Confidentiality and privacy breaches in a university hospital emergency department

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.     

Automating and improving the data quality of a nursing department quality management program at a university hospital

BACKGROUND: The development and implementation of a relational database program for nursing quality management at a university hospital was stimulated by a lack of consistent data management and analysis tools in the existing noncomputerized program. PROGRAM DEVELOPMENT AND IMPLEMENTATION: An initial software prototype implemented in the critical care service included data collection instruments for five areas: medication errors, patient falls, returns to an intensive care unit within 48 hours, hospital-acquired skin breakdown, and unplanned extubations. Access to the database was limited and paper reports only were disseminated on a scheduled basis. In a second phase, the database is being deployed throughout the nursing department using a local area network. Nurse managers will enter and interact with the quality database online and have access to graphics, reports, and action plan development. POSSIBLE ERRORS: A wide range of potential errors influences decisions on how to collect, store, retrieve, and process quality management data. Each type of error affects the nurse manager's ability to identify significant patterns or trends that are amenable to intervention. There is no right way of constructing and implementing a quality improvement database; only an optimum balance between cost, complexity, and efficacy. SUMMARY AND CONCLUSIONS: Initial feedback from end uses has been positive. A three-year experience with a personal computer database suggests that the personal computer-based information technology is appropriate for small to medium applications and can support departmentwide CQI efforts. A case scenario using simulated data is included to illustrate the use of computerized reports in assessing and taking action on an increase in falls.     

The university department of general practice: its function and role

The need is stressed for university departments of general practice to examine their role and create a philosophy which will guide their function. The success of a department depends upon clear objectives, teamwork, and integration with the teaching given by other clinical departments in the medical school. The contribution of general practice to undergraduate training is discussed and problems associated with the recruitment of staff are indicated.     

Managing Risk When Contemplating Multiple Relationships.

Entering into dual relationships with psychotherapy patients has been a topic of significant controversy in professional psychology. Although these types of extratherapeutic alliances have generally been considered to be unethical conduct, some authors recently have supported their development as both ethical and, in some cases, even therapeutic (A. Lazarus & O. Zur, 2002). In this article, the authors briefly review the general literature regarding dual relationships and offer the reader guidelines in applying an ethically based, risk-managed, decision-making model that could be helpful when a practitioner is considering entering into such relationships or when such relationships inadvertently develop. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Student and department chairman views of the performance of university professors.

Compared evaluations of students for 713 university courses taught over 4 semesters by 347 professors to rankings made by department chairmen of their faculty. The faculty were ranked by professional visibility, current research, teaching impact, communication ability, and departmental contributions. 16 of 27 rhos computed for visibility and student evaluations of teaching were negative. A substantial number of relationships for research were around zero. Relationships for teaching and communications were moderately positive. One-year stability coefficients of rankings by chairmen were high for a single chairman but considerably lower when a change of chairman took place. In a chairman's view, research and visibility are highly related, but effective teaching is only moderately related to these performance criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making the best use of a department of clinical radiology--guidelines for doctors

A total of 17 patients with alimentary tract duplications underwent surgery at National Taiwan University Hospital from 1978 to 1994. Fifteen patients (88%) had gastrointestinal duplication and two (12%) had esophageal duplication. Common presenting symptoms of gastrointestinal duplication were melena and abdominal pain. The ileum was the most common site of duplication. Multiple duplications were seen in three patients. All duplications were cystic, except for one single appendiceal duplication. Ectopic gastric mucosa was detected in nine of the 16 nongastric duplications. One patient with ileal duplication had ectopic pancreatic tissue. Twelve patients received resection of the duplication with a segment of bowel and primary anastomosis, three patients underwent simple excision and two patients had partial resection of the duplication and stripping of the residual mucosa. Two patients had other associated congenital anomalies: one had ventricular septal defect and the other, imperforate anus and malrotation of intestine. There was no operative mortality or morbidity in this series.     

