Biomedical subjects

C M Watts

Publications and source records attributed to C M Watts.

6 recordsLinked to original sources

PubMed2001

Who bounces back? Physiologic and other predictors of intensive care unit readmission.

OBJECTIVE: To determine the influence of changes in acute physiology scores (APS) and other patient characteristics on predicting intensive care unit (ICU) readmission. DESIGN: Secondary analysis of a prospective cohort study. SETTING: Single large university medical intensive care unit. PATIENTS: A total of 4,684 consecutive admissions from January 1, 1994, to April 1, 1998, to the medical ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The independent influence of patient characteristics, including daily APS, admission diagnosis, treatment status, and admission location, on ICU readmission was evaluated using logistic regression. After accounting for first ICU admission deaths, 3,310 patients were "at-risk" for ICU readmission and 317 were readmitted (9.6%). Hospital mortality was five times higher (43% vs. 8%; p < .0001), and length of stay was two times longer (16 +/- 16 vs. 32 +/- 28 days; p < .001) in readmitted patients. Mean discharge APS was significantly higher in the readmitted group compared with the not readmitted group (43 +/- 19 vs. 34 +/- 18; p > .01). Significant independent predictors of ICU readmission included discharge APS >40 (odds ratio [OR] 2.1; 95% confidence interval [CI] 1.6-2.7; p < .0001), admission to the ICU from a general medicine ward (Floor) (OR 1.9; 95% CI 1.4-2.6; p < .0001), and transfer to the ICU from other hospital (Transfer) (OR 1.7; 95% CI 1.3-2.3; p < .01). The overall model calibration and discrimination were (H-L chi2 = 3.8, df = 8; p = .85) and (receiver operating characteristic 0.67), respectively. CONCLUSIONS: Patients readmitted to medical ICUs have significantly higher hospital lengths of stay and mortality. ICU readmissions may be more common among patients who respond poorly to treatment as measured by increased severity of illness at first ICU discharge and failure of prior therapy at another hospital or on a general medicine unit. Tertiary care ICUs may have higher than expected readmission rates and mortalities, even when accounting for severity of illness, if they care for significant numbers of transferred patients.

APACHE↗

PubMed2000

Occurrence of Candida albicans in infections of endodontic origin.

Microorganisms are recognized as the etiological agent for the majority of pulpal and periradicular disease. Although bacteria have been the most studied, fungi have also been associated with infected root canals. The purpose of this study was to evaluate the contents of infected root canals and aspirates of cellulitis/abscesses of endodontic origin for the presence of Candida albicans using the polymerase chain reaction (PCR). PCR primers specific for the 18S ribosomal RNA gene of C. albicans were used to survey 24 samples taken from infected root canals and 19 aspirates from periradicular infections of endodontic origins. The presence of C. albicans was detected in 5 of 24 (21%) samples taken from root canals, but none was detected in the periradicular aspirates. The results indicate that PCR is an extremely sensitive molecular method that may be used to identify C. albicans directly in samples from infections of endodontic origin.

Candida albicans↗

PubMed1999

Trauma services: a profit center?

BACKGROUND: Previous studies have demonstrated inadequate reimbursement for severely injured patients with a resultant negative economic impact for the trauma service and hospital. The purpose of this study was to assess the total cost of care for all injured patients discharged from the trauma service in fiscal year 1997, and to determine the proportion of costs for the most severely injured on total cost. In addition, we assessed the total service costs and the revenue for treatment of the most severely ill. The final result was the determination of the profit (loss) margin for the entire service. STUDY DESIGN: All patients discharged from our Level I Trauma Center in fiscal year 1997 were included (n = 696). The population was then stratified into 2 subgroups using the Injury Severity Score (ISS). Patient grouping was facilitated by integration of the trauma registry with the hospital cost accounting system. The population was sub-divided into 2 distinct groups. Group A represented all patients with an ISS >15 (n = 192). Group B contained all patients with an ISS <15 (n = 504). Length of stay and mortality of each group was recorded. Cost of care was determined by the hospital cost accounting system TSI (Transition System Incorporated, Boston, MA), which is designed to generate cost center data on a cost per patient basis. Total costs were determined for the entire population and Groups A and B. The proportion of costs consumed by each group was then calculated. Reimbursement was determined by calculating expected payments for each patient. These calculations are based on previously agreed upon allowances from each insurer and are reconciled at the end of each fiscal year to ensure accuracy. RESULTS: The average length of stay for the population and Groups A and B were 7.5, 9.8, and 6.7 days respectively. Mortality in each group was 9.7%, 19.3%, and 6%. Over 92% of the population sustained blunt mechanism injury and only 8% were penetrating. When controlled for length of stay, the profit margin for Group A is $1,242/day and for Group B is $519/day. Comparison of mean cost/patient between Group A and Group B was $35,727 versus $17,623, respectively. CONCLUSION: Trauma centers can be profitable. Group A is responsible for 44% of the total service cost while accounting for only 28% of the discharges. Moreover, this group is responsible for 57% of the profit, and yields the greatest return. The ability to care for the sickest patients, while enormously costly, is essential to the economic viability of the trauma center and its future growth.

Cost Allocation↗

PubMed1994

The case for using objective scoring systems to predict intensive care unit outcome.

The acceptance and more widespread use of objective probability estimates will depend on addressing several practical issues. Physicians generally are unfamiliar with these estimates, their origin, and how they should be used. Physicians need to understand the conceptual origins of prognostic systems, their strengths and limitations, and their usefulness in helping to resolve uncertainty and improve critical decision making. Better communication and understanding of patient and family preferences and values will be necessary to ensure that the use of numerical predictions will not be the dominant or exclusive consideration. No matter how refined and elaborate these systems become, they represent simplification of even more complex biologic decision-making systems. The predictions must be interpreted carefully and used by trained intensivists, with the constant opportunity to exercise human discretion. The challenge to the developers of these systems will be to improve their accuracy, refine their use with specific disease entities that are important in determining outcome in critical care (e.g. multi-organ system failure, sepsis, adult respiratory distress syndrome), improve display of data and ease of data capture with automated systems, and construct data-bases and predictive equations that are fluid, constantly growing, and adjusting to capture developments in medical care.

Decision Making, Organizational↗

PubMed1983

Continuing education in pulmonary disease for primary-care physicians.

A continuing medical education program was implemented and evaluated in 16 community hospitals. It was targeted at primary-care physicians and used physicians identified by their peers as being educationally influential for the dissemination of information. Self-study materials were used, followed by an intensive 2-wk preceptorship that resulted in a significant increase in physician knowledge. Inpatient chart audits identified a series of changes in the management of chronic obstructive pulmonary disease in the intervention hospitals that were not noted in the control hospitals. These included the increased use of intravenously administered fluids, loading doses of intravenously administered bronchodilators, aerosolized and single agent bronchodilators, and respiratory therapy services. Continuing medical education, delivered through community-based educationally influential physicians, is an effective way of changing physician behavior in small communities with no prior ongoing educational programs. This approach should improve patient care and may reduce the need for participation of academic faculty in traditional continuing education programs.

Education, Medical, Continuing↗

PubMed1976

Pneumoperitoneum. A complication of mechanical ventilation.

Pneumoperitoneum occurred in three adults receiving mechanical ventilatory support. Since the presence of a perforated viscus could not be confirmed by combinations of clinical, surgical, or autopsy findings in any of these patients, it appears that the free abdominal air in these patients was a complication of the ventilatory therapy. It is possible that such a complication may be more common than is currently recognized and thus should be added to the differential diagnosis of pneumoperitoneum.

Adolescent↗