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PubMed1999

Epidemic hysteria in Virginia: the case of the phantom gasser of 1933-1934.

OBJECTIVE: We studied an example of epidemic hysteria occurring outside a closed community and involving fear of being "gassed." The description presented is that of a previously unrecorded case of epidemic hysteria in the state of Virginia during 1933-1934. DATA SOURCES: Data were gathered from contemporary newspaper accounts. CONCLUSION: The case of the Virginia "gasser" is one in a long series of epidemic hysteria incidents during the 20th century, coinciding with heightened awareness of environmental pollution and triggered by imaginary or exaggerated contamination threats. A recommendation is provided on how physicians should approach such episodes.

Conversion Disorder↗
PubMed2000

The impact of utilization management on readmissions among patients with cardiovascular disease.

OBJECTIVE: To determine if prospective utilization reviews that lead to reduced hospital length of stay (LOS) relative to days requested by an attending physician affect the likelihood of readmission for privately insured patients with cardiovascular disease. DATA SOURCES: Data obtained from a private insurance company on utilization management decisions from 1989 through 1993. During this five-year period, 39,117 inpatient reviews were conducted, 4,326 (11.1 percent) on patients with cardiovascular disease. We selected for analysis all 4,326 reviews performed on patients with cardiovascular disease. STUDY DESIGN: We used proportional hazard analysis (Cox regression) to investigate the relationship between LOS reductions relative to days requested by a patient's attending physician and the likelihood of readmission within 60 days of discharge. Separate analyses were performed for medical and procedural admissions. PRINCIPAL FINDINGS: There were 2,813 requests for medical admission, and 1,513 requests for procedural admission. Requests for admission were rarely denied. Length of stay was reduced relative to that requested by the treating physician for 17 percent and 19 percent of medical and procedural admissions, respectively. Cumulative 60-day readmission rates were 9.5 percent for medical admissions and 12.3 percent for procedural admissions. We found no relationship between LOS reduction and the likelihood of readmission for medical admissions. However, patients admitted for procedures who had their length of stay reduced by two or more days were 2.6 times as likely to be readmitted within 60 days as those who had no reduction in their length of stay (95% CI: 1.3-5.1; p < .005). CONCLUSIONS: Utilization management (UM) rarely denies requests for inpatient treatment of cardiovascular disease. The association between LOS reduction and the likelihood of readmission for patients admitted for cardiovascular procedures raises concern that UM may adversely affect clinical outcome for some patients. Further research is needed to definitively elucidate any relationship that might exist between utilization review decisions and quality of care.

Adult↗
PubMed2000

Are recent cohorts healthier than their predecessors?

OBJECTIVES: This article examines changes in the health status of Canadian adults between 1978/79 and 1996/97. DATA SOURCES: Data are from the the Canadian Vital Statistics Data Base, the 1991 General Social Survey, the 1978/79 Canada Health Survey (CHS), and the 1996/97 National Population Health Survey (NPHS). ANALYTICAL TECHNIQUES: Age-specific mortality rates are presented for 1978 and 1996. The cumulative incidence of heart disease is shown for 1991. Cross-sectional comparisons of prevalence rates for selected chronic conditions, activity limitation, disability days, smoking and overweight are shown for 1978/79 and 1996/97. Multiple logistic regression models were used to test differences in odds ratios for the chronic conditions and for activity limitation between the CHS and the NPHS. SUDAAN, which accounts for the complex survey design, was used to estimate standard errors of the prevalence and of the coefficients in the logistic model. MAIN RESULTS: Lower mortality rates and lower prevalence of heart disease, high blood pressure, arthritis and activity limitation suggest that recent cohorts are healthier than previous cohorts. When the age effect was controlled along with education and income, the odds of having these conditions were generally lower for each successive cohort, and lower in the mid-1990s than in the late 1970s. However, the odds of having diabetes were higher in 1996/97 than in 1978/79, and higher among more recent cohorts than among earlier cohorts.

Adult↗
PubMed2000

Anemia.

PURPOSE/OBJECTIVES: To review the current knowledge of anemia associated with cancer management and nursing interventions. DATA SOURCES: Published theory, research, and clinical practice sources. DATA SYNTHESIS: Anemia often is overlooked as a priority associated with quality patient care. The diagnosis of cancer and associated treatments magnify the incidence of anemia among the cancer population. Untreated anemia negatively affects the success of radiation therapy, activities of daily living, quality of life, and morbidity and mortality. CONCLUSIONS: Identifying the underlying cause(s) of anemia in patients with cancer is critical to positive care outcomes and requires early nursing assessment and interventions. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role in maintaining and improving well-being and quality of life of patients at risk for anemia by understanding erythropoiesis, pathophysiology, nursing assessment (including laboratory data assessment), and nursing interventions related to anemia.

