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J R Sharp

Publications and source records attributed to J R Sharp.

16 recordsLinked to original sources
PubMed1995

The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part II.

In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article.

Cost Control↗
PubMed1994

The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part I.

Drucker writes that the emerging theory of manufacturing includes four principles and practices: statistical quality control, manufacturing accounting, modular organization, and systems approach. SQC is a rigorous, scientific method of identifying variation in the quality and productivity of a given production process, with an emphasis on improvement. The new manufacturing economics intends to integrate the production strategy with the business strategy in order to account for the biggest portions of costs that the old methods did not assess: time and automation. Production operations that are both standardized and flexible will allow the organization to keep up with changes in design, technology, and the market. The return on innovation in this environment is predicated on a modular arrangement of flexible steps in the process. Finally, the systems approach sees the entire process as being integrated in converting goods or services into economic satisfaction. There is now a major restructuring of the U.S. health care industry, and the incorporation of these four theories into health care reform would appear to be essential. This two-part article will address two problems: Will Drucker's theories relate to health care (Part I)? Will the "new manufacturing" in health care (practice guidelines) demonstrate cost, quality, and access changes that reform demands (Part II)?

Forms and Records Control↗
PubMed1993

Beta zoomies.

Explore the source record for details and available documents.

Beta Particles↗
PubMed1992

Peer review: determining what's best for patients by professional self-assessment.

Many influences outside of physician control have begun to undermine traditional physician autonomy. Studies of physician practices reveal differences not based on patient case mix alone, but on variations in decisions and lack of intra-physician accountability. Failure of physicians to be accountable to each other is related to inadequate due process understanding, fear of legal recriminations from peers, and a traditional long-standing history of individuality and accountability. The malpractice crisis and the advent of a National Practitioner Data Bank of physicians whose privileges or licenses have been modified serves as an impetus to rebuild accountability into a new emphasis on peer review based on optimum patient-focused outcome. To get physician buy-in, a five-step process is described which is separate from professional review of privileges and is seen as collegial, educational, and patient focused.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

The new Air Force fitness test: a field trial assessing effectiveness and safety.

Two thousand one hundred thirty-nine Air Force members were stratified in risk categories based on a questionnaire about their exercise habits and risk factors which could preclude participation in the new Air Force fitness test. Those at risk were interviewed by a practitioner and placed in a supervised fitness program or exempted from testing. All others were tested by the 1.5-mile field run. Based on these data it is estimated that 40% of the Air Force was exercising regularly and only 50% would pass the old category III standards, with 33% passing the new category IV standard. Thirteen percent of the Air Force would be in the highest risk category, but after a practitioner interview alone, only 7.9% would be exempted from testing altogether, almost all for known or suspected cardiac conditions. This screening and interviewing process is not a significant additional workload on Medical Treatment Facilities and may enhance the safety of the new Air Force fitness program.

Adult↗
PubMed1988

Biopsy evaluation of chronic active hepatitis. Peritoneoscopy with directed liver biopsy versus blind percutaneous liver biopsy.

In this prospective study of chronic active liver disease, we compared the assessment of hepatic histology in samples obtained by peritoneoscopy with directed liver biopsy and blind percutaneous liver biopsy in 23 cases (22 patients, one patient studied twice). In blinded fashion, a pathologist assessed all specimens for evidence of cirrhosis and degree of necroinflammatory change. Two clinicians independently reviewed clinical and laboratory findings in both sets of biopsies. Each committed in writing recommendations regarding immunosuppressive therapy, follow-up interval, and rebiopsy date. The final diagnosis differed from that made by percutaneous and directed biopsy in 2 of 23 (9%) and 1 of 23 (4%) cases, respectively. Six cases of cirrhosis were correctly diagnosed by both biopsy methods, but only four of the six cirrhotic cases were diagnosed by gross peritoneoscopic findings. In only 2 of 23 (9%) cases was there disagreement in the degree of necroinflammatory change between the blind and directed biopsies that affected treatment recommendations. We conclude that blind percutaneous biopsy adequately diagnoses and monitors activity in viral chronic hepatitis for treatment purposes.

Adult↗
PubMed1982

Comparison of CO2- and N2O-induced discomfort during peritoneoscopy under local anesthesia.

The most comfortable gas for peritoneoscopy has been the subject of debate. We subjected 46 patients to double-blind comparison of carbon dioxide and nitrous oxide during initial pneumoperitoneum. The discomfort from local anesthesia was similar in both patient groups. The patient's and the physician's assessment of discomfort during gas insufflation showed that carbon dioxide was more uncomfortable as perceived by the patient (p = 0.02), the physician (p = 0.0006), and objectively assessed by degree of abdominal splinting (p = 0.006). The presence of intraabdominal adhesions had no relationship to discomfort. We conclude that nitrous oxide is more comfortable for institution of pneumoperitoneum during peritoneoscopy under local anesthesia.

Adult↗
PubMed1980

Chronic active hepatitis and severe hepatic necrosis associated with nitrofurantoin.

Nitrofurantoin has been associated with an acute hepatocellular and cholestatic injury, but only rarely with a lesion resembling chronic active hepatitis. Death from nitrofurantoin hepatotoxicity after long-term therapy has not been previously described. We report five cases of chronic active hepatitis, including two deaths, associated with nitrofurantoin and discuss previously reported cases. All of the 20 patients were women and had taken the drug from 4 weeks to 11 years. Most patients had a low serum albumin and an elevated gamma globulin; antinuclear antibody was positive in 12 patients. Eighteen patients improved clinically and biochemically when the drug was withdrawn. Cirrhosis occurred in four patients. Both of the patients who died had taken the drug for more than 1 year and had a clinical course of progressive hepatic failure. Severe hepatic necrosis was noted at autopsy in both patients.

Adult↗
PubMed1980

"Melanosis" of the duodenum associated with a gastric ulcer and folic acid deficiency.

Melanosis involving the duodenum is extremely rare. We present endoscopic, microscopic, and histochemical studies of a patient with melanosis of the duodenum associated with a gastric ulcer and a folic acid deficiency. The pigment is similar to that observed in melanosis coli and histochemically does not stain like melanin or lipofuscin. The pigment disappeared with correction of the folate deficiency and healing of the gastric ulcer, suggesting a possible relationship with these entities.

Aged↗
PubMed1979

Mechanical and neurogenic factors in postvagotomoy dysphagia.

Postvagotomy dysphagia (PVD) has been attributed to either periesophageal obstruction or failure of the lower esophageal sphincter (LES) to relax, presumably from interruption of preganglionic, contraction-inhibiting vagal fibers--a postvagotomy achalasia (PVA). This report describes a patient with periesophageal fibrosis which was successfully treated with dilation, and a second patient with an achalasia-like pattern on esophageal manometry after unilateral high, transthoracic vagotomy. The second patient is the first manometrically documented example of achalasia in a human subject related to proximal vagotomy. Most, if not all, PVD is due to esophageal obstruction and PVA is rare.

Adult↗
PubMedDate not supplied

Correcting the practice styles of errant physicians.

In spite of their reluctance, physicians cannot continue to avoid judgments on the practice styles of their professional colleagues. Both tort law and an increasingly aggressive buyer and consumer community demand attention to problem physicians. Physician executives can play a leadership role in helping physicians understand their role in the peer review process.

Medical Staff, Hospital↗