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At least 973 records · Page 54Linked to original sources
PubMed2004

Improving the quality of information on pathology request forms.

BACKGROUND: We have investigated the causes of incomplete pathology request forms received at our clinical chemistry laboratory. Based on a request form audit we found that the data most frequently missing from a pathology request form was the doctor's name, unique identification provider number, or signature. METHODS: We examined the effect of issuing the requesting doctors with self-inking stamps personalized with their name and a unique provider number. RESULTS: The intervention led to an immediate and sustained improvement in compliance, with the proportion of incomplete forms falling from 43% to 2%. In contrast, distribution of a memorandum alone made no significant change to the number of pathology request forms with incomplete data arriving at the laboratory. CONCLUSION: This study describes a simple and low-cost solution to one of the causes of incomplete pathology request forms. It also demonstrates the effectiveness of systems improvement in health care.

Medical Records↗
PubMed2005

Cost-utility analyses in orthopaedic surgery.

BACKGROUND: The rising cost of health care has increased the need for the orthopaedic community to understand and apply economic evaluations. We critically reviewed the literature on orthopaedic cost-utility analysis to determine which subspecialty areas are represented, the cost-utility ratios that have been utilized, and the quality of the present literature. METHODS: We searched the English-language medical literature published between 1976 and 2001 for orthopaedic-related cost-utility analyses in which outcomes were reported as cost per quality-adjusted life year. Two trained reviewers independently audited each article to abstract data on the methods and reporting practices used in the study as well as the cost-utility ratios derived by the analysis. RESULTS: Our search yielded thirty-seven studies, in which 116 cost-utility ratios were presented. Eleven of the studies were investigations of treatment strategies in total joint arthroplasty. Study methods varied substantially, with only five studies (14%) including four key criteria recommended by the United States Panel on Cost-Effectiveness in Health and Medicine. According to a reader-assigned measure of study quality, cost-utility analyses in orthopaedics were of lower quality than those in other areas of medicine (p = 0.04). While the number of orthopaedic studies has increased in the last decade, the quality did not improve over time and did not differ according to subspecialty area or journal type. For the majority of the interventions that were studied, the cost-utility ratio was below the commonly used threshold of $50,000 per quality-adjusted life year for acceptable cost-effectiveness. CONCLUSIONS: Because of limitations in methodology, the current body of literature on orthopaedic cost-utility analyses has a limited ability to guide policy, but it can be useful for setting priorities and guiding research. Future research with clear and transparent reporting is needed in all subspecialty areas of orthopaedic practice.

Arthroplasty, Replacement↗
PubMed1992

The perinatal autopsy: a contemporary approach.

As autopsy rates in general hospitals decline, interest in the perinatal autopsy continues to rise, reflecting the emergence of a vigorous specialty growing in parallel with fetal medicine, prenatal diagnosis and clinical genetics. Perinatal autopsies are best carried out in tertiary centres which provide these services. Meticulous documentation, flexibility of technique, intelligent use of laboratory tests and wide systematic histopathologic sampling are emphasized. Microbiologic examination is of particular value when carried out by a laboratory having a special interest in genital tract and perinatal pathogens. Karyotyping must be selective if resources are to be conserved and is most productive when there are multiple malformations. Perinatal autopsy is not complete without examination of the placenta and significant lesions should be clearly distinguished from curiosities and from changes secondary to fetal death. The pathologist's wider contribution to perinatal medicine includes providing high quality data to epidemiology units and auditing committees, contributing to the multidisciplinary management of prenatally diagnosed fetal abnormalities, monitoring iatrogenic disease patterns and supporting the process of perinatal grief management. Special problems and diagnostic challenges are to be found when investigating sudden, unexplained intrauterine fetal death, hydrops, bone dysplasias and complicated multiple pregnancies.

Autopsy↗
PubMed2000

Deaths following hernia surgery: room for improvement.

BACKGROUND: Abdominal wall herniae are common and may well lead to death. The aim of this study was to examine the deaths of patients with an inguinal, femoral or incisional hernia to identify aspects of management which could be improved upon. METHOD: Data collected by the Scottish Audit of Surgical Mortality 1994-1997 was analysed by interrogation of the database for all deaths on a surgical ward or within 30 days of surgery where the principle diagnosis was inguinal, fermoral or incisional hernia. RESULTS: There were 133 deaths out of 31,525 operations over the 4-year period. Mortality was highest among femoral hernia operations in women (37 deaths/1184 operations; 3.1%) and 59% of femoral hernia surgery was performed outwith normal working hours. The 133 patients were elderly (mean age 79 years) and unfit, but less than half the operations involved consultant anaesthetists or consultant surgeons. Delay in referral contributed to death in 15/133 patients and adverse factors in management, particularly in the perioperative period, caused the death of 2 patients and contributed to the death of a further 29/133. CONCLUSIONS: Herniae carry a significant mortality in elderly, unfit patients who require close attention to perioperative management. These patients should be anaesthetised and operated upon by consultant staff during the normal working day.

