Contribution of locally and externally designed quality management activities to hospitals'' efforts to improve patient care

Toxic shock syndrome (TSS) has gained notoriety because of its association with tampon use. However, there is an increasing awareness of the syndrome on many of the specialised burn units in hospitals through the United Kingdom. TSS primarily affects children with small-percentage burns, and it is this group of patients that normally would be expected to make an uneventful recovery. One unit, where 100-150 children are admitted per year, has seen four cases of confirmed TSS over a two-year period. There does not appear to be the same risk of TSS in adult burned patients, and this lower incidence may be the result of an increase in the production of antibodies to toxic shock toxins with increase in age.     

Contribution of psychological reports to patient management.

Examined 227 and 113 psychological reports done on 4 psychiatric services for children and adults. The specific referral requests, E.g., intellectual evaluation, diagnostic impression, and personality appraisal, were rated by the referrer regarding the manner in which the reports confirmed previous information or provided new and significant information. About 2/3 of the requested items provided new information or confirmed information previously suspected but not well established. After 2 mo., the referral source was interviewed regarding the effects of the report on patient management and care. 12 actions were categorized. In 52% of the reports some modification was reported of patient management or disposition as a result of the psychological report. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of clinical pharmacists on psychiatric patients

BACKGROUND: Studies of population biology are scarce in Mediterranean striped dolphins (Stenella coeruleoalba) mostly because of the lack of samples. Until now, studies of physical maturity, growth, and development of the flipper bones were not available for this species in the Mediterranean. METHODS: The osteological features and metric characters of the pectoral limbs of Mediterranean striped dolphins were analyzed with radiological techniques. Measurements were made directly on the radiographic films. RESULTS AND CONCLUSIONS: We found five carpal bones arranged in a proximal row of three and a distal row of two, although one or two additional osseous elements were occasionally observed. The phalangeal formula (excluding metacarpals) was established as 1-2:8-9-10:6-5-7:3-2:1-2. In metacarpals, epiphyseal ossification centers matured at the same time at both ends. As a general rule, the ossification of the epiphyses in the flipper bones showed a decreasing gradient in the proximodistal direction, confirming the pattern previously described in other species. Phalangeal epiphyses were not useful as indicators of skeletal maturity, and grading epiphyseal maturation of the distal radius and ulna is proposed as the more straight-forward and precise method for assessing bone maturation. In females, maturity of the flipper was achieved between 5 and 6 years of age and 160-175 cm of body length, whereas this maturation occurred between 8 and 9 years of age and 170-181 cm in length in males. Prediction of gender through examination of flipper structure was not feasible.     

Staffing to meet patient care needs

Brain proteins are released into body fluids in a fashion which reflects the underlying pathogenetic mechanisms for individual diseases. It is therefore important to distinguish not only different protein markers (reflecting various brain cells from which they have been released), but also their metabolism at different sites within the body (e.g. reticulo-endothelial system vs renal clearance) which will have an important bearing on whether fragments of the protein are found in urine or blood. It is clear that different patterns of protein abnormalities would be helpful in differential diagnosis of the individual diseases which afflict the nervous system. It would also be useful to monitor these proteins either as surrogate markers of the natural history of the condition or in the various therapies for each disease.     

The path to a clinical pathway: collaborative care for the patient with an ostomy

A colostomy and ileostomy clinical pathway was developed at a southeastern teaching hospital in 1990 in response to excessive lengths of stay and costs at our hospital compared with national data for this patient group. A multidisciplinary clinical pathway team was formed and charged with the development, implementation, and ongoing monitoring of the clinical pathway tool and its effect on the outcomes of the population of patients with colostomies and ileostomies. Through this multidisciplinary collaboration, length of stay and cost have been reduced while quality care indicators have been maintained. This article presents the sample pathway we developed and describes the pathway development process, documentation, the variance analysis process, and the outcomes achieved with implementation. A urostomy/urinary diversion pathway that was developed after variance analysis review of the colostomy and ileostomy clinical pathway is also presented.     

Say no to government control of patient care

Healthcare reform threatens to jeopardize the role of physicians in deciding what is appropriate care for their patients. Factors outside the doctor-patient relationship, such as a global budget and limited access, will exert increasing influence on the decision-making process, according to Dr Dewberry. In this commentary, he explores the roots of this dangerous trend and suggests that physicians take an uncompromising stance against it.     

Using health care outcomes to improve patient care in the NICU

The authors describe their use of outcomes research in improving the care of infants in a ten-hospital network of neonatal intensive care units. Improvements in the processes of care for infants born with very low birth weights, and those suffering from chronic lung disease and nosocomial infections, are among the issues discussed.     

Interventions to reduce decibel levels on patient care units

The University of Virginia Health System inpatient satisfaction survey identified noise as the most important irritant to surgical inpatients. Analysis of the level and pattern of noise on patient floors and intensive care units was done with baseline measurements followed by then two separate interventions: 1) education of nursing and physician staff 2) closing patient room doors. A decibel meter (M-27 Dosimeter) recorded the noise level over 24 hours. Patients doors were open in the initial measurements. Next, three 1-hour education sessions were conducted by a surgeon and nursing supervisor to review noise-reduction strategies with the staff. These included using pagers in vibrate mode, minimizing overhead announcements, and conducting nurse reports and physician teaching sessions in classrooms away from the nurses' station. Finally, the doors were closed except as visitors and staff entered the room. Little impact was seen from staff education. Closing patient doors on surgical floors decreased noise an average of 6.0 dB, a change that patients can readily perceive. Conversely, intensive care unit patients are exposed to more noise with closed doors, presumably because most noise emanates from equipment within the room. A policy of closing patient floor room doors may increase patient satisfaction.     

Bridging science and practice to improve patient care.

Replies to the comments by Tyron (see record 2009-06923-008), Silverstein and Auerbach (see record 2009-06923-009), and Raps (see record 2009-06923-010) on the authors original article (see record 2008-03389-001). I was very pleased to read these comments about the priority of bridging research and clinical practice and to have the benefit of further perspectives on how this goal might be achieved. The article to which these comments were addressed suggested changes in both clinical research and practice that might develop or strengthen such a bridge. Suggestions for clinical research included evaluating the mechanisms of change in psychotherapy so we know what is critical to include in practice, evaluating who responds to treatment in ways that can be integrated into practice, and increasing the use of qualitative research. Suggestions for practice included using systematic measures to evaluate patient progress, codifying the experiences of practitioners so they contribute to our accumulated knowledge base, and promoting direct collaborations of researchers and practitioners. The above commentaries emphasized specific points about research on mechanisms, qualitative research methods, and the challenges of providing treatments given the nature and scope of the problems that clients present. These commentaries add to the discussion in novel ways and also illustrate the obstacles that may compete with bridging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contribution of P.K. Anokhin to the development of clinical physiology

The paper reviews P. K. Anokhin's works whose physiological studies promoted solution of clinical medical problems. The use of his theory of functional systems enabled one to solve many issues of clinical physiology and practical medicine, such as the nature of pain and the mechanisms of anesthesia, that of narcotic sleep, the pathogenesis of hypertensive disease, the principles of compensation of dysfunctions in the body, medical strategy in the prevention of diseases, etc.     

'Talk to me' patient communication in a long-term care facility

1. Staff are important facilitators for communication among elderly patients, who often are alone and bored for long periods. 2. Staff serve as an essential link between the patients and the outside world, and serve as a conduit for initiating contact between residents. 3. Environment--including the selection of roommates, the proximity of residents, and the volume of radios and televisions--may greatly alter residents' ability to communicate.