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At least 1,783 records · Page 99Linked to original sources
PubMed1999

[The use of resources. Unnecessary stays in pediatric surgical services].

BACKGROUND: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard. OBJECTIVE: The main aim of this work is to determine the percentage of inadequate stays in a pediatric surgery service and to identify the causes that provoke them. METHOD: It was a concurrent study in pediatric patients entered, at least 24 hours, by different disease for surgery, observation or study. Revising trained applied the pediatric version of the Appropriateness Evaluation Protocol on the medical records of these patients. It has been measured if the stay was appropriated or not, and the cause. RESULTS: The studied patients (279) caused a total of 1,001 stays of those which 373 (37.3%) were deemed to be unnecessary. The diseases with greater number of inappropriate stays were cryptorchidia (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissues surgery (43.1%). A 68.2% of the unnecessary stays were responsibility of the hospital-service-surgeon, a 22.6% to the associated environment-familiar, and a 9.2% to the lack of alternative resources to the hospital. CONCLUSIONS: A meaningful proportion by day of hospital stay would be avoided. The unnecessary stays search facilitates the weak points identification on those which to develop improvement actions.

Child↗
PubMed1987

A successful implementation of a hospital pharmacy computer module.

The Mississauga Hospital Pharmacy Department recently implemented the unit dose dispensing portion of a hospital-wide computer system. Initially, a pharmacist was assigned to the position of Computer Preceptor to build the data base and help coordinate the implementation process. A joint management/staff Computer Advisory Committee was also formed. This group revised job descriptions, workload priorities and the physical layout of the department and directed the implementation plan. Staff training was conducted at first on a "volunteer" basis, followed by a formal program, using a training manual developed by a staff pharmacist. Staff concerns were constantly monitored and various "morale boosters" were utilized. The computerized dispensing was run parallel with the manual system on two nursing units for one week prior to undertaking a step-by-step conversion of the hospital. Following the "break-in" period, procedures will be formalized and quality assurance programs established.

Hospital Bed Capacity, 500 and over↗
PubMed2000

The precautionary principle: between responsibility and policy.

It is important to distinguish between the idea of the "precautionary principle", a precise concept that made its appearance under specific circumstances in the 70s in order to respond to certain environment-related issues, and the idea of "precaution", itself more or less confused with the idea of "caution", a term used to describe a general attitude to risk and uncertainty. Although it is easy to identify the notion of "precaution" with a general philosophy of responsibility, the "precautionary principle" has no meaning except when used to describe public precautionary policies. And though we cannot give a precise definition of the idea of precaution, in the sense of caution, we can however give a precise description of the "precautionary principle", based on the techniques, always specific, which are implemented in the name of the precautionary principle. In France we have developed the habit of considering precautionary actions as part of an overall moral principle, while totally disregarding the laws defining the "precautionary principle" and including it within the power framework of state policy. It is essential to clear up this confusion, along with all of its potentially dangerous legal consequences, before we can envisage an informed discussion on the "precautionary principle", its field of application and the conditions governing its implementation.

Decision Making↗
PubMed2001

Can we prevent cardiovascular diseases in low- and middle-income countries?

Ischaemic heart disease, the largest cause of death worldwide, is rapidly becoming a major threat in low- and middle-income countries. Experience in a variety of populations has demonstrated that lowering certain risk factors, such as hypertension and hypercholesterolaemia, reduces illness and deaths from cardiovascular diseases. A dual approach is recommended: screening and intervening in cases of relatively high risk, while fostering population-wide preventive activities. This is both feasible and affordable. Now is the time to make such efforts.

Cardiovascular Diseases↗
PubMed2006

Moral education in medical schools.

The present report summarizes challenges in teaching medical ethics, defines its goals, describes theoretical frameworks for moral education, and reviews strategies for teaching medical ethics to serve as guidelines in developing medical ethics instruction. Medical teachers should clarify the instructional goals in cognitive, attitudinal, and behavioral domains. The cognitive developmental and behavior-analytic theories called for ethical instruction using a series of discussions based on real-life ethical dilemmas while pointing out all the basic rules related to medical practice. Ethical courses for medical students should be student-centered, problem-based, and integrative. Ethical instruction should be systematically taught to every student, but additional elective courses could also be used. Moral education for residents should be more focused to issues specific to their specialties. Medical researchers need both formal ethical training and informal teaching, and role modeling. Finally, experienced staff could use small group discussions of shared ethical problems to maintain their ethical knowledge and skills.

Education, Medical↗
PubMed1991

Adolescence: a literary passage.

Using Erikson's and Gilligan's theories of adolescent development, this paper presents a content analysis of the depiction of adolescent development in a sample of Newbery Medal winners and honor books. Some diversity was found among the major characters, but white males were overrepresented. Many of the characters underwent an identity crisis. Some passed through the identity versus role confusion stage; others, especially in the almost prototypical male-initiation-rite stories, discovered ways to deal with nature (industry) which engendered a far clearer sense of self (identity). The major female characters experienced the two phases more or less simultaneously, but a similar fusion existed for a number of the male characters. The themes of "separation" and "connection" were paramount in the stories, and what Gilligan has called "the ethic of care" was presented positively. Some main characters matured only when they recognized their responsibility to others.

Adolescent↗
PubMed1979

Menu planning competencies in administrative dietetic practice. II. Practitioners' ratings of competence.

A nationwide sample of administrative and generalist dietitians rated five competencies with sub-competencies and ninety-two descriptors related to menu planning. Each item was rated numerically for importance and frequency of time consideration. Data were grouped according to three levels of practitioner experience. It was concluded that an effective methodology was developed for analyzing competencies for dietetic practice.

Administrative Personnel↗