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PubMed1997

Case management.

Providing cost-effective high quality healthcare services ranks as the number one concern for anyone involved with the healthcare delivery system. While quality of care should always be the number one priority, controlling healthcare costs receives most of the attention. With limited healthcare dollars and providers assuming more of the financial risk for services rendered, a whole assortment of cost-containment strategies are being introduced in an effort to maintain some semblance of financial viability. Healthcare providers can approach cost control from two different angles. On the fixed-cost operational overhead side, traditional cost-containment techniques have focused on downsizing, maximizing productivity, staffing redesign, improved purchasing contracts, standardization, inventory control, and other more individualized restructured service models. On the variable-cost clinical side, cost control has been approached by introducing a variety of cost-containment strategies designed to improve efficiency and effectiveness of provider performance. While many of these strategies, previously discussed in the Journal of Healthcare Resource Management have stressed the importance of education, guidelines, pathways, and other clinical "tools for improvement," the success of many of these tools resides in the ability to provide real-time intervention. Real-time intervention rather than the more passive retrospective variance analysis has the greatest potential for producing cost savings by actually making a recommendation that prevents the unwanted event from occurring. In many institutions, the case manager bears the responsibility for monitoring and managing these programs. This article describes various case management models currently used by different institutions.

Ancillary Services, Hospital↗
PubMed1999

Urinary dosage of nuclear matrix protein 22 (NMP22) like biologic marker of transitional cell carcinoma (TCC): a study on patients with hematuria.

UNLABELLED: This study was performed to evaluate the clinical usefulness of nuclear matrix protein 22 (NMP22) as urinary marker for bladder cancer and to define its role in comparison with urinary cytology in diagnostic management of patients with hematuria. MATERIALS AND METHODS: NMP22 values in voided urines were determined on 90 patients (81 males, 14 females) with macro or microscopical hematuria, using the NMP22 test-kit (Matritech) based on an enzyme-linked immuno-sorbant assay. The cut-off value for positive samples was 10U/ml. In all cases urinary cytology was performed on the same sample. Patients suspected for the presence of a transitional cell carcinoma (TCC) underwent cytoscopic control. Statistical signification of the medians difference was analyzed using both medians variance analysis and Student's test. The increasing in diagnostic predictivity was analyzed elaborating contingency tables and performing consequently chi 2 test. RESULTS: 32 cases of TCC were endoscopically detected: sensitivity of cytopathology was 75.8%, specificity was 62.5%. The positive predictive value of the cytology was 22% and negative predictive value was 49%. The results concerning NMP22 dosage are: sensitivity 84%, specificity 62%. Positive predictive value of NMP22 test was 30% and predictive negative value was 40%. No significant differences between cytopathology and NMP22 dosage were founded (p > 0.995). Considering both cytopathology and NMP22 dosage, sensitivity was 82.7% and specificity raises up to 90.6% with statistical signification (P < 0.001). The median NMP22 value in patients affected by TCC endoscopically confirmed (group A) was 55.2 U/ml, in subjects with no evidence of malignancy (group B) it was 19.1 U/ml. The difference shows statistical signification (p < 0.001). In 20 cases with TCC, hystological grading were available and were investigated in relationship with NMP22 title in U/ml, median NMP22 value for each grade was: CIS = 102 U/ml, G0 = 35 U/ml, G1 = 30 U/ml, G2 = 66 U/ml, G3 = 54 U/ml. It can be assessed that NMP22 test is useful in differentiating subjects affected by TCC from subjects with no evidence of malignancy and may help in early diagnosis of TCC and in predicting recurrent even if low grade tumors especially if used in association with cytology and endoscopy.

Biomarkers, Tumor↗
PubMed1999

Remote regional cerebral blood flow consequences of focused infarcts of the medulla, pons and cerebellum.

