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Biomedical subjects

W A Gliebe

Publications and source records attributed to W A Gliebe.

16 recordsLinked to original sources
PubMed1981

Misguided surveillance: public actions and medical care assessment.

The public has accused physicians of overusing or misusing ancillary services and clinical laboratory tests, and government agencies have been entrusted to help eliminate performance of these so-called unnecessary services. Here, the author documents the confused and contrary evidence that became the basis of established public policies toward monitoring physician performance or behavior. In next month's issue, the author will examine physicians' roles in medical care assessment.

Laboratories↗
PubMed1981

Misguided surveillance: physicians' roles in medical care assessment. Part II.

In his article last month, Mr. Gliebe showed that no consensus has been reached on what the indicators of quality of medical care are actually measuring. In this article, he emphasizes that judgments of overuse or misuse of ancillary services and laboratory tests cannot be made without first judging quality of care, yet quality measurement capabilities are minimal. He maintains that since medical care review is mandated, it should be based on valid data obtained from the clinician involved in the patient's treatment. Thus, he suggests as a possible solution focusing on the individual clinical case.

Health Services↗
PubMed1979

Student peer review of diagnostic tests at the Medical College of Ohio.

Students in their clinical clerkship performed retrospective reviews of their peers' laboratory usage patterns. Data covering the patient's history and physical examination, problem list, and treatment plan had been completed by students during internal medicine and pediatrics rotations. This information, along with the first day's diagnostic orders, was provided to community medicine clerkship students who then evaluated the cost and medical necessity of diagnostic tests ordered in light of the problem information. Application of such cost control programs, before students form definitive conceptions of treatment, may contribute to more cost-conscious behavior in their future medical practice.

Clinical Laboratory Techniques↗
PubMed1979

Involuntary deviance: schooling and epileptic children.

There exists in schools an unwritten set of presuppositions defining "normalcy." Students going beyond these boundaries of normalcy are encouraged (sometimes punitively) to change their behaviors. However, there is a growing awareness that not all children going beyond normalcy do so willingly. The phenomenon here termed "involuntary deviance" represents a way of perceiving and dealing with special students. An example, the case of children with epilepsy, is presented to illustrate the need for health educators and other educators to be familiar with such medical problems and, among their students, to help decrease the social stigma attached to some of these conditions. This need will become more urgent as the practice of mainstreaming students becomes increasingly prevalent.

Attitude↗
PubMed1978

Diagnostic testing as a cost factor in teaching hospitals.

The interpretation of laboratory tests by resident physicians is an integral part of the process of medical education. Therefore, the resident's awareness of the validity, reliability, and usefulness of laboratory tests and their alternatives, coupled with an analytical dialog between the supervising attending physician and the resident can help limit the ordering of diagnostic tests to what is logically and scientifically appropriate. Such a dialog may partially address the issue of teaching cost-effectiveness within the graduate medical education curriculum.

Costs and Cost Analysis↗
PubMed1978

Evaluating inpatient costs: the staging mechanism.

Inpatient records at a short-term hospital over two years were analyzed according to the stage or degree of severity of their discharge diagnosis to examine their utilization of services. Patients with a more severe disease stage for surgical and medical conditions generated substantially higher total charges, ancillary charges, and had longer lengths of stay. At the 75th percentile (representing that value at which three-quarters of the cases fall below it in magnitude), increases in total charges from Stage I to II for ulcer of stomach, appendicitis, and diverticulitis were 103, 168, and 110 per cent, respectively. Ancillary charges for these diseases showed even greater increases, 167, 200, and 160 per cent, respectively. Components of ancillary charges revealed similar trends. The results suggest that a twofold review mechanism incorporating length of stay and charges, using the staging technique, would make the review procedure more discriminating in identifying cases appropriate for review.

Costs and Cost Analysis↗
PubMed1978

Diagnostic testing as a cost factor in teaching institutions.

Clinical data are analyzed to examine the degree of reliance residents in training place on diagnostic tests and procedures in patient management and the extent of educational costs incurred for patient care in a teaching hospital. To help limit the ordering of diagnostic tests, resident trainees need to be kept aware of the validity, reliability, and diagnostic utility of specific laboratory tests in certain clinical situations.

Diagnostic Services↗
PubMedDate not supplied

Faculty consensus as a socializing agent in professional education.

To assess the effectiveness of the professional socialization process in a professional school, this study focused on emerging attitueds of nursing students, perceived limits of their role, nursing autonomy, and rights of patients. Student attitudes were compared to attitudes of instructors to determine if socialization was taking place. Consensus among student attitudes was found to increase during the educational program, and attitudes of nursing students did approach those of their instructors. Degree of faculty consensus was suggested as a major determinant of the effectiveness of the socialization process in professional schools.

Attitude of Health Personnel↗