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PubMed1978

A social systems model of nursing home use.

Causal modeling (path analysis) was applied to data from the 39 mental health catchment areas of Massachusetts to analyze the effects of sociocultural and health-resource variables on long-term-care utilization. The variables chosen explained 53 percent of the variance of long-term-care use by persons 60 and older: 41 percent was explained by the sociocultural variables and 12 percent by the health-resource variables. With data adjusted for age, the major determinant of long-term-care use was ethnicity: less long-term care was used in areas with more persons who were foreign-born or had a foreign-born parent. The effects of other health resources (supply of primary care physicians and use of mental and general (short-term) hospitals) were small and negative.

Aged↗
PubMed1979

[Report on a computer based evaluation of 1,800 cases of abortion].

1800 cases with interruption of pregnancy are subjected to a computer analysis by means of a data-adjusted medical record for patients with interruption of pregnancy, which is in use in our hospital since 1975. The age distribution reveals a frequency peak between the ages of 35 and 38 years. The striving for a 2-children family is evident. Operating complications occurred in 1.1 per cent of the cases only, 0.4 per cent were perforationes and 0.7 per cent were lacerations of the cervix. This is due to the general application of the vacuum aspiration and the preferred performance of the operations up to the 10th gestational week. The great significance of the application of effective contraceptives is emphasized, since 48 per cent of the women had renounced contraceptives without any reason. Over 40 per cent of the women had employed contraceptives previously, but later on they had abandoned such means, 20 per cent of these women without a special cause. The physician's responsibility for the education of the women is stressed.

Abortion, Induced↗
PubMed1983

Influence of dietary fat on spontaneous lesions of Syrian golden hamsters.

Dietary corn oil was consumed by Syrian golden hamsters at levels of 4.5 g [low fat (LF)] or 18 g [high fat (HF)]/385 kilocalories (kcal) from 3 to 7 weeks of age followed by a diet containing 9 g [medium fat (MF)]/385 kcal for life. In other groups MF diet was given from 3 to 7 weeks of age and followed by either LF or HF for life. A separate group was fed MF continuously after 3 weeks of age. Spontaneous lesions, which were altered by these dietary protocols, are reported. An HF diet fed after 8 weeks increased the incidence of flank organ hyperplasia and prostatitis, but it decreased prostatic fibrosis in males. Consumption of HF diets after 8 weeks by females increased survival and resulted in an elevated incidence of thyroid adenomas, ovarian cell hyperplasia, vaginal papillomas, and adrenal cortical cell adenomas. In age-adjusted data the increase in ovarian cell hyperplasia and adrenal cortical cell adenomas was shown to be due to HF diet and not to be a consequence of extended survival. Periodontitis and calcification of cardiac tissues decreased in hamsters fed HF diets after 8 weeks, but cell vacuolization and hyperplasia of the anterior pituitary gland and epithelial hyperplasia in the forestomach were increased. Salivary gland adenocarcinomas were observed only in hamsters fed HF diets. Feeding HF levels, either during weeks 3-7 or after week 8, decreased osteofibrosis and otitis media and increased urinary bladder epithelial hyperplasia, adrenal cortical cell lipomatosis, and bone chondrosis. Calcification of gastric and renal arteries decreased as dietary fat levels increased either before or after 8 weeks of age in males and only when fed after 8 weeks in females. Colitis and focal glandular hyperplasia of the colon mucosa were increased in both sexes by an HF diet being given before or after 8 weeks of age.

Animals↗
PubMed1995

Reducing health care delivery costs using clinical paths: a case study on improving hospital profitability.

The process of merging and benchmarking clinical and financial data is pivotal to the development of appropriate clinical pathways. Bristol Regional Medical Center (BRMC), facing the challenge of managed care organizations (MCOs), instituted this process and achieved significant cost savings, largely because of the working partnership between the administration and its medical staff. In DRG 89, Simple Pneumonia and Pleurisy, Age Greater than 17 with CC, data adjusted for severity of illness and cost of living were furnished to BRMC by HCIA Inc. Major benchmark or "best practice" variations were incorporated into new clinical pathways, leading to decreased resource use, no compromise in the quality of care, and a beneficial halo effect on other unrelated DRGs.

