Biomedical subjects

Rita Smith

Publications and source records attributed to Rita Smith.

4 recordsLinked to original sources

PubMed2006

Reducing unnecessary inpatient laboratory testing in a teaching hospital.

After an inpatient phlebotomy-laboratory test request audit for 2 general inpatient wards identified 5 tests commonly ordered on a recurring basis, a multidisciplinary committee developed a proposal to minimize unnecessary phlebotomies and laboratory tests by reconfiguring the electronic order function to limit phlebotomy-laboratory test requests to occur singly or to recur within one 24-hour window. The proposal was implemented in June 2003. Comparison of fiscal year volume data from before (2002-2003) and after (2003-2004) implementation revealed 72,639 (12.0%) fewer inpatient tests, of which 41,765 (57.5%) were related directly to decreases in the 5 tests frequently ordered on a recurring basis. Because the electronic order function changes did not completely eliminate unnecessary testing, we concluded that the decrease in inpatient testing represented a minimum amount of unnecessary inpatient laboratory tests. We also observed 17,207 (21.4%) fewer inpatient phlebotomies, a decrease sustained in fiscal year 20042005. Labor savings allowed us to redirect phlebotomists to our understaffed outpatient phlebotomy service.

Hospitals, Teaching↗

PubMed2005

Advanced nursing practice: policy, education and role development.

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Accreditation↗

PubMed2004

Radiographic features of lumbar disc degeneration and self-reported back pain.

OBJECTIVE: To characterize the occurrence of radiographic features of lumbar disc degeneration including the presence of osteophytes, endplate sclerosis, and disc space narrowing and to determine their relationship with self-reported back pain. METHODS: Subjects aged 50 years and over were recruited from a primary care based community health index in Aberdeen, UK. Subjects were invited to complete an interviewer administered questionnaire and to have lateral spinal radiographs performed. The questionnaire included questions concerning the occurrence of back pain, both ever and in the past year. The inter-vertebral disc spaces (L1/2 to L4/5) were evaluated for the presence and severity of anterior osteophytes, endplate sclerosis, and disc space narrowing using a semi-quantitative score (grade 0-3). Logistic regression was used to determine the association between these individual radiographic features of lumbar disc degeneration (using for each feature, the most severely affected vertebra) and back pain, with adjustments made for age and gender. RESULTS: There were 286 men (mean age 65.3 years), and 299 women (mean age 65.2 years) with spinal radiographs. Osteophytes were the most frequent radiographic feature. Osteophytes and endplate sclerosis were more frequent in men than women, but there was no gender difference in the frequency of disc space narrowing. All radiographic features increased in frequency with age; for osteophytes this was true only after excluding mild (grade 1) osteophytes. Compared to those without, those with disc space narrowing were more likely to report back pain both ever, [odds ratio (OR) = 2.1; 95% confidence interval (CI): 1.5 to 3.0] and in the past year (OR = 1.7) with the strength of the association increasing with increasing severity of narrowing. Endplate sclerosis was not linked with back pain although moderate (grade 2) sclerosis was associated with back pain, both ever and in the past year. Compared to those without, or those with mild osteophytes, those with more severe osteophytes (grade > 1) were more likely to report back pain ever (OR = 1.7; 95% CI: 1.2 to 2.5). CONCLUSION: These data highlight the frequent occurrence, and the increase in frequency with age, of the individual radiographic features of lumbar disc degeneration in population samples of men and women. Disc space narrowing appeared more strongly associated with back pain than the other radiographic features.

Aged↗

PubMed2002

Pain management: the global connection.

Understanding pain and the cultural perceptions patients and staff hold about it is crucial to developing a pain management program that complies with Joint Commission requirements.

Guideline Adherence↗