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PubMedDate not supplied

Review of cefotaxime sodium for surgical prophylaxis. A model for the evolution toward single-dose or short-course cost-effective regimens.

Cefotaxime is a parenteral broad-spectrum cephalosporin, used extensively worldwide for chemotherapy of serious infections. Since its release in 1979, cefotaxime has also been studied to minimize surgery-related infections and, more than any other new compound, has been used in a volume of evaluable cases. Because of the current cost-containment medical practice environment, most cefotaxime prophylaxis studies have established single-dose or short-course regimens. Over 9000 published cefotaxime prophylaxis cases were reviewed, and 81 references were cited. Single-dose cefotaxime was clearly indicated for a wide variety of operations, including hysterectomy, cesarean sections, bone and joint procedures, upper gastrointestinal cases, biliary tract procedures, transurethral resections, open urologic procedures, and some vascular cases. Approximately 24 hr of prophylaxis (cefotaxime X 4 doses) may be required for colorectal resections, cardiac surgery, head and neck surgery, transplants, and some pediatric surgical cases. Although contaminated abdominal cases and trauma surgery were not a true prophylaxis use, cefotaxime regimens have reduced wound morbidity to less than or equal to 10%. Changing to one- to four-dose schedules will have very favorable clinical impact by reducing prophylaxis cost, pharmacy preparation time, adverse reactions, and antimicrobic-resistance pressures. Surgeons should not hesitate to employ new cephalosporins (cefotaxime and others) with proved limited dose indications that would greatly benefit their patients and the hospital environment.

Bacterial Infections↗

PubMedDate not supplied

Teleradiology technologies and some service models.

Teleradiology has become increasingly important in the managed care radiology practice environment. In order to fully appreciate the teleradiology operation, we have to understand the current technology available, some service models, and trade-off factors. This paper is organized in three parts. The first part is a review component of a teleradiology operation as well as state-of-the-art technologies. In the second part, we generalize several service models based on our past experience to illustrate the trend in teleradiology applications. The last part on trade-off factors is derived from field data. Four major factors (image capture, workstation, image compression and communication technology) balance a teleradiology operation in terms of cost, image quality, and turnaround time. The major issues in teleradiology yet to be resolved are patient confidentiality and image authenticity.

California↗

PubMedDate not supplied

Nurse empowerment through context, structure, and process.

Empowerment is most often conceptualized and measured from an individual perspective. Yet, in the nursing practice environment it requires a more comprehensive perspective. In this article the author requires a more comprehensive perspective. In this article the author proposes that nurse empowerment most likely occurs when there is a congruent linkage among a nursing vision, structural components that involve nurse participation, and the use of a process of inquiry. An empowerment quotient for nursing could be measured on a continuum for each of these three components.

Authoritarianism↗

PubMed2004

Laparoscopic cholecystectomy in geriatric patients.

BACKGROUND: The results and advantages of laparoscopic cholecystectomy in the geriatric population have received minimal attention. Several early reports related high conversion rates complications and mortality. This case series review is focused on the results of laparoscopic cholecystectomy in the geriatric population in a private practice environment. METHODS: The records of all patients undergoing cholecystectomy by the author over the past 12 years were reviewed. The entire series consists of 248 patients in whom 239 procedures were completed laparoscopically, with 9 patients converted to an open cholecystectomy. This report identifies 82 patients who were aged 65 years or older at the time of the laparoscopic cholecystectomy. The results of this series are reported in three progressive geriatric age groups: 65 to 74, 75 to 84, and 85 to 95 years. RESULTS: All 82 geriatric patients reported from this series were symptomatic from their gallbladder disease. A majority of all patients in all age groups were female. Gallstones were present in 77 patients, and 5 patients had a gallbladder ejection fraction of less than 35%. In this series of laparoscopic cholecystectomy, 26.8% had an emergent procedure for acute cholecystitis and the remainder had an elective or semielective procedure for symptomatic cholecystitis. The majority of patients between the ages of 65 and 84 years had elective procedures whereas the majority of patients over age 85 had an emergent procedure. There were 2 deaths. The first death (age 86 years) was from extensive metastatic cancer from the gallbladder, and the second patient (age 91 years) died of sepsis and multiple system organ failure. Each patient in this entire series had an attempt at laparoscopic removal of the gallbladder. The conversion rate was 3.6% in the entire series of 248 patients and also 3.6% in the geriatric series. Ninety-one percent of the patients in this geriatric series were discharged home after only 24 to 48 hours of postoperative observation. CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in the geriatric population. The procedure should be recommended for all geriatric patients who have symptomatic cholecystitis before the development of acute cholecystitis or severe fibrosis with dense adhesions from chronic cholecystitis.

