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PubMed1988

Health care delivery systems in review.

Plagued with insolvency, physician discontent, and employer demands, the health maintenance organization (HMO) industry is seeking solutions to their crippling ailments. As buyers are more difficult to find for troubled plans, some executives are forced to resign or face bankruptcy. Still other executives have been able to turn around their financial and physician staffing challenges. The preferred provider organization (PPO) industry remains in the background of the HMO turmoil, facing the issues of quality assurance and cost containment.

Financial Management↗
PubMed1989

Post abortion syndrome by K and R.

Although the decision to abort rarely is an easy one for a woman, many women who have made the choice to abort deny that their decisions have left them emotionally crippled. The concept of a Post Abortion Syndrome (PAS) remains foreign to these women. What follows is a letter from a woman who had an abortion in the 1970s and an answer from a friend.

Abortion, Induced↗
PubMed1986

South Carolina hospitals unite to share charity care burden.

Four Columbia-area hospitals formed a partnership in 1984 to more equitably distribute responsibility for care of the medically indigent. This was primarily a response to the state's weak Medicaid program, which funded only 12 inpatient days per year per client. Resulting shortfalls especially crippled regional tertiary care facilities. The partnership included Richland Memorial, Baptist Medical Center, and Providence, all in Richland County; and Lexington County Hospital. These facilities provide service to about 1 million of South Carolina's 3 million people. Richland, although exclusively receiving county tax funds, questioned its provision of unlimited indigent care because of inadequate payment and unsponsored patients. Providence, expanding into a referral hospital with only 15 percent of the market share, wanted county funds available to any facility serving county residents. When Richland county opened its indigent fund to all the county's hospitals, recognizing the charity care private hospitals had been providing without county support, the hospitals formed the Midlands Hospitals Indigent Care Partnership. Each contributed to a fund to support charity care. The program's major fault was underestimating the hospitals' true cost of providing indigent care because it failed to account for the more intense use of services by the medically indigent population. The project accomplished its objectives of focusing public attention on the problem, resulting in passage of a state law to expand Medicaid benefits and other state initiatives to address the problem.

Hospital Administration↗
PubMed1976

Clinical telemetry of EMG and temporal information during gait.

Multichannel telemetry has formed an integral part of the clinical assessment of children's walking problems. EMG signals and temporal information from foot switches are transmitted from a small belt-pack unit which provides almost complete freedom of movement for the child. Although patients with various crippling diseases have been studied, the investigation of problems resulting from cerebral palsy has been most valuable clinically. The effects of orthopaedic surgery to release or transfer muscles can be asssessed more positively and the causes of some unexplained gait patterns can be investigated more thoroughly.

Cerebral Palsy↗
PubMed1986

Meeting the pastoral care needs of an aging population.

As hospitals increasingly operate nursing homes, retirement centers, and home health agencies, pastoral personnel will be challenged to demonstrate to hospital planners the importance of providing pastoral care for the elderly clients of these services. Older persons have significant needs that cannot be met by psychotherapy, social work, or other disciplines. The "young old," for example, are typically in early retirement and often feel useless and without dignity. The "middle old" are in transition between independence and dependence, health and chronic illness, and it is the thought of dying that most haunts them. The major concerns of the "frail old" are suffering and the provident care of God, particularly in the face of crippling or catastrophic illness. Through the process of life review and active listening, pastoral care specialists can help elderly persons find the inner power that produces hope and character. Departmental restructuring may be necessary, however, to meet the increased demand as the hospital moves into geriatric life care. Local church personnel could be used as well to provide hands-on service. Pastoral care departments should be alert to plans for hospital expansion and develop creative, long-range strategies for providing care.

Aged↗
PubMed1985

Health care and the elderly.

America's health care crisis is hitting our elderly and threatens to cripple Medicare, the elderly's financial support system. Medicare was designed to ensure that every elderly American would be protected against the destruction of life savings as a result of illness. Elderly Americans would be able to enjoy their golden years without the financial burden of medical bills. Today, this vision is almost extinct. Medicare has been placed on the endangered species list. Market predictions indicate that Medicare's Hospital insurance Trust Fund will be depleted by 1988 if current trends continue. The elderly presently must pay on the average about 14% of their health care bill. In addition, Medicare pays little for long-term care; and about 45% of long-term care is paid for out-of-pocket by the elderly and their families. Alternative approaches are desperately needed of Medicare if our elderly are to survive.

Aged↗
PubMed1989

Costs, needs must be balanced when buying computer systems.

A healthcare institution must carefully examine its internal needs and external requirements before selecting an information system. The system's costs must be carefully weighed because significant computer cost overruns can cripple overall hospital finances. A New Jersey hospital carefully studied these issues and determined that a contract with a regional data center was its best option.

