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PubMed1977

Rape: an organized approach to evaluation and treatment.

Rape is a rapidly spreading form of violence. The physician must examine and treat the victim and establish an adequate record for legal purposes. Treatment of the victim includes follow-up for late-emerging ego disruption and is greatly aided by employing the assistance of organized agencies such as a hospital-based Social Service or a Rape Crisis Center. It is also important that the victim receive adequate protection against venereal disease and pregnancy.

Female↗

PubMed1977

Cancer registries in Australia.

Cancer registries are at an early stage of development in Australia. Population-based registries are located in New South Wales Registry and Western Australia, and of these, only the New South Wales Registry is fully functioning. A hospital-based registry is maintained in Victoria. We have a national cancer registry in principle but it will not be functional for many years. Preliminary statistics for New South Wales indicate a cancer pattern similar to Caucasian populations. Some epidemiologic surveys have been undertaken.

Australia↗

PubMed1978

Health information for patients: The hospital library's role.

Libraries today, including most hospital-based patients' libraries, are involved only peripherally in providing patient health science information. Hospital libraries should collaborate with health professionals in getting health information to patients--along with the library's more traditional roles of providing recreational reading for patients and serving the informational needs of the physician and medical staff. The library should act as the center for educational materials and programs within the hospital. Many health agencies, health educators, physicians, and librarians have been discussing the need for patient health education, but there are few effectively organized or established education centers. This paper discusses an overview of patient health education and intellectural freedom, proposes a new role for the existing hospital library in patient health education, and suggests guidelines for establishing a patient education center.

Health Education↗

PubMed1978

AMTEC: a cooperative effort in medical technology education.

A committee in the St. Louis Metropolitan area has been established to promote communication and cooperation among the area's existing hospital-based programs in medical technology. Area Medical Technology Education Coordinators (AMTEC) was established three years ago primarily to facilitate the administrative functions of medical technology education and to serve as an instrument for the exchange of ideas. Its primary undertaking has been the central processing of applications to the area programs, as an aid in the admission process. In addition, a continuing education program sponsored by the committee has been established, and various "curriculum sharing" activities have been sponsored for the students enrolled in the schools. Future plans for the committee include sponsoring an on-going evaluation process of graduates by employers, and establishing a criterion-referenced question pool. The authors describe the experiences of the committee to date and plans for the implementation of future goals.

Medical Laboratory Science↗

PubMed1978

Improving physician performance by continuing medical education.

In 1973 the division of continuing medical education of the University of Saskatchewan initiated a 3-year study to determine the effect of hospital-based education on the prescribing accuracy of physicians. This study was undertaken in response to an urgent need to develop more effective methods of continuing medical education and improved techniques of measuring their effectiveness. The educational program focused on common prescribing problems that had previously been defined by experts in the field. Problem frequency was determined by the monitoring of hospital records prior to institution of the educational program and at 3, 6 and 12 months after the program had concluded; this was found to be a satisfactory method of identifying educational needs and is considered to provide a measure of the quality of medical care. Fifteen physicians at three rural hospitals participated in the study. Seventeen physicians at two similar hospitals served as controls. The average problem frequency for topics selected at the study hospitals was reduced by 63% (the percentage of possible improvement), whereas at the control hospitals the frequency of the same problems declined by 32% over the same period. The results of this study provide evidence that an intensive, problem-based program on therapeutics can improve physician performance.

Drug Prescriptions↗

PubMed1978

Cooperation between an academic subspecialty department and a community-based family medicine department: a developmental model.

While new, community-based family practice residency programs desperately need support from sister departments in academic centers, a variety of problems frequently prevents such cooperation. At the University of Wisconsin, Madison, the Department of Human Oncology, which is University Hospital-based, has worked to develop an appropriate educational program in oncology, together with and for the Department of Family Medicine and Practice, which is community-based. This paper, relating how and why these two departments have cooperated in this project, is presented to assist other departments in similar situations.

Family Practice↗

PubMed1978

There's more to patient care than medicine.

There is a side to patient care that goes beyond caring for physical complaints. Here the patient's psychological and spiritual needs are dealt with. At holistic health center, the attitude of caring for the whole patient is an essential ingredient of the care system. Because of the success of these centers, hospitals have become interested in establishing similar hospital-based models.

Adolescent↗

PubMed1978

Hospital child care center yields high dividends.

In an effort to reduce staff turnover and to improve employee morale, a medical center established an around-the-clock, hospital-based child care center. A developmental atmosphere is maintained in the center by establishing goals for each child enrolled in the program and monitoring each child's progress on a regular basis.

Child↗

PubMed1978

Auditing the quality of care of a crisis center.

The purpose of this paper is twofold: First, it defines and describes different types of audits and areas of patient care which lend themselves to a quality of performance review. Second, it describes an audit application at a hospital-based crisis intervention center and the corrective action taken on the basis of the findings. The major emphasis of the audit was to determine the quality of medical-psychiatric consultation and to develop criteria for its initiation.