Aged↗

PubMed2026

Comparison of summative assessments between simulated electronic health records versus traditional paper-based patient cases: A non-inferiority randomized controlled trial.

INTRODUCTION: Electronic health records are fundamental to contemporary pharmacy practice, yet evidence supporting their use in pharmacy education is lacking. This single-center, non-inferiority randomized controlled trial with blinded outcome assessment evaluated whether delivering patient cases via a simulated academic EHR (aEHR) was non-inferior to a traditional paper-based format in student exam performance. METHODS: 53 third-year PharmD students at the University of British Columbia were randomized 1:1 to complete a mock summative examination using either the aEHR or paper-based case delivery, stratified by self-reported EHR comfort level. The primary outcome was mean written exam score (%). Non-inferiority was pre-specified at a margin of 14%. Adjusted linear regression was used for the primary analysis, with a multiple imputation sensitivity analysis. Student perceptions were explored through post-exam focus groups analyzed using inductive thematic analysis. RESULTS: 42 students (21 per group) completed the exam and were included in the primary analysis. Mean scores were 66% (SD 11) in the aEHR group and 68% (SD 10) in the paper group. The adjusted mean difference (paper minus aEHR) was -2.2% (95% CI -9.2% to +4.8%), satisfying non-inferiority but not superiority. Sensitivity analysis (n = 53) yielded consistent results (-2.3%; 95% CI -7.1% to +4.1%). Focus groups revealed initial student anxiety with the aEHR but recognized its alignment with clinical practice. DISCUSSION: These findings support the feasibility of integrating simulated EHRs into summative pharmacy assessments without compromising performance. CONCLUSION: Simulated EHRs are a non-inferior assessment medium compared with paper-based formats and represent a viable step toward technology-driven pharmacy practice environments.

Humans↗

PubMedDate not supplied

Billing for psychiatric evaluations: options for coding and reimbursement.

The complexity of the current practice environment challenges clinicians to master complicated billing and coding regulations. Failure to properly bill and code can result in reduced potential revenue for services providers and, if improperly done, could lead to paybacks or penalties for the clinician. The purpose of this article is to assist psychiatrists in choosing the optimal coding for new evaluations and to understand the documentation requirements. Comparisons are provided between the "psychiatry codes" and the "evaluation and management" series. Details of required history, examination, and medical decision-making are listed in order to provide the tailed knowledge necessary to appropriately utilize some higher paying evaluation and management coding options for psychiatric evaluations.

Decision Making↗

PubMed2006

Supporting pre-registration students in practice: A review of current ICT use.

It is unclear how current healthcare students based in the United Kingdom (UK) use information and communication technology (ICT) to support their learning and care delivery in practice environments. This position reflects the dearth of current empirical evidence that needs development in this rapidly changing field. Using focus group interviews involving 16 students from nursing and the allied health professions, to reflect the interprofessional nature of healthcare education, this research explored how students employ technology in placement settings. The students drew on networked resources for personal learning and gave examples of use to meet patient and user needs. Technology also provided a vehicle for communication with the University, though use was complicated by a number of issues. Access to computers and the Internet whilst in placement environments proved problematic for some, with the culture not seeming to support ICT use. Lack of time, attitudes towards computers and ICT skills also affected student engagement. These findings provide information to guide the development of ICT use in placement settings.

Allied Health Personnel↗

PubMed2005

Factors affecting collaborative care between pharmacists and physicians.

BACKGROUND: To have a positive impact on patient outcomes achieved with drug therapy, it is likely that pharmacists will work more closely with physicians to manage medications collaboratively. Yet, little is known about the factors that will support such collaborative care between pharmacists and physicians. OBJECTIVE: The objective of this study was to identify significant influences on collaborative care between pharmacists and physicians, from the perspective of pharmacists. METHODS: Data were collected through a survey mailed to a national sample of 321 pharmacists identified by state pharmacy associations as being innovative practitioners. Three types of influences were assessed: individual characteristics, contextual factors, and exchange characteristics. Individual characteristics included demographics and a personality measure. Context variables included practice environment and professional interactions between pharmacists and physicians. Exchange characteristics were trustworthiness, role specification, and relationship initiation. Four items asked about the pharmacist's collaborative care with a physician. A hierarchical linear regression analysis was performed with collaborative care as the dependent variable and the individual, context, and exchange characteristics as the independent variables. RESULTS: One hundred sixty-six usable surveys (53.4%) were returned. About 64% of the respondents were male, with a mean age of 43.7 (SD+/-11.2) years. Linear regression analysis of the complete model produced an R(2)=0.805 (P<.001). Significant predictors in the model included the context variable, professional interaction, and the exchange characteristics, trustworthiness and role specification. CONCLUSION: Overall, the collaborative working relationship model largely explained collaborative care between pharmacists and physicians. Researchers are encouraged to use these findings when studying pharmacist-physician collaboration. In addition, pharmacists seeking to work with physicians should attend to developing trustworthiness and clarifying their clinical roles with physicians.

