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Biomedical subjects

B Mozes

Publications and source records attributed to B Mozes.

At least 37 records · Page 2Linked to original sources
PubMed1996

Factors affecting change in quality of life after prostatectomy for benign prostatic hypertrophy: the impact of surgical techniques.

PURPOSE: The impact of prostatectomy on quality of life was assessed in patients with benign prostatic hypertrophy (BPH) who were classified according to the expected benefit from surgical intervention. The relative impact of the 2 surgical techniques (open versus closed) on short-term quality of life was compared. MATERIALS AND METHODS: An observational study was done on 545 consecutive patients with BPH undergoing prostatectomy at 3 medical centers in Israel between 1991 and 1992. Repeated structured interviews preoperatively, and at 4 and 12 months postoperatively were performed, including 6 quality of life questionnaires evaluating BPH specific (symptom severity and symptom effect) and generic (activity, independence, mental health and health perception) parameters. In addition, the interviews consisted of socio-demographic data elements. Clinical details regarding severity of prostatic disease and co-morbidity were obtained from the medical charts. RESULTS: We found a correlation between postoperative change in symptom effect and in generic quality of life measures (r-0.11 to 0.20, p < 0.04). The postoperative decrease in the mean symptom effect score was 56% and 52% for severe and moderate preoperative levels, respectively. There was no decrease in the mean symptom effect score for the mild preoperative level (18% of these patients had postoperative deterioration). A secondary operation, and the combination of diabetes mellitus and poor activity level were risk factors for lack of improvement in patients with moderate preoperative symptom effects. We found that the impact of open prostatectomy on quality of life was similar to that of the closed technique after adjustment for patient attributes, except for those with an indwelling urinary catheter in whom an open operation was advantageous. CONCLUSIONS: In patients with BPH and mild symptom effects, and in subgroups of patients with moderate symptom effects surgery should not be recommended. Based on short-term measures of quality of life there is no justification for a preference between open and closed operations.

Aged↗
PubMed1995

Factors associated with inappropriate hospitalization in medical wards: a cross-sectional study in two university hospitals.

A comparative study of the appropriateness of hospitalization was conducted in the medical departments of two university hospitals in Israel. A cross-section of 297 patients on one hospitalization day was analyzed using the Appropriateness Evaluation Protocol (AEP). Data were independently collected by two reviewers (R1 and R2). The study revealed a significant difference in the percent of inappropriate hospitalization between the two hospitals, i.e. 13.3% (R1) or 19.3% (R2) for hospital B, and 24.5% (R1) or 32% (R2) for hospital A. The reviewers were in agreement regarding evaluation (92.6%, Kappa 0.78) of 275 index days. A multivariate analysis of the index days with agreed appropriateness correlated with occupancy and length of stay. Routine monitoring of appropriateness of hospital stay should, therefore, be targeted to medical departments with relatively low occupancy rates and/or prolonged average stay.

Aged↗
PubMed1994

The appropriateness of performing coronary angiography in two major teaching hospitals in Israel.

OBJECTIVE: To assess the appropriateness of using coronary angiography in two major medical centers in Israel. METHODS: (a) Development of dichotomous appropriateness rating by concensus of an expert panel for possible indications to use coronary angiography; (b) applying the panel's rating to clinical data gathered from interviews and records of 499 patients who underwent coronary angiography. RESULTS: Angiographies were performed inappropriately in 58% of patients: in 56% neither prognostic stratification was performed, nor was comprehensive medical therapy prior to angiography undertaken. Referral to catheterization from an acute care hospital, compared to ambulatory referral, correlated independently with an inappropriate angiogram. CONCLUSION: In the Israeli public health system there is still a high rate of inappropriate coronary angiography, most of the cases being due to error in management before performing angiographies.

Aged↗
PubMed1994

Case-mix adjustment using objective measures of severity: the case for laboratory data.

