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Biomedical subjects

S A Chapman

Publications and source records attributed to S A Chapman.

29 records · Page 2Linked to original sources
PubMed1985

Which hospital services are most overused? Results from a medical audit.

When we assessed the extent of unnecessary ordering of clinical services by medical house staff at a large university hospital, 21% of services were judged to be unwarranted. Most overordered were nuclear medicine services, followed by laboratory tests. Because of their large volume, clinical laboratory services accounted for 78% of all unwarranted orders. Unwarranted use of hospital services is substantial and variable among physicians and services. This study confirms the value of medical record reviews for documenting the need for and guiding the course of hospital cost-containment programs.

California↗
PubMed1984

The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital.

To test the hypothesis that physician education is an effective strategy to reduce total hospital costs, we evaluated three educational interventions at a large university hospital. This prospective controlled study spanned two academic years and involved 1,663 patients and 226 house staff. In the first year, weekly lectures on cost containment (medicine and surgery) and audit with feedback (medicine only) both failed to produce a significant change in total hospital charges. The "dose" of the intervention was increased on medicine in the second year by combining the lecture and audit strategies. Again, total charges did not change significantly. While decreased use occurred for certain selected services, the impact was not great enough to affect total hospital charges significantly. We conclude that, in the absence of other cost containing incentives, physician education alone is not an effective hospital cost containment strategy.

Adult↗
PubMed1984

Ischemia and revascularization of the middle cerebral territory of the rat brain by manipulation of the blood vessels in the neck.

Ischemia of the middle cerebral territory in the rat brain has been produced by anastomosing the right common carotid artery to the right jugular vein, and occluding the left internal and common carotid arteries. Revascularization is performed by ligating the right common carotid artery distal to the arteriovenous anastomosis and removing the clips from the left carotid arteries. The majority of the rats made ischemic deteriorated progressively and died if revascularization was not carried out, but only 10% of them died if the operation was performed within one hour, although the rate rose to 90% if the operation was delayed for 4 hours.

Animals↗
PubMed1984

Some scanning electron microscopic studies of the surface of coronal sections cut from the rat brain.

The cut surfaces of coronal sections of the rat cerebral hemispheres have been examined with the scanning electron microscope. Under low magnification the structures of the brain are easily identified. Using the focusing power of the microscope and the ability to tilt the specimen in its column, under higher magnification the neurones, glial cells, cell processes, bundles of myelinated axons and the cerebral blood vessels can be examined in great detail. This method of study should prove of value in the future for the investigation of brains which have been subjected to experimental procedures and those affected by disease.

Animals↗
PubMed1984

Lessons for teaching cost containment.

Increasing financial restrictions on hospitals by the federal government and changing physician reimbursement procedures make it more important to control the use of medical care resources by physicians. A prospective controlled study was made of an educational program for the medical and surgical house staffs and for medical students designed to reduce unneeded orders for low cost, high volume ancillary and nursing services. The program was comprised of six mutually reinforcing components: lectures, medical record audits and reviews, group feedback in the form of cost summaries containing information on unnecessary ordering, hospital price booklets, current patient bills, and pertinent journal articles. Operating at a time of retrospective hospital cost reimbursement, the program achieved only modest reductions in the residents' and students' use of hospital services and no substantive effect upon hospital costs. However, the program participants accepted the program enthusiastically. Several factors crucial to such educational cost containment programs were identified. The authors believe that experience with the program has valuable lessons for other hospitals initiating cost-control efforts.

California↗
PubMed1984

What's so special about special care?

Special care units are the most advanced, intensive, technological, and costly of hospital services. They also have proliferated rapidly. Yet little is understood about the definition, prevalence, genesis, costs, or benefits of SCUs. This paper defines and examines the many forces that have promoted the growth of special care, including hospital cost containment policies, fee-for-service reimbursement, medical ethics, standards of care, and manpower, and the much less numerous forces that have inhibited its spread. It is concluded that a sound appreciation of the dynamics of SCUs will be crucial to guiding future policy decisions as the nation's population ages and as hospitals continue to improve their capability to care for critically ill patients.

Attitude of Health Personnel↗
PubMed1980

Ventricular ependyma of normal and hydrocephalic subjects: a scanning electronmicroscopic study.

Recent scanning electronmicroscopic studies of the ependymal surfaces of the lateral, third and fourth ventricles of a variety of animals have shown that most areas are covered by numerous cilia. In this paper, the density of the ciliary population in each of the ventricles is illustrated with material taken from human and rat brains. The authors' examination of Hy3 mice with hydrocephalus, and a number of other reports of examinations of animals with genetic and artificially induced hydrocephalus, have shown that the cilia are lost only from the ependymal surfaces covering those parts of the ventricular wall which are stretched and thinned by the raised intraventricular pressure. Thus the loss of the cilia is most probably the result of the hydrocephalus, and not its cause. Theories concerning the functions of the cilia are reviewed, and a new one accounting for why they are present in such large numbers is suggested. It is proposed that the cilia, together with the ventricular system and the cerebrospinal fluid, provide a cooling system for the brain.

Animals↗
PubMed1980

The influence of systemic aspirin on rat small diameter vein grafts: a scanning electron microscopic study.

Small diameter vein grafts have been shown previously to have a poor patency rate unmedicated rats. Oral aspirin administered to male and female rats for one week pre-operatively reduced the number of platelets laid down on the luminal surface of their grafts, and resulted in a greater number of grafts remaining patent up to one hour after the blood flow through them had been established. The patency rate of grafts examined one to 17 weeks after operation was significantly better in female rats than in males given aspirin pre- and post-operatively. The different effect of aspirin in preventing thrombosis of the vein grafts of the two sexes makes its clinical usefulness for this purpose suspect.

Animals↗
PubMed1979

Long-term effects of heparin on veins grafted into the common carotid arteries of rats--a scanning electron microscopic study.

Jump grafts made from veins with diameters of about 1 mm have very poor patency rates. Dissection and anastomosis damage the endothelia of the arteries and veins and expose collagen in the subendothelial layers of these vessels. Within 1 hr of the introduction of blood flow through the grafts, deposits of fibrin and platelets led to blockage of the grafts. In 9 rats, heparin was given intravenously about 0.5 hr before completion of the grafting procedure; heparin was also used to wash out the veins for grafting. In 11 rats, heparin was used only to wash out the veins for grafting. At periods 1-11 weeks later, the grafts were reexamined. All were patent except 1 from the first group, examined at 7 weeks, and 1 from the second group, examined at 10 weeks. Scanning electron microscopy showed that complete healing of the venous endothelium took several weeks. Heparin was equally effective in keeping the grafts patent when given intravenously and used locally or when only used locally. This study indicates, therefore, that long-term patency in small diameter vein grafts can be achieved merely by washing out the veins for grafting with a solution of heparin.

Animals↗