Biomedical subjects

Jack Jacob

Publications and source records attributed to Jack Jacob.

6 recordsLinked to original sources

PubMed2006

A standardized method for assigning gestational age: a tool for measuring gestational age based newborn intensive care outcomes.

We developed a computer-generated algorithm for standardizing the assignment of a best gestational age. Our database collected information on maternal last menstrual period (LMP), prenatal ultrasonography, obstetrical estimated date of confinement (EDC), use of assisted reproductive technology (ART), and newborn assessment based on the Ballard examination. The algorithm for determining best gestational age was developed based on the literature on the accuracy of prenatal and neonatal dating. We examined the performance of the algorithm using patients admitted to our neonatal intensive care unit (NICU) with a best gestational age <or= 32 completed weeks. Based on agreement of the obstetric EDC with either the first-trimester ultrasonography or LMP and first- and second-trimester ultrasonography, 64.4% of patients were classified as having certain dating. The Ballard assessment played a role in assigning a best gestational age in 11.3% of patients. We demonstrated differences in outcomes based on dating certainty within subpopulations in our NICU. An objective standardized methodology for assigning gestational age is a useful tool for comparing gestational age-based outcome measures between institutions.

Algorithms↗

PubMed2006

Evaluation and development of potentially better practices to improve the discharge process in the neonatal intensive care unit.

OBJECTIVE: Our goal was to identify potentially better practices that create a successful discharge planning process that spans the entire newborn intensive care stay to the next level of care by embedding the discharge planning into all aspects of patient care and communication. METHODS: Potentially better practices were developed through recommendations from a content expert and a literature review. Internal benchmarking, self-assessment tools, monthly conference calls, the Neonatal Intensive Care Quality Improvement Collaborative 2002 listserv, parent feedback, and semiannual conferences were used to finalize recommendations and implement practices. RESULTS: Potentially better practices included (1) create an easy-to-use/easy-to-access discharge planning tool kit, (2) restructure written and oral communication tools and processes to reflect plans for the day, the stay, and the way to discharge, (3) maximize the impact and use of caregiver educational tools, and update materials and delivery systems for caregiver education, (4) use continuous quality improvement tools and processes to ensure parent/caregiver and staff satisfaction, and (5) analyze and enhance transfers into and interactions with the community. CONCLUSION: The potentially better practices are recommendations that are designed to integrate organizational, clinical, and operational processes to ensure optimal discharge planning from admission through follow-up in the community.

Communication↗

PubMed2006

Implementation and case-study results of potentially better practices to improve the discharge process in the neonatal intensive care unit.

OBJECTIVE: The objective of this study was to implement potentially better practices for discharge planning in the NICU. METHODS: Each participating hospital completed a self-assessment tool on discharge planning and a staff satisfaction survey. Parent satisfaction data were obtained from an Internet-based survey. Many projects regarding discharge planning were completed at each participating center. A major emphasis was the development of transition points to span discharge planning over the entire hospitalization. Results of compliance with tasks or processes that were identified by the transition points and results of staff and parent satisfaction surveys were monitored over time. RESULTS: The implementation of the transition points at each center demonstrated an improvement in the completion of discharge tasks within the recommended time frame. Combined results of all centers demonstrated a moderate improvement in compliance with transition points from baseline to final measurement in the following areas: unit orientation (56%-81%), identification of a parent feeding plan (74%-92%), completion of cardiopulmonary resuscitation training (55%-72%), and car seat education (42%-63%). Staff survey results showed improvement from baseline to final measurement in the following areas: staff satisfaction with the discharge process (32%-50%), clear documentation of the discharge plan (26%-40%), and clarity of team members' roles in the discharge process (24%-44%). A resource kit on discharge planning was developed for staff and included a section with parent education material. An Internet-based parent satisfaction survey was implemented successfully. CONCLUSIONS: All centers that participated in the collaborative made significant strides in the discharge planning process. Overall, parent satisfaction with discharge planning was high, and improvements were noted in staff satisfaction and availability of resource material.

Attitude of Health Personnel↗

PubMedDate not supplied

Consumer access to health care information: its effect on the physician-patient relationship.

Studies have shown that physicians exchange minimal information with patients during a patient encounter. Yet patients of all socioeconomic backgrounds increasingly desire and seek medical information, especially over the Internet. This change in patient behavior is likely to have a profound effect on the physician-patient relationship. Many physicians react defensively when patients bring them information on their condition with questions about traditional and non-traditional therapies. This can degrade trust and communication, both key elements in the physician-patient relationship. There are several models of the physician-patient relationship that are described. The deliberative or collaborative model, where the physician helps the patient choose their preferred health-related values, represents our societal norm. Such a model is conducive to physicians acting as a directed facilitator for medical information acquisition by patients. It is also consistent with patients' desire to obtain on-line information under the guidance of a physician. Such a model can not only aid patient's acquisition of medical information, but also help patients assess the quality of information, and help them apply the information to their personal situation. The adoption of this new role for physicians is likely to enhance the therapeutic aspects of the physician-patient relationship.

Alaska↗

PubMedDate not supplied

The electronic medical record: decision support and the effective use of clinical guidelines.

Embedding clinical guidelines into an electronic medical record is a form of clinical decision support that has the potential to improve the quality and consistency of care provided at the clinical encounter. The manuscript describes the consensus method of developing clinical guidelines and its components that have an impact on its output. These include questions asked, participants, the presentation of information, method of structuring group interaction, and method of synthesizing judgments. Clinicians need to be aware of how these elements can affect guideline development. The quality of research on guideline development is varied. The process of guideline development is poorly documented, not evidence-based, and lacks the transparency that allows users to judge the output and quality of local adherence. The manner in which the presentation of guidelines is structured and implemented is also important in determining adherence. Monitoring guidelines by building a feedback loop is critical for ongoing guideline improvement. The literature on the long-term impact of electronic guidelines on clinician behavior is lacking.

Decision Support Systems, Clinical↗

PubMedDate not supplied

Clinical outcomes for newborn intensive care in Alaska.

Recent clinical outcomes for the Newborn Intensive Care Unit (NICU) at Providence Alaska Medical Center based on Alaska Neonatology's Clinical Outcomes Database are presented. There has been a decrease in overall mortality, with much of the improvement occurring in babies from 22 to 25 weeks gestation in the years 1998--2002. There has also been a decrease in the incidence of severe intraventricular hemorrhage / periventricular leukomalacia. Earlier discharge of babies has also been documented, as measured by post conceptual age at discharge. No improvement in the incidence of retinopathy of prematurity and nosocomial sepsis were seen. Rates of chronic lung disease and babies going home in oxygen have increased. Outcomes that have failed to improve are the focus of quality improvement initiatives. Clinical outcome information systems such as the NICU outcomes database are essential for assessing clinical performance and provide the foundation and focus for quality improvement initiatives.

Alaska↗