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Biomedical subjects

S J Jay

Publications and source records attributed to S J Jay.

At least 55 records · Page 3Linked to original sources
PubMed1988

Malpractice, ethics, and resident training.

Although patient care issues will become more complex, the basic ingredients of ethical and legally "safe" medicine will remain-quality medical care buttressed by quality patient-physician relationships. Teaching hospitals and program directors must assist residents in accomplishing these goals. Our successes will lead to further improvement in the quality of patient care and medical education-and hopefully to a better end than the "big crunch" proposed by Hawking.

Ethics, Medical↗
PubMed1988

Effect of storage temperature and shaking rate on pH and blood-gas results for two quality-control products.

Directions for pre-analytical handling of ampules of two commercially available aqueous quality-control products (contrlL and G.A.S.) contain vague instructions such as "store at room temperature" and "shake vigorously" before analysis. We examined the effect of different storage temperatures (25, 31, and 38 degrees C) and shaking rate (one, two, and four shakes per second) on pH and blood-gas results. For both products, increasing the storage temperature significantly decreased pO2 results, the magnitude of the bias being greatest for those solutions with the highest O2 tensions. However, increasing the shaking rate partly offset this bias. Increasing storage temperature also decreased results for pCO2 and increased results for pH for both manufacturers' ampules with the highest CO2 tensions, and this bias was not offset by increasing the shaking rate. We conclude that both storage temperature and shaking rate must be precisely defined and carefully monitored before these products are used in a quality-control program.

Blood Gas Analysis↗
PubMed1988

Informal communication networks and change in physicians' practice behavior.

This study used influential physicians to disseminate information concerning the advantages of developing and using computer-stored personal order sets with a hospital information system. The results indicate that continuing medical education delivered through influential physicians is an effective way of changing physicians' practice behavior.

Communication↗
PubMed1986

Physician utilization of computers in medical practice: policy implications based on a structural model.

The development of policies regarding computer-based medical technology is hampered by a lack of knowledge about the process by which such applications are adopted and utilized by physicians. This study was designed to test a model of the process by which physicians change their practice behavior by utilizing a computer-based hospital information system (HIS). A structural model was developed, estimated, and tested using data from 270 members of the medical staff of a 1160 bed, private teaching hospital. The overall model consists of a measurement model which assumes that the observed variables are generated by a smaller number of unobserved variables or factors; and a structural equation model that relates exogenous and endogenous variables. The model indicates that consultation with other physicians on a hospital service leads to greater exposure to potential computer applications resulting in less concern about the potential impact of computers on medical practice. Physicians who are more knowledgeable about computers are far more likely to tailor the system to their individual practice by developing their own personal order sets for use on the HIS. All of these factors result in increased use of the HIS by physicians. A number of policy implications related to the introduction of new computer-based technology into medical practice settings are discussed.

Attitude to Computers↗
PubMed1986

Pleural effusions. 1. Preliminary evaluation--recognition of the transudate.

Part 1 of this two-part article describes how to document the presence and location of pleural effusion, perform thoracentesis, and differentiate transudates from exudates. If the pleural fluid is found to be a transudate, no further tests are indicated. Part 2, starting on page 181, details pleural fluid analysis, describes pleural biopsy and thoracoscopy, and presents a clinical strategy for evaluating pleural effusion.

Diagnosis, Differential↗
PubMed1986

Pleural effusions. 2. Definitive evaluation of the exudate.

Based on the current literature, the following steps seem reasonable in evaluating a pleural effusion: document the presence, location, and approximate volume of pleural fluid; decide clinically on the likelihood of an exudative effusion; if clinical evaluation suggests an exudative effusion, perform a thoracentesis and obtain fluid for diagnostic evaluation; perform the necessary tests to characterize the effusion as a transudate or an exudate; if a transudate exists, normally do not perform further tests on the effusion; if an exudate exists, perform selected tests to narrow the differential diagnosis; if this evaluation is undiagnostic, consider closed pleural biopsy; if the diagnosis remains unclear after two closed biopsies, consider pleuroscopy with biopsy or open pleural biopsy at the time of a thoracotomy.

Amylases↗
PubMed1986

Why doctors don't use computers: some empirical findings.

The attitudes of 148 medical students, 141 residents, and 644 practising physicians towards computer applications in medicine were studied. The results indicate that physicians recognize the potential of computers to improve patient care, but are concerned about the possibility of increased governmental and hospital control, threats to privacy, and legal and ethical problems. In general, all three groups are uncertain as to the potential effects of computers on their traditional professional role and on the organization of practice. Practising physicians, however, express more concern about these potential effects of computers than do medical students and residents. While attitudes appear to be somewhat independent of prior computer experience, they significantly affect the extent to which physicians use a computer-based hospital information system. This may be a major reason for the slow introduction of clinical computer systems.

Attitude of Health Personnel↗
PubMed1985

Serum angiotensin converting enzyme activity in patients with psoriasis.

Serum angiotensin converting enzyme activity is frequently increased in patients with active sarcoidosis. In spite of a reported association between sarcoidosis and psoriasis, serum angiotensin converting enzyme activities have not been reported for patients with psoriasis. We found the mean (SD) angiotensin-converting enzyme activity for 51 healthy subjects was 18.6 (5.8) kU/l, but for 52 patients with psoriasis without coexisting sarcoidosis, it was 28.3 (6.7) kU/l. There is a significant difference between these means (p less than 0.01). Forty-two percent (22/52) of the psoriasis patients had an increased serum angiotensin converting activity. Other diseases sometimes associated with an increased serum angiotensin converting enzyme activity were excluded as possible causes of a elevated activity in our patients with psoriasis. We conclude that almost half of the patients with psoriasis will have an elevated serum angiotensin converting enzyme activity, even when coexisting sarcoidosis is absent.

