Search PubMed⌕ Search

Biomedical subjects

F Rosner

Publications and source records attributed to F Rosner.

At least 163 records · Page 9Linked to original sources
PubMed1988

Malaria. A city hospital experience.

We reviewed the charts of 24 patients with malaria seen at the Queens Hospital Center, Jamaica, NY, over the past five years. Twenty-three patients were foreign citizens. Eighteen patients were infected with Plasmodium vivax and six with Plasmodium falciparum. Malaria was suspected on admission in 19 of the 23 hospitalized patients. Five patients were admitted with unrelated diagnoses, and four of these experienced diagnostic delay. All diagnoses were confirmed with thin blood smears. Twenty-one patients were febrile, and 18 patients had prominent gastrointestinal tract symptoms. Serum glucose level was increased in nine patients, and hypoglycemia occurred in one. Four patients also had intestinal parasites. Malaria should be suspected in travelers with gastrointestinal tract symptoms, and patients with malaria may have other parasitic infections. Most patients with P vivax infections can be treated as outpatients, since the course is usually uncomplicated.

Adolescent↗
PubMed1988

Financial risk and hospital cost for elderly patients. Age- and non-age-stratified medical diagnosis related groups.

The purpose of this study was to analyze hospital resource consumption for Medicare patients in non-age- and age-stratified medical diagnosis related groups (DRGs). This study of patients in 74 non-age-stratified DRGs (N = 3643) and 113 age-stratified DRGs (N = 2898) demonstrated that older medical patients (usually greater than or equal to 75 to 80 years of age) had (on average) higher total hospital costs, a longer hospital length of stay, more diagnoses per patient, a greater percentage of outliers, and a higher mortality compared with younger patients in these same DRGs. These findings raise the question of the equity of DRG payment vis-à-vis older Medicare patients in both non-age- and age-stratified medical DRGs. Financial disincentives to treat older medical patients may limit both their access and quality of care in the future.

Aged↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups.

A number of methods are being studied to modify and improve the accuracy of the Medicare Diagnosis-Related Group (DRG) hospital classification system. This study analyzed resource consumption for 2,431 medical Medicare patients in the 53 non-complicating condition-stratified (i.e., non-complication and comorbidity) medical DRGs. Resource consumption per patient increased as the number of complications and comorbidities per patient per DRG increased, as measured by total hospital cost, hospital length of stay, the number of diagnoses and procedures per patient, the percent outliers, and mortality. Patients with more than four complications and comorbidities generated significant financial risk ($5,667 loss per patient) under DRG reimbursement. This study raises the question of the equity of DRG reimbursement for the medical non-complication and comorbidity-stratified DRGs. A method for DRG adjustment based on complications and comorbidities should be implemented by Congress to assure equitable payment for patients in these medical DRGs.

Costs and Cost Analysis↗
PubMed1988

Spectrum of diseases for resident education in internal medicine.

We examined the spectrum of diseases to which medical residents were exposed in a fully integrated residency program comprised of a voluntary and a municipal acute-care hospital. Although circulatory disorders and diseases of the respiratory and nervous systems accounted for the majority of cases, a broad spectrum of diseases was present for residents' training at both institutions. These observations must be considered within the context of the changing nature of medical practice in the United States, with a marked shift from inpatient to outpatient and office medical care.

Cardiovascular Diseases↗
PubMed1988

Hospital costs, cancer patients and medical diagnosis-related groups.

This study analyzed hospital resource consumption for 5,065 Medicare patients in 90 noncancer designated medical diagnosis-related groups (DRGs) by whether or not patients had a diagnosis of a malignancy (i.e. cancer). Patients with cancer had greater hospital resource utilization than noncancer patients in these medical DRGs. Cancer patients had a greater percentage of outliers (p less than 0.02), twice the financial loss under DRGs, more diagnoses (p less than 0.001) and procedures (p less than 0.0001) per patient, and a greater mortality (p less than 0.0001) than noncancer patients. These findings raise the question of the equity of DRG payment vis-à-vis medical cancer patients in many medical DRGs, and whether the DRG scheme may provide disincentives to treat some elderly Americans with cancer.

Costs and Cost Analysis↗
PubMed1987

Pregnancy outcome in cancer patients. Experience in a large cooperative group.

To evaluate the potential teratogenicity and mutagenicity of modern cancer treatment, the authors enumerated from a cooperative clinical trial group 133 pregnancies in 66 women with malignant neoplasms (53% with Hodgkin's disease, 26% with other lymphomas and leukemia, and 21% with solid tumors). The gestations were divided into the following groups: Group 1, 43 pregnancies ending before therapy; Group 2, therapy given at conception or during 32 pregnancies; and Group 3, 58 pregnancies after therapy. Although the total frequencies of abnormalities were similar in Groups 1 and 2 (23% of 35 pregnancies not electively aborted and 28% of 25, respectively), there were slightly more elective abortions and birth defects related to radiation exposure at a susceptible time of gestation in Group 2. Still, there were eight normal infants among the ten fetuses who were liveborn and had first trimester exposure to chemotherapy alone; so, drug therapy early in pregnancy is not inevitably teratogenic. The apparent and surprising excess of abnormal outcomes in Group 3, 40% of 50 pregnancies, was due to low birth weight and premature terminations of pregnancy, rather than an excess of congenital anomalies. The type of unfavorable outcomes in Group 3 and their concentration in the first year posttherapy suggested they could represent defects in factors (e.g., uterine or hormonal) that normally maintain gestations, and not genetic damage to oocytes. Limitations of the data, collected by mail from physicians and their patients, included biases of self-reporting and low statistical power. Prospective study, probably through interinstitutional collaboration, seems necessary, if accurate estimates are to be made of the frequency of certain outcomes, such as spontaneous abortion and minor anomalies.

Adolescent↗
PubMed1987

The ethics of randomized clinical trials.

Randomized clinical trials pose a number of fundamental ethical problems to which morally sensitive investigators must give careful consideration. The randomized double-blind clinical trial is ethically justified and the preferred method of demonstrating therapeutic effectiveness and safety. Alternate methods such as crossover and self-controlled designs, the use of historical controls, observational methods, and practitioner's clinical trials also exist and have their place in certain circumstances. The use of randomized double-blind clinical trials must assure adequate explanation of the research plan to the patient, the documentation of informed consent, adequate consideration of safety, and an acceptably low risk/benefit ratio.

Clinical Trials as Topic↗