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At least 487 records · Page 27Linked to original sources

PubMed2005

Encouraging a systems approach for adherence to national asthma guidelines.

PURPOSE: There is a lack of information in the literature reflecting systems effects on adherence to national asthma guidelines. The purpose of this pilot study is to provide a descriptive account of the preparedness of academic primary care sites to follow national asthma guidelines related to spirometry, peak flow meters, standard history forms, severity assessment, follow-up assessment sheets, patient self-assessment sheets, and asthma action plan templates. METHODS: This was a cross-sectional descriptive study. A short survey was mailed to medical directors on behalf of primary care academic clinical sites to assess the availability of guideline tools in their practices. Medical directors were also asked to rate their perception of how essential the guidelines were in the management of asthma. RESULTS: Medical directors agreed that the guideline tools were essential in managing asthma. However, with the exceptions of peak flow meters and standard history forms, most sites were not equipped with these tools for providers to use. CONCLUSIONS: The findings highlight the importance of the practice environment on the implementation of national asthma guidelines and encourage larger studies to include an assessment of the systems in place to enable guideline adherence. By taking systems into account, interventions may be potentially much more effective in improving the quality of care.

Academic Medical Centers↗

PubMed1998

Characterization of a phosphotriesterase from genetically-engineered Escherichia coli.

A phosphotriesterase (PTE) capable of hydrolyzing organophosphate esters was purified from Escherichia coli strain DH-5 alpha carrying a cloned opd gene from Flavobacterium. The effects of pH, temperature and metal ion concentrations on enzyme stability and activity were investigated. Optimum conditions for PTE's catalytic activity were determined to be 35 degrees C and pH 8.5. Protein-metal equilibrium binding experiments showed that PTE could accommodate two equivalents of Co2+ or Zn2+ ions. PTE protein was found to have higher affinity for Co2+. In addition, Co2+ was found to possess the most positive effects in maintaining and restoring PTE's stability and catalytic activity when compared to other divalent metal ions. Assessment of the feasibility of PTE operation in a practical environment was performed in a system designed to mimic a continuously stirred tank reactor (CSTR) with different solution compositions in the flow reservoir. PTE was deactivated in 24 hours when the inflow solution contained 5% ethanol or 1 mM EDTA, while it retained one third of its initial activity in a deionized water stream. When the inflow solution contained 1 mM Co2+, PTE was found to retain activity throughout the 24-hour experiment.

Aryldialkylphosphatase↗

PubMed2003

A non-viral gene delivery system designed for clinical use.

Gene delivery can be accomplished using non-viral systems, and these have received increased attention These include ex vivo transfection of cells using an electric field to induce transient cell-membrane permeability (electroporation). This approach has the distinct advantage of not requiring the inclusion of a secondary agent (e.g. a lipid, viral package or carrier protein) any of which can be immunogenic or toxic. Available electroporation systems utilize a low volume (<1 mL) processing chamber and are open systems. The MaxCyte system employs a continuous flow design and can very rapidly process volumes ranging from 0.02 mL to >1 L. Transgenes for markers (eGFP) and functional proteins (e.g., cytokines, angiogenic factors) have been loaded in plasmids up to 14 kB in size. With appropriate application of pre- and post-processing cell manipulations, very satisfactory loading efficiencies and cell viability have been obtained. Cells can be processed with multiple plasmids, resulting in expression of the corresponding number of gene products. This capability has been considered for therapeutic and bioprocessing applications. The MaxCyte system was designed specifically for ex vivo clinical applications. The electrodes are manufactured of special materials and under precise conditions, in order to eliminate potential risks from electrolytic effects. The processing chamber and associated containers can be provided as disposable, sterile, closed (or functionally closed) systems-quite similar to the disposable harnesses used with cell separators. This system is thus suitable for integration into a current good manufacturing practice environment.

Clinical Trials as Topic↗

PubMed2004

Mathematical-statistical models of generated hazardous hospital solid waste.

