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PubMedDate not supplied

Early social intervention in the emergency department.

OBJECTIVES: To assess the usefulness of an early medical social intervention conducted by a specially oriented medical social workers stationed in the Emergency Department. METHODS: Prospective study during a 2-month reference period, in a 900-bed inner-city teaching hospital that has approximatively 30,000 emergency department visits annually, providing health care facilities for a metropolitan area with a population of 230,000. RESULTS: Among 6,000 patients presenting to the emergency department during the study, 72 were found to require social intervention (1.2% of all emergency department visits, 6.85% of admissions to the hospital). Social intervention consisted of telephone calls (89%), correspondence by letters (26.5%), counsel and advice (23.5%), out-hospital intervention (14%) and resulted in: house-keeping help (34.5%) or transferal to nursing homes or nursing hospitals (28%) of elderly patients; aid to homeless and socially disadvantaged people, such as transferal to homing city shelters, clothing supply, etc., allowing extra hospital maintenance (23.5%); regularization of health insurance affiliation (10%); aid in various other social situations (22%). CONCLUSION: An early medical social intervention in the emergency department resulted in alternatives to hospital admission for a high proportion of patients (82%).

Adolescent↗
PubMed1986

Economic and health aspects of peptic ulcer disease and H2-receptor antagonists.

The costs of peptic ulcer disease to society are very high. Costs can be expressed as either direct or indirect. Direct costs include hospitalization or clinic visits, physicians' fees, and medication. Indirect costs are loss of productivity due to absenteeism from work or loss of income from death of an employee. The daily cost of different ulcer drugs such as the histamine (H2)-receptor antagonists for intravenous treatment, acute healing, and maintenance can easily be compared. As newer anti-ulcer drugs such as H2-receptor antagonists have been introduced into the marketplace, the number of prescriptions and medication costs have increased rather than decreased. In part, this may be accounted for by the high frequency with which H2 antagonists are prescribed for patients with non-ulcer dyspepsia. Some patients have chronic peptic ulcer disease with multiple painful recurrences or complications such as hemorrhage, perforation, or obstruction. They may require long-term care or drug maintenance, hospitalization, or surgery. For patients with chronic ulcer disease or complications, randomized controlled trials to compare the efficacy, safety, and costs of different forms of therapy (maintenance drugs, surgery, or placebo) have not been reported. However, based upon good efficacy and safety for acute healing and long-term drug maintenance for painful duodenal ulcer disease, long-term maintenance with H2-receptor antagonists is now prescribed for many patients. No controlled randomized trials have been reported to document that long-term maintenance with H2-receptor antagonists actually reduces peptic ulcer complications. However, by current cost estimates, long-term H2-receptor antagonist therapy is less expensive than ulcer surgery for uncomplicated ulcer disease for up to eight years. However, maintenance drug therapy after eight years may be more expensive than elective ulcer surgery in patients with chronic peptic ulcer disease who are good surgical candidates. Patients with complications of peptic ulcer disease seem to represent a different subset than patients with symptomatic ulcer disease. Further studies in these subsets are needed to ascertain the most effective, safest, and least expensive management such as surgery, long-term drug maintenance, or intermittent drug therapy to prevent recurrent ulceration or complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Chronic Disease↗
PubMed1994

The impact of membership in a health maintenance organization on hospital admission rates for acute chest pain.

