A prospective randomized trial of the surgical blood order equation for ordering red cells for total hip arthroplasty patients

BACKGROUND: The majority of crossmatched blood is for surgical patients, and most of it is never transfused. An alternative system for ordering red cell (RBC) units, called the surgical blood order equation (SBOE), which incorporates specific patient variables for surgical patients, has been developed. STUDY DESIGN AND METHODS: A prospective double-blind randomized trial compared the SBOE with the maximal surgical blood order schedule (MSBOS) system for ordering allogeneic RBC units in 60 patients undergoing total hip arthroplasty. Autologous RBCs were available for none of the patients. RESULTS: There were no differences in patient demographic, surgical, or laboratory variables at any time. The median number (range) of allogeneic RBC units ordered was 2 (2-3) for the MSBOS and 0 (0-3) for the SBOE (p<0.0001). The SBOE ordered the correct number of RBC units for 58 percent of patients, while the MSBOS did so for 7 percent (p<0.0001). The SBOE had a lower crossmatch-to-transfusion ratio than the MSBOS (0.83 vs. 4.12). Costs were also lower with the SBOE. CONCLUSION: Incorporation of patient factors in the use of the SBOE system resulted in increased efficiency of blood-ordering practices for total hip arthroplasty.     

心房扑动患者的下腔静脉-三尖瓣环峡部和房间隔缓慢传导的电生理意义

目的　用电 解剖标测方法标测右心房 ,然后比较心房扑动 (AFL)和房室结折返性心动过速(AVNRT)患者在下腔静脉 三尖瓣环峡部 (CTI)和心房间隔部 (AS)的电冲动传导速度 ,以便确定AFL患者除了解剖结构上的异常外 ,是否伴有心房电生理方面的异常变化。方法　 1 0例AFL患者 ,男性 7例 ,女性 3例 ,平均 (53± 1 0 )岁 ;1 3例AVNRT患者 ,男性 5例 ,女性 8例 ,平均 (51± 1 1 )岁。对这两组患者进行了详细的电 解剖标测、电生理检查和射频消融术。分别以周长为 60 0、40 0、和 30 0ms在冠状静脉窦 (CS)起搏的情况下测量AFL和AVNRT患者的CTI和AS的冲动传导速度 ,并将两组患者在CTI和AS的冲动传导速度进行比较。结果　与AVNRT患者相比 ,AFL患者在各个起搏周长 (PCL)时CTI和AS的冲动传导速度都明显减慢 (P <0 0 5)。另外 ,在AFL组 ,AS的冲动传导速度在起搏周长 60 0、40 0ms时低于CTI,但在 30 0ms时差异无显著性 (P >0 0 5)。因为在AFL组 ,PCL为 30 0ms时的冲动传导速度明显低于 60 0和 40 0ms时的冲动传导速度 ,致使PCL为 30 0ms时CTI和AS的冲动传导速度差异无显著性。结论　与CTI相比 ,AS的冲动传导速度在所有患者都较慢 ,而AFL患者在CTI和AS的冲动传导速度减低更明显 ,并且在CTI的冲动传导速度减慢具有频率依     

Transitional cell carcinoma of the urinary bladder: histologic clearance with combined 5-FU chemotherapy and radiation therapy. Preliminary results of a bladder-preservation study

Fourteen patients with transitional cell carcinoma of the urinary bladder were treated with 4,000 cGy of pelvic irradiation concurrent with two 96-hour infusions of 5-fluorouracil (5-FU). Three weeks after completion of this regimen, patients underwent repeat cystoscopy and deep-muscle biopsy at the site of their original neoplasms. Eight of 14 (57%) had no tumor left in the biopsy specimen, and they received an additional course of chemotherapy and radiation therapy to a total dose of 4,400 cGy to the pelvis and 6,000 cGy to the bladder. Five of the 14 had residual tumor in the biopsy specimen (one did not undergo biopsy) and went on to planned cystectomy. Two of the five had no tumor in the cystectomy specimen. Overall, ten of the 14 patients (71%) have been downstaged to a condition of P0 (no tumor) following 4,000 cGy and two courses of 5-FU. Of eight patients with retained bladders, seven remain well at a median follow-up of 7 months. At a range of follow-up of 3-21 months and a median of 7 months, 13 of 14 patients remain tumor-free. This regimen results in a greater percentage of downstaging than conventional irradiation alone, and may allow bladder preservation for those with radiation therapy- and chemotherapy-responsive tumors.     

Radionuclide thyroid studies: a survey of practice in the United States in 1981. Special report

A survey was conducted to determine the radiopharmaceuticals and radionuclide imaging methods used for thyroid studies in the U.S. in 1981. The final sample, made up of 299 hospitals, was taken from a random sample consisting of 10% (337) of U.S. hospitals performing nuclear medicine studies. The survey showed that over one half of thyroid scans were obtained with Tc-99m pertechnetate and over one half of uptake studies were performed with I-131. Uptake determinations accompanied 78% of scans. Only 8% of the uptake studies were performed without scans. I-123 was more commonly used on the west coast and in the northeast, and there was interest in a more readily available and less expensive supply of I-123. Thyroid studies accounted for 6.7% of all nuclear imaging procedures. Approximately 7,760,000 nuclear medicine imaging procedures were performed in the U.S. in 1981.     

PMD6 Chronic Care Costs of New Medicare HMO Enrollees: Implications for Disease Management

Cost-effective care for chronic conditions is a growing concern of health plans enrolling increasing numbers of the elderly and disabled under Medicare risk contracts. This study provides evidence of the prevalence, patterns of care, and costs of chronic illnesses among new Medicare HMO enrollees. The results provide a foundation for estimates of the cost-effectiveness of drug therapy and care management programs that serve this group.
METHODS: We used national Medicare claims data to examine chronic care services and associated costs for a sample of 19,084 beneficiaries who enrolled in an HMO in 1995. We constructed three measures of cost: the total Medicare-covered cost, the cost of medical claims with the chronic condition coded as a diagnosis, and the regression-estimated effect of the chronic condition on cost.
RESULTS: 58% of the new Medicare HMO enrollees in our sample were treated for at least one of the selected chronic conditions in the six months before enrollment. One-third of the new enrollees had multiple conditions represented by diagnoses in more than one of eighteen chronic-condition groups. Persons with chronic conditions accounted for 93% of pre-enrollment Medicare costs among new HMO enrollees. Per 1,000 enrollees, pre-enrollment Medicare costs were greatest for those with hypertensive disease, coronary heart disease, heart failure, and diabetes.
CONCLUSIONS: The concentration of utilization and costs in those with chronic conditions suggests that appropriate drug therapy and care management for those with chronic conditions should be a top priority for HMOs with Medicare risk contracts. These estimates of prevalence suggest a need for HMOs to screen new Medicare HMO enrollees for chronic conditions immediately upon enrollment to ensure continuity of care.