MR imaging of double-outlet right ventricle.
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Child↗
Biomedical subjects
J A Alexander
Publications and source records attributed to J A Alexander.
Health care governance: are we keeping pace?
This article reviews current activity of AUPHA programs in the areas of teaching, continuing education, and research in health care governance. Survey data from a sample of 61 AUPHA programs are used to relate these activities to trends in the practice of institutional governance and changes in the health care environment that affect such practices. Areas of concern are identified and recommendations for improvement made.
Community-Institutional Relations↗
A resource-dependence model of hospital contract management.
This study empirically examines the determinants of hospital entry into management contracts with multihospital systems. Using a resource-dependence framework, the study tests whether market conditions, regulatory climate, management effectiveness, and certain enabling factors affect the probability of hospital entry into a contract management arrangement. The study used a pooled sample of 312 contract-managed and 936 traditionally managed hospitals. Results suggest the importance of management effectiveness, regulatory climate, and hospital ownership (investor owned or nonprofit) as predisposing conditions of contract management.
Contract Services↗
Infectious esophagitis following liver and renal transplantation.
Upper gastrointestinal endoscopy was performed for the evaluation of infectious esophagitis in 19 consecutive subjects evaluated prospectively before orthotopic liver transplantation (OLTx), in a separate group of 27 subjects post-OLTx, and in 21 subjects following orthotopic renal transplantation (ORTx). None of the pre-OLTx patients had evidence of infectious esophagitis, whereas 11% of the post-OLTx and 24% of the post-ORTx patients had esophageal infections. Candida esophagitis was found only in the post-ORTx patients, whereas cytomegalovirus and herpes simplex viral esophagitis were found in both the post-ORTx and post-OLTx patients. Dysphagia was associated with evidence of herpes simplex virus infection (P less than 0.001) and epigastric pain was associated with Candida infection (P less than 0.001). No association between the administration of prednisone or the blood level of cyclosporine A and esophagitis was found. Finally, the use of standard low-dose mycostatin prophylaxis was not effective for prevention of Candida esophagitis. Nonetheless the use of higher doses of mycostatin was therapeutic.
Candidiasis↗
The effects of patient care unit organization on nursing turnover.
Turnover among hospital nurses has traditionally been explained in terms of personal attributes of the nurse and extrinsic rewards such as pay and fringe benefits. However, turnover and its determinants may be viewed in the context of a structural model, operating primarily at the level of the hospital patient care unit. Four sets of organizational variables were analyzed to assess their independent and combined effects on nursing turnover rates in hospitals.
Communication↗
Hospital selection into multihospital systems. The effects of market, management, and mission.
The growing literature on multihospital systems (MHS) has concentrated on assessing system performance without a concurrent examination of the assumptions related to the conditions under which hospitals and systems affiliate with each other. Using a net present-value framework the current study develops and tests a model that explains the entry patterns of hospitals into multihospital systems. Specifically, we assess the role of the hospital's market, management activity, and mission compatibility with the system as predisposing conditions of MHS affiliation. The model is tested on a sample of 306 affiliated and 918 nonaffiliated hospitals under conditions of market equilibrium and disequilibrium, and for hospital entry into both non-profit and investor-owned multihospital systems. Results suggest that the relative impact of market factors, hospital management characteristics, and mission compatibility on MHS entry will vary systematically as a function of assumptions about the hospital's market and the type of system with which the hospital affiliates.
Economic Competition↗
Pancreatitis following liver transplantation.
Since 1981, when the liver transplantation program was initiated at the University of Pittsburgh, we have been impressed with the prevalence of pancreatitis occurring following liver transplantation in patients transplanted for hepatitis B-related liver disease. To either confirm this clinical impression or refute it, the records of the 27 HbsAg+ patients and those of an additional 24 HbsAg- but HbcAb and/or HbsAb+ patients who underwent orthotopic liver transplantation were reviewed to determine the prevalence of clinical pancreatitis and hyperamylasemia (biochemical pancreatitis) following liver transplantation (OLTx). Post-OLTx hyperamylasemia occurred significantly more frequently in HbsAg+ patients (6/27) than it did in the HbsAg- patients (0/24) (P less than 0.05). More importantly, clinical pancreatitis occurred in 14% (4/27) of the HbsAg+ patients and 0% (0/24) of the HbsAg- patients. Interestingly, in each case, the pancreatitis was associated with the occurrence of acute hepatitis B infection of the allograft. Based upon these data, we conclude that pancreatitis occurring after liver transplantation is more common in patients transplanted for active viral liver disease caused by hepatitis B than in those with inactive viral liver disease. These observations suggest that pancreatitis occurring in, at least some cases following liver transplantation for viral liver disease, may result from hepatitis B virus infection of the pancreas.
Acute Disease↗
Cytomegalovirus infection of the upper gastrointestinal tract before and after liver transplantation.
