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PubMed1987

Quality and cost control of home care services through coordinated funding.

The growing cost and demand for home care has resulted in increased concern over the quality and cost-effectiveness of care. In Tulsa, Oklahoma, local home care funders reduced the cost and enhanced the quality of home care through a system coordinating the funding and assessment of care. The foundation of this system was the funders' agreement on common definitions of services and service standards and their adoption of a uniform unit-cost reimbursement rate. Another aspect of the coordination was a joint Request for Proposals process that set out specified criteria for home care agencies seeking funds. A home care assessment team was established by Tulsa's local funders to perform ongoing monitoring and evaluation of the home care agency selected to receive funds. As a result of the coordinated funding and assessment system, the quality and efficiency of home care improved measurably, and community access to care increased.

Consumer Behavior↗

PubMed1999

Effect of rotational speed on nickel-titanium file distortion.

Separation of instruments while performing root canals is something that has plagued all practitioners. The purpose of this study was to evaluate the effect of rotational speed on nickel-titanium file distortion and separation. Forty extracted human molars were instrumented with Profile (Dentsply Tulsa Dental Products, Tulsa, OK) ISO .04 rotary nickel-titanium instruments at 166.67 or 333.33 rpm. The instruments were evaluated after instrumentation for separation and/or distortion. The results of this study were statistically significant and indicate that file distortion and/or separation is four times as likely to occur at 333.33 rpm vs. 166.67 rpm.

Dental High-Speed Technique↗

PubMed2001

Comparison of nickel-titanium file distortion using electric and air-driven handpieces.

The use of rotary instrumentation has increased dramatically in endodontics. Air-driven and electric handpieces are both currently available for use with the nickel-titanium files. To date no studies have compared the frequency of instrument separation and/or distortion while using the two types of handpieces with rotary files. The purpose of this study was to determine whether there is a difference in the frequency of file separation/distortion when an electric handpiece is compared with an air-driven handpiece. Extracted human molar teeth were instrumented with nickel-titanium Profile ISO .04 taper rotary files (Dentsply Tulsa Dental Products, Tulsa, OK) under controlled conditions and the results examined for statistical significance. The teeth chosen for the study fit the following criteria: minimal caries, curvature of any root no greater than 60 degrees and at least one root with a minimum of 30-degree curvature. The air-driven handpiece was used at 167.67 rpm and the electric handpiece at 150 rpm per manufacturer's recommendations. Files were examined both before and after use to evaluate whether breakage or deformation had occurred. There was no significant difference in file breakage or distortion when the handpieces were compared. There were, however, a significantly greater number of file separations/ distortions noted in the #8 Profiles (ISO size 20) than with the other files. It may be prudent to view this file as a disposable instrument.

Air↗

PubMed2001

Comparison of a warm gutta-percha obturation technique and lateral condensation.

This study was designed to compare a warm gutta-percha obturation technique, Thermafil Plus (Tulsa Dental, Tulsa OK), with lateral condensation for the ability to adapt gutta-percha to the walls of a root canal system. An extracted sectioned and mounted maxillary central incisor had canal irregularities created and was subsequently subjected to multiple obturations using both techniques. Length of fill, replication to working length, number of artificial depressions replicated, quality of replications, number of voids, and general appearance of obturation were all evaluated using standardized criteria. Data evaluation consisted of a one way analysis of variance on the same type defects between obturation groups followed by a Scheffé post-hoc test. A statistically significant difference was found between the groups in each category of evaluation. Gutta-percha using Thermafil was better able to flow into lateral spaces, had fewer voids, and replicated the surface of the root better. It also, however, was extruded out the apical foramen more than in the lateral condensation group.

Analysis of Variance↗

PubMed2005

Behaviour of bone marrow osteoblast-like cells on mineral trioxide aggregate: morphology and expression of type I collagen and bone-related protein mRNAs.

AIM: To investigate the in vitro behaviour of rat bone marrow cells (RBM) on mineral trioxide aggregate (MTA) (ProRoot, MTA Root Canal Repair Material; Dentsply Tulsa, Tulsa, OK, USA) compared with intermediate restorative materials (IRM) (Dentsply Caulk, Milford, DE, USA). METHODOLOGY: RBM were obtained from rat femur and were primary cultured and then subcultured. Cells were then seeded on three dishes of each material, and cultured for 3 days, after which they were evaluated morphologically using scanning (SEM) and transmission (TEM) electron microscopy. Furthermore, the calcium released from hydrated material, the cell proliferation ratio and alkaline phosphatase (ALP) activity were analysed, and the expression of type I collagen and bone-related protein mRNAs were evaluated. The data were averaged and analysed via one-way analysis of variance (anova) and were then compared by the Scheffe's test. RESULTS: SEM showed that RBM attached to MTA and had a flattened appearance without nuclear protrusions and microspikes. TEM showed that the cells attached in the same manner as the control group, but gaps larger than 2 microm were frequently seen. The calcium released from hydrated MTA was about 130 ppm after 3 days of immersion in saline. The ALP activity was similar to the control group. Cell proliferation and expression of type I collagen mRNA was significantly lower, while the expression of osteopontin mRNA was significantly higher than the control group at the third day of culture. In IRM groups, a few rounded cells were observed on the material but no living cells were seen. CONCLUSIONS: MTA is a material of low toxicity which does not inhibit cell growth, but does suppress the differentiation of osteoblast-like cells.

