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Predicting patient nonappearance for surgery as a scheduling strategy to optimize operating room utilization in a veterans' administration hospital.

BACKGROUND: Previous attempts at improving operating room utilization have generally emphasized more accurate scheduling, starting the first case on time, and reducing turnover time. Surgical case cancellations have largely been ignored except for recommendations for preoperative screening and good physician-patient communication to improve patient compliance. METHODS: A retrospective review of operating room records was initially used to identify reasons for surgical cancellations. This was followed by a retrospective stratified case-control study of patient records to identify preexisting factors that predict the failure of patients to appear for surgical procedures as scheduled. Factors assessed included demographics, type of surgical procedure, compliance with previous healthcare visits, substance abuse, mental illness, travel distance, and neurologic problems. RESULTS: The authors reviewed their operating room utilization and found patient nonappearance rates to be a substantial source of surgical cancellations. Furthermore, multivariate analysis demonstrated that patient nonappearance could be strongly predicted from patient noncompliance with clinic visits and other clinical procedures without reference to the other variables assessed. Further analysis of data from an independent sample of patients confirmed this observation. CONCLUSIONS: Noncompliance with hospital visits for surgical procedures can be predicted from noncompliance with other healthcare encounters. Surgical procedures for previously noncompliant patients should be booked at the end of the operating room day, when the cancellation is least likely to interfere with operating room flow.

Adult↗

An individual patient comparison of response to a memory training program--psychogenic V organic amnesia: brief report.

Psychogenic amnesia ("dissociative amnesia" in DSM-IV) has received relatively little attention in the literature. We compared neuropsychological and behavioral findings between a patient with psychogenic amnesia and one with organic amnesia from their early stages in a rehabilitation program. A 52-yr-old man developed anterograde and retrograde amnesia and short-term memory disturbance 1 mo after an operation for esophageal carcinoma, with no loss of personal identity and information. No apparent organic causes were identified, but because the patient and his wife rejected psychiatric treatment and memory deficit characteristics were compatible with that of an organic origin, the patient was referred to a physiatrist. A 46-yr-old man with anterograde amnesia was diagnosed with limbic encephalitis based on findings of magnetic resonance imaging and single-photon emission computed tomography, which showed lesions in both medial temporal lobes. Both patients underwent "memory book" training because they showed preserved performance in motor learning tasks. The first patient's responses to training contrasted with the other's and were indicative of psychogenic amnesia, with cancer representing a precipitating stress. Counseled by the physiatrist, the patient and his wife accepted suggestions to undergo psychiatric treatment. We propose that it is important to consider behavioral responses to memory rehabilitation as well as neuropsychological findings in differentiating psychogenic amnesia from an organic one and that physiatrists may be pivotal in diagnosing and initiating treatment in such psychiatric disorders.

Amnesia↗

Pediatric endocrine diseases in pre-Hispanic Aztecs.

Aztec medical and religious knowledge derived from Olmecs (800 BC), Teotihuacans (100 BC) and Toltecs (1100-1521 AC); however, there is no unique source that accurately presents Aztec medicine. Sahagfin combines naturalism and religion but not magic ("First Memorials", "Matritense Codex", "Florentine Codex" and "General History of New Spain"); Hernández gives a naturalistic image but is full of mistakes ("Natural History of the New Spain"); Badiano tries to match Aztecs with contemporary Europeans and with the first century medicine of the Romans ("Badiano Codex"), and Ruiz de Alarcón contains plenty of magical concepts ("Book of Superstition"). For the Aztecs, surveillance of growth was very important and represented a balance between body and soul. They described the different steps of pubertal development. They had specific treatments for thyroid disease in children, mainly hypothyroidism and goiter. There are no references to rickets, nor to type 1 or 2 diabetes mellitus.

Child↗

[Sleep disorders]

OBJECTIVE: The aim of this article is to review and update the knowledge about sleep disorders in childhood. SOURCES: Normal sleep ontogenesis and therapeutics for the most prevalent sleep disorders were reviewed. The text was based on classical articles and books and on Medline (publications from 2000 and 2001) using the key words sleep disorders and childhood. the article was structured on descriptive topics containing definition of the sleep disorder, age, clinical presentation and therapeutics. SUMMARY OF THE FINDINGS: Sleep disorders are frequent concerns referred in pediatrics outpatient clinics, and a correct diagnosis is the main goal to establish therapeutic procedures. CONCLUSIONS: In the majority of cases clinical history is sufficient to establish diagnosis and assuring parents of the benign evolution of the symptoms the better treatment.

