PubMed Health⌕ Search

Biomedical subjects

G Land

Publications and source records attributed to G Land.

At least 19 recordsLinked to original sources
PubMed1997

Consumer reports in health care. Do they make a difference in patient care?

CONTEXT: Consumer reports in health care are a relatively recent phenomenon. Primarily designed to assist consumers in making more informed decisions about their personal health care, they appear to have an important by-product-they led to positive changes in the behavior of clinicians and health care delivery organizations. While there has been much speculation on their impact on health care consumer behavior, consumer reports offer an effective strategy in improving the quality of patient care. OBJECTIVE: To examine the impact of an obstetrics consumer report developed and issued by the Missouri Department of Health on hospital behavior. DESIGN AND SETTING: A retrospective study of hospital behavior using both primary survey and secondary clinical data. PARTICIPANTS: Consumer reports were issued in 1993 to all Missouri hospitals providing obstetrical services (n=90). A survey was conducted a year later, and the results were analyzed with other available data to determine the effect of the report. Two hospitals discontinued obstetrical services by the time of the survey; of the remaining 88 hospitals, 82 (93%) responded to the survey. MAIN OUTCOME MEASURES: The following outcomes were examined: (1) number and percentage of hospitals that previously did not have services at the time report was issued, but had, or planned to have, services after a guide was published; (2) the percentage of obstetrical policies that were changed, planned to change, or are under discussion for change (car seat program, obstetrical follow-up services, formal transfer agreement, nurse educator for breast-feeding, and availability of tubal ligations); and (3) clinical outcomes, including satisfaction, appropriateness of charges, and the rates of cesarean delivery, high-risk infant transfer, ultrasound, vaginal birth after cesarean, very low birth weight, and newborn death. RESULTS: Within 1 year of the report, approximately 50% of hospitals that did not have car seat programs, formal transfer agreements, or nurse educators for breast-feeding prior to the report either instituted or planned to institute these services. Hospitals in competitive markets that did not offer one of these services at the time of the report were more likely to institute a service and/or were about twice as likely to consider improving several indicators. Clinical outcome indicators all improved in the expected direction. CONCLUSION: Public release of consumer reports may be useful not only in assisting consumers to make informed health care choices, but also in facilitating improvement in the quality of hospital services offered and care provided. Changes occur especially in competitive markets.

Cesarean Section↗
PubMed1996

Screening protocol for Torulopsis (Candida) glabrata.

A screening test has been developed for the presumptive identification of Torulopsis (Candida) glabrata from other common clinical isolates of yeast-like fungi. An interlaboratory comparison of a protocol consisting of morphology on cornmeal Tween 80 agar and trehalose fermentation at 42 degrees C was successful in differentiating T. glabrata from other taxa that are frequent or possible clinical isolates. The screening results for 517 clinical yeast isolates, 241 of which were T. glabrata, were compared with their final identification via commercial systems (API20C Yeast Identification System [bioMERIEUX, Hazelwood, Mo.] and Rapid Yeast Identification Panel [Dade Microscan, Sacramento, Calif.]). The trehalose screening test has a sensitivity and a specificity of 97.8 and 95.8%, respectively, and a positive predictive value of 97.4% and a negative predictive value of 96.5%. Overall, the trehalose screen had an efficiency rating of 93.9% for ruling in or out T. glabrata. Since T. glabrata represents a substantial part of the workload in a clinical laboratory, a significant reduction in direct and indirect costs should be realized.

Candida↗
PubMed1995

The development of a consumer guide on the quality of obstetrical services: the Missouri experience.

Missouri published a consumer guide on obstetric in the spring of 1994. This article describes the events and processes that led to the publication of the guide. The guide provided obstetrical quality-of-care indicators on structure, process, and outcomes for each facility doing deliveries. The article describes the principles followed in developing the guide, how the indicators were chosen, how the guide was constructed, and what data sources were used. Several lessons were learned including: a guide opens communication within the provider community, development of a guide is a long process, an advisory committee and preliminary review of findings by providers are necessary, and strong technical expertise is essential.

Algorithms↗
PubMed1994

Prenatal care access and pregnancy outcomes in Missouri.

Women's access to prenatal care and perception of barriers to obtaining care were acquired from data derived from the 1990 NICHD/Missouri Maternal and Infant Health Survey. Maternal surveys were available for 479 fetal deaths, 902 VLBW, 802 MLBW, and 919 normal birth weight infants. Very low birth weight mothers were less likely to receive prenatal care, perceived more barriers to obtaining prenatal care, and were more unhappy about their pregnancy than were the mothers of normal weight infants.

Female↗
PubMed1994

Black-white disparities in health status in Missouri.

