PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “data auditing”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement.

AIM: The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement. BACKGROUND: Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis. METHOD: A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005. FINDINGS: Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study. CONCLUSION: Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

Aged↗

Vaginal birth after caesarean section (VBAC): exploring women's perceptions.

AIMS AND OBJECTIVES: This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. BACKGROUND: The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. DESIGN AND METHODOLOGY: Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. RESULTS: This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. CONCLUSIONS: Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. RELEVANCE TO CLINICAL PRACTICE: This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.

Decision Making↗

Glaucoma treatment in Australia: changing patterns of therapy 1994-2003.

AIM: To document the change in pattern of glaucoma treatment in Australia over the decade 1994-2003. METHODS: Observational study: retrospective data audit. RESULTS: The total number of prescriptions for glaucoma items has increased in this time period from 1.9 million to 3.3 million, with a cost increase to the Pharmaceutical Benefits Scheme (PBS) of in excess of 50m dollars. The largest increase has been in the class of prostaglandin analogues, which now comprise 49% of all glaucoma topical therapy prescriptions. Rates of laser trabeculoplasty and trabeculectomy surgery have fallen by 60% and 58%, respectively. Rates for secondary procedures such as repeat trabeculectomy, drainage implant devices and cycloablation have remained stable, although with some variation between Australian states. CONCLUSIONS: The introduction of multiple new medications has resulted in a decline in the amount of glaucoma surgery and laser trabeculoplasty performed. There has been an associated increase in the total number of glaucoma prescription items dispensed, and a large increase in the cost to the PBS of this change. Outcome measures of the benefit of these changes are lacking.

Antihypertensive Agents↗

Maintaining the accuracy of a computer practice register: household index.

In this practice, with a family practitioner committee list of 9726 patients, we use a computer register for recall, screening, morbidity data, audit, and repeat prescribing. The computing techniques used to achieve accuracy in maintaining the register are described. After one year of full use the register was validated by using the computer to select a random sample of 200 patients from patients' computer records that had not been updated recently. Two patients were untraceable, and in only 11 records were errors of information found, none of which was important. We think that it is feasible and valuable to have a household index.

Computers↗

Gastric cancer in Scotland: changing epidemiology, unchanging workload.

OBJECTIVE: To determine the changes in incidence of and mortality from gastric cancer in Scotland between 1978 and 1987 and in the operative workload in Lothian between 1979 and 1988. DESIGN: Analysis of national incidence statistics for gastric cancer derived from the Scottish national cancer registry, deaths from gastric cancer recorded by the registrar general for Scotland, and Lothian surgical audit data. SETTING: Scotland and Lothian Health Board area. PATIENTS: Patients in Scotland with gastric cancer during 1978 to 1987 inclusive; patients in Scotland with gastric cancer recorded on their death certificate as cause of death during 1978 to 1987; patients who had an operation in Lothian for gastric cancer during 1979 to 1988. MAIN OUTCOME MEASURES: Changes in incidence of and mortality from gastric cancer in Scotland from 1978 to 1987 and in the number of operations performed for gastric cancer in Lothian from 1979 to 1988. RESULTS: Mortality from gastric cancer in Scotland fell by about 25% over the 10 years. The incidence and standardised incidence of gastric cancer showed a marginal decline of about 9%. The differences in trends between incidence and mortality were significant (p less than 0.05). CONCLUSIONS: This study shows that the surgical workload associated with gastric cancer is not declining. This is because the incidence has remained almost static, which may be due to the relative increase in the numbers of older people in the population, who are at greater risk of developing gastric cancer. Gastric cancer should not be regarded as a disease in decline. Incidence and workload should determine resources allocated to this disease rather than mortality statistics.

Adult↗

Community surveillance of complications after hernia surgery.

OBJECTIVE: To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. DESIGN: Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. SETTING: Academic surgical unit of three consultant surgeons. PATIENTS: 510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. RESULTS: The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. CONCLUSIONS: Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.

Anti-Bacterial Agents↗

Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients.

