Guidelines for use access to compuuterized medical records

Computerization of the medical record allows the unique capability to provide differential access to various components of the record by users outsid of the immediate provider/patient health care setting Guidelines for designers, programmers, and users of computerizeid medical records have been defined in order to clarify which data elements or categories are appropriate for communication to various parties involved in utilizing patients information.     

Artificial sapphire contact probes in Nd:YAG endometrial ablation: a quantitative in vitro and in vivo study

Artificial sapphire contact probes offer theoretical advantages in Nd:YAG endometrial ablation. To examine this, an in vitro and in vivo study of laser-tissue interaction was performed. In vitro, a linear correlation was found between applied energy and total depth of effect, that is, photovaporization and photocoagulation. Using a Round (MTR 1.5) contact probe, an applied energy of 30 joules gave a depth of myometrial effect of 3.3 mm. In vivo, there was a significant reduction in tissue effect (p less than 0.001) compared to in vitro. Difficulty of manipulation of the contact laser probe within the uterus also caused a significant reduction (p less than 0.001) in depth of tissue ablation achieved on the posterior uterine wall compared with that achievable at the uterine fundus, but this may be counteracted by increasing applied energy.     

Productive relationships with mover-and-shakers. Recognizing the agents of influence in your hospital

Hospital administrators need every available asset these days, and one potential resource is the people in every organization who seem to naturally attract and lead others. The authors tell how to, first, recognize such persons and, second, establish a constructive relationship with them.     

Sequence effects on local DNA topology.

Nuclear Overhauser effect-derived distances between adenine H2 protons and anomeric H1' protons on the same strand or on the complementary strand are presented for several different DNA duplexes. The cross-strand (n)AH2 to (m + 1)H1' distances [designated as x, where (n) and (m) are complementary residues] vary by up to 1 A depending on the sequence. In all possible A-containing pyrimidine-purine steps (CA, TG, and TA), x is greater than 4.5 A. In GA steps, x varies within rather wide limits in the range 3.8-4.5 A, whereas in AA steps the lower limit is 3.7 A and the upper limit is approximately 4.2 A. In purine-purine steps, x is affected by at least three factors: (i) adjacent pyrimidine-purine steps at the 5' end [e.g., YRA sequences (where Y = T or C and R = G or A)], or a pyrimidine-purine step at the 3' end of the pyrimidine-pyrimidine step on the complementary strand, cause x to increase, (ii) an AT step at the 3' end of a purine-purine step (e.g., RAT) causes x to decrease, and (iii) substitution of bases at the next-nearest neighbor position leads to changes in x at GA and AA steps. The latter factor seems to be due to a cooperative effect arising from formation of the "anomalous" B' structure when the substitution produces an AnTm tract (which always produces a decrease in x). The data indicate that (n)AH2-(n + 1)H1' distances on the same strand (designated as s) are also sequence dependent. Thus on AA steps, neighboring substitutions produce the same effect on s as on the cross-strand x distances. The results lead to the ability to predict changes in AH2-H1' distances depending on the DNA sequence. By using high-resolution x-ray B-type structures as a set of allowable B conformations, a very good correlation was found between x and the minor groove width parameters P-P or H1'-H1'. Thus, the x distances are a direct probe of the minor groove width in B-type DNA, and changes in this distance therefore reflect changes in the minor groove width. Since many of the sequences studied are sites of protein recognition, the observed sequence-structure dependence in DNA probably plays an important role in the process of recognition by proteins and minor groove ligands such as drugs.     

Correlates of hopelessness in psychiatrically hospitalized children

The importance of hopelessness within the study of childhood psychiatric disorders is becoming increasingly apparent. The present study divides a child inpatient sample (age 7 to 12 years) into two groups based on scores from the Kazdin Hopelessness Scale for Children. Comparisons made between the two groups on various measures showed that children with high hopelessness had lower cognitive ability, "difficult child" temperament characteristics, more anxiety, lower self-esteem, and a higher degree of psychopathology than the low-hopelessness group. The role of hopelessness in academic success and future psychopathology are discussed.     

The impact of different coding systems on DRG assignment and data

The Diagnosis Related Group (DRG) classification system is widely used to describe the casemix of acute care hospitals, making it possible to compare the casemix of hospitals from different countries. However, in order to fully understand these comparisons, it is necessary to clarify the impact which the different coding systems used in various countries may have had on the results. The DRG system is based on codes from the International Classification of Diseases 9th Revision Clinical Modification (ICD9CM). Countries which use other coding systems convert, i.e. map, their codes into the nearest ICD9CM equivalent before allocating the DRGs. The impact of mapping on both medical and surgical DRGs is discussed and new titles are given for the affected DRGs. As far as possible, problems caused by mapping are distinguished from those caused by differences in coding practices. Based on the analysis of the classification systems, the mapping tables and the resulting DRG data, it is concluded that using mapped data does not have a great impact on the DRGs. Only 37 DRGs (7.8%), 15 medical and 22 surgical classes, are affected by mapping problems. However, while the scale of these problems is not large, given the large number of different surgical classification systems currently in use in Europe, the introduction of a standard surgical classification system for Europe is recommended.     

Changes in alpha-adrenoceptors during long-term treatment of rabbits with prazosin

Acute intravenous prazosin (0.05 mg/kg) caused marked falls in mean arterial pressure and postsynaptic alpha 1-adrenoceptor blockade in rabbits. During chronic oral dosing (3--21 days), tolerance developed and blood pressure returned to base-line pretreatment levels. This did not appear to be related to changes in plasma renin activity, body weight, prazosin kinetics, or alpha 2-adrenoceptor responsiveness. However, pressor responses to the alpha 1-adrenoceptor agonist phenylephrine and the mixed alpha 1/alpha 2-agonist noradrenaline increased during chronic prazosin therapy. Despite the development of apparent "tolerance," the response to bolus injections of prazosin was unchanged. No changes in the maximum number of prazosin binding sites or their dissociation constant were observed in the heart, spleen, forebrain, or hindbrain after 21 days treatment. It appears that although compensatory mechanisms develop during chronic prazosin treatment, they are not mediated by alterations in alpha 1-receptor binding but are related to changes in alpha 1-adrenoceptor responsiveness beyond the drug-receptor binding site.     

Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation

To evaluate the risk of definitive intracranial microsurgical aneurysm obliteration as a function of the timing of the operative intervention, we retrospectively reviewed 106 consecutive patients in good clinical condition who underwent such surgery. The patients who were operated upon within the first 8 days of their most recent subarachnoid hemorrhage formed the "early" group; the patients operated upon between the 9th and 31st day were considered to have undergone "late" surgery. On the basis of their clinical outcome the patients were allocated to one of four outcome categories ("good," "fair," "death") both at the time of their hospital discharge and at their most recent clinical re-evaluation, a minimum of 6 months after discharge from the hospital. There was no significant difference in the operative mortality in each group (early surgery, 5%; late surgery, 4%); additionally, no significant difference was noted in the incidence of either intraoperative complications or postoperative morbidity. A suggestive but statistically insignificant increase in the incidence of postoperative cerebral ischemic events was seen in the "early" surgery group (8% vs. 4% for the "late" surgery group). The potential significance of these findings for the timing of intracranial aneurysm surgery is discussed.