ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In one community, 100 elderly persons (25 HMO and 75 private patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status also were collected to determine whether these variables would related to HMO membership. Satisfaction scores were compared between HMO and private care groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private care group, whereas satisfaction with cost was higher in the HMO group. Interestingly, the HMO group evaluated private care and HMO care similarly. The private group related HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Inner-city adults (n = 108) with a chronic disease (sickle cell disease or asthma) and their unaffected siblings (n = 108) with a chronic disease (sickle cell disease or asthma) and their unaffected siblings (n = 50) were interviewed and ratings of health perceptions and opinions about medical care were compared. Persons with a chronic disease reported unfavorable ratings of their health (P< .001). Their siblings reported moderately favorable health perceptions but much worry and concern about their health. When compared wit the asthma subgroup, persons with sickle cell disease reported more adverse ratings of health outlook susceptibility to illness, sickness orientation, humaneness of medical care, and satisfaction with medical care (P< .05). These observations demonstrate low health perceptions in adults with two chronic medical conditions and more negative perceptions in persons with sickle cell disease. They indicate possible opportunities for improving medical care for patients with these conditions to achieve better perceptions of health, outlook, and medical services.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In 1981 a statewide program supplying free insulin to 3,720 patients of state health clinics was discontinued. We attempted to assess whether this action had an adverse effect medically and financially on those concerned. A computer randomized sample of 351 patients (9%) was studied by personal interview and questionnaire. Information obtained focused on certain events that occurred 18 months before and after the program ceased. Measurements used to determine medical impact were number of hospitalizations, emergency room and physician visits, changes in weight and glucose levels, and episodes of ketoacidosis. Financial impact was measured by cost of hospitalization and physician visits. Our results revealed no significant changes in any of the medical parameters studied except for fasting serum glucose levels above 300 mg/dl, which occurred less frequently after the free insulin program was discontinued. There were fewer hospitalizations, more visits to physicians, and no change in number of emergency room visits after discontinuance of the free program. The overall cost saving was estimated to be $883,558 for the 18-month study period, in addition to the $550,000 the plan had been costing the state.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Arteriovenous malformations of the small intestine are an uncommon cause of gastrointestinal hemorrhage. When we reviewed the records of 406 patients admitted to the hospital because of gastrointestinal blood loss, we found nine patients who had AVMs of the small intestine. We have developed an algorithm that presents a rational diagnostic approach to patients with hemorrhage from the small intestine. Single contrast barium roentgenograms were not helpful in this series. Endoscopy is not helpful unless the scope can be passed to the area of involvement. Arteriography is the most helpful diagnostic maneuver and should be considered early in the work-up for suspected intestinal AVMs. In addition, arteriography can be useful in localizing the precise area of bleeding so that resection can be limited to the involved areas.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The recent changes in the mechanisms of health care funding have complicated trauma care and trauma center development. Hard data are needed on the current financial position of trauma care to plan for the future. To reduce the cost of trauma care without sacrificing the quality, we must know how the trauma dollar is spent. We reviewed the records fo 100 random admissions to the trauma service of our institution in 1985. The records were examined for length of stay (LOS), intensive care unit length of stay (ICU-LOS), total hospital bill, types of third-party coverage, and overall collection rate. The hospital bill was broken down to identify the origins of trauma costs. To provide a control group, 100 patients admitted to the general surgical service and 100 other admissions were also analyzed. Trauma patients had greater LOS, ICU-LOS, total bills, and costs per day. Blunt trauma resulted in a greater LOS than penetrating trauma, but similar total bills. The collection rate from the blunt trauma patients was significantly greater. The greatest differences between trauma patients and others in resource utilization are the result of longer ICU-LOS and greater use of blood products. We did not identify any sites of potentially significant cost cutting that would not compromise patient care.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

After evaluating approximately 500 patients to identify the cause of erectile dysfunction. I selected 60 patients to receive a therapeutic injection of the vasoactive drugs papaverine and phentolamine mesylate (Regitine) into the corpora cavernosa. Fifty-two patients (87%) obtained erections that were adequate for sexual intercourse; these patients continued a self-injection program. Older patients with vasculogenic erectile dysfunction responded poorly. Ten patients, seven of whom had responded adequately, subsequently had implantation of a penile prosthesis. Although the self-injection group had few complications, 16 of 30 patients (53%) who had long-term follow-up subsequently discontinued the injections.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In a ten-year review at a large community teaching hospital clostridia accounted for less than 1% of all positive bloodstream isolates (26 episodes in 25 patients). All but one of the isolates were clinically significant. Twenty-two patients (88%) had a serious underlying medical condition, and 17 of the episodes (65%) were associated with a bowel source; twelve patients (48%) died of their infection. Clostridial bloodstream infections are particularly clinically significant in patients with serious underlying disease.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Nisoldipine is a new calcium channel blocker of the dihydropyridine family with a high affinity for coronary vessels. We assessed the efficacy of nisoldipine in the treatment of asymptomatic ischemia in 12 patients with chronic, stable angina. Two to four weeks of daily therapy with prn nitroglycerin and placebo was followed by 24-hour ambulatory electrocardiographic recording for ST segment assessment. After two weeks of once-daily nisoldipine, 10 to 20 mg, the ambulatory recording was repeated. A significant difference was seen in ischemia-magnitude products of asymptomatic ischemic episodes in placebo versus active drug periods (P< .05). When total ischemic burden was considered (ST segment depression during both painless and painful episodes), the difference was even more significant (P< .02).

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID