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Biomedical subjects

M Ault

Publications and source records attributed to M Ault.

15 recordsLinked to original sources
PubMed2001

The value of a hospitalist service: efficient care for the aging population?

BACKGROUND: We studied patients of a hospitalist teaching service and patients receiving routine private care (control subjects). We sought to evaluate whether inpatients cared for by an academic hospitalist service had lower lengths of stay and resource utilization rates. METHODS: Using monthly hospital census data, 477 hospitalist cases and 1,160 control cases were selected by explicit criteria from the Medicaid population of a large, university-affiliated, community medical center between July 1, 1996, and June 30, 1997. Outcomes in hospitalist faculty patients were compared to those of control patients under the care of private providers. RESULTS: Median length of stay was 4 days for control subjects and 3 days for the hospitalist service (p < 0.0001). Median total cost per case was $4,853 for control subjects and $4,002 for hospitalist patients (p < 0.0001). Only patients > or = 65 years old showed statistically significant reductions in both length of stay (p < 0.0001) and total cost (p = 0.002). Subspecialty consultation rates were 37.6% for control subjects and 16.6% for hospitalist cases (p < 0.0001). We noted increasing consultations for patients > or = 65 years old, especially in the control group (p = 0.001). No significant differences in mortality, 30-day readmissions, or interfacility transfers were observed. CONCLUSIONS: Patients cared for by an academic hospitalist service that includes actively participating medical residents appear to have lower lengths of stay, total costs, and consultation rates than patients receiving routine private care. The reductions are largely observed among patients > or = 65 years old.

Adolescent↗
PubMed2001

Ultrasonography performed by primary care residents for abdominal aortic aneurysm screening.

A prospective pilot study was undertaken to assess a protocol to educate primary care residents in how to personally perform ultrasonography for abdominal aortic aneurysm screening. Resident exams were proctored by a primary care physician trained in ultrasonography and were scored on the level of competence in doing the examination. Patients had ultrasound performed by a resident, followed by repeat examination by the vascular lab. Primary care resident abdominal aortic imaging was achieved in 79 of 80 attempts. Four abdominal aortic aneurysms were identified. There were 75 normal examinations; resident ultrasonography results were consistent with the results of the vascular lab. Ten residents achieved an abdominal aortic ultrasound-independent competence level after an average of 3.4 proctored exams. The main outcome of this study is that a primary care resident, with minimal training in ultrasonography imaging, is able to rapidly learn the technique of ultrasonography imaging of the abdominal aorta.

Aortic Aneurysm, Abdominal↗
PubMed1999

Percutaneous dilatational tracheostomy: still a surgical procedure.

Although percutaneous dilatational tracheostomy (PDT) has been shown to be a cost-effective bedside alternative to open tracheostomy (OT), prior reports of the complications of the procedure are contradictory. Reported complications range from minor events to fatal ones, in varying percentages. This prospective study was designed to identify the type and severity of complications accompanying the introduction of PDT to a tertiary medical center. Surgical and medical intensive care unit (ICU) patients requiring elective tracheostomy were identified as appropriate for PDT using approved institutional criteria. All procedures were performed at an ICU bedside in the presence of a surgeon privileged to perform OT. Demographic data, procedural information, and patient outcome (including minor and major complications, length of stay, and survival) were collected. PDT was performed in 96 ICU patients, with complete data available for 95 patients. PDT was performed in an average of 13.1+/-1.0 minutes. Twenty-three major and minor complications occurred, including two perioperative deaths, in 15 patients (15.8%). A total of 37 PDT patients (38.9%) died in the hospital, indicative of the severity of illness of patients requiring tracheostomy. Based on the experience to date, Cedars-Sinai Medical Center (Los Angeles, CA) continues to require a surgeon privileged to perform OT to participate in all PDT procedures.

Aged↗
PubMed1993

Use of the peripherally inserted central catheter for parenteral nutrition during pregnancy.

BACKGROUND: Parenteral nutrition is required during pregnancy to treat hyperemesis gravidarum and other conditions in which enteral intake is inadequate. We describe the peripherally inserted central catheter. The catheter is inserted into the antecubital vein using local analgesia, thus eliminating some of the risks associated with obtaining central venous access. CASE: Three pregnant patients required parenteral nutrition for refractory hyperemesis gravidarum. The peripherally inserted central catheter was successfully placed, and central venous administration of hyperosmolar solutions was accomplished without complication for periods of 28-137 days. Maternal weight gain and fetal growth were adequate. CONCLUSIONS: The peripherally inserted central catheter avoids some of the risks related to obtaining central venous access and permits long-term administration of parenteral nutrition into the central venous circulation.

Adult↗
PubMed1993

Analysis of behavior state conditions and associated environmental variables among students with profound handicaps.

