Biomedical subjects

Maureen Smith

Publications and source records attributed to Maureen Smith.

8 recordsLinked to original sources

PubMed2025

The development and usability of 'The Genetics Navigator': a digital solution for adult and paediatric clinical genetics services.

Clinical genetic services address diverse genetic testing needs, but there is no comprehensive digital solution to meet this variety. We aimed to develop and test the usability of the Genetics Navigator (GN), a platform designed to enhance genetic services for paediatric and adult patients. The GN prototype was created with input from a patient and clinician advisory board, informed by prior research. Usability testing involved genetics patients (N = 14), parents of paediatric patients (N = 4), and the general public (N = 10). Participants provided feedback using the 'think aloud' method when using the platform. We used the System Usability Scale (SUS) for quantitative evaluation. Qualitative data were coded by platform section, item, and identified key areas for improvement. Building on the Genetics Adviser platform, we added video and written content for various genetic conditions and patient groups, including pre-test education, counselling, decision support, history collection, post-test result disclosure, and management. Key feedback during rounds of usability testing emphasized the need for a supportive design, seamless workflow, and engaging experience of the tool. The tool was modified to reflect the feedback, and the GN achieved an average SUS score of 87.7 ± 10.9 (N = 28), indicating above-average usability. Future research will evaluate its clinical and cost-effectiveness in a randomized trial.

Humans↗

PubMed2006

Accidental iatrogenic pneumothorax in hospitalized patients.

OBJECTIVE: Iatrogenic pneumothorax (IP) is an inherent risk to patients who undergo procedures that involve the intentional puncturing of the lung. IP also could occur accidentally to patients who do not undergo such procedures; such accidental IP (AIP) is suggestive of lapses in safe care. This study assessed the risk for AIP in patients hospitalized with specific diagnoses who underwent specific procedures. RESEARCH DESIGN: We analyzed 7.5 million discharge abstracts from 994 short-term acute care hospitals across 28 states in 2000 in the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project Nationwide Inpatient Sample. AHRQ Patient Safety Indicators (PSIs) were used to identify AIP. AIP incidences and associated diagnoses and procedures were explored. RESULTS: Patients who were admitted for pleurisy, cancer of the kidney and renal pelvis, or conduction disorders and complications of cardiac devices had the highest rates of developing AIP during hospitalization, with AIP rates at 2.24%, 1.14%, and 0.83% respectively. The procedure-specific rates for AIP varied from 2.68% for patients who underwent thoracentesis to 1.30% for those who underwent nephrectomy, to 0.06% for those who underwent gastrostomy. Thoracentesis appeared to be a high-risk procedure for patients who were admitted for secondary malignancies, pleurisy, or pneumonia, with AIP rates at 3.76%, 3.13%, and 2.28%, respectively. CONCLUSIONS: Although AIP is most common after thoracentesis, it is a substantial threat to patients undergoing a wide range of procedures.

Hospitals↗

PubMed2005

US physicians' perceptions of the effect of practice guidelines and ability to provide high-quality care.

OBJECTIVES: In the USA, health care organizations frequently disseminate practice guidelines to physicians, but physicians often resist implementing guidelines when they perceive no improvements in quality of care will result. Greater involvement with a single health care organization may a inverted exclamation market physicians' perceptions of guidelines. We examined the relationship between the perceived effect of guidelines on practice and perceived quality of care for US primary care physicians (PCPs) and specialists with varying levels of financial involvement with a single managed care organization. METHODS: Data were from the 1996-1997 Community Tracking Study, a nationally representative, cross-sectional survey of 12,528 physicians. Data were adjusted for possible confounders using ordinal logistic regression. RESULTS: Almost half the physicians described a moderate to very large perceived effect of guidelines (46% of PCPs, 46% of specialists). Physicians' financial involvement with a single organization was modest: PCPs received on average 24% of their revenue from their largest contract, while specialists averaged 18%. For specialists, increasing perceived effect of guidelines was associated with increasingly negative perceptions of quality of care [beta= -0.16, 95% confidence interval (-0.22, -0.10)]. Similar results were obtained for PCPs with low levels of financial involvement with a single organization. However, this negative association disappeared for PCPs with higher levels of financial involvement. CONCLUSIONS: PCPs with substantial financial involvement with a single organization who perceive greater effects of guidelines on practice have less negative perceptions of their ability to provide high-quality care. Although our data cannot confirm a causal relationship, financial involvement with a single organization may be one factor linking practice guidelines to high-quality care.

