Who Is a Health Care Provider?: Statutory Interpretation as a Middle-Ground Approach to Medical Malpractice Damage Caps.

Debates over the effectiveness, constitutionality, and fairness of medical malpractice damage caps are as old as the laws themselves. Though some courts have struck down damage caps under state constitutional provisions, the vast majority hesitate to invalidate malpractice reform legislation. Instead, statutory interpretation offers a non-constitutional method of challenging the broad scope of damage caps without fully invalidating legislative efforts to curtail "excessive" malpractice liability.

Impact of late gadolinium enhancement image acquisition resolution on neural network based automatic scar segmentation.

Background: Automatic myocardial scar segmentation from late gadolinium enhancement (LGE) images using neural networks promises an alternative to time-consuming and observer-dependent semi-automatic approaches. However, alterations in data acquisition, reconstruction as well as post-processing may compromise network performance. The objective of the present work was to systematically assess network performance degradation due to a mismatch of point-spread function between training and testing data.

Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction.

Unlabelled: Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians.

Restrictive Ventilatory Patterns in Residents of Continuing Care Retirement Communities.

Restrictive ventilatory patterns (RVPs) in older adults may contribute to morbidity and decreased quality of life. The purpose of this study was to begin to understand (a) the number of older adults residing in Continuing Care Retirement Communities with RVPs, (b) factors associated with RVP, and (c) whether RVP is associated with ambulation level. This descriptive study was conducted at three sites.

Integrated complex care coordination for children with medical complexity: a mixed-methods evaluation of tertiary care-community collaboration.

Background: Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN), by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC). Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC.

Endoscopy training during general surgery residency.

The endoscopic experience of surgical residents was evaluated following the introduction of a formal surgical endoscopy program, which consisted of a 2-month rotation, generally at the postgraduate year 2 level. The resident was assigned to one attending surgeon and also had a formal laboratory session. There were many benefits, including a significant increase in endoscopic encounters.

Formal endoscopy training for senior and junior house staff.

The upper endoscopic experience of junior and senior surgical residents was analyzed before (period 1) and after (period 2) creating a 2-month rotation with a dedicated surgical endoscopist. Three hundred sixty-two endoscopies were performed during the study period, with 295 (81%) being performed after formalizing training. A chi-square analysis was performed and found to be statistically significant for each group when compared to a control experience with colonoscopy.

Percutaneous gastrostomy made simple.

The use of percutaneous endoscopic gastrostomy has obviated the necessity of laparotomy for enteral access. The authors propose a new technique for introduction of the gastrostomy tube. It entails use of the laparoscopic trocar to gain entrance into the gastric lumen.

Intraoperative cholangiography revisited.

The charts of 1351 patients undergoing cholecystectomy at our institutions from 1985 through 1989 were reviewed retrospectively to evaluate the indications for and the success of intraoperative cholangiography. A total of 800 patients underwent intraoperative cholangiography. They were divided into two groups based on the absence (CR-) or presence (CR+) of clinical and/or operative criteria suggestive of the existence of common bile duct stones.

An appraisal of small and diminutive colonic polyps.

A retrospective review of all colonoscopic polypectomies performed in a busy surgical endoscopy unit over a 6-month period was undertaken. All patients were included who presented with colonic polyps measuring less than 1 cm in diameter for which sufficient specimens were available for histopathologic examination. In all, 262 were polyps removed from 206 patients; of these, 158 (60%) were neoplastic.

Route of admission and hospital costs for urologic patients.

This study of 2,549 urology patients examined resource consumption by route of admission into the hospital. Almost all urologic admissions were more expensive as emergencies. These more expensive emergency urologic admissions had higher diagnostic costs, a longer hospital length of stay, and a greater severity of illness than their less expensive non-emergency counterpart.

[Study of gastric APUD cells in gastroduodenal hemorrhage].

It was found that in patients with gastroduodenal hemorrhage the number of serotonin-, histamine-, and melatonin-producing apudocytes in the gastric mucosa increases while the number of cells producing gastrin, adrenaline, and noradrenaline reduces. In timely arrest of hemorrhage, the primarily increased number of melatonin-producing apudocytes diminishes with time from the onset of bleeding and reaches normal values gradually. The essential differences in the content of melatonin- and noradrenaline- producing apudocytes in patients with and without hemorrhage allow this morphological sign to be used as diagnostic and prognostic criteria in gastroduodenal hemorrhages.

