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Biomedical subjects

K M Peddecord

Publications and source records attributed to K M Peddecord.

At least 37 records · Page 2Linked to original sources
PubMed1986

The association between cerebrovascular disease and smoking: a case-control study.

A retrospective case-control study was carried out to examine the relationship between cigarette smoking and cerebrovascular disease occurrence. Cases were obtained from the University of California-American Heart Association, San Diego Stroke Data Bank, and controls from selected Veterans Administration and University of California, San Diego, outpatient departments. When cigarette smoking was dichotomously coded into categories of low and high lifetime exposure, consistent significant positive associations were found with cerebrovascular disease occurrence in both bivariate and multivariate analysis when controlling for blood pressure. These associations, however, were not found when smoking was categorized as smoker, ex-smoker, and non-smoker. No association was found between passive smoking and cerebrovascular disease. The results indicate that a cumulative lifetime exposure to active cigarette smoking is directly associated with cerebrovascular disease.

Blood Pressure↗
PubMed1985

Education, training, professional certification, and work patterns of directors in interstate laboratories.

Education, professional training, certification, and work patterns of 988 laboratory directors employed in 440 clinical laboratories licensed under the Clinical Laboratories Improvement Act of 1967 are examined. Directors of hospital laboratories as opposed to independent laboratories were more likely to be physicians (82.8% vs. 68.0%), to have completed a formal residency program (75.5% vs. 62.0%), and to be certified in both anatomic and clinical pathology (65.3% vs. 57.1%). Only 51.9% of pathologists confined their work to a single laboratory, while 64.8% of directors with Ph.D.s or other doctorates directed only one laboratory. Most laboratories (81.5%) have at least one associate director. Hospital directors are more often full time (30 or more hours per week) than their independent laboratory counterparts, 74.4% vs. 42.4%, respectively. When the education and experience of individuals entering the field between the 1950s and 1970s are examined, it is evident that fewer individuals with bachelor's or master's degrees now are able to qualify as laboratory directors.

Certification↗
PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗
PubMed1983

Health care competition in the 1980s: its potential impact.

The health care industry will face continuing pressure from government and the private sector to contain costs. This paper provides an overview of health care costs, financing changes and cost inflation in the health care sector. The potential impact of competition oriented insurance plans, activities of business health care costs containment coalitions, and preferred provider organizations are reviewed. Regulatory trends and the effects of hospital reimbursement reforms on diagnostic radiographic and imaging services are discussed.

Delivery of Health Care↗
PubMed1980

Clinical laboratory proficiency test performance. Its relationship to structural, process and environmental variables.

This comparative analysis of clinical laboratories was intended to develop a more quantitative understanding of environmental, structural, and process variables and their relationships to the quality of laboratory services. The quality of laboratory services was defined as analytic capability demonstrated on proficiency-test specimens of the College of American Pathologists. Independent variables describing the laboratory environment, as well as structural and process aspects of management, were obtained from management reports, staffing records, and workload reports. Although correlations between the eight proficiency testing indices and the independent variables were generally low, a number of significant correlates were evident in three areas: bacteriology, parasitology, and qualitative hematology. Environmental variables describing organizational size were related to proficiency, as were variables dealing with accreditation by the College of American Pathologists and time accredited by the College of American Pathologists. The education and experience of personnel and the percentage of specialized supervisors were related to proficiency-testing success in bacteriology and parasitology. Empirical evidence suggests that the size of the laboratory indirectly affects proficiency in these three tested areas. Presumably, this relationship is mediated through specialization of work and reinforcement of learning. Few significant correlates were evident in the five remaining areas tested: chemistry, quantitative hematology, blood bank, immunology, and syphilis serology. Despite the concentration of personnel resources and other assets in larger laboratories, size appeared to have no effect on proficiency-testing performance in these five areas.

Bacteriology↗
PubMed1980

The medical technologist and evaluation of health technologies.

Increased social pressure for accountability in the medical care fields and recognition that new and expensive health care technologies have limited impact on health status has brought acknowledgment that the United States has no rational approach to identification, evaluation, and implementation of innovative medical technologies. As in other health care sectors, comprehensive and long-range evaluation of impacts of new medical laboratory technology on both the laboratory and the patient are lacking. It is evident that as questions concerning cost effectiveness are raised, more rigorous evaluation of laboratory technologies must be undertaken. Federal legislation has mandated creation of a National Center for Health Care Technology (NCHCT) with a primary mission to stimulate assessment of health care technologies. This legislation could provide the basis for a more rational approach to technology assessment. Potential implications of technology assessment on laboratory practices and third party reimbursement policy, as well as potential opportunities for laboratory professionals, are discussed.

Government Agencies↗
PubMed1976

Studies on the deterioration of antigen E in extracts of Ambrosia elatior.

Five per cent (w/v) extracts of defatted Ambrosia elatior pollen were prepared in bicarbonate-buffered saline (Coca's extract) and Coca's extract with 50% glycerol (Gly-Coca's extract). Sterile extracts were stored in untreated glassware and glassware coated with silicone. Stock extracts were diluted in phosphate-buffered saline (PBS) and stored at 5 +/- 3 degrees C. Extracts 1:20, 1:40, and 1:400 were assayed at approximately 6-wk intervals for antigen E. Quantitative determinations were made by modified double diffusion in agarose gels using known standards of antigen E for comparison. Results from the first year of this 3-yr study show no significant reduction in 1:20 Gly-Coca's extracts and a highly significant reduction of antigen E in 1:20 Coca's extracts. Further analysis of variance indicates significant reduction in all 1:40 and 1:400 extracts. Differences in the initial extracting solvents did not significantly affect these more dilute extracts. No significant differences were observed in the untreated and silicone-coated glassware. In terms of per cent antigen E reduction, 1:20 Gly-Coca's showed negligible reduction and Coco's at 1:20 declined nearly 50% in antigen E content. Extracts stored at 1:40 retained only 40% of the original antigen E content, while diluted extracts stored at 1:400 retained only 35% of the initial antigen E after 1 yr of storage at 5 +/- 3 degrees C.

