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Medicaid expenditures in Oklahoma increased 98.2% from 1986 through 1991 while those of the United States went up 111.0%. Of this increase, 21.6% was due to inpatient care and 25.9% to nursing home care. With respect to beneficiaries, 34.9% of the increase was attributable to the aged and 31.4% to the disabled. AFDC recipients accounted for only 19.1% of the increase.
While major causes of traumatic spinal cord injuries have been described as motor vehicle crashes, falls, sports-related events, and injuries related to violence, causes of serious consequence but of lesser magnitude have not been widely reported. This report, drawn from Oklahoma State Department of Health spinal cord injury surveillance data, describes the incidence and circumstances surrounding hunting-related spinal cord injuries. All of the injuries resulted from falls from trees or tree stands. The incidence rate of injury was less than one per 100,000 licensed hunters. Half of the injuries resulted in neurological damage severe enough to result in permanent paralysis or death. The circumstances of the injuries suggest a need for educating hunters concerning safe hunting practices and safe tree stand use, including inspection of trees for weak or dead branches, and use of a safety belt when ascending, descending, or sitting in a tree or tree stand.
This article discusses the impact of Oklahoma's new patient referral law on leases between medical care providers. The statute appears to ban certain practices that could be quite common, so the article offers some advice on how to avoid running afoul of the statute.
The epidemiology of nosocomial infections was studied for 5 years in 10 Oklahoma hospitals. These were categorized into small and large hospitals. The seven small hospitals averaged 47 beds and the three large hospitals averaged 266 beds. Overall, most of the infected patients were < 5 years of > 60 years of age. Females accounted for the majority of the infections. In general, the three most common sites of infection were the urinary tract, surgical wounds, and the lower respiratory tract. Escherichia coli was the single most frequently identified agent followed by Staphylococcus aureus and Staphylococcus epidermidis. The most frequently reported risk factors among patients acquiring a nosocomial infection were the use of prior antibiotics, indwelling urinary catheters, and intravenous catheters or cut-down. The specific problems associated with nosocomial infections, such as sites of infection, risks of infection, and the types of organisms isolated, essentially had not changed much since the 1960s, the 1970s, and for most of the 1980s.
Farm-related injury is often cited as a major factor in rural health care. This is an attempt to obtain an estimate of the frequency of serious farm injuries in Oklahoma. It is apparent that current available data bases are not adequate to be definitive, but mortality data is available, albeit incomplete. One hundred thirty-two deaths were recorded on death certificates for 1987 through 1991, with falls accounting for nearly half. The other data are summarized, and a review of the farm injury literature is presented. In summary, it is clear that farm injuries are a significant problem and steps to prevent them are required.
In addition to clearly defined health risks that develop during pregnancy (e.g., toxemia and diabetes), pregnant women are at risk for physical violence inflicted by intimate partners. Although estimates in public and private health-care settings indicate that 4%-17% of women experience violence during pregnancy, population-based prevalence estimates of this problem have not been available. This report uses 1990 and 1991 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) in Alaska, Maine, Oklahoma, and West Virginia to assess the prevalence of physical violence against women during the 12 months preceding childbirth* and its relation to maternal characteristics.
In its short history, OSTAR has proven to be a fast, accurate tracking system for Schedule II prescriptions within Oklahoma. Information is available immediately in many cases and, having been entered into the system by the pharmacist, is very accurate. Approximately 50 percent of the information is being transmitted through electronic means at this time, and that percentage is increasing daily due to software companies making modifications to their pharmacy programs. System deficiencies have proven to be minimal, even less than anticipated. Efforts are still underway to ensure that data is received in a uniform manner; i.e., some data systems include zeroes at the end of the patient number, which causes investigators to have to query in more than one form. These pharmacies and companies are currently being notified and are making the necessary changes. The technical problems usually encountered with a new system have been limited, and data has been useful from the first month of the program. Feedback from impaired physicians has indicated they would not have been so free to divert Schedule II substances through prescriptions if this system had been in place. OBN has active cases involving a large number of physician scammers that are a direct result of OSTAR and it has enhanced cases on at least one physician and provided valuable information for search warrants. Agents are able to make better cases for prosecutors while completing investigations in much shorter periods of time. Local law enforcement personnel who have accessed OSTAR have become convinced that it is a most effective tool, and use of the system has complemented their investigations.(ABSTRACT TRUNCATED AT 250 WORDS)
This study estimates the extent of work-related chronic disease fatalities in Oklahoma. Occupational cancer, pneumoconiosis, and chronic respiratory, cardiovascular, renal, and neurological diseases are addressed specifically. Also, the costs of chronic occupational illness are estimated. Because many cases of work-related disease find their way to the primary care physician, an individual who often has little formal training in the recognition and diagnosis of occupational or environmental illness, the education of primary care physicians and medical students in occupational disease recognition and prevention is encouraged.
