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Biomedical subjects

R J Sullivan

Publications and source records attributed to R J Sullivan.

At least 73 records · Page 4Linked to original sources
PubMed1980

Adherence to explicit strategies for common medical conditions.

Explicit strategies (protocols) were prepared by the staff of a primary care clinic for use as professional standards by physicians, nurse practitioners and physicians' assistants to improve care and facilitate quality assessment in cases of urinary tract infection and upper respiratory illness. Over a 2-year period, audit of 3,442 records for adherence to protocol guidelines revealed a variation with time of 38 to 100 per cent in checklist utilization and 55 to 100 per cent in compliance with specified procedures. Shifting patterns of clinic load and alterations in feedback mechanisms to providers had little relation to guideline adherence. The range in scores was attributed to patient symptom variability with subsequent difficulty applying explicit strategies, and to failure of providers to record details contributing to clinical decisions. With this range of "success" following self-imposed predefined strategies, it is not surprising that retrospective record reviews using short sample periods and criteria established by outside expert panels document wide variation in quality.

Delivery of Health Care↗
PubMed1978

Standards for practice: effectiveness and acceptance.

Carefully designed and highly specific standards for medical practice can improve the pattern of practice when applied by interested and committed physicians or by other similarly motivated health care providers. However, this is not popular with the physician, and the improved pattern of practice is dependent on continued feedback. The standards must be designed with a specific population and setting in mind; therefore it is unlikely that an effective operational plan can be devised and implemented that will achieve improved practice patterns in the immediate future. Meanwhile, more general standards might be used to identify a smaller number of cases, which can then be reviewed by other physicians, using professionally accepted but subjective practice criteria.

Diagnosis, Computer-Assisted↗
PubMed1978

Cytochemical demonstration of esterases in peripheral blood leukocytes.

Cytochemical methods for alpha naphthyl acetate esterase and chloroacetate esterase have been used to identify human monocytes and granulocytes. In this study, a standard procedure for staining alpha naphthyl acetate and chloroacetate esterase activities was modified by extending the range of pH of the incubation mixture and the duration of staining and was applied to cat, dog, goat, guinea pig, hamster, human, pig, rabbit, rat, and sheep leukocytes. The results for both enzymes showed (1) incubation time and pH had discrete effects on staining and (2) species differences for in vitro conditions to demonstrate esterase activity were pronounced.

Acetates↗
PubMed1978

The cytochemistry of rabbit peripheral blood leukocytes.

The authors report on their investigations of the differentiation between neutrophilic and eosinophilic granulocytes of the peripheral blood in healthy rabbits. By varying the pH-value and the incubation time it is possible to achieve a reliable differentiation between neutrophilic and eosinophilic granulocytes of the rabbit by means of 6 different cytochemical methods which could only be made incompletely with the routine methods used up till now (Eosin-, Giemsa-, Wright's-colouring etc.). Moreover, monocytes and lymphocytes can also be identified reliably.

Alkaline Phosphatase↗
PubMed1976

The cost of auditing outpatient records.

When patient records are to be auditied in a program designed to assess the quality of medical care rendered, careful consideration must be given to the cost of the system implemented. Structured data collection and a defined treatment plan are advantageous in facilitating the use of nonphysicians for the majority of the audit. A system using checklists to ensure adequate recording of subjective and objective data and a defined treatment plan for a common symptom complex were implemented by physicians and physician's assistants with a patient load averaging more than 1,000 patient contacts per week in a general medical clinic at Duke University Medical Center. Audit was subsequently accomplished at a cost of 96 cents per record. To reduce this cost, more efficient methods of selecting records for audit should be developed.

Costs and Cost Analysis↗