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Development and assessment of specialized liaison librarian services: clinical vs. basic science in a veterinary medicine setting.

In 1998, the University of Florida Health Science Center Libraries (HSCL) developed and implemented a Liaison Librarian Program, dedicated to providing customized, subject-specific services to the faculty, students, clinicians, researchers, staff, and administrators of the six Health Science Center Colleges (Dentistry, Health Professions, Medicine, Nursing, Pharmacy, and Veterinary Medicine). Subject- and role-specific (clinical vs. basic sciences) liaisons were assigned. This paper describes the HSCL liaison program, exemplified by the liaisons' work with the College of Veterinary Medicine. Preliminary program evaluation, a pilot project developed to discern the needs of the veterinary medicine clientele and facilitate awareness of liaison services, and subsequent re-evaluation of patron awareness and satisfaction are also discussed.

Communication↗

Perceptions of counselor-trainees given content of a pre-intake form.

88 counselor-trainees were given information about a potential client using either a problem-focused or strength-focused pre-intake form. Based on the information provided, counselor-trainees rated the client on the perceived severity of client's problem, difficulty of treatment, attractiveness of case, anticipated duration of treatment, and usefulness of the pre-intake information. This pilot project suggested that the type of information provided to trainees influenced their perceptions of the case, in particular, affording a more positive view of the client.

Attitude of Health Personnel↗

SAIL: automating interlibrary loan.

The National Library of Medicine (NLM) initiated the System for Automated Interlibrary Loan (SAIL) pilot project to study the feasibility of using imaging technology linked to the DOCLINE system to deliver copies of journal articles. During the project, NLM converted a small number of print journal issues to electronic form, linking the captured articles to the MEDLINE citation unique identifier. DOCLINE requests for these journals that could not be filled by network libraries were routed to SAIL. Nearly 23,000 articles from sixty-four journals recently selected for indexing in Index Medicus were scanned to convert them to electronic images. During fiscal year 1992, 4,586 scanned articles were used to fill 10,444 interlibrary loan (ILL) requests, and more than half of these were used only once. Eighty percent of all the articles were not requested at all. The total cost per article delivered was $10.76, substantially more than it costs to process a photocopy request. Because conversion costs were the major component of the total SAIL cost, and most of the articles captured for the project were not requested, this model was not cost-effective. Data on SAIL journal article use was compared with all ILL requests filled by NLM for the same period. Eighty-eight percent of all articles requested from NLM were requested only once. The results of the SAIL project demonstrated that converting journal articles to electronic images and storing them in anticipation of repeated requests would not meet NLM's objective to improve interlibrary loan.

Automation↗

Operation start-up.

When Mount Carmel Health System sized up the Medicare market in Columbus, Ohio, executives liked what they saw: Seniors trusted them more than insurers to run a managed care plan. Only six months later, their provider-sponsored plan opened for business under a HCFA pilot project. Here's how Mount Carmel pulled it off.

Aged↗

Identifying costs for capitation in psychiatric case management.

This article presents an example of how one hospital identified costs for capitation in psychiatric case management. An 18-month postacute case management pilot project collected data on a nurse-specific and patient-specific basis. Costs were identified using activity-based costing methodology.

Accounting↗

Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents.

The aims of this case report are to describe the application of an early and intensive task-oriented physical therapy program for gait relearning following stroke and to report the patients' ability to comply with the program. Ten patients, 60 to 75 years of age (mean = 69.8, SD = 7.3), with a middle cerebral artery infarct (confirmed by computerized tomography) were assigned to this special physical therapy program. Patients were treated twice a day, 5 days a week, from the eighth day after stroke for 5 consecutive weeks. To promote gait relearning, a program of early standing (using a tilt table when necessary), combined with weight-shifting exercises and feedback via a limb-load monitor as well as locomotor activities including exercises on a Kinetron and treadmill walking, was adapted for each patient's level of motor recovery. Walking on the treadmill (with a safety harness) was initiated as early as the second week after stroke in 4 patients, and all patients had started Kinetron training by the second week. Except for 1 patient, who was withdrawn from the study because of an infection, all patients showed good treatment compliance (93.6%) with the planned 50 treatments and were able to withstand a mean treatment duration of 44.8 minutes (SD = 6.3, range = 37.5-58.5), twice a day, during the first week of the program (8th to 14th day after stroke). Results from this pilot project indicate that intensive and graded locomotor activities can be very well tolerated in the early period after stroke.

