Evaluating the cost of one telehealth application connecting an acute and long-term care setting

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.     

The histology and growth kinetics of canine renal oncocytoma

A renal oncocytoma was diagnosed in a 10-year-old English springer spaniel with a 5-month history of anorexia, vomiting and weight loss. The tumour, which was localized to the kidney, was treated by simple nephrectomy and the dog made a full recovery. Histologically, the tumour consisted of cells with abundant eosinophilic cytoplasm forming acini and alveolar nests set within a loose fibrovascular stroma. The results of cell kinetic studies (AgNOR score 2.68, PCNA index 5.2%) were comparable with findings reported for benign human renal tumours. This appears to be the first reported case of renal oncocytoma in a dog.     

Histochemical study of endocervical glycoproteins throughout the normal menstrual cycle and adjacent to cervical intraepithelial neoplasia

Intracellular endocervical mucins from 45 normal uteri at different phases of the menstrual cycle, assessed by endometrial histology, have been investigated quantitatively. Both acidic and neutral mucins are produced by mucosal cells, although acidic mucin is far in excess of neutral mucin. Both acidic components undergo cyclical changes: an increase in sialoglycoproteins occurs in the periovulatory phase with a decrease in the secretory phase when sulphomucins increase. This suggests that sialoglycoprotein plays a role in the production of sperm-penetrable mucus at midcycle. Endocervical mucins adjacent to 37 examples of cervical intraepithelial neoplasia have also been investigated. In nine cases glands immediately adjacent to the abnormal squamous epithelium showed a decrease in sulphomucins together with an increase in sialomucins when compared with others 8 mm distant. Such changes are similar to those described adjacent to colonic adenocarcinoma and may reflect a premalignant mucosa.     

American College of Cardiology/American Heart Association preoperative assessment guidelines reduce resource utilization before aortic surgery

BACKGROUND: Methods used for evaluation of cardiac risk before noncardiac surgery vary widely. We evaluated the effect over time on practice and resource utilization of implementing the American College of Cardiology/American Heart Association Guidelines on Preoperative Risk Assessment. METHODS: We compared 102 historical control patients who underwent elective abdominal aortic surgery (from January 1993 to December 1994) with 94 consecutive patients after guideline implementation (from July 1995 to December 1996) and 104 patients in a late after guideline implementation (from July 1, 1997, to September 30, 1998). Resource use (testing, revascularization, and costs) and outcomes (perioperative death and myocardial infarction) were examined. Patients with and without clinical markers of risk for perioperative cardiac complications were compared. RESULTS: The use of preoperative stress testing (88% to 47%; P <.00001), cardiac catheterization (24% to 11%; P <.05), and coronary revascularization (25% to 2%; P <.00001) decreased between control and postguideline groups, respectively. These changes persisted in the late postguideline group. Mean preoperative evaluation costs also fell ($1087 versus $171; P <.0001). Outcomes of death (4% versus 3% versus 2%) and myocardial infarction (7% versus 3% versus 5%) were not significantly different between control, postguideline, and late postguideline groups, respectively. Stress test rates were similar for patients at low risk versus high risk in the historical control group (84% versus 91%; P =.29) but lower for patients at low risk after guideline implementation (31% versus 61%; P =.003). CONCLUSION: Implementation of the American College of Cardiology/American Heart Association cardiac risk assessment guidelines appropriately reduced resource use and costs in patients who underwent elective aortic surgery without affecting outcomes. This effect was sustained 2 years after guideline implementation.     

Association of point-of-purchase tobacco advertising and promotions with choice of usual brand among teenage smokers

The objective is to determine the relationship between brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes and choice of usual brand among school students. A cross-sectional survey was designed that merged records of store tobacco advertising and promotions. The survey was administered to 3,890 U.S. high school smokers with a usual brand, matched to 196 convenience stores. Choice of Marlboro as a usual brand was associated with presence of a Marlboro gift with purchase (p <.001) and a greater brand share of interior (p = .05) and exterior (p = .05) advertising voice for Marlboro. Choice of Camel as a usual brand was associated with a greater share of interior advertising voice for Camel (p <.001) but was unrelated to a Camel gift with purchase promotions (p > .05) and negatively associated with a greater share of exterior advertising voice for Camel (p < .001). The results are consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but resultsfor Camel are mixed and inconclusive. Further research is required to confirm and extend these findings.