What constitutes an adequate smear in fine-needle aspiration cytology of the breast?
Explore the source record for details and available documents.
Biopsy, Needle↗
Biomedical subjects
T R Miller
Publications and source records attributed to T R Miller.
The health care costs of smoking.
Explore the source record for details and available documents.
Adult↗
Job-related diseases and occupations within a large workers' compensation data set.
The objective of this report is to describe workers' job-related diseases and the occupations associated with those diseases. The methods include aggregation and analysis of job-related disease and occupation data from the Bureau of Labor Statistics' Supplementary Data System (SDS) for 1985 and 1986--the last years of data available with workers' compensation categories: death, permanent total, permanent partial, and temporary total and partial. Diseases are ranked according to their contribution to the four workers' compensation (WC) categories and also ranked within occupations according to the number of cases. Occupations are ranked according to their contribution to specific diseases within one of the four categories. The following diseases comprise the greatest numbers of deaths: heart attacks, asbestosis, silicosis, and stroke. Within the permanent total category, the diseases with the greatest contributions are heart attack, silicosis, strokes, and inflammation of the joints. For the permanent partial category, they are hearing loss, inflammation of joints, carpal tunnel syndrome, and heart attacks. For the temporary total and partial category, they are: inflammation of joints, carpal tunnel syndrome, dermatitis, and toxic poisoning. Hearing loss or inflammation of joints are associated with more than 300 occupations. Circulatory diseases comprise a larger share of job-related diseases than is generally acknowledged. Occupations contributing the most heart attack deaths are truck drivers, managers, janitors, supervisors, firefighters, and laborers. Ratios of numbers of deaths to numbers of disabilities are far higher for illnesses than injuries. Occupations that are consistent in their high ranking on most lists involving a variety of conditions include nonconstruction laborers, janitors, and construction laborers. The large SDS, though dated, provides a tentative national look at the broad spectrum of occupational diseases as defined by WC and the occupations associated with those diseases in 1985 and 1986. Some description of the spectrum of diseases encountered today is possible especially for occupations, such as those mentioned above for which employment has expanded in the 1990s.
Administrative Personnel↗
Interobserver variability in the classification of proliferative breast lesions by fine-needle aspiration: results of the Papanicolaou Society of Cytopathology Study.
This study evaluates the applicability of the published cytologic criteria in the categorization of proliferative breast lesions by assessing the diagnostic accuracy and interobserver reproducibility of a panel of experts. Twelve breast fine-needle aspiration (FNA) specimens of biopsy-proven nonproliferative breast lesion (NPL) (1 case), proliferative lesions without atypia (PL) (7 cases), proliferative lesion with atypia (PLA) (1 case), and low-nuclear grade ductal carcinoma in situ (DCIS) (3 cases) were selected. Six FNAs were Papanicolaou (PAP) and 6 were Diff-Quik-stained (DQ). Six expert cytopathologists classified the smears using a summary of published criteria as a guideline. All 6 participants rendered the same cytologic diagnosis in 2/12 (16%) cases. The agreement among the 6 raters was low (Kappa = 0.35). Cytohistologic correlation was achieved in 26/72 (36%) FNA diagnoses. The correlation of the PAP-stained cases was better than the DQ: 17/36 (47%) PAP and 9/36 (25%) DQ correlated. Improving the correlation was achieved by amalgamation of NPL and PL into "low risk" and PLA and DCIS into "high risk" categories: 47/72 (65%) FNA diagnoses then correlated with histology [29/36 (81%) PAP and 18/36 (50%) DQ]. We conclude that the cytologic criteria of proliferative breast lesions need to be further defined and assessed. Consideration should be given to minimizing the number of diagnostic categories and adopting a terminology that has a direct effect on patient management.
Adult↗
Highway crash costs in the United States by driver age, blood alcohol level, victim age, and restraint use.
This paper estimates 1993 U.S. highway crash incidence and costs by driver age, alcohol use, victim age, occupant status, and restraint use. Notable findings are: (1) crash costs of novice drivers are high enough to yield preliminary benefit-cost ratios around 4-8 for a provisional licensing system that restricts driving after midnight and 11 for zero alcohol tolerance for young drivers with violators receiving a 6-month suspension; (2) the costs to people other than the intoxicated driver per mile driven at BACs of 0.08-0.099% exceed the value of driver mobility; (3) the safety costs of drunk driving appear to exceed $5.80 per mile, compared with $2.50 per mile driven at BACs of 0.08-0.099%, and $0.11 per mile driven sober; (4) highway crashes cause an estimated 3.2% of U.S. medical spending, including more than 14% of medical spending for ages 15-24; (5) ignoring crash-involved occupants whose restraint use is unknown, the 13% of occupants who police reported were traveling unrestrained accounted for an estimated 42% of the crash costs; and (6) if these unrestrained occupants buckled up, the medical costs of crashes would decline by an estimated 18% (almost $4 billion annually) and the comprehensive costs by 24%.
Accidents, Traffic↗
Who is driving when unrestrained children and teenagers are hurt?
