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At least 163 records · Page 9Linked to original sources

PubMed1999

Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data.

OBJECTIVES: The purpose of this study was to develop a convenient and inexpensive method for identifying an individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND: Rates of readmission are high after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS: Administrative information on all 1995 hospital discharges in New York State which were assigned International Classification of Diseases-9-Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS: A total of 42,731 black or white patients were identified. The subgroup of 9,112 patients (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and Medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSIONS: Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients.

Black or African American↗

PubMed1988

Automated sample handling in a clinical laboratory.

Bar codes have received wide acceptance and have permeated many industries since their early days in the railroad industry. They offer a simple and cost-effective approach to a variety of operational situations. Clinical labs are especially well-suited for this technology.

Chicago↗

PubMed1998

Derivation of a clinical prediction model for the emergency department diagnosis of ectopic pregnancy.

OBJECTIVE: To derive a clinical prediction model for estimating the pretest probability of ectopic pregnancy in ED patients with first-trimester abdominal pain or vaginal bleeding. METHODS: All hemodynamically stable first-trimester patients presenting to the ED of a tertiary care military teaching hospital over a 14-month period with a chief complaint of abdominal pain and/or vaginal bleeding had clinical data coded prior to determining outcome. They were then followed longitudinally until a criterion standard pregnancy outcome was established. RESULTS: Of the 486 patients enrolled, 280 (58%) had viable intrauterine pregnancies, 167 (34%) had nonviable intrauterine pregnancies, and 39 (8%) had ectopic pregnancies. Using a recursive partitioning model, a high-risk group was derived (that was separated from intermediate and low-risk groups), consisting of patients with abdominal peritoneal signs or definite cervical motion tenderness, with a sensitivity of 31% (95% CI: 17-48%), a specificity of 93% (95% CI: 90-95%), a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.74. A low-risk group, consisting of patients with either fetal heart tones or tissue at the cervical os, or the absence of pain other than midline menstrual-like cramping and lacking any pelvic tenderness, was differentiated from an intermediate-risk group, with a sensitivity of 96% (95% CI: 81-100%), a specificity of 22% (95% CI: 18-26%), a positive likelihood ratio of 1.2, and a negative likelihood ratio of 0.17. CONCLUSION: A clinical prediction model for estimating the probability of ectopic pregnancy in ED patients has been derived. It may prove to have practical clinical application for estimating pretest probability of ectopic pregnancy as well as assisting in medical decision making when laboratory and ultrasonographic findings are nondiagnostic. Clinical application should await prospective validation in an independent sample.

Abdominal Pain↗

PubMed1997

Use of calcium channel blockers and breast carcinoma risk in postmenopausal women.

BACKGROUND: The use of calcium channel blockers in an elderly population recently was reported to be associated with the incidence of cancer. The Cardiovascular Health Study, a multisite observational cohort study, provided the opportunity to investigate the epidemiologic association between the use of calcium channel blockers and breast carcinoma risk in 3198 women age > or = 65 years. METHODS: Standard questionnaires and clinical procedures were administered at four study sites annually from 1989-1990 to 1993-1994. Drug usage was assessed by a medication inventory and hospitalizations for 75 incident invasive breast carcinoma cases were identified using International Classification of Diseases-9 Clinical Modification codes. Time-dependent Cox proportional hazards regression models were used to assess associations between incident breast carcinoma and the use of specific antihypertensive medication including calcium channel blockers. RESULTS: In adjusted Cox proportional hazards models, an elevated risk of breast carcinoma was associated with use of calcium channel blockers (hazard ratio [HR]: 2.57; 95% confidence interval [CI], 1.47-4.49). This association persisted when the comparison group was users of other antihypertensive medication. No associations between the use of other antihypertensive medication with incident breast carcinoma were found. Associations were enhanced by assessment of high dose at baseline (HR: 4.42; 95% CI, 1.37-14.27) and when calcium channel blockers were combined with estrogen use (HR: 4.48; 95% CI, 1.58-12.75). The association was found to be strongest for the use of estrogens with immediate release calcium channel blockers (HR: 8.48; 95% CI, 2.99-24.08). CONCLUSIONS: Although the number of cases was limited in this observational study, associations found between the use of calcium channel blockers and incident invasive breast carcinoma warrant further investigation. Site specific carcinomas should be included as an outcome of ongoing and planned long term clinical trials using calcium channel blockers.