Decision Support Systems, Management↗
PubMed1994

Deriving passage difficulties for a tracking study via the Cloze technique.

The current report demonstrates the importance of formally accounting for passage difficulty when using the tracking procedure. Cloze responses to 82 encyclopedia excerpts (343-349 words each) were obtained from a large pool of normal-hearing adults and scored verbatim. Passage difficulty, derived via ANOVA, was then defined as the deviation of a passage's mean Cloze score from the score for all passages, corrected for differences among respondents. The passage difficulties were applied in an alternating conditions tracking experiment with one adult cochlear implant user. Conditions included conventional auditory-visual and auditory-only tracking and experimental mode-switching techniques in which the talker changed modalities during the correction phase. An ANCOVA of the word-per-minute scores was conducted, with passage difficulty as a covariate and passage adjustment values as the output. Tracking rates and percentage of words correct from the beginning and end of training were examined. Use of adjusted data reversed the interpretation of performance change, demonstrating the need for determining passage difficulties a priori.

Audiometry↗
PubMed1993

Consumption and harm: drinking patterns of the Irish, the English and the Irish in England.

There has been controversy over the relationship between alcohol consumption and related problems amongst the Irish in England. Irish migrants have high Standardised Mortality Ratios for chronic liver disease and cirrhosis and high hospital admission rates for alcohol-related diagnoses in England. Yet it has been considered that people from the Republic of Ireland, whether living in Ireland (Conniffe et al., 1990) or in England (Pearson et al., 1991), actually drink less than the English. This paper reviews the evidence. In recent years Irish per capita volume alcohol consumption has been comparable to that of the U.K., although the distribution of consumption differs. Women in Ireland are less likely to drink than women in England and Wales, while men in Ireland are more likely to drink at high-risk levels than men in England and Wales: their average weekly consumption levels are closer to those of high-consuming men in Yorkshire and Humberside, who also drink more than the U.K. national average. Men in Ireland also appear to be more likely to experience drinking problems than their counterparts in England and Wales, although this may be related to factors other than the total amount of alcohol consumed. Although a previous study of General Household Survey data indicated low-risk alcohol consumption levels for people from the Irish Republic living in Britain, a reanalysis of these data adjusting for age and gender shows drinking rates that are very high.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Childhood blindness: a new form for recording causes of visual loss in children.

The new standardized form for recording the causes of visual loss in children is accompanied by coding instructions and by a database for statistical analysis. The aim is to record the causes of childhood visual loss, with an emphasis on preventable and treatable causes, so that appropriate control measures can be planned. With this standardized methodology, it will be possible to monitor the changing patterns of childhood blindness over a period of time in response to changes in health care services, specific interventions, and socioeconomic development.

Abstracting and Indexing↗
PubMed1993

[Symptomatic sinus dysfunction. A new use of electrophysiology].

The authors undertook a prospective electrophysiological study of 950 patients: 53 subjects considered to be "controls" since they were free of any history of syncope or faintness were identified, as well as 39 symptomatic subjects with a strong suspicion of sinus dysfunction, since no other detectable cause of fainting episodes was found by extracardiac investigation, 24 hour ECG nor electrophysiology. Following the creation of a computerised tool enabling not only the entry of indirect tests, processing, averaging of results, printing and memorization, but also assistance in interpretation, several electrophysiological parameters were used: heart rate and existence of sinus arrhythmia, Strauss tests with adjusted data or not, effective nodal refractory period, Guize, Narula and Mandel tests, and an atropine (0.03 mg/kg) test which was performed only in the symptomatic group. These tests were studied by single-variate and correlative analysis to define their normal ranges, their critical values and their dependence or independence. The performance of each test (i.e. its efficiency, and the specificity and sensitivity of each critical value) was measured. Tests found to be most useful (specificity and efficiency > 90%) were as follows: Mandel test = CSRT > or = 534 ms, Narula test = TECASA > or = 339 ms, heart rate < or = 55/min, type II, IIa and chaotic Strauss curve associated with a pathological Guize test. The combination of these tests in this algorithm resulted in an increase in sensitivity to 84%, at the price of a very moderate fall in specificity to 87%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Nonlinear statistical models for the joint action of toxins.