Historically, the overall health status as measured by life expectancy and infant mortality of Black and White Missourians has been significantly different. We analyzed birth, death, child death and communicable disease data to determine if Blacks have narrowed the gap in health status. The overall health status of Black and White Missourians improved over the last two decades. However, the gap in health status still remains, and in some cases, has gotten worse. This occurred despite the increase in health care financing through Medicare and Medicaid. To narrow the gap in health status between Blacks and Whites requires addressing prevention and the social problems along with the medical problems.

Adolescent↗
PubMed1993

The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986.

Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study.

Abstracting and Indexing↗
PubMed1992

Nonphysician transport of intubated pediatric patients: a system evaluation.

OBJECTIVE: To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN: Retrospective chart review. SETTING: A 600-bed university hospital with a 16-bed neonatal ICU and a 12-bed pediatric ICU. PATIENTS: All intubated pediatric patients (422 of 614 patients transported during the study period) transported by the dedicated neonatal/pediatric transport team from April 1988 to April 1990. MEASUREMENTS AND MAIN RESULTS: The transport records of intubated pediatric patients were abstracted. Recorded data included age, weight, gestational age, vital signs, diagnosis, interventions received, and use of paralytic agents and sedatives/analgesics. Patients were analyzed in three groups: group 1 (n = 295) included neonates; group 2 (n = 66) included patients greater than 1 month and less than 1 yr of age; and group 3 patients (n = 61) were ages greater than 1 yr. Group 1 had nine (3.1%) complications or patient deteriorations; four (1.4%) were related to the endotracheal tube. Group 2 had one (1.5%) airway complication and one deterioration. Group 3 had no complications or deteriorations. All but one of the airway complications were effectively handled by the transport team. At the referring hospital, the transport nurse or respiratory therapist intubated 62 (19.8%) patients in group 1, five (7.5%) in group 2, and three (4.9%) patients in group 3. Sixty-seven (23%), 21 (32%), and 30 (49%) patients of groups 1, 2, and 3, respectively, were paralyzed for transport. No complications were secondary to the use of paralytic agents or sedatives. CONCLUSIONS: Under proper medical guidance, well-trained nonphysician personnel can provide low-risk transport of intubated pediatric patients. Use of sedatives and paralytic drugs did not increase the risk of complications or patient deterioration.

Child↗
PubMed1992

Sodium valproate acutely inhibits lamotrigine metabolism.

Concomitant administration of sodium valproate (VPA) reduced lamotrigine (LTG) total clearance by approximately 21% and increased elimination half-life and AUC. Reduced elimination occurred acutely within the first hour. Renal elimination of LTG was not impaired. The most probable explanation for this effect is hepatic competition between VPA and LTG for glucuronidation. Volume of distribution and parameters related to absorption, Cmax and tmax were unchanged.

Adult↗
PubMed1991

Single center experience of the effect of delayed function on outcome in retransplant recipients of cadaveric renal allografts.

The incidence of DRF in the regraft study group was most commonly seen in patients with a historic high level of HLA sensitization. Primary NF was an immune mediated event seen in 63% of third regrafts. Delayed use of CyA with ALG induction coverage provides good graft survival with either double or triple maintenance therapy. Stricter patient selection for third transplants and aggressive clinical monitoring of the regrafted patient has provided a 1-year actuarial graft survival result of 88% at our transplant center.

Antilymphocyte Serum↗
PubMed1989

Increasing cesarean section rates in very low-birth weight infants. Effect on outcome.

Examination of a linked birth and death certificate file from Missouri revealed a remarkable increase in the use of cesarean section for very low-birth weight infants (500 to 1499 g) from 24% to 44% in the years 1980 to 1984. In the same years the rate for 1500- to 2499-g infants went from 21% to 26% and the rate for 2500- to 7000-g infants went from 14% to 18%. We studied first-day death rates in very low-birth weight infants as an indicator of potential benefit from this increase in cesarean sections. During the 5-year period first-day deaths averaged 10% and 22% in the cesarean and vaginal birth groups, respectively. This difference was explained almost entirely by deaths in the 500- to 740-g birth weight group, where the death rates were 33% and 59%, respectively. Although this difference remained statistically significant after adjustment for gestational age and other factors that differed between the groups, it was nullified by an excess of deaths in the succeeding 6 days of life. Overall, the odds of death in the first week in these infants weighing 500 to 749 g was 0.85 (95% confidence interval, 0.52 to 1.39) in the cesarean vs vaginal deliveries. We conclude that there is little evidence that the use of cesarean section for the delivery of very low-birth weight infants, independent of maternal or fetal compromise, improves overall survival. We were unable to find reasons to justify the sharp increase in the use of cesarean sections for these small infants.

Cesarean Section↗
PubMed1989

The pharmacokinetics of lamotrigine (BW430C) in healthy subjects with unconjugated hyperbilirubinaemia (Gilbert's syndrome).

