Assessing health care delivery to male versus female veterans.

The study reported was undertaken to explore allegations that women veterans have not received the quality of care in the Department of Veterans Affairs (VA) that is typical of that being received by their male counterparts. The study consisted of a chart review of male and female inpatients (n = 114) and telephone interviews with a subsample of these veterans (n = 55) treated at a large metropolitan VA hospital. Overall, chart documentation was poor, regardless of gender.

Surgical treatment of Takayasu arteritis.

The role of surgical therapy for Takayasu arteritis remains controversial. From 1973-1991, 23 patients with Takayasu arteritis have been treated at the University of Southern California. Twelve patients have required 17 arterial reconstructions for symptomatic complications of arterial disease refractory to medical therapy.

A review of carotid endarterectomy at a large teaching hospital.

Before 1981, the neurologic morbidity and mortality associated with carotid endarterectomy (CEA) in the Los Angeles County/USC Medical Center public teaching institution was 20 per cent, similar to results from other hospitals. In 1981, a standardized protocol was adopted in an attempt to improve surgical outcome following CEA. Between 1981 through 1990, 89 patients with a mean age of 60.

Cost-effectiveness of home care.

Home health care is uniformly accepted by patients, caregivers, health professionals, policymakers, and the public as a desirable way to provide care to disabled individuals and the frail elderly. Given the lack of positive impact of home care upon functional status, cost, and nursing home use, as well as documented additional cost, future research must focus upon positive aspects from past experiences. Careful targeting of patients most likely to benefit from this care has produced better results.

Voltage-sensing residues in the S4 region of a mammalian K+ channel.

The ability of ion-channel proteins to respond to a change of the transmembrane voltage is one of the basic mechanisms underlying electrical excitability of nerve and muscle membranes. The voltage sensor has been postulated to be the fourth putative transmembrane segment (S4) of voltage-activated Na+, Ca2+ and K+ channels. Mutations of positively charged residues within S4 alter gating of Na and Shaker-type K+ channels, but quantitative correlations between the charge or a residue in S4 and the gating valence of the channel have not yet been established.

Cross-linking a maturation-dependent ram sperm plasma membrane antigen induces the acrosome reaction.

ESA152 is a highly hydrophobic 18 kDa sialoglycoprotein, which becomes expressed on ram sperm in the proximal cauda epididymis. ESA 152 is expressed on all regions of the sperm surface, most strongly on the posterior region of the head, most weakly on the anterior region of the head. In this paper, we show that induction of the acrosome reaction with Ca2+ ionophore causes ESA152 to be redistributed from the posterior to the anterior region of the head plasma membrane.

Extra-anatomic bypass of failed traumatic arterial repairs.

Arterial injuries are best treated by primary repair or anatomically placed interposition grafts. Occasionally, these repairs fail due to adverse local factors, such as soft-tissue infection or enteric contamination. In these instances, limb salvage may require extra-anatomic arterial reconstruction.

Clinical applications of carbon dioxide/digital subtraction arteriography.

During an 18-month period 33 patients in whom there were contraindications to the use of iodinated contrast arteriography underwent 40 carbon dioxide/digital subtraction arteriograms for lower extremity ischemia (19), severe hypertension and renal insufficiency (12), or arterial aneurysm (2). Contraindications to iodinated contrast agents included renal insufficiency, congestive heart failure, and contrast hypersensitivity. Sixteen aortic, 15 iliac-femoral-popliteal-tibial, five aorta-iliac-femoral and four aorta-iliac-femoral-popliteal-tibial carbon dioxide/digital subtraction arteriography studies were performed.

Magnetic resonance imaging of a post-traumatic arteriovenous fistula in the lower extremity.

Currently, magnetic resonance (MR) is most useful as a means of providing distinct images of gross abnormalities in major blood vessels. While new advances and further refinements will continue, MR has proven its value as a convenient and effective diagnostic tool for the recognition and delineation of vascular abnormalities, such as acquired arteriovenous fistulae (AVFs). We report a case of a chronic, post-traumatic AVF, in which MR angiography provided excellent anatomic detail and angiographic correlation.

Normal band 3-cytoskeletal interactions are maintained on tanktreading erythrocytes.

Normal nonnucleated erythrocytes subjected to continuous hydrodynamic shear exhibit membrane deformation or "tanktreading," a process important for reduction of the bulk viscosity of circulating blood. To characterize the effect of this unique process on the erythrocyte membrane we have measured the lateral diffusion of band 3 during tanktreading. Band 3 is normally constrained through interactions with the spectrin-actin cytoskeleton, therefore, any significant disruption of these interactions would result in alterations in band 3 dynamics.

Sinistral (left-sided) portal hypertension.

Between 1953 and 1988, 21 patients with splenic vein thrombosis (SVT), 12 of whom had sinistral portal hypertension (SPH) were treated at our institution. SVT was identified at autopsy in nine patients. Twelve additional patients presented with SPH: bleeding esophageal varices, SVT and normal hepatic function.

Is arterial proximity a valid indication for arteriography in penetrating extremity trauma? A prospective analysis.

