OBJECTIVE: To compare health insurance payments and patient outcomes for recurrent episodes of care for nine common lumbar and low-back conditions initiated with chiropractic treatment vs. episodes initiated with medical treatment. DATA AND METHODS: Retrospective analysis of episodes constructed using 208 ICD-9-CM codes from 2 yr of insurance claims data for a large population of beneficiaries in the private fee-for-service sector. A total of 7077 patients were represented within 9314 episodes of care, of which 8018 episodes were initiated by clearly identified chiropractic or medical physicians. There were 1215 patients with initial physician or chiropractic-initiated episodes who had recurrent episodes. Outcome measures included total insurance payments, total outpatient payments, lengths of initial and recurrent episodes, consistent use of initiating providers for recurrent episodes and time lapsed between episodes. RESULTS: Total insurance payments within and across episodes were substantially greater for medically initiated episodes. Analysis of recurrent episodes as measures of patient outcomes indicated that chiropractic providers retain more patients for subsequent episodes, but that there is no significant difference in lapse time between episodes for chiropractic vs. medical providers. Chiropractic and medical patients were comparable on measures of severity; however, the chiropractic cohort included a greater proportion of chronic cases. CONCLUSION: Patients who "cross over" between providers for multiple episodes are more likely to return to chiropractic providers, which suggests that chronic, recurrent low-back cases may gravitate to chiropractic care over time. The findings from this and related studies point out the importance of appropriately operationalizing cost and outcome variables in analyses of care for conditions such as chronic and/or recurrent low-back pain.

Chiropractic↗

PubMed1997

Association between visual reaction time and batting, fielding, and earned run averages among players of the Southern Baseball League.

BACKGROUND: This study was performed to investigate the relationship between vision reaction time (VRT) and batting, fielding, and pitching skill in baseball. METHODS: A vision screening of 213 professional baseball players in the Southern Baseball League was performed, and the visual reaction times of these players were determined. Official Southern Baseball League statistics were consulted to obtain the players' batting average, fielding average, and earned run average. RESULTS: The mean visual reaction time for all players was 239 msec. There was no significant association between mean VRT and age or race. The mean VRT for dominant eyes was not significantly different from the mean VRT for nondominant eyes. For the 92 players who batted at least 100 times, an association was found between mean VRT and batting average (p = 0.017). For the 168 fielders in the league playing at least 20 games, no statistically significant association was found between mean VRT and fielding average. Similarly, no association was found between mean VRT and earned run average for the B8 pitchers who had participated in more than 20 games. CONCLUSIONS: An association was found between visual reaction time and batting skill in baseball. No association was found between visual reaction time and fielding or pitching skill.

Baseball↗

PubMed1997

A new probable increasing cause of esophageal ulceration: alendronate.

We present a case of esophageal ulcerations caused by alendronate (Fosamax), a recently marketed medication. The patient presented with a chief complaint of retrosternal pain and severe odynophagia of 5 days duration. She was taking prednisone 10 mg and azathioprine 100 mg p.o. q.d. for systemic lupus erythematosus. To prevent osteoporosis, she was started on alendronate 10 mg q.d. 2 wk before her symptoms started. Endoscopy of the upper GI tract revealed two deep, large ulcers at the gastroesophageal junction. Multiple biopsy specimens revealed necroinflammatory debris and acute esophagitis. However, no organisms were identified, and the result of her HIV test (ELISA) was negative. Alendronate was discontinued, and her symptoms resolved completely in 1 wk. Follow-up endoscopy performed 4 wk later revealed complete healing of the ulcers.

Adult↗

PubMed1997

Tardive dyskinesia and ethnicity: review of the literature.

Tardive dyskinesia (TD) is a side effect of long-term neuroleptic administration. The wide variation of 2 to 51% in its reported prevalence can be attributed to the varied definitions of TD, the use of different methods of assessment, and the lack of control of independent variables. Why only certain patients develop this side effect is an intriguing question. The occurrence of TD in family members and in those persons with a family history of Parkinson's disease (PD) is suggestive of genetic vulnerability. Further support for a genetic predisposition comes from the fact that only certain strains of monkeys, such as the Cebus apella strain, have a higher propensity to develop TD than others, such as the Macaca sepciosa strain. If genetic factors play a significant role in the development of TD, then, genetically diverse ethnic groups may have a different propensity for the development of TD. One method of evaluating such a possibility is to compare its prevalence in different countries. The current literature on ethnic differences in the prevalence rates of TD is reviewed. This area of study needs further rigorous investigation.

Animals↗

PubMed1997

Induction of phosphorylation on BRCA1 during the cell cycle and after DNA damage.