Attitude of Health Personnel↗

PubMed2004

Unique considerations in caring for a pediatric burn patient: a developmental approach.

Treatment of the child with a burn injury is a dynamic and complex process incorporating pediatric physiology, cognition, and emotional development. An understanding of child development and the importance of the family plays a key role in the child's recovery at all ages. An account of a teenager's burn injury is depicted through the voices of the teenager and his nurse. This article explores that experience and provides a comprehensive look at the role of the burn team, family, and community in his recovery.

Adaptation, Psychological↗

PubMed2004

Evolving treatment in a decade of pediatric burn care.

BACKGROUND: Over the last decade, an ambulatory burn care (ABC) and procedural sedation (PS) program was instituted at St Louis Children's Hospital (SLCH). This study assessed the effect of these interventions on resource utilization. METHODS: The authors reviewed the hospital experience comparing 1993 with 2002 data regarding gender, age, burn depth, patient admissions, inpatient days, and ABC visits. Outcome measures included length of stay (LOS), incidence of infection, and hospital charges. RESULTS: Gender, age, and burn depth were similar; 192 patients were admitted in 1993. In 2002, there were 167 admissions and 118 patients treated solely on an ABC basis resulting in a total of 285 burn patients treated (+48%). Hospital days decreased from 2,041 (1993) to 963 (2002 [-53%]). LOS declined from 10.4 +/- 8.3 days (1993) to 5.8 +/- 14.2 days (2002 [-44%; P <.05]). PS was used sporadically in 1993, and increased to 71% in patients in 2002. There were no ABC visits in 1993 and 501 visits in 2002. The incidence of infection was 5.2% in 1993 versus 3.0% in 2002 (P <.05) Average charge per patient fell 45% from 13,286 dollars (1993) to 7,372 dollars (2002), adjusted to 1993 dollars using medical care price index. CONCLUSIONS: Over a 10-year period, the program achieved a significant reduction in resource utilization while increasing the number of patients treated and maintaining a low incidence of infection. This was due in large part to a shift to ABC and the use of PS.

Adolescent↗

PubMed2003

Interdisciplinary rounds: impact on patients, families, and staff.

Interdisciplinary rounds are a new care coordination strategy in several healthcare settings. This article describes the process used by clinical nurse specialists in one institution to broaden existing discharge planning rounds to interdisciplinary rounds. In addition, a survey queried advanced practice nurse subscribers to two listserves, the ANPACC and CNS-L, to determine how other institutions conducted interdisciplinary rounds, including structure, membership, and leadership. As a result of the changed focus in rounds, the target institution noted greater participation by all disciplines in achieving patient and family outcomes, increased early recognition of patients at risk, and improved communication among members of the healthcare team. These findings were supported by participants in the Internet survey. It was determined that interdisciplinary rounds are a valuable mechanism for improved patient outcomes and increased staff professionalism.

Attitude of Health Personnel↗

PubMed2003

The public health roles of health visitors and school nurses: a survey.

This article describes a qualitative study that examined the family centre public health role of health visitors and the child-centre public health role of school nurses. A telephone survey of key health visitor and school nurse informants in the West Midlands was undertaken. Respondents to the survey were asked to give examples of practice that related to Holman's (1992) public health typology. A wealth of data were obtained, which included 344 different examples of practice interventions. The majority of examples of practice given by the respondents were categorized as primary preventive interventions. The least represented concerned community empowerment and health protection. The findings of the survey give evidence of the current transitional nature health visitor and school nurse practice. Identified is some reorientation in practice and adoption of currently advocated models of public health, which have community participation, empowerment, and health protection as essential features.

Attitude of Health Personnel↗

PubMedDate not supplied

Does encouragement boost visual acuity testing results?

AIM: To investigate the hypothesis: 'Patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. METHOD: Fifty patients were randomly selected from general eye clinics with five exclusions. A quasi-experimental, non-equivalent comparison before/after design was used to consider the way patients' vision is tested using the Snellen visual acuity chart in the eye department at Kettering General Hospital. RESULTS: The results were significant (t = 5.78 df=49 p < 0.001) and supported the initial hypothesis that 'patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. CONCLUSION: The results of the study suggest that the subjects did get better visual acuity scores when encouragement was used and recommendations were made to change the clinic protocol.

Adult↗