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Biomedical subjects

B J Reilly

Publications and source records attributed to B J Reilly.

At least 37 records · Page 2Linked to original sources
PubMed1984

National health insurance: a new imperative.

When viewed from the perspective of the policy analyst, observed inequities in the access to health services and the rising costs of physician and hospital care are among the most important issues confronting the American health delivery system. Recognizing that publicly financed health insurance programs result in a more equitable distribution of medical services, this paper focuses on the components of a national health insurance scheme that not only offers a comprehensive range of benefits but also employs prospective payment and a set of financial incentives to control the costs of care provided by physicians, hospitals, and other health facilities. The national health insurance program proposed in this paper is designed to eliminate or reduce unwarranted expenditures on plant and equipment; the responsibility for approving and funding capital acquisitions is also regarded as an integral component of the program.

Capital Expenditures↗
PubMed1984

Pediatric urography: comparison of metrizamide and methylglucamine diatrizoate.

A non-ionic contrast medium (metrizamide) was compared to an ionic agent (methylglucamine diatrizoate) for pediatric urography. Fifty children were divided into two age groups: under 5, and 5 to 10. In younger children, metrizamide gave more excellent images (19% vs. 0%) and fewer inadequate images (0% vs. 18%) than methylglucamine diatrizoate (p = 0.06). In older children, metrizamide likewise gave more excellent images (44% vs. 14%) and fewer inadequate images (0% vs. 7%). The same pattern was seen when the two groups were combined (excellent, 28% vs. 8%; inadequate, 0% vs. 12%) (p = 0.05). Differences with respect to changes in hematocrit, serum osmolality, serum sodium, and SGOT were statistically significant, but not adverse reactions. In terms of both efficacy and safety, the authors conclude that metrizamide is preferred for pediatric urography.

Child↗
PubMed1983

Competition's flawed perspective on the health care market and an alternative approach.

This article contends that competition advocates have treated the public market as peripheral to the development of a private allocative efficient market based on price determinations. A system which omits 40% of distributive resources, 30% of its users and over 50% of hospital revenues sets the stage for cost/charge spirals that promote greater inefficiencies than those which presently exist. The government in the sixties set a goal of universal quality service for medical care. However, this goal has not been achieved and the sky-rocketing cost for medical care is putting an increasing burden on the government. The authors attempt to provide a basis for the incorporation of the concept of the mixed market through a definition of public and private reimbursement systems. The public sector, rather than paying directly for care, purchases it in an efficient market which it helps to form. The government working with other health insurance companies in the private market attempts to set reasonable charges for reimbursement for medical services. Any price above the competitive level will be paid directly by the consumer. However, quality care is guaranteed to the consumer at the reasonable charge by insurance company referred physicians.

Cost Control↗
PubMed1983

Renal osteodystrophy in children undergoing continuous ambulatory peritoneal dialysis.

Fifteen children undergoing continuous ambulatory peritoneal dialysis for 0.3 to 2.4 years were evaluated longitudinally for renal osteodystrophy. Immunoreactive parathyroid hormone, 25-OHD, total and ionized calcium, inorganic phosphate, and alkaline phosphatase levels were measured regularly. Skeletal radiographic studies were performed at the onset and conclusion of CAPD and at six-month intervals during therapy. All children received 1,25(OH)2D3 and aluminum hydroxide, and nine received supplemental calcium. Plasma 25-OHD concentrations were normal to elevated, and calcium increased steadily to high normal levels despite a trend to persistent hyperphosphatemia. The increased calcium levels suppressed parathyroid hormone overactivity in only one patient. At the onset of CAPD, nine patients had hyperparathyroid bone disease seen radiographically, three of whom also had rachitic lesions. At the end of CAPD, the hyperparathyroid lesions had improved in four patients, completely resolved in three, and deteriorated in two. Rachitic lesions had completely healed in two patients and improved in the third. However, among the six children without radiographically evident lesions at onset of CAPD, hyperparathyroid bone lesions developed in two and rachitic lesions in two others during CAPD. Although CAPD and appropriate therapy benefited most patients with renal osteodystrophy, the benefits were not uniform, and bone lesions deteriorated in some.

Adolescent↗
PubMed1983

Neonatal ascites due to lysosomal storage disease.

The clinical and radiographic features of four newborns with lysosomal storage disease (LSD) in whom the dominant presenting clinical feature was ascites are presented. The diseases included infantile Gaucher disease, GM I gangliosidosis, infantile sialidosis, and Salla disease. Abdominal distention due to ascites and hepatosplenomegaly, and hypoplastic lungs were seen in all four infants. In the infant with Gaucher disease, the ribs and long bones were markedly thinned. Varying degrees of coarsening of the trabecular pattern of the bones and thinning of the cortex, and a lack of modeling were seen in all patients. Metaphyseal irregularity was noted in the patients with sialidosis and Salla disease. These skeletal radiographic findings may alert the radiologist to the cause for ascites in these patients, which is obscure. In all four patients, there was a history of perinatal death due to the same disease in a sibling; ascites was present in three of the siblings. The diagnosis was missed at autopsy in each of these siblings, underlining the lack of awareness of LSD as a cause for neonatal ascites.

