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PubMed2006

Drug use in a geriatric long-term care setting: comparison between newly admitted and institutionalised patients.

BACKGROUND AND OBJECTIVE: Advanced age, co-morbid diseases, functional dependence and frailty are associated with polypharmacy and overall high health expenditures. Polypharmacy is commonly defined as the concomitant ingestion of four or more medications, particularly in community-dwelling patients, but the number of drugs being taken by institutionalised and hospitalised patients may be as high as ten. The aim of this study was to compare drug use in newly admitted patients (AP) to a geriatric medical centre for long-term care (LTC) with that of institutionalised patients (IP) at the centre. METHODS: A cross-sectional study was conducted, between January 2001 and December 2002, in 324 functionally dependent and cognitively impaired elderly patients (> or = 65 years of age), consisting of 167 IP (127 females, 40 males) staying at the centre for > or = 3 months and 157 (117 females, 40 males) consecutive new admissions for LTC. All patients underwent a comprehensive geriatric assessment, which included a structured medical history, history of drug use, physical examination and functional and cognitive examinations. Overall drug use, drug categories and the basis of use (regular and/or as needed) were compared between the two groups of patients. The pattern of drug use was defined as use of drugs either on a 'regular' basis or on an 'as needed' basis at any time during the 3 weeks preceding the comprehensive geriatric assessment. RESULTS: IPs were younger, more dependent, more cognitively impaired, had more co-morbidity and had nonsignificantly higher overall drug use than APs. APs used drugs mainly on a 'regular' basis. All of the IPs and most (97%) of the APs were taking drugs according to regular regimens. However, advanced age in IPs was associated with lower overall drug use, predominantly of medications taken on a 'regular' basis, and higher use of drugs taken on an 'as needed' basis, whereas in APs, advanced age was associated with higher use of both types of medications. CONCLUSION: IPs used more drugs on an 'as needed' basis, probably because of closer medical supervision of these patients than those in the community. Better knowledge of the patient's medical condition and treatment, together with better monitoring in the community through patient caregiver instruction, on the one hand, and computerisation of medical data accessible to all healthcare providers, on the other hand, might reduce drug use on a regular basis and, consequently, the costly and adverse effects of polypharmacy.

Aged↗

PubMed2003

Assessment of Markov-dependent stochastic models for drug administration compliance.

OBJECTIVE: There are few analytical results that describe patient compliance with drug administration regimens. The purpose of this paper is to develop and assess stochastic approaches for mathematical modelling of patient compliance with administration regimens. METHODS: Two stochastic models based on Markov-dependent random variables and on the Ising model were assessed for their ability to describe the variable nature of drug compliance. RESULTS: Both models use only experimentally accessible data, and their predictions were tested against published clinical compliance data obtained from electronic monitoring devices. The models satisfactorily fitted administration interval distribution data from several patients treated with diltiazem, a calcium channel antagonist, or zidovudine, an antiretroviral agent. The Ising model provides additional analytical expressions for the distribution of success runs and 'drug holidays' in administration regimens. These distribution predictions were tested with success run data for diltiazem and drug holiday data for two nonsteroidal anti-inflammatory drugs, piroxicam and tenoxicam. CONCLUSIONS: Stochastic models can provide useful insights into drug compliance, and can be used to identify the administration patterns that are more likely to occur during drug self-administration in populations.

Algorithms↗

PubMed1995

Value of on-line informational databases in a radiology department.

Radiologists and ancillary personnel in a radiology department frequently access a variety of paper-based information during their workday to facilitate decision making. This information can be as mundane as telephone numbers and work schedules or as important as a detailed emergency procedure for treating a patient with a severe contrast reaction. We have installed some hierarchical, textual database systems on the same computer that runs our radiology information system. Several different databases are maintained, including protocol manuals, emergency procedures, and a directory of telephone and pager numbers. This information is accessible from any terminal connected to our radiology information system and from any personal computer connected to our department's local area network or terminal server. Advantages include decreased costs from the photocopying, consumption, and distribution of paper; ubiquitous access for all users to a single source of information; faster and more powerful ways to access data than paper-based media provide; decreased risk of inadvertently using information from an obsolete document; and convenience in maintaining computerized versus paper-based information. Because we use software that is either free or that came with our computer's operating system, no additional software costs were involved.

