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Medical Department (medical + department)
Selected AbstractsOrganizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses,RESEARCH IN NURSING & HEALTH, Issue 2 2010Patricia A. Patrician Abstract The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p,<,.01), emotional exhaustion (OR 12.70, p,<,.01), intent to leave (OR 3.03, p,<,.01), and fair to poor quality of care (OR 10.66, p,<,.01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:99,110, 2010 [source] Validity of a Discharge Diagnosis of Heart Failure: Implications of MisdiagnosingCONGESTIVE HEART FAILURE, Issue 4 2008Cāndida Fonseca MD Heart failure (HF) costs are largely due to hospitalization. The validity of a death/discharge diagnosis of HF (DDHF) is largely unknown. The authors assessed the validity of DDHF and the impact of misdiagnosing. The case notes of patients consecutively admitted to a medical department between January and June 2001 were reviewed. Cases with DDHF or cardiovascular diseases, potential precursors of HF (PPHF), were included. The diagnosis of HF (European Society of Cardiology guidelines) was classified as definite, possible, or miscoded. Of the 1038 patients admitted, 234 were enrolled: 157 with DDHF and 77 with PPHF. One hundred eighty patients had a definite diagnosis of HF. Of the 157 diagnoses coded as definite HF, 130 were correct, 21 had possible HF, and 6 were miscoded. Of the 77 patients classified as having PPHF, 38 had definite HF. The accuracy of the DDHF diagnosis was 72.2%: 21.1% were underdiagnosed and 8.3% overdiagnosed. DDHF failed to capture many HF admissions and therefore alone underestimates the prevalence, burden, and costs of the syndrome. [source] Application of Telemedicine in a Pain Clinic: The Changing Face of Medical PracticePAIN MEDICINE, Issue 4 2000Rouzanna Burton MS Telemedicine systems aim to provide quality health care services to persons whose access is otherwise restricted by geography and environment. The military medical department has a unique mission to provide all medical care for the battlefields and peacekeeping missions anywhere in the world. In addition, the medical department has to ensure the health of all soldiers, family members, and retirees during peacetime. Hospital closures coupled with a decreased number of military physicians have left many health care beneficiaries without readily available specialty care. They face long waiting lists or incur high out-of-pocket expenses in order to see medical specialists. As a result of the establishment of a virtual Telepain clinic, 56,400 miles were saved in patient and clinician travel. Use of technologies in the emerging field of telemedicine has lead to the creation of numerous military and civilian medical applications such as virtual dermatology, virtual psychiatry, virtual cardiology, virtual nuclear medicine/radiology, virtual pharmacology, and in future, virtual dentistry and ophthalmology. [source] Evaluation of cost of treatment of drug-related events in a tertiary care public sector hospital in Northern India: a prospective studyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2009Smita Pattanaik WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Drug related events include ADRs, events due to patient or physician noncompliance, drug overdosage and drug interactions. , Economic burden of management of drug related events are substantial and include both direct and indirect costs. , Some data regarding cost of treatment of ADR exist from south and western India. WHAT THIS STUDY ADDS , An approximate cost of management of drug related events presenting to the emergency medical department in a tertiary care hospital over a period of 4 months. , Compares the cost incurred in a public sector hospital to the projected cost of management of same events in a private sector hospital. , Gives a rough estimate of economic burden on the health care system due to adverse drug events. AIMS Drug related events (DREs) contribute significantly to hospital admissions. These are largely preventable events and require optimum use of the therapeutic agents. The study was conducted to analyze the cost of treatment of DREs. PATIENTS & METHODS All visits to medical emergency department of a tertiary care public sector hospital in northern India were recorded in a prospective, non-interventional manner over a period of 4 months. DREs were recognized and were followed up till their stay in the hospital. Data about the cost generating components of direct and indirect costs of treatment of DREs were collected. The projected cost of treatment of the same DREs in a private sector hospital was estimated and compared. RESULTS Out of 1833 admissions, 92(5.01%) were due to DREs. Maximum cases were due to non compliance (66%) followed by ADR (28%) and drug overdose(6%). The common DREs leading to ED visits were cerebrovascular accident(19.44%), followed by accelerated hypertension(18.36%) and diabetic ketoacidosis(14.04%). Total cost of management of all the 92 DREs in our hospital was calculated to be INR17,37,339(,30,215). The direct cost was INR1,72,961(,3008) and the approximate indirect cost was INR15,64, 378(,27, 206). The projected cost of management of all the 92 DREs was estimated to be INR63,63,872(,1,01, 676) in a private sector hospital. CONCLUSION The study shows that ADEs leading to emergency department visits and hospitalizations constitute