BACKGROUND AND OBJECTIVES: Ischemic stroke represents the third leading cause of death and the most common cause of permanent disability in the United States. Carotid endarterectomy has been widely utilized as a procedure to reduce the risk of stroke and represents the most commonly performed peripheral arterial surgery. This cooperative project was initiated to assess the appropriateness of carotid endarterectomies performed on Medicare beneficiaries and the postoperative outcomes (mortality and stroke) in these patients. METHODS: Retrospective review was performed on the inpatient medical records of 774 patients who underwent 813 carotid endarterectomy procedures in eight hospitals during calendar years 1993 and 1994. Medicare claims data were also analyzed for all carotid endarterectomies performed in Oklahoma during calendar years 1992 through 1995. RESULTS: A history of transient ischemic attack or stroke in the distribution of the operated carotid artery was documented in 57% of the cases. The majority of patients had preoperative ultrasound imaging of the carotid arteries and a preoperative angiogram was performed before 96% of the procedures. Accepted indications for the surgery were documented for 98% of the procedures. Stroke or death within 30 days of the date of the carotid endarterectomy occurred after 4.9% (0-8.8% by hospital) of the procedures. CONCLUSIONS: This project demonstrated considerable variation between hospitals in the outcomes of patients undergoing carotid endarterectomy and the potential for improved care of patients with regard to discharge planning, education, and use of anticoagulant or antiplatelet medications postoperatively.
In 1992, traumatic brain injuries (TBIs) accounted for 34% of all injury deaths in the United States. To provide current estimates of TBI-associated morbidity and deaths, CDC has developed guidelines for public health agencies to use for TBI surveillance. This report describes recent findings from Colorado, Missouri, Oklahoma, and Utah based on these guidelines. These findings indicate a decrease in the annual rate of TBI and that rates of TBI are highest in association with falls and motor-vehicle crashes.
During October 1995-June 1996, CDC and state and local public health agencies investigated outbreaks of pneumococcal pneumonia with bacteremia at chronic-care facilities (CCFs) serving predominantly elderly populations in Massachusetts, Oklahoma, and Maryland. This report summarizes these investigations and identifies measures that may prevent such outbreaks.
The Oklahoma City bombing experience in April of 1995 provided a unique opportunity to test the effectiveness of an existing disaster plan. The critical care nurses at Columbia Presbyterian Hospital learned valuable lessons about managing intense activity, equipment and supplies, staffing resources, and visitor issues. The degree to which the bombing affected the emotional state of personnel was unanticipated, and leaders learned that critical stress management interventions should be included in every emergency preparedness plan. Additionally, recommendations include using runners for communication; assigning specific roles (supplies, staffing, triage); keeping additional staff in reserve for shift relief; ensuring ample hospital staff members are available to coordinate visitors and media; and setting up record systems to preserve continuity. The unique lessons learned as a result of this terrorist attack can be used by other critical care nurses to understand and refine disaster plans.
Three isolations of swine influenca virus were made from 2 swine herds in west-central Oklahoma. Many swine in these herds had signs of respiratory tract disease, and in 1 herd, some affected animals also had diarrhea. Two isolations were made in swine testicle cell line and 1 in embryonating chicken eggs. All 3 strains were cytopathogenic for swine testicle cells.
