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TELERADIOLOGY FOR CONSULTATION BETWEEN PRACTITIONERS AND RADIOLOGISTS

ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 277-280页

作者： FRANKEN, EA BERBAUM, KS SMITH, WL CHANG, P DRISCOLL, C BERGUS, G UNIV IOWA COLL MED DEPT FAMILY PRACTICE IOWA CITY IA 52242 USA

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Medical counterbioterrorism: The response to provide anthrax prophylaxis to New York City US postal service employees

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 441-446页

作者： Partridge, R Alexander, J Lawrence, T Suner, S Brown Univ Sch Med Rhode Isl Hosp Injury Prevent CtrDept Emergency Med Providence RI 02912 USA Maine Med Ctr Dept Emergency Med Portland ME 04102 USA Univ Vermont Coll Med Dept Surg Burlington VT USA Rhode Isl Dept Hlth Emergency Med Serv Children Providence RI 02908 USA Off Emergency Preparedness Dept Hlth & Human Serv Rockville MD USA

Study objective: We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. Methods: A description of the response effort is presented. Data were collected on standardized forms and included the numbers of postal employees screened and offered antibiotic prophylaxis, as well as the numbers of patients seen per worker hour by various medical professionals. Results: One hundred members of 5 disaster medical assistance teams and other health professionals were deployed to New York City within 18 hours of activation. Over a 68-hour period, 7,076 patients were evaluated, representing all postal employees in the 6 major postal facilities in New York believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen during the first 24 hours, 3,875 during the second 24 hours, and the remaining 749 during the last 20 hours of operations. An average of 161 employees were screened per hour. The antibiotic most commonly dispensed was ciprofloxacin, followed by doxycycline and amoxicillin. Conclusion: The deployment of disaster medical assistance teams and other agencies to New York City to provide prophylaxis against inhalation anthrax to US Postal Service employees provides lessons for a rapid, efficient, and effective response to acts of bioterrorism. This deployment might also serve as a scaleable model for future events requiring medical prophylaxis.

关键词：炭疽/预防和控制抗菌药/治疗应用生物恐怖/预防和控制救灾计划/组织和管理效率组织预测卫生服务研究普查/组织和管理模型组织管理纽约市职业卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据人员配备和时间安排/组织和管理邮政转诊和会诊/组织和管理回顾性研究危险因素时间因素工作负荷量人类

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PROGRESS AND PROBLEMS OF INTERHOSPITAL CONSULTING BY COMPUTER NETWORKING

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 1-11页

作者： PARSONS, DF Wadsworth Center for Laboratories and Research New York State Department of Health P.O. Box 509 Empire State Plaza Albany New York 12201-0509

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NEPHROPATHOLOGY CONSULTATION VIA DIGITIZED IMAGES

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 281-292页

作者： CRONENBERGER, JH HSIAO, H FALK, RJ JENNETTE, JC University of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina 27599

Investigations into a digitized image communications system were prompted by a need to bring expert consultation to physicians in community practice. Pathologists desired the capability to concomitantly view, annotate, and discuss images with referring physicians at distant sites. Methods included evaluation of the human and procedural domain into which the system was to be integrated. The GDCN computer consultation system has the consultant nephropathologist first evaluate the processed biopsy slides, digitize representative images, transmit them with the diagnosis to referring nephrologist, and, finally, conduct an interactive consultation and review of the biopsy and case. Image resolution and compression variables must be set for each individual medical consulting application. For the GDCN, it was found that the 640 x 496 x unlimited color with compression ratios not exceeding 1:32 are acceptable. An obvious improvement of this computerized system over the noncomputerized review sessions is the ability to immediately share and discuss a new image that had not been previously sent. In the old noncomputerized consultation, only images that had been mailed could be discussed. The computerized sessions allow transmission (10 sec) of a new image that the consultation might demand. The computerized sessions also provide the ability to show the referring nephrologist an area of biopsy interest that the pathologist had not previously transmitted. Biopsy slides can be viewed during the consultation, an area digitized, and that image transmitted to the nephrologist during the consultation. Hardware and costs for the sending station were: [table: see text] This system far exceeds the requirements for this particular application; however, it is sufficient to support future, higher-technology computer applications. If necessary, this same system could be used with a less expensive computer, a less expensive camera, software compression, and a single monitor. These alteration

关键词：活组织检查计算机通信网络/经济学计算机通信网络/仪器和设备计算机通信网络/组织和管理图像处理计算机辅助/经济学图像处理计算机辅助/仪器和设备图像处理计算机辅助/方法肾疾病/病理学肾脏病学/组织和管理病理学临床/组织和管理转诊和会诊/组织和管理远程医学人类

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Zimbabwe's hospital referral system: does it work?