Journal Article↗

[Blood glucose monitoring in the management of type 1 diabetes in childhood].

In the last twenty years, blood glucose self-monitoring has attained a nearly optimal level, with reliability, easiness, quickness and safety, which makes it tolerable to a greater number of patients and allows young diabetics to make more easily something which is mandatory to the management of type 1 diabetes. The principles of treatment are identical in children, adolescents and adults. However, many patients experience difficulties in applying the ideal therapeutic model. This must be particularly taken into account in children, who are in a stage of full intellectual and psychological development. Inappropriate demands can drive them to failure and go against the main objective at this period of life, which is education. Reference documents help pediatricians to the daily practice of home blood glucose monitoring and, more generally, management of childhood diabetes: ISPAD Consensus Guidelines (ISPAD=International Society for Pediatric and Adolescent Diabetes), which has been translated in French, and Cahiers de l'AJD (AJD Note books), for educating new patients. Blood glucose monitoring is recommended: to evaluate the glycemic response to the effect of insulin; to confirm hypoglycemia; to prevent hyperglycemia in case of disease; in case of physical exercise. The frequency of home blood glucose monitoring should be individualized, depending on the acceptability for the young patients and the insulin therapeutic regimen.

Adolescent↗

[A bibliographic study on Tongui-bigan with a special reference to its influence on Japan and China].

In this work my main focus was put on two things; first, to examine the history of publication of Tongui - bogam within the nation with particular interest in the changing aspect observed from the bibliographical terms, and second, to examine the process through which Tongui - bogam was introduced to Japan and China, and the influence the book brought the two nations. Some of the findings concerning the domestic publication of Tongui - bogam are as follows. The first printing of the book was made in 1613, under the auspice of Naeui - won, one of the government organs in the capital in charge of medical affairs. It was printed with wooden movable type carved at Hullyeon - togam, the military training bureau. As for the question of the history of the domestic publication of Tongui - bogam after the first printing in 1613, we don't have enough data yet. Although there are many different editions of Tongui - bogam extant today, with different size and different font each, I could find so far only three copies which carry the data concerning its publication, one printed in 1659 by the Kyongsang provincial government with newly engraved woodblock, one printed in 1754 again by the Kyongsang provincial government with re-engraved woodblock, and one printed in 1814 by the Cholla provincial government with newly re-engraved woodblock. Each of the three was a revised edition at the time of its publication because every time it was based on the copy corrected by Naeui - won. In addition to the above mentioned three different editions of Tongui - bogam, three are quite a few copies originally printed with wooden movable type of different font, at various time and various places. None of them has any record concerning the date and place of its publication, and none of them shows that it was based on the Naeui-won corrected version as a mother copy. Accordingly, all of them carry quite a few erratum misprinting and it seems quite certain that all of them were produced before 1659. I also feel that the 1724 Japanese edition was based on one of the pre - 1659 copies. In Japan, the first publication of Tongui - bogam was made in the year of 1724 (the 9th year of Kyoho in Japanese year title) under the auspice of the Japanese government i.e. the Tokugawa Bakuf. The book carries a preface written by a man named Fubihara, then the vice president of national university, and a postscript written by Minamoto mototoru, a government attached monk physician. It was a woodblock printing and the title of the book was "Kankoku - Teisei Tongui - bogam. The reason the word "Kankoku-Teisei" the Revised Edition Printed with Officially Engraved Woodblocks", was added to the title was that the publication was made by the government and before publication the government ordered Minamoto to read through the original Tongui-bogam throughly and make corrections if any misprintings be found. Minamoto also put the so-called kunto marks, the Japanese way of punctuation system on the original text all the way so that they could read it in the their own way. As the question of what edition of Tongi - bogam the Japanese used as a mother copy and whwn and how the mother copy had been brought to Japan are not clear at all. But judging from the fact that it carries quite a few erratum in spite of their efforts at proofreading before engraving the woodblock, it seems likely that Tongui - bogam they used as a mother copy was the one which was printed in Korea before 1659. In 1659 Tongui-bogam was published in Korea by the Kyongsang provincial government in Taegu with newly engraved woodblock. According to the attached record concerning its publication, it was a revised edition based on the Naeui - won corrected-copy, and this edition carries no misprintings in it at all. On the other hand, among the various editions of the extant Tongui - bogam today we can find some copy which, originally printed from wooden movable type, carries almost the same misprinting as those found in the 1724 Japanese edition. In other words, we are quite certain that the mother copy of the 1724 Japanese edition was brought to Japan before the Naeui - won - corrected - edition began to appear in Korea in 1659. The second publication of Tongui - bogam in Japan was made in 1799 in the city of Osaka. It was reprinted from the original woodblock of 1724 edition, and this second edition was later used in China in 1890 as a mother copy. The first publication of Tongui - bogam in China was made in the year 1766. It was a woodblock edition printed in Kwangtung province, located in the southern end of China. According to the attached preface written by a high ranking official named Nŭngŏ, a native of Kwangtung area, the publication was originally initiated by the governor of that province Mr. Wang, who deeply admired the value of Tongui - bogam. Since the Tongui - bogam at that time was available only in Bigak, the palace library in Peijing, the capital of the Ch'ing dynasty, the governor Mr. Wang had to send a man to Peijing to make a manuscript copy of Tongui - bogam of 25 of the volumes. But unfortunately Mr. Wang left his post before his plan to publish the book was realized and it was thanks to another native man named Chwahanmun who donated big money to cover the expenses of publication. The 1766 edition of Tongui - bogam, one copy of which is now in the possession of Kyungbuk University library, is understandably not a good copy, because it has many erratum in it. But it was reprinted afterwards sometimes with re-engraved woodblock many times at various places in China. The second publication of Tongui - bogam in China appeared in 1890. It carries a preface written by Mincheyusang. It was based on the Japanese edition printed in 1799 in Oosaka. What is interesting with Mr. Min's preface is that it shows their deep admiration of the value of Tongui - bogam on one hand, and at the same time very critical attitude toward the basic philosophy of Hŏjun on the other hand.

