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At least 1,477 records · Page 82Linked to original sources
PubMed2004

Doctors' new tool to fight lawsuits: saying 'I'm sorry.' Malpractice insurers find owning up to errors soothes patient anger. 'The risks are extraordinary'.

A lot of attention and energy has been spent over the past several years on reducing the amount of settlements and awards in malpractice cases. Of course these are important issues, but the best situation for physicians is not to be sued at all. Therefore, the medical community needs to start focusing on ways to prevent lawsuits from being filed in the first place. Recent studies and publications indicate that physicians may have more control over the lawsuit lottery than they realize. An article that appeared on the front page of the May 18, 2004 edition of the Wall Street Journal is reprinted below with permission. This article supports the proposition that the best tool to minimize the possibility of being sued may be as simple as expressing condolence and empathy when there is a bad outcome. The lawsuit reform bill that recently passed the Oklahoma legislature, H.B. 2661, contains an "I'm Sorry Law" that permits physicians to express condolence without those statements being used against them in court. For more information regarding the power of an apology, physicians may want to obtain the book by Michael S. Woods, M.D. (a speaker at the OSMA Physician Survival Summit) titled: "Healing Words: The Power of Apology in Medicine." The book can be obtained from: Doctors in Touch, 708.697.6447 or info@doctorsintouch.com.

Anger↗
PubMed2004

Natural disasters: responding to the unexpected.

No matter how well-prepared a hospital is for emergencies, when one does occur it invariably poses problems that were unforeseen. In this article, hospital security officials evaluate their response to two major disasters that occurred within two months of each other--the Oklahoma ice storm and the Seattle/Olympia earthquake.

Disaster Planning↗
PubMedDate not supplied

Case study: improving efficiency in a large hospital laboratory.

Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third-party design expertise and quarterly metric reporting through Argent Consulting. Abbott incorporated lessons learned from the SFH OEC project with organizational changes to improve the way they work with customers. Following is a step-by-step description of the OEC project to allow others to benefit from the experience (Figure 1).

Efficiency, Organizational↗
PubMed2005

Why should your practice perform compliance audits based on the latest OIG Work Plan?

Why have compliance audits, or medical record reviews, become an essential part of many progressive medical facilities? Because medical record reviews are known to improve reimbursement, documentation, and internally identify compliance issues that should to be promptly addressed, in order to protect the organization from substantial monetary penalties and legal sanctions by the federal government. This article discusses the importance of auditing based on the areas of focus recently identified in the OIG Work Plan. These include VA physician billing, pathology/clinical laboratory services, identifying referring physicians in Oklahoma that are sanctioned, high level E/M services, consultations, and red flags that are raised due to overuse of modifier -25 and -59.

Fees, Medical↗
PubMed2005

A diabetes prevention assessment tool for American Indians.

INTRODUCTION: American Indians have a disproportionately higher risk of developing type 2 diabetes. Few data are available about the perceptions of diabetes among American Indians, and no culturally appropriate tools are available for assessment of perceptions related to health and diabetes. METHODS: A diabetes prevention assessment tool was developed to measure perceptions of health and diabetes among American Indians. Predominant themes from qualitative interviews were used to develop the items for the tool. Data were collected at two autumn powwows, or intertribal dances, in Oklahoma. Reliability testing was performed using 185 surveys from American Indian adults not living on reservations. Principal axis factor analysis was performed to identify possible relationships among the items. RESULTS: Five themes, or factors, were found to categorize the perceptions of health: 1) lifestyles, 2) barriers to healthy lifestyles, 3) personal responsibility, 4) self-care behaviors, and 5) culturally defined well-being. Two factors classified the perceptions of diabetes: 1) a cognitive factor, related to personal experience, and 2) an affective factor, related to emotions. CONCLUSION: Our diabetes assessment tool identified factors that should be considered when developing health promotion and diabetes prevention programs for American Indians. A valid assessment tool for the American Indian population could provide valuable, formative data that would increase understanding of the culturally related obstacles to health promotion and diabetes prevention.

