Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals

In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes.

Managing professional work: three models of control for health organizations

Three arrangements for structuring the work of professional participants in professional organizations are described, contrasted and evaluated. Arguments are illustrated by application to the organization of physicians within hospitals. The primary rationale, the support structures that have fostered its development, the key structural features and the advantages and disadvantages of each arrangement are described. The effect on these arrangements of structures and forces external to any particular professional organization is emphasized.

Seizures: a reaction to contrast media for computed tomography of the brain

Seven patients had seizures in association with the use of intravenous contrast media for cranial computed tomography. Caution and close observation are indicated when contrast agents are administered to patients with suspected focal brain disorders that may lower the seizure threshold. Patients with tumors metastatic to the brain appear to be at specially increased risk.

Measuring the complexity and uncertainty of surgery and postsurgical care

This article reports the results of a survey of a nationwide sample of more than 900 surgeons and post-surgical nurses, who were asked to rate the relative complexity and uncertainty of 71 surgical procedures frequently performed in hospitals. Average scores assigned to each surgical procedure by both types of raters are reported and the extent of agreement is assessed across indicator questions and types of raters. A surprisingly high level of agreement was observed. Explanations for the extent of agreement are discussed and uses for these scores are described.

Intracranial involvement of giant-cell arteritis

Two cases of giant-cell arteritis with cerebral arteritis are presented. The clinical situation and the suggestive but nonspecific angiographic features make the antemortem diagnosis possible. Greater awareness of this entity will facilitate its diagnosis and the institution of effective steroid therapy.

Application of "cusp writer" findings to practical and theoretical occlusal problems. Part II

The cusp writer is a teaching aid to facilitate understanding of the correlation between cusp angulations and the various occlusal determinants. The cusp writer provides graphic evidence that the occlusal determinants which influence configurations (i.e., incisal guidance, condylar guidance, plane [curve] of occlusion, curve of Spee [compensating curve], and plane of motion) are reciprocal, one tempering the value of the other. Cusp writings demonstrate the following: (1) The angle of the plane (curve) of occlusion to the plane of motion in concert with the other occlusal infuluence determines the optimal height and angulation of the cusps. (2) Cusps appear to be steep or shallow relative to each other, to the plane of occlusion, and to the plane of motion. (3) The steepness of the curve of Spee determines the relative cusp height and angulation of one tooth to another, from an anterior to a posterior direction in the dental arch. (4) The angle of the tangent to any segment of the curve of Spee to the plane of motion determines the optimal height and angulation of the cusps of the segment. (5) The graphs show that the flatter the curve of Spee, the more uniform the cusp height and angulations are from anterior to posterior teeth. The steeper the curve of Spee, the more irregular the cusp height and angulations are with steeper anterior cusps and flatter posterior cusps. (6) The steeper the curve of Spee, the flatter the molar cusp angulations must be to avoid deflective and/or interceptive occlusal contacts on the balancing side. (7) With the syndrome of a steepening curve of Spee due to the loss of one or more lower posterior teeth, the cusps of the remaining opposing teeth must be constantly flattened by wear or selective grinding and reshaping to avoid traumatic occlusion, unless the drifting is interrupted by restorative dentistry. (8) Cusp angulation of artificial teeth should be chosen to harmonize with the angle of incidence of the compensating curve tangents to the plane of motion. (9) Condylar guidance has less influence on cusp angulation in comparison to incisal guidance and the other occlusal determinants. (10) Changing the hinge axis location 1/2 inch (12.5 mm.) distally and/or superiorly has very little effect on the influence of the above occlusal determinants on cusp configuration, if the vertical dimension of occlusion remains constant.

Application of "cusp writer" findings to practical and theoretical occlusal problems. Part I

The cusp writer is a teaching aid used to facilitate understanding of the correlation between cusp angulation and the various occlusal determinants. Cusp writings represent an on-edge view of mandibular movement occurring in translation and rotation. Cusp writings demonstrate that: (1) the influence of incisal guidance on cusp angulation is almost 60 per cent greater in molars and 100 per cent greater in pre-molars than the influence of the condylar guidance; (2) steepening or flattening by wear, grinding, or reconstructing the lingual contour of the upper canine or other incisal guide teeth by as little as 1 mm. can change the incisal guide angulation from 15 to 25 degrees depending upon the vertical overlap; (3) these changes can create interceptive or deflective occlusal contacts with trauma and pain on the balancing side in the molar and temporomandibular joint areas; and (4) the incisal guidance of denture teeth is inevitably altered when teeth are tilted, uprighted, or turned for esthetics or phonetics. Such changes alter the occlusal function, harmony, and stability of the dentures.

The Use of Computer Tomography in Ophthalmology

Fifty-three orbital lesions of various types were studied by computer tomography to assess the capabilities and limitations of this technique. Although CT scanning in ophthalmology is in its infancy, results showed that it is useful in the investigation of a number of pathological conditions, including congenital anomalies, arteriovenous malformations, bone lesions, trauma, inflammation, granulomas, pseudotumors, epidermoid cysts, and tumors arising in or near the optic nerve, behind the optic bulb, or in the lacrimal region, as well as changes following eye surgery.

Computed tomography: immobilization of the head by dental holder

Movement of the patient's head during computed tomographic studies with the EMI scanner causes some degradation of the quality of the examination. With sufficient movement, major artifacts appear which may obscure intracranial pathology. A simple method of head fixation, utilizing a dental mold, greatly reduces the incidence of unsatisfactory scans.

Computed tomography with the EMI scanner in the diagnosis of primary and metastatic intracranial neoplasms

The findings and diagnostic results in 600 examinations of primary and metastatic intracranial neoplasms performed at one hospital with the EMI scanner are presented and the effectiveness of this method is compared with that of radionuclide imaging, cerebral angiography, and pneumoencephalography. The computed scan proved to be highly reliable in the diagnosis of glioma, cerebral metastases, meningioma, and acoustic neuroma.

Sensitive technique for measuring differences in reflectivity

A new technique for measuring reflectivity differences between two samples is reported. An electrically driven tuning fork is used to place the two samples alternately in the beam of a reflectometer, and a lock-in amplifier is used for detection of the difference signal. Advantages of this system include short deadtime, vacuum operation, and extremely high Q. The sensitivity is such that changes in reflectivity of the order of 0.001% can be observed.