A general approach using nonlinear regression models is presented for evaluating additivity, synergism, and antagonism of mixtures of toxins for proportions and ratio-scale response measures. This approach provides several advantages over the analysis methods typically used, which involve linear regression with logits or probits. A single model fit is performed, rather than a multistep procedure. Nonadditive alternative models can be easily constructed and tested against the appropriate additive models. The approach avoids the use of data "adjustments" for nonzero background response rates. The analyses are performed in the natural response metric, making interpretation straightforward. Also, the nonlinear regression model can be reparameterized to provide more meaningful primary parameters.

Animals↗
PubMed1993

[Detectability of pulmonary coin lesions: a comparative assessment of the image quality of a storage phosphor system and a conventional film screen system].

The object of this study was to compare the prototype of a storage phosphor digital radiography system (Siemens) which allows postprocessing image data adjustment with the stored information, with an optimised conventional film system with respect of image quality and diagnostic accuracy. The test objects were pulmonary coin lesions as the search for primary or secondary lung tumours is one of the most frequent clinical requests and the detectability of coin lesions depends very much on their relative contrast against the surrounding area. In order to achieve reproducible results, an anthropomorphic lung phantom was used. Besides the conventional film radiograms the unprocessed digital radiograms and twelve series with variations of the processing parameters were evaluated. To achieve a homogeneous radiation image an anatomically shaped lead-loaded acrylic glass compensation filter was used. With regard to the true-positive demonstration of coin lesions there were no significant differences between the chosen film system and all digital radiograms. Image processing had no recognisable influence on the demonstration of the findings. Coin lesions of 3 mm diameter were detected only by chance; the detectability of lesions of 5 mm and 10 mm in diameter respectively depended mainly on their localisation. Lesions of 15 mm diameter were detected independent of their localisation. The results indicate that the storage phosphorus radiography system is already comparable to an optimised conventional film system concerning the conspicuity of coin lesions. If the image is homogenised by means of an anatomically shaped lead-loaded acrylic glass compensation filter, selective postprocessing adjustment of the digital radiograms for the evaluation of the mediastinum or the lung parenchyma is unnecessary.

Humans↗
PubMed1995

Prophylactic oophorectomy in inherited breast/ovarian cancer families.

Prophylactic oophorectomy is chosen by some women at high risk of ovarian cancer due to inherited predisposition. Unfortunately, this surgery is not 100% effective in preventing intra-abdominal carcinomatosis that histologically resembles ovarian cancer. To determine the incidence of post-oophorectomy carcinomatosis and to quantify the effectiveness of preventive surgery, a multicenter study is ongoing between the National Cancer Institute (NCI), Creighton University, and the United Kingdom. The prospective incidence of malignancy, especially of tissues derived from coelomic epithelium (primarily ovary, fallopian tube, and peritoneum), was compared between women of similar genetic risk who have or have not undergone oophorectomy. Analysis of 12 NCI families has been completed. Prospective observation ran from the date of family ascertainment until the date of cancer incidence, death, or December 31, 1992. Approximately 1600 person-years of observation occurred among 346 first-degree relatives of a breast or ovarian cancer case patient for women who had not undergone oophorectomy. Eight ovarian cancers occurred, compared with two carcinomatosis cases during 460 person-years of observation among 44 oophorectomized women. Compared with Connecticut Tumor Registry data adjusted for age, race, and birth cohort, there was an approximately 24-fold excess of ovarian cancer among non-oophorectomized women and a 13-fold excess of "ovarian" cancer among oophorectomized women, though this difference was not statistically significant. The confidence intervals around these numbers were large, and a collaborative analysis will be required to determine whether this apparent protective effect is real.

Breast Neoplasms↗
PubMed1977

Vaginal temperature rhythms in sheep.

