Influence of ejection fraction on hospital mortality, morbidity, and costs for CABG patients

BACKGROUND: Preoperative ejection fraction (EF) has been shown to adversely affect postoperative hospital mortality and morbidity for patients undergoing isolated coronary artery bypass grafting. METHODS: To investigate influence of EF on isolated coronary artery bypass grafting outcomes (overall hospital mortality, hospital cardiac mortality, hospital morbidity, and hospital costs), data were reviewed from 1,354 consecutive patients who underwent isolated coronary artery bypass grafting between January 1, 1990, and April 30, 1992, at a single nonprofit hospital. Overall hospital mortality was 4.06% (cardiac, 2.36%). Hospital morbidity was 14.25% (including mortality). Hospital costs (not charges) averaged $16,673 per patient. To explore the impact of preoperative EF, EF was stratified into regular intervals. Each interval was then compared with regard to hospital mortality, morbidity, and average costs. A new statistical tool, discharge analysis, was developed to analyze the cost data. This was necessary because previous efforts at cost analysis have used tools inappropriate for real world cost data. RESULTS: The statistical analysis showed that patients with EF of 0.40 or greater had the best outcomes (lowest mortality, morbidity, and cost). Once the EF is 0.40 or greater the EF does not carry further predictive value. At EF less than 0.40, patients with EF less than 0.30 have a poorer outcome than patients with EF of 0.30 to 0.39. CONCLUSIONS: (1) Ejection fraction is a valid predictor of mortality, morbidity and resource utilization based on statistical analysis. (2) Patients can be broadly grouped as having EF greater than 0.40, less than 0.30, or from 0.30 to 0.39 with regard to clinical and cost outcomes. (3) Postoperative length of stay is not predicted by risk-adjusted EF. (4) A new tool, discharge analysis, is presented to facilitate cost analysis.     

Effects of mood states, costs, and benefits on helping.

263 college students participated in a factorial experiment designed to test the hypotheses that mood states interact with costs and with benefits in determining helping. Positive and negative mood states were induced by varying the difficulty of a bogus aptitude test; neutral-mood (control) Ss did not take the test. Benefits for helping were manipulated by asking Ss to collect donations for a worthwhile charity (the American Cancer Society) or to a less worthwhile charity (Little League baseball). In the high-costs-for-helping condition, Ss were asked to collect donations by going door to door, whereas in the low-cost condition, Ss were asked to sit at donations desks. Pretests indicated that the manipulations effectively induced the intended mood states, costs, and benefits. The results generally support the hypotheses. Positive-mood Ss volunteered more than neutral-mood Ss, and whether negative-mood Ss volunteered more or less than neutral-mood Ss depended on the costs and benefits. It is suggested that the seemingly conflicting results of previous investigations of negative mood and helping can be explained by interactions of mood states with costs and with benefits. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.     

Explaining the enigmatic anchoring effect: Mechanisms of selective accessibility.

Results of 3 studies support the notion that anchoring is a special case of semantic priming; specifically, information that is activated to solve a comparative anchoring task will subsequently be more accessible when participants make absolute judgments. By using the logic of priming research, in Study 1 the authors showed that the strength of the anchor effect depends on the applicability of activated information. Study 2 revealed a contrast effect when the activated information was not representative for the absolute judgment and the targets of the 2 judgment tasks were sufficiently different. Study 3 demonstrated that generating absolute judgments requires more time when comparative judgments include an implausible anchor and can therefore be made without relevant target information that would otherwise be accessible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a stroke protocol on hospital costs of stroke patients

OBJECTIVE: To determine the impact of a protocol on hospitalization costs for patients admitted with stroke. DESIGN AND SETTING: Nonrandomized control trial in an urban community hospital with 376 beds. PATIENTS: All patients admitted with a diagnosis-related group code of 014 (cerebrovascular disease) were included (N = 390). Patients with subdural hematoma (N = 2) or subarachnoid hemorrhage (N = 2) were excluded. INTERVENTION: A protocol for treatment of acute stroke was developed that included a critical path for nursing care, an algorithm for emergency department care, and suggested admission orders for physicians. MAIN OUTCOME MEASURES: The hospital information system computer database was searched for hospitalization charges, length of stay, tests performed, and treatments provided. RESULTS: Patients treated with the protocol had lower charges compared with historical (p = 0.026) and concurrent (p = 0.02) control groups. Lower charges were accounted for by a decreased length of stay in the protocol group compared with historical (p = 0.001) and concurrent (p = 0.13) controls. Tests and treatments provided were similar except that carotid Doppler studies and deep venous thrombosis prophylaxis were more frequently done in those treated with the protocol (p = 0.001 for carotid Doppler and p = 0.026 for deep venous thrombosis prophylaxis). There were no differences in outcome measures such as death or discharge disposition. Medical complications were similar in all groups. CONCLUSIONS: There were significant savings in hospitalization cost for patients with acute stroke after introduction of a treatment protocol. These savings were almost entirely related to decreased length of stay. The protocol led to modest differences in tests ordered and treatments provided.     

