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Biomedical subjects

K R White

Publications and source records attributed to K R White.

At least 19 recordsLinked to original sources
PubMed2001

Is hospital case management a rationalized myth?

In this article the adoption of case management processes in US hospitals is discussed. While such process change is prevalent, there is a paucity of systematic empirical evidence that hospital case management improves efficiency or effectiveness. Using an institutional theoretical framework, motivations other than improved efficiency and effectiveness are proposed that may drive hospitals to adopt change to their technical core processes, in the form of case management. Further research using these propositions as an adjunct to cost-benefit analyses would be important to validate the rationale behind the widespread adoption of hospital case management processes.

Attitude of Health Personnel↗
PubMed2001

Cost and cost-effectiveness of universal screening for hearing loss in newborns.

OBJECTIVE: To estimate the cost and cost-effectiveness of universal newborn hearing screening. STUDY DESIGN AND SETTING: Decision analysis model utilizing the hospital perspective. This model evaluated 4 distinct protocols for screening a fixed and defined hypothetical cohort of newborn infants. OUTCOME MEASURES: Cost of screening and the number of infants with hearing loss identified through universal screening. RESULTS: Otoacoustic emissions testing at birth followed by repeat testing at follow up demonstrated the lowest cost ($13 per infant) and had the lowest cost-effectiveness ratio ($5100 per infant with hearing loss identified). Screening auditory brainstem evoked response testing at birth with no screening test at follow-up was the only protocol with greater effectiveness, but it also demonstrated the highest cost ($25 per infant) and highest cost-effectiveness ratio ($9500 per infant with hearing loss identified). These findings were robust to sensitivity analysis, including best-case and worst-case estimation. The prevalence of hearing loss and the fraction of infants returned for follow-up testing had a large impact on the absolute level, but not relative level of protocol cost and cost-effectiveness. CONCLUSION: The otoacoustic emissions testing protocol should be selected by screening programs concerned with cost and cost-effectiveness, although there are certain caveats to consider. SIGNIFICANCE: The most significant barriers to implementation of universal newborn hearing screening programs have been financial, and this study compares the most common protocols currently in use. This study can assist program directors not only in the decision to initiate universal screening but also in their choice of screening protocol.

Child Health Services↗
PubMed2001

Are nurses adequately prepared for end-of-life care?

PURPOSE: To determine end-of-life (EOL) care core competencies and educational needs from practicing oncology nurses and to describe the characteristics of the respondents that are associated with selection of the leading core competencies. DESIGN AND METHODS: A researcher-developed mailed descriptive survey to members of the Oncology Nursing Society in Georgia, Virginia, Washington, and Wisconsin in late 1999. FINDINGS: Nearly all respondents indicated that EOL care was a part of their practice and that continuing education was important, but one-third of the respondents had less than 2 hours of continuing education in 2 years. How to talk to patients and families about dying was the top-rated core competency, consistent across age, educational level, practice role, and practice setting. Pain control and comfort care were also frequently selected as important EOL care issues about which more education is needed. CONCLUSIONS: Results show guidelines for improving educational curricula and considering characteristics of nurses when planning EOL educational programs.

Adult↗
PubMed2000

Hospitals sponsored by the Roman Catholic Church: separate, equal, and distinct?

For centuries, the Catholic Church has been a major social actor in the provision of health services, particularly health care delivered in hospitals. Through a confluence of powerful environmental forces at the beginning of the twenty-first century, the future of Catholic health care is threatened. Although Catholic hospitals are a separate case of private, nonprofit hospitals, they have experienced environmental pressures to become isomorphic with other hospital ownership types and, on some dimensions, they are equal. To keep pace with the changing demands of religion and the social role of the hospital, Catholic hospitals continue to redefine themselves. To justify a distinct and legitimate social role, more research should be conducted to develop and measure indicators of Catholic identity.

Catholicism↗
PubMed1998

Four nurse entrepreneurs: what motivated them to start their own businesses.

