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Biomedical subjects

D E Fetterolf

Publications and source records attributed to D E Fetterolf.

8 recordsLinked to original sources
PubMed1998

The use of inexpensive computer-based scanning survey technology to perform medical practice satisfaction surveys.

The recent availability of inexpensive document scanners and optical character recognition technology has created the ability to process surveys in large numbers with a minimum of operator time. Programs, which allow computer entry of such scanned questionnaire results directly into PC based relational databases, have further made it possible to quickly collect and analyze significant amounts of information. We have created an internal capability to easily generate survey data and conduct surveillance across a number of medical practice sites within a managed care/practice management organization. Patient satisfaction surveys, referring physician surveys and a variety of other evidence gathering tools have been deployed.

Electronic Data Processing↗
PubMed1991

Quality assurance without tears.

The drive to improve the quality of our health care system is daily forced by numerous factors which need little elaboration. Needless to say, major changes are about to occur in the way health care is delivered, not only regionally but also nationally. Farsighted individuals or institutions will take steps to survive in a destabilizing health care market. They must learn the new language of quality.

Hospital Administration↗
PubMed1986

In vivo bone lead measurements: a rapid monitoring method for cumulative lead exposure.

Lead concentrations (microgram/g wet weight) in human bone (tibia) were measured noninvasively in vivo employing an X-ray fluorescence technique. Forty-five workers who had been subjected to chronic industrial exposure were found to have a mean bone lead content of 52.9 micrograms/g wet weight (0 to 198 micrograms/g). In addition to bone lead content, blood lead, body burden of lead as assessed by urinary lead excretion after EDTA chelation, zinc protoporphyrin, and unstimulated urinary lead excretion were evaluated. The results suggest that the in vivo measurement of tibia lead content may serve as an acceptable indicator of body lead burden and provide a practical technique for lead screening purposes. The correlation coefficient between X-ray fluorescence findings and lead excretion following Ca-EDTA administration is 0.69; p less than 0.001.

Bone and Bones↗
PubMedDate not supplied

Effects of elevated lead and cadmium burdens on renal function and calcium metabolism.

To assess the pathophysiologic significance of increased body burdens of lead and cadmium, detailed renal function studies and evaluation of calcium, phosphorus, and vitamin D metabolism were carried out in 38 industrial workers exposed to lead and cadmium for 11 to 37 yr. Body burden of lead, as assessed by x-ray fluorescence measurement of tibia lead content, was elevated in 58% of the men and, when assessed by excretion of lead after Ca-EDTA infusion, was elevated in 36%. Liver or kidney cadmium burden, as assessed by neutron activation analysis, was elevated in 31%. Creatinine clearance was normal in all workers. One worker was hyperuricemic and two were proteinuric; three had increased beta 2 microglobulin excretion and one had diminished urinary acidifying ability. Maximal urinary concentrating ability was abnormal in a significant fraction, i.e., 52% of the men. Individuals with a high lead burden had a slight decrease in mean serum phosphorus but no accompanying phosphaturia. There was no abnormality of serum calcium. Twenty-two percent of subjects were hypercalciuric and two had low vitamin D levels, but these abnormalities bore no relation to heavy metal burden. In this carefully characterized group of men with chronic lead and calcium exposure, definite, if subclinical, effects on renal function and serum phosphorus but not calcium or vitamin D metabolism were demonstrable.

Adult↗
PubMedDate not supplied

A framework for evaluating underutilization of health care services.

Underutilization is becoming increasingly recognized as an area of importance in managed care, where aggressive measures to control overutilization are creating concern among the general public. The author sought solid definition of underutilization and methods for its evaluation in the medical literature but was impressed at the small number of peer-reviewed articles on the subject. A review of key issues is discussed, including a number of methods a health plan may use to approach the identification of underutilization within its domain. Methods include the use of "gold standard" population health requirements; statistically defined underutilization; second-order, combined variables; and socially defined underutilization. Sample statistics identified within the author's plan are identified, and recommendations for their implementation and use are made.

Guideline Adherence↗
PubMedDate not supplied

Medical informatics.

Explore the source record for details and available documents.

Data Collection↗
PubMedDate not supplied

The use of imperfect data in managed care organizations.

Two critical milestones appear to be occurring in the development of medical groups moving to improve medical care effectiveness. These include the abilities to work with imperfect and unflattering data. There is a clear linkage between these two concepts, because forward clinical improvement or business planning is often delayed as individual physicians seek to await "perfect data" when confronted with unflattering information. In the form of "profiles" in particular, providers often react negatively, with complaints that the information is "imperfect" or that it fails to capture some nuance of their sicker or unique patient populations. The translation of imperfect information to effective clinical practice anyway remains a success fundamental to managing highly competitive medical groups and health plans. It is centrally dependent on the understanding, use, and application of "imperfect data".

Creativity↗