OBJECTIVE: We evaluate the impact of membership in a staff-model health maintenance organization (HMO) on hospital admission rates for patients presenting to an emergency department with acute chest pain. DATA SOURCES AND STUDY SETTING: Primary prospective data were gathered from all 3,006 patients presenting with a chief complaint of chest pain to the emergency department (ED) of a university teaching hospital from October 1987 to November 1989. STUDY DESIGN: Prospective cohort analysis used clinical data to stratify patients into groups at high (> or = 25%), medium (8-24%), and low risk (< or = 7%) of acute myocardial infarction (AMI). Insurance status was determined as either HMO, Medicare, commercial, Medicaid, or self-pay. Triage decisions were recorded, and patient outcomes of AMI and other final diagnoses were determined for all patients. DATA COLLECTION METHODS: Clinical data were recorded by the physicians in the ED as part of a detailed protocol. Insurance data were recorded separately by the ED staff as part of the hospital administrative database. Patient outcomes were recorded daily by research nurses for hospitalized patients; for patients who were discharged from the ED, telephone or physician follow-up was accomplished within seven days after discharge. PRINCIPAL FINDINGS: HMO patients were more likely to be admitted to the hospital than patients in other insurance groups in both the medium- and low-risk patient categories. Within the low-risk category, after controlling for clinical differences in a multiple logistic model, HMO membership retained an independent positive association with hospital admission compared to all other insurance groups except Medicaid. CONCLUSIONS: For patients with acute chest pain who were at medium and low risk of acute myocardial infarction, HMO membership was associated with higher rates of hospital admission. These findings suggest that organizational factors beyond financial incentives may exercise an important influence on hospitalization rates for HMO patients.

Acute Disease↗
PubMed1999

Strategic adaptation of US rural hospitals during an era of limited financial resources: a longitudinal study, 1983 to 1993.

This research investigated the competing effects of environmental and organizational pressures on rural hospitals' revenue-enhancing and cost-containment strategies from 1993 to 1993. In general, organizational pressures (multihospital system membership and non-government control) exerted more influence than environmental ones. Also, strategies generally were sustained over time and were particularly interdependent with hospitals' maintenance of staffed beds. Strategies did respond to environmental pressures, however, with revenue enhancement associated with local market competition and munificence, and cost containment associated with pressures from Medicare reimbursement.

Capital Financing↗
PubMed2005

[Analysis of maintenance therapy in hospitalized patients with exacerbation of bronchial asthma: a six-year observation].

The subjects of the study were 504 patients with bronchial asthma (BA) exacerbation, hospitalized in Saint Petersburg Hospital #32 in 1997 - 2004; the maintenance therapy in these patients was analyzed. Severe exacerbations were diagnosed in 256 (51%) of the patients, moderate--in 200 (40%), and mild--in 48 (9%). The study revealed that 78% of patients had been given instructions on their preventive anti-inflammatory therapy, informed about the doses of medications and the duration of the therapy. However, only 13% of the patients received anti-inflammatory therapy that was adequate to the severity of the illness, and only 32% of all the patients demonstrated correct technique of using meter dose inhalers. Correlations (p < 0.05) were established between these factors and poorer asthma control (R = -0.07) and the severity of the exacerbations (R = -0.41). Seventy-seven per cent of BA patients hospitalized for severe exacerbations either did not received inhaled glucocorticosteroids (IG) or received them irregularly, and only 8% of the patients received adequate anti-inflammatory therapy. The main causes of inadequate therapy were low compliance (46%) and poor level of patients' knowledge (22%). Unavailability of medications was reported only by 29% of the patients. The main cause of poor compliance was fear of corticosteroid therapy side effects; and the most common scenario of not following physician's recommendation was premature discontinuation of IG therapy. In conclusion, the rational way of the maintenance therapy optimization is correct choice of preventive anti-inflammatory medications and adequate inhalation delivery systems, patients' education, and overcoming of poor compliance at hospital stage. This is of particular importance in frequently hospitalized patients with BA.

Acute Disease↗
PubMedDate not supplied

Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: unbound quinine concentrations following a simple loading dose regimen.

Nine children with severe falciparum malaria were treated with an intravenous quinine regimen which did not require burettes or infusion pumps, to determine its practicability and to ensure that therapeutic drug concentrations were achieved and maintained throughout the dose interval. The regimen comprised quinine dihydrochloride (15 mg/kg; 12.5 mg/kg of the free base), which was added to a bag of intravenous fluid (after wastage of all but 100 mL), and given via standard giving sets over 2 h. Blood was drawn sequentially during the infusion, and for 12 h thereafter; plasma water was obtained by ultrafiltration of samples at the bedside, and quinine concentration was measured, in plasma and plasma water, by high performance liquid chromatography. Drug administration was practicable without burettes or infusion pumps; unbound drug concentrations exceeded the 99% inhibitory concentration for local parasites within 0.5 h, and remained within the therapeutic range for the entire dose interval. This loading dose regimen can now be recommended for young children in African hospitals; maintenance doses of 10 mg/kg should be given at 12 h intervals until oral antimalarial drugs are possible. These recommendations will need to be modified if susceptibility to quinine declines.