Online Systems↗

PubMedDate not supplied

Unimage, a new RIS for the DIOGENE 2 environment at Geneva Cantonal University Hospital.

The effective management of a radiology department depends on adequate computing tools for imaging specialists--radiologists and technicians--and administrators. The rapid evolution of imaging techniques in radiology requires flexible systems for describing the daily operation of a service and accessing data generated by every possible source. In order to compensate for the insufficiencies of our current radiology information system (RIS), and within the framework of the migration towards the DIOGENE 2 hospital information system, a new RIS, named Unimage, has been implemented at the Cantonal University Hospital of Geneva. Unimage has been designed not only to fit the current and future needs of the radiology department, but also to operate in different services, i.e. diagnostic radiology, nuclear medicine and therapy radiology. Among its functionalities, Unimage offers a simple two-way data communication with the PACS world. The technical choices we have made in the design of the new RIS include a distributed environment, as well as a graphical (X/Motif) user interface. The main functionalities and the technical implementation of Unimage are described in this paper.

Appointments and Schedules↗

PubMed1993

Saccadic overhead: information-processing time with and without saccades.

Information-processing time was compared for serial and spatially distributed visual presentations with performance measures that permit the separation of total time into its during-display and post-display components. For all subjects, there was a significant saccadic overhead, that is, less time was required with the serial format, which allowed data access without eye movements. However, the magnitude of the overhead decreased as task complexity increased. All subjects were able to exercise some control over the distribution of total processing time, trading off short during-display times with longer post-display times and vice versa.

Adult↗

PubMed1987

Unlocking information technology.

Computer technology has made vast quantities of information more readily available through accessible data bases. This article discusses the use of information technology and some of the problems that have prevented it from being more widely used. Also included is information on some rehabilitation-related data bases.

Computer Literacy↗

PubMed1990

Microwave/satellite relays.

The intent of this article is to show examples of how microwave/satellite relays can be used in the design of public-safety communication systems. It's important to keep in mind that microwave/satellite relays are used to move information from one location to another. Information can be two-way-radio voice traffic, paging and data access. There are many other applications that can utilize microwave satellite relays, but they are beyond the scope of this article. Ultimately, microwave/satellite relays should be considered a resource that can greatly enhance both public-safety and EMS responsiveness.

Disaster Planning↗

PubMed1990

Demographics, strategic planning, and marketing: a low budget approach.

Health care organizations with constrained planning budgets can access data sources which will be of great assistance in strategic and market analysis. The data described in this article can be obtained for $250 or less. For segmenting the market even further, down to the International Classification of Disease (ICD)-9 Code Level, the National Center for Health Statistics of the Department of Health and Human Services publishes an annual data book which indicates the use rates for every ICD-9 Code. This extremely valuable data source is all less than $10. Managers can take inexpensive data from the Census and from HHS and proceed to determine major opportunities and challenges facing their institutions. The same data then serve as the basis for planning about how to meet those challenges or take advantage of those opportunities. Finally, the same data will allow product line management to proceed on the basis of quantitative goals that are established in terms of the actual facts of the local situation. The skills required to perform these analyses are not complex, but the task is time intense.

Data Collection↗

PubMed1993

Innovations in anesthesia pre-screening through data systems and telecommunications.

