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Biomedical subjects

R L Goldman

Publications and source records attributed to R L Goldman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Magnetic resonance imaging in cervical spine trauma.

The ability of magnetic resonance imaging (MRI) to diagnose locked facets was examined in a series of six patients with traumatic cervical spine fractures. Plain films, computed tomography, and magnetic resonance scanning were done immediately following injury. Cord edema, contusions, and acute disc herniation were well visualized on magnetic resonance images. Magnetic resonance proved to be equally effective in diagnosing unilateral and bilateral locked facets, and demonstrated the disruption of the posterior longitudinal ligament (PLL) with clarity. The magnetic resonance diagnostic criteria of locked facets, herniation of intervertebral discs, and rupture of the posterior longitudinal ligament are described. Besides permitting direct visualization of the spinal cord, MRI may have a role in the diagnosis and management of acute bony injury to the cervical spine.

Adult↗
PubMed1993

Marketing animal facilitated therapy.

Animal Facilitated Therapy (AFT) is the therapeutic use of the human-animal bond to improve a patient's physical and emotional health. It is an emerging treatment modality that is gaining acceptance among medical practitioners and healthcare administrators. Medical care has traditionally focused on the clinical well-being of the patient. But it is now widely recognized that emotional health is an integral part of physical health. Many patients have unmet psychological and emotional needs that affect their ability to heal and to maintain health. Because some animals have the capacity for interrelationships with people, companion animals can provide an adjunct to traditional therapies. For many patients, particularly those having long-term disabilities, the interaction with an animal fills important emotional needs which can improve mental and physical health. AFT often works when other therapeutic modalities have failed. It gives health professionals an alternative method for reaching patients who are depressed or who have withdrawn from social intercourse. AFT can be used in a variety of situations and settings. Programs are often staffed by trained volunteers and can be implemented and maintained at a relatively low cost. Marketing Animal Facilitated Therapy must focus on creating awareness about the health benefits derived from the human-animal bond, stimulating demand for animal therapy programs in healthcare settings, and generating funding for operating expenses and replication of services.

Animals↗
PubMed1993

Practical applications of healthcare marketing ethics.

All businesses--healthcare businesses in particular--have an absolute duty to treat their customers ethically; anything less is unacceptable. Author Goldman discusses four ethical principles that can be applied to help ensure that marketing decisions conform to the highest ethical standards.

Ethics, Institutional↗
PubMed1993

Symptomatic leiomyoma of the adrenal.

Small leiomyomas of the adrenal gland are pathologic curiosities, usually discovered incidentally at autopsy, and thought to arise from smooth muscle of the adrenal vasculature. We report the clinical, radiologic and pathologic features of a symptomatic adrenal leiomyoma, which, to our knowledge, represents the first recorded example.

Adrenal Gland Neoplasms↗
PubMed1992

The reliability of peer assessments of quality of care.

OBJECTIVE: To critically examine the literature regarding the interreviewer reliability of the standard practice of peer assessment of quality of care. DATA SOURCES: Computerized searches of the English-language literature from 1966 through 1990 using MEDLINE, HEALTHLINE, and SCISEARCH databases were performed to identify studies reporting data on interreviewer agreement of implicit evaluations of patient care episodes. STUDY SELECTION: Seventeen studies were identified. Five studies were excluded from this review because of deficiencies in the methods or lack of data on chance-corrected indexes of agreement. DATA EXTRACTION SYNTHESIS: The degree of agreement beyond chance was compared with accepted standards in the 12 remaining studies. Most of these studies found agreement corrected for chance to be in the range regarded as poor, indicating that physician agreement regarding quality of care is only slightly better than the level expected by chance. CONCLUSIONS: Given the magnitude of the resources devoted to quality assurance and the centrality of peer assessment to these efforts, there is a need for a global reexamination of the peer review process. A number of proposals appear to have potential for improving the peer review process including more objective assessment procedures, multiple reviewers, higher standards for reviewers, elimination of systematic reviewer bias, use of outcome judgements, and adoption of practice guidelines.

Bias↗
PubMed1992

An initial assessment of the Veterans Affairs occurrence screening program.

The Department of Veterans Affairs (VA) established a computerized occurrence screening program in its medical centers in October 1988. Data collected from these hospitals suggest that occurrence screening has been a useful component of the VA's overall quality assurance effort; opportunities for improvement were found in 4.2% of all occurrences. When asked to name the three most effective criteria, there was strong agreement among participating hospitals--50% or more of the facilities ranked readmissions, death, and admission within three days of an unscheduled outpatient visit as the most effective. A majority of facilities (56%) named occurrence screening as one of the more effective elements in identifying quality-of-care issues. These findings must be balanced against important limitations of the occurrence screening process; however, guided by the data it collected, the VA has recently made several changes in its occurrence screening program to address these limitations.

Data Collection↗
PubMed1992

Development of a customer service program in a large, multi-site blood bank.

The concepts of Total Quality Management (TQM) and Continuous Quality Improvement (CQI) have been widely applied but not in the unique ambulatory care setting represented by Irwin Memorial Blood Centers (IMBC). The traditional definition of quality for blood banks has been concerned with the products offered to physicians, hospitals and patients. This program expanded the definition to include customer service. A Quality of Service Steering Committee (QSSC) identified the needs and requirements of Irwin's key customer groups as a first step in embarking on its Quality of Service Program (QSP).