Humans↗
PubMed1985

Computers and clinical judgment: the role of physician networks.

In order to study the relationship between physician networks and utilization of a computer-based hospital information system (HIS), blockmodel analysis and multidimensional scaling were used to analyze and spatially represent the network of professional relations among 24 physicians in a private group practice. A blockmodel analysis of patient referrals, consultations, discussions, and on-call coverage identified four groups of physicians who share common locations and perform similar roles within the network. Investigation of the shared attributes of these groups supports this relational structure. The results suggest that the center-periphery model of diffusion of new ideas among professionals may be too simplistic. Instead, the communication network may involve multiple central cohesive subgroups of physicians who differentially initiate patient referrals and consultations with physicians in other subgroups. Network location was found to have a significant effect on the adoption and utilization of the HIS independently of background and practice characteristics of physicians. The results also suggest that adoption of an innovation and its implementation or utilization may involve separate processes that need to be differentiated in future research.

Computers↗
PubMed1985

Diagnostic procedures for pleural disease.

Using a systematic approach based upon findings obtained from the patient's history, physical examination, routine laboratory studies, and chest roentgenograms, the clinician will establish the presence and location of pleural effusion in the majority of cases. The selective use of tests based upon the clinician's initial diagnostic impressions will allow accurate separation of transudative from exudative effusions; exudative effusions will be diagnosed in over 85 per cent of patients. There remain many unanswered questions regarding the diagnosis of pleural effusion. Prospective studies are needed to establish diagnostic algorithms that minimize under- and overutilization of tests. The introduction of Medicare Prospective Reimbursement under Diagnosis-Related Groups (DRGs) on October 1, 1983, may provide the appropriate incentives to hospitals and clinicians to carry out these important studies.

Amylases↗
PubMed1983

Serum angiotensin converting enzyme activity in patients with histoplasmosis.

The association between increased serum angiotensin converting enzyme (ACE) activity and active sarcoidosis is well documented. During a recent outbreak of acute histoplasmosis, a disease that shares many of the clinical and roentgenographic features of sarcoidosis, we examined serum ACE activity. Twenty-one (25%) of 86 patients with histoplasmosis had increased serum ACE activity. There were neither roentgenographic nor other substantive clinical differences between the groups of patients with increased and normal ACE values. Therefore, an increase in serum ACE activity must not be assumed to be caused by sarcoidosis unless histoplasmosis had been excluded.

Acute Disease↗
PubMed1983

The role of physician networks in the diffusion of clinical applications of computers.

This study utilizes network analysis to examine the process by which physicians adopt and utilize computers in providing patient care. It also demonstrates how network techniques can be used to determine the role and position of individual physicians in their professional network and to develop educational programs designed to increase the clinical use of computers.

Communication↗
PubMed1983

Nosocomial infections.

Recent developments in the understanding of nosocomial infection in general and nosocomial respiratory infections in particular are elucidated. Although the discussion focuses on aerobic bacteria, data are presented to indicate the growing realization that unusual and newly discovered microorganisms play a significant role in hospital-acquired infections. Strategies for the control or prevention of nosocomial infections are highlighted.

Critical Care↗
PubMed1983

Utilization of computers in clinical practice--role of physician networks: preliminary communication.

This study examines the influence of physician networks on the utilization of computers in clinical practice. Data on patient referrals, consultations, professional discussions, and on-call coverage were collected from 24 physicians who comprise a private group practice. Their utilization of a computerized hospital medical information system (HIS) in caring for patients admitted to a 1160-bed private, university affiliated, teaching hospital was determined. A matrix representing the professional relations among these physicians was subjected to smallest space analysis, a form of multidimensional scaling. Also, a number of indices that describe structural and interactional properties of the network and individual physicians were computed. The three-dimensional representation of the network that resulted from the analysis suggests a two-step process of adoption and utilization of medical technology. Physicians who were engaged in outside professional activities and in the training of medical students and house staff were more likely to utilize the system in caring for patients. These physicians, who were more centrally located and dominant in the referral and consultation process, were more likely to influence the practice patterns of their colleagues. The use of network analysis to identify influential physicians whose involvement is essential to the success of efforts aimed at introducing computers into clinical practice is discussed.

Computers↗
PubMed1982

Recurrent postictal pulmonary edema: a case report and review of the literature.

A 37-year-old woman with a post-traumatic seizure disorder had four well-documented episodes of postictal acute pulmonary edema and respiratory failure. Subtherapeutic blood concentrations of phenytoin were documented on each admission. Each episode followed one or more grand mal seizures and was characterized by the development of diffuse nodular-appearing alveolar infiltrates, tachypnea, and severe hypoxemia that rapidly resolved with supportive therapy. There was no evidence of gastric acid aspiration, acute lung infection, or underlying heart or lung disease. To determine the frequency of postictal pulmonary edema in our institution, we reviewed the clinical records and chest roentgenograms of 45 consecutive patients who were admitted to our emergency room following a well-documented grand mal seizure. Only one patient (described in this report) had chest roentgenographic evidence of pulmonary edema. A review of the English literature revealed only 11 reported cases of postictal pulmonary edema since 1965 and a total of 42 episodes in 27 patients since 1908. There were no clearly documented cases of postical pulmonary edema following electroconvulsive therapy in 18 published reports totaling more than 38,000 subjects. Our findings suggest that while postictal pulmonary edema may occur repeatedly in the same patient, the overall frequency of this complication is low.

Adult↗