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Biomedical subjects

R Kellogg

Publications and source records attributed to R Kellogg.

12 recordsLinked to original sources

Specialty newborn care: trends and issues.

OBJECTIVE: This report explores the availability of neonatal special care services in the US and examines the variation in those services from both the staffing and service perspectives. STUDY DESIGN: The American Hospital Association survey of hospitals and a special national survey of hospitals with special care services were used as data sources to describe changes in the status of high-risk care between 1983 and 1997. The latter survey had a 69% response rate and was a collaborative effort among the March of Dimes, the Maternal and Child Health Bureau, the American Hospital Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Ross Labs, and the National Perinatal Information Center (NPIC). RESULTS: The study found that across all regions of the US, the special care supply has expanded. However, the study shows wide variation in medical staffing even among those hospitals offering the most intensive services; 25% had no physician in-house coverage 24 hr/d. CONCLUSION: There is wide availability of high-risk newborn care which is a possible oversupply; however, differential physician staffing raises issues regarding the need for more standardized care.

Health Services Accessibility↗

Administrative data for quality improvement.

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

Birth Weight↗

Effects of electrical and electromagnetic stimulation after anterior cruciate ligament reconstruction.

A need exists to develop new methods of neuromuscular electrical stimulation (NMES) that are both effective and relatively pain-free. The purpose of this pilot study was to determine the effects of both NMES and a new method of electromagnetic (NMES/PEMF) stimulation for reducing girth loss and for reducing pain and muscle weakness of the knee extensor muscles in patients during the first 6 weeks after reconstructive surgery of the anterior cruciate ligament (ACL). Seventeen patients receiving ACL reconstructive surgery participated as a control group (N = 3), as an NMES group (N = 7), and with combined NMES and magnetic field stimulation (NMES/PEMF) (N = 7). Patients receiving NMES/PEMF rated each type of stimulation for perceived pain and were measured for their torque. Torque results revealed a mean decrease of 13.1% for NMES/PEMF patients. The mean percent of thigh girth decreased 8.3% for controls, 0.5% for NMES, and 2.3% for NMES/PEMF patients. The NMES/PEMF patients rated NMES as causing about twice the pain intensity as NMES/PEMF during treatments. As a result of this data, the authors conclude that both NMES and NMES/PEMF are effective in reducing girth loss and that NMES/PEMF is less painful than NMES alone in treating patients after ACL reconstruction.

Adolescent↗

A factor-analytic conceptualization of attitudes toward male and female homosexuals.

A wide spectrum of opinions and beliefs concerning homosexuals was sampled, compiled into a questionnaire format, and administered to a large group of heterosexual subjects. Factor analysis yielded six independent sets of attitudes that describe the variance in heterosexual reactions to homosexuals. The relationship of sex differences and familiarity with homosexuals to variations in response style is discussed.

Anxiety↗

Attribution theory, insomnia, and the reverse placebo effect: a reversal of Storms and Nisbett's findings.

Storms and Nisbett found that insomniacs got to sleep faster than usual on nights when they took placebos believed to be arousal pills. Our study attempted: (a) to replicate the reverse placebo effect using a method of measurement considered more accurate than the original technique, (b) to evaluate the effect of an arousal pill therapy after therapy is discontinued, and (c) to clarify which of two hypotheses better accounts for the effect. Using 42 insomniacs, the design varied whether pills were administered (pill) or withheld (no pill) and whether or not high justification was provided for taking the pills. The high-justification-pill and the high-justification-no-pill groups were given information intended to justify their participation, while the no-justification-pill and no-pill-no-justification groups were treated like the original arousal and control groups. Instead of a decrease in latency to sleep, the no-justification-pill group but not the high-justification-pill troup displayed a typical placebo reaction on nights they took the pills. Our results cast suspicion on the original finding. The lack of response by the high-justification-pill group is discussed in terms of Bem and Kelley's views of attribution theory.

Arousal↗