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PubMed1994

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1995 rates--HCFA. Final rule with comment period.

We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In addition, in the addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1994. We are also setting forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. Finally, we are revising the criteria used by the Medicare Geographic Classification Review Board (MGCRB) to decide on applications by hospitals for geographic reclassification for prospective payment purposes.

Capital Financing↗
PubMed1994

Hip dysplasia in spastic cerebral palsy.

Previous reports have noted a relationship between pelvic obliquity and hip dysplasia in spastic cerebral palsy but did not confirm its existence by scientific study. A study is reported that confirms the association of pelvic obliquity with hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation prior to surgery, 80 patients were indexed into five body alignment types. Reclassifications were performed with passage of time in order to study the natural history and effects of surgery. In all cases, hip dysplasia was found to be consistent with the forces related to pelvic obliquity.

Adolescent↗
PubMed1992

An issue-charged first year for AHA's Davidson.

Reclassification and reform were major issues in Richard Davidson's first year as president of the American Hospital Assn. Those issues, as well as a litany of other budget and legislative battles, promise to rank among his biggest challenges during his second year in office. He's cleared the first hurdle in the reform battle--finding a plan most AHA members can accept.

American Hospital Association↗
PubMed1998

Combating silent PPOs.

A silent PPO is a contracting entity that negotiates discounts with providers but sells access to the discounts to other, nonrelated parties after services are provided to individuals covered by the nonrelated parties' insurance policies. Healthcare financial managers should be alert to the presence of silent PPOs when entering into contract negotiations. To combat silent PPOs, a two-pronged approach--prevention and detection--is advisable. Factors to consider include appropriate contract language stating that all clients with access to the discounts have a contract with the PPO, presence of the PPO's logo on a patient's insurance card, and the PPO's willingness to limit the number of providers in its network. Warning signs that indicate the presence of a silent PPO include a high volume of retroactive reclassifications, single employers taking discounts from multiple PPO networks, or payments for services provided to single individuals coming from multiple PPO networks.

Contract Services↗
PubMed1999

Transrectal ultrasound for staging prostate carcinoma prior to radiation therapy: an evaluation based on disease outcome.

BACKGROUND: Despite its subjectivity and inaccuracy, digital rectal examination (DRE) has a long history of well-documented prognostic significance in patients with prostate carcinoma. To the authors' knowledge, very few studies have evaluated the relative prognostic merits of transrectal ultrasound (TRUS) versus DRE. This question is addressed in this study. METHODS: The outcome for 558 men with T1-T3, N0, M0 adenocarcinoma of the prostate who underwent both DRE and TRUS and received external beam radiation without androgen ablation was evaluated relative to the prognostic information from DRE, TRUS, or both. The outcome endpoints were no evidence of disease (NED) (no relapse or rising prostate specific antigen level) and freedom from metastases. Prognostic factors were evaluated with univariate and multivariate techniques. The median follow-up was 55 months. RESULTS: Both purely DRE-based and purely TRUS-based T categories correlated significantly with NED status. For DRE T categories, 6-year NED rates for T1/T2 and T3 disease were 64% and 36%, respectively (P < 0.001). For TRUS T categories, the rates for T1/T2 and T3 were 63% and 39%, respectively (P < 0.001). There were significant differences in patient composition between DRE and TRUS T categories. Only 40% of patients were in the same DRE and TRUS category, but the majority of the reclassification based on TRUS was within rather than between major T categories (T1/T2 vs. T3). Changes between the prognostically significant T1/T2 versus T3 categories occurred in < or =25%. This accounted for the similarity in NED outcome for DRE and TRUS T categories. However, TRUS categories did not discriminate significantly for metastatic recurrence between T1/T2 and T3 categories, whereas DRE categories did. Upstaging or downstaging by TRUS relative to DRE did not alter the DRE prognostic groupings substantially. CONCLUSIONS: There was no clinically meaningful superiority of TRUS over DRE in the definition of prognostically useful T categories. Moreover, the addition of TRUS to DRE did not enhance the prognostic value of DRE findings in any meaningful way. Despite its subjectivity and inaccuracy, DRE provides prognostic information at least equivalent to TRUS and is preferable because of its low cost.

