A cost-benefit analysis of mechanical ventilation. An examination of DRG 475

OBJECTIVE: An economic evaluation of the resources used for mechanically ventilated patients using various measures for the benefits of extending life. METHODS: Regression analysis is applied to New York State discharge data for patients under DRG 475 during 1992-96 to predict age-specific survival rates and payments per life saved. Sensitivity analysis is used to compare benefits of extending life associated with different economic values of life with the payments per life saved at each age. RESULTS: Payments per life saved decreased over time, primarily due to reduced reimbursements. Payments exceeded the age-adjusted and the quality-of-life and age-adjusted benefits for all economic values of life at ages 90 and older. CONCLUSIONS: Since the benefits of extending life associated with DRG 475 exceed the payments per life saved at most ages, economic evaluations may be best applied with psychosocial evaluations to allocate resources more ethically.     

Role of the lateral septal noradrenergic system in the elaboration of male sexual behavior in rats

The study was aimed at investigating the possible involvement of noradrenergic mechanisms in the lateral septum (LS) for elaboration of male sexual behavior in rats. In this study, norepinephrine (NE), yohimbine (YOH), isoproterenol (ISOP), propranolol (PROP), saline (SAL) and dimethyl sulfoxide (DMSO) were injected bilaterally in the LS in six different groups of sexually active male rats, and various components of sex behavior were recorded. The application of NE (3 microg) and alpha(2)-antagonist YOH (1 microg) produced a stimulation of most of the components of male sexual behavior, and there was increase in sexual arousal as well as performance. The microinfusion of nonspecific beta-agonist ISOP (2 microg) also produced a stimulation of copulatory behavior whereas beta-antagonist PROP (2 microg) produced an inhibition. The stimulation of male sexual behavior by YOH application at the LS could be due to an increased release of NE by its blocking effect on presynaptic alpha(2)-receptors. These results suggest that the noradrenergic system in the LS has stimulatory effect upon male sexual behavior, probably acting through beta-receptors.     

Use of unconventional therapies by children with cancer at an urban medical center

PURPOSE: The aim of this study was to determine the prevalence, modalities, and determinants of use of unconventional therapies among children with cancer receiving conventional treatment at an urban academic medical center in the United States. PATIENTS AND METHODS: We interviewed the parents of patients and/or patients who were receiving or had received conventional therapy for treatment of childhood cancer. Of 78 patients/ parents asked, 75 consented to the interview, which included demographic factors, life events, and use of unconventional therapies. All participants also consented to the abstraction of chart data for this study. RESULTS: Overall, 84% of respondents reported the use of one or more unconventional therapies. The most commonly used modalities were changes in diet, nutritional and herbal agents, and mind/body treatments. Most users had tried more than one unconventional modality. No difference in use was seen by cancer diagnosis, race/ethnicity, socio-economic status, or educational attainment of the respondent. Of the therapies used, 50% were not reported to the physicians. Of patients reporting use of an unconventional approach, 85% were concurrently enrolled on clinical trials for primary treatment of their cancer. CONCLUSIONS: The use of unconventional therapies is highly prevalent among children with cancer and is not associated with demographic or clinical factors or participation in clinical trials. The possibility that an unconventional treatment may interact with a protocol treatment underscores the need for more information about the use of such therapies among all patients.     

Long-term outcome of adult-onset minimal-change nephropathy

BACKGROUND.: Adult-onset minimal-change nephropathy has been associated witha slower response to corticosteroids and a less benign prognosiswhen compared to children. However, there are few long-termoutcome data reported. METHODS.: We have reviewed retrospectively 51 idiopathic adult-onset minimal-changenephropathy patients investigated and treated at a single centre. RESULTS.: Male to female ratio was 1:1.4, mean age at diagnosis was 37years, and average length of follow-up was 14.1 years. Significantcomorbidity was identified in 33%. A raised serum creatininewas found in 55% but returned to normal almost invariably uponremission. At presentation, hypertension was found in 47% ofpatients, microscopic haematuria in 33%, hypercholesterolaemiaand hypertriglyceridaemia in 96%, and hyperuricaemia in 42%.Remission (complete or partial) was achieved by 46, 70 and 92%within 4, 8 and 21 weeks respectively, in patients treated withsteroids; steroid resistance was encountered in 8%. The timeto remission was positively correlated with age (P=0.002) andinitial albumin level (P=0.005), and negatively correlated tothe number of subsequent relapses (P=0.029); 33% of patientshad a spontaneous remission at some time during the diseasecourse. Patients with multiple relapses were treated with cyclophosphamideand 63% of them had remained in remission after 5 years. Hypertensionwas present in 25% of patients after an average interval of11 years. At the time of the final follow-up, only three patientshad a raised creatinine and all but three patients were in completeremission. CONCLUSIONS.: Adult-onset minimal-change nephropathy shares the same goodlong-term outcome as the childhood counterpart, with sustainedremission and preserved renal function.     

A Constant ComDarative Method for Teaching Research Critiquing to Baicalau reate Nursing Students

The essence of the constant comparative method is the use of four research articles, each on the same topic, which are read repeatedly by students throughout the research course. By the completion of the course students have read all portions of all four reports and have evaluated their adequacy both individually and as compared to other studies.
The constant comparative method is used in introductory nursing research courses for baccalaureate students. The goal of developing competent consumers is introduced early in the course, and its value to nursing practice is stressed.