Anemia↗
PubMed2000

A cost analysis of community screening for diabetes in the central Wisconsin Medicare population (results from the MetaStar pilot project in Wausau).

CONTEXT: Type 2 diabetes mellitus is often undiagnosed and untreated. OBJECTIVE: To estimate the costs and possible savings of screening for Type 2 diabetes mellitus in the Wisconsin Medicare population from a population health perspective. DESIGN: The costs and benefits of community screening were analyzed using various primary and secondary data sources. Data on the community screening were obtained by MetaStar, collaborators at the screening site, and published material. Results from a Monte Carlo simulation model, developed by the CDC Diabetes Cost-Effectiveness Study Group, and recent developments in diabetes research were used to estimate the incidence levels of major complications for Type 2 diabetes. SETTING AND PARTICIPANTS: Medicare beneficiaries in central Wisconsin residing in the Wausau Hospital Service Area, which is composed of 14 zip codes. RESULTS: Of 826 Medicare patients screened, 32 were diagnosed as having diabetes. If we use the same assumptions offered by the CDC Study Group, we find that the excess lifetime costs from screening and early treatment ($4850) exceed costs saved from preventing complications ($378), costing an average of $4471 per diabetic. However, if we alter assumptions on cardiovascular disease reduction risk and routine care costs, we find that screening could save an average of $619 per diabetic detected. CONCLUSIONS: The costs of community screening, using the CDC Study Group's assumptions, are greater than the costs of diabetes without screening in this population. However, recent evidence on cardiovascular disease risk and routine care costs could alter the results, leading to lower costs and greater benefits in the future. More research is necessary, particularly in the area of quality of life measures, to more accurately reflect the benefits of screening.

Aged↗
PubMed2000

Bioethical considerations in cancer prevention and early detection practice and research.

PURPOSE/OBJECTIVES: To review current ethical issues in cancer prevention and early detection, discuss some of the key methods and theories in contemporary bioethics, present clinical scenarios that illustrate moral problems that nurses may encounter, and show how the theories and methods can assist ethical decision making. DATA SOURCES: Published articles, abstracts, and books; case studies developed from clinical experience and literary sources. DATA SYNTHESIS: Oncology nurses face a host of ethical considerations when providing cancer prevention and early detection education and services and when conducting research in this arena. A variety of ethical methods and theories--including principlism, casuistry, utilitarianism, rights-based theories, virtue ethics, ethics of care, and communitarian ethics--may assist nurses in tackling ethical challenges. CONCLUSIONS: The growing field of cancer prevention and early detection raises a number of moral issues that have implications for oncology nursing. Because no single method or theory provides a complete account of bioethics, ethical problem solving should be approached using a variety of methods and theories whereby they can be coherently and appropriately applied together. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of ethical issues related to cancer prevention and control and consider them when planning patient care and research programs.

Bioethics↗
PubMed2000

Managing the primary care practice on the Web

Physicians and administrators have little hope of responding appropriately to the challenges of the health care market without data to support decision making. Desired Mayo Clinic s Primary Care Practice was to have the ability to access and integrate data from many platforms in many formats from the Enterprise and bring this information to the desktop in a robust interactive display. The solution was delivery of the data to the Web through an interface using Java with access to Online Analytical Processing (OLAP) tools for summarization, graphical display and reporting. Communicating major trends, assisting in planning and management, visually displaying alerts in summary data and individual patients that are all possible through an easy-to-use Web application. To really understand what the summarized data represents, the physicians must be able to drill down, download and explore their own detail data. A pilot project was developed to test the capabilities of the development environment, the acceptance Web tools, the ability to deliver timely information and the methodology of using a multi-dimensional database to define the data. The Family Medicine practice at four separate locations was chosen for the demonstration project. Two practices in Rochester, MN and practices in two smaller towns, totaling 50 physicians and administrative personnel, were the first clients using the system. A cross-functional team examined a variety of development issues such as data sources, data definitions, levels of security, data analysis types, and style of display. Demonstrations of the prototype met with an overwhelming positive response from administrators and department leaders. The Physician Patient Management solution collects, analyzes, and communicates the information needed to meet today s health care challenges.

Journal Article↗
PubMed2000

Heritability of self-reported health.