Adenocarcinoma↗
PubMedDate not supplied

[Classification of cytological smears of the cervix with neuronal methods].

BACKGROUND: Cytological smears obtained from the cervix are routinely examined under the microscope as part of screening programs for the early detection of cervical cancer. The aim of the present study was to investigate whether a simple feature extraction approach using only standard image processing techniques combined with a neural classifier would lead to acceptable results that might serve as a starting point for the development of a fully automated screening system. MATERIALS AND METHODS: Gray-value images of 106 cervical smears (512 x 512 pixels) divided into two groups--inconspicuous (57) and atypical (49)--by an experienced pathologist on the basis of the original smears were employed to evaluate the method. From these images, 31 features quantifying properties of either the cell nucleus or the cytoplasm were extracted. These features were categorized with three different architectures of a neural classifier: learning vector quantization (LVQ), multilayer perceptron (MLP) and a single perceptron. CONCLUSIONS: The results show a reclassification accuracy of about 91% for all three algorithms. Sensitivity was uniform at approximately 78%, and specificity varied between 75% and 91% in the leave-one-out evaluation. These very good results provide strong encouragement for further studies involving PAP scores and colour images.

Artificial Intelligence↗
PubMed1981

Federal funding formulas and the 1980 census.

Distribution of federal funds has achieved equal status with Congressional reapportionment as a motivation and justification for the Census of Population and Housing. This article describes the effects that U.S. population redistribution during the 1970s, as measured by the 1980 Census, will have on the spatial distribution of federal grants-in-aid provided to state and local governments through programs with formula-based funding systems. The conclusion is that funding changes will not match population changes. The overall redistribution of federal grants-in-aid to state and local governments occurring in response to incorporation of 1980 Census population counts into federal funding formulas will be far less than the level of population redistribution since 1970. Use of intercensal data, formula specifications, limited geographic specificity in many formula allocations, and nonformula determinants of formula-based grants all weaken the relationship between Census-measured population change and the receipt of federal funds at the local level. Despite all the intervening factors, it is probably that in many programs there will be some redistribution of funds when the 1980 Census counts are incorporated into the allocation formulas. But the importance of measurement errors and threshold and reclassification effects may equal that of true population change in determining the funds received by local communities.

Financing, Government↗
PubMed1999

Spauligodon ovifilus n. sp. (Nematoda: Pharyngodonidae) and other helminths from Diplodactylus stenodactylus (Reptilia: Gekkonidae) from Australia.

Spauligodon ovifilus n. sp. (Nematoda: Pharyngodonidae) from the large intestines of the gecko Diplodactylus stenodactylus is described and illustrated. Prevalence of infection was 50% (mean intensity 5.9 +/- 6.3, range 1-21). Spauligodon ovifilus n. sp. represents the thirty-fifth species to be assigned to this genus and is distinguished by the extremely long filament of the egg. This is the first report of species of Spauligodon from Australia. In addition, 1 gecko harbored 1 female of Wanaristrongylus papangawurpae, a new host record; 1 gecko harbored 1 encapsulated larva of Abbreviata sp. Review of species assigned to Spauligodon caused the reclassification of Spauligodon azerbajdzanicus to Skrjabinodon azerbajdzanicus n. comb.

Animals↗
PubMed1999

A clinical review of Charcot-Marie-Tooth.

CMT polyneuropathy is a complex genetically and clinically heterogeneous group of disorders. The rapid advances in our understanding of the molecular basis of these groups of neuropathies have helped to resolve some of the controversial issues regarding the clinical and genetic classification. However, there is still confusion and chaos in the terminology employed by different groups of researchers. A reclassification based on the molecular mechanisms of these neuropathies will help in the future to unify and simplify the diagnosis of these complex disorders. The understanding of the molecular mechanisms will also help in the future to find a way to control or treat these hereditary neuropathies.

Charcot-Marie-Tooth Disease↗
PubMed1998

Is there more than one species in the genus Toxoplasma??