OBJECTIVE: To analyze the literature of ileal pouch anal anastomosis (IPAA) regarding complications and functional outcome, to provide audit data for individual surgeons and units to assess their own performance against and also to serve as reference standard for the assessment of novel alternatives. BACKGROUND: IPAA is the standard restorative procedure for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). This operation is, however, associated with distinct rates of failure, complications and fecal incontinence. METHODS: A meta-analysis on pooled incidences of complications of IPAA was conducted. Medline search and cross-reference search identified studies on IPAA (n > or = 50). Two authors independently performed the data extraction on study characteristics, diagnosis, type of operation, pouch-related complications, pouch failure and functional results. In case of disagreement consensus was reached by joint review of the study. Estimates of pouch-related complications, pouch failure and functional results are described as pooled percentages with 95% confidence interval. RESULTS: The initial search based on 1,206 abstracts yielded 43 studies eligible for further analysis. Indications for IPAA were UC in 87.5%, FAP in 8.9% and other diagnoses in 3.6%. The median follow-up was 36.7 months. Pouch failure was 6.8%, increasing to 8.5% in case of follow-up of more than 60 months. Pelvic sepsis occurred in 9.5%. Severe, mild and urge fecal incontinence were reported in 3.7, 17, and 7.3%, respectively. No effect of experience, duration of follow-up and type of surgical technique on the incidence of pouch failure and pelvic sepsis was demonstrable. CONCLUSIONS: Current techniques for restorative surgery after proctocolectomy are associated with non-negligible complication rates and leave room for improvement and continuation of development of alternative procedures.

Colitis, Ulcerative↗

Provision for major obstetric haemorrhage: an Australian and New Zealand survey and review.

Obstetric haemorrhage is a leading cause of maternal death and the most common contributor to serious obstetric morbidity. Maternal mortality audit data suggest that appropriate preparation and good emergency management leads to improved outcome. The aim of this study was to assess facilities relevant to major obstetric haemorrhage management in all units in Australia and New Zealand that offer operative obstetric services. The questionnaire was divided into ten sections: demographics, facilities, staffing, policies and guidelines, drugs, procedures, equipment, point of care testing, availability of O negative blood and free comments. Responses were received from 240 (76.4%) of the 314 hospitals surveyed (187 public and 53 private). One hundred and nine units (45%) had fewer than 500 deliveries per year Distances to referral facilities were frequently very large. Of the 90 hospitals (38.1%) without an onsite blood bank, 12 did not have a supply of blood for emergencies. Half of all units (n=121) had on-site intensive care or high dependency facilities and 72.9% (n=175) had an on-site cardiac arrest team. Only 58.8% of units (n=141) had a written haemorrhage protocol. Findings are presented in the context of other literature, including evidence-based guidelines. Haemorrhage responds well to appropriate treatment, although careful preparation and anticipation of problems is required. In our region geographical factors and different systems of healthcare complicate provision of obstetric services. Where facilities are limited, women should be offered antenatal transfer to a larger centre.

Anesthesia↗

Is the number of documented diabetes process-of-care indicators associated with cardiometabolic risk factor levels, patient satisfaction, or self-rated quality of diabetes care? The Translating Research into Action for Diabetes (TRIAD) study.

OBJECTIVE: Simple process-of-care indicators are commonly recommended to assess and compare quality of diabetes care across health plans. We sought to determine whether variation in the number of simple diabetes processes of care across provider groups is associated with variation in other quality indicators, including cardiometabolic risk factor levels, patient satisfaction with care, or patient-rated quality of care. RESEARCH DESIGN AND METHODS: We used cross-sectional survey and chart audit data for 8,733 patients with diabetes who received care from 68 provider groups nested in 10 health plans that participated in the Translating Research Into Action for Diabetes study. Analyses using hierarchical regression models assessed associations of the mean number of seven simple process measures with each of the following: HbA(1c) (A1C), systolic blood pressure (SBP), HDL and LDL cholesterol levels, patient satisfaction with care, and patient-rated quality of care. RESULTS: After adjusting for case-mix differences across groups and plans, an average of one additional documented process of care for each patient in a group or plan was associated with significantly lower mean LDL cholesterol levels (-4.51 mg/dl [95% CI 1.46-7.58]) but not with A1C, SBP, or HDL cholesterol levels. The number of care processes documented was associated with patient satisfaction measures and self-rated quality of diabetes care. CONCLUSIONS: Variation in the number of simple process-of-care indicators across provider groups or health plans is associated with differences in patient-centered measures of quality, but assessment of the quality of cardiometabolic risk factor control will require more advanced clinical performance indicators.

