Major General Hospital Research Articles

Enhancing medical database security.

A methodology for the enhancement of database security in a hospital environment is presented in this paper which is based on both the discretionary and the mandatory database security policies. In this way the advantages of both approaches are combined to enhance medical database security. An appropriate classification of the different types of users according to their different needs and roles and a User Role Definition Hierarchy has been used. The experience obtained from the experimental implementation of the proposed methodology in a major general hospital is briefly discussed. The implementation has shown that the combined discretionary and mandatory security enforcement effectively limits the unauthorized access to the medical database, without severely restricting the capabilities of the system.

THE DANGERS RESULTING FROM INACCURATE COMPUTER‐BASED OPERATIVE RECORDS

SUMMARY The accuracy of a computer‐based recording system of operative procedures was audited at a major district general hospital. The system is supposed to provide accurate records of theatre activity, to allow for improved nursing resource allocation and provide surgeons with a basic record of their operations. Mistakes were present in the details of 27% of the cases entered. Such inaccuracies highlight a major danger to surgeons with regard to their accountability for operations attributed to them. Mistakes can only cause further problems with regard to audit and future resource allocation.

Effects of nonparticipation in trauma center system on emergency department utilization

The University of Illinois Hospital (UIH) serves an inner-city urban population in one of the highest crime rate districts in Chicago. On May 20, 1986, the city's Level I Trauma ordinance took effect with the University of Illinois Hospital declining to participate. To measure the impact of the ordinance on a nonparticipating hospital, we undertook a retrospective analysis of our trauma patient utilization statistics. Consecutive monthly patient census data of 71 months was compiled with emphasis on patient presenting complaints and related subspecialty evaluation. We observed significant decreases of patients presenting with head injuries, fractures, and animal bites as well as with major trauma, minor trauma, and general surgery hospital admission. The final disposition of the patients arriving by ambulance was consistent with the observed decrease in major traumatic conditions and in minor traumatic conditions. However, the mean number of patient presentations per day (ppd) admitted to regular medical or surgical beds decreased from 2.70 ppd to 2.30 ppd while the mean number of ppd sent home increased from 2.64 ppd to 3.49 ppd. These data suggest that loss of trauma center status designation has a profound effect on utilization of emergency departments not participating in the trauma system. Nonparticipation appears to be associated with a significant decrease in utilization rates for major and minor trauma patients and a significant increase in the number of patients discharged who had arrived by the Chicago Fire Department Paramedic System (CFD). This effect on the emergency department extends to utilization of inpatient services.

Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service.

To obtain information regarding patterns of alcohol and substance use, portions of the Diagnostic Interview Schedule (DIS) were administered to 53 schizophrenic patients who presented to the crisis service of an emergency room in a major general hospital. The number of individuals in the sample qualifying for a lifetime diagnosis of an alcohol abuse-related disorder was quite high (47%), and there was a strong correlation between disorders of alcohol abuse and the use of other drugs. Other than alcohol, marijuana was the most frequently abused drug. Individuals who qualified for a diagnosis of an alcohol-related disorder were compared with those who did not on a variety of diagnostic and demographic variables. The authors conclude by suggesting that the high-risk rates of drug use-related disorders reported in this sample may be due to the preferential use of emergency services by schizophrenic patients with alcohol and drug abuse-related disorders.

The establishment of a behavior therapy unit within a general hospital in Venezuela: The first five years

This article describes the formation of a behavior therapy unit in a major general hospital in Venezuela. The unit was begun in 1978 despite considerable opposition. Initially sporadic seminars were given in which the essentials of behavior therapy were taught. This gradually grew into a 2-year post-graduate course in behavior therapy—a year of background and a year of clinical assignments. A wide range of treatments are used, all of which have a solid data base. Our experience shows that it is possible to design small behavior therapy units, not only in psychiatric hospitals but in general hospitals as well.

A study of the errors produced when weak antibodies are tested by the indirect antiglobulin method

An investigation is reported into the error rate of the indirect antiglobulin test when random, weakly reactive samples are tested. Tests were completed by the majority of laboratory staff in 2 transfusion services and 3 major general hospital blood banks, during their routine daily work. A significant level of technical difficulty was revealed, from 5.2 to 60.8% of positive tests being called negative, and from 5.7 to 32.3% of negative tests being called positive. Reproducibility of weakly reacting duplicates was generally poor, as was the allocation of score values to the agglutination reactions. The significance of these findings relative to the content of quality control surveys is discussed.

The Acute Abdomen

Although there are other books dealing with the acute abdomen, this volume will be welcomed because it represents the experience of a major American general hospital widely known for its accident and emergency facilities. The Acute Abdomen is dedicated by the medical staff of the Wayne County General Hospital to the memory of Dr. Wayne W. Glas and contains much of the surgical thinking of the Department of Surgery which Dr. Glas directed for many years.