntary reporting of adverse events, and, in the near future, the National Report on the Quality of Laboratory Services. The introduction of successful approaches from other industries, such as Six Sigma and Lean, also will help reduce the rate of laboratory errors. The clinical laboratory has done more than most other sectors of health care to decrease the occurrence of medical errors, making it a key partner inpatient safety.

Humans↗
PubMed2006

Development of a security vulnerability assessment process for the RAMCAP chemical sector.

The Department of Homeland Security (DHS), Directorate of Information Analysis & Infrastructure Protection (IAIP), Protective Services Division (PSD), contracted the American Society of Mechanical Engineers Innovative Technologies Institute, LLC (ASME ITI, LLC) to develop guidance on Risk Analysis and Management for Critical Asset Protection (RAMCAP). AcuTech Consulting Group (AcuTech) has been contracted by ASME ITI, LLC, to provide assistance by facilitating the development of sector-specific guidance on vulnerability analysis and management for critical asset protection for the chemical manufacturing, petroleum refining, and liquefied natural gas (LNG) sectors. This activity involves two key tasks for these three sectors: Development of a screening to supplement DHS understanding of the assets that are important to protect against terrorist attack and to prioritize the activities. Development of a standard security vulnerability analysis (SVA) framework for the analysis of consequences, vulnerabilities, and threats. This project involves the cooperative effort of numerous leading industrial companies, industry trade associations, professional societies, and security and safety consultants representative of those sectors. Since RAMCAP is a voluntary program for ongoing risk management for homeland security, sector coordinating councils are being asked to assist in communicating the goals of the program and in encouraging participation. The RAMCAP project will have a profound and positive impact on all sectors as it is fully developed, rolled-out and implemented. It will help define the facilities and operations of national and regional interest for the threat of terrorism, define standardized methods for analyzing consequences, vulnerabilities, and threats, and describe best security practices of the industry. This paper will describe the results of the security vulnerability analysis process that was developed and field tested for the chemical manufacturing sector. This method was developed through the cooperation of the many organizations and the individuals involved from the chemical sector RAMCAP development activities. The RAMCAP SVA method is intended to provide a common basis for making vulnerability assessments and risk-based decisions for homeland security. Mr. Moore serves as the coordinator for the chemical manufacturing, petroleum refining, and LNG sectors for the RAMCAP project and Dr. Jones is the chief technology officer for ASME-ITI, LLC for RAMCAP.

Chemical Industry↗
PubMed1993

The Australian development of national quality indicators in health care.

BACKGROUND: The Australian Council on Healthcare Standards (ACHS) conducts a voluntary program of health facility accreditation modeled along the lines of the Joint Commission. To increase clinician involvement in the accreditation process and in quality assurance programs and to enable some assessment of the outcome of care in a facility at the time of survey, the ACHS, together with the medical colleges, is developing objective measures of care (clinical indicators). METHODS: Ten medical colleges are now involved in the program. The first set of measures, the Hospital-Wide Medical Indicators (HWMIs) developed in conjunction with the Royal Australian College of Medical Administrators, was formally introduced into the accreditation process in January 1993. These indicators were developed by a combined working party of the Care Evaluation Program and the Royal Australian College of Medical Administrators. The HWMIs address the areas of trauma, postoperative pulmonary embolism, readmissions to hospital, returns to the operating room, hospital-acquired infection, medication errors, and hospital throughout. CONCLUSION: It is hoped that the development of objective measures of care (clinical indicators) will facilitate the accreditation process. The development of these measures also enables Australian physicians to compare patient care throughout the hospital with national indicators of quality of care.

Accreditation↗
PubMed1995

Client interests in premarital counseling: a further analysis.

A survey was conducted of over 150 college students concerning their attitudes toward premarital preparation. In general, the students valued brief, high-quality, low-cost, voluntary programs led by well-trained clergy or mental health professionals. However, females, students with more supportive family backgrounds, and religious students were more willing to participate in longer-than-average programs. Students with more supportive family backgrounds were also willing to pay more for such programs and to participate earlier in their relationship's development and were more willing to accept mandatory programs. Religious students were more interested in those led by clergy and less interested in those led by mental health or social workers. Female students were more interested in in-depth programs that focus on awareness and skill-building.

