Evaluation of bedside blood glucose monitoring by the phlebotomy team in an acute general care hospital.

A feasibility study was undertaken to evaluate laboratory phlebotomists performing bedside glucose monitoring (BGM) over a 3-month period on a medical and surgical floor. Specific questions included: feasibility of providing testing on a 24-h basis, accuracy, appropriate utilization, effect on patient care, and an analysis of cost. In all, 1975 tests were performed on 114 patients. BGM results were within 15% of the laboratory's result 97% of the time. Patient and physician satisfaction was high. Although the cost of BGM is slightly higher than a laboratory glucose test, its use appeared to reduce the length of hospital stay by 0.47 days. Practical information on initiating a highly successful BGM program is provided.

Warfarin: a quality assurance model for concurrent drug monitoring.

Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.

Uncovering young children's psychological selves: individual and developmental differences.

3 major goals were addressed: (1) to examine whether 3 1/2-7 1/2-year-old children have consistent and meaningful concepts that reflect psychological self-understanding, (2) to uncover individual differences in young children's self-concepts, and (3) to determine whether any observed differences are stable over time. A new method was developed for assessing young children's self-concepts. 180 children between 3 and 8 years of age were presented with pairs of statements representing the high and low end points of 10 psychological dimensions. For example, the statements "It's not fun to scare people" and "It's fun to scare people" represent the low and high ends of the psychological dimension of aggression. Children were then asked to pick the statement that best described themselves. The dimensional scores were factor analyzed and higher-order factor scales were constructed. These factor scales were found to be internally consistent and psychologically meaningful in each age group, indicating that even young children have psychological concepts of themselves. Moreover, substantial individual differences were demonstrated on the scales even among the youngest children. Finally, these differences were found to be moderately stable over a 1-month test-retest.

The emergent personologist: the structure and content of 3 1/2-, 5 1/2-, and 7 1/2-year-olds' concepts of themselves and other persons.

This study was based on the premise that personological conceptions are based in memory; hence age-related changes observed in memory should also be found for children's concepts of persons. Of particular interest was the general and specific temporal structure of children's concepts. 72 3 1/2-, 5 1/2-, and 7 1/2-year-old children were asked general and specific questions about the behaviors and internal states of themselves, their best friends, and an acquaintance. General questions were about typical and/or frequent events and were not located in a particular point in time (e.g., "What have you usually done in school?"); specific questions were temporally located (e.g., "What did you do in school today?"). Behavior questions concerned activities and involved action verbs; trait questions concerned internal states and involved adjectives. Responses were coded into the same 4 mutually exclusive categories of General Behavior, General Trait, Specific Behavior, Specific Trait as the question categories. The proportion of specific responses about persons increased reliably from 3 1/2 to 5 1/2 years, whereas the proportion of general responses was high and did not differ across the age groups. Furthermore, the proportion of trait, but not behavior, descriptions provided increased between 3 1/2 and 7 1/2 years. The results indicate that even young children have concepts of themselves and other persons that are not restricted to specific points in time and thus may form the basis for later dispositional conceptions.

Personality attributions based on speech samples of children with repaired cleft palates.

OBJECTIVE: This study examined whether or not assumptions made about personality characteristics based on speech samples differed for children with repaired cleft palates (CP) versus unaffected children. DESIGN: Audiotapes of speech samples were presented in random order to blind raters. PATIENTS/PARTICIPANTS: The subjects were 20 children (10 females, 10 males) with repaired CP and 16 control (i.e., unaffected) children (8 females, 8 males). All children were 8 to 12 years of age, Caucasian, living in the St. Louis area, and lower-middle to upper-middle class. The raters were 20 (13 females, 7 males) 6th grade Caucasian students who attend a private school in the area. SETTING: Raters heard tapes in a group setting, but with individual headphones, in their school's cafeteria. MAIN OUTCOME MEASURE: Each speech sample was rated (7-point Likert scale) by each student rater on a variety of personality characteristics based on the "Big Five" personality factors. RESULTS: A factor analysis of the items revealed a two-factor solution, although the factors were highly negatively correlated. No significant differences were found between ratings for the CP sample and the control sample for either factor scale (ANOVA, p = .93; p = .67). Similarly, when the two factors were combined to form a single factor, no significant differences were found between the ratings for the CP sample and the control sample (ANOVA, p = .79). CONCLUSIONS: Overall, it does not appear that children differentially associated personality characteristics based on speech to children with repaired CP versus unaffected children, in the absence of visual input.