Biomedical subjects
Publications and source records attributed to R Kravitz.
Interproximal lesions can now be restored without local anesthesia and removing unnecessary healthy tooth structure. This paper will focus on a new ultra-conservative technique in Class II composites utilizing the laser, a new technique in cavity preparation.
Extensive caries resulting in the need for a stainless steel crown in primary teeth may now be prepared with the use of the WaterlaseTM YSGG Laser, (Biolase) hard and soft-tissue laser. The use of the laser eliminates the need for local anesthesia, thereby providing optimal patient comfort and compliance.
OBJECTIVE: To describe the definition, extent, and factors associated with overcrowding in emergency departments (EDs) in the United States as perceived by ED directors. METHODS: Surveys were mailed to a random sample of EDs in all 50 states. Questions included ED census, frequency, impact, and determination of overcrowding. Respondents were asked to rank perceived causes using a five-point Likert scale. RESULTS: Of 836 directors surveyed, 575 (69%) responded, and 525 (91%) reported overcrowding as a problem. Common definitions of overcrowding (>70%) included: patients in hallways, all ED beds occupied, full waiting rooms >6 hours/day, and acutely ill patients who wait >60 minutes to see a physician. Overcrowding situations were similar in academic EDs (94%) and private hospital EDs (91%). Emergency departments serving populations < or =250,000 had less severe overcrowding (87%) than EDs serving larger areas (96%). Overcrowding occurred most often several times per week (53%), but 39% of EDs reported daily overcrowding. On a 1-5 scale (+/-SD), causes of overcrowding included high patient acuity (4.3 +/- 0.9), hospital bed shortage (4.2 +/- 1.1), high ED patient volume (3.8 +/- 1.2), radiology and lab delays (3.3 +/- 1.2), and insufficient ED space (3.3 +/- 1.3). Thirty-three percent reported that a few patients had actual poor outcomes as a result of overcrowding. CONCLUSIONS: Episodic, but frequent, overcrowding is a significant problem in academic, county, and private hospital EDs in urban and rural settings. Its causes are complex and multifactorial.
BACKGROUND: Although psychiatric disturbances are highly prevalent among traumatically injured inpatients, few investigations have assessed the impact of these disorders on surgical length of stay (LOS) and cost. METHODS: The authors identified all trauma-registry recorded psychiatric diagnoses among patients admitted to University of California Davis Medical Center between January 1993 and December 1996. Linear and logistic regressions were used to assess the unique effects of psychiatric diagnoses on inpatient LOS and cost. RESULTS: A total of 29% of patients had one or more registry-recorded psychiatric diagnosis. Patients with alcohol abuse diagnoses demonstrated 10% to 12% decreases in LOS and cost (p < 0.01), whereas patients with stress disorders, delirium, and psychoses demonstrated 46% to 103% increases in LOS and cost (p < 0.01). CONCLUSION: Patients with recognized psychiatric disorders uniquely impact inpatient trauma surgery LOS and cost. Additional investigations of the processes and outcomes of care could lead to cost-effective performance improvement efforts that target the amelioration of comorbid psychiatric disorders among physically injured trauma survivors.
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The identification of the colonized versus the infected dermal ulcer continues to be a major challenge for clinical practitioners. The purposes of this 3-month, prospective study were (1) to examine the current practice of culturing and use of antibiotics in treating dermal ulcers and (2) to examine associated symptoms of infected dermal ulcers in a 250-bed community hospital. A consecutive series design was used to obtain all patients (N = 63). The study revealed that 70% (44) of the patients dermal ulcers were not cultured. Additionally, symptoms normally associated with dermal ulcer infection, such as erythema, swelling, and abnormal drainage, were not always present in patients with infectious dermal ulcers.
Because of recent concerns about the professional satisfaction of physicians in general and of military physicians in particular, the authors surveyed a national sample of 1,392 military physicians; 88% responded. Two-thirds of physicians were at least somewhat satisfied with the professional abilities of their peers and with the quality of care they were able to provide, but only 19% were satisfied with salary and 27% with practice efficiency. Characteristics of physicians that were independently related to overall satisfaction included age, recruitment pathway, workload, specialty, and perceived availability of key resources. Indicator variables for the individual medical facilities were also significantly related to global satisfaction, suggesting a separate "hospital effect" that bears additional investigation. Efforts to improve satisfaction may enhance recruitment and retention of military physicians.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
More hospitals are using skin ulcer protocols to standardize care for the purpose of enhancing skin ulcer healing and reducing costs. This article outlines the role of the ET nurse in facilitating the development of a nursing protocol specific to an institution's needs. It outlines development of a monitoring tool to assess compliance and discusses the impact such a process had on the nursing and medical staffs in one community teaching hospital.