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Biomedical subjects

E Rhinehart

Publications and source records attributed to E Rhinehart.

At least 19 recordsLinked to original sources
PubMed2001

Capillary liquid chromatography of multiple peptides with on-line capillary electrophoresis immunoassay detection.

A competitive immunoassay for neuropeptide Y (NPY) based on capillary electrophoresis (CE) with laser-induced fluorescence detection was developed utilizing polyclonal antisera as the immunoreagent and fluorescein-labeled NPY as the tracer. The assay was performed with on-line mixing of reagents, automated injections, and a 3 s separation time. The assay had a detection limit of 850 pM. To detect NPY at lower concentrations, the assay was coupled on-line to reversed-phase capillary liquid chromatography (LC). In this arrangement, 5 microL samples were preconcentrated by capillary LC and eluted by a gradient of isopropanol-containing mobile phase. The resulting chromatographic peaks were monitored by the CE immunoassay. With preconcentration, the concentration detection limit was improved to 40 microM and NPY could be measured in push-pull perfusion samples collected from the paraventricular nucleus of freely moving rats. The technique was extended to simultaneous detection of NPY and glucagon secretion from islets of Langerhans.

Chromatography, Liquid↗
PubMed2000

Watching the bottom line: enhancing the role and impact of infection control in a managed care environment.

Health care expenditures exceeded $1 trillion in 1997, with projections for $2.2 trillion in expenditures by 2008. Decreasing organizational revenues and efforts to reduce operating costs have had a direct impact on infection control programs. Senior managers in hospitals and other provider organizations are focusing on achieving and maintaining revenues while controlling costs. Infection control professionals must align themselves and their programs with these organizational goals by (1) identifying areas in which the infection control program can support and enhances revenues, (2) facilitating the avoidance of excess costs for care, especially those related to nosocomial infection, (3) identifying opportunities for cost reduction through value analysis, and (4) participating in efforts to measure and prevent other adverse outcomes of care.

Cost Control↗
PubMed2000

Improving infection control in home care: from ritual to science-based practice.

While many home care policies and procedures are developed with the best of intentions, they frequently lack a scientific basis and have been perpetuated over the years. This article discusses infection control rituals in home care and hospice and the importance of making patient care practice decisions based on sound scientific principles.

Communicable Disease Control↗
PubMed1999

Putting infection control principles into practice in home care.

Implementing sound, rational infection control practices in home care has been challenging since guidelines, standards, and most references have been developed for the acute care setting. This article provides guidance for adapting appropriate infection control interventions for patient care practices to the home care setting. Such practices include handwashing, home infusion therapy, respiratory care, wound care, urinary tract care, and isolation precautions. Assessment of the home care environment, cleaning and reprocessing of equipment, surveillance, implications for occupational health, and program design are also discussed.

Home Care Services↗
PubMed1998

Admission and termination policies. Minimizing risk and liability.

Changes in Medicare reimbursement coupled with the demands of managed care plans to reduce resource utilization continue to challenge patient management in home care. As home care agencies endeavor to achieve optimal outcomes with reduced resources, professional liability exposures may increase. Agencies should protect themselves using sound admission, care management, and discharge policies, as well as other risk management options.

Aged↗
PubMed1997

Health care consumer report cards: what do patients and families really want to know? What should they want to know?

Much attention has recently been focused on the health care industry's ability to demonstrate the quality of the services they provide. Health care provider organizations have begun to face growing demands for performance information from all sides, both within the industry (accrediting and regulating bodies) as well as from consumers. At present, the health care industry defines quality in three basic dimensions: (1) clinical quality, (2) service quality, and (3) customer satisfaction. Information is available to the public regarding performance due to partnerships of accrediting bodies and health care purchasers. This article explores what patients and families really want to know about their providers and health care facilities.

Humans↗
PubMed1996

The synergy of quality management & risk management in home care.

For a number of years the health care risk management industry has been addressing unplanned and unanticipated adverse events. Organizations that are proactive in their approach to risk and quality management will have big payoffs in clinical quality improvement, service quality improvement, employee satisfaction, and customer satisfaction.

Home Care Services↗
PubMed1996

Managed care: what to expect as Medicare-HMO enrollment grows. 1.

Managed care is restructuring the American health care system and is beginning to make inroads into the Medicare-eligible population. Advantages of managed care for older patients include an emphasis on prevention, more flexibility in care delivery, and fewer restrictions and wider coverage (eg, prescriptions) than Medicare fee-for-service, and opportunities to develop measures for quality of care. Disadvantages include limitations on access and choice and a potential for professional conflict of interest. Early managed care enrollment favors the healthy "young-old;" questions remain about whether HMOs can provide quality care to the frail elderly with complicated and expensive health care needs.

Aged↗
PubMed1996

Managed care: new challenges, new roles for the primary care physician. 2.