Alkaline Phosphatase↗

PubMed1998

Correlation between surface water contamination with amoeba and the onset of symptoms and diagnosis of amoeba-like keratitis.

AIM: A seasonal variation was noted in the incidence of amoeba-like keratitis in Iowa. The level of contamination of amoeba in surface water has been found previously to vary on a monthly basis for Tulsa, Oklahoma, a region with a similar climate. It was hypothesised that this seasonal variation in amoeba-like keratitis correlated with the concentration of amoeba in surface water. METHODS: The monthly variation in the onset of symptoms was determined and date of diagnosis in 137 cases of amoeba-like keratitis, in Iowa, from January 1993 to the end of December 1996. RESULTS: Over a 4 year period a significant variation was found, on a monthly basis, in the onset of symptoms as reported by the patient. There were two peak periods per year when the onset of symptoms was most frequent: June and November. This corresponded closely with the concentration of amoeba in the ground water reported for a similar region in the mid-west (Tulsa, Oklahoma). A yearly increase was found in the number of cases diagnosed from January 1993 to the end of December 1996. CONCLUSIONS: This study supports the hypothesis that the concentration of amoeba in surface water may influence the rate of an amoeba-like keratitis infection.

Acanthamoeba↗

PubMed2002

Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice.

OBJECT: The authors report a series of 22 patients in whom major complications developed after cervical spinal manipulation therapy (CSMT). A second objective was to estimate the regional incidence of these complications and to compare it with the very low incidences reported in the literature. METHODS: During a 5-year period, practioners at a single group neurosurgical practice in Tulsa, Oklahoma, treated 22 patients, who were markedly worse during, or immediately after, CSMT. The details of these cases are reported. The 1995 US Government National Census was used to define the regional referral population for Tulsa. The published data regarding the incidence of serious CSMT-related complications and the rate of CSMTs undertaken nationally were used to estimate the expected number of CSMT-related complications in the authors' region. The number (22 cases) reported in this series was used to estimate the actual regional incidence. Complications in the series included radiculopathy (21 cases), myelopathy (11 cases), Brown-Séquard syndrome (two cases), and vertebral artery (VA) occlusion (one case). Twenty-one patients underwent surgery. Poor outcomes were observed in three, outcome was unchanged in one, and 17 improved. The number of patients in this series exceeded the expected number for the region. CONCLUSIONS: Cervical spinal manipulation therapy may worsen preexisting cervical disc herniation or cause disc herniation resulting in radiculopathy, myelopathy, or VA compression. In cases of cervical spondylosis, CSMT may also worsen preexisting myelopathy or radiculopathy. Manipulation of the cervical spine may also be associated with higher complication rates than previously reported.

Adult↗

PubMed1991

Patient goal setting as a method for program improvement/development in partial hospitalization programs.

Data were collected from a study of 49 patients in 1990 and 106 patients in 1991 admitted into Country View Treatment Center and Green Country Counseling Center. Country View is a 30-bed chemical dependency residential center operating under St. John Medical Center in Tulsa, Oklahoma. Green Country is an evening partial hospital chemical dependency program operating under St. John Medical Center in Tulsa, Oklahoma, The tools used in this study were the Country View Patient Self-Reporting Questionnaire, the global Rating Scale, and the Model of Recovering Alcoholics Behavior Stages and Goal Setting (Wing, 1990). These assessments were specifically designed to measure the patient's perceptions of goal setting and the patient's perspective on treatment outcome. The study outcome resulted in program improvement (Green Country evening partial hospital program) and the development of the Country View Substance Abuse Intermediate Link (SAIL) Program (day partial hospital).

Day Care, Medical↗

PubMed1989

Health policy brief: obstetrics in nonmetropolitan Oklahoma.