This research work was carried out under the assumption that wastes generated from hospitals in Irbid, Jordan were hazardous. The hazardous and non-hazardous wastes generated from the different divisions in the three hospitals under consideration were not separated during collection process. Three hospitals, Princess Basma hospital (public), Princess Bade'ah hospital (teaching), and Ibn Al-Nafis hospital (private) in Irbid were selected for this study. The research work took into account the amounts of solid waste accumulated from each division and also determined the total amount generated from each hospital. The generation rates were determined (kilogram per patient, per day; kilogram per bed, per day) for the three hospitals. These generation rates were compared with similar hospitals in Europe. The evaluation suggested that the current situation regarding the management of these wastes in the three studied hospitals needs revision as these hospitals do not follow methods of waste disposals that would reduce risk to human health and the environment practiced in developed countries. Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching, private). In these models number of patients, beds, and type of hospital were revealed to be significant factors on quantity of waste generated. Multiple regressions were also used to estimate the quantities of wastes generated from similar divisions in the three hospitals (surgery, internal diseases, and maternity).

Environmental Monitoring↗

PubMed2004

QT-screen: high-throughput cardiac safety pharmacology by extracellular electrophysiology on primary cardiac myocytes.

Cardiac safety pharmacology focuses mostly on the drug-induced prolongation of the QT interval in the electrocardiogram. A prolonged QT interval is an important indicator for an increased risk of severe ventricular arrhythmia. Guidelines demand safety tests addressing QT prolongation in vitro and in vivo before a drug enters clinical trials. If safety risks will be detected not until an advanced stage of preclinical drug development, a considerable sum of money has already been invested into the drug development process. To prevent this, high-throughput systems have been developed to obtain information on the potential toxicity of a substance earlier. We will discuss in this publication that the QT-Screen system, which is based on primary cardiac myocytes, is able to provide a sufficient throughput for secondary screening. With this system, extracellular field potentials can be recorded from spontaneously beating cultures of mammalian or avian ventricular cardiac myocytes simultaneously on 96 channels. The system includes software-controlled and automated eight-channel liquid handling, data acquisition, and analysis. These features allow a user-friendly and unsupervised operation. The throughput is over 100 compounds in six replicates and with full dose-response relationships per day. This equals a maximum of approximately 6,000 data points per day at an average cost for consumables of 0.20 US pennies (U.S.) per data point. The system is intended for a non-good laboratory practice-compliant screening; however, it can be adapted to be used in a good laboratory practice environment.

Action Potentials↗

PubMed1997

Sources of data for pharmacoepidemiological studies of child and adolescent psychiatric disorders.

In view of the dramatic shift to managed care models for United States health care delivery, reliable information on the prevalence and variations in psychopharmacological drug therapies for youth in community practice settings is essential. Pharmacoepidemiology, the study of medication use in large populations, aims to accomplish that challenging task. This article offers child psychopharmacologists a brief introduction to data sources for pharmacoepidemiology. Knowledge of these data sources combined with epidemiological methods for data analysis is a beginning step to assess the psychotropic medication prescribing patterns of community physicians. This review is organized in the following sequence: (1) characteristics of the "usual practice environment" according to setting, patient population, and physician characteristics; (2) validity issues related to data sources and their potential for outcomes research; (3) data sources divided into primary and secondary types that are described in terms of their features, advantages, and limitations, followed by examples of selected applied studies using such information; (4) procedures for analyzing secondary data; (5) data analytic and longitudinal approaches; and (6) access, confidentiality, and funding. A goal for future investigators in this emerging field is to develop applied research that is clinically sophisticated, methodologically sound, and public health-minded.

Adolescent↗

PubMed1995

Technical considerations in planning a distributed teleradiology system.

A large-scale teleradiology project is under way to link a Florida imaging center to the UCLA Department of Radiology. The initial goal is to provide Florida patients in a routine clinical practice environment with subspecialty consultation by academic radiologists. The plan then calls for the addition of other domestic and international sites. Technical issues in planning to establish the necessary teleradiology infrastructure include wide area network design, image compression, distributed archiving, and special viewing station features. Special emphasis is placed on archive design that makes intelligent use of information, such as triggering events from the radiological information system (RIS) for image prefetching and visual cues from photo-icons for full-size image retrieval. Concepts such as teleconsultation and remote procedure monitoring are aimed at providing the same level of services at distant sites that would be available in-house. This article highlights the system design parameters that must be considered to engineer a scalable distributed teleradiology system.

