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Biomedical subjects

C M Wylie

Publications and source records attributed to C M Wylie.

At least 19 recordsLinked to original sources
PubMed1981

The complex wane of peptic ulcer. I. Recent national trends in deaths and hospital care in the United States.

Cimetidine use rose dramatically for peptic ulcer (PU) disease during 1977-1979. Although death rates were dropping before these years, the added choice of treatment may have speeded the wane of PU. Hospital discharge rates in for PU fell in 1971-1976, and in 1978; they remained level in 1977, however, possibly because Cimetidine stimulated more inpatient care in that year. The gradually diminishing length of stay steepened its fall for younger patients in 1977-1978. Moreover, fluctuating surgery rates reached an unusually low level in 1978. Cimetidine treatment could be among the factors postponing surgery of about 30,000 PU cases hospitalized in 1978, the first year of its availability. Since this study used data from the National Center for Health Statistics, we need larger numbers, longer postcimetidine experience, and more detailed analyses to increase the certainty of these findings.

Adolescent↗
PubMed1981

The complex wane of peptic ulcer. II. Trends in duodenal and gastric ulcer admissions to 790 hospitals, 1974-1979.

Data on duodenal ulcer (DU) and gastric ulcer (GU) admissions to 790 general hospitals during 1974-1979 were analyzed to form more detailed time trends than in Part I. Annual admissions for DU fell less for 1977-1979 than between earlier years; for GU, admissions rose slowly in 1977-1979 after falling in previous years. Decisions about hospitalization may have changed, therefore, to admit proportionately more ulcer patients beginning 1977, the year of cimetidine's release. Also at that time the proportion of patients admitted with complications began to rise, slightly for DU and more steeply for GU; before cimetidine, that proportion had changed little for successive years. Despite the rising number with complications, case fatality rates actually fell in 1977-1979, particularly so in 1978 for DU. A fall in surgery for uncomplicated DU began in Spring 1977, some months before cimetidine became available. Finally, the average hospital stay fell more rapidly after 1977, both for DU and GU, and for surgical and nonoperated patients. The data do not say definitively that cimetidine's apparently protective effect against surgery lasts more than 2 years for uncomplicated DU. Nevertheless, the use of cimetidine, plus the high expectations before its impending release, probably caused the change in trends documented in this study.

Adolescent↗
PubMed1979

Reassessing the early effect of concurrent review on length of stay: Illinois, 1971--72.

The Hospital Admission and Surveillance Program (HASP) was a pre-PSRO program in Illinois. Established in February 1972, its objective was to reduce the cost of care given to Medicaid beneficiaries in that state. HASP approved length of stay (L.O.S.) on a prospective only basis, so that all Medicaid patients were reported promptly on admission. During 1972, the Illinois Medicaid program was rapidly expanding in patient volume, but not in scope of services. This study compares patients admitted to 46 hospitals in Illinois before and after the establishment of HASP. To adjust for changes in case mix between the two periods, each patient was matched for age, diagnosis and illness severity with patients in an appropriate comparison group. The complex process of matching raised the likelihood that changes in L.O.S. were caused by HASP's activities and not by other factors. L.O.S. fell significantly more for Medicaid than for non-Medicaid patients. In addition, the mix of diagnoses changed more markedly for Medicaid than non-Medicaid patients, emphasizing the need for case mix adjustments in this before-and-after study. Some findings suggest that the "post-HASP" admissions had the greater need for hospital care; this trend affected both Medicaid and non-Medicaid patients, however, The combined evidence suggests that concurrent review, as implemented by HASP, helped shorten L.O.S. in 1972. Whether quality of care changed was not studied.

Age Factors↗
PubMed1976

Comparison of hospital admissions for cerebrovascular disease in Michigan and North Carolina.

Hospital admission rates and death rates for cerebrovascular disease differ markedly between states. Hospital admission data were analyzed: (a) to ascertain why death rates from this disease group are lower in Michigan than in North Carolina and (b) to clarify whether hospital care in either state has inadequacies that can be corrected quickly. Among both whites and blacks of the same age, case-fatality ratios were higher in North Carolina than in Michigan. Subarachnoid and cerebral hemorrhages were diagnosed more often in the southern state. For both areas, the records showed a marked underreporting of hypertension and diabetes mellitus as secondary conditions in the hospital admissions; elevated blood pressures were about equally common in each state but were treated more vigorously in Michigan. Secondary diagnoses of respiratory disease and use of anti-infective agents were reported more frequently in North Carolina. In contrast, diabetes mellitus was more prevalent in Michigan admissions. Some reasons for these findings are advanced, particularly as they relate to diagnostic and treatment patterns. Finally, the need for more detailed research is emphasized to create guidelines for better hospital care of cerebrovascular disease.

Aged↗