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Biomedical subjects

C Z Margolis

Publications and source records attributed to C Z Margolis.

At least 37 records · Page 2Linked to original sources
PubMed1984

Increase in relevant data after introduction of a problem-oriented record system in primary pediatric care.

We determined the effect of the problem list and standard data base components of the problem-oriented record (POR) on kibbutz clinic care. We compared quantity and type of data collected and number of problems identified before and after POR implementation at an experimental clinic with the same variables measured at a similar clinic. Family history, prenatal, natal, nutritional, immunization, environment, review of systems, psychosocial and total data collected, as well as number of chronic problems identified, increased significantly after POR implementation.

Child↗
PubMed1984

Problem-oriented record: effect on problem identification in the hospital.

The problem-oriented record (POR) is a medical record format that consists of a standard data base, a problem list, problem-oriented plans and problem-oriented progress notes. It has been claimed repeatedly that the use of a POR improves medical care. The effect of the standard data base and problem list components of the POR on the process of care was determined. Process of care was defined as the quantity and type of data collected and the number of problems identified per patient, which were measured before and after introduction of the POR into the pediatric wards of a regional university hospital, using a standardized audit technique. The same measures were also made in the pediatric wards of two similar hospitals at which the POR had not been introduced. Data collection scores in the experimental hospital for both subjective and objective data increased significantly both after POR implementation and also in comparison with the two other hospitals. The type of data collected was determined by the POR forms. The number of problems identified increased, but not significantly. We conclude that the standardized data base and problem list components of the POR can increase the amount and determine the type of data collected in pediatric wards, while not significantly affecting the number of problems identified.

Child↗
PubMed1983

Uses of clinical algorithms.

The clinical algorithm (flow chart) is a text format that is specially suited for representing a sequence of clinical decisions, for teaching clinical decision making, and for guiding patient care. A representative clinical algorithm is described in detail; five steps for writing an algorithm and seven steps for writing a set of algorithms are outlined. Five clinical education and patient care uses of algorithms are then discussed, including a map for teaching clinical decision making and protocol charts for guiding step-by-step care of specific problems. Clinical algorithms are compared as to their clinical usefulness with decision analysis. Three objections to clinical algorithms are answered, including the one that they restrict thinking. It is concluded that methods should be sought for writing clinical algorithms that represent expert consensus. A clinical algorithm could then be written for any area of medical decision making that can be standardized. Medical practice could then be taught more effectively, monitored accurately, and understood better.

Clinical Competence↗
PubMed1982

A required course in decision-making for preclinical medical students.

Objectives, methods of instruction, and evaluation of a preclinical course in decision-making are described in this article. One set of objectives that related to learning to read and write clinical algorithms was taught by having students read a clinical algorithm about a problem, solve a patient management problem about the problem, and write an algorithm. A second set of objectives that related to learning clinical decision analysis was taught by solving problems and discussing them. Three methods used to evaluate three classes showed the following results: large increases in taped interview problem (TIP) scores after learning algorithms, high mean scores on a final examination that tested all course objectives, and high voluntary class attendance. It is concluded that preclinical medical students can be taught cognitive decision-making skills, that the TIP is a promising tool for measuring such skills, and that careful monitoring of a course in clinical decision-making may provide valuable information regarding learning and teaching technical clinical management.

Curriculum↗
PubMed1979

Problem-oriented record. A critical review.

After 10 years of experience using the problem-oriented record (POR), Weed proposed that both patient care and clinical education could be improved by changing traditional medical records to a problem-oriented format. The problem-oriented system of record keeping has since been attempted or adopted by many physicians in the United States and abroad. This article will review four aspects of the POR. First, it will define the format of the POR in an ambulatory and ward setting. Second, it will discuss POR implementation. Third, it will attempt to assess the extent to which POR is in use currently. Fourth, it will review the studies that have attempted to evaluate the effectiveness of the POR.

Ambulatory Care↗
PubMed1979

Reliability of the middle ear examination.

Interobserver reliability of physical signs elicited and diagnoses made on middle ear examination were studied. Effect on reliability of variation in observer knowledge, patient age and instrument were defined. Two board-certified, color-seeing pediatric specialists who worked in the same clinic examined consecutively 350 ears with the same otoscope for each case. Over a period of four months, four different otoscopes were used to examine at least 50 ears with each. The following groups of findings were graded independently by the pediatrician according to pre-set criteria: color, landmarks and light reflex. Diagnosis was also recorded. At no time did the observers discuss their findings or diagnoses. Degree of interobserver agreement was expressed by the reliability coefficient (values given below) and the K coefficient. Overall agreement on findings ranged from 0.50 for landmarks to 0.85 for air-fluid level. Overall agreement for diagnoses was 0.72. Specific agreement on physical findings ranged from 0.0 for presence of air-fluid level to 0.85 for absence of air-fluid level. Specific agreement on diagnoses ranged from 0.08 on serous otitis to 0.56 on otitis media and 0.61 on normal. After the age of one year, agreement did not increase with age. Agreement did not change significantly with different instruments or as the study progressed. We concluded that equivalence of observer knowledge strongly increases agreement, while patient age less than one year decreases agreement, and type of instrument does not affect agreement. Clinicians should be trained to recognized middle ear signs and diagnoses according to specified criteria to maximize interobserver agreement.

Age Factors↗
PubMed1978

Problem acuteness and medical record utility.

We studied the usefulness of having the patient's medical record available to the pediatrician at the time of the patient's visit. For most acute problems, the medical record had no effect on the management of the patient, whereas the record frequently affected the handling of chronic or recurrent problems. These results suggest a means of improving the effectiveness of pediatric emergency room management and also a means for defining empirically criteria for evaluation of care by record audit.

Acute Disease↗
PubMed1975

A review of pediatric inpatient care.

Between 101 and 188 medical records of children hospitalized in each of three community hospitals and one major teaching hospital were examined to determine need for admission and quality of care administered. Two of the hospitals had been similarily studied two years before. Twenty-five percent of all admissions and 17% of all patient days were considered unnecessary. The smallest number of inappropriate admissions was found in the major teaching institution, but one of the community hospitals without any teaching affiliation was notably better than the other two. The teaching hospital and the same community hospital also achieved the lowest questionable management rates. Significant (P less than 0.5) but minimal reduction had occurred in number of unnecessary admissions when first and second utilization studies in these two hospitals were compared.

Child↗