Commerce↗
PubMed1989

The volunteer spirit is alive and well at Scottish Rite Hospital. Interview by Melissa Gaskill.

Today, Scottish Rite Hospital for Crippled Children in Dallas serves 10,000 Texas children with the help of 600 or so volunteers who log about 82,000 hours a year. This astonishing volunteer program has earned the hospital awards and recognition--including this year's AHA award for the outstanding volunteer program in Region 7--and has helped create the warm, team atmosphere that sets this hospital apart. President J.C. Montgomery takes pride in his volunteers and in the other part of that team, the paid staff. A member of the Texas Hospital Association board of trustees, he is also on the board of the Texas Hospital Education and Research Foundation and chair of that group's Investment Committee. Health Texas recently visited with Montgomery about the hospital and the volunteer program.

Hospital Bed Capacity, under 100↗
PubMed1999

Identifying the precursors of Hodgkin and Reed-Sternberg cells in Hodgkin's disease: role of the germinal center in B-cell lymphomagenesis.

In the course of T-cell-dependent immune responses, germinal centers (GCs) are established within secondary lymphoid organs. In these structures, B lymphocytes clonally expand and modify their immunoglobulin (Ig) V genes by somatic hypermutation. In a process called affinity maturation, GC B cells expressing antigen receptor with increased affinity to the cognate antigen are selected, whereas B cells acquiring unfavorable mutations die by apoptosis. By molecular single cell analysis of Hodgkin and Reed-Sternberg (HRS) cells in Hodgkin's disease (HD), it could be shown that the HRS cells in classical as well as lymphocyte predominant (LP) HD represent clonal populations of mature B cells. Whereas HRS cells in classical HD appear to derive from crippled GC B cells that lost the capacity to express antigen receptor, the precursors of the HRS cells in LP HD are mutating, antigen-selected GC B cells. It is likely that chromosomal translocations resulting from mistakes in class switch recombination or somatic hypermutation (and potentially V gene editing) play an important role in the pathogenesis of GC B-cell-derived lymphomas.

Cell Differentiation↗
PubMed1999

The media's influence on a poison center's call volume.

Although erratic at times, a poison center's (PC) call volume is generally predictable, but an emergent increase in call volume from an alarmed public can rapidly overwhelm existing personnel making it difficult to manage true emergencies. This is illustrated by a product recall concerning food allegedly contaminated with asbestos occurring in January 1998. Utilizing an on-line database, all calls over a 5-d period concerning this recall were reviewed and tabulated by both the date and time received. Corporate communications polled the print, radio and TV media to determine when the product recall stories were presented. This information was compared to and correlated with the Regional Poison Information Center (RPIC) call volume. Over a 5-d period the RPIC responded to 487 calls regarding the recall with 86.2% received in the first 33 h after the initial broadcast. During this 33-h period a total of 797 calls were documented at the RPIC indicating 52.7% of the call volume being related to the recall. Over the same period 4 local TV and radio stations broadcast the story 33 times with 1 station airing it 19 times in a 24-h period. Two newspaper stories were published. The public has a right to be alerted to potential health hazards, but a sudden increase in calls to a PC can be crippling. Based on this and similar experiences our PC developed a strategy, in concert with corporate communications, to respond to future incidents with the goal of reducing the adverse impact on PC call volume through the promotion of balanced and responsible information.

Asbestos↗
PubMedDate not supplied

[Multifocal motor neuropathy with block of nerve conduction. Report of three cases].

INTRODUCTION: Multifocal motor neuropathy is a severe chronic demyelinating, disimmune, crippling and potentially treatable disease. The clinical features are characterized by a syndrome of progressive motor deficiency with muscle atrophies, fasciculations, areflexia, myokimias and cramps, that sometimes we misdiagnosed as motor neuron disease. Electrophysiologically it is characterized by the occurrence of multifocal conduction blocks of motor fibres. CLINICAL CASES: Three patients with asymmetric multifocal motor neuropathy are reported in whom diagnosis was made by nerve conduction studies. All the patients had developed an asymmetric chronic progressive motor deficit that involved mostly upper limbs. One patient exhibited mild tactile sensory disturbances and a sural nerve biopsy showed moderated involvement of myelinated fibers. All the patients showed electrophysiologically, multifocal conduction blocks of motor fibers with spared conduction through sensory fibers at the same segments where motor conduction was blocked. The response to high doses intravenous cyclophosphamide therapy followed by 100 mg orally for six months, was satisfactory in all three patients. There was no response to previous trials with prednisone, azathioprine, and intravenous immunoglobulin. One patient was also submitted to several sessions of plasma exchange without benefit. The patient had been previously diagnosed as having motor neuron disease. CONCLUSION: The importance of early diagnosis of this disorder and the possibility of successful treatment with high doses of intravenous cyclophosphamide is stressed.

