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At least 55 records · Page 3Linked to original sources
PubMed1990

Analyzing clinical case distributions to improve an emergency medicine clerkship.

Recommendations for a core curriculum for undergraduate emergency medicine education have been published. It is expected that a combination of bedside teaching and didactic sessions will cover all aspects of the curriculum, but this has not been demonstrated. This study describes a method of using the distribution of clinical cases to shape the mix of clinical and didactic learning in an emergency medicine clerkship. All senior students at the Albany Medical College participate in a four-week emergency medicine rotation. A brief log describing each clinical encounter is maintained by the students. Data from one year were sorted into 32 categories adapted from American College of Emergency Physicians guidelines and were tabulated. A criterion of 80% of students encountering at least one case in each category was chosen to ensure a reasonable level of exposure to a particular case or topic. One hundred twenty-three students were exposed to an average of 63.7 +/- 27.5 (SD) patients. Seven categories met the criterion, and the remaining 25 categories failed the criterion. Results indicate that exposure to certain categories of patients with appropriate monitoring can be reasonably ensured in our clinical setting. The didactic portion of the curriculum can be adjusted so that categories not meeting the clinical criterion will be emphasized, whereas those meeting the criterion will be de-emphasized. A method has been described that identifies gaps in the clinical exposure of students and permits appropriate identification of didactic sessions to create a clerkship more consistent with recommended guidelines.

Clinical Clerkship↗
PubMed1990

Distributive and clinical activity measurement using spreadsheet software.

Documentation of distributive and clinical activities is an important factor in maintaining and expanding pharmacy services. In order to illustrate the impact of pharmacists' efforts on risk management and the reduction of drug costs, the pharmacy must effectively monitor workload. This report describes a method to identify and estimate time required for both distributive and clinical functions. Tabulation of the distributive work units is automated through the hospital billing system. Clinical monitors are dependent on manual documentation by decentralized clinical pharmacists. The clinical coordinator and the pharmacy director review the documented clinical monitors to insure compliance and standardization. Productivity and workload calculations are performed automatically via the spreadsheet software once all the distributive and clinical units are entered. Identifying clinical functions and measuring the associated workload has aided in justifying new positions. Future considerations include calculating the impact of clinical services on revenues, expenses, and staffing.

Connecticut↗
PubMed2000

Lithium monitoring before and after the distribution of clinical practice guidelines.

OBJECTIVE: To determine whether distribution of clinical practice guidelines improves lithium monitoring and whether standards of monitoring differed between patients in psychiatric contact and those seen only in primary care. METHOD: Standards of monitoring were assessed for patients on lithium in northeast Scotland throughout 1995 and/or throughout 1996. Guidelines were circulated in January 1996 to all local general practitioners and psychiatrists. Monitoring was compared between 1995 and 1996 and for patients with and without psychiatric contact. RESULTS: Both primary care and psychiatric records were scrutinized for 422 and 403 patients prescribed lithium throughout 1995 and 1996, respectively. While monitoring was poor on several parameters during both years, frequency of measurement of both thyroid and renal function improved in 1996. Standards of monitoring were better for patients in psychiatric care. CONCLUSION: Standards of lithium monitoring require further improvement. Locally agreed practice guidelines are helpful but patients on lithium should be in continuing contact with an experienced psychiatrist.

Antimanic Agents↗
PubMed2006

A semi-parametric method for describing the age-specific distribution of clinical measurements in cross-sectional study.

Age-specific distribution of clinical measurements in cross-sectional study is described in this paper. Since the distribution of measurements usually varies with age, a model with an age-dependent structure is needed. We propose here a statistical method for describing the age-specific distribution using an extension of the power-normal-model. The age-dependent parameters are to be estimated through a nonparametric smoothing technique based on the local likelihood method. As a consequence, we can compute a smoothed percentile curve of measurements with reference to age. Several kinds of clinical measurements are analyzed to determine the proposed method.