UNLABELLED: The aim of this study was to evaluate regional and remote diaschisis of inferior brain stem or cerebellar infarcts in 25 patients presenting with relatively limited lesions. Patients presented with medullary, pontine or cerebellar infarction. METHODS: Lesions were evaluated on MRI (0.5 T). Regional cerebral blood flow (rCBF) was assessed by means of SPECT, after injection of 9rmTc-hexamethyl propyleneamine oxime (HMPAO) and, when possible, inhalation of 133Xe in the same session. For each method, asymmetry indices (Als), comparing contralateral to ipsilateral rCBF values, were calculated in four areas of each cerebral hemisphere and in the cerebellum and later compared with values obtained in healthy subjects (P = 0.05). RESULTS: Higher rCBF values were observed in the contralateral cerebellum in 2 of 7 patients with selective lateral medullary lesions, and cerebellar Als were significantly increased. When a cerebellar infarct was associated with a lateral medullary lesion, the cerebellar and contralateral hemispheric asymmetries were more severe. Unilateral paramedian pontine infarcts had more frequent consequences on the cerebellum (2 of 3 cases), with rCBF or tracer uptake being reduced in the ipsilateral or the contralateral lobe. Inverse cerebral hemispheric asymmetry could then be observed. Bilateral pontine lesions were difficult to evaluate. Using 99mTc-HMPAO, discrete cerebellar asymmetry was observed in 3 of 6 cases. Pure cerebellar infarcts in the posterior inferior cerebellar artery territory were always associated with a severe ipsilateral flow drop in the cerebellum, and contralateral hemispheric diaschisis was frequent (3 of 4 patients), predominating in the frontotemporal cortex and subcortical structures. This was also more obvious using 99mTC-HMPAO than 133Xe. Variance analysis showed that hemispheric diaschisis was more severe in mixed brain stem and cerebellar infarcts than in pure cerebellar or brain stem lesions. Furthermore, cerebellar and hemispheric AI values were not correlated with measurements of clinical deficits, disability or handicap. CONCLUSION: Unilateral and limited inferior brain stem lesions can have ipsi- or contralateral consequences on the cerebellum and cerebral hemispheres rCBF. These remote effects are related to lesions of the main pathways joining these structures, resulting in deactivation and, in some cases, overactivation. Contrary to what has been suggested, consequences on cerebral hemispheres are more severe in mixed cerebellar and brain stem infarcts than in pure cerebellar lesions.

Adult↗
PubMed1998

Marketing quality and value to the managed care market.

Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche.

Case Management↗
PubMed1999

How IDSs can make their risk contracts more profitable.

To understand the causes of financial losses associated with risk arrangements, and eliminate those deficits, integrated delivery systems (IDSs) need to be able to perform detailed analyses on all aspects of their utilization data. Evaluations of utilization should begin with a traditional variance analysis to pinpoint areas where costs are higher than anticipated. Then, a series of increasingly specific analyses should be performed on utilization data within those areas. Often, losses may be attributable to the inability of primary care physicians to serve as effective patient care managers. IDSs, therefore, should compare the practices of their primary care physicians and share results in a way that highlights each physician's performance while ensuring physician anonymity. IDSs should take steps to reduce future losses by providing physicians and utilization management staff with information that will help them control costs, developing a performance-improvement plan for primary care physicians, and implementing payment incentives for physicians.

Benchmarking↗
PubMed1998

[Nutritional improvement of French type bread].

In Argentina there is an increasing production of soybean and consequently of oil, it gives a very important amount of proteins of good quality. Also dairy industry produces an useful protein: whey protein concentrate (WPC). The objective of this work is to improve the nutritional value of French bread adding soy flour and whey proteins to the mixture. Physics, sensory and nutritional evaluation were made with statistic treatment by variance analysis, Duncan multiple range test. Soy flour and WPC had an opposite behavior with the water absorption, while the first show an increasing the second produce a decreasing of the absorption values. About the alveographics values they produce a similar effect which is a stretching of the dough. In bread manufacture the product quality was reduced when soy flour and WPC were individually used but this deleterious effect was less important when they were used together in the recipe. Nutritional parameters were improved specially when the soy flour that was used had low heat treatment (PDI 61).

Bread↗
PubMedDate not supplied

[Diagnostic importance of fibronectin in chronic liver diseases].

