Impact of a shared decision-making program on patients with benign prostatic hyperplasia.

Objectives: To determine patient views about the Shared Decision-Making Program (SDP), an interactive videodisk program designed to inform patients with benign prostatic hyperplasia (BPH) about their condition and treatment options and to determine its impact on perceived knowledge and treatment preference.

Methods: Six hundred seventy-eight patients with symptomatic BPH from eight Canadian centers viewed the SDP. Before and after viewing the video, patients answered questionnaires designed to assess treatment preference, knowledge gained, and satisfaction with this educational format.

Safe and cost-effective laparoscopic removal of adnexal masses.

Study Objective: To evaluate laparoscopic removal of adnexal masses using a plastic bag to avoid peritoneal spillage.

Design: An observational study.

Setting: A university-affiliated private hospital.

Promoting multiculturalism in healthcare on a zero budget.

When a B.C. health commission proposed strategies for promoting cultural awareness in healthcare, members of one hospital staff took up the challenge.

The medical information highway: where is the access ramp?

In this article, an analogy is drawn between a health care information system and a freeway transportation system. Unfinished access ramps and disconnected road sections are likened to unlinked computer information systems. It is not until there is "connectivity" between roadways that vehicles can take advantage of the efficiencies of a freeway system or until there are comprehensive, integrated information systems that quality health care can be provided.

Assessing palliative care educational needs of physicians and nurses: results of a survey. Greater Victoria Hospital Society Palliative Care Committee.

The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians' and nurses' perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care.

Case study: assessing laparoscopic cholecystectomy. The GVHS experience.

This article describes the experience at the Greater Victoria Hospital Society of assessing the appropriateness of introducing laparoscopic cholecystectomy (lap chole) within the framework of an established technology assessment process. Lap chole promised to deliver cost savings; however, these could only be realized by capitalizing on the reduced length of stay by removing the surgical beds from service. A cautionary note is raised as to whether the increased use of lap chole in the population is appropriate.

From nursing information systems to patient information systems.

Clinical information systems, developed for specific disciplines, reinforce the fragmentation of patient care and fail to support integrated, patient centered approaches. Fundamental restructuring of systems development is required to prepare the health care system and the practice of nursing for the future.

Five-year agreement for equipment acquisition.

A three-hospital system in western Canada had decided to replace its old imaging processing equipment but wrestled with the most effective way to purchase it. As Mr. Clark describes in this practical guide to the process, the hospitals combined their buying power, negotiated a long-term agreement and found a supplier committed to total quality management.

Three choices for death.

Ethicists and lobbyists for euthanasia have added qualifiers like "direct" and "indirect" to the word. Nonetheless, they still mean killing. E.

Macrophage-tumor cell associations: a factor in metastasis of breast cancer?

In human breast carcinomas tumor cells and macrophages are often proximal. We previously reported on the relationship between tumor cell growth and macrophage concentration and report here on the possible involvement of macrophages in the metastatic process. We hypothesize that during the initial stages of metastasis, tumor cells are likely to encounter macrophages and form aggregates.

Surgical management of the post-phlebitic leg syndrome.

Twenty-five patients (32 limbs) with severe retrograde ejection venous syndrome (post-phlebitic leg syndrome) were surgically treated from 1971 to 1986 using a "very complete fasciotomy" with or without other individualized procedures. Clinical data, venographic findings, operative choices, and outcome were analyzed retrospectively. The theoretic benefit of adopting this new and conceptually accurate diagnostic label and the principle of "no incompetent perforators, no ulcers" is discussed.

Effects of age and severity of illness on outcome and length of stay in geriatric surgical patients.

From April 1, 1990, to March 31, 1992, 8,899 patients who were 65 years of age and older underwent an anesthetic and surgical procedure in a 1,000-bed community hospital in Victoria, British Columbia, Canada. The hospital has been using a proprietary system called MedisGroups for assessing the severity of illness on admission and in-hospital morbidity. All patients were followed up until death or discharge from the hospital.

PTCA in elderly patients: hospital events.

Background: Medical treatment of the elderly is changing to include the aggressive management of coronary artery disease with percutaneous transluminal coronary angioplasty.

Objective: The purpose of this study was to review major hospital events of patients aged 70 years or more, who underwent a first percutaneous transluminal coronary angioplasty.

Methods: A retrospective medical record review was done of 246 consecutive patients of 70 years or more, from January 1985 to December 1988, at a tertiary care community hospital.

Job-sharing: an innovative approach for administration.

A job-sharing arrangement for the Assistant Directors of Physiotherapy at the Royal Jubilee Hospital proved to be an innovative and successful experience demonstrating the feasibility of job-sharing at administrative levels in rehabilitation. Physiotherapy is traditionally a female dominated profession. By the time therapists are most highly skilled and clinically experienced, they have arrived at prime marriage and child-bearing years.

New technology, physical facilities and the environment.

Technology assessment is already a powerful tool for dealing with issues of appropriateness and effectiveness of clinical technology; it can be significantly enhanced as a valuable process if it is extended to deal with issues of how best to integrate the considered technology with the physical environment and facilities in which it will be used. These issues include: staff and patient safety and comfort; code compliance; effective accommodation of work flow; staff training; and ongoing operational costs. The methodology of technology assessment can effectively assist health facility administrators in evaluating the appropriateness and effectiveness of energy conservation projects and in addressing environmental concerns.

Quality utilization management: preliminary results to a Canadian approach.

VI-CARE (Victoria Integrated Care Alternative Review and Evaluation) was introduced in 1988 to improve utilization of hospital services while matching patient needs to their care. Objective criteria were used to review admissions: examination of occupancy, waiting lists, the MedisGroup patient severity index and surgical hours indicate the preliminary success of the program. Formal research is underway, but article two of the two-part series suggests targeted utilization be implemented in conjunction with quality assurance activities.

Adult learning and video training in health care.

Research has shown that the use of video in health care training can be used effectively, but only in selected situations. The author has given some guidelines on the use of video as a teaching media by broadly grouping its effective use in three main areas. Classification of the groups is given.

Salvage after postoperative thrombosis of the carotid artery.

When dense hemiparesis has developed appropriate to the operated vessel after carotid surgery, the patient has been immediately returned to the operating room for reexploration of the vessel and thrombectomy. Over a 5-year period, we identified four patients who developed dense hemiparesis in the recovery room postoperatively. A fifth patient with a similar problem after carotid subclavian bypass was included for analysis.

Preoperative needle localization to detect early breast cancer.

A retrospective review of 200 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and characteristics of malignancies found in this group. Fine-needle localization was recommended if one of the following criteria was present: (1) evidence of a mass, (2) microcalcifications, (3) architectural distortion. Of the 200 localizations, 192 specimen radiographs were analyzed: 186 contained the lesion, 6 (3 percent) missed the lesion.

Concerted contractions of tumour fragments derived from a pure mucoid carcinoma of the breast in vitro.

Organized tissue fragments obtained by dissociation of a pure mucoid carcinoma of the breast were cultured in vitro. The cellular organization of the fragments appears similar to that observed in vivo, and consist of mucous-filled spherules surrounded by a single layer of tumour cells. Time-lapse video recordings revealed that the cells surrounding these fragments undergo a concerted contraction and relaxation over the time span of several hours.