Patient Care (patient + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Patient Care

  • direct patient care
  • good patient care
  • optimal patient care
  • quality patient care
  • safe patient care

  • Terms modified by Patient Care

  • patient care activity

  • Selected Abstracts


    ANZ JOURNAL OF SURGERY, Issue 7 2008
    FANZCA, FFPMANZCA, Stephan A. Schug MD
    No abstract is available for this article. [source]


    BIOETHICS, Issue 6 2009
    ABSTRACT According to many researchers, it is inevitable and obvious that psychiatric illnesses are biological in nature, and that this is the rationale behind the numerous neuroimaging studies of individuals diagnosed with mental disorders. Scholars looking at the history of psychiatry have pointed out that in the past, the origins and motivations behind the search for biological causes, correlates, and cures for mental disorders are thoroughly social and historically rooted, particularly when the diagnostic category in question is the subject of controversy within psychiatry. This is obscured by neuroimaging studies that drive researchers to proclaim ,revolutions' in psychiatry, namely in the DSM. Providing neuroimaging evidence to support the contention that a condition is ,real' is likely to be extremely influential, as has been extensively discussed in the neuroethics literature. This type of evidence will also reinforce the pre-existing beliefs of those researchers or clinicians who are already expecting a biological description. The uncritical credence given to neuroimaging research is an ethical issue, not in its potential for contributing to misdiagnosis per se but because of the motivations that often drive this research. My claim is that this research should proceed with an awareness of presumptions and motivations underlying the field as a whole, in addition to an explicit focus on the past and potential future consequences of classification and diagnosis on the groups of individuals under study. [source]

    Patient Care Competency in Emergency Medicine Graduate Medical Education: Results of a Consensus Group on Patient Care

    Randall W. King MD
    "Patient Care" is the first listed core competency of the six new core competencies recently formulated by the Accreditation Council for Graduate Medical Education (ACGME) and, arguably, the most important. To assist emergency medicine (EM) program directors in incorporating and assessing this competency, the Council of Emergency Medicine Residency Directors (CORD-EM) held a consensus conference in March 2002. Definitions of this competency were generated that are specific for the training of practitioners in EM. These built upon the ACGME base definition, but include elements unique to or critically important in EM. In addition, all of the ACGME assessment tools were examined and prioritized for use in assessing the competency of EM residents in the area of patient care. Suggestions for an implementation process are also described. [source]

    Utilizing Pharmacologic Treatment Options to Improve Patient Care in Alzheimer's Disease

    Article first published online: 11 APR 200
    First page of article [source]

    Patient Care Through Pregnancy Termination

    Mary Beth Haire RN
    No abstract is available for this article. [source]

    Noninvasive Coronary Angiography: A Revolutionary Technique Seeking Its Role in Patient Care

    Ezra A. Amsterdam MD
    No abstract is available for this article. [source]

    FOREWORD: The Third International Consultation on Sexual Medicine: Advancing Science in the Interest of Patient Care

    Francesco Montorsi Chairman
    No abstract is available for this article. [source]

    Advocate for Patient Care

    THE LARYNGOSCOPE, Issue 2 2004
    Jonas T. Johnson MD
    No abstract is available for this article. [source]

    9 A Communication Tool for Emergency Medicine Residents to Improve Patient Care and Professional Development

    Jacqueline Mahal
    For every patient in the ED, a web of communication is created. A resident is at the center of this web , connecting team members in and outside the ED. Careful communication, a required ACGME competency, helps the team provide safe, high-quality care and master their respective specialties. We designed a three module curriculum that supports ACGME core competencies by providing training in professional communication and a framework with which to organize patient data. In the first module, residents are introduced to the concept that there is more to communication than content alone. Other elements include context, audience and forum. Together, these components comprise relevant communication. The second module introduces the Disposition, Situation, Background, Assessment, Recommendation, Safety (D-SBARS) Framework, an ED modification of The Joint Commission's communication tool. This framework will enable the resident to focus on communicating the relevant data for a particular audience in an appropriate manner. In the last module, residents participate in a case-based role-play. After presentation of a complicated patient, residents are each assigned a communication task. They communicate with attendings, ED staff and consultants. Each role is played by senior residents. Finally, participants deliver presentations to the on-coming team on "rounds" under time constraints, declining from two minutes to 30 seconds. Residents experience how the D-SBARS tool helps them communicate critical clinical and safety. [source]

    Guidelines on the insertion and management of central venous access devices in adults

