Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.

Objective: Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents.

Background: Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees.

Scapholunate interosseous ligament disruption in professional basketball players: treatment by direct repair and dorsal ligamentoplasty.

In the authors' experience scapholunate interosseous ligament (SLIL) disruption with resultant scapholunate dissociation (SLD) is the most frequent disabling carpal injury among professional basketball players. Prompt diagnosis, precision surgical repair, and intensive sport-specific rehabilitation are requisites for optimal recovery. This article reports the techniques and results of a consistent surgical protocol comprising accurate carpal reduction, direct SLIL repair, and dorsal intercarpal ligament augmentation for 25 professional basketball players with disabling SLD.

Care coordination.

As health care grows more complex, improving care coordination is essential.

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

Purpose: The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist.

An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass.

We report a case of pronator syndrome with an ipsilateral supracondylar process, where the median nerve was compressed as it pierced an abnormal muscle bundle that originated from the supracondylar process.

Crossing the quality chasm: implications for health services administration education.

Programs in Health Services Administration (HSA) should respond to the mandate to improve patient care as put forth by the Institute of Medicine (IOM) and other reports on the proliferation and consequences of medical errors. This article will identify a framework to base curriculum change, competency areas, and educational methods to impart quality improvement knowledge and skills. The first six competency areas reflect the six redesign imperatives from the IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001): redesign of the care process; use of information technologies; knowledge and skills management; development of effective teams; coordination of care; and use of performance and outcomes measurement.

Patient safety: a case study in team building and interdisciplinary collaboration.

This case report presents specific steps taken to address potential patient safety problems, particularly those regarding collaboration between nurses and house staff at The George Washington University Hospital. Issues affecting patient care (e.g.

Dissociation of conditioned locomotion and Fos induction in response to stimuli formerly paired with cocaine.

A discrete stimulus (flashing light) was paired with cocaine (20 mg/kg) to induce conditioned locomotion. To identify brain regions activated during this response, Fos was measured with immunohistochemistry. Although paired subjects displayed robust conditioned locomotion, Fos was not increased in any limbic brain regions analyzed.

Dealing with human factors and managing change in knowledge management: a phased approach.

Ten human factors affect the implementation of knowledge management initiatives, including fear, cultural change, capturing of tacit knowledge, ease of use, stakeholder involvement, and benefits realization. To deal with these factors, a phased change management approach is offered, consisting of an assessment, strategic planning, organization development, systems design, orientation and training, team building, and continuous evaluation and improvement.

Strategic positioning: a case study in governance and management.

This case describes the experience of the Detroit Medical Center (DMC) in restructuring its governance and management. It provides a background on the DMC, examines the driving forces that led to modification of its structure, identifies key principles in guiding the change, and describes the strategies and specific steps taken in managing structural change. Finally, the critical lessons learned about leadership style, communication, agenda development, and relations with the board, medical staff, and management are discussed.

Preparing health care professionals for quality improvement: the George Washington University/George Mason University experience.

Seventy-seven medical, physician assistant, nurse practitioner, and health services management students were provided training in quality improvement, community-oriented primary care, and teamwork. These students were then formed into 13 interdisciplinary teams to apply their knowledge in underserved areas ("service learning") under a community and faculty preceptor.

Blessed are the flexible: the George Team.

Our educational efforts produced several intersecting interdisciplinary groups: faculty, students, faculty/students and our community sites, with faculty, clinical staff, and students. As we worked through the issues, these interdisciplinary teams found that commitment to change, caring for patients, and open, honest communication were essential to keeping the project teams on track. We have increased our understanding of both the complexity and value of interdisciplinary collaborative education.

Microflora and acarofauna of bed dust from homes in Upper Silesia, Poland.

Background: Pyroglyphid mites are considered a major cause of house dust allergy. The occurrence and possible pathogenic role of other biologic components of house dust, in particular bacteria, has received less attention.

Objective: The aim of this study was to examine bacteria present in the samples of house dust from beds, in comparison to fungi and mites recovery.

[Allergy to house dust mites].

There are presented the etiology and pathogenesis of house dust and house dust mite allergy. The house dust mite ecology, physicochemic and immunochemic properties of house dust mite allergens, methods of quantitating exposure to these allergens; the relationship between level of exposure, sensitization and disease, likewise avoidense measures for mite allergens in houses are described.

Rapid host nation medical deployment.

Rapid development of land-based units in Operation Desert Shield/Storm presented critical needs for medical support. Integration of small Navy mobile medical teams in Bahrain and a larger United States Army Hospital unit in Riyadh, Saudi Arabia, at host nation hospitals presented an innovative method of providing this support. The success of these ventures in convenience and quality of care establishes the host nation interaction with military medical professionals as a workable, satisfying, and important adjunct to standard military medical care.

Preparations for war in a Saudi Arabian host nation hospital.

This paper describes how the King Fahad National Guard Hospital in Riyadh, The Kingdom of Saudi Arabia, integrated United States Army (USA) medical units and prepared the hospital to receive war casualties during Operation Desert Storm. In particular, preparation of the hospital, the staff, and military systems are reviewed. The report will also discuss operations at the hospital during Operation Desert Storm and the major lessons learned.

Grateful Med: gateway to world-wide literature.

Grateful Med is a computer software package developed by the National Library of Medicine which provides access to MEDLINE and other medical databases. The program is available for both IBM and Macintosh computers, is inexpensive, easy to install and has excellent documentation. Health professionals in all areas find Grateful Med to be a user-friendly, cost-effective way to search current, world-wide medical literature.

Building a team on a medical floor.

The article describes a case in which dysfunctional teamwork was threatening patient care on medical units. Various team-building techniques were used by trained facilitators. Survey results showed that the interventions resulted in improved communication, morale, and working relationships.

[Preliminary studies of the occurrence of Ixodes ricinus (Acari: Ixodida: Ixodidae) in the areas of the Cracow-Czestochowa highland at various stages of human industrial activities].

In the years 1987-88 the density of the population of I. ricinus on the territory of Kraków-Czestochowa Highland including the Ojców National Park was studied. The method of collection of ticks from 100 m2 fields was applied.

Preliminary study on the concentration and species composition of bacteria, fungi and mites in samples of house dust from Silesia (Poland).

Twenty-one samples of house dust collected from dwellings situated in Upper Silesia (Poland) were subjected to bacteriological, mycological and acarological examination. Moreover, in two samples the concentration of bacterial endotoxin was estimated by the use of Limulus test. The mean concentration of bacteria in the examined samples was 2831.

Paracooperioides peleae gen. et sp. n. (Nematoda: Trichostrongylidae) from the vaal ribbok, Pelea capreolus (Forster, 1790).

A new genus and species of trichostrongylid nematode, Paracooperioides peleae, was collected from the small intestines of vaal ribbok, Pelea capreolus (Forster, 1790), from the bontebok National Park, Swellendam, Cape Province. These nematodes are small and slender with a small cephalic inflation. The cuticle bears numerous transverse striations which are more pronounced anteriorly.