Crisis Intervention↗

PubMed1978

Survey shows increase in hospital training programs.

A 1976 AHA survey has determined that the extent of hospital-based training programs for the allied professions has increased since 1973, when the previous survey was conducted. Both surveys depict the wide range of types of such programs offered by hospitals.

Allied Health Personnel↗

PubMed1978

Arrhythmias in ambulatory persons. A review and experience of 1,000 consecutive recordings.

The value of 24-hour ambulatory monitoring of the ECG for the diagnosis of symptoms of dizziness, palpitations and syncope is controversial. In this study results from a hospital-based, clinical service have been analysed. Of 1,000 consecutive dynamic electrocardiograms (DCG), 678 were performed for assessment of dizziness, syncope or palpitations in 405 patients. 36 of the patients had pacemakers. 60 DCGs were technically inadequate. The recordings were classified according to the correspondence between DCG findings and symptoms noted in the patient diary: (I) Completely diagnostic: significant arrhythmias (SA) corresponding to diary symptoms - 99 recordings. (II) Incompletely diagnostic: (a) absence of SA in the presence of diary symptoms - 90 recordings; (b) presence of SA but no diary symptoms - 197 recordings; (c) presence of SA corresponding to symptoms other than that for which the DCG was indicated - 52 recordings. (III) Non-diagnostic: absence of both SA and diary symptoms - 180 recordings. Incompletely diagnostic categories were regarded as clinically valuable in that they either excluded a cardiac arrhythmia as a cause of symptoms (group IIa) or they revealed SA which did not correspond to diary symptoms (group IIc). The absence of symptoms corresponding to SA was ascribed to poor diary keeping in 54 of 197 recordings. These results are discussed in the context of the findings in normal and symptomatic patients. A clinical 24-hour ambulatory ECG monitoring service provided useful diagnostic information in 65% of recordings and 74% of patients.

Adolescent↗

PubMed1978

Patient education in the community hospital.

Recent events have led to a favorable climate for the development of hospital-based patient education. A pilot model program in a community hospital is utilized to illustrate the variety of settings in which patient education is conducted, and includes: group classes, patient clubs, volunteer visits, individual instruction, community outreach, screening and detection programs, and behavior modification workshops. The use of television for inpatient education is highlighted in a discussion of media approaches and needs.

Audiovisual Aids↗

PubMed1976

The nature of information used in making clinical decisions in general practice.

This preliminary study indicates that in general practice:(1) Acquisition of appropriate clinical information is more often than not dependent on prior information of a highly selected kind available economically only to a personal doctor.(2) The amount of previous information which could be stored outside the brains of a personal doctor and his patient is relatively enormous and almost unlimited.(3) But, the amount of this externally stored previous information which will ever be used, referred to, or be clinically useful is minimal.(4) Logic branching systems for obtaining this essential clinical information for each episode are of two kinds. There is first the system which is universally appropriate to all patients and all diseases as a whole, a field in which the computer is becoming pre-eminent, but which also has its limitations. Secondly there is the highly personalised system, constituted by the clinical dialogue of the patient and his personal doctor, the structure of which, at present, defies any simplification and which we abandon at our peril.(5) Continuing care by group-practice teams operating under one roof eliminates the need for fragmentation of primary clinical records.(6) A simple up-dated manually-prepared paper summary of clinical problems encountered and therapeutic activity taken, may well be the essential core of this shared record. This would be backed up by the ad hoc clinical records of each health care professional as accessible, second level archives, conforming to some simple, systematic and universally accepted structure (Bjorn and Cross, 1970).It would be of great interest to know whether or not the same conclusions would be drawn from a similar study of the selected clinical problems which are dealt with by the hospital-based specialist services.

Decision Making↗

PubMed1976

Comparative costs to the Medicare program of seven prepaid group practices and controls.

This research was conducted in order to compare costs to the Medicare program for providing health care service to old people enrolled in two forms of health delivery organization: open market and prepaid group practice (pgp). Two data sources were employed: cost data provided by the Social Security Administration for seven prepaid group practices in five SMSAs and northern California and interviews conducted with administrators of the prepaid groups to determine: organizational sponsorship, incentive structure, pattern of selectivity of patients, and resource availability. Major findings are: (1) Enrollees in prepaid groups incur higher physician costs. This includes services provided by practitioners in and outside the plans. (2) Overall, prepaid groups demonstrate savings to the Medicare program in provider-initiated services- in hospital care and extended care facility services, but not in home health care. (3) Reduced spending in the hospital component does not imply reduction in the extended care facility or home service. (4) Outpatient costs in the hospital are generally higher in the open market modes, probably because this mode of care is viewed as an alternative to physician visits. (5) The greatest cost savings to the Medicare program are demonstrated by groups which are relatively small, yet hospital-based.

