Comparison of patients' compliance with prescribed oral and inhaled asthma medications.

Background: Noncompliance with medications is one of the most serious problems facing health care today. However, methods to measure compliance have many limitations.

Methods: To measure specific drug compliance and dosing frequency of two asthma medications, we used medical records data and pharmacy claims data from 276 patients who had concurrent prescriptions for inhaled anti-inflammatory agents and oral theophylline.

Using control charts to help manage accounts receivable.

The relative performance of a healthcare organization's accounts receivable (AR) department is a critical factor affecting an organization's financial well-being. Park Nicollet Medical Center (PNMC), Minneapolis, Minnesota, changed the way it measured its AR department's performance, switching from the rolling averages method of performance measurement to the percentage collected method of performance measurement, and was able to improve its patient accounts management effort.

Magnetic resonance imaging in a patient with I-cell disease.

Autopsy reports in I-cell disease patients describe no salient abnormality of central nervous system morphology. Magnetic resonance imaging of the cranium in a patient with I-cell disease showed ventriculomegaly with frontal lobe atrophy and bifrontal leukomalacia. Central nervous system morphological abnormalities may occur in a subset of patients with I-cell disease.

"Cyberphysiologic" strategies for children: the clinical hypnosis/biofeedback interface.

This article presents an in-depth discussion of the integrated use of self-hypnosis and biofeedback in the treatment of pediatric biobehavioral disorders. The rationale for integrating these techniques and their similarities and differences are discussed. The concepts of children's imaginative abilities, mastery, and self-regulation are examined as they pertain to these therapeutic strategies.

Pathogenesis of pulmonary fibrosis: platelet-derived growth factor precedes structural alterations in the Hermansky-Pudlak syndrome.

Peptides that modulate mesenchymal cell function have been detected in the fibrotic lung disorders once physiologic dysfunction is present. Despite this close association with manifest disease, their role in initiating alveolar remodeling remains unknown. We examined the hypothesis that one potent peptide, platelet-derived growth factor (PDGF), would be present at the alveolar surface before the onset of physiologic dysfunction in patients in whom pulmonary fibrosis subsequently develops.

Chiropractic: a medical perspective.

Chiropractic health care is founded on the premise that many diseases are the result of spinal nerve impingements or interference. These nerve impingements are postulated to be the result of misaligned vertebra or "subluxations." Research indicates that spinal manipulation may be beneficial in low back pain, but the claim that spinal manipulation is of value for optimizing general health and treating non-musculoskeletal conditions is unfounded.

A systems approach to assure optimal proficiency testing in the hematology laboratory.

Although CLIA 88 has probably caused the laboratorian to place inordinate emphasis on proficiency testing, we believe that it will ultimately improve clinical laboratory practice. Due to the increased numbers of challenges within a mailing, the laboratorian has a greater ability to gauge magnitudes and types of any existing error. These magnitudes can be compared with previously established limits to determine the need for corrective action.

Nonpalpable breast lesions: correlation of stereotaxic large-core needle biopsy and surgical biopsy results.

One hundred women, each with a single nonpalpable breast lesion evident at mammography, underwent computer-guided sterotaxic 14-gauge needle biopsy followed by hook-wire localization and open surgical biopsy. Lesions were not less than 5 mm in diameter. Core biopsy yielded essentially correct findings in 96 cases and in 35 of 36 cancers.

Performance characteristics of the HemoCue B-Glucose analyzer using whole-blood samples.

We evaluated the HemoCue B-Glucose (HemoCue Inc, Mission Viejo, Calif) analyzer for accuracy, precision, linearity, and recovery. One hundred eighteen capillary whole-blood samples were analyzed in duplicate on the HemoCue B-Glucose and the YSI 2300 STAT Glucose/L-Lactate (Yellow Springs [Ohio] Instruments) analyzers; corresponding plasma glucose levels were measured in duplicate on the Roche Cobas MIRA (Roche Diagnostic Systems, Nutley, NJ) analyzer. Plasma glucose levels were converted to whole-blood equivalent glucose levels by using a factor of 1.

