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Biomedical subjects

R Hand

Publications and source records attributed to R Hand.

At least 19 recordsLinked to original sources
PubMed2001

The analgesic effects of subhypnotic doses of propofol in human volunteers with experimentally induced tourniquet pain.

This double-blind, placebo-controlled study was performed to determine whether subhypnotic doses of propofol have analgesic or sedative effects. Of 48 subjects randomly assigned to 1 of 4 bolus-infusion treatment groups, group 1 (n = 16) received propofol at 16 micrograms/kg per minute; group 2 (n = 16) received propofol at 32 micrograms/kg per minute; and group 3 (n = 8) received 10% intralipids at 16 micrograms/kg per minute; and group 4 (n = 8) received 20% intralipids at 32 micrograms/kg per minute. Following a bolus of the study drug, a maintenance infusion was started and continued throughout the study. Thirty minutes after the study drug began infusing, an Observer's Assessment of Alertness/Sedation Scale was completed, a tourniquet was inflated, and a maximum tourniquet tolerance time (TTT) was obtained. Pain was assessed every 5 minutes while the tourniquet was inflated and immediately before deflation using a 0 to 10 verbally administered numeric rating scale (NRS). No significant differences in TTT were noted between the 2 propofol groups. However, the TTT for both propofol groups differed significantly from the control group (intralipid groups combined) (P < .05). There was a statistically significant difference in the time it took the propofol groups to reach a NRS score of 8 or greater when compared with the control group (P < .05). Sedation scores differed significantly between the control and the propofol at 32 micrograms/kg per minute groups (P < .05). The results of this study suggest that propofol given at subhypnotic doses could serve as a valuable adjunct for acute postoperative pain management.

Adult↗
PubMed1997

Mortality and length of stay as performance indicators for pneumonia in the elderly.

BACKGROUND: Mortality and length of stay are frequently used as performance measures for hospitals. If they are valid measures, they should be reproducible from year to year with attributable variation rather than random variation. METHODS: We compared hospitals on 2 outcomes, mortality and length of stay, in pneumonia in Medicare patients. The database was from 20 Illinois hospitals with the largest number of discharges for diagnosis-related group 89 (pneumonia with complications/comorbidities) for the years 1989 through 1992. This comprised 16,249 claims for hospitalization in patients 65 years of age or older. RESULTS: The distributions showed trends toward lower mortality and shorter stays over the 4 years. Correlation of performance from year to year at each hospital for mortality was low with none of the calculated correlation coefficients significant at p < .05. Correlations for length of stay were higher (all coefficients significant at p < .01). For length of stay, the correlation between 1991 and 1992 was .766 (p < .00005, r2 = .587), showing that nearly 60% of differences (variance) were caused by differences in performance. In contrast, for mortality in 1991 and 1992, the correlation was .301 (p = .0986, r2 = .091), showing that less than 10% of differences (variance) between hospitals were caused by differences in performance. Similar results were obtained when the 20 hospitals were ranked and their rank correlations calculated. CONCLUSION: For pneumonia in Medicare patients, differences in length of stay between hospitals are caused by differences in performance, while differences in mortality are random.

Aged↗
PubMed1996

Rural hospital mortality for myocardial infarction in Medicare patients in Illinois.

OBJECTIVE: To compare rural and nonrural hospitals for mortality for Medicare patients with myocardial infarction. DESIGN: A retrospective analysis of variance from Illinois for the year 1989. Claims were aggregated by hospital and the hospitals grouped into geographic areas that were completely rural (N = 32), partially rural with small cities (N = 82), exurban (N = 21), suburban (N = 43), and urban (N = 44). PATIENTS: 11,753 patients older than 65 years hospitalized for acute myocardial infarction. RESULTS: In rural hospitals, the mean in-hospital mortality rate was 24.3% compared to rates of 18.3-20.9% at hospitals in the other four regions (P = 0.10, power = 0.68). Rates for coronary angiography were 0% at rural hospitals compared to 8-20% at hospitals in the other four regions (P < 0 0.0005, power = 0.99). CONCLUSION: There is a trend toward higher in-hospital mortality for myocardial infarction at rural hospitals. Whether this is caused by their inability to perform coronary angiography during the index admission warrants further investigation.

Aged↗
PubMed1996

Secondary diagnoses as predictive factors for survival or mortality in Medicare patients with acute pneumonia.

