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Biomedical subjects

S B Boxerman

Publications and source records attributed to S B Boxerman.

At least 19 recordsLinked to original sources
PubMed1997

Cytomegalovirus and HLA-A, B, and DR locus interactions: impact on renal transplant graft survival.

Graft failure rates for renal transplantations performed between 1989 and 1994 and recorded in the US Renal Data System database were retrospectively evaluated for interactions between cytomegalovirus and HLA-A, B, and DR loci. Twelve significant interactions were observed. There were significantly greater risks of graft failure for the total effect of cytomegalovirus and donor or matched HLA-DR9, recipient or matched HLA-B-51, and matched HLA-B13. We conclude that further study of renal transplants with these combinations of cytomegalovirus and HLA loci is needed to determine whether the observed interactions should be taken into consideration when matching donors with recipients.

Adult↗
PubMed1996

Optimum investments in project evaluations: when are cost-effectiveness analyses cost-effective?

This manuscript extends the classical models of the value of information to ask whether a hospital's net financial return is ever maximized by a cost-effectiveness analysis of retrospective data when watchful waiting and a full randomized clinical trial are alternative methodologies. The manuscript demonstrates that (1) some small-scale retrospective analyses may negatively affect net income and (2) under some conditions, larger-scale retrospective analyses may maximize net income. The manuscript also suggests that risk aversion increases the value of information and therefore the optimum expenditure on a project evaluation.

Cost-Benefit Analysis↗
PubMed1994

The value of risk-reducing information.

This manuscript integrates the utility-increasing advantages of risk reductions into well-known value-of-information justifications for executive information systems (EIS). Accordingly, even some EISs which never pay for themselves financially can be advantageous if they sufficiently reduce the uncertainty of net income for "risk averse" hospitals. The manuscript demonstrates the potential importance of risk reductions in the context of a hypothetical hospital administrator charged with selecting among alternative managed care contracts, each with uncertain outcomes. An administrator representing a hospital with diminishing marginal utility from income, a standard interpretation of risk-aversion, may find that an otherwise unprofitable EIS reduces income variations (risk) sufficiently to justify its purchase.

Contract Services↗
PubMed1990

Continuing education needs of board members, administrators, and health care personnel.

Our society is becoming more aware of the basic fact that education is a lifelong process. The dynamic world in which we live requires that we continually update our knowledge and skills. Educational institutions that have traditionally viewed their mission as one of providing a sequence of courses leading to a specific degree are now expanding their role to include postgraduate nondegree offerings. The MIS area certainly ranks high among those fields that have a dynamic characteristic. Institutions with particular academic strength in this area can provide a needed service--and at the same time create a market niche for themselves--by developing and presenting continuing education programs in the area of MIS.

Computer Literacy↗
PubMed1984

Gastrointestinal microecology in the critically ill neonate.

The fecal and gastric microflora of 178 critically ill neonates was compared with that of 30 normal full-term infants. Significant findings included increased frequency of single species retrieval and decreased frequency of mixed aerobic-anaerobic fecal cultures in the ill infants. Also noted were increased retrieval of pathogenic organisms, ie, staphylococcus aureus from gastric and fecal cultures of the ill infants, and decreased retrieval rates of Escherichia coli enterococcus, B fragilis, and other anaerobes in the feces of this group. Yeast retrieval was increased in the feces of the ill neonates. Statistical analysis showed that delivery route, birth weight, and antibiotic therapy were significantly related to the retrieval rates of certain organisms in the gastric and fecal flora of the ill neonate. Given the breast-fed and formula-fed infants have different normal floral patterns, this study suggests that the flora of the ill neonate conforms to a different pattern. Implications in the prevention and treatment of various neonatal septic processes may be drawn from this data.

Birth Weight↗
PubMed1983

Out-of-plan use and disenrollment: outgrowths of dissatisfaction with a prepaid group plan.

Two opposing theories have been suggested to describe the relationships among member dissatisfaction with a prepaid group practice (PGP), the choice to go outside for care normally covered by the plan, and disenrollment from the PGP: 1) out-of-plan use--a consequence of dissatisfaction, precedes disenrollment and 2) dissatisfaction produces two independent effects--out-of-plan use and disenrollment. Preliminary results are reported on an evaluation of these relationships based on a sample of 1823 families at the Medical Care Group of St. Louis. Dissatisfaction is found to be the most important predictor of both out-of-plan use and disenrollment. However, no direct relationship exists between the latter two variables. This result lends support for the model, which specifies that PGP members respond differently to dissatisfaction with the plan; some go outside the PGP for their care while others simply disenroll.

Consumer Behavior↗
PubMed1983

Disenrollment from a prepaid group plan. A multivariate analysis.