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HEALTH POLICY AND PLANNING 1998年第4期13卷 359-370页

作者： Sanders, D Kravitz, J Lewin, S McKee, M Univ Western Cape Publ Hlth Programme ZA-7535 Bellville South Africa Oregon Hlth Sci Univ Dept Publ Hlth & Prevent Med Portland OR 97201 USA MRC Ctr Epidemiol Res S Africa Tygerberg South Africa Univ London London Sch Hyg & Trop Med Dept Publ Hlth & Policy Hlth Serv Res Unit London WC1E 7HT England

Background: Anecdotal evidence has suggested inefficiency in the pyramidal health care referral system established in Zimbabwe in 1980, as part of its primary health care (PHC) model. Aim: To assess the functioning of the pyramidal referral system in two rural districts surrounding Harare, Zimbabwe, with regard to two common indicator conditions: pneumonia in children and malaria in adults. Methods: For a three-month period, all complete inpatient records with discharge diagnoses of pneumonia or malaria from three hospitals representing different levels of care were analyzed (n = 227). Data were collected on demographic and patient care variables. The appropriateness of admissions and referrals was determined by an assessment of the severity of illness and 'intensiveness' of care required. Data were analyzed for differences among the three hospitals and between the two indicator conditions. Per night inpatient bed costs for each hospital were also calculated. Results: For pneumonia in children, 56.8% of patients admitted at the secondary level, 53.8% of patients at the tertiary level and 57.8% of patients at the quaternary level were of mild severity. For malaria in adults, 74.0% of patients seen at the secondary level, 81.5% of patients at the tertiary level and 54.3% at the quaternary level were of mild severity. For pneumonia, there were no differences in severity between the three hospitals whereas for malaria significant case-mix differences among the hospitals were found. Most patients attending the highest level referral facility were inappropriate admissions who could have been treated at a lower level of care. The majority of patients at all the hospitals studied had used that hospital as their first or second point of contact with the health services. There were large variations in the inpatient per night bed costs between the three hospitals. Conclusions: Using the indicator diseases of pneumonia in children and malaria in adults, this study concluded tha

关键词：卡方分布发展中国家诊断相关患者组评价研究卫生政策卫生服务研究医院乡村/经济学医院乡村/组织和管理医院乡村/利用疟疾/治疗肺炎/治疗转诊和会诊/组织和管理转诊和会诊/标准津巴布韦成年人儿童人类

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Getting referrals for diabetes education and self-management training

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DIABETES EDUCATOR 1999年第6期25卷 959-+页

作者： Albisser, AM Harris, RI Sperlich, M Albisser, JB Better Control Med Comp Inc Dis Management Div Miami FL 33139 USA

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MULTIMEDIA COMMUNICATIONS IN HEALTH-CARE

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 257-268页

作者： REIS, H BRENNER, D ROBINSON, J NYNEX SCI & TECHNOL INC CAMBRIDGE MA 02139 USA

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Management of suicide attempts in Italy and Sweden - A comparison of services offered to consecutive samples of suicide attempters

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GENERAL HOSPITAL PSYCHIATRY 2000年第6期22卷 432-436页

作者： Runeson, B Scocco, P DeLeo, D Meneghel, G Wasserman, D Karolinska Inst St Gorans Hosp Dept Clin Neurosci Sect Psychiat S-11281 Stockholm Sweden Univ Padua Dept Neurol & Psychiat Sci WHO Collaborating Ctr Res & Training Suicide Prev Padua Italy Griffith Univ Brisbane Qld 4111 Australia Karolinska Inst Natl Inst Psychosocial Med Natl Swedish Ctr Suicide Res & Prevent Mental Ill Stockholm Sweden Karolinska Inst WHO Collaborating Ctr Stockholm Sweden

The aim of the study was to compare the management of suicide attempts by patients in Sweden and Italy with a view to providing a perspective on differences in treatment. Two consecutive samples of suicide attempters from Huddinge (n=97) and Padua (n=100) were studied in trans of sociodemographic characteristics previous care, referral, medical and psychiatric care, hospitalization, aftercare and short-term compliance. In Italian somatic management of acute suicidal crises, there are more physicians specializing in anesthesia or internal medicine working in ambulances and emergency wards, and there is a heavier emphasis on somatic care. Swedish management procedures seem to entail more medical examinations and biohumoral tests. Moreover, the procedures at the Swedish hospital give priority to early psychiatric intervention, and admission to psychiatric inpatient care is more frequent. However, it is not normal practice in emergency psychiatric care at either of the centers for specialists to serve in the immediate liaison consultation. There are differences in assessment and treatment between the two countries that may provide a perspective on their procedures, implying that current procedures for managing patients belonging to groups identified as "high-risk" in terms of suicide may be modified. (C) 2000 Elsevier Science Inc.

关键词：出院后医疗/组织和管理急诊室精神病/组织和管理住院/统计学和数值数据意大利精神卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据精神病学/组织和管理卫生保健质量转诊和会诊/组织和管理社会经济因素自杀未遂/预防和控制自杀未遂/心理学自杀未遂/统计学和数值数据瑞典青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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TELERADIOLOGY FOR THE EMERGENCY ROOM

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 293-297页

作者： KAGETSU, NJ ABLOW, RC Department of Radiology St. Luke's-Roosevelt Hospital Center Columbia University College of Physicians and Surgeons 428 West 59th Street New York New York 10019

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Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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