Managed care is revolutionizing health care, according to panelists in this roundtable discussion. Primary care physicians need to see patient care not as episodic but as a total, preventive package. In managed care, physicians hire nonphysician extenders for patient screening and function as a manager and consultant to an interdisciplinary team that extends beyond the four walls of the office practice. Patients need to know that primary care physicians can handle most of their problems; the specialist should be referred cases that are complicated and require procedures or second opinions. Outcome studies in managed care are lacking in important areas of geriatric medicine, such as treatment of psychiatric illnesses and Alzheimer's disease.

Fee-for-Service Plans↗
PubMed1995

Managing infectious waste: guidance for home care.

Infectious waste handling is a major concern for all health care professionals, yet most literature on the subject focuses on the acute care setting. Home care agencies must develop infectious waste protocols that keep in mind federal, state, and local regulations.

Guidelines as Topic↗
PubMed1992

Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals.

BACKGROUND: Concern is increasing regarding the risk of transmission of blood-borne pathogens by means of improperly reprocessed medical devices. METHODS: On-site surveys of policies and practices were performed in 18 reprocessing areas in eight randomly selected hospitals in Massachusetts to assess current practices for reprocessing of flexible fiberoptic endoscopes. Manufacturers' and internal written protocols, were reviewed, employees were interviewed, and procedures were observed. Reprocessing included high-level disinfection in 17 of 18 areas, with 16 areas using 2% glutaraldehyde; ethylene oxide gas sterilization was used in one area. RESULTS: Considerable interhospital and intrahospital variability was found in high-level disinfection procedures, including equipment, contact time (range 10 to 45 minutes), disinfectant testing, and rinsing. Disinfection of internal channels was inadequate in three areas, recommended sterilization of biopsy forceps was not performed in five, and written protocols were unavailable in three. Ad hoc deviation from established written or verbal protocols occurred in eight areas during reprocessing of flexible fiberoptic endoscopes from patients known to have AIDS; ethylene oxide sterilization was used in seven areas and a separate device was used in one. Interviews with personnel revealed that lack of knowledge of high-level disinfection contributed to the discrepancies between policy and practice. CONCLUSIONS: We conclude that reprocessing of flexible fiberoptic endoscopes is inconsistent and potentially ineffective. Knowledge that a flexible fiberoptic endoscope was used for a patient with AIDS influences practice.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Adaptation of the Centers for Disease Control guidelines for the prevention of nosocomial infection in a pediatric intensive care unit in Jakarta, Indonesia.

We attempted to implement a nosocomial infection control program based on the Centers for Disease Control (CDC) guidelines in an urban Indonesian public hospital at the request of Project Hope. Adoption of unmodified CDC guidelines was impeded by a substandard physical plant, absence of an infection control infrastructure, limited sterilization capabilities, lack of clinical microbiologic laboratory support, and the expense of single use medical devices. After on-site evaluations, CDC guidelines were extensively modified so that they were appropriate for local conditions and culture. Strategies included inexpensive architectural modifications, addition of sinks and a commode, introduction of disinfection procedures for reuse of disposable medical devices, and adaptation of available supplies for maintenance of aseptic technique. On subsequent site visits, many physical changes had been accomplished, and handling of reusable and disposable medical devises had improved considerably but adoption of clinical practice policies was incomplete. We conclude that it may be difficult to implement and sustain improvements in clinical practice in the absence of an infection control infrastructure and a strong commitment by hospital clinicians and administrators. Additional research is needed to refine flexible methods for rapidly assessing the specific infection control needs of institutions with widely disparate resources, patient populations, environments, and cultures.

Centers for Disease Control and Prevention, U.S.↗
PubMed1989

Employee health for critical care duty.

Many patients present for care in critical care settings every day. Some have known or suspected infectious diseases, whereas others may have infections that remain undetected throughout the hospital course. Through careful attention and compliance to the primary, secondary, and tertiary strategies of prevention, practitioners in critical care can remain healthy and uninfected while providing lifesaving care to their patients.

Communicable Diseases↗
PubMed1987

Nosocomial clonal dissemination of methicillin-resistant Staphylococcus aureus. Elucidation by plasmid analysis.

An outbreak of methicillin sodium-resistant Staphylococcus aureus (MRSA) infection and colonization, mainly centered in the vascular surgery service, occurred in a 1000-bed tertiary care center between December 1983 and December 1984. Methicillin-resistant S aureus isolated before and during the outbreak was studied by both bacteriophage typing and by restriction endonuclease digestion of bacterial plasmid DNA. Bacteriophage typing was discrepant in nine (56%) of the 17 repeated analyses compared with one (3.4%) of the 29 for plasmid profiling. These typing methods revealed that the epidemic strain was introduced to the hospital from the community 15 months before the outbreak. The outbreak was caused by cross-transmission of the epidemic strain by health care personnel and was controlled by treatment of colonized personnel, education of personnel, and institution of barrier precautions for colonized or infected patients. Plasmid profiling with restriction endonuclease digestion was easier, more rapid, and more specific than bacteriophage typing in the evaluation of this outbreak.

Cross Infection↗