Aged↗

A survey of beef muscle color and pH.

The objectives of this study were to define a beef carcass population in terms of muscle color, ultimate pH, and electrical impedance; to determine the relationships among color, pH, and impedance and with other carcasses characteristics; and to determine the effect of packing plant, breed type, and sex class on these variables. One thousand beef carcasses were selected at three packing plants to match the breed type, sex class, marbling score, dark-cutting discount, overall maturity, carcass weight, and yield grade distributions reported for the U.S. beef carcass population by the 1995 National Beef Quality Audit. Data collected on these carcasses included USDA quality and yield grade data and measurements of muscle color (L*, a*, b*), muscle pH, and electrical impedance of the longissimus muscle. About one-half (53.1%) of the carcasses fell within a muscle pH range of 5.40 to 5.49, and 81.3% of the carcasses fell within a longissimus muscle pH range of 5.40 to 5.59. A longissimus muscle pH of 5.87 was the approximate cut-off between normal and dark-cutting carcasses. Frequency distributions indicated that L* values were normally distributed, whereas a* and b* values were abnormally distributed (skewed because of a longer tail for lower values, a tail corresponding with dark-cutting carcasses). Electrical impedance was highly variable among carcasses but was not highly related to any other variable measured. Color measurements (L*, a*, b*) were correlated (P < 0.05) with lean maturity score (-.58, -.31, and -.43, respectively) and with muscle pH (-.40, -.58, and -.56, respectively). In addition, fat thickness was correlated with muscle pH and color (P < 0.05). There was a threshold at approximately .76 cm fat thickness, below which carcasses had higher muscle pH values and lower colorimeter readings. Steer carcasses (L* = 39.62, a* = 25.20, and b* = 11.03) had slightly higher colorimeter readings (P < 0.05) than heifer carcasses (L* = 39.20, a* = 24.78, and b* = 10.80) even though muscle pH was not different between steer and heifer carcasses. Dairy-type carcasses (pH = 5.59, L* = 37.56, a* = 23.40, and b* = 9.68) had higher muscle pH values and lower colorimeter readings than either native-type (pH = 5.50, L* = 39.55, a* = 25.13, and b* = 11.00) or Brahman-type (pH = 5.46, L* = 39.75, a* = 25.17, and b* = 11.05) carcasses (P < 0.05).

Algorithms↗

The outcome of critically ill Indigenous patients.

OBJECTIVE: To investigate the short-term outcome of critically ill Indigenous patients. DESIGN AND PARTICIPANTS: Retrospective cohort study using de-identified audit data from a tertiary intensive care unit (ICU) in Western Australia for the 11-year period 1 January 1993 to 31 December 2003. MAIN OUTCOME MEASURES: Hospital mortality (crude, and adjusted for severity of illness). RESULTS: Of 16 757 ICU patients, 1076 (6.4%) were identified as Indigenous. The Indigenous patients were younger and more commonly had chronic liver and renal diseases. Indigenous people represented 3.2% of the population of Western Australia in 2001, but represented 3.1% and 9.5% of all elective and emergency ICU admissions, respectively. Diagnoses of sepsis, pneumonia, trauma, and cardiopulmonary arrest were common among critically ill Indigenous patients. Following emergency admission, the crude hospital mortality for Indigenous patients was higher (22.7% v 19.2%; crude odds ratio, 1.24; 95% CI, 1.04-1.47) than for non-Indigenous patients. The crude hospital mortality of critically ill Indigenous patients was lower than that predicted by the APACHE II prognostic model and was similar to that of non-Indigenous patients after adjusting for severity of illness and chronic health status. CONCLUSIONS: The pattern of critical illness affecting Indigenous Australians in Western Australia was different from that affecting non-Indigenous patients. The crude hospital mortality was high, but similar to that of non-Indigenous Australians after adjusting for severity of illness and chronic health status.

