Establishing a Telephone Medication Order Policy and Protocol for a Small Private Hospital in Jamaica.

OBJECTIVE: To institutionalize an evidence-based policy/protocol adapted from the Agency for Healthcare Research and Quality (AHRQ) national medication standards for managing telephone medication orders (TMO) and to determine the impact of the policy/protocol on the number of telephone medication errors (TME) on two medical units of a small private hospital in Jamaica. METHODS: Kotter's Eight-step Change Model was used to facilitate organizational change among nurses and physicians by teaching and implementing the TMO policy/protocol adapted from AHRQ standards and collecting pre-policy and post-policy frequency of TMEs. A convenience sample of 80 nurses and physicians participated in training about the policy/protocol, took post-instructional tests and participated in the implementation of the policy/protocol. Chart audits over six weeks monitored adherence to the policy/protocol. The annual monthly mean of TMEs for the prior year was compared with the number of TMEs just prior to implementation of policy/protocol and at the end of the first six weeks of implementation. RESULTS: One hundred per cent of the convenience sample of 80 nurses and doctors passed the post-instructional test; the workforce adhered fully to the protocol during six weeks of implementation, and there was a 100% reduction in TMEs between the prior year and six weeks after policy/protocol implementation. CONCLUSIONS: Kotter's eight-step framework of organizational change was a successful strategy in institutionalizing and sustaining adherence to the TMO policy/protocol, reducing the number of TMEs and positively influencing the organizational culture.

Is there value in audition extramurals?

BACKGROUND: It has become common for fourth-year medical students interested in surgical careers to leave their parent university to take extramural elective rotations in surgery at other institutions. These "audition extramurals," while of some educational value, are often repetitions of prior clerkships and may not broaden the student's educational horizons. Instead, they are intended to enhance a student's competitiveness in the match. While recent opinions and questionnaires have suggested that such extramural rotations are not valuable in general surgery, no study has formally evaluated the effect of extramural electives on the residency match. METHODS: Over a 6-year period, the authors reviewed the outcome in 99 students who took extramural elective rotations in surgery. Of the 99 students, 28 were from the authors' institution who left to do extramural rotations elsewhere and 71 were outside students who came to the University of South Florida for an elective. While the elective rotation increased the probability of an interview, it did not alter ranking or probability of matching. RESULTS: For general surgery students, the elective rotation may actually decrease competitiveness, while for specialty students, it appears necessary but not sufficient to improve match outcome. The elective might facilitate placement for students who did not match, but did not do so predictably. CONCLUSIONS: The authors conclude that extramural elective rotations should be taken for educational value only and not as auditions for residency.

Children. The unwitting target of environmental injustices.

Children have little control over where they live, what they eat, the financial circumstances of their families, or the developmental activities and behaviors that make them vulnerable to environmental contaminants. Minority and poor families disproportionately live in communities with landfills, hazardous waste facilities, incinerators, industrial plants, and old housing with poor indoor air quality and lead-based paint. Residents of these communities are also more likely than are more affluent communities to consume fish on a regular basis from local waters, many of which have banned fishing. Consequently, these children and their families are exposed more frequently than are children in other communities to potentially dangerous chemicals that can affect health. Data indicate that poor and minority children have higher rates of asthma, elevated blood lead levels, learning disabilities, and hyperactivity than do non-minority and more affluent children. When a group of people is exposed unfairly and inequitably to toxins in their communities, workplaces, and schools, a phenomenon called environmental discrimination or environmental racism exists. Environmental justice is a US governmental remedy that requires the application of fair strategies and processes in the resolution of inequality related to environmental contamination. The US response resulted in the establishment of offices of Environmental Justice within the EPA and ATSDR and passage of important legislation and policies, such as the Community Planning and Right-to-Know Act of 1986, Executive Order 12898 (Federal Actions to Address Environmental Justice in Minority Populations), and Executive Order 13045, a parallel order to protect low-income and minority children from actual and potential environmental hazards. Communities and advocacy groups play an important role in promoting healthier environments for children. Frequently, low-income and minority communities are perceived as less powerful, less organized, and ill equipped to defend against actual and potential sources of environmental contamination. Health care professionals are in a strategic position to assist with community development, organizing, and empowerment through educational programming, networking, and supporting other activities that bring attention to the plight of environmentally vulnerable communities.

Health care crisis in the black community: challenges prospects, and the black nurse.

The Black community, particularly in major urban settings, is faced with escalating social, economic, and life-style problems, which threaten the life and well-being of current and future generations of Black people in crisis proportion. The rising number of deaths due to heart disease and stroke, homicide and accidents related to substance abuse, AIDS, cancer, and infant mortality are among the leading culprits. They interfere with prospects of longevity, joblessness, poverty, and homelessness and further complicate the crisis. These problems have implications for the practice of nursing. The magnitude of the problems dictate the need for modifications in the health care delivery system and how future practitioners of nursing are educated. The inextricable role of the community, although often underaddressed, in solving its own problems is among the promising strategies for resolving the crisis. Black nurses, in particular, must accept the challenge and the opportunity to test innovative and sensitive interventive strategies which will enable the Black community to emerge from the complex and haunting problems which threaten well-being.

