Assessing clinical pathways use in a community hospital: it depends on what "use" means

BACKGROUND: Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. METHODS: A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. RESULTS: The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. CONCLUSIONS: Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.     

Group climate development in cognitive and interpersonal group therapy for social phobia.

This study was designed as a longitudinal study of 80 participants in cognitive group therapy (RCT, n = 40) and interpersonal group therapy (RIPT, n = 40) for social phobia during 10 weeks of residential therapy. The aim was to investigate the patterns of group climate development and its impact on treatment outcome. Data were collected using MacKenzie's Group Climate Questionnaire (GCQ) 4 times during treatment, and a multilevel (mixed) model approach was used in the analyses. Engagement in RCT groups showed a linear increase during treatment in contrast to a linear decline among patients in RIPT groups. This divergence might be explained by the focus on extragroup and intragroup relationships in RCT and RIPT, respectively. Neither conflict nor avoidance followed the expected pattern, nor did their mean levels influence outcome. However, when 6 extreme values of conflict were removed, there was support for a low–high–low pattern of conflict. In general, these results do not support MacKenzie's generic model of group climate development but suggest that sample characteristics, treatment models, and setting can play major roles in determining the group climate. Of the group climate variables, only the mean level of engagement predicted a change in social anxiety over the course of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Co-occurrence of avoidant personality disorder and child sexual abuse predicts poor outcome in long-standing eating disorder.

Few consistent predictive factors for eating disorder have been identified across studies. In the current 5-year prospective study, the objective was to examine whether (a) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (b) how the predictors interact. A total of 74 patients with long-standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at 1-, 2-, and 5-year follow-up. A mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder, and sequelae after child sexual abuse are potential targets for treatment that need further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation of a professional practice model for nursing in a rural hospital

Growing concern about rural hospitals and the health of rural citizens highlight the need for high quality, progressive nursing care. To address this concern, several program changes to improve patient and organizational outcomes were made in one rural hospital; implementation success varied. Hospital culture and changes occurring within the health care environment affected the change process.     

Self-scheduling in five med/surg units. A comparison

As part of an Enhanced Professional Practice Model, self-scheduling was implemented in five medical/ surgical units. Each unit had varying degrees of success. The five factors that influenced successful implementation-committee structure, staff education, negotiation skills, guidelines and managerial support-are discussed.     

Liquid anti-solvent recrystallization to enhance dissolution of CRS 74, a new antiretroviral drug

This study concerns a new compound named CRS 74 which has the property of inhibiting Human Immunodeficiency Virus (HIV) protease, an essential enzyme involved in HIV replication process. It is proved in this study that the original CRS 74 exhibits poor aqueous solubility and a very low dissolution rate, which can influence its bioavailability and clinical response. In an attempt to improve the dissolution rate, CRS 74 was recrystallized by liquid anti-solvent (LAS) crystallization. Ethanol was chosen as solvent and water as the anti-solvent. Recrystallized solids were compared with the original drug crystals in terms of physical and dissolution properties. Recrystallization without additives did not modify the CRS 74 dissolution profile compared to the original drug. CRS 74 was then recrystallized using different additives to optimize the process and formulate physicochemical properties. Steric stabilizer in organic phase ensured size-controlling effect, whereas electrostatic stabilizer in aqueous phase decreased particle agglomeration. Cationic additives avoided drug adsorption onto stainless steel T-mixer. In general, additive improved drug dissolution rate due to improvement of wetting properties by specific interactions between the drug and the additives, and ensured continuous production of CRS 74 by electrostatic repulsion.     

Electromagnetic Interference Reduction Filters

This paper presents the theory and application of lumped-image parameter reactive filter networks, absorptive-type filter networks, and combined absorptive-reactive filter networks as conducted electromagnetic interference reduction circuits. A comparison of the passband characteristics by specific examples is given for filter configurations of the pi, T, absorptive, and absorptive-reactive type under implementation conditions of a fixed source impedance and a varying load impedance as encountered when filtering prime power sources feeding ac to dc converters. This paper illustrates the problem the design engineer faces when applying the usual data given in filter catalogs. The filter characteristics are presented for 50-ohm resistive source and load conditions because of MIL-STD-220A quality control testr equirements. A test configuration is recommended to determine the admittance transfer of a filter network, indicative of the networks performance characteristics under application conditions.     

用USB电源对超级电容器充电至7V的电路

初看来,用5V USB端口为超级电容器充电似乎是简单的事,但是要将三只超级电容充电至7V,并将输入电流限制在USB端口的最大极限500mA内,就比较困难了.     

A two-step acid mercury removal process for pulverized coal

A correlation predicting the effectiveness of a two-step acid wash coal cleaning protocol using sequential leaching of mercury from the coal was developed and the effectiveness of the two-step wash procedure was then determined for two bituminous coals. Increasing the hydrochloric acid concentration and temperature in the USGS four stage sequential leaching protocol increased the amount of mercury leached during the HCl step. Using these revised conditions, sequential leaching was then shown to correspond to the mercury removals achieved in the two-step wash method. Mercury removal rates of 50-70% were realized for the bituminous coals by pre-treating the coal prior to a wash with hot concentrated HCl.