Tadalafil-associated anterior ischaemic optic neuropathy.
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Adenocarcinoma↗
Biomedical subjects
P D Fox
Publications and source records attributed to P D Fox.
Acute suprachoroidal hemorrhage during phacoemulsification.
We present a case of acute suprachoroidal hemorrhage that developed during routine phacoemulsification in an 85-year-old patient after uneventful administration of periocular anesthesia. Pre-existing risk factors included advanced age, glaucoma, myopia, and hypertension. The scleral tunnel prevented major expulsion of intraocular contents; however, raised intraocular pressure prevented intraocular lens implantation. The rarity of this condition raises questions regarding the further management and precautions related to it.
Acute Disease↗
Identification and assessment of high-risk seniors. HMO Workgroup on Care Management.
CONTEXT: Many older adults with chronic illnesses and multidimensional needs are at high risk of adverse health outcomes, poor quality of life, and heavy use of health-related services. Modern proactive care of older populations includes identification of such high-risk individuals, assessment of their health-related needs, and interventions designed both to meet those needs and to prevent undesirable outcomes. OBJECTIVE: This paper outlines an approach to the tasks of identifying and assessing high-risk seniors. Intervention identification of high-risk seniors (also called case finding) is accomplished through a combination of periodic screening, recognition of high-risk seniors by clinicians, and analysis of administrative databases. Once identified, potentially high-risk individuals undergo on initial assessment in eight domains: cognition, medical conditions, medications, access to care, functional status, social situation, nutrition, and emotional status. The initial assessment is accomplished in a 30- to 45-minute interview conducted by a skilled professional--usually one with a background in nursing. The data are used to link some high-risk persons with appropriate services and to identify others who require more detailed assessments. Detailed assessment is often performed by interdisciplinary teams of various compositions and methods of operation, depending on local circumstances. CONCLUSION: The rapid growth in Medicare managed care is presenting many opportunities for developing more effective strategies for the proactive care for older populations. Identification and assessment of high-risk individuals are important initial steps in this process, paving the way for testing of interventions designed to reduce adverse health consequences and to improve the quality of life.
Activities of Daily Living↗
Efforts to improve primary care delivery to nursing home residents.
OBJECTIVE: To describe a primary care practice model used by health maintenance organizations (HMOs) that serve medicare beneficiaries to improve the provision of primary care to nursing home residents. PARTICIPANTS: Medicare beneficiaries who reside in nursing homes and who are enrolled in HMOs. CONCLUSION: Several HMOs are using physician-nurse practitioner teams to provide primary care to nursing home residents. The potential to improve the delivery of these services in nursing homes, particularly to long-stay residents, is apparent. However, obstacles arise in developing this practice model in HMOs, including difficulty recruiting both nurse practitioners and physicians and the lack of HMO-based research on the effects of such a model.
Aged↗
The impact of policy standardization on the Medigap market.
This study examines the impact of policy standardization on the market for Medicare supplemental, or "Medigap," policies. Prior to 1992, insurance carriers could sell any benefits they chose, so long as minimum benefit requirements were met. In July 1992, federal legislation was implemented that required all new Medigap policies to conform exactly to one of 10 standardized sets of benefits. Using pre- and post-standardized policy information from six states, this study analyzes the impact of this legislation. Overall, standardization has affected the market positively, and as a result, consumers are better able to make informed choices about the benefits they are purchasing.
Community Participation↗
Managed care and chronic illness: an overview.
The growth in managed care raises a number of issues with respect to people with chronic illness. One issue is whether HMOs enroll their fair share of people with chronic illness. Another issue is how to address the fears among people with chronic illness or disabilities who are faced with requirements to join managed care plans.
Aged↗
Medigap reform legislation of 1990: have the objectives been met?
The 1990 medigap reform legislation had multiple objectives: To simplify the insurance market in order to facilitate policy comparison, provide consumer choice, provide market stability, promote competition, and avoid adverse selection. Based on case study interviews with a cross-section of individuals and organizations, we report that most of these objectives have been achieved. Consumers of medigap plans are able to make more informed choices, largely because they can adequately compare policies based on standard benefits. Marketing abuses have apparently declined, as evidenced by a decrease in the number of consumer complaints. Finally, no major detrimental impact on the insurance industry was detected. Beneficiaries still face some confusion in this market, however, such as understanding the rating methodologies used to set premiums and how this may affect their choices. Confusion could increase with the growth of managed care options.
Aged↗
Medigap regulation: lessons for health care reform.
Congress enacted legislation in 1990 that dramatically changed the rules for selling supplemental health insurance, or "Medigap" policies, to the elderly. Most notably, policy coverage was standardized. Insurance carriers are allowed to sell only the ten specified packages of benefits, which reduces consumer choice but facilitates comparison shopping. This legislation is important in its own right and also offers lessons for U.S. health care reform. To examine the changes brought about by this legislation and analyze their implications for health care reform, we conducted site visits to nine states and interviewed insurer representatives, executive branch officials, congressional staff, and various interest groups for two years.
