OBJECTIVE: To determine whether transferring the care of patients to another senior resident the day after admission to the hospital adversely affects the efficiency and quality of care. DESIGN: Retrospective analysis of a natural experiment. SETTING: The general medical service of the Minneapolis Veterans Affairs Medical Center, a major tertiary teaching hospital of the University of Minnesota internal medicine residency program. PATIENTS/PARTICIPANTS: Subjects were all the patients admitted to the medicine service from 5:00 PM to 6:00 AM over an eight-month period. INTERVENTION: After 5:00 PM, half of the patients were admitted to the hospital by a cross-covering senior resident (CC group of patients), and their care was transferred to a different senior resident the following day. The other patients were initially evaluated by the primary senior resident (PE group of patients). Assignment to the different services was a random, sequential process. MEASUREMENTS AND MAIN RESULTS: The CC group had significantly more laboratory tests performed during their hospital stay than did the PE group of patients (44 vs. 32, p = 0.01), even when adjusted for length of stay. Using multiple linear regression to adjust for other clinical parameters including length of stay, DRG weight, and number of consults, the authors found that being a CC subject was a significant predictor of the number of laboratory tests obtained (p = 0.01). Furthermore, the median length of stay in the CC group (n = 74) was longer than that in the PE group (n = 72) (eight days vs. six days); this was of borderline statistical significance, using a two-sample median test (p = 0.06). CONCLUSION: Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays.

Chi-Square Distribution↗

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Changes in ribonuclease with age in the fungus Rhizoctonia solani.

The enzyme ribonuclease (RNase) which was isolated from Rhizoctonia solani Kuehn degraded ribonucleic acid from both Torula yeast and from Rhizoctonia solani mycelia. As the Rhizoctonia mycelia aged, there was an increase in both the total and the specific activities of the RNase present in the mycelia. This change is discussed in relation to the age dependent decrease in protein synthesis in this fungus.

Cryptococcus↗

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Electromyographic latency changes in the ankle musculature during inversion moments.

Ten uninjured subjects (ages 18 to 30 years) had electromyographic testing of the peroneus longus, peroneus brevis, and tibialis anterior muscles in response to inversion moments at two speeds (50 and 200 deg/sec) and two joint angles (neutral and 20 degrees of plantar flexion) using a hydraulically controlled tilt platform. Subjects underwent 10 trials of each type of inversion moment on Day 1 testing, which included both legs. On Day 2, subjects again underwent 10 trials of each type of inversion moment, but only on one leg. Reliability was assessed by comparing left and right leg data within muscle groups for Day 1 testing. Repeatability was assessed by comparing Day 1 with Day 2 data. The latency measurements (the time between the beginning of the inversion moment and the onset of first motor response) for the peroneus brevis and tibialis anterior muscles were found to be reliable and repeatable with no significant differences between the same muscle groups. The peroneus longus muscle had a significant difference between legs but was found to be highly repeatable. Speed of inversion moment and plantar flexion angle both caused significant changes in latency response of the peroneus muscles, with increased speed producing a shorter latency response and increased angle causing a longer latency response. Our results indicate a loss of protective reflexes with increasing plantar flexion.

Adolescent↗

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