a significant economic burden. Training of the patients and the prescribers may lessen the economic burden on the patient as well as the health care system. [source] The use of nationwide on-line prescription records improves the drug history in hospitalized patientsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008Bente Glintborg What is already known about this subject ,,Structured medication interviews improve the medication history upon hospitalization ,,Pharmacy records are valid lists of the prescribed medications available to individual patients ,,In Denmark, treating doctors now have access to their patients' pharmacy records through a real-time online electronic database What this study adds ,,Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits ,,Pharmacy records may be used to minimize patients' recall bias and improve the medication lists Background Structured medication interviews improve the medication history in hospitalized patients. In Denmark, a nationwide electronic version of individual pharmacy records (PR) has recently been introduced. Use of these records could improve the medication lists in hospitalized patients. Methods We prospectively included 500 patients admitted to an acute medical department. In individual patients, the PR was compared with (i) the medication list written in the patient chart and (ii) drug information provided by the patient during a structured drug interview upon admission and during a home visit after discharge. Results Median patient age was 72 years. Upon admission, patients reported using 1958 prescription-only medications (POM) (median four drugs per patient, range 0,14), of which 114 (6%) were not registered in PR. In PR, 1153 POM (median one per patient, range 0,11) were registered during the month preceding admission. The patients did not report 309 (27%) of these upon admission. Home visits were performed in a subgroup of 115 patients. During home visits, 18% of POM registered in PR during the preceding month were not reported. Drug type was predictive of reporting irrespective of patient sex or age. Cardiovascular drugs were reported most and dermatologicals were reported less frequently. Underreporting might be due to recall bias, non-adherence or discontinuation of drugs. Conclusions Omission errors are frequent despite structured medication interviews. Pharmacy records or medication lists from all treating doctors must be included in medication reviews in order to reduce recall bias. [source] Corporate Travel Medicine: Benefit Analysis of On-Site ServicesJOURNAL OF TRAVEL MEDICINE, Issue 4 2001Timothy S. Prince Background: Corporations with employees who travel internationally address their travel-related medical needs in a variety of ways. Options utilized include corporate medical departments, local health departments, and local clinics, both contracted and independent. Methods: A travel clinic at a university medical center routinely provided preventive travel medicine services for many of the local companies. Two of these companies had on-site medical clinics which routinely saw patients for occupational and personal health reasons. At these companies, the university travel clinic assisted in moving employee travel medicine services to the on-site clinic. Direct and indirect costs for new, predeparture employee travel care at each company were compared before, and after, the move on-site. Results: When measured per patient, total cost savings associated with the on-site travel clinic were greater than 15% at both companies (17%, 25%), primarily due to the value of the employees' time saved with decreased travel. Utilization increased at one company by 24% over the first 8 months and lead to higher overall cost, but this cost increase was only 4%. Informal assessments of the value of the on-site service at both companies was uniformly positive. Conclusion: For certain corporate settings, on-site clinics may be effective ways of providing travel medicine services. [source] Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City HospitalPSYCHOGERIATRICS, Issue 4 2009Katsuyuki UKAI Abstract Background:, In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital. Methods:, Physical complications that occurred in our ward in the 12 months from April 2007 to March 2008 were recorded. Our ward has 50 beds and, over the 12 months, the average occupation rate was approximately 90%. We subdivided physical complications into two categories: (i) serious emergencies occurring in the ward with a possible high risk of mortality within a few days (e.g. pneumonia and upper airway obstruction); and (ii) life-threatening complications arising in the ward that required diagnosis and treatment by specialists from other medical departments (e.g. bone fracture and cancer). Results:, Serious emergencies with a high risk of mortality occurred 56 times. Six patients died. Life-threatening complications requiring diagnosis and treatment by specialists from other departments occurred 44 times. Both categories of physical complications in occurred at a high rate, with various types of diseases recorded. Conclusions:, The present study confirms the high frequency of physical complications that require treatment in facilities for patients with senile dementia. It is necessary to diagnose and treat these various physical complications and to cooperate with specialists from other medical departments. [source] | ||||||||||