Bibliography of Medicine↗

The indigenization of neurasthenia in Hong Kong.

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.

Combined Modality Therapy↗

Evolutionary patterns in ontogenetic transformation: from laws to regularities.

The concept of heterochrony derives from classical approaches to the study of ontogeny and phylogeny. Under the influence of landmark books by deBeer (1930) and Gould (1977), the traditional theories have been revised to fit into the conceptual framework of modern genetics and evolutionary theory. The current scheme, however, suffers from a problem of lack of precise definitions. The term heterochrony is now used to refer to a developmental process as well as to an evolutionary pattern. That is, it refers to a microevolutionary process of adaptation, operating in local populations under selection and to a macroevolutionary pattern based on undefined internal laws of form. Such conceptually contradictory frameworks are a source of confusion and of empirical misuse of concepts. We propose to reduce the dependence of current thinking about heterochrony on the concept of "timing" and instead focus on the organization of sequences of developmental events in ontogeny. Although Haeckelian views have been rejected, most experts would agree that some subtle parallelism between ontogeny and phylogeny does occur. This relationship deserves renewed attention and urodeles are particularly suited to study it due to their variable patterns of ontogeny and complex life cycles. Current reductionist attempts to apply the morphological terminology and postulates of classical heterochrony concepts to cellular and molecular (genetic) aspects of morphogenesis are problematic. Molecular heterochrony requires a linear or strictly hierarchical structure of gene regulation of development. In addition, isomorphism between genetic mutations and morphological changes would be required for the existing terminology to apply. Finally, we caution against a broad interpretation of heterochronic processes at the molecular level, since the approach may end up permitting the meaningless interpretation of any developmental change as heterochrony.

Animals↗

Adult health screening and referral in the emergency department.

INTRODUCTION: The United States Public Health Service (USPHS) recommends using all available patient encounters to provide preventive healthcare to patients. Many studies have demonstrated the importance of performing preventive care in the emergency department (ED). These studies have used the ED as a location for patient identification and treatment, rather than as a referral site. The primary objective of this study was to identify and refer patients with unmet healthcare needs seen in the Emergency Department. A secondary objective was to determine if the patient would accept health referrals and follow-up with a doctor or clinic. METHODS: Age and gender-specific algorithms were developed from the USPHS Clinicians' Book of Preventative Health, Second Edition. A convenience sample of patients who presented to the emergency department was asked to participate in the study to obtain 50 subjects in each age and gender grouping. After one week the patients were followed up by telephone, and after one month the computer database was queried to confirm that an appointment had been made with a doctor or clinic as recommended. RESULTS: Three hundred and twelve patients in the Emergency Department were enrolled in the study. The demographic profile of the patients surveyed consisted of 152 (48.7%) African Americans, 81 (26.0%) Hispanics, and 12 (3.8%) Caucasians. Of those enrolled, 59.9% had a primary care physician, and 78.2% had insurance coverage. The study revealed that 28.8% of the subjects did not need a referral, 51.3% needed 1 to 3 referrals, and 19.9% needed 4 to 8 referrals. The most common needs were for tetanus immunizations (41.2%) and stool for occult blood (41.0%); the least common was for Pap smears (2.6%) and blood pressure (2.0%). Most patients accepted the referrals (88.3%), but only a fourth of those (22.6%) reported making a follow-up appointment. The appointment was confirmed in the computer system in 39.6% of the cases. The highest rate of follow-up was for prostate screening (41.4%); the least was for drug abuse (0.0%). CONCLUSION: Most of the patients in this study were found to have unmet healthcare needs. Many of the patients were given referrals and followed up with the clinic or physician for the healthcare problems identified. This study reinforces the value of the USPHS guideline to use all available patient encounters for preventive healthcare.