Age Factors↗

PubMedDate not supplied

Trends in the prescribing of antidepressant pharmacotherapy: office-based visits, 1990-1995.

Data from the National Ambulatory Medical Care Survey for the period 1990 through 1995 were used to discern the population-adjusted rate of office-based physician-patient encounters at which the prescribing or continuation of antidepressant pharmacotherapy (tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs], or others), a diagnosis of depression (International Classification of Diseases, 9th Revision, Clinical Modification codes 296.2 through 296.36, 300.4, or 311), or both were documented. National estimates of the number of office-based visits resulting in a prescription for or continuation of antidepressant pharmacotherapy for any purpose escalated from 16,534,268 in 1990 to 28,664,796 in 1995, a 73.4% increase. Although the number of office-based visits at which a diagnosis of depression was documented increased 23.2% during this period, the proportion of patients with a diagnosis of depression who were prescribed or continued antidepressant pharmacotherapy increased only 14.9%, from 52.1% in 1990 to 67.0% in 1995. Among patients with a diagnosis of depression, use of a TCA declined from 42.1% in 1990 to 24.9% in 1995. In contrast, use of an SSRI for the treatment of depression increased from 37.1% in 1990 to 64.6% in 1995. The rate of office-based visits at which the use of antidepressant pharmacotherapy for any purpose was documented increased from 6.7 per 100 US population in 1990 to 10.9 in 1995, a 62.7% increase; documentation of a diagnosis of depression increased from 6.1 per 100 US population in 1990 to 7.1 in 1995, a 16.4% increase; and the recording of a diagnosis of depression in concert with the prescribing or continuation of antidepressant pharmacotherapy increased from 3.2 per 100 US population in 1990 to 4.8 in 1995, a 50.0% increase. Further research is required to elucidate the effect of observed trends on clinical and financial outcomes.

Adolescent↗

PubMedDate not supplied

The cost of antibiotics in treating upper respiratory tract infections in a medicaid population.

OBJECTIVE: To examine the use and cost of the nonindicated treatment regimens of antibiotics for nonspecific upper respiratory tract infections (URIs) in a Medicaid population. DESIGN: A cross-sectional sample of Kentucky Medicaid claims for 50000 people (July 1, 1993-June 30, 1994). SETTING: Episodes of care were created linking outpatient and emergency department visits for URIs to medications filled within a 5-day period. PARTICIPANTS: Individuals who were seen in ambulatory care for a URI as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 460 and 465. Of the 15706 episodes, 95% were outpatient office episodes. The outpatient episodes were accounted for by 8784 patients and 946 physicians. MAIN OUTCOME MEASURES: Use of antibiotics in URI episodes. Proportionate costs and costs per episode were computed based on claims paid by Medicaid. RESULTS: Sixty percent of outpatient episodes and 48% of emergency department episodes resulted in an antibiotic prescription being filled. In outpatient settings, episodes in which secondary diagnoses of either otitis media or acute sinusitis were found accounted for less than 6% of the episodes that resulted in an antibiotic prescription being filled. The most frequently filled antibiotic was amoxicillin, although second- and third-generation cephalosporins were the second most frequently occurring antibiotic class. Twenty-three percent and 9% of outpatient and emergency department episodes, respectively, resulted in a prescription filled for antihistamines. In outpatient episodes, antibiotics account for 23% of the total cost of care. In emergency department visits, antibiotics account for 8% of the cost of URIs. Antibiotics cost, on average, $9.91 for each episode of care in outpatient office visits. An estimate of the cost of antibiotics for URIs in a year for the Kentucky Medicaid program is $1.62 million. CONCLUSIONS: The results indicate that a substantial proportion of resources in Medicaid are being used for nonindicated and ineffective treatments for URIs. With the increase in antibiotic-resistant pathogens and shrinking public health care funding, the current treatment for URIs should be reexamined.

Aged↗

PubMed1998

Patterns of emergency department visits for disorders of the eye and ocular adnexa.

OBJECTIVE: To characterize the magnitude and patterns of visits to the emergency department (ED) for problems related to the eye and ocular adnexa. METHODS: The National Hospital Ambulatory Medical Care Survey was used to obtain information on ED visits in the United States for conditions of the eye and ocular adnexa in 1993. Patients were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes. National projections were based on a staged probability design. RESULTS: There were 2.32 million projected ED visits for problems of the eye and ocular adnexa in 1993. Forty-nine percent of visits were for injuries, two thirds of which occurred in males. Thirty-five percent of injuries occurred in the home and 18% occurred in the workplace. Only 3% of patients required hospitalization. Most patients had private insurance, but substantial variations in coverage existed for patients who used the ED for injury- vs non-injury-related care. CONCLUSIONS: Emergency departments in the United States provide a large amount of eye care, much of which is for conditions other than trauma. Differences in insurance coverage for injury- and non-injury-related eye care indicate that factors other than medical urgency are involved in the decision to use ED services. Further studies are needed to determine the cost-effectiveness and quality of ocular-related ED visits.

Adolescent↗

PubMed1999

Racial difference in the incidence of retinal detachment in Singapore.

OBJECTIVE: To determine the incidence of retinal detachment (RD) operations in a multiracial Southeast Asian population. DESIGN: Population-based incidence study using a universal medical savings database in Singapore. METHODS: Information on all RD operations performed for rhegmatogenous RD (International Classification of Diseases, Ninth Revision, Clinical Modification code 361.0) between 1993 and 1996 was retrieved and analyzed from a population-wide, government-administered medical savings database. Exudative, tractional, and unoperated-on rhegmatogenous RD are excluded. The 1990 Singapore population census was used to allow an estimation of age-, sex-, and race-specific annual incidence of RD. RESULTS: Between 1993 and 1996, 1126 RD operations were performed on Singapore residents. The average annual incidence of RD operations was 10.5 per 100,000 population (95% confidence interval [CI], 10.2-10.9). The annual incidence was highest for Chinese (age-adjusted incidence, 11.6 per 100,000), followed by Malays (7.0 per 100,000), and lowest for Indians (3.9 per 100,000). The age-adjusted relative risk of RD operation for Chinese compared with Indians was 3.0 (95% CI, 2.9-3.1). Males were twice as likely as females to require RD surgery (age-adjusted relative risk, 2.0; 95% CI, 1.7-2.4). Chinese men 40 years and older had a 30.9 times higher risk (95% CI, 9.9-96.1) than Indian females younger than 40 years. CONCLUSION: The incidence of RD is strongly associated with male sex and ethnic origin.

Adolescent↗

PubMed1989

Pediatric patients, race, and DRG prospective hospital payment.

The diagnosis related group (DRG) prospective hospital payment system contains inequities in hospital payment for certain groups of patients. Patients of lower socioeconomic status may be underreimbursed by DRGs. We analyzed pediatric patients and hospital resource consumption by race (white, Hispanic, and black) using a DRG prospective payment "all payer" system. All hospitalized pediatric admissions over a 3-year period (N = 14,489) were analyzed by race at a large academic medical center. Mean hospital length of stay and cost per patient (adjusted for DRG weight index) was significantly greater for black and Hispanic pediatric patients compared with whites. Financial risk as measured by outliers and losses under DRGs was greater for blacks and Hispanics compared with whites. Black and Hispanic patients had a higher proportion of emergency admission to the hospital compared with whites, a greater severity of illness (as measured by total International Classification of Diseases, ninth revision, Clinical Modification codes), and (on average) higher diagnostic costs for each episode of illness. Our data suggest that black and Hispanic pediatric patients have a greater hospital resource consumption (adjusted for DRG group case mix) compared with whites, at least at our large medical center in the Northeast. Hospitals that treat greater numbers of black and Hispanic pediatric patients may be at a substantial disadvantage under per-case DRG payment.

Academic Medical Centers↗

PubMed1989

Weighted ventriculographic wall motion score for improved survival prediction in patients with coronary artery disease. Coronary Artery Surgery Study.

