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Biomedical subjects

A J Joseph

Publications and source records attributed to A J Joseph.

8 recordsLinked to original sources
PubMed1997

Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study.

This study examines the question of whether chest pain observation units increase the proportion of chest pain patients with an extended evaluation for cardiac ischemia ("rule out myocardial infarction [MI] evaluation"), decrease the number of missed MIs, and decrease costs. This is a multiple site registry study of 8 established chest pain observation units (complying with the American College Emergency Physician's Observation Section's standards) compared with previous studies on chest pain evaluation without the use of observation (5 studies, 12,405 patients). A total of 23,407 of 444,189 emergency department patients (5.3%) had the chief complaint of chest pain during the study period. In the chest pain observation units, 153 of 2,229 patients (6.9%) with acute MI were identified. Most of the observation chest pain patients (76%) were discharged home without hospital admission. Compared to previous studies, a higher proportion of patients underwent a "rule out MI evaluation" (67%, 95% confidence interval [CI] 66%, 68% vs 57%, 95% CI 56%, 58%; p <0.001) equal to 2,250 additional patients completely evaluated ($1,219,500 additional costs). A lower proportion of MIs were missed (0.4%, 95% CI 0.3%, 0.5% vs 4.5%, 95% CI 4.0% to 5.5%; p <0.001) as estimated by return visits within 72 hours. Compared to previous studies, final hospital admission rate was lower (47%, 95% CI 46%, 48% vs 57%, 95% CI 56%, 58%; p <0.001), equal to 2,314 hospital admissions avoided in the study population ($4,093,466 saved costs). Calculated true costs overall were lower by $2,873,966 at the study hospitals. Thus, chest pain observation units increased the proportion of chest pain patients thoroughly evaluated with improved quality of care and lower costs.

Chest Pain↗
PubMed1997

Right-to-know training of workers with IQ less than 70: a pilot study.

Chemical emergencies occur frequently in the workplace. Laws and regulations have been enacted to reduce the risk of injuries to workers, including workers with an IQ less than 70. These regulations require employers to educate their workers about the nature and hazards of toxic substances in the workplace, about methods to reduce exposure, and about appropriate responses in case of an accident or an emergency. From May to August 1996, a project examined the responses of 58 Goodwill Industries employees before and after their attendance at a mandatory "Right-to-Know" training program. Responses to five questions relating to the safe use of chemicals were analyzed. A combination of quantitative and qualitative evaluations determined that for the 28 subjects with IQ < 70, the program did not achieve its goals. However, the program did provide fuller information for the 30 subjects with IQ > or = 70. The findings of this pilot study show the need to develop training programs tailored to meet the needs and conditions of workers with IQ < 70.

Accidents, Occupational↗
PubMed1997

Chest pain centers.

Conceptually, the Chest Pain Center model is nothing more than a system of delivering health care. It is a model that all hospitals can embrace as a framework for organizational decision making in meeting the heart-care needs of their communities. It also provides a framework for clinical decision making. By adopting some or all of the common features of the model, hospitals develop a common language, similar to what took place when CCUs first opened in the 1960s. Application of evidence-based clinical practice is promoted. Approaches that account for both clinical outcomes and financial outcomes will be further refined. One result will be simultaneous improvement in clinical outcomes and a decrease in costs, but the most important aspect of the Chest Pain Center model is that it puts the patient first.

Chest Pain↗
PubMed1995

Advances in the use of ancillary diagnostic testing in the emergency department evaluation of chest pain.

This article discusses the advances of ancillary studies used to evaluate the emergency department patient with chest pain caused by acute myocardial infarction (AMI) or ischemia. This article examines how these studies have improved the early detection of patients with AMI, improved differentiation of acute ischemic coronary events from nonischemic causes of chest pain, more accurately stratified patients for adverse outcome, and decreased the number of patients with AMI inadvertently discharged from the emergency department. Ancillary studies discussed include nonstandard ECGs, nuclear imaging, serum markers, and emergency department observation units. Emergency department echocardiography is discussed elsewhere in the issue.

Chest Pain↗
PubMedDate not supplied

The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part 2.

Part 1 of this two-part article addressed the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility was emphasized and a number of ethical dilemmas were reviewed, including confidentiality issues. Part 2 addresses strategies for handling difficult psychological issues that often come up in the process of internal consulting. Transference, resistance, regressions, and counterproductive group dynamics are reviewed. These psychological issues may be the predominant source of stress in an internal consulting experience. Case examples are presented along with some empowering strategies. It is hoped that through this review, the quality professional will be better prepared to meet the exciting and rewarding challenges of internal consulting.

Consultants↗
PubMedDate not supplied

The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part I.

Expertise in quality and process improvement is becoming widely recognized as a valuable resource. The more objective viewpoint and experience of consulting firms or outside professionals in quality and change management often is critical to the success of organization-wide quality or change implementation. Outside consultants, however, are not inexpensive. It is predictable that there will be an increasing tendency for healthcare systems to look internally for organizational and quality expertise. Part one of this article discusses the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility is discussed. Ethical dilemmas are a core challenge, and a number of real-life scenarios and associated strategies are presented.

Consultants↗
PubMedDate not supplied

Transcatheter hepatic artery embolization for spontaneous rupture of amyloid liver.

Spontaneous rupture of amyloid liver is a fatal complication. A 48-year-old man with systemic amyloidosis secondary to multiple myeloma presented with acute hemoperitoneum. Emergency angiogram showed extravasation of contrast from the liver into the sub-hepatic space, which was successfully stopped by embolization of the right hepatic artery.

Amyloidosis↗