This paper examines driver characteristics in crashes where child and teenage motor vehicle crash victims were injured, in particular factors that determine whether or not the victim was restrained. Analyzing the data on children and teenagers who are injured revealed that the presence of a second adult in a vehicle increased the likelihood that these passengers were unrestrained. Other findings are more predictable: victim restraint use generally mirrored driver restraint use; a male driver, a young driver, a drinking driver, a speeding or reckless driver, an unlicenced or suspended driver, and a night-time trip each independently raised the odds that child and teenage passengers were not restrained when they were injured.
Accidents, Traffic↗
Creating injury episodes using medical claims data.
BACKGROUND: Health care episodes are traditionally created for a specific condition using defined relevant diagnosis and procedure codes and a start and end period. Our goal is to use 1987 to 1989 medical claims data to create distinct episodes of care as a result of injury. METHODS: Claims for 102,000 people younger than 65 years were obtained from Medstat Systems, Inc. Injury claims were identified by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes and separated into 10 body regions. Using linked inpatient and outpatient claims data, we established clear zones--a maximum period for a return visit for medical treatment--for each of 10 body regions injured by hospitalization status. These clear zones were used to create episodes of injury. RESULTS: A total of 295,165 injury claims created 79,564 episodes of injury. Limb and trunk injuries typically have the most follow-ups in terms of number of claims and spacing between claims. Brain injuries, even for admitted patients, result in an average of fewer than two follow-up claims. On average, hospitalized patients require only one more follow-up than nonadmitted patients. CONCLUSIONS: This paper presents a method for identifying injury episodes using a medical claims database. The analysis suggests that follow-up to check for minor long-term sequelae of brain injury is rare.
Adult↗
Costs of occupational injuries to teenagers, United States.
OBJECTIVES: This paper estimates the incidence and costs of teenage occupational injuries by severity in the United States. METHODS: Existing estimates of occupational injury costs are adapted for the teenage population. Incidence estimates are constructed using data from the US 1993 Annual Survey of Occupational Injury and Illness and the 1993 Census of Fatal Occupational Injuries combined with incidence data from the National Health Interview Survey. RESULTS: In 1993, an estimated 371,000 teenagers were injured in the workplace, accounting for 4.2% of all occupational injuries. These injuries cost $5 billion, approximately 3% of the total of injury costs involving teenagers. CONCLUSIONS: Teenagers appear to account for a larger share of the total number of occupational injuries relative to their presence in the employed workforce, but a lower share of the costs of such injuries.
Accidents, Occupational↗
Hypercalcemia in malignant paraganglioma due to parathyroid hormone-related protein.
A 15-year-old boy had hypercalcemia in association with malignant retroperitoneal paraganglioma. He had suppressed circulating levels of intact parathyroid hormone, whereas parathyroid hormone-related protein (PTHrP) immunoreactivity was elevated in plasma. Both the serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were normal. Preoperatively the patient required control of hypercalcemia with intravenous pamidronate therapy. His circulating calcium and PTHrP concentrations became normal after a successful surgical resection of the primary retroperitoneal tumor. To our knowledge, this is the first reported case of elevated PtHrP levels in a patient with paraganglioma which resolved postoperatively.
Adolescent↗
Costs and benefits of a community sobriety checkpoint program.
OBJECTIVE: Alcohol-involved crashes cost society more than $100 billion a year. Sobriety checkpoints are effective in apprehending drunk drivers. This article compares the costs and the estimated monetary benefits from a hypothetical community sobriety checkpoint program. METHOD: The analysis is constructed around a hypothetical community with 100,000 licensed drivers. A literature review suggests that a generously funded intensive checkpoint program (156 checkpoints per year) can be expected to reduce alcohol-attributable crashes by about 15%. The benefits (cost savings) of the checkpoint program are calculated using 1993 alcohol-involved crash incidence from the National Highway Traffic Safety Administration. Costs per alcohol-involved crash and the percentage of alcohol-involved crashes attributable to alcohol are updated from published studies. RESULTS: Estimated annual savings to the hypothetical community total $7.9 million. This includes $3.1 million for averted fatalities, $4.5 million for averted non-fatal injuries, and $0.3 million for averted property damage. Every $1 spent on a sobriety checkpoint program can be expected to save the community more than $6, including $1.30 of insurer costs. CONCLUSIONS: An intensive sobriety checkpoint program can save a community more in automobile crash costs than the program costs.
Accidents, Traffic↗
How safe are our schools?
OBJECTIVES: The goal of this study was to provide national estimates of the frequency and cost of school injuries. METHODS: Six years of National Health Interview Survey data were used to estimate nonfatal injury incidence rates, multiple sources were used to estimate fatalities, and national highway crash data were used to estimate school bus injury incidence. RESULTS: Each year, 3.7 million children suffer a substantial injury at school, resulting in an estimated $3.2 billion in medical spending and $115 billion in good health lost. Nonschool fatalities greatly exceed school fatalities; from an incidence per hour perspective, however, school hours are no safer than nonschool hours despite greater formal supervision. School bus injuries account for half of school injury deaths but less than 1% of total school injury costs. CONCLUSIONS: Nonfatal injury is a problem in schools. The concentration of injury at secondary schools suggests that interventions there may be most cost-effective. Data on school injury causes are greatly needed.
