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Biomedical subjects

R M Gardner

Publications and source records attributed to R M Gardner.

226 records · Page 13Linked to original sources
PubMedDate not supplied

Continuous quality improvement applied to medical care: experiences at LDS hospital.

At LDS Hospital the authors are implementing continuous quality improvement (CQI), a systems-analytic approach to quality management in industry, as an approach to quality management in medical domains. Their approach consists of 1) choosing a process to be improved, 2) assembling a team of expert clinicians that understands the process and the outcomes, 3) determining key steps in the process and expected outcomes, 4) collecting data that measure the key process steps and outcomes, and 5) feeding back the data to the practitioners. CQI theory states that the practitioners will use the information and their own best intentions to improve the manner in which they provide care. The authors have developed statistical tools that display the data and distinguish between random and assignable variation.

Delivery, Obstetric↗
PubMedDate not supplied

A computerized laboratory alerting system.

A computerized laboratory alerting system (CLAS) has been developed as part of an ongoing effort to improve the quality of care at LDS Hospital. The system identifies potentially life-threatening conditions on the basis of laboratory findings and then generates appropriate warnings and transmits them to clinicians. Use of the system has led to a significant increase in the proportion of patients in life-threatening situations who have received appropriate care (50.8% before implementation vs. 62.5% afterward, P less than 0.05). Among patients with hypokalemia, falling potassium levels, hyperkalemia, hypokalemia during treatment with digoxin, hyponatremia, falling sodium levels, hypernatremia, hypoglycemia, or hyperglycemia, the average length of time spent in the life-threatening situation has decreased from 30.4 to 15.7 hours (P less than 0.05) and the average length of stay has decreased from 14.6 to 8.8 days (P less than 0.05). There has been little change in the proportion of patients with findings indicating metabolic acidosis who have received appropriate care (32.3 vs. 34.6%). We conclude that CLAS has an important role in patient care at our hospital.

Artificial Intelligence↗
PubMedDate not supplied

Computer-based data entry for nurses in the ICU.

Efforts are being made to improve the efficiency and quality of care in intensive care units (ICUs) at Latter Day Saints Hospital. The ICUs have been computerized, and the collection, storage, and presentation of patients' data have been improved. Nurses use computers for entering clinical data and plans for nursing care, and the effects of these changes on the work patterns of nurses in the ICU have been evaluated. Contrary to our expectation, our studies showed a decrease in the proportion of time that nurses spent in direct patient care (from 49.1% to 43.2%) and an increase in the proportion they spent entering clinical data (from 18.2% to 24.2%) after computerization. These changes, however, were attributed to a decrease in the severity of patients' illnesses, rather than the availability of the computer. There was no measurable difference in the proportion of time spent at other nursing activities.

Data Interpretation, Statistical↗
PubMedDate not supplied

Computer surveillance of hospital-acquired infections and antibiotic use.

Surveillance of hospital-acquired infections and antibiotic use is required of US hospitals. The time and cost needed to actively perform this surveillance can be extensive. We developed a computerized infectious disease monitor that automatically generates four types of surveillance "alerts" for patients with hospital-acquired infections, not receiving antibiotics to which their pathogens are susceptible, who could be receiving less expensive antibiotics, or who are receiving prophylactic antibiotics too long. Surveillance personnel using computer screening for two months found more hospital-acquired infections when compared with our traditional surveillance methods, while requiring only 35% of the time. In addition, alerts from the computer identified 37 patients not receiving appropriate antibiotics, 31 patients who could have been receiving less expensive antibiotics, and 142 patients, during one month, receiving prolonged cephalosporin prophylaxis. Computer screening can help focus the activities and improve the efficiency of hospital surveillance personnel.

Anti-Bacterial Agents↗
PubMedDate not supplied

Exercise performance of subjects with ankylosing spondylitis and limited chest expansion.

To examine the mechanism of exercise limitation associated with chest wall restriction (CWR), we compared the ramp (1 W/3 s) exercise performance of six untrained subjects with ankylosing spondylitis (AS) and six healthy subjects matched for age and body size. Subjects with AS had CWR (maximum rib cage expansion : 1.4 +/- 0.2 cm; means +/- sem). The maximum oxygen uptake (VO2max) of AS subjects (2.15 +/- 0.2 1-stpd) was less than their predicted VO2max (2.68 +/- 0.13 1-stpd; p less than 0.03) and the measured VO2max of matched healthy subjects (2.78 +/- 0.22 1-stpd; p less than 0.03). Subjects with AS achieved 95 percent of predicted maximum heart rate, and their maximum voluntary ventilation exceeded their maximum exercise ventilation by at least 15 l X min-1 unless parenchymal pulmonary disease was present. We conclude that maximum ramp exercise performance of AS subjects with CWR is decreased. Deconditioning or cardiovascular impairment rather than ventilatory impairment appears responsible for the observed reduction of VO2max.

Adult↗
PubMedDate not supplied

Reference values for pulmonary tissue volume, membrane diffusing capacity, and pulmonary capillary blood volume.

Pulmonary tissue volume (Vti), carbon monoxide diffusing capacity, membrane diffusing capacity, pulmonary capillary blood flow and pulmonary capillary blood volume were measured in ninety (54 men and 36 women) healthy lifetime nonsmokers using an inert gas rebreathing technique. Prediction equations were generated using multiple linear regressions with height and age as the independent variables. Normalizing the data by dividing by functional residual capacity eliminated all sex differences. In contrast to the other variables, normalized pulmonary tissue volume did not correlate with any of the independent variables tested. Therefore, an average normalized Vti value can be recommended as a reference value

Adult↗
PubMedDate not supplied

Biomedical instrumentation in the Soviet Union.

By utilizing biomedical instrumentation from other nations, and by designing and fabricating instrumentation in several institutes under the control of the Medical Industries Ministry and the U.S.S.R. Academy of Medical Sciences, the Soviet Union has attempted to a bridge a 20 to 30-year technology gap. The lack of interagency cooperation and sophisticated manufacturing capability, combined with a system not directed to recognizing or exploiting innovation from within, suggests continued dependence on other countries. The Soviet system in these regards serves well as an example of a bureaucracy and system limiting technologic advancement. It is hoped that future actions in this country, in response to the U.S. Food and Drug Administration's direct regulatory control over U.S. medical devices, will not lead to a similar stifling of technology development.

Biomedical Engineering↗