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At least 1,153 records · Page 64Linked to original sources
PubMed1995

Cost of patient follow-up after potentially curative colorectal cancer treatment.

OBJECTIVE: To estimate the cost of follow-up among colorectal cancer patients treated with curative intent based on the broad spectrum of surveillance strategies suggested in the literature. DESIGN: Economic analysis of the costs associated with 11 separate surveillance strategies. Charge data were obtained from the Part B Medicare Annual Data file and the Hospital Outpatient Bill file. SETTING: Ambulatory care. MAIN OUTCOME MEASURES: Medicare-allowed charges and an actual-charge proxy for 5 years of follow-up after treatment for colorectal cancer patients on a nationwide basis. RESULTS: Medicare-allowed charges varied widely for the 5 years of posttreatment follow-up from a low of $561 to a high of $16,492. When Medicare-allowed charges were converted to a proxy for actual charges using a conversion ratio of 1.62, the range was $910 to $26,717, a 28-fold difference in charges. CONCLUSIONS: Charges vary extensively across follow-up strategies, with no indication that higher-cost strategies increase survival or quality of life.

Colorectal Neoplasms↗
PubMed1993

The Ciskei tuberculosis information system.

The organization and evaluation of tuberculosis services have been badly neglected in developing countries. The Ciskei information system controls (a) the issue of treatment of tuberculosis outpatients and (b) the notification of patients and their movements throughout treatment. "TB teams" of one to two nurses and a health assistant, based in each district, monitor the issue of treatment to outpatients. Compliance varies between about 50-80 pc in different districts. A central computerised tuberculosis register collects information about all patients coming under treatment and their subsequent movements until treatment stops. Its value is more in monitoring and correcting the running of the service than in collecting information. It uses alphabetical lists to reduce double registrations, enter follow up information, eliminates duplicates if entered and identify relapses. Reminder letters are sent out automatically when required. Tabulations can be done from the data file, special series of sputum positive patients studied and relapses analysed. There were 1,711 sputum positive registrations in 1991, compared with 1,741 in 1990. More occurred in the winter months. The three year self referred relapse rate is just over four pc. Intensive follow up of 584 patients showed 12 different outcomes; of 404 recorded as completing treatment, 1.7 pc relapsed later, compared with 11.7 pc of the others. The register has been invaluable to the monitoring, control and evaluation of the TB programme in Ciskei. Documentation is limited to copies of forms needed anyway for the ongoing care of patients.

Aftercare↗
PubMed1993

Appropriate information: new products and services.

Effective health information services require action on three major levels: identifying and acquiring appropriate resources; applying appropriate methodologies for management of information and its communication; and stimulating local initiatives and applications. WHO's Programme of Library and Health Literature Services proposes its methodologies and products for creating and improving effective information services to health workers.

Developing Countries↗
PubMed1994

Security Audit Center--a suggested model for effective audit strategies in health care informatics.

As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.

Automation↗
PubMed1993

Cancer in association with polymyalgia rheumatica and temporal arteritis.

In our prospective controlled study, a total of 185 patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA) diagnosed during 1978-83 and their 925 matched controls were cross checked with the data files at the Cancer Registry of Norway at the end of 1987. Malignancy was registered in 27 patients (14.6%) and 131 controls (14.2%) between 1953 and the end of 1987. Malignancy was registered in 16 (24.6%) of the patients with biopsy demonstrating arteritis temporalis. The hazard rate for developing malignancy after diagnosis for the whole patient population was not significantly different from the controls. The hazard rate for developing malignancy in patients with positive biopsy, however, was 2.35 times higher than in the controls (p = 0.036) and 4.40 times higher than the rest of the patient population (p = 0.007) (Cox proportional hazards model). The general long interval between diagnosis of PMR and/or TA and registration of malignancy (mean 6.5 years) is not consistent with a paraneoplastic mechanism.

Adult↗
PubMed1993

Sampling variance estimates for SSA program recipients from the 1990 Survey of Income and Program Participation.