Age Distribution↗
PubMed1995

Applying a controlled medical terminology to a distributed, production clinical information system.

To maximize the value of computerized medical records systems, an organizing structure is needed. That structure can be provided by a controlled medical terminology (CMT). At Columbia-Presbyterian Medical Center, we have been employing a controlled medical terminology, our Medical Entities Dictionary (MED), to mediate the storage and retrieval of patient data and enable decision support applications. This paper describes how the MED is actually used for data management in our distributed clinical information systems environment. Our system tools which access the MED for production purposes facilitate the mapping of terms from many sources to a uniform representation of concepts and also return information about the relationships between concepts. Applications which access a CMT for production purposes should be optimized for performance in high volume settings, fault tolerant, synchronizable, extensible, portable, and maintainable. We briefly describe our system architecture and then demonstrate how we utilize the MED for translation and semantic information as data is moved into and out of our patient database. We discuss our current tools and present a preview of the next generation of applications which will manage access to the MED for our production systems.

Computer Communication Networks↗
PubMed1990

[Clinico-bacteriological studies on the etiology of bacterial prostatitis. I. The distribution of clinical isolates and bacteria-specific immunoglobulin in EPS].

The distribution of clinical isolates from patients with prostatitis and pathogenicity of the isolates were studied. A new method for measuring the bacteria-specific immunoglobulins in expressed prostatic secretion (EPS) was developed and used for the detection of local immuno-reaction against pathogenic bacteria in the cases with prostatitis. There were no cases with increased antibodies specific for gram-positive cocci (GPC), indicating that the pathogenecity of GPC in bacterial prostatitis was doubtful. On the other hand, specific antibodies against gram negative rods (GNR) were elevated in all cases with acute prostatitis and changes of the antibody titers were correlated well to clinical courses. The present clinico-statistic and immuno-biological studies re-confirmed that E. coli was the main organism in uncomplicated bacterial prostatitis.

Adolescent↗
PubMed1998

Mapping dose distributions.

Clinical dose calculations are often performed by scaling distances from a dose distribution measured in one medium to calculate the dose in another. These perturbation calculations have the mathematical form of a mapping. In this paper we identify five conditions required for particle transport to reduce to this form and develop a new mapping for electrons which approximately satisfies these conditions. This continuous scattering mapping is based on two parameters, the scattering power of the medium which determines the shape of the scaling paths, and the stopping power of the medium which determines where the energy is deposited along these paths. Pencil beam dose distributions are calculated with EGS4 in one medium and mapped to other media. The resultant distributions are compared with EGS4 calculations done directly in the second medium. The accuracy of the mapping algorithm is shown to be superior to both linear density scaling and the MDAH electron pencil beam algorithm [Kenneth R. Hogstrom, Michael D. Mills, and Peter R. Almond, "Electron beam dose calculations," Phys. Med. Biol. 26, 445-459 (1981)] for pencil beams in homogeneous media and inhomogeneous phantoms (both slab and nonslab geometries) for a variety of materials of clinical interest.

Algorithms↗
PubMed2002

Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory and executive function, and uneven distribution of clinical subtypes.

Neuropsychological performance in 151 patients with schizophrenia was examined using cluster analysis to identify neurocognitive subtypes. Hierarchical and iterative partitioning methods identified four clusters using an extended neuropsychological battery. Consistent with previous findings two extreme clusters were characterized by near normative performance and profound global dysfunction, respectively. The two remaining neurocognitive clusters displayed moderate-severe dysfunction and were differentiated by unique patterns of abstraction and flexibility, attention, spatial memory, and sensory-perception. Analysis of variance revealed an interaction between global memory and executive function for clusters III and IV. Although limited cluster differences were found relative to clinical and historical data, the distribution of previously defined clinical subtypes was uneven among neurocognitive clusters. Paranoid patients were significantly more likely to be classified into cluster II and disproportionately absent from clusters I and IV. Patients with negative and disorganized clinical subtypes comprised a disproportionate component of clusters I and IV but were less likely to be classified in cluster II. This suggests greater correspondence than previously postulated between systems responsible for clinical symptomatology and those moderating neurocognitive dysfunction.