Adult↗
PubMedDate not supplied

[Miraculous recoveries in the frescoes of the Decani Monastery].

Serbian medieval medicine can be said to have the same characteristics as western medicine of those times in terms of practical medical science, whereas the ancillary medical branches were under Byzantine influence. Besides the compositions of Christ's miracles and paraboles are underlying part of the fresco/painting, the scenes of Christ's miraculous recoveries have an important place in the christian iconography of the New Testament events. One of the most impressive cycles of Christ's miracles in the Serbian and Byzantine medieval art was painted in c. 1340 year in the church dedicated to the Ascension of Lord Christ at Dechani Monastery and constructed between 1327 and 1335. A considerable number of 22 frescoes of different artistic value and technique displays the miraculous recovery of patients afflicted by various chronic ailments: paralytics (razlabljeni), lepers, and handicapped (blind, lame and deaf). One scene presents the bleeding (krvotociva) women. Scenes of recovery from nervous and mental diseases are especially impressive. Patients with atrophic arm, these with hemiplegy, epilepsy, an somnambulist boy, lunatics and possessed are there painted. The magnificent compositions of the miraculous recovery of a patient with ascites (debela, vodena bolest) and these affected by disorders of mainly neuromuscular and locomotor systems are performed by talented masters. The King Stefan Urosh Dechanski Third (1322-1331) founded the hospital in the Dechani Monastery, as a purely medical institution for providing treatment. This hospital was organized and modelled on the hospital in the Pantocrator Monastery in Constantinople. His biographer Gregory Camblak described that this hospital took in patients suffering from epilepsy (svestenoga neduga radi stradalcem) and serious nervous disorders, lepers, cripples, paralytics and those with lung diseases. Regardless of differences in the artistic level, most of these frescoes are impressively natural and realistic. This supports the ascertain that masters painted even some of patients from Monastery Hospital. The scenes of Christ's miraculous recoveries in the Dechani Monastery are undoubtelly significant for both the cultural history and the Serbian medieval medicine. This considerable cycle of the monumental painting and frescoes with medical matter, constitutes the basis for research of the Serbian medicine of the Middle-Ages.

Catholicism↗
PubMed2000

Hodgkin and reed-sternberg cells represent an expansion of a single clone originating from a germinal center B-cell with functional immunoglobulin gene rearrangements but defective immunoglobulin transcription.

Single cell studies aimed at clarifying the nature and clonality of Hodgkin and Reed-Sternberg (HRS) cells of classical Hodgkin's disease (HD) have so far produced conflicting results. Using an improved single cell procedure, the HRS cells of 25 patients with nodular sclerosing HD lacking B- and T-cell antigens, with and without Epstein-Barr virus infection, were analyzed for the presence of immunoglobulin (Ig) gene rearrangements. One patient with HD developed follicular lymphoma 2 years later. Both lymphomas originated from a common precursor identified as a germinal center B cell. The data show that all but one of the investigated cases harbored rearranged Ig genes, which were clonal in all instances and carried a high load of somatic mutations. The Ig coding capacity was preserved in 18 of the 24 cases (75%) with rearrangements. However, expression of Ig messenger RNA was not detectable in the HRS cells with the exception of Ig kappa light chain expression in some tumor cells of 1 case. The lack of Ig gene transcription in HRS cells was confirmed by analyzing the HD cell lines L428 and KM-H2 in transient transfection experiments. An Ig promoter/enhancer reporter construct showed virtually no activity in these cells compared to 5 control B-cell lines. We conclude that (1) classical HD is a B-cell lymphoma in most instances, (2) HRS cells are clonal without any exception, (3) they are derived from germinal center B-cells that (4) mostly lack crippling mutations but (5) have consistently lost their Ig gene transcription ability, due to functional defects in the Ig gene regulatory elements. (Blood. 2000;95:1443-1450)

Adolescent↗
PubMed2000

Active management of a patient with endstage pulmonary emphysema using lung volume reduction surgery and intensive rehabilitation.

INTRODUCTION: Lung volume reduction surgery (LVRS) and pulmonary rehabilitation are newer options available in the treatment of advanced emphysema. We describe the progress of our first local patient to have undergone these 2 new treatment modalities. CLINICAL PICTURE: A 65-year-old man with advanced emphysema, limited by crippling dyspnoea despite maximal medical therapy with inhaled bronchodilator therapy, methylxanthines and supplementary oxygen. TREATMENT: Physical reconditioning with a 4-week inpatient pulmonary rehabilitation programme, followed by LVRS and a further 6-week outpatient pulmonary rehabilitation. OUTCOME: Dramatic improvements in spirometric indices, arterial blood gases, exercise capacity and overall functional status. Improvements maintained at one-year follow up period. CONCLUSIONS: LVRS with pulmonary rehabilitation is an exciting new treatment option in a select group of patients with advanced emphysema. Their role in improving overall performance status and quality of life should be considered in patients otherwise considered to have reached the limits of medical therapy.

