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Berlin Brandenburg

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  • 1994  (16)
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  • 1994  (16)
  • 1
    In: Archives of Internal Medicine, August 8, 1994, Vol.154(15), p.1721(9)
    Description: 〈p〉BACKGROUND: Acute hospitalizations represent substantial financial liability to closed health care systems. Among hospitalized patients, those with repeated admissions are high-cost users. Most managed care plans employ case management to control hospital use. This technique attempts to detect and fulfill unmet medical and social needs, intensify postdischarge care, identify and mobilize effective community services, and enhance primary care access. Despite the popularity of case management to control hospital use, few trials have examined its efficacy. METHODS: We conducted a randomized controlled trial of an intervention of case managers at a university-affiliated Veterans Affairs medical center. Six hundred sixty-eight patients aged 45 years or older who were discharged from the general medicine inpatient service, who had access to a telephone, and who received primary care at the hospital's clinics were randomized to the intervention (N=333) and control (N=335) groups. Within 24 hours of discharge, case managers mailed educational materials and access information to intervention patients, and within 5 days they called to review and resolve unmet needs, early warning signs, barriers to keeping appointments, and any readmissions. Case managers contacted intervention patients if they made no visits for 30 days. This resulted in a total of 6260 patient—case manager contacts. Control and intervention patients were followed up for 12 months. RESULTS: Intervention patients had more frequent visits per patient per month to the general medicine clinic (0.30±0.23 vs 0.26±0.22, P=.008), but we detected no significant differences between groups in nonelective readmissions, readmission days, or total readmissions. CONCLUSIONS: Frequent contacts for education, care, and accessibility by case managers using protocols were ineffective in reducing nonelective readmissions.(Arch Intern Med. 1994;154:1721-1729)〈/p〉
    Keywords: Medical Case Management -- Models ; Hospital Admission And Discharge ; Veterans Hospitals
    ISSN: 0003-9926
    E-ISSN: 15383679
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  • 2
    Language: English
    In: The Journal of Infectious Diseases, 1 October 1994, Vol.170(4), pp.759-765
    Description: Using the hybrid capture method, condylomata acuminata from healthy patients (controls) and patients with altered cell-mediated immunity were analyzed for multiple human papillomavirus (HPV) DNA: 82.9% and 38.0% of lesions from 41 controls and 21 patients, respectively, were HPV DNA-positive only with probes for low-risk HPV types (P = .00035). Using probes for both lowand high-risk HPV types, 16.3% and 52.3% of lesions from 43 controls and 21 patients, respectively, were positive for both probes (P = .0038). Evidence of multiple HPV types was also found by Southern blot and in situ hybridization studies. The mean HPV copy number detected by either probe did not differ significantly among patient groups. Using sensitive techniques, such as hybrid capture, multiple HPV types, including those associated with genital malignancy, can be detected in condylomata acuminata. Serial biopsies demonstrate the dynamic nature of genital HPV infection and that changes in the predominant HPV types may be reflected in tissue pathology.
    Keywords: Health sciences -- Medical diagnosis -- Diagnostic methods ; Health sciences -- Medical conditions -- Physical trauma ; Philosophy -- Metaphysics -- Ontology ; Biological sciences -- Biology -- Genetics ; Health sciences -- Medical conditions -- Diseases ; Biological sciences -- Biology -- Anatomy ; Biological sciences -- Biology -- Genetics ; Physical sciences -- Chemistry -- Chemical compounds ; Health sciences -- Medical conditions -- Infections ; Biological sciences -- Biology -- Microbiology
    ISSN: 00221899
    E-ISSN: 15376613
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  • 3
    Language: English
    In: Journal of the American College of Cardiology, April 1994, Vol.23(5), pp.1085-1090
    Description: . The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas. . Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies. . During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension. . Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39). . Protruding atheromas seen on transesophageal echocardiography predict future vascular events.
