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Biomedical subjects

M Jones

Publications and source records attributed to M Jones.

At least 991 records · Page 55Linked to original sources
PubMedDate not supplied

A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma.

BACKGROUND: Despite improved understanding of the pathophysiology of asthma, morbidity and mortality continue to rise, with disproportionate increases occurring among urban, indigent minorities. New approaches in the management of asthma are therefore necessary to reverse these dramatic and costly trends. OBJECTIVE: To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care. METHODS: Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in the primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient educational program (IEP) or routine care (control group). Patients in the IEP received asthma education, bedside spirometry, a telephone call 24 hours after discharge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine management group received conventional inpatient asthma care and routine follow-up. RESULTS: The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments (60% vs. 27%; P = .01) and significantly fewer emergency department visits (P = .04) and hospitalizations (P = .04) for asthma in the 6 months following IEP intervention, as compared with control patients. This represented a substantial cost savings to the managed care organization. CONCLUSION: Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.

Acute Disease↗
PubMedDate not supplied

Factors affecting remission and survival in patients with advanced Hodgkin's disease treated with MVPP.

One hundred and fourteen patients with clinical or pathological stages IIIB and IV Hodgkin's disease have been treated with MVPP chemotherapy followed by radiotherapy to sites of previously bulky disease. The minimum follow-up is 2 years with a median of 5 years. The overall remission rate was 92 per cent with 74 per cent achieving CR. A discriminant analysis showed that the presence of bulky disease was the only independent factor that predicted a lower chance of CR (66 per cent vs 82 per cent, P = 0.045). The 5-year survival was 70 per cent overall and 85 per cent for CR patients. A Cox multivariate analysis demonstrated that stage III disease, age less than 36 years and female sex were all variables which independently predicted a more favourable prognosis in terms of overall survival. However, a similar analysis for survival of CR patients showed that age less than 36 years and the absence of bulky disease were the only two factors to independently predict a more favourable outcome. Of 14 patients who did not receive the chemotherapy according to protocol 5 have relapsed compared to 7 of 70 who did. A Cox analysis confirmed that this variable was the only one of significant prognostic import in predicting relapse-free survival. Using the Cox analyses we have been able to devise a scoring system which accurately predicts the outcome for these patients. This model may be useful in determining which patients have a worse prognosis following treatment with MVPP thus allowing more intensive therapy to be given to such patients while minimising treatment for those with favourable features.

Adolescent↗
PubMedDate not supplied

Medicaid and non-Medicaid prenatal care by nurse-midwives. Comparison of risk, time, care coordination, and reimbursement.

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance payment (HRPI) on use of provider time, care coordination activities, and financial reimbursement. Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care providers in giving antepartum, intrapartum, and postpartum care was highest for the HRPI women. However, the two medical assistance groups started prenatal care significantly later and had fewer visits, and one-third did not return for their 6-weeks postpartum visit. The HRPI group also had a higher cesarean birth rate. Rates of care coordination activities such as calls, referrals, and consultations were significantly higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximately 73% of the total amount billed was collected compared with approximately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.

Adolescent↗