The recruitment and retention of African American nurses: an analysis of current data.

The Recruitment and Retention of African American Nurses: An Analysis of Current Data reviews data collected by the American Nurses Association. During the years 1984-85, 1987-88, and 1990-91, the American Association of Colleges of Nursing, and The National League for Nursing observed trends in minority participation in nursing. Trends regarding African American nurses are emphasized. Data categories analyzed include: (1) registered nurses in practice; (2) admissions, enrollments, and graduations from undergraduate programs of all types; and (3) masters and doctoral enrollment. Detail analysis is performed for African American participation in baccalaureate programs, with a particular focus on the role of nursing programs in historically Black colleges and universities (HBCU). The data demonstrate that there has been growth in the numbers of African American and other minority groups entering nursing and completing undergraduate nursing programs. However, representation is below parity for the minority group's membership in American society. One interesting finding is that HBCUs graduate approximately 25% of African American nurses yearly despite the fact that they enroll less than 3% of the students in baccalaureate programs. The data also suggest a severe underrepresentation of minorities enrolled in masters and doctoral programs [corrected].

Nursing careers for the homeless: a curriculum for success.

The Nursing Careers for Homeless People Project (NCHPP) is a comprehensive multi-dimensional academic and social strategy designed to assist homeless individuals who have an interest and aptitude for nursing to achieve career mobility in nursing. NCHPP is a 2-phase project: (1) a Pre-Admission Readiness Program (PRP) and (2) the Collegiate Phase. The 3-month PRP focuses on socialization to nursing, building self-concept, academic enhancement, and career exploration. The Collegiate Phase includes academic, social, and financial support, as well as assistance with job placement and follow-up. NCHPP has enrolled 96 students to the PRP since 1994 and graduated 70 students or 73%. Fifty-three percent of the PRP graduates were admitted to a Bachelor of Science (BS) or Associate of Science (AS) program in nursing, and 54% of the PRP graduates are employed in health oriented positions. Two students from the first group of PRP graduates are scheduled to receive the degree of Bachelor of Science in Nursing in May 1999. There have not been any graduates from associate degree programs due to part-time attendance, long waiting lists for entry into the nursing program, and transfer of students from the AS program to the BS program. Although there are many challenges and obstacles faced by homeless people, the NCHPP has succeeded in decreasing welfare rolls, unemployment, and poverty.

Knee and hip arthroplasty infection rates in persons with haemophilia: a 27 year single center experience during the HIV epidemic.

Total joint replacement (TJR) is an option for the management of chronic haemophilic arthropathy. Because surgery is technically challenging, there is a high rate of deep prosthetic infections, particularly in human immunodeficiency virus (HIV)-infected individuals. We determined the incidence of deep infection rates following total knee and hip arthroplasties in HIV-seropositive and HIV-seronegative persons with haemophilia. Fifty-one primary joint replacements were performed on 32 patients seen at a regional comprehensive haemophilia care center from 1975 to 2002. Thirty prostheses were placed in patients who were HIV-seropositive prior to surgery (n = 14) or seroconverted later (n = 16). Median age at the time of surgery was 33 years (range: 20-61) among 19 HIV-seropositive patients and 35 years (range: 26-74) among 13 HIV-negative patients. Median duration of follow-up was 83 months (range: 2-323). Rate of primary joint infection per artificial joint-year by HIV status was compared by Poisson regression. Main outcome measures were the incidence of primary replacement joint infections by HIV status. Deep infections developed in five (9.8%) of 51 replacement joints. There were two infections during 204.15 joint-years without HIV infection and three infections during 205.28 joint-years with HIV infection. The incidence rate of joint infection (0.98 vs. 1.46 per 100 joint-years) was not increased with HIV (relative risk, RR: 1.49, 95% CI: 0.25-8.93, P = 0.66). We conclude that HIV infection is not a contraindication to knee or hip replacement arthroplasty in the appropriate clinical setting.

Clinical correlations and prognosis based on serum autoantibodies in patients with systemic sclerosis.

Of 397 systemic sclerosis (scleroderma) patients from the University of Pittsburgh, who had serum determinations of both anti-Scl-70 and anticentromere antibody (ACA), 26% had anti-Scl-70 and 22% had ACA. No patient had both autoantibodies. Weak associations with HLA-DR5 and HLA-DR1 were detected with anti-Scl-70 and ACA, respectively. ACA was found almost exclusively (96%) in patients with limited cutaneous scleroderma (the CREST syndrome variant), but the majority (57%) of patients with limited scleroderma did not have this antibody. Among patients with limited scleroderma, those with ACA more often had calcinosis and telangiectasias and less often had pulmonary interstitial fibrosis and restrictive lung disease. However, the frequency of pulmonary hypertension and the survival rates were similar in the ACA+ and ACA- limited scleroderma patients. Two-thirds of patients with anti-Scl-70 had diffuse scleroderma, but only 33% of all diffuse scleroderma patients had this antibody. Within the subset of diffuse scleroderma, anti-Scl-70 was associated with peripheral vascular disease (digital pitting scars) and pulmonary interstitial fibrosis, but was not predictive of cardiac or renal involvement or survival. ACA and anti-Scl-70 are useful in diagnosing and classifying systemic sclerosis variants and in predicting the natural course of the disease. Their mutually exclusive occurrence suggests either 2 separate clinical entities or important host factors determining their production.

