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PubMedDate not supplied

The effects of a cost-education program on hospital charges.

An educational intervention designed to change physicians' use of inpatient services was implemented on two general medical services for a year. The intervention consisted of a brief orientation to cost containment issues, a pamphlet that outlined practical cost containment strategies and listed the charges for commonly ordered tests and services, and access to detailed interim patients' bills generated during the hospitalization. Two concurrent control services received no intervention. Over 1,600 admissions were evaluated. The geometric mean length of stay was 0.61 days shorter on intervention services compared with control (5.15 vs. 5.76 days, p less than 0.01). The geometric mean hospital charges were $388 less for intervention patients ($3,199 vs. $3,587, p less than 0.005). Neither patients' demographic characteristics nor case mix could explain the reductions. The authors conclude that a simple program utilizing information already in existence in most hospitals can result in a significant and meaningful reduction in length of stay and charges.

Cost Control↗
PubMedDate not supplied

The effects of a low-cost intervention program on hospital costs.

OBJECTIVE: To assess the impact of a low-cost education and feedback intervention designed to change physicians' utilization behavior on general medicine services. DESIGN: Prospective, nonequivalent control group study of 1,432 admissions on four general medicine services over 12 months. Two services were randomly selected to receive the intervention. The other two served as controls. Admissions alternated between control and intervention services each day. Results were casemix-adjusted using diagnosis-related groups (DRGs). Three internists blinded to patient study group assignment assessed quality of care using a structured implicit instrument. SETTING: Four general medicine services at a university hospital. INTERVENTIONS: A brief orientation, a pamphlet of cost strategies and common charges, detailed interim bills, and information about projected length of stay and usual hospital reimbursement for each patient. PATIENTS/PARTICIPANTS: Each service was staffed by a full-time internal medicine faculty member, one third-year and two first-year internal medicine houseofficers, three medical students, and a clinical pharmacist. Physicians were assigned to services for one-month periods by a physician unaware of the study design. To prevent crossover, houseofficers assigned to a service returned to the same service for all subsequent general medical inpatient assignments. MEASUREMENTS AND MAIN RESULTS: Geometric mean length of stay was 0.44 days (7.8%) shorter for the intervention services than for the control services (p less than 0.01), and geometric mean charges were $341 (7.1%) less (p less than 0.01). Effects persisted despite using a more precise cost estimate or casemix adjustment. Intervention houseofficers demonstrated superior cost-related attitudes but no difference in knowledge of charges. Audits of quality of care detected no significant difference between groups. CONCLUSION: This low-intensity intervention reduced length of stay and charges, even under the cost-constrained context of the prospective payment system.

Cost Control↗
PubMed1996

Strategies to promote the use of advance directives in a residency outpatient practice.

OBJECTIVE: To evaluate patient education and resident education strategies to promote advance directives in the outpatient setting, and to assess barriers to implementation. DESIGN: Controlled clinical trial. SETTING: The internal medicine residents' practice of an urban, university medical center. PATIENTS/PARTICIPANTS: Medical residents and 250 patients seen at least twice in the 3 months prior to the study. INTERVENTIONS: We randomized practice days: one to patient education, one to resident education, and three controls. Resident education consisted of a lecture, a videotape of a model advance directives discussion, and videotaping of an actual discussion by each resident, followed by individual review. Patient education consisted of distributing pamphlets in the waiting room and offering all patients an opportunity to discuss advance directives. MEASUREMENTS AND MAIN RESULTS: We interviewed 187 of these patients (response rate 75%) and surveyed 62 residents (response rate 70%). After 18 months, there were no significant differences in the number of advance directives in charts among the three groups. Documented advance directives discussions with patients in the resident education group increased from 3% to 17% (p < .001), more than those in the patient education (5%) or control group (10%, p = .04). Residents in the resident education group were more likely to report discussing advance directives than those in the patient education or control groups (p = .05). Lack of time (95%) and lack of continuity (76%) were the most frequently cited barriers. In multivariate logistic regression, nonwhite race and non-U.S. birth were negatively associated with patient interest in advance directives. Patient race and birthplace were not associated with actual discussions of advance directives. CONCLUSIONS: Even with intensive efforts to educate outpatients and residents about advance directives, important barriers remain, raising questions about how best to promote advance directives among outpatients.

