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Biomedical subjects

S M Homan

Publications and source records attributed to S M Homan.

32 records · Page 2Linked to original sources
PubMed1987

Independent value of signal-averaged electrocardiography and left ventricular function in identifying patients with sustained ventricular tachycardia with coronary artery disease.

To determine if the signal-averaged electrocardiographic detection of late potentials is an independent marker of sustained ventricular tachycardia (VT) in patients with documented chronic coronary artery disease (CAD), 57 patients underwent signal-averaged electrocardiography. Mean ejection fraction was 47 +/- 13% in the 14 patients with sustained VT and 56 +/- 19% in the 43 patients without VT (difference not significant). The sensitivity, specificity and accuracy of late potentials for detecting patients with VT were 64% (9 of 14), 79% (34 of 43), and 75% (43 of 57), respectively. Univariate analysis and stepwise logistic regression of angiographic and electrocardiographic variables identified late potentials as an independent marker of the patient with sustained VT. The odds ratio for late potentials to detect patients with prior sustained VT was 2.6. Six-month follow-up revealed a cardiac mortality rate of 11% and an arrhythmia event rate of 22% in patients with late potentials vs a cardiac mortality rate of 3% and an arrhythmia event rate of 13% in patients without late potentials. Thus, signal-averaged electrocardiographic detection of late potentials is useful in identifying patients with prior sustained VT independent of left ventricular function.

Adult↗
PubMed1987

Enteral feeding in very-low-birth-weight infants. A comparison of two nasogastric methods.

Nutritional benefits and feeding-related complications were prospectively compared in 53 preterm very-low-birth-weight infants receiving isoenergetic feeding by either the continuous nasogastric (n = 30) or intermittent nasogastric (n = 23) route. Stepwise regression techniques were used to develop models relating feeding-associated factors. Feeding method significantly affected weight gain in infants 1000 to 1249 g birth weight with continuous nasogastric feeding associated with an additional weight gain of 3.6 to 6.1 g/kg/d. No effects of feeding method on changes in occipitofrontal circumference, triceps skin-fold thickness, bilirubin values, or total protein values were demonstrable. There were few major differences between feeding groups on measures of feeding complications. Continuous nasogastric feeding was fairly well tolerated and resulted in improved weight gain when compared with intermittent nasogastric feeding in preterm infants 1000 to 1249 g birth weight.

Body Weight↗
PubMed1987

In vitro cyanide release from sodium nitroprusside.

In vitro release of cyanide from sodium nitroprusside in 5% dextrose in water solution following exposure or non-exposure to fluorescent light (500 ft candles or 791 microwatt per square cm [muWcm-2]), was measured by a cyanide-specific ion electrode at 4, 8, 24, 48, and 72 h. The cyanide concentrations were significantly increased at 24 h in the light-exposed solution. In this group, 100% of the cyanide was released from sodium nitroprusside at 72 h exposure to light. However, cyanide concentrations showed no significant changes for 72 h in the light-protected solutions, which were either exposed to 500 foot candles fluorescent light or stored in a dark room. Less than 2.5% of the cyanide was released from sodium nitroprusside at 72 h in both of the light-protected groups. No significant differences in cyanide concentrations were observed at 8 h among the exposed or non-exposed solutions. After 24 h of exposure, the cyanide concentrations in the exposed group were significantly higher than those of the two light-protected solutions. However, there were no significant differences between the cyanide concentration in the light-protected solutions. These results substantiate the safety of sodium nitroprusside solution for 24 h if the sodium nitroprusside containing solutions are properly protected from light. An additional study performed showed that a significant amount of cyanide released from sodium nitroprusside was adsorbed to the surface of polyvinylchloride.

Cyanides↗
PubMed1987

Glomerular basement membrane and lamina densa in infants and children: an ultrastructural evaluation.

The glomerular basement membrane and lamina densa are complex structures that change in composition and thickness with age. We studied their ultrastructural morphology in 37 infants and children, from 1 day to 11 years of age, who died without clinical or morphological evidence of renal disease. The glomerular basement membrane and its lamina densa rapidly increase in width during the first 2 years of life, followed by continued, albeit slower, growth during later childhood.

Aging↗
PubMed1987

Value-based leadership: are Catholic hospitals a step ahead?

An organization's culture is a pattern of beliefs and expectations shared by its members. It produces norms that shape behavior to ensure that the organization's day-to-day operations reflect the shared values. If the organization's performance is to be enhanced, these values not only must be communicated to all members but also must be internalized by them. Do managers in the Catholic health care ministry have sufficient understanding of their organization's culture as well as that of the sponsoring religious institute? A recent study to assess managers' educational needs contained a set of questions that addressed this particular issue. Responses to the survey, offered to acute care hospitals in the St. Louis metropolitan area, indicated that managers in Catholic health care organizations consider finance and accounting, planning, and interpersonal skills to be more important than the sponsoring religious institute's values in performing their jobs. Such a finding suggests the need for formal training in the mission and role of the Catholic health care ministry and for the continued use of mission effectiveness programs to assist in imparting the religious sponsor's charism and values to employees.