Plasma fibronectin was determined in 29 patients with decompensated cirrhosis (7 patients had bacterial infection) and 23 patients with malignant liver disease. The obtained values were compared with the fibronectin values in 20 healthy subjects belonging to the control group in order to determine the possible diagnostic value of this dimer glycoprotein of high molecular weight whose role in the organism has not been completely explained. Fibronectin was determined on nephelometer with the use of specific antiserum by Behringwerke. The results expressed as mean values and SD were compared with monofactorial variance analysis (method One-way ANOVA). Fibronectin values in patients with liver cirrhosis were statistically significantly lower than in the control group (p < 0.01), which is also the case with correlation with malignant liver disease (p < 0.01). The fibronectin values in patients with malignant diseases were almost the same as the control group values (p < 0.01). In 7 patients with liver cirrhosis and bacterial infection the fibronectin values were statistically significantly higher in relation to those in the remaining 22 patients with cirrhosis but without bacterial infection (p < 0.001). The investigation in this study indicated that the decrease of mean fibronectin values is related to hepatic failure which is of diagnostic value, while normal values in malignant diseases do not favor the opinion on fibronectin as a tumor marker. Higher fibronectin values in infection in patients with liver cirrhosis are not clear, which indicated the total complexity of the relation between fibronectin as a dimer glycoprotein and chronic liver diseases including malignant.

Bacterial Infections↗
PubMed1999

Antiperinuclear factor as a prognostic marker in rheumatoid arthritis.

OBJECTIVE: Antiperinuclear factor (APF) is an autoantibody detected in >50% of patients with rheumatoid arthritis (RA); it shows a specificity of roughly 90%. We investigated the possible role of APF as a prognostic marker in RA. METHODS: A series of 103 patients with RA who fulfilled the 1987 American College of Rheumatology criteria (88 women and 15 men; mean age 55.5 yrs, mean disease duration 9 yrs) were prospectively followed. Sixteen variables were assessed in each patient at inclusion and over a 3 year period. APF was determined by indirect immunofluorescence assay using human buccal mucosal cells as substrate. APF assays were done at entry and at the end of followup without knowledge of the clinical status of the patients. Mann-Whitney U, chi-squared tests, variance analysis, and kappa index were used for statistical analysis. RESULTS: Eighty of 103 patients completed followup. APF was detected in 40 of 80. At inclusion, APF correlated with the visual analog scale (VAS) of pain (p = 0.02). However, patients who showed APF positivity at entry had a less favorable course than APF negative individuals, as shown by a worse VAS of well being (p = 0.01), Ritchie index (p = 0.01), number of painful joints (p = 0.03), grip strength (p = 0.01), C-reactive protein (p = 0.04), and Health Assessment Questionnaire score (p = 0.03) at the end of the study. In addition, APF positive patients showed a worse radiological course (p = 0.03). CONCLUSION: Our results suggest APF is a possible marker of poor prognosis in RA.

Adult↗
PubMed1976

[Radiological anatomical examinations in skulls from anthropological collections (author's transl)].

A total of 114 skulls dating from the Neolithic Age, the Bronze Age and the Iron Age, of Incas and Red Indians, of Asians from North and South China, as well as Negro skulls found in Turkey were radiologically analysed and compared with control skulls of recent origin. The 3 standard X-ray views were taken (postero-anterior, axial and lateral) and appropriate linear and angle measurements were carried out. The resultant 4120 values were compared by variance analysis and the differences between the groups are presented. The differences in linear values may be attributable merely to racial variation; the constancy of the obtained angle measurements is striking. The results were also compared by means of linear regression with measured volume values of the brain skull; it was thereby possible to develop a new formula by means of which the volume of the brain skull can be calculated from the parameter BPH (introduced by the author) and from the distance B with the help of a constant factor. The importance of Radiology in Anthropology is pointed out.

Anthropology, Physical↗
PubMed1998

[Infection of sexually transmitted diseases in female patients with inflammation of genitourinary tract by polymerase chain reaction].

Using polymerase chain reaction (PCR), Neisseria gonorrhoeae (NG) from 5899 female out-patients with inflammation of genitourinary tract was detected. Among 18.57% positive cases, the effective rates of the gonorrhea (26.07%) and urethritis (23.73%) were higher than those of the Condyloma acuminatum (CA) (17.73%), vaginitis (17.70%), and cervicitis (11.54%)(P< 0.01), indicating that there were various degrees of NG infection in genitourinary tract diseases. Moreover, Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), NG, and human papilloma viruses (HPV) were also detected in 8329 patients with vaginitis. Among 20.01% positive cases, the positive rate of UU was 39.95%, CT 21.36%, NG 17.70%, and HPV 16.40%. Variance analysis showed that significant differences existed in the vaginitis caused by different pathogens ( P <0.01); namely, four kinds of pathogens were present in the patients with vaginitis.