    Summary Central venous access devices are used in many branched of medicine where venous access is required for either long-term or a short-term care. These guidelines review the types of access devices available and make a number of major recommendations. Their respective advantages and disadvantages in various clinical settings are outlined. Patient care prior to, and immediately following insertion is discussed in the context of possible complications and how these are best avoided. There is a section addressing long-term care of in-dwelling devices. Techniques of insertion and removal are reviewed and management of the problems which are most likely to occur following insertion including infection, misplacement and thrombosis are discussed. Care of patients with coagulopathies is addressed and there is a section addressing catheter-related problems. [source]

    Clinical outcome of diabetic foot ulcers treated with negative pressure wound therapy and the transition from acute care to home care

    Stephanie C Wu
    Abstract Diabetic foot ulcers affect millions of people in the United States of America and impose tremendous medical, psychosocial and financial loss or burden. Negative pressure wound therapy (NPWT) is generally well tolerated and appears to stimulate a robust granulation tissue response compared with other wound healing modalities. This device may be a cost-effective adjunctive wound healing therapy. This literature review will focus on the clinical outcome of diabetic foot ulcers treated with NPWT, its implication in the transition from acute care to home care, factors that might influence clinical outcomes in home care as well as quality-of-life aspects in these patients. Patient care for diabetic foot ulceration is complex and necessitates multiprofessional collaboration to provide comprehensive wound care. It is clear that when we strive for limb preservation in this most high-risk population, it is important to have an available versatile, efficacious wound healing modality. There is a need for an easy transition from acute care to home care. Resources need to be combined in a collaborative and synergistic fashion to allow patient to perform many daily living activities while receiving the potential benefits of an advanced wound healing modality. [source]

    Digital photography: A primer for pathologists

    Roger S. Riley
    Abstract The computer and the digital camera provide a unique means for improving hematology education, research, and patient service. High quality photographic images of gross specimens can be rapidly and conveniently acquired with a high-resolution digital camera, and specialized digital cameras have been developed for photomicroscopy. Digital cameras utilize charge-coupled devices (CCD) or Complementary Metal Oxide Semiconductor (CMOS) image sensors to measure light energy and additional circuitry to convert the measured information into a digital signal. Since digital cameras do not utilize photographic film, images are immediately available for incorporation into web sites or digital publications, printing, transfer to other individuals by email, or other applications. Several excellent digital still cameras are now available for less than $2,500 that capture high quality images comprised of more than 6 megapixels. These images are essentially indistinguishable from conventional film images when viewed on a quality color monitor or printed on a quality color or black and white printer at sizes up to 11×14 inches. Several recent dedicated digital photomicroscopy cameras provide an ultrahigh quality image output of more than 12 megapixels and have low noise circuit designs permitting the direct capture of darkfield and fluorescence images. There are many applications of digital images of pathologic specimens. Since pathology is a visual science, the inclusion of quality digital images into lectures, teaching handouts, and electronic documents is essential. A few institutions have gone beyond the basic application of digital images to developing large electronic hematology atlases, animated, audio-enhanced learning experiences, multidisciplinary Internet conferences, and other innovative applications. Digital images of single microscopic fields (single frame images) are the most widely utilized in hematology education at this time, but single images of many adjacent microscopic fields can be stitched together to prepare "zoomable" panoramas that encompass a large part of a microscope slide and closely simulate observation through a real microscope. With further advances in computer speed and Internet streaming technology, the virtual microscope could easily replace the real microscope in pathology education. Later in this decade, interactive immersive computer experiences may completely revolutionize hematology education and make the conventional lecture and laboratory format obsolete. Patient care is enhanced by the transmission of digital images to other individuals for consultation and education, and by the inclusion of these images in patient care documents. In research laboratories, digital cameras are widely used to document experimental results and to obtain experimental data. J. Clin. Lab. Anal. 18:91,128, 2004. © 2004 Wiley-Liss, Inc. [source]

    Delirium unit: Our experience

    Dorothy Milly Wong Tin Niam
    The optimal model of care for patients with delirium in tertiary institutions is unknown. The aim of this project was to assess whether managing delirious patients in a secure unit could improve quality of care without significantly increasing the cost. We set up a delirium and surveillance unit at a tertiary hospital in Western Australia. The key elements of the unit were to provide a secure environment with staff trained and committed to delirium care. Patient care was based on comprehensive geriatric principles. The activities and outcomes were audited over an initial period after the establishment of the unit and a second audit was conducted following improvements based on the results of the initial audit. Managing patients in a delirium unit improves quality of care of patients and is cost-effective. The best model appears to be one where there is a dedicated consultant-led unit with ongoing staff education. [source]

