Improving the transition to home healthcare by rethinking the purpose and structure of the CMS 485: first steps

Transition points are the weak links in communication between providers. As an example, the discharge home often is a hurried "handoff" from inpatient physician to home care agency, whose visiting nurse admits the patient for a period of observation, medication management, rehabilitation, and teaching. The primary means of communication between physician and home health agency is the CMS 485, a form that contains the orders and that physicians frequently sign well after patients begin receiving services. This paper describes the first phase of a project that restructured and automated the CMS 485 using an existing electronic health record. The principles guiding the restructuring are described along with early reaction to and revision of the form to address operational issues. The paper also discusses evaluation plans and a web-based system of communication that will be developed in the second phase of the project.     

Decrease in rabbit bladder mucosal glycoprotein after oophorectomy

Hormonal manipulation has been shown to result in less efficient bladder clearance of bacteria. We describe the use of a double antibody technique to semiquantitatively demonstrate the diminution of bladder glycoproteins from the transitional epithelium in oophorectomized rabbits. Rabbit bladder glycoprotein was isolated and used to immunize Swiss-Webster mice. Bladders of normal and oophorectomized rabbits were sequentially stained with mouse antirabbit sera and fluoresceinated goat antimouse antibody. A significant loss of bladder epithelial glycoprotein was evident in oophorectomized rabbits as compared to controls. This study, utilizing a semiquantitative immunologic staining technique, suggests an intact glycoprotein layer is important in the bladder defense mechanism.     

Targeting services to chronically disabled elderly: the preliminary experiences of the National Long Term Care Channeling Demonstration.

In response to concerns about the adequate provision of long term care, the National Long Term Care Channeling Demonstration has been funded by the Department of Health and Human Services. The project is designed to provide coordinated community services as an alternative to institutionalization to those elderly individuals at risk of placement. This preliminary work examines the demonstration's experience in its attempt to target services to these individuals. Although final research results are not yet available, the method, problems, and results of the initial case finding and screening approaches provide additional knowledge concerning the targeting experience.     

Clinical use of multiple nonsteroidal antiinflammatory drug preparations within individual rheumatology private practices

The clinical use of nonsteroidal antiinflammatory drugs (NSAID) was studied in 15 rheumatology private practices in the USA (in California, the District of Columbia, Florida, Idaho, Minnesota, Pennsylvania and Tennessee). Among 1,423 patients with rheumatoid arthritis (RA) under care in these 15 practices, the most extensively used NSAID preparation within any of the 15 individual practices was taken by a median of 19.5% of patients (mean 20.7%, range 8-36%), and the 3 most extensively used preparations by a median of 45.9% (mean 47.7%, range 34.7-63.5%). The median number of NSAID preparations used (singly) in each of the individual practices was 15 (range 8-20), including a median of 7 (range 4-10) used by more than 5% of the patients with each practice. The NSAID usage of these patients with RA seen in private practice settings was met by 8 preparations for 70%, by 10 preparations for 80%, and by 14 preparations for 90% of the 1,423 patients.     

Effect of prior treatment with thioglycolate on the incubation period of intraperitoneally injected scrapie

Injection of mice with thioglycolate 5 days prior to intraperitoneal injection of scrapie brain homogenate led to a statistically significant increase in scrapie incubation periods. This was seen with two different scrapie strains (ME7 and 139A), in different mouse strains (C57BL/6J and Compton White), and at several dilutions of the scrapie inoculum.     

Elevated protein carbonylation in the brain white matter and gray matter of patients with multiple sclerosis

Oxidative stress has been implicated in the pathophysiology of multiple sclerosis (MS). Increased levels of reactive oxygen species (ROS) derived from infiltrating macrophages and microglial cells have been shown to reduce the levels of endogenous antioxidants and to cause the oxidation of various substrates within the MS plaque. To determine whether oxidative damage takes place beyond visible MS plaques, the occurrence of total carbonyls (TCOs) and protein carbonyls (PCOs) in the normal-appearing white matter (NAWM) and gray matter (NAGM) of eight MS brains was assessed and compared with those of four control brains. The data show that most (7/8) of the MS-WM samples contain increased amounts of PCOs as determined by reaction with 2,4-dinitrophenylhydrazine and Western blot analysis. These samples also have high levels of glial fibrilary acidic protein (GFAP), suggesting that oxidative damage is related to the presence of small lesions. In contrast, we detected no evidence of protein thiolation (glutathionylation and cysteinylation) in the diseased tissue. To our surprise, MS-NAGM specimens with high GFAP content also showed three times the concentration of TCOs and PCOs as the controls. The increase in PCOs is likely to be a consequence of reduced levels of antioxidants, in that the concentration of nonprotein thiols in both MS-WM and -GM decreased by 30%. Overall, our data support the current view that both NAWM and -GM from MS brains contain considerable biochemical alterations. The involvement of GM in MS was also supported by the decrease in the levels of neurofilament light protein in all the specimens analyzed. To the best of our knowledge, this is the first study demonstrating the presence of increased protein carbonylation in post-mortem WM and GM tissue of MS patients.