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 4
    In: Sexually Transmitted Diseases, March-April, 1994, Vol.21(2), p.103(4)
    Description: Background and Objectives: Though human papillomavirus (HPV) DNA can be detected in the majority of condylomata acuminata, the major capsid protein of HPV (L1 protein) can be detected in only 10% to 50% of lesions in immunohistochemical assays. Goal of Study: To evaluate the association between anatomic location of genital HPV infections and the ability to detect HPV L1 protein. Methods: Condylomata acuminata from 49 male and 51 female patients were evaluated for L1 protein by immunohistochemistry. Thirty of these lesions were vulvar; 20 were cervical; 1 was vaginal; 45 were penile; and 4 were perianal. A quantitative analysis of L1 -positive nuclei in the lesions was performed. Results: L1 protein was detected in 20 (20%) of all lesions. L1 protein was detected in seven (35%) of the cervical lesions compared to nine (12%) of exophytic condylomata acuminata of males and females (P = 0.038). A statistically significant difference was noted between cervical and exophytic condylomata acuminata lesions (46.6 vs. 7.8) (P = 0.0006). No association between oral contraceptive use and L1 protein detection was found. Conclusions: The major capsid protein of HPV can be detected in condylomata acuminata of the uterine cervix more often, and in higher quantities, than in lesions of the vulva or penis. Further studies are needed to assess the effects of sex hormones and the anatomic location of the infection as they relate to transmission of HPV.
    Keywords: Genital Warts -- Physiological Aspects ; Proteins -- Measurement ; Papillomavirus
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 5
    In: Sexually Transmitted Diseases, 1994, Vol.21(1), pp.47-52
    Description: Background and Objecfives: The prevalence of chlamydial infection decreases with age possibly in part because of increasing immunity.Goal of this Sfudy:To determine whether increased age is an independent predictor of decreased chlamydial infection and whether chlamydia-specific antibody titer and blastogenesis increase with age.Sfudy Design: Data from all patients cultured for Chlamydia frachomafis between January 1984 and August 1989 were examined and multiple logistic regression models were used to identify the independent predictors of culture positivity. Antichlamydial antibody titer and chlamydia-specific blastogenesis were examined for a subset of patients for correlation with age.Results: Young age was found to be predictive of chlamydial infection independent of all factors examined in men and women. Antibody titers had no relation to age (n = 245) whereas the level of blastogenesis correlated only weakly with age (n = 155).Conclusions: Assays of systemic immunity do not reflect the protection from chlamydial infection associated with age.
    Keywords: Chlamydia Infections -- Demographic Aspects ; Chlamydia Trachomatis -- Physiological Aspects;
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 6
    Language: English
    In: Clinical Orthopaedics and Related Research, 1994, Vol.305(1), p.209-217
    ISSN: 0009-921X
    Source: Wolters Kluwer - Ovid - Lippincott Williams & Wilkins (via CrossRef)
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  • 7
    In: Investigative Radiology, 1994, Vol.29(5), pp.558-563
    Description: Don S, Cohen MD, Kruger RA, Winkler TA, Katz BP, Li W, Dreesen RG, Kennan N, Tarver R, Klatte EC. Rabbit pneumothorax: feasibility of an animal model to simulate neonatal pneumothorax. Invest Radiol 1994;29:558-563. RATIONALE AND OBJECTIVES.: The feasibility of developing an animal model to simulate radiographic features of neonatal pneumothorax was investigated, and supine computed radiography (CR) and film-screen radiography (FS) images were compared. METHODS.: 5-Fr pigtail catheters were inserted into the right pleural space of three New Zealand white rabbits. Two CR and two FS supine images were obtained using identical technique. After serial 4-mL injections of air, one CR and one FS supine image were obtained. The images were masked and randomized, and four radiologists reviewed the images for typical signs of pneumothorax. Chest computed tomography (CT) was performed before the injection of any air and after completion of the study. RESULTS.: At zero-mL air volume, radiologists did not perceive a pneumothorax. As the air volume increased, the number of signs of a pneumothorax increased; there was no significant difference between CR and FS in the number of signs of pneumothorax detected at any volume. Chest CT confirmed that there was no unexplained air leak. The volume of air injected correlated with the calculated volume from the CT. CONCLUSIONS.: This induced, volume-controlled, animal model simulated the supine radiographic features of neonatal pneumothorax.
