Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium.     

Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury

This study was designed to evaluate factors that affect blood volumes transferred to skin during simulated needlestick injuries in an in vitro paper prefilter model and an ex vivo porcine tissue model. The effect of needle type and size, penetration depth, and glove use on the volume of radiolabeled blood transferred was determined in each model. Blood volumes ranged from 0.47 +/- 0.26 microL (30-gauge needle, 0.5-cm depth, in vitro model) to 5.88 +/- 1.45 microL (18-gauge needle, 2.0-cm depth, in vitro model). Needle size and penetration depth were significantly associated with transfer volume. Glove material reduced the transferred blood volume by 46%-86% in both models. Transfer volumes were within the same order of magnitude for all conditions. Hence, virus titer in the source blood may be a better predictor of needlestick infectivity than is exposure volume. Regardless, gloves may exert some protective effect and should be worn whenever needles are handled.     

Agglomeration behavior of solid nickel on polycrystalline barium titanate

This letter describes the phenomenon that takes place between nickel/barium titanate couples when heated under conditions employed in multilayer ceramic capacitor manufacturing practice: a 4 h, 1300 °C isothermal anneal in 1% H₂-99% N₂. Dense, sputtered nickel films were observed to dewet the titanate and agglomerate into discrete or interconnected islands via a solid-state process. Up to a critical film thickness value of ∼ 1.4 μm, the degree of agglomeration was found to display an exponential dependence on the thickness of the original nickel film.     

A portable program to present courseware on microcomputers

In computer assisted instruction, certain main functions which have to be carried out by the computer can he distinguished. The performance of these functions will have different software and hardware requirements in different educational environments and both the requirements and the technology to implement them will change over time. It is therefore advantageous to make CAI systems as adaptable as possible. One approach to this is to divide the systems into independent modules each designed to achieve good portability both for software and for hardware. This paper describes such a module which is part of the Modular CAI System Delft. The program makes it possible to present on different types of microcomputers courseware designed using other modules of the system. The program is implemented in Pascal to yield maximum portability on modern microcomputers. Its future and portability are discussed.     

Two-port isotropic radiator for unpolarized waves

The possibility of radiating an equal amount of power in all directions and all polarizations, using a two-port antenna excited by two independent noise sources, is considered.     

Hepatitis C: Part I. Routine serologic testing and diagnosis

Hepatitis C, which is caused by the hepatitis C virus (HCV), is a major public health problem in the United States. HCV is most efficiently transmitted through large or repeated percutaneous exposures to blood. Most patients with acute HCV infection develop persistent infection, and 70 percent of patients develop chronic hepatitis. HCV-associated chronic liver disease results in 8,000 to 10,000 deaths per year, and the annual costs of acute and chronic hepatitis C exceed $600 million. An estimated 3.9 million Americans are currently infected with HCV, but most of these persons are asymptomatic and do not know they are infected. To identify them, primary health care professionals should obtain a history of high-risk practices associated with the transmission of HCV and other bloodborne pathogens from all patients. Routine testing is currently recommended only in patients who are most likely to be infected with HCV.     

Process improvement in healthcare: overall resource efficiency

This paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healthcare processes, breaking down work into micro processes, tasks, and resources. In addition, we propose an axiological model which breaks down general performance goals into process metrics. The connexion between both types of models is made explicit as a system of metrics for process flow and resource efficiency. The conceptual models offer exemplars for practical support in process improvement efforts, suggesting to project leaders how to make a diagrammatic representation of a process, which data to gather, and how to analyze and diagnose a process's flow and resource utilization. The proposed methodology links on to process improvement methodologies such as business process reengineering, six sigma, lean thinking, theory of constraints, and total quality management. In these approaches, opportunities for process improvement are identified from a diagnosis of the process under study. By providing conceptual models and practical templates for process diagnosis, the framework relates many disconnected strands of research and application in process improvement in healthcare to the unifying pursuit of process improvement. Copyright © 2011 John Wiley & Sons, Ltd.