PGD8 Comparison of Prevalence Rates of Low Back Disorders Obtained from Two Large National Claims Databases

Large national claims databases are sources of vital information concerning health care resource utilization. However, the comparability of data obtained from such databases has not yet been ascertained.
OBJECTIVE: To compare prevalence rates of low back disorders obtained from two large national inpatient claims databases and to study variations in length of stay and corresponding costs.
METHODS: Data were obtained from two independent databases with inpatient claims information including ICD-9 codes for specific diagnoses, demographics, length of stay (LOS), and payments or charges made. One of the databases is a 20% national inpatient sample of all community hospitals in the U.S. (HCUP). The other national database consists of data gathered for privately insured population (MarketScan). Claims for specific diagnoses of low back disorders (ICD-9 codes: 720.0–724.9) for 1994 were obtained. Using age, gender, and diagnosis-adjusted rates (direct method), the overall low back disorder rates were compared. Also age, gender, and diagnosis-specific low back disorder rates were compared between two databases.
RESULTS: The overall adjusted prevalence rates of low back disorders were 1.49 and 1.88 per 100 admissions for HCUP and MarketScan, respectively. Significant difference was observed in the age, gender-adjusted rates for diagnosis of displacement of lumbar intervertebral disc without myelopathy, with MarketScan showing a higher rate as compared to HCUP (1.06 vs. 0.78/100 admissions). The adjusted average LOS and age, gender, and diagnosis-specific LOS were higher for HCUP than MarketScan. The specific and adjusted payments (based on MarketScan) were, however, higher than the charges reported in HCUP.
CONCLUSIONS: The prevalence rate of low back disorders is higher in the MarketScan database than in HCUP. The differences in the length of stay and associated costs might be attributable to other variables such as geographical variations.     

A new improved clinical staging system for multiple myeloma based on analysis of 123 treated patients

The effect of the presenting clinical features on survival time was evaluated in 173 patients of a population of 201 individuals with multiple myeloma observed at Malmo General Hospital during the 11-yr period 1960 to January 1, 1971. Complete follow-up was continued until December 1978. One-hundred and five of the patients came from the city of Malmo and constitute a complete nonselected myeloma population. Bivariate correlation and multivariate regression analyses showed that the survival (i.e., the prognosis) could be accurately predicted in IgG and pure Bence Jones myeloma patients from (A) serum creatinine level, (B) serum calcium level, and (C) bone marrow plasma cell percentage; and in IgA myeloma patients from (A) hemoglobin level, (B) serum calcium level, and (C) serum M-component level. The results were synthesized to produce a simple and reliable clinical staging system with three stages (i.e., risks of death). To facilitate the clinical application, multivariate regression equations were developed to optimally predict the prognosis, and graphs were constructed in order to make the staging of the myeloma patients easier and quicker. The comparison of the duration of survival between the three groups of staged patients confirmed the high reliability of the present staging system.     

huBC1-IL12, an immunocytokine which targets EDB-containing oncofetal fibronectin in tumors and tumor vasculature, shows potent anti-tumor activity in human tumor models

IL-12 is a cytokine which showed anti-tumor effects in clinical trials, but also produced serious toxicity. We describe a fusion protein, huBCI-IL12, designed to achieve an improved therapeutic index by specifically targeting IL-12 to tumor and tumor vasculature. huBC-1 is a humanized antibody that targets a cryptic sequence of the human ED-B-containing fibronectin isoform, B-FN, present in the subendothelial extracellular matrix of most aggressive tumors. B-FN is oncofetal and angiogenesis-associated, and is undetectable in most normal adult tissues. The original murine BC-1 antibody has been used successfully for immunoscintigraphy to image brain tumor mass in glioblastoma patients. In huBCI-IL12, each of the lgG heavy chains is genetically fused to the N-terminus of the IL-12 p35 subunit, which in turn is disulfide-bonded to the p40 subunit,     

Continuous video recording: a new clinical research tool for studying the nursing care of cancer patients

AIM: The aim of this study was to clarify issues around the patient-nurse interaction during pulsed dose rate (PDR) brachytherapy. BACKGROUND: Cancer diagnosis, response and survival rates as well as the side-effects of radiation therapy are well described in international literature. However, no scientific data apparently exist on the reactions and behaviour of cancer patients during stressful irradiation treatments nor on nursing performance in these situations. The study involved gynaecological and anal cancer patients. Treatment needles (10-20 cm) were implanted in the tumours of these patients during the PDR brachytherapy. This treatment was administered during a 15-30-minute period each hour, for a duration of 30-60 hours. Patients were partially isolated and immobilized, and typically positioned on the back or side. In preparation for the therapy, patients had to fast and drink sparingly. Observation and nursing care could only be performed during pauses in the treatment. METHOD: This paper is based on 142 hours of continuous video recording of patients undergoing PDR brachytherapy. Data were collected on five patients and 17 nurses. FINDINGS: The study shows that nurses were with patients for approximately 1/4 of the available time. The majority (75%) of any communication with patients centred around physical care. Although patients were in a stressful situation, they did not anticipate receiving any psychological support from nursing staff. Patients showed individual patterns of behaviour and coping. CONCLUSIONS: Continuous video recording, as a research tool can document accurately interaction and behaviour between cancer patients and nursing staff. Video recording discloses examples of both eminent and negligent nursing care and as such can be a useful tool for instruction and for future research. The credibility, validity and limitations of using video recording are discussed.     

FLT3 receptor expression on the surface of normal and malignant human hematopoietic cells

FLT3 ligand is a hematopoietic growth factor that plays a key role in growth of primitive hematopoietic cells. FLT3 receptor mRNA is found in early hematopoietic progenitors and in human myeloid leukemia blasts. Much less is known about the surface expression of FLT3 receptor on human hematopoietic cells. Using human 125I-FLT3 ligand, we have identified and characterized surface FLT3 receptors on normal and malignant human hematopoietic cells and cell lines. Our results showed that surface display of FLT3 receptor was greatest in fresh myeloid leukemia blast cells and myeloid leukemia cell lines. Erythroleukemic and megakaryocytic leukemia cell lines (n = 5) bound little to no 125I- FLT3 ligand. Scatchard analysis of 125I-FLT3 ligand binding data shows that three myeloid leukemia cell lines, ML-1, AML-193, and HL-60, as well as normal human marrow mononuclear cells, exhibit high affinity FLT3 receptors. Crosslinking of 125I-FLT3 ligand to FLT3 receptors on the surface of ML-1 myeloid leukemia cells indicates that the FLT3 ligand. The rates of FLT3 ligand internalization and degradation were determined by binding 125I-FLT3 ligand to ML-1 cells and acid stripping to distinguish surface bound from internalized ligand. Internalized 125I-FLT3 ligand was detected within 5 minutes after binding to ML-1 cells. In addition, we evaluated the effect of FLT3 ligand on megakaryocytic colony growth and nuclear endoreduplication, alone or in the presence of thrombopoietin. FLT3 ligand did not promote colony forming unit megakaryocyte (CFU-Meg) colony growth or megakaryocyte nuclear maturation, nor did FLT3 ligand augment the effects of thrombopoietin on these measures of megakaryopoiesis. These data indicate that the FLT3 receptor shares several characteristics with the c-kit receptor including dimerization and rapid internalization. However, the more restricted cellular distribution of the FLT3 receptor may target the effects of FLT3 ligand to primitive hematopoietic cells and to myeloid and lymphoid progenitor cells, in contrast to the pleiotropic effects of the c-kit receptor ligand, stem cell factor.