Showing papers in "Maryland medical journal in 1989"

Hospitalized head-injured patients in Maryland: incidence and severity of injuries.

Abstract: Hospital discharge data collected from all acute care hospitals in Maryland were used to examine severity-specific rates of hospitalized head injuries in 1986. Findings indicate that males are at twice the risk of females for hospitalization for head injury; whites and nonwhites are at similar risk. Evidence that the rate of hospitalization for head injury may be increasing underscores the importance of head injury as a major public health problem in Maryland.

Methodologic approach for a large functional trauma registry.

Abstract: The utility of a clinical trauma registry (TR) is directly related to the constituents of the data base and to the accuracy of the data, which is contingent on a carefully constructed data collection system. A TR was developed by traumatologists at a busy Level I trauma facility that predominantly receives patients having incurred blunt injury. Four dedicated data collectors gather the AP information within 24 to 48 hours after admission, with prompt Attending Surgical review for verification. Examples of data output prove this is a functional system. Using a careful methodologic approach for design and implementation, clinicians can create a large, functional trauma registry with many potential applications.

Pharmacotherapeutics in the elderly.

Abstract: Drugs are the most cost-effective modality of chronic care, and older adults with multiple illnesses often need multiple drugs. Because this may lead to drug interactions, adverse drug effects, and problems with compliance, drug regimens should be individualized and as few drugs as possible used. When a new drug is indicated, it is important for the physician reassess the appropriateness and continued need for the existing regimen. Patients and providers must agree on a particular regimen, its goals, promises, and limitations.

Demographic and epidemiologic considerations for developing preventive strategies in the elderly.

Abstract: More than 29 million Americans are aged 65 and older, over 12 percent of the US population. This number is expected to increase to 35 million by the turn of the century and to 67 million by the year 2050. Growth is expected to be greatest among the oldest and most disabled members of this group, those aged 85 and older. Persons 65 and older are the largest consumers of medical care; their care needs will be even greater as we enter and move through the twenty first century. Most persons needing long-term care will reside in the community, not in nursing homes. In light of these projections, we must be concerned with community based prevention at all levels.

Health maintenance issues of the elderly. Vision: age-related macular degeneration.

Abstract: Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States among persons over 50 years old. The majority of patients who develop severe visual loss from AMD have exudative disease. Treatment for AMD has been shown to be effective for only a small portion of patients who have well-defined choroidal neovascular membranes (CNVM) outside the foveal center. Even when successfully treated, severe visual loss is postponed for only about 18 months because of the high rate of recurrent CNVMs extending through the fovea. Presently, low-vision aids are the only treatment available for the majority of patients with exudative disease.

Use of health and rehabilitation services following head injury.

Abstract: The impact on public health of head injury as a major source of death and disability, especially among adolescents and young adults, is well recognized. In Maryland the primary annual incidence of head injury severe enough to result in death or hospitalization has been estimated to be 149 per 100,000 population. These figures are comparable to national and other regional estimates reported in the literature. Improvements in the acute care management of head injury have generally led to improved survival. Language: en

What physicians should know about small area variation analysis.

Abstract: Geographic variations in the use of medical care may occur because of differences in patient severity of illness, patient access or use of medical care, physician practice patterns, availability of technology, economic incentives, and malpractice concerns. These variations are leading to greater scrutiny of appropriateness and cost effectiveness of medical care.

Health promotion and disease prevention in the care of older adults: preventive practice in primary care.

Abstract: Prevention is an important and appropriate component of the primary care of older adults. Office-based approaches to prevention include routinely scheduled examinations for health maintenance and case finding for early disease and disability during visits scheduled for other purposes. The primary care clinician is the optimal person for effective preventive intervention in patients 65 years and older. The spectrum of preventive activities ranges from screening by history taking, physical examination, and laboratory tests to intervention by counseling and therapeutic intervention. Unfortunately, substantial barriers exist to widespread incorporation of preventive practices into primary care, including the need for information and the low level of third-party reimbursement in this area.

Rehabilitation in the elderly.

Abstract: Prevention of disease should be every physician's goal, however, when primary or secondary prevention fail, rehabilitation of the patient becomes an additional goal. Elderly patient can be as successfully rehabilitated as younger patients, but their special needs are most successfully met by a multidisciplinary team. Almost every patient with a disability warrants a trial of rehabilitation aimed toward placing the patient in the least restrictive environment possible. Rehabilitation is especially useful in patients with arthritis, and following stroke, joint replacement, and amputation.

Predictors of rehabilitation outcome among patients with SCI.

Abstract: Because rehabilitation medicine has undergone major changes with respect to patient management and case mix since 1980, it is important to determine whether the factors predictive of rehabilitation outcomes also have changed over time.

Clinical experience with ketoprofen in the management of osteoarthritis and rheumatoid arthritis.

Abstract: Over 100 forms of musculoskeletal disorders affect approximately 50 million persons in this country. While the etiology and cure of many arthritis disease processes remain elusive, the number of drugs available to ease the pain and reduce the inflammation associated with arthritic diseases has increased, improving the outlook for patients.