This brief is a summary of a 68-page analysis of a survey conducted by the Center for Health Policy Research, Oklahoma Medical Research Foundation, Tulsa. There are 9 appendices and 96 data analysis tables in the complete analysis. The survey was conducted in the summer and fall of 1988. Survey instruments were mailed to all Oklahoma obstetricians and family and general practitioners not practicing in Tulsa or Oklahoma counties. There were 300 responses, 274 of which were validated for inclusion into the study. The complete survey will be of interest to some institutions and groups and is available upon request. Customized analysis of the survey variables also is available to interested parties upon request.

Fees, Medical↗

PubMed1978

Use of cytology for tumor diagnosis in private veterinary practice.

Cytologic and histologic services were offered without charge to veterinarians in the greater Tulsa area by the Tulsa Registry of Canine and Feline Neoplasms. During the first 3 years of operation, all veterinarians treating dogs or cats used the histologic service and slightly less than one-half used the cytologic service. The number of cytologic accessions increased 77% during the 2nd year and 27% during the 3rd year. For corresponding years, the increase in histologic accessions was 5% and 11%. The 7 hospitals from which 79% to 90% of the cytologic specimens were received were compared with the 8 to 14 hospitals that used cytologic service infrequently. The frequency of use of cytology was not related to number of veterinarians in the hospital, number of animals seen in the hospital, or number of tissues received by the Registry from the hospital. The order of frequency of the most numerous cytologic specimens was fine-needle aspirations of masses in or beneath the skin, mammary preparations, effusion sediments, fine-needle aspirations from lymph nodes, and urine sediments.

Animals↗

PubMedDate not supplied

[Root canal preparation for obturation using nickel-titanium mechanical devices].

Engine-driven ProFile instruments manufactured by Maillefer (Switzerland) and Tulsa Dental Products (USA) have been used for cleaning and shaping root canals. Both of them are nickel titanium, U-shaped instruments designed for a controlled slow speed (250 rpm) rotary handpiece. In contrast to the Maillefer instruments ProFile Series 29 files (Tulsa Dental) show a constant 29% increase between tip diameters. As these more tapered instruments (ProFile 0.04; 0.06) are rotated, they produce a "crown-down" preparation, resulting in a tunnelform taper from orifice to apex. According to our experiences ProFile instruments are useful alternative tools for root canal preparation quickly and efficiently.

Dental Instruments↗

PubMed1998

Mobile Outreach Crisis Services (MOCS): an innovative model for taking psychiatric care into the community.

Mobile outreach psychiatric services have become a popular model of providing care to the mentally ill. A mobile program has been instituted in Tulsa, Oklahoma, to provide care to homeless mentally ill in Tulsa County and to assist with emergency crisis intervention. The SPMI (Severely and Persistently Mentally III) have been a challenge for both medical and psychiatric providers, and MOCS (Mobile Outreach Crisis Services) was developed to address these problems. This article describes MOCS, briefly reviews recent literature, and discusses ways this program can benefit primary care physicians.

Adult↗

PubMedDate not supplied

Sabotaging one's own medical care. Prevalence in a primary care setting.

This study determines the prevalence of medically self-sabotaging behaviors reported by patients in a primary care setting. A 19-item self-report survey was completed by patients on-site at the Family Medicine Clinic, University of Oklahoma College of Medicine-Tulsa. Four hundred eleven consecutive male and female patients were seen for nonemergent care. Each of the 19 items was endorsed by at least 1 respondent. The most commonly endorsed self-sabotaging behaviors were not seeking medical care when needed (37.2%) and not taking a prescribed medication (25.1%). Significantly more women (26.4%) than men (17.5%) reported not taking a prescribed medication (P < .05). After excluding these 2 commonly endorsed items, 27 (6.6%) of the respondents reported at least 1 other self-sabotaging behavior, with most indicating 1 (63.0%) or 2 (22.2%); the remaining 4 individuals reported 4 to 12 behaviors. Significantly more men (4.8%) than women (0.6%) reported not following instructions from a physician or nurse to prolong illness (P < .05). A few patients (6.6%) seen in a primary care university outpatient clinic acknowledged the active and intentional sabotage of their medical care, beyond not taking a prescribed medication or seeking medical care when needed. This is probably a conservative estimate and indicates that medical care is actively compromised by a few patients.

Female↗

PubMed1979

Burns as a manifestation of child abuse and neglect.

A multidisciplinary child abuse team investigated children with burns admitted to a general hospital in Tulsa, Okla. Of the 26 burn cases investigated, 14 were found to be accidental, seven accidental with extreme degrees of neglect, and five nonaccidental burns. There are correlations between physical findings and social characteristics, which may aid in the identification and disposition of children with burns. A multiplicity of injuries suggests that nonaccidental burns are not spontaneous abuse, but a planned form of aggression. The high mortality of the abused group indicates the seriousness and severity of nonaccidental injuries. This experience has also shown that nonaccidental burns in children demand a thorough investigation of medical, social, and emotional factors.