Effects of negation and situational presence on the accessibility of text information.

In 2 experiments, participants read narratives containing a color term that was mentioned either within the scope of an explicit negative or not, and with the described situation being such that the color was either present or not. Accessibility of the color term was measured by means of a probe-recognition task either 500 ms (Experiment 1) or 1,500 ms (Experiment 2) after participants read the sentence mentioning color. After the 500-ms delay, the accessibility of the color term was influenced by the structure of the sentence. After the 1,500-ms delay, the accessibility was influenced by the content of the described situation. These results are consistent with the view that comprehenders construct a linguistic representation of the text as well as a situation model in which only present properties are represented. An alternative account, according to which comprehenders only construct a perceptual simulation of the described situation, is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of environment on growth, efficiency of feed utilization, carcass fatness, and their association

The effects of environmental factors (house type, temperature, and type of watering system) on gain (G), feed consumption (FC), feed conversion (FCR), accumulation of abdominal fat (AF), and the association between FCR and AF of broilers were studied in a series of seven experiments. In addition, the adjustment of broilers to new housing environments and the factors affecting this adjustment were evaluated. The 4- to 7-wk G and FC were greater in groups raised at 21.1 C than 26.7 C. There were no consistent effects of environmental temperature on FCR (significantly reduced in 21.1 C groups compared with the 26.7 C groups in two of four trials) or in AF (significantly greater in 21.1 C groups than in 26.7 C groups in one of four trials). Environmental temperatures had no consistent effect on the relationship between FCR and AF. Both waterer types and environmental temperature affected the adjustment of broilers to placement in individual cages. Adjustment was better (less mortality and shorter periods of reduced FC) in the 21.1 C environment and when cup instead of trough waterers were provided. The 4- to 6-wk G and FC were reduced in the caged birds compared with the floor pen birds, but the FCR and AF were not consistently different. The initial (4-wk) BW significantly affected the 6-wk BW, G, FC, and FCR, but was not correlated with AF.     

Visual selective attention and reading efficiency are related in children

We investigated the relationship between visual selective attention and linguistic performance. Subjects were classified in four categories according to their accuracy in a letter cancellation task involving selective attention. The task consisted in searching a target letter in a set of background letters and accuracy was measured as a function of set size. We found that children with the lowest performance in the cancellation task present a significantly slower reading rate and a higher number of reading visual errors than children with highest performance. Results also show that these groups of searchers present significant differences in a lexical search task whereas their performance did not differ in lexical decision and syllables control task. The relationship between letter search and reading, as well as the finding that poor readers-searchers perform poorly lexical search tasks also involving selective attention, suggest that the relationship between letter search and reading difficulty may reflect a deficit in a visual selective attention mechanisms which is involved in all these tasks. A deficit in visual attention can be linked to the problems that disabled readers present in the function of magnocellular stream which culminates in posterior parietal cortex, an area which plays an important role in guiding visual attention.     

Effects of hospital downsizing on surviving staff

BACKGROUND/OBJECTIVE: Current albumin solders for tissue-welding are soluble in physiological fluids, prior to laser irradiation. These solders are therefore subjected to mechanical alterations, which can weaken the solder-tissue repair. In this study, an albumin solder (laser activated) was developed with low solubility and with the ability to retain (partially) its mechanical characteristics in saline solution. STUDY DESIGN/MATERIALS AND METHODS: Gauged protein samples of solder were immersed into 0.5 ml saline solution for fixed intervals of time. The solder samples contained four bovine serum albumin (BSA) concentrations: 56%, 66%, 70%, and 75% (by weight). A Bradford protein assay measured the BSA solubility of the solders. The 70% and 75% BSA solders were also used to weld in vitro Wistar rat intestine sections with a diode laser (lambda = 810 nm, power = 270 mW). RESULTS: The solubility of the 75% BSA solder was significantly decreased with respect to the other solders (Anova, P < 0.05). This solder also showed comparable weld strength (13 gm) to the 70% BSA solder. CONCLUSION: The 75% BSA solder strongly reduced the albumin solubility in saline solution, without affecting its tissue-welding properties.     

Effects of the PIPC model on outcome measures of productivity and costs

The purpose of this experimental research was to determine the effects of the Partners in Care Practice Model (PIPC) on the outcomes of productivity and costs. Over an 18-month study period, no significant differences were found in costs per patient day between the pilot and control units; however, significant differences were found in actual salaries, amount of time spent in documentation, and supply costs. Differences in costs and productivity reflected increased training costs and costs for additional supplies on the pilot unit.     

Repression, accessibility, and the translation of private experience.

