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Biomedical subjects

T G Quattlebaum

Publications and source records attributed to T G Quattlebaum.

12 recordsLinked to original sources
PubMed1991

Effectiveness of computer-generated appointment reminders.

Previous studies of appointment reminders among general pediatric patients have been done exclusively among low socioeconomic populations in clinics with low continuity of care and using block scheduling methods. This study of mailed computer-generated appointment reminders took place in a setting with patient demographics and practice techniques similar to those of many private pediatric practices. During a 6-month period, 901 appointments that were made more than 7 days prior to the scheduled date were randomly assigned to receive reminder postcards or to serve as controls. The overall broken appointment (no-show) rate was reduced from 19% in the control group to 10% in the reminder group, representing a 48% reduction (P = .0002). The magnitude of reduction of no-shows was similar for appointments scheduled more than 14 days prior to the appointment time (39%) as well as those scheduled more recently (58%). Equivalent results were seen with well-child appointments (47%) as with other visits (50%). Both lower and higher socioeconomic groups demonstrated similar results. The mailed postcards cost $0.20 each and were highly cost effective, generating an estimated $7.50 for each $1 spent during the study. With reductions similar to those found in this study, computer-generated appointment reminders are likely to be cost effective in other practices if current no-show rates are greater than 2% to 4%.

Appointments and Schedules↗
PubMed1989

Computerized patient scheduling in outpatient residency practices.

A computerized appointment system is described that accommodates the special needs unique to residency training programs. Appointments are scheduled automatically according to the type of problem with which the patient presents to the office as well as the differing time requirements of faculty physicians and residents at various levels of training. The system provides for the easy and flexible scheduling of residents and the automation of appointment reminders.

Ambulatory Care Information Systems↗
PubMed1989

In-training examinations as predictors of resident clinical performance.

Previous attempts to predict resident clinical performance based solely on measures of cognitive skills have been uniformly unsuccessful. For the past 8 years, a formative residency evaluation system has been used that includes yearly comprehensive oral in-training examinations (OITEs) assessing each resident's performance in the three areas of professional competence: cognitive, psychomotor, and affective. The results of these examinations and scores received on the written in-training examination (WITE) given by the American Board of Pediatrics were compared with faculty ratings received during the subsequent year of residency. No significant correlation was found at any level of training between WITE scores and clinical performance. Analysis based on clinical setting did not improve these results. Oral in-training examination scores, however, were highly correlated with clinical performance ratings. In addition, with oral in-training examination scores, the "problem" interns--those whose clinical performance rating placed them in the lower 10% of interns--were predicted with a high degree of significance, sensitivity, and specificity. Predictions based on WITEs were not significant. Simultaneous evaluation of all three areas of professional competence should be done when predictions of resident performance are attempted. The OITE is a powerful formative evaluation tool, providing valuable learning experiences as residents are objectively assessed while they perform patient-centered tasks that represent critical skills in the practice of medicine. It allows early detection and possible amelioration of future problems in the clinical performance of a resident.

Clinical Competence↗
PubMed1988

Predicting resident clinical performance with in-training examinations.

Yearly oral in-training examinations that assess resident performance in the three domains of professional competence (cognitive, psychomotor, and affective) given over a seven year period correlated highly with subsequent resident clinical performance and also predicted with a high degree of significance, sensitivity, and specificity those "problem" interns whose clinical performance placed them in the lower 10% of interns. Scores received on written in-training examinations were not significantly correlated with clinical performance and did not identify "problem" residents.

Clinical Competence↗
PubMed1986

Estimates of need for transfusions during hypertransfusion therapy in sickle cell disease.