Global ventricular function parameters such as the ejection fraction and the sum of wall motion scores for segments of the left ventricle are excellent predictors of long-term survival in patients with coronary heart disease. These are usually determined from a monoplane right anterior oblique view. It was hypothesized that a biplane weighted wall motion score that included the left anterior oblique projection might better predict survival. A new score (BISCORE) was derived for 1,433 Mayo Clinic ventriculograms coded by the methods of the Coronary Artery Surgery Study (CASS). Weighting coefficients for each left ventricular segment were derived by the proportional hazards technique, and this resulted in the equation BISCORE = 120 - (8.6 x anterobasal + 3.4 x basal septum + 2.9 x apical + 2.7 x posterolateral + 2.4 diaphragmatic), which yielded a score from 0 (all segments aneurysmal) to 100 (all segments normal). This score stratified the original 1,433 patients into distinct groups by survival. As a single variable it was better than previous wall motion scores and ejection fraction at predicting survival. When prospectively applied to 5,172 Coronary Artery Surgery Study patients, this new score again proved to be a better predictor of survival than previous unweighted scores. Since the new score contains terms from the left anterior oblique ventriculographic projection, it is concluded that this projection adds information to that of the right anterior oblique projection regarding survival. Furthermore, this weighted score appears more highly associated with survival than unweighted scores.

Coronary Disease↗

PubMedDate not supplied

The ratio of AIDS to non-AIDS Medicaid medical costs from 1992 to 2000.

Our research objective was to calculate and forecast the monthly increase in medical and prescription costs for Medicaid patients with acquired immunodeficiency syndrome (AIDS) and compare these values with costs for non-AIDS patients. A retrospective analysis of AIDS patients and a control group of Georgia Medicaid beneficiaries was conducted between January 1, 1988, and December 31, 1991. AIDS patients were defined using the Keyes algorithm of combinations of International Classification of Diseases, 9th Revision, Clinical Modification codes. The AIDS patient group was matched demographically to a group of non-AIDS patients. Data were adjusted to account for eligibility status, and the ratio of AIDS costs to non-AIDS costs was modeled with an econometric time series procedure. A total of 1966 AIDS patients were identified from 900,000 Medicaid recipients in the study period; 58.0% were male and 59.8% were black. Age was bimodal at < or = 1 year and 33 years. The best fit for the medical cost ratios produced a significant regression coefficient of .37. The initial ratio of AIDS to non-AIDS forecast was 4.25 in January 1992. The January 2000 forecast of this ratio increased to 42.56. This increase equates to an additional $8510.19 per AIDS patient-month for January 2000 in 1991 dollars. The outpatient prescription ratio for AIDS versus non-AIDS patients was not predictable. However, the greatest observed discrepancies were attributed to the expense for antihemophilia products. Overall, the most important finding was the accelerating medical costs for treating AIDS patients compared with costs for treating non-AIDS patients. These results may, in part, reflect additional costs for treating intravenous drug users and pediatric AIDS patients.

Acquired Immunodeficiency Syndrome↗

PubMed2026

Psychiatric Diagnoses and Psychotropic Medications Among Military-Affiliated Adolescents and Young Adults With Polycystic Ovary Syndrome.

PURPOSE: To study rates of psychiatric diagnoses and psychotropic medication prescription among U.S. military-affiliated adolescents and young adults (AYA) with polycystic ovary syndrome (PCOS). METHODS: This retrospective matched cohort study included U.S. military-affiliated AYA (aged 15-21 years) enrolled in TRICARE Prime for at least 6 months during the surveillance period (January 2016 to October 2023). Military-affiliated AYA were grouped into three categories: individuals diagnosed with PCOS (N = 6,911), age-matched individuals with no diagnosed PCOS symptoms (N = 35,814), and individuals with diagnosed symptoms suggestive of PCOS (N = 2,136). The presence of a psychiatric diagnoses and prescriptions for psychotropic medications were obtained via the International Classification of Diseases, 10th Revision, Clinical Modification codes and National Drug codes, respectively. RESULTS: AYA with diagnosed PCOS had higher odds of having a psychiatric diagnosis and being prescribed a psychotropic medication compared to an age-matched comparison group (psychiatric diagnosis odds ratio [OR] = 2.48 [2.35-2.62], medication OR = 2.14 [2.03-2.25]) and individuals with symptoms suggestive of PCOS (psychiatric diagnosis OR = 1.11 [1.003-1.23], medication OR = 1.16 [1.05-1.28]). DISCUSSION: The odds of psychiatric comorbidities and psychotropic medication prescription were more than twice as high as among U.S. military-affiliated AYA with PCOS. More research is needed to determine whether health-care utilization and military-related factors impact mental health outcomes among AYA with PCOS. Additionally, tailored, multidisciplinary mental health services for AYA with PCOS are needed.

