Religious aspects of futile treatment.
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Cultural Diversity↗
Biomedical subjects
H L Smith
Publications and source records attributed to H L Smith.
Pharmacology and neurochemistry of nefazodone, a novel antidepressant drug.
Nefazodone is a new antidepressant drug with a pharmacologic profile distinct from that of the tricyclic, monoamine oxidase inhibitor, and serotonin selective reuptake inhibitor antidepressants. Nefazodone was initially discovered for its ability to block 5-HT2A receptors and its reduced potency as an alpha 1-adrenergic blocker. It was later shown to inhibit both serotonin and norepinephrine uptake in vitro, attributes which most likely impart its clinical efficacy and which differentiate nefazodone from its chemical predecessor trazodone. The combination of these two mechanisms may ultimately result in a facilitation of 5-HT1A-mediated neurotransmission, which may be beneficial for treating symptoms of depression as evidenced by recent clinical findings. In addition, the preclinical profile of nefazodone demonstrates that it has decreased anticholinergic and antihistaminic activity relative to traditional agents. Clinical findings to date are consistent with these observations.
Animals↗
Considerations in predicting mental health care use: implications for managed care plans.
Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.
Age Factors↗
Healthcare reform perspectives of rural and urban hospital leaders--issues and attitudes.
What are the perspectives of rural and urban hospital leaders--administrators, physicians, and board members--regarding healthcare reform? Both groups support substantial reform in healthcare delivery. They agree that changing malpractice and tort laws is one of the leading strategies for reforming healthcare and that reform should be financed by income tax credits or a combination of employer premiums and government taxes.
Attitude of Health Personnel↗
Quality of work life in home care. The contribution of leaders' personal concern for staff.
The process of healthcare restructuring is creating substantial stress for healthcare organizations and professionals. As the health system focuses on issues associated with restructuring, concern for staff may be minimized when nursing administrators and other healthcare leaders address contextual pressures and their impact on service delivery. The authors examine how leaders' personal concern for nurses and homemakers contributes to quality of working life in home health. Strategies aimed at enhancing personal concern for staff are discussed from the perspective of transformational leadership.
Adult↗
Lower Medicare mortality among a set of hospitals known for good nursing care.
The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality than hospitals that are otherwise similar with respect to a variety of non-nursing organizational characteristics. Research to date on determinants of hospital mortality has not focused on the organization of nursing. We capitalize on the existence of a set of studies of 39 hospitals that, for reasons other than patient outcomes, have been singled out as hospitals known for good nursing care. We match these "magnet" hospitals with 195 control hospitals, selected from all nonmagnet U.S. hospitals with over 100 Medicare discharges, using a multivariate matched sampling procedure that controls for hospital characteristics. Medicare mortality rates of magnet versus control hospitals are compared using variance components models, which pool information on the five matches per magnet hospital, and adjust for differences in patient composition as measured by predicted mortality. The magnet hospitals' observed mortality rates are 7.7% lower (9 fewer deaths per 1,000 Medicare discharges) than the matched control hospitals (P = .011). After adjusting for differences in predicted mortality, the magnet hospitals have a 4.6% lower mortality rate (P = .026 [95% confidence interval 0.9 to 9.4 fewer deaths per 1,000]). The same factors that lead hospitals to be identified as effective from the standpoint of the organization of nursing care are associated with lower mortality among Medicare patients.
Analysis of Variance↗
Leadership and quality of working life in home health care.
Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behaviour is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.
Analysis of Variance↗
Supervisors' concern for staff: opportunities and outcomes.
Numerous ideas are constantly surfacing on how to manage organizations better. As health care supervisors familiarize themselves with these concepts and consider implementing new strategies, it is important not to forget the basics. This is especially true when considering staff motivation. The value of demonstrating personal concern, or consideration, for staff is examined from the perspective of transformational leadership. It has been suggested that transformational leaders are visionary and demonstrate concern for individual staff members. The association of leader support for personal concern with enhanced job attitudes is analyzed and then illustrated in several health care supervisor situations. A case study of these relationships is presented for a home health agency. The results point to the value of supervisors actively demonstrating concern for staff.
Administrative Personnel↗
Determining costs associated with quality in health care delivery.
This article examines the costs associated with quality in health care delivery. A model applicable to health care settings is specified according to investments in quality and the cost of not achieving quality. The premises and basic theories underlying the model are explored. The model was developed at Lovelace Health Systems in Albuquerque, New Mexico, as a decision making tool. The specific cost elements comprising the quality cost model are identified and illustrated using the working model adopted at Lovelace. The managerial impact of the quality cost model and the implications for other health care organizations are examined.
Decision Making, Organizational↗
Nonreporting of births or nonreporting of pregnancies? Some evidence from four rural counties in north China.