Aged↗

Ontario's attempt at primary care reform hits another snag.

Ontario is the latest province to step into the health care reform spotlight. Proponents hope its proposed series of primary care pilot projects, built around the concept of patient rostering, will improve the delivery of care. If the project goes ahead, doctors in 5 participating sites will be paid under a capitation system, with payments starting at $70.29 annually for men aged between 25 and 35.

Adult↗

Families' needs in emergency departments: instrument development.

BACKGROUND: Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined. AIM: The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs. METHOD: Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires. RESULTS: The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate. CONCLUSIONS: This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.

Adolescent↗

Role redesign in perioperative settings.

Perioperative services team members at Presbyterian Hospital of Dallas employed a methodical redesign process to redefine team members' relationships and revise roles to be patient focused. One outcome of this redesign process was the creation of multiskilled worker (ie, unlicensed assistive personnel) roles within self-managed perioperative specialty teams. An initial pilot project using the multiskilled workers in the neurosurgical specialty service resulted in increased physician and perioperative nurse collaboration and efficiency.

Evaluation Studies as Topic↗

Training effective interpreters for diabetes care and education: a new challenge.

PURPOSE: This article describes a pilot project to improve knowledge, attitudes, and skills of ad hoc interpreters working with Native American diabetes patients with limited English proficiency. METHODS: Case-based studies reflecting clinical situations were developed. Key concepts and terms from the cases were translated into the Navajo language and carefully back translated using the newly standardized Navajo diabetes terminology. Twenty-two health care workers from 2 Indian Health Service facilities were recruited for a pilot study to compare the performance of interpreters trained in a formal workshop using the case studies with that of interpreters who independently reviewed a video made from the training. RESULTS: Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics; the independent study group perceived less improvement. CONCLUSION: Formal training for interpreters working with diabetes patients should be considered by diabetes educators working in settings where medical interpreters are needed. Diabetes educators should encourage back translation of key diabetes concepts to understand exactly what is being said to patients. Those working with multiple interpreters should make sure there are opportunities for interpreters to discuss translations of key concepts with each other and the educators so that translations are accurate and consistent among interpreters. Independent study did not appear to be an effective way to improve the ability of interpreters to translate current diabetes concepts accurately.

Cultural Diversity↗

Developing and implementing standards of practice for clinical pharmacy services.

The authors' department has attempted to bring more order to the provision and evaluation of clinical services through the development of "Clinical Standards of Practice." A pilot project was initially conducted on one satellite. Pharmacists were asked to prepare a list of minimum standards that could be agreed upon and that everyone believed were achievable even on the busiest days. After standards were developed and implemented, a procedure was established to evaluate compliance through review of pharmacy records and patient materials. Staff received feedback concerning the results of the review. As a result of the success with the pilot, Clinical Standards of Practice have been developed by staff and are in use throughout the department. Plans for the future include continuous revision of the standards to reflect changing departmental goals and directions and a change to a "pharmacist specific" rather than a current "nursing unit specific" monthly review format to facilitate performance review and staff development. Eleven standards are shown in the appendices.

Clinical Competence↗

Development of a curriculum in colposcopy.