In an environment of change, innovators or entrepreneurs emerge to develop new methods and processes of delivering health care in a way that lowers the overall costs of care while improving outcomes. This qualitative study looks at the factors that motivate nurse entrepreneurs as well as the characteristics of nurse entrepreneurs and their business ventures. The rationale for health care managers to capitalize on nurse entrepreneurship is discussed as an effective method of strategic adaptation.

Cost Savings↗
PubMed1998

Nursing entrepreneurship in an era of chaos and complexity.

To adapt to a workplace characterized by chaos and complexity, individual nurses and the profession as a whole must position themselves in a more entrepreneurial stance. We describe the forces in the health care environment that present opportunities for nursing entrepreneurship. Skills and personality traits that promote entrepreneurship are discussed with suggestions for positioning the nursing profession and individual nurses as proactive innovators to satisfy the needs of the new health care marketplace.

Entrepreneurship↗
PubMed1997

Efficiency evaluation of community-based youth services in Virginia.

This study investigates the efficiency of community-based youth services in the Commonwealth of Virginia using data envelopment analysis (DEA). Efficiency was calculated based on resources available, the demand of services, and the service units produced. Results demonstrated the extent of inefficiency in community-based youth programs and how much efficiency can be improved relative to comparison with peer groups. The differences between large and small communities, urban and rural communities, and rich and poor communities were analyzed. There was no significant difference between each type for all three categories.

Adolescent↗
PubMed1997

Graduate management education for nurses: a comparative study.

This paper examines graduate management education programs for nurses using two programs of one University as a case study. Historically, Schools of Nursing have provided educational programs for nurse executives. More recently, a combination of nursing and business programs have gained popularity. A survey of nurses with the Master of Science (MS) from a School of Nursing and the Master of Science in Health Administration (MSHA) from a Department of Health Administration was conducted to assess demographic variables and job characteristics. Differences in job characteristics of the alumni of the two programs are evaluated and discussed.

Adult↗
PubMed1997

Newborn hearing screening in Hawaii.

Hawaii has been a pioneer and national leader in implementing universal newborn hearing screening. In fact, Hawaii is one of only two states (Rhode Island is the other) which have a statewide newborn hearing screening program in which 95% or more of all newborns are screened. Hawaii is the best example of a truly integrated system of services to provide effective intervention for all infants and toddlers who are identified as having a hearing loss. The success of the newborn hearing screening program is measurable in two ways: 1) all available information indicates that not a single infant with hearing loss has been missed by the screening process and not a single infant has been misdiagnosed as having a hearing loss; and 2) many of the children identified with hearing loss by the newborn hearing screening program have transitioned out of the early intervention program with age-appropriate developmental and communication skills. The success of Hawaii's program is a tribute to the enthusiastic support and collaboration of legislators, pediatricians, hospital staff, and DOH personnel.

Hawaii↗
PubMed1996

Newborn hearing screening: comparison of a simplified otoacoustic emissions device (ILO1088) with the ILO88.

INTRODUCTION: The acceptance of universal newborn hearing screening has been affected by the availability of an accurate, cost-effective tool. Transient evoked otoacoustic emission (TEOAE) procedures have been used successfully in hospital-based programs. A modified TEOAE method, using a narrow band signal, may be capable of maintaining accuracy while reducing test time. A comparison between a simplified narrow band TEOAE screening device (ILO1088-Echosensor) and the standard ILO88 Quickscreen mode was initiated in this study. METHODS: One thousand ears of newborns in a normal nursery were tested using both devices. RESULTS: Results demonstrated that there was good agreement between the two devices. The possibility that the 5.9% discrepancy between the two screeners may be related to restrictions in the protocol that prohibited calibrating or refitting the probe during the test should be explored. DISCUSSION: The ILO1088 automated screener demonstrated good potential as a quick, accurate hearing screening device for newborns with the potential of reducing screener training and the need for off-line interpretation of the results when employed in a universal program.

Female↗
PubMed1996

Neurons with different temporal firing patterns in the inferior colliculus of the little brown bat differentially process sinusoidal amplitude-modulated signals.

