Nutrition priority system: a model for patient care

The criterion for the level of nutrition monitoring used by many hospitals and residential care facilities has traditionally been the patient's diet order. Patients on "regular" diets may receive minimal monitoring (if any) with little discharge instruction, and patients on "modified diets" receive a full assessment with specified routine follow-up by nutrition-care team members and detailed discharge planning. The concentration on the diet rather than the patient gives cause for concern, but in residential care facilities such concerns are magnified. While it is appropriate to monitor a 60-year-old patient with adult-onset diabetes whose disease of 20 years' duration is stable, the present diet order system insists that that patient be monitored intensely but ignores his 80-year-old neighbor on a general diet, despite her poor appetite and 87-lb weight. The authors developed a priority system that sets three levels of patient care and materials for teaching the system to treatment team members. The system is based on the patient's needs, not the diet order. Although reduction in staff time would have been an additional welcome result, use of the system does permit the more efficient utilization of the dietitian's and dietetic technician's time. The greatest effect has been individualized, monitored nutrition care for residential psychiatric patients.     

医院门诊排队系统的成本-效益模型研究

提出了医院门诊随机服务系统的“成本—效益”的类型;建立了不同类型的“成本—效益”模型;讨论了“成本差”、“效益差”和“投资回报率”,指出了增加收益、降低成本、提高投资回报率的途径。     

An assessment of priority and educational value in a medical curriculum

A randomly selected group of teachers, students, first-year graduates (junior doctors in the first year of postgraduate training after their final medical school examination), general practitioners and specialists responded to a postal questionnaire designed to assess their views on the priorities in medical curriculum and the educational value attributed to its content. Comparisons were made among the five participating groups and the outcome of the assessment was compared with the existing curriculum.     

Markov排队模型在医院管理中的应用

目的用科学的定量方法解决医院病人排队等候时间长的问题。方法以某医院门诊手术室外科活组织检查大夫的人数设置为例，运用Markov排队模型进行定量的分析和讨论。结果由计算得，增加一个医生后，病人到达即手术而无需等待的概率提高，排队等待手术的病人数下降。结论利用排队论的方法可以较好地解决医院服务系统中人员的安排配置问题，为医院管理提供可靠的决策依据，具有良好的指导意义。     

Basic priority rating model 2.0: current applications for priority setting in health promotion practice

Priority setting is an important component of systematic planning in health promotion and also factors into the development of a comprehensive evaluation plan. The basic priority rating (BPR) model was introduced more than 50 years ago and includes criteria that should be considered in any priority setting approach (i.e., use of predetermined criteria, standardized comparisons, and a rubric that controls bias). Although the BPR model has provided basic direction in priority setting, it does not represent the broad array of data currently available to decision makers. Elements in the model also give more weight to the impact of communicable diseases compared with chronic diseases. For these reasons, several modifications are recommended to improve the BPR model and to better assist health promotion practitioners in the priority setting process. The authors also suggest a new name, BPR 2.0, to represent this revised model.     

Hypertension a priority?

Hypertension (HT) in Africa has recently been the subject of an exchange of correspondence in the British Medical Journal (BMJ). It was argued in one paper that its treatment should be a priority and that one death could be prevented for every US$1800 spent upon antihypertensive drugs. One letter writer argued that the figure was an underestimate and could not compare in terms of cost-effectiveness with, for example, epilepsy treatment at around $20/year. A better approach, however, would be to urge patients with HT to eat less salt and to restrict drug treatment to those with symptoms or complications. Another writer went further, noting what little money is available to African patients and hospitals, and that one cannot realistically expect a peasant farmer to spend $40/year on a drug for a disease which causes him no suffering. A simple rural hospital could save lives from many conditions, each at a fraction of the cost of antihypertensive drug treatment. Nonetheless, other writers to the BMJ argue that stroke and cerebrovascular disease in Africa are likely to become more common and that it is extremely important that cost-effective approaches are found to control HT in developing countries.     

An American partnership for universal coverage

The United States must address its health care problems head on to ensure a thriving middle class and global competitiveness. Many employers are ambivalent about their future role as sponsors of health coverage and poolers of health risk and skeptical about government solutions. Nonetheless, employers have often been innovative purchasers of health care, and they maintain an interest in investing in public health/prevention and research to develop stronger evidence about efficacy. Whether or not employers want to remain the dominant mechanisms for pooling risk and purchasing coverage, they must partner with government and consumers to send stronger, more consistent signals to providers to deliver value.     

