PubMed Health⌕ Search

Biomedical subjects

J F Fieselmann

Publications and source records attributed to J F Fieselmann.

10 recordsLinked to original sources
PubMed1998

Outreach education to improve quality of rural ICU care. Results of a randomized trial.

This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational program. After review of the medical records of eligible patients, a multidisciplinary team of intensive care unit specialists from an academic medical center delivered an educational program with content specific to the findings and capacity of the hospital. The outcome measures included patient care processes, patient morbidity and mortality outcomes, and resource use. Results indicated that the outreach program significantly improved many patient care processes (lab work, nursing, dietary management, ventilator management, ventilator weaning). The program marginally reduced hospital ventilator days. Both total length of stay and ICU length of stay fell markedly in the intervention group (by an average of 3.2 and 2.1 d, respectively), while the control group fell only 0.6 and 0.3 d, respectively. However, these effects did not reach statistical significance. Unfortunately, the program had no detectable effects on the clinical outcomes of mortality or nosocomial events. We conclude that an outreach program of this type can effectively improve processes of care in rural ICUs. However, improving processes of care may not always translate into improvement of specific outcomes.

Aged↗
PubMed1997

Assessing the impact of patient characteristics and process performance on rural intensive care unit hospital mortality rates.

OBJECTIVE: To examine the relationship between patient characteristics, processes of care, and risk of hospital mortality in rural intensive care units (ICU). DESIGN: Retrospective data analysis of ICU patients admitted to 19 rural Iowa hospitals between 1992 and 1994. SETTING: ICUs in rural Iowa hospitals. PATIENTS: ICU patients treated on mechanical ventilators meeting eligibility criteria. MEASUREMENTS AND MAIN RESULTS: Patient age (odds ratio = 1.03, p < .01), a higher Acute Physiology and Chronic Health Evaluation II score (odds ratio = 1.06, p < .01), and a longer pre-ICU length of stay (odds ratio = 1.14, p < .05) were associated with a higher risk of death. Seven processes of care were examined (i.e., laboratory work, nursing assessment, stress ulcer protection, immobilization protection, nutritional management, ventilator management, and weaning). Considerable variation was observed between hospitals in performance of processes of care. Controlling for patient characteristics, better performance in ulcer protection (odds ratio = 0.1, p < .05) and ventilator management (odds ratio = 0.03, p < .05) were related to lower risk of mortality. A model incorporating both patient characteristics and processes of care achieved higher predictive accuracy than a model containing only patient characteristics (area under the receiver operating characteristic curve: 0.80 vs. 0.70, p < .01). CONCLUSIONS: Most of the variation in mortality was explained by differences in patient physiologic and demographic characteristics at ICU admission. After adjusting for patient characteristics, better performance in some processes of care would have significant impact on reducing risk of mortality.

APACHE↗
PubMed1995

Preventing cardiopulmonary arrest via enhanced vital signs monitoring.

A physician-nurse collaborative team developed and implemented a research-based protocol and algorithm for improving vital signs monitoring and early intervention for at-risk patients. Project evaluation showed that in general the protocol and algorithm were used appropriately and consistently and prevented negative patient outcomes.

Algorithms↗
PubMed1994

Characteristics of self-referred patients.

BACKGROUND: This paper defines and characterizes the self-referred patient, and answers key questions about self-referred patients' access to general medical and preventive care. METHOD: Five years of data (July 1987 to June 1992) from The University of Iowa Hospitals and Clinics, a 900-bed tertiary care facility, were used to identify the demographics of self-referred patients. Routine data for all internal medicine patients were collected, as were questionnaire data from a sample of self-referred patients in 1991-92 from subspecialty clinics (172 patients) and general and emergency medicine services (136 patients). Questions were designed to obtain information concerning the decision for referral and the accessibility of general medical and preventive care. RESULTS: Thirty-five percent of the patients obtaining care in internal medicine were self-referred patients. This percentage increased from 26.5% to 34.5% of patients over the five-year period. More general medicine patients (45%) self-referred than did subspecialty service patients (32.5%). Sixty percent of these patients did not have a primary care physician. Almost 30% of these patients had no access to preventive care. Many of the self-referred patients (49%) were within an age range (41-75 years) most appropriate for preventive services. CONCLUSION: This study characterizes a large and expanding group of self-referred patients presenting to a university hospital for care. Many of these patients did not have a primary care physician. Thus, there are opportunities to improve medical and preventive care for such patients.

Academic Medical Centers↗
PubMed1993

Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients.

