The aridity of Saudi Arabia, in general, makes air pollution studies very important, not just on a local level but also on an international level. A comprehensive field study of atmospheric sulfur dioxide (SO2) concentration was conducted in Jiddah, Saudi Arabia (one of the fastest growing cities in the world) ...

OBJECTIVE: To compare the self-reported role of nursing home medical directors in 1989 (prior to the implementation of the nursing home reform amendments of OBRA 87 in 1990) with the role outlined in the Joint Commission on Accreditation of Healthcare Organizations Long Term Care Standards Manual. DESIGN: Survey. MEASUREMENTS: Using ...

In spite of concerns on the part of doctors and hospitals regarding the level of malpractice litigation, they have failed to appreciate the value of effective quality management programmes in minimizing this risk. This paper describes some of the main components of these complex programmes, highlighting the importance of credentialling ...

The Accreditation Council for Graduate Medical Education in the United States has recently required institutions with residency and fellowship training programmes to develop an Institutional Policy Review Document outlining how the educational quality of these programmes is monitored. Whereas departments may have assumed this responsibility in the past, this is ...

This paper will describe a successful application of Quality Improvement concepts to the complex Perioperative System at an academic medical center in the Northeast. The initiation of multi-disciplinary teams (including surgeons, anesthesiologists, and nurse managers) will be discussed, as will the steps, skills, and techniques employed. The paper will catalogue ...

One of the highest priorities in today's hospitals is the provision of quality care to patients. The medical librarian has an increased responsibility to furnish quality information to the medical staff. Traditional methods of reference service continue to work well, but it is increasingly important for librarians to become more ...

A twice-yearly audit of a sample of medical records from each department of a general hospital was initiated by a quality assurance committee and pursued for 8 years. Missing entries that were considered obligatory for good medical performance of each service were identified, and the results (expressed as percent of ...

As the demand for immunohistochemical tests (IHC) extends beyond artistry to more widespread medical diagnostic need, the field requires improvements in quality, reproducibility, speed, and standardization. Automated IHC offers the opportunity to impart new levels of quality, reproducibility, and standardization while reducing labor and reagent costs. In addition, the controlled ...

Parkview Episcopal Medical Center in Pueblo, CO, has been implementing a continuous quality improvement (CQI)-driven organization since April 1988. Under the leadership of Michael Pugh, the medical center's president and CEO, Parkview has made great progress in this effort. However, there is much more to be accomplished in the years ...

Evaluating the quality of medical care is a documented activity extending as far back as 1910, when William Flexner, MD, examined the nation's medical schools. Standards promulgated by the federal government and by voluntary accreditation agencies have been primarily responsible for driving the development and widespread use of monitoring activities ...

Total quality management (TQM) is a unifying business strategy for achieving and sustaining growth. TQM proceeds, step by step, project by project, to transform the organization into one smoothly working, quality-focused team. For successful implementation of TQM, the small projects are every bit as important as the large ones. The ...

We evaluate the effectiveness of the daily record review (DRR) of 4393 ambulatory medical patients seen at the emergency room department of a teaching pediatric hospital in Paris between 8th January and 11 March 1991. For these patients, 137 potential quality problems were found, 117 of them remaining after discussion ...

The Medical Center for Refugees in Linköping, Sweden, includes a medical ward for refugees and asylum applicants. It was started in January, 1986 and is financed by the Swedish Immigration Board. Sixty percent of the patients are war-wounded and 40% have diagnoses non-related to war. This article describes a group ...

Current quality of life measuring tools are suited for economic decision making, not to investigate causal processes which lead to patients making evaluations of their lives. An alternative approach is presented based on research into positive versus negative life-satisfaction. Quality of life is a causal sequence of psychological states where ...

Because of the demand for accountability and the necessity that the medical transcription department function as a revenue-generating entity within the hospital structure. HIM professionals are rejecting inadequate solutions and looking for long-term improvements in medical transcription quality and productivity. It has been our experience that many hospitals and clinics ...

Medical case management's purpose is to improve the quality of health care and decrease medical expenses associated with high cost medical cases. Patient satisfaction can be used as a measure of the quality of medical case management. This investigation resulted in a reliable and valid questionnaire for assessing patient satisfaction ...

