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Biomedical subjects

J Sutton

Publications and source records attributed to J Sutton.

106 records · Page 6Linked to original sources
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Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting.

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Acute Disease↗
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Mapping nursing interventions from a hospital information system to the Nursing Interventions Classification (NIC).

TOPIC: Using the Nursing Interventions Classifications (NIC) as a standard to classify interventions identified in a hospital intervention system. SOURCES: Literature and the authors experience with standardized data systems for nursing. PURPOSE: To describe the processes used and the issues that arose as interventions from a hospital nursing information system were mapped to interventions in the NIC. CONCLUSIONS: The NIC provided a standard for the classification of nursing interventions from a hospital information system resulting in data that could be compared across sites. Ongoing testing of nursing intervention classifications is recommended.

Databases, Factual↗
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Speech-to-text: the next revelation for recording data.

There are numerous tools available for communicating and storing information. Administrators may want to consider speech-to-text-technology. Programs are available that are accurate, easy to use and easily integrated into existing hospital information systems. Computerized voice recognition systems that provide direct speech-to-text are available today and are often referred to as the "listening typewriter." You speak, the computer listens and then types out what it thinks it heard. Such a system has a vocabulary or collection of words that may be spoken by a user. The program analyzes the phonetic structure of words in the vocabulary. A database table compares sounds made by the voice to words in the vocabulary. Two types of recognition are available--realtime and deferred server-based. With realtime transcription, dictation appears on the workstation screen in front of the dictating radiologist. With the deferred system, the dictated session goes to a queue on a server and waits there to be processed, on operation often known as batch processing. Failure of the system can be prevented by clustering or having a redundant server that takes over for the primary server if it should fail. Options to consider for a speech transcription system include security for electronic signatures and a provision for quality assurance or editing professionals who will review documents for errors in recognition. Some software systems offer a program that examines the final document for new or misspelled words, while other systems require error correction to be completed within the last 10 dictated words. The distributed voice model contains a profile of users' pronunciations and allows the computer to recognize a voice that, associated with login ID, differentiates it from others. This model allows a physician to dictate from different locations. Although the cost of the hardware is impressive and requires a thorough cost benefit analysis, such a system can be an excellent solution for large institutions with several locations.

Capital Expenditures↗
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Marketing on a shoestring.

Marketing includes the many steps taken to sell a product or service from its conception to its purchase or use. In healthcare, three cost-effective audiences to target are referring physicians and their staffs, local HMOs and PPOs, facility employees and patients. The potential users of such services--your target audience--should be made aware of new offerings such as the addition of special procedures, a new piece of equipment, or perhaps a new physician with special capabilities. To ensure a productive effort, a marketing attempt must follow two cardinal rules: first, the product or service offered must be of high quality and, second, the marketing effort must be carried out consistently. An effective marketing campaign should create an impression within the community about the facility by emphasizing those aspects of the department or facility that make it unique. Are its hours of operation adequate? Do its personnel project a professional attitude and demeanor? Does it have a specialty that makes it unique within the healthcare community? The most powerful marketing tool of all is word of mouth, which is based on the judgments clients make after visiting the facility-department or facility employees smile and greet visitors, they are polite and helpful on the telephone, their attitudes are professional, and so forth. Such impressions are worth millions in goodwill and can be used as a marketing tool. Last, an actual case study from my hospital explains how we determined the need for and marketed an open MRI system.

Cost-Benefit Analysis↗
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Morphometric differences between cytologically benign and malignant serous effusions.

The morphometric differences between benign and malignant serous effusions, as diagnosed by standard cytologic criteria in 95 unselected cases (50 benign and 45 malignant), were studied using the IBAS semi-automated image analysis system, which calculates various parameters from tracings of cellular and nuclear outlines. Fourteen cases were also stained for cytokeratin proteins (with the CAM 5.2 antibody) by the immunoperoxidase technique and reanalyzed for positive cells. Significant differences were found for mean values between cytologically benign and malignant cases for cellular and nuclear areas, perimeters and maximum diameters, but not for two form factors. Some differences were enhanced in the CAM 5.2-stained cases. Real morphometric differences in samples of cells from benign and malignant cases are the basis of cytologic diagnosis. Fully automated diagnostic systems could operate on arbitrary threshold values, but there is considerable overlap in specimen means for all parameters between benign and malignant cases.

Adult↗
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[Hormonal variation during physical exertion at high altitude].