    Qualitative Data Collection and Analysis Methods: The INSTINCT Trial

    William J. Meurer MD
    Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source]

    What sticks: How medical residents and academic health care faculty transfer conflict resolution training from the workshop to the workplace

    Ellen B. Zweibel
    Workshops in conflict resolution were given to enhance the ability of residents and academic health care faculty to collaborate in multidisciplinary teams, patient care, hospital committees, public health issues, teaching, and research. A qualitative research study on the transfer of learning from the workshops to the workplace reports on the attitude, knowledge, and skills consistently reported both immediately after the workshops and twelve months later. Learners' descriptions of workplace conflict confirmed they gained a positive outlook on conflict and their own ability to solve problems and apply conflict resolution skills, such as interest analysis and communication techniques, to gain perspective, reduce tension, increase mutual understanding, and build relationships in patient care, teaching, research, and administration. [source]

    Understanding Surge Capacity: Essential Elements

    Donna F. Barbisch RN
    As economic forces have reduced immediately available resources, the need to surge to meet patient care needs that exceed expectations has become an increasing challenge to the health care community. The potential patient care needs projected by pandemic influenza and bioterrorism catapulted medical surge to a critical capability in the list of national priorities, making it front-page news. Proposals to improve surge capacity are abundant; however, surge capacity is poorly defined and there is little evidence-based comprehensive planning. There are no validated measures of effectiveness to assess the efficacy of interventions. Before implementing programs and processes to manage surge capacity, it is imperative to validate assumptions and define the underlying components of surge. The functional components of health care and what is needed to rapidly increase capacity must be identified by all involved. Appropriate resources must be put into place to support planning factors. Using well-grounded scientific principles, the health care community can develop comprehensive programs to prioritize activities and link the necessary resources. Building seamless surge capacity will minimize loss and optimize outcomes regardless of the degree to which patient care needs exceed capability. [source]


    CYTOPATHOLOGY, Issue 2006
    D.R. Bolick
    Liquid based Pap (LBP) specimen adequacy is a highly documented, yet poorly understood cornerstone of our GYN cytology practice. Each day, as cytology professionals, we make adequacy assessments and seldom wonder how the criteria we use were established. Are the criteria appropriate? Are they safe? What is the scientific data that support them? Were they clinically and statistically tested or refined to achieve optimal patient care? In this presentation, we will take a fresh look at what we know about Pap specimen adequacy and challenge some of the core assumptions of our daily practice. LBP tests have a consistent, well-defined surface area for screening, facilitating the quantitative estimates of slide cellularity. This provides an unprecedented opportunity to establish reproducible adequacy standards that can be subjected to scientific scrutiny and rigorous statistical analysis. Capitalizing on this opportunity, the TBS2001 took the landmark step to define specimen adequacy quantitatively, and set the threshold for a satisfactory LBP at greater than 5,000 well visualized squamous epithelial cells. To date, few published studies have attempted to evaluate the validity or receiver operator characteristics for this threshold, define an optimal threshold for clinical utility or assess risks of detection failure in ,satisfactory' but relatively hypocellular Pap specimens. Five years of cumulative adequacy and cellularity data of prospectively collected Pap samples from the author's laboratory will be presented, which will serve as a foundation for a discussion on ,Pap failure'. A relationship between cellularity and detection of HSIL will be presented. Risk levels for Pap failure will be presented for Pap samples of different cellularities. The effect of different cellularity criterion on unsatisfactory Pap rates and Pap failure rates will be demonstrated. Results from this data set raise serious questions as to the safety of current TBS2001 adequacy guidelines and suggest that the risk of Pap failure in specimens with 5,000 to 20 000 squamous cells on the slide is significantly higher than those assumed by the current criteria. TBS2001 designated all LBP to have the same adequacy criterion. Up to this point, it has been assumed that ThinPrep, SurePath, or any other LBP would be sufficiently similar that they should have the same adequacy criteria. Data for squamous cellularity and other performance characteristics of ThinPrep and SurePath from the author's laboratory will be compared. Intriguing data involving the recently approved MonoPrep Pap Test will be reviewed. MonoPrep clinical trial data show the unexpected finding of a strong correlation between abundance of endocervical component and the detection of high-grade lesions, provoking an inquiry of a potential new role for a quantitative assessment of the transition zone component. The current science of LBP adequacy criteria is underdeveloped and does not appear to be founded on statistically valid methods. This condition calls us forward as a body of practitioners and scientists to rigorously explore, clarify and define the fundamental nature of cytology adequacy. As we forge this emerging science, we will improve diagnostic performance, guide the development of future technologies, and better serve the patients who give us their trust. Reference:, Birdsong GG: Pap smear adequacy: Is our understanding satisfactory? Diagn Cytopathol. 2001 Feb; 24(2): 79,81. [source]