APACHE↗

Childhood accident prevention: putting audit into practice.

This article describes an audit of children presenting at accident and emergency departments following an accident. The authors explain how the audit data informed a strategy for childhood accident prevention schemes in Newcastle for 1995/96.

Accident Prevention↗

Implementation of nutrition standards for older adults.

This article reports on a study exploring the process of implementing nationally developed standards for the nutritional care of older adults. In particular, the study focused on issues which enabled or hindered the effective implementation of the standards. A multisite case study design was used. The intervention involved a two-day workshop on facilitated teamwork and implementation strategies. The standards were implemented over a six-month period and a number of semi-structured interviews were conducted in each of the homes throughout this period. Pre- and post-audit data of nutritional care were collected in each of the homes to ascertain the extent to which care had changed. The standards were used effectively as a basis for making significant changes to the way staff provided nutritional care. The research highlighted the importance of using a strategic and well planned approach which addresses four important factors: ensuring the topic area is a priority; using a teamwork approach; identifying a facilitator; and providing necessary educational opportunities.

Aged↗

Management of acute myeloid leukaemia. A regional audit in the south and west of the United Kingdom.

In a retrospective audit data were collected on all 231 patients from 26 hospitals diagnosed with AML in the south and west region of the UK in 1996. Their median age at diagnosis was 67 years. Sixty one percent (142/231) of patients were treated with chemotherapy; most of the rest received blood product support only; and 7% (15) had no treatment at all. Sixty eight percent of patients aged under 60 years were treated in a clinical trial compared with 24% of patients over 60. The major reasons given for not entering patients in a trial were ineligibility in the younger cohort and poor performance status in the older group. Twenty elderly patients (12.5%) refused to be entered in a trial. In an unselected cohort of patients with AML the accrual into clinical trials is impressively high for patients under 60 years. However, this is a disease of the elderly and comparable enrolment is not seen with elderly patients despite being managed by the same haematologists. If the percentage of patients entered into trials is to be defined as a quality standard, then it is important for those trials to be relevant to the population being treated.

Adolescent↗

Outcomes in rural obstetrics, Atherton Hospital 1991-2000.

Analysis of annual obstetric audit data collected over the decade 1991-2000 from the Atherton Hospital in Far North Queensland provides ongoing evidence of safe obstetric practice provided by a group of non-specialist doctors in a rural community. During that period, there were 2997 deliveries; of these, 2400 (80.1%) were public patients and 596 (19.9%) were private patients. There were 16 perinatal deaths (perinatal mortality rate 5.3/1000). This is remarkably consistent with the outcome of the previous decade, 1981-90, when the total deliveries was 2883 with 15 perinatal deaths (perinatal mortality rate 5.2/1000). However, compared with 1981-90, the number of Caesarean sections rose from an overall rate of 13.0% (public 10.6%; private 18.3%) to an overall rate of 17.4% (public 16.7%; private 20.4%). In 1981-90, there were 909 private confinements (31.5% of total) and in 1991-2000 there were 597 (19.9% of total). This decline in the number of private obstetric cases may have significant implications for future models of care. There were no maternal deaths in the 20 years 1981-2000.

Delivery, Obstetric↗

NTP Toxicology and Carcinogenesis Studies of Telone II(R) (Technical-Grade 1,3-Dichloropropene [CAS No. 542-75-6] Containing 1.0% Epichlorohydrin as a Stabilizer) in F344/N Rats and B6C3F1 Mice (Gavage Studies).

