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Biomedical subjects

J Schriefer

Publications and source records attributed to J Schriefer.

10 recordsLinked to original sources
PubMed2003

Congenic mice reveal sex-specific genetic regulation of femoral structure and strength.

Genetic linkage studies in C3H/HeJ (C3H) and C57BL/6J (B6) mice identified several chromosomal locations or quantitative trait loci (QTL) linked to femoral volumetric bone mineral density (vBMD). From QTL identified on chromosomes (chr) 1, 4, 6, 13, and 18, five congenic mouse strains were developed. In each of these mice, genomic DNA from the QTL region of the donor C3H strain was transferred into the recipient B6 strain. Here we report the effects of donated C3H QTL on femoral structure, cortical vBMD and bending strength. Femoral structure was quantified by the polar moment of inertia (Ip) at the mid-diaphysis, which reflects the bending or torsional rigidity of the femur. Although the C3H progenitor mice have a smaller Ip than B6 progenitor mice, the congenic mice carrying the C3H segment at Chr 4 had significantly increased Ip in both males and females, giving these mice stronger femora. In female mice from the congenic Chr 1 strain, Ip was increased whereas male mice from the Chr 1 strain had smaller femoral cross-sections and significantly reduced Ip. This sex-specific effect on femoral structure was seen to a lesser extent in Chr 18 congenic mice. In addition, cortical vBMD was measured using peripheral quantitative computed tomography. Cortical vBMD was similar among most congenic strains except in Chr 6 congenic mice, where cortical vBMD was significantly less in females, but not in males. We conclude that (1) chromosomal QTL from C3H mice, which are genetically linked to total femoral vBMD, also regulate femoral structure; (2) the QTL on Chr 4 improves femoral structure and strength; (3) QTL on Chr 1 and 18 impart sex-specific effects on femoral structure; and (4) the QTL on Chr 6 imparts a sex-specific effect on cortical vBMD and femoral strength.

Animals↗
PubMed2000

Merging clinical pathway programs as part of overall health system mergers: a ten-step guide. Spectrum Health.

BACKGROUND: Mergers, acquisitions, and reorganizations can be stressful and accompanied by ambivalence, confusion, and uncertainty. Providing clear and simple steps for merging clinical pathways may help organizations move through the transition process more smoothly. The ten steps according to which Spectrum Health merged its pathway program-conduct an inventory of previous efforts, plan for the ideal program, bring staff together early in the merger process, decide on a common format, standardize the development and revision process, standardize a reporting tool, create a clinical pathway manual, implement an educational plan, present the program to key customers, and appoint an advisory group-need not be done sequentially. The ten-step pathway merger program uses pathways as a means to improve the quality of the care provided, with a focus on multidisciplinary clinical pathway teamwork. Before the merger, the two hospital systems' pathway programs used different approaches to operations and pathway format. When the announcement to merge came in September 1997, steps to merge the clinical pathway programs began. DISCUSSION: More than two years into the merger, Spectrum Health continues to struggle with the evolution of the health system. Clinical pathways represent just one of the significant and extensive issues related to organizational mergers; organizational values, finances, vision, mission, customer relations, strategic priorities, and people issues are a few of the others. Focusing on merging programs such as clinical pathway programs can help put one large piece of the merger puzzle in place and reduce some of the ambiguity associated with all mergers. Executive support is critical to the success of the clinical pathway program.

Critical Pathways↗
PubMed1997

Combining case management, pathways, and report cards for secondary cardiac prevention.

BACKGROUND: Many disease treatment tools can be shifted into prevention. Many cardiac rehabilitation programs have focused on a 12-week exercise plan with minimal long-term follow-up. In 1995 Butterworth Hospital established a cardiac prevention and rehabilitation program focusing on long-term modification of cardiovascular risk factors. CLINICAL PATHWAY: The pathway was created as the outpatient extension of three inpatient cardiovascular pathways. Unlike inpatient pathways, the outpatient pathway was integrated into the medical record as a major care planning and documentation tool. ENROLLMENT: Since the entry of the first group of patients in January 1995, average quarterly enrollment has increased from less than 15% to 32% of eligible patients. THE REPORT CARD: Butterworth adopted Dartmouth Medical Center's (Hanover, NH) value compass and instrument panel approach under the rubric of report card. As an internal, clinical quality improvement tool, the report card is not used for public reporting, although prevention and rehabilitation report cards are provided to payers. Information on cost and utilization, patient satisfaction, functional health status, and clinical outcomes, as well as the current improvement activities, are covered. Report cards have been issued in June 1996, September 1996, and January 1997, each highlighting activities that drive program improvements. CONCLUSION: The combination of case management, pathways, an outcomes database, and report cards creates a marketable program for secondary prevention of cardiac disease.

