Measuring, managing, making a difference.

What is disease management, and how does it work? The author offers an overview of this process and describes how HIM professionals can play an important role in this initiative.     

On balance, a positive outcome.

Picking up the pieces after a broken marriage can be painful, but the split can be beneficial. A review of a half-dozen failed mergers shows that divorce carries a price, but ultimately the former partners believe they will be stronger operating independently and can do a better job serving their communities.     

Computer-simulated clinical encounters. I. Development, utilization, and evaluation of a program.

Positive findings from the two-year pilot study indicated no significant difference in academic learning and clinical performance when students substituted computer-simulated experiences for hospital-based clinical experiences. There was also strong evidence that the time spent by students in fewer hospital-based clinical experiences was more decisively monitored by faculty. Based on these positive findings, the computer-simulated clinical encounters are being continued as part of the established curriculum in the coordinated undergraduate program in dietetics at The Ohio State University.     

Injuries, crashes, and construction on a superhighway.

Crash and injury-crash rates increased significantly on segments of an Illinois superhighway undergoing major construction, compared to crash rates of preceding years and to crash rates on segments not undergoing construction. Maintaining separation of traffic on segments under construction resulted in smaller increase in injury-crash rates than crossover diversion of traffic from lanes under construction into previously one-way roads.     

First, do no harm. Second, turn a profit

In the past, a good bedside manner and nimble fingers were characteristics of a good doc. But in these cost cutting, profit-motivated days, hospital and health plans are now looking for physicians who can boost the bottom line. It's called "economic credentialing." Medical groups don't like it, and they're suing.     

Chlorination, chlorination by-products, and cancer: a meta-analysis.

OBJECTIVES. Individual epidemiological investigations into the association between chlorination by-products in drinking water and cancer have been suggestive but inconclusive. Enough studies exist to provide the basis for a meaningful meta-analysis. METHODS. An extensive literature search was performed to identify pertinent case-control studies and cohort studies. Consumption of chlorinated water, surface water, or water with high levels of chloroform was used as a surrogate for exposure to chlorination by-products. Relative risk estimates were abstracted from the individual studies and pooled. RESULTS. A simple meta-analysis of all cancer sites yielded a relative risk estimate for exposure to chlorination by-products of 1.15 (95% CI: 1.09, 1.20). Pooled relative risk estimates for organ-specific neoplasms were 1.21 (95% CI: 1.09, 1.34) for bladder cancer and 1.38 (95% CI: 1.01, 1.87) for rectal cancer. When studies that adjusted for potential confounders were pooled separately, estimates of relative risks did not change substantially. CONCLUSIONS. The results of this meta-analysis suggest a positive association between consumption of chlorination by-products in drinking water and bladder and rectal cancer in humans.