Three hundred seventy-three patients with a penetrating extremity injury were studied to assess the yield of arteriography. Patients underwent arteriography if any of the following was present: bruit, history of hemorrhage or hypotension, fracture, hematoma, decreased capillary refill, major soft-tissue injury, or nerve or pulse deficit. In the absence of these findings, arteriography was performed if the injury was in "proximity" to a major neurovascular bundle.

Surgical procedures in the management of Takayasu's arteritis.

Takayasu's arteritis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Variable results have been reported after medical and surgical management. Twenty female patients with Takayasu's arteritis were treated from 1973 to 1989.

An effective treatment protocol for intraarterial drug injection.

Between 1972 and 1988, 48 patients with extremity ischemia after an intraarterial drug injection were treated with the following protocol: heparin, dextran 40, dexamethasone, elevation, and early mobilization of the extremity. A tissue ischemia score, derived by assessing the color, capillary refill, sensory function, and temperature of the extremity, was used to assess the ischemic injury. Each sign was scored either normal = 0 or abnormal = 1; then summed to provide the tissue ischemia score (range, 0 to 4).

Carbon dioxide digital subtraction arteriography: a pilot study.

To investigate the diagnostic value of carbon dioxide arteriograms in patients with peripheral vascular disease, ten patients in whom standard contrast arteriography was contraindicated underwent carbon dioxide digital subtraction arteriography. Lower extremity ischemia or severe hypertension with renal insufficiency were the indications for arteriography. Standard contrast arteriography was precluded by chronic nondialysis-dependent renal insufficiency, severe congestive heart failure or contrast hypersensitivity.

Role of routine arteriography in blunt lower-extremity trauma.

During an 18-month period, 53 patients with unilateral blunt lower-extremity trauma were entered into a prospective study designed to determine how often clinically occult arterial injuries are identified by routine arteriography, and how often these injuries are of sufficient magnitude to warrant therapeutic intervention. Patients underwent diagnostic arteriography if one or more of the following abnormal clinical findings were present: distal pulse deficit, nerve deficit, soft-tissue loss, decreased capillary refill, bruit, or a history of hemorrhage or hypotension. In the absence of these findings, arteriography was performed for significant orthopedic injuries, i.

Cost-effectiveness of Veterans Administration hospital-based home care. A randomized clinical trial.

A randomized design was used to examine the cost-effectiveness of a Veterans Administration hospital-based home care program that case managed inpatient and outpatient care. Patients (N = 419) with two or more functional impairments or a terminal illness were randomized to hospital-based home care (n = 211) or customary care (n = 208). Functional status, satisfaction with care, and morale were measured at baseline and at 1 and 6 months after discharge from the hospital; health care utilization was tracked for 6 months.

The whole is greater than the sum of its parts: the anatomy of the Department of Veterans Affairs Medical District 17 Health Services Research and Development Field Program.

The Medical District 17 Health Services Research and Development (HSR&D) Field Program was funded by the Veterans Administration (now the Department of Veterans Affairs--VA) in January 1983. This article describes the organization, progress, and accomplishments of this field program, and it provides a review of the breadth of health services research that is being conducted in Medical District 17. Overall, the field program has conducted research that addresses significant problems in the delivery of health care within the VA system.

An analysis of decision making in discharge planning.

A repeated-measures design was used to examine medical professionals' discharge planning strategies. Physicians, residents, nurses, and social workers were presented with 16 hypothetical case scenarios and asked to: (1) rate the appropriateness of four discharge options (nursing home, community nursing, adult day, and outpatient clinic care), and (2) select the most appropriate discharge plan for each case. Four within-group variables were included in the scenarios: physical impairment, caregiver availability, follow-up required, and patient compliance.

Professional shopping of physician services: an extension of the simulated patient technique.

Health care researchers have recently begun to use professional shopping to evaluate physician services. The results of two studies conducted by The Cleveland Clinic Foundation indicate that: (1) such studies are easily conducted; (2) physicians are comfortable with the use of professional shopping to obtain patient feedback; (3) the technique is a valuable research tool for improving medical services from a patient's perspective; and (4) there is potential value in using professional shopping as a quality assurance technique.

A randomized trial of Veterans Administration home care for severely disabled veterans.

This randomized study screened hospital admissions to all wards except Psychiatry and Spinal Cord Injured during a 3-year period to identify 233 severely disabled patients (2 impairments on the Katz Index of ADL) and caregivers who were willing to participate in a pretest-multiple posttest trial of the Hines VA Hospital-based Home Care (HBHC) Program. Patient functional status, morale, and satisfaction with care were measured at baseline, 1 month and 6 months post discharge. Caregiver satisfaction and morale were assessed at the same time periods.

Blood flow in the atrophied pancreas.

Pancreatic and islet blood flow was measured by quantitative determination of microspheres within atrophied pancreases of rats rendered dietarily copper-deficient. The deficient state effects selective acinar necrosis and its replacement with non-inflammatory lipomatosis. While blood flow to lipomatous glands remained intact, it was significantly less (0.