Aged↗
Can regulation improve long-term care insurance? Lessons from the Medigap experience.
This article uses recent experiences from the Medigap market to draw conclusions about the advisability of alternative methods of regulating the market for long-term care insurance. The analysis is based in part on interviews of state insurance regulators, insurance companies, and interest-group representatives. The authors conclude that some regulation of the market is appropriate, but that the structure and extent of regulation found in the Medigap market would likely be inappropriate for the long-term care insurance market at this time.
Aged↗
Do HMOs care for the chronically ill?
This DataWatch refutes the notion that chronic illness is more prevalent among persons covered by indemnity insurance than by health maintenance organizations (HMOs). This is true even when health status and sociodemographic factors are accounted for in the analysis. The study analyzes the prevalence of chronic illness among privately insured nonelderly persons in HMOs and indemnity plans, using data from the 1992 National Health Interview Survey. More data are needed to examine this issue for Medicare and Medicaid populations.
Activities of Daily Living↗
Beyond the benefit package.
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California↗
Aggressive management of an epidemic of chronic pseudophakic endophthalmitis: results and literature survey.
Six cases of chronic endophthalmitis following extracapsular cataract extraction and lens implantation are reviewed. All were referred for tertiary management by one surgeon over a period of just over 2 years. In two of the cases coagulase negative staphylococci were isolated and in three Propionibacterium spp were retrieved. In the remaining case a mixed growth of coagulase negative staphylococci and Propionibacterium acnes was cultured. The surgical management, microbiological results, and eventual visual outcome are discussed. To our knowledge, this is the first documented outbreak of chronic pseudophakic endophthalmitis with commensal organisms from a single centre.
Aged↗
Laser photocoagulation for proliferative retinopathy in sickle haemoglobin C disease.
The effect of sectoral, scatter laser photocoagulation on proliferative sickle retinopathy (PSR) was investigated by reviewing fluorescein angiograms of 88 sickle cell-haemoglobin C patients enrolled in a controlled, randomised trial. Follow-up was for a median period of 2.9 years. Complete infarction of all PSR in an eye occurred in 7 of 74 treated eyes and 2 of 60 control eyes. Treatment resulted in significantly greater regression (decrease in number or size of PSR lesions) in eyes of patients aged < 25 years at enrollment but not in eyes of patients > or = 25 years at enrollment. Infarction of individual PSR lesions was significantly more common in treated eyes. Treated PSR was significantly more likely to infarct if small (< 15 degrees circumferential involvement) and if flat rather than elevated. New PSR was significantly less likely to develop in treated eyes.
Adult↗
Influence of alpha thalassaemia on the retinopathy of homozygous sickle cell disease.
Homozygous alpha+ thalassaemia (alpha-/alpha-) ameliorates some of the clinical manifestations of homozygous sickle cell (SS) disease but its effect on retinal complications remains unknown. This has been assessed by visual examination and fluorescein angiography in 39 subjects with SS disease and homozygous alpha+ thalassaemia and in 39 age/sex matched controls with SS disease but with a normal alpha globin genotype (alpha alpha/alpha alpha). The results indicate that homozygous alpha+ thalassaemia reduces the extent of peripheral retinal vessel closure but has no apparent effect on the frequency of proliferative sickle retinopathy.
Adolescent↗
Academic medical centers and managed care: uneasy partners.
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Academic Medical Centers↗
Geriatric care approaches in health maintenance organizations.
The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.
Geriatric Assessment↗
Treatment of iatrogenic choriovitreal neovascularisation in sickle cell disease.
The effect of scatter photocoagulation on the perfusion of iatrogenic choriovitreal neovascularisation (CVN) has been assessed by a randomised trial in 35 CVN lesions in 18 eyes with proliferative sickle retinopathy. No difference in size or vascularity of CVN lesions was apparent between the nine treated and nine control eyes over a median follow-up of 42 months. Scatter photocoagulation by the stated protocol was not effective in the treatment of CVN.
Adult↗
Influence of genotype on the natural history of untreated proliferative sickle retinopathy--an angiographic study.
The natural history of untreated proliferative sickle retinopathy (PSR) has been observed in 35 patients (40 eyes) with homozygous sickle cell (SS) disease and in 112 patients (114 eyes) with sickle cell-haemoglobin C (SC) disease over a mean follow-up period of 4.5 years (range 0.5-14.0 years). In both genotypes progression of PSR was most frequent between ages 20 and 39 years. Spontaneous regression was more common in SS disease (p = 0.01), and more likely to proceed to complete non-perfusion. In SC disease PSR tended to be stable in patients aged 40 and over, and non-perfused PSR lesions were significantly more likely to reperfuse (p = 0.01) than in SS disease. In both genotypes regression was not influenced by size or elevation of the PSR lesion. The tendency for PSR to regress in SS disease suggests that treatment is unnecessary in SS patients aged 40 and over.
Adolescent↗