PubMed Health⌕ Search

Biomedical subjects

J J Skarzynski

Publications and source records attributed to J J Skarzynski.

12 recordsLinked to original sources
PubMed1995

Interdisciplinary, functional approach to quality review.

Dramatic changes in the standards of the Joint Commission on Accreditation of Healthcare Organizations, as part of its "Agenda for Change," pose new challenges for health care managers. The goal of the "Agenda for Change" is to focus accreditation on the actual performance of important functions while continuously stimulating improvement in the organization's performance and outcomes of care. In 1994, seven important functions--improvement of performance, leadership, management of information, assessment of patients, education of patients and families, operative and other procedures, and treatment of patients--were identified by JCAHO. Performance, as defined by JCAHO, can be measured through observing specific dimensions, such as, availability, safety, timeliness, effectiveness, continuity, efficiency, and respect and caring. These are considered important elements in the determination of quality, value, cost, and patient outcome. In 1995, JCAHO identified 11 important functions--patient rights and organizational ethics, assessment of patients, care of patients, education, continuum of care, improving organizational performance, leadership, management of the environment of care, management of human resources, management of information, and prevention and control of infection. In addition each institution has the opportunity to decide by prioritization where it wants to devote resources. This article reports on one hospital's response to the new JCAHO initiatives.

Cardiology Service, Hospital↗
PubMed1995

Integrating quality assessment and improvement.

A hospital's mission--to influence change at the provider level--resulted in a continuous shift to improve methodologies in quality surveillance. Interdisciplinary reviews reduce burdensome processes as well as the inherent costs of time and money. Audits were streamlined or combined when appropriate, and a uniform process improved communication and respect for other disciplines.

Decision Trees↗
PubMed1989

Bilateral basal Xe-133 retention and ventilation/perfusion patterns in mild and subclinical congestive heart failure.

The Xe-133 ventilation pattern in congestive heart failure (CHF) was assessed using 24 inpatient ventilation/perfusion studies performed to rule out pulmonary embolism. Patients with histories of CHF, myocardial infarction (MI), and cardiomyopathy were included in the study. Frank pulmonary edema, pulmonary embolism, and other known lung diseases such as chronic obstructive lung disease, tumor, and pneumonia were excluded. Fifteen of the 24 patients had abnormal ventilation scans. Twelve of the 15 showed bilateral basal Xe-133 retention on washout; the remaining 3 showed diffuse, posterior regional retention. On perfusion scans, 14 of the 15 abnormal ventilation patients showed evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, or patchy perfusion, and all of them had a history of CHF or cardiac disease. Nine of the 24 patients had normal ventilation scans, including normal washout patterns. Seven of the nine had normal perfusion (p less than 0.01). Four of the nine normal ventilation patients had a history of cardiac disease or CHF but no recent acute MI. Bilateral basal regional Xe-133 retention, coupled with perfusion scan evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, and patchy perfusion pattern, appears to be a sensitive and characteristic ventilation/perfusion finding in mild or subclinical CHF.

Diagnosis, Differential↗
PubMed1986

"Matching" ventilation/perfusion images in fat embolization.

Forty-eight hours after fracture of the tibia and fibula, a 27-year-old man developed the triad of findings noted in the fat embolism syndrome (neurologic changes, respiratory distress, and petechiae). An initially normal chest-x-ray, which progressed to one of bilateral fluffy diffuse infiltrates, aided in making the diagnosis. Ventilation/perfusion lung images were performed at the time of the radiographic changes and showed "matching" defects. Transcapillary passage of lipid breakdown products was considered to be the cause. While all parts of the lung showed reduced ventilation/perfusion, the upper half of the lung fields was affected more prominently, as opposed to emboli of venous origin, which most frequently involve the lung bases.

Adult↗
PubMed1985

High incidence of gastric reflux during hepatobiliary imaging in pancreatitis.

A review of 100 consecutive hepatobiliary studies revealed eight cases in which there was prominent gastric reflux of the Tc-99m diisopropyl-IDA beginning 0.5 to 2.0 hours into the procedure. Five of these individuals had pancreatitis (four acute, one chronic). Hence, pancreatitis was involved in five out of eight of the studies with marked gastric reflux. A study of discharge records showed that a total of ten of the patients in this series had pancreatitis. Since only five showed prominent gastric reflux, the incidence was 50%. Other disorders accounted for the three remaining gastric reflux cases observed in 90 patients.

Adult↗