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Injury is a major public health problem. E-coding is an important epidemiologic tool that would allow for quantitative estimates of injury morbidity and mortality. This information could then be used to develop and evaluate injury control interventions. E-coding has been successfully implemented at the county level in Nebraska and efforts should be supported to expand this effort statewide.
The authors present a computer system for hypertension control in a specialized department in Paris. The hypertension clinic performs the initial evaluation of the disease in ambulatory care or during a short hospitalization period. The general practitioner (GP) is mainly in charge of the long term follow-up. The objective of the system is to improve the communication between the patient, the clinic and the GP. Data are collected during each visit at the clinic. The computer is used to produce evolutive summary reports for each patient and to control the appointment system. Thus, the data processing system improves the quality of the individual follow-up and, at the same time, a medical data bank is available for epidemiological and pharmacovigilance studies.
Steam sterilization is a common method for processing reusable instruments in ambulatory care settings. Ensuring that sterilization practices are consistent with accepted standards is a quality-of-care parameter as well as an infection control issue. Factors that must be considered in improving performance in this important area are: operator training and continued competency, selection of chemical and biological media and methods, work flow controls, documentation methods and standards, written policies and procedures to support practices, and ongoing monitoring of the system and practices with feedback to responsible persons.
In video-controlled tasks, visuomotor performance is generally initially poor with rotated visual display, but improves through trial-by-trial learning. We hypothesise that the inaccurate processing of the visual hand-to-target vector mainly results from the persistent influence of non-visual information relating to arm posture. To test this hypothesis, arm-related proprioceptive and visual information were independently manipulated in a video-controlled pointing task. Analysis of movement vectors revealed that the target was located according to the visual hand but its proprioceptive orientation (Allelocentric(1) system of reference, N = 10), or according to the proprioceptive hand location and orientation (Egocentric system of reference, N = 8). The prevalence of one system of reference correlated with the accuracy of proprioceptive signals informing about arm posture. One obstacle in mastering video-controlled task results thus from the persistent influence of proprioceptive information in the spatial coding of visual goals for action, which however differs across individuals.
Data on the number of admissions for diarrhoea each week to the West Kalimantan Provincial Hospital, Pontianak, Indonesia over a 5 year period, 1992-1996, were collected. After cleaning and exclusion of extreme values, transformation was then performed to ensure that the data were free of special cause variation and normally distributed. A control chart was then constructed to provide an 'early warning' system for hospital authorities in order to facilitate the management of the epidemic and to improve patient care.
Effective discharge planning should serve to reduce length of stay (LOS) and lower readmission rates. A combined prospective/retrospective study was undertaken to assess the effectiveness of anticipated discharge order forms in decreasing LOS for staff pediatric patients. Resident physicians provided advance notice of the planned discharge date to nursing staff and patient family members. Patient selection was random, and the data were collected prospectively. These subjects were matched with patients for whom the order form was not used, and the data was collected retrospectively. Matching variables included: diagnosis, age, gender, race, and method of payment. There were 103 matched pairs. LOS was collapsed into low and high categories. There was a significant difference when comparing subject groups (chi 2 = 8.5; P = 0.005). Whereas only 14% of experimental patients were categorized as high LOS, 32% of control patients were classified as such. Physician prediction of discharge date helped decrease patient LOS.
Complying with the Immigration Reform and Control Act of 1986 was predicted to be a major headache, but hospitals have found the law easy to follow and the fallout limited--if some basic steps aren't overlooked.
This article discusses issues that are essential to ensuring the reliability of the conclusions of oncology clinical trials. Though quality control is important at every stage of a well-run clinical trial, the authors focus on the quality of the data as evidenced by the results and conclusions of the study. Good quality control principles and practices are discussed for study planning, design, conduct, analysis, and interpretation.
The computer has now an important role in analysis laboratory. Particularly the microbiological sector may receive a considerable support by the computer. In fact it's possible to form an effective epidemiologic hospital observatory, by making a systematic and continuous control of bacterial ecology in hospital wards, through the statistical results elaborated by computer. This is the object of the microbiological sector in the hospital's laboratory in Pistoia Town.
This is the second in a two-part series discussing and illustrating the application of statistical process control (SPC) in hospital epidemiology. The basic philosophical and theoretical foundations of statistical quality control and their relation to epidemiology are emphasized in order to expand the mutual understanding and cross-fertilization between these two disciplines. Part I provided an overview of the philosophy and general approach of SPC, illustrated common types of control charts, and provided references for further information or statistical formulae. Part II now discusses alternate possible SPC approaches, statistical properties of control charts, chart-design issues and optimal control limit widths, some common misunderstandings, and more advanced issues. The focus of both articles is mostly nonmathematical, emphasizing important concepts and practical examples rather than academic theory and exhaustive calculations.
Conscientious sign-out between medical interns is important for the continuity of care of hospitalized patients. We developed a standardized sign-out card that prompted the intern going off duty to transmit patient care information to the inter on call. The card was tested in a prospective, randomized, controlled trial in which one group of interns used the card, and another group did not. Any instance of poor sign-out was reported on a questionnaire completed by the intern who had been on call the previous night. The group using the sign-out cards reported poor sign-out on 8 nights (5.8% of questionnaires), and the control group reported it on 17 nights (14.9% of questionnaires, p = .016). The card was time-effective and inexpensive, resulted in more complete data recording, and possibly decreased the morbidity associated with poor sign-out.
