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At least 811 records · Page 45Linked to original sources
PubMed2004

Spinning SATURN.

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Adolescent↗
PubMed2006

Use of PASRR programs to assess serious mental illness and service access in nursing homes.

OBJECTIVE: This study assessed the implementation of state Preadmission Screening and Resident Review (PASRR) programs with respect to identification of serious mental illness among nursing facility applicants and residents and access to mental health services. METHODS: A national survey was conducted with representatives from agencies that implement PASRR in all 50 states and the District of Columbia. Also, 44 states sent PASRR data for review. Four states were selected for an in-depth study; six nursing homes per state were selected and one staff member from each facility was interviewed (N=24). Medical records were reviewed for 30 to 40 residents from each facility who met criteria for potentially having a disabling serious mental illness (N=786). RESULTS: Medical records showed that 50 percent of patients at the time of admission and 68 percent of patients at the time of the record review had a psychiatric diagnosis, typically a diagnosis of depressive disorder. At the time of admission, fewer records identified individuals with a serious mental illness (9 to 20 percent) or a primary diagnosis of any psychiatric illness (5 to 12 percent). Many records indicated that in-depth, required PASRR screens were not performed. Ninety percent of the states reported that Medicaid covers only basic psychiatric consultation services, such as medication monitoring, in nursing facilities. Between 30 and 32 percent of national survey respondents also characterized access to facilities that provide mental health services as limited and of variable quality. Although all 24 nursing facilities reported providing psychiatric consultation services, access to other mental health services, such as psychosocial rehabilitation or individual counseling, varied considerably. CONCLUSIONS: Nursing facility compliance with administration and documentation of PASRR screens appears problematic. Nevertheless, there do not appear to be excessively high numbers of residents with serious mental illness, suggesting that state PASRR programs may contribute positively to the identification of people with serious mental illness. However, many nursing facility residents have some type of psychiatric illness, and PASRR legislation does not appear to have enhanced their ability to gain access to mental health services beyond standard psychiatric consultation and medication therapy.

Adult↗
PubMed1986

Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome.

Nine patients with severe obstructive sleep apnea syndrome (OSAS)--for whom several therapeutic approaches, including palatopharyngoplasty, had failed--were treated with a combined maxillary, mandibular, and hyoid advancement. Objective evaluation--performed before and 4 to 18 months after surgery, using nocturnal polysomography--indicated that the OSAS had improved or had disappeared. This surgical approach is beneficial for specific cases of OSAS, which can be identified by mandatory presurgical tests.

Female↗
PubMed2004

A survey of compliance: Medicaid's mandated blood lead screenings for children age 12-18 months in Nebraska.

BACKGROUND: To determine the frequency of Medicaid mandated blood lead level (BLL) screening compliance rates by clinical site. METHODS: Retrospective chart review for evidence of BLLs. Data analyses were conducted using frequencies, percentages & chi-square. RESULTS: The overall incidence of documented BLLs was 78.9% with one clinic demonstrating 100% BLLs while the others had 72%. Screening rates differed significantly by clinical site (X2 = 18.460, df = 3, p < 0.001). CONCLUSION: Although universal blood lead screening is mandated, there were missed opportunities to obtain BLLs in 21.1% of the records reviewed. Only one clinic had 100% documentation of BLLs when children on Medicaid were seen between the ages of 12-18 months.

Child↗
PubMed2006

Laboratory diagnosis and management challenges in the antiphospholipid syndrome.

The antiphospholipid syndrome (APS) is characterized by recurrent arterial and/or venous thrombosis and pregnancy morbidity manifested by early or late losses. Laboratory diagnosis ofAPS relies on the demonstration of a positive test for antiphospholipid antibodies (aPL). In clinical practice, the gold standard tests are those that detect anticardiolipin antibodies (aCL) and/or the lupus anticoagulant (LA). Although other specificities for aPL have been described their clinical utility and standardization has still to be established. Persistence of aPL positive tests must be demonstrated, and other causes and underlying factors considered. Although it is universally recognized that the routine screening tests (aCL and/or LA) might miss some cases, careful differential diagnosis and repeat testing are mandatory before the diagnosis of 'seronegative APS' can be made. Correct identification of patients with APS is important, because prophylactic anticoagulant therapy can prevent thrombosis from recurring, and treatment of affected women during pregnancy can improve fetal and maternal outcome.