Adult↗
PubMed1999

[Effect of the NMDA receptor antagonist on parameters of delayed visual differentiation and rearrangement of the impulse activity of neurons in visual and prefrontal cortices in monkeys].

With the aid of a multichannel leads the unit activity was recorded in the 17th and 8th cortical fields along with registering behavioural data in Rhesus monkeys. Multi-factor variance analysis revealed that the 2-amino-5-phospho-valeric acid (APV) effect involved a significant worsening of the monkeys' behavioural characteristics: duration of the short-term memory shortened (2-4-fold), motor reactions' time increased, and the changes of cognitive characteristics were always followed by significant rearrangements of the unit activity in the above areas. The data obtained suggest that these cognitive dysfunctions are due to a desynchronisation of unit activity in different areas of the cortex including the neuronal assemblies maintaining the short-term memory mechanisms associated with the glutamatergic structures.

Animals↗
PubMed1999

[Neurophysiological correlates of delayed visual differentiation in monkeys: effect of location of the NMDA-receptor intracortical blockade].

A multi-factor variance analysis revealed that the 2-amino-5-phosphonovalerian acid (APV) effect was manifested in monkeys by a decrease in the number of correct responses entailing a two-fold shortening of the short-term information storage, as well as by an augmentation of the motor responses' time. The correct responses' probability depended on the APV diffusion localisation in the cortex whereas the motor responses' time did not depend on it. The APV effect was accompanied by a desynchronisation of the unit activity in fields 46 and 17. Neurophysiological correlates of cognitive functions, are discussed.

2-Amino-5-phosphonovalerate↗
PubMed1999

Managing nursing assets: a primer on maximizing investment in people.

Nurse managers require critical competencies and skills to thrive in today's turbulent health care environment. A nurse manager's relationship with nursing staff is the primary variable that can reduce nursing turnover and improve unit morale in a variety of measurable ways. Self-confidence is the cornerstone competency required for the nurse manager's success. Nurse managers set the context for the delivery of patient services. To do so effectively, a working partnership with finance and human resources is required. Both functions can provide essential information for real time decision making, including variance analysis, flexible budgets, absenteeism rating, turnover rate, and innovative compensation programs.

Humans↗
PubMed2000

[Seroepidemiological study of brucellosis in a rural endemic area].

BACKGROUND: This study investigated the prevalence of Brucella spp. antibodies in the general population in the Health Area of Tremp (Region of Pallars Jussà, Lleida). It also identified the risk factors with the presence of these. PATIENTS AND METHODS: A total of 346 (191 men and 155 women) were studied. Information about the sex, age, location, the personal and familiar antecedents of brucellosis, occupational risk, contact with the animals and the consumption of non-hygienic dairy products was recorded. The estimation of the seroprevalence was carried out by the ELISA IgG test. The association of independent variables with the presence of antibodies was assessed by the Coombs to Brucella and the ELISA IgG tests. It was assessed by using the calculation of the analysis variance. RESULTS: The personal antecedents, the contact with the animals and the occupational risk all showed a statistically significant relation (p < 0.05) with the Coombs and ELISA IgG tests. The familiar antecedents showed a significant relation with the ELISA IgG. The consumption of dairy products and the location showed no statistically significant relation. A seroprevalence was obtained among the researched population of 11.9%, the maximum occurred in Isona surgery (25.6%) and the minimum in Tremp (9.8%). CONCLUSIONS: The seroprevalence is high and the epidemiological profile associated with the fact of being seropositive is associated with the profession of the study subject and it coincides with de infection mechanisms present in the area.

Adolescent↗
PubMed1999

Longitudinal cephalometric changes in the maxilla, mandible and maxillary-mandibular relationship between 10 and 14 years of age.

