PURPOSE: The purpose of this study is to examine two different dimensions of an outpatient pediatric tonsillectomy and adenoidectomy (T&A) clinical pathway at a tertiary care children's hospital. First, the analysis investigates whether the T&A clinical pathway effectively aids in the decision to discharge a pediatric patient as a day surgery (DS) (less than 12 hours) rather than as an outpatient observation surgery (OPO) (12 to 23 hours). Second, the pathway's impact on quality and financial outcomes is explored. PATIENTS AND METHODS: Forty prepathway pediatric T&A patients were randomly selected and matched to 40 pathway pediatric T&A patients by age, gender, medical history, and surgeon to form a retrospective cohort. Using chi-square and analysis of variance, the two groups were compared by type of discharge (DS or OPO), length of stay, readmission rates, and costs. RESULTS: The results show that patients on a pathway were more likely to be discharged as a DS. The shift toward DS discharges effected significant reduction in average length of stay and overall direct costs. Furthermore, there was no difference in readmission rates. CONCLUSION: These results indicate that the development and implementation of a pathway is an effective method in reducing length of stay and overall direct costs while maintaining quality outcomes.

Adenoidectomy↗

PubMedDate not supplied

The avrRpm1 gene of Pseudomonas syringae pv. maculicola is required for virulence on Arabidopsis.

We demonstrate that the avirulence gene avrRpm1, isolated from Pseudomonas syringae pv. maculicola strain Psm M2 via interaction with the Arabidopsis resistance gene RPM1, is also required for maximal virulence on this host. Two avrRpm1::Tn3-Spice marker-exchange mutants do not elicit a hypersensitive reaction on RPM1-containing Arabidopsis accessions Col-0 and Oy-0. Surprisingly, these mutants neither generate disease symptoms, nor grow in planta, after inoculation onto susceptible accessions Nd-0, Fe-1, and Mt-0. These deficiencies can be corrected in a merodiploid containing a wild-type avrRpm1 allele, and are not observed following gene-replacement with avrRpm1::Tn3-Spice alleles containing insertions just beyond the 3' terminus of the avirulence gene open reading frame. AvrRpm1 mRNA is expressed in low, but detectable amounts, in rich media. Induced accumulation of transcript is observed 3 h after shift to minimal media, and an avrRpm1::Tn3-Spice marker-exchanged reporter gene reaches maximal induction 30 min after shift. AvrRpm1 transcription starts 5 base-pairs 3' of the putative regulatory "hrp-box" cis-element found upstream of many P. syringae avr and hrp genes. Transcriptional induction of the marker-exchanged reporter gene in minimal media is enhanced by a carbon source. Induction in planta is the same in either resistant or susceptible Arabidopsis accessions, and is unaffected by the presence or absence of wild-type avrRpm1. As previously observed for many other P. syringae avr genes, transcriptional regulation of avrRpm1 in minimal media is dependent on hrpL and hrpS.

Arabidopsis↗

PubMedDate not supplied

Experimental drug-induced changes in renal function and biodistribution of 99mTc-MDP.

Increased renal uptake of 99mTc methylene diphosphonate (MDP) was observed irregularly in rats after methotrexate, vincristine or gentamicin, administered separately. Cisplatin regularly induced a dose-related increased MDP uptake which correlated with the degree of tubular damage histologically. The augmented MDP renal uptake was not consistently accompanied by a decreased clearance of simultaneously injected I-131 Hippuran, particularly at lower drug dose levels. This observation agreed with previous evidence that the mechanisms of tubular transport of diphosphonates and organic acids like Hippuran are different. At higher dose levels, the augmented MDP uptake was accompanied by increased renal calcium, hypophosphatemia, elevated serum urea nitrogen and creatinine, and only occasional, mild hypercalcemia. The magnitude of the increased renal uptake of MDP observed could not be explained by alterations in iron metabolism or by dehydration. Drug-induced renal retention of MDP by a factor of 2 or more above normal appears to be a useful indicator of tubular damage when other parameters of renal function are sometimes normal.

Animals↗

PubMedDate not supplied

Comparison of 99mTc phosphate and diphosphonate complexes in experimental renal infarcts.

The 3-hour biodistribution of 99mTc complexes of five diphosphonates (HMDP, NMMDP, DMAD, DPD, and APD), imidodiphosphonate (IDP), and pyrophosphate (PYP) was compared in rats with segmental renal infarction induced by a 1-hour occlusion of a renal artery branch. 95mTc labeled MDP was a reference substance in all animals. Three agents (APD, HMDP and IDP) had a higher infarct/normal kidney concentration ratio than MDP, the latter two by virtue of a lower content in normal kidney. HMDP, DPD, and IDP had very high liver concentrations. DPD showed relatively high concentrations in soft tissues and blood. The blood and kidney levels of PYP were higher than those of MDP but the infarct/normal kidney ratios were similar. None of the agents had a higher uptake in bone than MDP: four had a significantly lower uptake. The increased concentration of 99mTc MDP in the infarcts was readily seen in camera images one day after renal artery occlusion, but not at three or seven days. Increased diphosphonate uptake was accompanied by an influx of calcium in both cortex and medulla. The accumulation of diphosphonate in areas of infarction was not modified by infusions of verapamil or Captopril.

Animals↗

PubMedDate not supplied

The epidemiology of alcohol and drug abuse among adolescents.

The primary purpose of this paper was to review systematically some of the more salient findings from a decade of research on the epidemiology of alcohol and drug abuse among adolescents. Data from most of the on-going nationwide studies regarding lifetime, past year, and past month use of various drugs were examined. While there is evidence of a downturn for some of the indicators, it is still too early to know if this is a temporary shift in rates or the beginning of meaningful trends toward lower levels of drug use. The second purpose was to challenge the alcohol and drug fields to consider more seriously the problem of multiple drug use and abuse. This was accomplished by showing that the relative percentage of youth who have used "only marijuana" has gone down as the percentage of youth who have used marijuana, other illicit drugs, and cigarettes and alcohol as well, has increased. Regression and discriminant analyses of data from the 1980 Monitoring the Future study of high school seniors reveals that variables that previously have differentiated users from nonusers are also useful in differentiating types of multiple drug users. The most important conclusion from this paper is that persons characterized as "daily" users of marijuana are better typed as multiple drug users.

Adolescent↗

PubMedDate not supplied

[Influence of non-diabetic pregnancy on fructosamine and HbA1c concentration].

HbAIc and fructosamine concentrations were measured in the course of 177 nondiabetic pregnancies and compared with the corresponding values of 24 nondiabetic nonpregnant women. In all three trimesters HbAIc and fructosamine were significantly lower than the corresponding values in the nonpregnant women; HbAIc: 1st trimester 4.77 +/- 0.62%, 2nd trimester 4.38 +/- 0.59%, 3rd trimester 4.33 +/- 0.49%, p < 0.01; fructosamine 1st trimester 2.13 +/- 0.17 mmol/l, 2nd trimester 2.02 +/- 0.15 mmol/l, 3rd trimester 1.90 +/- 0.15 mmol/l, p < 0.01; nonpregnant women: HbAIc 5.13 +/- 0.41%, fructosamine 2.53 +/- 0.17 mmol/l. However, if the fructosamine is correlated to the respective total protein concentration a constant value results for the course of pregnancy. The changes in the HbAIc and fructosamine concentrations in pregnancy should be taken into account when treating pregnant diabetics.

Adult↗