Adverse events following DTP immunization in Maryland, 1987.

Abstract: Between January 1, 1987 and December 31, 1987, a total of 184 adverse events were reported to have occurred within 28 days following diphtheria, tetanus, pertussis (DTP) immunization in Maryland. More than half the reports (54 percent) were of serious or major vaccine reactions. Screaming episodes were the most frequently reported serious reaction, having occurred in 64 (35 percent) of the reports.

Planning for medical decision making: living wills and durable powers of attorney.

Abstract: The enactment of living will and durable power of attorney statutes in most states, including Maryland, provide individuals with a mechanism for setting forth their preferences for medical treatment in the event of their inability to make treatment decisions on their own behalf. Although still under used, these mechanisms are becoming more common, and physicians will be confronting them more frequently. The following overview of the Maryland Life Sustaining Procedures Act and the Durable Power of Attorney Act and discussion of their advantages and limitations is from the perspective of patients and their physicians.

Prevalence of risk behaviors and HIV infection in Maryland STD clinics.

Abstract: Persons who are receiving evaluation and treatment for sexually transmitted diseases are at moderately increased risk for acquiring HIV infections The scope of STD clinic services should be broadened to include counseling, education, and referral services for health needs related to risk of HIV infection

Cytopathology: new legislative, regulatory, and proficiency testing requirements.

Abstract: In 1988, a combination of efforts by the press, the Maryland General Assembly, the Department of Health and Mental Hygiene (DHMH), and an advisory panel of pathologists and cytotechnologists led to broader and stricter regulation of cytopathology laboratories in Maryland. A new law called for standards covering the maximum number of slides a cytotechnologist may examine, unsatisfactory specimens, slide and records retention, a limitation on the use of out-of-state laboratories by Maryland physicians, and a mandatory, state-run proficiency testing program. Maryland's proficiency testing program is modeled on that of New York State but incorporates improvements in diagnostic definitions, testing mechanisms, and retraining requirements.

Medical care behind bars: Maryland prison system.

Abstract: The inmate population in the Maryland prison system has increased dramatically over the past 10 years due to changes in sentencing by the courts. At the same time, costs of inmate health care have increased markedly following court cases mandating adequate care, an amelioration of prior inadequate standards of care. The unique demographic and disease risk characteristics of inmates predispose them to a distinct set of health problems. The state is legally obligated to provide health care to individuals sentenced to confinement in state prisons. It is often the first care these individuals have received in many years.

A transient granulocyte killing defect secondary to a varicella infection.

Abstract: A varicella infection in a previously healthy young girl was complicated by bacterial sepsis, arthritis, and osteomyelitis in multiple locations. This secondary complication caused by Staphylococcus aureus was associated with a transient defect in granulocyte function and an alteration in the representation of CD4 and CD8 positive lymphocyte subpopulation. The mechanism responsible for secondary bacterial infections following varicella may be due to transient defects in granulocyte function.

Health maintenance of the elderly. Sexuality.

Abstract: Empirical research, clinical experience, and greater sophistication about the interaction of social, psychological, and biological factors have produced marked changes in the appreciation of the importance of sexuality in older persons. An earlier view linking sex exclusively with reproductive function has given way to a holistic view of sex as vital to self-concept, the maintenance of healthy interpersonal relationships, and a sense of integrity. Older adults often have difficulty communicating sexual problems, concerns, and questions because of their conflicting attitudes and perceptions. Sexual problems often are presented covertly, expressed in vague terms, or masked by embarrassment. Physicians need to be aware of the possibility of covert sexual dysfunctions, clear about their own attitudes and expectations to avoid stereotyping the elderly, and knowledgeable about pharmacological, organic, and psychosocial bases of sexual problems in older patients.

Practice computerization: hints and suggestions.

Abstract: Roughly 13 percent of United States physicians in private practice own microcomputers and use them to manage their offices. This is an increase of nearly 8 percent in just five years. At this rate, 20 percent of physicians will own computers by the end of the decade. The consensus is that the pressures of costs, regulations, and competition render a simple manual ledger ineffective. A ledger cannot provide an alert to recall a patient, summarize financial data, nor produce medical reports for regulatory agencies. Consequently, to remain successful in the 90s, more physicians are turning to microcomputers to "manage" their practices more efficiently.

AIDS as a cause of dementia in the elderly.

Abstract: Acquired Immune Deficiency Syndrome (AIDS) is frequently complicated by central nervous system (CNS) involvement. Progressive dementia is an increasingly recognized manifestation of AIDS-associated neurologic syndromes.

American practitioners and the global primary care movement.

Abstract: In conclusion, comparative studies of primary health care in various parts of the world can lead to new solutions for underserved communities in Maryland and other parts of the US. Careful review of how similar principles work under different circumstances will open new approaches. Current international experience shows that each country must evolve its own health care system. We have much to learn from those who are poorer than we, where limited resources stimulate local innovation and less waste.