Although high annual disenrollments from prepaid group practices (PGPs) present significant problems to the manager, studies on this subject generally have been limited to simple descriptions of the phenomenon. The authors' approach utilizes multivariate techniques--discriminant analysis and logistic regression--to overcome the simplicity of these bivariate studies. It allows an examination of the significant correlates of disenrollment in a stepwise manner that adjusts for the effects of all variables included in the models. Two surveys conducted by the Medical Care Group of St. Louis (MCGSL) provide data for this research. After classifying the sample of 2,402 families as continuous enrollees, voluntary disenrollees, and mandatory disenrollees, the analyses show that these groups represent significantly different member populations. The variables that significantly and independently discriminate among them include sociodemographic characteristics (subscriber age, race, education and occupation, and family size and income), satisfaction level with the plan, and presence of alternatives to the PGP (nonplan family members and coverage by alternative health insurance). These findings suggest that voluntary and mandatory disenrollment behavior may be more complex than previously considered. Moreover, the PGP manager is faced with perplexing problems in attempting to control this troublesome phenomenon.

Analysis of Variance↗
PubMed1982

Circumcision: II. Effects upon mother-infant interaction.

The effects of circumcision upon mother-infant interaction were examined in an observational study of 59 mother-infant pairs during hospital feedings on days 2 and 3 of life. Each pair was observed during 4 hospital feedings using a specifically designed mother-infant interaction observation system that examined 43 discreet behaviours relating to feeding, gaze, facial expression, vocalizations and touch. The experimental group was circumcised after the second feeding and the control group after the fourth feeding. Analysis revealed no major behavioral differences between the experimental and control groups. Yet, different trends between the two groups were observed regarding two variables shortly after surgery. These differences disappeared by 24 h post-operatively. Differences related to the frequency of feeding intervals and infant availability scores. The study also revealed a surprisingly limited repertoire of behavior exhibited by both the mother and infant during feeding sessions. Our data suggest that circumcision has brief and transitory effects on mother-infant interactions observed during hospital feeding sessions, the only time mothers who are not rooming-in have an opportunity to be with their infants.

Adult↗
PubMed1980

Matching technical jobs with needs.

Selecting a suitable mix of engineers and technicians who can respond to changing technological needs can be a formidable task for the administrator.

Biomedical Engineering↗
PubMed1980

CSF lactate levels in high risk neonates with and without asphyxia.

Determination of CSF lactate levels were performed in 150 nonasphyxiated and 46 asphyxiated high risk neonates. Statistical analysis of log lactate levels of nonasphyxiated infants showed significant relationship to gestational and postnatal ages (P < .0001 and < .0002, respectively). CSF lactate elevation was seen in 16/29 infants studied within eight hours of asphyxia in contrast to 0/17 infants studied after eight hours (P < .001). Higher incidence of CSF lactate elevation was seen in term infants (7/8), infants with fetal distress (13/17), and very low Apgar scores (11/18). Seven of eight infants with markedly elevated lactate levels had both fetal distress and very low Apgar scores. CSF lactate determination in the immediate postasphyxial period appears to be an objective way of assessing the severity of cerebral hypoxia.

Apgar Score↗
PubMed1979

Are microcomputers appropriate for your practice?

The overly simplistic view of the process of automation widely presented to physicians needs to be counterbalanced. Computers are becoming cheaper, easier to program, and simpler to operate. However, the physician must be aware of the gap between personal computing and serious use of computers in his practice. To bridge this gap, the physician must analyze his needs to identify appropriate applications to automate, plan the implementation of these applications, and choose the necessary hardware and software resources. To do so it may be valuable for him to seek the help of an expert. Although the physician can certainly perform the necessary tasks, he should be aware that to perform them efficiently there are a number of aspects he should seriously consider.

Computers↗
PubMed1979

Continuity of medical care: its impact on physician utilization.

Past research in continuity of medical care has generally examined its determinants or its consequences. A model is proposed which combines these lines of research and incorporates a continuity measure as a process and specifying variable. The validity of this model is tested with a set of data consisting of 1,410 persons with major illness episodes. Results show that the model is supported, at least in part. Variables that significantly influence the number of ambulatory visits to a physician include the patient's payment method, the severity of his illness and his referral status. Moreover, the practice type of the usual physician emerges as a significant determinant of physician utilization when the level of continuity is controlled. The use of this more comprehensive model in future studies on continuity is indicated.

Ambulatory Care↗
PubMed1979

Using simulation in decision making.

The health care administrator can use digital simulation as a quantitative decision-making technique. Understanding its conceptual framework will enable the administrator to work with a technical specialist to formulate and solve problems.

Computers↗