A complete life cycle for the ubiquitous protozoan parasite Toxoplasma was proposed over 25 years ago. Since that time, despite attempts to make the genus polyspecific, there has been only one species, Toxoplasma gondii, consistently recognised in the genus. Recent studies on taxa in genera closely related to Toxoplasma such as Neospora, Hammondia, Frenkelia, Isospora and Sarcocystis, have convincingly showed the need for a reclassification of many of the species in these genera. However, in addition to these genus level studies, over the last 10 years several laboratories have used molecular techniques including isoenzyme electrophoresis, restriction fragment length polymorphism analyses, random amplified polymorphic DNA - polymerase chain reaction, and comparisons of the small subunit ribosomal RNA gene, DNA polymerase alpha intron, and 70 kDa heat shock protein gene nucleotide sequences to investigate the genetic diversity among strains in the species T. gondii. Overall, the results of these analyses confirm that the strains in the genus Toxoplasma comprise a limited number of clonal lineages, directly correlated with their virulence in mice. The aim of this presentation is to review the molecular research in this area in order to raise the hypothesis that there may be more than one species in the genus Toxoplasma, which may contain taxa with distinct and different life cycles.

Animals↗
PubMed2000

Reconsidering the limits of normal hearing.

A proposal is made that 15 dB HL, rather than 25 dB HL, be considered the upper limit of normal hearing sensitivity. This recommendation is based on an explanation of the change from an earlier philosophy and the fact that so many people with hearing levels that average less than 25 dB HL consider themselves to have hearing difficulty. Such reclassification of people with slight to mild hearing losses would dignify their clinical complaints and aid in counseling that would assist them with their hearing difficulties.

Adolescent↗
PubMed1999

Well-differentiated adenocarcinoma or dysplasia of the gastric epithelium: rationale for a new classification system.

BACKGROUND: Gastric neoplastic lesions labelled as high-grade adenoma/dysplasia by Western pathologists are often diagnosed as mucosal carcinoma by Japanese pathologists. We examined whether stratifying histological diagnoses by invasion status could increase the extent of agreement between Western and Japanese pathologists and could reduce the frequency of discrepant diagnoses between biopsy samples and corresponding resected specimens. METHODS: Thirty-five histological slides of gastric lesions that had previously been individually reviewed by eight expert gastrointestinal pathologists from Japan, North America and Europe were reassessed by the same pathologists with particular attention to the aspect of invasion. Kappa statistics were used to determine the extent of agreement between Western and Japanese pathologists before and after reclassifying the diagnoses according to invasion status. Moreover, we examined the number of discrepant assessments regarding 14 lesions of which there were both biopsy specimens and resected specimens. RESULTS: There was agreement between the Western and Japanese pathologists in only 11 (31%) of the 35 slides (kappa coefficient 0.15) when traditional diagnostic categories were used. However, after high-grade adenoma/dysplasia, noninvasive carcinoma and suspected carcinoma were grouped together, there was better agreement, namely in 22 (63%) of the slides (kappa coefficient 0.41). Moreover, such reclassification significantly reduced the number of discrepant diagnoses between biopsy and endoscopic mucosal resection specimens by three Western pathologists, from 19 (45%) of 42 assessments when high-grade adenoma/dysplasia was grouped together with low-grade adenoma/dysplasia, to 6 (14%) of 42 assessments when grouped with suspected and definite carcinoma. CONCLUSIONS: To improve the international comparability of gastric histological diagnoses we recommend that high-grade adenoma/dysplasia, noninvasive carcinoma and suspicion of invasive carcinoma be grouped together as a single category of noninvasive high-grade epithelial neoplasia.

Adenocarcinoma↗
PubMed2000

Pathologic and clinical features influencing outcome of thin cutaneous melanoma: correlation with newly proposed staging system.

