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Biomedical subjects

J D Blair

Publications and source records attributed to J D Blair.

At least 19 recordsLinked to original sources
PubMed2001

An integrated doctoral educational model for developing researchers in health care strategic management.

Doctoral education varies according to how students that graduate from a particular program are prepared for various type of careers. PhD programs principally work to develop researchers; researchers produce and disseminate new knowledge in a given area of expertise. This manuscript looks specifically at a PhD program designed to produce researchers in healthcare strategic management. This program is based in a business school and builds on general business principles to produce strategists that do research in the healthcare context. The business school program (type B) will be analyzed according to the areas (or potential areas) of research done by its graduates. The different areas are shown in a table where one axis is research content (i.e., specifically what the functional area of research is) and the other axis is publication outlet (i.e., what journal the research is disseminated in). Advantages of the type B program are compared to advantages of a PhD program based in a healthcare administration or healthcare management school (type H program) in terms of publications in these different areas.

Curriculum↗
PubMed2000

The paradox prescription: leading the medical group of the future.

Leaders of health care organizations must constantly deal with paradox in and around their organizations. The paradox profile is a modeling technique for examining how organizations prioritize their dealings with the eight competing issues from which the four paradoxes are derived. This article demonstrates the leadership challenges that exist when a paradox is present and how these tensions differ when the integrative status of the medical group--as either part of an integrated system or not--is considered.

Conflict, Psychological↗
PubMed1998

Competitive forces in the medical group industry: a stakeholder perspective.

Applying Porter's model of competitive forces to health care, stakeholder concepts are integrated to analyze the future of medical groups. Using both quantitative survey and qualitative observational data, competitors, physician suppliers, integrated systems new entrants, patient and managed care buyers, and hospitals substitutes are examined.

Cooperative Behavior↗
PubMed1992

Urban-rural hospital affiliations: assessing control, fit, and stakeholder issues strategically.

Urban-rural hospital affiliations are an outgrowth of both the external pressures on rural hospitals to survive and the need for urban hospitals to maintain or increase their share of the tertiary referral market. This article discusses the significant role of stakeholders in these affiliations, develops a fourfold typology of urban-rural hospital affiliations based on the notions of organizational control and fit, suggests four generic strategies for forming affiliations, and analyzes four actual cases of affiliation.

Conflict, Psychological↗
PubMed1990

Hospital-physician joint ventures: a strategic approach for both dimensions of success.

Joint ventures between hospitals and the physicians on their medical staffs have produced successes and failures. Each joint venture has two very different dimensions of success--financial and collaborative. The most successful ventures are able to accomplish both of these often conflicting goals. To enhance hospital executives' success in joint ventures with physicians, a strategic approach with a series of six steps and their corresponding models or maps is proposed. The steps in this strategic approach are: (1) identify key stakeholders and linkages among them; (2) surface stakeholder conflict using problem-oriented maps; (3) diagnose the venture on both dimensions of success; (4) classify the venture using both dimensions of success; (5) select a strategy to optimize the venture's current potential for success; and (6) select an approach to transform the venture with limited potential for success.

Conflict, Psychological↗
PubMed1990

Achieving competitive advantage through strategic human resource management.

The framework presented here challenges health care executives to manage human resources strategically as an integral part of the strategic planning process. Health care executives should consciously formulate human resource strategies and practices that are linked to and reinforce the broader strategic posture of the organization. This article provides a framework for (1) determining and focusing on desired strategic outcomes, (2) identifying and implementing essential human resource management actions, and (3) maintaining or enhancing competitive advantage. The strategic approach to human resource management includes assessing the organization's environment and mission; formulating the organization's business strategy; assessing the human resources requirements based on the intended strategy; comparing the current inventory of human resources in terms of numbers, characteristics, and human resource management practices with respect to the strategic requirements of the organization and its services or product lines; formulating the human resource strategy based on the differences between the assessed requirements and the current inventory; and implementing the appropriate human resource practices to reinforce the strategy and attain competitive advantage.