OBJECTIVE: To assess whether vital sign measurements could identify internal medicine patients at risk for cardiopulmonary arrest. DESIGN: Retrospective case-control study comparing 72 hours of pre-arrest vital sign measurements with 72 hours of vital sign measurements for patients from the same units who did not experience cardiopulmonary arrest. SETTING: Twelve non-intensive care internal medicine units at a large midwestern academic medical center. PATIENTS: Cases included all 59 inpatients who had experienced cardiopulmonary arrest between May 1989 and December 1990; patients who were designated do-not-resuscitate (DNR) or had less than 72 hours of vital sign recordings were excluded. Controls included 91 inpatients without cardiopulmonary arrest who were matched for units and who had 72 hours of vital sign recordings. RESULTS: The occurrence of one or more respiratory rates > 27 breaths per minute over a 72-hour period had a sensitivity of 0.54 and a specificity of 0.83 (odds ratio = 5.56, 95% CL = 2.67-11.49) in predicting cardiopulmonary arrest. Other respiratory rate thresholds were also predictive of arrest. The ability of respiratory rate to predict arrest was stronger in units with high incidences of arrest relative to units with low incidences, for example, in units for the management of gastrointestinal disease (sensitivity = 1.00, specificity = 0.86) and renal disease (sensitivity = 0.69, specificity = 0.87). Respiratory rate remained a significant predictor (p < 0.001) after controlling for patient age and gender. Pulse rate and blood pressure were not predictive of cardiopulmonary arrest. CONCLUSIONS: Using elevated respiratory rates as a signal for focused diagnostic studies and therapeutic interventions in internal medicine patients may be useful in reducing the incidence of subsequent cardiopulmonary arrest, and lowering associated morbidity and mortality.

Adolescent↗
PubMed1991

The occupational history in the primary care setting.

PURPOSE: To assess the need for services in occupational medicine, we determined the prevalence of reported occupational exposures in patients seen in the primary care setting. In addition, we evaluated the validity of our survey instrument. PATIENTS AND METHODS: All patients (n = 1,112) seen over a 3-month period of time in the Primary Care Clinic at the Iowa City Veterans Affairs Medical Center were considered eligible for this study. A survey instrument was developed to obtain specific information regarding occupational exposures. The questionnaire was administered to 534 or 48% of all eligible patients. The validity of the survey instrument was evaluated by comparing chest radiographs in subjects with a history of exposure to asbestos, coal dust, or silica to those in patients who were not exposed to any of these agents. RESULTS: We found that almost 75% of the patients reported prior occupational exposure to at least one potentially toxic agent, and over 30% claimed exposure to at least four potentially toxic agents. The validation study indicated that the reported exposure history for asbestos, coal dust, and silica is significantly associated with anticipated changes on chest radiographs. These findings suggest that this easily administered survey instrument is valid for pneumoconiotic dust exposures and may also be valid for other potentially toxic exposures. CONCLUSION: Data from our study indicate that patients seen in the ambulatory care setting may have clinically significant occupational exposures that are relevant to their medical condition.

Air Pollutants↗
PubMed1977

Removal of foreign bodies (two teeth) by fiberoptic bronchoscopy.

In special situations the flexible fiberoptic bronchoscope, with its increased visual range and extended capabilities for extraction, may be utilized to augment rigid bronchoscopy. Recently developed tools for extraction (claw, basket, forceps, and balloon catheter) may be inserted through the channel of the fiberoptic bronchoscope to capture small, peripheral foreign objects. We present the case of a 76-year-old man in whom two aspirated teeth were removed from the right lower lobe (RB9a and RB9b) using the fiberoptic bronchoscope, a wire basket, and a Fogarty balloon catheter. Rigid tube bronchoscopy was contraindicated because the patient had just sustained a fractured skull and jaw in an automobile accident.

Aged↗
PubMedDate not supplied

Methods of determining the prevalence of changes in vital signs among internal medicine inpatients.

OBJECTIVE: To investigate the prevalence of changes in vital signs and methods of summarizing these changes. DESIGN: A survey of vital sign values for all eligible inpatients over a three-day period. PATIENTS: All 91 patients who remained for an entire three-day period in January 1991 on 1 of 11 nonintensive care internal medicine units in the medical center. RESULTS: Prevalence of changing vital signs varied by type of vital sign, inpatient unit, and method of computation. A method of computation that relies on daily extreme vital sign values. Pulse rates and blood pressure were more variable than respiratory rates. CONCLUSIONS: Mean daily pulse rates and blood pressure may be useful for quality assessment purposes, whereas individual readings may be more appropriate for respiratory rates. Computation of expected rates of changing vital signs should be tailored to inpatient unit type.

Academic Medical Centers↗