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PubMedDate not supplied

Lessons learned during 15 years of clinical information system experience.

This article describes lessons learned during an initial intensive care unit point-of-care clinical information system implementation and subsequent expansions to other units and hospitals in a multihospital healthcare delivery system. Although the implementation and expansions were primarily successful, lessons learned include developing a broad base of support, making decisions through consensus, addressing conflict when it occurs, keeping user expectations realistic, preparing for the change process, implementing the computer information system in stages, challenging existing work processes, viewing the implementation as a process, and choosing a project leader with outstanding communication and group process skills in addition to technical skills.

California↗
PubMedDate not supplied

Assuring the accuracy of home glucose monitoring.

BACKGROUND: An estimated 2.5 million diabetic patients in the United States practice self-monitoring of blood glucose (SMBG). The validity of the glucose values they obtain is in doubt. An American Diabetes Association consensus panel reported that up to 50% of SMBG determinations might vary more than 20% from their true value. Accurate glucose values are an integral part of intensive treatment and reduction of long-term complications. The objective of this study was to determine the technical skill and accuracy of SMBG in an outpatient population. METHODS: This study was conducted in two family practice residency sites where 111 patients with type 1 and type 2 adult diabetes were observed testing their blood glucose values on their own glucose monitors. Patient-measured glucose levels were immediately compared with a laboratory value obtained from a calibrated hand-held glucose monitor. RESULTS: Fifty-three percent of patient glucose values were within 10% of the control value, 84% were within 20% of the control value, and 16% varied 20% or more from the control value. Two patients had dangerously inaccurate glucose determinations. Four glucose monitors required replacement. The patients were observed using a 13-point checklist of critical steps in calibration and operation of their glucose monitor. Only 1 patient made no errors in testing. CONCLUSIONS: Despite multiple technical errors when using SMBG, most patients obtained clinically useful values. This project can be easily introduced into a medical office.

Adult↗
PubMedDate not supplied

[The aging of the French population is inevitable].

Probable population trends in France up to the year 2000 are explored. "Between now and the year 2000, the French population will grow by three or four million. There will be 12 million persons over the age of 60, as compared to 10 million today. The working population will be more numerous, but older. Only the number of young people is difficult to estimate, because of the uncertainty concerning the birth rate." The demographic consequences of alternative fertility trends are discussed. (SUMMARY IN ENG AND SPA)

Birth Rate↗
PubMed1986

[And then, the dinosaurs disappeared].

"This paper starts by putting the present fertility decline experienced by many industrialized countries, in a global prospect of social evolution, and shows to what extent this decline is a new phenomenon. Using a so-called 'infernal' scenario, wherein Canadian fertility continues to fall, the author then emphasizes that society would have at its disposal a remarkably long delay for bending the path leading to extinction, although some forces may also lead to an acceleration of the demographic decline." (SUMMARY IN ENG AND SPA)

Americas↗