Biomedical subjects

James W Moore

Publications and source records attributed to James W Moore.

10 recordsLinked to original sources

PubMed2004

Pharmacist involvement in antimicrobial use at rural community hospitals in four Western states.

PURPOSE: Pharmacist involvement in antimicrobial use at small rural hospitals in four Western states was studied. METHODS: Surveys were mailed in July 2000 to hospitals with a daily patient census of <150 in Idaho, Nevada, Utah, and eastern Washington. RESULTS: Seventy-seven (77%) of 100 hospitals returned completed surveys. Only 5% of the hospitals had onsite pharmacists 24 hours per day. An onsite pharmacist was present for a median of 26 hours per week in hospitals without 24-hour pharmacist coverage (range, 0-116 hr/wk). Many hospitals (71%) had policies for monitoring or controlling antimicrobial use, but only 28% had a system capable of monitoring compliance with such policies. Few hospitals had systems for recommending changes in antimicrobial selection on the basis of susceptibility test results (27%) or for monitoring physician compliance with dosage recommendations by pharmacists (21%). Onsite pharmacist hours were significantly associated with pharmacists being involved in the initial ordering of antibiotics and providing active oversight of antimicrobial use. There was a negative correlation between onsite pharmacist hours and use of third-generation cephalosporins and carbapenems. CONCLUSION: A survey showed that rural hospital pharmacists in four Western states spent relatively little time monitoring and influencing antimicrobial prescribing.

Anti-Bacterial Agents↗

PubMed2004

Assessing the status of infection control programs in small rural hospitals in the western United States.

BACKGROUND: Organized infection control (IC) interventions have been successful in reducing the acquisition of hospital-associated infections. Rural community hospitals, although contributing significantly to the US health care system, have rarely been assessed regarding the nature and quality of their IC programs. METHODS: A sample of 77 small rural hospitals in Idaho, Nevada, Utah, and eastern Washington completed a written survey in 2000 regarding IC staffing, infrastructure support, surveillance of nosocomial infections, and IC policies and practices. RESULTS: Almost all hospitals (65 of 67, 97%) had one infection control practitioner (ICP), and 29 of 61 hospitals (47.5%) reported a designated physician with IC oversight. Most ICPs (62 of 64, 96.9%) were also employed for other activities outside of IC. The median number of ICP hours per week for IC activities was 10 (1-40), equating to a median of 1.56 (0.30-21.9) full-time ICPs per 250 hospital beds. Most hospitals performed total house surveillance for nosocomial infections (66 of 73, 90.4%) utilizing Centers for Disease Control and Prevention (CDC) definitions (69 of 74, 93.2%). Most also monitored employee bloodborne exposures (69 of 73, 94.5%). All hospitals had a written bloodborne pathogen exposure plan and isolation policies. CDC guidelines were typically followed when developing IC policies. Access to medical literature and online resources appeared to be limited for many ICPs. CONCLUSIONS: Most rural hospitals surveyed have expended reasonable resources to develop IC programs that are patterned after those seen in larger hospitals and conform to recommendations of consensus expert panels. Given these hospitals' small patient census, short length of stay, and low infection rates, further studies are needed to evaluate necessary components of effective IC programs in these settings that efficiently utilize limited resources without compromising patient care.

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

PubMed2004

Validity of the minimum data set in identifying urinary tract infections in residents of long-term care facilities.

OBJECTIVES: To determine the validity of the Minimum Data Set (MDS) to detect cases of urinary tract infection (UTI) that meet specific evidence-based criteria. DESIGN: Prospective surveillance. SETTING: Sixteen long-term care facilities (LTCFs) in Idaho. PARTICIPANTS: Residents of participating LTCFs for whom an MDS form was completed. MEASUREMENTS: Prospective surveillance of all types of infection, including UTI, and data collection on clinical manifestation, microbiology, and treatment; MDS data on identification of UTI. RESULTS: A stratified analysis demonstrated that the validity of MDS was 14% when using the evidence-based criteria for UTIs as the criterion standard. The estimated sensitivity and specificity of MDS entries were 57.9% and 86.5%, respectively. The estimated positive and negative predictive values for the study population were 13.9% and 98.2%, respectively. CONCLUSION: MDS has the potential to be an important measure of quality in the long-term care setting. When used to detect residents with UTIs, it appears to greatly overestimate the number of cases while adequately screening out residents without UTIs. These problems may be overcome by providing more-explicit definitions for UTIs to be used by providers when completing MDS information on individual residents.

