Surgical rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors.

Purpose Of Study: Surgical readmissions are a concern to the integrity of the Medicare Trust Fund and gaining attention from policymakers concerned about solvency. This study explores factors associated with variation in surgical readmission rates across the states and provides implications for Medicare Case Management.

Primary Practice Setting(s): Acute inpatient hospital settings.

Acute myocardial infarction rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors.

Purpose Of The Study: Acute myocardial infarction (AMI) readmission among the older adults is frequent and costly to the Medicare Trust Fund and to the patient in preventable suffering. In this study, we explore factors that are associated with states having AMI readmission rates that are higher than the U.S.

Heart failure rehospitalization of the Medicare FFS patient: a state-level analysis exploring 30-day readmission factors.

Purpose Of Study: Heart failure readmission among the elderly is frequent and costly to both the patient and the Medicare trust fund. In this study, the authors explore the factors that are associated with states having heart failure readmission rates that are higher than the U.S.

Pneumonia rehospitalization of the Medicare fee-for-service patient: a state-level analysis: exploring 30-day readmission factors.

Purpose Of The Study: Pneumonia hospitalization and subsequent readmission among the elderly are frequent and costly both to patient and to the Medicare trust fund. In this study, we explored the factors that are associated with states having pneumonia readmission rates that are higher than the U.S.

Comparison of four evaluation approaches in transcutaneous electrical nerve stimulation treatment in two incomplete tetraplegic subjects.

Introduction:   In the present investigation, we applied the whole-hand transcutaneous electrical nerve stimulation (TENS) therapy to two incomplete tetraplegic subjects and assessed their progress with four evaluation methods.

Methods:   Two spinal cord injured subjects with spastic upper extremities participated in the study. The TENS therapy was added to their regular treatment.

Proprioceptive neuromuscular facilitation in combination with electrical stimulation: combined treatment in comparison to each treatment alone.

The objective of the study was a quantitative examination of Proprioceptive Neuromuscular Facilitation (PNF) exercise in simultaneous combination with FES of lower extremity muscles in comparison to voluntary movement, training with PNF alone, or training with FES alone. Two subjects were monitored during a one-month rehabilitation period. The PNF pattern included flexion, adduction, and external rotation of the hip, knee flexion, and dorsiflexion with inversion of the ankle, a pattern similar to the swing phase of walking.

Dermatome electrical stimulation as a therapeutic ambulatory aid for incomplete spinal cord injured patients.

Electrical stimulation of the L-3,4 dermatome during treadmill walking is proposed as a gait training modality in incomplete spinal cord injured patients. The dermatome stimulation proved to be efficient in diminishing the extensor tone occurring after loading of the paralyzed limb during the stance phase of walking and resulting in improved flexion of the leg during the swing phase.

FES Rehabilitative Systems for Re-Education of Walking in Incomplete Spinal Cord Injured Persons.

Objective. The aim of the paper is to present various relatively simple functional electrical stimulation (FES) systems that affect neural circuits and reflex behavior by providing necessary peripheral input to the lower extremities of incomplete spinal cord injured (SCI) persons. Methods.

Effects of respiratory muscle training and electrical stimulation of abdominal muscles on respiratory capabilities in tetraplegic patients.

Thirteen tetraplegic patients were included in the study of the effects of respiratory muscle training and of electrical stimulation of the abdominal muscles on their respiratory capabilities. Each patient was subjected for three 1 month lasting periods of the study: for inspiratory muscle training, expiratory muscle training and for a period without training. The sequence of these three periods was random for each patient.

Influence of electrically stimulated ankle plantar flexors on the swinging leg.

The influence of functional electrically stimulated ankle plantar flexors on the swinging lower extremity was studied in incomplete spinal cord injured persons. Stimulation sequences with different time and frequency parameters were delivered to ankle plantar flexors and knee extensors and to the peroneal nerve. The results of kinematic assessment showed that stimulated calf muscles provide noticeable forward and upward propulsion to the swinging leg.

Improvement in step clearance via calf muscle stimulation.

The aim is to study the influence of electrically stimulated calf muscles on the effectiveness of the swinging leg movement. The study is carried out with a group of patients with incomplete spinal cord injuries both under stationary conditions and during crutch-assisted walking. Before stimulation is applied to the ankle plantar flexors, the knee extensors are inactivated.

The prediction of cardiac risk in patients undergoing vascular surgery.

In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.

Axillofemoral bypass. Expectations and results.

We studied 33 patients who received axillofemorofemoral or axillofemoral polytef (polytetrafluoroethylene [PTFE]) grafts. The follow-up period ranged from six to 60 months. Most patients were operated on for limb salvage.

Chylous ascites after abdominal aortic surgery.

Chylous ascites is an unusual postoperative complication that can lead to significant mechanical, nutritional, and immunologic consequences. We present the report of a patient with chylous ascites after abdominal aortic aneurysm repair. Paracentesis is essential for diagnosis and is often useful in the initial management of the patient with mechanical respiratory distress.

A critical review of amputation in vascular patients.

A study was made of 53 patients who underwent amputation for peripheral vascular disease over a 5-year period at West Virginia University Medical Center. The follow-up period ranged from 1 to 6 years. Data concerning operative deaths, risk factors, use of prosthetic devices, and ultimate self-sufficient living were obtained.

The relationship of the possible hepatic toxicity of chemotherapeutic drugs and carcinoembryonic antigen elevation.

The value of the serum level of carcinoembryonic antigen (CEA) as an indicator of recurrent colorectal carcinoma has been accepted, and the use of serial CEA levels to monitor postoperative chemotherapy has been suggested, However, elevated CEA levels may be associated with nonneoplastic conditions, of which the most difficult to evaluate is hepatic disease. The effect of chemotherapy on hepatic function and therefore on CEA level is not clear. We discuss a patient who, after a potentially curative resection for adenocarcinoma, demonstrated a rise in CEA level in the absence of recurrent carcinoma.

Spontaneous aorto-vena caval fistula: hemodynamic monitoring.

Rupture of an atherosclerotic abdominal aortic aneurysm into the inferior vena cava presents a challenging surgical problem. Marked hemodynamic changes are produced by the large arteriovenous shunt. Hemodynamic monitoring with a Swan-Ganz catheter will quantitate these alterations and can help direct appropriate therapy.

Gastroschisis update.

Sixty-four infants with gastroschisis have been managed in the 9-yr period, 1970-1979, with four postoperative deaths. The silo technique has been the standard method of management in this series, permitting initial expansion of the abdominal cavity without increased abdominal pressure and respiratory embarassment. Removal of the silo and complete closure of the abdominal wall deficit were possible 5-12 days later.

Advances in the management of gastroschisis.

Twenty-eight cases of gastroschisis have been treated over a five-year period. Twenty-two silos were placed and 19 infants had uncomplicated silo closure. Enlargement of the abdominal wall defect to allow optimum reduction of the edematous bowel was essential to closure in less than a week.