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Biomedical subjects

C F Federspiel

Publications and source records attributed to C F Federspiel.

At least 19 recordsLinked to original sources
PubMed1999

Identifying medical center units with disproportionate shares of patient complaints.

BACKGROUND: A pilot study was conducted to learn whether an academic medical center's database of patient complaints would reveal particular service units (or clinics) with disproportionate shares of patient complaints, the types of complaints patients have about those units, and the types of personnel about whom the complaints were made. RESULTS: During the seven-year (December 1991-November 1998) study period, Office of Patient Affairs staff recorded 6,419 reports containing 15,631 individual complaints. More than 40% of the reports contained a single complaint. One-third of the reports contained three or more complaints. Complaints were associated with negative perceptions of care and treatment (29%), communication (22%), billing and payment (20%), humaneness of staff (13%), access to staff (9%), and cleanliness or safety of the environment (7%). Complaints were not evenly distributed across the medical center's various units, even when the data were corrected for numbers of patient visits to clinics or bed days in the hospital. The greatest proportion of complaints were associated with physicians. DISCUSSION: Complaint-based report cards may be used in interventions in which peers share the data with unit managers and seek to learn the nature of the problems, if any, that underlie the complaints. Such interventions should influence behavioral and systems changes in some units. SUMMARY AND CONCLUSIONS: Further experience should indicate how different types of complaints lead to different kinds of interventions and improvements in care. Tests of the system are also currently under way in several nonacademic community medical centers.

Academic Medical Centers↗
PubMed1998

What health professionals can do to identify and resolve patient dissatisfaction.

BACKGROUND: Patient satisfaction affects consistency of self-care, health outcomes, level of service utilization, choice of health professionals, and decisions to sue in the face of adverse outcomes. Understanding patients' specific dissatisfactions may help health professionals and administrators identify and rectify organizational deficiencies before they become costly. COMMON CAUSES OF COMPLAINTS: As part of a series of research projects, more than 12,000 patient/family complaint narratives were examined in which patients or patients' family members told interviewers or patient advocates about the care they received from their health professionals in both inpatient and outpatient settings. Complaints may be categorized as involving issues of care and treatment, communication, humaneness, access and availability, environment, and billing/payment. STRATEGIES FOR RESOLVING COMPLAINTS: Even though caregivers may not have control over all the factors that lead to dissatisfaction, they can often hear and address complaints. As a result, they may not only contribute to quality of care but improve the systems in which they practice. The challenges are how to prevent dissatisfaction in the first place, and, if it does occur, to identify and if possible rectify patient concerns. Three case studies are provided. CONCLUSION: All health professionals must be involved in efforts to resolve problems that compromise patient care. Some problems could be prevented if administrators and leaders used complaint data to recommend new policies and procedures or to identify and counsel with health care team members who generate disproportionate numbers of complaints. If all are involved in both prevention and problem solving, resources devoted to uncovering, understanding, and resolving patient complaints are likely to prove cost-effective.

Attitude of Health Personnel↗
PubMed1997

New use of anticonvulsant medications among children enrolled in the Tennessee Medicaid Program.

