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Biomedical subjects

R K Shukla

Publications and source records attributed to R K Shukla.

At least 19 recordsLinked to original sources
PubMed1997

A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals.

Not-for-profit (NFP) and for-profit (FP) hospitals were compared on several performance indicators including revenues, costs, productivity/efficiency, and profitability. The indicators were adjusted, where appropriate, for outpatient activity and a case-mix index for all patients. FP hospitals had higher profit margins as well as higher gross and net revenues per case-mix adjusted admission. On the other hand, NFP hospitals had lower total cost per case-mix adjusted admission even after subtracting taxes from FP hospital costs. There were no significant differences between the two groups on efficiency and productivity indicators--paid hours per case-mix adjusted admissions, occupancy levels, and case-mix adjusted ALOS. The higher profits of FP hospitals were attributed to revenue management rather than cost and efficiency management.

Analysis of Variance↗
PubMed1996

Role of epidural medication in the treatment of resistant low back pain.

Two hundred and eight patients of low back pain were studied in the department of orthopaedic surgery, GSVM Medical College, Kanpur. The patients were put on intensive conservative treatment in the form of analgesics, hard bed rest, spinal extension exercises, traction and lumbosacral support. Thirty-two patients did not respond to this treatment and their symptoms were of more than 6 months duration and they were subjected to epidural injection of local anaesthetic agent, saline and corticosteroids. The failed 6 cases were investigated for consideration of surgery. The aim of this study is to develop standardised strategy for the treatment of low back pain. For the low back pain patients not responding to intensive conservative treatment, an idea has been put forward in the form of epidural medication prior to considering them to surgery to prevent unnecessary incidence of "failed back". A trial of epidural injection is suggested to avoid surgery.

Adolescent↗
PubMed1992

Factors and perspectives affecting nursing resource consumption in community hospitals.

The consumption of professional and non-professional nursing resources on medical/surgical nursing units varies sharply among community hospitals. In an effort to explain the variation, this study examines several factors: socio-economic characteristics of the population; supply of registered nurses; hospital characteristics such as size, complexity and diversity of services; patient characteristics such as case mix index and nursing care acuity index; and production system characteristics such as efficiency of technical support systems and the structure of nursing care delivery. Nursing skill mix varies more than the staffing levels among hospitals. The research suggests that factors associated with a clinical-rational model such as nursing acuity index and the efficiency of clinical/support systems explains little, whereas factors associated with economic-rational model of hospital revenues--like case mix, number of hospital services, poverty (through Medicaid program) and age distribution (through Medicare program)--do significantly affect nursing resource consumption. The results point to the presence of resource allocation to nursing based on hospital revenues rather than patient care needs.

Analysis of Variance↗
PubMed1990

Comparison of subjective versus data base approaches for improving efficiency of operating room scheduling.

This paper compares subjective and four data-based models to estimate length of surgery for operating room scheduling systems. The four data-based models for predicting case block length are based on 1) procedure, 2) procedure and surgeon, 3) procedure and case complexity, and 4) procedure, case complexity, and surgeon. Data-based approaches performed better than subjective estimates. In establishing data-based standards it is more important to account for complexity of cases than for differences among surgeons.

Appointments and Schedules↗
PubMed1990

Effect of an admission monitoring and scheduling system on productivity and employee satisfaction.

This article develops and evaluates an admission monitoring and scheduling system designed to reduce fluctuation of work load on nursing units. Effects of the system on work-load distribution, full-time equivalents, labor cost, and employees are assessed in a 235-bed hospital. The system provided more stable work loads and had a potential for improving productivity by about 3 percent, and reducing by about 40 percent the number of days nurses are asked to take off without pay during low-census periods.

Admitting Department, Hospital↗
PubMed1985

Admissions monitoring and scheduling to improve work flow in hospitals.

As part of a five-year effort to evaluate alternative methods of improving nurse productivity, this study was undertaken to better understand work flow monitoring as a technique for stabilizing staffing patterns and to improve productivity in hospitals. Two admissions scheduling and monitoring systems were studied and compared with an admissions system without an explicit monitoring function in three medical-surgical units of a 641-bed community hospital. The admissions system based on monitoring case mix was found to be more effective than the system based on monitoring census. Both were significantly more effective than the admissions system without an explicit monitoring function.

Admitting Department, Hospital↗
PubMed1985

A longitudinal approach for measuring integration and continuity of nursing care.

Munson and Clinton developed an instrument to measure cross-sectional variation in integration and continuity of nursing care in team, modular, and primary nursing units in a hospital. In this study I show that when the instrument is adapted for longitudinal studies of nursing care, it provides more reliable and sensitive measurements. My results also indicate that the primary nursing care structure provides higher integration and continuity of care and care management than the team and the modular structures, and that the modular structure scores higher than the team structure.

Continuity of Patient Care↗
PubMed1984

Patients perception of care under primary and team nursing.

The relationship between the structure of nursing care and patient satisfaction is examined after equalizing the quantity and quality of nursing staff. An all-registered-nurse model of primary nursing is compared to team nursing. The nursing competency scores of registered nurses (as measured by the Slater scale) on two patient care units were equalized through 6 months of continuing education and staff development programs. A patient checklist was used to determine satisfaction with care and perceived omissions in care. No significant differences in satisfaction with care were found between the two units. The unit with primary nursing was perceived as having significantly higher omissions in care in three categories: dietary needs, reaction to therapy, and contact with nurses. The results suggest that the effect of nursing care structures on patient perception of care may be contingent upon the efficiency of the support systems and the competency of the nursing staff.

