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At least 469 records · Page 26Linked to original sources
PubMed2003

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral.

OBJECT: In an age of multimodality and multidisciplinary treatment of cerebral aneurysms, patient outcomes have improved significantly. For a number of complex surgical procedures, hospitals with high case volumes yield superior outcomes. The effect of hospital volume on the mortality rate after emergency and elective cerebral aneurysm clip occlusion in a nationally representative sample of patients is unknown. METHODS: Using clinical data derived from the Nationwide Inpatient Sample for the years from 1995 through 1999, 12,023 patients who underwent clip occlusion of a cerebral aneurysm (International Classification of Diseases, Ninth Revision, Clinical Modification code 3951) were included. Patient age, comorbid conditions, nature of admission, and diagnosis of subarachnoid hemorrhage were abstracted. Hospital case volume was grouped into quartiles. Unadjusted and case-mix adjusted analyses were performed. The mean patient age was 53.2 +/- 13.5 years. The overall crude postoperative mortality rates for emergency and elective aneurysm clip occlusion were 12.2 and 6.6%, respectively. Very low volume hospitals demonstrated higher mortality rates than very high volume hospitals for both emergency (14.7 compared with 8.9%, p < 0.001) and elective (9.4 compared with 4.5%, p < 0.001) aneurysm surgery. Patient-specific predictors of death in the multivariate model were renal disease (odds ratio [OR] 3.32, p < 0.042); age (> 60 years, OR 2.36, p < 0.001; 51-60 years, OR 1.63, p < 0.001; 40-50 years, OR 1.25, p = 0.047); chronic obstructive pulmonary disease (present, OR 1.52, p < 0.001); and nature of admission (emergency, OR 1.18, p = 0.03). Provider-specific predictors of death included very low volume (OR 1.59, p < 0.001); low-volume (OR 1.37, p = 0.001); and high-volume (OR 1.45, p < 0.001) hospitals compared with very high volume hospitals. CONCLUSIONS: A significant volume-outcome effect exists for surgical treatment of cerebral aneurysms in the US. Factors influencing this effect should be investigated to guide future healthcare policy and evidence-based referral. Whenever possible, healthcare practitioners should refer patients to centers in which superior outcomes are consistently demonstrated.

Adult↗
PubMed2004

Risk of constipation in patients prescribed fentanyl transdermal system or oxycodone hydrochloride controlled-release in a California Medicaid population.

OBJECTIVE: To compare the risk of developing constipation between patients prescribed fentanyl transdermal system or oxycodone hydrochloride (HCl) controlled-release. DESIGN: California Medicaid (Medi-Cal) claims data. SETTING: Medicaid beneficiaries in California. PARTICIPANTS: Chronic pain patients who received a prescription for transdermal fentanyl or oxycodone controlled-release between October 1, 1997, and February 28, 2000, for at least three consecutive months. MAIN OUTCOME MEASURES: Constipation was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification code (ICD-9-CM 564.0). The association between long-acting opioid use and constipation was determined by multivariate logistic regression after controlling for drug strength, short-acting opioid usage, and comorbidities. Odds ratios (ORs), 95% confidence intervals (CIs), and P values were reported. RESULTS: A total of 2,095 patients were included in the regression analysis (transdermal fentanyl = 877; oxycodone controlled-release = 1,218). Seventy-five patients received a constipation diagnosis (transdermal fentanyl = 28; oxycodone controlled-release = 47). Approximately 40% of patients were at least 65 years of age. Overall, oxycodone controlled-release patients had a significantly greater risk of developing constipation compared with transdermal fentanyl patients (transdermal fentanyl: n = 877; oxycodone controlled-release: n=1,218; OR = 2.55; 95% CI = 1.33-4.89; P = 0.005). Among patients who were 65 years or older, oxycodone controlled-release patients were 7.33 times more likely to be constipated than transdermal fentanyl patients (transdermal fentanyl: n = 518; oxycodone controlled-release: n = 317; OR = 7.33; 95% CI = 1.98-27.13; P = 0.003). CONCLUSION: These findings suggest that patients prescribed transdermal fentanyl may have a significantly lower risk of developing constipation compared with oxycodone controlled-release, particularly in the elderly.