Adolescent↗
PubMed1996

Practice guidelines. What are internists looking for?

To determine features of the presentation of clinical practice guidelines that may enhance their use by internists, we conducted a cross-sectional survey to which 1,513 (60%) of 2,513 eligible internists responded. Endorsements by respected colleagues and by major organizations were identified as very important by 72% and 69% of respondents, respectively. Respondents preferred short pamphlets and manuals summarizing a number of guidelines and felt that concise recommendations (86%), synopsis of supporting evidence (85%), and quantification of benefit (77%) were important in guideline presentation. We conclude that guideline developers should gain the endorsement of major organizations and present key aspects in brief, easily assimilated formats.

Attitude of Health Personnel↗
PubMed1990

The adult patient's difficulties with inhalers.

Fifty percent or less of adult patients can be expected to be able to use the conventional metered dose inhaler (MDI) efficiently if the only tuition they receive is the manufacturer's instruction pamphlet and a high proportion of patients should be expected to develop a poor inhalation technique unless their ability to use an MDI is checked regularly. Because of these problems I believe that the future of the conventional MDI is limited. The new generation of inhalation devices have exciting design features and are undoubtedly better than established inhalation systems in that they are as effective and much easier to use. When these new devices are all available for the delivery of bronchodilators and corticosteroids there is no doubt that many patients will benefit. They should be prescribed in preference to the MDI for all patients whose ability to use a conventional pressurized inhaler is not routinely assessed prior to the institution of therapy and at regular intervals thereafter.

Adult↗
PubMed1999

One size does not fit all: the case for tailoring print materials.

Printed health education materials frequently consist of mass-produced brochures, booklets, or pamphlets designed for a general population audience. Although this one-size-fits-all approach might be appropriate under certain circumstances and even produce small changes at relatively modest costs, it cannot address the unique needs, interests, and concerns of different individuals. With the advent and dissemination of new communication technologies, our ability to collect information from individuals and provide feedback tailored to the specific information collected is not only possible, but practical. The purpose of this article is to: (a) distinguish between tailored print communication and other common communication-based approaches to health education and behavior change; (b) present a theoretical and public health rationale for tailoring health information; and (c) describe the steps involved in creating and delivering tailored print communication programs. Studies suggest computer tailoring is a promising strategy for health education and behavior change. Practitioners and researchers should understand the approach and consider the possibilities it presents for enhancing their work in disease prevention.

Algorithms↗
PubMedDate not supplied

Wolfe Tone's death: suicide or assassination?

The final events of Wolfe Tone's short and stormy life are fairly common knowledge. He was captured on board the French flagship Hoche when the vessel surrendered to a superior British naval force off Lough Swilly on October 10, 1798. Despite his protests that he was entitled to normal prisoner-of-war treatment, he was brought in irons a month later to Dublin. A court martial was hurriedly convened and he was found guilty of treason on Saturday November 10 and condemned to be hanged two days latter. According to the generally accepted version of subsequent events he cut his own throat early on the Monday morning. The assistant surgeon of the 5th Dragoon Guards dressed the wound "-but only with a view to prolong life until the fatal hour of one o'clock". This surgeon was Benjamin Lentaigne, a Royalist emigre from France. Despite the pleas of John Philpott Curran, a leading advocate of the day, the military authorities refused to allow any consultation with a civil surgeon. Was this just bloody mindedness or was there an even more sinister reason? Two possibilities come to mind. One was that the wound had been so incompetently treated that a consultant would have been forced to make adverse comments, the other that the throat wound was not due to a cutting injury but, to a bullet fired either deliberately or accidently and a knife or razor was then used to try and camouflage the original trauma. In 1812 Lentaigne published a pamphlet in Latin in which he made reference to an unusual neck would stating that "-the bullet passed through his throat...." There is no direct evidence that the victim was Tone, why did the writer not make this clear? It may be he was reluctant to expose the medico-military inefficiency or callousness or to jeopardise his son's career. Whatever the true facts, the verdict must remain the Scots one of "Not proven".