Adolescent↗

[Determining visual acuity with LH symbols and Landolt rings].

PURPOSE: Lea (LH) symbols seem to be favourable for visual acuity assessment in childhood. The symbols of the LH test are well standardized and applicable to preschool children. We compared the visual acuity determined by LH single symbols (LH) and the acuity measured with the Landolt-C (LC). PATIENTS AND METHODS: 138 cooperative subjects aged 7 to 91 years were examined. Their visual acuity was either normal or reduced due to various etiologies. Their refractive error was corrected. The monocular LH and LC were determined by a 3/4 criterion (study 1). In 19 healthy subjects aged 21 to 58 years, acuity was reduced stepwise by 5 different calibrated occlusives (study 2). A Lighthouse single symbol book (LH symbols) was used at a distance of 3 m. LC was determined at a distance of 5 m. The luminance of the test field was 180-200 cd/m2. The right eye of each patient and the amblyopic eye of the squinting patients was taken for statistical evaluation. The strabismic patients' interocular differences of LC and LH were compared. RESULTS: Within study 1, LC ranged from 0.02 to 2.0 and LH from 0.03 to 2.5. LH overestimated LC by 1.4 lines on an average (t-test p < 0.0001). The regression equation lgLH = 0.95 lgLC + 0.11 describes a high correlation (r = 0.95) between LH and LC. The relations between LH and LC of 43 strabismic amblyopic patients and the remaining subjects did not significantly differ. Due to the criterion of an interocular LH-difference > 1 line, 85.7% resp. 90% of the strabismic amblyopic patients with an interocular LC difference > 1 resp > 2 lines were detected. In study 2, LC ranged from 0.1 to 1.6, LH from 0.12 to 2.0. The mean difference LH-LC was 1.3 lines. The regression equation was lgLH = 0.91 lgLC + 0.08 (r = 0.95). CONCLUSION: LH symbols allow a reliable measurement of recognition acuity. Due to the design of the symbols, they are excellently suitable for application to preschool children. Age related normal values should be established. The systematic difference between the LC acuity and the LH acuity measured with the Lighthouse LH single symbol book by 1.4 lines has to be considered.

Adolescent↗

References concerning birth control methods in Ancient Indian Classics: an exposition.

Reproduction is the basic phenomenon of Biological activity. Like other living beings man has a desire to reproduce. Unlike others he can control reproduction at his will. From early vedic periods belonging to several centuries prior to Christian era, we find references concerning methods of controlling the population over growth. Views of vedic sages, sexologists of ancient and medieval India regarding the birth control methods are expressed in this presentation.

Books↗

Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: a metaanalysis.

OBJECTIVES: To assess (i) the efficacy of short-term proton pump inhibitors (PPIs) in non-cardiac chest pain (NCCP) and (ii) the performance of an empirical short-term treatment with PPI (PPI test) to establish a diagnosis of abnormal acid reflux in NCCP. METHODS: Metaanalysis of English language studies identified by searching MEDLINE (1966-May 2004), EMBASE (1980-May 2004), Cochrane Controlled Trials Register, and abstract books from major gastroenterology meetings (1993-2004). For the metaanalysis of PPI efficacy in NCCP, we selected randomized controlled trials (parallel group and crossover designs) comparing PPI therapy with placebo. For the metaanalysis of PPI test performance, we selected uncontrolled studies comparing the test with a standard reference. RESULTS: Eight studies were included in the PPI efficacy analysis. The pooled risk ratio for continued chest pain after PPI therapy was 0.54 (95% CI 0.41-0.71). The overall number needed to treat was 3 (95% CI 2-4). The pooled sensitivity, specificity, and diagnostic odds ratio for the PPI test versus 24-h pH monitoring and endoscopy were 80%, 74%, and 13.83 (95% CI 5.48-34.91), respectively. All studies were small and there was evidence of publication bias or other small study effects. CONCLUSION: PPI therapy reduces symptoms in NCCP and may be useful as a diagnostic test in identifying abnormal esophageal acid reflux.