Accidents, Traffic↗
Conducting a managed care contract review.
Healthcare providers traditionally focus on price when negotiating managed care contracts, but other important contract terms can affect the degree of legal, strategic, and financial risk a provider bears. In addition to having a review of all contracts by legal counsel, providers should conduct a separate business review of the contract terms, from making sure terminology and references are clearly defined or explained to assessing the details of the dispute resolution procedures. Providers should fully understand--and possibly refuse--requirements that could result in additional costs.
Contract Services↗
Physician resource profiling enhances utilization management.
Physician resource profiling, the analysis of a physician's resource consumption, enhances performance uniformity and efficiency and assists in utilization management. Developing reliable profiles requires the shared participation of an organization's finance personnel and physicians. Selecting or developing benchmarks for performance comparisons, assessing the integrity of the organizational data used, and testing the developed profiles all should be completed before the physician resource profiling can be used to support decision making.
Benchmarking↗
Perils and pitfalls in the diagnosis of Cushing's syndrome.
Explore the source record for details and available documents.
Adrenalectomy↗
Comparison of adaptations to a 12-month exercise program and late outcome in patients with healed myocardial infarction and ejection fraction <45% and >50%.
To characterize the differences in adaptations to endurance exercise training and prognosis between patients with depressed and normal left ventricular (LV) function, 20 patients with coronary artery disease were studied and followed for 7 years. Patients with normal LV function had enhancement of LV systolic function, but the group with LV dysfunction did not exhibit cardiac adaptations and had more cardiac events than those with normal LV function.
Adaptation, Physiological↗
Geographic variation in expenditures for workers' compensation physician claims.
We examine interstate variations in the cost of claims for physician care using injury claims from Worker's Compensation, and consider some of the factors that may explain cost differences. Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. Statistical analyses reveal considerable variation in expenditures for physician care of injuries across states, even after controlling for case mix and state characteristics. We also find that the presence of HMOs and of general practitioners as a percent of physicians are associated with lower claims, and that the percent of the state that is urban is associated with higher claims. The large variation in costs suggests a potential to affect the costs of physician care for work-related injuries.
Geography↗
Low-grade lymphoma of mucosa-associated tissue in the parotid gland: a case report of fine-needle aspiration cytology diagnosis using flow cytometric immunophenotyping.
A 66-year-old woman with Sjögren's syndrome for 7 years presented with an enlarged right parotid gland. The left parotid gland, which showed myoepithelial sialadenitis (MESA), had been resected 4 years earlier. A fine-needle aspiration (FNA) biopsy of the right parotid gland was performed. Examination of the smears revealed cells of intermediate size with a round-to-irregular nuclear outline and distinct pale cytoplasm intermixed with small mature round lymphocytes. The chromatin was slightly paler and less clumped than in small mature lymphocytes. A small inconspicuous nucleolus was seen in most of the cells. Flow cytometry immunophenotyping performed on the FNA biopsy material showed a monoclonal population of B cells with kappa light chain restriction. The cytomorphology coupled with the immunophenotyping study in this clinical context suggested the diagnosis of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Extensive staging work-up revealed no evidence of disseminated disease. The right parotid gland was surgically excised. Histology and gene rearrangement studies confirmed the cytologic diagnosis. To our knowledge, this is the first description of a low-grade lymphoma of MALT in a salivary gland to be diagnosed by FNA.
Aged↗
Costs of gunshot and cut/stab wounds in the United States, with some Canadian comparisons.
This article estimates the costs of U.S. gunshot and cut/stab wound by intent. It also compares U.S. to Canadian gunshot experience. Incidence data are from published sources, the National Hospital Ambulatory Medical Care Survey (NHAMCS), and cause-coded emergency department discharge and hospital discharge data systems. Medical care payments and lost earnings per case come from National Crime Survey data, a literature review, and weighting of costs by diagnosis from Databook on Nonfatal Injury-Incidence. Costs, and Consequences by Miller et al. (The Urban Institute Press, Washington, DC. 1995) with the diagnosis distribution of penetrating injuries from the discharge data systems. Quality of life losses are estimated primarily from jury awards to penetrating injury victims. In 1992, gunshots killed 37,776 Americans; cut/stab wounds killed 4095. Another 134,000 gunshot survivors and 3,100,000 cut/stab wound survivors received medical treatment. Annually, gunshot wounds cost an estimated U.S. $126 billion. Cut/stab wounds cost another U.S. $51 billion. The gunshot and cut/stab totals include U.S. $40 billion and U.S. $13 billion respectively in medical, public services, and work-loss costs. Across medically treated cases, costs average U.S. $154,000 per gunshot survivor and U.S. $12,000 per cut/stab survivor. Gunshot wounds are more than three times as common in the U.S. than in Canada, which has strict handgun control. With the same quality of life loss per victim, gunshot costs per capita are an estimated U.S. $495 in the U.S. vs U.S. $180 in Canada. Per gun, however, the costs are higher in Canada, Gunshot wound rates rise linearly with gun ownership.
Canada↗