Famous Persons↗
PubMed2004

[On the 150th birthday of Paul Julius Möbius (1853-1907)].

In memory of Paul Julius Möbius (1853-1907) on the occasion of his 150th birthday Among his profession Leipzig neurologist and psychiatrist Paul Julius Möbius made a name for himself by clinical studies on singular neurological topics. Several of these contributions have been acknowledged until today by giving his name to these symptoms or illnesses (cf. 'Möbius sign', 'Möbius syndrome', 'Möbius disease'). It was also him who divided nervous illnesses into endogenous and exogenous ones. Furthermore, Möbius made significant contributions towards the understanding of the causes for some mental illnesses, e.g. it was him who postulated a psychogenic development of hysteria. Through his pathographies as well as his work as a major reviewer and editor of 'Schmidt's Annals of Domestic and Foreign Entire Medicine' Möbius became known to a greater public. Even more well-known, if not infamous, Möbius's name is for his pamphlet on 'The Physiological Mental Weakness of Woman'. As a result of it's repeated republication he was accused to be hating women and his major contributions towards the progress of the neurosciences have been neglected.

Germany↗
PubMed1997

Calculation of residence times and radiation doses using the standard PC software Excel.

We developed a program which aims to facilitate the calculation of radiation doses to single organs and the whole body. IMEDOSE uses Excel to include calculations, graphical displays, and interactions with the user in a single general-purpose PC software tool. To start the procedure the input data are copied into a spreadsheet. They must represent percentage uptake values of several organs derived from measurements in animals or humans. To extrapolate these data up to seven half-lives of the radionuclide, fitting to one or two exponentional functions is included and can be checked by the user. By means of the approximate time-activity information the cumulated activity or residence times are calculated. Finally these data are combined with the absorbed fraction doses (S-values) given by MIRD pamphlet No. 11 to yield radiation doses, the effective dose equivalent and the effective dose. These results are presented in a final table. Interactions are realized with push-buttons and drop-down menus. Calculations use the Visual Basic tool of Excel. In order to test our program, biodistribution data of fluorine-18 fluorodeoxyglucose were taken from the literature (Meija et al., J Nucl Med 1991; 32:699-706). For a 70-kg adult the resulting radiation doses of all target organs listed in MIRD 11 were different from the ICRP 53 values by 1%+/-18% on the average. When the residence times were introduced into MIRDOSE3 (Stabin, J Nucl Med 1996; 37:538-546) the mean difference between our results and those of MIRDOSE3 was -3%+/-6%. Both outcomes indicate the validity of the present approach.

Adult↗
PubMed2006

Biological monitoring of exposure to organophosphate pesticides in children living in peri-urban areas of the Province of Quebec, Canada.

OBJECTIVE: This study was undertaken to assess the exposure to organophosphate (OP) pesticides in children from peri-urban areas of the Province of Quebec, Canada, through measurements of semi-specific alkylphosphate (AP) metabolites. METHODS: Eighty-nine children aged between 3 and 7 years were recruited via pamphlets sent to day-care centers. A first morning urine void was collected early in the spring of 2003 prior to summertime, which is the usual period of outdoor pesticide use. During summertime, up to five more first morning voids were repeatedly collected, at 72-h intervals, over a 13-day period. The potential determinants of exposure were assessed by a questionnaire at the time of urine collection. RESULTS: Methylphosphate metabolites were detectable in 98.2% of the 442 samples analyzed while ethylphosphates were detected in 86.7% of the samples. The geometric mean concentration (GM) of the total AP metabolites was 61.7 mug/g creatinine (range: 2.7-1967.3 mug/g creatinine). The difference in urinary AP concentrations between samples collected during spring and summer was non-significant (P=0.08). There was also no significant difference in the mean AP concentrations between summer samples of individuals living in municipalities where outdoor pesticide use is or is not restricted (P=0.25). However, the presence of a pet in the house was associated with an increase in AP concentrations during spraying season (P=0.02). Pesticides were seldom used, as reported by the questionnaire. A significant correlation was also observed (P<0.001) between the urinary AP concentrations in samples provided by siblings at the same time period. CONCLUSIONS: Mean concentrations of AP were generally higher than those reported in other studies. The observed exposure apparently occurred mainly through the dietary ingestion of OP residues. These data raise questions on the levels of OP residues in Quebec food and the possibility that our participants consumed more fruits and vegetables than those in other studies.