Anecdotal evidence for an increased incidence of non-Hodgkin's lymphoma (NHL) had been informally discussed within several clinical practices in north central Oklahoma. This study was conducted to determine the incidence rates of NHL in Garfield and Kingfisher counties and to evaluate whether these counties represented unique cancer clusters. Data were collected from medical records and tumor registries in 22 area hospitals between 1990-1994. The annual incidence rate per 100,000 persons for Garfield county was 15.51 (95% CI: 10.9-20.1), and for Kingfisher county, 24.22 (95% CI: 12.4-36.1). Both of these rates are increased from the national incidence rate of 13.7 cases of NHL per 100,000 persons, suggesting a significant clinical impact. However, a statistical significance was not detected given the conservative methodology and the small populations involved. The difficulties of performing community-based research, the need for epidemiological studies to reduce clinical experience bias, and the need for centralized cancer data management are discussed.
The Indian Health Service has been providing dental services to American Indians in Oklahoma for more than 40 years. The dental program is part of an integrated health care delivery system that is one of the oldest examples of a staff model Health Maintenance Organization (HMO).
From September 1982 to August 1997, 767 bone marrow or peripheral blood stem cell transplants have been performed at the Health Sciences Center in Oklahoma. Five hundred and two (502) autologous transplants (AutoTX) preceded by high-dose myeloablative therapy were performed for breast cancer (BC, 36%), non-Hodgkin's lymphomas (NHL, 24%), Hodgkin's disease (HD, 10%), acute myeloid leukemia (AML, 8%), testicular cancer (TC, 4%), multiple myeloma (MM, 2%) and other malignancies (16%). Two hundred and sixty-five (265) allogeneic marrow transplants (AlloTX) (related, unrelated) were carried out in chronic myeloid leukemia (CML, 30%), AML (23%), acute lymphoid leukemia (ALL, 14%), myelodysplastic syndrome (MDS, 9%), severe aplastic anemia (SAA, 8%), and other diseases (14%). Compared between 1980s to 1990s, 100-day mortality rates have decreased from 28% to 5% for AutoTX and from 40% to 25% for AlloTX. In the AutoTX setting, major changes included the routine use of growth factors post-transplant and the switch from bone marrow to growth factor-mobilized peripheral blood as a source of stem cells over the last five years. In the AlloTX setting, improvements in recognition and control of cytomegalovirus and Candida organisms, the selective use of growth factors and screened blood products, and better selection of unrelated donors using DNA-based techniques of HLA-matching have contributed to reduce early mortality from infection and primary graft failure. The five-year survival outcomes are comparable to those reported in registry data from the International Bone Marrow Transplant Registry (IBMTR) and the National Marrow Donor Program (NMDP).
The Oklahoma Premorbid Intelligence Estimate-3 (OPIE-3) combines Wechsler Adult Intelligence Scale-3rd edition (WAIS-III) subtest raw scores (vocabulary, information, matrix reasoning, and picture completion) and demographic data (i.e., age, education, gender, ethnicity, and region) to predict FSIQ scores. Differences between OPIE-3 estimated FSIQ scores and actual FSIQ scores were compared across 13 age groups in a random sample (N=1201) of the WAIS-III standardization sample. There were mean differences in estimated FSIQ between age groups (P<.01). There was a trend that the OPIE-3 algorithms underestimated FSIQ for individuals 16-17 (2.7 points) and 80-89 years old (3.5 points). However, the differences in estimation errors were small and the percentage of individuals misclassified by more than 10 FSIQ points by age group was similar across groups. The OPIE-3(2ST), OPIE-3MR, and OPIE-3VOC yielded robust estimates of FSIQ across age groups in a neurologically intact sample. Limitations, particularly with individuals aged 16-17 and 85-89 years, are discussed.
Tumors involving the clavicle by primary or metastatic growth may require clavicular resection often with rib resection. The resulting cosmetic and functional impairment of clavicular resection may be significant with a sloped appearing shoulder girdle and chronically impaired movement of the upper extremity. We report a 48-year-old woman presenting with a bulky metastatic renal cell mass of her left clavicle extending to the chest wall. We report en-bloc clavilculectomy and chest wall resection with a novel method of reconstruction using a single methyl methacrylate and prolene composite prosthesis in a configuration resembling the state of Oklahoma.