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Biomedical subjects

J L Melvin

Publications and source records attributed to J L Melvin.

At least 19 recordsLinked to original sources
PubMed1999

Impact of Health Care Financing Administration changes on stroke rehabilitation.

This article reviews the early influences of Medicare on the delivery of rehabilitation services, and discusses the changes in payment for hospital-based rehabilitation in the 1997 Balanced Budget Act. Among these changes is a prospective payment system for rehabilitation hospitals and units. This article also addresses Health Care Financing Administration's efforts to comply with this portion of the Act. Finally, some of the impacts that might result from these payment policies are discussed.

Aged↗
PubMed1996

Physical medicine and rehabilitation workforce study: the supply of and demand for physiatrists.

OBJECTIVE: Analysis, results, and implications of a supply and demand workforce model for physical medicine and rehabilitation. Explicit issues addressed include: (1) the supply implications of maintaining current (1994-1995) output of physiatrists from residency programs; (2) the implications of continued growth in managed care on the demand for the services of physiatrists; (3) likely future supply and demand conditions; and (4) strategies to adapt to future conditions. DESIGN: A workforce model of the supply and demand for physiatrists was developed. Parameters of the model are estimated using econometric models and by applying the judgments of a consensus panel. The model evaluated several different scenarios regarding managed care growth, competition from other providers and other factors. RESULTS: Based on the analysis, physiatrists will continue to be in excess demand through the year 2000. More aggressive growth in managed care can affect this result. CONCLUSIONS: Based on an overall assessment of supply and demand conditions, and under the assumption that the supply of new entrants each year remains in the range of 1994-1995 levels, demand for physiatrists will continue to exceed supply, on average, through the year 2000. Excess supply has, and will, emerge in selected geographic areas. If the profession is successful in informing the market regarding the advantages of physiatry, the profession can continue to grow without experiencing excess supply, in the aggregate, for the foreseeable future.

Forecasting↗
PubMed1995

Orthotic treatment of the hand. What's new?

Keeping abreast of the latest orthotic products is challenging. Commercial orthoses need to be critically evaluated for their applicability to the person with rheumatic disease. Custom-made orthoses play an invaluable role in achieving a wide range of therapeutic goals: improving function and pinch, stabilizing individual joints, preventing positional contractures, protecting joints from trauma, stretching the intrinsic muscles, correcting joint- and soft-tissue contractures, and controlling inflammation.

Arthritis↗
PubMed1993

Medical economics of PM&R. V. Surviving the complexities of academic medical centers.

The mission statements of academic medical centers call on them to accomplish many goals. This often leads to conflicting choices when selecting activities and establishing policies. When individual faculty members are expected to divide work time to meet research, teaching and clinical needs, careful planning and disciplined decisions of action are necessary to avoid a sense of ambiguity and frustration.

Academic Medical Centers↗
PubMed1993

Specificity of ICD-9-CM coding practices for stroke rehabilitation.

Designed for acute care classification, the 9th version of the International Classification of Disease, Clinical Modification (ICD-9-CM) is also used to describe the principal diagnosis in medical rehabilitation. ICD-9-CM (ICD-9) coding practices for all stroke cases found in two nationally representative databases were examined (sample sizes over 17,000 and over 2,000). Of the more than 100 codes selected, four were indicated for 67% and 72% of stroke cases in the two data sets, respectively. Codes 436 and 438 distinguish acute from late stroke effects; whereas code 434.9 identifies stroke, but not its duration. The most frequently used code in the larger database, 342.9, refers to the manifestation of hemiplegia rather than to diagnosis, and thus is not specific to stroke. Other less frequently selected ICD-9 codes are more specific to the underlying pathophysiology (e.g., thrombosis, embolus or hemorrhage). Results emphasize the need for more precise selection of etiologic ICD-9 codes for stroke rehabilitation so that they describe specific pathology.

Cerebrovascular Disorders↗
PubMed1989

Habituation of optically evoked blink reflex in mentally retarded adults.

This study was done to record the difference in habituation patterns of optically evoked blink reflexes in mentally retarded and normal adults. Sets of photic stimuli with fixed interstimulus duration were utilized in normal volunteers and mentally retarded adults. The interstimulus duration decreased with each sequential set. The blink responses were recorded on fibreoptic recording paper. These electrophysiological methods show objectively that the blink responses to light which habituate in normal adults fail to do so in those who are mentally retarded.

Adult↗
PubMed1988

Abdominal distention as an indication of post-polio ventilatory insufficiency. Clinical note.

Post-polio patients may experience episodes of recurrent respiratory insufficiency even after years of relatively stable pulmonary function. This patient's case was clearly documented with pulse oxymetry at night. Her major complaint, that of abdominal distension, was successfully addressed with the use of negative pressure ventilation. The likely cause of the abdominal distension was the excessive swallowing of air during episodes of ventilatory insufficiency. The goal of care for this patient was a safer, less stressful, more comfortable and restful nighttime routine with less daytime fatigue. The symptom of abdominal distention served as an indicator of a significant threat to her well being. Psychological support was a key element in her acceptance of the use of the ventilatory support equipment.

Abdomen↗
PubMed1988

Anorectal injuries incident to enema administration. A recurring avoidable problem.

Injuries to the anorectum have been described as having resulted from therapeutic enema use. We report three cases occurring in patients with premorbid perianal pathology. All extended hospitalization although each was managed nonoperatively. These accidents can be prevented by pre-enema rectal examination and attention to perianal anatomy and patient complaints of discomfort during the procedure.

Adult↗