Biomedical subjects
Publications and source records attributed to R L Simpson.
What are the chief information officers thinking? The 1997 Health-care Information and Management Systems Society/Hewlett Packard Leadership Survey gives us a glimpse. The study's results involving information technology present some ambitious plans.
Many nurses are stepping beyond the boundaries of traditional practice and creating their own business or service centers. New entrepreneurial opportunities include working on computer-based patient records, providing consulting services, developing policies and more. Getting involved--joining informatics groups, taking classes--is the first step.
Technologic forces are transforming both the nursing profession and nursing education. How will these changes affect nurses? What is at stake? As society moves to an information economy, one's value will be determined by the ability to access and use information (knowledge).
Despite all the media hype, critical security issues do surround the Internet. Nurses need to ask two key questions: How is the Internet used in my organization and What kind of Internet connection do we have?
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Technology will continue to change and adapt at a furious pace. Nobody expects nurse executives to be high-tech gurus. However, understanding the general principles behind many of the technological tools today can help.
Although most health care providers fear the unnamed backer, the real risk of computer security danger lies in the hands of seemingly innocuous or harmless individuals within the institution. Creating information security from the inside out is the key to ensuring privacy and confidentiality.
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The purpose of this trial was to evaluate the antihypertensive efficacy of the concomitant administration of selected doses of hydrochlorothiazide (HCTZ) on a background of losartan potassium (losartan) 50 mg, a selective angiotensin II receptor antagonist. Patients with essential hypertension ( > or = 95 mmHg inclusion criteria) with a mean sitting diastolic blood pressure (SiDBP) of 105 +/- 0.4 (S.E.) mmHg entered a 4-week, single-blind monotherapy period of losartan 50 mg once daily. At the end of the monotherapy period, patients whose blood pressure was adequately controlled were discontinued. Patients whose blood pressure was partially controlled based on a SiDBP > 92 mmHg entered a 12 week double-blind period and were randomly assigned to either receive placebo (n = 80), HCTZ 6.25 mg (n = 80), HCTZ 12.5 mg (n = 72) or HCTZ 25 mg (n = 80) in addition to losartan 50 mg. During the losartan monotherapy period, there was a 4 mmHg fall in SiDBP with a further fall of 5 mmHg after 12 weeks of double-blind therapy in the losartan/placebo control group. Based on the between group differences in BP change from the end of the losartan monotherapy period (baseline) to end of 12 weeks of double-blind, the concomitant administration of a very low dose of HCTZ (6.25 mg) with losartan did not significantly decrease SiDBP compared with the fall in blood pressure in the losartan/placebo control group (diff. between groups = -2 (95% C.I.[-4.1, +0.9] mmHg)). However, the concomitant administration of HCTZ 12.5 or 25 mg with losartan 50 mg resulted in significantly different (p < or = 0.05) reductions in diastolic blood pressure compared to the losartan/placebo group (diff. between groups = -4 (95% C.I. [-6.3, -1.1] mmHg) for 12.5mg combination group; -6 (95% C.I. [-8.3, -3.3]) mmHg for the HCTZ 25 mg combination group). The proportions of patients treated with losartan plus HCTZ 12.5 mg or 25 mg that achieved a trough SiDBP < 88 mmHg or a trough SiDBP > or = 88 mmHg but with a decrease of at least 5 mmHg were 71% and 83%, respectively. The percentage of clinical adverse experiences that were considered drug-related as assessed by the investigator were generally similar across all treatment groups. There were no reports of orthostatic hypotension in any of the treatment groups. Changes in serum glucose, potassium and uric acid were not appreciably different amongst the treatment groups. In summary, in patients with predominantly moderate to severe essential hypertension, the addition of HCTZ 12.5 mg or 25 mg to losartan 50 mg produced effective control of blood pressure in a substantial majority of patients who only partially responded to losartan monotherapy. There were no differences amongst the treatment groups with respect to drug-related adverse experiences in this trial.
Advances in the areas of nursing data systems now make it possible to better define and describe nursing language. This in turn clarifies what nursing contributes to the patient's wellness and to the organization's bottom-line.
Multiple compressions along a nerve have a cumulative effect on condition, both antegrade and retrograde. This nerve compromise renders the nerve more susceptible to a second source of compression. The proximal source of compression may be subclinical yet partially responsible for the cumulative compression syndrome. The primary "crush" may be anatomic or metabolic in origin. Strict attention to the patient's history and physical findings permit separation of the multiple compressions, making the choice of surgical decompression easier. Provocative testing and work simulation are important in examination, as is EMG testing. Complete medical evaluation can aid in diagnosing patients presenting with peripheral nerve compression and additional risk factors. Surgical decompression of a nerve with multiple levels of compression may not relieve all symptoms. Dynamic compressions in the work place and other nonsurgical types of compression must be identified so the prognosis for complete recovery is improved.
As issues of security, accountability and access are resolved, the Internet will act as the central infrastructure for a global as well as a community health information network. It will help nurses extend their services to the community and to educate specific patient populations.
Where possible, an environment should be composed of opportunity and excitement, rather than fear of failure. New models of behavior transform fear of failure without losing the overarching commitment to the patient.
Clear action plans can guide nurse executives toward creating an integrated clinical environment. A guide identifies how each environment is affected by changing delivery models.
Technology management involves continually making decisions about upgrades, changes or adjustments. Suggestions for managing the process of system selection and ongoing technology management are given.
When business-critical systems fail, most people look at the technological reasons. Yet, studies report the problem may be the people using the system. Social and behavioral reengineering of clinical work processes and work flows must involve key clinicians.