We wished to determine if a claims-based method for severity adjustment would predict mortality or survival in pneumonia based on age, gender, and secondary diagnoses. We used a discriminant analysis model of severity of illness developed from Medicare Part A claims data. Our data base was taken from a hospitalized population age 65 years or older coded as DRG 89 (pneumonia with complications/comorbidities). There were 35,677 cases with a mortality = 11.2% in the derivation cohort from 1989 to 1990, and 19,915 cases with a mortality = 9.8% in the validation cohort from 1991. In the derivation cohort, 98% of patients predicted to live, lived, whereas 18% of patients predicted to die, died. Of the three variables, secondary diagnoses had greatest explanatory power. Receiver operating characteristic curves showed that the model performed best at 40% survival. Results were confirmed with the 1991 validation cohort. The model could be applied to hospitals with as few as 172 discharges. This simple, claims-based method can predict survival in pneumonia. It may be useful in selecting medical records for intensified review of medical quality.

Aged↗
PubMed1995

Health insurance status and the use of emergency and other outpatient services by adults with sickle cell disease.

STUDY OBJECTIVE: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. DESIGN: Retrospective analysis of visits. SETTING: Emergency department and outpatient clinics of an urban university hospital. PARTICIPANTS: One hundred seventy-two subjects, who made 771 visits to the ED during 1990. RESULTS: Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P < .00005). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be younger, to be users of primary-care services, and to live closer to the hospital (P = .0004). CONCLUSION: Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.

Adult↗
PubMed1995

Interpreting quality improvement data with time-series analyses.

In quality improvement efforts, the data are frequently a series of measurements taken over time. A collection of statistical methods, commonly referred to as time-series analysis, provides a simple and understandable method for interpreting this longitudinal data. In this article, we present a time-series analysis of data on the quality of prenatal care at a mid-sized public hospital. We will demonstrate some simple tests that alert us to the potential value of using more sophisticated tests of association such as regression. Using regression, we show how to confirm a visual impression of an improvement. The analytical approach we present here is useful with many types of process or outcome data from health care quality improvement efforts.

Data Collection↗
PubMed1995

Prolonged survival of mice with glioma injected intracerebrally with double cytokine-secreting cells.

A novel approach toward the treatment of glioma was developed in a murine model. The genes for both interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) were first transfected into a mouse fibroblast cell line that expresses defined major histocompatibility complex (MHC) determinants (H-2k). The double cytokine-secreting cells were then cotransplanted intracerebrally with the Gl261 murine glioma cell line into syngeneic C57BL/6 mice (H-2b) whose cells differed at the MHC from the cellular immunogen. The results indicate that the survival of mice with glioma injected with the cytokine-secreting allogeneic cells was significantly prolonged, relative to the survival of mice receiving equivalent numbers of glioma cells alone. Using a standard 51Cr-release assay, the specific release of isotope from labeled Gl261 cells coincubated with spleen cells from mice injected intracerebrally with the glioma cells and the cytokine-secreting fibroblasts was significantly higher than the release of isotope from glioma cells coincubated with spleen cells from nonimmunized mice. The cellular antiglioma response was mediated by natural killer/lymphokine-activated killer and Lyt-2.2+ (CD8+) cells. The increased survival of mice with glioma and the specific immunocytotoxic responses after immunization with fibroblasts modified to secrete both IL-2 and IFN-gamma indicate the potential of an immunotherapeutic approach to gliomas with cytokine-secreting cells.

Animals↗
PubMed1994

Use of statistical control charts to assess outcomes of medical care: pneumonia in Medicare patients.

Detection of nonrandom variation in outcomes with statistical control charts is at the heart of quality improvement techniques. The authors examined the charts' ability to detect variations in outcome of pneumonia. They surveyed Medicare claims data for DRG 89, pneumonia with complications or co-morbidities, from November 1988 through October 1991 at 20 Illinois hospitals with the most Medicare discharges for DRG 89. Control charts were constructed on five outcomes--mean length of stay, range of length of stay, mortality, readmissions, and complications. Standard techniques from industrial statistics were used to construct the historical means and control limits derived from 2 years of data, to plot the monthly samples from the 3rd year of data and to score the control charts for nonrandom variation at less than 1% probability. The observed number of control charts with nonrandom variation was 33 of 100; the expected number was 9.18 (p < 0.0001). Nineteen hospitals had 1 to 3 control charts with nonrandom variation on the five outcomes, whereas only one hospital had none. The number of control charts with nonrandom variation per hospital did not correlate with hospital size, occupancy, teaching status, location, or payer-mix. Statistical control charts provide simple tools for identification of nonrandom variation in outcomes. To the extent that these variations can be related to quality issues, the charts will be useful for quality management.

Aged↗
PubMed1993

Staging procedures, clinical management, and survival outcome for ovarian carcinoma.

