scholarly journals Automated Dispensing Cabinet Optimization in a Level 2 Trauma Center

2021 ◽  
Vol 67 (4) ◽  
pp. 17-21
Author(s):  
Tony Vu ◽  
Yifan She
Keyword(s):  
Performance Indicators ◽  
Pharmacy Staff ◽  
Topic Area ◽  
Improvement Project ◽  
Fill Ratio ◽  
Continuous Quality ◽  
Significant Difference ◽  
Impact Patient Care ◽  
Clinically Significant ◽  
Baseline Difference

Introduction Opportunities have been identified regarding timely delivery of medications due to lack of ADC inventory related to stock outs or other variances in pharmacy workflow (i.e. compounding and distribution times). These opportunities for improvement impact patient care and result in both nursing and pharmacy staff frustration. Additionally, there are significant costs associated with unused medications stored in ADCs, taking up valuable real estate that would otherwise house more opportune inventory. This situation has created a need for more efficient management of the ADC inventory. Currently, research in the topic area is sparse. We hypothesize that the systematic management and oversight of ADC inventory will demonstrate a significant improvement in key performance indicators and provide insight to the current gaps in knowledge. Methods This study will be a continuous quality improvement project with a combination of retrospective data review and prospective optimization interventions of automated dispensing cabinets (Pyxis®). Interventions include review and adjustment of ADC par levels, removal of unused/stagnate medications, standardization of stock, and continual review of ADC inventory turns and associated optimization opportunities. The primary outcomes are the change in vend/fill ratio from baseline, change in medication stockout percentage from baseline. Results There was no significant difference in vend/fill ratio after the optimization phase compared with baseline [Difference 0.13 (11.56 ± 6.1 vs. 11.43 ± 5.41) respectively, (p=0.84)]. Medication stockout percentage was also found to be similar with baseline [Difference -0.05 (0.71% ± 0.12 vs. 0.76% ± 0.08) respectively, (p=0.37)]. For secondary outcomes, the change in blind stockout percentage from baseline was -0.04 [0.13 ± 0.02 vs. 0.17 ± 0.02, (p=0.004)] and the change in medications dispensed per day from baseline was 317 [2656 ± 143 vs. 2339 ± 200, (p=0.0002)]. Conclusion Optimization of automated dispensing cabinets yielded marginal improvements in vend/fill ratio and stockout percentage and significantly improved overall efficiency through an increase in the number of medications stocked in ADCs and number of medications dispensed per day from ADCs. Evaluation of more clinically significant performance indicators may better characterize the benefits from the optimization process.

Hearing Aid Gain Usage by Children

1989 ◽  
Vol 20 (2) ◽  
pp. 149-152 ◽  
Author(s):  
Kenneth W. Berger
Keyword(s):  
Hearing Aid ◽  
Appreciable Difference ◽  
Significant Difference ◽  
Clinically Significant

Hearing aid gain usage by two groups of children was examined. No appreciable difference was noted between the groups, nor was there a clinically significant difference between gain usage by these children as compared with a sample of adult hearing aid wearers.

Do Deeper Levels of Cervical Biopsies Preceded by a Pap Smear Diagnosis of LSIL, ASCUS, or NILM/HPV+ Increase the Yield of Identifying Clinically Significant Lesions?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
K G Manjee ◽  
W G Watkin
Keyword(s):  
Pap Smear ◽  
Past History ◽  
Prior History ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Significant Difference ◽  
History Of ◽  
Clinically Significant ◽  
Almost All

Abstract Introduction/Objective Cervical biopsy is performed following an abnormal pap smear or positive HPV testing in an attempt to uncover clinically significant lesions [HSIL/invasive carcinoma (HSIL+)]. An excisional procedure is considered if biopsy confirms HSIL+. When preceded by pap smear of LSIL, ASCUS, NILM/HPV+ or persistent HPV, continued surveillance is recommended for biopsies showing no SIL or LSIL. In our laboratory, cervical biopsies are routinely sectioned at 3 levels. Deeper levels are often ordered when initial sections are non-diagnostic. p16 immunohistochemistry, with or without deeper levels, is often ordered to confirm HSIL, or to differentiate HSIL from mimics. In this study, we examine whether and in what clinical situations does obtaining additional levels uncover clinically significant lesions. Methods 430 cervical biopsies between January-May 2018, with recent cytology of LSIL, ASCUS or NILM/HPV+ were identified in the pathology database. HPV status (if known), final biopsy diagnosis and past history of LSIL/HSIL were recorded. For each biopsy, orders for additional levels and/or p16 immunohistochemistry were recorded resulting in 4 categories: C1-no additional levels or p16, C2-deeper only, C3-deeper+p16 and C4-p16 only. Final diagnoses were divided into HSIL+, LSIL and no SIL. Results There was no significant difference in prior history of LSIL/HSIL and HPV status between all categories. Biopsy results were as follows: HSIL+: 11/222 (5%) C1; 1/78 (1%) C2; 7/43 (16%) C3; 15/87 (17%) C4 LSIL: 91/222 (41%) C1; 7/78 (9%) C2; 16/43 (37%) C3; 35/87 (40%) C4 No SIL: 120/222 (54%) C1; 70/78 (90%) C2; 20/43 (46%) C3; 37/87 (42%) C4 The average number of additional levels in C2 and C3 was 3.8 and 1.8, respectively. Conclusion Deeper levels alone did not enhance the detection of HSIL+. Almost all LSIL/HSIL were detected when initial levels were diagnostic or suspicious and supported by p16 immunohistochemistry. 3 levels are adequate to detect clinically significant lesions.