Six ovariectomized adult sheep were tethered in a temperature--and light--controlled room and given feed and water ad lib. Vaginal temperatures were recorded at 10m intervals for 12 or 17d. Hourly means were calculated and subjected to statistical anlayses by time--series procedures. Initial analysis revealed a positive linear trend in most animals suggesting a low frequency rhythm with a period greater than the 17d experimental period. All subsequent analyses were, therefore, conducted on data adjusted for a linear trend. The periodogram, correlogram and spectral density analyses revealed a predominant circadian rhythm in 5 of the 6 animals. Ultradian rhythms, with periods of 12 and 8h, were also present in some animals. The magnitude of the rhythmic change in vaginal temperature, as estimated from the amplitude of the circadian component, varied from 0.05 degrees to 0.16 degrees C. Calculation of the external acrophase indicated that the daily maximum temperature occurred between 0851 and 1727.

Animals↗
PubMedDate not supplied

Predictors of nutritional supplement use by the elderly.

We conducted a population survey to describe patterns and determine predictors of the use of nutritional supplements and single-ingredient vitamins and minerals among elderly living in five adjacent urban and rural counties in the Piedmont area of North Carolina. The stratified random sample consisted of 3939 black and white participants age 65 or older from the Duke Established Populations for Epidemiologic Studies of the Elderly. The use of nutritional supplements within the previous 2 weeks was determined during an in-home interview. Multivariate analyses, using weighted data adjusted for sampling design, were conducted to assess the association between nutritional supplement use and predisposing, need, and enabling factors. Nutritional supplement use was reported by 26.2% of participants and was more likely for those who were white women, were high school educated, were underweight, took prescription drugs, had five or more health visits in the previous year, and had supplemental health insurance. It was less likely for those with poor self-rated health. The majority (71.5%) of nutritional supplement users took at least one single-ingredient supplement. Use of such products was more likely in those who were white, born and raised in an urban area, and high school educated, and was less likely in those with impaired functional status. Nutritional supplement use is prevalent in community-dwelling elderly and is more commonly associated with demographic factors and access to health care than with need factors.

Aged↗
PubMedDate not supplied

Clinical pathway for pneumonia: development, implementation, and initial experience.

BACKGROUND: As part of a large multidisciplinary project to reduce cost, decrease hospital length of stay, and improve efficiency of patient care at Saint Mary's Hospital, a clinical pathway for pneumonia was developed and implemented. METHODS: After using analysis of severity-adjusted data to determine which conditions would be best targets for improvement, a utilization management steering committee created a multidisciplinary group to develop a clinical pathway for pneumonia. This group was led by physician champions and consisted of representatives from nursing, respiratory therapy, pharmacy, and home healthcare. With information gained from chart abstraction, which identified "best practice" patterns, guidance from the medical literature, and local expertise, this group developed a clinical pathway that included an auxiliary protocol for respiratory care and a detailed educational brochure for patients. Before implementing the clinical pathway, extensive educational activities were undertaken involving the medical staff, house staff, nurses, and other staff. Data collected on consecutive patients discharged after implementation of the pathway were compared with data collected on patients discharged before the pathway in 1994. RESULTS: For DRG 89, the patients who were on the pathway in comparison to the control patients from 1994 had a lower average length of stay by 1.45 days (5.84 vs. 7.29 days) and a lower average total charge by $1,453 ($9,511 vs. $10,964). For DRG 90, the patients who were on the pathway in comparison to the control patients from 1994 had a lower average length of stay by 1.83 days (3.45 vs. 5.28 days) and a lower average total charge by $1319 ($5450 vs. $6769). CONCLUSIONS: The pneumonia clinical pathway that was implemented was associated with reductions in the length of stay and total charges. These reductions were seen in relationship to historical controls and to patients cared for concurrently who were not placed on the pathway. Although not fully used on all pneumonia patients, the presence of the pathway probably had some positive effects even on patients not formally on the pathway, through systems changes and educational influences. The pathway also positively influenced other conditions by the use of ancillary algorithms for conditions other than pneumonia, and the more rapid administration of antibiotics for other infectious diseases. Also, lessons learned in the creation of this first pathway have been helpful in streamlining the process of future pathway development.

Connecticut↗
PubMed1998

[Clostridium difficile outbreak in surgical wards].

