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R Kay

Publications and source records attributed to R Kay.

259 records · Page 15Linked to original sources
PubMedDate not supplied

Distal hypospadias in the adult.

The majority of patients with distal hypospadias undergo surgical reconstruction in childhood for social, emotional, and technical reasons. Rarely, patients with hypospadias do not receive repair during childhood and seek surgical treatment as adults. The authors recently performed reconstruction on two adult patients with primary distal hypospadias. One patient had voiding problems, necessitating sitting, and the other patient desired repair for cosmetic reasons. In performing the surgical repair, the authors observed that the amount, as well as the elasticity, of the redundant foreskin was less in adults than in children. Urologists with a full repertoire of surgical skills can expect excellent results in patients with primary distal hypospadias.

Adolescent↗
PubMedDate not supplied

Mortality of patients transferred to a tertiary care hospital.

BACKGROUND: Seriously ill patients are often transferred from community hospitals to tertiary care hospitals. OBJECTIVES: To review the numbers, sources, and outcomes of patients transferred to the Cleveland Clinic Hospital from 1989 through 1992. METHODS: Retrospective analysis. RESULTS: Compared with the Cleveland Clinic's overall hospital mortality rate of 3.09% (3760 of 121,014 patients) during this period, the mortality rate among transferred patients was 8.26% (1092 of 13,226 patients). Although transferred patients accounted for only 10.9% of the total admissions, they represented 29.0% of the deaths. Transfers from other hospitals in the Cleveland Health Quality Choice (HQC) program, a community-wide quality-assessment project, increased 40.2% in 1992 (during the initial data collection period for the HQC program), while those from non-HQC hospitals increased only 0.9%. CONCLUSIONS: Patients transferred to a tertiary care hospital from other acute care hospitals have a 2.7-fold greater chance of dying in the hospital than nontransferred patients. Public scrutiny of quality may increase the likelihood of transfer of seriously ill patients to tertiary care centers.

Diagnosis-Related Groups↗
PubMedDate not supplied

Utilizing physician leadership to reduce length of stay.

With the proliferation of prospective payment, managed care and the concomitant shift in risk from payer to provider, hospitals are investing in utilization management programs to reduce cost per case while maintaining or improving clinical quality. This article discusses a major component of the utilization management program at the Cleveland Clinic Foundation: the use of physician champions. Overall, the length of stay reduction initiative resulted in a shorter average length of stay by 1.8 days (22 percent).

Cost of Illness↗
PubMedDate not supplied

Balancing the perfect scorecard. Inquiry as intervention in physician practice management.

We describe how inquiry into several operational aspects of health care delivery in the Division of Medicine at the Cleveland Clinic Foundation improved clinical and administrative functions, demonstrating the principle that inquiry is intervention. The process of inquiry displays data on a "performance wheel" that summarizes several indicators, allowing easy comprehension of performance in various operational aspects and a visual appreciation of the interaction among these operational aspects.

Appointments and Schedules↗
PubMedDate not supplied

Seizure recurrence in temporal lobe epilepsy.

We report on a patient with clinical, electroencephalographic and radiological features of temporal lobe epilepsy, whose seizures were initially controlled with antiepileptic treatment. Five years after the onset of seizures, he developed more frequent and prolonged episodes of confusion, which were misinterpreted as secondary to temporal lobe epilepsy. Further investigation revealed the presence of hypoglycaemia and the eventual diagnosis of metastatic insulinoma.

Adult↗