4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

scholarly journals The Minimum Clinically Significant Difference in Visual Analogue Scale Pain Score in a Local Emergency Setting

2009 ◽  
Vol 16 (4) ◽  
pp. 233-236 ◽  
Author(s):  
MSM Mark ◽  
TTS Au ◽  
YF Choi ◽  
TW Wong
Keyword(s):  
Visual Analogue Scale ◽  
Pain Score ◽  
Analogue Scale ◽  
Education Level ◽  
Chinese Patients ◽  
Visual Analogue Scale Pain ◽  
Emergency Setting ◽  
Significant Difference ◽  
Analogue Scale Pain ◽  
Clinically Significant

Objectives To determine whether the minimum clinically significant difference (MCSD) in visual analogue scale (VAS) pain score varies with age, gender, education level and cause of pain (trauma versus non-trauma) in Chinese patients. Methods This was a prospective descriptive study of local Chinese patients 15 years of age or older who presented with pain to the accident & emergency department. On presentation, patients were asked to indicate their current pain severity with a single mark through a standard 100–mm visual analogue scale. Then they would be offered an analgesic for pain-relief. After 30–45 minutes, the patients were asked to give a verbal categorical rating of their pain as ‘a lot better’, ‘a little better’, ‘much the same’, ‘a little worse’, or ‘much worse’ and to mark the level of pain on a VAS of the same type as used previously. The MCSD in VAS pain score was defined as the mean difference between the current and preceding scores when the subject reported ‘a little worse’ or ‘a little better’ in pain. Data were compared based on gender, age, education level, and traumatic versus non-traumatic causes of pain. Results 186 patients were enrolled in the study, yielding 77 evaluable comparisons where pain was rated as ‘a little better’ or ‘a little worse’. Overall, the MCSD in VAS pain score in the group was 17 mm (95%CI 13.6 mm to 20.6 mm). There were statistically significant differences between the MCSD in VAS pain score between genders and causes of pain (trauma versus non-trauma). Conclusions The MCSD in VAS pain scores was found to be 17 mm. There was significant differences in MCSD in VAS pain score in different genders and between trauma and non-trauma cases.

Attention Deficit Hyperactivity Disorder, Creativity, and the Effects of Methylphenidate

PEDIATRICS ◽  
1993 ◽  
Vol 91 (4) ◽  
pp. 816-819
Author(s):  
Jeanne B. Funk ◽  
John B. Chessare ◽  
Michael T. Weaver ◽  
Anita R. Exley
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Repeated Measures ◽  
Creative Thinking ◽  
Adhd Group ◽  
Hyperactivity Disorder ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Difference ◽  
Clinically Significant

Given that children with attention deficit hyperactivity disorder (ADHD) are more impulsive than peers, this study explored whether they are correspondingly more creative, and whether creativity declines when impulsivity is decreased through methylphenidate (Ritalin) therapy. A repeated-measures quasi-experimental design was used to compare the performance of 19 boys with previously diagnosed ADHD and 21 comparison boys aged 8 through 11 on two administrations of alternate forms of the Torrance Tests of Creative Thinking-Figural (nonverbal). Boys with ADHD received prescribed methylphenidate only for the first session. Overall, mean Torrance summary scores for comparison boys (mean = 115.1, SD = 16.1) were higher than for boys with ADHD (mean = 107.6, SD = 12.7). However, the difference between means was small (7%) and did not meet the 25% criterion for a clinically significant difference. No changes in performance over time (comparison group) or medication state (ADHD group) were observed. These data suggest that, when measured nonverbally, the creative thinking performance of boys with ADHD is not superior to that of peers who do not have ADHD. Regarding the effects of methylphenidate, prescribed therapy did not influence performance on this measure of creative thinking.

