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Biomedical subjects

G Gifford

Publications and source records attributed to G Gifford.

14 recordsLinked to original sources
PubMed1994

The effects of scheduled intern rotation on the cost and quality of teaching hospital care.

We studied the effect of scheduled intern rotations on the cost and quality of inpatient care at one teaching hospital. For all discharges from the internal medicine service between 1980 and 1986, we identified 1,705 rotation patients and 3,141 no-rotation patients. Using linear or logistic regression analysis to control for baseline differences, we evaluated for the effect of rotation. We found that rotation was significantly related to longer length of hospital stay, b = 0.341 days, p = 0.001, and higher hospital charges (for log charges, b = 0.053, p = 0.016. Hospital deaths, nursing home placements, and 30-day readmissions were not significantly related to rotation, p > 0.1. These results suggest that the systematic discontinuity induced by scheduled intern rotations may be another source of increased health care costs experienced at teaching hospitals.

Continuity of Patient Care↗
PubMed1993

The effect of HMOs on premiums in employment-based health plans.

This study documents the effect of HMOs on premiums in employment-based health plans. We analyzed a survey of Minnesota employers conducted in 1986. Among 922 usable observations, 239 firms offered HMOs in addition to fee-for-service (FFS) health plans. We estimated an equation for the probability of offering an HMO, followed by equations for HMO enrollment share, and HMO and FFS premiums. The weighted average HMO and FFS premium in firms that offer HMOs was compared to the premium of FFS-only firms. We found that offering an HMO raises the average premium for family coverage health insurance by $25.14 per month and for single coverage by $3.68 per month. This effect was smaller for firms in the Twin Cities metropolitan area. HMOs may be viewed as a progressive and innovative health care benefit, but they are likely to increase firms' health insurance premiums.

Cost Sharing↗
PubMed1992

A new intraoral flap: facial artery musculomucosal (FAMM) flap.

By combining the principles of nasolabial and buccal mucosal flaps, we have designed a new axial musculomucosal flap based on the facial artery. This flap has been designated the facial artery musculomucosal (FAMM) flap. The flap has proven to be reliable either superiorly based (retrograde flow) or inferiorly based (antegrade flow). It is versatile and has been used 18 times in 15 patients, with one failure and two partial losses. It has been used successfully to reconstruct a wide variety of difficult oronasal mucosal defects, including defects of the palate, alveolus, nasal septum, antrum, upper and lower lips, floor of the mouth, and soft palate.

Adolescent↗
PubMed1991

A simultaneous equations model of employer strategies for controlling health benefit costs.

We estimated a simultaneous equations model of employer health insurance cost control strategies and their effectiveness in reducing health plan premiums. We hypothesized that as premiums increase, employers will shop more actively for health plans, place incentives on providers to control medical care costs, increase employee cost sharing for medical care, and be more likely to offer an HMO. In turn, we expected each of these strategies, except offering an HMO, to reduce average health plan premiums. The model was estimated with 1985 data from a sample of 922 Minnesota employers. We found that high premiums are related to three of the proposed cost control strategies. Employers with higher premiums shop more, are more likely to seek provider incentives, and offer an HMO. However, these employers appear to have lower employee cost sharing. Employers with higher employee cost sharing and those that offer an HMO had lower health plan premiums.

Community Participation↗
PubMed1990

The relationship of house staff experience to the cost and quality of inpatient care.

The inexperience of house staff has been offered as one explanation for the increased cost of care at teaching hospitals, but conclusive evidence for this has been lacking. We studied the relationship of house staff experience to the cost and quality of inpatient care in a large series of internal medicine patients at one teaching hospital. We defined house staff experience by the month of academic year during which the patient received care. Our measures of cost were length of hospital stay and total hospital charges, while our measures of quality were hospital deaths, hospital readmissions, and nursing home placement. Multiple linear regression analysis on 21,679 hospital discharges revealed increasing house staff experience to be associated with a significant decline in length of stay (95% confidence interval for b, -0.006 to -0.066 days per discharge per month of house staff experience) and total hospital charges (95% confidence interval for b, -0.002 to -0.017 log dollars per discharge per month of house staff experience). These findings constitute an estimated average decline of 0.43 days per discharge and +370 per discharge over the academic year. Logistic regression analysis found no relationship of house staff experience to hospital deaths, readmissions, or nursing home placement. These findings suggest that the process of training inexperienced physicians may represent an important source of inefficiency for teaching hospitals struggling in a competitive environment.

Costs and Cost Analysis↗
PubMed1988

Profit vs. public welfare goals in investor-owned and not-for-profit hospitals.

A study of goal formation in a matched sample of investor-owned and not-for-profit hospitals was conducted to determine differences in the perceptions of employees regarding their hospitals' commitments to patient/community welfare goals versus profit maximization. These perceptions were compared to available operating data for the same hospitals. While the investor-owned hospitals as a group generally were found to emphasize patient/community welfare values less than their not-for-profit counterparts, this did not hold true when matched pairs were analyzed. In some of the matched subsets, the not-for-profit hospitals were much more profit-oriented than the investor-owned hospitals. This research reveals that strong patient/community service values do not universally characterize not-for-profit hospitals, and conversely investor-owned hospitals cannot always be characterized as profit maximizers.