The influence of the physical exercise at high altitude on the endocrine function was studied in 8 normal native men of sea level and in 8 natives men of high altitude. The sea level dwellers were studied both, at sea level, during an acute exposure to low barometric pressure and after 3 months of acclimatization to altitudes over 3,500 meters above the sea level. The experiments at high altitude were conducted at an altitude of 4,500 meters above the sea level. Two types of exercise were carried out, sub-maximal and maximal, at fasting state, between 8 and 10 a.m. During an acute exposure to altitude the physical exercise produced a marked rise of glucose, cortisol and growth hormone and a fall in the insulin content of plasma. In the sea level dwellers, acclimatized to altitude during 3 months, an elevation of growth hormone was observed only during maximal physical effort. Marked variation in glucose and cortisol were observed during both types of exercise. This shows that in these subjects some adaptative changes have ocurred but of lesser extent as those observed in altitude natives. In the high altitude native higher basal concentrations of growth hormone and glucagón as well as a lower glucose concentration in blood, were found. During exercise the high altitude dweller showed no significant changes in somatotropin, meanwhile an important elevation of cortisol occurred. These findings indicate that the high altitude native has metabolic and endocrine responses to exercise similar to those found in well fitted atletes of sea level. The exposure to altitude provoked a rise in glucagon concentration directly proportional to the time of exposition ot altitude. The physical exercise did not elucidate any change in the glucagon content of blood.

Adult↗
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Accidents to patients in hospital: a comparative study.

A comparative study of 50 reported accident patients (cases) and 50 non-accident patients (controls) was carried out in 10 wards in a large, acute hospital, using primary and secondary data from patients, nurses and records. Folstein's Mini-Mental State test was used to measure the mental status of patients. The mental status of the controls was significantly better than that of the cases. Nurses' responses indicated that significantly more accident patients were incontinent of urine than non-accident patients. There were also indications from patients of three additional unreported accidents. Further study was needed to estimate, more closely, the frequency of unreported patient accidents. This is the second paper in a series of three. The first appeared in Nursing Times on August 17, and the final one will be published on September 28, along with implications for practice and recommendations.

Accidents↗
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Unreported accidents to patients in hospital.

A study to discover the incidence of unreported patient accidents was carried out in 10 wards in a large acute hospital. There were three separate survey days, 10 weeks apart, and sources of data included patients, records and accident report books. The 574 patients who participated in the study had sustained, during their stay in hospital, 75 accidents. Of these 49 (65%) were reported (documented on an accident report form) and 26 (35%) were unreported. Multiple unreported accidents to three patients accounted for 14 of the unreported accidents. Patient responses suggested that staff knew about the unreported accidents in the majority of cases. Conclusions and recommendations from this, and the two preceding studies include improved maintenance, increased awareness of patients' views and radical change to the present reporting procedure, as ways of improving patient accident data, patient safety and care.

Accidents↗
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Incidence and documentation of patient accidents in hospital.

A one-year in-depth, prospective study of 728 reported patient accidents in 10 wards at a large acute hospital was carried out, using both primary and secondary data from patients, staff and records. Over 200 patients were interviewed. The fact that this represented just 29% of study patients was not surprising, owing to the high incidence of poor mental status among accident patients. However, a large amount of valuable information was collected. Some results confirmed earlier studies, in particular, that falls to older patients were the most common type of accident. The new findings revealed large differences between patients' and staff's accounts of the accidents, that the reporting of the most serious accident outcomes were often the most poorly recorded and that lunar cycles may influence patient accident frequency. This is the first in a series of three articles on patient accidents in hospital. Each one is the account of a distinct study but they were carried out consecutively at the same hospital, using the same ward population. The studies, each with different strengths and limitations, are intended to stand together to provide a more comprehensive understanding of patient accidents.

Accidents↗
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Survival in patients with invasive breast cancers less than one centimeter.

This article describes our study of the long-term outcomes for 115 women with minimally invasive breast cancer (i.e. < 1 cm) who were treated at Charleston Area Medical Center from 1973-1988. Our goals in initiating this study were to find out whether or not minimally invasive breast cancer (MIBC) is curable by local modalities and if there are subgroups with MIBC that have a lower survival rate. We conclude that the curability of MIBC is quite high with effective locoregional treatment. However, even in patient with such small tumors, 20% will recur. Additional markers are needed to differentiate high and low-risk patients in order to select who might benefit from adjuvant systemic therapy.

Adult↗