Cost of neonatal intensive and special care

A detailed costing of neonatal intensive and special care was made for the year 1986 at the Rotunda Hospital. Cost was expressed at 1986 prices in punts. There was 1,364 admissions including external transfers giving a total of 10,086 bed days, divided into 1,044 intensive care and 9,042 special care bed days. The total cost of intensive and special care was 1,342,500 pounds. Costs per inpatient day were 288 pounds for intensive and 115 pounds for special care. Sixty percent of the intensive care bed days were used by infants weighting less than 1,500 g birth weight and 93% by infants less than 2,500 g birth weight; this emphasizes the effect of population mix on resource use. The average cost of intensive care survivors by birth weight were: less than 1,000 g - 16,226 pounds (8,052 pounds-23,535 pounds); 1,000 g-1,499 g - 13,412 pounds (1,898 pounds-22,456 pounds); 1,500 g-2,499 g - 8,864 pounds (633 pounds-17,666 pounds); 2,500 g + - 5,123 pounds (384 pounds-12,636 pounds). The average cost of all admissions to special or intensive care was 984.24 pounds. Using this figure (984.24 pounds) and assuming that 13% of all births in 1986 required special or intensive care the total health care expenditure on neonatal special or intensive care in 1986 amounts to 8.03 million pounds of a total Department of Health budget of 1,269 million pounds. By allocating infants to the currently used neonatal diagnostic related groupings (DRGs) and assigning costs at 1987 US reimbursement levels, the total cost to the Rotunda would be 1,878,750 pounds punts. The current level of DRGs derived from the reimbursement rates in the United States which is insufficient to meet the actual cost incurred there, is 40% greater than current total funding of neonatal intensive and special care in the Rotunda. Current funding levels in the United Kingdom are 13% to 80% greater than in the Rotunda.     

Recovery of the human immunodeficiency virus from fibreoptic bronchoscopes.

Ten bronchoscopes that had been used on patients with the acquired immunodeficiency syndrome were sampled to determine the nature and extent of microbial contamination. Samples were taken by irrigating the suction biopsy channel with modified viral transport medium and by swabbing the insertion tube. Sampling was repeated after they had been cleaned in detergent and after two minutes' disinfection in 2% alkaline glutaraldehyde. Before being cleaned the seven bronchoscopes tested by polymerase chain reaction were contaminated with the human immunodeficiency virus, though infectivity and antigen assays gave negative results. Other organisms identified were hepatitis B virus (1), commensal bacteria (9), and Pneumocystis carinii (4). Mean bacterial contamination was 2.27 log colony forming organisms per millilitre. Cleaning the bronchoscope before disinfection removed all detectable contaminants with a reduction in bacterial growth of up to 8 log colony forming units/ml.     

Excretory urography with iohexol: evaluation in children

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.     

Effects of adenosine on autonomic control of heart rate in man

Six healthy subjects (two female) aged 23-40 years participated in a double-blind randomized cross-over study to investigate autonomic mechanisms involved in the chronotropic effect of adenosine in conscious man. Adenosine was infused in increasing doses following saline, propranolol (0.2 mg kg-1 body weight) or propranolol (0.2 mg kg-1 plus atropine (0.04 mg kg-1). Heart rate and blood pressure were measured supine, on standing and during a Valsalva manoeuvre. Plasma catecholamines were measured in the supine and standing positions. Following saline, adenosine (up to 120 micrograms kg-1 min-1) caused a dose-related increase in heart rate (mean +/- SD maximum increase 18 +/- 8 bpm; P less than 0.01). The change in heart rate with adenosine after propranolol (12 +/- 9 bpm; P less than 0.05) did not differ significantly from the corresponding change following saline but was abolished by propranolol plus atropine, which, in turn, was associated with a mean maximum decrease in heart rate of 5 +/- 3 bpm (P less than 0.01). The increase in heart rate during the initial 30 s on standing was augmented with adenosine compared with saline (16 +/- 5 bpm; P less than 0.01). A significant increase in plasma noradrenaline on standing was also found with adenosine compared with saline (6.37 +/- 2.86 vs. 4.77 +/- 1.79 nmol 1(-1); P less than 0.05). The heart rate response to the Valsalva manoeuvre was not affected by adenosine. These results suggest that the positive chronotropic effect of infused adenosine in conscious man may in part be caused by an inhibition of cardiac vagal tone.(ABSTRACT TRUNCATED AT 250 WORDS)     

A set of X-ray test objects for image quality control in digital subtraction fluorography. II: Application and interpretation of results

In the previous article we introduced a set of test objects for quality control of digital subtraction fluorography (DSF) systems. These test objects have been evaluated using several commercial DSF systems in their clinical environment. In this second article we present test images and results obtained during these trails and explain how the test objects can be used to analyse the imaging performance of DSF systems.     

