Morbidity and cost of atopic eczema in Australia

The severity, morbidity and financial costs of atopic eczema (AE) were assessed during a 1-year prospective study of a cohort of 85 people aged 14-63 years (mean 36 years) with the disease. A dermatologist examined each participant using the Six Area Six Sign Atopic Dermatitis severity scoring system to classify severity. Participants completed a Dermatology Life Quality Index (DLQI), a Nottingham Eczema Severity Score (NESS) and an ongoing diary of health-care consultations and treatment costs. Follow up by mail to each participant was conducted every 2 months and participants completed a NESS, a DLQI and a diary of costs incurred. The DLQI data revealed that 36% spent over 10 min per day applying treatments, 28% indicated that AE influenced the clothes they wore, 21% felt embarrassed by their skin and 15% reported problems with treatments. There appeared to be a relationship between increased morbidity and increased severity. The average annual out-of-pocket cost for products used for treatment was A$425, ranging from A$13.50 to over A$2000 per individual. The average out-of-pocket cost for medical consultations was A$120, ranging from zero to over A$800 per individual. Although there were concerns about the reproducibility of the severity and morbidity measures, the data showed that AE can have substantial effects both financially and from a personal perspective for those affected.     

Severity and risk adjusting relating to obstetric outcomes, DRG assignment, and reimbursement

Obstetric risk has important implications for reporting and benchmarking quality in today's managed health care environment. Administrative data, including diagnosis related group (DRG) information collected by hospitals, is used by payers and governmental groups for reimbursement, monitoring quality, and setting financial rates. Obstetric conditions that affect the patient experience are coded but do not often contribute to the overall DRG assignment. This strategy, therefore, may provide comparisons that are misleading to consumers and payers. Additionally, financial rates often do not provide adequate reimbursement for the cost incurred in caring for high-risk patients. Finally, risk prediction strategies have historically been used to both identify vulnerable patients for early management and make more equitable comparisons of groups of patients.     

Non-aromatic naphthalane preparation; preliminary clinical study in the treatment of psoriasis vulgaris

This study aimed to prove the similarity of the composition of non-aromatic Croatian naphthalane (NAN) with brown naphthalane (BN), which is used in the treatment of psoriasis vulgaris. The comparison of the compositions was performed by obtaining GC fingerprints, which were supported by GC-MS data. In spite of remarkable differences in general profiles of the GC chromatograms, lower and medium molecular weight components of NAN were found to be qualitatively the same as the saturated constituents of BN. Quantitatively, lower molecular weight components as well as all n-alkanes were comparatively lower in NAN. NAN, additionally, contained higher molecular weight components, among which there were saturated oligocyclic hydrocarbons (up to pentakishomohopanes), described as responsible for the curing effect of naphthalane. The composition characteristics of NAN including its non-aromatic character made it suitable for a clinical study. In the treatment, the efficacy was determined by means of comparison of Psoriasis Area Severity Indices, PASI, at the beginning and at the end of the therapy. Adult volunteer-patients, nine males and six females, applied NAN over the whole body, except the scalp, at the room temperature for 20 min and this was followed by the selective UVB radiation. After the 3-week therapy, all essential clinical manifestations as erythema, desquamation and infiltration were significantly reduced in 14 patients; in nine cases the improvement was 50–93%, while the state of five patients improved between 25 and 50%. In one case, there was no obvious change. No exacerbation occurred during the therapy period. No adverse effect on hematological or biochemical parameters was noticed.     

膀胱穿刺造瘘在PKRP中的应用

目的 比较有无膀胱穿刺造瘘的经尿道等离子前列腺电切术（PKRP）治疗重度前列腺增生症（BPH）的疗效与安全性。方法 以未行膀胱穿刺造瘘的PKRP治疗BPH63例（A组），行膀胱穿刺造瘘的PKRP治疗重度BPH57例（B组），通过比较术中出血量，前列腺切除重量，手术时间，术后膀胱冲洗时间，住院时间，评价两种方法的安全性，通过比较术后3mo最大尿流率（Qmax）、残余尿（Ru）、国际前列腺症状评分（IPSS），生活质量评分（QOL），评价两种方法的疗效，以及通过比较术后出血，尿道狭窄，拔管后排尿困难，膀胱颈挛缩等比较术后并发症。结果 B组术中出血量，冲洗液吸收量，手术时间，术后并发症低于A组，两组比较安全性差异有显著意义，术后3mo两组Qmax、RU、IPSS、QOL较术前均明显改善，且差异有显著意义，但两组间比较差异无显著意义。结论行膀胱穿刺造瘘在PKRP术中出血少，冲洗液吸收量少。术后并发症减少，适用于重度BPH的手术治疗。     

Satisfaction with current health status in patients with a history of acute coronary syndrome

ABSTRACT

Objective: To describe satisfaction with current health status in patients with a recent history of an acute coronary syndrome (ACS) event and to determine the association between satisfaction and patient-specific variables.

Research design and methods: Patients from an ACS registry who were discharged from a university affiliated hospital over a 3-year period were mailed the study questionnaire.

Main outcomes measures: Data included demographics, cardiac-specific measures, and general health status (SF-8 PCS, MCS and the EQ-5D VAS) and health status preference weight (EQ-5D Health Index). Satisfaction with current health status was assessed by a single question derived for this study with a 5-point Likert scale from ‘not satisfied at all’ to ‘highly satisfied.’ ANOVA determined the association between levels of satisfaction and health status scores. A multivariate linear regression model determined the association of patient, disease, and treatment variables with satisfaction. Independent variables were determined to be significant if the p-value in the model was <0.05.