In the present study, longitudinal growth changes in the maxilla, mandible, and maxillary-mandibular relationship occurring between the ages of 10 and 14 years were evaluated in 19 female and 15 male subjects. All subjects had a clinically-acceptable occlusion, a normal growth pattern, and none had undergone orthodontic treatment. Serial cephalometric radiographs were taken at the ages of 10, 11, 12, and 14 years. The effects of age and sex on the sagittal growth of the jaws were studied by means of variance analysis. The results show that A-Ptm, B-Ptm, Pg-Ptm, A'-Ptm, B'-Ptm, and S-N-Pg measurements were affected by age, and the measurements A-Ptm, A'-Ptm, Wits and ANB by sex. Duncan's multiple range test was applied to those measurements where F values were found to be statistically significant. As a result, it was observed that the greatest growth changes occurred between 12 and 14 years old.

Adolescent↗
PubMed1999

Evidence-based clinical outcome management in interventional cardiology.

In conclusion, through the use of pathways and case management, evidence-based clinical outcome management has occurred. The author's institution now has a process that enables it to accomplish three objectives: (1) the ability to track outcomes, (2) the ability to obtain information about opportunities for improvement and develop action plans for this, and (3) the ability to judge through continued variance analysis whether the actions taken made a difference or whether more changes are necessary. Based on this evidence, supported by the literature, the author's institution has been able to offer quality patient care at a reasonable cost.

Angioplasty, Balloon, Coronary↗
PubMed2000

Rectification and rapid activation at low Ca2+ of Ca2+-activated, voltage-dependent BK currents: consequences of rapid inactivation by a novel beta subunit.

A family of accessory beta subunits significantly contributes to the functional diversity of large-conductance, Ca(2+)- and voltage-dependent potassium (BK) channels in native cells. Here we describe the functional properties of one variant of the beta subunit family, which confers properties on BK channels totally unlike any that have as yet been observed. Coexpression of this subunit (termed beta3) with Slo alpha subunits results in rectifying outward currents and, at more positive potentials, rapidly inactivating ( approximately 1 msec) currents. The underlying rapid inactivation process results in an increase in the apparent activation rate of macroscopic currents, which is coupled with a shift in the activation range of the currents at low Ca(2+). As a consequence, the currents exhibit more rapid activation at low Ca(2+) relative to any other BK channel subunit combinations that have been examined. In part because of the rapid inactivation process, single channel openings are exceedingly brief. Although variance analysis suggests a conductance in excess of 160 pS, fully resolved single channel openings are not observed. The inactivation process results from a cytosolic N-terminal domain of the beta3 subunit, whereas an extended C-terminal domain does not participate in the inactivation process. Thus, the beta3 subunit appears to use a rapid inactivation mechanism to produce a current with a relatively rapid apparent activation time course at low Ca(2+). The beta3 subunit is a compelling example of how the beta subunit family can finely tune the gating properties of Ca(2+)- and voltage-dependent BK channels.

Amino Acid Sequence↗
PubMedDate not supplied

[Acute pharmacological test with clonidine for the tremor in patients with Parkinson disease].

INTRODUCTION: Idiopathic Parkinson's disease has a prevalence of 1/1,000 and in 70-75% of these patients tremor is the commonest symptom. Of all the typical symptoms of this disease, the tremor is the most difficult to control. It is therefore necessary to seek drugs to solve this serious problem. OBJECTIVE: To evaluate the usefulness of clonidine in the acute treatment of resting and postural tremor in patients with idiopathic Parkinson's disease. PATIENTS AND METHODS: Acute pharmacological test (administration of 0.3 mg of clonidine chlorhydrate intramuscularly). The evaluation was done using a clinical protocol before administration and 30, 60, 120 and 240 minutes afterwards. Statistical comparison was done by variance analysis, taking a value of p < 0.0025 as significant. We included 28 patients (15 men and 13 women) of an average age of 66.9 years, and average duration of the disease of 5.53 years. Diagnosis followed the strict criteria of UKDDDSBB. RESULTS: There was no difference in the evaluations before and after the first dose of L-dopa. For both types of tremor, from 60 minutes onwards there were significant differences, with the maximum 120 minutes after administration (p < 0.0001). CONCLUSIONS: Clonidine is useful in the acute treatment of postural and intention tremor in patients with idiopathic Parkinson's disease. Its action is that of reducing the liberation of noradrenaline, synergically with the exciting dopaminergic system. It also seems to reduce the activity of spontaneous discharge at both thalamic and cortical levels.

Adolescent↗