OBJECTIVE: To describe the new use of anticonvulsant medications among children enrolled in the Tennessee Medicaid program. DESIGN: A retrospective cohort study. PATIENTS: New users of anticonvulsant medications in 1992 were identified from the 206,098 children (aged 0-18 years) enrolled continuously for 12 months in the Aid to Families With Dependent Children program or foster care program of Tennessee Medicaid. MAIN OUTCOME MEASURES: New users were categorized according to the diagnosis codes of health care encounters occurring 90 days before to 90 days after the first anticonvulsant prescription was filled as having diagnoses consistent with (1) epilepsy or convulsions, (2) neonatal seizures, (3) central nervous system disease, (4) no epilepsy diagnoses but diagnoses for which anticonvulsants might appropriately be used (jaundice, headaches, or psychiatric disorders), or (5) no diagnoses for which an anticonvulsant might appropriately be used. The children in each group were described according to sociodemographic variables, with logistic regression used to analyze variations in the subsequent filling of anticonvulsant prescriptions. RESULTS: Of 647 children continuously enrolled in the Tennessee Medicaid program who were new anticonvulsant users in 1992, 58% had at least 1 health care encounter coded as epilepsy or convulsions, 2% had a diagnosis of neonatal seizures, 8% had central nervous system diagnoses, 16% had specific nonepilepsy diagnoses (jaundice, headache, or psychiatric diagnoses), and 16% had no diagnoses for which anticonvulsants might appropriately be prescribed. For children with epilepsy diagnoses, white race (P = .002) and undergoing tests (P < .001) were independent predictors of a child filling 6 or more prescriptions in the year following the first prescription CONCLUSIONS: A large proportion of new users of anticonvulsants among children enrolled in the Tennessee Medicaid program received these medications for indications other than epilepsy. For children with epilepsy diagnoses, there was considerable variation in the subsequent filling of prescriptions. Further analysis of these variations in practice will allow for the development of policies that will maximize benefit for children who need anticonvulsant therapy, while diminishing unnecessary exposure to potentially toxic drugs for children who do not.

Adolescent↗
PubMed1993

Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation.

Burst fractures of the lumbar spine that are located below the thoracolumbar junction present a challenge when operative management is indicated. Short-segment instrumentation offers the advantage of incorporating fewer motion segments in the fusion, but may not provide adequate long-term stabilization. The goal of this study was to assess the axial stiffness and torsional rigidity of several short-segment instrumentation procedures. Compressive axial stiffness and torsional rigidity were measured in six intact porcine lumbar spines (L1-L5). A corpectomy was performed to simulate a burst fracture injury and decompression. Posterior instrumentation, posterior instrumentation with an anterior strut (a wood block), and anterior instrumentation with an anterior strut one level above and one level below the fracture site were applied as treatment strategies. VSP plates (Acromed, Cleveland, OH) for posterior instrumentation and the Kaneda system (Acromed, Cleveland, OH) for anterior instrumentation were used. Load-displacement and torque-angle plots were generated and used to calculate 144 estimates of axial stiffness and 144 estimates of torsional rigidity for these constructs. These analyses showed that, in comparison with the intact spine, posterior instrumentation alone was an average of 76% less stiff axially, posterior instrumentation with an anterior strut was 3% more stiff (not significantly different from intact), and anterior instrumentation with an anterior strut was 15% more stiff. Posterior instrumentation alone was an average of 30% less rigid in torsion, posterior instrumentation with an anterior strut was 26% less rigid, and anterior instrumentation with an anterior strut was 24% less rigid than the intact spine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Clinical impact of picture archiving and communication systems: evaluation of a prototype system.

Opinion surveys were gathered before and 6 months after installation of a prototype picture archiving and communication system (PACS) (PACS/1, Siemens Medical Systems, Iselin, NJ). Median turnaround times and the percent of delayed or missing reports were calculated for 1,026 baseline and 8,438 follow-up studies at 6 months. Neuroradiological (neuro) computed tomography (CT) used PACS, while neuro magnetic resonance (MR), body CT, and body MR served as controls. The opinion surveys showed improved service in all categories, including those not directly affected by PACS. PACS images favorably impressed 86% of respondents, but most considered the system too slow, unreliable, and the storage capacity too low. A majority of 81% recommended against purchase of PACS now. There was an overall increase in the median report turnaround time for both neuro CT and the controls. Neuro CT showed a 41% decrease in delayed or missing reports, but controls also showed similar decreases. The effects of this prototype PACS on turnaround time or on report delivery could not be distinguished from section-wide changes in CT and MR services. Future improvements in PACS should vigorously address increased speed, reliability, and storage capacity.

Attitude of Health Personnel↗
PubMed1992

Reproducibility of trunk isoinertial dynamic performance in patients with low back pain.