Adolescent↗
PubMed2005

Ethics versus education: pelvic exams on anesthetized women.

In a survey of junior and senior medical students at the University of Oklahoma, a large majority of respondents reported having performed pelvic exams on anesthetized gynecologic surgery patients. Nearly three-quarters also reported believing that these patients had not specifically consented to undergo exams by students during their surgical procedures. While some students and medical educators maintain that pelvic exams under anesthesia are necessary for the development of students' examination skills, this assertion has not gone unquestioned. Serious ethical concerns have been raised by members of the medical community and women's advocacy groups, and the practice was recently outlawed in one state. Despite this widespread opposition, non-consented pelvic examinations evidently remain a common practice in US teaching hospitals. Our consideration of this controversial issue leads us to conclude that explicit, informed consent must be obtained in order for pelvic examinations to be performed on surgical patients, or risk compromising the doctor-patient relationship.

Anesthesia, General↗
PubMed2006

Co-morbidity in an elderly inpatient population: are the risks of co-existing conditions differentially distributed?

This study examines the distribution of co-morbidity among 167,738 inpatients, aged 65 or more, who experienced an episode of hospitalization during 1999 in short-term institutions that are located in Oklahoma. The analysis was conducted in two phases. In the first, logistic regression analysis was used to examine covariates that separate inpatients who presented at least one secondary diagnosis from those who were not co-morbid. Limited to those whose condition was complicated by at least one secondary diagnosis, Probit analysis was used to assess the covariates of the number of co-existing conditions. The covariates examined were the individual's racial status, demographic attributes, primary diagnosis, source of admission and discharge destination. Results indicate that the oldest of the elderly, African Americans and, to a lesser extent, Native Americans presented more complex cases than other members of the study population. The paper concludes with the policy implications that are associated with the differential distribution of co-morbidity.

Black or African American↗
PubMed2006

Body mass index and blood pressure screening in a rural public school system: the Healthy Kids Project.

INTRODUCTION: All students (N = 2053) in Anadarko public schools, grades kindergarten through 12, were invited to be screened for height, weight, and blood pressure to assess the health status of this multiracial, multiethnic (American Indian, white, African American, and Hispanic) population in southwestern Oklahoma. METHODS: The Centers for Disease Control and Prevention's 2000 growth charts were used to determine body mass index (BMI) percentiles, and standards from the National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents were used to assess blood pressure. RESULTS: Seven hundred sixty-nine students with active consent participated in the screening. Of these, approximately 28% were overweight. American Indians were at significantly greater risk of being overweight or at risk for overweight than whites (relative risk [RR], 1.4; 95% confidence interval [CI], 1.1-1.7) as were African Americans (RR, 1.5; 95% CI, 1.1-2.0), whereas Hispanics (RR, 1.3; 95% CI, 0.9-2.0) did not have a statistically significant increased risk compared with whites. BMI at or above the 95th percentile was strongly associated with elevated blood pressure (> or =90th percentile) (RR, 3.8; 95% CI, 2.6-5.4). CONCLUSION: Students who participated in this BMI screening in the Anadarko public school system evidenced high rates of excess weight, with American Indians and African Americans at greatest risk. Elevated BMI was strongly associated with elevated blood pressure.

Adolescent↗
PubMed2006

Milk-alkali syndrome in pre-eclamptic pregnancy: report of a patient and evaluation of albumin-corrected calcium in pre-eclamptic pregnancies.