Adolescent↗
PubMed2003

Breath alcohol ignition interlock devices: controlling the recidivist.

This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.

Accidents, Traffic↗
PubMed2003

Breath alcohol ignition interlock devices: controlling the recidivist.

This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.

Accidents, Traffic↗
PubMedDate not supplied

The road to JCAHO disease-specific care certification: a step-by-step process log.

In 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented Disease-Specific Care (DSC) certification. This is a voluntary program in which organizations have their disease management program evaluated by this regulatory agency. Some of the DSC categories are stroke, heart failure, acute MI, diabetes, and pneumonia. The criteria for any disease management program certification are: compliance with consensus-based national standards, effective use of established clinical practice guidelines to manage and optimize care, and an organized approach to performance measurement and improvement activities. Successful accomplishment of DSC certification defines organizations as Centers of Excellence in management of that particular disease. This article will review general guidelines for DSC certification with an emphasis on Primary Stroke Center certification.

Benchmarking↗
PubMedDate not supplied

Patient safety: a priority in the US Department of Health and Human Services.

This descriptive article provides information about some of the major patient safety initiatives within the operating and staff divisions of the US Department of Health and Human Services. The research for this article was done using the internet. Many health professionals and consumers turn first to the internet while researching a disease or new diagnosis, or while seeking general health information. It is important for nurse administrators to know what resources are readily available to help them implement regulatory requirements, what voluntary programs exist for reporting problems with medical products, what resources are available for consumers to make informed health choices, and where they can get information about specific Department of Health and Human Services programs.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Documenting the scholarship of clinical teaching through peer review.

The essence of teaching is to make a positive difference in the lives of students. To this end, the nursing department at Kent State University developed and implemented a faculty-driven, voluntary program for peer review of clinical teaching. The authors describe the clinical peer review program and its positive outcomes.

Clinical Competence↗
PubMed1998

HIV prevalence in pregnant women in Europe: differences in assessment methods and prevalence levels across countries.

OBJECTIVE: To describe methods used to assess HIV prevalence and to assess prevalence levels and time trends among pregnant women in various European countries. METHODS: We used the European HIV Prevalence Database to examine annual HIV prevalence data in pregnant women for the years 1990 to 1996 (20 countries). RESULTS: In Western Europe, prevalences were generally obtained through unlinked anonymous surveys, whereas in most Central, and Eastern European countries, they were based on testing programs (voluntary or mandatory). Prevalences (per 10,000) were highest (i.e., 10-30/10,000) in large western urban areas including Amsterdam, Barcelona, London, Milan, Paris, and Rome; between 1 and 2 in Scandinavian countries; and down to 0.5/10,000 in Central and Eastern European countries (except Ukraine, 1996: 5/10,000). Prevalences decreased in Rome, whereas they increased in London, the Czech Republic, and since 1995 in Russia and Ukraine; elsewhere, no time trends were detected. CONCLUSIONS: Methodologic differences and potential biases should be considered when comparing these data. HIV prevalence in pregnant women is useful for monitoring the AIDS epidemic and for assessing and improving prevention. Efforts should be made to offer voluntary counseling and testing to women at risk for HIV and provide treatment to those who are infected.

Europe↗
PubMed1990

Standardization of image quality and radiation dose in mammography.

Image quality is the cornerstone to the practice of high-quality mammography. To ensure high quality in the practice of mammography, the American College of Radiology has established a voluntary program for the accreditation of mammographic screening sites. Between August 15, 1987, and February 1, 1989, 647 mammography units completed the accreditation program. Data collected from those units are presented, demonstrating that broad ranges of image quality and dose currently exist among mammographic screening sites. Reasons are discussed for the wide ranges observed, and steps are proposed to narrow the ranges of image quality and dose in the practice of mammography.

Accreditation↗