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PubMed1990

Understanding mass media coverage of disease clusters.

The responsibility of informing the general public about disease clusters belongs to health investigators. In the majority of instances the investigators must send their messages through the mass media. The authors analyzed nightly network television news coverage of disease clusters during the period 1978-1987, and newspaper coverage of four disease clusters. Formal content analysis of about 600 stories showed that the mass media focuses on human interest, conflicting information, blame, and political symbolism in their coverage of clustered health events. The authors offer suggestions to health practitioners about improving their communications with journalists.

Disease Outbreaks↗
PubMed1991

Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland.

In the 1970s, mass vaccination projects were started in various parts of the world against measles and congenital rubella, with eradication as the final goal. In many developing and industrial countries, including Finland, the elimination of measles failed because of low vaccination coverage. In Finland, a combined measles, mumps, and rubella (Virivac) vaccination program was started in 1982. Computerized recording of the vaccinated children was considered necessary and was integrated with the population registry to identify the hard-to-reach families. Several interventions improved compliance: a mass media campaign and notification of nonvaccinated children to local health professionals and parents. All successive campaigns increased vaccination coverage significantly, with the notification of parents about their nonvaccinated child being especially effective. A vaccination coverage of over 96% was achieved, which theoretically prevents measles, mumps, and rubella transmission.

Child↗
PubMed1996

Improving the coverage of neonatal BCG vaccination.

BACKGROUND: It is recommended that neonates at higher risk of contracting tuberculosis (such as in certain ethnic groups) should be vaccinated with BCG as soon as possible after birth. In Milton Keynes, during the late 1980s, there was anecdotal evidence to suggest that many higher-risk cases were not receiving BCG vaccination. The objectives of the study were to audit the neonatal BCG vaccination programme and to develop a system for improving and monitoring coverage. METHOD: Two main sources of data were used: the obstetric computer, which gave the denominator of women considered to be in a higher-risk group, and the community child health computer, which gave the numerator of BCG vaccinations given. A case note audit was used to check the quality of these data. A computer-generated reminder was used to make sure that the antenatal assessment of risk was known about immediately after delivery. RESULTS: Estimated vaccine coverage rose from about 20 per cent (1988-1990) to 78 per cent by 1993. The audit suggested that about 8 per cent of vaccinations were not being recorded and 9 per cent were given unnecessarily. In addition, about 2 per cent were picked up postnatally and 1 per cent were missed completely. CONCLUSION: Improved coverage and adequate monitoring can be achieved using the two computerized systems. This methods has applications to other conditions where antenatal assessment can predict risk for a neonate, such as Hepatitis B or sickle cell disease.

BCG Vaccine↗
PubMed1984

The island pedicle rotation advancement gastrocnemius musculocutaneous flap for complete coverage of the popliteal fossa.

The medial head of the gastrocnemius flap is a large, versatile flap that can be used to cover areas above the popliteal fossa, thereby minimizing the necessity for amputation in many traumatic injuries to this area. By advancing the medial head of the gastrocnemius muscle and rotating it on the neurovascular pedicle of the medial sural vessels, we have covered a 17 cm X 20 cm defect of crushed muscle, tendon, and bone in a leg that was traumatically amputated proximal to the knee. This procedure makes possible muscular coverage for bone, stainless steel plate, and reanastomosed arteries and veins above the knee and provides skin coverage extending to 70% of the circumference of the popliteal fossa. Autografting provides coverage for the remainder of the wound. Subsequent extension and flexion of the viable knee joint was achieved.

Adult↗
PubMed1986

Influence of soft tissue coverage on the healing of cortical defects in canine diaphyseal bone.

The influence of soft tissue coverage on bone healing was investigated in dogs. A standard diaphyseal bone defect was left open, closed with skin, or closed with skin and muscle. Specimen radiography, callus morphometry, microscopy, and fluorescent microscopy were used to assess bone healing. The defects healed in all groups. Defects left open produced significantly more periosteal callus (p less than 0.01). Abscess formation was observed in the callus. The trabecular structure was abnormally oriented. Histomorphometric measurements of the rate of bone formation were the same regardless of the presence or type of soft tissue coverage. Failure to disturb the intramedullary blood supply may have minimized the differences in healing among the 3 groups. Nevertheless, soft tissue coverage was observed to prevent bone infection and to accelerate the restoration of normal cortical architecture.

Animals↗
PubMed1995

Bilateral gluteus maximus V-Y advancement musculocutaneous flaps for the coverage of large sacral pressure sores: revisit and refinement.