BACKGROUND: First reported in 1923 due to excessive ingestion of milk and bicarbonate for peptic ulcer disease, milk-alkali syndrome nearly disappeared by the 1980s. More recently, however, this syndrome has become a more common cause of hypercalcemia. This increase is likely due to the increased use of calcium carbonate for the prevention and treatment of osteoporosis. Pregnancy likely places women at risk for milk-alkali syndrome due to increased intestinal absorption of calcium. Recommendations for increased oral calcium intake during pregnancy along with frequent use of calcium carbonate for GI symptoms during late pregnancy increase this risk. METHODS: We performed a retrospective chart review of pregnant women with pre-eclampsia, ages 18-35 years, who were admitted for delivery to the University of Oklahoma Health Sciences Center. Serum calcium levels were reviewed and compared with those of an age- and sex-matched control group consisting of 100 non-pregnant women admitted to the same facility. RESULTS: Twenty-nine of the 100 pregnant patients (29%) had an albumin-corrected calcium above normal compared to only six patients (6%) in the control group (P = 18.32, p < 0.0001). The highest corrected serum calcium in the pregnant group was 12.3 mg/dl compared to 10.7 mg/dl in the control group. SUMMARY: Milk-alkali syndrome is not an uncommon cause of hypercalcemia, and pregnancy may predispose women to milk-alkali syndrome as demonstrated by the patient reported. Albumin-corrected calcium is frequently high in women with pre-eclampsia but ionized calcium is not.

Adolescent↗
PubMed1991

Patient demographic characteristics and housestaff performance in the care of patients with human immunodeficiency virus disease.

A retrospective review of the medical records of 45 patients with human immunodeficiency virus (HIV) disease was conducted in an Oklahoma internal medicine teaching clinic. Demographics of this patient population and house staff performance in the care of these patients was evaluated. The study population demographics were similar to national findings with the exception of lower documented homosexual/bisexual transmission among males and higher heterosexual transmission among females. Deficiencies in documentation were noted in the areas of route of acquisition, mental status, and functional level. In several instances patients who were candidates for zidovudine and/or Pneumocystis prophylaxis were not receiving these treatments. The quality of care could be enhanced through the use of HIV evaluation and treatment protocols as well as specially designed, HIV-specific medical records to improve data collection. These HIV-specific medical records can be found in the appendices.

Clinical Protocols↗
PubMed1991

Risk assessment for HIV infection: validation study of a computer-assisted preliminary screen.

Development has been undertaken for microcomputer software intended to assess individual risk for HIV infection by analyzing personal case histories pertinent to drug abuse, receptive blood transfusion, and sexual behavior. The software performs interactive confidential interviews of individuals desiring expert assistance when deciding whether to commit to an antibody test. In the first phase of a validation study, 87 subjects responded to the computer interview. For each subject, human immunodeficiency virus (HIV) antibody status was on clinical record. This sample included 70 subjects, 29 of whom were HIV seropositive, recruited from the clientele of an AIDS antibody testing and counseling facility. In this phase, the software accurately assessed 28 of 29 seropositives (96.6%) to be at risk for HIV. The second phase was based upon participation of an additional 74 subjects who were undergraduates at the University of Oklahoma. In this presumed low-risk sample, 55 members reported never having previously tested for HIV antibodies. Seven members (12.7%) of the untested group were declared at risk in the course of receiving confidential computer screen advice. Of these 7, there were 3 members (42.9%) who were motivated by the computer to voluntarily seek HIV antibody testing. Of the 7 declared at risk, 2 members (3.9%) were among the 51 seronegative subjects classified as heterosexuals without specific and identified risks. All Phase II subjects seeking follow-up antibody tests were found seronegative.

Diagnosis, Computer-Assisted↗
PubMed1991

Interview with Senator Don Nickles on domestic health care issues. Interview by Richard L. Reece.

Senator Nickles (R-Okla) was interviewed in March in his Oklahoma City office on the 18th floor of the Liberty Bank Building. The interview was shortened by a late start and because the Senator was on his way to an editorial meeting of the Daily Oklahoman. Nonetheless, Senator Nickles, a young and energetic man in his early forties, was relaxed and in no apparent rush. Nickles, still the youngest Senator in Washington, has been a US Senator for 11 years. Because of the combination of youth and promise of long tenure, he is considered to be a rising power in the Senate. He is a conservative and a philosophical ally of medicine.

Delivery of Health Care↗
PubMed1990

Locus of control and drinking behavior in American Indian alcoholics and non-alcoholics.