Adult↗

PubMed2005

Gaining hospital administrators' attention: ways to improve physician-hospital management dialogue.

BACKGROUND: Despite marked differences in training and professional interests, physicians and hospital managers face similar problems stemming from the unprecedented rate of change in the health care delivery system: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, increasing government and managed care regulations, heightened consumerism, and an aging patient population. In the face of these mounting challenges, both physicians and hospital managers could benefit significantly from a climate of collaboration and interdependence. METHODS: This article presents a "case report" of a community teaching hospital in which practicing physicians and hospital administrators collaborated to develop an operating plan for the next 3 years to improve the practice environment. RESULTS: The physicians recommended new clinical priorities to enhance service to patients and families, to improve physician-physician communication, to develop clinical protocols, and to build coordinated diagnostic treatment centers, which the administration has implemented. SIGNIFICANCE: Physicians and hospital managers can no longer pass on cost increases at will to patients and third-party payers. Nor can physicians and managers ignore the heightened power of patients and third-party payers. Effective dialogue and collaboration are in all parties' interests to optimize patient care and to develop innovative services. Despite the tensions created by competition and rapid change, transformation from a blaming to a learning environment may be a key strategic advantage in today's health care marketplace.

Advisory Committees↗

PubMed2000

Selecting the perioperative patient focused model.

The Project Team on a Perioperative Model was charged with finding or creating a theoretical model for perioperative nursing. Team members evaluated 15 existing theories and decided to use the conceptual model developed by AORN's Data Elements Coordinating Committee. The Perioperative patient Focused Model is logical, and the concepts and principles are supported in practice environments.

Decision Making↗

PubMed1996

Physician attitudes toward human immunodeficiency virus testing in pregnancy.

OBJECTIVE: Our purpose was to determine physician attitudes regarding voluntary versus mandatory status of human immunodeficiency virus testing in pregnant women. STUDY DESIGN: A questionnaire was sent to a sampling of the membership in District IX of The American College of Obstetricians and Gynecologists. Members were queried about experience with pregnant patients who were human immunodeficiency virus positive. Practice characteristics were sampled, as were experiences with antiviral agents in pregnant women. RESULTS: Physician attitudes were influenced by their type of medical practice environment. Bioethical considerations were further influenced by data reflecting zidovudine use in pregnant women. Two thirds of respondents favored mandatory human immunodeficiency virus testing of all pregnant patients. More than 90% favored public health reporting of all human immunodeficiency virus-positive patients. One quarter of respondents were not current on California human immunodeficiency virus codes. A persistent percentage do not offer human immunodeficiency virus counseling or testing. CONCLUSION: Considerable physician support exists for mandating human immunodeficiency virus testing in all pregnant patients as the primary means of decreasing maternal-fetal human immunodeficiency virus transmission and the considerable resulting costs.

Attitude of Health Personnel↗

PubMed1996

Making peer review statistically accountable.

BACKGROUND: The peer review process used in most hospitals is largely anecdotal, leading to criticisms about the objectivity of the methods employed. METHODS: The results of 1,500 consecutive abdominal operations performed by general surgeons working at three hospitals in a single community were reviewed. The outcome profile of each surgeon was compared statistically to the cumulative profile of the surgical community with adjustments for physiologic status of the patient, difficulty of the operation, and indications for surgery. RESULTS: A problem surgeon was thus identified whose poor results were significantly different from the rest of the surgical community and could not be explained on the basis of unfavorable patient mix or complexity of the procedures undertaken. CONCLUSIONS: Statistical comparison of a surgeon's outcome profile with those of his colleagues working in the same practice environment is suggested as an approach to the task of peer review that might prove preferable to the usual retrospective review of problem cases.

Abdomen↗

PubMed1997

Single-subject research in rehabilitation: a review of studies using AB, withdrawal, multiple baseline, and alternating treatments designs.