OBJECTIVE: To explore the contribution of genes and environmental factors to variation in a common measure (i.e., a five-point--excellent, very good, good, fair, and poor--Likert scale) of self-reported health. DATA SOURCES: Data were analyzed from 4,638 male-male twin pair members of the Vietnam Era Twin (VET) Registry who responded to a 1987 health survey. STUDY DESIGN: Varying models for the relationship between genetic and environmental influences on self-reported health were tested in an attempt to explain the relative contributions of additive genetic, shared and nonshared environmental effects, and health conditions reported since 1975 to perceived health status. DATA COLLECTION: A mail and telephone survey of health was administered in 1987 to VET Registry twins. PRINCIPAL FINDINGS: Variance component estimates under the best-fitting model included a 39.6 percent genetic contribution to self-reported health. In a model which included the effect of health condition, genes accounted for 32.5 percent and health condition accounted for 15.0 percent of the variance in self-reported health. The magnitude of the genetic contribution to perceived health status was not significantly different in a model with or without health condition. CONCLUSIONS: These data suggest over one-third of the variability of self-reported health can be attributed to genes. Since perceived health status is a major predictor of morbidity, mortality, and health services utilization, future analyses should consider the role of heritable influences on traditional health services variables.

Aged↗
PubMed2001

Comparing mortality and time until death for medicare HMO and FFS beneficiaries.

OBJECTIVE: To compare adjusted mortality rates of TEFRA-risk HMO enrollees and disenrollees with rates of beneficiaries enrolled in the Medicare fee-for-service sector (FFS), and to compare the time until death for decedents in these three groups. DATA SOURCE: Data are from the 124 counties with the largest TEFRA-risk HMO enrollment using 1993-1994 Medicare Denominator files for beneficiaries enrolled in the FFS and TEFRA-risk HMO sectors. STUDY DESIGN: A retrospective study that tracks the mortality rates and time until death of a random sample of 1,240,120 Medicare beneficiaries in the FFS sector and 1,526,502 enrollees in HMOs between April 1, 1993 and April 1, 1994. A total of 58,201 beneficiaries switched from an HMO to the FFS sector and were analyzed separately. PRINCIPAL FINDINGS: HMO enrollees have lower relative odds of mortality than a comparable group of FFS beneficiaries. Conversely, HMO disenrollees have higher relative odds of mortality than comparable FFS beneficiaries. Among decedents in the three groups, HMO enrollees lived longer than FFS beneficiaries, who in turn lived longer than HMO disenrollees. CONCLUSIONS: Medicare TEFRA-risk HMO enrollees appear to be, on average, healthier than beneficiaries enrolled in the FFS sector, who appear to be in turn healthier than HMO disenrollees. These health status differences persist, even after controlling for beneficiary demographics and county-level variables that might confound the relationship between mortality and the insurance sector.

Aged↗
PubMed2001

Nurse documentation: not done or worse, done the wrong way--Part I.

PURPOSE/OBJECTIVES: To focus on nursing documentation and expanding technologies (e.g., facsimile, telephone, e-mail, computer charting) that offer different ways to record, deliver, and receive patient records and avoid nursing liability for inadequate or inaccurate documentation. DATA SOURCES: Nursing, non-nursing healthcare, legal journals, case law, and related Internet sources. DATA SYNTHESIS: To avoid liability for inadequate or inaccurate documentation, nurses must be aware of the major issues involved in documentation litigation. New technology is altering how healthcare documentation is done and raising new confidentiality issues. CONCLUSIONS: Nurses should follow their facility's guidelines and principles for documentation of patient care, especially when using more advanced technologies. IMPLICATIONS FOR NURSING PRACTICE: Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices will help guard against liability and ultimately improve patient care.

Documentation↗
PubMed2001

Nurse documentation: not done or worse, done the wrong way--Part II.

PURPOSE/OBJECTIVES: To focus on nursing documentation and how it can lead to a malpractice lawsuit. DATA SOURCES: Nursing, non-nursing healthcare and legal journals, case law, and related Internet sources. DATA SYNTHESIS: To avoid liability for inadequate or inaccurate documentation, nurses must be aware of how their documentation can either lead to a malpractice claim or actually decrease their chances of ever being named in a malpractice lawsuit. Malpractice cases often are decided based on documentation. The only viable way to defend against allegations of professional negligence is accurate and complete patient charting or defensive documentation. CONCLUSIONS: By examining case law involving inadequate or inaccurate documentation, nurses will be able to effectively adopt documentation practices or policies to decrease potential litigation. IMPLICATIONS FOR NURSING PRACTICE: Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices will help guard against liability and ultimately improve patient care.

Communication↗
PubMed2000

Household spending on health care.