Algorithms↗

PubMed2004

Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury.

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.

Autistic Disorder↗

PubMed2003

Detection of antimicrobial resistance by small rural hospital microbiology laboratories: comparison of survey responses with current NCCLS laboratory standards.

Microbiology laboratory personnel from 77 rural hospitals in Idaho, Nevada, Utah, and eastern Washington were surveyed in July 2000 regarding their routine practices for detecting antimicrobial resistance. Their self-reported responses were compared to recommended laboratory practices. Most hospitals reported performing onsite bacterial identification and susceptibility testing. Many reported detecting targeted antimicrobial resistant organisms. While only 5/61 hospitals (8%) described using screening tests capable of detecting all 8 targeted types of resistance, most (57/61, 93%) were capable of accurately screening for at least 6 types. Conversely, most hospitals (58/61, 95%) reported confirmatory testing capable of identifying only 3 or fewer resistance types with high-level penicillin resistance among pneumococci, methicillin and vancomycin resistance among staphylococci and enterococci, and extended spectrum beta-lactamase production by Gram-negative bacilli presenting the greatest difficulties. Furthermore, only 50% of hospitals compiled annual antibiogram reports to help physicians choose initial therapy for suspected infectious illnesses. This survey suggests that the antimicrobial susceptibility testing in many rural hospitals may be unreliable.

Anti-Bacterial Agents↗

PubMed2003

An analysis of aversive stimuli in classroom demand contexts.

Although recent research has identified numerous variables that can affect behavior maintained by negative reinforcement, questions remain concerning the potential aspects of the demand context that evoke problem behavior. To date, few studies have examined these questions within general education classrooms. The current study assessed the influence of social and task-difficulty variables on problem behavior maintained by negative reinforcement. Teachers in general education classrooms implemented three analyses to determine the influence of these variables on the problem behavior of 4 boys. Results are discussed in terms of response covariation within the demand context.

Adolescent↗

PubMed2003

Training parents to implement pediatric feeding protocols.

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.

Behavior Therapy↗

PubMed2002

The influence of therapist attention on self-injury during a tangible condition.

This study investigated the effects of therapist attention on the self-injurious behavior (SIB) of a 6-year-old girl with developmental disabilities. After results of a functional analysis indicated that SIB was maintained by attention and tangible reinforcement, tangible conditions with and without contingent verbal attention were compared. Results suggested that the inclusion of verbal attention in a tangible condition may confound functional analysis outcomes for behavior that is maintained by attention.

Attention↗

PubMed2002

Teacher acquisition of functional analysis methodology.

The current study examined methods for training teachers to use functional analysis methods. Teachers first received written and verbal instructions detailing attention and demand conditions. They then received training that included modeling, rehearsal, and performance feedback. Finally, probes were taken during ongoing class instruction. Results indicate that teachers acquired the skills and used them in classroom settings.

Behavior Therapy↗

PubMedDate not supplied

Understanding keys to successful implementation of electronic decision support in rural hospitals: analysis of a pilot study for antimicrobial prescribing.

Electronic clinical decision support systems (CDSS) have been hailed for their potential to improve clinical outcomes. Using a pretest/posttest design, an Internet-based CDSS designed to optimize antimicrobial prescribing was pilot tested for community-acquired pneumonia in 5 rural hospitals in southwestern Idaho. An antimicrobial management team was created in each hospital to address clinicians' perception of excessive time required for direct use of the CDSS. In pooled hospital data, agreement with CDSS recommendations improved to a statistically significant level. However, inspection of data at the individual hospital level demonstrated that almost all improvement occurred in a single hospital. Failure in the other hospitals appeared to be primarily a consequence of organizational and cultural barriers. These barriers are discussed to understand keys for successful future implementation of CDSS in rural hospitals, drawing on experience with cultural barriers from other industries, specifically aviation.

Adult↗