    Differentiating Large-scale Surge versus Daily Surge

    J. Lee Jenkins MD
    This breakout session at the Academic Emergency Medicine 2006 Consensus Conference examined how baseline overcrowding impedes the ability of emergency departments to respond to sudden, unexpected surges in demand for patient care. Differences between daily and catastrophic surge were discussed, and the need to invoke a hospital-wide response to surge was explored. [source]

    Metrics in the Science of Surge

    Jonathan A. Handler MD
    Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process. With a combination of online discussion through a group e-mail list and in-person discussion at a breakout session of the Academic Emergency Medicine 2006 Consensus Conference, "The Science of Surge," seven consensus statements were generated. These statements emphasize the importance of funded research in the area of surge capacity metrics; the utility of an emergency medicine research registry; the need to make the data available to clinicians, administrators, public health officials, and internal and external systems; the importance of real-time data, data standards, and electronic transmission; seamless integration of data capture into the care process; the value of having data available from a single point of access through which data mining, forecasting, and modeling can be performed; and the basic necessity of a criterion standard metric for quantifying surge capacity. Further consensus work is needed to select a criterion standard metric for quantifying surge capacity. These consensus statements cover the future research needs, the infrastructure needs, and the data that are needed for a state-of-the-art approach to surge and surge capacity. [source]

    Connecting patient needs with treatment management

    R. Kerwin
    Objective:, To propose ideas for the development of a core strategy for monitoring patients with schizophrenia to ensure physical health and optimal treatment provision. Method:, A panel of European experts in the field of schizophrenia met in Bordeaux in June 2006 to discuss, ,Patient management optimisation through improved treatment monitoring.' Results:, Key consensus from the discussion deemed that weight gain, oral health and ECG parameters were core baseline parameters to be monitored in all patients with schizophrenia. Further, an identification of a patient's own barriers to treatment alongside local health service strategies might comprise elements of an individualised management strategy which would contribute to optimisation of treatment. Any monitoring strategy should be kept simple to encourage physician compliance. Conclusion:, A practical solution to the difficulties of providing holistic patient care would be to suggest a limited set of physical parameters to be monitored by physicians on a regular basis. [source]

    Profiles in Patient Safety: Antibiotic Timing in Pneumonia and Pay-for-performance

    Jesse M. Pines MD
    The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay-for-performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in-depth case-based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay-for-performance for pneumonia conforms to American Medical Association guidelines on pay-for-performance. [source]

    Primary small cell carcinoma of the lung initially presenting as a breast mass: A fine-needle aspiration diagnosis

    Wei Liu M.D.
    Abstract The incidence of metastases to the breast from extramammary sites is relatively low compared with the incidence of primary breast carcinoma. Primary sites which have a predilection for metastases to the breast include, in the order of decreasing frequency, malignant melanoma, lymphoma, lung carcinoma, ovarian carcinoma, and soft tissue sarcoma, followed by gastrointestinal and genitourinary primaries. Most lung primaries metastasizing to breast represent adenocarcinoma. Other types of lung carcinoma, including small cell carcinoma, are relatively rare. We report a case of lung small cell carcinoma metastasizing to the breast and initially presenting with a breast mass in a 50-year-old female. The tumor was first diagnosed on a fine-needle aspiration biopsy specimen (FNAB) from the breast lesion and subsequently supported by core biopsy. A discussion of the differential diagnoses to consider on FNAB follows. Because of the difference in treatment for primary small cell carcinoma of breast versus primary small cell carcinoma of the lung, as well as the difference in prognosis for both malignancies, determining the site of primary malignancy is crucial to adequate patient care. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]