Analysis of Bone Age Data From National Cooperative Growth Study Substudy VII

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_5) ◽  
pp. 1031-1036
Author(s):  
Stephen F. Kemp ◽  
Judy P. Sy
Keyword(s):  
Age Determination ◽  
Bone Age ◽  
Strongly Correlated ◽  
Growth Study ◽  
Gh Therapy ◽  
Pubertal Stage ◽  
Significant Difference ◽  
Clinically Significant ◽  
National Cooperative ◽  
Age Determinations

National Cooperative Growth Study substudy VII was conducted 1) to compare standardized hand–wrist and knee bone age determinations in pubertal children treated with growth hormone (GH); 2) to compare local determinations of bone ages with centrally determined bone ages; 3) to relate the response to GH therapy to the bone age determinations; and 4) to ascertain the predictive value of each type of bone age determination. Eligible subjects were those in the National Cooperative Growth Study who were at Tanner pubertal stage 2 or greater for breasts (girls) or genitals (boys). Radiographs of the hand–wrist were taken annually, and radiographs of the knee were taken at the beginning and the end of the study. Separate bone age determinations were made from these radiographs. A combined hand–wrist and knee bone age determination also was derived. There were 990 patients in the study; in 925 (677 boys), there were both hand–wrist and knee bone age determinations from the baseline pubertal radiographs. There was only one radiographic assessment in 496 patients, two in 205 patients, and three to eight in the remaining patients. The strongest correlation was between the hand–wrist bone age and the hand–wrist plus knee bone age (r = .995). Also strongly correlated were knee with hand–wrist (r = .872) and knee with hand–wrist plus knee (r = .914). For none of these bone age methods was any statistically significant difference found between the methods. The locally determined bone ages correlated strongly with the centrally determined bone ages for knee (r = .850), hand–wrist (r = .928), and hand–wrist plus knee (r = .930); however, the locally determined knee and hand–wrist values were less (by ∼0.3 year) than the centrally determined values. These differences, however, do not appear to be clinically significant.

scholarly journals The effect of 5S-Continuous Quality Improvement-Total Quality Management approach on staff motivation, patients’ waiting time and patient satisfaction with services at hospitals in Uganda

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Naoki Take ◽  
Sarah Byakika ◽  
Hiroshi Tasei ◽  
Toru Yoshikawa
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Waiting Time ◽  
Continuous Quality Improvement ◽  
Double Difference ◽  
General Hospitals ◽  
Staff Motivation ◽  
Continuous Quality ◽  
Significant Difference ◽  
Referral Hospitals

This study aimed at analyzing the effect of 5S practice on staff motivation, patients’ waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

scholarly journals Digital models and orthodontic diagnosis: what degree of reliability?

2021 ◽  
Vol 8 ◽  
Author(s):  
ABDOUL Hafizou RABE ◽  
Fatima SALEK ◽  
Intissar El IDRISSI ◽  
Fatima ZAOUI ◽  
Hicham BENYAHIA
Keyword(s):  
Systematic Review ◽  
Numerical Models ◽  
Meta Analysis ◽  
Physical Models ◽  
Cochrane Library ◽  
Digital Models ◽  
Significant Difference ◽  
Clinically Significant ◽  
Conventional Models ◽  
Plaster Models

Abstract  Background: Our study aims to evaluate, through a systematic review, the reliability of numerical models compared to conventional models on the main parameters of orthodontic diagnosis  Method: four databases were consulted: PubMed; Google Scholar, Cochrane Library, and Ebscohost. The research included published studies since 2010, meta-analysis studies, randomized and non-randomized controlled trials, prospective and retrospective studies. Results: Among 3811 selected references, only five studies met our inclusion criteria. In the systematic review, there were statistical differences between the digital models and the plaster models. However, this difference is clinically acceptable. On the other hand, there are some limitations, relative to the types of the severity of the congestion, the elapsed time to digitize, and the numerical means. Conclusion: The results of our systematic review have shown that there is no clinically significant difference between the numerical and physical models for the majority of diagnostic parameters.

scholarly journals A Comparison Between Two Types of Radiographic Film for Accuracy of Measurements of Approximal Osseous Defects

2006 ◽  
Vol 7 (3) ◽  
pp. 22-29
Author(s):  
Farah Masood ◽  
Christos Angelopoulos ◽  
Alan Glaros
Keyword(s):  
Bone Loss ◽  
Ground Truth ◽  
Radiographic Film ◽  
Radiographic Images ◽  
Accuracy Of Measurements ◽  
Significant Difference ◽  
Molar Teeth ◽  
The Difference ◽  
Clinically Significant ◽  
Osseous Defects

Abstract Aim The purpose of this study was to compare two types of conventional radiographic film: Ekta-speed plus and Insight (Eastman Kodak Co, Rochester NY, USA) for accuracy of measurements of approximal bone loss. Methods and Materials Four dried human mandibles with complete dentition were selected. Radiographic images were made with a standardized technique. Mesial and distal bone levels on the mandibular premolar and molar teeth were measured on the two types of radiographs (Ekta-speed plus and Insight) by nine observers. The data obtained by the observers were compared with the primary investigators’ corresponding measurements, which served as “the ground truth” for this study. Results The results of the analysis of variance (ANOVA) demonstrated a significant difference for the Ektaspeed plus film (p = .001), but the difference was not clinically significant. The level of intra-rater reliability was high for the observers (0.969 to 0.990). Conclusion Performance of Ekta-speed plus and Insight films was found to be similar. Citation Masood F, Angelopoulos C, Glaros A. A Comparison Between Two Types of Radiographic Film for Accuracy of Measurements of Approximal Osseous Defects. J Contemp Dent Pract 2006 July;(7)3:022-029.

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