A proposal for a computerized clinical records file for a department of general surgery

The author suggest a computerized program for filing clinical records of surgical institution. The proposed file is written in DB III plus (Ashton-Tate) and consists of one file .dbf and 4 files .prg. The database file contains anagraphic and clinical data of the patients. The program files make it possible to attribute a personal code to patients, print records of single patients, calculate the time of operation and assist in codifying diagnostic related groups (DRGs). The author stresses the utility of a medical computerized records system containing only few but important clinical data. It makes it possible to perform the most analysis of surgical series without the aid of a professional programmer.     

Sport psychology training within a clinical psychology program and a department of intercollegiate athletics.

Many applicants to clinical and counseling psychology programs are interested in receiving the training needed to practice competently in the professional specialty area of sport psychology. In this article, the authors describe a collaborative training and service relationship between an APA-accredited clinical psychology program and an intercollegiate athletics department. Sport Psychology Services provides performance enhancement, program evaluation, and mental health services to the athletic department. In return, graduate students receive applied training, financial support, and opportunities to conduct research. The authors present program evaluation data and offer practical guidelines to graduate programs wishing to establish similar training opportunities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The peregrinations of an applied generalist in government, industry, a university psychology department, and a business school.

The career of an applied psychologist, in measurement, industrial/organizational psychology, consumer behavior, and evaluation research, is chronicled from his undergraduate education through his position as a business school professor. This biographical odyssey compares a variety of employment settings; traces the major influences on his career; provides a commentary on applications, research, and scholarship in a business school setting vs a psychology department; and offers a synopsis of his interests and activities as he moves into his status as an emeritus professor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Derivation of a clinical prediction model for the emergency department diagnosis of ectopic pregnancy

OBJECTIVE: To derive a clinical prediction model for estimating the pretest probability of ectopic pregnancy in ED patients with first-trimester abdominal pain or vaginal bleeding. METHODS: All hemodynamically stable first-trimester patients presenting to the ED of a tertiary care military teaching hospital over a 14-month period with a chief complaint of abdominal pain and/or vaginal bleeding had clinical data coded prior to determining outcome. They were then followed longitudinally until a criterion standard pregnancy outcome was established. RESULTS: Of the 486 patients enrolled, 280 (58%) had viable intrauterine pregnancies, 167 (34%) had nonviable intrauterine pregnancies, and 39 (8%) had ectopic pregnancies. Using a recursive partitioning model, a high-risk group was derived (that was separated from intermediate and low-risk groups), consisting of patients with abdominal peritoneal signs or definite cervical motion tenderness, with a sensitivity of 31% (95% CI: 17-48%), a specificity of 93% (95% CI: 90-95%), a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.74. A low-risk group, consisting of patients with either fetal heart tones or tissue at the cervical os, or the absence of pain other than midline menstrual-like cramping and lacking any pelvic tenderness, was differentiated from an intermediate-risk group, with a sensitivity of 96% (95% CI: 81-100%), a specificity of 22% (95% CI: 18-26%), a positive likelihood ratio of 1.2, and a negative likelihood ratio of 0.17. CONCLUSION: A clinical prediction model for estimating the probability of ectopic pregnancy in ED patients has been derived. It may prove to have practical clinical application for estimating pretest probability of ectopic pregnancy as well as assisting in medical decision making when laboratory and ultrasonographic findings are nondiagnostic. Clinical application should await prospective validation in an independent sample.     

Severe sepsis in the emergency department and its association with a complicated clinical course

Among the most common causes of upper extremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which affect injury risk during this event. In this study, we measured impact forces during low-height (0-5 cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and a subsequent, lower-frequency oscillation. This behavior was well-simulated by a two-degree-of-freedom, lumped-parameter mathematical model. Increases in body mass caused greater increases in the peak magnitude of the low-frequency component (Fmax2) than the high-frequency component (Fmax1). However, increases in fall height more strongly influenced Fmax1, which exceeded Fmax2 for all but very low fall heights. Model predictions suggest that fall heights greater than 0.6 m carry significant risk for wrist fracture, since above this height, peak forces surpass the average fracture force of the distal radius. Finally, while the shoulder experiences lower peak force than the wrist (since Fmax1 is not transmitted proximally), it undergoes considerably greater deflection, and thereby absorbs the majority of impact energy during a fall.     

