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Biomedical subjects

J W Steiner

Publications and source records attributed to J W Steiner.

At least 19 recordsLinked to original sources
PubMed1997

The virtual laboratory: regional clinical diagnostics for integrated delivery systems.

With the rise of integrated delivery systems (IDSs), hospital laboratories need to transform themselves to better serve these large regional systems. Four factors are driving this need for transformation: the decline in the customer base of hospital clinical laboratories, the expanding number of test options, the need to control costs, and the proliferation of new technologies. In the future, clinical diagnostic capabilities will be available via integrated regional laboratory systems, or "virtual laboratories". The virtual laboratories serving IDSs will consist of a control center to manage laboratory services across the system, a core laboratory to perform large-volume testing and all testing that does not require a rapid turnaround, satellite laboratories for quick-turnaround testing, and a range of point-of-care testing options. Developing these virtual laboratories will pose challenges, including a redeployment of resources and a reengineering of testing policies and procedures. Success in implementing a virtual laboratory also will depend on the development of effective information systems technology to link the laboratory's components.

Clinical Laboratory Information Systems↗
PubMed1997

The challenges and opportunities of laboratory regionalization.

These are some of the major historical trends and rationale for the sea change in laboratory medicine today. The creation of cooperative regional networks and consolidated regional laboratories potentially can: 1) Pool the technologic strengths of individual laboratories across a region; 2) Create economies of scale by combining capacities for certain procedures; 3) Lower unit costs by increasing volumes of business from nonpatients; 4) Span all of the traditional testing venues along the new expanding continuum of care. The authors in this monograph will take the saga forward in time, outlining critical organizational, technologic, and strategic aspects of the newly evolving laboratory of the 21st century.

Automation↗
PubMed1995

The transformation of hospital laboratories: why regionalization, consolidation, and reengineering will lead laboratories into the 21st century.

In 1990 we predicted that the growth of prospective payment and fixed reimbursement plans would force hospitals to transform the hospital laboratory into a cost center. The need to create alternative modes of care would further lead hospitals to create regional laboratory consortia. This would include the "commercialization" of the laboratory so that it could become a regional resource and expand outreach activities. This report updates events since 1990. Indeed, the arrival of prospective payment and fixed reimbursement has caused a radical upheaval among health care providers in every part of the country. The transformation was more rapid than we expected, particularly in two areas. First, the commercial laboratory industry devoured itself. By 1995 the consolidation movement ended and three huge national laboratory chains now provide laboratory services throughout the United States. Second, not only did prospective payment arrive in the form of capitated contracts for laboratory services, but it arrived with remarkable speed. It was coupled with the absolute decline for three years in Medicare reimbursement for lab services. Such changes to reimbursement levels have seriously undercut the financial viability of the laboratory industry. Hospital-based laboratories are responding to these pressures with three strategies: reengineering, consolidation, and networking. Six identifiable trends will drive the transformation of laboratories into regional provider consortia between now and the year 2000. We predict that the speed of this transformation will be even faster than that experienced by the consolidation of commercial laboratories. This will occur because hospital labs are already a component within integrated delivery systems. As these systems transform and evolve, the laboratories must transform in concert. Our experience indicates that laboratory consolidation delivers economic benefits that are considerably greater than either networking or reengineering. Consolidation, accompanied by new testing technologies and tighter data links, will lead the transformation of today's hospital laboratory into a "virtual" laboratory. Such laboratories will be self-sufficient, capable of performing all but esoteric tests in-house. It will be a "laboratory without walls," emphasizing testing performed at the point of care, be it bedside, physician's office, clinic, nursing home, ambulance, workplace, or patients' homes. A combination of economic and organizational pressures will cause hospital-based laboratories to adopt some form of regionalization within the next two to three years.

Capitation Fee↗
PubMed1991

[The physician as judicial expert witness].

Excellent special knowledge and consideration of the limits of competence in his own special field as well as in the court procedures are characteristic of a medical expert at law court. Only he provides medical expert knowledge that the court lacks in criminal, civil and social law. This must not mislead him to try to solve legal problems, ie to play the role of a "judge in white". Therefore knowledge of our jurisdiction is a necessity. Duties and rights of medical experts are discussed. The necessary human conduct with the person concerned is emphasized. The correct way of preparing an expert evidence is discussed in the special case of the causal connection. In conclusion it seems mandatory to include the topic 'medical expert' into the theoretical and practical education of physicians.

