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Biomedical subjects

J Hadley

Publications and source records attributed to J Hadley.

At least 19 recordsLinked to original sources
PubMed1992

Use of a portable manometer as a screening procedure in voice rehabilitation.

Abnormal tone in the pharyngo-oesophageal (PO) segment may lead to failure in developing oesophageal speech. Videofluoroscopy may give a qualitative assessment of the PO segment but is expensive, time consuming and lacks quantification. A custom built PO segment manometer was therefore assessed as a means of predicting eventual oesophageal speech outcome. Two groups of patients were studied. In group 1 (18 patients) the PO segment pressures were compared to their videofluoroscopy findings. Videofluoroscopy categorized the patients into four groups. The PO pressures corresponded to this grouping, pressures above 20 mmHg being associated with voice failure. In group 2 (12 patients) the PO pressures in the early post-operative period were compared to their eventual speech outcome. In all cases the pressures predicted the eventual speech outcome. The pressure manometer is a simple, cheap and portable device which is a reliable screening test to predict the potential for oesophageal speech.

Esophagus↗
PubMed1992

Young physicians most and least likely to have second thoughts about a career in medicine.

To identify factors associated with apparent disaffection with medicine as a career, the authors analyzed data for 4,931 young physicians surveyed in 1987. Using survey responses, the authors classified 932 of the physicians (18.9%) as most likely to have second thoughts about their career choices and 1,094 (22.2%) as least likely to have second thoughts. The group with the greatest reservations included significantly higher proportions of white women, blacks, and Hispanics. This group reported significantly lower incomes, higher educational debt, and more hours and patients' visits per week. Among employee physicians, those most disaffected were significantly more likely to report inappropriate use of tests and procedures and lack of autonomy in their practices. The authors conclude that it is important to reexamine the heavy reliance on debt financing of medical education, especially for minority students, and to explore the equality of career opportunities for women and minorities in medicine.

Adult↗
PubMed1992

Profits, community role, and hospital closure: an urban and rural analysis.

The number of hospital closures increased substantially after the implementation of Medicare's Prospective Payment System (PPS). This acceleration in closures raised a number of concerns over current payment policies and their impact on access. This paper investigates hospital closures that occurred in 1985 through 1988. A hospital's financial status and mission or community standing were found to be determinants of hospital closure. Closed hospitals are much less likely to be publicly owned but more likely to offer fewer facilities and services, and have fewer cases. This may suggest that the patients directly affected by the closure can be absorbed by other hospitals or other nonhospital providers. Profitability is associated with the Medicare case-mix index and the share of Medicare patients. The findings also suggest that the case mix index may be rewarding some small hospitals in excess of the costs attributable to case-mix. For both urban and rural hospitals, a low share of Medicare patients increased the risk of hospital closure, independently of the relationship between Medicare share and profit. The share of Medicare patients also affected closure indirectly, through its effects on profit. Competition appears to affect the odds of closure through its effects on the number of cases. In addition, hospitals in areas with small or declining population are more at risk than other hospitals in both urban and rural areas.

Costs and Cost Analysis↗
PubMed1991

Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome.

To investigate the association between insurance status and condition on admission, resource use, and in-hospital mortality, we analyzed discharge abstracts for 592,598 patients hospitalized in 1987 in a national sample of hospitals. In 13 of 16 age-sex-race-specific cohorts, the uninsured had a 44% to 124% higher risk of in-hospital mortality at the time of admission than did the privately insured. After controlling for this difference, the actual in-hospital death rate was 1.2 to 3.2 times higher among uninsured patients in 11 of 16 cohorts. The uninsured also were 29% to 75% less likely to undergo each of five high-cost or high-discretion procedures and 50% less likely to have normal results on tissue pathology reports for biopsies performed during five of seven different endoscopic procedures. Our results suggest that insurance status is associated with a broad spectrum of aspects of hospital care.

Adolescent↗
PubMed1991

Is it fair?

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Health Benefit Plans, Employee↗
PubMed1991

Conundrums.

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Cost Allocation↗
PubMed1990

Pseudotumour of the maxillary antrum.

Orbital pseudotumour is a non-specific inflammation of the orbit which forms a tumour-like mass composed of increased connective tissue and ground substance with vascular proliferation and an infiltrate of chronic inflammatory cells. No demonstrable aetiological agents are found locally, and there is no evidence of specific disease entities such as Hodgkins, SLE or temporal arteritis. The condition may present in many different ways to the otolaryngologist, and is therefore a rare but important differential diagnosis to be born in mind. We report a rare case of orbital pseudotumour presenting initially with involvement of the maxillary antrum and in association with Riedel's thyroiditis.

Female↗
PubMed1990

The influence of calcium alginate haemostatic swabs upon operative blood loss in adenotonsillectomy.

Although adenotonsillectomy is regarded as a minor procedure, it has been shown that 18% of patients may experience an operative blood loss of 10-20% of the total blood volume. The aim of this study was to determine whether calcium alginate haemostatic swabs reduce operative blood loss in adenotonsillectomy. Seventy-two patients (ages 2-12 years) entered a prospective trial in which the operation was performed either with normal gauze swabs or calcium alginate swabs. Thirty-six children were randomized to each group. The mean blood loss was found to be 34.9 ml (2.07% of total blood volume) and 47.8 ml (2.97% of total blood volume) respectively. Although there was no significant reduction in operative blood loss using calcium alginate, in both groups the blood loss was much smaller than that stated by the majority of previous workers.

Adenoidectomy↗
PubMed1990

Building blocks.

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Financing, Organized↗
PubMed1989

The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage.

In this paper, we report the results of an analysis of hospital expenses in 43 large SMSAs between 1980 and 1984. We found that hospital rate regulation--specifically Medicare's TEFRA and PPS and state multi-payer systems--was the single most important factor leading to the slowdown in the rate of increase in hospital costs between 1980 and 1984. In 1984, hospital costs covered by Medicare's PPS were 12.5% lower than they would have been in the absence of rate regulation, and in the four states covered by all-payer rate regulation, hospital costs were between 11% and 15% lower. In contrast, changes in the proportion of people either covered by employer-group health insurance or enrolled in HMOs, reduced hospital costs by less than 1%. Measures of competition suggest that hospital costs are higher where there is more competition. We also found that almost all of the effect of regulation on costs came from gains in the efficiency of producing hospital care and/or from reductions in the quality of care. It appears that controlling hospital payment rates gave hospitals a strong incentive to provide care at lower cost.

Catchment Area, Health↗