The purpose of this study was to assess consistency of response in repeated measurements of isoinertial trunk performance among patients with low back pain. An underlying assumption was that inconsistency can detect lack of effort. Ninety-two patients, 53 men and 39 women, were evaluated using a multiaxis isoinertial dynamometer. The patients were asked to perform with maximum effort against 25 and 50% maximum isometric torque in each plane of motion. Torque, velocity, and range of motion were measured in repeated trials. Correlations between first and second trials were extremely high in all cases even through the range of performance was diverse. Percentage differences between first and second trials were found to be approximately normally (Gaussian) distributed. On the basis of normality, we calculated limits for the percentage difference between first and second trials, within which patients with low back pain would be expected to fall 95% of the time. These limits, presented separately for men and women, are given for each combination of measurements of torque, velocity, and range of motion; plane of motion; and two levels of resistance. Resistance was measured at 25 and 50% of maximum isometric. The limits may be used as guidelines to assess maximum performance for patients with low back pain.

Back Pain↗
PubMed1992

Increased incidence of syphilis in Tennessee during the 1980s: challenges for a new decade.

Although recent increases in the incidence of syphilis are well known to public health officials, the general medical community is less well informed regarding the dramatic rise in cases. We present trend data from Nashville and Tennessee over the past decade. These statistics emphasize specific factors, such as drug abuse, that contribute to new difficulties in controlling this sexually transmitted disease.

Contact Tracing↗
PubMed1992

Transforming growth factor-beta and transforming growth factor beta-receptor expression in human meningioma cells.

The transforming growth factor-beta (TGF beta) family in mammals includes three closely related peptides that influence proliferation and numerous physiologic processes in most mesenchymal cells. In this study, Northern blots, immunohistochemistry, TGF beta radioreceptor assays, TGF beta receptor affinity labeling and [3H] thymidine incorporation were used to evaluate whether primary cell cultures of human meningiomas synthesize the three TGF beta isoforms, bear TGF beta receptors, and respond to TGF beta. Transcripts for TGF beta 1 and 2 were detected in the three cases analyzed. Transforming growth factor-beta 1 immunoreactivity was detected in three of six cases, and TGF beta 2 and 3 immunoreactivity were detected in each case analyzed. Media conditioned by cells cultured from six meningiomas also contained latent TGF beta-like activity. Transforming growth factor-beta receptor cross-linking studies identified TGF beta binding sites corresponding to the type 1, type 2, and type 3 receptors on meningioma cells. Treatment with active TGF beta 1 produced a statistically significant reduction in [3H] thymidine incorporation after stimulation with 10% fetal calf serum and epidermal growth factor in all six cases studied.

Blotting, Northern↗
PubMed1989

Expenditures for nonspecific back injuries in the workplace.

This study reports results based on the 29,421 Tennessee Workers' Compensation claims that were closed in 1986. The study encompasses over $160 million in paid claims. Nearly 8000 cases (27%) involved back injuries, of which more than 90% were nonspecific. Forty percent of the total expenditures were for these nonspecific back injuries. Counterpart data on 8696 injuries involving extremities are included for comparison. Medical expenses account for about 40% of all payments. Data concerning time intervals between injury and return to work are provided. Separate analyses reveal characteristics of those subjects in the highest total expenditure decile, the 2941 subjects who received 57% of total dollar payments. This report provides fiscal data supporting recent appeals for a reappraisal of the clinical management of nonspecific back problems.

Back Injuries↗
PubMed1989

Experience of a Medicaid nursing home entry cohort.

Long-term care cost-containment policies have focused on reducing the numbers of persons entering nursing homes. To provide insight and background for such efforts, the authors studied the experience of Medicaid nursing home entry cohorts in three individual States. They found substantial interstate variation in rates of nursing home entry and subsequent patterns of discharge, suggesting the operation of fundamentally different policies for provision of Medicaid nursing home services. Analysis of the cost effectiveness and quality of care implications of these policies may provide guidance for future cost-containment efforts.

Aged↗
PubMed1989

Mast cell and lymphoreticular infiltrates in neurofibromas. Comparison with nerve sheath tumors.