Humans↗

PubMed1994

Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience.

PURPOSE: The purposes of this study were (1) to determine the current population-based mortality rate for the surgical treatment of abdominal aortic aneurysms (AAA) in Michigan, (2) to document changes in mortality rates over 11 years, and (3) to identify risk factors for operative mortality. METHODS: A statewide database provided clinical information on all Michigan hospital admissions with a diagnosis of AAA from 1980 to 1990. The mortality rate analysis included all admissions with a primary diagnosis of AAA that underwent repair. Determination of diagnoses and comorbidities were based on International Classification of Diseases-ninth revision-Clinical Modification codes. RESULTS: Conventional surgical repairs were performed on 8185 intact and 1829 ruptured AAA. Hospital mortality rates accompanying operation for intact AAA decreased from 13.6% in 1980 to 5.6% in 1990 (p < 0.001). Mortality rates over the 11 years averaged 10.7% in women and 6.8% in men (p < 0.001). Mortality rates averaged 10.7% in 4170 admissions of patients 70 years old or older and 4.2% in 4015 admissions of patients 69 years old or younger. Preexistent kidney failure was associated with an average mortality rate of 41.2% compared with 6.2% without this comorbidity. Preexistent dysrhythmia increased mortality rates from 6.6% to 13.6%. Uncomplicated hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, arterial occlusive disease, and ischemic heart disease in recent years were not associated with increased mortality rates. Hospitals with an annual volume of 21 or more intact AAA repairs had a surgical mortality rate of 6.2%, compared with 8.9% in hospitals with lower surgical volume (p < 0.001). Mortality rates for surgical repair of ruptured AAA averaged 49.8% and did not improve significantly over the 11 years studied. CONCLUSION: Despite a dramatic drop in surgical mortality rates, repair of intact AAA remains a formidable undertaking. This population-based series documents a substantially higher mortality rate than most selected series. The unchanged mortality rate for ruptured AAA suggests that development of better algorithms to identify those AAA most apt to rupture and earlier intervention in those instances is likely to improve patient survival rates.

Age Distribution↗

PubMed1999

Outcome of temporal lobectomy: expectations and the prediction of perceived success.

PURPOSE: This study examined the independent contributions of medical and psychosocial factors to perceived surgical success. We aimed to develop a multidimensional model predictive of perceived surgical outcome. METHODS: Fifty anterior temporal lobectomy (ATL) patients were prospectively assessed, using a formally coded, semistructured clinical interview. This has been routinely administered pre- and post-operatively as part of a larger, nationwide study of Australian ATL patients. The interview covers a broad range of epileptological, psychiatric, neuropsychological and psychosocial issues. Variables from these domains were examined in relation to the patient's perception of surgical success at the 6-month post-operative review. RESULTS: Variables that correlated with success were analysed using principal components analysis and multiple regression. A predictive model of perceived surgical success emerged, which highlighted the multidimensionality of outcome. Independent effects were observed for both medical and psychosocial factors. These included the patients' pre-operative expectations of surgery, their post-operative seizure outcome, and affective state. The findings also highlighted the importance of discarding sick role behaviours associated with chronic epilepsy, after surgery. CONCLUSIONS: Traditional outcome measures (seizure frequency, post-operative affect) are significant in the patient's evaluation of surgical success. These traditional measures, however, do not account for the process of psychosocial adjustment surrounding seizure surgery. This process involves two major components: (1) positive anticipation of change prior to surgery, and (2) learning to discard roles associated with chronic epilepsy after surgery.

Adult↗

PubMed1995

Verbal exchange structure of brief psychodynamic-interpersonal and cognitive-behavioral psychotherapy.