Clinical Competence↗
PubMed1983

Utilization of physical therapy personnel in one hospital. A work sampling study.

The purpose of this study was to illustrate the adaptability and use of work sampling, an industrial engineering technique, as a dependable method for collecting personnel utilization data in the physical therapy department of a general hospital and to demonstrate the concept of work sampling to physical therapy supervisors and personnel unfamiliar with this approach. Over a six-week period, a total of 5,824 observations were made at randomly selected 15-minute intervals during the 40-hour work week. Percentages of total time used in observed activities for all physical therapy personnel were divided as follows: 1) direct care, 20.38 percent; 2) indirect care, 11.18 percent; 3) administration, 2.27 percent; 4) communication, 3.28 percent; 5) clerical, 9.56 percent; 6) personal time, 24.60 percent; and 7) out-of-department, 28.72 percent. Physical therapists were most likely to be involved in personal duties from 8 AM to 9 AM (35%) and from 4 PM to 4:30 PM (41%). They showed greatest productivity from 9 AM to 10 AM (59%) and spent time in out-of-department activities rather consistently throughout the day. A conclusion of this study was that work sampling may be used successfully to collect personnel utilization data in a physical therapy department.

Humans↗
PubMed1983

All-RN model of nursing care delivery: a cost-benefit evaluation.

The proponents of the primary model of nursing, in which a single nurse bears direct and indirect responsibility for a given number of patients during their hospital stay, suggest that both nurse and patient stand to gain from this system of service delivery. In this study, an all-RN model of delivery was compared with a team model and a modular model. The study was carefully designed to control for the quantity and quality of nurses in all three models. The study found no appreciable differences among the three models in the quality of care delivered. The all-RN model, however, was found to be more costly than the other two models.

Attitude of Health Personnel↗
PubMed1983

Technical and structural support systems and nurse utilization: systems model.

There are two major components to nursing support systems: technical support systems, for the distribution of supplies and medicines to patients and for communication among hospital personnel, and structural support systems, for the organization of nursing staff-RNs, LPNs, and aides-into a systematic, working assignment pattern. Four hospital studies that used different combinations of technical and structural support systems were compared for the amount of time registered nurses were able to spend on direct patient care activities. It was found that a structural support system based on the primary nursing model, coupled with a decentralized technical support system, maximized direct patient care time.

Hospital Communication Systems↗
PubMed1982

Primary or team nursing? Two conditions determine the choice.

The cost-benefit analysis of the primary nursing structure is contingent on the factors that affect the proper use of nursing skills. By reducing the problems of coordinating the work, primary nursing has the potential of greater professional nurse involvement with patients. However, in a unit with inefficient support systems, inappropriate use of professional skills in primary nursing render the primary nursing structure less cost-beneficial than the team nursing structure. We may postulate here that primary nursing will be more cost-beneficial than team nursing when the nursing support system requires very little of the RNs' time and the patients require highly skilled care. In a hospital that has inefficient nursing support systems and on nursing units that have mostly self-care to intermediate care patients, primary nursing will only diminish proper use of nursing skills without significant potential to improve the quality of care. On the contrary, with highly efficient nursing support systems and on nursing units that have mostly intermediate use to extensive care patients, primary nursing will have great potential to improve quality and to use nursing skills properly.

Continuity of Patient Care↗
PubMed1980

Reactivity of trachea, bronchi, and lung strips to histamine and carbachol in rhesus monkeys.

Responses of isolated airway smooth muscles of a subhuman primate to carbachol and histamine were investigated. Isolated lung parenchymal strips of rhesus monkeys (RM) exhibited approximately equal sensitivity (i.e., ED50) and contractility (i.e., maximum tension) to carbachol and histamine. Tracheal chains and bronchial strips responded with concentration-dependent contractions to carbachol. Trachea did not exhibit any contractile responses to histamine. Bronchial strips responded with weak contractile responses to histamine when compared with those elicited ay carbachol. Histamine-induced contractions on bronchi and lung strips were easily antagonized by pyrilamine (H1-receptor antagonist) (10(-6) to 5 X 10(-6) M). Carbachol-contracted trachea and bronchi responded with relaxations to histamine and dimaprit (H2-receptor agonist) that were antagonized by metiamide (H2-receptor antagonist) (5 X 10(-5) M). The present findings indicate 1) a differential reactivity of central and peripheral airway smooth muscles of RM to histamine and carbachol; 2) lung strips of RM appear to possess only H1 types of histamine receptors; 3) bronchial smooth muscles of RM have a small population of H1-receptors mediating bronchoconstriction; and 4) a preponderance of inhibitory H2-receptors in the tracheobronchial smooth muscles of rhesus monkeys. If these subhuman primate findings apply to the airways of man, they could aid considerably in furthering our understanding of the pathophysiology of the respiratory tract.

Animals↗
PubMed1978

True macrodactyly of the hand.

A case of true progressive macrodactyly was treated by cosmetic amputation of the middle and ring fingers with defatting of the palm and dorsum of the hand. Three months later the result was satisfactory.

Amputation, Surgical↗