question archive answer the following questions pertaining to the abstract below Abstract Administrators routinely seek to increase contribution margin (revenue minus variable costs) to better cover fixed costs, provide indigent care, and meet other community service responsibilities
answer the following questions pertaining to the abstract below Abstract Administrators routinely seek to increase contribution margin (revenue minus variable costs) to better cover fixed costs, provide indigent care, and meet other community service responsibilities
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answer the following questions pertaining to the abstract below
Abstract
Administrators routinely seek to increase contribution margin (revenue minus variable costs) to better cover fixed costs, provide indigent care, and meet other community service responsibilities. Hospitals with high operating room (OR) utilizations can allocate OR time for elective surgery to surgeons based partly on their contribution margins per hour of OR time. This applies particularly when OR caseload is limited by nursing recruitment. From a hospital's annual accounting data for elective cases, we calculated the following for each surgeon's patients: variable costs for the entire hospitalization or outpatient visit, revenues, hours of OR time, hours of regular ward time, and hours of intensive care unit (ICU) time. The contribution margin per hour of OR time varied more than 1000% among surgeons. Linear programming showed that reallocating OR time among surgeons could increase the overall hospital contribution margin for elective surgery by 7.1%. This was not achieved simply by taking OR time from surgeons with the smallest contribution margins per OR hour and giving it to the surgeons with the largest contribution margins per OR hour because different surgeons used differing amounts of hospital ward and ICU time. We conclude that to achieve substantive improvement in a hospital's perioperative financial performance despite restrictions on available OR, hospital ward, or ICU time, contribution margin per OR hour should be considered (perhaps along with OR utilization) when OR time is allocated.
Margin is an accounting term (margin = [revenue − costs]/revenue). Many hospitals operate with small margins. In the United States, hospitals' average margins were 2.7% in 1999 (1). Forty-three percent of not-for-profit hospitals had negative margins (2). Hospitals improve their margins by increasing their contribution margins (contribution margin = [revenue − variable costs]). Variable costs are those that increase with each successive patient receiving care (e.g., disposable anesthesia circuits). The remainder of hospital costs are fixed costs (e.g., surgical lights).
Many hospitals are also challenged by a growing shortage of skilled hospital nurses available at average national wage rates. This case study describes a hospital at which surgeons reported that many patients needing elective surgery were waiting months for surgery because of difficulties in recruiting additional nursing staff. In this paper, we address the dilemma of allocating surgical services in an environment where demand exceeds available capacity and the hospital is constrained by relatively small margins.
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Question 1
What is meant by bariatric surgical procedures?
Question 2
In a patient with marked obesity, is bariatric surgery better than a balloon
inserted into the stomach?
Question 3
Does intravenous nutrition always have to be given via a central vein?
Question 4
Why has there been an explosion of obesity in the young?
Question 5
Are proteins mostly absorbed from the intestinal lumen into the blood as
amino acids?
Question 6
What are 'congeners' in alcohol?
Question 7
Cholesterol is synthesized in the body. What is the comparative
role of diet and endogenous production in the level of serum
cholesterol?
Question 8
We frequently read of the severe but 'rare' side-effect of myositis with
statins. Do these drugs have more 'common' side-effects?
Question 9
Is there a relationship between brain disease and alcohol intake? Does
alcohol have a proven toxic effect on the brain?
Question 10
What is the difference between malabsorption and malnutrition and how
can these be differentiated clinically
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. Answer 1
The term 'bariatric' is derived from a Greek word meaning 'weight'.
Procedures are designed to reduce weight by restricting the size of the
stomach or by-passing the stomach. Stomach operations include:
? Gastric banding: a band is placed laparoscopically around the upper
part of the stomach (lap-banding), creating a small pouch and a
narrow passage into the stomach.
Answer 2
There are no comparative data as they are two different treatments.
Balloon insertion into the stomach is used for 6 months only to help
obese patients lose weight. Bariatric surgery is used on morbidly obese
patients when all medical therapy has failed.
Answer 3
It is usual to give parenteral nutrition via a central catheter but there are
specially formulated mixtures for use via a peripheral line. Peripheral
parenteral nutrition is useful initially, as the catheter only lasts 5 days.
Answer 4
There is no single lifestyle factor. There appear to be a number of causes,
including taking less exercise, watching television and playing computer
games, as well as an increase in food intake, particularly of fatty, sugary
foods that are very rich in calories. The different degrees of overweight
are shown in Table 5.2.
Answer 5
No, unlike carbohydrates, which are hydrolyzed to monosaccharides and
then absorbed, proteins are broken down into small peptides and only
some amino acids prior to absorption.
Step-by-step explanation
Answer 6
During the distillation process of spirits, in addition to ethyl alcohol,
other alcohols (e.g. isoamyl alcohol) are produced. It is thought that these
'congeners' play a big role in 'hangovers'! Port and bourbon have a
higher congener content than gin and vodka. Obviously, the quantity
drunk also plays a role!
Overweight 25-30 Mildly increased
Obese 30
Class I 30-35 Moderate
Class II 35-40 Severe
Class III 40 Very severe
Answer 7
Cholesterol is synthesized in the body, mainly in the liver. The higher
the amount of cholesterol in the diet, the lower the amount of cholesterol
synthesized, and vice versa. Thus, it is difficult to significantly lower
your serum cholesterol by diet alone unless the diet is very restrictive.
Familial hypercholesterolemia is related to a reduction in the number of
low-density lipoprotein (LDL) receptors.
Answer 8
Gastrointestinal side-effects, including abdominal pain, flatulence,
constipation, diarrhoea, nausea and vomiting, occur frequently but are
often tolerated without complaint.
Answer 9
Yes, alcohol has a toxic effect on the brain; try mental arithmetic after a
few drinks. Alcohol causes blackouts and memory lapses, even in small
amounts. Wernicke-Korsakoff syndrome due to thiamine deficiency is
seen in chronic abusers, as are epilepsy and dementia.
Answer 10
Malabsorption is the term used to describe a failure of absorption of
nutrients. Malnutrition is weight loss which, when severe, has a high
mortality. It is usually due to poor dietary intake (e.g. in sub-Saharan
Africa) or secondary to malignant disease in the West. Malabsorption,
if severe, can lead to malnutrition but this is now relatively rare. In a
patient with malnutrition, malabsorption must be excluded, usually on
the patient's history.
