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Biomedical subjects

H L Smith

Publications and source records attributed to H L Smith.

At least 91 records · Page 5Linked to original sources
PubMed1990

Strategic adaptations to PPS by rural hospitals: implications for theory and research.

Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS-induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the future.

Costs and Cost Analysis↗
PubMed1990

Gastric emptying of liquids in cystic fibrosis.

Epigastric impedance recording was used to measure the rate of gastric emptying (GE) of a liquid test meal in 45 control children and 28 CF patients. Epigastric impedance was recorded in the fasting state and following ingestion of orange squash. In 8 controls and 8 CF patients the test was repeated with the addition of 1.25% fat to the test meal. Mean time to half-emptying (t1/2) was 13.5 min in controls and 15.6 min in CF patients (NS). The addition of fat to the test meal prolonged t1/2 in all controls and most CF patients. In those CF patients in whom GE of orange + fat was more rapid than orange alone, repetition of the test with added pancreatic enzymes reversed this effect. We concluded that GE of clear liquids in CF patients does not differ significantly from normal controls, and that most CF patients behave like controls in their response to fat in the test meal.

Adolescent↗
PubMed1989

A retrospective on Japanese management in nursing.

Managers in the public and private sectors have turned to Japanese management techniques as a means to improve quality and productivity. Many health care organizations have also adopted Japanese management concepts in the belief that performance will be improved. This article reviews the concepts, fundamental premises, and case studies of Japanese management in nursing. At issue is the value of Japanese management practices for nurses, patients, and organizations.

Career Mobility↗
PubMed1989

Isolation of Vibrio cholerae from aquatic birds in Colorado and Utah.

Vibrio cholerae was isolated from cloacal swabs and freshly voided feces collected from 20 species of aquatic birds in Colorado and Utah during 1986 and 1987. About 17% (198 of 1,131) fecal specimens collected from July 1986 through August 1987 contained the organism. Both O1 and non-O1 V. cholerae strains were isolated from the fecal specimens. Isolates from eight birds (representing five species) agglutinated in O group 1 antiserum. Supernatants of broth cultures from three isolates which typed as V. cholerae O1 serotype Ogawa gave reactions typical of cholera toxin when tested on Y-1 mouse adrenal cell cultures. Several serovars of non-O1 V. cholerae were isolated from the fecal specimens; serovar 22 was the most prevalent type. All non-O1 isolates were cytotoxic to Y-1 mouse adrenal cells. Only non-O1 V. cholerae was detected in water samples collected from the habitat of the birds. The results of this study suggest that aquatic birds serve as carriers and disseminate V. cholerae over a wide area.

Animals↗
PubMed1989

Effect of dystonic movements on oesophageal peristalsis in Sandifer's syndrome.

A 5 year old girl with gross gastrooesophageal reflux had pronounced dystonic neck movements that resolved after fundoplication and resolution of the oesophagitis (Sandifer's syndrome). Oesophageal manometry before operation showed that peristalsis improved when she tilted her head to one side. Dystonic posturing may promote acid clearance from the distal oesophagus.

Child, Preschool↗
PubMed1989

The Lovelace Medical Center: strategies for advancing health care services in the southwest.

Organized in 1922, the Lovelace Clinic successfully provided health care services throughout the Southwest utilizing a group practice format under the aegis of a nonprofit foundation. In 1984, the Foundation contracted with Hospital Corporation of America to form a for-profit health care organization which allows the provision of high quality health care through a group practice professional corporation, a 238-bed inpatient facility, a 70,000-member health maintenance organization, and an independent research and education foundation.

Foundations↗
PubMed1989

Integrating theory and research on the institutional determinants of fertility.

This article links recent conceptual theories regarding the determinants of fertility with research designs appropriate for testing those theories. The most important causal factors in these theories--typically social or cultural institutions, occasionally emergent properties of the collective behavior of individuals--are properly conceptualized at the macro level. Research designs must therefore feature variation at this level and are at a minimum comparative. Noncomparative micro-level research designs will be misspecified from the standpoint of theory. A case is also made for continuing to incorporate the observation of individual-level behavior into any comprehensive research design. A focus on macro determinants of fertility does not imply that fertility outcomes are determined at the institutional level. Instead, there remains some process whereby systemic properties are translated into individual behaviors. Recommendations for comparative community-level studies are discussed. The multilevel analysis framework is reviewed as a paradigm for the conceptual features of cross-contextual analysis.

Data Interpretation, Statistical↗
PubMed1988

Physicians and the organizational evolution of medicine.

Within medicine there is growing uneasiness and debate about changes in medical care delivery. Much of this concern centers on the evolution of organizations and the role of physicians. The emergence of multi-institutional organizations, the rise of investor-owned health care corporations, and the expansion of group medical practice illustrate the increasing organizational influence in medicine. Added to these trends are new financial incentives confronting both physicians and organizations so that the environment increasingly favors conflict. This article reviews the primary strategies for resolving physician-organization conflicts, including cooperation between physicians and organizations, having physician representatives in governance and management, restructuring incentives, and restructuring organizations. Although these strategies have various merits, we suggest that every physician has a personal responsibility to become more involved in organization and management issues. Physicians can play an important role in guiding the evolution of medicine.

Conflict, Psychological↗
PubMed1988

Silastic catheters for antibiotics in cystic fibrosis.

A randomised comparison of percutaneous Silastic catheters and conventional intravenous cannulae for giving intravenous antibiotics in patients with cystic fibrosis showed that Silastic catheters were favoured by the patient, lasted longer, and had fewer complications.

Adolescent↗
PubMed1988

Service- and facility-sharing.

The Veterans Administration and the United States Air Force hospitals in Albuquerque recently established a service- and facility-sharing arrangement. In this article, the authors share lessons learned from planning and executing the arrangement-lessons that any organization considering a large-scale joint venture will want to keep in mind.

Hospital Bed Capacity, 300 to 499↗
PubMed1988

The evolving role of health care organizations in research.

Many hospitals and health care organizations are contending with fierce financial and competitive pressures. Consequently, programs that do not make an immediate contribution to master strategy are often overlooked in the strategic management process. Research programs are a case in point. Basic science, clinical, and health services research programs may help to create a comprehensive and fundamentally sound master strategy. This article discusses the evolving role of health care organizations in research relative to strategy formulation. The primary costs and benefits from participating in research programs are examined. An agenda of questions is presented to help health care organizations determine whether they should incorporate health-related research as a key element in their strategy.

Cost-Benefit Analysis↗