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A data registry to collect procedure and outcome information on bariatric surgery in Michigan is underway through a new initiative involving 20 hospitals and dozens of surgeons affiliated with Blue Cross Blue Shield of Michigan.
In March 2005, CDC reported a multistate outbreak of Pseudomonas fluorescens bloodstream infections associated with use of syringes preloaded with heparin intravenous catheter flush. The heparin flush became contaminated during preparation by IV Flush, LLC (Rowlett, Texas). Thirty-six patients in four states were identified who had been exposed to the contaminated flush and subsequently experienced P. fluorescens bloodstream infection during December 2004-February 2005. Based on a recommendation by the Food and Drug Administration (FDA), IV Flush voluntarily recalled the preloaded syringes in late January; on January 31 and February 4, 2005, FDA issued nationwide alerts recommending that consumers and institutions stop using and return the preloaded syringes to IV Flush or the distributor (Pinnacle Medical Supply, Rowlett, Texas). Approximately 3 months after the product was recalled, patients in Michigan and South Dakota were identified with P. fluorescens bloodstream infections. As of April 2006, a total of 15 patients in Michigan and 13 in South Dakota had been identified with delayed onset P. fluorescens bloodstream infections, with occurrences ranging from 84 to 421 days after their last potential exposure to the contaminated flush. The patients all had indwelling central venous catheters and received treatment during October 2005-February 2006 at clinics known to have used the contaminated flush. This report describes the investigation of these cases, which determined that these were delayed onset cases of P. fluorescens bloodstream infection from a past exposure to contaminated flush, and provides recommendations for ongoing surveillance for delayed P. fluorescens bloodstream infections among similarly exposed patients.
To continue its mission of providing information to improve understanding of health care in Michigan and to aid in planning and decisionmaking, the Michigan Health Care Data Corporation needs to achieve several things. The following is a look at its history and structure, MSMS participation, public reports, and future expectations.
This issue of Michigan Medicine marks a turning point in MSMS posture regarding advance directives ("living wills"). For many years, MSMS has discussed the issue and has supported legislation, more or less behind the scenes. We are now involved in a more proactive stance, trying to encourage more discussion and wider use of these devices, whether or not legislation is enacted. In this article I will: 1) review some basic terms and ethical principles; 2) recount the deliberations of the MSMS Committee on Bioethics on this topic; and 3) indicate why the time is now ripe for more action by Michigan physicians.
Six years of statistics on interlibrary lending and borrowing among basic unit health sciences libraries in Michigan are examined to determine the effect of the availability of an automated interlibrary loan system, DOCLINE, on interlibrary lending volume and patterns within Michigan. A trend analysis projection of expected volume is made and the predicted value compared with the actual value following the adoption of the DOCLINE system. Interlibrary loan (ILL) volume is tested to see if yearly volume increases are statistically significant. The number of libraries changing from net lender to net borrower or the reverse after the adoption of DOCLINE is tracked. Results fail to support the expectation that DOCLINE would produce major change in ILL volume or pattern.
Seasonal abundance of immature Coquillettidia perturbans was studied at 3 sites in south-central Michigan in 1987 and 1988. A modified boat bilge pump and funnel separators proved to be good sampling and sorting devices. Pupae were found in late May to early July, first and second instars were most abundant in July and August, while third and fourth instars were present year-round. Overall, larvae were most numerous in August and September, indicating that Cq. perturbans has a single generation per year in Michigan, with midsummer to fall as the main period of larval development, and with third and fourth larval instars as overwintering stages. Parasitism of Cq. perturbans larvae by a previously undiscovered mermithid nematode was documented at 2 sites in late summer.
Dietitians' attitudes and knowledge about aging are important because of the potential influence on quality and quantity of nutrition services provided to older adults. Four instruments were used to survey active members of The American Dietetic Association (ADA) in Michigan. The survey was mailed to 1,408 dietitians; 738 responded (52.4%). The responding dietitians were predominantly under 40, well educated, and female, which was consistent with the 1986 national census of ADA members. The results indicated that dietitians hold positive attitudes toward older adults in most areas. An exception was that a majority of the dietitians perceived older adults as resistant to treatment. Although dietitians' knowledge about aging generally was adequate, the questionnaire revealed that dietitians lacked knowledge in the areas of economic and health status; dietitians answered that older adults have a lower income and are sicker and more institutionalized than is in fact true. These are critical areas of deficiency in knowledge by dietitians, since food and nutrition issues often involve money and health. In the problem-solving section of the study, the dietitians usually focused on one specific environment or area of concern. Neither the full range of all possible environments for older adults nor the diversity of older adults' needs was usually considered. Continuing education as well as comprehensive undergraduate courses on aging would have a positive influence on Michigan dietitians' attitudes and knowledge about aging.