Child↗
PubMed2004

Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women.

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention. The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fisher's exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.

Accidental Falls↗
PubMedDate not supplied

Accidental childhood death and the role of the pathologist.

The following study provides an overview of accidental childhood death. This study is based on a review of 369 cases of fatal childhood accidents taken from the records of the Department of Histopathology, Women's and Children's Hospital, Adelaide, Australia, over a 34-year period from 1963 to 1996. Data provide information on deaths due to motor vehicle accidents, drownings, accidental asphyxia, burns, poisonings, electrocution, and miscellaneous trauma. In addition, certain categories have undergone further examination, including asphyxial deaths due to unsafe sleeping environments and unsafe eating practices, drowning deaths, and deaths on farms, following identification of significant child safety problems in these areas as part of the "Keeping Your Baby and Child Safe" program. Previously unrecognized dangers to children detected through this program include mesh-sided cots, V-shaped pillows, and certain types of stroller-prams. The production of information pamphlets and packages for parents and the recall of certain dangerous products following recommendations made by pathologists demonstrate that pediatric and forensic pathologists have an important role to play in preventive medicine issues and in formulating public health strategies.

Accident Prevention↗
PubMed2005

A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents.

The primary purpose of this study was to test the efficacy of a brief, multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents. A total of 604 participants, 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study. A randomized control trial was conducted with participants randomly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer (Project SPORT) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home. Differences between intervention groups were evaluated with a series of MANCOVA tests. Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption, alcohol initiation behaviors, alcohol use risk and protective factors, drug use behaviors, and exercise habits, and at 12-months for alcohol use risk and protective factors, cigarette use, and cigarette initiation (p's < 0.05). A post hoc analysis examining interactions between past 30-day use of marijuana and/or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption, drug use behaviors, and drug use initiation at 3-months, and for drug use behaviors and exercise habits at 12-months (p's < 0.05). A brief, 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later. Long-term sustained effects for cigarette and marijuana use, and both vigorous and moderate physical activity, were found among adolescents using marijuana and/or cigarettes prior to intervention.

Adolescent↗
PubMed1993

Interobserver variation using the AO/ASIF classification of long bone fractures.

A comprehensive classification system has been proposed by the AO/ASIF Foundation for the classification of long bone fractures. After an explanatory talk and with the aid of an illustrated pamphlet, 18 orthopaedic surgeons were asked to classify 10 long bone fractures according to the AO system. Three of the participating surgeons had previous experience of the classification system. After individual classification, a consensus classification was derived and the results of the individual and consensus codings were compared. Only 32 per cent of all codings agreed with the final consensus. There was no difference between the surgeons with previous experience of the system (66 per cent) and novice coders (69 per cent) in the number of inaccurate codes when compared with the consensus codes. Reasons for error in coding are discussed. It is recommended that if the AO system is used for the purposes of research and computer-based audit, a consensus of opinion is used as the basis of classification.

Femoral Fractures↗
PubMed1990

Effects of an experimental program on post-hospital adjustment of early discharged patients.

This paper reports the results of a study evaluating the effects of an experimental program on post-hospital adjustment of early discharged patients after total hip arthroplasties. This experimental program consisted of patient teaching by means of a pamphlet and videotape, and regular home visits by a community health nurse. A significant difference was found between the experimental and control patients in perceived preparedness for discharge and post-hospital exercise compliance. The early discharged experimental patients demonstrated post-hospital objective and subjective functional capabilities equal to those of the control patients. This study is seen to have implications for nursing service and nursing education.