Child↗
PubMed1987

Pharmacologic management of asthma.

Obstructive airway disease from asthma needs to be distinguished from other causes, classified with regard to clinical pattern, and assessed to identify severity and precipitating factors. Intervention of acute symptoms is most effective with inhaled sympathomimetic bronchodilators backed up with short courses of high-dose oral corticosteroids for symptoms that are suboptimally responsive to bronchodilation alone, especially for those patients with a history of emergency care requirements and/or hospitalization. Maintenance therapy with scheduled daily use of inhaled beta2 agonists, cromolyn, and slow-release theophylline can be used prophylactically for patients with chronic disease. The inhaled beta2 agonists are the most effective therapeutic agents for relieving acute bronchospasm and for decreasing responsiveness of the airways to specific stimuli such as exercise; however, even the newer agents have sufficiently short duration of effect to limit efficacy for maintenance therapy. Cromolyn and slow-release theophylline are commonly used for chronic therapy; cromolyn has the merit of virtually no toxic potential but is less convenient and less likely to be effective, at least for more severe asthma, than theophylline. Corticosteroids uniquely decrease the inflammatory component of asthma, thereby decreasing or preventing airway obstruction from mucosal edema and secretions. Short courses of high-dose oral steroids without tapering provide useful and safe intervention for acute symptoms, whereas alternate-morning oral use and the new generation of topical inhaled agents provide acceptably safe alternatives for managing chronic disease not controlled with other measures. Nonpharmacological factors that require therapeutic consideration include environmental factors such as cigarette smoke and aeroallergens, and general physical conditioning. Compliance with the medical recommendations requires dealing with dysfunctional attitudes and beliefs held by the patient and/or family and the fostering of an internal locus of control by including the patient in the decision-making process.

Adolescent↗
PubMed1992

Dehydration from outdoor work and urinary stones in a tropical environment.

A questionnaire survey was carried out to determine the prevalence of urinary stone disease in 406 male workers in several occupations. There were 119 quarry drilling and crusher workers (outdoor, physically active), 77 quarry truck and loader drivers (outdoor, physically inactive), 92 postal deliverymen (outdoor, physically active), 75 postal clerks (indoor, physically inactive), and 43 hospital maintenance workers (indoor, physically active). The prevalence of urinary stone disease was five times higher in outdoor workers (5.2 per cent) compared to indoor workers (0.85 per cent, P less than 0.05). Contrary to expectation, no increased risk of urolithiasis was apparent in physically inactive workers. Chronic dehydration is likely to be the most important risk factor for the increased risk of urolithiasis in outdoor workers in the tropics, and should be easily prevented by increased water intake.

Adult↗
PubMed1978

Prevention of electrical shock hazards in physical therapy.

Basic electrical safety information for the physical therapist is presented, and the most hazardous areas in a physical therapy clinic are identified. Physical therapy modalities are no safer than the power receptacle (wall outlet) into which they are plugged. High frequency physical therapy equipment should never be operated without a three-prong polarized plug and a matching polarized wall receptacle. Three-to-two prong adapters must never be used. Hydrotherapy is an especially dangerous area and should be equipped with ground fault detector receptacles with ground fault interrupters that cut the current when the electrical ground is lost. Ultrasound leakage current measurements on many older ultrasound units may now exceed today's acceptable standards. An external isolation transformer may be required to modify older ultrasonic units before they meet present standards. Physical therapists must never assume that rountine electrical safety inspections are being conducted by hospital maintenance personnel. The physical therapist is responsible for ensuring that all hazardous areas are rountinely checked for electrical safety.

