Biomedical subjects
K Kerr
Publications and source records attributed to K Kerr.
Microbiological evaluation of a hospital-delivered meals service using precooked chilled foods.
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The plasma dexamethasone "window" and the dexamethasone suppression test in depression.
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Current management of depression.
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Dexamethasone suppression test (DST) and plasma dexamethasone levels in depressed patients.
The dexamethasone suppression test (DST) was evaluated in newly hospitalized patients with a DSM-III diagnosis of major depression. Patients with other psychiatric disorders and a normal control group were also studied. Plasma dexamethasone levels were obtained in all patients, and the relationship between plasma cortisol and plasma dexamethasone was examined. Rates of non-suppression in patients with major depression (39%) were not significantly different from those in patients with minor depression (25%), mania (38%), or other psychiatric illnesses (17%). The ranges of dexamethasone levels at 8 a.m. and 4 p.m. were similar between patient groups and controls. However, there was a significant difference in dexamethasone levels between suppressors and nonsuppressors, irrespective of diagnosis, which could not be explained by differences in weight or plasma dexamethasone half-life. Inappropriately high dexamethasone levels were found in some patients with a 1 mg test, a problem that critically affects the sensitivity of the test procedure.
Reporting the case of Baby Jane Doe.
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Variation of the angle of anomaly with accommodation?
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Accommodative and fusional vergence in anomalous correspondence.
Strabismic subjects who have anomalous correspondence often exhibit covariation in their angle of deviation and angle of anomaly. One hypothesis is that these covariation responses represent a neurological link between binocular correspondence and vergence innervation; an alternative is that they are neurologically independent. A description of these two interpretations is followed by certain implications and predictions.
Automated processing of data from pharmacokinetic investigations.
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Continuity of care after July: what happens to the resident's patients?
When internal medicine residents leave teaching programs, continuity of care for outpatients is affected. The authors had departing residents send their patients computer-generated letters identifying another physician to provide continuing care. The letters were randomly withheld from 20% of the patients (NL), and they were compared with patients who received letters (RL). A telephone survey was administered and visits and no-show rates were determined. The RL patients more often knew of the change in provider (84% vs 54%, p less than 0.01) and identified the resident as the source of the information (77% vs 43%, p less than 0.01) than NL patients. There were no significant differences between RL and NL patients in mean numbers of appointments (1.0 vs 0.8) or no-show rates (24% vs 21%) following housestaff turnover. Both groups wanted to be told by the physician about future changes and were willing to be informed by letter. A computer-generated letter appears to be an effective way of notifying patients about transfer of care during the annual housestaff turnover in teaching programs.
Health barriers to walking for exercise in elderly primary care.
Health status is acknowledged by nursing theory as a factor in the probability of health behavior changes. Yet few studies have addressed the health-related barriers encountered by chronically ill elderly patients in primary care clinics who are trying to increase their physical activity. This study used self- and interviewer-administered instruments to assess potential barriers to physical activity in a sample of 60- to 80-year-old patients entering a walking program. Pain, fatigue, and mobility and sensory impairments were prevalent and could be significant barriers to participation. The authors present specific suggestions for helping patients overcome these barriers.
Home-based radiology transcription and a productivity pay plan.
Shands Hospital in Gainesville, Fla., decided to evaluate the way it provided transcription services in its radiology department. It identified four goals: increased productivity, decreased operating expense, finding much needed space in the radiology department and increasing employee morale. The department performs 165,000 procedures annually, with 66 radiologists, 29 faculty, and 37 residents and fellows on staff. Six FTEs comprised the transcription pool in the radiology department, with transcription their only duty. Transcriptionists were paid an hourly rate based on their years of service, not their productivity. Evaluation and measurement studies were undertaken by the hospital's management systems engineering department. The transcriptionists' hours were then changed to provide coverage during the periods of heaviest dictation. The productivity level of the transcription staff was also measured and various methods of measurement reviewed. The goal was a pure incentive pay plan that would reward employees for every increase in productivity. The incentive pay plan was phased in over a three-month period. Transcriptionists were paid for work performed, with no base pay beyond minimum wage. The move to home-based transcription was planned. The necessary equipment was identified and various issues specific to working at home were addressed. Approximately six months later, the transcriptionists were set up to work at home. The astounding results achieved are presented: 28% increase in productivity, operational cost savings exceeding $25,000 and a space savings of 238 square feet.