Activities of Daily Living↗
PubMed1985

Scaling segmental moments of inertia for individual subjects.

The purpose of this investigation was to validate methods of scaling human segmental moments of inertia for the transverse principal axis. Firstly, two methods of scaling Chandler et al.'s (Pamphlets DOT HS-801 430 and AMRL TR-74-137, Wright Patterson Air Force Base, OH, 1975) mean subject data to estimate the segmental moments of inertia were used. Chandler et al.'s data were scaled using body mass and segment length (formula 1) or body mass and standing height (formula 2). These data were then compared with a procedure of using the cadaver whose anthropometric measurements most closely match those of the subject. The difference between the criterion data (Chandler's subject data) and scaled values were plotted on scatter diagrams with confidence limits of p less than 0.05 at d.f. = 17. For procedure 1, 43% of the scaled values were plotted within the confidence limits using formula (2) (mass and standing height), compared with 26% for formula (1) (mass and segment length). Formula (1) markedly underestimated the tallest and heaviest subjects. In procedure 2, only 16% and 21% of the scaled values, using formula (1) and (2), respectively, fell within the confidence limits. Results suggested that scaling formulae approximate the moment of inertia of body segments with only limited accuracy. However, if scaling was to be adopted then mean moment of inertia data from an appropriate data set, using the formula that incorporates subject mass and standing height, gave results closest to the criterion value.

Anthropometry↗
PubMed1991

Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians.

BACKGROUND: In an effort to find more practical smoking intervention models for primary-care settings, three physician-and-nurse team approaches to patient counseling were compared with brief physician advice alone. METHODS: Subjects were 3,161 adult smokers surveyed while waiting to see 1 of 40 primary-care physicians. Physicians delivered a brief stop-smoking prompt to 2,707 (86%) of these smokers and referred them to an on-site smoking counselor (e.g., nurse) who randomly provided a two-page pamphlet (advice-only control) or one of three brief nurse-assisted interventions: (a) self-quit training, (b) recruitment to a group program, or (c) a combination intervention. Smokers usually (87%) agreed to see the counselor. RESULTS: After 3 months, subjects in the three nurse-assisted conditions were more likely to report a serious quit attempt (50% vs 39%, P less than 0.001) than were physician-advice-only subjects. Quit rates at 3 months were also higher (P less than 0.001) in the nurse-assisted self-quit (12.9%), recruitment (14.1%), and combination (13.0%) conditions, compared with those for brief physician advice only (7.6%). CONCLUSION: If long-term efficacy is confirmed, these nurse-assisted counseling approaches will serve as practical smoking intervention models for most medical-care delivery settings.

Adult↗
PubMed1991

The Tromsø Study: identification of and a controlled intervention on a population of early-stage risk drinkers.

BACKGROUND: In a health survey of more than 21,000 men and women ages 12-62 years, measurement of gamma-glutamyltransferase (GGT) and answers on five questions on alcohol consumption were used as a basis for selecting an intervention population of early-stage risk drinkers. Altogether 290 men and 48 women met the criteria for inclusion. METHODS: The 338 subjects were randomized to a control group and two intervention groups. The minor intervention consisted of a single consultation during which possible reasons for the elevated GGT were discussed and a pamphlet with advice on changes in drinking habits was handed out. In the major intervention group the intervention was directed more specifically toward alcohol, with an extensive interview on drinking habits. In addition, the subjects in this group were offered follow-up consultations for new measurements of GGT. RESULTS: All three groups were examined after 1 year with GGT determination and an interview on change in drinking habits during the past year. At follow-up, significant decreases in mean GGT (26.5 U/liter) and self-reported alcohol intake (24.7 g/day) were observed in the intervention groups compared with the control group. No significant differences were, however, observed between the intervention groups. CONCLUSION: The study indicates that modest and simple interventions may yield important changes in drinking habits in early-stage risk drinkers.

Adolescent↗