Since 1987 the Social Security Administration (SSA) has published a special set of tabulations on SSA program recipients in the Annual Statistical Supplement to the Social Security Bulletin using data derived from the Census Bureau's Survey of Income and Program Participation (SIPP). Estimates of sampling errors pertaining to these tabulations were derived from the 1984 SIPP panel. This article provides updated sampling error estimates for the 1990 SIPP panel to be used in conjunction with the SIPP-based tabulations provided in the Annual Statistical Supplement for 1992 and 1993. The computational approach is essentially the same as that used in the earlier analysis. Sampling variances are estimated by half-sample replication using the pseudo stratum and half-sample codes available on SIPP public use data files. Generalized tables of standard errors are provided for all SSA program participants. An appendix provides detailed specifications about the calculations. In order that it be self-contained, this article repeats much of the methodological exposition in the previous article that appeared in the October 1988 issue of the Social Security Bulletin.

Adolescent↗
PubMed1993

[Cervical cytological diagnosis of carcinoma].

The predictive value of specifically diagnosing carcinoma by cervical cytology and the sensitivity of the Pap smear in assessing cervical carcinoma were evaluated by retrieving all cytological diagnoses stating carcinoma and all histological diagnoses stating cervical carcinoma from our data files covering the period from 01.04.88 to 31.03.91. In 115 patients the specific cytodiagnosis was followed up by histology, and in 107 patients the histological diagnosis was preceded by a Pap smear no more than two months old. The cytological recognition of invasion depended on the depth of invasion. Macroinvasive squamous cell carcinoma was specifically diagnosed by cytology in 77 per cent of the cases, while the cytological prediction of squamous cell carcinoma was confirmed as invasive carcinoma in 83.3 per cent of the cases. Adenocarcinoma assessed by cytology was confirmed in 84.4 per cent of the cases, while the sensitivity in specifying the diagnosis cervical adenocarcinoma was 54.6 per cent. No false negative Pap smears were seen in the material.

Adenocarcinoma↗
PubMed1993

A mobile real-time bioengineering front end system.

In the study of physiological system dynamics, a mobile Front End System is needed in faithfully monitoring and recording physiological signals at various experimental sites. Local real-time mode operation is required at the site of the experiment such that the significant dynamic response or event from the subject can be easily captured and displayed as the experiment progresses. An additional requirement is the interfacing with the campus computer network such that numerous network computing resources can be employed in further processing of the captured data. The system is configured by using general-purpose components such as a 50MHz PC-486, a DAS-HRES data acquisition board and some other necessary peripheral devices. An algorithm has been developed for the continuous manipulation of two queues to maintain the real-time task scheduling. Traces can be played back in forward or reverse mode at varied speed after the recording has been made. As desired, any trace segment can be picked up in the play back mode from the huge data files. The system is incorporated in a live subject bioinstrumentation laboratory and has the capability of monitoring signals from four simultaneously experimental setups. The signal types involved are membrane potentials, ECG, EMG, blood pressure, and respiratory flows and gas concentrations.

Algorithms↗
PubMed1993

[Future of administration and management in clinical laboratory].

Some problems in administering and managing clinical laboratories relate to technology, safety and health. Total systematization will help resolve these problems, and includes several new ideas, such as total investigation, total automation, total safety, total flexibility, total standardization, total estimation and a totally open-door. Patient-orientation is also important. In our physiological department, this aim was obtained to some extent by the introduction of computerization, optical data filing system and personnel arrangement.

Forecasting↗
PubMedDate not supplied

Temporal and geographic trends in the autopsy frequency of blunt and penetrating trauma deaths in the United States.

