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Biomedical subjects

S Cavanaugh

Publications and source records attributed to S Cavanaugh.

13 recordsLinked to original sources
PubMed2000

Graduate medical education costs in nonacademic health center teaching hospitals: evidence from Maryland.

As managed care has grown, much concern has been expressed about the potential plight of the nation's 125 academic health centers (AHCs). Less concern has focused on non-AHC teaching hospitals, although most studies of graduate medical education (GME) costs include these hospitals in their estimates. While most studies have found that costs increase positively with various measures of "teaching intensity," some have concluded that hospitals with smaller programs have costs that are the same or less than comparable nonteaching hospitals. However, few studies have tested whether AHCs' cost structures are sufficiently similar to those of other hospitals to reliably include them in the same estimation. This article tests that assumption for Maryland hospitals, finds it violated, and presents results for non-AHC teaching hospitals. The results reveal that, at least in Maryland, even small teaching programs add to hospital costs.

Academic Medical Centers↗
PubMed1999

Effects of a pneumonia clinical pathway on time to antibiotic treatment, length of stay, and mortality.

OBJECTIVES: A clinical pathway standardizing management for patients with an admission diagnosis of pneumonia was initiated after a previous study found delayed time to initial antibiotic administration, a longer length of stay, and higher mortality rate for the authors' patients as compared with those in a "benchmark" hospital. The current study was undertaken to determine whether implementation of the clinical pathway resulted in statistically significant decreases for these measures, both in the initial year following pathway implementation and two years later. METHODS: A retrospective chart review was completed for three cohorts of pneumonia patients admitted via the ED: 1) three months immediately prior to pathway implementation, 2) 10-12 months after implementation of the pathway, and 3) 34-36 months after implementation of the pathway. Four standard antibiotic regimens were used following pathway implementation: community-acquired, community-acquired penicillin-allergic, nursing home-acquired, and nursing home-acquired penicillin-allergic. Demographics, medical history, presentation signs and symptoms, process of care, and outcome data were abstracted from each patient's medical record. RESULTS: The mean time to antibiotic administration decreased from 315 minutes prepathway to approximately 175 minutes during the first postpathway period and 171 minutes at three years (ANOVA, p < 0.0001). The percentage of patients who received antibiotics in the ED increased from 58% prepathway to 94% during the first postpathway period and 97% at three years (chi square, p < 0.0001). Length of stay decreased from 9.7 prepathway to 8.9 days during the first postpathway period and 6.4 days at three years (ANOVA, p < 0.0001). There was no significant change of in-hospital mortality (9.6% prepathway to 5.2% and 4.9%) in the two respective periods. CONCLUSIONS: This study demonstrates that implementation of a pneumonia clinical pathway for the management of hospitalized patients admitted via the ED decreases the time to initial antibiotic treatment and increases the proportion of patients initially treated with antibiotics in the ED. These effects were evident in the first year following pathway implementation and sustained at the three-year study interval.

Aged↗
PubMed1999

Laparoscopic supracervical hysterectomy vs. abdominal hysterectomy in a community hospital. A cost comparison.

OBJECTIVE: To evaluate the feasibility for an institution to offer laparoscopic supracervical hysterectomy as a cost-effective alternative to total abdominal hysterectomy (TAH) in a managed care environment. STUDY DESIGN: Retrospective study in which 138 consecutive laparoscopic supracervical hysterectomies performed between December 1992 and May 1996 were reviewed and compared to 354 consecutive TAHs performed during the same period. Operating time, use of operative room supplies, length of stay and actual total, fixed and variable costs of each case were calculated for the entire hospital stay and for each hospital cost center. Differences between costs were analyzed by ANCOVA using age, patient weight, specimen weight and number of operative procedures performed at the time of hysterectomy as covariants. RESULTS: The mean operative room time was significantly greater for laparoscopic supracervical hysterectomy than for TAH (167.4 [SD 51.2] vs. 103 minutes [30.3, P < .001]). In contrast, length of stay was significantly shorter for laparoscopic supracervical hysterectomy than for TAH (0.8 [SD 1.1] vs. 3.4 days [.9, P < .001]). The adjusted mean costs of both operative room time and supplies were significantly higher for laparoscopic supracervical hysterectomy than for TAH (P < .001). In contrast, the mean cost of length of stay for laparoscopic supracervical hysterectomy was significantly lower (P < .001). However, the adjusted mean total costs of the entire hospital stay were not significantly different: $2,716 for laparoscopic supracervical hysterectomy vs. $2,702 for TAH (F = .7, P = .8). The absence of significant differences between procedures resulted from our limited use of disposable supplies (no automated stapling device) and from shorter lengths of stay, which compensated well for the higher operative room costs of time and supplies incurred with laparoscopic supracervical hysterectomy. CONCLUSION: Laparoscopic supracervical hysterectomy is, at least in the short term, a cost-effective alternative to TAH in a managed care environment.

Adult↗
PubMed1997

Evaluation of a school climate instrument for assessing affective objectives in health professional education.