Journal Article↗
PubMed2004

Neoplasms in the Navy, 1998-2000: a descriptive analysis of the Physical Evaluation Board database.

Records with diagnoses for neoplasms (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 140-239) contained in the U.S. Navy Physical Evaluation Board database for 1998 to 2000 were identified (n = 427 cases, 342 malignant and 85 benign). The four most common sites of occurrence were other and unspecified sites (27%), lymphatic and hematopoietic tissues (22%), benign neoplasms (20%), and genitourinary organs (12%). Crude overall cancer rates were 37.7 cases per 100,000 male subjects and 55.4 cases per 100,000 female subjects. Overall, Hodgkin's disease was the most common diagnosis, with a rate of 3.3 cases per 100,000 population. It also had the highest rate among male subjects, with 3.5 cases per 100,000 male subjects of all ages and 4.2 cases per 100,000 men more than 40 years of age. For women, breast cancer had the highest rate of 8.5 cases per 100,000 subjects. These values are consistent with or lower than the published reports of U.S. Navy and national rates. Ongoing surveillance of malignancies among Navy personnel is an important part of force health protection.

Adult↗
PubMed1984

Variation in resource use within diagnosis-related groups: the severity issue.

Several authors have suggested that diagnosis-related groups (DRG's) make inadequate allowance for the severity of illness. Before modifications of DRG's are developed, the sources of within-group variation must be precisely defined; not all variation is attributable to the severity of illness. The limitations of the Uniform Hospital Discharge Data Set (UHDDS), of the International Classification of Diseases, Ninth Revision, Clinical Modification coding system and of the original rules of DRG construction must be evaluated and, if necessary, corrected before new approaches to groupings are considered. The most promising potential modifications of existing groups and weights are those that make use of the UHDDS, or of the UHDDS plus additional diagnoses and procedures. The addition of entirely new data elements to the discharge abstract and the pricing process should be considered only as a last resort.

Costs and Cost Analysis↗
PubMed2000

[Clinical results and color-coded duplex ultrasound findings 4 years after conditioned TRAM flap-plasty].

Presented is a new technique in preoperative conditioning of the pedicled TRAM-flap employing an interventional-radiologic procedure, selective embolization of the deep inferior epigastric artery (DIEA). During a four year period in 40 patients with a mean age of 48.4 (31-66) years breast reconstruction was performed by a superiorly pedicled TRAM-flap following preoperative conditioning. 30 of 40 patients were eligible for follow-up one to five years postoperatively. The mean interval between embolization and surgery amounted to 3.6 months. In 25 of 30 cases embolization of the DIEA was performed bilaterally, in 5 of 30 cases unilaterally. 14 of 30 patients underwent preoperative radiotherapy for breast cancer. Applying CCDS the peak flow values were determined in the superior epigastric arteries (TRAM/contralateral side). Pre-embolization values (54.9 cm/s/55.8 cm/s), post-embolization values (57.2 cm/s/57.9 cm/s) and late postoperative values (61.0 cm/s/61.6 cm/s) proved a statistically significant effect of selective embolization on peak flow without relevant difference between TRAM and contralateral side (p < 0.05). Postoperative flap complications consisted of partial necrosis in 2 of 30, fat necrosis in 1 of 30, impaired would healing in 5 of 30 and postoperative bleeding in 2 of 30 cases. Abdominal would healing complications occurred in 5 of 30 cases, abdominal wall weakness was found in 8 of 30 and hernia formation in 4 of 30 cases. Corrective surgery was performed at the breast (TRAM-flap) in 22 of 30 and at the abdomen (donor site) in 9 of 30 cases. Patient acceptance concerning selective embolization and TRAM-flap surgery was very high. 29 of 30 patients confirmed that they would again choose this type of breast reconstruction. The pedicled TRAM-flap following preoperative conditioning by selective embolization of the DIEA constitutes a safe and reliable method of breast reconstruction with autogenous tissue. It is superior to the pedicled TRAM-flap without delay and offers definite advantages compared to alternative techniques of enhanced flap vascularization.

