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Biomedical subjects

J J Stoddard

Publications and source records attributed to J J Stoddard.

30 records · Page 2Linked to original sources
PubMed1994

Graduate medical education reform. Service provision transition costs.

OBJECTIVE: To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education. DESIGN: An economic model using two scenarios for substitution of house staff (residents and fellows): (1) a lower-cost model under which nonphysician providers assume many house staff responsibilities, but additional aspects of their workload are taken over by staff physicians, nurses, and ancillary personnel; and (2) a higher-cost traditional model that relies more heavily on staff physicians to replace house officers. SETTING: US teaching hospitals. MAIN OUTCOME MEASURES: Projected net substitution costs of house staff on a per full-time equivalent basis and aggregate national cost estimates of substitution. RESULTS: Net annual house staff substitution costs were estimated to be $58,000 and $77,000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23,200 house staff under a reformed system, total (net) substitution costs to teaching hospitals were estimated at approximately $1.4 billion to $1.8 billion nationally on an annual basis. CONCLUSIONS: Graduate medical education reform, while likely to result in substantial long-term cost savings, will necessitate transitions in service provision that are likely to generate some new costs in the short term.

Economics, Medical↗
PubMed1994

Health insurance status and ambulatory care for children.

BACKGROUND: Many children in the United States lack health insurance. We tested the hypothesis that these children are less likely than children with insurance to visit a physician when they have specific conditions for which care is considered to be indicated. METHODS: We examined the association between whether children were covered by health insurance and whether they received medical attention from a physician for pharyngitis, acute earache, recurrent ear infections, or asthma. Data were obtained on the subsample of 7578 children and adolescents 1 through 17 years of age who were included in the 1987 National Medical Expenditures Survey, a national probability sample of the civilian, noninstitutionalized population. RESULTS: Uninsured children were more likely than children with health insurance to receive no care from a physician for all four conditions (unadjusted odds ratios, 2.38 for pharyngitis; 2.04 for acute earache; 2.84 for recurrent ear infections; and 1.87 for asthma). Multiple logistic-regression analysis was subsequently used to control for age, sex, family size, race or ethnic group, region of the country, place of residence (rural vs. urban), and household income. After adjustment for these factors, uninsured children remained significantly more likely than insured children to go without a visit to a physician for pharyngitis (adjusted odds ratio, 1.72; 95 percent confidence interval, 1.11 to 2.68), acute earache (1.85; 95 percent confidence interval, 1.15 to 2.99), recurrent ear infections (2.12; 95 percent confidence interval, 1.28 to 3.51), and asthma (1.72; 95 percent confidence interval, 1.05 to 2.83). CONCLUSIONS: As compared with children with health insurance, children who lack health insurance are less likely to receive medical care from a physician when it seems reasonably indicated and are therefore at risk for substantial avoidable morbidity.

Adolescent↗
PubMed1994

Prevalence and impact of multiple childhood chronic illnesses.

OBJECTIVE: To determine the prevalence and impact of multiple chronic conditions on children's health status and utilization of health services. DESIGN: Analysis of the 1988 National Health Interview Survey on Child Health. SETTING: Nationally representative sample of the U.S. civilian, noninstitutionalized population. PARTICIPANTS: A total of 17,710 children less than 18 years of age selected in a stratified cluster sampling of U.S. households. INTERVENTION: None. RESULTS: We estimated that fewer than 5% of children have multiple (two or more) chronic conditions and that less than 1% of children had three or more such conditions. However, despite this low overall prevalence, some notable features of multiple chronic conditions stand out. Many of the most prevalent condition-pairs were allergy related, and the rates of co-occurrence of these disorders were generally higher than would be predicted on the basis of prevalence rates for the individual conditions. Children with multiple chronic conditions had more mental and physical health problems and used substantially more health services than other children. For example, the prevalence of developmental delay, learning disabilities, and emotional and behavioral problems increased sharply with the number of chronic conditions reported. Notable deterioration in such health status measures as days in bed, school absences, and activity limitation was also observed with increasing numbers of chronic conditions. Similarly, utilization of hospital and physician services increased in tandem with increasing numbers of chronic conditions. CONCLUSIONS: Children who have multiple conditions of a chronic nature, even if few in number, have increased morbidity across a variety of measures.

Adolescent↗
PubMed1994

Yersinia enterocolitica infection in a patient with sickle cell disease after exposure to chitterlings.