Surgical management of the sacral defect using the gluteal muscle or musculocutaneous flap has been well accepted over the years. In this study, refinements in the bilateral gluteus maximus V-Y advancement musculocutaneous flaps were made. These refinements include having sharper angle (60 degrees or less) at the donor sites of the flap, cutting the edges of the gluteal muscle of 3 cm beyond the skin flap, and cutting most parts of the gluteal muscle at a depth of only 2.5 cm (at the level of upper third portion). These improvements result in less tension closure of the donor site, easier closure of the advanced flaps in two planes without tension, and better preservation of most parts of the gluteal muscular insertions to the femur and their functions. The design of V-Y advancement has successfully maintained the superior and inferior gluteal vessels and inferior gluteal nerve. In this study, the average sacral defect was more than 12 cm in diameter, and each advanced flap was 15 x 12 x 3 cm in size. Of the 63 consecutive patients undergoing bilateral gluteus maximus V-Y advancement musculocutaneous flaps with refinements for coverage of large sacral pressure sores, 59 (93%) achieved complete healing after an average follow-up period of 28 months. Only 4 patients had recurrences of sacral sore. In this study, the duration of hospital stay for flap coverage averaged 38.5 days. Four patients (6%) had superficial dehiscences of the donor site requiring skin grafting. Ten patients (16%) developed stitch abscesses and 9 patients (14%) had wound infections, but no flap was lost. No significant functional impairment related to the flap procedure was noted. The operative technique described in this paper is not only simple and noninvasive, but with our refinements of flap design, the bilateral gluteus maximus V-Y advancement musculocutaneous flaps also provide reliable and durable coverage for large sacral pressure sores.

Adult↗
PubMed2000

Immediate coverage of exposed, denuded cranial bone with split-thickness skin grafts.

Avulsion injuries of the scalp are challenging to treat. If the periosteum is not intact and the status of local tissues does not allow local flap transposition, coverage of the exposed, denuded skull becomes a problem. Most authors have obtained a bed of granulation tissue at the site of exposed bone before skin grafting, which requires a prolonged waiting period. In 5 consecutive patients, the authors obtained coverage in a single operation by removing the outer table of the skull with a high-speed burr, followed by immediate application of a skin graft over the bleeding, cancellous bone. This resulted in stable coverage and shortened the hospital stay significantly. They describe their technique and compare it with others.

Adult↗
PubMed2002

Outcomes for surgical coverage of pressure sores in nonambulatory, nonparaplegic, elderly patients.

Pressure sores are a common complication of long-term institutional care. Surgical coverage of late-stage ulcers in the elderly refractory to conservative therapy remains controversial. The authors reviewed the outcome of 22 predominately nonambulatory, nonparaplegic, elderly patients with coverage of 27 pressure sores. The mean patient age was 59 years (range, 50-82 years). The average follow-up was 6 months (range, 3 months-2 years). There were 11 complications for the 22 patients (50%) and the 27 ulcers (41%). Postoperatively, a well-healed ulcer was present in 19 of 27 patients (70%) at 6 months. Of the 19 reconstructed sacral ulcers, there were 10 complications (53%) and one recurrence at 6 months. Seven trochanteric ulcers were covered with tensor fascia lata flaps without complications or recurrences at the 6-month follow-up. One ischial ulcer was managed using a V-Y hamstring advancement flap, resulting in dehiscence and a subsequent revision. The authors advocate surgical coverage to treat late-stage pressure sores in nonparalyzed elderly persons to reduce the morbidity, mortality, and economic burden of patients with late-stage pressure ulcers. With an increasing geriatric population, prevention and postoperative care are necessary to diminish the incidence, recurrence, and burden of pressure sores.

Aged↗
PubMed1983

Coverage of the infected wound.

Fifty-four consecutive patients with chronic wounds were identified by the following criteria: (1) established infection for 6 months, (2) exposure of bone, mediastinum, or other vital structure, (3) mechanical and/or vascular limitations to delayed closure techniques, (4) no response to wound debridement in prolonged antibiotic therapy. These wounds were divided into four groups: osteomyelitis (21), pressure sore (17), soft tissue wound (10), and osteoradionecrosis (6). Wound treatment in all patients included debridement, muscle flap closure, and culture specific antibiotic therapy. These consecutively treated patients over a 4-year period presented with an average duration of chronic infection of 2.9 years. Ninety-three per cent of these patients after treatment have demonstrated stable coverage without recurrent infection with a minimum of 1 year and a maximum of 4.6 years follow-up. The results demonstrate safe, effective coverage (93% of patients) of chronic infected wounds associated with long bone and pelvic osteomyelitis as well as chronic perineal sinuses following proctocolectomy and osteoradionecrosis. Debridement with short-term (average 12 days) antibiotic therapy has been effective when muscle flap coverage is provided.