Results of a multicenter trial using a mechanical lithotripter for the treatment of large bile duct stones.

A prospective, uncontrolled trial of the use of a prototype mechanical lithotripter was performed in 116 patients at nine centers. Standard endoscopic approaches had failed to remove all stones, primarily because of large size (80% of patients). For 92% of patients, common bile duct stones were successfully captured and fragmented following the use of this lithotripter.

The detection of problem analytes in a single proficiency test challenge in the absence of the Health Care Financing Administration rule violations.

The Clinical Laboratory Improvement Act of 1988 (CLIA 88) has dramatically changed proficiency testing (PT) practices having mandated (1) satisfactory PT for certain analytes as a condition of laboratory operation, (2) fixed PT limits for many of these "regulated" analytes, and (3) an increased number of PT specimens (n = 5) for each testing cycle. For many of these analytes, the fixed limits are much broader than the previously employed Standard Deviation Index (SDI) criteria. Paradoxically, there may be less incentive to identify and evaluate analytically significant outliers to improve the analytical process.

Approach to diagnosis of oxidative metabolism disorders.

Mitochondrial oxidation of a variety of substrates produces the bulk of energy requirements for most cell types. Impairment of oxidative metabolism may result in a broad spectrum of clinical signs and symptoms. A disorder of oxidative metabolism should be suspected when an unexplained association of signs and symptoms occurs, particularly when it is progressive, involving organs with no common embryologic origin.

Use of vacuum tumescence device for impotence secondary to venous leakage.

The causes and treatment of venogenic impotence are still controversial. From September 1989 to April 1991, 317 men complaining of impotence were evaluated in our Erectile Dysfunction Clinic. Seventy patients were suspected of having venous leakage, and all men had dynamic cavernosography performed.

A multispecialty group practice response.

Employers want value from the health care system, according to author J. Paul O'Conner, and they define this as quality care at a low cost. In response to this pressure, O'Conner's organization created an exclusive provider organization which he describes in detail.

Detection of beta-blocker use in people with asthma.

Although there have been numerous reports of adverse outcomes for people with asthma who are placed on beta-blockers, there has been no description of how often people with asthma receive prescriptions for beta-blockers. Despite the fact that pharmacy claims are available and can be used for clinical evaluation, there has been no description of a practical surveillance or warning system to recognize and reduce the rate of beta-blocker use in people with asthma. This study used administrative claims data to estimate the prevalence of patients with asthma who also had prescriptions for beta-blockers.

Home intravenous antibiotic therapy.

Concern regarding the soaring costs of in-hospital treatment has stimulated interest in providing alternatives when patients no longer need careful observation and daily nursing care. To facilitate ongoing intravenous antibiotic therapy for selected patients, home or outpatient intravenous therapy programs have been developed. Such therapies require a team approach with an emphasis on patient selection criteria, and educational strategies, as well as careful follow-up.

Achieving the Health Care Financing Administration limits by quality improvement and quality control. A real-world example.

With the enactment of the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88), the federal government is now using proficiency testing as the primary indicator of laboratory quality. Laboratories with proficiency test failures are now at risk of a variety of harsh penalties including large monetary fines and suspension of operations. To minimize the risk of failed proficiency testing, we initiated a continuous quality improvement program in our general chemistry laboratory in conjunction with the use of a new survey-validated quality control product.

Hydrosyringomyelia and diastematomyelia detected by MRI in myelomeningocele.

Magnetic resonance imaging of the spine in 45 patients with myelomeningocele revealed hydrosyringomyelia in 24 and diastematomyelia in two. No patient at initial imaging manifested symptoms referable to hydrosyringomyelia; both patients with diastematomyelia had flaccid lower extremities. One patient developed an upper extremity monoparesis which resolved with syringo-peritoneal shunt placement; no other patient manifested symptoms or required surgery.