    Clinical significance of cultures collected from fine-needle aspiration biopsy

    Laura A. Granville M.D.
    Abstract The rate of positive cultures in fine-needle aspiration biopsy (FNAB) specimens is evaluated, and the value of submitting FNAB culture is assessed. Review of 3,300 FNAB specimens from 2,416 patients were tabulated for culture results, when obtained from the FNAB material. For positive culture results, clinical impact was assessed. Of 3,300 FNAB specimens and 2,416 patients, 185 had cultures performed (6% of specimens, 8% of patients). Of the 185 cultured specimens, 63 (34%) were positive and 122 (66%) were negative. Of the 63 positive cultures, 23 (12% of all FNAB cultures) had a significant impact on patient care. In our institution the FNA culture rate is 6%. When cases with clinical or microscopic suspicion of infection are cultured, 34% are positive for aerobic or anaerobic bacteria, mycobacteria or fungus. Culture in FNA specimens is a useful adjunct to diagnosis and impacts care in 12% of patients cultured at FNAB. This method can be used to triage patients with suspected infectious diseases and can aid in managing patients who may have recurrent infections. Diagn. Cytopathol. 2008;36:85,88. © 2008 Wiley-Liss, Inc. [source]

    The other side of the needle: A patient's perspective

    Lori A. Haack S.C.T. (A.S.C.P.)
    Abstract Cytopathology laboratories monitor the analytical processes that have an impact on patient care through sound, quality assurance programs. What often frustrates pathologists is their relative inability to influence pre-analytical variables, those processes that are health-care-provider driven. The performance of fine-needle aspirates (FNAs) is a unique opportunity for the pathologist to become directly involved in the pre-analytical phase of patient care. We formulated a patient satisfaction survey, to assess the care provided by the FNA team, as it is related to patient safety, satisfaction and complications related to the FNA procedure. The application of patient surveys is a valuable tool to identify, track and monitor complications related to the performance of FNAs and as an ongoing monitor of direct involvement of the pathologist in the pre-analytical process. Diagn. Cytopathol. 2006;34:303,306. © 2006 Wiley-Liss, Inc. [source]

    Fine-needle aspiration cytology in the diagnosis of superficial lymphadenopathy: a 5-year Brazilian experience

    M.Sc., Marcos Roberto Martins M.D.
    Abstract To determine the accuracy of fine-needle aspiration (FNA) in the diagnostic assessment of lymphadenopathies, a retrospective study was conducted on 627 cases of FNA of the lymph nodes performed at Department of Pathology, UNIFESP (Federal University of São Paulo), between 1997 and 2001. Cytology results were compared to the results of biopsies if available. The cytological diagnosis was unsatisfactory in 14.7% of cases, positive in 46%, and negative in 39.3%. Among the positive cases, 79.4% were classified as metastases, 14.2% as lymphoma, and 6.4% as indeterminate. Anatomopathological exams for the determination of cytohistological correlation were available in 218 of the 627 cases. There were three (1.88%) false-negative and two (1.25%) false-positive cases. Accuracy tests revealed 97.41% sensitivity, 95.45% specificity, and 96.88% efficacy, with cytohistological agreement being almost perfect (, = 0.92). The high accuracy of this study based only on cytomorphological criteria associated to the variety of malignant neoplasias diagnosed by the procedure demonstrates its relevance on patient care, especially in areas of limited financial resources. Diagn. Cytopathol. 2006; 34:130,134. © 2006 Wiley-Liss, Inc. [source]

    Radiologically guided percutaneous fine-needle aspiration biopsy of the liver: Retrospective study of 119 cases evaluating diagnostic effectiveness and clinical complications

    Ph.D., Ziwen Guo M.D.
    Abstract We reviewed 119 percutaneous, radiologically guided fine-needle aspirations (FNA) from 114 patients with liver masses to evaluate diagnostic effectiveness and complications of this procedure. Satisfactory material was obtained in 118 cases (99%), of which 78 were diagnosed as positive (66%), three suspicious (2%), five atypical (4%), and 32 (27%) as negative for malignancy. Compared to surgical biopsy (48 cases) and clinical data, the sensitivity and specificity of FNA for malignancy was 95.1% and 100%, respectively, yielding a positive predictive value of 100% and a negative predictive value of 88.8%. Four cytology cases (3.4%) were false-negatives (FN); all were interpretive errors. Four FN surgical biopsies (8.3%) were sampling errors. Minor complications occurred in three cases (2.5%). We conclude that FNA is safe and effective for determining the malignant potential of liver masses and should be the procedure of choice. Our experience suggests that having a pathologist present in the radiology suite provides optimal patient care. Diagn. Cytopathol. 2002;26:283,289. © 2002 Wiley-Liss, Inc. [source]

    Fast track: Has it changed patient care in the emergency department?