California↗

PubMed1999

Adding values: an experiment in systematic attention to values and preferences of community long-term care clients.

OBJECTIVES: We tested the effects of providing case managers with tools to assess and respond to client values and preferences on their subsequent knowledge of clients' values and their practices in arranging long-term care. METHOD: Using a quasi-experimental design with newly enrolled, cognitively intact clients, we compared case managers, clients, and care plans at the experimental and control agency. RESULTS: Three weeks after enrollment, experimental clients were significantly more likely to report that case managers had asked them about their own preferences and offered them choices about services. Actual client values reported at the 3-month follow-up were similar for the two groups, with experimental case managers only slightly more accurate judges of their clients' responses to values questions. At follow-up, experimental case managers reported more case activity tailoring plans to client preferences, a finding confirmed by record reviews. Client acuity, measured by ADL functioning and prior hospital use, was associated with less perceived discussion of client preferences during the initial care planning process, but more case activity related to client preferences during the first three months. DISCUSSION: The study suggests it is possible to sensitize case managers to the importance of assessing and acting on client values. Getting them to do so consistently, however, may require changes in the practice environment.

Activities of Daily Living↗

PubMed2002

Primary care for elderly people: why do doctors find it so hard?

PURPOSE: Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. DESIGN AND METHODS: We conducted in-depth interviews with 20 primary care physicians. Using an iterative approach based on grounded theory techniques, a multidisciplinary team analyzed the content of the interviews and developed a conceptual model of the difficulty. RESULTS: Three major domains of difficulty emerged: (i) medical complexity and chronicity, (ii) personal and interpersonal challenges, and (iii) administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician's training and personal values, shaped the experience of providing care and how difficult it seemed. IMPLICATIONS: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education. The voices of these physicians and the model resulting from our analysis can inform such change.

Adult↗

PubMed1999

A critical appraisal of the draw and write technique.

The draw and write technique is increasingly popular in health education research with children. It is generally employed in the setting of the school classroom and is promoted as a 'bottom-up' approach which enhances participation by children. In this paper we critically appraise the use of this method. Against the background of a consideration of carrying out qualitative health promotion research with children we examine the origins and use of children's drawings in a number of disciplines and practice environments. We argue that, although the draw and write technique has made an important contribution to health education research, it fails to reflect the processes involved in the construction and collection of such data. A range of methodological, analytical and ethical issues are raised. We conclude that health education research with children must involve taking children seriously as social actors and query the assumption that drawing enables children to communicate their thought any more than does conversational language. We suggest that the development of research should be premised upon an appreciation of the social context and the world of the child.

Child↗

PubMed1986

Clinicians' use of research findings. A review of literature with implications for physical therapists.

The purpose of this paper is to review the literature regarding research utilization by human service professionals, discuss factors that may contribute to utilization, describe recommendations that have been suggested to increase research utilization, and make suggestions for future investigations about research utilization by physical therapists. The literature suggests that research information is not used routinely by human service professionals. The nature of research communication, the training and personal characteristics of human service professionals, and the practice environments of human service professionals, such as physical therapists, probably influence the degree to which research is utilized. Specific interventions may be effective at increasing research utilization by physical therapists. A number of possible research methods are available for evaluating the present state of research utilization by physical therapists and the effects of interventions on this utilization.

Attitude of Health Personnel↗

PubMed2000

Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery.

