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Biomedical subjects

M Arndt

Publications and source records attributed to M Arndt.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Responsibility for patient education and incidence of homologous blood transfusions in unilateral breast cancer operations].

According to a judgement by the German Federal Court of 17 December 1991 the surgeon is legally bound to inform the patient before hand of the risk of a possible homologous blood transfusion during surgery. If the transfusion probability exceeds 5%, this obligation is really relevant, 228 patients with primary breast cancer of stage pT1 - 3N0 - 2M0 had been treated either radically (n = 146) or by a breast-preserving operation (n = 82) from January 1989 to December 1993. 400 to 800 ml erythrocyte preparations had been placed at disposal in advance for each patient. The rate of blood transfusions, pre- and postoperative haemoglobin (Hb), age, tumour size, lymph node involvement, kind and duration of operation as well as postoperative course have been analysed 43 of 228 (18.9%) patients received a homologous blood transfusion within 24 hours after operation. Transfusion rate per year decreased from 39.4% (1989) to 44.8% (1990), 12.2% (1991), 16.6% (1992) and 3.1% in 1993. On the contrary mean pre-and postoperative haemoglobin levels did not differ significantly (p < 0.05) between the different years: 13.4 +/- 0.8 respectively 12.1 +/- 1.1 g/dl (1989) and 13.5 +/- 1.3 respectively 12.1 +/- 1.3 g/dl (1993). Patients who had transfusions were significantly (p < 0.05) more likely to suffer from preoperative anaemia and larger tumors, and they have been treated by mastectomy more frequently compared to patients without transfusion. There were no correlations between transfusions and age, tumour size, lymph node involvement, kind and duration of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Total quality management: field of dreams?

Total quality management promises to reconcile cost/quality conflicts, increase customer satisfaction, and improve hospitals' competitiveness as well as operational and financial performance. This article reviews the hospital literature on TQM and concludes that there is little evidence to substantiate these claims. The article concludes with implications for research and management.

Economic Competition↗
PubMed1995

Indications for hysterectomy: variation within and across hospitals.

This study investigates the factors associated with the probability of finding specific clinical indicators (benign or malignant tumor, cancer in situ, fibroid, abscess/empyema, or positive culture of salpinx, fallopian tube, fetus, or uterus) that validate necessity for hysterectomy. Data for the 4,660 cases in the study come from 42 Pennsylvania hospitals. The probability that validating indicators were present varied significantly at the hospital level but not at the level of individual surgeons within hospital, suggesting that physicians in different hospitals adopted different practice styles. The results at the hospital level indicate that higher hysterectomy volume increased the probability of validating findings, whereas presence of an OB/GYN program was associated with lower probability of validating findings. The policy and management implications of these results are discussed.

Adult↗
PubMed1995

Admission severity of illness and resource utilization: comparing Medicaid and privately insured patients.

This study compares Medicaid patients and privately insured patients. Regression analyses examine the effect of Medicaid status on hospital admission severity, length of stay, and ancillary charges for 14,557 patients in ten medical DRGs and ten surgical procedures. The results show that Medicaid patients were significantly sicker on admission, especially the medical patients. After adjustments for patient age and sex, admission severity of illness, case mix, and hospital, Medicaid patients still had significantly longer lengths of stay and higher ancillary charges, although the effect was not as strong for ancillary charges. We suggest that this association between Medicaid status and length of stay and ancillary charges may be due to greater difficulty in discharge planning for Medicaid patients, health status differences not captured adequately in severity classification, and utilization review practices. The implications of these findings for hospital management, health care policy, and future research are discussed.

Ancillary Services, Hospital↗
PubMed1995

The adoption of corporate restructuring by hospitals.

This study investigates factors associated with the adoption of corporate restructuring by hospitals in Massachusetts, where restructuring occurred much more rapidly than it did nationally. Drawing on studies of management innovation in hospitals, this article hypothesizes that early adopters will differ from those that adopt later on the basis of individual and organizational factors, and that institutional forces will explain later adoption. The findings show no differences between early and later adopters but do show that after an intense period of restructuring, hospitals became less likely to adopt the innovation. The article concludes with a discussion of the impact of reimbursement laws on the adoption pattern and the implications for the diffusion of management innovation, particularly under health care reform.

American Hospital Association↗
PubMed1995

The implementation of total quality management in hospitals: how good is the fit?

Total quality management has become popular among hospitals because of its promise to reconcile trade-offs between cost and quality. However, assumptions inherent in TQM may not translate to the hospital environment: hierarchical management control over the technical core and the dominance of rational decision making. This article considers these two assumptions and suggests that the application of TQM to hospitals take them into account because they may compromise its success.

Health Services Research↗
PubMed1995

[Transfusion incidence and indications for homologous blood sparing measures in single stage breast carcinoma operations].