Aged↗

PubMed1975

Outpatient management of anticoagulation.

The Anticoagulation Service insures uniformity of approach to the regulation of anticoagulation for patients of hospital-based primary physicians. There has been no anticoagulant-related mortality in 254 patient treatment-years, and the major complication rate is 4% of treatment courses. There is a relatively low complication rate because of the systematic approach to anticoagulation therapy, recognition of the importance of patient education, communication with the primary physician, and flexibility of drug dosage and patient visit regimens. Achieving the therapeutic range of the prothrombin time with minimum complications is the goal of this Service. The hallmark of adequate control is predictable response of the prothrombin time to adjustments in drug dosage. Statistical analysis of six years' experience has provided support for the thesis that control of anticoagulation and incidence of complications are not significantly altered by patient age, sex, or the presence of concurrent nonthromboembolic medical illness.

Administration, Oral↗

PubMed1976

Antileprosy measures in Bombay, India: an analysis of 10 years' work.

Leprosy control measures adopted in Bombay consist of health education, case-detection, and treatment, and are carried out mainly by the Acworth Leprosy Hospital and its subsidiary, the Greater Bombay Leprosy Control Scheme. Although the data collected on different aspects of leprosy during the 10-year period 1963-72 are hospital-based and retrospective, their analysis provides a useful indicator of the possible situation in the field. Health education is provided by medical social workers, field staff, and physicians, and the significance of this activity in relation to early detection of leprosy is analysed. It is shown, however, that case-holding is a more urgent priority than case-detection. Trials have confirmed the effectiveness of chemoprophylaxis with dapsone for contacts of infectious index cases in crowded households. Comparison of annual expenditure per outpatient in leprosy clinics with that for inpatients in a leprosy hospital demonstrates greater cost-effectiveness of outpatient treatment. Some practical recommendations are made for leprosy control.

Communicable Disease Control↗

PubMed1977

Conceptual framework for drug usage review, medical audit and other patient care review procedures.

The following concepts are discussed: (1) quality assurance programs, (2) drug usage review, (3) utilization review, (4) peer review, (5) medical audit, (6) patient care audit and (7) medical care evaluation studies. A framework within which all types of hospital quality assurance mechanisms can be constructed is proposed and their interrelationships are described. The pharmacist's particpiation in the hospital's overall quality assurance program is stressed in two main areas-drug usage review, performed jointly with the medical staff, and quality assurance of pharmaceutical services, a peer review function of the pharmacy profession. These services are primarily drug distribution and control, drug information, clinical pharmacy, continuing education, and other pharmacy and pharmacist functions. Both functions may be viewed as parts of the pharmacy audit, one of several patient care audits within the facility. Pharmacists in skilled nursing facilities have quality assurance responsibilities similar to those of hospital-based pharmacists.

Drug Utilization↗

PubMed2026

Short-term aerobic exercise as an adjunct treatment for depression in acute geriatric psychiatry: Results of a randomized controlled trial.

BACKGROUND: This randomized controlled trial examined whether short-term aerobic exercise provided additional clinical benefit over an active control in older inpatients with depression in geriatric psychiatry. METHODS: 100 patients (mean age 76 years) were randomized to 2-week supervised aerobic ergometer training (intervention group, IG) or a flexibility program (control group, CG), both delivered in addition to treatment as usual (TAU). Adherence, training exposure and adverse events were recorded to assess feasibility. The primary outcome was clinical improvement measured with the Clinical Global Impression of Change (CGI). Secondary outcomes included depressive symptom severity assessed by the Beck Depression Inventory-II (BDI-II) and clinician-rated Hamilton Rating Scale for Depression (HAMD), physical activity, 6-min walk test (6MWT) performance, and fluoxetine-equivalent antidepressant dose (FLX). RESULTS: Thirty-nine participants attended at least 80% of sessions, with lower adherence in the IG. Weekly training duration differed between groups (74.0 ± 31.9 vs. 95.0 ± 25.3 min/week, p = .003). CGI did not differ between groups (IG: MD -0.31, 95% CI -0.67 to 0.05; p = .069). Depressive symptom severity decreased over time in both groups (p < .001), without significant between-group differences for HAMD (MD -0.22, 95% CI -2.55 to 2.12) or BDI-II (MD -0.62, 95% CI -3.68 to 2.45). 6MWT and FLX increased over time (both p < .001), without group differences (6MWT: MD -1.08 m, 95% CI -20.04 to 17.89; FLX: MD 5.69 mg/day, 95% CI -2.40 to 13.77). CONCLUSION: Short-term aerobic exercise was deliverable, but showed no additional clinical benefit over low-intensity flexibility during TAU. Further research should determine dose, duration and adherence for clinically relevant effects.

Humans↗