An evaluation of a model ecosystem with DDT

The reproducibility, variability, and reliability of a simple aquatic-terrestrial model ecosystem experiment was tested withp,p-DDT. The variation among the model replicates as well as within the units was studied by using hierarchal analysis of variance. The complete budget of the chemical was calculated and a theoretical transport model was constructed. The degradation and accumulation of DDT was followed by gas Chromatographic residue analysis, which showed good reproducibility of the experimental design. The degradation of DDT in the model was similar to that found in the field, but the determination of concentration factors was questionable. The material balance tables revealed that the soil and bottom substrates were the main contributors, which regulated the fate of the chemical in the model. The usefulness of the model is presented in this report.     

An assessment of lead exposure potential from residential cutoff valves

It is increasingly recognized that even very low lead exposure can result in measurable and permanent neurologic damage, especially to infants and young children. Although lead exposure from tap water continues to decline in the United States as a result of various regulatory and corrosion control measures, tap water continues to represent a significant (about 14 to 20 percent) source of total lead exposure. As of March 2002, nearly all valves used in residential plumbing systems continue to be made with 5 to 7 percent leaded brass. In this study, the authors measured the amount of lead discharged by these parts under laboratory conditions and found that the typical resident would be exposed to small amounts of lead, particularly from gate and ball valves. Typically, water passes through three to six such valves before reaching the tap. Thus, these leaded-brass valves represent a significant, widespread, and needless source of lead exposure to the U.S. public, especially given that numerous models of no-lead valves are now commercially available.     

An overlooked priority: puberty in sub-Saharan Africa

Early adolescence remains an overlooked window of opportunity for public health intervention with girls and boys in sub-Saharan Africa. Minimal health data exist on pubescent girls and boys. Considerable morbidity and mortality related to HIV, sexually transmitted infections, and pregnancy emerge soon after puberty, suggesting the importance of targeting early adolescents. The fundamental goal of primary prevention would be better served if girls and boys between the ages of 10 and 14 years were targeted for effective and contextually relevant interventions. Such interventions should address healthy transitions to young adulthood to effectively advance the public health agenda with postpubescent (aged 15 to 24 years) young women and men. The global health community is overdue to build the empirical database for intervention with this age group.     

An ontology-based nurse call management system (oNCS) with probabilistic priority assessment

Background  

The current, place-oriented nurse call systems are very static. A patient can only make calls with a button which is fixed to a wall of a room. Moreover, the system does not take into account various factors specific to a situation. In the future, there will be an evolution to a mobile button for each patient so that they can walk around freely and still make calls. The system would become person-oriented and the available context information should be taken into account to assign the correct nurse to a call.     

The San Diego Immunization Survey: a model for local vaccination coverage assessment

OBJECTIVES: Assessing vaccination coverage as part of a comprehensive intervention has been demonstrated to result in increased coverage rates. The National Immunization Survey provides coverage estimates at the national level and selected urban areas. However, it is important for other localities to understand vaccination coverage in their areas. The San Diego Immunization Branch conducts the San Diego Immunization Survey (SDIS) to gather vaccination coverage information in San Diego County. This article describes the methodology and results of the SDIS. METHODS: The SDIS is a two-phase immunization survey. The first phase is a random-digit-dialing survey in which vaccination information is obtained by phone. The second phase involves the verification of this information and/or obtaining vaccination information via the registry or the child's provider(s). RESULTS: In 2005, the sample size included 839 respondents. From 1995 to 2005, coverage for the following individual vaccines increased: diphtheria and tetanus toxoids, and acellular pertussis (92.0% to 96.5% for > or = 3 doses, and 75.0% to 89.0% for > or = 4 doses), polio (83.0% to 94.7%), measles-mumps-rubella (85.0% to 95.8%), Haemophilus influenzae type b (87.0% to 93.2%), and hepatitis B (67.0% to 93.6%). CONCLUSION: The results of the SDIS demonstrate that San Diego County has exceeded the Healthy People 2010 goal to reach at least 80% coverage for the series of universally recommended vaccinations.     

Credentialing becomes a priority for JCAHO

Your medical staff credentialing and peer review policies could come under careful scrutiny in the coming months as the Joint Commission on Accreditation of Healthcare Organizations takes aim at the effectiveness and professionalism of evaluation processes. At its most recent Executive Briefings Conference, the Joint Commission developed a list of characteristics for peer review that eventually could be incorporated into Joint Commission standards.     

Making total quality a clinical priority

Outlines the introduction of total quality systems into all clinical services within a community-based NHS Trust in the West Midlands. Provides practical details of each aspect of the quality-planning process. Shows the commitment of clinicians to "managing quality improvement".