The incidence of malignant melanoma is increasing. Because of increased awareness, early recognition of malignant melanoma has become more common. In 1997, a new staging system for cutaneous melanoma was proposed, with reclassification of thin melanoma < 1 mm, with and without ulceration. This report evaluates the pathologic and clinical features of thin melanomas influencing recurrence and survival from a tertiary cancer center in an attempt to correlate findings with the proposed staging system. A review of the Roswell Park Cancer Institute tumor registry identified 352 patients with thin cutaneous melanomas (< 1.0 mm) seen during an 18-year period ending August 30, 1998. Overall survival was 93 and 87 per cent at 5 and 10 years, respectively. Disease-free survival was 94 and 93 per cent at 5 and 10 years, respectively. Local recurrence occurred in 3 per cent of patients, regional recurrence in 3 per cent, and metastatic disease in 3 per cent, for an overall recurrence of 7 per cent, with a median follow-up of 118 months. Only the presence of ulceration was a significant prognostic factor for recurrence by both univariate and multivariate analysis. Failure rates (any recurrence) by Clark levels I, II, and III/IV were 3, 5, and 10 per cent, respectively (P = 0.14). Failure rates by tumor thickness (mm), for 0.0-0.24, 0.25-0.49, 0.50-0.74, and 0.75-0.99 were 3, 4, 7, and 10 per cent, respectively (P = 0.49). Ten-year disease-free survival for ulceration versus no ulceration was 40 and 94 per cent, respectively (P < 0.0001). We conclude that thin cutaneous melanoma carries an excellent prognosis with appropriate treatment. Our findings support inclusion of ulceration in a new staging system. Lesions 0.76 to 0.99 mm and Clark level III and IV may warrant close observation as a separate subgroup.

Adult↗
PubMed2000

Phylogenetic relationships within the Gentianales based on NDHF and RBCL sequences, with particular reference to the Loganiaceae.

Phylogenetic relationships in the Gentianales with focus on Loganiaceae sensu lato are evaluated using parsimony analyses of nucleotide sequence data from the plastid genes rbcL and ndhF. Inter- and intrafamilial relationships in the Gentianales, which consist of the families Apocynaceae (including Asclepiadaceae), Gelsemiaceae, Gentianaceae, Loganiaceae, and Rubiaceae, are studied and receive increased support from the combination of rbcL and ndhF data, which indicate that the family Rubiaceae forms the sister group to the successively nested Gentianaceae, Apocynaceae, and Loganiaceae, all of which are well supported. The family Gelsemiaceae forms a distinct, supported group sister to Apocynaceae. The Loganiaceae sensu stricto form a strongly supported group consisting of 13 genera: Antonia, Bonyunia, Gardneria, Geniostoma, Labordia, Logania, Mitrasacme, Mitreola, Neuburgia, Norrisia, Spigelia, Strychnos, and Usteria. These genera form two well-supported lineages. Several members of Loganiaceae sensu Leeuwenberg and Leenhouts, i.e., Androya, Peltanthera, Plocosperma, Polypremum, and Sanango are clearly not members of the Gentianales. The earlier exclusion of Buddlejaceae (including Buddleja, Emorya, Gomphostigma, and Nicodemia) as well as the reclassification of the genera Nuxia and Retzia to Stilbaceae of the Lamiales are all well supported.

Journal Article↗
PubMed1975

Angiostrongyliasis cantonensis (eosinophilic meningitis, Alicata's disease).

Angiostrongyliasis is an infectious disease caused by nematode parasites of the genus Angiostrongylus. The rat lung worm Angiostrongylus cantonensis, primarily a parasite of rodents, is largely responsible for human cases of eosinophilic meningitis, or meningoencerphalitis, which occurs on many Pacific islands and in Southeast Asia. The disorder, which frequently occurs in epidemic extent, is caused by invasion of the central nervous system by developing larvae of the parasite. The infection is most frequently due to ingestion of food containing the infective, third-state, larvae. Meningitic and ocular forms of the disease have been recognized. The disease has been described or referred to under a variety of synonyms. The terms eosinophilic meningitis, eosinophilic meningoencephalitis, and epidemic eosinophilic meningitis were first used to describe the disease before its etiology was known. These terms, however, lack specificity, because the eosinophilic meningitic syndrome may accompany many other parasitic as well as nonparasitic diseases of the central nervous system. Nevertheless, they are still being widely used, since in most cases only the epidemiology of the disease points to the etiologic role of A. cantonensis. Direct clinical or laboratory evidence of the etiologic agent is usually not established because reliable tests are not yet available. The term angiostrongylosis, or angiostrongyliasis, if used without the adjective, also may give rise to confusion, since the same term is applied to the pulmonary infection of dogs by A. vasorum and might be used for infection by any other Angiostrongylus species. Even the term cerebral or ocular angiostrongyliasis may prove in the future to have similar disadvantages. The scientifically correct term angiostrongyliasis cantonensis has been used recently. It is sufficiently specific and formed in analogy to the names of other parasitic diseases of man, like schistosomiasis japonica, schistosomiasis mansoni, schistosomiasis haematobia. For the murine infection, as well as for the disease produced experimentally in animals, the term angiostrongylosis cantonensis ought to be reserved because of the preferential use by veterinarians of the ending osis for designation of pathological changes produced in animals by parasites. After the recent discovery of A. costaricensis, another rat parasite causing human disease in Costa Rica, it becomes necessary to distinguish between angiostrongyliasis cantonensis (eosinophilic meningitis) and angiostrongyliasis costaricensis (intra-abdominal eosinophilic granulomatosis). A potential disadvantage of these terms may be encountered in case of a systemic revision or reclassification of the parasite. This has happened at intervals. A. cantonensis was named Pulmonema cantonensis by its discoverer and later was described under the name Haemostrongylus ratti.