Age, resource consumption, and outcome for medical patients at an academic medical center.

At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format.

Hospital costs, cancer patients, and surgical diagnostic related groups.

This study of 4,359 Medicare patients in 107 noncancer stratified surgical Diagnostic Related Groups (DRGs) tested the hypothesis that patients with a diagnosis of a malignancy (i.e., cancer) in these DRGs would have higher resource utilization than patients without a diagnosis of a malignancy (i.

Hospital costs by clinical parameters for peripheral vascular surgical DRGs.

Health care in America has entered a new era. Administrators and U.S.

DRGs, orthopedic surgery, and age at an academic medical center.

The federal Medicare Diagnostic Related Group (DRG) hospital reimbursement system has been on line for 5 years. Hospitals contend that profit margins have dropped to dangerously low levels, due to the federal DRG Prospective Payment System. The authors analyzed all orthopedic surgical admissions to a large academic medical center under DRG reimbursement and characterized patients by age, resource utilization, and outcome.

The identifier concept: variables to stratify patient costs within cardiothoracic surgical diagnostic related groups.

Prospective payment systems using the diagnostic related group payment mechanism are changing the economic incentives offered to hospitals. This study of all cardiothoracic surgical patients (N = 1825) treated during a 2-year period at an academic medical center demonstrated that patients within cardiothoracic diagnostic related groups could be stratified as to resource consumption (i.e.

Site-specific distribution of large-bowel adenomatous polyps. Emphasis on ethnic differences.

The anatomic distribution of adenomatous polyps occurring in the large intestine of 98 consecutive patients was studied. Fifty-two of the patients were black and 46 were white. Seventy-nine percent of lesions in whites were found in the distal colon and rectum, whereas in blacks this occurred in only 47 percent.

Financial risk and hospital cost for elderly patients. Age- and non-age-stratified medical diagnosis related groups.

The purpose of this study was to analyze hospital resource consumption for Medicare patients in non-age- and age-stratified medical diagnosis related groups (DRGs). This study of patients in 74 non-age-stratified DRGs (N = 3643) and 113 age-stratified DRGs (N = 2898) demonstrated that older medical patients (usually greater than or equal to 75 to 80 years of age) had (on average) higher total hospital costs, a longer hospital length of stay, more diagnoses per patient, a greater percentage of outliers, and a higher mortality compared with younger patients in these same DRGs. These findings raise the question of the equity of DRG payment vis-à-vis older Medicare patients in both non-age- and age-stratified medical DRGs.

Financial risk, hospital cost, complications, and comorbidities in surgical noncomplication- and noncomorbidity-stratified diagnostic related groups.

The purpose of this study was to analyze resource consumption in the 147 non-complicating condition-stratified surgical diagnostic related groups (DRGs). Analysis of 2647 surgical patients in these non-CC-stratified surgical DRGs demonstrated that patients with more CCs per DRG generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality rates than patients in these same DRGs with fewer CCs. These findings suggest that the current DRG classification system may be inequitable to certain groups of patients or types of hospitals vis-à-vis the non-CC-stratified surgical DRGs.

Altered aortic protease and antiprotease activity in patients with ruptured abdominal aortic aneurysms.

Aortic elastase, antiprotease (a-1-antitrypsin) and total protein were assayed in 37 patients who underwent an operation on the abdominal aorta for ruptured abdominal aortic aneurysms (AAA), an elective procedure for AAA or aortofemoral bypass for occlusive disease. Aortic elastase modified by local antiprotease activity (elastase/a-1-antitrypsin) was significantly higher in patients with a ruptured AAA compared with patients with an elective AAA or occlusive aortic disease: 241 nanograms per milligram of tissue in AAA-rupture versus 57 nanograms per milligram of tissue in AAA-elective versus 32 nanograms per milligram of tissue for occlusive (p less than 0.003).