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.     

Psychiatric and psychological factors in patient decision making concerning antidepressant use.

The observation that the use of antidepressants has strongly increased during the past decade implies that on a micro level doctors and patients more often decide that antidepressants are the appropriate treatment. Therefore, it is important to increase insight into patients' decision making regarding the use of antidepressants. The decision making model used in the present study was based on A. Bandura's (1986) social cognitive theory. Two cohorts of patients were recruited and followed for 9 months. Among patients who use antidepressants (N = 166), the stronger pros and weaker cons of discontinuation and self-efficacy predicted more proximal goal intentions. Goal intentions predicted discontinuation after 9 months. Among patients who had used antidepressants in the past (N = 73), stronger pros of discontinuation and the weaker perceived functions of antidepressants predicted a more positive evaluation of their present state, compared with when they still used antidepressants. These temporal comparisons, in turn, predicted renewed use of antidepressants after 9 months. The results provide a framework for supporting and influencing decision making with regard to the use of antidepressants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An adaptive approach to human decision making: Learning theory, decision theory, and human performance.

Describes a general model of decision rule learning, the rule competition model, composed of 2 parts: an adaptive network model that describes how individuals learn to predict the payoffs produced by applying each decision rule for any given situation and a hill-climbing model that describes how individuals learn to fine tune each rule by adjusting its parameters. The model was tested and compared with other models in 3 experiments on probabilistic categorization. The 1st experiment was designed to test the adaptive network model using a probability learning task, the 2nd was designed to test the parameter search process using a criterion learning task, and the 3rd was designed to test both parts of the model simultaneously by using a task that required learning both category and cutoff criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of drugs to improve athletic performance

In sports, medical drugs are applied for supposedly ergogenic effects. Forbidden drug use (doping) implies that the drug enhances performance, which is not always the case. Amphetamines are ergogenic particularly during short-term, explosive exercise. Amphetamines exert an ergolytic effect on high-intensity endurance exercise. Caffeine has an ergogenic effect on endurance performance in dosages of 3 to 6 mg/kg. Doping regulations allow a small amount of caffeine intake. Androgenic and anabolic steroids elicit an increase in muscle growth and strength. In females low doses appear to be ergogenic in all sport types. beta 2-adrenergic agonists appear to have a positive effect on strength and muscle growth. The effects on endurance performance are still unknown. Although growth hormone is used in sports, scientific studies show that compared with placebo no difference in strength and muscle volume is observed. Blood doping and administration of erythropoietin are effective in enhancing endurance performance.     

An introduction to wavelet theory and application for the radiological physicist

The wavelet transform, part of a rapidly advancing new area of mathematics, has become an important technique for image compression, noise suppression, and feature extraction. As a result, the radiological physicist can expect to be confronted with elements of wavelet theory as diagnostic radiology advances into teleradiology, PACS, and computer aided feature extraction and diagnosis. With this in mind we present a primer on wavelet theory geared specifically for the radiological physicist. The mathematical treatment is free of the details of mathematical rigor, which are found in most other treatments of the subject and which are of little interest to physicists, yet is sufficient to convey a reasonably deep working knowledge of wavelet theory.     

Using the theory of reasoned action (TRA) to understand the decision to use condoms in an STD clinic population

The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individual's prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.     

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)     

严格环境管理提高环境意识

环境伴随着经济的发展越来越体现了它的重要性,全社会应重视环境、保护环境,以预防为主,加强综合治理,使我们的天更蓝、水更净、草更绿,到处充满着春的意境.     

加强焦炉管理稳定提高焦炭质量

焦炉管理对焦炭质量的影响,以及加强焦炉管理,稳定加热制度的主要方法.     

CMA leads drive to improve physicians'' management skills

PURPOSE: To report bilateral aplasia of the optic nerves, chiasm, and tracts in an otherwise healthy infant. METHOD: Case report. RESULTS: Ophthalmologic examination disclosed bilateral microphthalmos and optic nerve aplasia. Physical, neurologic, and genetic evaluations were otherwise normal. Magnetic resonance imaging of the brain and orbits disclosed bilateral aplasia of the optic nerves, chiasm, and tracts. CONCLUSION: Bilateral aplasia of the optic nerves, chiasm, and tracts may occur in an otherwise healthy infant.     

The use of response patterns to improve item scoring.

