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Biomedical subjects

M J Strauss

Publications and source records attributed to M J Strauss.

27 records · Page 2Linked to original sources
PubMed1986

Rationing of intensive care unit services. An everyday occurrence.

We investigated the extent to which bed availability affects decision making in an intensive care unit (ICU). For 1,151 ICU patients, we determined the number of empty ICU beds available at times of admission and discharge and the outcome for those patients. For a randomly chosen group we assessed severity of illness. Patients admitted during times of bed shortage were, on average, more severely ill than those admitted when many beds were unoccupied. Patients discharged under crowded conditions were sicker and had a shorter stay than patients discharged when more beds were available. The relative risk of discharge was inversely related to empty bed availability, illness severity, and age. Bed availability had no effect on rates of death in the ICU, death after discharge, or readmission to the ICU. We conclude that physicians can effectively ration intensive care beds on a regular basis by altering admission and discharge decision making.

Bed Occupancy↗
PubMed1986

Cost and outcome of care for patients with chronic obstructive lung disease. Analysis by physician specialty.

We studied the effect of physician specialization and board certification on costs and outcome of health care for a group of 213 patients with chronic lung disease followed prospectively for a year. Linear, semilogarithmic, and logistic regressions were used to control for differences in pulmonary function, functional ability, and sociodemographic characteristics. The cost of health services during the year was estimated from the total charges incurred. Patient's pulmonary function, functional ability, number of medical conditions, and insurance status were significant predictors of total cost. Combinations of these variables were important determinants of institutional days, outcome health status, and survival. Physician specialization and board certification were not significant descriptors of total costs or outcomes, although large variances limited the power of these findings. We conclude that differences in characteristics of primary care physicians do not appear to affect significantly the total cost or outcome of care for patients with moderate to severe chronic lung disease.

Aged↗
PubMed1978

3-Benzazocine amidinium nitronates. An unusual type of opiate antagonist.

An interesting type of 3-benzazocine ring system which contains amidine functionality has been found to have significant narcotic antagonist activity. The isomeric 2-benzazocine, which incorporates similar structural features, except for the position of the ring nitrogen and adjacent phenyl substituent, is inactive. These 2- and 3-benzazocines can be synthesized in a single step from appropriately structured amidines and naphthalenes, and such syntheses may provide useful routes to new and interesting types of narcotic antagonists.

Amidines↗
PubMedDate not supplied

Pressure ulcer status and post-discharge health care resource utilization among older adults with activity limitations.

In a prospective cohort study, we evaluated post-discharge health care utilization for patients 65 years of age or older whose activity was limited to bed or chair at the time of hospital admission. Post-discharge health care utilization was compared for those who did and those who did not develop a pressure ulcer during the hospital stay. Resource utilization was assessed using Medicare charges and payments reported for 1 year following the date of discharge. Pressure ulcer status during the index hospitalization was determined by study nurses. Sociodemographic data (age, gender, race, marital status) were recorded from the medical record. During the hospital stay, measures of severity of illness, occurrence of infections and other complications, service type (medical or surgical), ICU admission, and major and minor surgery were documented. At the time of discharge, the primary care nurse noted whether the patient was still confined to bed or chair and whether he or she was discharged to a nursing home. The study patients used substantial health care resources in the year following the index hospitalization, with mean Medicare charges and payments of $24,027 and $11,123, respectively. Eleven percent of the patients had developed pressure ulcers during the index hospitalization. These patients incurred Medicare payments during the 12-month post-discharge period that were, on average, $13 higher per day of follow-up than those of patients who had been at risk for, but did not develop, pressure ulcers during the index hospitalization (p = .02). Multivariate analyses suggested that activity limitation to bed or chair is an independent predictor of Medicare payments post-discharge. The in-hospital development of pressure ulcers is associated with higher daily Medicare payments in the year post-discharge, but this association does not remain statistically significant after adjusting for activity level at the time of hospital discharge.

Activities of Daily Living↗