Financial Indicators for Critical Access Hospitals

CONTEXT: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules. PURPOSE: To develop comparative financial indicators specifically designed for CAHs using Medicare cost report data. METHODS: A technical advisory group of individuals with extensive experience in rural hospital finance and operations provided advice to a research team from the University of North Carolina at Chapel Hill. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form. FINDINGS: Chief executive officers found the indicators to be useful and the underlying formulas to be appropriate. The multiple years of data provide snapshots of the industry as a whole, rather than trend data for a constant set of hospitals. CONCLUSIONS: The CAH Financial Indicators Report is a useful first step toward comparative financial indicators for CAHs.     

Impact of briefly-assessed depression on secondary prevention outcomes after acute coronary syndrome: a one-year longitudinal survey

Background  

Patients with acute coronary syndromes (ACS) are at increased risk of further acute cardiac events. Secondary prevention aims to decrease morbidity and mortality post-ACS. Depression is related to increased risk in this population, and to poorer secondary prevention activities. However, lengthy depression assessment techniques preclude depression assessment in routine care. The present study investigated the relationship of briefly-assessed depression with secondary prevention outcomes one year post-ACS.     

Autocorrection of three-dimensional time-of-flight MR angiography of the Circle of Willis

OBJECTIVE. The purpose of this study was to investigate the efficacy of a retrospective adaptive motion correction technique known as autocorrection for reducing motion-induced artifacts in high-resolution three-dimensional time-of-flight MR angiography of the circle of Willis. MATERIALS AND METHODS. Ten consecutive volunteers were imaged with an unenhanced gradient-recalled echo three-dimensional time-of-flight MR angiography sequence of the circle of Willis. Each volunteer was asked to rotate approximately 2 degrees after completion of one third and one half of the acquisition in the axial, sagittal, and oblique planes (45 degrees to the axial and sagittal planes). A single static data set was also acquired for each volunteer. Unprocessed and autocorrected maximum-intensity-projection images were reviewed as blinded image pairs by six radiologists and were compared on a five-point image quality scale. RESULTS. Mean improvement in image quality after autocorrection was 1.4 (p < 0.0001), 1.1 (p < 0.0001), and 0.2 (p = 0.003) observer points (maximum value, 2.0), respectively, for examinations corrupted by motion in the axial, oblique, and sagittal planes. All three axes had statistically significant improvement in image quality compared with the uncorrected images. Changes in image quality after the application of the autocorrection algorithm to static angiogram data were not statistically significant (mean change in score = -0.13 points; p = 0.29). CONCLUSION. Autocorrection can reduce artifacts in motion-corrupted MR angiography of the circle of Willis without distorting motion-free examinations.     

Impact of childhood cancer on the mental health of parents

BACKGROUND: When a child is diagnosed with cancer, the family experiences great stress and disruption to daily life. As part of a national study in New Zealand, we evaluated the mental health of mothers and fathers of children with cancer, making comparisons to parents of children from the general population. PROCEDURE: This was a cross-sectional study. All children diagnosed with cancer at ages 0-14 years in New Zealand during a defined period were ascertained from the national cancer registry and other databases. The population-based comparison children were selected using national birth records. Parents from both groups completed self-administered questionnaires containing the General Health Questionnaire (GHQ-12) and other measures. The analyses included 218 mothers and 179 fathers of children with cancer, and 266 mothers and 224 fathers of children in the comparison group. Multivariate regression was used to adjust for demographic and socioeconomic characteristics, life events, and social support. RESULTS: Mothers and fathers of children with cancer had poorer GHQ-12 and mood rating scores than those of controls. The adjusted difference in the mean total GHQ-12 score (comparing mothers of children with cancer to mothers of controls) was 2.2 (95% confidence interval 1.3-3.2). The 12 items of the GHQ were each scored 0-3, and the total score was the sum, so 2 points is a small difference. For fathers the difference was 1.5 (95% confidence interval 0.6-2.4). Some subgroups of cancer group parents had poorer emotional health scores than others, including those with poor social support and no paid employment and also those who were bereaved. CONCLUSIONS: We found statistically significant but small differences between the mental health of parents of children with cancer and controls. The small differences suggest that as a group the parents of children with cancer are relatively resilient.     

