RUGs and equity of access to nursing home care

Case-adjusted prospective reimbursement systems, such as resource utilization groups (RUGs), may promote nursing home cost containment, but they may do no better than existing systems at encouraging homes to admit the more dependent and thus costlier Medicaid patients, if the homes' reluctance to admit these patients is due to a shortage of nursing home beds. Using 1983 data on Wisconsin nursing homes, this paper presents evidence that suggests that the presence of excess demand, rather than low reimbursement rates, causes nursing homes to exclude the more costly Medicaid patients. Consequently, to benefit fully from RUGs, it is necessary either to eliminate excess demand (by increasing supply or decreasing demand) or to decide which patients have priority for admission and assign reimbursement payments to these patients that significantly favor these patients. Otherwise, access to nursing home care under RUGs is left to chance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cystic variant of calcifying epithelial odontogenic tumor.

Calcifying epithelial odontogenic tumor (CEOT) is a benign, locally aggressive odontogenic neoplasm characterized by sheets and nests of epithelial cells with deeply eosinophilic or occasionally clear cytoplasm, calcifications, and eosinophilic amorphous material that stains positive for amyloid. Although many cases of CEOT are associated with impacted teeth and occasionally appear radiographically as dentigerous cysts, a true cystic variant has not been previously reported. We report a 15-year-old white male with a large cystic maxillary lesion that filled most of the left maxillary sinus. It deformed the medial wall, the inferior orbital floor, and caused narrowing of the left inferior meatus. Histologically, the cystic lining showed characteristics of CEOT. An intraluminal component that featured histologic characteristics of CEOT was identified during surgery. The lesion was enucleated and the postsurgical course of the patient was uneventful. Because follow-up has been for less than 1 year, a meaningful long-term prognosis cannot be determined at present. However, the patient has not reported any symptoms or signs of recurrence during the follow-up period.     

Monitoring health care system performance in Iowa.

Monitoring the performance of the health care delivery system is a public health function that becomes more important as organized delivery systems begin to take control over larger portions of the medical care market. The study reported here illustrates how standard medical care epidemiology can be applied to analysis of health care system performance to aid governmental efforts to monitor new developments in the medical care market. In order to evaluate the efficiency of hospital care delivered in Iowa, age- and sex-adjusted population admission rates for five common procedures were generated for all 99 counties. The five common procedures were defined as follows: hernia, tonsillectomy, cesarean section, hysterectomy, and cholecystectomy. In addition, variations in 11 ambulatory care-sensitive condition rates were analyzed. Residents of at least 15 counties were at significantly greater than average risk of receiving each of the common procedures (chi 2 test, P < 0.05). Counties that had a high rate for one procedure tended to have a high rate for at least one other procedure. Several counties had more than twice the mean rate. Even a 10% reduction, when added across all five common procedures. amounts to well over 2,000 hospitalizations avoided. It is assumed that reductions would be concentrated in high-rate counties. If a 50% reduction could be achieved in only part of the ambulatory care-sensitive procedures, more than 10,000 hospital admissions could be avoided.     

Genotype determining low catechol-O-methyltransferase activity as a risk factor for obsessive-compulsive disorder

In the present study, we address the role of the gene for catechol-O-methyltransferase (COMT), a key modulator of dopaminergic and noradrenergic neurotransmission, in the genetic predisposition to obsessive-compulsive disorder (OCD). We show that a common functional allele of this gene, which results in a 3- to 4-fold reduction in enzyme activity, is significantly associated in a recessive manner with susceptibility to OCD, particularly in males. This association is further supported by psychiatric evaluation of patients who carry microdeletions encompassing the comt gene. The mechanism underlying this sex-selective association remains to be defined and may include a sexual dimorphism in COMT activity, although close linkage with a nearby disease susceptibility locus cannot be excluded at this point.     

Health analytics: the road not traveled.

