Determining technologist staffing requirements and productivity in an academic setting

The department of radiology at New England Deaconess Hospital, in response to the recently imposed legislative constraints on reimbursement for the care of hospitalized patients, has extended a method developed in 1977 to define staffing requirements and productivity and to track departmental operating efficiency.     

Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project

PURPOSE. To present an evaluation of a 5-year, community-based, chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other resources. DESIGN. The evaluation used a matched comparison design and a review of archive and interview data. SETTING. Florence, South Carolina (population: 56,240). SUBJECTS. A random sample of 1642 persons in Florence (and 1551 in the comparison) who responded to a risk factor questionnaire and underwent a physical assessment; 70.7% of baseline subjects participated in the postintervention. Forty key persons were interviewed concerning project effectiveness. INTERVENTIONS BY PROJECT. Walk-a-thons, a speakers' bureau, media messages, restaurant food labeling, and cooking seminars. More than 31,000 participants were involved in 585 activities. MEASURES. Questionnaires focused on hypertension, obesity, high cholesterol, smoking, and exercise. Physical assessments determined lipid, lipoprotein, apolipoprotein, and blood pressure levels. Analysis of covariance was used for baseline and postintervention comparisons. Content analysis was used on archive and interview data. RESULTS. The project had a slightly favorable intervention effect on cholesterol and smoking, but failed to have an effect on other risk factors for cardiovascular disease. The project influenced community awareness, enlisted influential community members, and fostered linkages among local health services. CONCLUSIONS. Health departments can be instrumental in community risk reduction programming; however, they may not replicate projects having greater resources.     

Weight loss and disease progression in HIV infection

Weight loss and malnutrition continue to be important issues that clinicians face when treating patients with HIV infection. In addition to specific clinical consequences, weight loss in these patients is linked to a greater risk of death and opportunistic complications. A loss of as little as 5% to 1-% of baseline body weight can be associated with a risk of death that is 2.5 times that seen in patients with HIV infection who do not lose weight. Furthermore, weight loss in patients with HIV infection can increase the risk of individual opportunistic infections by as much as 61% to 176%. Future studies may help define the prognostic implications of lipodystrophy and changes in body cell mass in patients with HIV who are taking antiretroviral therapy.     

Development of a pediatric critical care transport team: experience at a military medical center

INTRODUCTION: A pediatric critical care transport program was initiated and organized at Naval Medical Center San Diego in January 1994. The primary goal of the program was to formally train military pediatric residents in the early stabilization and transport of the critically ill neonatal and pediatric patient. It was also felt that such a program would generate significant cost savings to the Department of Defense. We present the statistics, training protocol, and the cost savings. In addition, we surveyed previous residents who had been involved with this program to determine its perceived benefit. METHODS: In the first phase of this project, the pediatric critical care transport program database from January 1994 to December 1997 was reviewed. The number and types of transports were recorded. Next, we determined cost savings for the transport program for fiscal year 1996-1998 (the period for which fiscal data were available). In the second phase of this project, we sent surveys to the 23 graduating residents who had participated in the pediatric critical care transport program. The survey sought to determine the perceived value of the transport training experience and the degree to which that training is now being used. All investigators were blinded to the responses. Statistical analysis consisted of determining the percentage of each response. RESULTS: During the 4-year period reviewed, 404 transports were performed (198 neonatal and 206 pediatric). During fiscal year 1996-1998, there was a cost avoidance of $1,962 per transport. In the second phase, 91% of the surveys were returned and analyzed. The majority of residents were practicing in overseas or isolated communities. All respondents rated their experience in the pediatric critical care transport program as worthwhile and educational, and they complemented their training in the neonatal and pediatric intensive care units. Seventy-one percent of the respondents had transported a critically ill neonate or child to another facility within the last year. CONCLUSIONS: In summary, we report our experience with the development of a pediatric critical care transport program. The program was developed to provide military pediatric residents instruction and experience in the stabilization and transport of critically ill children. In addition, we were able to demonstrate a significant cost avoidance.     

Investigation of under-ascertainment in epidemiological studies based in general practice

BACKGROUND: One of the aims of the Study of Infectious Intestinal Disease (IID) in England is to estimate the incidence of IID presenting to general practice. This sub-study aims to estimate and correct the degree of under-ascertainment in the national study. METHODS: Cases of presumed IID which presented to general practice in the national study had been ascertained by their GP. In 26 general practices, cases with computerized diagnoses suggestive of IID were identified retrospectively. Cases which fulfilled the case definition of IID and should have been ascertained to the coordinating centre but were not, represented the under-ascertainment. Logistic regression modelling was used to identify independent factors which influenced under-ascertainment. RESULTS: The records of 2021 patients were examined, 1514 were eligible and should have been ascertained but only 974 (64%) were. There was variation in ascertainment between the practices (30% to 93%). Patient-related factors independently associated with ascertainment were: i) vomiting only as opposed to diarrhoea with and without vomiting (OR 0.37) and ii) consultation in the surgery as opposed to at home (OR 2.18). Practice-related factors independently associated with ascertainment were: i) participation in the enumeration study component (OR 1.78), ii) a larger number of partners (OR 0.3 for 7-8 partners); iii) rural location (OR 2.27) and iv) previous research experience (OR 1.92). Predicted ascertainment percentages were calculated according to practice characteristics. CONCLUSION: Under-ascertainment of IID was substantial (36%) and non-random and had to be corrected. Practice characteristics influencing variation in ascertainment were identified and a multivariate model developed to identify adjustment factors which could be applied to individual practices. Researchers need to be aware of factors which influence ascertainment in acute epidemiological studies based in general practice.     

Potential toxicity of retrograde uterine passage of particulate matter

Dusting powders are commonly used on surgical gloves, examination gloves, and condoms. In addition, they are used in diaphragms, sanitary napkins, and toiletries. These dusting powders can gain access to the abdominal cavity through the vagina or through surgical intervention. The toxicity of these dusting powders in the abdominal cavity can be divided into acute and chronic complications that may be life-threatening. The use of medical and surgical products without dusting powders is strongly recommended.     

Prevalence of eye disorders among the elderly in Los Angeles

A series of 431 vision screening records of seniors 55 years of age and older were analysed. Patients were examined by the UCLA Mobile Eye Clinic at two senior centers in the Los Angeles area, between the years 1982 and 1990. Sixty-eight percent of patients were females and 32% were males. The mean (+/-S.D.) age was 69 (+/-7.5) years. Common diagnoses were refractive errors (65.2%) and impaired visual acuity (37.0%). The prevalences of refractive errors were: hyperopia, 24.8%; myopia, 10.4%; presbyopia, 54.1%; and astigmatism, 31.8%. In most patients (94.0%), impaired visual acuity was corrected by spectacles. The prevalence of cataract was 29.5% and age-specific prevalences of cataract increased with age. The prevalences of other eye disorders were as follows: glaucoma, 6.3%; diabetic retinopathy, 1.2%; and macular degeneration, 5.1%. This study highlights the degree of ophthalmic disorders identified by vision screenings in the elderly population in senior centers; our results are consistent with previously reported studies of eye diseases in the elderly.