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Biomedical subjects

R Kirk

Publications and source records attributed to R Kirk.

At least 37 records · Page 2Linked to original sources
PubMed1992

Developing home care standards you can count on ... and cost on!

Cost management is a six-step process that begins with identifying important activities of patient care, identifying desired outcomes of patient care, and the most predictable and efficient process to be used to ensure outcome accomplishment. The more caregivers and managers understand the cost-benefit connection between patient care and resource costs, the easier it will be for them to manage (rather than be a victim of) quality, productivity, and profitability.

Cost-Benefit Analysis↗
PubMed1992

The big picture. Total quality management and continuous quality improvement.

The pressure to improve the quality of clinical and customer service outcomes continues to escalate. In most cases, sustained improvement (either incremental or breakthrough) is a direct result of improving service delivery and work processes. The challenge, for managers, is to design work processes that predictably lead to satisfying and cost-effective results. Total quality management (TQM) and continuous quality improvement (CQI) may seem like "this year's fads," but they are form, not fashion. TQM and CQI processes generate a customer-responsive environment in which employees can contribute to achieving the organization's mission, vision, and strategic objectives.

Humans↗
PubMed1990

Common sense quality management.

How would you like to be responsible for an organization that achieved positive patient results, satisfied high-performing nurses, and had a healthy bottom line? Here's a common sense quality management model sophisticated enough to meet your needs and simple enough to implement at all levels of your organization.

Humans↗
PubMed1990

Using workload analysis and acuity systems to facilitate quality and productivity.

Reimbursement, budget, and nurse availability constraints no longer support the quality-at-any-cost concept. However, clear definitions of clinical and satisfaction outcomes, nursing responsibilities that contribute to those outcomes, and reasonable time targets for staff contributions can help nurses at all levels analyze and prioritize work load to build new or update existing acuity systems. The author describes specific methods nurse executives and managers can use to involve and guide staff members in (1) determining realistic and compatible standards of care, performance, and resource productivity, (2) integrating quality-based time standards into acuity systems, and (3) using acuity information to manage delivery of a targeted, desired level of ongoing quality care.

Administrative Personnel↗
PubMed1988

The laboratory interpretation of coagulase-negative staphylococcal bacteraemia in neonates.

In an attempt to detect markers of significance of coagulase-negative staphylococci (CNS) isolated from neonatal blood cultures, epidemiological data and the rate of appearance of positive blood cultures were examined. The main epidemiological factor studied was the relative abundance of the different biotypes of CNS in blood cultures, on neonatal skin and the hands of neonatal unit staff. Our results showed that the relative recovery rates of biotypes found from these sources showed no significant differences. The number of positive blood culture bottles in each set and the number of days taken for growth to appear showed wide variations. A higher proportion of aminoglycoside-resistant strains were found in the group showing both blood culture bottles positive and in the group where isolates were obtained by 24 h of incubation. We conclude that there is no advantage in biotyping CNS in assessing clinical significance, but the association of aminoglycoside resistance with the isolation pattern of CNS in neonatal blood cultures requires further examination.

Bacterial Typing Techniques↗
PubMed1987

Cardiac tamponade following varicella.

An 18-month-old girl presented with cardiac tamponade five weeks after varicella. An emergency pericardiocentesis was performed and, subsequently, an anterior pericardiectomy. She eventually made a complete recovery following corticosteroid treatment.

Cardiac Tamponade↗
PubMed1987

Management development: a needs analysis for nurse executives and managers.

Clearly, both the nurse executive and nurse manager roles are becoming more complex. I feel an enthusiasm by the professionals in those positions to pursue development activities that will help them do their jobs better and with less discomfort. Nurse executives obviously know the power of combining knowledge with experience. How do the different leadership and management development needs identified by these NE fit with your organization's needs? What is the content in your leadership and management development programs? Are your programs meeting the real needs of your executive and management-level staff? One way to find out is to do a simple survey. Today, nurse executives are responsible and accountable for challenges we never considered possible, even a few years ago. But along with the new challenges came the flexibility and positive attitudes of NEs to respond to changes and acquire new skills such as cost accounting, computers, or marketing. It's this type of proactive thinking that helps nurse leaders turn problems into opportunities and their situations into success stories.

Administrative Personnel↗
PubMed1986

Personalized versus usual care of previously uncontrolled hypertensive patients: an exploratory analysis.

This study was conducted to explore whether the quality of provider care may contribute to blood pressure reduction and whether other factors related to the treatment of hypertension may explain decline in blood pressure. In the study, 46 uncontrolled (greater than or equal to 140/90 mm Hg), medically treated hypertensive patients who received more personalized care differed significantly in the magnitude of blood pressure reduction from 36 usual-care patients (10/7 vs 2/2 mm Hg means for systolic and diastolic blood pressure reduction, respectively). About twice as many experimental patients as controls were reclassified as having "controlled" blood pressure, and this difference reached statistical significance. A multiple regression analysis for personalized-care subjects showed that no dynamic variables were related to blood pressure changes. It was postulated that more personalized care may have accounted for the significant difference between groups in blood pressure reduction. Similar personalized monitoring services might be important additions to usual medical care in order to control blood pressure more fully in high-risk hypertensive patients.

Biofeedback, Psychology↗
PubMed1985

Experimental analysis of adherence counseling: implications for hypertension management.

A time series "reversal" design demonstrated that behavioral counseling increased medication adherence from about 60 to 100% for a black, hypertensive patient. However, inadequate pharmacological treatment yielded no clinically important blood pressure decrease. The combination of improved compliance and minimal blood pressure reduction led the patient's physician to explore higher doses and alternate medications to achieve blood pressure control. The physician's aggressive medical treatment was initiated only after the patient's compliance had been improved. Thus, this study suggests that paraprofessional counseling can increase compliance and illustrates the need for both behavioral and physiological data in clinical management to avoid blaming patients for poorly controlled blood pressure.

Adult↗
PubMed1984

Is coagulase-negative staphylococcal bacteraemia in neonates a consequence of mechanical ventilation?

The clinical symptoms associated with coagulase-negative staphylococcal bacteraemia in infants on a Special Care Baby Unit were investigated. They were compared with those of blood culture-negative controls matched for age and weight. Infants with positive cultures were further sub-divided by judging the isolate to be a contaminant or a pathogen. There was a high incidence of respiratory symptoms in the latter patients, particularly in infants of less than 37 weeks gestation. These symptoms often responded to antimicrobial chemotherapy, particularly in infants given correct antibiotics, as demonstrated by laboratory sensitivity testing. Bacteraemia was usually detected shortly after starting mechanical ventilation, and may be its consequence in premature infants. Gentamicin-resistance occurred in over 50 per cent of blood culture isolates of coagulase-negative staphylococci. We postulate that coagulase-negative staphylococci can be a neonatal pathogen requiring appropriate antimicrobial chemotherapy.

Coagulase↗
PubMed1984

The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension.

Ten noncompliant hypertensive patients were monitored and received counseling from trained aides. Monitoring and lay counseling was associated with a reduction of -10 mmHg in systolic blood pressure and of -7 mmHg in diastolic pressure (P less than 0.05). Medication adherence increased from 69% to 84%. Counseling resulted in pressure decreases equal to those obtained by usual care for similar but compliant patients. This analysis provides a model for paraprofessional adjunctive counseling of patients thought to be adhering poorly to their medication regimen, which may improve control of hypertension.

Blood Pressure↗