Adult↗
PubMed1984

Health problems encountered by nurse practitioners and physicians in general medicine clinics.

Distribution of health problems encountered by nurse practitioners and physicians in general/adult medicine clinics was studied. Proportional samples by clinics were selected from a total of 13,039 patient visits made to four clinics during an 18-week period in 1978. A Patient Encounter Form was used as the instrument and the ICD-9-CM as the coding system. Results showed that (a) 25.1% of the 13,039 patient visits were made to the nurse practitioners and 74.9% to the physicians, (b) 23 frequently reported health problems constituted more than 50% of all health problems seen by both provider groups, and (c) health problems with V codes constituted less than 30% of all health problems seen by both provider groups. Many similarities in health problems seen by nurse practitioners and physicians may indicate that nurse practitioners in the general/adult medicine specialty are used more to substitute for physicians in managing selected health problems than to complement medical practice.

Adolescent↗
PubMedDate not supplied

[Supply of outpatient care in the Lazio region: geographic distribution and characteristics of outpatient clinics].

Outpatient care accounts every year for a large share of the National Health Fund spending, however characteristics of supply have not been thoroughly investigated. Objective of the study is the description of the outpatient care system of Lazio region and of the main characteristics of outpatient clinics, through indicators obtained using data from the Outpatient Care Information System (SIAS) for 1999. Outpatient clinics were classified into three categories: ASL managed clinics, private clinics and hospital trusts. Absolute and relative density of supply (respectively DAO and DRO) were used as indicators of clinics distribution in the regional area. Number of specialties, average procedure weight and volume of procedures performed were used as indicators of complexity. Absolute density of supply (DAO = n. of dispatch points/population) is generally high, and a large and statistically significant variability is observed (p < 0.001). The relative density (i.e. the correlation coefficient between DAO and population density) is positive overall (r = 0.43), but it is higher within the private sector (r = 0.62) independently from provider category. Statistically significant differences were observed among categories of providers in terms of average number of specialties (ASL managed: 9.9; private clinics: 1.7; hospital trusts: 16.1), average weight (ASL managed: 1.1; private clinics: 0.9; hospital trusts: 1.3) and average volume of procedures supplied (ASL managed: 35.000; private clinics: 59.000; hospital trusts: 282.000). The administrative SIAS database was a useful tool to define indicators aimed at describing characteristics of the outpatient care system, although these results must be confirmed with a higher and more homogeneous level of coverage.

Ambulatory Care↗
PubMed1985

Twenty-four hour emergency pharmaceutical services.

Operation of an emergency department satellite pharmacy in which the pharmacist provided clinical, educational, and drug distribution services during patient visits is described. In a Detroit trauma and ambulatory-care center, drugs were dispensed to outpatients 24 hours a day from a satellite pharmacy located in the 75-bed emergency department. Emergency department pharmaceutical services were expanded to include distributive, clinical, and educational activities by the pharmacist on a 24-hour basis. The pharmacist contributed to improved inventory control and billing for drug products. When reductions in the work force were necessary, the institution chose to retain 24-hour pharmacist coverage during emergency department patient visits and to eliminate 24-hour dispensing to outpatients. In this urban trauma center, the emergency department pharmacist's clinical, distributive, and educational services contributed substantially to delivery of patient care.

Education, Pharmacy↗
PubMed1997

Factors affecting the distribution of clinical mastitis among udder quarters in French dairy cows.

