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Biomedical subjects

A L Weinberg

Publications and source records attributed to A L Weinberg.

7 recordsLinked to original sources
PubMed1998

Standardized or narrative discharge summaries. Which do family physicians prefer?

OBJECTIVES: To determine whether family physicians prefer discharge summaries in narrative or standardized format and to determine factors affecting this preference. DESIGN: Mailed survey. SETTING: Internal medicine ward at a teaching hospital. PARTICIPANTS: Random sample of 180 family physicians practising in the Ottawa-Carleton area. Of the original sample, 20 were not family physicians and were excluded. Of the 160 physicians remaining, 126 responded for a response rate of 78.8%. INTERVENTION: For a stratified random sample of patients, medical records and narrative discharge summaries were abstracted using a data acquisition form to capture essential information. Information on completed forms was transformed into standardized summaries. Physicians were sent both narrative and standardized summaries. MAIN OUTCOME MEASURE: Physicians' format preference as indicated on an ordinal 7-point scale. RESULTS: The standardized format was preferred with a score of 4.28 versus 3.84 for the narrative (P < .05). Responses indicated the standardized format provided information most relevant to ongoing care, with a mean score of 4.82 (95% confidence interval [CI] 4.48 to 5.15), and easier access to summary information (5.60, CI 5.30 to 5.89). The narrative summary better described patients' admission (3.54, CI 3.18 to 3.90). Preference for standardized summaries correlated with lengthier narrative summary (P < .05), shorter length of stay (P < .05), and physicians' dissatisfaction with previous summaries (P < .001). Standardized discharge summaries were significantly shorter (302 versus 619 words, P = .004) than narrative summaries. CONCLUSIONS: Physicians preferred a standardized format for discharge summaries. Format preference is influenced by physician, patient, and discharge summary characteristics.

Attitude of Health Personnel↗
PubMed1995

Quality assessment of a discharge summary system.

OBJECTIVE: To assess the completeness of hospital discharge summaries and the efficiency of the discharge summary system in two urban teaching hospitals. DESIGN: Descriptive study, with follow-up telephone survey. SETTING: General internal medicine services at two urban tertiary care hospitals affiliated with the University of Ottawa. PATIENTS: A total of 135 patient charts, representing 10% of the patients discharged from the services between Aug. 1 and Dec. 31, 1993. Three charts were unavailable for review, and 26 were excluded because of patient death, early patient discharge (within 48 hours after admission) or lack of discharge summary; this left 106 summaries for analysis of completeness and 114 (including the charts without a summary) for analysis of efficiency. OUTCOME MEASURES: Completeness: proportion of summaries in which the following information was reported: admission diagnosis, drug allergies, physical examination, significant laboratory tests and results, discharge diagnosis, discharge medications and medical follow-up. Efficiency: time taken to generate the discharge summary and whether the patient's family physician received it. RESULTS: Of the 106 charts with a discharge summary, information was available from the dictation system database for all but one (99.1% complete). Information was missing on the admission diagnosis in 34.0% (36/106) of the summaries, the discharge diagnosis in 25.5% (27/106) and the discharge medications in 22.8% (23/101). Of the 268 significant laboratory tests and results noted in the charts 115 (42.9%) were not reported in the discharge summary. Of the 94 discharge summaries in charts with the patient's family physician listed on the facesheet, 38 (40.4%) were not received by the family physician. CONCLUSIONS: Considerable deficiencies in the completeness of the discharge summaries and the efficiency of the discharge summary system were found in the participating hospitals. Replication of this study in other settings is indicated, and strategies to improve the process should be pursued.

Data Interpretation, Statistical↗
PubMed1983

Medical research council trial of antilymphocyte globulin in renal transplantation. A multicenter randomized double-blind placebo controlled clinical investigation.

A total of 173 patients who received live donor or cadaveric primary or secondary renal transplants at five British hospitals were entered into a randomized double-blind controlled clinical trial of equine antilymphocyte globulin (ALG) administered prophylactically to prevent rejection. The ALG was prepared in the early 1970s and used cultured human lymphoblasts as antigen. Following transplantation all patients were treated with a standard immunosuppressant regimen of steroids and azathioprine and, in addition, were given either 30 mg/kg ALG or placebo daily for 10 days by intravenous infusion. In comparison with more recently produced materials, the ALG employed in this study was of moderate potency in prolonging skin graft survival in monkeys. Primary graft failure occurred in 27 patients (15/86 ALG and 12/87 placebo). At three to five years after transplantation 50 of the remaining patients had died, almost all from diseases relating to their renal condition, and 25 more had suffered complete graft failure. No significant differences were found between patients treated with ALG and placebo in the numbers with functioning grafts during the 3 years following transplantation, in the time between transplantation and the first rejection episode, or in the number of episodes during the first six months after transplantation. This applied whether live or cadaveric grafts were employed. Within the first 6 months of operation, infection was given as a major contributory cause of death in 12 patients treated with ALG and in 5 who received placebo (P greater than 0.1). Infections were also slightly more common during the two weeks following transplantation in those receiving ALG (13/86 ALG, 10/87 placebo). As expected, graft survival was significantly better in patients who received live donor grafts (P = 0.001) and in patients with the least donor-recipient histocompatibility mismatches (P = 0.008). The results of this multicenter trial show no therapeutic benefit to renal graft recipients from the administration of ALG, and suggest that the risks of fatal infection may have been aggravated. Use of such equine ALG in similar dose regimens is therefore, not, justified in renal transplantation, especially if some part of the apparent effects on fatal infections is real. It is stressed that these findings are relevant only to the equine ALG used in this study, which was raised with cultured human lymphoblasts as the antigen, and to ALG prepared in a similar way and of similar potency. It should not be inferred that these results are applicable to ALG prepared in other ways.

Adolescent↗