Blood Banks↗
PubMed1990

Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection.

BACKGROUND: Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids. Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation. METHODS: We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis. For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection. Tissues were examined histologically on routine sections and with special stains and electron microscopy. RESULTS: The histologic features seen in peliosis hepatis associated with HIV infection, but not in the four cases unrelated to HIV infection, were myxoid stroma and clumps of a granular purple material that on Warthin-Starry staining and electron microscopy proved to be bacilli. The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis. The clinical courses of two of the patients with this "bacillary peliosis hepatis" indicate that it responds to antibiotic treatment. CONCLUSIONS: HIV-associated bacillary peliosis hepatis is an unusual, treatable opportunistic infection, probably caused by the same organism that causes cutaneous bacillary angiomatosis. Our failure to find bacilli in non-HIV-associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Marketing alternatives for hospitals to the nursing crisis.

The current nursing shortage problem as defined in this article, is the result of a supply and demand imbalance. The demand for nurses is growing at a faster rate than the supply. If strategies are not implemented to correct this imbalance the demand for nurses will continue to surpass the supply, negatively affecting access to and delivery of quality patient care. Factors contributing to the increased demand for nurses and the dwindling supply must be examined if solutions to the problem are to be found and implemented. Factors contributing to the growing demand for nurses include the decreasing use of ancillary personnel by hospitals in an effort to tighten their budgets; the impact of Medicare's prospective payment system on hospital lengths of stay; the increase in patient acuity with advances in medical technology; and alternative health care opportunities pulling nurses away from the hospital setting. The supply of RNs is shrinking in relation to demand because of low retention rates; declining nursing school enrollment; non-competitive wages; poor working conditions; alternative career opportunities for women; and the lack of power and support within the nursing profession. An active marketing approach that relies on this assessment of contributing factors has been formulated in an attempt to resolve the problem and meet the increasing demand. Recommendations have been made and ranked in the order of their priority and pros and cons established for each. The strategies developed have been divided into four basic marketing categories of product, price, place, and promotion. If the problem is to be resolved these strategies must be marketed to hospitals, their administrators, nurses, other allied health professionals, third party payors, educators, and the general public. The nursing profession itself must find the unity and strength within its own group of professionals to build political and economic powers to enhance their product. Nursing is at a crossroad. Much depends on how we cope with the current shortage and its related issues. Nurses have the opportunity to shape their future. Hopefully, with proactive strategies, the profession will transform from a passive role to an active, vital force of the health care environment. The authors believe that through our marketing approaches this can be accomplished.

Employee Incentive Plans↗
PubMed1989

Marketing a practical health care policy for the United States.

A policy for universal health care in the United States has been proposed by leading health planners. All citizens of the United States should be entitled to basic health care of adequate quality. Basic care should include physicians, hospitals, and clinic services, emergency and preventive care, and certain other treatments and services. Key to this practical health care policy is the method by which it will be financed. This policy combines several widely discussed financial methods such as Medical Individual Retirement Accounts, catastrophic health insurance, and the combination of what is now known as Medicare and Medicaid into one umbrella package. Active competition within the health care delivery system is essential. To prepare the health care consumer for this competitive environment, an active marketing program by providers, corporations, and all levels of government is basic. For such a policy to be implemented, it must be marketed to the legislature, professional organizations within the health and insurance fields, to educators and to the public.

Community Participation↗
PubMed1989

It is time to move from health maintenance to health promotion.

The American health care delivery system has traditionally emphasized the treatment of illness instead of the promotion of wellness. Traditional Health Maintenance Organizations (HMOs) have attempted to reduce costs by controlling utilization, discounting and/or sharing risk with providers rather than promoting wellness and prevention. These efforts have, for the most part, been unsuccessful and health care costs and HMO premiums continue to rise. The authors propose it is time for a change and we must look again at what wellness programs can accomplish. It is time to move from an ineffective "health maintenance" approach towards one of "health achievement." Models for the proposed change already exist in the business community where companies have successfully used wellness programs as a tool to decrease health benefits expenditures. The changes proposed must be addressed on multiple levels. Perceptions, attitudes and approaches must be changed. The benefits of wellness must be individually marketed to target groups: blue and white collar workers, business executives and professionals, home makers, preschool and school age children, the elderly and the unemployable.

Attitude to Health↗
PubMed1988

Cerebral arteriovenous fistula in the Klippel-Trenaunay-Weber syndrome.

A 12-week-old girl presented with cutaneous haemangiomata and hemihypertrophy of the chest and right upper extremity--stigmata of the Klippel-Trenaunay-Weber syndrome. Screening cranial CT-scan followed by cerebral angiogram revealed what is believed to be the first reported occurrence of a cerebral arteriovenous fistula in a patient with this syndrome. Craniotomy and clip application successfully obliterated the fistula. Although rare at present, neurovascular involvement in the Klippel-Trenaunay-Weber syndrome may be found more frequently with the newer non-invasive diagnostic methods for screening these children. Such findings may strengthen the putative classification of this syndrome within the group of primary mesodermal (vascular) phakomatoses.

Angiomatosis↗