Coale and Banister argue that in China, elevated sex ratios in retrospective surveys are in part a function of collecting birth histories in a culture in which the definition of a birth may exclude mortality shortly after birth: an infant death in the West may be a stillbirth in east Asia. I present data from a recent sample survey featuring a retrospective pregnancy history. These data reveal that at least in the first pregnancy, from which the preponderance of sample births arise, there is no evidence of elevated female infant mortality or of high numbers of stillbirths, but that reported sex ratios are unusually high. The proportion of stillbirths grows for later pregnancies, but not enough to account for high sex ratios. Retrospective fertility data regarding recall over a recent interval are vexed less by a misunderstanding of what a live birth is than by a "misunderstanding" of what a (reportable) pregnancy is.
Abortion, Legal↗
Reduction of structured population models to threshold-type delay equations and functional differential equations: a case study.
It is shown by way of a simple example that certain structured population models lead naturally to differential delay equations of the threshold type and that these equations can be transformed in a natural way to functional differential equations. The model examined can be viewed as a model of competition between adults and juveniles of a single population. The results indicate the possibility that this competition leads to instability.
Age Factors↗
Creating a satisfying practice setting for physicians. The experience of a hospital-based group practice.
Medical groups are challenged to develop a satisfying context for physicians to deliver patient care. This article reports on the efforts of the Lovelace Medical Center and the Lovelace Clinic, P.C. (professional corporation), in Albuquerque, New Mexico, to create a distinctive environment for its medical staff members. A job-design model is examined wherein core job characteristics and physician growth-need strength influence critical psychological states and satisfaction. The results of this longitudinal study suggest that from the perspective of primary care physicians, the practice setting at Lovelace has improved markedly between 1984 and 1990. In addition, fewer changes were observed for specialists, ostensibly due to extremely favorable perceptions of the practice setting at Lovelace during this time period. The implications of these results point primarily to the value of consciously designing and periodically monitoring the practice environment within medical groups.
Attitude of Health Personnel↗
Does planning pay off? A look at the experience of New Mexico's rural hospitals.
When Medicare's prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors.
Chief Executive Officers, Hospital↗
Nursing department strategy, planning, and performance in rural hospitals.
Do strategic planning and nursing department strategies explain major differences in hospital performance? Answers to this question surfaced in a study of nursing directors of rural New Mexico hospitals. The results indicate that managerial strategies, cost-control strategies, and strategic planning by the nursing department explain differences in net income and operating margin. These results imply that nursing directors can take an active role in influencing the strategic direction and fiscal achievements of rural hospitals.
Analysis of Variance↗
Epigastric impedance recording for measuring gastric emptying in children: how useful is it?
Epigastric impedance recording was used to measure gastric half-emptying time (t1/2) of orange squash in 45 healthy infants and children. The relationship between age, body size, and composition and the impedance increase after gastric filling was investigated, together with the effects on half-emptying time of adding fat, increasing viscosity, and increasing osmolality in the test meal. The mean t1/2 for orange squash was 13.5 min. The increase in impedence per unit volume ingested showed a significant inverse relationship with age (r = -0.62, p < 0.001), and with various anthropometric variables (r ranged from -0.48 to -0.80, p < 0.01). No relationship was observed between t1/2 and age, sex, body size, or composition. Addition of 1.25% triglyceride or a 600-fold increase in viscosity of the test meal were both accompanied by a significant lengthening of t1/2 (p = 0.005 and p < 0.001, respectively), but t1/2 did not alter with a fourfold increase in test meal osmolality. The test was well tolerated by all subjects, but its usefulness is limited by susceptibility to movement artefact, and also the necessity to use simple, liquid test meals.
Adolescent↗
Muscle rigidity in meningococcal meningitis.
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Adolescent↗
Assessing hospital administrators' responses to prospective payment. A case study in New Mexico.
Few studies have assessed the relationship between hospital administrators' efforts at planning and subsequent performance of health care organizations. Nonetheless, planning is viewed as an important mechanism for aligning health services delivery efforts with community needs and operating constraints. When prospective payment (PPS) was first introduced, hospital administrators had little choice other than to plan how they would respond to the new reimbursement policies. However, it is unclear whether they actively undertook planning in an effort to address prospective payment and related pressures. This article presents a case study of rural New Mexico hospital administrators' efforts to respond to prospective payment. Two dimensions of planning effort by administrators--intensity and formality--are analyzed within rural hospitals during the PPS transition (i.e., 1983 to 1987) and after its full implementation (i.e., since 1988). The findings suggest that planning intensity during the PPS transition is associated with higher performance; notably, higher net patient care revenues, lower costs per patient day, higher operating margins, higher net income, and higher planning effectiveness. However, the strength of these associations weakened as PPS was fully implemented. Given the exploratory nature of this evaluative case study, the results should be viewed as preliminary until confirmed by larger studies. The implications for research that evaluates planning-performance relationships in the health care field are discussed.
Attitude of Health Personnel↗