OBJECTIVE: To examine national trends in the percentage of blunt and penetrating trauma deaths autopsied. DESIGN, SETTING, AND PARTICIPANTS: For each year from 1980 through 1989, we used national mortality data files to determine the autopsy frequency (percentage of deaths autopsied) of all deaths in the United States. We analyzed variation in the autopsy frequency of blunt and penetrating trauma deaths by cause of injury and place of occurrence of death. RESULTS: The autopsy frequency of blunt and penetrating trauma deaths in the United States increased by 14.3% during the 1980s to 58.9% in 1989 (62,004 of 105,309 deaths autopsied), while the autopsy frequency of all deaths decreased by 23.6% during the same period to 11.5% in 1989 (248,272 of 2,153,859 deaths autopsied). Among trauma deaths, homicides remained far more likely to be autopsied than nonhomicides (deaths due to unintentional injuries, suicides, and injuries of undetermined intentionality). The autopsy frequency of homicidal trauma deaths in 1989 was 90.0% or higher in 44 states and ranged from 79.6% in Mississippi to 100.0% in six states. The autopsy frequency of nonhomicidal trauma deaths in 1989 was 90.0% or higher in two states and ranged from 10.3% in Oklahoma to 94.5% in Hawaii. Nationwide, we found significant differences in the autopsy frequency of trauma deaths in 1989 between metropolitan and nonmetropolitan counties, both for homicides (97.7% vs 89.3%; P < .001) and nonhomicides (58.2% vs 29.9%; P < .001). CONCLUSIONS: The percentage of blunt and penetrating trauma deaths autopsied has increased recently in the United States, but extensive geographic variation in autopsy frequency suggests that the benefits of autopsy findings for trauma care quality improvement and public health surveillance of injuries are distributed unevenly throughout the nation.

Autopsy↗
PubMed1993

Detection of contralateral breast cancer by mammography in women with previous breast cancer and the impact of endocrine therapy.

AIMS: To determine the efficacy and extent of screening mammography for detection of contralateral breast cancer in a cohort of women with previous unilateral mammary carcinoma, and to assess the effect of endocrine therapy on the risk of developing cancer in the contralateral breast. METHODS: Women with previous breast cancer eligible for mammography were identified from the Auckland breast cancer data file and the extent and outcome of mammographic screening determined by questionnaire and survey of mammography reports. The extent of adjuvant hormonal therapy and development of contralateral breast cancer was ascertained from the ABCDF records. RESULTS: Of 703 eligible subjects, 59% had undergone screening mammography with a cancer detection rate of 17 per 1000 mammograms and a benign to malignant ratio was 1.7 to 1. Contralateral breast cancer developed in 2.9% of 1980 women with previous unilateral mammary tumours who did not receive endocrine therapy with 1.1% of 374 women who were given adjuvant hormonal treatment (p = 0.04). CONCLUSIONS: The efficacy of mammography in those screened was comparable to major overseas screening programs, but the proportion of women undergoing mammography in this high risk group was relatively low suggesting a need for greater promotion of mammography in Auckland. The use of adjuvant endocrine therapy significantly reduced the rate of development of contralateral breast tumours supporting the current development of formal trials of chemoprevention of breast cancer in women at high risk groups of the disorder.

Breast Neoplasms↗
PubMed1993

Electronic fetal monitoring in the United States in the 1980s.

OBJECTIVE: To measure the frequency with which electronic fetal monitoring was used for childbirth in United States hospitals in the 1980s and to examine variation in use according to risk factors at labor onset. METHODS: Two data sets from the National Center for Health Statistics (the 1980 National Natality Survey and the 1988 National Maternal and Infant Health Survey) were used to generate proportional frequencies for electronic fetal monitoring use. These data files are based on representative samples of live births (9941 and 9953, respectively) drawn by probability methods from the entire country during a calendar year. Consistency in the sampling methods and questionnaire procedures, and use of sampling weights, permitted national estimates to be generated. RESULTS: Use of electronic fetal monitoring increased from 44.6% of live births in 1980 to 62.2% in 1988. In both time periods, low-risk women received monitoring more frequently than did women with risk indicators. Use grew by 64% in low-risk women (from 46.5% in 1980 to 76.3% in 1988) but only by 32% in women with risk conditions at labor onset (from 42.6% in 1980 to 56.2% in 1988). CONCLUSIONS: Use of electronic fetal monitoring increased during the 1980s, disproportionately so for low-risk women. This trend raises questions about the efficacy of monitoring for improving pregnancy outcomes.

Female↗
PubMed1996

The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer.