Adult↗
PubMedDate not supplied

The use of Biobrane for coverage of the pediatric donor site.

Donor site dressings are highly diverse. The ultimate goal of any coverage is to minimize pain and healing time. Recently, synthetic laminates have become popular. Experience with Biobrane has mainly been with adult patients. This study examines the use of Biobrane in a pediatric population. One hundred eight consecutive applications of Biobrane in 95 patients (mean age 7.9 years) were reviewed. All applications were treated in identical fashion. Biobrane was left in place until healing occurred unless primary nonadherence occurred or fluid collections developed over a significant area, rendering the area nonadherent. Forty-three early removals of Biobrane were necessary at a mean of 3 1/2 days after application. The back and hip regions, with 43% and 80% early removal rates, respectively, were the areas where Biobrane was least successful in providing donor coverage until the site healed. The chest and thigh had successful full-term coverage in greater than 90% of cases. The principal basis for early removal was fluid accumulation, which reduced adherence. Early removal did not affect the healing time of the donor site. These results demonstrate a modest effectiveness of Biobrane as a donor site dressing on the back and hip regions in pediatric patients with burns. Selection of sites for which good success can be expected should be paramount in the decision to use this donor site material in this patient population.

Adolescent↗
PubMedDate not supplied

Skin coverage with Biobrane biomaterial for the treatment of patients with toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that may involve a large body surface area and mucosal surfaces. The microscopic changes that occur with this condition are similar to those that occur with superficial dermal burns, such as dermal detachment from the underlying dermis. Complications of TEN are related to the loss of the epithelial skin barrier and include pain, fluid and electrolyte loss, and an increased risk of sepsis. The treatment of a patient with TEN is best accomplished in a burn unit, where expert treatment of these complications can be provided. Medical treatment includes the administration of immunosuppressive therapy and the discontinuation of any previous corticosteroid treatment. Surgical management includes the debridement of necrotic areas. In this article, the surgical management of 8 consecutive patients with TEN who were admitted to the intensive care burn unit at the Hospital Universitario de Getafe in Madrid, Spain, from 1996 to 1998 is described. These patients were treated with extensive early debridement of necrotic skin areas followed by wound coverage with Biobrane (Dow B. Hickam, Inc, Sugarland, Tex), a temporary semisynthetic skin substitute. Skin coverage with this material decreases pain and fluid loss, and it possibly facilitates epithelization and decreases the risk of sepsis, without adverse side effects. This semisynthetic material meets some standards of an ideal skin substitute: it is easy to use, provides several beneficial physiologic effects, and improves patients' comfort. In the 8 cases of patients with TEN that were studied, the use of Biobrane skin substitute for the coverage of massive areas of detached skin was found to be an important aspect of treatment.

Adult↗
PubMed1999

Free medialis pedis flap as a coverage and flow-through flap in hand and digit reconstruction.

BACKGROUND: Skin and soft-tissue defects of the hand and digit present a challenge for the hand surgeon especially in meeting the reconstructive needs of thickness, texture, color matching, and sensation. It becomes an even bigger challenge to reconstruct the defect in a devascularized finger with segmental loss of the neurovascular bundle. We use the relatively new flap, the medialis pedis flap, to solve the above conditions and compare it with traditional flaps. METHODS: From May of 1994 to March of 1997, the free medialis pedis flap was used to reconstruct 19 digit and hand defects; the flap sizes ranging from 1.5 x 3.0 cm to 3.0 x 9.0 cm. Sixteen flaps were used for simple coverage of digit defects, including 12 for single-digit and 4 for multiple-digit reconstruction. The remaining three flaps were used as coverage and a flow-through flap for devascularized fingers. RESULTS: All 19 flaps survived and achieved a good protective sensation. The appearance was very satisfactory, and the donor-site scars were without sensory problems. CONCLUSION: Compared with traditional flaps, the free medialis pedis has the following advantages: it provides good thickness, texture, and color matching for hand and digit resurfacing; it can be used as a flow-through flap and as coverage for a devascularized finger in a one-stage procedure; the size of the feeding vessels of the flap matches those of the digital vessels well; and it consists of glabrous skin rich in nerve endings, so it has good potential for sensory recovery. Because of all of these characteristics, the free medialis flap may become a better consideration for hand surgeons.

