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101.
BACKGROUND: Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE: To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS: National mailed survey of primary care physicians in 1997-1998, oversampling physicians in areas with more capitated health plans. RESULTS: The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS: Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients. 相似文献
102.
Association of a polymorphism in the lipin 1 gene with systolic blood pressure in men 总被引:1,自引:0,他引:1
Ong KL Leung RY Wong LY Cherny SS Sham PC Lam TH Lam KS Cheung BM 《American journal of hypertension》2008,21(5):539-545
BACKGROUND: Lipin 1 plays a role in abdominal obesity, insulin resistance, and hypertriglyceridemia. The gene is located at 2p25.1, a susceptibility locus for hypertension. We studied the association of tagging single-nucleotide polymorphisms (SNPs) in the lipin 1 (LPIN1) gene with hypertension and blood pressure. METHODS: Twelve tagging SNPs from the HapMap database were genotyped using Sequenom MassArray in 268 hypertensive subjects and 407 normotensive controls, of whom 268 matched the cases in age and sex. RESULTS: None of the tagging SNPs were found to be associated with hypertension after correcting for multiple testing, although carriers of the minor allele of rs10520097 had nominally lower odds for hypertension (P = 0.014). After excluding subjects who were on antihypertensive medications, the minor allele of rs10495584 was nominally associated with lower mean systolic and diastolic blood pressures in men (121.1 +/- 14.2 and 76.3 +/- 10.2 mm Hg vs. 127.4 +/- 15.2 and 80.1 +/- 10.5 mm Hg, P = 0.002 and 0.007, respectively), but not in women (P > 0.05). The association of rs10495584 with systolic blood pressure in men remained significant after correcting for multiple testing and adjustment for age, waist circumference, insulin resistance, triglyceride, and high-density lipoprotein (HDL) cholesterol (beta = -0.158, P = 0.005). An analysis of statistically similar SNPs (ssSNPs) in the regions surrounding rs10495584 suggested that its effect may be caused by its high linkage disequilibrium (LD) with the SNP, rs11524, in which the major allele forms an exonic splicing silencer sequence. CONCLUSION: Our study provides further evidence that lipin 1 may play a role in blood pressure regulation, especially in men. 相似文献
103.
Amorosi SL Tsilimingras K Thompson D Fanikos J Weinstein MC Goldhaber SZ 《The American journal of cardiology》2004,93(4):509-511
Patients on long-term anticoagulation who require interruption of therapy for surgery may receive "bridging therapy" with continuous-infusion unfractionated heparin or low-molecular-weight heparin (LMWH). We estimated the costs of bridging therapy with: (1) LMWH self-administered at home, (2) LMWH administered by a nurse to patients at home, and (3) continuous-infusion unfractionated heparin in the hospital. For surgeries requiring an overnight stay, bridging costs are estimated to be 672, 933, and 3,816 US dollars, respectively, for each of these strategies. 相似文献
104.
This paper reports a field study of the social and psychological features of young drug misusers in Glasgow. The investigation was of the anonymous self-report type and was based upon a questionnaire and two personality inventories (the PEN and the IP AT Anxiety Scale). Clear distinctions were found between those who do misuse drugs and those who do not. The trend was for drug misuse to be consistently related to elevated levels of anxiety, neuroticism and psychoticism, whereas extroversion-introversion proved to be a personality dimension unrelated to the misuse of drugs. Identified drug misusers differed substantially from non-misusers in their opinions and beliefs about drugs in general. Further, they were more likely to have experienced an unhappy home and school life, to have more involvement in the use of tobacco, alcohol, and pre- or extra-marital sex, and were more prone to unemployment problems. 相似文献
105.
Paul S. Nabity PhD Carlos A. Jaramillo MD PhD Patricia A. Resick PhD Cindy A. McGeary PhD Blessen C. Eapen MD Casey L. Straud PsyD Willie J. Hale PhD Timothy T. Houle PhD Brett T. Litz PhD Jim Mintz PhD Donald B. Penzien PhD Stacey Young-McCaughan RN PhD Terence M. Keane PhD Alan L. Peterson PhD Donald D. McGeary PhD Consortium to Alleviate PTSD 《Headache》2021,61(9):1334-1341
106.
Surendra Karki Gillian Land Stacey Aitchison Jacqueline Kennon Paul D. R. Johnson Susan A. Ballard Karin Leder Allen C. Cheng 《Journal of clinical microbiology》2013,51(10):3374-3379
Contact precautions are recommended in hospitals to prevent the transmission of vancomycin-resistant enterococci (VRE); however, there is no clear policy for how long patients should be under contact precautions due to a lack of information on the duration of carriage of these organisms. We conducted a retrospective cohort study to understand the duration of carriage of VRE (by screening of a single stool culture) and associated factors among patients who had been identified with VRE infection and/or colonization since the year 2000 at our health facilities. Of the 345 eligible participants, 136 did not respond, 90 declined to participate, and 16 did not send in the required specimens. Of the 103 remaining participants, 13 were found to have current VRE fecal carriage. The proportion of colonized patients fell from 40% (2/5) in the first year to 23.3% (7/30) in year 4. None of the 40 patients who had VRE detected >4 years prior were found to be colonized at the time of the study. The longest duration of detected VRE positivity was 46.5 months. Univariate analysis revealed that recent exposure to any antibiotics (P = 0.016), multiple antibiotics (P = 0.001), amoxicillin-clavulanic acid (P = 0.021), piperacillin-tazobactam (P = 0.007), glycopeptides (P < 0.001), meropenem (P = 0.007), aminoglycosides (P = 0.021), or fluoroquinolones (P = 0.021), being the index case in a clinical specimen (P = 0.016), and recent hospitalization (P < 0.001) were significantly associated with continued carriage on follow-up. In the surviving outpatients, a significant proportion appeared to clear VRE carriage. Our results suggest that in the absence of recent risk factors, such as hospitalization or antibiotic use, patients with a remote history of colonization (>4 years) may no longer require contact isolation precautions. 相似文献
107.
