Post-acute service use following acute myocardial infarction in the elderly

This exploratory study examined the extent to which factors beyond characteristics of the patient, such as discharging hospital attributes and State factors, contributed to variations in post-acute services use (PASU) in a cohort of elderly Medicare patients following acute myocardial infarction (AMI). Thirty-seven percent of this cohort received PAS within 30 days of discharge and home health care was the most common type of service used. Patient severity of illness at hospital discharge, for-profit ownership of the discharging hospital, and discharging hospital provision of home health services were shown to be important predictors of PASU. After adjusting for many patient and hospital characteristics, however, variation in PASU remained across States.     

The selective impairment of arithmetical procedures

The theoretical distinction between arithmetic facts and procedures was first made by Groen and Parkman (1972). This was confirmed with a neuropsychological single case described by Warrington (1982) who had impaired arithmetical facts but well preserved arithmetical procedures. Since this time there have been several patients described who showed a selective impairment of arithmetic facts. There have also been reports of cases with impaired arithmetical procedures. However, there has not yet been a case reported with the selective impairment of procedures in the context of intact arithmetic facts. This paper describes a patient, SR, with probable Alzheimer's dementia who had well preserved addition, multiplication and subtraction facts but who nevertheless had severe difficulties with a range of arithmetical procedures such as multidigit sums, decimals and fractions. The implications of this case for current theoretical models are discussed.     

A randomized clinical trial of beta carotene vs placebo for the treatment of cervical HPV infection

The objective of the study was to determine if oral beta carotene would improve abnormalities observed in Papanicolaou smears or reduce the amount of HPV DNA in genital samples. A randomized double blind placebo controlled trial was designed for 117 women with abnormal cervical morphology, not undergoing laser ablative therapy, at The Royal Women's Hospital, Victoria. Thirty milligrams of oral beta carotene were administered daily for 12 months. Post-intervention cervical cytology and the amount of HPV DNA present on tampon specimens as determined by polymerase chain reaction and Hybrid Capture were the main outcome measures. After 12 months therapy there was no difference between the beta carotene and placebo groups in Papanicolaou smear results (58% and 62% normal) and HPV positivity (42% and 46% positive) ( P > 0.86). Women taking beta carotene were not more likely to have improved cervical cytology or a decrease in the amount of HPV DNA ( P > 0.2). The median post-intervention beta carotene level was 0.63 µm ml⁻¹ (range 0.04–1.6) for the beta carotene group and 0.15 µm ml⁻¹ (range 0.02–1.51) for the lecithin group ( P < 0.0001). This clinical trial did not identify a beneficial effect of 30 mg of oral beta carotene on cervical cytology, or on the amount of HPV DNA present from tampon specimens.     

Temperament in children delivered by vacuum extraction

Thomas and Chess's temperament variables were studied via questionnaires in two samples of children delivered by vacuum extraction and in a standardization sample at six months and at one and two years of age. Temperament was not systematically related to vacuum extraction delivery per se or to its indications or to offspring neonatal somatic impairment.     

Optimal strategies for the diagnosis and treatment of coronary artery disease. Analysis using microcomputer

A computer program has been developed to aid in diagnostic and therapeutic decisions concerning a patient with chest pain. It provides an analysis tailored to the individual patient, in that the data used in the analysis depend on specific patient characteristics. The user can elect to examine all stored data values (probabilities, quality-adjusted life expectancies, and monetary costs), and to alter any of them. Decisions at three stages in the patient workup are considered: prior to any diagnostic test, following an exercise tolerance test, and following coronary angiography. The results of the analysis can be displayed in several tabular and graphical formats. In addition, the program can carry out a Monte Carlo simulation (or probabilistic sensitivity analysis) to determine the effect of uncertainty in the data on the stability of the choice of optimal strategy.