This study compared the validity of 2 methods of scoring the Minnesota Vocational Interest Inventory. One method used keys developed in the usual manner by selecting items that differentiated between specific occupational groups and a reference group of tradesmen-in-general. The other method used keys developed by selecting items that were part of response patterns that differentiated between criterion and reference groups. 3 occupational keys were developed and cross-validated: painter, printer, and electrician. Results showed that the keys were about equal in their ability to separate criterion from reference groups, but the key developed from response patterns used far fewer items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low vision: physician screening helps to improve patient function

Low vision is a common problem of older patients. As a primary care practitioner, you are not expected to treat most ocular problems, but you can play an important role by identifying patients with visual impairment. Familiarize yourself with the normal visual changes that occur with aging as well as the more common age-related ocular diseases, including glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy. You can identify patients with visual problems with a careful history and basic in-office tests of visual acuity. Refer patients found to have visual impairment to an eye care specialist for further evaluation.     

开展QC小组活动，完善质量管理体系

质量管理小组 (简称ＱＣ小组 )是美国质量管理专家Ｗ .Ｅ戴明博士吸取了我国著名的“鞍钢宪法”中群众管理的基本经验 ,即“两参一改三结合” ,运用全面质量管理理论 ,于 1 962年在日本创建的 .ＱＣ小组的迅速发展 ,在世界上产生了很大的影响 .1 978年我国引进全面质量管理 ,介绍了日本的ＱＣ小组活动的经验以后 ,ＱＣ小组活动很快被我国企业普遍接受 ,吸引广大职工参加企业各项管理活动 ,创造了巨大的经济效益和社会效益 ,已成为现代化管理的要求和必然趋势 .没有生产第一线广大职工参与管理 ,没有职工的主动性、创造性 ,企业的质量管理体…     

Multialternative decision field theory: A dynamic connectionst model of decision making.

The authors interpret decision field theory (J. R. Busemeyer & J. T. Townsend, 1993) as a connectionist network and extend it to accommodate multialternative preferential choice situations. This article shows that the classic weighted additive utility model (see R. L. Keeney & H. Raiffa, 1976) and the classic Thurstone preferential choice model (see L. L. Thurstone, 1959) are special cases of this new multialternative decision field theory (MDFT), which also can emulate the search process of the popular elimination by aspects (EBA) model (see A. Tversky. 1969). The new theory is unique in its ability to explain several central empirical results found in the multialternative preference literature with a common set of principles. These empirical results include the similarity effect, the attraction effect, and the compromise effect, and the complex interactions among these three effects. The dynamic nature of the model also implies strong testable predictions concerning the moderating effect of time pressure on these three effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

A verification procedure to improve patient set-up accuracy using portal images

The M(r) 30,000 polypeptide of the hydrophobic protein fraction of the energy-transducing NADH-ubiquinone oxidoreductase (complex I) of bovine heart mitochondria was identified as the ND2 gene product based on a comparison of amino acid analysis and partial N-terminal sequencing results with the known DNA sequence of ND2 (Anderson, S. et al. (1982) J. Mol. Biol. 156, 683-717). A simple purification procedure was devised for this ND2 gene product. The procedure, which is described, involves treatment of bovine complex I with a chloroform-methanol (2:1 [v/v]) solution. The antiserum raised against this purified bovine ND2 gene product cross-reacted with the approximately M(r) 39,000 polypeptide extracted from the Paracoccus denitrificans membranes with chloroform-methanol (2:1 [v/v]).     

Does CTAP prior to hepatic resection improve patient survival rates?

The purpose of our study was to compare survival rates of colon carcinoma patients who had undergone attempted curative hepatic resection based on liver staging by computed tomographic angiography (CTA) or portography (CTAP) with previously reported survival rates of patients who underwent similar surgery without preoperative CTAP evaluations. A total of 404 CTAP studies performed at three institutions were reviewed. Of this group, 197 had colon carcinoma. Sixty-nine of the colon patients went to surgery. Actuarial adjusted yearly survival rates were calculated for the prior CTAP colon group and compared to historical controls. The control survival data were taken from reports published prior to the CTAP era. Our study demonstrated no difference in the 1-year survival data between the groups. However, the CTAP patients had greater survival in years 2-4. This greater survival may be multifactorial but in part due to better surgical selection caused by CTAP.     

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)