Analysis of Variance↗
PubMed1987

Activity of polymorphonuclear (PMN) leukocytes during bovine herpes virus-1 induced respiratory disease: effect of recombinant bovine interferon alpha I1.

Following infection of cattle with bovine herpes virus-1 there is a state of generalized immunosuppression involving various leukocytes including polymorphonuclear (PMN) leukocytes. Since the PMN is considered to be pivotal in recovery from secondary bacterial infections during bovine respiratory disease, investigations were initiated to determine PMN activity in this disease and whether interferon could modulate PMN activity. In this study, the in vivo administration of recombinant interferon alpha-I1 was shown to increase PMN functions as measured by migration/chemotaxis and generation of reactive oxygen species. This augmented activity of PMN appeared to correlate with the reduction of overall clinical disease, that is, number of sick days, lung lesions and weight loss. In the study administration of interferon by the intranasal or intramuscular route were as effective in stimulating PMN function. Based on these studies it was concluded that the reason for improved performance of calves treated with interferon would be due to its immunomodulatory effects on leukocytes. Although interferon did not alter the initial suppression of PMN functions, these functions returned to normal and exceeded normal activities by 7-9 days post-infection, the time when maximal bacterial activity normally is present.

Animals↗
PubMed1985

Effect of bovine alpha 1 interferon on bovine herpesvirus type 1-induced respiratory disease.

Treatment of calves with bovine recombinant alpha 1 interferon prior to challenge with bovine herpesvirus type 1 increased the animals' ability to withstand a subsequent Pasteurella haemolytica challenge. The reduction in viral-bacterial synergy observed following interferon treatment did not appear to be due to a direct effect of the interferon on virus replication in the upper respiratory tract. Thus, even though interferon-treated animals shed slightly less virus from their nasal passages than did untreated animals, this reduction was not statistically significant. Furthermore, there was no difference in the level of intranasal interferon secreted by control or interferon-treated animals. These results suggest that interferon treatment does not affect the production of endogenous interferon. In contrast, a significant difference was observed between the number of days that control animals were sick, the levels of serum fibrinogen and the functional activity of polymorphonuclear neutrophilic granulocytes obtained from infected calves. These results suggest that bovine recombinant alpha 1 interferon may have a greater immunomodulatory effect than a direct antiviral effect in this model. This is further supported by the observation that bovine herpesvirus type 1 is relatively resistant to the direct antiviral effect of bovine recombinant alpha 1 interferon in vitro.

Animals↗
PubMed1984

Intralingual naloxone reversal of morphine-induced respiratory depression in dogs.

A descriptive study was done to determine whether naloxone is efficacious in reversing morphine-induced respiratory depression in dogs when administered intralingually into the ventral lateral surface of the tongue. Mean minute ventilation was depressed to half of resting baseline levels using fixed intravenous doses of morphine sulfate. Intralingually administered naloxone reversed this respiratory depression rapidly within one minute, and resulted in a greater than fourfold increase in mean minute ventilation above established baseline levels.

Animals↗
PubMed1983

A gait analysis system in clinical practice.

A gait analysis system using a transduced walkway, monitored by microcomputer to measure the time and distance factors of gait, has been in regular clinical use for over two and a half years. The results are easy to understand and have provided objective data which has been found useful in a number of clinical situations. Some of the ways in which the system has been used are described.

Adolescent↗
PubMed1976

Suppression of interferon production by vitamin A.

Vitamin A (retinoic acid) suppressed interferon production by L cells infected with Newcastle disease virus (NDV). This suppression was maximal when cells were treated with retinoic acid for 2 h after NDV adsorption, indicating that the inhibitory step was an early event. It was not due to inhibition of total RNA synthesis. Retinoic acid treatment caused both a delay in appearance of interferon and a reduced rate of synthesis thereafter.

Adsorption↗
PubMedDate not supplied

Physician perspectives on the structure and function of group practice HMOs.

This article explores physicians' perspectives regarding how their HMOs function and their satisfaction with and loyalty to HMOs. Three HMOs were studied: a mature (28-year-old) staff model, a 16-year-old staff model, and a 13-year-old group model with both HMO and fee-for-service patients. While these HMOs were found to vary somewhat in terms of emphasis on patient care versus costs, methods used to control costs and degrees of centralization of decision making, they all received high overall satisfaction and loyalty scores. The staff model HMO with a more decentralized decision making structure received the highest satisfaction/loyalty score from its physicians. The degree to which physicians perceive the HMO to be effective and supportive and the use of educational programs and peer review to influence resource use were also found to be significantly related to physician satisfaction and loyalty.

Analysis of Variance↗