Cardiac Rehabilitation↗
PubMed1996

The Quality Cup winner: Fletcher Allen Health Care's early extubation team.

Many organizations are looking for ways to reduce the cost and improve the quality of open-heart surgery. Fletcher Allen Health Care in Burlington, Vermont used a total quality management approach to do just that. The result was a dramatic improvement in outcomes. Fletcher Allen won the 1994 USA Today Quality Cup for its efforts.

Awards and Prizes↗
PubMed1995

Improving breastfeeding support: a community health improvement project.

BACKGROUND: Because of the brevity of the postpartum hospital stay, mothers and their newborns are discharged home before breastfeeding is well established. In 1992, feedback from patients who had given birth at Fletcher Allen Health Care (Burlington, VT) suggested a need for more consistent, expert, and timely assistance with breastfeeding in the hospital and better continuity of care during the first few weeks at home. QUALITY IMPROVEMENT TEAM: In 1993 a team developed objectives, analyzed the problem and possible solutions, and made eight recommendations on how the hospital could do more to promote breastfeeding. Implementation by team members and hospital staff included policy development, staff education, acquisition of funding, a visiting professorship, development of a lactation consultant coordinator and team, and patient surveys to evaluate the program. A late 1994 survey of 63 postpartum patients on their day of discharge indicated a high level of satisfaction with breastfeeding support in the hospital. CURRENT STATUS: Activities are being undertaken for lactation consultation coverage, further policy development, implementation of nurse competency validation, improved patient and family education materials, and continued evaluation of the breastfeeding support program through patient surveys. CONCLUSION: In the face of barriers such as the project's large scope, a paucity of internal team members, and a large number and variety of recommendations, some of the recommendations and follow-up plans have yet to be implemented. Yet the project has yielded improvements in care and provides a model of how hospitals can expand their traditional boundaries of care and quality improvement into community health issues.

Breast Feeding↗
PubMed1995

Managing critical pathway variances.

As the use of critical pathways expands at an increasing rate, we are faced with the issue of how to manage variances from the pathway. Variance management is not clearly defined in the literature, and many institutions search for the best approach. We have implemented a number of different techniques for variance management at Fletcher Allen Health Care. Our success benefits both patients and providers.

Algorithms↗
PubMed1994

The synergy of pathways and algorithms: two tools work better than one.

BACKGROUND: Clinical quality improvement efforts at the Medical Center Hospital of Vermont (MCHV) led to the development of critical pathways, which show the ideal plan of care, and algorithms, which help clinicians make one of many complicated decisions within a plan of care. A synergy appears to develop when pathways and algorithms are used together. DEVELOPMENT OF PATHWAYS AND ALGORITHMS: A steering committee supports and oversees pathway and algorithm efforts. A quarterly tracking report updating progress for all pathways and algorithms is circulated to all nurse managers, medical staff, and administrators. When combining pathways and algorithms, the pathway is created first. Algorithms are developed for trouble spots within a pathway. CORONARY ARTERY BYPASS GRAFT (CABG) PATIENTS: Having developed the pathway for CABG patients, the CABG case management team meets monthly to review outcomes and variances. For example, an algorithm for managing atrial arrhythmias--the chief cause of variance for one month's results--was developed. The combination of pathways and algorithms for CABG patients has resulted in a reduction of 2.5 days for total length of stay (including 1 day on the surgical intensive care unit [SICU]), for a mean cost savings of $3,500. Re-admission to the SICU, reintubation, and mortality rates have all decreased. CONCLUSION: The idea of reaping the benefits of both pathways and algorithms is becoming more popular at MCHV, where teams use algorithms to improve on complicated processes underlying the pathways.

Algorithms↗
PubMedDate not supplied

Strategies for involving physicians in continuous quality improvement.

To realize significant and sustained improvement in quality and in overall performance, hospitals must have the support and participation of the medical staff. Although it sometimes is difficult to recruit busy physicians to join the effort, they will become champions if their experience is productive and results in improved patient care. This article outlines a number of straightforward approaches that will help healthcare quality professionals obtain physician involvement in the improvement effort.

Attitude of Health Personnel↗
PubMedDate not supplied

Report cards: tools for managing pathways and outcomes.

An overriding concern of many health care providers is how to maintain quality in such a turbulent, cost-driven environment. It is essential for health care providers to determine the effectiveness of their care and to institute changes in practice to affect patient outcomes in a positive fashion. Determining the appropriate outcomes to measure and formatting the report in an easy-to-read manner with meaningful information is important for presentation to a variety of audiences. We describe a report card methodology for disseminating outcome information that can easily be adapted in other settings.

Critical Pathways↗