A verbal exchange is a set of 2 people's co-occurring speech-act categories that accomplish some subtask within an interpersonal encounter. Factor analysis of verbal response mode (speech act) frequencies in 1,630 segments (each approximately 10 to 12 min) drawn from the brief psychodynamic-interpersonal or cognitive-behavioral treatment of 39 mainly depressed clients identified 6 exchanges in each treatment--4 that were the same in both treatments (Revealing, Storytelling, Explaining, and Inquiring) and 2 that distinguished each treatment (Exploring and Interpreting in psychodynamic-interpersonal treatment; Prescribing and Reframing in cognitive-behavioral treatment). The exchanges showed distinctive temporal patterns across segments of sessions and across sessions of each time-limited treatment. The verbal exchange is a midsize concept that links atomistic verbal codes with clinical or theoretical concepts.

Adult↗

PubMed1999

Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study.

The aim of this study was to assess the accuracy and utility of administrative health data in identifying persons with inflammatory bowel disease on a population basis and to determine the incidence and prevalence of this disease in the Canadian province of Manitoba. The data from Manitoba Health (the province's single insurer) were used to identify residents with physician and/or hospital contacts for Crohn's disease or ulcerative colitis based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes between 1984 and 1995. Of 5,182 eligible individuals, 4,514 were mailed questionnaires and 2,725 responded. Cases were defined as individuals with five or more separate medical contacts with one of these diagnoses or three or more such contacts if they were resident for less than 2 years. The accuracy of the study case definitions was high when compared with either self-report or chart review. The 1989-1994 age- and sex-adjusted annual incidence was 14.6/100,000 for Crohn's disease and 14.3/100,000 for ulcerative colitis. The prevalence of Crohn's disease in 1994 was 198.5/100,000, and that of ulcerative colitis was 169.7/100,000. In conclusion, the authors have successfully established and validated a population-based database of inflammatory bowel disease based on administrative data. The high incidence rates and dynamic epidemiology of inflammatory bowel disease in Manitoba indicate the presence of important environmental risk factors, which warrants further investigation.

Adolescent↗

PubMed1999

Placenta previa: preponderance of male sex at birth.

To determine the relation between placenta previa and male sex at birth, the authors conducted two types of analysis: 1) a historical cohort analysis of singleton live births in New Jersey hospitals during 1989-1992 (N = 447,963); and 2) a meta-analysis of previously published studies on the subject. For the cohort analysis, subject mother-infant dyads were identified from linked birth certificate and maternal and infant hospital claims data. The infant's sex for mothers with an International Classification of Diseases, Ninth Revision, Clinical Modification, code of 641.0-641.1 for placenta previa (n = 2,685) was compared with infant's sex for mothers without placenta previa (n = 445,270). For the meta-analysis, seven published articles were located and summary effects were calculated using both fixed-effect and random-effects models. In the present cohort study, the male:female ratio at birth was significantly higher in women with placenta previa (1.19) than in those without placenta previa (1.05) (p<0.001). The association of placenta previa with male sex persisted when the analysis was either stratified or adjusted for the effects of maternal age, maternal parity, maternal smoking during the index pregnancy, race/ethnicity, the infant's gestational age, and the infant's birth weight. The meta-analytic results from the fixed-effect and random-effects models showed a 14% excess of placenta previa when women were carrying a viable male fetus as compared with a viable female fetus during pregnancy. The results were the same regardless of whether the present cohort study was included in the meta-analysis. In conclusion, the evidence obtained from these analyses strongly argues for an association between placenta previa and male sex at birth. The mechanism for this association remains to be determined.

Cohort Studies↗

PubMed1999

A computerized method of identifying potentially preventable heart failure admissions.

Heart failure (HF) is both highly prevalent and costly to society. Successful self-care is essential to effective HF management. This study sought to develop a method to identify, via medical records (International Classification of Diseases, 9th Revision, Clinical Modification) coding, HF admissions attributable to ineffective self-care. Expert panels completed an iterative series of mailed surveys to generate and validate a list of coded diagnoses that represent HF sequelae modifiable through self-care. Sixteen diagnoses resulted. Chart review at one hospital revealed that these modifiable sequelae were frequently present but not coded. A computerized method of identifying self-care deficits would allow nurses to identify patients in need of patient education.

Abstracting and Indexing↗