We examined how well single neurons in the inferior colliculus (IC) of an FM bat (Myotis lucifugus) processed simple tone bursts of different duration and sinusoidal amplitude-modulated (SAM) signals that approximated passively heard natural sounds. Units' responses to SAM tones, measured in terms of average spike count and firing synchrony to the modulation envelope, were plotted as a function of the modulation frequency to construct their modulation transfer functions. These functions were classified according to their shape (e.g., band-, low-, high-, and all-pass). IC neurons having different temporal firing patterns to simple tone bursts (tonic, chopper, onset-late, and onset-immediate) exhibited different selectivities for SAM signals. All tonic and 83% of chopper neurons responded robustly to SAM signals and displayed a variety of spike count-based response functions. These neurons showed a decreased level of time-locking as the modulation frequency was increased, and thereby gave low-pass synchronization-based response functions. In contrast, 64% of onset-immediate, 37% of onset-late and 17% of chopper units failed to respond to SAM signals at any modulation frequency tested (5-800 Hz). Those onset neurons that did respond to SAM showed poor time-locking (i.e., non-significant levels of synchronization). We obtained evidence that the poor SAM response of some onset and chopper neurons was due to a preference for short-duration signals. These data suggest that tonic and most chopper neurons are better-suited for the processing of long-duration SAM signals related to passive hearing, whereas onset neurons are better-suited for the processing of short, pulsatile signals such as those used in echolocation.

Animals↗
PubMed1996

Profession building in the new health care system.

To further the goals of greater legitimacy and power, it is necessary for nursing to abandon many of the profession building strategies it has pursued in the past. We describe the traditional framework for profession building in nursing and some reasons it is no longer effective. In contrast, a contemporary framework for profession building in nursing is presented. Because nursing, like other complex adaptive systems, is strongly anchored by its past trajectory, it will require considerable energy and resources to make the transition.

Health Care Reform↗
PubMed1996

Church ownership and hospital efficiency.

Using a sample of California hospitals, the effect of church ownership was examined as it relates to nonprofit hospital efficiency. Efficiency scores were computed using a nonparametric method called data envelopment analysis (DEA). Controlling for hospital size, location, system membership, and type of church ownership, church-owned hospitals were found to be more frequently in the efficient category than their secular nonprofit counterparts. The outcomes have policy implications for reducing healthcare expenditures by focusing on increasing outputs or decreasing inputs, as appropriate, and bolstering the case for church-sponsored hospitals to retain the tax-exempt status due to their ability to manage their resources as efficiently as (or more efficiently than) secular hospitals.

California↗
PubMed1996

Effects of exam procedures on transient evoked otoacoustic emissions (TEOAEs) in neonates.

Debris in the ear canal and ear canal collapse in newborns have been shown to interfere with recording transient evoked otoacoustic emissions (TEOAEs). The purpose of this study was to prospectively evaluate the effects of two simple ear canal cleaning procedures on the TEOAE responses of normal newborns. Three hundred and sixteen ears were studied with an initial TEOAE followed randomly by either an otoscopic exam and refit procedure or a probe refit procedure. At the time of each procedure, any superficial debris attached to the otoscope or probe were removed before the second TEOAE was repeated with identical procedures. The study sample consisted of two equal groups of ears (otoscopic exam and refit). Each group initially had equal proportions of ears with no emission, a weak emission, or a robust emission. In the otoscopic group, 12 of 51 (24%) weak emissions converted to robust emissions, 10 of 53 (19%) no emissions converted to robust emissions, and 15 of 53 (28%) no emissions improved to weak emissions. In the refit group, 20 of 50 (40%) weak emissions converted to robust emissions, 13 of 57 (23%) no emissions converted to weak emissions, and 9 of 57 (16%) no emissions improved to weak emissions. Both the otoscopic viewing procedure and the refit procedure were effective in improving the TEOAE response.

Acoustic Stimulation↗
PubMed1996

Nursing management of adults who have cystic fibrosis.

Cystic fibrosis has ceased to be a terminal illness for children and has become a chronic disease affecting both children and adults. Life expectancy, already over 29 years, is increasing with new therapeutic interventions. Pathophysiology, assessment, and treatment information is presented here to assist adult health nurses in caring for patients with cystic fibrosis.

Adult↗