Austria↗
PubMed1990

Regionalization of laboratory care: a viable option for the 21st century.

The conversion of the hospital laboratory to a cost center under pressure of prospective payment and fixed reimbursement is increasingly forcing hospitals to consider alternative modes for delivery of laboratory care. Changes in the health care environment, amended statutes and regulations, and, particularly, dramatic developments in laboratory equipment, methodologies, and data processing technology make it advisable and feasible to contemplate the creation of regional laboratory consortia. A fundamental step in this direction is the "commercialization" of the hospital laboratory through a change in focus from being an in-house support program to becoming a regional resource. By the same token, the hospital laboratory can become an effective competitor of independent laboratories and be reconverted to a profit center. Creation of hospital laboratory consortia in a splintered, competitive environment requires a committed entrepreneurial effort and convincing evidence of potential benefits. The sequence of steps needed to achieve regional laboratory integration include concerting the goals and objectives of the interested parties, creating an appropriate committee structure, conducting a feasibility assessment, identifying alternative organizational and operational options, selecting a favorite option viewed by all parties as a win/win proposition, developing a business plan, and determining an implementation action plan. The major disadvantages of regionalization of laboratories are employee displacement, potential leveling of quality standards, and reduced hospital control. The major advantages include elimination of duplicate capital, personnel, and service costs, improved efficiency through test batching, reduced unit costs, increased technical capability through staff, instrument, and systems sharing, disengagement from hospital-imposed limitations, strengthened ability to penetrate the marketplace, freeing of hospital space for more direct patient care activities, and achieving a means for bonding physicians to the institutions.

Commerce↗
PubMed1977

Attrition from general practice: career patterns of Toronto medical school graduates.

Reported here are the results of a study of the degree to which medical careers in general practice versus specialization are pursued by graduates of the University of Toronto Faculty of Medicine in the first six years after the completion of their internships. The retention rates in general practice and residency are documented on an annual basis using the life table method. The annual rate of attrition from general practice dropped substantially after the first three years. Fifteen percent of the initial general practice group dropped out during the first year, 10 percent of the remainder in the second year, and 8 percent of the rest in the third year. In each of the subsequent three years, the attrition rate was 4 percent, 4 percent, and 2 percent, respectively.

Career Choice↗
PubMed1968

Electron microscopic and biochemical characteristics of nuclei and nucleoli isolated from rat liver.

Rat liver nuclei were freed of cytoplasmic contamination by washing with Triton-X-100 and subsequent centrifugation through 2.2 M sucrose. Electron microscopic examination showed that the outer membranes of the nuclei had been removed, but that the nuclei otherwise resembled the nuclei of intact liver. Morphological studies, chemical estimations of DNA, RNA, and protein and the estimation of cytoplasmic "marker" enzymes suggested that contamination of nuclei by cytoplasmic components was limited. These nuclei were obtained in yields of about 70% and were suitable for the isolation of nucleoli. Nucleoli were isolated by the breaking of the nuclei by ultrasound and subsequent differential centrifugation. In ultrastructural appearance, the isolated nucleoli resembled nucleoli in intact tissue. However, at high magnifications the "granular" component of isolated nucleoli appeared to consist of tightly twisted fibers. The nucleoli could be obtained in yields of at least 30%, and the values for the chemical composition of the isolated nucleoli agreed with values previously reported.

Acid Phosphatase↗
PubMed1967

An attempted simulation by computer of a committee on admissions.

The rising interest in formalized premedical courses preparatory to professional courses in medicine and the problem of selecting applicants to such courses have led to the formulation of a scoring technique to evaluate applicants to the first year of the premedical course offered by the Faculty of Medicine, University of Toronto. This method was applied to applicants considered for provisional admission in March 1966, and for final admission in August 1966, independently of the conventional selection carried out by the Admissions Committee. The results of the two methods are compared and discussed, and a combined selection procedure, using both the score and the Committee approach, is described.

Adult↗