Adult↗
PubMedDate not supplied

Social influences on Pap smear screening frequency.

Incidence and mortality rates of cervical cancer among Native American women is two to five times that of comparable Whites. Social and cultural differences contribute to this problem. We studied thirty age 40 and older American Indian women, half of whom had obtained at least one Pap in the past three years, the other half of whom had not. We asked: Do the two groups differ in their attitudes concerning Pap tests and those with whom they interact concerning Pap tests? and: Do they interact differently with different social groups concerning Pap tests? Data were obtained from chart audits and Given's Health Belief Questionnaire. The groups did not differ as to who they discussed Pap tests with or whose opinions they respected. They respected healthcare professionals most, family/friends less, and co-workers/others least. These findings suggest that the advanced practice nurse has an opportunity to improve Pap screening rates in this population.

Adult↗
PubMed2001

A second survey of Scottish emergency psychiatry.

OBJECTIVE: To survey NHS services providing emergency psychiatric assessment in Scotland and to compare the findings with those of the survey conducted 8 years ago. DESIGN: Postal and telephone questionnaire of all primary care trusts, the one integrated trust and three Island Health Boards in Scotland. RESULTS: All parts of Scotland provide a 24 hour service for the assessment of psychiatric emergencies. There is a range of multidisciplinary responses during office hours with a total of 75 multidisciplinary Community Mental Health Teams, 18 Community Psychiatric Nursing Teams, 11 liaison psychiatry teams and one dedicated emergency team. However, for most of the week, the service is provided by a duty basic grade doctor in each area with the exception of Orkney. CONCLUSIONS: Planning the most appropriate emergency and crisis service for any population depends on suitable data being available. Eight years after the first survey there is still no systematic collection of data on emergency contacts in Scotland. The systematic collection of National data is required for effective audit, planning and development of these services. The working definitions proposed in the first survey would be suitable for coding.

Crisis Intervention↗
PubMed1992

Relationship between Pap smear performance and physician ordering a mammogram.

BACKGROUND: Although Pap smear screening for cervical cancer in general has been successfully implemented, mammography screening for breast cancer remains relatively underused. Patients having one screening test are more likely to have other screening tests performed. The objective of this study was to determine whether visits by women for Pap smears serve as opportunities for physicians to order a screening mammogram. METHODS: A matched case-control design was used for this retrospective study. Eligible women included those over 50 years of age who had no history of breast cancer or mastectomy and who had made at least one visit to a family practice residency program during the 2-year study period. Cases were randomly selected from women who had mammograms performed. For each case, one control subject who did not have a mammogram was matched by age and number of visits. A chart audit was performed to collect data on the characteristics of these women and whether they completed their screening tests. RESULTS: The adjusted odds ratio (controlling for the patient's age and number of physician visits) for mammogram completion among women who had a Pap smear compared with those who did not was 6.67. This effect persisted after controlling for other confounding factors using logistic regression. CONCLUSIONS: Performing a Pap smear appears to serve as a prompt for the physician to order a screening mammogram. That physicians appear to provide screening tests, particularly Pap smears and mammograms, as a package of services should be considered when future efforts to improve implementation are made.

Aged↗
PubMed2004

Prescription monitoring of anti-hypertensive drug utilisation at the Panjab University Health Centre in India.

INTRODUCTION: The present pilot study was conducted in order to establish the drug-prescribing trend of anti-hypertensive agents at the Panjab University Health Centre in India. METHODS: A pilot study of six-month duration was conducted at the Panjab University Health Centre. The information was collected from the patients attending the outpatient department through a random sample method. World Health Organisation-based prescription-auditing proforma was used for data collection. RESULTS: This study revealed that most of the male patients were on monotherapy (60 percent). In the monotherapy category, four classes of drugs were used. These were calcium channel blockers (48.1 percent), beta-blockers (46.2 percent), ACE inhibitors (3.9 percent) and diuretics (1.9 percent). Among monotherapy drugs, calcium channel blockers were prescribed most whereas diuretics were least used. Among those who were treated with drug combinations, 92.1% received two drugs and 7.9 percent received three drugs. In combination therapy, a two-drug combination consisting of beta-blockers and calcium channel blockers was given to the majority of the patients. Overall, 57.8 percent patients were treated with a single anti-hypertensive drug and 42.2 percent were treated with anti-hypertensive drug combinations. CONCLUSION: The present study represents the current prescribing trend for anti-hypertensive agents and it highlights certain shortcomings in the existing prescribing practice. There is a considerable scope for improvement, particularly the under-utilisation of diuretics in the present prescribing pattern of anti-hypertensive drugs.