Adult↗
PubMed2000

Progress in the classification of hematological neoplasms. From REAL to WHO concept

Recent advances in immunology, molecular biology and cytogenetics as well as the development of new diagnostic techniques set out the necessity for the redefinition and reclassification of hematological malignancies. Therefore, WHO in 1995 assigned the Society of Hematopathology and European Association for Hematopathology to create a new classification of these neoplasms. The result of collaborative efforts of leading hematopathologists from both organizations is the World Health Organisation (WHO) classification of hematological neoplasms. WHO classification adopted basic concepts, defined criteria introduced by REAL classification of lymphoid neoplasms and extended them to myeloid, histiocytic and mastocytic neoplasms. WHO classification of hematological neoplasms is represented by a list of disease entities and its variants, opened for inclusion of new entities, updating of diagnostic criteria and changes of nomenclature. The clinical relevance of the proposed entities has been evaluated by the clinicians, members of Clinical Advisory Committee. The proposed classification is a challenge to the clinicians to create new treatment strategy, directed towards particular disease entities. The presentation of WHO classification in our review is limited to myeloid and lymphoid neoplasms.

Journal Article↗
PubMed2000

Management of ipsilateral intrapulmonary metastases in the new TNM system for non-small cell lung cancer.

BACKGROUND: Recently, the Union Internationale Contre le Cancer and American Joint Committee on Cancer reclassified not only TNM staging but also ipsilateral intrapulmonary metastases (PM) as T4 in a same lobe or M1 in different lobes. To determine whether the new PM staging is appropriate, we studied the prognosis of PM. METHODS: From January 1981 to October 1997, we performed a lobectomy or pneumonectomy with mediastinal lymph node dissection, and had 42 patients with PM. We analyzed the postoperative prognosis of the patients with ipsilateral PM compared with the same stage group without PM (the non-PM). RESULTS: In the previous classification of PM (the old PM), 2 patients were categorized as stage IIA, 9 as IIB, 17 as IIIA, and 14 as IIIB. After reclassification (the new PM), 37 patients were categorized as stage IIIB, and 5 as IV. The old PM stage IIIA group had a significantly poor prognosis compared with the non-PM stage IIIA. However, the prognosis of the new PM group was compatible with that of the non-PM. None of the other staging group had a significant difference in the prognosis. CONCLUSIONS: The management of PM in the new TNM system for non-small cell lung cancer is appropriate.

Adenocarcinoma↗
PubMed2000

The delegate's dilemma: ACAT re-assessment in hostels.

The provision for 'ageing in place' in the Aged Care Act of 1997 has provided an opportunity for hostel facilities to broaden their scope of care for older people. Aged Care Assessment Teams (ACATs) are required to provide assessments to give approval for high or low level entry to these facilities, and to provide approval for reclassification from low to high care. However, guidelines for ACAT assessments are contradictory with respect to the Resident Classification Scale (RCS) which provides the facility funding formula, thus creating gatekeeping compared with advocacy difficulties for the ACAT. If the facility can support a claim of high care need for a resident via the RCS but the ACAT (using different and less in-depth criteria) does not agree with that claim, then the care of that resident might be compromised due to inadequate funding. Recommendations made to solve this dilemma include conferring the right of the hostel staff to reclassify residents when necessary, with the responsibility for confirmation of that classification to remain with the trained validation officers from the Commonwealth Department of Health and Family Services, not the ACAT.

Activities of Daily Living↗