The relationship between Hemoglobin S (Hb S) level and simultaneous values of reticulocyte count, hemoglobin (Hb), and hematocrit (Hct) were studied in six patients with sickle cell disease who were receiving a transfusion protocol because of cerebrovascular accidents. There was good correlation between Hb S and reticulocyte count (r = 0.601), Hb (r = -0.530), and Hct (r = 0.479). Although three of the six patients had similar patterns of relationship of Hb S to reticulocyte count and four of six had similar patterns of relationship of Hb S to Hb and Hct, the other patients had distinctly different patterns. "Decision levels" of reticulocyte count, Hb and Hct, indicating the probable need for transfusion, were determined by the point at which the regression line plus 1 standard error would yield the maximum Hb S considered safe. Although all individual decision levels could separate patients with regard to the need for transfusion, decision levels for the group as a whole could not do so for Hb or Hct and could do so for reticulocyte count only with reduced specificity and predictive value. After an individual patient's pattern of relationship has been established, estimates of Hb S based on reticulocyte count, Hb, or Hct can be used as an inexpensive screen for the need for transfusion.

Anemia, Sickle Cell↗
PubMed1985

Significant attitude changes among residents associated with a pediatric nurse practitioner.

In the study reported here, significant changes in attitudes occurred over a three-year period among pediatric residents who had close association with a pediatric nurse practitioner (PNP) in their residency program. Residents entering the training program had an overall uncertain attitude toward PNPs but did respond favorably to the PNP's participation in the care of well children, patient education, and follow-up care. The greatest number of attitude changes toward the PNP took place after the first year of interaction between the residents and the PNP. After the first year, the residents favored the PNP's participation in the care of minor illnesses and stable chronic illnesses and in management of telephone calls from parents with concerns. Second-year residents also felt that the PNP was accepted by patients and physicians, that the PNP contributed to the reduction of health care costs, and that the PNP should have an expanded role. Upper-level residents continued to express favorable attitudes. The findings support the authors' hypothesis that favorable attitudes on the part of physicians toward PNPs can be cultivated during residency training by exposing residents to a PNP role model. In addition, the findings suggest that subsequent years of exposure will reinforce these favorable opinions if favorable opinions are established early in residency training.

Attitude of Health Personnel↗
PubMed1976

Sudden death among postoperative patients with tetralogy of Fallot: a follow-up study of 243 patients for an average of twelve years.

Two hundred and forty-three patients were evaluated following total correction of tetralogy of Fallot with special emphasis on postoperative conduction disturbances and on the occurrence of sudden death. The average follow-up period was 12 years with a range of 6 1/2 to 16 1/2 years. Sudden death occurred in seven patients. Four deaths were among those with right bundle branch block pattern (RBBB) and three of the four had premature ventricular contractions (PVC) for more than one month postoperatively. PVCs were documented in ten of the 158 patients with RBBB; sudden death occurred in three (30%). Three of the ten (30%) patients with trifascicular block pattern (TB) died suddenly, while no deaths occurred in 24 patients with bifascicular block pattern (BB). Progression of RBBB to BB and TB occurred in 18 patients from one month to seven years postoperatively (58% of BB and 40% of TB). The risk of sudden death in patients with RBBB and PVCs following tetralogy repair is high and warrants consideration of suppressive therapy. TB also carries a high risk. The finding that RBBB may progress to BB or TB mandates long-term careful follow-up of all tetralogy patients with postoperative conduction disturbances.

Adolescent↗
PubMedDate not supplied

Implementation of multiuser MUMPS language database systems on microcomputers.

This paper outlines the problems involved in implementing multiuser MUMPS language database systems on microcomputers and discusses practical solutions. Examples of the techniques presented are derived from experience with a large database system, PTIN/PTQ/MEDAR, running on an IBM AT with up to 10 separate users.

Computer Systems↗
PubMedDate not supplied

A multiuser MUMPS language patient/physician scheduling system for microcomputers.

A microcomputer based patient and physician scheduling system is described that accommodates the special needs unique to residency training programs. Appointments are scheduled automatically according to the type of problems the patient brings to the office as well as the differing time requirements of attending physicians and residents at various levels of training.

Appointments and Schedules↗