In summary, the anesthesia pre-screening concept along with the supporting computer systems allow for fingertip nursing informatics, data collection, and retrievability, providing the continuity of care so emphasized in health care today. Departmental efficiency is maximized in both processing and communicating the patient information for the caregivers through the up-to-the-minute accuracy and safety built into the data system. At this point in APS implementation, the scope of cost-savings has yet to be fully identified, yet the perception is that it is quite substantial. At the same time, recent research results confirm our hypothesis that the personal touch provided by APS phone screening and individual case management has improved patient safety, convenience, and satisfaction along with overall effectiveness. Since the CAPS system will grow in scope and complexity over the next few years, the system will be migrated to a clientserver configuration. Although "client-server" may be an overused term, its potential for improved data accessibility, integrity, and raw processing throughput is great once the field solidifies in this area. The addition of graphical user interfaces and natural language facilities will further enhance the ease of use of the system. In the near term, an on-line version of the Physician's Desk Reference will be added for use during patient calls. This computerized version offers speed as well as a more comprehensive searching ability as opposed to its tree-based cousin.

Anesthesia Department, Hospital↗

PubMed1994

Preparing for the JCAHO survey.

In summary, the future success of a health care organization's ability to meet changing JCAHO standards will be dependent on the integration of information throughout the organization. The growing demand for reliable and accessible data for all levels of staff has become a daily need in health care. One of the key questions that will be posed by future JCAHO surveyors will center on current abilities to integrate and send information from a variety of sources to those who need the data within the organization. Many organizations are planning and implementing strategic plans to create linkages between existing information systems and further the overall systems knowledge of all staff.

Accreditation↗

PubMed1996

Information technology, Part 3. The technology hierarchy.

The era of the networked society--and medical care depending on networked intelligence--is dawning. Physicians need to plan for office practice information systems in common, with an eye to conveying data electronically between all the locations of care and all the providers involved in caring for defined populations of people. The shared database will become the most important asset of the collection of providers who make up the delivery system that creates it. This will be accomplished by layering technology on local and wide-area networks of group practices, hospitals, health plans, and payers and developing standards that make data accessible in the same format to all users, no matter where they are.

Computer Communication Networks↗

PubMedDate not supplied

Repeatability and reproducibility of germicide tests: a literature review.

The results of a quantitative antimicrobial assay can be summarized by the log reduction value. For an assay to be proposed as a standard method, it is usually necessary to conduct a collaborative study to demonstrate that the repeatability and reproducibility standard deviations (SDs) of the log reduction values are sufficiently small. It is not clear, however, precisely how small those SDs should be. This paper describes the results of a literature review conducted to determine the range of repeatability and reproducibility SDs for standard quantitative antimicrobial assays. The underlying premise is that, for an assay to have been accepted as a standard method, its repeatability and reproducibility SDs must have been sufficiently small. This premise implies that the repeatability and reproducibility SDs of standard assays establish de facto guidelines for acceptability. The survey comprised papers where the SDs could be extracted directly or where they could be calculated from accessible data. Papers describing suspension tests as well as hard surface tests were included. For the standard antimicrobial assays reviewed, repeatability SDs ranged from 0.25 to 1.21 and the reproducibility SDs ranged from 0.31 to 1.54.

Anti-Bacterial Agents↗

PubMed1983

Survey-based indices for nursing home quality incentive reimbursement.

Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of implementation issues.

Abstracting and Indexing↗

PubMed1998

Hospital management decision support: a balanced scorecard approach.

Hospital management teams receive voluminous data from a wide variety of sources, but are unable to distill the essential data they require to make good decisions. We have used a methodology, which helps teams define and use important management data coupled with an information system that makes this data accessible. Results of our evaluation indicate that the process of developing a Balanced Scorecard indicator system helps management teams to define meaningful strategic objectives and measurable performance indicators. The framework combined with the information acts as an integrating force, providing a shared understanding of the unit's goals. We conclude that a customized decision support system, which integrates multiple measures in a balanced Scorecard framework, is a powerful tool for enabling complex decision making by a management team.