BACKGROUND: Colposcopy for the detection of genital malignancy and disease associated with human papillomavirus, along with cytologic screening and histopathologic correlation, allows for intervention before the onset of invasive disease. Family physicians are interested in learning colposcopy, but there are few reports in the literature on the training of colposcopists. METHODS: A colposcopy curriculum for family physicians was designed with goals, objectives, and instructional strategies selected to enhance learning and quality assurance of the current principles of colposcopic evaluation. During the pilot project, a third-year resident studied a syllabus and reviewed slides, practiced performance skills, and observed colposcopies. After demonstrating competence, the resident evaluated patients with instructor supervision and feedback. RESULTS: Resident performance data from written test scores and a performance checklist indicated an excellent learning curve. High resident satisfaction was reported. Suggestions from expert reviewers were incorporated into the final curriculum product. The evaluation data indicated that, based on this pilot program, family practice residents can effectively learn colposcopy. CONCLUSIONS: Colposcopy is a highly technical skill that can be learned by family physicians through professional training. Competency in colposcopy can provide a new dimension to their practice in the diagnosis and treatment of female lower-genital-tract disease. This colposcopy curriculum is an initial effort in the identification of the content and process required to train family physicians in the use of this diagnostic procedure.

Clinical Competence↗

A specialized hospice for dementia patients and their families.

This article reports the development of a small pilot program and briefly describes its activities. The growing number of dementia patients in American communities indicates a need to extend hospice services to these patients and their families. It is difficult to determine at present whether this need could be met more effectively by encouraging existing hospices to accept these patients or by establishing specialized programs such as this one. Research in this area is indicated, as well as the sharing of information among hospices providing care to other specialized groups--people with AIDS or terminally ill children for example. The Alzheimer's Family Care Hospice has provided services to eight terminally ill dementia patients and their families in a pilot project sponsored jointly by the Rush Alzheimer's Disease Center and the Chicago Area Chapter of the Alzheimer's Association. Another six patients did not meet admission criteria.

Aged↗

Health care IT collaboration in Massachusetts: the experience of creating regional connectivity.

The state of Massachusetts has significant early experience in planning for and implementing interoperability networks for exchange of clinical and financial data. Members of our evolving data-sharing organizations gained valuable experience that is of potential benefit to others regarding the governance, policies, and technologies underpinning regional health information organizations. We describe the history, roles, and evolution of organizations and their plans for and success with pilot projects.

Clinical Pharmacy Information Systems↗

Telemedicine based screening of infants at risk for retinopathy of prematurity.

Retinopathy of Prematurity (ROP) is a major risk for permanent visual loss in extreme prematures. In stage 3+ (zone I and II), defined as threshold disease, the risk for retinal detachment with subsequent blindness is about 50% without treatment, compared to only a few percent with laser photoablation. Visualisation and interpretation of the critical retinal changes requires a high degree of expertise. Therefore, screening by general ophthalmologists will not identify all cases at threshold necessary to prevent blindness in as many infants as possible. The development of a new digital wide-field camera system (RetCam 120) allows documentation of nearly the entire retina within minutes. Recently, sensitivity, specificity, positive predictive power and negative predictive power have been evaluated to be high. Data collection is also possible by trained staff of the neonatal care units. Data can be transferred electronically, even though it could be transferred through physical transport. Analyzing the data in a central reading center specialized in the treatment of ROP will allow optimal timing of treatment and thus salvage vision in more infants. In addition, unnecessary referrals that are not only expensive but put also stress on the very vulnerable prematures can be avoided. At present, efforts are made to realize a pilot project in Eastern Bavaria that will test the potentials of telemedicine based screening for ROP. In addition, the potential of the system will be evaluated in other neuroophthalmological diseases.

Germany↗

Enhancing nurse mobility in Europe: a case for language skills.

The recognition of professional qualifications in all European Union (EU) member states for nurses is covered by both sectoral and general systems directives, yet in reality, few nurses take up their rights as European citizens to live and work in another EU country. One of the main reasons for this is a lack of linguistic skills. This article argues that the nursing profession should be taking a more active role in enabling nurses to move freely around Europe by encouraging language acquisition. It is argued that there are political, social, economic, professional and individual reasons why this should be so. The author gives a brief account of a pilot project which is currently under way to help improve (albeit in a small way) this situation. The project, which has been granted financial support of 100,000 ECU from the European Commission's new training programme, Leonardo da Vinci, will create a multimedia language pack in four languages aimed specifically at nurses.

Communication Barriers↗