Search PubMed⌕ Search

Biomedical subjects

J Hadley

Publications and source records attributed to J Hadley.

At least 55 records · Page 3Linked to original sources
PubMed1994

Measuring hospital efficiency with frontier cost functions.

This paper uses a stochastic frontier multiproduct cost function to derive hospital-specific measures of inefficiency. The cost function includes direct measures of illness severity, output quality, and patient outcomes to reduce the likelihood that the inefficiency estimates are capturing unmeasured differences in hospital outputs. Models are estimated using data from the AHA Annual Survey, Medicare Hospital Cost Reports, and MEDPAR. We explicitly test the assumption of output endogeneity and reject it in this application. We conclude that inefficiency accounts for 13.6 percent of total hospital costs. This estimate is robust with respect to model specification and approaches to pooling data across distinct groups of hospitals.

Data Collection↗
PubMed1994

Myxoma of the larynx: a case report and a review of the literature.

Laryngeal myxomas are rare benign mesenchymal tumours in contrast to myxomatous degeneration in laryngeal polyps which occurs frequently. A correct diagnosis of myxoma is usually not difficult to reach if the possibility of myxomatous degeneration in laryngeal polyps is excluded and strict pathological criteria are adhered to. We report a myxoma arising from the left vocal fold in a 64-year-old male who presented with a four-year history of intermittent dysphonia. Although excision was microscopically incomplete, there is no evidence of recurrence macroscopically 18 months later and the patient remains asymptomatic.

Humans↗
PubMed1994

An experimental approach to the evaluation of the biopersistence of respirable synthetic fibers and minerals.

The biopersistence of fibers and minerals in the respiratory tract is an important parameter in the toxicity of those materials. The biopersistence of respirable synthetic fibers and minerals in man can be most closely evaluated in an animal model. While acellular and in vitro systems are important for initial evaluation of solubility and durability, they cannot simulate the dynamics of inhalation deposition and clearance and the subsequent systemic reaction to fibers and minerals that occurs in the animal. To evaluate the biopersistence of synthetic fibers, male rats were exposed to a well defined rat respirable aerosol of man-made vitreous fibers (MMVF), 6 hr/day for 5 days. Following exposure, subgroups were sacrificed at intervals ranging from 1 hr to 52 weeks. Following sacrifice, the lungs were removed, weighed, and immediately frozen at 20 degrees C for subsequent digestion by low temperature plasma ashing. The number, size distribution, and chemical composition of the fibers in the aerosol and lung were determined. With this animal model the role of biopersistence in altering the geometry and clearance of fibers can be systematically evaluated. The model also can be applied for the evaluation of the biopersistence of nonfibrous minerals.

Air Pollutants↗
PubMed1994

Health reform: the good, the bad, and the bottom line.

The Health Security Act is a pragmatic plan for achieving universal health insurance coverage for a broad package of benefits at reasonable cost. It proposes necessary and reasonable changes in insurance market practices and administrative structure. It finances the reformed system with a credible combination of achievable cost savings, mandatory private-sector payments, and limited "sin" taxes. Political constraints-the inability to tax openly or redistribute tax subsidies-result in weak incentives for consumers to choose low-cost plans and an inefficient scheme for providing subsidies to the poor. The act also unnecessarily restricts and regulates fee-for-service plans and the training of health workers. We propose changes to correct the act's weaknesses without compromising its basic objectives.

Community Participation↗
PubMed1994

Nurse advocacy, ethics, and health care reform.

As health care reform decrees many changes in terms of providing care to the consumer, it is crucial that nurses retain their ethical responsibilities as patient advocates. This article reviews the concerns of ethical decision making and gives some direction in the re-evaluation of problems. The document, Nursing's Agenda for Health Care Reform, provides a framework for new action paradigms that enable nurses to participate in seeking ethically sound health care policies for their patients.

Ethics, Nursing↗
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↗