A conceptual framework for the study of school climate and development of professional caring ability is proposed that is compatible with research on learning environment and socialization. Student input characteristics were measured demographically and through use of previously validated scales from the Parental Bonding Instrument; student outcome characteristics were measured on the Caring Ability Inventory for which considerable empirical validity evidence exists. The primary focus of this evaluation addressed reliability and validity of an instrument designed to assess learning environment that had not previously been used in postsecondary education. Four abbreviated School Climate scales were studied: Respect, Trust, Morale, and Caring. Source data were obtained from the initial phase of a longitudinal study of baccalaureate nursing students throughout the United States. Factor analysis, score reliability, and item-total correlation results indicate the School Climate instrument has indicate the School Climate instrument has theoretical and practical utility for program evaluation and improvement in health professional education.

Adult↗
PubMed1997

The child with attention deficit hyperactivity disorder and learning disability.

The following case is presented to demonstrate the difficulties associated with treatment of Attention Deficit Hyperactivity Disorder (ADHD) when it is comorbid with a learning disability (LD). These two disorders exist simultaneously in about 30% of those diagnosed with ADHD. It is often difficult to separate the effects of one condition from those of the other. Researchers and clinicians often struggle with questions concerning the origin of inattentive symptoms. A child with LD may have trouble attending if placed in a classroom setting not designed to deal with issues related to LD, while a child with attention deficit may not be progressing as well as expected because of problems maintaining attention. This case highlights the need for a multi-faceted approach to the treatment of ADHD, as well as, the need for continued evaluation of the effectiveness of the treatment plan instituted.

Attention Deficit Disorder with Hyperactivity↗
PubMed1995

Bench evaluation: three face-shield CPR barrier devices.

UNLABELLED: Due to the fear of disease transmission, the practice of mouth-to-mouth (M-M) rescue breathing is rarely performed; to address this concern, many types of CPR barrier devices have been developed. These include bag-valve-mask devices, mouth-to-mask devices, and face shields (FS). The purpose of this study was to measure the volumes delivered during mouth-to-face shield (M-FS) breathing, to measure the back pressure and calculate the resistance to flow through their 1-way valves, and to test for backward leak of gas through the valves. METHODS: Three FS brands were evaluated: Kiss of Life (KOL), MicroSHIELD (Micro) and Res-Cue Key (RCK). Volume delivered during M-M and M-FS breathing was evaluated by 10 rescuers who used the devices while performing rescue breathing on a CPR mannequin. Back pressure was measured and resistance calculated by directing airflow through the 1-way valves. Backward leak was evaluated by measuring the O2 concentration at the rescuer side of the valve while 100% O2 was directed toward the patient side of the valve. Differences among the brands were evaluated using analysis of variance. RESULTS: The mean (SD) values for volumes in L were: M-M 1.00 (0.25), Micro 0.77 (0.20), RCK 0.64 (0.10), and KOL 0.24 (0.11). Mean values for back pressure in cm H2O at 50 L/min were Micro 16.7 (1.29), KOL 7.22 (0.13), and RCK 2.15 (0.16). Significant backward leak only occurred with RCK. CONCLUSION: Not one of the FSs tested met all of the requirements suggested by the American Heart Association and by the International Standards Organization.

Analysis of Variance↗
PubMedDate not supplied

Recent changes in consultation-liaison psychiatry. A blueprint for the future.

To better understand the changes in the past 5 years on consultation-liaison (C-L) services in the United States, 119 university programs were surveyed. The return response was 64%. Of the 76 respondents, 32% had decreased funding, 54% no changes or stable finding, and 14% improved funding. Nonetheless, 57% of the programs reported funding difficulties as a major problem. Understaffing was reported by 51% of the programs. Liaison activities have ceased or are reduced in 70% of the programs; 15% reported an increase in liaison, particularly for transplantation. C-L services have been affected by illness acuity (68%), shorter hospital stays (79%), and older populations (54%). The diagnostic mix shows increases in HIV-related disorders, drug abuse, and delirium. The discussion includes recommendations for C-L services given these findings.

Combined Modality Therapy↗
PubMedDate not supplied

Relationships among childhood parental care, professional school climate, and nursing student caring ability.

A mailed random-sample survey of 350 senior baccalaureate nursing students explored relationships among early maternal and paternal care, the caring climate of nursing schools, and caring ability. Caring ability was quantified with the Caring Ability Inventory, Maternal and paternal care were measured with the Parental Bonding Instrument. School climate was measured on the Charles F. Kettering School Climate Inventory. There is no linear correlation between level of maternal or paternal care and subsequent caring ability (r = .01 and 0.01, respectively). However, a curvilinear relationship exists: Those with higher caring are respondents who scored both at the highest and the lowest levels of maternal care. Moreover, levels of caring within nursing schools appear to moderate caring ability developed at home. A caring school climate is the strongest predictor of caring ability (r = 0.16, P < .01). Thus, it is of concern to note that only 52 per cent of the respondents rated their schools high in caring. Caring is a valued attribute in professional nursing. If this quality is to flourish, it must be cultivated within the climate of nursing schools that exert a major professional socializing influence on future nurses.

Education, Nursing, Baccalaureate↗