Antigens↗
PubMedDate not supplied

Methods for a model blind proficiency testing system.

The method developed for establishing a blind proficiency testing (PT) system is presented. The Laboratory Assurance Program of the Graduate School of Public Health at San Diego State University is developing and pilot testing innovative strategies that will evaluate and improve the performance of clinical laboratories. To date, a total of 32 laboratories have been incorporated into this program along with 12 counseling and testing sites. From June 1988 to December 1989, five blind PT surveys for human immunodeficiency virus type 1 antibody testing were conducted, representing 306 proficiency specimens entered into the testing system as simulated patient specimens. Despite the difficulties and expense involved, we found the system to be acceptable and to have certain advantages over conventional methods of external testing.

AIDS Serodiagnosis↗
PubMedDate not supplied

Analytic results of HIV-1 testing using blind proficiency testing.

The use of blind proficiency testing (PT) to examine analytic performance of human immunodeficiency virus type 1 (HIV-1) antibody testing. A total of 32 hospital, blood bank, public health, and commercial laboratories were included in this study. Test sera were introduced as clinical specimens for HIV-1 testing from private practitioners, group practices, clinics, and hospitals in Southern California. A total of 26 laboratories were located throughout California, with six laboratories located in six other states. Results from 306 enzyme immunoassay screening tests and 192 supplemental tests for HIV-1 were reported. Although one positive specimen was reported as indeterminate in almost 30% of results, screening and supplemental testing performances were excellent, with accuracy levels comparable to performance reported on open PT and performance evaluation surveys in the United States. The indeterminate results were attributed to the interpretive criteria used rather than to laboratory errors. Blind PT can be an important tool in improving the quality of total laboratory testing, the usefulness of laboratory results in patient care, and ultimately the health of the public.

AIDS Serodiagnosis↗
PubMedDate not supplied

Identification of nonanalytic issues in HIV-1 antibody testing using blind proficiency testing.

Blind proficiency testing was used to examine nonanalytic performance indicators for human immunodeficiency virus type 1 (HIV-1) antibody testing. Physician offices, clinics, and hospitals located throughout Southern California submitted simulated patient specimens to laboratories as routine test requests. A total of 32 laboratories were involved during five blind proficiency testing surveys. Turnaround time for a reactive specimen ranged from three to 17 days. Laboratory charges for evaluating a reactive specimen varied depending on the volume of testing, prevalence of reactive specimens, and whether screening and confirmatory tests were billed separately or as a package price. Charges for an enzyme immunoassay screening test plus supplemental tests ranged from $11.75 to $114.50, with a median of $31.00 for 24 laboratories that participated in one of the five surveys. Evaluation of laboratory report content revealed that 37% of the 16 screening reports and 71% of the 14 supplemental reports contained information that was unrelated to the patient results. Evaluation of the testing system documents the need to monitor multiple outcomes of the total laboratory testing process, not just the analytic testing phase.

AIDS Serodiagnosis↗
PubMedDate not supplied

Use of a modified nominal group process for improving laboratory performance in human immunodeficiency virus type 1 antibody testing. Reaching consensus on three questions concerning HIV-1 testing.

Using expert panels of medical technologists and public health microbiologists, a modified nominal group process was used to reach a consensus on three questions concerning current human immunodeficiency virus type 1 (HIV-1) testing methods. The questions related to important sources of error, improving the testing process, and improving proficiency testing. The modified nominal group process proved to be effective in developing lists of errors in laboratory testing; it provided a fast, economic means of identifying possible areas for improving laboratory quality assurance and training programs. For the HIV testing model, the focus group panelists indicated laboratory pipetting errors, labeling, and specimen identification as the most important sources of error. To improve the quality of this testing, the panel recommended standardizing test interpretation and restricting testing to laboratories licensed to perform HIV-1 testing. To improve proficiency testing, the use of blind specimens and establishing minimum standards of performance were suggested.

California↗
PubMedDate not supplied

Competency assessment--an exploratory study.

CLIA '88 regulations require that laboratories evaluate and assure the competency of all personnel who perform laboratory tests. The study objective was to determine the interpretation of, compliance with, and implementation of these regulations by laboratories. Interviews were conducted with a stratified nonrandom sample of 20 laboratories including hospital, blood bank, commercial reference, physician office, group practice, and independent laboratories from 12 selected states. Information was collected about the history and development of their competency assessment programs and activities, their definition of competent staff, the interrelationship of competency assessment with performance appraisals, cost, benefits, and the assessment methods and tools used. Competence of laboratory personnel is a complex issue reflecting the dynamics and environment of each unique laboratory setting. This research found no consistent method of competency assessment implementation. This report provides a summary of methods and approaches. Learning what other laboratories are doing will assist managers in developing meaningful and cost-effective competency assessment programs. Documenting all competency assessment activities is important; it serves as a personnel performance management tool and satisfies inspectors. Used in the spirit of continuous quality improvement, the competency assessment program may point to ways of improving processes, personnel, and performance.

Employee Performance Appraisal↗