Costs of epilepsy in an intermediate care facility for persons with mental retardation

Epilepsy is a significant comorbid condition in institutionalized persons with developmental disabilities and may contribute significant additional costs. This study was conducted to provide an estimate of the costs of epilepsy from the institutional perspective. Costs were measured retrospectively for 50 persons with epilepsy and 50 persons without epilepsy matched by severity of developmental disability. A time and motion study was employed to assign opportunity costs to documented nursing and physician activities. Two separate methods of attribution were used and incremental costs attributable to epilepsy were found to be approximately $825 and $918 per person over a 6-month period. The following categories accounted for costs: personnel (47.0%), drug (39.6%), hospitalization (9.4%), and laboratories/procedures (4.0%). Results are useful for describing the economic burden of epilepsy.     

The irrelevance of fusimotor activity to the Achilles tendon jerk of relaxed humans

In two normal subjects the sciatic nerve was blocked completely using concentrated lidocaine. The muscle afferent and reflex electromyographic responses to reproducible percussion of the Achilles tendon were recorded while the blocks developed. The intensity of percussion was sufficient to produce an Achilles tendon jerk in one subject when at rest and in the other during reinforcement. The block did not alter the muscle afferent response to tendon percussion in either subject. It is concluded that background fusimotor activity is not a prerequisite for the tendon jerk and that, during complete relaxation, there may be no significant fusimotor drive directed to the triceps surae. The varying ease with which tendon jerks can be elicited in different normal subjects or in different muscles of the same subject appears to be related not to fusimotor activity but to differences in the "central excitability state."     

Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury.

A bilayer artificial skin composed of a temporary Silastic epidermis and a porous collagen-chondroitn 6-sulfate fibrillar dermis, which is not removed, has been used to physiologically close up to 60% of the body surface following prompt excision of burn wounds in ten patients whose total burn size covered 50--95% body surface area (BSA). Following grafting, the dermal portion is populated with fibroblasts and vessels from the wound bed. The anatomic structure of the artificial dermis resembles normal dermis and serves as a template for the synthesis of new connective tissue and the formation of a "neodermis," while it is slowly biodegraded. This artificial skin has physiologically closed excised burn wounds for periods of time up to 46 days before the Silastic epidermis was removed. At the time of election when donor sites are ready for reharvesting, the Silastic epidermis is removed from the vascularized artificial dermis and replaced with 0.004 autoepidermal graft in sheet or meshed form. Clinical and histologic experience in a relatively short follow-up period (2--16 months) indicates that "neodermis" retains some of the anatomic characteristics and behavior of normal dermis, thus promising improvement in the functional and cosmetic results, as well as providing physiologic function as a skin substitute. The artificial skin is easily sterilized and stored at room temperature, capable of large scale production, and immediately available for grafting, indicating its potential for easy and relatively economic use in the burn patient.     

Accuracy in coronary graft flow measurement

A blood flow calibration apparatus is described for use with electromagnetic flow probes. It is an automatic gravity-flow system, which provides a constant level and therefore constant flow at any preset rate. On several occasions, the use of this device has helped to determine whether flow probes require simple adjustment, factory repair, or replacement. Using this system, a systematic error in the manufacturer's "precalibration" averaging +22% (range, 9 to 50%) has been discovered, and appropriate corrections have been made. The accuracy of these corrections has been confirmed by a rapid, in vivo method of calibration, which also is described and which can be carried out during the conduct of aortocoronary bypass operation. It is recommended that all groups measuring coronary graft flow become familiar with their electromagnetic flowmeter and probes by means such as those described, in the interest of accurate flow measurement after bypass operation.     

Eucharistic health care facility transcends professionalism

The members of a Catholic health care facility individually and corporately celebrate Christ's presence in the fullness of eucharistic faith. To be in a Catholic hospital is to have a Gospel experience among Gospel people.     

Prevention and management of infection in trauma

Examination of the causes of late mortality in multiple trauma patients reveals that as much as 78% of all deaths may be attributed to septic complications, suggesting the value of understanding the prevention and treatment of traumatic sepsis. In penetrating trauma, the protective features of the skin are eliminated, and systemic mechanisms of host defense are compromised. These changes in the host defense mechanism and the risk of infection influence the choice and technical features of wound closure and the use of antibiotics. Early diagnosis is imperative, but difficult.     

Medicare appeals process offers hope for some hospitals

For hospital officials who feel wronged by Medicare's payment system, a recent opportunity to appeal geographic status has stirred new hope for survival. Last September, the Health Care Financing Administration published interim final regulations detailing criteria hospitals have to meet to merit reclassification; hospitals had until Nov. 6, 1990, to file their appears. Now, officials are slogging through nearly 1,000 completed applications. "There has been pent-up demand for some review" of geographic classification, says one official.