Involving clinicians in fee collections: Implications for improving clinical practice and increasing fee income in a community mental health center

This paper examines the relationship between a client's payment or non-payment of fees and treatment outcome, diagnosis, and training of the therapist. Clients who pay regularly are more satisfied and have higher goal attainment regardless of diagnosis. A statistical study and clinical case examples are presented which demonstrate that the failure to pay is clinically significant information and that involving clinicians in the fee collection process can improve clinical treatment and increase the agency's fee income.An earlier version of this paper was presented at the Annual Conference of the National Council of Community Mental Health Centers in San Francisco, California, on February 22, 1980.     

Silicone rubber catheter venography using standard angiographic techniques

Single- and double-lumen silicone rubber central venous catheters were subjected toin vitro destructive testing. Using this data we devised a clinical technique for the detection of central venous thrombosis incorporating mechanical injection of the catheters, serial filming, and magnification radiography. In 20 patients studied, thrombosis was detected in 12 and extravasation in 3. Two partially occluded catheters burst during forceful injection. Our technique demonstrated the presence and extent of thrombosis at the cathetel tip more clearly than did other venographic methods and has been especially useful in assessing the results of thrombolytic therapy.     

中国香港与西方儿童分泌性中耳炎发病率的比较

目的 调查中国香港儿童分泌性中耳炎发病率，并且进一步与西方的研究结果做比较。方法 1995～1998年，在中国香港特别行政区随机抽取小学、幼稚园(4～5岁)及幼儿园(2～3岁)，对6872名2～7岁儿童进行检查，在校内接受由耳鼻咽喉科专家施行的耳镜检查及由听力学家执行的鼓室导抗测试。为了与西方研究结果作出标准化的比较，根据他们所采用的诊断标准重新计算。结果 在划分为2～3岁、4～5岁及6～7岁的研究对象中，若以耳镜临床诊断作标准，本研究分泌性中耳炎发病率为5．2％～21．6％；若以鼓室导抗图作诊断标准，发病率为7．3％～30．7％。同一组数据，发病率计算结果是会因为采用不同的鼓室导抗图诊断定义而有偏差，但无论是用哪种方法，结果 都与西方同龄研究的发病率差异无显著性，而且发病率随年龄增加而下降。结论 香港2～3岁、4～5岁，及6～7岁中国儿童的分泌性中耳炎发病率与西方文献报告没有显著性差异。     

Family history of inflammatory bowel disease in patients with idiopathic ocular inflammation

PURPOSE: To determine the prevalence of a family history (FMH) of inflammatory bowel disease (IBD) in patients with idiopathic ocular inflammation (OI). DESIGN: Retrospective observational study. METHODS: Medical records of idiopathic OI patients seen between January 1995 and June 2005 in the University of Illinois Uveitis Clinic were screened for a FMH of IBD. FMH included first, second, and third degree relatives. RESULTS: 727 (32.8%) patients had idiopathic OI. 26 of 727 (3.6%) and 10 of 727 (1.4%) reported a FMH of ulcerative colitis (UC) and Crohn's disease, respectively. 16 (2.2%) patients with a FMH of indeterminate colitis were excluded from subsequent comparisons. The prevalence of a FMH of IBD among patients with idiopathic OI was 3- to 15-fold higher than the prevalence of UC and Crohn's in the general population (0.055% to 0.27%). Keratoiritis was more common and granulomatous disease less frequent in patients with a FMH of IBD (P = .014 and .019). Patients tested 26.3% with a FMH of IBD, and 66.7% of patients tested with IBD themselves, were HLA-B27 positive (odds ratio [OR] 5.6, 95% confidence interval [CI] 0.77 to 45.8), compared with 40.1% of patients with neither (OR 1.87, 95% CI 0.61 to 6.83). CONCLUSIONS: A FMH of IBD may be an independent risk factor for the development of OI. In contrast to the subgroup of patients with a personal history of IBD, HLA-B27 may not be an appropriate marker in the subgroup of patients with merely a FMH of IBD, emphasizing the importance of investigating other immunologic factors that may predispose patients with IBD and their relatives to OI.     

High-throughput loss-of-heterozygosity study of chromosome 3p in lung cancer using single-nucleotide polymorphism markers

Loss of DNA copy number at the short arm of chromosome 3 is one of the most common genetic changes in human lung cancer, suggesting the existence of one or more tumor suppressor genes (TSG) at 3p. To identify most frequently deleted regions and candidate TSGs within these regions, a recently developed single-nucleotide polymorphism (SNP)-mass spectrometry-genotyping (SMSG) technology was applied to investigate the loss of heterozygosity (LOH) in 30 primary non-small-cell lung cancers. A total of 386 SNP markers that spanned a region of 70 Mb at 3p, from 3pter to 3p14.1, were selected for LOH analysis. The average intermarker distance in the present study is approximately 180 kb. Several frequently deleted regions, including 3p26.3, 3p25.3, 3p24.1, 3p23, and 3p21.1, were found. Several candidate TSGs within these frequently detected LOH regions have been found, including APG7L at 3p25.3, CLASP2 at 3p23, and CACNA2D3 at 3p21.1. This study also showed that SMSG technology is a very useful approach to rapidly define the minimal deleted region and to identify target TSGs in a given cancer.     

Continuous infraclavicular brachial plexus block in a child

Continuous regional anesthesia for both intra- and postoperative use in adults is becoming more common. As with many new anesthesia techniques, however, there is often a lag time before the same techniques are utilized in children. Our patient was a 10-year-old child requiring reoperation on her fifth digit with planned 48-h admission for range of motion exercises. We wanted to have a continuous regional blockade to control the patient's pain during the postoperative manipulations of the digit. A search of the literature from the last 10 years did not show any reports of the placements of a continuous brachial plexus block in children. In this case report, we present the successful placement and use of a continuous infraclavicular catheter in a child undergoing upper extremity surgery.