Adult↗
PubMed2000

HCFA's final rule on APCs is out: ED managers can breathe sighs of relief.

The final rule on ambulatory payment classifications (APCs) for outpatient services from the Health Care Financing Administration (HCFA) was published in the April 7, 2000, Federal Register, with a July 1, 2000, implementation date. EDS might receive increased reimbursement for services under APCs, in sharp contrast to previous predictions of a 15% decrease in reimbursement. Instead of combining CPT and ICD-9-CM coding for clinic and emergency visits APCs, HCFA has assigned three APCs for the emergency department and a fourth APC for critical care. There is no APC for a medical screening exam, which could improve reimbursement. There is no separate APC for observation services, which means no additional payment will be given. You can continue to use your current charge structure and correlate present levels of service with the appropriate CPT visit level. You will have to "unbundle" visit levels to list nursing and physician procedures separately as specific line items.

Ambulatory Care↗
PubMed2001

Predictors of psychosocial teaching styles in a family practice residency program.

BACKGROUND AND OBJECTIVES: Although physician clinical precepting has been extensively studied, little information exists about the teaching styles of behavioral science faculty. This study investigated group characteristics associated with two styles of teaching--authoritative and collaborative--used by behavioral science faculty in a family practice residency training program. METHODS: A 6-year retrospective study was conducted with 89 family practice residents and 1,228 patients. Unstructured written comments about direct observation of resident-patient encounters in a family practice clinic were coded using a combination of qualitative and quantitative approaches, then analyzed in relationship to variables such as gender perceived resident ability and level of training, ethnicity of patient, and severity of patient diagnosis. RESULTS: Overall, behavioral scientists used twice as many collaborative as authoritative teaching comments. Male behavioral scientists used more authoritative comments than did female behavioral scientists. First-year residents and female residents received more teaching generally than did their more-experienced and male counterparts. Perceived global performance of resident and severity of patient diagnosis were also related to teaching style. CONCLUSIONS: Behavioral science faculty should consider that group characteristics of teachers, residents, and patients may influence teaching style.

Behavioral Sciences↗
PubMedDate not supplied

Treatment of chronic heart failure in a managed care setting. Baseline results from the Achieving Cardiac Excellence Project.

BACKGROUND: Effective therapy for chronic heart failure (CHF) is underutilized despite a broad consensus regarding treatment recommendations. METHODS: As a quality improvement project designed to reduce preventable hospitalizations associated with CHF, we examined use of angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta-adrenergic receptor blockers (BB) in a population of patients enrolled in a managed care plan. Medicare and commercial enrollees were included. Patients with CHF were identified using claims data (International Classification of Disease 9th Clinical Modification code 428) covering January 1, 1998 through December 31, 1998. Drug utilization data were obtained from the plan's pharmacy benefits database. Data were available for 1220 patients. RESULTS: The mean age (+/- SD) was 71 +/- 12 years, 53% were female, and 84% were Medicare enrollees. Prescriptions for ACEI, ARB and BB were filled by 52%, 9% and 25% of patients, respectively. Prescriptions for diuretics, digitalis preparations, and calcium channel blockers (CCB) were filled by 69%, 34%, and 32%, respectively. Therefore, almost half of patients with CHF were not receiving ACEI therapy, even though it had been proven to reduce morbidity and mortality related to CHF. Furthermore, three-quarters of patients were not receiving BB therapy, a similarly effective therapy. In contrast, CCB and digitalis have not been convincingly shown to reduce mortality in patients with CHF broadly defined. Utilization of CCB and digitalis exceeded that of BB. CONCLUSIONS: Managed care organizations should develop, test, and implement network-level strategies designed to optimize the appropriate utilization of effective drug therapies for patients with CHF.