Factors related to the distribution of clinical bovine mastitis between rear and front quarters were studied using data from a 4 year survey of commercial dairy herds in western France. The study involved 844 mastitis cases affecting 597 lactations of 500 French Friesian cows from 44 herds. Risk factor hypotheses were related to certain aspects of lactation, udder conformation and management practices. Distribution was modelled using a hierarchical logistic regression. Rear quarters were affected in 61.9% of cases. The only significant risk factor was the cow's parity; rear quarter clinical mastitis was more frequent in primiparous than in multiparous cows. In this retrospective study, udder conformation did not seem to play a significant role in mastitis distribution. No overdispersion parameter was observed, indicating that each mastitis case could be considered as an independent event.

Animals↗
PubMedDate not supplied

[Non-fermenting Gram-negative bacilli: distribution in clinical specimens and antimicrobial susceptibility].

In the present work was studied the prevalence, distribution in clinical specimens, and antimicrobial susceptibility of non-fermentative Gram-negative bacilli (NFGNB) from patients attended at Hospital "Angela I. de Llano" (Corrientes, Argentina). A total of 125 strains of NFGNB were recovered from various clinical specimens from July, 1997 to December, 1998. Isolates were identified by classical biochemical tests. Drug sensitivity was performed by standard methods with cefotaxime (CTX), ceftazidime (CAZ), piperacillin (PIP), ampicillin-sulbactam (AMS), piperacillin/tazobactam (TAZ), imipenem (IMP), amikacin (AKN), gentamicin (GEN) and ciprofloxacin (CIP). The most common isolates were Pseudomonas aeruginosa (48.8%); Acinetobacter baumannii (16.8%), Acinetobacter spp. (6.4%), Chryseobacterium spp. (5.6%), Stenotrophomonas maltophilia (4%), and others (18.4%). Most of them were recovered from respiratory secretions (36.0%), and urine (26.4%). IMP was the most effective antimicrobial. Many species of NFGNB showed resistance to several antibiotics tested (CTX, GEN, AMS, and CIP). Due to multiresistance found by more prevalent NFGNB, constant survey of antibacterial sensibility are essential for a correct control and management of nosocomial infections, and ambulatory patients with some risk factors.

Argentina↗
PubMed2006

Simulation of correlated continuous and categorical variables using a single multivariate distribution.

Clinical trial simulations make use of input/output models with covariate effects; the virtual patient population generated for the simulation should therefore display physiologically reasonable covariate distributions. Covariate distribution modeling is one method used to create sets of covariate values (vectors) that characterize individual virtual patients, which should be representative of real subjects participating in clinical trials. Covariates can be continuous (e.g., body weight, age) or categorical (e.g., sex, race). A modeling method commonly used for incorporating both continuous and categorical covariates, the Discrete method, requires the patient population to be divided into subgroups for each unique combination of categorical covariates, with separate multivariate functions for the continuous covariates in each subset. However, when there are multiple categorical covariates this approach can result in subgroups with very few representative patients, and thus, insufficient data to build a model that characterizes these patient groups. To resolve this limitation, an application of a statistical methodology (Continuous method) was conceived to enable sampling of complete covariate vectors, including both continuous and categorical covariates, from a single multivariate function. The Discrete and Continuous methods were compared using both simulated and real data with respect to their ability to generate virtual patient distributions that match a target population. The simulated data sets consisted of one categorical and two correlated continuous covariates. The proportion of patients in each subgroup, correlation between the continuous covariates, and ratio of the means of the continuous covariates in the subgroups were varied. During evaluation, both methods accurately generated the summary statistics and proper proportions of the target population. In general, the Continuous method performed as well as the Discrete method, except when the subgroups, defined by categorical value, had markedly different continuous covariate means, for which, in the authors' experience, there are few clinically relevant examples. The Continuous method allows analysis of the full population instead of multiple subgroups, reducing the number of analyses that must be performed, and thereby increasing efficiency. More importantly, analyzing a larger pool of data increases the precision of the covariance estimates of the covariates, thus improving the accuracy of the description of the covariate distribution in the simulated population.

Clinical Trials as Topic↗
PubMed2001

[Long-term observations on type distribution of clinical isolates of beta-hemolytic streptococci in Sapporo. II. Type distribution of Group B streptococci during the fifteen-year period between 1985 and 1999].