    Keywords: Pneumothorax -- Diagnostic Imaging ; Pneumothorax, Artificial -- Methods;
    ISSN: 0020-9996
    E-ISSN: 15360210
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  • 8
    In: Clinical Orthopaedics and Related Research, 1994, Vol.305, pp.209-217
    Description: The chance of a person with osteoarthritis of the knee receiving a knee replacement is highly variable. To understand better the reasons for this variation, all practicing orthopaedists in Indiana were surveyed about their management of severe knee osteoarthritis and their perception of tricompartmental knee replacement as a therapeutic option. Their perceptions of indications and outcomes of knee replacement were compared with the self reported annual number of patients for whom they performed (or referred to other surgeons for) tricompartmental knee replacements. A completed survey was returned by 220 (79%) of the 280 orthopaedists surveyed; analyses were limited to the 188 respondents who had cared for at least one patient with osteoarthritis of the knee in the prior 2 weeks (mean = 13). These surgeons reported performing (or referring patients for) a mean of 31 knee replacements in the prior year (SD 45, median 21, range 0–480 knee replacements). There was strong agreement (〉95%) among respondents for seven (21%) of 33 surgical indications and contraindications, and more general agreement (〉60%) for 21 (64%). In the live factors (15%) for which there was disagreement, there was no consistent relationship between opinions and self reported knee replacement performance rate. Surgeons reporting more knee replacements had significantly higher estimates of pain relief and functional improvement following surgery, and lower esti-
    ISSN: 0009-921X
    Source: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.〈img src=http://exlibris-pub.s3.amazonaws.com/LWW%20logo.png style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: Psychological Reports, December 1994, Vol.75(3), pp.1176-1178
    Description: For elderly volunteers (10 high and 10 low on anxiety) scores on the State-Trait Anxiety Inventory for Children, Mini-Mental State Examination, and subtests of the Wechsler Memory Scale—Revised suggested anxiety adversely affected sustained attention of these elderly persons, but may not be evident on verbal and figural memory tasks.
    Keywords: Psychology
    ISSN: 0033-2941
    E-ISSN: 1558-691X
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  • 10
    Language: English
    In: The American Journal of Medicine, 1994, Vol.96(6), pp.504-508
    Description: OBJECTIVE: To assess the effectiveness of fluconazole for suppression of relapse of histoplasmosis in patients with acquired immunodeficiency syndrome (AIDS). DESIGN: Retrospective, nonrandomized, open trial. SETTING: Multicenter at two university referral centers and in five private practices. PATIENTS: Seventy-six patients with AIDS and disseminated histoplasmosis who completed induction treatment with amphotericin B, itraconazole, or fluconazole and maintained on treatment with fluconazole to prevent relapse. INTERVENTIONS: Fluconazole was given at dosages of 100 to 400 mg per day. Patients were followed by their primary physicians, who completed questionnaires collecting information about treatment and relapse status. Blood and urine specimens were submitted periodically for Histoplasma capsulatum var. capsulatum artigen determination. MEASUREMENTS AND MAN RESULTS: Nine of the 76 patients relapsed during fluconazole therapy and another was removed from the study because of allergic rash. Survival after initiation of therapy for histoplasmosis was 94 weeks, ranging from 74 weeks for those who received less than 1 g of amphotericin B for induction and none for maintenance therapy to 156 weeks for those who received greater than 1 g for induction and additional amphotericin B for maintenance therapy before beginning fluconazole (P 〈0.02). Antigen levels fell at rates of 0.05 units/week in urine and 0.02 units/week in serum in patients who were successfully maintained in remission and increased by [greater than or equal to] 22 units/week in 4 of 6 patients who relapsed. CONCLUSIONS: Fluconazole [greater than or equal to] 200 mg daily is a reasonable choice for chronic suppressive therapy of histoplasmosis in patients who cannot take itraconazole because of drug interactions, malabsorption, or side effects.
    Keywords: Medicine
    ISSN: 0002-9343
    E-ISSN: 1555-7162
    E-ISSN: 15527162
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