Adrenergic beta-Antagonists↗
PubMed2003

Gastric secretion--from Pavlov's nervism to Popielski's histamine as direct secretagogue of oxyntic glands.

Gastric acid and pepsin secretions result from the interplay of neurohormonal factors with stimulatory and inhibitory actions on oxyntic glands. At the turn of XIX century, the notion of nervism or entire neural control of digestive functions, developed by Pavlov prevailed. However, in the second part of XX century, hormonal control has been thought to play a major role in the mechanism of gastric secretion, especially gastrin, which was isolated and synthesized in 1964 by Gregory. Polish traces in gastroenterological history started with the discovery of histamine, a non-nervous and non-gastrin compound in oxyntic mucosa by L. Popielski in 1916, who found that this amine is the most potent and direct stimulant of gastric acid secretion. This histamine concept was supported by leading American gastroenterologists such as A.C. Ivy, championed later by C.F. Code, and clinically applied for testing gastric secretion by K. Kowalewski. Recently, it received a strong support from pharmacological research when J. Black designed H(2)-receptors antagonists, which were first discovered by M.I. Grossman and S.J. Konturek to inhibit not only histamine-, but also meal- and vagally-induced gastric acid secretion, thus reinforcing the notion of the crucial significance of histamine in the control of gastric secretion as the final common chemostimulator. In conclusion, Polish traces appear to be substantial in gastric history due: 1) to discovery by Popielski that histamine is a major, direct stimulus of gastric secretion; 2) to clinical application of this agent by Kowalewski in testing maximal gastric secretory activity; and 3) to clinical use of histamine H(2)-antagonists in control of gastric acid secretion and treatment of peptic ulcers.

Animals↗
PubMed2004

Promotion of fibronectin independent invasion by C5a peptidase into epithelial cells in group A Streptococcus.

BACKGROUND & OBJECTIVES: Group A Streptococcus, causative agent of several clinical manifestations codes for multiple protein invasins which help the bacterium to enter non-phagocytic cells. C5a peptidase (SCPA) is a surface protein conserved among different serotypes of M1 strain. The present study was taken up to study SCPA promoted fibronectin independent entry of GAS into epithelial cells. METHODS: An isogenic 90226 emm1deltaAB (M1(-)) mutant was constructed with thermosensitive pGhost vector. This isogenic M1(-) mutant expressed SCPA on the surface as determined by Western blotting and immunofluorescence. RESULTS: On preincubation with anti-SCPA serum, the isogenic M1(-) strain exhibited 54 per cent decreased invasion as compared to the bacteria incubated with control serum. Also, purified recombinant SCPA proteins blocked internalization of M1(-) streptococci into HEp-2 cells. The M1(-) strain invaded at the same efficiency in the presence or absence of fibronectin. INTERPRETATION & CONCLUSION: These results suggested that SCPA acted as a potential invasin of group A streptococcus and promoted invasion independent of fibronectin.

Adhesins, Bacterial↗
PubMed2003

G-scan--mobile multiview 3-D measuring system for the analysis of the face.

The development of optical 3-D measuring techniques and their use in industrial quality assurance, in design, and for rapid prototyping has experienced strong growth. A large number of optical 3-D measuring methods and systems are on the market in dentistry. CAD/CAM production has become firmly established in dental medicine, not least due to the systematic introduction of the Cerec technique and the digiDent method. The scanners on which these technologies are based are designed for a relatively small measuring area. To be able to measure and three-dimensionally assess the face--and the numerous changes in the face/forehead/neck region--it was necessary to design and develop a self-calibrating measuring system with gray code for clinical use: the G-Scan measuring system. Objects up to a size of 500 x 500 x 400 mm can be acquired three-dimensionally with it, with a measuring inaccuracy of 10 to 70 microm in a typical measuring time of 15 s. The present article describes the measuring principle, the system parameters, and the features of the new measuring system, and illustrates the measuring results on 3-D displays of the face in static occlusion and in functional occlusion positions.