BRCA1, the familial breast cancer susceptibility gene product, is a 220-kDA phosphorylated protein. BRCA1 immunoprecipitated from MCF7 cells blocked in G1-S phase or progressing through S-phase of the cell cycle migrated more slowly through SDS polyacrylamide gels than BRCA1 from cells maintained in serum-supplemented media, serum-free media for 24 h, or delayed in G2-M phase by treatment with colchicine. Restoration of BRCA1 to the faster-migrating form, which occurred on release of cells from the G1-S-phase block, was prevented by the phosphatase inhibitor okadaic acid. Phosphatase treatment of immunoprecipitated BRCA1 resulted in the conversion of the slower-migrating form to the faster-migrating form. Although these results suggested that BRCA1 was preferentially hyperphosphorylated near the G1-S-phase boundary of the cell cycle, exposure of cells to DNA-damaging agents including UV light or treatment with hydrogen peroxide (H2O2) also promoted BRCA1 hyperphosphorylation. These same stimuli also eliminated the punctate nuclear staining pattern normally observed for BRCA1 in control cells. These results indicate that BRCA1 undergoes cyclic hyperphosphorylation during the cell cycle; however, this modification, as well as changes in BRCA1 nuclear staining, also occurs in response to DNA damage.

Aphidicolin↗

PubMed1997

Advance directives affecting medical treatment choices.

Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners' treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.

Advance Directives↗

PubMed1997

False assumptions, ethnocentrism and cultural imposition ... Madeleine Leininger's theory of culture care and its place in Aotearoa.

Explore the source record for details and available documents.

Anthropology, Cultural↗

PubMed1997

Management of PROM at term.

Explore the source record for details and available documents.

Dinoprostone↗

PubMed1997

Anomalous origin of the right coronary artery from the pulmonary artery in association with a ventricular septal defect.

Origin of the right coronary artery from the pulmonary artery is a rare lesion occasionally found at angiography or autopsy. We report the rare preoperative diagnosis, in a child, of anomalous origin of the right coronary artery from the pulmonary artery, in association with a ventricular septal defect. The chest radiograph was normal, but auscultation revealed a continuous murmur at the left sternal border and electrocardiography showed right and left ventricular hypertrophy. A transthoracic echocardiogram depicted anomalous origin of the right coronary artery from the pulmonary artery. Color-flow Doppler echocardiography indicated possible right-coronary-artery-to-right-ventricle fistulae. Diagnosis was made by selective left coronary arteriography, which showed retrograde filling of the right coronary artery from collateral vessels. Selective left coronary arteriography depicted intercoronary flow, with no fistulae. Operative repair consisted of moving the proximal right coronary artery from its origin at the pulmonary trunk to the aorta. An associated procedure for correction of the ventricular septal defect was performed. The postoperative cardiac angiogram showed that the ventricular septal defect was closed and that flow through the right coronary artery was normal. Preoperative diagnosis of anomalous origin of the right coronary artery from the pulmonary artery is important, because this condition is surgically correctable.

Aorta↗

PubMed1997

Bivector traction for unstable cervical spine fractures: a description of its application and preliminary results.

The management of acute, displaced odontoid fractures requires the restoration of sagittal alignment and rigid external or internal immobilization to prevent late instability and achieve union. This report introduces a new traction technique for the reduction of posteriorly displaced type 2 odontoid fractures. Seven patients with traumatic injuries to the dens were placed in bivector traction for an awake closed reduction. Sagittal alignment was restored and maintained in all patients with no neurologic deterioration or traction-related complications during an average of 11 days (range, 2-28 days) in traction. The overall sagittal alignment corrected from an initial average of 12.2 mm (range, 5-22 mm) of posterior displacement to an average of 1.1 mm (range, 0-3 mm) at the completion of reduction. Only one patient had residual angulation, which measured 5 degrees. Three patients achieved an osseous union and the remaining four required a posterior C1-C2 fusion for nonunion. Although operative stabilization may be the preferred approach in this patient population and injury pattern, we conclude that bivector traction is a safe and effective technique for the initial management of posteriorly displaced odontoid fractures. In addition, its role can be expanded to the closed reduction of lower cervical spine fractures in patients with fixed flexion deformities secondary to ankylosing spondylitis or disseminated intraosseous segmental hyperostosis.

Accidental Falls↗

PubMed1997

Tissue distribution of ketamine in a mixed drug fatality.

While reports of ketamine abuse are increasing, reports of ketamine deaths and tissue concentrations associated with fatalities are rare. We report here a case of a mixed drug fatality involving ketamine and ethanol. Ketamine analysis was carried out by gas chromatography with a nitrogen-phosphorus detector (NPD). We found the following tissue concentrations: blood 1.8 mg/L; urine 2.0 mg/L; brain 4.3 mg/kg; spleen 6.1 mg/kg; liver 4.9 mg/kg, and kidney 3.6 mg/kg. The blood ethanol concentration was 170 mg/dL. Because an empty nalbuphine ampule was found in the possession of the deceased, the blood was assayed for this opioid compound using a gas chromatography/mass spectrometry (GC/MS) method. None was detected at a limit of detection of 0.02 mg/L.

Adult↗