Carotid endarterectomy: characterization of recent increases in procedure rates.
(41/1417)INTRODUCTION: Recent increases in the rate of carotid endarterectomies (CEAs) have been attributed to results of clinical trials demonstrating efficacy when CEA is performed in centers of excellence. Subsequent population-based data suggest that trial results may not be matched in the community. This study was undertaken to characterize trends in CEA procedure rates after the dissemination of trial data and to describe any change in patient outcomes with population-based data from a single state. METHODS: Hospital administrative data on CEAs from 1992 to 1996 (n = 45,744) were obtained for the state of Florida. Annualized CEA rates per 100, 000 Florida residents were analyzed to determine trends in patient age, sex, admission type, size of hospital beds, ownership type and teaching status, and annual hospital and surgeon CEA volume. Outcomes were examined to track trends in complication rates. RESULTS: The annual number of CEA procedures increased 74% from 63.7 per 100,000 residents per year to 110.8 per 100,000 residents per year between 1992 and 1996. A single large increase occurred during the second half of 1994 when CEAs increased 73.5% from 16.6 per 100, 000 residents per quarter to 28.8 per 100,000 residents per quarter after a clinical alert on benefits to CEAs in asymptomatic patients. Over 5 years, there were significant trends toward more nonemergent admissions, and more procedures were performed in high-volume hospitals and by high-volume surgeons. Procedure rates in both women and very elderly patients increased more than 70%, which was in step with younger patients and men. The incidence of inpatient stroke and death declined over the 5-year period, whereas the rate of perioperative myocardial infarction remained constant. CONCLUSIONS: Experience from Florida indicates that CEA rates increased as results of the Asymptomatic Carotid Artery Study disseminated. Trial results have been broadly interpreted to include women and very elderly patients. More patients are being referred to busier hospitals and to high-volume surgeons, which should continue to result in better patient outcomes. (+info)
A survey of stool culturing practices for vibrio species at clinical laboratories in Gulf Coast states.
(42/1417)Non-cholera Vibrio infections are an important public health problem. Non-cholera Vibrio species usually cause sporadic infections, often in coastal states, and have also caused several recent nationwide outbreaks of gastroenteritis in the United States. We report a survey of laboratory stool culturing practices for Vibrio among randomly selected clinical laboratories in Gulf Coast states (Alabama, Florida, Louisiana, Mississippi, and Texas). Interviews conducted with the microbiology supervisors of 201 clinical laboratories found that 164 (82%) received stool specimens for culture. Of these, 102 (62%) of 164 processed stool specimens on site, and 20 (20%) of these 102 laboratories cultured all stool specimens for Vibrio, indicating that at least 34,463 (22%) of 152, 797 stool specimens were cultured for Vibrio. This survey suggests that despite an increased incidence of non-cholera Vibrio infections in Gulf Coast states, a low percentage of clinical laboratories routinely screen all stool specimens, and fewer than 25% of stool specimens collected are routinely screened for non-cholera Vibrio. (+info)
The implementation of speech recognition in an electronic radiology practice.
(43/1417)For both efficiency and economic reasons, our practice (200,000 examinations) has converted all remote dictation to speech recognition transcription (PowerScribe, L & H, Burlington, MA). The design criteria included complete automation to the existing radiology information system (RIS), with full RIS capabilities immediately available following dictation. All dictations for computed tomography, magnetic resonance imaging, ultrasound, and nuclear medicine were converted from remote transcription to speech recognition over a 2-week period (following a 4-week installation phase and 8 days of training). The average turnaround time for these reports decreased from approximately 2 hours to less than 1 minute. Reports are then sent to the institutional Electronic Medical Record and are available throughout all facilities in a nominal 2 minutes. Speech recognition rates were surprisingly high, although certain phrases caused consistent difficulties and certain staff required retraining. This presents our analysis of both successful and problematic areas during our design and implementation, as well as statistical performance analyses. (+info)
Effects of a large-scale deployment of soft-copy devices for picture archiving and communication systems viewing.