Economic Competition↗
PubMed1989

Assessing key stakeholders: who matters to hospitals and why?

A key stakeholder perspective, informed by illustrative quantitative and qualitative data, is developed for hospital administrators. These data provide answers to the questions, Who matters to hospitals? and Why do they matter? A tool kit for assessing stakeholders also is presented to help hospital executives identify their institutions' key stakeholders, determine the power of these stakeholders and their core values, and define who within their institutions should be responsible for the routine management of different stakeholders. These tools facilitate the management of each key stakeholder, ensuring that each strategic decision is examined in terms of the likely reaction of key stakeholders and is supplemented with plans for gaining stakeholder acceptance. Managers should recognize that the answers to Who matters? and Why? will vary by type of hospital and by the specific issue being addressed.

Community-Institutional Relations↗
PubMed1989

The importance of relationships in hospital negotiation strategies.

Negotiation is one important way for hospital executives to manage conflict and to accomplish new projects. Because of the rapidly changing nature of the health care environment, as well as conflicts and politics within their organizations, managers need to negotiate effectively with a wide range of other parties. Hospital managers should consider the relative importance of both the substantive and relationship outcomes of any negotiation. These two factors, when viewed both in terms of the priorities of the hospital executive and the other party may guide the executive's anticipation of negotiation scenarios and selection of appropriate negotiation strategies.

Communication↗
PubMed1989

A strategic approach for negotiating with hospital stakeholders.

Executives should consciously formulate negotiation strategies which are linked to the broader strategic posture of the hospital. This approach provides a diagnostic and action-oriented framework for (1) determining and focusing on desired outcomes and (2) anticipating actions stakeholders are likely to take.

Cooperative Behavior↗
PubMed1988

Too many on the seesaw: stakeholder diagnosis and management for hospitals.

If hospital managers are to cope with the environmental turbulence and uncertainty facing hospitals, they must effectively manager their stakeholders. The stakeholder approach helps integrate managerial concerns normally treated separately, such as strategic management, marketing, human resource management, organizational politics, and social responsibility. This approach enables hospital executives to develop strategies for handling conflicting demands for effectiveness and efficiency from various stakeholders. Four generic strategies hospital managers can use depending on the type of stakeholder are detailed, and an overarching strategy for hospital managers is discussed.

Health Facility Administrators↗
PubMed1987

Development and experimental application of contact probe catheter for laser angioplasty.

A sapphire contact probe laser catheter was developed to increase the dimensions of tunnels created by laser angioplasty. The device consisted of a round sapphire probe (2.2 mm diameter) attached to an 8F catheter into which a 0.2 mm optical fiber was inserted with a tip maintained at 3 mm from the sapphire. The fiber was connected to a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. A saline perfusate was circulated through the catheter during laser emissions to prevent excessive heating of the fiber tip. The system was used in vitro on 16 sections of atherosclerotic calcified human cadaver aortic walls, using diluted blood as a medium, at powers ranging from 10 to 40 W and exposure times from 1 to 4 seconds. Six craters were created at each energy level. The system was also used on six human cadaver, agar-embedded, obstructed iliac and femoral arteries, using 40 W and 2 second laser emissions. Dimensions of probe-created craters were compared with those obtained using bare fibers. The shape of the probe craters was that of a truncated cone with the entry hole wider than the exit, as opposed to the cylindrical shape created with unmodified bare fibers. At 120 J (seconds X watts), areas of entry and exit probe-formed holes were greater than those created with the bare fibers (6.7 +/- 0.5 and 3.4 +/- 0.6 versus 0.2 +/- 0.01 mm2, respectively, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1987

Efficiency and safety of optically modified fiber tips for laser angioplasty.