Antihypertensive Agents↗
PubMed2004

Pediatric resident education and needs assessment in clinical pharmacology.

OBJECTIVE: To identify perceived and unperceived educational needs of residents to organize a seminar series in clinical pharmacology. METHOD: All pediatric residents (48) and all attending general pediatric staff (20) were sent structured questionnaires with potential seminar topics. Data from previous pharmacy chart audits and complaints lodged with patient care representatives were analyzed as the environmental scans. RESULTS: There was a 75% response rate from both residents and staff. The responses were very similar and the only significant difference was the response to a seminar on correcting electrolyte imbalances which the residents favoured (p = 0.005). The environmental scans identified pain management as one of the main areas needing improvement. CONCLUSION: Perceived learning needs of residents are similar but not identical to those identified by the faculty. Environmental scanning can be used to identify unperceived learning needs.

Chi-Square Distribution↗
PubMed2006

Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care.

Discriminatory treatment of African Americans in healthcare is well recognized, yet the literature is unclear on the specific role that perceived racism and mistrust play in the patient-provider relationship. The purpose of this study was to test a mid-range theoretical model entitled Perceptions of Racism and Mistrust in Health Care (PRMHC). This model hypothesized that perceived racism influences cultural mistrust, which affects trust in providers--and these combined psychosocial aspects of healthcare affect satisfaction with the care received. One-hundred-forty-five African-American subjects participated in structured interviews to collect demographic and psychosocial data. Provider data was obtained through chart audits. In a group of low-income African Americans in two primary care clinics, perceptions of racism and mistrust of whites had a significant negative effect on trust and satisfaction. Perceived racism had both a significant, inverse direct effect on satisfaction as well as a significant indirect effect on satisfaction mediated by cultural mistrust and trust in provider. Structural equation modeling analysis supported the hypothesized theoretical relationships and explained 27% of the variance in satisfaction with care. The findings add to the existing literature by enhancing our understanding of the complex perspectives on trust and overall satisfaction with care among African-American patients. Results suggest that improving health outcomes for African Americans requires a broader understanding of cultural competence, one that addresses societal racism and its impact on provider-patient relationships.

Adult↗
PubMed1989

Outpatient antiarrhythmic drug use from 1970 through 1986.

Antiarrhythmic drugs have been marketed in the United States for more than three decades. However, little is known about the prevalence of use of these drugs. Using data from the National Prescription Audit, we examined trends in outpatient use of oral antiarrhythmic agent types 1 and 3 from 1970 through 1986. Using the National Disease and Therapeutic Index, we assessed prescribing physician specialty and general demographic and clinical characteristics of recipients. We adjusted the numbers of prescriptions dispensed for broad changes in the US population demographics over the 17-year period. From 1970 through 1986 the number of antiarrhythmic agent prescriptions dispensed increased by 200%, from 3.8 million to 11.5 million. This increase is greater than that expected due to changes in size of the US population, estimated changes in prevalence of heart disease, or estimated changes in the proportion of patients with heart disease who have arrhythmias. The weight of evidence suggests that more persons were receiving antiarrhythmic agents in 1986 than in 1970. Physicians probably recognized and/or treated arrhythmias more frequently in 1986 than in 1970.

Adult↗
PubMed1993

Detection of intracranial tumors, subarachnoid hemorrhages, and subdural hematomas in primary care patients: a report from ASPN, Part 2.

BACKGROUND: The initial diagnosis of intracranial tumor, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH) can be difficult. This study was undertaken to determine the incidence and presenting signs and symptoms of these disorders in primary care settings, and to determine whether a more aggressive investigative strategy for patients with headache is justifiable. METHODS: Weekly return cards and a chart audit were used to collect data over a 19-month period on every patient who had a new diagnosis of intracranial tumor, SAH, or SDH. Age and sex reports were collected annually. RESULTS: Twenty-five new tumors, 17 SAHs, and 8 SDHs were reported in 58 practices (a rate of 12/100,000 patients per year). Only one half of these patients had headaches, and no abnormalities were found on neurological examination of many. Diagnosis was delayed in only four patients with headache caused by a brain tumor and in three patients with SAHs. Diagnosis was delayed in two of the latter because of false-negative CT scans. CONCLUSIONS: Although clinical findings and CT scans are not reliable indicators, clinicians are able to detect the majority of these rare conditions without undue delay by selecting a small subset of patients for further investigation. More extensive use of CT scans appears to be a weak strategy to improve detection of these serious disorders, as increased use would lead to increased health care costs and unintended adverse effects, and provide little benefit.