Under a ruling by the Bundesgerichtshof from December 17, 1991 (AZ VI ZR 40/91), the surgeon is obliged to inform a patient about the risks of a possible blood transfusion if the transfusion frequency is 5% or more. Between January 1989 and December 1994, 273 patients with primary breast cancer at the stages pT1-3, N1-2, M0 underwent one-time modified radical mastectomy (n = 164) or a breast conserving operation (n = 109) in our hospital. The number of blood transfusions, pre- and postoperative haemoglobin, age, tumour size, lymph node involvement, kind and duration of the operation and the postoperative course were analysed. In all, 44 of the 273 patients (16.1%) received an homologous blood transfusion perioperatively. The annual transfusion rates were 39.4% (1989), 44.8% (1990), 12.2% (1991), 16.6% (1992) and 3.1% (1993), falling to 2.2% in 1994. The mean pre- and postoperative haemoglobin concentrations did not differ significantly (p > 0.05) over the years: 13.4 +/- 1.0 g/dl and 12.0 +/- 1.1 g/dl in 1989 and 13.7 +/- 1.2 g/dl and 11.8 +/- 1.2 g/dl in 1994. Patients who received transfusions had preoperative anaemia (p < 0.021), bigger tumours (p < 0.0005) and mastectomy operations significantly more frequently than patients not given transfusions. There were no correlations between transfusions and age, lymph node involvement and kind and duration of operation. We conclude that, cognizant of a transfusion frequency of 2.2% in our hospital in one-time breast cancer operations, only patients with anaemia or large tumours require blood transfusions, for which autologous blood donations or normovolaemic haemodilution are the choices. The patients' attention is to be drawn to these. In cases of normal preoperative haemoglobin and small tumours, the physician should inform the patient that experience has shown that in all probability a blood transfusion will not be necessary and so a preoperative autologous blood donation or normovolaemic haemodilution can be dispensed with.

Adult↗
PubMed1994

Nurses' medication errors.

This paper reports on a qualitative study of nurses' experiences with medication errors. Using discourse analysis within a framework of an interpretive research design, the phenomenon of a not too uncommon occurrence in nursing practice was examined. Insight into nurses' involvement with medication errors was gained from interviews, group discussions and self-reports. Documents of disciplinary proceedings, where the Professional Conduct Committee of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting has dealt with incidents of medication errors, supplemented the data. Decisions made in situations of medication errors have moral implications at personal, institutional, and professional levels. The moral courage that is needed to learn from mistakes can be enhanced through honest dealings with the situation. Where the attention is shifted from the person involved onto the problem at hand, fair judgement may be advanced and the fear of owning up to a mistake be diminished. Only when reflected upon, can personal experience merge into the stream of development and progress. This study contributes to such reflection. Three key issues are discussed in-depth as they evolved during analysis of the data: These issues deal with identification and change; with guilt and shame and the reconciliation with human precariousness; and with teaching and learning. The manner in which discourse analysis was used here represents an innovative attempt to advance qualitative methodology in nursing research.

Adaptation, Psychological↗
PubMed1994

[The risks of anesthesia in obstetric interventions].

In obstetric anaesthesia, general anaesthesia combined with endotracheal intubation, spinal anaesthesia and peridural anaesthesia is used. The main risks of general anaesthesia are: difficult intubation, aspiration of acid gastric content in non-fasting patients, depression of the fetus with narcotics and the occurrence of awareness of the mother. The main dangers of spinal anaesthesia are: hypotension of the mother leading to reduced utero-placentar blood flow due to sympathetic block, post-spinal headache and vomiting. The specific risks of peridural anaesthesia are: maternal hypotension, the possibility of inadvertent intravenous injection of local anaesthetics leading to cardiac and cerebral intoxication, inadvertent intrathecal application of local anaesthetics followed by total spinal block which requires reanimation and inadvertent dura perforation followed by long-lasting headache. Most anaesthesia-related maternal deaths by far occur during Caesarean section performed under general anaesthesia, but at present there is no clear evidence that the anaesthetic risk of spinal or peridural anaesthesia, on the one hand, is lower than that one of general anaesthesia, on the other.

Anesthesia, Epidural↗
PubMed1994

[LEVEL 1--a new blood warming device].

Hypothermia of less than 35 degrees C, which frequently occurs in connection with massive blood transfusion, is a serious problem in many patients, in particular in those with polytrauma. The restoration of normal body temperature is very important and requires the use of a rapidly-acting, efficient and safe blood warmer, which is able to work effectively at high flow-rates. The LEVEL 1 (Technologies, Rockland, MA) is such a new blood warmer and works as a heat-exchanger via an aluminium column. This system is highly effective. Six hundred ml of sodium chloride 0.9% are warmed from 4 to 35 degrees C within one minute. This device is quickly operational and has a low priming volume. The LEVEL 1 is the only device currently available which is able to warm blood sufficiently during a very rapid blood transfusion.

Blood Component Transfusion↗