Third-party payers typically use patients' discharge diagnoses to determine "appropriate" Emergency Department (ED) usage. This analysis compared the resource intensity involved in ED evaluation for "inappropriate" and all other ED visits. In this retrospective database review, 11 discharge diagnoses (DX11) (chronic nasopharyngitis; chronic sinusitis; chronic pharyngitis; rhinitis; constipation; head cold; hemorrhoids; toothache; flu; headache; and tension headache) were identified by a third party payor as being "inappropriate" for ED evaluation. The chief complaints of all patients seen in 1994 and 1995 with one of the DX11 were identified along with their E & M billing level, ED length of stay (LOS), and the frequency of consultation. In this urban, university trauma center, 1994 and 1995 visits totaled 120,402. Eighty-two different chief complaints were associated with a final diagnosis of DX11; 79% of all ED patients presented with one of the chief complaints (AllCC). Four percent of patients with DX11 were admitted, and the AllCC group had comparable resource utilization to the entire ED population. Patients' presenting complaints are incapable of predicting diagnosis or disposition. Retrospective denial of payment by discharge diagnosis is inappropriate.

Emergency Service, Hospital↗

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ACE: a peer education and counseling program meets the needs of incarcerated women with HIV/AIDS issues.

In this article, female prisoners who are peer educators and counselors in an HIV/AIDS program at Bedford Hills Correctional Facility, New York State's only maximum security prison for women, describe the positive role of a peer support program. Using examples from their own experiences, the women discuss the strengths of the AIDS Counseling and Education Program (ACE) in meeting the medical and psychosocial needs of the prison population concerning HIV/AIDS. The role of nurses in a correctional setting is discussed throughout the article and a final section discusses how nurses working together with peer health workers can create an effective team to meet the challenges of the AIDS epidemic within a correctional setting.

Acquired Immunodeficiency Syndrome↗

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A model for international research collaboration.

Explore the source record for details and available documents.

Faculty, Nursing↗

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Lung mineral fibers of former miners and millers from Thetford-Mines and asbestos regions: a comparative study of fiber concentration and dimension.

Fiber dimension and concentration may vary substantially between two necropsy populations of former chrysotile miners and millers of Thetford-Mines and Asbestos regions. This possibility could explain, at least in part, the higher incidence of respiratory diseases among workers from Thetford-Mines than among workers from the Asbestos region. The authors used a transmission electron microscope, equipped with an x-ray energy-dispersive spectrometer, to analyze lung mineral fibers of 86 subjects from the two mining regions and to classify fiber sizes into three categories. The most consistent difference was the higher concentration of tremolite in lung tissues of workers from Thetford-Mines, compared with workers from the Asbestos region. Amosite and crocidolite were also detected in lung tissues of several workers from the Asbestos region. No consistent and biologically important difference was found for fiber dimension; therefore, fiber dimension does not seem to be a factor that accounts for the difference in incidence of respiratory diseases between the two groups. The greater incidence of respiratory diseases among workers of Thetford-Mines can be explained by the fact that they had greater exposure to fibers than did workers at the Asbestos region. Among the mineral fibers studied, retention of tremolite fibers was most apparent.

Aged↗

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Childhood lead poisoning: a re-evaluation.

Long recognized as an environmental toxin of fearsome lethality, lead effects are commonly described as extremely serious, particularly as regards the central nervous system. It is postulated here that this represents only part of the pathologic spectrum. Ohter lead-related conditions, as yet unrecognized, may include a wide range of central nervous system dysfunctions that although severe, are not so acutely dramatic or widely destructive as the classic encephalopathic or preencephalopathic states. These conditions remain etiologically unrecognized primarily because of (1) the variable nature of onset, (2) the variable nature of the manifestations, (3) the relative subtlety of the dysfunctions, and most importantly, (4) the absence of consistant, unequivocal evidence demonstrating the relationship of lower blood lead levels with pathologic effects. This last is seen as pivotal, and an extensive examination of the reasons for its absence is presented. It is postulated that biological variability, a concept widely used in medicine but rarely invoked in the researching of lead toxicity, is a crucial ingredient in lead research. It is further asserted that the grevious lack of etiologic recognition will continue until that factor is incorporated into research designs.

Central Nervous System Diseases↗

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The relationship of hyperactivity to moderately elevated lead levels.