Adult↗
PubMed1978

The effects of outpatient psychiatric utilization on the costs of providing third-party coverage.

Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.

Ambulatory Care↗
PubMed1984

Knowledge of their health insurance coverage by the elderly.

Current legislative proposals to increase competition among private insurers assume that people are or can be well-informed about their insurance coverage. Evidence from the National Medical Care Expenditure Survey shows that among the population 65 years of age and older knowledge about health insurance coverage is substantial but generally lower than in the population younger than 65 years of age. Multivariate analysis is used to identify factors associated with high and low levels of knowledge. Although correct knowledge of coverage of particular services is highly associated with current experience of health problems, with use of these health services, and with the cost for private insurance, overall knowledge is lowest among some groups at high risk of serious illness, in particular, the old, nonwhites, and persons enrolled in Medicare but without Medicaid or private insurance supplements.

Aged↗
PubMed1997

The effect of universal coverage on health expenditures for the uninsured.

OBJECTIVES: Universal coverage will trigger an increase in health-care spending, because the uninsured will use more services after they are insured. The effect of insurance status on expenditures is estimated here from a multivariate statistical model. METHODS: The model is estimated with data from the 1987 National Medical Expenditure Survey, aged to 1994 using population projections from the US Bureau of the Census and expenditure projections from the Health Care Financing Administration. RESULTS: Expenditures for the full-year uninsured increase by approximately $700 per person in 1994 as a result of universal coverage. Nearly half of the increase is because of a substantial increase in the likelihood of hospitalization. CONCLUSIONS: If the uninsured are enrolled in plans similar to those offered by employers currently, personal health-care spending increases by approximately $20 billion in 1994. There are other costs associated with universal coverage that are not included in this figure.

Adolescent↗
PubMed1997

Effect of anode-cathode configuration on paresthesia coverage in spinal cord stimulation.

OBJECTIVE: To provide a theoretical basis for the selection of the anode-cathode configuration in spinal cord stimulation for the management pain when one percutaneous epidural electrode or two electrodes in parallel are used. METHODS: A computer model of spinal cord stimulation at T8-T9 was used to calculate the dorsal column areas recruited in stimulation by various configurations used in clinical practice. RESULTS: Tripolar (or bipolar) stimulation by a single electrode, symmetrically placed over the dorsal columns, recruits the largest area and will give the widest paresthesia coverage. Stimulation by two symmetrically placed electrodes connected in parallel to a single channel pulse generator may give similar results, because of their generally smaller distance from the spinal cord, but a "summation effect" does not exist. A smaller dorsal column area is activated when two offset electrodes are used. An electrode placed laterally or transverse bipolar stimulation results in unilateral, usually segmentary, paresthesia. CONCLUSIONS: The relative positions of cathodes and anodes and their distance from the spinal cord are the major determinants of dorsal column/dorsal root activation and paresthesia distribution. The large interpatient variability of the intraspinal geometry is the main cause of differences in paresthesia coverage among patients having optimally placed electrode(s). Changes of paresthesia coverage over time are more probable when multiple electrodes are used.

Computer Simulation↗
PubMed1983

Local arterialized island flap coverage of difficult hand defects preserving donor digit sensibility.

Small to moderate-sized defects of the hand overlying joint surfaces, flexor tendons, Silastic implants, and tactile surfaces require full-thickness skin and subcutaneous tissue either for primary coverage or in anticipation of secondary reconstruction. In this report, six difficult hand wounds are resurfaced with an arterialized island pedicle from the lateral surface of the nearby digit in lieu of multistage distant pedicle flaps. The Littler neurovascular island flap has been modified to include only the digital artery and venae comitantes at its pedicle, preserving digital nerve intact in the donor digit. Microsurgical separation of the digital artery from the digital nerve minimizes the sensory loss of the donor digit. Cortical reeducation at the recipient site is unnecessary. The lengthy pedicle allows an arc of coverage over the palm, dorsum of the hand, and adjacent digits. Results in six cases have been favorable. Flap survival has been 100 percent. Maximum flap size was 5.5 X 2.5 cm. Two-point discrimination of the donor defect averaged 4.5 mm. No significant donor morbidity was noted, with the exception of one case in which there was a mild degree of hypertrophic scarring across the volar aspect of the proximal interphalangeal joint. The one-stage procedure minimizes the number of hospitalizations and disability time. Its proximity to injury, versatility, and relative speed with which it can be raised encourages its usage for primary coverage (two cases in this series). Preservation of near normal two-point discrimination of the donor site allows either the radial or ulnar surface of the nearby digit to be used.

Adolescent↗