Ascites↗
PubMed1982

Osteomyelitis in the neonate. Clinical aspects and the role of radiography and scintigraphy in diagnosis and management.

Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal.

Diphosphonates↗
PubMed1982

The embattled hospital: cost control measures versus imperatives for expansion.

As the costs of the American health care system escalate, there is a tendency to identify the biggest cost item and attempt to reduce it to a manageable size. However, since that biggest cost item, the hospital, is a creation of uncontrolled forces within the system as a whole, attempts to manage costs will be limited in effectiveness. The hospital is the end product of an uncontrolled system, a product that displays little understanding of the economic principles of trade-off, efficiency, and productivity. To limit spending in the hospital care system, controls must be rooted in an analysis of the forces that have shaped the hospital's present form and structure. Factors to be considered are those that have defined what a "good" hospital is, who its real consumers are, and what economic and quality control factors must be part of the entire health system. This article suggests modification of public policies relative to medical manpower an insurance, and recommends adoption of reimbursement by Diagnostic Related Groups.

Cost Control↗
PubMed1982

Intussusception on small bowel examinations in children.

Six children in whom an intussusception was diagnosed on a small bowel follow-through examination are presented. The radiographic signs of intussusception on such a study include: (1) a narrow channel of barium representing the compressed lumen of the intussusceptum, (2) a soft-tissue mass on either side of this channel due to hypertrophy and edema of the walls of the intussuceptum and intussuscipiens, (3) a coil spring appearance around the narrow channel, and (4) a mass lesion at the distal end of the narrow channel. Not all of these signs are present in each case. Intussusception is a dynamic process and the value of delayed films and frequent fluoroscopy during small bowel follow-through studies in these cases is stressed. All six cases had a demonstrable lesion as a lead point. Jejunal intussusceptions are usually caused by bening lesions--malignancy being found almost exclusively in distal intussusceptions.

Adolescent↗
PubMed1981

Pulmonary function and bronchial hyperreactivity in long-term survivors of bronchopulmonary dysplasia.

Nine children with bronchopulmonary dysplasia were studied at a mean age of 8.4 years. Persistent respiratory symptoms were common. Pulmonary function tests demonstrated airway obstruction and abnormal blood gas levels in most. In six of eight children results of methacholine challenge tests were positive, indicating bronchial hyperreactivity. Abnormal chest radiographs persisted in eight children. The bronchial hyperreactivity is a likely consequence of airway damage in infancy and is the probable reason for episodic wheezing in the early years of life. Improvement in expiratory flow rates following bronchodilator inhalation suggests that such therapy may improve function in these children.

Bronchial Provocation Tests↗
PubMed1980

Assessing the outcomes of a home nursing programme: previously hospitalized versus non-hospitalized patients.

This study utilizes four outcome measures to compare the success of a home nursing programme on a group of patients previously hospitalized and a non-hospitalized group. The outcome measures are: mortality, stabilization, hospitalization and nursing home confinement at discharge from the programme. No significant differences were found between the groups, except for nursing home confinement which was higher for the non-hospitalized group. The relationships remained the same even when age and functional status were considered as alternative hypotheses. Implications of this study suggest that home nursing programmes are likely to be as successful with previously hospitalized, as they are with non-hospitalized, patients. Secondly, in evaluating the impact of home nursing programmes on patients, the potential stabilizing influence of the hospital must be taken into account before examining the programme in isolation.

Aftercare↗
PubMed1980

Evaluating patient education: a case study of a diabetes program.

This paper presents an evaluation of a diabetic education program for patients at Stephens County Hospital in Toccoa, Georgia. An analysis of covariance is employed along with multiple classification analysis to determine the effect of the program in reducing hospital readmissions. The major finding is that the teaching program is an important variable in the reduction of readmissions. A second outcome is that the occurrence of diabetic ketoacidosis (DKA) on initial admission is a second factor in determining readmissions. Patients having the benefit of instruction are less likely to experience readmission than those not being educated; those having DKA are more likely to be readmitted within six months from release than those not having this degree of loss of control. Implications of this study suggest that in designing a diabetic education program, greater attention must be focused upon the needs of the ketosis-prone patients.

Analysis of Variance↗
PubMed1980

Home health services for previously hospitalized and non-hospitalized patients with circulation ailments: a research note.

This research note is an investigation of the effectiveness of a home nursing program which compares a group of patients with circulation problems who were hospitalized prior to service with a similar group which was not hospitalized. Four outcome measures are utilized: mortality, stabilization, hospitalization, and nursing home confinement. It is hypthesized that because of the greater likelihood of complication and severity of illness experienced by the hospitalized patients, they should exhibit higher mortality, hospitalization and nursing home confinement, and lower stabilization at discharge. The hypotheses are analyzed by means of the t-test. Results indicate the hypotheses to be in the direction expected with the exception of nursing home confinement which is more likely to occur among those not previously hospitalized. Implications of this study suggest that home health programs would seem to have a greater chance of success among circulatory patients who are not hospitalized prior to service. In analyzing the effectiveness of home health programs in the future, investigators should recognize the intervening effects of hospital admission on the patients.

Aftercare↗