The prevalence of upper gastrointestinal CMV infection was determined in 90 adult transplant patients: 54 were evaluated prior to orthotopic liver transplantation (OLTx), while 36 were evaluated one to six weeks after OLTx. Upper gastrointestinal endoscopy, with biopsies of the stomach and duodenum for viral culture and histopathologic examination, was performed on each subject. Those without esophageal varices had their esophagus biopsied also for viral cultures and histopathologic examination. In addition, a gastric brushing for cytologic examination was obtained on all patients. All 90 patients studied were known to be CMV-sero-positive prior to transplantation. Therefore all infections were considered to be reactivation infections. Gastrointestinal CMV infection was more common in patients studied post-OLTx (33%) than it was in those studied pre-OLTx (2%) (P less than 0.001). The presence of gastrointestinal CMV infection was associated with a decreased T lymphocyte helper/suppressor ratio in peripheral blood. CMV duodenal infections were associated with the presence of endoscopic and histologic inflammation. Of the various diagnostic methods utilized, viral cultures of intestinal tissue were found to be the most useful in establishing a diagnosis of infection.
Cytomegalovirus Infections↗
Organisation turnover among registered nurses: an exploratory model.
In light of current concerns over nursing shortages and productivity, turnover among hospital nurses has assumed renewed importance as a managerial issue. This study examines the thesis that organisation of hospital work is a determinant of voluntary turnover among registered nurses. This perspective differs from previous work in this area in that both turnover and its determinants are conceptualised at the organisational rather than individual level, thus opening the way for administrative intervention to reduce turnover. The conceptual model is tested using multiple regression techniques on a sample of 310 community hospitals. Results suggest the importance of administrative work structures and the professionalisation of the workforce as contributors to higher turnover.
Hospital Bed Capacity↗
Bovine pericardial patch fibrosis requiring reoperation.
Glutaraldehyde-fixed bovine pericardium (GFBP) has multiple uses. Its use as a vascular patch material is under investigation. A case report of severe fibrosis causing early reoperation of a GFBP patch used to repair coarctation of the aorta is presented.
Aortic Coarctation↗
Hospital-physician integration and hospital costs.
The integration of physicians into the management and policy-making structure of the hospital has been widely touted as necessary to achieve organizational efficiencies in a changing health care environment. This paper examines the implications of five such integrative strategies for hospital costs. Our findings indicate that greater administrative participation by physicians is consistently related to higher costs. We also found that other integrative strategies are associated with higher hospital costs in specific types of hospitals. We discuss the implications of our findings for hospital managers and policy makers.
Costs and Cost Analysis↗
The effects of corporate restructuring on hospital policymaking.
Hospital corporate restructuring is the segmentation of assets or functions of the hospital into separate corporations. While these functions are almost always legally separated from the hospital, their impact on hospital policymaking may be far more direct. This study examines the effects of corporate restructuring by community hospitals on the structure, composition, and activity of hospital governing boards. In general, we expect that the policymaking function of the hospital will change to adapt to the multicorporate structure implemented under corporate restructuring, as well as the overlapping boards and diversified business responsibilities of the new corporate entity. Specifically, we hypothesize that the hospital board under corporate restructuring will conform more to the "corporate" model found in the business/industrial sector and less to the "philanthropic" model common to most community hospitals to date. Analysis of survey data from 1,037 hospitals undergoing corporate restructuring from 1979-1985 and a comparison group of 1,883 noncorporately restructured hospitals suggests general support for this hypothesis. Implications for health care governance and research are discussed.
Decision Making, Organizational↗
Clinical comparison of the Roche Septi-Chek and Dupont Isolator blood culture systems.
A study was conducted to compare the recovery of clinical isolates by the DuPont Isolator and Roche Septi-Chek blood culture systems. A total of 5,262 blood culture specimens were processed by the two systems. Of these, 358 cultures contained significant isolates: 219 were positive in both systems, 68 were recovered only by Isolator, 71 were recovered by Septi-Chek only (not statistically significant). Of the isolates recovered in both systems, 159 were positive the same day, 55 were recovered first by Isolator, and 5 were recovered first by Septi-Chek. In cases where Isolator recovered organisms first, the average difference in time was one to two days. Regarding particular groups of organisms, there was no difference between the systems in recovery of Enterobacteriaceae, anaerobes, yeast, and gram-positive bacteria, except for Streptococcus pneumoniae. Septi-Chek recovered S. pneumoniae significantly more often. These results suggest that these two systems are essentially comparable, except with S. pneumoniae, although the Isolator frequently provided results more rapidly.
Bacteria↗
Hospital acquisition or management contract: a theory of strategic choice.
Differences in the mission of the hospital and the multihospital system are key elements underlying the development of a management contract. Preliminary analysis suggests that the number of potential new acquisitions is severely limited, that contract management is not a stepping stone to acquisition, and that many recent management contracts appear to be attempts to overcome problems beyond the hospital's and the contractor's direct control.
Contract Services↗
The dynamics of change in the American hospital industry: transformation or selection?
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Health Services Research↗
Hospital corporate restructuring gains widespread acceptance.
Corporate restructuring is becoming an increasingly popular strategy for hospitals faced with declining revenues, new regulatory incentives or expanded market objectives. This article, based on data from two American Hospital Association surveys of hospital governing boards, explores the corporate restructuring trend in hospitals and considers its impact upon hospital governance.
Data Collection↗
Hospital participation in multihospital systems.
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Contract Services↗
The diagnosis of dementia.
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Alzheimer Disease↗