Controversy exists with respect to whether moderately elevated lead levels are toxic in certain children with various central nervous system dysfunctions. One way of addressing this controversy is to remove the lead; if the condition is ameliorated a presumption of toxicity becomes reasonable. Such a strategy is reported herein. Children with an operationally defined central nervous system dysfunction (hyperactivity) and moderately elevated lead levels were treated with a lead chelating agent in a random allocation double blind treatment regimen. The finding of statistically significant and obvious behavioral improvement reported by three separate evaluators (i.e., parent, teacher, and treating physician) of the child suggests that the presumption of a toxic relationship between moderately elevated lead levels and hyperactivity is supported.

Analysis of Variance↗

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Chelation therapy in children as treatment of sequelae in severe lead toxicity.

Certain children who experience a toxic lead episode requiring hospitalization in infancy or early childhood will manifest central nervous system dysfunctions, including hyperactivity, as sequelae of this experience. In this study, findings indicate that persistent, higher-than-normal lead levels, dating back to the time of the initial toxicity, may well be a mechanism underlying some of these sequelae. Consequently, some part of these sequelae may be preventable and/or treatable.

Child↗

PubMedDate not supplied

Cimetidine and carbamazepine: a complex drug interaction.

Cimetidine has been shown to inhibit the elimination of carbamazepine after a single oral dose. The mechanism of this interaction is thought to be inhibition of carbamazepine metabolism by the hepatic microsomal enzyme system. Because carbamazepine metabolism undergoes autoinduction with chronic administration, it is not known whether or not the clinical significance of this interaction can be predicted from the results of a single-dose study. The purpose of this study was to evaluate the presence of an interaction under steady-state enzyme-induced conditions. Using an open treatment design, carbamazepine, 300 mg b.i.d., was taken by eight healthy volunteers for 42 days (days 1-42). Cimetidine, 400 mg t.i.d., was taken for 7 days (days 29-35). Steady-state carbamazepine increased 17% after 2 days of cimetidine treatment (from 4.7 +/- 0.8 to 5.5 +/- 1.4 micrograms/ml; p less than 0.05). Six of the eight subjects noted side effects shortly after starting cimetidine treatment. Carbamazepine returned to the pre-cimetidine level and the side effects diminished by the 7th day of cimetidine administration. Therefore, the clinical significance of this interaction appears to be time dependent, and could not be predicted from the results of single-dose studies.

Adult↗

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Clinical assessment of the probability of coronary artery disease: judgmental bias from personal knowledge.

Probability estimates of angiographic coronary artery disease made by experienced, board-certified staff cardiologists were compared with those of cardiologists in training (fellows). In addition, estimates made before coronary angiography were compared with those made several months later based on written clinical summaries of 15 items of objective clinical and test data. Cardiologists were asked to estimate the probabilities of coronary artery disease, multivessel disease, and triple-vessel or left main disease. The study population consisted of 510 consecutive patients without valvular disease referred for the first time for coronary angiography to three hospitals. Both staff and fellows consistently overestimated the pre-angiographic probability of coronary artery disease. The probabilities estimated from patient summaries were always significantly lower than the pre-angiographic assessments. Only staff cardiologists reliably assessed the probabilities of coronary artery disease during the second assessment (p less than 0.05). Thus, estimates of disease probability based on clinical judgment vary according to the source of information, and these estimates are more accurate when physicians have objective data on hand and do not know the identities of the patients.

Coronary Angiography↗

PubMedDate not supplied

Health status in VA patients: results from the Veterans Health Study.

Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring outcomes and measuring the case mix of patients who use the VA. The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF-36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non-VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care.

Adult↗

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Rationale for use of local hyperthermia with radiation therapy and selected anticancer drugs in locally advanced human malignancies.

The addition of local hyperthermia to radiation therapy has significantly improved the ability of oncologists to control superficial malignancies. Large tumours, tumours which cannot be heated adequately, and those situated in areas where surrounding normal tissues have decreased radiation tolerance, however, are difficult to eradicate even with this combination treatment. We believe that properly selected and scheduled anticancer drugs will add substantially to the efficacy of local hyperthermia and radiation. A review of the literature concerning the cytotoxic interactions of various anticancer agents with hyperthermia, with radiation and with relevant physiological parameters is presented. From this review, anticancer drugs which are good candidates for trimodality therapy are identified and a general approach to trimodality scheduling is suggested.

Animals↗