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Biomedical subjects

R Burns

Publications and source records attributed to R Burns.

120 records · Page 7Linked to original sources
PubMedDate not supplied

Factors predicting readmission of older general medicine patients.

OBJECTIVES: 1) Identify demographic, clinical social support, functional, and psychological factors about which data are available within 24 hours of hospital admission associated with emergent unscheduled readmission for a group of older general medicine patients; 2) develop a model to predict emergent readmission. DESIGN: Interview- and chart-based study of emergent admissions that occurred within 60 days of discharge. SETTING: General medicine wards of the Memphis Veterans Affairs Medical Center, an 862-bed university-affiliated tertiary care facility. PATIENTS/PARTICIPANTS: General medicine patients greater than or equal to 65 years old (n = 173). Inclusion criteria were willingness to participate, written consent (patient or family member), and patient interview within 36 hours of admission. MEASUREMENTS AND MAIN RESULTS: The dependent variable was emergent readmission within 60 days of discharge from the hospital. Independent variables included demographic (age, race, income, education), social support (marital status, living arrangements), psychological (cognition, depression), activities of daily living functioning, and clinical (diagnoses, type and source of admission, length of stay, numbers of hospitalizations and days of hospitalizations in the past year, illness severity) parameters. Readmitted patients were emergently admitted and more severely ill, had more diagnoses of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), less ischemic heart disease, and more hospitalizations and hospital days in the past year (all p less than 0.05). Logistic regression identified diagnostic group (COPD or CHF), emergent admission, and admission severity of illness as predictive of readmission. The likelihood of being readmitted was 5.4. Accuracy of the three-variable model was 76%, predicted value positive, 73%, and predictive value negative, 77%. CONCLUSIONS: Chronically ill patients who are severely ill at index admission and who have had several hospitalizations in the past year tend to be readmitted. Using this model, high-risk patients may be prospectively targeted to reduce readmissions.

Aged↗
PubMedDate not supplied

Iodine intake in pregnancy in Ireland--a cause for concern?

BACKGROUND: Adequate dietary iodine intake is necessary to maintain maternal thyroid function at a level permitting normal neuropsychological development of the foetus. AIMS AND METHODS: To determine dietary iodine status by measuring urinary iodine excretion (UIE), proportional to dietary intake, in Irish mothers during the first trimester of pregnancy. RESULTS: Median UIE showed seasonal variations, being lower in summer than in winter. The median values in pregnant women were, summer 45microg/l, winter 68microg/l. Equivalent values for controls were 43 and 91microg/l respectively. UIE required to achieve WHO recommended daily iodine intakes would be 120-180microg/l. In the Irish subjects UIE values suggestive of iodine deficiency (<50microg/l) were observed in 55% of pregnant women tested in summer and 23% in winter. Dairy milk iodine, a major dietary iodine source, showed similar variation. CONCLUSIONS: While there is as yet no available evidence of widespread thyroid hypofunction in the Irish obstetric population, the findings are a cause of concern, which if confirmed by a more comprehensive investigation, may indicate the need for iodine prophylaxis.

Adult↗
PubMedDate not supplied

Malignant melanoma: a literature review and case presentation.

The authors present a case report of acral lentiginous malignant melanoma in a 77-year-old male. Melanoma is a rare but increasingly present malignant lesion of the lower extremity. It is the most common malignant neoplasm in blacks and is often misdiagnosed. Early, accurate diagnosis and biopsy of suspicious lesions is the cornerstone of treatment in order to decrease possible future morbidity and mortality. The authors discuss the clinical features, differential, diagnosis, predisposing factors, diagnosis, classification, and treatment of malignant melanoma.

Aged↗
PubMedDate not supplied

Thirty polymorphic nuclear microsatellite loci from black walnut.

Black walnut (Juglans nigra L) is a large tree, native to the eastern United States, that is prized for its high-quality timber and edible nut. Thirty (GA/CT)n nuclear microsatellite markers were identified from black walnut for use in population genetic studies, genome mapping, DNA genotyping of important clones, studies of gene flow, and tree breeding. The markers were polymorphic based on a diversity panel of 10 black walnut individuals from eight Midwestern U.S. states.

Juglandaceae↗
PubMedDate not supplied

Assessing the extent of integration achieved through physician-hospital arrangements.

In this article we examine management service organizations (MSOs), physician-hospital organizations (PHOs), hospital-affiliated independent practice associations (IPAs), and hospital-sponsored "group practices without walls" (GPWWs) that allow physicians to retain their practices and link hospitals and health systems to physicians through contractual arrangements. Also examined were medical foundations (MFs), integrated salary models (ISMs), and integrated health organizations (IHOs) that own the physical assets of physician practices and contract with payors for physician and hospital services. The research provides several new insights for understanding the structure and process of physician-hospital integration. It was found that the extent of processual integration in physician-hospital organizational arrangements can be measured along six dimensions: administrative and practice management services; physician financial risk-sharing; joint ventures to create new services; computer linkages; physician involvement in strategic planning; and salaried physician arrangements. These dimensions are consistent with the conceptual and empirical dimensions developed by others. These findings refute the notion raised by some industry observers that the new physician-hospital organizational models simply formalize integrative activities already in place. Earlier studies from the 1980s reported that hospitals integrated physicians through involvement in governance, capital planning, and the provision of practice management services. In contrast, we found that current integration.

American Hospital Association↗
PubMedDate not supplied

Evaluation of the color coded Doppler ultrasound in detecting carotid bifurcation disease.

The color coded continuous wave doppler ultrasound was compared with angiography in 201 arteries, 83 with greater than 50% diameter stenosis and 118 with less than 50% stenosis. Overall accuracy in identifying hemodynamically significant (greater than 50% diameter stenosis) was 87% in the presence of peak velocities greater than 5000 Hz and a blue color coded image. Negative predictive value was 94.5%. False positives were mainly due to the presence of severe external carotid stenosis and increased flow due to contralateral carotid occlusion. Within the limitations of the test being an indirect method, it is a reliable screening method for detecting hemodynamically significant carotid artery disease.

Arterial Occlusive Diseases↗