Review of the development of health administration by chronological examination of textbooks reveals that the definition of health administration has changed. In the process of conversion to a business management model, health analytics have been undervalued by health administration programs. Health analytics can be defined as "techniques for the analysis of health services that require in-depth understanding of the workings of the health system and are grounded in a rational-comprehensive public health model of health administration." Health analytics are not simply the application of business techniques to health services. Quality assessment and planning methods are examples of two important aspects of health administration that are addressed by health analytics.     

Histopathology of mixed anaerobic intraabdominal infection in mice

Summary This study characterized acute peritonitis and chronic abscess formation resulting from experimental mixed anaerobic infection withBacteroides melaninogenicus andFusobacterium necrophorum. At intervals after infection liver and spleen samples were obtained, fixed, and processed for histological examination. An acute to chronic infection progressed in mice infected with this mixture of anaerobic bacteria, whereas, no infection resulted when either organism was injected alone. Acute inflammatory cell infiltrates were noted in tissue samples at 12 h postinfection. Small, discrete areas of liver cell necrosis with neutrophilic infiltrates were observed as early as 24 h. By 48 h after infection the liver parenchyma was infiltrated with both acute and chronic inflammatory cells, with moderate to severe hepatocyte degeneration recognized at 72 h. Large intrahepatic abscesses were present in the subphrenic (upper lobe) area 2 to 6 weeks after experimental infection.     

Intensity modulated proton therapy: a clinical example

In this paper, we report on the clinical application of fully automated three-dimensional intensity modulated proton therapy, as applied to a 34-year-old patient presenting with a thoracic chordoma. Due to the anatomically challenging position of the lesion, a three-field technique was adopted in which fields incident through the lungs and heart, as well as beams directed directly at the spinal cord, could be avoided. A homogeneous target dose and sparing of the spinal cord was achieved through field patching and computer optimization of the 3D fluence of each field. Sensitivity of the resultant plan to delivery and calculational errors was determined through both the assessment of the potential effects of range and patient setup errors, and by the application of Monte Carlo dose calculation methods. Ionization chamber profile measurements and 2D dosimetry using a scintillator/CCD camera arrangement were performed to verify the calculated fields in water. Modeling of a 10% overshoot of proton range showed that the maximum dose to the spinal cord remained unchanged, but setup error analysis showed that dose homogeneity in the target volume could be sensitive to offsets in the AP direction. No significant difference between the MC and analytic dose calculations was found and the measured dosimetry for all fields was accurate to 3% for all measured points. Over the course of the treatment, a setup accuracy of +/-4 mm (2 s.d.) could be achieved, with a mean offset in the AP direction of 0.1 mm. Inhalation/exhalation CT scans indicated that organ motion in the region of the target volume was negligible. We conclude that 3D IMPT plans can be applied clinically and safely without modification to our existing delivery system. However, analysis of the calculated intensity matrices should be performed to assess the practicality, or otherwise, of the plan.     

The orientation of horizontal cell dendrites in the superior colliculus of the hamster: an analysis based on three-dimensional reconstruction of intracellularly injected neurons

Summary We have employed intracellular injection of horseradish peroxidase (HRP) and 3-dimensional, computer-assisted reconstruction to delineate the organization of the dendrites of horizontal cells in the superficial laminae (the stratum griseum superficiale-SGS, and stratum opticum-SO) of the hamster's superior colliculus. Fifteen well-filled cells were analyzed. The dendrites of these cells were generally parallel to the frontal plane. An average of 74.8±13.0% of the total dendritic arbor of the recovered horizontal cells was located within 30° of this plane. The long axis of horizontal cell dendritic trees deviated an average (mean ± s.d.) of 21.7±13.2° from the frontal plane and the average extent of the dendritic tree in this plane was 637±216 m. This differed significantly from the average dendritic extent in the rostrocaudal axis (358±146 m, p<0.001). In some cases, portions of the dendritic arbors of horizontal cells appeared to be oriented along lines of isoelevation or isoazimuth of the visual field representation in the superficial laminae. For other cells, there was no clear relationship between dendritic orientation and the visual field map.