OBJECTIVE: To evaluate the relationship between survival and patterns of clinical management for ovarian carcinoma. DESIGN: Retrospective analysis of cancer registry data including follow-up, operative reports, and pathology reports. SETTING: Seventy-seven Illinois hospitals with active cancer registries. PATIENTS: A total of 2669 women with newly diagnosed ovarian carcinoma from 1983 through 1988. MAIN OUTCOME MEASURES: Frequency of use of specific staging procedures and treatment options. Survival was estimated using the Kaplan-Meier product-limit method. RESULTS: Thirty percent of 632 stage I patients, 31% of 233 stage II patients, and 45% of 516 stage III patients underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, sampled peritoneal washings, and node biopsy. Five-year survival for those receiving this extensive surgery (who were therefore pathologically staged) was as follows: stage I, 80%; stage II, 63%; and stage III, 28%. For those not receiving this extensive surgery (who were therefore clinically staged), the 5-year survival at these stages was 76%, 62%, and 21%, respectively. The overall survival curves were not significantly different between those who were pathologically staged and those who were clinically staged for stage I patients (P = .27) or stage II patients (P = .47), but were for stage III patients (P = .01). Platinum-based combination chemotherapy was given to 76% of 221 patients with pathological stage III disease. Their 5-year survival--50% for the group with no residual disease and 20% for the group with residual disease--was better than for those receiving regimens without platinum--37% and 5%, respectively, for the two groups--and the overall survival curves were significantly better for those receiving platinum (P < .0005 for both groups). The groups receiving platinum had younger patients. CONCLUSIONS: Extensive surgery for pathological staging was not usually done for management of ovarian cancer, while platinum-based chemotherapy was commonly used. Failure to undergo extensive surgery had little impact on survival for stage I and II patients. However, use of extensive surgery and platinum-based chemotherapy improved survival for stage III patients. The improved survival for this group receiving platinum-based chemotherapy may be explained in part by selection of younger patients for this treatment.

Female↗
PubMed1993

Patient mix in the primary ambulatory care clinics of an academic medical center.

BACKGROUND: The authors wished to learn whether the primary ambulatory care clinics of a university hospital had a sufficiently diverse patient mix for training in common medical problems. METHOD: Claims data for all the ambulatory care clinics at the University of Illinois Hospital from June 1989 through June 1990 were examined for principal diagnoses. The diagnoses were grouped into common ambulatory care diagnosis clusters. The frequencies of the clusters were compared with the national frequencies from the National Ambulatory Medical Care Survey of 1989. RESULTS: Only eight of 25 leading clusters nationally were seen with frequencies greater than 1% in the hospital's primary care clinics (i.e., family practice, general internal medicine, general pediatrics). This number increased to 22 when the clinics of other specialties were included. CONCLUSION: To create an appropriate patient mix for training medical students and residents in ambulatory care, the university hospital examined in this study could supplement the use of its primary care clinics with the use of clinics in other specialties. This may be a less expensive and administratively less complex alternative to using off-campus private practices for such training.

Academic Medical Centers↗
PubMed1991

Hospital variables associated with quality of care for breast cancer patients.

OBJECTIVE: To determine the degree of compliance with clinical standards among hospitals for care of breast cancer patients and account for variations in compliance. DESIGN: Analysis of cancer registry data submitted to the American Cancer Society, Illinois Division, Chicago, for a concurrent prospective descriptive study of breast cancer, supplemented by other hospital data from public sources. SETTING: Ninety-nine Illinois hospitals evenly distributed among rural counties, counties with small cities outside the Chicago metropolitan area, exurban counties in the Chicago metropolitan area, suburban Cook County, and urban Chicago. PATIENTS: A total of 5766 newly diagnosed patients with histologically confirmed breast cancer in 1988, representing 84% of the estimated 6900 new cases in the state for that year. MAIN OUTCOME MEASURES: Descriptive statistics and multiple linear regression analyses of five dependent quality variables from clinical indicators related to early diagnosis, hormone receptor determination, adjuvant therapy, radiation therapy, and axillary lymph node dissection. RESULTS: At the hospitals studied, (1) late stage (IIb through IV) at diagnosis was associated with urban location, higher proportion of poorly insured patients, fewer breast cancer cases treated, and lower oncology charges (proportion of variance explained, R2 = .50, P less than .00001); (2) omission of hormone receptor test for stages II through IV was associated with urban location and higher proportion of poorly insured patients (R2 = .18, P less than .00003); and (3) omission of indicated radiation therapy was associated with urban location and fewer breast cancer cases (R2 = .21, P less than .00001). Omission of adjuvant therapy and omission of axillary lymph node dissection were not significantly associated with any of the hospital variables examined. CONCLUSIONS: The findings suggest that there is a group of urban hospitals, generally small and marginally reimbursed, where comprehensive diagnosis and treatment of breast cancer are not obtained.

