Secure, web-accessible call rosters for academic radiology departments.
(33/1470)
Traditionally, radiology department call rosters have been posted via paper and bulletin boards. Frequently, changes to these lists are made by multiple people independently, but often not synchronized, resulting in confusion among the house staff and technical staff as to who is on call and when. In addition, multiple and disparate copies exist in different sections of the department, and changes made would not be propagated to all the schedules. To eliminate such difficulties, a paperless call scheduling application was developed. Our call scheduling program allowed Java-enabled web access to a database by designated personnel from each radiology section who have privileges to make the necessary changes. Once a person made a change, everyone accessing the database would see the modification. This eliminates the chaos resulting from people swapping shifts at the last minute and not having the time to record or broadcast the change. Furthermore, all changes to the database were logged. Users are given a log-in name and password and can only edit their section; however, all personnel have access to all sections' schedules. Our applet was written in Java 2 using the latest technology in database access. We access our Interbase database through the DataExpress and DB Swing (Borland, Scotts Valley, CA) components. The result is secure access to the call rosters via the web. There are many advantages to the web-enabled access, mainly the ability for people to make changes and have the changes recorded and propagated in a single virtual location and available to all who need to know. (+info)
Judging surgical research: how should we evaluate performance and measure value?
(34/1470)
OBJECTIVE: To establish criteria to evaluate performance in surgical research, and to suggest strategies to optimize research in the future. SUMMARY BACKGROUND DATA: Research is an integral component of the academic mission, focusing on important clinical problems, accounting for surgical advances, and providing training and mentoring for young surgeons. With constraints on healthcare resources, there is increasing pressure to generate clinical revenues at the expense of the time and effort devoted to surgical research. An approach that would assess the value of research would allow prioritization of projects. Further, alignment of high-priority research projects with clinical goals would optimize research gains and maximize the clinical enterprise. METHODS: The authors reviewed performance criteria applied to industrial research and modified these criteria to apply to surgical research. They reviewed several programs that align research objectives with clinical goals. RESULTS: Performance criteria were categorized along several dimensions: internal measures (quality, productivity, innovation, learning, and development), customer satisfaction, market share, and financial indices (cost and profitability). A "report card" was proposed to allow the assessment of research in an individual department or division. CONCLUSIONS: The department's business strategy can no longer be divorced from its research strategy. Alignment between research and clinical goals will maximize the department's objectives but will create the need to modify existing hierarchical structures and reward systems. Such alignment appears to be the best way to ensure the success of surgical research in the future. (+info)
Queen's University alternative funding plan. Effect on patients, staff, and faculty in the Department of Family Medicine.
(35/1470)
OBJECTIVE: To determine the effect of the Queen's University alternative funding plan (AFP) on the Department of Family Medicine in terms of patient, staff, and faculty satisfaction; patient encounter logistics; clinical volume; and academic activity. DESIGN: Before-after study. SETTING: Department of Family Medicine at Queen's University of Kingston, Ont. PARTICIPANTS: Patients, faculty, and staff of the Department of Family Medicine's Family Medicine Centre. INTERVENTIONS: The AFP of Queen's University. MAIN OUTCOME MEASURES: Patient satisfaction, staff and faculty job satisfaction, patient waiting time, time spent with patients, patient volume, number of publications, and amount of research funding obtained by faculty members. These outcomes were measured before the AFP began (time 0), 1 year post-AFP (time 1), and 2.5 years post-AFP (time 2). RESULTS: In some categories patients' satisfaction decreased at time 1, but in all cases it was either unchanged or improved at time 2. Staff and faculty job satisfaction did not change over time. Patients spent less time in the waiting room at time 2 than at time 0. Patient volume dropped about 10% between time 0 and time 2. Publication rate did not change, but external research funding increased significantly during the study period. CONCLUSION: The AFP has improved academic productivity, decreased patient volume by 10%, and improved patient flow during clinics. No negative effects on patient satisfaction or on job satisfaction of staff or faculty are apparent. (+info)
Providing after-hours on-call clinical coverage in academic health sciences centres: the Hospital for Sick Children experience.