OBJECTIVE: To determine whether adverse occurrence screening of inpatient discharge summaries by means of a limited number of criteria can provide an effective medical quality control system without requiring substantial additional resources. DESIGN: The medical records department used 14 criteria to screen all inpatient discharge summaries shortly after discharge. Summaries ...

The choice of the correct material for medical syringes is determined by the requirements demanded by users and manufacturers. New advances are making it easier to meet these requirements and leading to higher quality products with increased reliability. In this article, the author looks at the requirements of a good ...

Computing systems for quality assessment in the operative departments, in anaesthesia and intensive care were developed at the Altona General Hospital, Hamburg. The main goals were to support quality assurance as a tool for the medical staff which they can use actively in their routine work and to reorganize uneconomical ...

In summary, quality assurance in medicine and in CVIR must be an important part of daily practice. The JCAHO is gradually moving toward quality improvement as a goal, rather than simply monitoring performance. Physicians must lead the way in dealing with the issues of monitoring performance, with the ultimate goal ...

In 1987, Ellen Gaucher took an unusual trip. As senior associate director of the University of Michigan's sprawling 11,000-employee Medical Center, she was invited to a conference about a movement that was rapidly growing in the word of business--total quality. The occasion was the organizational conference of the National Demonstration ...

The historical development of price indexes as wage adjustment mechanisms is reviewed, as is the theory of aggregation and methods for dealing with quality and technological change. The construction of the U.S. Bureau of Labor Statistics (BLS) Medical Care Price Index (MCPI) is detailed. ARIMA analysis of the MCPI for ...

In 1991 the third of a series of trials of concurrent case note screening was conducted over a 4 month period in one surgical and one medical unit of a busy metropolitan public teaching hospital in South Australia. The conclusion reached was that there is insufficient evidence of consistent improvement ...

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators ...

To determine the characteristics and effects of quality assurance programs in emergency medical service (EMS) systems in Michigan, medical directors of all EMS medical control authorities in Michigan were mailed a survey consisting of 14 closed-ended and open-ended questions including 2 using a subjective continuum scale; the study included phone ...

These few subjects are only a small fragment of the scope of pediatric medicine but are critical in their impact. The depth of material needed to cover the subject adequately should fill a textbook. If, however, aviculturists could master these seven areas, the numbers of babies requiring medical or surgical ...

A system is described that improves the quality of medication cart filling, increases the speed and quality of medication cart checking, and decreases omissions or incorrect dosage errors in medication administration. In a system where scheduled medications and PRN medications are kept in separate drawers, all of the patients' oral ...

Even though much of the quality-assurance process had been automated at Kettering Medical Center (KMC) in Dayton, Ohio, reviewers still had to key in data from paper records each day. An extensive paper trail continued until Kettering took the leap to total paperless review using eight laptop computers with internal ...

Endotracheal intubation is a critical skill necessary in a number of situations encountered by air medical personnel. The purpose of this study was to establish a threshold for the quality assurance indicator of successful tracheal intubation in a physician-staffed air medical system. The records of all patients transported by a ...

This study is unique in that it involved the efforts of several professional groups at eight medical centers to solve a common quality assurance problem. The study used a systematic approach to evaluate and improve the quality of care provided to veterans transferred from one facility to another. The initial ...

The American Medical Association's long-standing commitment to improving the quality of medical care has been marked by a variety of efforts, from improvement of medical education and accreditation to technology assessment and peer review. But with increasing nationwide attention on evaluating quality of care, the AMA, as well as many ...

Good results have been achieved in the treatment of patients with burns with new splinting materials and proper splinting techniques. This article focuses on the thermoplastic splinting materials Clinic and Spectrum (Northcoast Medical Inc., San Jose, Calif.) and the comparable thermoplastic products Polyform (Smith & Nephew Rolyan, Inc., Menomonee Falls, ...

Attitude studies of patients, their relatives, and sometimes even widows or widowers suggest that about 80 per cent of a small sample of Swedish in-patients are satisfied. However, the discontinuity of patient-staff relations in 69 per cent of out-patients is disturbing. There is a possibility that medical quality in the ...