Determination of the state and content of water in human normal and cataractous lenses by differential scanning calorimetry.

The state of water in normal and cataractous human lenses was determined by differential scanning calorimetry. Results indicate that water 'bound' to the lens proteins decreases during the process of cataract formation. These findings are consistent with the documented knowledge concerning cataract-related changes in the lens proteins.

The Women's Centre in Jamaica: an innovative project for adolescent mothers.

In 1978 the Jamaican Women's Bureau established the Women's Centre, the first project in the developing world to help pregnant teenagers avoid the usual hardships of poverty and dependence. The women take courses in academic subjects and prenatal and postnatal health, and receive good medical care. Fathers and parents are involved in counseling sessions where practical life skills, including family planning, are emphasized. The young mothers improve dramatically in self-confidence, self-esteem, and in their ability to take care of their babies. The Centre's success has helped to loosen the policies of the Jamaican government on the education of pregnant school-age women.

PIP: In 1978 the Jamaican Women's Bureau established the Women's Centre, the 1st project in the developing world to help pregnant teenagers avoid the usual hardships of poverty and dependence. The women take courses in academic subjects and prenatal and postnatal health, and receive good medical care. Fathers and parents are involved in counseling sessions where practical life skills, including family planning, are emphasized. The young mothers improve dramatically in self confidence, self esteem, and in their ability to take care of their babies. The Centre's success has helped to loosen the policies of the Jamaican government on the education of pregnant school age women.

Vibrational Intensities. XXIV: Data Processing System for Infrared Gas-Phase Intensity Measurements.

A data recording and processing system is described which transfers gas-phase intensity data directly to punched paper tape, uses a digital computer for all phases of the data handling, and thus substantially reduces the time for the measurement of a single band. The recorder pen position is continually converted to a digital record by a shaft encoder operating at positions on the spectrometer lead screw that are determined by a Schmidt-Trigger encoder unit. Auxiliary information and data output are recorded by utilizing a series of programs that eventually generate sets of partial differentialp/( partial differentialS(i)). The use of this system is illustrated by considering its application to a determination of the absorption band intensities of trans HFCCFH.

Reference Raman spectra of ten phosphorus-containing pesticides.

The Raman spectra of malathion, ethion, methyl parathion, parathion, EPN, 0,0-diethyl-0-(2,4-dichlorophenyl) phosphorothioate, dichlorvos, mevinphos, tributyl phosphorotrithioite, and 2,4-dichlorobenzyltributylphosphonium chloride have been recorded. These spectra are presented, along with tables giving values for the frequencies.

The circle system without absorber. Use with controlled ventilation.

An investigation is described into the performance of two types of circle system used without a carbon dioxide absorber in both the laboratory and in the operating theatre with controlled ventilation. The newer system was found to be more efficient than the old but in both types of system the tidal volume was found to be very important, a large tidal volume resulted in increased efficiency. The possibility of predicting arterial blood carbon dioxide using this system is briefly discussed, and rules are suggested for the use of the system.

Reference Raman spectra of DDT and five structurally related pesticides and of five pesticides containing the norbornen group.

The Raman spectra of DDT and 5 structurally related pesticides, TDE (DDD), Perthane, methoxychlor, dicofol, and tetradifon, and of 5 pesticides containing the norbornene group, heptachlor, chlordane, dieldrin, endrin, and endosulfan, have been recorded. These spectra are presented, along with tables giving values for the frequencies.

Reference Raman spectra of eleven miscellaneous pesticides.

The Raman spectra of ICP (propham), CIPC (chlorpropham), carbaryl, EPTC (ethyl N,N-dipropyl (3-chlorophenyl) carbamate), pebulate, CDEC (2-chloroallyl diethyldithiocarbamate), thiram, maneb, zineb, ferbam, and nicotine have been recorded. These spectra are presented, along with tables giving values for the frequencies.

Subacute sensory neuronopathy secondary to dorsal root ganglionitis in primary Sjögren's syndrome.

Sensory neuropathies, particularly trigeminal neuropathy, have been recognized as neurological complications of Sjögren's syndrome, but the pathogenesis has not been established. We describe a woman with primary Sjögren's syndrome who developed a progressive debilitating subacute sensory neuronopathy. Results of electrophysiological studies were consistent with involvement of the trigeminal and dorsal root ganglia. A thoracic dorsal root ganglion biopsy showed lymphocytic infiltration and degeneration of ganglion cells. We believe that this is the first description of biopsy-documented dorsal root ganglionitis in a subacute sensory neuronopathy associated with Sjögren's syndrome and that the finding suggests an immunopathogenic basis.