Centric Relation↗
PubMed2004

Conducting research: practical steps.

Developing a research protocol and obtaining funding for carrying out the research are only the first steps in doing research. Understanding the means to conduct the research is equally important. As research is a joint effort of a team, a mechanism of collaboration must be developed to engage all those with an interest in the research. This includes the community in which the research is to be undertaken, representatives of those who will participate in the research, the academic community who will be involved in the research, and those who will sponsor the research. These individuals can be formed into a 'steering committee' to guide the development, conduct, analysis and communication of the research. Careful consideration must be given to the benefits and risks of the research. These must be precisely spelled out in the research protocol, and all aspects of the research must be independently evaluated for technical competence, accuracy, communication and liability for injury by an ethics review committee. The research must follow precisely the protocol developed. Administrative procedures, including recruitment and management of staff, outlining standard procedures and quality assurance procedures must be clearly outlined and followed. Carefully handling the information collected in a research project is vital to ensuring the quality and validity of the research.

Biomedical Research↗
PubMed2005

National trends in surgical procedures for degenerative cervical spine disease: 1990-2000.

OBJECTIVE: Degenerative cervical spine disease is one of the most common indications for spinal surgical intervention. The impact of the unprecedented changes in healthcare technology and delivery over the past decade is unknown. We examined this issue using the Nationwide Inpatient Sample database, a representative sample of all United States inpatient hospitalizations. METHODS: All adult patients undergoing spinal procedures with a principal diagnosis of cervical spine disease were selected for analysis according to International Classification of Diseases 9th Revision clinical modification codes. Patients diagnosed with infection, neoplasia, fracture, or trauma, as well as those with noncervical or nonspecific principal diagnoses, were excluded. RESULTS: The total number of cervical spine procedures in the sampled population rose twofold, from 53,810 in 1990 to 112,400 in 2000. Anterior fusion procedures rose (17.8-69.5% of procedures), whereas nonfusion decompressions declined sharply (70.5-24.6%). Patient diversity increased with increasing rates of surgery among women (25.0-51.0 per 100,000) and minorities (18.4-45.7 per 100,000). Although average age (47.5-49.2 yr) and medical comorbidities (8.7-13.5% of patients) increased, mortality (0.21-0.14% of hospitalizations) and average length of stay (5.2-2.2 d) declined. Inflation-adjusted hospital charges rose by 48% to a total exceeding 2 billion dollars in 2000. CONCLUSION: Compared with one decade ago, the surgical treatment of degenerative cervical spine disease has evolved to include a higher percentage of anterior and fusion procedures performed on a more diverse, older, and comorbid patient population, with shortened hospital stay and improved morbidity and mortality, although at substantially increased cost.

Adult↗
PubMed2006

An ounce of (pre-bill) prevention is worth a pound of (claims) cure.

Optimal revenue cycle health depends in part on effective eligibility and coverage verification, chargemaster maintenance, charge capture and documentation, and clinical soft coding. With appropriate technology, knowledgeable staff, and efficient processes, hospitals can "diagnose" their revenue cycle health.

Eligibility Determination↗
PubMed1992

Hysterectomy prevalence and death rates for cervical cancer--United States, 1965-1988.

Since the 1960s, hysterectomy has been one of the most frequently performed inpatient surgical procedures in the United States, with an estimated 33% of women undergoing a hysterectomy by 60 years of age. However, rates of cervical cancer mortality that do not allow for the proportion of women with hysterectomies in the population will underestimate the rates in the true at-risk population (i.e., women with intact uteri) and may influence apparent secular trends in rates of cervical cancer mortality. This report uses national mortality and hospital-discharge data to compare death rates, corrected and uncorrected for hysterectomy prevalence, for women who died with an underlying diagnosis of cervical cancer (International Classification of Diseases, Ninth Revision [ICD-9] and ICD-9-Clinical Modification, code 180).

Adult↗