Care guidelines: journey through the managed care maze.

Home health care agencies face significant challenges as they respond to the changes in reimbursement for health care services. In this era of "out of control" increases in costs for health services, health care managers must ensure the prudent allocation of health care dollars while maintaining adequate quality of services delivered. One method advocated to accomplish this goal is a change from a fee-for-service reimbursement system to a managed care model.

Surgical management of epilepsy associated with developmental anomalies of the brain.

Background: Disorders as the central nervous system forms during the pre-, peri-, or postnatal periods may cause developmental anomalies of the brain. Such maldevelopment, ranging from slight to severe disturbances, appears to be the mechanism for causing childhood seizure disorders. However, the surgical treatment of these lesions responsible for intractable partial seizures remains undefined.

Seizure control and extent of mesial temporal resection.

Controversy exists about the extent of mesial temporal lobe resection that improves seizure control in patients with temporal lobe epilepsy. In this retrospective study, 70 patients with mesial temporal seizure activity (without evidence of tumor or vascular malformation) were surgically treated and followed for at least 2 years. The extent of mesial temporal resection was based on the findings of interictal and ictal discharges using depth electrodes, which were inserted preoperatively or intraoperatively by the orthogonal approach to the amygdaloid and hippocampal regions.

The nursing plan: innovative home health documentation.

In order to improve documentation, a home health agency task force analyzed and revised its current nursing care plan system. Nurses in the five-county service area were involved in all aspects of the development. The system combines nursing interventions and patient outcomes with the overall physician plan to generate a totally computerized treatment plan.

The shorthand vertical mattress stitch: evaluation of a new suture technique.

The shorthand vertical mattress suture is a new suture technique that provides the same amount of wound eversion in less time than the classic method. A randomized, prospective clinical trial was designed to test this hypothesis in a University-affiliated community hospital. Thirty patients who presented to the emergency department with traumatic lacerations requiring primary closure were eligible for this study.

A competency achievement orientation program. Professional development of the home health nurse.

One of the vital components to the assurance of quality nursing care is a comprehensive orientation program. The concept of a competency achievement program facilitates the development of independent practice and judgment skills on the part of today's home healthcare nurse. The authors discuss one agency's program to meet the needs of newly employed registered nurses.

Evoked and spontaneous otoacoustic emissions. A comparison of neonates and adults.

Evoked otoacoustic emissions (EOAEs) and spontaneous otoacoustic emissions (SOAEs) were compared between neonates and adults. Several differences were seen for EOAEs: (i) the occurrence of EOAEs was significantly greater in adults than in neonates, and in neonates it increased with extra-uterine age; (ii) the high frequency EOAE intensity was greater in neonates than in adults; (iii) the EOAE intensity was significantly greater in neonates than in adults. No age-related differences for SOAEs were found: (i) age was not significantly related to the presence/absence of SOAEs in neonates or adults; (ii) the occurrence of SOAEs was, however, significantly greater in females than in males in both neonates and adults.

Seizure control after surgery on cerebral arteriovenous malformations.

Prediction of seizure control after surgery on cerebral arteriovenous malformations (AVM's) is currently unavailable. Between 1982 and 1990, 54 patients (30 males, 24 females) with epilepsy caused by a supratentorial cerebral AVM, without prior manifestation of intracranial hemorrhage, were surgically treated. Patients ranged in age from 11 to 59 years at seizure onset and from 13 to 70 years at surgery; the duration of seizure history ranged from several months to 27 years.

A strategy for growth in home care. The clinical nurse specialist.

One of the most challenging problems that faces today's home healthcare providers is how to deliver quality care within the constraints imposed by changing population, limited resources, and regulations. This problem is particularly apparent to those who provide rural healthcare. Use of the clinical nurse specialist can promote quality care while facilitating the development and expansion of home health services.

Fibroblast-dependent tumorigenicity of melanoma xenografts in athymic mice.

Two human melanoma cell lines, UCT-Mel 2 and UCT-Mel 3, were invariably tumorigenic in nude mice when inoculated s.c. in doses of 10(6) cells or higher; 10(5) cells or less did not give rise to tumours.

Unusual growth characteristics of human melanoma xenografts in the nude mouse: a model for desmoplasia, dormancy and progression.

When human melanoma cells are injected into nude mice they usually give rise to tumours that grow progressively and do not elicit a prominent host response. We have recently developed a melanoma cell line, UCT-Mel 7, that did not show these characteristics. In the first place UCT-Mel 7 showed a consistently unusual, phasic growth pattern.

Insulin-like growth factors I and II expression in the healing wound.

Demonstrating temporal variation in the expression of messenger RNA (mRNA) for growth factors may give some indication as to whether growth factor synthesis is regulated in wound healing. The aim of this study was to evaluate the expression of insulin-like growth factors (IGF) I and II in the wound. Two wound models, an incisional model and a subcutaneous sponge implant model, were used in this study.

Home care aide evaluation. Assuring competency & quality.

Supervision and evaluation of the direct care provider can be a costly and time-consuming activity. A comprehensive process to coordinate the various aspects of the home care aide evaluation is a creative solution for the efficient use of supervisory and staff time, paperwork reduction, and cost containment.

