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Biomedical subjects

P Sullivan

Publications and source records attributed to P Sullivan.

At least 37 records · Page 2Linked to original sources
PubMed2001

Hospital reengineering: an evolving management innovation: history, current status and future direction.

This article summarizes six years of research on reengineering in hospitals and is the result of two national surveys and eighteen site visits to hospitals that engaged in reengineering in the 1990s. The research shows that actual hospital reengineering differs substantially from that which was initially proposed by early promoters of reengineering. However, this evolved reengineering continues to be implemented by the majority of hospitals in the United States. The authors illustrate how extensive reductions of managers and changes of nursing models have been in the past six years. Data comparing financial and cost competitiveness changes are also shown. The authors then explore the continued experiences of two early proponents of reengineering and find that their competitive outcomes to be in contrast with their early statements. Finally, the authors suggest a number of reasons that may impact on the success or failure of reengineering.

Decision Making, Organizational↗
PubMed2001

Massive choroidal detachment masking overlying primary rhegmatogenous retinal detachment: a case series.

Choroidal detachment (CD) along with primary rhegmatogenous retinal detachment (RRD) as a presenting finding is a well-recognised association. The pathogenesis appears to revolve around the hypotony induced by the primary RRD and an unstable choroidal vascular system. We present 3 patients with massive CD with minimal or no overlying RRD, initially misdiagnosed as a CD due to other causes. Since the correct diagnosis may be delayed, such cases form a real challenge in differential diagnosis and management. The underlying cycle where the retinal defect of a primary RRD is buckled by a CD, followed by the regression of the latter and the recurrence of the RRD is demonstrated.

Aged↗
PubMed2000

A nested case-control study of stomach cancer mortality among automobile machinists exposed to metalworking fluid.

PURPOSE: In a nested case-control study of 140 stomach cancer deaths (1941-1984) among 46,384 automobile workers, we examined risk in relation to lifetime exposure to metalworking fluid (MWF) in machining and grinding operations.METHODS: Exposure was defined during varying windows of biologic time (<10 years before death, 10-20 years before death, and > 20 years before death) and evaluated using a nonparametric smoothing technique and conditional logistic regression. Exposure was measured by duration, intensity (mg/m(3)), and cumulative exposure (mg/m(3)-years) to each MWF type (straight, soluble, or synthetic), as well as by duration of exposure to selected metals, additives, and components of the fluids.RESULTS: When data from three plants were combined, grinding with water-based synthetic or soluble MWF increased the risk of stomach cancer mortality. Those grinding with synthetic MWF with more than 1.3 mg/m(3)-years exposure during the 10 years just prior to death experienced a 4.4-fold risk of stomach cancer (95% CI 1.5-13.1). Increased risk was also observed among those in the highest category of soluble grinding grading exposure (OR 1.9; 85% CI 1.0-3.6). In plant-specific analysis, there was evidence of increased risk of stomach cancer associated with exposure to straight MWF and iron, as well as the water-based fluids.CONCLUSIONS: Study findings suggest that stomach cancer mortality was associated with exposure to each MWF type. Results suggesting that synthetic MWF may act as a stomach cancer promoter are of particular concern because this MWF is widely used in today's high speed grinding operations.

Journal Article↗
PubMed2000

Performance on ABA-ASA in-training examination predicts success for RCPSC certification. American Board of Anesthesiology-American Society of Anesthesiologists. Royal College of Physicians and Surgeons of Canada.

PURPOSE: Most Canadian University Departments of Anesthesia require residents to take the American Board of Anesthesiology-American Society of Anesthesiologists (ABA-ASA) in-training examination (ITE). The result is expressed as a percentile relative to all examinees at similar levels of training. Its value as a predictor of performance in the Royal College of Physicians and Surgeons of Canada (RCPSC) certification examinations is not known. METHODS: All English speaking Canadian residency programs in Anesthesia were surveyed. Results of the ABA-ASA ITE of former residents who had completed RCPSC certification were collected as percentile scores according to level of training. Level of training was based on the number of months of anesthesia training and classified according to American residency program nomenclature. The ABA-ASA ITE scores were correlated with success on the RCPSC written and oral examinations. The probability of success on the RCPSC examinations was determined by calculating the cutoff score with the best sensitivity and specificity as determined by Receiver Operating Characteristic (ROC) curves for each year in which the examination was taken and for both the written and oral examinations. RESULTS: Nine residency programs provided information on 165 residents. A weak positive correlation was found between scores on each year of the ABA-ASA exam. Scores > 50th percentile for any year were highly predictive of success in the written component ( > 60th percentile for the oral component). Scores < 20th percentile were predictive of failure on both the written and oral components of the RCPSC examination. CONCLUSION: The ABA-ASA ITE is a useful tool in predicting performance on the RCPSC examination.