OBJECTIVES: This article examines changes in household spending on health care between 1978 and 1998. It also provides a detailed look at household spending on health care in 1998. DATA SOURCES: Data on household spending are from Statistics Canada's Family Expenditure Survey for survey years between 1978 and 1996, and from the annual Survey of Household Spending for 1997 and 1998. ANALYTICAL TECHNIQUES: Proportion of after-tax spending was calculated by subtracting average personal income taxes from average total expenditures and then dividing health care expenditures by this figure. Per capita spending was calculated by dividing average household spending by average household size. Constant dollar figures and adjustments for inflation were calculated using the Consumer Price Index (1998 = 100) to control for the effect of inflation over time. MAIN RESULTS: Almost every Canadian household (98.2%) reported health care expenditures in 1998, spending an average of close to $1,200, up from around $900 in 1978. In 1998, households dedicated a larger share of their average after-tax spending (2.9%) to health care than they did 20 years earlier (2.3%). Health insurance premiums claimed the largest share (29.8%) of average health care expenditures, followed by dental care, then prescription medications and pharmaceutical products.

Budgets↗
PubMed1999

Progress in schistosomiasis control in China.

PURPOSE: To briefly review schistosomiasis situation in the past, progress in the control program and problems to be solved. DATA SOURCES: Data from literature published at home and abroad on the control and research of schistosomiasis in China in biomedical journals and monographs, and a few data from the Office of Endemic Diseases Control, Ministry of Health, are collected. STUDY SELECTION: Information on this topic are screened and the important ones are selected. RESULTS: Schistosomiasis in China was serious. Through hard work for control for half decade, great progress has been achieved after implementation of the control program. Control approaches are introduced. Compared with data in the early 1950s, endemic provinces decreased from 12 to 5, infected persons, from more than 10 million to around 865,000, and the areas of Oncomelania snail habitats, from 14 billion m2 to 3.6 billion m2. Proportion of symptomatic patients among those infected has a significant reduction. The national criteria for control and elimination of schistosomiasis in China are introduced. CONCLUSIONS: The achievements of schistosomiasis control are tremendous but the tasks in China are arduous. Especially after last year's heavy flood, areas of snail habitats are increasing. To consolidate the success and to put the still endemic areas under control are long-term and arduous tasks confronting China.

Animals↗
PubMed1999

Prevention and therapy of hepatitis B.

PURPOSE: To review the achievements of the prevention and therapy of hepatitis B (HB) in China during the thirty years after the discovery of hepatitis B virus (HBV) in 1967. DATA SOURCE: Data come from an English language literature search using MEDLINE 1966-1999, especially 1982-1999, and Chinese language literature, published and unpublished, from the Chinese Health Administration. STUDY SELECTION: After reviewing of the literature we select 14 articles to address our statement. DATA EXTRACTION: Two observers independently evaluated the quality of the data materials obtaining from these articles. RESULTS: Investigation of HBV vaccine development in China was almost simultaneously with the same kind of work in the international. At least 200 million people have accepted the vaccination of HBV vaccine. The vaccination of the HBV vaccine in China has decreased the prevalence of HBV infection no matter in urban cities or in rural area. The protection against HBV infection can be maintained at least for 9-11 years. CONCLUSIONS: Vaccination of HBV vaccine in China is successful and has obtained great achievements in the prevention and therapy of HB.

China↗
PubMed2001

A global measure of physical functioning: psychometric properties.

OBJECTIVE: To examine the psychometric properties of a global physical functioning scale (GPFS) developed as a self-report measure and constructed to scale physical functioning from very poor (1) to excellent (100). DATA SOURCES: Data collection took place between January 1997 and September 1999. It consisted of self-ratings of surgical patients and the ratings of clinicians. The setting was the surgical department at a university hospital. STUDY DESIGN: Test-retest reliability and the convergence of the scores of patients and clinicians were examined in 106 patients before elective coronary or gastrointestinal surgery. Inter-rater reliability was tested in 36 hospitalized patients with cardiologic or vascular surgical diseases who were rated by random selection from a pool of 91 clinicians. The patients also rated their physical functioning. Discriminative validity, sensitivity to change, ceiling and floor effects, and influence of emotional state upon the scores were tested in 127 patients in six diagnostic groups who scored the GPFS before and subsequent to surgery. The concurrent validity was examined in 101 patients who scored the GPFS and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) before elective coronary surgery. PRINCIPAL FINDINGS: The test-retest correlation (.90), correlation of the scores of the clinicians and patients (.87), and rater intraclass correlation coefficient (.82) were high. The GPFS discriminated among patients with different levels of physical functioning, and it was sensitive to change following coronary surgery. There were moderate ceiling and no floor effects. The correlation with the physical functioning scale of the SF-36 (PF-10) was .67. The GPFS differentiated patients with middle levels of physical functioning better than did the PF-10. CONCLUSIONS: The psychometric properties of the GPFS appeared adequate as a measure of general physical functioning. The scale is easy to use and also appears suitable for outcome studies following substantial changes in physical functioning as after coronary surgery.