Adolescent↗
PubMed1993

The indirect patient care effect of a unit-based clinical nurse specialist on preventable pulmonary complications.

PURPOSE: To examine the indirect effect of a unit-based expert nurse on the incidence of preventable pulmonary complications, which were defined as malpositioned endotracheal tube and inadvertent extubation. DESIGN: A nonequivalent control group/separate samples pretest/posttest design was used to test differences in the incidence of preventable pulmonary complications before and after a 6-month intervention by a unit-based expert nurse in the experimental unit. Retrospective medical record audits were used to collect data on all consecutive admissions to the experimental and control units in March and April of years 1 and 2. RESULTS: Estimated risk ratios demonstrated a significant reduction in preventable pulmonary complications in the experimental unit after the test, even though the acuity was significantly higher in posttest patients. It was concluded that indirect patient care by a unit-based clinical nurse specialist can reduce the incidence of preventable pulmonary complications.

Adolescent↗
PubMed1996

Risk of foot complications in long-term diabetic patients with and without ESRD: a preliminary study.

OBJECTIVE: The purpose of this preliminary study was to generate hypotheses for future research about the relationship between ESRD and foot complications in patients with long-term diabetes. DESIGN: A cross-sectional prevalence study was conducted comparing a sample of long-term diabetic patients with ESRD to a sample of long-term diabetic patients without ESRD. SAMPLE/SETTING: A convenience sample of 132 patients with long-term diabetes (> 15 years), with (N = 60) and without (N = 72) ESRD, was selected from ambulatory care settings and dialysis units. METHODS: Data were collected by chart audit, structured interview, and physical examination. RESULTS: Foot complications were greater in individuals with diabetes and ESRD (25%) than in diabetic individuals without ESRD (10%) (p = 0.02). Neither neuropathy, past or current smoking, race, gender, nor age were significantly associated with current foot complications (either current infection, ulcer, gangrene, or amputation). CONCLUSIONS: Research is needed to better understand foot complications in persons with long-term diabetes and ESRD so that the effectiveness of nursing and medical interventions to stabilize or prevent foot complications can be evaluated.

Adult↗
PubMed1997

A specialist nurse can replace pre-registration house officers in the surgical pre-admission clinic.

Pre-admission clinics reduce non-attendance rates for elective surgery and help in management of surgical waiting lists. Nurse-led pre-admission clinics have been reported to be successful by simple audits of their efficiency. However data are lacking comparing such nurses with PRHOs that they are replacing leaving open questions of their safety in this role. We performed a prospective study involving 100 consecutive patients attending the surgical pre-admission clinic. We compared clerking by a specialist nurse using a standard proforma and ordering pre-operative investigations with that of PRHOs who ordered investigations as is their normal practice. The specialist nurse was as accurate or more accurate than PRHOs in taking a surgical history with the exception of noting drug doses and frequencies, and taking a full social, alcohol and smoking history. She also performed well with regard to limited physical examination, ordering investigations and assessing ASA grades. With minor modifications to our proforma we believe the specialist nurse is safe to replace the PRHOs in the pre-admission clinic.

Diagnostic Tests, Routine↗
PubMed1993

Hospital characteristics: can an audit be predicted?

Each year Medicare-participant hospitals submit a cost report to the Health Care Financing Administration (HCFA) to settle their reimbursement claims. These reports are subject to audit, and a decision by HCFA to audit can be costly to the auditee. This article uses data from 6,270 cost reports filed in 1986 to explore the factors related to the probability of an audit. Logistic regression equations are estimated to examine how hospital characteristics influence the chance of audit. The results suggest that audit probability can be predicted with reasonable accuracy by a hospital's bed size, ownership type, teaching status, function, proportion of Medicare inpatient days, and geographic location.

Data Collection↗
PubMedDate not supplied

Using audit in a district-wide management system.

As a consequence of the NHS reforms, the budgeting and competitive tendering of clinical services between districts requires accurate accumulation of data. John Mosley and Roger Fairbanks describe how data obtained by clinicians from their own audit has been used to construct a casemix solution that provides the necessary financial information for a district.

Cost Allocation↗