James F. Hanley

Factors affecting compliance for general medicine consultations to non-internists☆

For a general medicine consultation service to be effective, compliance with recommendations is essential, as is an understanding of the factors that improve compliance. Residents in a general medicine consultation service attempted prospectively to improve their skills as consultants and to enhance compliance by implementing the following steps, reported to influence compliance: identify critical recommendations; make early, direct oral contact with the referring surgeon; limit the number of recommendations; and render definite recommendations. At the end of the study period, recommendations were tabulated and categorized as to whether each was diagnostic or therapeutic and critical or noncritical, and the time of contact with the referring surgeons was noted when applicable. Multivariate analysis of the factors, in relation to the type of recommendation, demonstrated that compliance can be improved, especially if a consultant clearly identifies the critical recommendations and makes contact with the referring physician within 24 hours.

Role of Helicobacter pylori infection in the incidence and clinical course of monoclonal gammopathy of undetermined significance

Role of helicobacter pylori infection in the incidence and clinical course of monoclonal gammopathy of undetermined significance

Improving house staff ordering of three common laboratory tests. Reductions in test ordering need not result in underutilization.

Most studies of modifying test ordering have focused on costs. Questions not addressed are whether programs to reduce testing lead to a higher proportion of clinically indicated tests and is underutilization an adverse outcome of such programs? To investigate this, we studied the house staffs ordering of three common laboratory tests at baseline and after educational and administrative interventions. Over a 2-year period, 3,603 urine cultures, sputum cultures, and admission urinalyses were reviewed. A lecture emphasizing the indications for these tests followed by chart audit and weekly feedback increased the proportion of clinically indicated tests. Subsequently, an administrative intervention requiring the intern to list the reason for ordering the test on the laboratory request form further improved test ordering. Underutilization, defined as a failure to order a potentially indicated test, was assessed during two representative periods. The “underutilization rate” (omitted tests per 100 patients) was no worse during maximal intervention than it was 9 months after the last intervention (7.7 vs. 11.1, NS). No immediate adverse consequences resulted from tests not ordered. Our findings indicate that it may be possible to selectively reduce the ordering of unnecessary tests without sacrificing quality of care.

Posterior compartment syndrome following ruptured Baker's cyst.

A 35 year old man presented with the sudden onset of left leg pain and swelling. Empirical anticoagulation for presumed deep vein thrombophlebitis was followed by acute worsening of symptoms. On further evaluation the patient was found to have a ruptured Bakers cyst and an acute posterior compartment syndrome.

The admission urinalysis - Impact on patient care

Although urinalysis is one of the most frequently ordered tests in primary care, its usefulness in screening has not been demonstrated. A retrospective review of 1,607 admission urinalyses for inpatients in a referral/community hospital identified 861 as clinically indicated and 746 as routine. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). Forty-five (6.0%) of the routine urinalyses yielded an abnormality that led to diagnostic action. Of these, 18 were normal on repeat testing and 17 were considered unlikely to represent significant disease. Therefore, only ten (1.3%) of the routine urinalyses affected patient therapy. In eight of these cases, the abnormality was pyuria, of which six proved to be asymptomatic bacteriuria. The admission urinalysis as a routine test had little impact on patient care in the authors’ institution.Although urinalysis is one of the most frequently ordered tests in primary care, its usefulness in screening has not been demonstrated. A retrospective review of 1,607 admission urinalyses for inpatients in a referral/community hospital identified 861 as clinically indicated and 746 as routine. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). Forty-five (6.0%) of the routine urinalyses yielded an abnormality that led to diagnostic action. Of these, 18 were normal on repeat testing and 17 were considered unlikely to represent significant disease. Therefore, only ten (1.3%) of the routine urinalyses affected patient therapy. In eight of these cases, the abnormality was pyuria, of which six proved to be asymptomatic bacteriuria. The admission urinalysis as a routine test had little impact on patient care in the authors’ institution.

Ineffectiveness of Measuring Routine Vital Signs in Adult Inpatients With Deep Venous Thrombosis

The purpose of this study was to evaluate the benefit, if any, of routine monitoring of vital signs on clinical outcomes in hospitalized patients with deep venous thrombosis (DVT). One hundred forty-nine patients with DVT included in this study were categorized into two groups: those that underwent measurement of vital signs every 6 hours or those that had vital signs measured every 8 hours. Vital signs included pulse, blood pressure, respiratory rate, and temperature. Frequency of measurement of vital signs did not alter average length of stay; for patients with every-4-hours measurement, this was 5.16 days and was not statistically significant from patients with every-8-hours measurement, who stayed an average of 4.85 days (p = 0.507). Similarly, more frequent vital sign evaluation did not result in a statistically significant difference in survival, progression of disease, nor did it predict the disposition of the patient. These results suggest that present frequency of measurement of vital signs is not cost or time effective because they do not result in a favorable outcome, length of stay, or disposition. The study further serves to highlight the need for an individualized assessment of vital sign measurement, because this will also lead to a more efficient allocation of hospital resources.

A single question may be useful for detecting patients with inadequate health literacy.

This paper presents Edugraph, ludic learning environment developed in the context of the LudicLearning project, which purpose is to facilitate the learning process of computer graphics basic concepts. The paper describes the game general characteristics, the production motivations, its objectives and its phase divided structure. Due to space limitation, only the game phase 2 is detailed described in this paper. Resumo. Este artigo apresenta o Edugraph, ambiente lúdico de ensino desenvolvido no contexto do projeto LudicLearning 1 , cujo objetivo é facilitar o aprendizado de conceitos básicos de Computação Gráfica. O artigo descreve as características gerais do jogo, as motivações para a sua produção, seus objetivos e a sua estruturação em fases. Devido à limitação de espaço, somente a fase 2 do jogo é descrita em detalhes neste texto. Palavras-Chaves: Ambientes Lúdicos de Ensino, Software Educacional

Profound hypoglycemia in a mail-order pharmacy customer as a result of a dispensing error

Accidental hypoglycemia is most commonly associated with the inadvertent ingestion of oral hypoglycemic drugs, and profound hypoglycemia can result in significant morbidity and mortality. Dispensing errors involving sulfonylureas are usually cited as the cause, and these errors have historically been related to sound-alike compounds or proximity errors. We present the case of a patient who received sulfonylureas meant for a different patient through the mail and simply complied with the instructions on the medication bottle, with the result of severe hypoglycemia. This case demonstrates the need for clinicians to properly assess all patients with profound hypoglycemia, evaluating them for inadvertent ingestion of hypoglycemic agents. Furthermore, pharmacies that provide mail-order prescription services must ensure patient safety through quality-control mechanisms.