Activities of Daily Living↗
PubMed2002

Health insurance for unemployed workers.

OBJECTIVE: In this article, we seek to inform the debate over providing assistance to workers who lose their jobs during the recession by assessing the potential impact of an economic downturn on health insurance coverage and reviewing available approaches to secure coverage for unemployed workers and their families. We also summarize recent research and analysis to examine the likely challenges and benefits of these approaches. DATA SOURCE: Data and analysis are primarily based on the Census Bureau's Current Population Survey, the Urban Institute's National Survey of America's Families, and Medicaid data from the Centers for Medicare and Medicaid Services. We also draw on recent surveys and analysis conducted by researchers in the health policy field. CONCLUSIONS: Maintaining health insurance coverage for unemployed workers is important to helping individuals and to stimulating our economy. While some families may be assisted by efforts to subsidize COBRA extension coverage, the potential reach of such an initiative is limited. Building on public programs such as Medicaid offers a targeted, efficient, and effective option but also presents financing challenges to federal and state governments.

Humans↗
PubMed2002

Two ophthalmology departments financed by compulsory health insurance: what is it that makes a difference in costs and clinical effectiveness?

AIM: To identify factors contributing to significant differences between two university hospital departments of ophthalmology, one in Paris, France, and the other in Zagreb, Croatia, in their clinical effectiveness and cost-efficiency. METHOD: Structural, clinical, and financial characteristics of a Croatian and French ophthalmology department were compared for the 1996-2000 period. We used Paris ophthalmology department reports from 1996-2000 period as data source. Data on the Zagreb department performance for the same time period were obtained from the financial department. After comparative analysis of performance to show consistency and comparability of the two departments according to the type and prevalence of pathology, case-mix, and approaches to therapeutic, educational, and research activities, hospital budget analysis was performed, with special reference to the length of hospital stay according to diagnosis, number of examinations, material expenses, salaries, and investment. The variables analyzed were the number of emergency, regular, and hospitalized patients; number of physicians; number and type of surgical procedures; number of patients and length of hospital stay according to diagnosis; hospital budget distribution; and usage of hospital beds. RESULTS: Although the structure, technology, level of education, organization, and patient profile at the two departments were similar, the mean number of operative procedures per specialist per year was different (109.4 for Zagreb vs 199.2 for Paris). Hospital bed occupancy was 99.4% in Zagreb and 74.9% in Paris. The mean duration of hospital stay was 7.5 days in Zagreb and 2.2 days in Paris. Zagreb had considerably longer hospital stay for all diagnoses except severe infections. Zagreb had lower investment in new technologies (0.4%) than Paris (20.1%), and higher material expenses (33.2% vs 10.1%, respectively). CONCLUSION: Different instruments of hospital services payment result in different clinical and organizational behavior of the hospital personnel and management. The three-fold longer stay in Zagreb can be explained by the mechanism of service payment, which is based on payment for capacity and structure and process in Zagreb instead of payment for service and service-related outcomes in Paris. Comparison of the two departments indicates that clinical efficiency and effectiveness cannot and should not be separated from financial incentives that can stimulate (Paris) or discourage (Zagreb) rational and evidence-based clinical behavior.

Cost-Benefit Analysis↗
PubMed2002

Suicide deaths and suicide attempts.

OBJECTIVES: This article examines suicide deaths among Canadians aged 10 or older between 1979 and 1998. It also examines hospital records for 1998/99 to provide some insight into suicide attempts. DATA SOURCES: Data are mainly from the Vital Statistics Database, the Hospital Morbidity Database, and the Person-oriented Information Database. Supplementary data are from the Adult Correctional Services and Homicide surveys, the National Longitudinal Survey of Children and Youth, and the World Health Organization. ANALYTICAL TECHNIQUES: Age-standardized rates for suicide deaths and hospitalized suicide attempts were calculated by sex and province/territory for Canadians aged 10 or older. Age- and sex-specific rates for suicide deaths and parasuicide-related hospitalizations were also calculated for seven age groups. MAIN RESULTS: The suicide death rate remained fairly stable between 1979 and 1998. The suicide rate of males was four times that of females, but females were hospitalized for attempted suicide at about one and a half times the rate of males. In 1998/99, about 9% of individuals who were hospitalized for an attempted suicide had been discharged more than once for a suicide attempt the same year.

Adolescent↗