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Biomedical subjects

J R Wheeler

Publications and source records attributed to J R Wheeler.

At least 109 records · Page 6Linked to original sources
PubMed1982

Quality, cost, and health: an integrative model.

This article presents an integrative model of the relations among health status, quality of care, and resource expenditure. It defines medical care quality in terms of outcomes, measured as the expected improvements in health status attributable to care. The consideration of how quality so defined is affected by the unconstrained, efficient use of resources for care leads to the specification of the absolutist definition of quality. Consideration of the incidence of individual and external costs and benefits of care provides the basis for distinguishing further between the individualized definition of quality, which depends upon individual preferences and ability to pay, and the social definition of quality, which includes consideration of external benefits, full social definition of quality, which includes consideration of external benefits, full social costs, and preferences for the distribution of welfare. An additional distinction is made between clinical efficiency and production efficiency. This article examines in detail the implications, for the selection of optimal strategies of care, of the three definitions of quality (absolutist, individualized, and social) and the two types of efficiency (clinical and production).

Attitude to Health↗
PubMed1982

Primary tumors of the aorta: report of a case and review of the literature.

A patient with an unusual vascular tumor, an angiosarcoma of the upper abdominal aorta, is described. The clinical, radiologic and pathologic features of this case along with 19 previously reported cases of primary aortic tumor are discussed. Primary aortic neoplasms are uncommon. They are histologically and morphologically diverse tumors in which major vascular obstruction and arterial tumor embolization dominates the clinical picture. At present, aortography combined with computerized tomography offer the best means of preoperative diagnosis.

Aged↗
PubMed1981

Experience with subclavian vein for vascular access.

We report our experience with the subclavian vein as a route for temporary vascular access. By modifying the technique described by Uldall one can place these catheters at the bedside without the need of a separate exit tunnel. They are easily maintained in place and allow for early discharge home while awaiting permanent vascular access maturation. The results of approximately 600 dialysis treatments showed adequate clearence with a mean postdialysis drop in creatinine of 5.0mg./dl. and BUN of 46mg./dl. Complication rates were minimal with no hemo or pneumothorax. The rate of complications between bedside and operating room placement was not different. We feel the low complication rate, the ease of insertion, and the patency at home makes this an attractive alternative to other means of temporary dialysis such as: peritoneal dialysis, repeat femoral vein catheterization or arteriovenous shunts.

Catheterization↗
PubMed1980

Management, employees plan education effort.

At a hospital-based clinical laboratory organization, a joint management-employee advisory committee coordinates policy, programs, and expenditures for continuing education activities.

Education, Continuing↗
PubMed1980

Secondary preventive health behavior.

A comprehensive model of secondary preventive health behavior, defined as the use of physician services for preventive care, is constructed which specifies the interrelationships among people's health beliefs, their health status, their accessibility to care, their sociodemographic characteristics, and their use of services. The model is tested by applying path analysis to a household survey of adult residents of Washtenaw County, Michigan. The results support the contention that many factors influence secondary preventive utilization, some principally directly and some largely indirectly through their effects on other variables. Accessibility to care, health status, health beliefs, and sex all directly influence use, while education and age have indirect effects. Income has indirect effects on use which, because they are in opposing directions, cancel each other out.

Attitude to Health↗
PubMed1979

Factors associated with utilization of the swine flu vaccination program among senior citizens in Tompkins County.

The health belief model is tested in the context of the swine flu vaccination program for senior citizens. Analysis is based on 232 responses to a questionnaire mailed to a simple random sample of 500 senior citizens in Tompkins County, New York. Social and psychologic variables identified by the model as important in determining utilization of preventive health services are: perceived susceptibility and severity of disease, perceived efficacy and danger associated with the preventive action, and general health motivations. Differences of means between users and nonusers for these variables are computed and compared with the results of a more sophisticated analytic technique--logit analysis--for use with dichotomous dependent variables. Results reveal that the health belief model accounts for 34 per cent of the variance in use of the vaccine by senior citizens. Perceived susceptibility to the disease and amount of danger associated with receiving the swine flu immunization are found to be the most important determinants of utilization.

Aged↗
PubMed1977

"Soft" angled bulldog clamp for carotid control.

A bulldog vascular clamp was modified to reduce both weight and clamping force, and to permit easy use in the control of delicate vessels such as the internal carotid artery during carotid endarterectomy. The final instrument (Codman and Shurtleff, Inc, Randolph, MA) retains a simple design.

Carotid Artery, Internal↗