Accident Prevention↗
PubMed1990

Use of a portable floor crane as an aid to resection of the massive panniculus.

Resection of the massive abdominal panniculus is technically difficult due to the weight of the tissue and the difficulty in controlling the tissue during surgery. The authors describe the use of a portable floor crane that facilitates resection by reducing the number of assistants required, increasing exposure, and providing for adequate control of the specimen, which assures proper preoperative markings and sterile preparation. Blood loss is reduced, as is operating time. The portable floor crane is usually available in hospital maintenance departments and can be easily modified for intraoperative use.

Abdomen↗
PubMed1998

Accidental transmission of HCV and treatment with interferon.

Accidental transmission of contagious pathogens, especially hepatitis C virus (HCV), by needlestick or other means as an occupational hazard for medical staff is of concern. We retrospectively analysed cases of work-related accidental injury with pathogens such as hepatitis B virus (HBV), HCV, syphilis and human immunodeficiency virus (HIV) reported to the centres for disease control at 15 hospitals (total 5776 beds) in the Gunma prefecture, Japan, from December 1990 to August 1993 (24.7 months). There were 416 such cases (16.8 cases/month), with an incidence of 0.2-3.5 accidents per month per hospital. Such accidents occurred in 297 (71.2%) nurses, 98 (23.5%) medical doctors, 13 (3%) laboratory technicians, four (1.0%) hospital maintenance workers, one (0.2%) assistant nurse, one secretary and two others. There were 323 (77.6%) injuries caused by needlestick, 42 (10.1%) from suture needles or surgical knife cuts, 17 (4.1%) from blood splatters from patients into the eyes or mouth, 10 (2.4%) from contact with injured skin and 24 (5.8%) simple skin contacts. Of the pathogens, 60.3% were HCV, 22.6% HBV, 5.8% syphilis, 0.7% HIV and 10.6% were of unknown origin. Four cases (1.6%) of HCV infection were found and treated with one or two courses of interferon therapy, and HCV was subsequently cleared. All four patients were cured with interferon therapy. None of the HBV-injured cases resulted in infection, possibly because of prophylaxis with HB immunoglobulin and HB vaccine. No HIV or syphilis infection was contracted. In summary, chronic HCV infection acquired as an occupational hazard can be cured by appropriate treatment, such as with interferon, after early detection of the infection.

Accidents, Occupational↗
PubMed1995

The cost of insulin-dependent diabetes mellitus (IDDM) in England and Wales.

This study estimates the direct health and social care costs of insulin-dependent diabetes mellitus (IDDM) in England and Wales in 1992 to be 96 million pounds, or 1021 pounds per person in a population with IDDM estimated at 94,000 individuals. These costs include insulin maintenance, hospitalization, GP and out-patient consultations, renal replacement therapy, and payments to informal carers. Expenditure is concentrated on younger age groups, with one-third of the total expended on those aged 0-24. Around one-half of the total costs can be directly attributed to IDDM, with the remainder associated with a range of complications of the disease. The single largest area of service expenditure is renal replacement therapy. The cost estimates are most sensitive to incidence rates of IDDM, numbers on dialysis and average duration of dialysis. A further 113 million pounds may be lost each year due to premature deaths resulting in lost productive contributions to the economy. The direct and indirect costs of IDDM are therefore significant. The cost of illness framework presented here should facilitate the economic evaluation of new and existing treatment regimens, which may improve value for money by reducing costs and/or increasing the quality or quantity of life for people with IDDM.

Adolescent↗
PubMed1995

Overcoming historical and organizational legacies: AHIMA poises to lead.

Considering leadership as both an individual and an aggregate characteristic, the article examines the leadership potential for members of the American Health Information Management Association (AHIMA) and for AHIMA as a professional organization within the field of health information management. AHIMA and its members are uniquely suited for leadership within this occupational field. The long association with paper records and a hospital maintenance function, however, plus the predominance of women within the field result in organizational features and political factors that could block leadership development.

Female↗