    Paul Kwa
    Abstract Objective: To determine whether the introduction of a designated fast-track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED. Methods: Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast-track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did-not-waits. Results: During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS 1 was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels. Conclusions: Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients. [source]

    Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?

    Glenn Ryan
    Abstract Objective:, To determine whether family members interfere with patient care when present during invasive procedures performed on their children in the ED. Methods:, A prospective observational study of consecutive cases of procedural sedation of children aged between 12 months and 16 years was conducted between March 2002 and March 2006 in the ED of a secondary-level regional hospital in south-east Queensland. Procedures performed included laceration repair, fracture reduction, foreign body removal and abscess incision and drainage. Parents/primary caregivers were encouraged to stay with their child. A stepwise explanation of the procedure and sedation to be used was undertaken, informed consent obtained and telephone follow up attempted 5,14 days post procedure. Results:, Six hundred and fifty-two patient encounters with parents or primary caregivers present for the procedure were included for a total of 656 procedures: 234 laceration repairs, 250 fracture reductions, 85 foreign body removals, 33 abscess incision and drainages, 14 dislocation reductions and 40 other procedures. Telephone follow up was successful in 65% (424) of cases. The mean age was 6.5 years. Family member interference occurred in one case (0.15%, 95% confidence interval 0,0.73%). In 17 cases (2.68%, 95% confidence interval 2.1,5.9%) family members present expressed concerns about the procedure during the telephone follow up but had not interfered at the time of the procedure. There were no significant differences between the concerned parents at follow up and the study group across key patient variables such as child's age (P = 0.369), weight (P = 0.379), respiratory rate (P = 0.477), sex (P = 0.308), procedure indication (P = 0.308) and airway manoeuvres (P = 0.153). Conclusion:, When family members are encouraged to stay for invasive procedures performed on their child, and careful explanation of the procedure, sedation, possible complications, choice of medication for sedation and possible side-effects is undertaken, family member interference is extremely rare. [source]

    Digital Imaging: A Promising Tool for Mushroom Identification

    Connie B. Fischbein BA
    Mushroom poisoning is a diagnostic and treatment dilemma for health care professionals. Decisions regarding treatment following ingestions are usually made without a firm identification of the fungus and tend to be more aggressive than necessary. The identification of mushrooms is beyond the scope of health care professionals, and a mycologist is essential to make an accurate identification. Telemedicine and digital imaging is an emerging technology that can assist in mushroom identification and facilitate patient care. The efficacy of using digital images sent over the Internet was tested in a pilot project. This article describes three cases in which digital images and verbal descriptions assisted in mushroom identification. When the actual specimen was sent to a mycologist, a definitive identification was obtained and compared with the presumptive identification. Digital images alone do not permit definitive identification; however, they often contain sufficient information to help the clinician rule out the possibility of a severely toxic species. Data accumulated to date indicate that digital imaging can be an important tool in the diagnosis and treatment of mushroom ingestion, and possibly other biologicals such as plants, insects, and reptiles. [source]

    Farrier services at veterinary teaching hospitals in the USA

    C. A. Kirker-Head
    Summary Horse health is best served when farriers and veterinarians collaborate in the care of their patients. Veterinary Teaching Hospitals (VTHs) provide an environment that can nurture that collaboration. While VTH veterinary services are well known, VTH farrier activities are undocumented. To characterise farrier services at VTHs in the USA, 27 VTH Diplomates of the American College of Veterinary Surgeons and/or VTH farriers completed a multiple choice questionnaire characterising VTH farrier details, training, certification, remuneration method, and clinical, teaching and research responsibilities; and farrier service prevalence, facilities and financial viability. Questionnaire response rate was 81%. Eighteen of 22 (82%) responding VTHs had in-house farrier services. Twenty-one of 22 (95%) VTH farriers were male. Farriers' ages ranged from <30 years (n = 1, 5%) to >50 years (n = 7, 32%). At 11 (61%) VTHs the farriers were paid by the client and at 7 (39%) by the VTH. Five farriers (23%) received a VTH salary. Eighteen of 22 (82%) farriers had a professional certification. At 5 (28%) VTHs the farrier service made a profit and operational costs were met at 13 (72%). Fifteen (83%) farrier services provided professional education in clinical settings and 13 (72%) in lecture settings. Nine (41%) VTH farriers participated in research activities. In the USA, VTH farrier services vary considerably in both nature and extent. The farriers' potential contributions to VTH operations are often recognised but not consistently exploited. VTH farriers are a valuable resource who can contribute effectively toward VTH patient care, veterinary education and research. [source]