BACKGROUND: Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting. METHODS: Ninety-three consenting adult outpatients undergoing anorectal surgery were randomly assigned to one of three anesthetic treatment groups: group 1 received local infiltration with a 30-ml mixture containing 15 ml lidocaine, 2%, and 15 ml bupivacaine, 0.5%, with epinephrine (1:200,000) in combination with intravenous sedation using a propofol infusion, 25-100 microg. kg-1. min-1; group 2 received a spinal subarachnoid block with a combination of 30 mg lidocaine and 20 microg fentanyl with midazolam, 1-2-mg intravenous bolus doses; and group 3 received general anesthesia with 2.5 mg/kg propofol administered intravenously and 0.5-2% sevoflurane in combination with 65% nitrous oxide. In groups 2 and 3, the surgeon also administered 10 ml of the previously described local anesthetic mixture at the surgical site before the skin incision. RESULTS: The mean costs were significantly decreased in group 1 ($69 +/- 20 compared with $104 +/- 18 and $145 +/- 25 in groups 2 and 3, respectively) because both intraoperative and recovery costs were lowest (P < 0.05). Although the surgical time did not differ among the three groups, the anesthesia time and times to oral intake and home-readiness were significantly shorter in group 1 (vs. groups 2 and 3). There was no significant difference among the three groups with respect to the postoperative side effects or unanticipated hospitalizations. However, the need for pain medication was less in groups 1 and 2 (19% and 19% vs. 45% for group 3; P < 0.05). Patients in group 1 had no complaints of nausea (vs. 3% and 26% in groups 2 and 3, respectively). More patients in group 1 (68%) were highly satisfied with the care they received than in groups 2 (58%) and 3 (39%). CONCLUSIONS: The use of local anesthesia with sedation is the most cost-effective technique for anorectal surgery in the ambulatory setting.

Adult↗

PubMed1994

Comments on the AAMC policy statement recommending strategies for increasing the production of generalist physicians.

The United States has a physician specialty imbalance, primarily a shortage of generalists (defined as family physicians, general internists, and general pediatricians) relative to other specialists. In recent years, the rising costs of health care, the expansion of managed care, and problems of access to care have accentuated the critical role that generalists must play in a cost-effective, accessible health care system. Despite numerous public and private initiatives designed to address the supply of generalist physicians, the ratio of generalists to specialists has been decreasing. Although the factors contributing to the shrinking proportion of generalists are many and are often outside the control of educators, there is evidence that medical schools can play a major role in influencing specialty choice. Recognizing the need to address the specialty imbalance in this country, the Association of American Medical Colleges (AAMC) appointed the Generalist Physician Task Force to develop a statement suggesting actions that the AAMC and its constituents could take to foster a greater representation of generalist physicians in the United States. The task force produced an Executive Summary, published as an AAMC policy statement in early 1993, that contained recommended strategies for medical schools, graduate medical education, and the practice environment. The authors of the present article critique these recommendations, provide a background and rationale for each of them, and give suggestions about how some of the recommendations might be implemented. While they are in general agreement with the AAMC policy statement, they feel the recommended strategies fall short of the need. They maintain that the AAMC statement represents an admirable but cautious approach to a daunting problem, and that the time is past when cautious approaches will suffice. The authors conclude with the hope that bolder initiatives will emerge from the new AAMC Office of Generalist Physician Programs.

Academic Medical Centers↗

PubMed1995

The kaleidoscope of general internist careers: a challenge for internal medicine training.

As internal medicine residency programs struggle to produce general internists in greater numbers and assure that they are adequately prepared for practice, it is imperative that the graduate medical education system have a clear picture of what competencies will be expected of those entering general internist careers. Feedback from the practicing community and large managed care organizations in Minnesota has made it clear that general internists in that state are functioning in a variety of positions requiring a wide range of skills depending on the practice description, choice of practice setting, and the complement of other primary care providers. General internists functioning in nontraditional careers have special curricular needs. It is imperative that training programs constantly monitor the changing practice environment and stay current on the variety of new generalist career choices to adequately prepare their residents for generalist careers. The graduate medical education enterprise needs to be involved in determining the best teaching strategies for the broad range of ambulatory general medicine competencies and in determining how best to preserve the richness of the medical subspecialty experience critical to the training of excellent general internists.