BACKGROUND: Increasing age has most often been associated with less aggressive approaches to treatment of nonmetastatic breast cancer in elderly women even after controlling for stage of disease at diagnosis. OBJECTIVE: To examine the influence of patient age on the initial treatment for breast cancer received by elderly women while controlling for the effect of patient comorbidity. METHODS: Cancer registry records for a cohort of 2252 women aged 66 years or older who were diagnosed as having nonmetastatic, invasive breast cancer between 1984 and 1989 and identified through the Virginia Cancer Registry were linked to Medicare Provider and Reimbursement data files. Multivariate models were used to assess the effects of age and comorbidity (as measured by the International Classification of Diseases, Ninth Edition, codes recorded on Medicare claims) on initial treatment approach while adjusting for stage of disease, race, residential location, marital status, and year of diagnosis. RESULTS: In baseline multivariable models, age was negatively associated with any surgical treatment, non-breast-conserving procedures, and radiotherapy following breast-conserving surgery. The odds of women aged 85 years and older receiving surgery were less than one third those of women aged 66 to 74 years (odds ratio, 0.31; 95% confidence interval, 0.16 to 0.60), while odds ratios across the same two age groups for nonbreast-conserving surgery and adjuvant radiotherapy were 0.55 (95% confidence interval, 33 to 92) and 0.03 (confidence interval, 0.01 to 0.13), respectively. With additional adjustment for aggregate comorbidity, odds ratio estimates in these same age-group comparisons were virtually unchanged at 0.31, 0.56, and 0.04. CONCLUSION: Aggregate comorbidity measured by inpatient International Classification of Diseases, Ninth Edition, codes on Medicare inpatient hospital claims does not explain age-related patterns in the initial treatment of elderly patients with breast cancer.

Age Factors↗
PubMed1995

[Cooperation between the public health office and federal health insurance in the area of health promotion].

During the last few years several health projects were realised in cooperation with health insurance societies. One of the projects concerned the sports possibilities for people suffering from chronic diseases. Another one supplied information on symptoms of cardiac infarction. Cholesterol levels were analysed, height an body weight were determined and blood pressure was measured. Additionally, several data on anamnesis were stored anonymously as data files. One of the projects was performed with a normal part of the population in the office of a bank. During this arrangement many young people were also examined. Another event was a "doctor-patient-seminar" on the subject of cardiac infarction. We wanted to demonstrate a few interesting differences between the two groups that were examined. We found a circadian difference in the means of blood samples taken at 1-hour intervals, in respect of the cholesterol levels, the time difference being approximately two hours after the last ingestion. The cooperation with health insurance societies is a good possibility in view of the difficult situation of local or communal finances, to realise health education projects with financial support by health insurance societies. The statistical difference between the two examined populations for special risks shows that population groups with coronary insults in their anamnesis and hence treated "on target", yield statistically significantly better results in respect of cholesterol, systolic and diastolic blood pressure, than the group defined as a normal population.

Adult↗
PubMed1996

The short-term effects of merger on hospital operations.

OBJECTIVE: The short-term effects of merger on three areas of hospital operations - scale of activity, personnel/staffing practices, and operating efficiency - is examined. DATA SOURCES: Secondary data obtained from the AHA Annual Surveys (1980-1990) were applied to analyze 92 hospital mergers over the period 1982-1989. STUDY DESIGN: The study employed a multiple time-series design involving a six-year longitudinal assessment of change in hospital operating characteristics before and after merger, and a parallel analysis of change in a randomly selected group of nonmerging hospitals. DATA COLLECTION: Pooled, cross-sectional data files were constructed. Comparisons were evaluated using paired and two-sample t-tests. PRINCIPAL FINDINGS: General merger effects occurred primarily in areas related to operating efficiency. Merger resulted in slowing rates of preexisting trends, rather than dramatic improvements in operating practices. CONCLUSIONS: The short-term impact of merger was generally modest but differed by the conditions under which the merger occurred. Specifically, mergers occurring later in the study period and mergers between similarly sized hospitals displayed greater change in operating characteristics than those occurring earlier in the study period and those between hospitals of dissimilar size. Such differences are attributed respectively to increased competitive pressures after PPS and to greater opportunities for consolidation and efficiencies in mergers involving similarly sized hospitals.