A study was conducted to determine whether the addition of albuterol inhalers to the Medicaid formulary of California would increase patient costs. Data on the treatment of asthma in 1,463 patients were obtained from the Michigan Medicaid formulary files for the period from July 1983 to December 1984. Annual inhalant costs for albuterol users were higher (+60.47) than for metaproterenol users (+47.66). However, the costs of additional asthma drugs and the total asthma drug costs were lower for the albuterol than metaproterenol users. Other asthma-related medical costs, including emergency-room and physician or clinic visits and days in hospital, were lower for the albuterol than metaproterenol users (+765 vs +1,135 per patient per year, P less than 0.05). These Michigan data were used to determine the costs in California. It was estimated that the addition of albuterol to the California Medicaid formulary would result in an annual per-patient saving of +3.46 in asthma medication and +521.33 in asthma-related medical costs.
The purpose of this study was to describe the characteristics of family physicians in Michigan who practice obstetrics and to identify important factors relating to a decision to discontinue obstetric practice. Questionnaires were mailed to all members of the Michigan Academy of Family Physicians (MAFP) who were listed as currently practicing obstetrics. Two hundred ninety-one questionnaires from the 357 mailed questionnaires were returned for a response rate of 81.5 percent. Two hundred thirty-five of the 291 respondents (80.8 percent) were practicing obstetrics in 1986. Twenty-two of the 235 physicians (9.4 percent) planned on discontinuing obstetric practice by early 1987. Reasons for discontinuing obstetrics included malpractice liability risk and cost and interference with lifestyle. Physicians who had recently discontinued or were planning to discontinue obstetric practice were significantly less likely than physicians practicing obstetrics to have a residency program affiliation (33 percent vs 58 percent). While malpractice concerns were found to be an important factor in deciding to discontinue the practice of obstetrics, practice arrangements and educational affiliations were other important factors that may be more amenable to change through educational or administrative interventions.
As part of an effort within Michigan to promote cost containment and equitably distribute hospital resources, the Acute Care Bed Need Methodology (ACBNM), a model for determining bed need based on normative use rates, was created. We describe herein the ACBNM, the associated interactive computer system, and the data base requirements, and make suggestions for improving the methodology. We also discuss the functions the ACBNM has served in Michigan and the role it could serve in future health planning efforts.
We analyzed a statewide telephone survey of Michigan adults to determine patterns of self-reported drinking and driving. The estimated prevalence of drinking and driving was 13.5 percent for men and 2.9 percent for women; the highest prevalence was among 18- to 24-year-old men (32 percent). Based on these estimates, over half a million Michigan adults drank and drove on over one million occasions during the month preceding the survey. Most drinking drivers (93 percent) reported binge drinking, yet 70 percent of them otherwise reported only moderate routine alcohol consumption, that is, they consumed fewer than 14 drinks a week on average. Because we were concerned about the validity of self-reports, we compared the patterns of self-reported alcohol use with the patterns of alcohol-related motor vehicle crashes. The pattern of self-reported drinking and driving (using age-, sex-, and region-specific estimates) was highly correlated with the pattern of injury in alcohol-related crashes (r = .96; p less than .0001). Self-reported patterns of alcohol use may be used to identify persons at highest risk for being injured or dying in a motor vehicle crash.
A survey among 1.12 million cattle slaughtered in 357 packing plants in Michigan during 1977 to 1981 was conducted to determine the prevalence of liver fluke infection. The condemnation rate of liver fluke-infected livers was 0.41, 3.7, and 13.9% in the southern, northern-lower, and upper regions of Michigan, respectively. The same trend in infection rates was observed in white-tailed deer that had been examined in diagnostic laboratories in the state. A serologic survey among 50 randomly selected dairy farms detected Fascioloides antibody-carrying cattle in 3 farms. The data on prevalence in slaughter cattle were slightly biased, because many slaughter cattle originated from other states in which F magna may be less common.
A syncytium-forming agent with reverse transcriptase activity was isolated in cell culture from materials collected from 19 Michigan goats and 1 goat recently imported from California. Syncytia formation could be maintained by subpassaging cells or filtered supernate from infected cultures with caprine fetal synovial membrane indicator cells. Electron microscopy by negative staining with ammonium molybdate revealed 100-nm retrovirus-like particles morphologically identified as caprine arthritis-encephalitis virus. The agent was recovered from synovial membrane explants, synovial fluid, colostrum cells, and peripheral blood mononuclear cells of clinically arthritic goats. Samples were collected from 9 Michigan goat herds, and virus was isolated from 7 of these herds.
