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At least 703 records · Page 39Linked to original sources
PubMed2006

The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital.

OBJECTIVE: The concurrent use of dietary supplements and prescription medications is common among patients with cancer. This study examines potential interactions between dietary supplements and prescription medications in a Veteran Hospital cancer population. METHODS: Eligible patients seen at the Hematology/Oncology clinic at the Veterans Administration Medical Center in Cincinnati, OH, were administered a survey to determine their use of dietary supplements. Medication profiles were compiled from patients' medical charts and pharmacy records. It was also noted whether supplementation was previously documented. Potential interactions between dietary supplements and prescription medications were identified from a literature search of documented interactions. Several demographic factors, including age, race, marital status, education and income, were assessed for differences between patients found to be at risk for interactions and those for whom no risks were identified. RESULTS: Dietary supplements were used by 61% of patients. Multivitamins were the most common supplement (80.3%) followed by minerals (40.6%) and herbal preparations (24.8%). Of the 121 patients taking supplements, 65 patients (54%) reported taking more than one. A potential risk for interaction between dietary supplement and prescription medication was identified in 12% of patients taking supplementations. Three patients were at risk for multiple interactions. Veterans who were not currently married were more likely to be at risk for interactions (P = 0.024). Only 28% of patients taking dietary supplements had this supplementation documented in their medical record. CONCLUSION: Dietary supplementation by a veteran cancer population is common. Interactions between the supplement and prescription medication is a potential problem. Patient-physician discussion and documentation of these issues should be systematically addressed.

Adult↗
PubMed1992

[Assessing performance and reimbursement in "emergency ambulatory surgery" from the viewpoint of hospital administration].

1) Definition of emergency and its payment is given, as well as the legal background of charging by the hospital. 2) The total work on outpatient departments of a central hospital is shown, especially that of surgical emergency cases. 3) The reasons for documentation of actual work are discussed, by whom and how, and the problems arising. 4) The payment for patients with social insurance is considered in respect of the official fees and the cost-averaging of the hospital as a nonprofit organisation.

Ambulatory Surgical Procedures↗
PubMed2006

National Veterans Health Administration hospitalizations for syncope compared to acute myocardial infarction, fracture, or pneumonia in community-dwelling elders: outpatient medication and comorbidity profiles.

The authors used 2 national Veterans Health Administration databases to identify outpatient medications and all 30 Elixhauser comorbidities for 2579 unique patients, age 65+ years, hospitalized for syncope in fiscal year 2004. For comparison, we identified other elderly patients hospitalized with acute myocardial infarction (N = 4491), fracture (N = 2797), or pneumonia (N = 9473). The categories of medications included drugs that affect the cardiovascular, central nervous, or the muscular skeletal system. The most notable differences between syncope compared to acute myocardial infarction patients occurred in central nervous system drugs in anticonvulsants/barbiturates, antidepressants, antihistamine/antinauseants, antipsychotics, and cholinesterase inhibitors (P < .0018). Comparing syncope patients with fracture patients, the central nervous medication profile was similar, but the cardiovascular medication profile differed (P < .0018); their hypertension comorbidities also differed (60.45% vs 46.34%); (P < .0016). These findings indicate significant potential associations that warrant further study. Studies linking national outpatient medications to hospitalizations for specific conditions can foster the development of more proactive pharmacovigilance systems.

Aged↗
PubMed1986

Paleoepidemiologic investigation of Legionnaires disease at Wadsworth Veterans Administration Hospital by using three typing methods for comparison of legionellae from clinical and environmental sources.

Multilocus enzyme electrophoresis, monoclonal antibody typing for Legionella pneumophila serogroup 1, and plasmid analysis were used to type 89 L. pneumophila strains isolated from nosocomial cases of Legionnaires disease at the Veterans Administration Wadsworth Medical Center (VAWMC) and from the hospital environment. Twelve L. pneumophila clinical isolates, obtained from patients at non-VAWMC hospitals, were also typed by the same methods to determine typing specificity. Seventy-nine percent of 33 VAWMC L. pneumophila serogroup 1 clinical isolates and 70% of 23 environmental isolates were found in only one of the five monoclonal subgroups. Similar clustering was found for the other two typing methods, with excellent correlation between all methods. Enzyme electrophoretic typing divided the isolates into the greatest number of distinct groups, resulting in the identification of 10 different L. pneumophila types and 5 types not belonging to L. pneumophila, which probably constitute an undescribed Legionella species; 7 clinical and 34 environmental VAWMC isolates and 2 non-VAWMC clinical isolates were found to be members of the new species. Twelve different plasmid patterns were found; 95% of VAWMC clinical isolates contained plasmids. Major VAWMC epidemic-bacterial types were common in the hospital potable-water distribution system and cooling towers. Strains of L. pneumophila which persisted after disinfection of contaminated environmental sites were of a different type from the prechlorination strains. All three typing methods were useful in the epidemiologic analysis of the VAWMC outbreak.

Antibodies, Monoclonal↗
PubMed2006

Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals.

OBJECTIVE: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities. BACKGROUND: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff. METHODS: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities. RESULTS: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.

Attitude of Health Personnel↗