Accidents, Home↗

PubMed1983

Assessment of a program's effectiveness in selecting individuals "at risk" for problems in parenting.

Administered the Child Abuse Potential (CAP) Inventory to 99 parents assessed as "At Risk" of parenting problems by the At Risk Parent-Child Program, Inc., Tulsa, Oklahoma. The study was designed to determine the number and extent of elevated abuse scores in an "At Risk" group compared to a norm group and to discover whether present "At Risk" parents were more seriously "At Risk" than past clients in the same program. During a 3-year period participants were offered the CAP-Inventory as part of the routine evaluation process. Results indicated the "At Risk" group scored significantly above a norm group, with 58% and 52% of the "At Risk" parents scoring above the 95th and 99th percentiles of the norm group, respectively. Comparison of the present results with data from a previous study in the same program (Milner & Ayoub, 1980) showed that the present "At Risk" group earned a significantly higher mean abuse score and had significantly more individual scores above the 95th and 99th percentiles of the norm group than did previous "At Risk" parents. The data indicated the Program is currently more effective in the selection of parents in need of its services. However, because the clients are in greater need, other findings (Thomasson, Berkovitz, Minor, Cassle, McCord, & Milner, 1981) suggest that the Program may now find itself having a more difficult time demonstrating program effectiveness because participants may be more resistant to treatment.

Adult↗

PubMed1988

Cost and efficacy of intravenous streptokinase plus PTCA for acute myocardial infarction when therapy is initiated in community hospitals.

The costs and clinical results of a thrombolytic therapy protocol using intravenous (IV) streptokinase in small community hospitals prior to emergency transfer for cardiac catheterization for possible percutaneous transluminal coronary angioplasty (PTCA) were prospectively studied in 56 patients with an acute myocardial infarction [Tulsa Heart Center-Myocardial Infarction Study Team (THC-MIST) protocol]. Findings were compared to those for 53 similar patients receiving "conventional therapy" during the same study period. The reperfusion rate for IV streptokinase was 63%. Additional emergency PTCA yielded a total reperfusion rate of 95%. Despite emergency cardiac catheterization for all THC-MIST patients, average hospital charges were not significantly different between the two groups ($20,495 vs. $20,722; THC-MIST vs. conventional therapy, respectively). Total charges (hospital plus physician fees) were also not significantly different ($22,986 vs. $22,400; THC-MIST vs. conventional therapy, respectively). Intensive care unit (ICU) days and total hospital stays were significantly less for THC-MIST patients (3.1 vs. 5.8 ICU days, p less than 0.05 and 8.8 vs. 12.4 hospital days, p less than 0.05; THC-MIST vs. conventional therapy, respectively). Thus initiation of IV streptokinase in community hospitals for acute myocardial infarction with subsequent transfer for possible PTCA can yield high reperfusion rates without significantly increasing health care costs.

Adult↗

PubMed1995

Seasonal distribution of pathogenic free-living amebae in Oklahoma waters.

Pathogenic free-living amebae cause serious human disease, including infection of the eye and the central nervous system. The purpose of this study was to sample aquatic environments in the Tulsa, Oklahoma, area year-round for the presence of these disease-causing amebae. A total of 34 pathogenic isolates were obtained from 2,016 processed water and swab samples. Pathogenicity was determined by the ability of amebae to cause death in mice after intranasal inoculation. Pathogenic amebae were isolated during every month of the year and were identified as Naegleria australiensis (38%), Acanthamoeba species (35%), N. fowleri (18%), and leptomyxid amebae (9%). Pathogenic leptomyxids have not previously been reported from the environment. The greatest percentage of recovery of pathogens occurred during the spring and autumn. The prevalence of pathogenic free-living amebae in the sampled waters was 1 pathogen/3.4 l water.

Acanthamoeba↗

PubMed1991

Simultaneous combined microbial removal of sulfur dioxide and nitric oxide from a gas stream.

A program is under way at the University of Tulsa to develop a viable process concept whereby a microbial process can impact on the problem of flue gas desulfurization and NOx removal. We have previously reported studies of SO2 reduction by Desulfovibrio desulfuricans and NOx reduction by Thiobacillus denitrificans. One potential process concept is the simultaneous combined removal of SO2 and NOx from cooled flue gas by contact with cultures of sulfate-reducing bacteria (SO2----H2S) and T. denitrificans (H2S----SO4(-2) as cultures-in-series or in coculture in a single contacting stage. Each of these contacting schemes has been investigated.

Air Pollutants, Occupational↗