Anti-Ulcer Agents↗

Statistics for the European Respiratory Journal.

This review summarizes statistical methods likely to be needed by researchers. It is not a replacement for a statistics book, and almost no symbols or mathematics are used. It seeks to guide researchers to the appropriate methods and to make them aware of some common pitfalls. Sections deal with methods for quantitative outcomes, both basic and more advanced, and parallel methods for qualitative or categorical outcomes. Reference is made to papers using the more advanced methods in the European Respiratory Journal in order that their relevance may be appreciated. The paper seeks to improve the quality of papers submitted to the European Respiratory Journal, to reduce the revisions to papers required of authors, and to enable readers of the journal to gain more insight into the interpretation of results.

Clinical Trials as Topic↗

[Learning gastroenterologic endoscopy].

1. Knowledge of the gastroenterological endoscopy and biopsy is necessary at all levels of medical education. 2. Knowledge of students: possible methods, diagnostic effectiveness, stress of the patients. Knowledge of the candidates for specialisation: indications, contraindications, possibilities of the method also in reference to the individual case. Persons interested in the subspecialisation gastro-enterology: theory, possibilities and limits, technical performance. Experienced endoscopists: regular refreshment and supplementation of knowledge and skill in highly specialised endoscopic centres. 3. Tested teaching methods are lecture, report, study of atlants and text-books, demonstrations of diapositives in connection with schematic figures, seminars with diapositives, film demonstrations, work at the patient under supervision of the tutor and use of a demonstration device as well as endoscopic demonstration by means of colour television. The centre is, however, the individual examination of the patient. 4. Knowledge of the subspecialist: History of endoscopy, knowledge of instruments, optics and endoscopic perspective, physical fundaments about light and photography, human macro- and microscopic anatomy, care of instruments and desinfection. Indications, contraindications, possibilities and limits of the method, emergency and intensive medicine, writing of the findings.

Disinfection↗

[Grassi's archives of the museum of comparative anatomy of Rome University "La Sapienza"].

The documents, reprints, books, correspondence of Grassi, found in his room at the University of Rome when he died, have been kept in the Institute of Comparative Anatomy, directed by Grassi himself from 1896 until 1925. This fund keeps documents concerning the whole life of the scientist, with a special reference to the Roman period. Numerous are the documents concerning his malariological studies between 1898 and 1910. A first reconaissance has been made in 1980 and then, twice in 1994 and 1998, the fund has been reorganized and an inventory of it has been made. It is collected in 48 boxes containing archivistic documents, 11 boxes of reprints and other publications. The inventory of archival documents has been computerized.

Academies and Institutes↗

The remarried family: an annotated bibliography, 1979-1982.

This bibliography was developed to provide professionals and interested others with a reference source for information on stepfamilies. The focus is on the remarried family and the characteristics common to its formation and integration. The bibliography is divided into six sections to facilitate easy reference. The sections are not mutually exclusive, however, and articles could be placed under more than one heading. The six sections are I. Demography/Legal Issues; II. Remarriage as a Transition; III. Remarriage Formation: Restructuring Relationships; IV. Children in Remarried Families; V. Treatment Issues; and VI. How-To Books. To complete this project, the published research literature from 1979 through 1982 was searched under the subject headings of blended families, second marriages, remarried families, stepfamilies and reconstituted families. Regret is expressed for any overlooked material.

Bibliographies as Topic↗

[Johann Sigismund Elsholtz--the forgotten pioneer and German-speaking hygiene].

In 1682, the term "hygiene" appeared for the first time in the German language, in Johann Sigismund Elsholtz's Diaeteticon. In the author's meaning this term is used to describe the tenet of the maintenance of good health. In his book, Elsholtz who was physician at the court of Frederick William, the Great Elector of Brandenburg, makes suggestions for wholesome food and drinking. He demands the availability of clean water and of a good air and draws attention to the importance of personal hygiene. Thus, Elsholtz should be referred to as a German pioneer of hygiene whose recognition has been long overdue.

Germany↗