Cardiovascular Diseases↗

PubMed1999

Applications of forensic identity testing in the clinical laboratory.

DNA analysis is becoming routine in the clinical laboratory for the diagnosis of human diseases using various tissue sources. Most clinical specimens are followed by tracking forms that include patient demographic data, accession number, and date and time of collection. As part of a thorough quality assurance program, proper documentation of test requisitions and tracking forms is mandatory. Despite these efforts, specimen mislabeling or other mix-ups can, and do, occur. We demonstrate the utility of the PM + DQA1 typing kit and STR analysis using the Visible Genetics automated DNA sequencing system in the proper identification of such clinical specimens as urine, blood, and paraffin-embedded tissues. In each case, sufficient DNA was extracted from these specimen types using a nonorganic extraction protocol for typing purposes. We conclude that DNA typing methods are feasible for distinguishing clinical laboratory specimens of questionable identity and compliment existing quality assurance techniques.

Blotting, Southern↗

PubMedDate not supplied

Laparoscopic partial pericystectomy of Echinococcus granulosus cysts in the liver.

Laparoscopic partial pericystectomy is a promising new therapeutical approach in surgery of hydatid liver disease. In combination with a review of the published results of laparoscopic therapy for hydatid disease the actual relevance of this technique should be defined. Together with our own experience with this technique we evaluated all patients with hydatid liver disease from Echinococcus granulosus published in literature operated either by pericystectomy or by partial pericystectomy. The review was projected as a search over DIMDI data access. This technique is practicable without increasing the risk of intraabdominal spillage of scolices if well-known security criteria are respected. Additional training is not necessary. Laparoscopic treatment of Echinococcus multilocularis is not possible yet, as complicated liver resections may be required for these patients. Hydatid hepatic cysts of E. granulosus however may be operated upon laparoscopically and do not necessarily require open surgery. While working under visual control minimal invasiveness is achievable and post-operative hospital stay can be reduced. This new technique is a feasible method, especially regarding obese patients, but on the other hand it is limited by a laparoscopically inaccessible intrahepatic localization (Segments IVa, VII, VIII and small centrally located cysts).

Echinococcosis, Hepatic↗

PubMed1999

Health systems consortium puts benchmarking online.

Putting benchmarking projects on the Web. A national consortium of health systems is moving its clinical benchmarking projects to the Worldwide Web so members can access data immediately. Find out what's online now and how a typical consortium benchmarking project works.

Academic Medical Centers↗

PubMed1999

[Natural histories of disease: a pragmatic approach to multidisciplinary research on health care seeking behavior and therapeutic itineraries].

Public health is determined by the interaction of social, cultural and biological factors. Because of this complexity, a multidisciplinary approach is needed when doing research on public health problems. Medical anthropology and epidemiology share a common interest for human behavior and health, so it is especially appropriate for these two disciplines to work together in studying health seeking behavior and the use of health systems. In order to better understand social and cultural factors associated with health seeking behavior, a suitable qualitative research method was needed for use in association with a medical and epidemiological approach in the research program "Use and perception of health systems by children and their family", carried out in Algeria, the Congo (Brazzaville), Morocco, and Togo. Three factors were considered important: coordinating the qualitative and quantitative research methods within a single time frame, involving all members of the multidisciplinary research teams in each country, and producing data accessible and useful to health care professionals and others responsible for health system performance. A case study method based on "natural histories of illness" was adopted, using home interviews of families about a recent illness episode of an under-5 child. There are several advantages to this approach: 1) analysis of illness episodes reveals the totality of the health seeking process, including therapeutic itineraries; 2) families have little difficulty in describing an illness episode in the order events occurred; 3) these accounts are easily understood by health professionals, resembling as they do a "clinical case study" approach; 4) the content is readily available in the form of common discourse for use by health program planners and administrators. The method is thus able to provide information necessary for organizing health services which meet the perceived needs of the population.

Algeria↗