Continuous quality improvement: maintaining quality of care with changing staffing patterns.
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Biomedical subjects
Publications and source records attributed to A Linton.
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1. Etiological factors that have been identified in relation to wandering include mental impairment, confusion, darkened or unfamiliar environment, boredom, stress, tension, anxiety, lack of control, lack of exercise, diseases of the central nervous system and cardiac decompensation. 2. The findings of this pilot study indicate that in structured settings such as SCUs, behaviors appear to be related to activities in the environment, e.g., quiet behaviors at night and more active behaviors during the day. 3. Psychotropic medications may not have the desired effect on behaviors in patients with Alzheimer's disease, however, nursing interventions geared toward modifying the environment may be useful in shaping behaviors of patients with dementia.
Computers are integral to medical practice, education, and research. While medical students learn computer skills during their training, many practicing physicians do not have the same computer experience. To familiarize this group with the exciting developments in medical informatics, the Himmelfarb Health Sciences Library and Department of Computer Medicine at the George Washington University Medical Center organized a workshop "Introducing Your Office Computer!" for attending physicians. The workshop featured a short lecture/video presentation on computer applications in medicine followed by a "computer fair" of five computer applications. Eleven physicians attended the workshop. Feedback was very positive; many called later to request more detailed instructions on using the programs demonstrated. It was a valuable experience for the staff, and new bridges were built between departments and clients.
A rapid automated method for isotopic analysis of 13C and 18O in CO2 has been developed. A variety of gas samples containing CO2 can be swept from serological tubes into a helium carrier flow; impurities are separated on a GC column so that a pure pulse of CO2 in He flows into the mass spectrometer. Isotopic ratio determinations are carried out as the pulse passes through the mass spectrometer, allowing a sample to be measured approximately every 4 min. A double, concentric needle-probe is used to flush the sample from the tube so that 100% sample recovery is achieved, maximizing sensitivity and preventing the possibility of fractionation. The precision of the technique, sigma(m-1), is better than 0.2% (0.0002 atom per cent excess) for 13C and 0.4% (0.83 p.p.m.) for 18O for 10 micromol of CO2 at natural abundance. Samples containing only atmospheric concentrations of CO2 can also be analyzed.
1. The effect of the plasma protein concentration on renal function remains controversial. Most, but not all, experimental studies suggest that a reduced plasma protein concentration perfusing the kidney may reduce tubular sodium reabsorption. Hypoproteinaemic disease states are usually associated with sodium retention, which is not always volume-dependent. 2. We induced a 21% and 24% reduction in plasma total protein and plasma albumin, respectively, in unanaesthetized sheep by acute extracorporeal plasmapheresis. Arterial pressure did not change, and changes in circulatory volume were minimised by infusion of crystalloid to maintain pulmonary artery occlusion pressure, measured using a Swann-Ganz pulmonary artery catheter. 3. After plasmapheresis, there was no significant change in creatinine clearance, sodium excretion, plasma renin activity or urinary kallikrein excretion. 4. After plasmapheresis, there was no significant reduction in plasma osmolality, increase in urine osmolality and fall in free water clearance. 5. The results suggest that in the absence of detectable changes in circulating volume or arterial pressure, acute hypoproteinaemia is associated with significant changes in renal water handling, but has no direct effect on sodium excretion or on renal release of renin and kallikrein.
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Microcomputers, and a new generation of on-line systems designed for the end-user, now make it possible for physicians to search MEDLINE and a variety of other databases in the convenience of their offices or homes. This article explains some basics of online searching, describes capabilities and options to consider when selecting a system, and identifies hardware and software needed to adapt a micro for online searching. A chart comparing system features and costs, and providing information on where to go for more information is also included.
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