Career Choice↗

PubMed1998

Developing curricula in spirituality and medicine.

In recent years patients and some members of the medical community have expressed the concern that doctors have forgotten about compassion and too often ignore their patients' spiritual concerns. Patients can and should expect their physicians to respect their beliefs and be able to talk with them about spiritual concerns in a respectful and caring manner. Medical schools must teach their students how to meet these expectations, and health care systems need to provide practice environments that foster compassionate caregiving. Medical educators are recognizing the need to bring the art of compassionate caregiving back into the medical school curriculum. This paper focuses on one approach to achieving this goal, the study of spirituality and medicine. The authors discuss the relationship of spirituality and healing, and describe studies that have shown patients' desire to have spiritual issues addressed by their physicians and the potential health benefits of spiritual beliefs. Finally, they describe common elements of the spirituality courses offered by approximately 50 U.S. medical schools, including 19 schools that have been awarded grants from the National Institute for Healthcare Research for the development of curricula in spirituality and medicine.

Curriculum↗

PubMed1995

Differences in professional practice model outcomes: the impact of practice setting.

Over the past several years, involvement strategies such as professional practice models and shared governance strategies have been implemented in a variety of nursing practice settings. This article reviews the results of a secondary analysis of an evaluation of a professional practice model at a large academic medical center. This review compares critical care and general acute care nurses in terms of their perceptions of and satisfaction with work in a professional practice environment and identifies and contrasts significant predictors of general job satisfaction and turnover intent within the two groups. Implications of differences in outcomes in different settings are explored.

Humans↗

PubMed1993

Dose quantities and instrumentation for measuring environmental gamma radiation during emergencies.

The dosimetry for exposure to gamma radiation in the environment is reviewed, including the factors used to convert measurements of traceable quantities to effective dose equivalent. A value of 0.70 Sv Gy-1 is widely used to convert air kerma or absorbed dose-to-air to effective dose equivalent, but recent work shows that a value of 0.86 Sv Gy-1 is more appropriate for deposited radionuclides. The arguments are reviewed and the implications of using operational dose equivalent quantities defined by the International Commission on Radiation Units and Measurements are considered. For planar deposited sources in the environment, it is shown that the use of ambient dose equivalent quantities without applying conversion factors, could significantly overestimate effective dose equivalent. In contrast, the adoption of the new effective dose quantity defined by the International Commission on Radiological Protection in Publication 60 will have a small impact on conversion factors for gamma radiation in the environment. Practical aspects of measurement are also considered, and five instruments suitable for measuring environmental gamma radiation have been evaluated in the laboratory and in field tests. The instruments include models with scintillation detectors, a Geiger-Müller detector, and a high-pressure ionization chamber, the choice being influenced by those commonly used in European Community countries for routine and emergency monitoring. The main disadvantage of all the instruments is the lack of spectral information, so a straightforward emergency instrument capable of discriminating between natural and artificial radionuclides has also been evaluated.

Accidents↗

PubMed1991

Productivity: a context for excellence.

Inductively created measures of the sort described above enable the ambulatory care manager to make a crucial decision: Are the outcomes worth the cost involved? As Collins (1988, p. 235) notes, "Our nursing product is quality care based on principles and standards of practice... and substantiated and enhanced through quantifying our practice." By using nursing resources wisely, we can "moderate the march on the market...for caring and access of what we are here for" (Cunningham, 1983, p. 90). In relaying her feelings during treatment for a malignant breast tumor, Kaufman (1989) supports the contention that caring and access are essential parts of a therapeutic regime. Curtin (1987, p. 7) warns that "You cannot provide health care by taking the care out of it." This project allowed nurses to create their own measurement system that identified and quantified the professional nursing tasks involved in each workload indicator. Nonprofessional activities were also identified, quantified, and delegated to appropriate levels of staff, thus increasing the control of the nurses over their own practice environment. In the words of Curtin (1987, p. 7), "Losers count time to make heads roll. Winners use their heads to make time count. This country cannot afford to place its health in the hands of losers."

Ambulatory Care Information Systems↗