OBJECTIVE: To evaluate the clinical consequences of a hospital outbreak of Clostridium difficile infections in the Netherlands. DESIGN: Descriptive. SETTING: Diakonessen Hospital Utrecht, the Netherlands. METHODS: In the period from 1 August 1995 to 1 September 1996 C. difficile infections were recorded (gastrointestinal symptoms after use of antibiotics and findings at C. difficile toxin assay in faeces, or sigmoidoscopy). The monthly incidence of infections increased to 5 patients in December 1995; at that time strict hygienic measures were implemented and perioperative antimicrobial prophylaxis was adjusted. Data on the clinical course were collected retrospectively from the records of the patients involved. RESULTS: In 20 patients, admitted for various reasons to the surgical wards, hospital stay was complicated by a C. difficile infection. The mean age was 70 years. Eleven patients presented with diarrhoea, eight patients had nausea and vomiting as well. Diagnosis was confirmed by C. difficile toxin determination in most patients (n = 15). Despite antibiotic treatment in 19 patients, recurrences were seen in five patients (25%) and five patients died (25%). The monthly incidence declined to 0-1 per month. CONCLUSION: C. difficile infections in surgical patients carry a significant morbidity and mortality. Preventive hygienic measures are important to control spread of the infection.

Aged↗
PubMed1985

The use of comparability ratios to adjust hospital trend data.

Hospital trend data may be affected by changes in diagnostic coding schemes. We studied the change from ICDA-8 (I-8) to ICD-9-CM (I-9) in a sample of roughly 13,600 double-coded Veterans Administration hospital diagnoses. Comparability ratios were computed and used to adjust trend data which overlap the time period when the shift from I-8 to I-9 occurred. With this adjustment for change in diagnostic coding scheme, apparent diagnostic trends are substantially altered.

Diagnosis↗
PubMed2005

Use of administrative data to risk adjust amputation rates in a national cohort of medicare-enrolled veterans with diabetes.

BACKGROUND: A reduction in diabetes-related lower extremity amputations is a national health care priority. OBJECTIVE: To develop a risk adjustment model for total amputation rates, using claims data. RESEARCH DESIGN: A retrospective longitudinal cohort analysis of veteran clinical users of the Veterans Health Administration (VHA)--Veterans with diabetes who were Medicare nonhealth maintenance organization enrolled in 1997 or 1998. Baseline risks ascertained in 1997 to 1998 were used to adjust Veterans Integrated Service Networks (VISN) amputation rates in 1999. MEASURES: Individual-level amputation outcome in VHA and private hospitals in 1999; VISN-level amputation rates adjusted for age, gender, race, foot risk factors, and macro- and microvascular complications; and rankings of 22 VISNs on amputation rates. RESULTS: A total of 218,528 patients incurred 3077 (14.1 per 1000) amputations in 1999, with 10.6 to 18.0 amputations per 1000 across 22 VISNs. Age, gender, race, prior amputation, infections, ulcers, peripheral vascular disease, and vascular complications were significant independent predictors of amputation (R = 0.20); demographic variables accounted for < 1% of the variance. The C statistic of the final model was 0.83. VISN rankings using age-, gender-, and race-adjusted rates were not substantially altered compared with rankings using the full risk-adjusted model (Spearman rank correlation, 0.85). CONCLUSION: Addition of foot risk and comorbidity variables increased the discrimination of a predictive model for total amputations in an elderly, largely male population of veterans with diabetes compared with use of demographic data alone. The authors suggest that this model be validated in other settings with availability of individual-level claims data.

Age Distribution↗
PubMed2002

Outpatient encounter data for risk adjustment--a view from Europe: comments on Welch.

This article comments from a European perspective on W. Pete Welch's article, which examines the use of outpatient encounter data for risk adjustment. Although diverse, Western European health care systems all seek to provide a comprehensive package of care, financed by premiums unrelated to health status. Some form of risk adjustment is therefore required as a basis for funding insurers in all systems. Two objectives have dominated: to secure equity between patients covered by different insurers and to ensure that (where implemented) competitive insurer markets operate efficiently. The commentary concludes that, although risk adjustment research of this type is important, the most fundamental requirement is to develop a more active purchasing function on the part of insurers.

Ambulatory Care↗