Ramnath Santosh Ramanathan Dolora Wisco Daniel Vela-Duarte Atif Zafar Ather Taqui Stacey Winners A Blake Buletko Fredrick Hustey Andrew Reimer Andrew Russman Ken Uchino M Shazam Hussain 《Journal of stroke and cerebrovascular diseases》2021,30(7):105801
ObjectivesMobile stroke unit (MSU) has been shown to rapidly provide pre-hospital thrombolysis in acute ischemic stroke (AIS). MSU encounters neurological disorders other than AIS that require emergent treatment.Methods/MaterialsWe obtained pre-hospital diagnosis and treatment data from the prospectively collected dataset on 221 consecutive MSU encounters. Based on initial clinical evaluation and neuroimaging obtained on MSU, the diagnosis of AIS (definite, probable, and possible AIS, transient ischemic attack), intracranial hemorrhage, and likely stroke mimics was made.ResultsFrom July 2014 to April 2015, 221 patients were treated on MSU. 78 (35%) patients had initial clinical diagnosis of definite/probable AIS or TIA, 69 (31%) were diagnosed as possible AIS or TIA, 15 (7%) had intracranial hemorrhage while 59 patients (27%) were diagnosed as likely stroke mimics. Stroke mimics encountered included 13 (6%) metabolic encephalopathy, 11 (5%) seizures, 9 (4%) migraines, 3 (1%) substance abuse, 2 (1%) CNS tumor, 3 (1%) infectious etiology and 3 (1%) hypoglycemia. Fifty-four (24%) patients received non-thrombolytic treatments on MSUConclusionAbout one third of MSU encounters were not AIS initially, including intracranial hemorrhage and stroke mimics. MSU can be utilized to provide pre-hospital treatments in emergent neurological conditions other than AIS. 相似文献
108.
Objective
Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students’ and doctors’ patient–provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students’ and/or doctors’ attachment style and EI on their PPC.Methods
Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised.Results
1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC.Conclusion
Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult.Practice implications
More research is needed to assess the influence of both attachment style and EI on PPC. 相似文献109.
Hatchard Taylor Byron-Alhassan Aziza Mioduszewski Ola Holshausen Katherine Correia Stacey Leeming Allison Ayson Gladys Chiasson Carley Fried Peter Cameron Ian Smith Andra 《International journal of mental health and addiction》2021,19(6):2485-2486
International Journal of Mental Health and Addiction - The caption for Fig. 1 was incorrect in this article as originally published. 相似文献
110.
Dolors Costa Concha Muoz Ana Carri Meritxell Nomdedeu Xavier Calvo Francesc Sol Elisa Luo Jos Cervera Teresa Vallespí Daniela Berneaga Cndida Gmez Amparo Arias Esperanza Such Guillermo Sanz Javier Grau Andrs Insunza María J. Calasanz María T. Ardaaz Jesús M. Hernndez Gemma Azaceta Sara lvarez Joaquín Snchez María L. Martín Joan Bargay Valle Gmez Carlos Javier Cervero María J. Allegue Rosa Collado Elias Campo Benet Nomdedeu 《Genes, chromosomes & cancer》2013,52(8):753-763
The infrequency of translocations in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemias (CMML) makes their identification and reporting interesting for the recognition of the recurrent ones and the genes involved in these neoplasias. The aims of this study were to identify new translocations associated with MDS and CMML and to establish their frequency in a cohort of 8,016 patients from the Spanish Group of MDS database. The karyotype was evaluable in 5,654 (70%) patients. Among those, 2,014 (36%) had chromosomal abnormalities, including 213 (10%) translocations identified in 195 patients. The translocations were balanced in 183 (86%) cases and unbalanced in 30 (14%) cases. All chromosomes were found to be involved in translocations, with the single exception of the Y chromosome. The chromosomes most frequently involved were in decreasing frequency: 3, 1, 7, 2, 11, 5, 12, 6, and 17. Translocations were found in karyotypes as the unique chromosomal abnormality (33%), associated with another chromosomal abnormality (11%), as a part of a complex karyotype (17%), and as a part of a monosomal karyotype (38%). There were 155 translocations not previously described in MDS or CMML and nine of them appeared to be recurrent. © 2013 Wiley Periodicals, Inc. 相似文献