American Hospital Association↗
PubMed1995

The influence of OASDI and SSI payments on the poverty status of families with children.

This is the second of two articles on the effects of Old-Age Disability Insurance (OASDI) and Supplemental Security Income (SSI) payments on the poverty status of children. Based primarily on a data file from the 1990 SIPP matched with Social Security Administration (SSA) administrative records, the principal findings in the article are that: (1) the families of children who were entitled to survivors benefits, and in particular those families in which the surviving parent was remarried, were much less likely to have income below the poverty threshold than other families with children who received OASDI benefits; (2) families with a child eligible for SSI payments, and headed by a single adult, received considerably less income from earnings, and had less income overall, than other families with children that received SSI payments; and (3) the primary reason that some families who received OASDI and SSI benefits remained in poverty was the absence of any employed family member.

Adolescent↗
PubMedDate not supplied

Quantifying the adequacy of prenatal care: a comparison of indices.

OBJECTIVES: In spite of the widespread use of prenatal care utilization indices in the scientific literature, little attention has been given to the extent to which these indices are comparable. This investigation contrasts the way five indices classified cases into categories of prenatal care use. METHODS: From the 1989-1991 South Carolina Public Use data files, single live births to resident mothers were selected for analysis (N = 169,082). Five prenatal care indices were compared: (a) the modified Institute of Medicine (Kessner) index, (b) a variation of the IOM index using the full American College of Obstetrics and Gynecology visit recommendation, (c) an index derived from the recommendations of the U.S. Public Health Service Expert Panel on Prenatal Care, (d) the GINDEX, and (e) the APNCU index. RESULTS: The proportion of cases assigned to prenatal care utilization categories by each index varied markedly, ranging from 33.6% to 58.1% for adequate care, 9.2% to 20.3% for inadequate care, and 7.4% to 22.6% for intensive utilization. CONCLUSIONS: The selection of a prenatal care utilization index for research and policy development purposes requires a careful consideration of the intent, criteria for defining adequacy, and coding assumptions of each index. As these indices are conceptually distinct in their measurement approach, they are likely to yield different patterns of prenatal care use in a population and cannot be used interchangeably. Recommendations for their use are provided.

Algorithms↗
PubMed1996

Update: fatal air bag-related injuries to children--United States, 1993-1996.

Dual air bags will be required standard equipment in all new passenger cars sold in the United States beginning in 1997 and all light trucks sold in the United States in 1998 but are available now in many earlier-model vehicles. Air bags are designed to supplement the protection provided by safety belts in frontal crashes; when combined with lap and shoulder safety belts, air bags assist in preventing fatal and nonfatal injuries in motor-vehicle crashes. However, passenger-side air bags have been associated with injuries to children who, in almost all cases, were unrestrained or incorrectly restrained in the front seat. In 1993, approximately 1.4 million (0.8% of all vehicles registered) were equipped with passenger-side air bags, compared with an estimated 21.6 million vehicles (11.4% of all vehicles registered) in 1996 (National Highway Traffic Safety Administration [NHTSA], unpublished data, 1996). NHTSA, the National Transportation Safety Board (NTSB), and CDC collaborated with the American Academy of Pediatrics, the Children's Hospital of Philadelphia, The Air Bag Safety Campaign, the National Safety Council, the Brain Injury Association, the National Association of Governors Highway Safety Representatives, the National Association of Children's Hospitals and Related Institutions, and the Health Resources and Services Administration to examine crashes from the Special Crash Investigation Data File maintained by NHTSA, in which fatal injuries in children (aged < 12 years) were associated with passenger-side air bags. This report presents the findings of this review, which indicate that during January 1993-November 1996, annual increases occurred for both the number of fatal injuries to children resulting from air-bag deployments and the proportion of dual air bag-equipped vehicles (Table 1).

Accidents, Traffic↗