Cellular heterogeneity produced by non-Schwannian elements may distinguish neurofibromas from other Schwann cell neoplasma and contribute to a different tumor biology. The present study compared cell counts of mast cells, T and B lymphocytes, and macrophages in 32 neurofibromas with those in 27 schwannomas, 9 malignant nerve sheath tumors, and 17 traumatic neuromas. Immunohistochemical and histochemical analyses were performed on formalin-fixed, paraffin-embedded tissues using two monoclonal antibodies against B-lymphocyte epitopes (LN-1 and LN-2), one monoclonal antibody against T-lymphocyte epitopes (UCHL-1), one polyclonal antibody recognizing alpha 1-antichymotrypsin (ACT), a macrophage/histiocytemarker, and toluidine blue O stains. Neurofibromas contained relatively high concentrations of mast cells significantly greater than the concentrations in other neoplastic or reactive nerve sheath tumors. Most neurofibromas also displayed moderate concentrations of LN-2 immunoreactive cells, similar to the concentrations in traumatic neuromas and not statistically different from cell counts in other tumor types. Limited, variable LN-1 and UCHL-1 immunoreactive infiltrates were detected in neurofibromas and some peripheral schwannomas. Rare or moderate ACT immunoreactivity was detected in the majority of neurofibromas, in contrast with the absence, or rare appearance, of ACT immunostaining in cranial and peripheral nerve schwannomas and moderate numbers of immunoreactive cells in many malignant nerve sheath tumors. Mast cells are an important cellular marker of neurofibromas and may participate in the pathogenesis of these neoplasms.

Antibodies, Monoclonal↗
PubMed1988

Sensitivity, specificity, and predictive value of body surface cultures in a neonatal intensive care unit.

We analyzed 24,584 cultures obtained from 3371 infants during a three-year period to determine how frequently body surface culture isolates matched those obtained subsequently from body fluids. The sensitivity, specificity, and predictive values of surface cultures were calculated daily for the two weeks up to and including the day that a body fluid culture was obtained. Isolates from cultures of material from the ear canal, nasopharynx, axilla, umbilicus, groin, rectum, stomach, and endotracheal tube were rarely the same as those recovered from blood or fluids of the cerebrospinal, joint, pleural, pericardial, and peritoneal spaces. With a frequency of sepsis of 3.3% among patients in our neonatal intensive care unit, the optimum sensitivity, specificity, and positive predictive values of surface cultures were 56%, 82%, and 7.5%, respectively. These values did not improve substantially for any specific times of surface cultures prior to sepsis, for anatomic sites cultured, or for pathogens recovered. We conclude that surface cultures are of limited value in predicting the etiology of sepsis in neonates.

Algorithms↗
PubMed1987

Evaluation of the Coulter S-Plus IV three-part differential as a screening tool in a tertiary care hospital.

The Coulter S-Plus IV separates leukocytes in peripheral blood by volume analysis into granulocytes, lymphocytes, and mononuclear cell fractions, the so-called three-part differential (3PD). White blood cell (WBC) counts, hemoglobin concentrations, platelet counts, 3PDs, and histograms were compared with smear differentials on 3,861 samples, including samples from oncology patients, to determine the predictive value of the Coulter parameters in detecting smear abnormalities. Results showed good correlation between the 3PD and smear differential for granulocytes and lymphocytes (correlation coefficients were 0.883 and 0.868, respectively) and poor correlation for mononuclear cells (0.492). No histogram region flag indicators were observed in the following samples: 15 of 40 samples with greater than or 1% blasts; 105 of 183 with greater than or 1 nucleated red blood cell (NRBC) per 100 WBCs; 65 of 113 with monocytosis greater than 1,600/microL (1.6 X 10(9)/L); 425 of 548 with greater than 2,000 bands/microL (2.0 X 10(9)/L); 84 of 112 with eosinophilia greater than 600/microL (0.6 X 10(9)L); and 88 of 149 with greater than 2% immature granulocytes. All samples with greater than 5% blasts were indicated by region flags and abnormal histograms. Oncology patient data were analyzed, yielding similar results. The authors established guidelines for using the Coulter 3PD data in their tertiary care laboratory to select samples that require smear evaluation.