(36/1470)
An increasing number of admissions of patients requiring complex and acute care coupled with a decreasing number of pediatric postgraduate trainees has caused a shortage of house staff available to provide after-hours on-call coverage in the Department of Pediatrics at Toronto's Hospital for Sick Children. The Clinical Assistant program created to deal with this problem was short on staff, did not provide adequate continuity of care and was becoming increasingly unaffordable. The Clinical Departmental Fellowship program was created to address the problem of after-hours clinical coverage. The program is aimed at qualified pediatricians seeking additional clinical or research training in one of the subspecialty divisions in the Department of Pediatrics. We describe the hiring process, job description and evolution of the program since its inception in 1996. This program has been mutually advantageous for the individual fellows and their sponsoring divisions as well as the Department of Pediatrics and the Hospital for Sick Children. We recommend the introduction of similar programs to other academic medical departments facing staff shortages. (+info)
Utilization and effectiveness of a weight-based heparin nomogram at a large academic medical center.
(37/1470)
OBJECTIVE: To determine the utilization rate of a weight-based heparin nomogram and to assess the performance of the nomogram outside of experimental conditions. STUDY DESIGN: Prospective cohort analysis. PATIENTS AND METHODS: A total of 747 consecutive patients treated with intravenous heparin therapy for any indication on an internal medicine service were evaluated for the utilization rate of the weight-based nomogram, the time needed to exceed heparin's therapeutic threshold (activated partial thromboplastin time [aPTT] of > 1.5 times the control value), and the time needed to achieve heparin's therapeutic range (aPTT of 1.5 to 2.4 times the control value). Physicians were encouraged to use the weight-based nomogram by using conventional continuing medical education techniques and by configuring the computerized order entry system to give physicians an equally easy and voluntary choice between choosing the weight-based nomogram or ordering heparin in the traditional fashion. RESULTS: The study program had no effect in increasing the utilization rate of the nomogram; this rate remained the same as before the program was initiated (10%). Less time was needed both to exceed the therapeutic threshold and to achieve a therapeutic range with the weight-based nomogram compared with physician-guided dosing (P < .001 and P = .021, respectively). No difference was demonstrated between the weight-based and physician-guided groups in incidence of bleeding complications or in the proportion of patients with one or more supratherapeutic aPTTs. CONCLUSIONS: The weight-based nomogram led to superior intermediate outcomes compared with physician-guided dosing. However, despite efforts intended to modify physician behavior, the utilization rate remained so low that it was ineffective. Further research into the reasons why physicians chose not to use the weight-based nomogram and further research into methods to translate efficacious therapies into effective patient care are indicated. (+info)
The interactions between clinical informatics and bioinformatics: a case study.
(38/1470)
For the past decade, Stanford Medical Informatics has combined clinical informatics and bioinformatics research and training in an explicit way. The interest in applying informatics techniques to both clinical problems and problems in basic science can be traced to the Dendral project in the 1960s. Having bioinformatics and clinical informatics in the same academic unit is still somewhat unusual and can lead to clashes of clinical and basic science cultures. Nevertheless, the benefits of this organization have recently become clear, as the landscape of academic medicine in the next decades has begun to emerge. The author provides examples of technology transfer between clinical informatics and bioinformatics that illustrate how they complement each other. (+info)
Personal values and cancer treatment refusal.
(39/1470)
This pilot study explores the reasons patients have for refusing chemotherapy, and the ways oncologists respond to them. Our hypothesis, generated from interviews with patients and oncologists, is that an ethical approach that views a refusal as an autonomous choice, in which patients are informed about the pros and cons of treatment and have to decide by weighing them, is not sufficient. A different ethical approach is needed to deal with the various evaluations that play a role in treatment refusal. If patients forgo further treatment, while curative or palliative methods are available, there is no perspective from which to integrate the weighing of pros and cons of treatment and the preferences and values of individual cancer patients. A discrepancy thus results as regards what "good reasons" are, evoking misunderstandings or even breaking off communication. Suggestions are given for follow up research. (+info)
Medical school in Split: intentions and achievements.
(40/1470)
This paper describes the origins, aims, and current status of the Split University School of Medicine. Split University School of Medicine was founded several times anew (in 1806, 1944, and 1974), and eventually started to operate as an independent faculty on March 26, 1997. Conceived as a small and efficient medical school, each year it enrolls 50 freshmen at the most. The whole curriculum contains 27 courses (no "majors" or "minors"), each of around 200 class hours, which amounts to a total of 5,610 teaching hours. The teaching process aims at achieving skills and knowledge necessary in general medical practice, at establishing an intellectual basis for further education, and corresponding with the specific medical needs of the coastal area ("Adriatic orientation") Student/instructor ratio is close to 2.0 and the teaching goals are defined better than in older medical schools in the region. The first results are already tangible. (+info)