Improving communication between hospital and community physicians. Feasibility study of a handwritten, faxed hospital discharge summary. Discharge Summary Study Group.
OBJECTIVE: To assess the timing, legibility, and completeness of handwritten, faxed hospital discharge summaries as judged by family physicians and to obtain their opinion on the information categories on a standardized discharge summary form. DESIGN: Fax survey of physicians for consecutive patients discharged from hospital over 8 weeks. SETTING: Three wards in a tertiary care teaching hospital. PARTICIPANTS: One hundred two family physicians and general practitioners practising in Hamilton, Ont. MAIN OUTCOME MEASURES: Proportions of summaries that were received, received within 48 hours of discharge, legible, and complete; types of information missing from incomplete summaries; proportion of physicians satisfied with the information categories. RESULTS: Of 271 consecutive patient discharges, 195 (72%) were eligible for study. Among those ineligible, 22 patients (8%) did not have a family doctor identified on their hospital records. Among records that did have a family physician identified, fax numbers were unavailable or unknown for 54 physicians (20%). One hundred two physicians completed 166 discharge summary assessments for a response rate of 85% (166/195). By 3 weeks after discharge, 138 discharge summaries (83%) had been received by patients' family doctors. Among those received, 86% were received within 48 hours of discharge; 92% were legible; and 88% were complete. Hospital doctors' signatures, patients' diagnoses, and follow-up plans were most frequently missing. Ninety-five percent of physicians were satisfied with the information categories included on the standardized form. CONCLUSIONS: Handwritten, faxed hospital discharge summaries were acceptable to family physicians for most patients. Criteria are needed for determining which patients require both handwritten and dictated discharge summaries. (+info)
Progressive adriamycin nephropathy in mice: sequence of histologic and immunohistochemical events.
BACKGROUND: As an experimental analogue of human focal glomerular sclerosis (FGS), adriamycin (ADR)-induced nephropathy is well-characterized in rats. Previously, this model has not been fully established in mice. The extension of this model to the mouse would be useful in the application of genetic and monoclonal antibody technology to characterize mechanisms of progressive renal disease. Herein, we describe a stable and reproducible murine model of chronic proteinuria induced by ADR. METHODS: Male BALB/c mice were intravenously injected with a single dose of ADR (10 to 11 mg/kg). Seven mice were sacrificed at weeks 1, 2, 4, and 6. Renal function, quantitative morphometric analysis, and electron microscopic studies were performed. Peripheral CD4+ and CD8+ T cells were evaluated using flow cytometric analysis of splenocytes. The leukocytic inflammatory pattern was analyzed by immunohistochemical examination. RESULTS: Overt proteinuria was observed from day 5 and remained significantly elevated throughout the study period. A focal increase in reabsorption droplets in tubular cells appeared at weeks 1 and 2, and numerous intraluminal casts were present after two weeks. Glomerular vacuolation and mild FGS appeared at week 4. At week 6, extensive focal and even global glomerular sclerosis, associated with moderate interstitial expansion and severe inflammation, were observed. A prominent macrophage infiltration appeared within both interstitium and glomeruli at week 2, followed by accumulation of both CD4+ and CD8+ T cells in interstitium but not glomeruli. There were almost no B lymphocytes seen at any time. CONCLUSION: This model should be useful in unraveling the pathogenesis of glomerular and interstitial inflammation and fibrosis in chronic proteinuric renal disease. (+info)
Facsimile transmission of prescriptions for patients enrolled in hospice programs. Drug Enforcement Administration (DEA), Justice. Final rule.
DEA is finalizing, without change, the interim rule with request for comment published in the Federal Register on July 25, 2000 (65 FR 45712). The interim rule amended Title 21, Code of Federal Regulations (CFR) 1306.11(g) to clearly articulate that prescriptions for Schedule II narcotic substances for patients enrolled in hospice care certified by Medicare under Title XVIII or licensed by the state may be transmitted by facsimile. No comments to the interim rule were received. This final rule makes the clarification permanent. (+info)
Using old technology to implement modern computer-aided decision support for primary diabetes care.
BACKGROUND: Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. OBJECTIVE: To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. IMPLEMENTATION: The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. CONCLUSION: Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices. (+info)
Disease reporting from an automated laboratory-based reporting system to a state health department via local county health departments.
OBJECTIVE: The authors assessed the completeness of disease reporting from a managed care organization's automated laboratory-based reporting system to the California Department of Health Services (CDHS) via local public health departments. METHODS: The authors identified all positive laboratory tests for 1997 from the computerized database of Kaiser Permanente Northern California for seven infections for which there are statutory reporting requirements: Campylobacter jejuni, Chlamydia trachomatis, Cryptosporidium parvum, hepatitis A, Neisseria meningitidis, Neisseria gonorrhoeae, and Salmonella (N = 7,331 reports). Cases were then matched by computer query to records of cases reported to CDHS. To determine why cases were not found in CDHS records, a sample of un-matched cases was searched at two county health departments. RESULTS: Overall, 84.5% (95% CI 83.4, 85.6) of the laboratory reports submitted with accompanying demographic information were successfully matched with cases in the CDHS disease surveillance database. Frequency of matching for specific diseases ranged from 79.4% (95% CI 75.6, 83.3) for N. gonorrhoeae to 88.4% (95% CI 85.3, 91.6) for C. jejuni. Reports were more likely to be matched when the county of residence was the same as the county of the health care facility. At the county level, reasons for failure of cases to be forwarded to CDHS included: errors due to manual data entry, failure to forward information from the county of diagnosis to the county of residence, and incorrect disease coding. CONCLUSION: Automated laboratory-based reporting is highly effective, but some data are lost with off-line transfer of information. To optimize surveillance accuracy and completeness, reporting at all levels should be done via direct electronic data transfer. (+info)
Participation of African social scientists in malaria control: identifying enabling and constraining factors.
OBJECTIVE: To examine the enabling and constraining factors that influence African social scientists involvement in malaria control. METHODS: Convenience and snowball sampling was used to identify participants. Data collection was conducted in two phases: a mailed survey was followed by in-depth phone interviews with selected individuals chosen from the survey. FINDINGS: Most participants did not necessarily seek malaria as a career path. Having a mentor who provided research and training opportunities, and developing strong technical skills in malaria control and grant or proposal writing facilitated career opportunities in malaria. A paucity of jobs and funding and inadequate technical skills in malaria limited the type and number of opportunities available to social scientists in malaria control. CONCLUSION: Understanding the factors that influence job satisfaction, recruitment and retention in malaria control is necessary for better integration of social scientists into malaria control. However, given the wide array of skills that social scientists have and the variety of deadly diseases competing for attention in Sub Saharan Africa, it might be more cost effective to employ social scientists to work broadly on issues common to communicable diseases in general rather than solely on malaria. (+info)
Family physicians' information seeking behaviors: a survey comparison with other specialties.
BACKGROUND: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice. METHODS: A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty. RESULTS: Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians. CONCLUSION: Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference. (+info)
Medicare program; e-prescribing and the prescription drug program. Final rule.
This final rule adopts standards for an electronic prescription drug program under Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). These standards will be the foundation standards or the first set of final uniform standards for an electronic prescription drug program under the MMA, and represent the first step in our incremental approach to adopting final foundation standards that are consistent with the MMA objectives of patient safety, quality of care, and efficiencies and cost savings in the delivery of care. (+info)