Attitude of Health Personnel↗
PubMed1987

Survey. Part I. Hospital department heads and planning: determining and answering the need for continuing education.

Planning skills are necessary to all line managers for effective performance of their jobs. It is doubtful whether hospital senior managers would disagree with this statement for any line managers whom they supervise. As with all management skills, continuing development and enhancement of planning skills are needed if a manager is to be up-to-date on current ideas and able to contribute fully to the organization's planning process. From this premise two questions arise: Do hospital line managers perceive a need for continuing development of their planning knowledge and skills? Does level in the organization (senior managers versus department heads) affect perception of these continuing education needs? This two part series describes a systematic investigation of the continuing education needs of hospital department heads in a Midwestern metropolitan area. Second, it compares department heads' perceptions of their own needs for continuing education in planning techniques and processes with the perceptions of senior managers regarding their department heads' needs. Differences in perceptions of the two management groups are explored and investigated. Finally, there are suggestions as to how department heads' continuing education needs can be effectively ascertained and met.

Data Collection↗
PubMed1987

Hospital department heads and planning. Part II: Determining and answering the need for continuing education.

Planning skills are necessary to all line managers for effective performance of their jobs. It is doubtful whether hospital senior managers would disagree with this statement for any line managers whom they supervise. As with all management skills, continuing development and enhancement of planning skills are needed if a manager is to be up-to-date on current ideas and able to contribute fully to the organization's planning process. From this premise two questions arise: Do hospital line managers perceive a need for continuing development of their planning knowledge and skills? Does level in the organization (senior managers versus department heads) affect perception of these continuing education needs? This two part series describes a systematic investigation of the continuing education needs of hospital department heads in a Midwestern metropolitan area. Second, it compares department heads' perceptions of their own needs for continuing education in planning techniques and processes with the perceptions of senior managers regarding their department heads' needs. Differences in perceptions of the two management groups are explored and investigated. Finally, there are suggestions as to how department heads' continuing education needs can be effectively ascertained and met.

Attitude of Health Personnel↗
PubMed1986

Widowhood, sex, labor force participation, and the use of physician services by elderly adults.

This paper investigated the relationships of widowhood, sex, and labor force participation with the use of ambulatory physician services by elderly adults. Data on 18,441 individuals aged 55 and over were taken from the 1978 Health Interview Survey. Hierarchical regression results indicated that although these three factors are related to physician utilization at the zero- and first-partial levels, only sex remained significant when their two- and three-way interactions and other variables from the behavioral model (including living arrangements) were introduced. This suggests that the effects of widowhood and labor force participation are spurious. Widows are simply more likely to live alone and are less likely to work than widowers; those who live alone and do not work are more likely to use health services (and more of them) than those who live with others and are gainfully employed.

Aged↗
PubMed1985

Veterans' and nonveterans' use of health services. A comparative analysis.

This study compares the use of health services by veterans with that by nonveterans; compares the use of health services by veterans from different service cohorts with each other; and examines the correlates of veterans' use of the VA health care delivery system. After adjusting for differences in the predisposing, enabling, and need characteristics, there were virtually no meaningful differences in the use of health services between veterans and nonveterans. This suggests that health care planning within the VA can proceed similarly to health care planning for the civilian population, albeit taking into consideration the significant difference in the sex distribution between the two populations. Virtually no meaningful or consistent veteran cohort effects on the use of health services were found. This suggests that health care planning within the VA may proceed without regard to changes in the nature of the veteran cohort structure. Finally, although there was a strong and obvious effect of service-connected disabilities (high-priority eligibility due to health status) on the use of the VA health care delivery system for veterans, there was no effect of being 65 years of age and older (high-priority eligibility due to age) on the use of the VA. Aside from service-connected disabilities, limited access to other health care delivery systems was the major factor behind the demand for VA care.

Aged↗
PubMedDate not supplied

Intraoperative autologous blood salvage with cardiac surgery: an analysis of five years' experience in more than 3,000 patients.

STUDY OBJECTIVE: To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery. DESIGN: Retrospective statistical analysis. SETTING: University hospital. PATIENTS: Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988. INTERVENTIONS: A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery. MEASUREMENTS AND MAIN RESULTS: The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 +/- 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable. CONCLUSION: Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.

Blood Substitutes↗
PubMedDate not supplied

Determining transition probabilities: confusion and suggestions.

Confusion regarding proper use of the terms rate and risk persists in the literature. This has implications for the proper modeling of prognosis and transition between health states in decision analysis and related techniques. The issue is complicated by the plethora of terms related to rate and risk. Although the suggestion to use the terms force and probability as substitutes for rate and risk has some appeal, the change in terminology by itself is unlikely to solve all the confusion or misuse of terms. This paper clarifies the proper definitions and estimations of rates and risks and suggests critical factors for the decision analyst to remember when using, modeling, or interpreting transition rates and risks.

Actuarial Analysis↗