A single oral dose of lamotrigine was administered to seven volunteers with Gilbert's Syndrome (unconjugated hyperbilirubinaemia). Plasma samples were assayed by high performance liquid chromatography (h.p.l.c.) and pharmacokinetic parameters were compared with those of a group of nine normal volunteers. In the subjects with Gilbert's Syndrome mean oral clearance (CLpo) was 32% lower (P less than 0.01) and the plasma elimination half-life (t1/2) was 37% lower (P less than 0.02) than in the normal controls. The amount of unchanged lamotrigine excreted in the urine was 30% greater in the Gilbert's subjects (P less than 0.01) although this only amounted to 9.5% of the administered dose. Subjects with Gilbert's Syndrome have some impairment of lamotrigine elimination but this is unlikely to be clinically important.

Adult↗
PubMed1986

Smoking and excess sick leave in a department of health.

Average number of sick leave hours per month taken by smoking and nonsmoking employees of Missouri's Department of Health were examined. During a 20-month period 97 smokers took 5.3 hours per month sick leave, whereas 309 nonsmokers took 4.3 hours, a 23% difference. Excess sick leave was taken by smokers regardless of their sex, marital status, or age group. Smokers who were male, unmarried, or older took 22% to 38% more sick leave than their nonsmoking counterparts. It was estimated that for excess sick leave only, the smokers cost the department $11,931 per year. Using total cost figures developed by Weiss yielded an estimated excess cost of $510,802 per year.

Absenteeism↗
PubMed1985

Lamotrigine (BW430C), a potential anticonvulsant. Effects on the central nervous system in comparison with phenytoin and diazepam.

Twelve healthy male volunteers received phenytoin 0.5 and 1 g, lamotrigine (a new anticonvulsant) 120 and 240 mg, diazepam 10 mg and placebo orally in a double-blind, cross-over, randomized trial. Maximum drug concentrations at 4 h, measured in plasma were 11.5 +/- 2.2 micrograms ml-1 for phenytoin and 2.7 +/- 0.4 micrograms ml-1 for lamotrigine. These levels were in the therapeutic range for phenytoin and the putative therapeutic range for lamotrigine. Side effects after diazepam (mainly sedation) and phenytoin (mainly unsteadiness) differed markedly from lamotrigine which produced no important side effects. Subjective effects as measured by visual analogue scales were caused by phenytoin and diazepam but not by lamotrigine. Diazepam impaired eye movements, adaptive tracking and body sway. Phenytoin impaired adaptive tracking, increased body sway and impaired smooth pursuit eye movement. Lamotrigine produced only a possible slight increase in body sway. There were significant correlations between performance and saliva levels of phenytoin and diazepam. It was concluded that the tests used were suitable for monitoring CNS effects of anticonvulsants and that lamotrigine possibly could have a more favourable CNS side effect profile than phenytoin.

Adult↗
PubMed1984

Tolerance and pharmacokinetics of A515U, an acyclovir analogue, in healthy volunteers.

A515U (6-deoxyacyclovir) is an analogue of acyclovir devoid of antiviral activity in vitro but which is well absorbed and undergoes conversion to acyclovir after oral administration to rats. The tolerance and pharmacokinetics of various doses of A515U have been studied in 8 healthy volunteers. Single oral doses of 25, 50, 100, 200 and 400 mg A515U and 400 mg acyclovir for comparison were administered to the volunteers at weekly intervals. Concentrations of the parent drug and acyclovir were determined in plasma and urine. The prodrug was well tolerated and did not cause adverse reactions or changes in haematological or biochemical variables. It was well absorbed and conversion to acyclovir was rapid and extensive at all doses. Plasma concentrations of acyclovir achieved with 50 mg A515U orally were comparable to and less variable than those produced by 400 mg acyclovir. A515U was rapidly cleared with a short plasma elimination half life of approximately 0.5 h. The attainment of high plasma concentrations of acyclovir by oral administration of a prodrug may represent an important advance in antiviral chemotherapy.

Absorption↗
PubMed1984

Update and evaluation of the AutoMicrobic yeast identification system.

The AutoMicrobic system (AMS) Yeast Biochemical Card (Vitek Systems Inc., Hazelwood, Mo.) is a system which has been designed for rapid and automated reporting of yeast identification in the clinical laboratory. Recent improvements have been implemented in the AMS data base to expand and enhance its yeast identification capabilities. These improvements include the addition of seven biotypes, changes in data analysis scheme, and construction of the taxonomic keys. The updated system was compared with the API 20C (Analytab Products, Plainview, N.Y.) yeast identification system and a rapid conventional method, using 1,106 clinical and stock yeast isolates. With these improvements, the AMS Yeast Biochemical Card had a correlation of 98.8% with the API 20C system and 93.4% with the rapid conventional method and significantly increased its capability of identifying Cryptococcus neoformans (98%). The most difficult organisms for the system to identify in 22 to 24 h were Cryptococcus terreus (58%) and Cryptococcus uniguttulatus (73%). The updated AMS not only provided more rapid results which were comparable to the other two systems but gave a substantial savings in set-up and reporting time as well.

Microbiological Techniques↗