PURPOSE: We describe certain clinical, epidemiologic, and host-susceptibility features of Yersinia enterocolitica infection in the context of a patient with underlying risk factors. PATIENTS AND METHODS: A 10-year-old black girl with sickle cell disease receiving chelation therapy for iron overload resulting from chronic transfusion therapy was admitted with acute abdominal pain and fever. RESULTS: Upon hospital admission, differential diagnoses included enterocolitis, appendicitis, and vasoocclusive crisis. On the 6th hospital day, the patient's stool culture became positive for Y. enterocolitica. Household exposure to raw pork intestines (chitterlings) was the presumed source of the infection. Deferoxamine therapy was withheld, and antibiotic therapy was administered with subsequent clinical improvement. CONCLUSIONS: Y. enterocolitica infection should be considered as a cause of abdominal pain mimicking appendicitis in patients with underlying risk factors (including certain sickle cell patients). History of exposure to raw or undercooked pork products and appropriate cultures should be obtained. Deferoxamine therapy should be withheld in iron-overloaded patients presenting with such symptoms because deferoxamine and iron overload constitute independent risk factors for Yersinia infection. Such patients should be advised to avoid potential exposures to this pathogen.

Anemia, Sickle Cell↗
PubMed1989

Hepatitis B virus transmission between children in day care.

We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected. In the second situation a 4-year-old boy with frequently bleeding eczematous lesions was discovered to be a hepatitis B carrier after having attended a day care center for 17 months. Testing of contacts at the center revealed no transmission to other children or staff (representing 887 person months of exposure). Nationwide surveillance data showed that for the period 1983 to 1987, 161 children 1 to 4 years of age were reported with acute hepatitis B. After children with known hepatitis B risk factors were excluded, 25% (7 of 28) of children with known day care status were reported as day care attendees, a percentage comparable to national estimates of day care attendance by this age group. This is the first reported case of hepatitis B virus transmission between children in day care in the United States. Although it appears that day care transmission of hepatitis B is infrequent, further studies are needed to define the risk more accurately.

Adult↗
PubMed1988

Subjective oscillopsia ("jiggling" vision) presumably due to aminoglycoside ototoxicity. A report of two cases.

Following aminoglycoside antibiotic therapy, two patients developed self-limited subjective oscillopsia in the absence of a detectable ocular motility disturbance (nystagmus or opsoclonus). Oscillopsia represents a rare, but highly distressing symptom resulting from disruption of the vestibulo-ocular reflex, producing profound illusory movement of the visual environment. Although the differential diagnosis includes vascular, inflammatory, and structural disorders impacting on either the central or peripheral projections of this brainstem reflex, iatrogenic aminoglycoside ototoxicity was the likely explanation in the two patients presented. Ways of minimizing the risk of aminoglycoside toxicity are briefly reviewed.

Anti-Bacterial Agents↗
PubMedDate not supplied

Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns.

CONTEXT: Increasingly short postpartum hospital stays in the United States precipitated a policy debate that culminated in passage of the Newborns' and Mothers' Health Protection Act of 1996. The debate occurred without population-based evidence for adverse health effects in newborns who are discharged early. OBJECTIVE: To determine whether early postpartum hospital discharge of normal newborns increases their risk for hospital readmission with feeding-related problems. DESIGN AND SETTING: Nested case-control analysis of 1991 to 1994 Wisconsin birth certificate and hospital discharge data. SUBJECTS: A total of 210 readmitted case patients and 630 control subjects selected from a cohort of 120 290 normal newborns who weighed at least 2500 g, were delivered vaginally of mothers with uncomplicated medical and obstetrical histories, and were discharged from the hospital either early (day of life 1 or 2) or conventionally (day 3). OUTCOME MEASURE: Readmission at age 4 to 28 days with discharge diagnoses indicating a primary feeding problem, secondary dehydration, or inadequate weight gain. RESULTS: Early discharges increased 3-fold (reaching 521/1000 discharges) during the study period, but feeding-related readmissions (1.7/1000) remained stable. Most readmitted newborns (53.8%) were 4 to 7 days old, many (34.3%) had concurrent dehydration and jaundice, and 29% were admitted through emergency departments. Readmitted newborns were significantly (P<.05) more likely to have been breast-fed, firstborn, or preterm or to have mothers who were poorly educated (<12th grade), unmarried, or receiving Medicaid. Readmission was not associated with early discharge (adjusted odds ratio, 1.05; 95% confidence interval, 0.71-1.53). CONCLUSION: Although several neonatal and maternal factors increase the risk that a normal newborn will be rehospitalized with a feeding-related problem, early discharge following an uncomplicated postpartum hospital stay appears to have little or no independent effect on this risk.

Case-Control Studies↗