Implications of the California Nurse Staffing Mandate for Other States

Objectives. To determine whether nurse staffing in California hospitals, where state‐mandated minimum nurse‐to‐patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. Data Sources. Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. Study Design. Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure‐to‐rescue, are affected by the differences in nurse workloads across the hospitals in these states. Principal Findings. California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California‐mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Conclusions. Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.     

Mucus clearance from peripheral and central airways of asymptomatic cigarette smokers

Insoluble radioaerosol particles have been used to monitor mucus clearance from peripheral, intermediate and inner lung zones. Nine asymptomatic cigarette smokers and nine healthy non-smokers who closely matched them for age, height and lung function were each tested twice under differing radioaerosol inhalation conditions ('high' and 'low' flow rate inhalation), so that clearance differences between smokers and non-smokers should not be masked by apparent clearance differences merely resulting from differing aerosol deposition patterns. Peripheral zone clearance in the smokers was closely similar to that in the non-smokers and was affected very little by changing from 'low' to 'high' flow rate inhalation. Inner zone clearance (calculated by a method which makes allowance for material cleared into the inner zone from more distal airways) was significantly slower in smokers than in nonsmokers for both inhalation conditions. In fact, inner zone clearance in the smokers after 'high' flow inhalation (favouring central aerosol deposition) was slower (p congruent to 0.05) than in the non-smokers after 'low' inhalation (favouring relatively peripheral deposition).     

Comparison of risk factors for cervical cancer in different populations

The incidence of cervical cancer has been found to vary between populations. Risk factors of cervical cancer include early age at first marriage, multiple marriages and antibodies to herpes simplex virus type 2 (HSV-2). The interrelatedness of these risk factors was examined by comparing data collected from 428 cancer cases and 947 control women selected from 6 populations having standardized cervical cancer incidence rates varying from 9.3 to 85.1 per 100,000. Logistic regression analysis revealed that multiple marriages, early age at first marriage or pregnancy and HSV-2 antibodies were all associated with significant risk when all 3 factors were entered into the model. Cervical cancer incidence rates were best predicted by the occurrence of HSV-2 antibodies among control women. To further assess the relation between cervical cancer rates and HSV-2 antibody, 2,306 additional sera representing an 0.8% random sample of females over 9 years of age residing in the Republic of Panama were assayed for antibodies to the virus, and the occurrence of antibodies was correlated with invasive cervical cancer rates specific to each Province. Data from both the random sample and the other study populations yielded a linear relation between the occurrence of HSV-2 antibodies and the incidence of cervical cancer. An exception was found for women living in Herrera Province, Republic of Panama, who had a higher cancer rate than predicted by HSV-2 antibody occurrence. The data suggested that infection with HSV-2 is a co-variable of venereal factors, although a role for the virus in the genesis of a certain proportion of cervical cancers is not excluded.     

Intracellular myocardial pH measured in vivo with sustained and reperfused coronary occlusion

Intracellular pH provides an important measure of the adequacy of local tissue perfusion. The purpose of this study was to measure regional intracellular myocardial pH (impH) in the ischemic zone in vivo during experimental canine coronary occlusion, with and without coronary reperfusion. Twenty adult dogs were studied. Ten dogs underwent permanent ligation of the proximal anterior left descending coronary artery (group L), five dogs had coronary reperfusion after 1 hour of total coronary occlusion (group R), and five dogs did not undergo ligation and served as controls (group C). Intracellular myocardial pH was measured by 31phosphorus nuclear magnetic resonance spectroscopy at baseline and then at 15-minute intervals for 6 hours after coronary occlusion (or after sham occlusion in group C). Baseline impH did not differ among groups (group C, 7.22 +/- 0.12 mean +/- standard error of mean; group L, 7.17 +/- 0.07; group R, 7.22 +/- 0.09). During hour 1 of total occlusion, the impH of both groups L (6.58 +/- 0.05) and R (6.55 +/- 0.08) was significantly reduced as compared with the impH of group C (7.3 +/- 0.12; p less than 0.05). At 0 to 1, 1 to 3, and 3 to 5 hours of reperfusion, the impH of group R (7.34 +/- 0.08, 7.27 +/- 0.07, and 7.29 +/- 0.06, respectively for these times) did not differ from group C (7.26 +/- 0.11, 7.21 +/- 0.07, and 7.25 +/- 0.10). At these same times, the impH of group L (6.47 +/- 0.05, 6.57 +/- 0.04, and 6.75 +/- 0.04) was significantly reduced as compared with both groups R and C (p less than 0.05). Thus a severe, persistent regional intracellular myocardial acidosis occurs in the ischemic zone with coronary occlusion but is rapidly corrected by reperfusion within 1 hour.