Breast Neoplasms↗
PubMed1991

Accuracy of precordial percussion in detecting cardiomegaly.

STUDY OBJECTIVE: To assess the value of precordial percussion in detecting cardiomegaly, and to compare it with palpation of the apical impulse. DESIGN: Descriptive study. SETTING: Hospitals and clinics of a university medical center. PATIENTS: Light indirect percussion of the precordium was performed on 72 inpatients and 28 outpatients. All patients had a posteroanterior radiograph of the chest. Percussors were unaware of the clinical history and of chest roentgenogram results. MEASUREMENTS AND MAIN RESULTS: Thirty-six patients (36%) had cardiomegaly, defined as a cardiothoracic ratio of greater than 0.5 on chest roentgenogram. The cardiothoracic ratio was significantly correlated with percussion distance from the midsternal line in the left fourth (r = 0.35, p less than 0.0006), fifth (r = 0.65, p less than 0.00001), and sixth (r = 0.40, p less than 0.0001) intercostal spaces. After adjustment for clinical symptoms and systolic and diastolic blood pressures, percussion distance in the left fifth intercostal space remained a significant independent predictor of the cardiothoracic ratio. Percussion distance in the left fifth interspace discriminated cardiomegaly with a receiver-operating characteristic (ROC) area of 0.95. Percussion dullness more than 10.5 cm from the midsternal line in the left fifth interspace had a sensitivity of 94.4% (95% confidence interval [CI], 79.9% to 99.0%) and a specificity of 67.2% (CI, 54.2% to 78.1%). Distance of the apical impulse from the midsternal line discriminated with an ROC area of 0.95, but an impulse was palpated in only 40% of cases. CONCLUSIONS: Percussion in the left fifth intercostal space accurately discriminates patients with and without cardiomegaly, and adds information beyond that obtainable from the history and other parts of the physical examination.

Adolescent↗
PubMed1990

The causes of cancelled elective surgery.

We reviewed causes of cancelled elective surgery in a community hospital. Over a 6-month period, during which 4100 operating room procedures were completed, cancellations occurred in 13% of cases scheduled for outpatient surgery, 9% of cases scheduled for admission the same day, and 17% of cases scheduled for inpatient surgery. Dental procedures had significantly higher rates of cancellation among outpatient procedures, and cardiovascular surgical procedures had significantly higher rates among inpatient procedures. Chart review of cancelled inpatient cases showed 43% due to administrative reasons with unsigned consent the most common cause. Medical factors were responsible in the remaining cases, with reevaluation of the surgical condition and associated medical illnesses equally common as reasons in this category. Appreciation of the usual reasons for cancellation can improve utilization by permitting administrators and providers to anticipate those cases in which problems might arise so that additional attention can be paid to them.

Appointments and Schedules↗
PubMed1990

Postoperative hospital retention following ambulatory surgery in a hospital-based program.

In an effort to learn more about resource utilization on ambulatory surgery in hospital departments of surgery and its impact on quality of care, we reviewed the causes of postoperative hospital retention following ambulatory surgery in a hospital-based program. Of 1971 patients operated on in a 6-month period, 188 were retained for a rate of 9.5%. Of these, 71 (3.6%) were retained for observation and 42 (2.1%) for surgery more extensive than planned. The remaining 75 (3.8%) patients represent complications of surgery or anesthesia. The age distribution of patients with complications was the same as the group overall with a single mode at about 30 years, while the distribution of patients retained for observation or who were admitted the day of surgery was bimodal with a second peak at about 70 years. All surgical specialties had comparable rates of postoperative retention, except gynecology which was significantly lower. Many of the patients had multiple procedures or surgery more extensive than planned.

Age Factors↗
PubMed1990

Differences in the technical and applied nutrition knowledge of older adults.

Although elder adults are much more knowledgeable about nutrition than ever before, diet behavior is not consistent with nutrition knowledge. One of the reasons for this inconsistency may be that the ability to apply technical nutrition knowledge is still inadequate. To test the hypothesis that technical nutrition knowledge is superior to applied nutrition knowledge, 96 volunteer seniors were given technical nutrition knowledge tests associated with heart disease, cancer, and high blood pressure. After the technical knowledge tests, subjects were asked to choose from among pairs the item that contained: (a) cholesterol, (b) more saturated fat, (c) more polyunsaturated fat, (d) substances that help to lower blood cholesterol, (e) more fiber, and (f) less sodium. Results support the notion that, in general, elder ability to apply nutrition knowledge is not as adequate as their technical nutrition knowledge.

Aged↗