Anesthesiology↗
PubMed2000

Relevance of the lesser occipital nerve in facial rejuvenation surgery.

Nerve injuries are possible during facial rejuvenation surgery. The great auricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in facial rejuvenation surgery. To understand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the nerve was studied in the laboratory in 19 hemifaces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and recorded. The great auricular nerve was also dissected to compare the two nerve territories. In the majority of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inferior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided the dominant supply to the ear, compensating for a small great auricular nerve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissection can injure the nerve if the flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to avoid nerve injury. And finally, if SMAS/platysma suspension sutures are placed, we suggest these be done in a vertical-oblique direction along the course of the lesser occipital nerve, because this should minimize the possibility of trapping terminal branches.

Cranial Nerves↗
PubMed2000

Repair of late retinal detachment after successful treatment of retinoblastoma.

PURPOSE: To analyze the results of vitreous surgery for late retinal detachment (RD) after successful treatment of retinoblastoma. METHODS: The records of all patients with retinoblastoma seen at a single ocular oncology service between 1982 and 1998 were reviewed to identify patients treated for late RD. Previous treatments, characteristics of the RD, surgical techniques used, and visual and anatomic results of the surgery were recorded. RESULTS: Of more than 500 charts reviewed, four patients treated for late RD were identified. All four had received previous, whole-eye, external beam radiotherapy and subsequently required cataract surgery. Other previous treatments included radioactive plaque, cryotherapy, xenon photocoagulation, and chemotherapy. At presentation, some patients had shifting subretinal fluid. None had a tear identifiable preoperatively, but two patients had a definite small slit tear at a tumor edge identified at surgery. One patient had a primary scleral buckle that failed. All patients had vitreous surgery with silicone oil. Average postsurgical follow-up was 30 months. Preoperative visual acuity ranged from 20/80 to light perception and improved postoperatively in two patients. The retina remained completely attached in three patients. CONCLUSIONS: Despite shifting subretinal fluid and no identifiable tear, a rhegmatogenous RD should be considered if it occurs late in patients with otherwise stable, treated retinoblastoma. Tumor reactivation must be excluded carefully. Vitreous surgery can be used to repair the RD successfully and improve vision.

Child, Preschool↗
PubMed2000

Perceptions of danger, risk taking, and outcomes in a remote community.

On the surface, the severity of the Antarctic environment is sufficient to account for the injury rates that might occur there. However, it is argued that injury occurrence is the outcome of multiple factors. A number of such factors, both in the nature of work in the Antarctic and in the characteristics of the human beings who work there are reviewed. An area that has received little attention is individual risk perceptions. It is contended that risk perceptions need to be taken into account when assessing the contributing factors to individual risk taking, as measured by accidents that occur. The literature on risk perceptions is reviewed as a precursor to an empirical study of risk perceptions and injuries at an Antarctic station. The referent for expeditioner practice and home comparisons is Australia.

Accidents↗
PubMed2000

How Do head and neck cancer patients prioritize treatment outcomes before initiating treatment?

PURPOSE: To determine, pretreatment, how head and neck cancer (HNC) patients prioritize potential treatment effects in relationship to each other and to survival and to ascertain whether patients' preferences are related to demographic or disease characteristics, performance status, or quality of life (QOL). PATIENTS AND METHODS: One hundred thirty-one patients were assessed pretreatment using standardized measures of QOL (Functional Assessment of Cancer Therapy-Head and Neck) and performance (Performance Status Scale for Head and Neck Cancer). Patients were also asked to rank a series of 12 potential HNC treatment effects. RESULTS: Being cured was ranked top priority by 75% of patients; another 18% ranked it second or third. Living as long as possible and having no pain were placed in the top three by 56% and 35% of patients, respectively. Items that were ranked in the top three by 10% to 24% of patients included those related to energy, swallowing, voice, and appearance. Items related to chewing, being understood, tasting, and dry mouth were placed in the top three by less than 10% of patients. Excluding the top three rankings, there was considerable variability in ratings. Rankings were generally unrelated to patient or disease characteristics, with the exception that cure and living were of slightly lower priority and pain of higher priority to older patients compared with younger patients. CONCLUSION: The data suggest that, at least pretreatment, survival is of primary importance to patients, supporting the development of aggressive treatment strategies. In addition, results highlight individual variability and warn against making assumptions about patients' attitudes vis-à-vis potential outcomes. Whether patients' priorities will change as they experience late effects is currently under investigation.

Activities of Daily Living↗