Toxicology and carcinogenesis studies of Telone II(R) (a soil fumigant containing approximately 89% cis- and trans-1,3-dichloropropene, 2.5% 1,2-dichloropropane, 1.5% of a trichloropropene isomer, and 1.0% epichlorohydrin) were conducted by administering the commercial-grade formulation in corn oil by gavage to groups of 52 male and 52 female F344/N rats at doses of 0, 25, or 50 mg/kg and to groups of 50 male and 50 female B6C3F1 mice at doses of 0, 50, or 100 mg/kg. Doses were administered three times per week for 104 weeks. Ancillary studies were conducted in which dose groups containing five male and five female rats were killed after receiving Telone II(R) for 9, 16, 21, 24, or 27 months. Mean body weights of high dose male rats were about 5% lower than those for the vehicle control and low dose male rats; no differences in body weights were observed among groups of female rats. Survival was comparable for the different groups of male and female rats. For male and female mice, the dosed groups initially weighed 6%-22% less than did the vehicle controls; the weight differential decreased to 5%-9% by the end of the studies. Twenty-five vehicle control male mice died during weeks 48-51 from suppurative inflammation of the heart (myocarditis). At the end of the studies, the survival of male mice was as follows: vehicle control, 8/50; low dose, 28/50; high dose 31/50. Survival of female mice was lower (P<0.05) in the high dose group than in the vehicle controls (46/50; 45/50; 36/50). The primary organs affected were the forestomach (rats and mice), urinary bladder (mice), lung (mice), and liver (rats). Compound-related nonneoplastic lesions included basal cell or epithelial hyperplasia of the forestomach (rats and mice), epithelial hyperplasia of the urinary bladder (mice), and kidney hydronephrosis (mice). Neoplastic lesions associated with administration of Telone II(R) included squamous cell papillomas of the forestomach (male rats: 1/52; 1/52; 9/52; female rats: 0/52; 2/52; 3/52; female mice: 0/50; 1/50; 2/50), squamous cell carcinomas of the forestomach (male rats: 0/52; 0/52; 4/52; female mice: 0/50; 0/50; 2/50), transitional cell carcinomas of the urinary bladder (female mice: 0/50; 8/50; 21/48), alveolar/bronchiolar adenomas (female mice: 0/50; 3/50; 8/50), and neoplastic nodules of the liver (male rats: 1/52; 6/52; 7/52). Although the study in male mice was considered inadequate due to the deaths at weeks 48-51 of 25/50 vehicle control animals, 2/50 of the high dose males had transitional cell carcinomas of the urinary bladder. Furthermore, increases were seen in the incidences of alveolar/bronchiolar neoplasms of the lung (1/50; 13/50; 12/50) and of squamous cell papillomas of the forestomach (0/50; 2/50; 3/50). These findings plus the finding of nonneoplastic lesions in two of these organs (basal cell or epithelial hyperplasia of the forestomach: 0/50; 0/50; 4/50; epithelial hyperplasia of the urinary bladder: 0/50; 9/50; 18/50) suggest that Telone II(R) may have been responsible for the development of these lesions in male mice. Development of lesions of the forestomach (basal cell hyperplasia and squamous cell papilloma) was observed to be time dependent. The results of the scheduled kills supported the findings of the carcinogenesis studies. When the results from the scheduled kills at all time points were pooled with those of the 24-month carcinogenesis studies, the incidences were as follows: basal cell or epithelial hyperplasia of the forestomach-- male rats: 3/77; 13/77; 31/77; female rats: 1/75; 5/77; 35/77; squamous cell papilloma of the forestomach-- male rats: 1/77; 1/77; 13/77; female rats: 0/75; 2/77; 8/77; neoplastic nodules of the liver--male rats: 1/77; 6/76; 8/77; female rats: 6/75; 8/77; 12/77. cis- and trans-1,3- Dichloropropane are the principle components (89%) in Telone II(R), but the 1.0% epichlorohydrin, a direct-acting mutagen and carcinogen added as a stabilizer, may have influenced the development of the forestomach lesions. 1,3-Dichloropropene was mutagenic in Salmonella typhimuriumnt of the forestomach lesions. 1,3-Dichloropropene was mutagenic in Salmonella typhimurium strains TA98, TA100, and TA1535 without metabolic activation and in TA100 and TA1535 with metabolic activation by Aroclor-induced male Sprague-Dawley rat and Syrian hamster liver S9. No mutagenic response was seen in TA1537. Sex-linked recessive lethal mutations were observed in Drosophila melanogaster, and 1,3-dichloropropene did not induce reciprocal translocations in D. melanogaster. A data audit was conducted on the Telone II&reg; 2-year carcinogenesis studies in rats and mice and the ancillary studies in rats. Except for the already known problem of survival of male vehicle control mice, no other discrepancies or problems that would compromise the validity of the findings or alter the interpretations of these studies were found. Under the conditions of these gavage studies, there was clear evidence of carcinogenicity for male F344/N rats, as indicated by Telone II&reg;-related increased incidences of squamous cell papillomas and carcinomas of the forestomach, as well as an increased incidence of neoplastic nodules of the liver. In female F344/N rats, there was some evidence of carcinogenicity because Telone II&reg; caused an increased incidence of squamous cell papillomas of the forestomach. The experiment in male B6C3F1 mice was considered to be an inadequate study of carcinogenicity because of reduced survival in the vehicle control group. However, there was some indication in the male mice of Telone II&reg;-related increases of transitional cell carcinomas of the urinary bladder, squamous cell papillomas of the forestomach, and alveolar/bronchiolar adenomas and carcinomas of the lung. There was clear evidence of carcinogenicity for female B6C3F1 mice, since Telone II&reg; caused increased incidences of transitional cell carcinomas of the urinary bladder; Telone II&reg; also increased the incidences of alveolar/bronchiolar adenomas of the lung and of squamous cell papillomas or carcinomas of the forestomach in the female mice. Telone II&reg;-related nonneoplastic lesions included basal cell or epithelial cell hyperplasia in the forestomach of male and female rats and male and female mice and epithelial hyperplasia of the urinary bladder in male and female mice. Synonyms: cis,trans-1,3-dichloropropene, D-D&reg; Soil Fumigant; Telone&reg; Soil Fumigants; Vorlex&reg; Soil Fumigants