Sediment Toxicity Assessment: Comparison of Standard and New Testing Designs

Standard methods of sediment toxicity testing are fairly well accepted; however, as with all else, evolution of these methods is inevitable. We compared a standard ASTM 10-day amphipod toxicity testing method with smaller, 48- and 96-h test methods using very toxic and reference sediments. In addition we compared parallel exposures of single species, either the amphipod Ampelisca abdita or the mysid Americamysis bahia, to multiple species, mysid, and amphipod, cohabiting the same types of chambers. These comparisons were performed for both water-only and sediment-water tests. Results of the comparison of the standard ASTM 10-day amphipod test with the smaller, 48- and 96-h test chambers indicate that survival was high in both test designs using the reference sediment. With toxic sediments, complete mortality occurred in less than 48 h using the smaller experimental chambers and only after 96 h in the larger experimental chambers. We concluded that although time to death is shorter in the smaller, shorter exposure chambers, there was no overall change in mortality for the organisms, and that the smaller chambers were predictive of the results obtained with larger chambers and longer exposures. For multiple species testing in whole sediment exposures there was no change in toxicity to either the amphipod or the mysid when they cohabited the same chamber. In contrast, for water-only exposures, A. bahia demonstrated less sensitivity when cohabiting the same chamber as A. abdita. Therefore, during whole sediment testing we can add A. bahia and A. abdita to the same test chamber without changing the toxicity to either species; however, in our 10-ml water-only exposures, the species should be tested separately. Received: 16 November 1999/Accepted: 13 May 2000     

Cardiac abnormalities in end stage renal failure and anaemia

Thirteen anaemic children on dialysis were assessed to determine the incidence of cardiac changes in end stage renal failure. Nine children had an increased cardiothoracic ratio on radiography. The electrocardiogram was abnormal in every case but no child had left ventricular hypertrophy as assessed by voltage criteria. However, left ventricular hypertrophy, often gross, was found on echocardiography in 12 children and affected the interventricular septum disproportionately. Cardiac index was increased in 10 patients as a result of an increased left ventricular stroke volume rather than heart rate. Left ventricular hypertrophy was significantly greater in those on treatment for hypertension and in those with the highest cardiac index. Abnormal diastolic ventricular function was found in 6/11 children. Children with end stage renal failure have significant cardiac abnormalities that are likely to contribute to the high cardiovascular mortality in this group. Anaemia and hypertension, or its treatment, probably contribute to these changes. Voltage criteria on electrocardiogram are of no value in detecting left ventricular hypertrophy. Echocardiography must be performed, with the results corrected for age and surface area, in order to detect and follow these abnormalities.     

Biotic Factors Modifying Acute Toxicity of Aqueous Cadmium to Estuarine Amphipod Leptocheirus plumulosus

A 96-h exposure to aqueous cadmium (Cd) is the recommended reference toxicity test for 10-day sediment bioassays with the estuarine amphipod, Leptocheirus plumulosus (US EPA 1994). This water-only test was used to assess the influence of organism size, sex, and nutritional status on the sensitivity of laboratory-cultured L. plumulosus to Cd. In addition, the response of field-collected amphipods was compared to similarly sized laboratory animals to assess potential seasonal changes in Cd sensitivity. Lipid content of test organisms was measured in these seasonal experiments and those evaluating effects of nutritional status because of its potential as an indicator of physiological condition. LC₅₀ values of laboratory animals size-sorted on nested 500-, 710-, and 1000-μm mesh sieves, increased with size class: 0.36, 0.65, and 0.88 mg Cd/L, respectively. Gravid females were less sensitive than males or mature females to aqueous Cd. Studies on the influence of the molt cycle on Cd toxicity indicated enhanced sensitivity of immediate postmolt animals that may explain some of the observed differences in Cd tolerance. Nutritional effects were investigated by comparing the sensitivity of fed and starved laboratory-reared amphipods. Starved juveniles and adults were significantly smaller than their fed counterparts and exhibited a 28–43% reduction in lipid content, respectively. However, comparison of LC₅₀ values indicated no significant differences in sensitivity to Cd between starved and fed juveniles (0.23 vs 0.30 mg Cd/L) or adults (0.37 vs 0.52 mg Cd/L). Field-collected amphipods were typically more sensitive to Cd than laboratory animals, regardless of the season, although their lipid content varied, ranging from 6.6% in August to 13.7% in November. Results are discussed with respect to the use and interpretation of toxicity tests with this species. Received: 18 February 1997/Accepted: 5 May 1997