腰椎峡部裂的CT表现和临床意义

目的:探讨CT在腰椎峡部裂诊断中的临床价值.材料与方法:分析了34例腰椎峡部裂的CT表现,对腰椎峡部裂导致腰神经嵌压的CT表现与其临床症状进行比较.结果:CT能显示峡部裂所致的椎管狭窄、侧隐窝和椎间孔狭窄及其他并发改变,CT表现与临床症状相符为76%.结论:CT对峡部裂以及手术方式的选择具有重要意义.     

Prevalence and clinical presentations of arthritis in HIV-positive patients seen at a rheumatology department in Congo-Brazzaville

It was previously postulated on the basis of clinical data that the cardiovascular sequelae of extracorporeal whole-body hyperthermia (e-WBH), i.e., hypotension (which requires catecholamine support) results in unique nephrotoxicity in combination with select chemotherapeutic agents. In an attempt to explain this phenomenon, we mimicked e-WBH physiological conditions in a rat model. Animals were treated with and without ifosfamide (IFO) and/or carboplatin (CBDCA) at 37 degrees C or 41.5-41.8 degrees C, with blood pressure monitoring and catecholamine support comparable to the clinical setting. Ex vivo post-treatment data (24 h) from artificially perfused kidneys (i.e., histology, urine volume, perfusion rate, glomerular filtration rate, and the reabsorption of sodium, glucose, and water) demonstrated unique toxicity including proximal tubular necrosis for the combination of WBH and IFO, for WBH and CBDCA and for WBH and IFO plus CBDCA, but not for IFO and CBDCA without WBH. These data, considered together with results derived from a subsequent clinical trial and the laboratory work of others were consistent with the hypothesis.     

妇科临床实习带教的经验总结

广州市白云区第一人民医院妇科作为实习带教医院,为实习生的业务发展起到了积极的作用,成为了在校学生由理论走向实践的桥梁,被学生认为是走向临床的难得的契机.我们在带教中全力以赴,抓住重点,加强自身建设,积极反映同学的诉求,开展自我监测和相互监督,全面提高整体水平,取得了良好的带教效果,现将经验交流如下.     

The evaluation of university programs in clinical and counseling psychology.

Describes the general values guiding evaluation of graduate programs in clinical and counseling psychology by the American Psychological Association and presents an outline of the evaluation procedure (e.g., evaluation requests, the visit). (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of clinical autopsy in monitoring the quality of the clinical diagnosis in an emergency department

OBJECTIVE: A total of 61 autopsies performed in patients died in emergency department of a university hospital were retrospectively analysed and the findings were compared with clinical diagnoses. METHODS: Sensitivity and specificity of the clinical diagnoses and the correction of medical procedures were measured. The influence of age and sex of patients was analyzed using Fisher's exact test and chi-square-test. RESULTS: The most common causes of death were cardiovascular diseases (52.46%). Autopsy showed unexpected major findings in 44.26% of cases. Major discrepancies between the autopsy reports and the clinical diagnoses, were present in 26.22% of all cases. Absolute concordance between clinical and autopsy diagnoses was obtained in 44.26% of cases. The major sensitivity of clinical diagnosis was found in cerebrovascular disorders (100%), upper digestive hemorrhage (100%), and acute myocardial infarction (82.35%). The lowest sensitivity was found in malignant tumors (16.66%), hemorrhagic pancreatitis (0%) and bowel infarction (0%). The patient cares were correct in 68.85% of cases. No statistically significant differences were observed in relation to age and sex. CONCLUSIONS: We concluded that autopsy is a useful method for evaluate diagnostic procedures and quality of medical cares in emergency departments.