Journal Article↗

2003 update on the Hypertension Initiative of South Carolina. Bringing South Carolina from "worst to first" in cardiovascular health.

Hypertension and its related comorbidities continue to drain South Carolina of approximately $9 billion dollars a year in direct medical costs and indirectly through lost productivity. Improving control rates of blood pressure and associated cardiovascular risk factors in the primary care physician's office is a fundamental and crucial step to decrease the very high incidence of stroke and cardiorenal diseases. By monitoring prescribing patterns through the Initiatives' data feedback program, providing evidence-based management approaches through educational seminars, and by applying improved treatment protocols, physicians can have a profound impact on outcomes. The growing collaborative partnership spawned by the Hypertension Initiative now includes primary care providers, Hypertension Specialists in the local community, and the ASH Carolinas-Georgia Chapter. The growth and impact of the partnership is facilitated by a dynamic data auditing and feedback program that provides the basis for constructive change focused on optimizing cardiovascular risk factor control in patients across the State. By continuing to make progress in addressing the control of blood pressure and associated cardiovascular risk factors through a growing collaborative partnership with primary care providers statewide, South Carolina can move from worst to first in cardiovascular health. In the future, we hope to add a dynamic health promotion program to active disease management efforts. In the process, South Carolina can move from a leader in cardiovascular disease to a model of cardiovascular health.

Education, Medical, Continuing↗

Successful development and application of a strategic dialysis planning model (RENPLAN).

Strategic planning for chronic dialysis services to allow cost-effective organization of resources and workforce planning is a difficult but essential task. The planning process within an individual unit involves consideration of both generic issues and issues specific to the unit. We used the Balance of Care approach to planning, which takes into account the affect that the dependency level of patients has on the therapeutic options and on how those options can be delivered. In a workshop format, we developed a spreadsheet computer model (RENPLAN) and applied it to facilitate discussion between clinical and non clinical health care professionals, dialysis unit managers, and renal patient representatives. Within the unit concerned, we used the model to explore a variety of planning options, including reducing the number of patients receiving automated peritoneal dialysis (proposed as a cost-reduction measure by managers). The model precisely calculates future resource requirements (staff numbers, hemodialysis stations, disposables costs), indicates deficits in clinical audit data, and facilitates education of non clinical managers regarding the major issues in dialysis planning. The RENPLAN model is freely available to all units and is adaptable for analysis of local planning issues.

Ambulatory Care Facilities↗