Aged↗
PubMed2000

[Chronic, unexplained pain: from complaint to action].

Every physician encounters patients with physical symptoms that remain unexplained, despite appropriate investigations. Medical curricula and textbooks fail to provide guidance about the management of such problems. Particularly specialists tend to feel helpless; this often leads to more referrals and unnecessary operations. Three patients, referred to a neurologist for a second opinion, had chronic, unexplained, crippling pains: a woman aged 53 with low back pain radiating to the right leg for 27 years, a man aged 31 with neck pain for 3 years and a woman aged 31 with pain in the left arm for 1.5 years. They had no recognisable features of depression. Their illness behaviour reversed after the neurologist reassured the patients and advised them to embark upon a strict programme of gradually increasing activities. In two of the patients, the scheme was supervised by the general practitioner. A follow-up interview (after a median interval of 3 years) of 27 similar patients referred for a second opinion showed some success with this approach in about half of them. In retrospect no predictive factors at baseline could be identified other than age and duration of symptoms. An indispensable first step in patients with unexplained, chronic pain is unqualified recognition of the symptoms, reassurance, and an explanation that avoids the mind-body division.

Adult↗
PubMed2000

Hospital for special surgery. A brief review of its development and current position.

On May 1, 1999, the Hospital for Special Surgery was 136 years old. To present a history that does adequate justice to the many people, who have been or still are involved in the making of it, is an impossible task. Nevertheless, this document is important because the hospital, first under the name of Ruptured and Crippled and then under that of Special Surgery has played such an important role in the development of orthopaedics and rheumatology in America during the past century. The reader must forgive an orthopaedic bias to this account and also realize the limitation of space that makes it at best fragmentary and incomplete. The account begins with a description of the hospital's current situation, physical layout and governance. A terse history of the hospital's origin and subsequent development follows, which includes a more specific description of the growth of its orthopaedic surgical services. Finally, separate records of the 112-year-old Postgraduate Orthopaedic Educational Program and 44-year-old Research Division are presented.

Education, Medical, Graduate↗
PubMed2000

Arthur Steindler. Orthopaedic scholar, teacher, and clinician.

Arthur Steindler, a native of Austria, immigrated to the United States in 1907 and during the next 50 years he became very influential in the development of orthopaedics during the twentieth century. His life is a compelling example of how an individual can make major contributions to the advancement of medical science and practice. His clinical interests spanned the entire range of musculoskeletal disorders including developmental, genetic, infectious, neoplastic and neuromuscular diseases, and their operative and nonoperative treatment. He founded the clinical and academic Orthopaedic Surgery programs at the University of Iowa in Iowa City and directed their growth for 34 years. During that time his clinical work, scholarship, and teaching helped the University of Iowa become a national and international orthopaedic center. He helped establish a statewide system to provide medical care for indigent patients and personally treated more than 70,000 patients, many of them children crippled by polio, tuberculosis, spastic paralysis, scoliosis, congenital deformities, and degenerative neuromuscular diseases. To improve the function of the weakened and deformed limbs of the children, he devised various innovative operations. He wrote more than 130 papers and nine books in several languages on the natural history, etiology, and treatment of musculoskeletal diseases and injuries, pioneered the application of biomechanics to evaluation and treatment of musculoskeletal disorders, and wrote the first comprehensive text on the mechanics of human movement. He taught more than 300 orthopaedists, and when Ruth Jackson, the individual recognized as the first woman orthopaedic surgeon in the United States, decided to pursue a career in orthopaedics, she sought out Arthur Steindler and received her formal orthopaedic education under his direction. That Steindler accomplished so much after moving to the small midwestern town of Iowa City at the age of 37 is impressive, and clearly documents his remarkable abilities and determination.

Academic Medical Centers↗
PubMedDate not supplied

[Frame of mind among Polish population in research carried out by the Central Statistical Office: initial analysis].

The authors are going to estimate the prevalence poor frame of mind and neurosis among Polish adult people, and try to appoint the relationships between psychiatric disorders and gender, age, civil status, education and maintenance. The questionnaire contains questions about quality of sleep, possibility to fix one's attention on acting, inner tension, self-confidence. Almost 1/4 of women and 18% of men have poor frame of mind. We find very strong and important relationships between neurosis and the poor frame of mind. There were no differences in mental state between people living in towns and villages. The unemployed and the cripples have worse psychological condition than working men. People who are divorced and widowed have statistically more often poor frame of mind and neurosis than the married. We also found a major correlation between poor frame of mind and neurosis and education. Low education is connected with poor psychological condition.

Adolescent↗