Empowering nurses. Patient satisfaction with primary nursing in home health.

Responsibility, accountability, and authority are the tools of primary nursing that enable nurses to impact patient care. It is important to determine if nurses empowered by a primary nursing care delivery system can positively influence patient outcomes. The authors describe an outcome audit conducted to study patient satisfaction with nursing care, one indicator of quality patient care.

Wound fluid amino acid concentrations regulate the effect of epidermal growth factor on fibroblast replication.

Growth factors and amino acids (AA) are required for cell proliferation. A comparison of the AA composition of wound fluid (WF) to that of Eagle's medium reveals that AA in WF may be limiting to cell replication. Yet WF supports fibroblast replication and stimulates AA uptake.

Noise and medial olivocochlear system in humans.

Evoked otoacoustic emissions (EOAE) and sound evoked olivocochlear feedback were performed in 200 subjects (noise induced hearing loss (NIHL), n = 109; sensori-neural hearing loss (SNHL), n = 91). Intensity of EOAE is greater in NIHL than in SNHL. This result does not seem to be related to the medial olivocochlear system since sound olivocochlear feedback was not significantly different between the two groups.

Age-related changes in evoked otoacoustic emissions.

Outer hair cells of the organ of Corti play an important part in the genesis of evoked otoacoustic emissions (EOAEs), which are related to cochlear biomechanics. The aim of this study was to investigate the age factor in relation to EOAEs in 166 ears of subjects between 6 weeks and 83 years of age. The results show that when age increases, the presence of EOAEs by age group and the frequency peak in spectral analysis decrease, and EOAE threshold increases.

Comparative lactate kinetics after short and prolonged submaximal exercise.

Arterial blood lactate concentrations were determined in two groups of eleven males before, during and after near 2 W.kg body mass-1 bicycle exercise. One group of subjects cycled for 3 min, whereas the second group exercised for 60 min.

Lactate removal ability and graded exercise in humans.

Venous lactate concentrations of nine athletes were recorded every 5 s before, during, and after graded exercise beginning at a work rate of 0 W with an increase of 50 W every 4th min. The continuous model proposed by Hughson et al. (J.

Blood lactate during constant-load exercise at aerobic and anaerobic thresholds.

Venous blood lactate concentrations [1ab] were measured every 30 s in five athletes performing prolonged exercise at three constant intensities: the aerobic threshold (Thaer), the anaerobic threshold (Than) and at a work rate (IWR) intermediate between Thaer and Than. Measurements of oxygen consumption (VO2) and heart rate (HR) were made every min. Most of the subjects maintained constant intensity exercise for 45 min at Thaer and IWR, but at Than none could exercise for more than 30 min.

Cloning and characterization of the mouse gene that encodes the peptide core of secretory granule proteoglycans and expression of this gene in transfected rat-1 fibroblasts.

A mouse liver genomic library was probed with a 450-base pair AccI----3' gene-specific fragment of a mouse bone marrow-derived mast cell proteoglycan cDNA to isolate 15-18-kilobase (kb) genomic clones containing the gene that encodes the peptide core of mouse secretory granule proteoglycans. Based on the nucleotide sequences of its 2.0-3.

Evoked otoacoustic emissions and sensorineural hearing loss.

Following Kemp's original studies, several others have confirmed the existence of otoacoustic emissions. Their clinical relevance remains, however, to be clarified. The various published studies have concerned small series.

Molecular cloning of a cDNA that encodes the peptide core of a mouse mast cell secretory granule proteoglycan and comparison with the analogous rat and human cDNA.

A cDNA that encodes a mouse secretory granule proteoglycan peptide core was isolated from a cDNA library prepared from nontransformed mouse bone marrow-derived mast cells (BMMC) using as a probe a 280-base-pair fragment of a rat cDNA that encodes the proteoglycan peptide core of rat basophilic leukemia (RBL)-1 cells. Based on the consensus nucleotide sequence and deduced amino acid sequence of the cDNA, the mouse BMMC proteoglycan peptide core is 16.7 kDa and contains a 21-amino acid glycosaminoglycan attachment region consisting of alternating serine and glycine residues.

Comparison of arterial and venous blood lactate kinetics after short exercise.

Seventeen healthy male volunteers participated in this study designed to compare arterial with both arterialized venous and venous lactate kinetics after short exercise. Blood samples drawn before, during, and after bicycle exercise were analyzed continuously for lactate. A mathematical function incorporating two exponential terms was fitted to the arterial, arterialized venous, and venous lactate recovery curves, and the parameters of the mathematical function were compared using a linear regression.

Effect of exercise duration on lactate kinetics after short muscular exercise.

Arterial blood lactate concentrations were measured in six normal males before, during and after 3- and 6-min bicycle exercises performed at three different work rates. The lactate recovery curves were fitted to a bi-exponential time function consisting of a rapidly increasing and a slowly decreasing component, which supplied an accurate representation of the changes in lactate concentration. Variations in the parameters of this mathematical model have been studied as a function of the duration of exercise and of the work rate, showing a clear dependence on exercise duration such that increasing exercise length decreases the velocity constants of the fitted curves.