Results: Respondents (490, 40.3% response rate) averaged 65.2?± 11.3 years of age; 71% male; 92% Caucasian; 64% with MI history; and 17% had their most recent cardiac event within 6 months. 63% of respondents were either mostly satisfied or highly satisfied with there current health status. Based on level of satisfaction, the mean PCS ranged from 36.9?± 8.9 to 63.0?± 6.2; mean MCS from 38.3?± 13.1 to 55.7?± 5.7; mean EQ-5D VAS from 37.0?± 21.7 to 90.8?± 20.7, and mean EQ-5D Health Index from 0.38?± 0.3 to 0.93?± 0.14, all ANOVA models p?<?0.001. Statistically significant independent variables in the multivariate linear regression model included the number of symptoms, DASI cardiac function score, perceived severity of disease, and age. Satisfaction with current health state was associated with older age, fewer symptoms, better DASI cardiac function scores, and lower perceived severity of illness.

Conclusion: Health-related quality of life, or health status, and satisfaction with health status have a direct, positive association. Greater burden of illness and younger age were significantly associated with dissatisfaction with health status. Extrapolation of results is limited to determining association but not causation due to the cross sectional study design.     

Perceived discrimination from management and musculoskeletal symptoms among New York City restaurant workers

Abstract

Background: Compared with other restaurant hazards, organizational stressors are an understudied topic. Among organizational stressors, discrimination from management (DFM) appears widespread.

Objective: Objectives were to assess the prevalence and links between musculoskeletal symptoms (MSSs) in three anatomical regions and five sources of DFM.

Methods: A cross-sectional, interviewer-administered survey among restaurant workers was used. Participants were randomly selected by type and geographic distribution.

Results: Eighty-four percent of workers reported having MSSs in at least one anatomical region. The prevalence of severe MSSs was 24·9%. The strongest association between DFM and frequency of MSSs was “upper extremities.” The strongest association between DFM and severity of MSSs was “any anatomical location.” Thirty-four percent of restaurant workers reported DFM; age was the most prevalent source of DFM.

Conclusions: In general, associations between DFM and MSSs were stronger by frequency than severity. The largest number of significant associations by sources of DFM was language and age.     

Laboratory data predicts survival post hospitalization

From a database of 93,077 in-patient admissions, patients assigned to catastrophic, very severe, moderately severe, and average 30-day mortality risk categories (as defined in Medicare Hospital Mortality Information, 1989 release, from the Health Care Financing Administration (HCFA)) were selected for study. These admissions account for 30% of all admissions, but 70% of. all deaths up to 1 year post admission. To determine whether laboratory information adds to the predictive power of the information used by HCFA, we compare the performance of 1 year survival predictors (Cox model) that use only diagnostic, demographic, and comorbidity information, with the performance of predictors that also include laboratory information. Using a separate set of patients not used for model definition, we find that laboratory data contain significant prognostic information independent of that already available in non-laboratory data. In HCFA's catastrophic disorders for example, non-laboratory information reduces the average risk of predicting a wrong outcome by 17% relative to considering only catastrophic group membership, and adding,laboratory data reduces this risk by a further 21%. These improvements result primarily from considering the outcomes of a small set of routine laboratory tests (maximum BUN, AST, and WBC, and minimum CO₂, hematocrit, and sodium).     

急性胰腺炎早期诊断和严重度预测指标

急性胰腺炎是常见的急腹症之一,近年发病率逐年上升。临床上,患者往往发病迅猛、病死率高。因此,早期诊断并及时预测胰腺炎的严重度,对提高临床治愈率、缩短疗程、提高疗效均具有重要意义。近年来研究发现,一些炎性因子和胰腺分泌的一些蛋白在急性胰腺炎时有比较明显的改变,而且与胰腺炎的严重度有一定的相关性。对急性胰腺炎的早期诊断有较高的临床价值,有望成为新的实验室标记物。     

The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system

Objective Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavo's scoring system was assessed, and inter‐rater correlation of NAPSI scores were evaluated. Materials and Methods Forty‐five patients with nail psoriasis were included. Target nails were selected and graded by the first dermatologist with both scoring systems. The nails were reevaluated by the second dermatologist with NAPSI. Results The two systems were highly correlated (P < 0.001). For NAPSI inter‐rater correlation was also significant (P < 0.001). Conclusion Our results showed that the qualitative and quantitative evaluations of the same rater were similar. Although the qualitative scoring system of Cannavo's is less time consuming than NAPSI, to suggest this system inter‐rater correlations should be evaluated.     

眼外伤伤情与超声诊断的关系

目的　分析眼外伤球内声像特征及眼底血流变化 ,寻求其与伤情的关系。方法　回顾性分析 3 88例不同眼外伤组阳性声像特点及视网膜中央动脉、眼动脉血流参数。结果　眼后段 (混合 )伤组视网膜中央动脉血流速度低于眼前段伤组 (P <0 .0 5 ) ;眼球穿通伤见多种损伤声像 ,其视网膜脱离发生率高于眼钝挫伤组 (P <0 .0 5 )。结论　视网膜中央动脉的血供与伤情有关 ;眼球穿通伤超声阳性率最高 ;超声对眼后段伤诊断准确 ,对前房深浅、晶体损伤可提供部分声像佐证。