The initiation of testing for antibody to HIV in the donor blood supply opened a new era of operational, safety, and legal complications for facilities in which transfusion medicine is practiced. Mounting dissatisfaction with increasing incidents of questionable release of blood forced regulators to take tougher actions. Blood banks were surprised and concerned that their practices could no longer effectively ensure blood safety. Concurrently, US businesses and manufacturers were looking for new answers regarding the question of improved quality in goods and services. The progression from quality control to quality systems is reviewed. In addition, where transfusion medicine is today, and where it has yet to go, as well as the tools available to make the transition, are discussed.
A procedure for auditing radiopharmaceutical formulations is described. To meet FDA guidelines regarding the quality of radiopharmaceuticals, institutional radioactive drug research committees perform audits when such drugs are formulated away from an institutional pharmacy. All principal investigators who formulate drugs outside institutional pharmacies must pass these audits before they can obtain a radiopharmaceutical investigation permit. The audit team meets with the individual who performs the formulation at the site of drug preparation to verify that drug formulations meet identity, strength, quality, and purity standards; are uniform and reproducible; and are sterile and pyrogen free. This team must contain an expert knowledgeable in the preparation of radioactive drugs; a radiopharmacist is the most qualified person for this role. Problems that have been identified by audits include lack of sterility and apyrogenicity testing, formulations that are open to the laboratory environment, failure to use pharmaceutical-grade chemicals, inadequate quality control methods or records, inadequate training of the person preparing the drug, and improper unit dose preparation. Investigational radiopharmaceutical formulations, including nonradiolabeled drugs, must be audited before they are administered to humans. A properly trained pharmacist should be a member of the audit team.
This paper proposes a number of revisions to CEN/TS 14463 (ClaML), which is a pre-standard mark-up language for the electronic publication of classification coding schemes. A CEN Taskforce in close collaboration with the WHO network carefully analysed 70 classifications from the healthcare domain. All were transformed in ClaML using a dedicated classification management tool. The proposal removes all formatting elements and adds a number of layout structuring elements. Several elements have been replaced by attributes to enforce internal consistency. A modest number of extensions are proposed to help users and authors in maintenance and version control. A pilot implementation has shown that ICD10 as one of the most complex traditional classifications can be adequately represented to produce quality printed output.
The landscape of healthcare delivery and medical data management has significantly changed over the last years, as a result of the significant advancements in information and communication technologies. Complementary and/or alternative solutions are needed to meet the new challenges, especially regarding security of the widely distributed sensitive medical information. Digital watermarking is a recently established research area with many applications; nevertheless, the potential of this technology to contribute value-added services to medical information management systems has only recently started to be realized by the research community. The paper presents a review of research efforts in the area of medical-oriented watermarking and proposes a wavelet-based multiple watermarking scheme; this scheme aims to address critical health information management issues, including origin and data authentication, protection of sensitive data, and image archiving and retrieval. In accordance with the strict limitations applying to medical images, the scheme allows the definition of a region of interest (ROI) whose diagnostic value is protected, since the only additional information embedded therein aims at integrity control. The robustness of the method is enhanced through a form of hybrid coding, which includes repetitive embedding of BCH encoded watermarks. The experimental results on different medical imaging modalities demonstrate the efficiency and transparency of the watermarking scheme.
This paper is based on 4 years of practical experience with a developmental pre- Digital Imaging and Communications in Medicine (DICOM) picture archiving and communication system (PACS) plus analysis from the respecification study data for a DICOM/HTML PACS replacement. High-performance, but economic, workstations are required within PACS for radiologists to rapidly and accurately report images. For economic reasons such workstations should utilise standard landscape orientation monitors. They must have full Radiology Information System (RIS) integrated reporting functionality to optimise radiologists' work. The workstations must also be capable of displaying request data and both new and associated old images and image reports from multiple modalities. All images should be imported as "folders" according to semi-intelligent "knowledge table" based DICOM 3.0 standard Worklist control exerted by image management servers. This information can be obtained by relevant image lists and decision charts. A description of an optimal standard monitor workstation environment and related issues based on experience and literature review is given.
BACKGROUND: Absence of medical documents damages the quality of treatment and service. Despite the computerized medical folder, its use is still limited, and not all countries have a national health communications systems. That is why the patients are asked to bring with them the documents they hold. However, some patients lose the documents and others are uncooperative due to forgetfulness, and a lack of knowledge. OBJECTIVES: To examine how patients perceive, keep and manage medical documents. DESIGN: The research was conducted in the qualitative method. SETTINGS: A cardiology clinic, in a big medical center in Israel. PARTICIPANTS: A total of 28 patients suffering from ischemic heart disease and/or rhythm disorders. The sample was a convenience one, and were taken from the population visiting the Cardiology Clinic from May to October 2003. METHODS: Semi-structured interviews were held with the participants. The data were processed by means of content analysis. RESULTS: The findings indicate that, even though the participants expressed that it is the health system's responsibility to manage medical documents, most of them kept, and some even managed, their medical documents via a personal folder. By keeping documents and deciding to whom and when to show them the patient functions as a self-care manager. This made them more involved in their treatment and, they felt in control and empowered. CONCLUSION: Patient's attention to documents, as keeper and router, results in demonstrations of responsibility and involvement in treatment, consequently empowering the patient.
The purpose of this retrospective study is to ascertain the physiopathological characteristics of patients on parenteral nutrition (PN), the types of diet used and duration of treatment. Presentation of epidemiological results and evolution of 637 adults receiving PN after a five-year period of nutritional follow-up, conducted by a Nutrition Team (NT) in hospital. For the purpose of this study, we used the Follow-Up charts of all the patients treated with PN from 1986-1990. The results obtained lead us to affirm that most patients suffered a malignant gastrointestinal process, that the duration of the PN was reduced significantly during the five-year term, mainly using dietary protocols, and that there was a gradual increase in preparations of nutrient units subjected to controls compared to the total prepared by the Pharmacy Department.