As part of community health care services provided by our hospital, there are regular visits by a nurse and/or a physician to patients in their homes. Durin one year from April 2001 to May 2002, we inadvertently skipped 15 visits. It was feared that if nothing were done, such a failure in duty would occur at least once a month. To find the way out of this situation and to reduce the number of skipped cases to zero, we made concerted efforts, turning to the methodology of Total Quality Management (TQM) activities.We tried to grasp the state of things to begin with, and investigated the root causes of the failure. The causes were analyzed using the fishbone diagram. Based on the results of analysis, preventive measures were adopted. Thanks to this, as of February 2004, there are no cases in which we have been remiss in visiting our patints for care in their homes.
Personal failure ; Patient visit for ; Use of ; Home ; etiology

The purpose of this study was to evaluate in aged patients with hip fracture, the degree of recovery at discharge and after discharge relative to the pre-fracture walking level, to clarify the factors involved in unsuccessful recovery. The patients were 189 patients aged 60 years and older who underwent surgery between 1988 and 1994. Patients who died within 1 year or lacked data on walking were excluded. Multiple logistic regression analysis was applied to data on the walking level before fracture, that at discharge, and the best walking level after discharge, to clarify factors involved in unsuccessful recovery. The rate of recovery to the pre-fracture level was 55.1% at discharge. Unsuccessful recovery at discharge was influenced by prior dementia, a history of cerebrovascular diseases, and an age of 85 or more years. Analysis showed an “after-discharge” recovery rate of 63.2%. Prior dementia and the residence outside one’s own home influenced unsuccessful recovery rate. These findings suggested that it is important to provide patients with such factors a more effective postoperative rehabilitation program not merely the standard rehabilitation program. In addition, a walking rehabilitation program should be offered to those who were re-hospitalized or admitted to other health care facilities.
Walking ; Personal failure ; Rehabilitation therapy ; Dementia ; seconds

Personal failure ; Sabah ; Therapeutic procedure ; Fansidar ; Malaria

Historically a calibre persistent submucosal artery was most often described in the stomach. However in later years it was also discovered in the duodenum and jejunum. It is an uncommon and important cause of massive gastrointestinal bleeding in which failure of detection and early intervention would lead to death. In this paper we report a 27-year-old man with no significant medical history who presented at the emergency unit for recurrent melaena, haematochezia and hypotension. Initial investigations failed to localize the source of bleeding. Emergency exploratory laporatomy revealed a small jejunal mucosal nodule that was actively spurting blood. Histopathological evaluation identified a calibre persistent submucosal artery.
Arteries ; jejunum ; Gastrointestinal Hemorrhage ; Diameter ; Personal failure

Medical co-morbidities are very common in patients with psychiatric conditions. Although respecting one's autonomy to make treatment decisions is the ethical default position, the capacity to make such decisions may need to be assessed, especially when patients are in relapse of their psychiatric condition, and/or when the decisions made are high-risk and possibly fatal. This case report highlights the ethical issues of refusing potential life-saving treatment in a patient who is in relapse of her schizoaffective disorder. In particular, the assessment of decisional capacity and the role of the doctors (if the patient lacks capacity) are discussed. Recommendations are also made on how to better manage such situations.
Adult ; Female ; Humans ; Kidney Failure, Chronic ; therapy ; Mental Competency ; Patient Care ; ethics ; Patient Participation ; psychology ; Personal Autonomy ; Schizophrenia

OBJECTIVES: Health Avatar Beans was for the management of chronic kidney disease and end-stage renal disease (ESRD). This article is about the DialysisNet system in Health Avatar Beans for the seamless management of ESRD based on the personal health record. METHODS: For hemodialysis data modeling, we identified common data elements for hemodialysis information (CDEHI). We used ASTM continuity of care record (CCR) and ISO/IEC 11179 for the compliance method with a standard model for the CDEHI. According to the contents of the ASTM CCR, we mapped the CDHEI to the contents and created the metadata from that. It was transformed and parsed into the database and verified according to the ASTM CCR/XML schema definition (XSD). DialysisNet was created as an iPad application. The contents of the CDEHI were categorized for effective management. For the evaluation of information transfer, we used CarePlatform, which was developed for data access. The metadata of CDEHI in DialysisNet was exchanged by the CarePlatform with semantic interoperability. RESULTS: The CDEHI was separated into a content list for individual patient data, a contents list for hemodialysis center data, consultation and transfer form, and clinical decision support data. After matching to the CCR, the CDEHI was transformed to metadata, and it was transformed to XML and proven according to the ASTM CCR/XSD. DialysisNet has specific consideration of visualization, graphics, images, statistics, and database. CONCLUSIONS: We created the DialysisNet application, which can integrate and manage data sources for hemodialysis information based on CCR standards.
Chronic Disease ; Compliance ; Continuity of Patient Care* ; Fabaceae ; Health Information Management ; Health Records, Personal ; Humans ; Information Storage and Retrieval* ; Kidney Failure, Chronic ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Semantics