To evaluate the safety and efficiency of optically modified fiber tips, craters were created in human cadaver atherosclerotic arterial walls using sapphire contact probes and lensed fibers connected to a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. Laser energy was emitted at a constant level of 50 J. The sapphire contact probe catheter consisted of a round 2.2 mm diameter synthetic sapphire attached to an 8F catheter into which a 0.2 mm diameter optical fiber was inserted with the distal tip maintained at 3 mm from the sapphire. The lensed fiber catheter consisted of a 0.2 mm optical fiber at the end of which a 1 mm diameter lens was made. The fiber was inserted into a 5F low profile balloon catheter with the lens maintained 3 mm beyond the catheter tip. During laser emissions the catheter tips were maintained in a stationary position in contact with tissue targets immersed in blood at an angle of 90 degrees. The diameter of holes at the entry and exit of craters, the depth of craters and thermal injury to adjacent tissue (rim of carbonization and vacuolization) were measured with microscopy. The volume of tissue removed was derived from these values. Controlled effect index was determined as the ratio of diameter of holes and the extent of thermal injury. Efficiency was determined as the ratio of volume of tissue removed and the energy required to vaporize tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1986

Histopathology after Nd-YAG laser percutaneous transluminal angioplasty of peripheral arteries.

Laser recanalization of occluded femoral or popliteal arteries was performed in 12 patients using a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. The histologic findings of the laser-irradiated arterial segments in two of these patients are reported. The specimens were obtained 2 and 4 weeks after the laser procedure. The laser-irradiated vessel in Patient 1 had been partially recanalized with reduction of the atherosclerotic occlusion from 3 to 1 cm. The lased arterial lumen manifested thermal injury to the inner quarter of the arterial wall with vacuolization and a rim of carbonization occupying 10% of the width of the arterial wall, but without thrombus formation. Histologic examination in Patient 2 revealed no fibrin deposits, atherosclerotic debris or thrombi at the intimal arterial edge. At the crater site, thermal injury was apparent with vacuolization of the intimal fibrous tissue. The histologic sections obtained 4 weeks after the procedure revealed new fibrous intimal tissue without endothelialization in some of the heavily calcified tissue sections. Where the plaques were noncalcified, reendothelialization was noted with only minimal damage to the surrounding tissue. No medial or elastic fiber disruption was seen, and no aneurysmal dilation had occurred. Intimal splitting with a cleft between the tunica media and the intima was noted at the site of previous balloon angioplasty. In conclusion, the follow-up histologic findings 2 and 4 weeks after laser angioplasty in two patients using a specially designed catheter delivery system and cooling blood perfusate revealed thermal injury to the inner quarter of the arterial vessel wall and no evidence of thrombus formation.

Aged↗
PubMed1983

Congenital peritoneal mesothelioma.

Only three primary peritoneal mesotheliomas in children have been previously reported. We describe a 6-wk-old girl with a papillary peritoneal mesothelioma of low grade malignancy. This is probably a congenital mesothelioma and is the youngest patient reported to date.

Female↗
PubMed1982

Brief clinical report: deletion of the long arm of chromosome 11, [del(11)(q23)].

We report sporadic occurrence of deletion of the long arm of chromosome 11 (q23 leads to qter) in a male newborn infant with intrauterine growth retardation, craniofacial, cardiac, and orthopedic abnormalities and neonatal death but without genital abnormalities. This deletion is seen predominantly in females; here we emphasize the importance of an XX sex chromosome constitution as a factor determining phenotypic expression of and survival in the del(11q) syndrome. We also provide a description of the cardiovascular system from postmortem examination. The cardiac findings are similar to those of two previously autopsied cases and will assist in early clinical diagnosis of the 11q-syndrome.

Abnormalities, Multiple↗
PubMed1982

Heterotopic growth of dysplastic cerebellum in frontal encephalocele in an infant of a diabetic mother.

An infant of a diabetic mother lived 13 days after birth. She had a small dysplastic 12.6 gm. brain, partly forming a frontal encephalocele. The uncleaved forebrain contained a mass of poorly organized heterotopic cerebellar cortex. The cerebellum itself had normal lamination, but was small and continuous with the dysplastic tissue. The ventricular system was absent except for a few midline ependymal rosettes, and the cerebral cortex was not developed. The cerebellar dysplasia resembled a proliferative and invasive lesion by its rostral extension.

Brain↗