PREOP is a prototype expert system that is designed to provide physicians with evidence-based recommendations concerning the assessment and care of patients with comorbid medical problems who are about to undergo surgery. The knowledgebase for this system is currently undergoing transition from the conventional advice of medical experts, which is ...

This chapter emphasizes spirometry guidelines for conducting medical surveillance and epidemiological studies beyond those addressed by the 1987 American Thoracic Society Spirometry Update. These guidelines include specific recommendations concerning testing equipment, test performance, quality control, and technician training. Use of these guidelines should help ensure that changes in lung function ...

Medical teachers usually do not have ready access to a resource for obtaining good quality illustrations for routine instructional activities and, at times, even for presentation of research findings in publications or at seminars. The inadequacy is especially apparent when human figures or objects need to be shown indicating depth ...

A medical director has enormous influence on medical cost and quality in managed care organizations. Little empirical work has been done on the attributes of an effective HMO medical director. The survey discussed in this article sought to examine those desirable traits from the perspective of medical directors who have ...

This article presents a method that is helpful in achieving compliance with the JCAHO medical staff monitoring standards. Since the QA activity of the medical staff is of great importance to the institution, it is imperative that monitoring activities are clearly documented and easily evaluated. Through the use of a ...

Part I of this article explored flaws in the operation of peer review in the selection of articles for journal publication and decision-making in the award of research grants, and Part II described medical peer review, its practitioners, and the distinctions between medical peer review and other activities and processes ...

The first part of this article explored the flaws in the operation of peer review in two contexts: selection of articles for journal publication and decision-making in the award of research grants. There it was suggested that, to the extent these flaws had adverse effects on the information available to ...

As hospitals increasingly emphasize efforts to measure and improve quality of care, the related issue of severity measurement emerges as a topic of strong interest. Severity measures can support hospital quality management in at least two areas: selection of medical records for individual case review and monitoring of patterns of ...

The relationship between quality of life (QOL) and alexithymia was examined in dialysis patients. Hemodialysis (HD) patients with diabetic nephropathy had poor QOL in medical dimension. Although they had good QOL in psychological and social dimensions, a high prevalence of alexithymia associated with self-control ability was observed. These results suggest ...

A significant number of workers suffer a variety of physical symptoms and illnesses associated with poor indoor air quality. These authors furnish employers with a guide for providing clean air in the workplace--an objective the achievement of which will reduce employee absenteeism and medical insurance costs, while increasing productivity and ...

The implementation of quality assurance monitoring is an important response to public demands for accountability in medicine as well as a requirement for institutional accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The author examines the somewhat elusive definition of quality as it is applied to medical ...

With the support and guidance of the medical staff, a protocol for IV theophylline dosing and monitoring has been implemented. The patients' theophylline needs are individually determined by pharmacists using clinical criteria and historical data determined for each patient. Ongoing monitoring and dosage adjustments are provided. The protocol is described ...

The Operative Registry, also known as DA Form 4108, constitutes the basic, geographically focused, sequential log of operative activities for any given Army Medical Treatment Facility. The information provided for the Registry, with specific refinements, constitutes an essential data base for quality assurance and utilization review. The experience at Madigan ...

Since implementation of Medicare's prospective payment system, the emphasis of medical peer review organization (PRO) activities is quality health care in the appropriate setting. The Texas Medical Foundation's dedication to quality health care is evident in its quality review, in its information to the medical community, and in its challenges ...

In the course of a quality assurance (QA) activity on the use of antimicrobics the authors set out to assess the management of urinary tract infection (UTI) in 76 patients. From culture data they noted an excellent or correct use in 78% of the patients, but a misuse in 22%. ...

The Biomedical Engineering Department (BME) at the University Medical Center, Tucson, Arizona, noted a sharp increase in the use of rented medical equipment. To increase efficiency, control costs, and provide effective quality assurance for rented equipment, a Medical Equipment Rental Vendor (MERV) program was formulated. The program increases efficiency by ...

The goal of quality assurance is to guarantee quality in medical care through the detection of problems with their subsequent evaluation and study, and through the implementation of corrective measures, when necessary. This article describes the criteria, methods, and results of a programme of quality assurance introduced in the Hospital ...