Abortion, Habitual↗
PubMed2005

Accuracy of transvaginal ultrasound in diagnosing endometrial pathology in women with post-menopausal bleeding on tamoxifen.

The incidence of endometrial pathology is increased in women with tamoxifen-induced post-menopausal bleeding (PMB). The aim of this study was to determine the accuracy of transvaginal ultrasound (TVS) in diagnosing endometrial pathology in symptomatic women taking tamoxifen, using endometrial thickness measurements (5 mm and 10 mm cut-offs) and morphological changes within the uterine cavity to define abnormality. The sensitivity of TVS was 97% (95% confidence interval (CI) 83% to 100%) and the specificity 35% (95% CI 17% to 56%) at a 5 mm threshold. The corresponding likelihood ratios for a positive test were 1.47 (95% CI 1.16-2.10) and a negative test were 0.09 (95% CI 0.02-0.53). The use of a higher 10 mm threshold, characterization of endometrial morphology or combining endometrial thickness and morphology did not improve overall accuracy. TVS measurement of endometrial thickness using a 5 mm cut-off is highly accurate in excluding endometrial disease in symptomatic women taking tamoxifen and may negate the need for further diagnostic testing in women unless symptoms recur. A positive TVS result is of little value, so further testing is mandatory in order to detect benign and malignant endometrial disease associated with tamoxifen and PMB.

Breast Neoplasms↗
PubMed2003

Drugs, prisons, and harm reduction.

The use of drugs in society raises important considerations for health and social policy. Critical health and social care issues arise when drugs are used inside prisons. This paper argues that there is an urgent need for prison drug policies to adopt the principles of harm reduction. However, current policy orthodoxy emphasises the control of drugs and punishment for drug taking. Key components of harm reduction are operationalised in this article by exploring the potential for harm reduction in prison within the context of English drug policy. Whilst the focus is on English policy debates, the discussion will have wider international resonance.

Community Health Services↗
PubMed2006

Risk of clozapine-associated agranulocytosis and mandatory white blood cell monitoring.

OBJECTIVE: To provide information for physicians and patients on which to base a decision as to whether to stop mandatory blood testing. DATA SOURCES: Articles on drug-induced blood dyscrasias were identified by searches of MEDLINE (1966-September 2005) and review of their bibliographies. Novartis was asked to provide additional data on clozapine, leukopenia, agranulocytosis, and suicidality. STUDY SELECTION AND DATA EXTRACTION: Data on the chance of clozapine-induced leukopenia and agranulocytosis were combined with data about possible fatality and compared with the risks associated with other medications and with life in general. DATA SYNTHESIS: The chance of clozapine-induced leukopenia or agranulocytosis decreases exponentially over time. In the US, the chance in the second 6 months of treatment is 0.70/1000 patient-years and, after the first year, 0.39/1000 patient-years. The case fatality rate of clozapine-induced agranulocytosis is estimated as 4.2-16%, depending on whether a granulocyte colony-stimulating factor is used. Nevertheless, treatment with clozapine reduces overall mortality, probably because it reduces suicidality. CONCLUSIONS: After at least 6 months' treatment with clozapine, the mortality involved in stopping white blood cell monitoring is about the same as the mortality associated with other medications, such as mianserin or phenylbutazone, and with life in general (traffic or occupational accident). If the patient has been well informed and wishes to stop the monitoring, it is a medically justifiable option to do so and is preferable to stopping treatment with clozapine since this drug reduces overall mortality.

Agranulocytosis↗
PubMedDate not supplied

Methodological issues in newborn screening evaluation with special reference to congenital adrenal hyperplasia.

Evidence-based evaluation of newborn screening is essential because of the increasing number of genetic tests, the mandatory nature of newborn screening in the United States, and the growing cost to the public to maintain expensive screening programs. This paper discusses the methodological problems that arise when applying universally accepted criteria to disorders such as congenital adrenal hyperplasia. These problems include the tendency of screening to alter the natural history of the disease, the lack of consensus about terms and definitions, and the paucity of longitudinal studies on screen detected neonates. In order to evaluate and compare candidate screens we recommend formal national trials of promising programs, with defined responsibility of state agencies, physicians, patients, and insurers for data submission and analysis.

Adrenal Hyperplasia, Congenital↗