Biomedical subjects

James K Stoller

Publications and source records attributed to James K Stoller.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Transudative chylothorax: report of two cases and review of the literature.

Transudative chylothorax is a rare entity that has been associated with a limited range of clinical settings. To date, transudative chylothoraces have been described in only 13 patients, most commonly as a result of hepatic cirrhosis. Recognition of the transudative nature of these effusions is important to avoid unnecessary diagnostic testing and inappropriate management strategies. This report describes the presentation, diagnosis and management of two patients with transudative chylothoraces, and provides a brief review of the relevant literature.

Ascites↗

PubMedDate not supplied

Alpha1-antitrypsin deficiency.

Alpha1-antitrypsin deficiency is a genetic disorder that affects about one in 2000-5000 individuals. It is clinically characterised by liver disease and early-onset emphysema. Although alpha1 antitrypsin is mainly produced in the liver, its main function is to protect the lung against proteolytic damage from neutrophil elastase. The most frequent mutation that causes severe alpha1-antitrypsin deficiency arises in the SERPINA 1 gene and gives rise to the Z allele. This mutation reduces concentrations in serum of alpha1 antitrypsin by retaining polymerised molecules within hepatocytes: an amount below the serum protective threshold of 11 micromol/L increases risk for emphysema. In addition to the usual treatments for emphysema, infusion of purified alpha1 antitrypsin from pooled human plasma represents a specific treatment and raises the concentrations in serum and epithelial-lining fluid above the protective threshold. Evidence suggests that this approach is safe, slows the decline of lung function, could reduce infection rates, and might enhance survival. However, uncertainty about the cost-effectiveness of this expensive treatment remains.

Humans↗

PubMedDate not supplied

Inpatient consultation: results of a physician survey and a proposed improvement.

We undertook the current survey-based study to assess clinicians' views on the determinants of effective inpatient consultation and the existing process of inpatient consultation at the Cleveland Clinic Hospital. A 25-question survey developed for this study using Likert scale responses was completed by 181 (of 404 eligible addressees, a 45% response rate) members of the Cleveland Clinic staff in the divisions of medicine, surgery, and pediatrics. Ratings of the overall value of inpatient consultation reflected moderate satisfaction (mean 6.9 of possible 10). Types of consults that were most valued were those requesting a procedure and those seeking assistance in establishing a diagnosis and in interpreting data. Features deemed most important in making a consult excellent were legibility of the consultant's note, timeliness of the response (i.e., within 24 hours), and direct communication of the consult question. The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult. Study findings indicate the opportunity to improve the process of inpatient consultation by implementing measures that enhance direct physician-to-physician communication about the consult, ensure timeliness, facilitate identification of the appropriate consultants, and allow easier auditing. We propose a novel process for requesting inpatient consultations that extends currently available hospital information systems but offers a process improvement that warrants development.

Attitude of Health Personnel↗

PubMedDate not supplied

A review of physician turnover: rates, causes, and consequences.

To assess current knowledge about physician turnover, this article reviews the available literature regarding the rates, causes, and consequences of physicians' leaving a practice. Reported rates of turnover vary widely, both because of differences in reporting methods and by type of healthcare organization and provider. A common contributor to turnover is a mismatch between physicians' expectations and organizational culture or rules, although greater understanding of ways to assess and to predict such mismatch is needed. The costs and consequences of physician turnover are substantial and may include: (a) financial consequences, (b) effects on patient satisfaction, and (c) effects on the organization or practice as a whole, related to the experience of other healthcare providers, and effects on institutional public relations. Our review suggests that greater attention to physician turnover is needed to clarify its frequency and predictors, and strategies to lessen its occurrence.

Attitude of Health Personnel↗

PubMedDate not supplied

The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center.

Although physician turnover in a healthcare organization can incur substantial costs, little formal attention has been given to estimating or modeling the financial impact on revenues. To address this gap in available information, the current study proposes a model by which to estimate the impact on revenue of physician turnover. We designed a financial model that accounts for the physician's departure, the search period for a successor physician, the time and rate at which the incoming physician increases initial productivity to reach the practice norm, and the ability of the remaining physicians in the practice to recover revenue during the search period. This model and the potential revenue impact underscore the importance of minimizing physician turnover and offer specific opportunities to minimize the potential revenue impact.

Humans↗