Quality assurance in eight adult medicine group practices.

Four evaluations of ambulatory medical care tasks were developed for use in quality assurance. The evaluations used medical records data and explicit criteria incorporating branching logic. They were implemented in eight general medicine provider groups in two teaching hospitals and six related health centers.

Fulminant polyneuritis after overdose of disulfiram and ethanol.

A 39-year-old woman developed a severe sensorimotor polyneuritis after simultaneous ingestion of ethanol and disulfiram in high doses. The disorder was similar to other cases of disulfiram neuropathy, but was acute and more severe. Disulfiram can cause a fulminant polyneuropathy that is not always benign and reversible.

The cost of quality assurance in medicine.

Cost analysis has been frequently neglected in program evaluations but is currently of high relevance in policy decisions on quality assurance in medicine. The Ambulatory Care Medical Audit Demonstration (ACMAD) Project implemented and evaluated a program of medical record-based quality assurance in eleven sites for nine medical topics. Total direct costs for the project were $1.

Evaluation of operational failures in clinical decision making.

Medical decision analysts are interested in the changes in health benefits from inappropriate ordering of tests, imperfect information from tests, and imperfect results of treatments. Operational failures in the decision-making sequence, caused by human and system factors, may also alter health benefits. An evaluation of operational failures in follow-up of positive urine cultures in pediatric patients is reported.

The revised estimated survival probability index of trauma severity.

The construction of a revised version of the Estimated Survival Probability Index (or ESP index) is described. The original index had been proposed as a tool that would be useful in grading from hospital medical records the severity of injuries sustained by patients hospitalized with trauma conditions. The revised index (RESP) is based on a data set of 61,419 records.

Severity measurement in multiple trauma by use of ICDA conditions.

We report here the results of a study of grading injury severity for patients with multiple traumatic injuries from ICDA codes listed on the face sheets of hospital medical records. We developed a method of scoring the severity of individual ICDA traumatic injuries with use of data from the NCHS Hospital Discharge Survey. When tested on a set of patients having multiple trauma conditions (also from the NCHS Hospital Discharge Survey), these scores had a strong relationship with fatality.

Wernicke's disease complicating surgical therapy for morbid obesity.

A case of Wernicke's disease complicating surgical therapy for morbid obesity is presented. Features emphasized include the occurrence of the condition in a nonalcoholic patient and the persistence of neurological signs and symptoms despite prompt therapy. Prophylactic treatment in situations of potential thiamine depletion is essential if iatrogenic Wernicke's disease is to be avoided.

Factors affecting trauma center utilization in Illinois.

The Illinois Trauma System has served as a prototype for many of the advanced emergency medical services systems developed during the past decade. The Illinois Trauma Study uses a cross-sectional research design to assess the trauma patient utilization patterns at hospitals in Illinois. Data were collected from 33 Trauma Centers and 43 nonsystem hospitals for the time interval July 1973-June 1974.

A new class of angiotensin-converting enzyme inhibitors.

Much current attention focuses on the renin-angiotensin system in relation to mechanisms controlling blood pressure and renal function. Recent demonstrations (ref. 1, ref.

Mevinolin: a highly potent competitive inhibitor of hydroxymethylglutaryl-coenzyme A reductase and a cholesterol-lowering agent.

Mevinolin, a fungal metabolite, was isolated from cultures of Aspergillus terreus. The structure and absolute configuration of mevinolini and its open acid form, mevinolinic acid, were determined by a combination of physical techniques. Mevinolin was shown to be 1,2,6,7,8,8a-hexahydro-beta, delta-dihydroxy-2,6-dimethyl-8-(2-methyl-1-oxobutoxy)-1-naphthalene-hepatanoic acid delta-lactone.