PubMed Health⌕ Search

Biomedical subjects

J J Harper

Publications and source records attributed to J J Harper.

12 recordsLinked to original sources
PubMed1995

Implementing a computer-assisted appropriateness review using DRG 182/183.

BACKGROUND: The focus on patient outcomes as performance measures and on processes of care as systems to improve is intensifying. Nevertheless, appropriateness reviews are likely to remain essential (for example, studies evaluating inpatient admission, laboratory testing, invasive procedures, and discharge planning) for several reasons. METHODS: Forbes Regional Hospital (Monroeville, PA) undertook to redesign the process of appropriateness reviews using a computer-assisted methodology. The change was predicated on accessing electronically recorded clinical data collected as part of a state-mandated discharge reporting requirement. RESULTS: More than 90% of diagnosis-related group 182/183 (gastrointestinal/esophagitis) admissions were deemed appropriate on the basis of later manual reviews. This redesign was accomplished at no added expense while the amount of time required to complete the study was decreased. The ability to easily examine relationships identified during the evaluation was also expanded. The experience led to greater enthusiasm on the part of the medical staff to pursue more quality improvement projects. Creation of software programs that can be used repeatedly, modified to change existing thresholds, or expanded to include other conditions was another benefit. Clinicians gained valuable experience and familiarity with information systems. Lastly, all this was accomplished without purchasing new hardware, acquiring updated software, or relying on the presence of an electronic medical record.

Concurrent Review↗
PubMed1993

Pneumonia mortality reduction and quality improvement in a community hospital.

Rather than explain adverse results on the basis of flawed data, a physician-directed quality improvement program was initiated to improve the delivery of care to patients admitted to Forbes Health System (Monroeville, Penn) with community-acquired pneumonia. Following the introduction of standardized physician orders and modification and elimination of inefficient processes of care, the mortality rate for this infection decreased from 10.2% to 6.8%. This initial exposure to the quality improvement process led to the participation of the medical staff in other related clinical and support service initiatives. In addition, Forbes and its clinical partners are now better positioned to respond to increasing government, managed care, and consumer inquiries relating to cost and quality outcomes. Finally, this positive experience facilitated the organization's transition from inspection-based quality assessment to quality improvement activities, which should assist in efforts to meet or exceed new accreditation standards.

Aged↗
PubMed1991

Biotypes of Haemophilus influenzae that are associated with noninvasive infections.

In this study, we examined the biotypes of Haemophilus influenzae strains associated with noninvasive infections in hospitalized patients. Over an 18-month period, a total of 388 strains were isolated from patients of various ages (neonates to the elderly), and the biotypes of the strains were determined. Strains of biotype II accounted for 48% of the isolates; this was followed by strains of biotypes III and I (26 and 16%, respectively). The remaining 10% of the isolates were made up of strains of biotypes IV, V, VI, and VII. A total of 6% of strains were capsulated. The distribution of biotypes in specimens from the respiratory tract and associated sites was comparable to that obtained in similar investigations, but examination of isolates from neonatal and genital specimens did not support the concept that H. influenzae biotype IV is a major urogenital pathogen. Conflicting results regarding the incidence of certain biotypes in specimens, particularly those from the urogenital tract, may be due to the selection of different subpopulations of patients. Data relating to the specimens were used to evaluate the association between biotype and clinical diagnosis, the presence of other potential bacterial pathogens in the specimens, and the presence of viruses in the specimens. None of the differences in the distribution of biotypes which were examined was statistically significant.

Adolescent↗
PubMed1987

Natural killer cells in viral arthritis.

Changes in natural killer (NK) cell activity were studied in patients with polyarthritis associated with rubella or Ross River virus infections. In 30 of 32 Ross River virus patients, peripheral NK cell activity was depressed at some stage of the disease but returned to normal levels as patients recovered from arthritic symptoms. Similar changes did not occur in rubella patients and no difference was found between changes in peripheral NK activity and serum interferon (IFN) levels in rubella patients with arthritis and those without. Neither the peak of NK cell activity in peripheral blood lymphocytes (PBL) recovered early in Ross River virus and rubella infections, nor the depression of NK cell activity late in Ross River virus infections could be correlated with changes in serum IFN levels. The decrease in PBL-NK cell activity in epidemic polyarthritis (EPA) patients could not be attributed solely to loss of NK cells from the peripheral circulation because limiting-cell-dilution (LCD) analyses indicated changes in peripheral NK cell activity were due to changes in both the number and lytic activity of NK cells. Despite the association between HLA-DR7 and EPA no differences were found in levels of peripheral NK cell activity in DR7+ and DR7- EPA patients. The demonstration that peripheral NK cells could kill autologous synovial cells suggested that NK cells in joints of EPA patients may contribute to the arthritis associated with Ross River virus infection.

Adult↗
PubMed1985

Isolation of Ross River virus from epidemic polyarthritis patients in Australia.

Ross River virus was isolated from two out of four seronegative serum samples obtained from epidemic polyarthritis patients in Australia. Virus isolated from each patient was found to be phenotypically diverse. These isolations suggest that previous failure to isolate virus from epidemic polyarthritis patients in this country may have been due to failure to obtain material (serum) from patients early enough in the course of the disease and to the use of relatively insensitive isolation techniques.

Alphavirus↗
PubMed1980

Augmentation of E-rosette formation by lymphocytes of cancer patients stimulated in vitro with tumor extracts.

The ability of tumour extracts to augment E-rosette formation by cancer patients' lymphocytes was demonstrated for colorectal carcinoma, breast carcinoma and melanoma. Positive augmentation reactions were obtained with 14 to 20 patients tested with extracts related to their own tumour types. Some lack of specificity was suggested by 5 positive reactions in the same patients tested with unrelated extracts. No false positives were found in normal subjects. The technique is simple, rapid and appears to depend on tumour-associated antigens in the extracts. Simultaneous leucocyte adherence inhibition tests on split samples of blood had a high degree of sensitivity and specificity, confirming the potential reactivity of the leucocytes and extracts used.

Humans↗