Using discharge abstracts from Michigan hospitals, we divided the state into hospital use communities with measured populations. We constructed population-based rates measuring use, cost, and some aspects of quality. The results cover 54 communities comprising 90 percent of the Michigan population and ranging in size from Detroit (population 600,000) to very small (population less than 25,000) communities. Age-adjusted patient days per 1,000 population, length of stay, cost per person per year, hospitalization rates for surgery, trauma and vascular disease, and childbirth problems show large variations, generally ranging from 2 to 1. High values usually are positively associated with each other and with population size. Patient days per 1,000 (mean 1,114, range 600-1,700) and cost per person(mean +223, range +110-+290) are distributed such that almost 75 percent of communities are below the mean. We believe this information will be useful to community hospital trustees, physicians, and administrators.
Percentage distributions for variables in the Michigan Ambulatory Medical Care Survey (MAMCS), both for the Detroit Standard Metropolitan Statistical Area (SMSA) and the State as a whole, are compared with those from the National Ambulatory Medical Care Survey (NAMCS). The MAMCS data are a subset of the NAMCS data, since the MAMCS was carried out by augmenting the NAMCS in Michigan. Differences in the impact of survey results for the three areas are examined in the context of planning and developing ambulatory health care services. A specific application of survey data is examined, namely, its use in planning the Health Care Institute of Wayne State University and the Detroit Medical Center. The survey results for the three areas are similar enough to warrant the use of data from the national survey in the planning and evaluation of health services locally, although special studies of a few items such as X-ray usage may be needed. To reestablish local credibility for national results, or to detect changes in patterns which may develop, another Statelevel survey is suggested at the time of a census. Based on the experience with the MAMCS, augmentation of the NAMCS or other national surveys would be used in other States.
BACKGROUND: Five-hundred twenty-eight licensed, telescopic drivers in the state of Michigan, were sent a questionnaire consisting of 50 questions to evaluate the demographics, formal training procedures experienced by these drivers, and their driving habits. METHODS: One-hundred forty-nine responses were tabulated to determine the characteristics of the telescopic driver in the state of Michigan. RESULTS: The findings show an increased necessity for dynamic assessment, training and follow-up of the telescopic wearer and for referral to a specific driving program to establish safe driving skills. CONCLUSION: As the field of low vision expands in its delivery of care, and with improvement in technology, the desire for telescopic driver's licenses will increase. The need for dynamic training procedures delivered by the multidisciplinary rehabilitative team becomes even more vital to ensure safe driving skills and to protect the privilege to drive. Extensive training, followup and communication must be an integral part of this process.
National policies to reduce consumption of sugars to about half of their current levels have been suggested to reduce caries, an approach which assumes that caries experience is directly related to amounts of sugars consumed. This paper uses data from the Michigan diet study to question whether such policies would be effective. The Michigan study (1982-1985) collected detailed dietary information and caries incidence over a three-year period on 499 children aged 10-15 years at baseline. Results showed that caries incidence was poorly related to sugars intake, whether measured as total daily amount, between-meal intake, sugars as a proportion of total energy, or frequency of consumption. Boys had an average daily consumption of 156 g of sugars from all sources, girls 127 g. Mean caries incidence was 2.9 DMFS over the three years. When children were divided into quartiles by amounts of sugars consumed, those in the highest quartile, compared to the lowest, had a relative risk of 1.22 of developing caries. This relative risk rose to 1.80 for proximal lesions. The risks were similar when consumption was restricted to between-meal sugars. If consumption of sugars were to be cut to half that of present levels in this population, fat consumption would be likely to rise from its present level fo 38 per cent of total energy to around 47 per cent. National policies to restrict consumption of sugars might therefore be not only expensive and ineffective, but could damage the public health by inadvertently leading to higher consumption of fats.
A prospective study using the Michigan National Animal Health Monitoring System was conducted to determine factors that affect the incidence of metritis in Michigan dairy herds. Data on herd management, disease, and environmental risk factors were collected from a stratified random sample of 97 herds with 7,835 cows for 12 months. Linear and logistic regression models were developed to assess the association between metritis and factors at the herd and cow level. Significant factors included retained placenta, dystocia, routine post partum examinations, herd size, and parity. Implications on the interpretation and use of results from herd- and cow-based analyses are discussed.