(44/1417)A study was developed to investigate several aspects of deployment of stand-alone computers and a web-based server for displaying digital images. The costs associated with installation, upgrades, training, and maintenance of both systems were documented, as well as patterns of usage and preferences of physicians for the two types of systems. A clinical archive was created to store relevant images with a web-based front end. Users were classified according to their imaging requirements and were given access to images from either the diagnostic archive (full study sets) or the clinical archive. The range of functionality of the web-based system was significantly lower than that of the stand-alone system; however, the costs associated with the administration of the stand-alone systems were far higher than those associated with a web server. A clinical archive was created to store relevant images with a web-based front end. This study illustrates the different approaches to distribution of images to clinicians with the costs of administration of each system. (+info)
Remedial education: can this doctor be saved?
(45/1417)In the first two years of the program 30 physicians have completed the program. A list of the distribution of specialties/practice areas [table: see text] served is provided in Table 1. The data reveal that the distribution of practice areas corresponds approximately to the distribution of physicians practicing in the state. The UF C.A.R.E.S Program provides a great benefit to physicians and their patients. It provides an atmosphere of professional collaboration and encouragement to address specific educational needs and underscores a commitment to providing continuing medical education, meaningful doctor-to-doctor collaboration, better patient care, and reflects a medical model of diagnosis and treatment of specific problems. (+info)
Effects of case management and new drugs on Medicaid AIDS spending.
(46/1417)This study evaluates the effects of Florida's participation in the Medicaid acquired immunodeficiency syndrome (AIDS) home and community-based waiver and the use of recently developed AIDS drugs on spending per Medicaid beneficiary. We find that monthly Medicaid spending for waiver non-participants was significantly higher than was spending for waiver nonparticipants. The major reason for the cost difference is that nonwaiver enrollees incurred significantly higher inpatient costs than did those enrolled in the waiver. Although waiver enrollees had higher drug spending, these represent only a fraction of the higher inpatient costs incurred by nonwaiver enrollees. Thus, it appears that adherence to appropriate medications reduces the need for inpatient care. The case management approach of the AIDS waiver may have similar effects for persons with other chronic diseases. (+info)
Outbreak of gastroenteritis associated with an interactive water fountain at a beachside park--Florida, 1999.
(47/1417)Since 1989, approximately 170 outbreaks associated with recreational water venues (e.g., swimming pools, waterparks, fountains, hot tubs and spas, lakes, rivers, and oceans) have been reported, with almost half resulting in gastrointestinal illness (1-5). This report summarizes the investigation of an outbreak of gastroenteritis in Florida during 1999. The findings indicated that Shigella sonnei and Cryptosporidium parvum infections caused illness in persons exposed to an "interactive" water fountain at a beachside park. (+info)
Classification of antibiotic resistance patterns of indicator bacteria by discriminant analysis: use in predicting the source of fecal contamination in subtropical waters.
(48/1417)The antibiotic resistance patterns of fecal streptococci and fecal coliforms isolated from domestic wastewater and animal feces were determined using a battery of antibiotics (amoxicillin, ampicillin, cephalothin, chlortetracycline, oxytetracycline, tetracycline, erythromycin, streptomycin, and vancomycin) at four concentrations each. The sources of animal feces included wild birds, cattle, chickens, dogs, pigs, and raccoons. Antibiotic resistance patterns of fecal streptococci and fecal coliforms from known sources were grouped into two separate databases, and discriminant analysis of these patterns was used to establish the relationship between the antibiotic resistance patterns and the bacterial source. The fecal streptococcus and fecal coliform databases classified isolates from known sources with similar accuracies. The average rate of correct classification for the fecal streptococcus database was 62.3%, and that for the fecal coliform database was 63.9%. The sources of fecal streptococci and fecal coliforms isolated from surface waters were identified by discriminant analysis of their antibiotic resistance patterns. Both databases identified the source of indicator bacteria isolated from surface waters directly impacted by septic tank discharges as human. At sample sites selected for relatively low anthropogenic impact, the dominant sources of indicator bacteria were identified as various animals. The antibiotic resistance analysis technique promises to be a useful tool in assessing sources of fecal contamination in subtropical waters, such as those in Florida. (+info)