OBJECTIVE: We evaluate the use of routinely gathered laboratory data to subclassify surgical and nonsurgical major diagnostic categories into groups homogeneous with respect to length of stay (LOS). DATA SOURCES AND STUDY SETTING: The source of data is the Combined Patient Experience database (COPE), created by merging data from computerized sources at the University of California San Francisco (UCSF) Medical Center and Stanford University Medical Center for a total sample size of 73,117 patient admissions. STUDY DESIGN: The study is cross-sectional and retrospective. All data were extracted from COPE consecutive admissions; the unit of analysis is an admission. The outcome variable LOS proxies hospital resource utilization for an inpatient stay. Nine (candidate) predictor variables were derived from seven lab tests (WBC, Na, K, C02, BUN, ALB, HCT) by recording the whole-stay minimum or maximum test result. DATA COLLECTION/EXTRACTION METHODS: Patient groups were formed by first assigning to major diagnostic categories (MDCs) all 73,117 admissions. Each MDC was then partitioned into medical and surgical subgroups (sub-MDCs). The 13 sub-MDCs selected for study define a study population of 32,599 patients that represents approximately 45 percent of inpatients. Within each of the 13 sub-MDCs, patients were randomly assigned to one of two data sets in a ratio of 2:1. The first set was used to create, the second to validate, three different LOS predictors. Predictive accuracies of individual DRG classes were compared with those of two alternative classification schemes, one formed by recursive partitioning (the sub-MDC) using only lab test results, the other by partitioning with both lab test results and individual DRGs. PRINCIPAL FINDINGS: For the eight largest sub-MDCs (81 percent of study population), individual DRGs explained 23 percent of the within sub-MDC variance in LOS, laboratory data classes explained 31 percent, and classes derived by considering individual DRGs and laboratory data explained 37 percent. (Each result is a weighted average R2. The average number of LOS classes into which the eight largest sub-MDCs were partitioned were 20, 10, and 10, respectively. Within six of the eight, partitioning on the basis of laboratory data alone explained more within sub-MDC variance than did partitioning into individual DRGs. CONCLUSIONS: Routine lab test data improve the accuracy of LOS prediction over that possible using DRG classes. We note that the improvements do not result from overfitting the data, since the numbers of LOS classes we use to predict LOS are considerably fewer than the numbers of individual DRGs.

California↗
PubMed1993

Inconsistency of a model aimed at predicting bacteremia in hospitalized patients.

Clinical prediction rules can help physicians determine the necessity for blood cultures in specific patients and/or in whom empiric antibiotic treatment should be administered. Before adopting a prediction rule its validity must be evaluated in different settings. We revealed independent predictors of true bacteremia and developed a risk score based on them in one group of adult hospitalized patients (n = 474; derivation set). An attempt was made to validate this risk score in a second group of in-patients at the same hospital (n = 438; validation set). The derivation set included 540 blood culture episodes and the validation set 516. A blood culture episode was defined as one or more of all blood specimens withdrawn for culture from one patient over one 24 hour period. Independent multivariate predictors of true bacteremia were: temperature of 39 degrees C or higher, current immunosuppressive therapy, serum alkaline phosphatase > 100 IU and hospitalization in an intensive care unit. In the low risk group, defined by the absence of the said predictors, the rates of true bacteremia were 5.1 and 4.6% for the derivation and validation sets, respectively. As raised temperature is the main clinical feature guiding physicians to suspect bacteremia, we examined the probability of true bacteremia in patients with a temperature of less than 38 degrees C and found it to be 5.6% in the two sets. The model identified high risk subset patient groups demonstrating true bacteremia in 38% of all episodes in the derivation set and the comparatively low rate of 12.1% (p < 0.01) for the validation set.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Patterns of unjustified pediatric hospital stay.

We examined the pattern of hospital stay in a pediatric division of a major teaching medical center in terms of justification of the hospital stay. Hospital stay days of all children admitted during 3 consecutive weeks were assessed prospectively according to predetermined criteria. Of the 2,048 hospital stay days 26% were unjustified, primarily due to unnecessary in-hospital follow-up and diagnostic evaluation that should have been carried out on an ambulatory basis. Logistic regression analysis revealed that neurological disorders and trauma, age younger than 3 years, specific ward, and the attending physician were significant predictors for unjustified hospital stay days. This method is proposed as a means for optimal reduction of redundant hospital stay and concomitant unnecessary economic burden.

Child↗
PubMed1991

Laboratory data predicts survival post hospitalization.