Many investigators have attempted to determine whether alcoholics differ from non-alcoholics in their perceived locus of control. The present study examined the responses of alcoholic and non-alcoholic American Indian males and females on Levenson's Multidimensional Locus of Control Scale. Subjects were 80 American Indian males and 40 American Indian females. All subjects were members of either an eastern (Cherokee) or western (Cheyenne) Oklahoma tribe. Results indicate no significant differences between the Cherokee male alcoholic and non-alcoholic group. Cheyenne male alcoholics reported significantly lower internal control scores than did Cheyenne male non-alcoholics. Within the female sample, alcohol use and tribal membership showed a significant interaction with locus of control. These findings suggest that locus of control may be a potentially useful clinical construct in the development of treatment plans and therapeutic issues for American Indian patients who are alcoholics.

Adult↗
PubMed1990

Rural physician survey.

In August 1989, the Physician Manpower Training Commission conducted a survey in an effort to learn what factors influence the recruitment and retention of physicians in rural Oklahoma communities. The results of the survey are summarized in this article.

Humans↗
PubMed1990

Human growth hormone and Creutzfeldt-Jakob disease.

For more than 20 years cadaver-derived human growth hormone (HGH) was used successfully to enhance linear growth in short children. In 1985 the US Food and Drug Administration (FDA) stopped use of the hormone in response to reported deaths due to Creutzfeldt-Jakob (CJD) agent in 3 former HGH recipients. To date, a total of 9 patients have been identified who both received HGH and became infected with CJD agent (7 in the United States, 1 in Britain, and 1 in New Zealand). Circumstances make it likely that HGH contaminated with a slow growing, viral-like particle may have been responsible for these fatalities. In Oklahoma at least 60 children and adolescents previously received HGH and are potentially at risk of developing CJD. It is important that health care providers responsible for the care of these individuals be aware of this fatal illness and remain informed of new developments in the field.

Adolescent↗
PubMed1990

Child abuse: a time for new awareness.

There were 7602 cases of confirmed child abuse and neglect in Oklahoma in 1989. Twenty-five children died from abuse during the fiscal year. Physician training in diagnosis and management of child abuse must be expanded. Physicians are required by state statute to report all cases of suspected abuse to the Department of Human Services. Sexual abuse of children appears to be increasing. A coordinated multidisciplinary effort which involves physicians can help manage this threat to childrens' health.

Child↗
PubMed1986

A statewide university hospital-based family medicine referral service.

A statewide university hospital-based family medicine referral service was established at the University of Oklahoma in July 1983. During the first six months of operation, 14 percent of all patients admitted to the family medicine inpatient service were referred by outside physicians. Referral patients had more diagnoses coded per admission (2.25) than continuity patients (1.56) (P less than .05). In referral patients, 23.3 percent of diagnoses fell into the 52 most common diagnostic cluster described by Rosenblatt et al compared with 50.9 percent in continuity patients (P less than .0005). Specialty consultations, invasive diagnostic procedures, surgical procedures, and average length of hospital stay were compared in the subgroup of patients with medical, pediatric, surgical, and gynecological principal diagnoses. Referred patients averaged 0.974 consultations per admission compared with 0.578 in continuity patients (P less than .01). An average of 1.237 invasive diagnostic procedures per admission were performed in referral patients compared with 0.626 in continuity patients (P less than .0005). Referral patients averaged 0.145 surgical procedures per admission compared with 0.123 in continuity patients (not significant). The average length of stay for both continuity and referral patients was 9.68 days per admission. A survey of the referring physicians indicated that both the physicians and the patients whom they referred were generally satisfied with the care provided by the service.

Diagnosis-Related Groups↗
PubMed1977

Determination of continuing medical education needs of clinicians from a literature search study. Part II. Questionnaire results.

Part II of this study of the needs of clinicians for continuing medical education (CME) examines the results of a questionnaire sent of Oklahoma physicians to determine if they would request formal CME courses in the same subject areas in which they had previously requested in formation from librarians. The degree of correlation between literature search requests and responses to the questionnaire confirms that the analysis of library information requests may be one approach to determining CME needs.

Bibliographies as Topic↗