OBJECTIVE: To review the "methodologic rules" for using single-subject research designs (SSRDs) and to review the use of SSRDs in rehabilitation research of the past decade. DATA SOURCES: CINAHL and MEDLINE searches using "single subject" and "single system" as key words for the period 1985-1995 yielded 61 articles related to rehabilitation. STUDY SELECTION: Studies were selected for review if they described one of four commonly used SSRDs, specifically AB, withdrawal, multiple baseline, or alternating treatments. DATA EXTRACTION: Studies cited were identified by consensus and either exemplify adherence to the experimental rules of SSRDs or illustrate errors that result in threats to the validity of stated findings. DATA SYNTHESIS: All four types of SSRDs have been reported in rehabilitation studies, sometimes incorrectly. CONCLUSIONS: SSRDs, with their client-centered focus, are ideally suited for researching human behavior in the rehabilitation practice environment. Although numerous sources clearly identify the methodologic requirements for single-subject experiments, several studies violate the basic rules, threatening the validity of the results of these studies. Other properly applied SSRDs illustrate the strengths of this approach, which can produce empirical support for rehabilitation interventions.

Humans↗

PubMed1996

Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding.

BACKGROUND: It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner. METHODS: Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups. Groups I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an Iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour. Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 ml (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality. RESULTS: One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume. One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection. CONCLUSION: Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.

Adult↗

PubMed2003

Liquid chromatography-(tandem) mass spectrometry of selected emerging pollutants (steroid sex hormones, drugs and alkylphenolic surfactants) in the aquatic environment.

Among the various compounds considered as emerging pollutants, alkylphenolic surfactants, steroid sex hormones, and pharmaceuticals are of particular concern, both because of the volume of these substances used and because of their activity as endocrine disruptors or as causative agents of bacterial resistance, as is the case of antibiotics. Today, the technique of choice for analysis of these groups of substances is liquid-chromatography coupled to mass spectrometry (LC-MS) and tandem mass spectrometry (LC-MS-MS). In the last decades, this technique has experienced an impressive progress that has made possible the analysis of many environmental pollutants in a faster, more convenient, and more sensitive way, and, in some cases, the analysis of compounds that could not be determined before. This article reviews the LC-MS and LC-MS-MS methods published so far for the determination of alkylphenolic surfactants, steroid sex hormones and drugs in the aquatic environment. Practical considerations with regards to the analysis of these groups of substances by using different mass spectrometers (single quadrupole, ion trap and triple quadrupole instruments, etc.), interfaces and ionization and monitoring modes, are presented. Sample preparation aspects, with special focus on the application of advanced techniques, such as immunosorbents, restricted access materials and molecular imprinted materials, for extraction/purification of aquatic environmental samples and extracts are also discussed.

Chromatography, Liquid↗

PubMed2003

Digital imaging overview.

Digital imaging consists of digital acquisition modalities, image, and information management systems. All modalities are available to be purchased as digital acquisition devices. Image management has been the domain for PACSs. PACSs are complex systems designed to transmit, store, and display medical images. They use and rely on many types of different information and display technologies. The initial focus for PACSs has been on solving the engineering issues associated with the transfer of large image data sets and the suitability of softcopy displays for diagnosis particular to the human visual system. For operating within a centralized radiology department, these are largely solved. However, for enterprise wide dissemination and distribution, there are still challenges in the form of expedient transfer syntaxes and image quality, but these are also being effectively addressed. Information management is the domain of the RIS. One of the goals of radiology management should encompass the development of a robust practice environment that emphasizes workflow enhancements with seamless integration of decision support tools. The concept of "person-machine" systems emphasizes taking full advantage of both human and machine capabilities with a capacity to grow and change function. As the computer capabilities increase, more jobs can be relinquished to the machine. The physician can then focus on tasks that require more complex judgment and comprehension. The goal of this human-machine hybrid is to have more power than either of its components alone. This multifaceted role will most likely be embedded in the background having agents query and retrieve context specific information to be presented to the user. As augmenters of human talent, computers can turn data into information and information into knowledge. Medical imaging is a beneficiary of the information technology developments driven by the consumer and business sectors. Although these applications of information technologies are not a solution to every problem, it certainly can bring the radiology department much closer to the desired ideal operational model. Even though there are many challenges to overcome, the benefits derived from a successful RIS/PACS implementation can be instrumental toward achieving a level of excellence in clinical service, teaching, and research that is unrivaled. Strategies for change management and quality improvement should begin by considering the entire chain of events from image acquisition through display to communication of a report.

Computer Communication Networks↗

PubMed2003

Workplace violence in Alberta and British Columbia hospitals.

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical-surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.

Adult↗

PubMed1993

Veterinary lawsuits. Trends and defense strategies.

This article provides a synopsis of malpractice claims presented to veterinarians. An explanation of the coverages provided in a malpractice insurance program is included. The problems facing veterinarians in today's litigious practice environment are outlined. For example, attorneys representing animal owners present veterinary malpractice lawsuits similarly to medical malpractice litigation for the reason that "case law" regarding veterinary malpractice lawsuits is not readily available.

Animals↗