From a database of 93,077 in-patient admissions, patients assigned to catastrophic, very severe, moderately severe, and average 30-day mortality risk categories (as defined in Medicare Hospital Mortality Information, 1989 release, from the Health Care Financing Administration (HCFA] were selected for study. These admissions account for 30% of all admissions, but 70% of all deaths up to 1 year post admission. To determine whether laboratory information adds to the predictive power of the information used by HCFA, we compare the performance of 1 year survival predictors (Cox model) that use only diagnostic, demographic, and comorbidity information, with the performance of predictors that also include laboratory information. Using a separate set of patients not used for model definition, we find that laboratory data contain significant prognostic information independent of that already available in non-laboratory data. In HCFA's catastrophic disorders for example, non-laboratory information reduces the average risk of predicting a wrong outcome by 17% relative to considering only catastrophic group membership, and adding laboratory data reduces this risk by a further 21%. These improvements result primarily from considering the outcomes of a small set of routine laboratory tests (maximum BUN, AST, and WBC, and minimum CO2, hematocrit, and sodium).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Factors affecting inappropriate hospital stay.

Fifty-four per cent of hospital stay days on the medical wards in a large teaching hospital, 40% on surgery and 26% on pediatrics, were found to be unjustified, using an assessment method based on explicit criteria. Despite the observed differences between the various specialties, the frequency distribution of the reasons for unjustified hospital stay days was essentially similar. Most of the unjustified hospital stay days were attributed to diagnostic evaluation, non-emergency treatment and immediate follow-up, which were carried out within the hospital rather than on an ambulatory basis. The major factors for unjustified hospital stay days were age, ethnic group, ward of admission and diagnostic category. These findings may contribute to the implementation of hospital utilization management programs aimed at cost containment.

Evaluation Studies as Topic↗
PubMed1989

Yield of the admission complete blood count in medical inpatients.

The clinical efficacy of routine admission complete blood count was evaluated in 302 patients admitted to internal medicine wards of a university teaching hospital. Patient medical problems, physical findings and medication history were evaluated by preset criteria to determine the proportion of tests performed for screening and the proportion of test results directly influencing patient management. Of the 282 complete blood counts performed, 80% were ordered routinely with no medical indications (screening tests). An haemoglobin abnormality was found in 16.7% of the patients, leucocyte abnormality in 16.1% and platelet abnormality in 4.6%. However, these results directly influenced patient management in only one case (0.14%). It is concluded that the utility of screening admission complete blood counts in medical inpatients is negligible.

Aged↗
PubMed1989

Evaluation of an intervention aimed at reducing inappropriate use of preoperative blood coagulation tests.

A multiphase intervention trial based on education, implementation of criteria, and restriction, aimed at modifying the established clinical policy of mandatory preoperative screening for coagulation abnormalities, was carried out on five surgical wards of a general hospital. The education period did not influence the ordering of partial thromboplastin time tests, despite a significant posteducational change in surgeons' attitudes. In contrast, administrative restriction of coagulation test orders led to a 50% decline on four of the five study wards. We conclude that an educational intervention followed by administrative restriction may be considered an acceptable means of overcoming clinician reluctance to change well-established but redundant clinical policy.

Attitude of Health Personnel↗
PubMed1988

Cost-effectiveness of in-hospital evaluation of patients with syncope.

In order to assess the utility of in-hospital evaluation of syncope we reviewed the records of 134 consecutive patients admitted within 6 h of a true syncopal episode, and obtained follow-up information on 130 of them 3 years later. All threatened cardiac rhythm and conduction disturbances were detected on the initial ECG recording. Prolonged ECG monitoring did not contribute additional diagnoses. Other diagnostic tests and procedures performed during the mean 7.5-day hospital stay only confirmed the findings of the initial history, physical and ECG examinations. Diagnostic evaluation was followed by therapeutic intervention in only 33 patients (24%); all interventions were clearly mandated by the initial admission evaluation. There were no cases of sudden death and no association between causes of death, the index syncope episode or prior history of syncope. We therefore propose that the evaluation of patients presenting within hours of a syncopal episode include only history taking, physical examination and the initial ECG recording. Further in-hospital evaluation should be limited to confirming initial positive findings. This approach may allow an estimated 85% reduction in costs involved in the management of similar patients, with probable negligible adverse effects on prognosis.

Aged↗
PubMed1988

Gastrointestinal phycomycosis in acute nonlymphatic leukemia.

A 37-year-old patient with acute nonlymphatic leukemia developed gastrointestinal phycomycosis during failure in bone marrow production. The clinical presentation was of acute typhlitis. Laparotomy revealed a necrotic mass in the region of the iliocecal valve, and on histologic examination hyphae of phycomycetes with invasion of the blood vessels were seen. The patient died as a result of widespread infection.

Acute Disease↗