During the fifteen-year period between 1985 and 1999, a total of 1,985 strains of Group B Streptococci isolated in Sapporo City General Hospital were classified by agglutination method. The results were summarized as follows: 1. Type distribution of 1,513 isolates of group B streptococci in and after 1992 when type NT6 and type JM9 were started to be typed for the first time was as follows; according to rate isolation it was in the order of type NT6 (412 strains 27.3%), JM9 (257 17.0%), III (220 14.5%), Ia (182 12.0%), following IV, Ib, V and II. 2. As for proportion of origin-materials of isolates, vaginal discharge was 49.5%, urine 26.8%, throat swab 6.8%, sputum 6.6%, pus or exudate 4.2%, blood or spinal fluid 1.8% and stomach contents was 1.3%. A proportion of vagina-origin strains went up to 55% in the second half (1992-1999) from 23% in the first half (1985-1991). 3. In type distribution of isolates in terms of origin-materials, the proportion of type III was significant by high in the stomach contents and blood and spinal fluid. Proportion of type Ia was significant by high in the sputum or throat swab. 4. Thirteen out of 28 strains (46.4%) from newborns were type III; 3 out of 4 (75.0%) from spinal fluid, 5 out of 10 (50.0%) from blood, 5 out of 13 (35.7%) from stomach contents.

Adult↗
PubMed1995

Distribution and clinical expression of the tRNA(Lys) mutation in mitochondrial DNA in MERRF syndrome.

The distribution and clinical expression of mutant mtDNA with an A-to-G transition at the 8,344th nucleotide position in the tRNA(Lys) gene were studied in different tissues of the probands and relatives in a Taiwanese family with myoclonic epilepsy with ragged-red fibers (MERRF) syndrome. The proportions of mutant mtDNA were 89% to 95% for muscles and 78% to 99% for blood cells in the symptomatic probands except for one who had no mutant mtDNA in the muscles. In asymptomatic maternal relatives, these were 1% to 80% for muscles and 54% to 78% for blood cells. However, there was a lack of correlation between the clinical severity and the proportion of mutant mtDNA. Furthermore, among the maternal relatives studied, some asymptomatic family members had proportions of mutant mtDNA > 80% in muscles and > 53% in blood cells. Although these findings may suggest a threshold effect of mtDNA in MERRF syndrome, clinical manifestations are difficult to predict from the proportions of mutant mtDNA at the tRNA(Lys) gene only.

Adolescent↗
PubMed1996

Measured electron energy and angular distributions from clinical accelerators.

Electron energy spectra and angular distributions, including angular spreads, were measured using magnetic spectrometer techniques, at isocenter, for two clinical linear accelerators: one scanning beam machine, which achieves field flatness by scanning a pencil beam over the desired field at the patient plane, and one scattering foil machine, which disperses the electrons through a graded-thickness scattering foil. All measurements were made at isocenter (in the patient plane), in air, 1 m from the nominal accelerator source. The energy measurements were confined to electrons traveling along the central axis; any widely scattered electrons were effectively neglected. The energy spectra of the scanning beam machine are all of nearly Gaussian shape and energy full-width-at-half-maximum intensity (FWHM) of about 5% of the peak mean energy (denoted (E0)*). The energy spectra of the scattering foil machine have a variety of forms as a function of energy, including even spectra with double peaks, and spectra which changed with time. The FWHM values ranged from 9%-22% of (E0)*. The angular spread measurements, at isocenter, yielded sigma theta (x) x (E0)* approximately 295 mrad-MeV for the scanning beam machine, and 346 mrad-MeV for the scattering foil machine, where sigma theta x denotes the standard deviation of the plane-projected angular distribution. These angular spreads are 30%-40% smaller than angular spreads reported by others on a very similar machine using the penumbra method. Possible causes of this discrepancy are discussed.

Electrons↗