Medical and economic impact of breast cancer treatment and prevention.
Explore the source record for details and available documents.
Breast Neoplasms↗
Biomedical subjects
C A Lyles
Publications and source records attributed to C A Lyles.
The view from managed care pharmacy.
This stratified, national telephone survey of fifty-one managed care organizations concerns the perspectives of managed care pharmacy directors on pharmacoeconomics, disease management, and the roles of the pharmaceutical industry and the Food and Drug Administration (FDA). Respondents rated clinical effectiveness assessments as most useful, cost-effectiveness assessments second, and quality-of-life assessments as least useful. Peer-reviewed and industry literature were rated as equally important for decision making. Most plans would consider establishing a partnership with a drug company for disease management, if they have not already done so. Most plans (76 percent) support some form of FDA regulation of pharmacoeconomic claims. Conversely, 69 percent favor either no regulation (24 percent) or less stringent regulation (45 percent) than exists today.
Cost-Benefit Analysis↗
Does the hospital board need a doctor? The influence of physician board participation on hospital financial performance.
In this study, the authors attempted to determine if physician board participation enhances or impairs the operational performance of a hospital. Two theories--managerialism and agency theory--are compared to determine if participation on the hospital board by inside (i.e., medical staff) and outside physicians provides informational advantages (managerialism) or poses the threat for opportunism (agency theory). Using hospital operating margin to measure hospital performance for a 4-year period (1985-1988), the findings indicate that boards with inside physician (medical staff) participation had significantly better performance than those without such physician participation. Supportive of the managerialist perspective, the findings strongly suggest that medical staff board participation can enhance operational performance. Implications of physician-hospital relations for future hospital strategies as well as health care reform issues are discussed.
Data Collection↗
Diagnostic blood loss in the patient undergoing head and neck surgery.
OBJECTIVE: To examine retrospectively the amount of blood lost solely for diagnostic purposes in a defined group of patients. DESIGN: Retrospective medical chart review of a case series. SETTING: Operating theater and surgical intensive care unit in a major tertiary care center. PATIENTS: Thirty-nine consecutive patients with head and neck cancer undergoing major surgical procedures and requiring overnight intensive care unit monitoring. MAIN OUTCOME MEASURES: Patient medical records were analyzed for procedure, starting hematocrit reading, intraoperative estimated blood loss and intravenous fluids, operative time, history of blood product transfusion, blood lost for each phlebotomy encounter, and the immediate cost therefrom. RESULTS: The mean diagnostic blood loss was 181 mL, which was 36% of estimated blood loss. In the group of 23 nontransfused patients, the average drop in hematocrit was 9.7%. This change in hematocrit correlated most strongly with operating time (P < .02) and the amount of intraoperative intravenous fluid administration (P < .05). The average cost to the patient directly from phlebotomy-associated charges was $542. CONCLUSION: Diagnostic blood loss contributes significantly to the overall blood loss in the patient undergoing head and neck surgery.
Blood Loss, Surgical↗
Hospital board effectiveness: relationships between governing board composition and hospital financial viability.
OBJECTIVE: Two theories--agency and managerialism--are compared with respect to their usefulness in explaining the role of insiders on the hospital board: whether their participation enhances or impairs board financial decision making. DATA SOURCES/STUDY SETTING: The study used 1985 hospital financial and governing board data for a representative sample of acute care California hospitals. STUDY DESIGN: Relationships were examined cross-sectionally between the presence or absence of insiders on the board and measures of hospital financial viability while controlling for the organizational factors of system affiliation, ownership, size, region, and corporate restructuring. PRINCIPAL FINDINGS: Multiple regression analysis found significant relationships between insider (CEO, medical staff) participation and hospital viability. CONCLUSIONS: These results support the managerial theory of governance by suggesting that the CEO and medical staff provide informational advantages to the hospital governing board. However, the cross-sectional design points to the need for future longitudinal studies in order to sequence these relationships between insider participation and improved hospital viability.
Analysis of Variance↗
Hospital board effectiveness: relationships between board training and hospital financial viability.
This study examined whether hospital governing boards that invest in board education and training are more informed and effective decision-making bodies. Measures of hospital financial viability (i.e., selected financial ratios and outcomes) are used as indicators of hospital board effectiveness. Board participation in educational programs was significantly associated with improved profitability, liquidity, and occupancy levels, suggesting that investment in the education of directors is likely to enhance hospital viability and thus increase board effectiveness.
Bed Occupancy↗
Repair of peripheral nerves of unequal diameters.
Four techniques for anastomosis were investigated for the anastomosis of a large proximal segment to a smaller distal segment of rat peripheral nerve with a size disparity of approximately 3 to 1. The techniques were perineural sutures (group I), KTP laser annealing (group II), collagen tubes with a 5-mm gap between the nerve segments (group III), and collagen tubes without a gap between the nerve ends (group IV). At 6 weeks there were no gross nerve distractions in groups I or IV. There were two failures in group II and three in group III. The percentage of fibers that crossed intact anastomoses were: group I, 89%; group II, 75%; group III, 115%; group IV, 125% (P less than .05 for the collagen tube repairs). Our results indicate that the suture technique is still the most reliable method of nerve repair. However, collagen tubes were effective in increasing the percentage of axons crossing the anastomosis.
Anastomosis, Surgical↗
Idiopathic sudden sensorineural hearing loss.
Idiopathic sudden sensorineural hearing loss remains one of the major unsolved otologic emergencies. In this paper the most important recent clinical literature is reviewed, a new method of clinical staging is presented, and unexplored potential treatments are presented. The method of clinical staging presented here is based on four elements represented by the acronym HEAR. The individual elements of the staging are hearing threshold (H), elapsed time from onset (E), audiogram shape (A), and related vestibular symptoms (R). Insufficiently explored potential treatments of sudden hearing loss include antiviral drugs, rheologic agents, and free radical scavengers.
Antiviral Agents↗
Effect of ligating peripheral branches on facial nerve regeneration.
Bilateral transection and reanastomosis of the main trunk of the facial nerve was performed on 18 rats. On one side of each rat, all peripheral branches except the mandibular branch were ligated with silk suture and divided distal to the ligatures. Axon counts after 1, 3, and 6 months showed a statistically significant increase in the number of axons in both the mandibular branch and the main trunk on the side with the peripheral ligation. These data indicate that peripheral branch ligation is a useful adjunct in facial nerve rehabilitation.
Action Potentials↗
Hospital ownership and psychiatric services. Implications of ownership and reimbursement changes on lengths of stay and availability of services.
Dramatic increases have occurred in the proportion of for-profit hospitals in the general hospital sector; even more pronounced increases have occurred within the psychiatric sector. Concomitant with this changing mix of ownerships, revised reimbursement plans are being proposed for psychiatry. Thus, providers of acute psychiatric inpatient care, although loosely aggregated, constitute a service system that is experiencing dynamic revision. This article examines the implications of these changes for health policy analysts and planners in the design of hospital payment mechanisms and in planning for resources to meet the needs of the public. The state of California is viewed as a system, and data from the state are examined to test traditional assumptions of economic behavior when less costly substitute services are available. The availability of services such as outpatient clinics, emergency psychiatric services, and partial hospitalization are found to vary according to hospital ownership. Differences in availability of these services influence the access to inpatient care experienced by various populations within the defined system. Although these services may permit earlier discharge from the hospital, the poor insurance coverage of ambulatory psychiatric care relative to inpatient hospitalization distorts this effect. The implications of these findings for public policy are discussed.
California↗