State conditions in combination with environmental events and factors significantly affect the level of alertness and responsiveness among students with profound and multiple handicaps. State conditions and environmental variables over a continuous, 5-hour period for each of 25 students in classroom settings were measured. Data were assessed using transitional probability, time series, and correspondence analysis procedures. Results showed the presence of state sequence patterns, short state change periods, and a relatively small amount of association between specific behavior states and the environmental factors and events measured in the study.

Adolescent↗
PubMed1990

Rapid differentiation of subarachnoid hemorrhage from traumatic lumbar puncture using the D-dimer assay.

The D-dimer assay of 40 cerebral spinal fluid (CSF) samples accurately differentiated subarachnoid hemorrhage (SAH) from traumatic lumbar puncture. The D-dimer assay was positive in all six patients with subarachnoid hemorrhage. Negative D-dimer values were obtained in control groups of 14 patients with hemorrhagic CSF secondary to traumatic lumbar puncture (LP) and in 20 patients with normal CSF. The D-dimer assay proved to be a better test than xanthochromia or the decline in erythrocyte count in sequentially collected tubes in differentiating subarachnoid hemorrhage from traumatic LP.

Antibodies, Monoclonal↗
PubMed1990

Pyomyoma associated with polymicrobial bacteremia and fatal septic shock: case report and review of the literature.

case of fatal septic shock due to pyomyoma (suppurative leiomyoma of the uterus) is reported. This unusual cause of sepsis and polymicrobial bacteremia should be rapidly identified because surgical therapy is essential for cure. Nine additional cases reported since 1945 are reviewed. Pyomyoma develops in association with either recent pregnancy or in postmenopausal patients who frequently have underlying vascular disease. The triad of: 1) bacteremia or sepsis; 2) leiomyoma uteri; and 3) no other apparent source of infection should suggest the diagnosis of pyomyoma.

Abscess↗
PubMed1989

Barriers to influenza vaccine acceptance. A survey of physicians and nurses.

The Immunization Practices Advisory Committee (ACIP) recommends that health care providers who contact high-risk patients receive influenza immunization annually. There are few available data on hospital employees' acceptance of these recommendations or their attitudes about influenza immunization. In a hospital where no formal influenza immunization program was in place, a survey of 193 nursing personnel and physicians showed that only 2.1% received the 1986-1987 trivalent influenza vaccine and 3.2% the monovalent A/Taiwan/1/86 vaccine before the 1986-1987 influenza season. An influenza-like illness developed in a total of 35.3% of hospital employees during the influenza season, and 76.6% of them cared for patients while ill. Fear of adverse reactions, avoidance of medications, and the inconvenience of vaccine administration were frequently cited reasons for declining immunization. Hospital employees would be more inclined to receive future influenza immunization if vaccine administration were more accessible and if they were informed that immunization were a national health care policy. During the influenza season, nurses and physicians should be considered a uniformly susceptible reservoir of infection capable of transmitting influenza to patients. Moreover, ACIP guidelines alone probably will not lead to acceptable immunization rates among health care providers; organized institutional efforts to promote immunization of health care providers may be required.

Attitude of Health Personnel↗
PubMed1988

Influenza surveillance in an acute-care hospital.

The epidemiology, significance, and clinical consequences of influenza in the hospital setting were studied in a prospective surveillance of adults in an acute-care hospital during the 1986-1987 influenza season, specifically searching for cases of nosocomial influenza. A total of 43 cases of influenza A were identified; 17 cases occurred among working hospital employees, 14 cases occurred among patients in the emergency room or clinics, ten were community-acquired cases among hospitalized patients, and two cases were nosocomially acquired. The nosocomial influenza attack rate was 0.3 per 100 hospital admissions. Both cases of nosocomial influenza were associated with secondary pneumonias and prolongation of hospital stay. These cases might have gone unrecognized in the absence of an influenza surveillance program. A potential reservoir of infection was the health care providers caring for the hospitalized patients. Further systematic influenza surveillance is needed to assess the global medical and economic impact of nosocomial influenza on hospitals, rather than simply relying on reports of institutional outbreaks.

Adult↗
PubMedDate not supplied

Do hospital employees benefit from the influenza vaccine? A placebo-controlled clinical trial.

Although current guidelines target hospital employees who contact high-risk patients as a high priority for influenza immunization, there are few data to support or refute this recommendation. Therefore, the authors enrolled 179 hospital employees in a randomized double-blind placebo-controlled clinical trial during the 1985-1986 influenza season. Influenza immunization was performed without serious adverse reactions and there was no increase in absenteeism attributable to the vaccination. Among those who developed clinical influenza, there was a trend toward fewer days of illness in the vaccinated group compared with the placebo group (6.0 vs. 8.0, p = 0.07). There were no statistically significant differences between subjects receiving influenza vaccine and those receiving the placebo when comparing incidences of influenza-like illness, severities of illness, and sick absenteeism. Influenza immunization of hospital employees was performed at minimal cost and risk but provided little benefit, most likely because of an unexpected drift of the prevalent influenza strain away from the vaccine type.

Absenteeism↗