Calibration↗
PubMed1987

Interstate variation in elderly Medicaid nursing home populations. Comparisons of resident characteristics and medical care utilization.

Nursing home care in the United States is financed primarily through the federal-state Medicaid program. Because Medicaid nursing home programs are administered within the individual states, there may be interstate differences in the characteristics of Medicaid nursing home residents and their utilization of medical care. We used Medicaid claims and enrollment data for calendar 1981 from three large states--Michigan, California, and New York--to study this question. We found that the populations of elderly Medicaid nursing home residents in each of the three states had similar characteristics. In contrast to the homogeneity of resident characteristics, there were pronounced interstate differences in the use of medical care, particularly for the relation between nursing homes and hospitals. California was characterized by frequent turnover among elderly Medicaid nursing home residents and a high rate of transfers to and from hospitals. One third of residents entered the nursing home in the study year, 43% of enterers came from the hospital, and 51% of enterers were discharged within 180 days of admission, usually to the community. In New York, both turnover among elderly Medicaid nursing home residents and interinstitutional transfers were less frequent. However, those residents entering from the hospital had an average pre-entry hospital stay of 60 days, three to five times that of the other two states. Medicaid payments per day of nursing home care totaled +60 per day, twice those in the other two states. Michigan was characterized by patterns of medical care utilization intermediate between these two extremes. These findings suggest caution in the interpretation of single-state studies of nursing home residents, particularly for those of the dynamic relation between nursing homes and hospitals. They also suggest that further study of the experience of the individual states could provide valuable insights into the effects of different levels of nursing home reimbursement and different policies for transfers between nursing homes and hospitals.

Aged↗
PubMed1987

Reducing antipsychotic drug prescribing for nursing home patients: a controlled trial of the effect of an educational visit.

We conducted a statewide, controlled trial of the efficacy of an educational visit in reducing antipsychotic drug prescribing for nursing home patients. Frequent antipsychotic drug prescribers were visited by a trained physician counselor who stressed known drug risks for elderly patients and suggested techniques for reducing antipsychotic drug use. Although well-received, the visit did not reduce antipsychotic drug prescribing. This negative finding suggests that future interventions address factors within the nursing home which encourage antipsychotic drug use.

Aged↗
PubMed1987

Impact of growing numbers of the very old on Medicaid expenditures for nursing homes: a multi-state, population-based analysis.

We utilized Medicaid data from five states which account for 39 per cent of Medicaid expenditures to study the impact of the near-trebling of persons age 85 and older (the very old) projected to occur by the year 2012 upon Medicaid nursing home expenditures. We found a one-year prevalence of Medicaid-covered nursing home residence of 20 per 100 among the very old. If this rate continues, with no changes in current levels of Medicaid nursing home payments, and if population forecasts are accurate, increasing numbers of the very old will generate an additional +6.3 billion (1982 dollars) annually of Medicaid nursing home payments by 2012: an increase of 280 per cent from 1982 levels. The stress this trend will place upon societal ability to check growth in public expenditures for medical care while maintaining basic services for other low income populations will be an important force shaping public health policy in the next 25 years.

Aged↗
PubMed1987

A comparison of Levin and sump nasogastric tubes for postoperative gastrointestinal decompression.

Prospective analysis of the relative postoperative efficacy of Levin and sump nasogastric tubes was performed. One hundred cases using each tube were randomly selected. Operations in the two groups were similar. Mean output per hour from the tubes was close: 25.29 cc from Levin, and 26.56 cc from sump tubes. Analysis of variance showed no significant difference. There was a difference (P = .05 level) in hourly drainage from women patients, 20.49 cc from Levin, and 25.14 cc from sump tubes. There were no major complications attributable to the tubes. Output from tubes was usually low in early postoperative hours, rising steadily for the first 3 days. Drainage per nursing shift decreased throughout the day. Fever is associated with nasogastric tube use. In the absence of other etiology, a diagnosis of "tube fever" can be made. There is no difference in the clinical efficacy of Levin and sump tubes. There is no scientific basis for the prevalent use of sump tubes.

Abdomen↗