This article explores two underlying assumptions of the structural deficits approach to psychoanalytic psychotherapy (e.g., Gedo, 1984; Kohut, 1984); (a) that the analyst must gain a knowledge of the patient's intrapsychic capacities through empathetic processes, and (b) that inaccessible memories are split off or repressed from expression within the analytic hour because the patient lacks the adequate intrapsychic capacities and structures to tolerate their associated affects. These assumptions are discussed within the context of contemporary views of multiple modes or forms of memory, repression, and the question of accessibility. It is concluded that the mechanisms of repression can operate at the stages of initial encoding as well as the retrieval stage and, consequently, that traumatic memory contents appearing to be relatively inaccessible may be so (a) because of active repression at the time of retrieval or (b) because a minimal number of associative connections have been established with other contents in memory. Thus, a greater portion of private experience is preconsciously available than would be suggested by the deficits approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of reward and response costs on inhibition in ADHD children.

This study examined effects of reward and response costs on the ability of 19 attention-deficit hyperactivity disorder (ADHD) and 17 control children to inhibit responding. Children were tested under 4 reinforcement conditions on a go/no-go learning task developed by J. P. Newman, C. S. Widom, and S. Nathan (1985). Two conditions involved both reward and response costs, 1 response costs only, and 1 reward only. ADHD children made more commission errors than controls across the 4 conditions. Analyses of learning curves indicated that group differences became larger on later trials. Thus, impaired inhibition was more generalized in ADHD children than in the psychopaths and extraverts studied by Newman and colleagues, and it became most evident when the children were required to improve learning across trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs

OBJECTIVE: The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program. METHOD: The patients (N = 197) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient, day hospital, and outpatient services provided by the CMHC. RESULTS: On average, the day hospital/crisis respite program cost less than inpatient hospitalization. The average saving per patient was +7,100, or roughly 20% of the total direct costs. There were no significant differences between programs in service utilization or costs during the follow-up phase. Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorders, and dual diagnoses; psychotic patients had the highest costs in both programs. The two programs had roughly equal direct service staff and capital costs but significantly different operating costs (day hospital/crisis respite operating costs were 51% of inpatient hospital costs). CONCLUSIONS: The programs were equally effective, but day hospital/crisis respite treatment was less expensive for some patients. Potential cost savings are higher for nonpsychotic patients. Cost differences between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service staff costs in the two programs may be an important clue for understanding why these programs provided equally effective acute care.     

加强矿山工程承包管理提高安全综合治理水平——矿山企业工程承包管理问题的探讨

安全生产是基本国策,矿山是高危行业,安全生产尤为重要,矿山安全事故多发生在采矿、掘进和剥离等作业环节.由于市场经济和企业股份多元化的推进,矿山采掘工程对外承包被广泛推广,项目单位可以减少大量投资,又可以利用社会力量,其管理工作必将发生转变与调整,如何搞好甲乙双方的合作,又能发挥工程承包的作用,保证安全生产,结合多年工作经验和管理中存在的问题,对工程承包施工企业深化管理进行了归纳和评述,可为其他矿山提供借鉴.     

Effects of market position and competition on rural hospital closures

OBJECTIVE: To examine the dynamic effects of competition and hospital market position on rural hospital closures. DATA SOURCE/STUDY SETTING: Analysis of all rural community hospitals operating between 1984 and 1991, with the exception of sole-provider hospitals. Data for the study are obtained from four sources: the AHA Annual Surveys of Hospitals, the HCFA Cost Reports, the Area Resource File, and a hospital address file constructed by Geographic Inc. DATA COLLECTION AND ANALYSIS: Variables are merged to construct pooled, time-series observations for study hospitals. Hospital closure is specified as a function of hospital market position, market level competition, and control variables. Discrete-time logistic regressions are used to test hypotheses. PRINCIPAL FINDINGS: Rural hospitals operating in markets with higher density had higher risk of closure. Rural hospitals that differentiated from others in the market on the basis of geographic distance, basic services, and high-tech services had lower risks of closure. Effects of market density on closure disappeared when market position was included in the model, indicating that differentiation in markets should be taken into account when evaluating the effects of competition on rural hospital closure. CONCLUSIONS: Our findings suggest that rural hospitals can reduce competitive pressures through differentiation and that accurate measures of competition in geographically defined market areas are critical for understanding competitive dynamics among rural hospitals.     

0加强矿山工程承包管理 提高安全综合治理水平——矿山企业工程承包管理问题的探讨

安全生产是基本国策,矿山是高危行业,安全生产尤为重要,矿山安全事故多发生在采矿、掘进和剥离等作业环节。由于市场经济和企业股份多元化的推进,矿山采掘工程对外承包被广泛推广,项目单位可以减少大量投资,又可以利用社会力量,其管理工作必将发生转变与调整,如何搞好甲乙双方的合作,又能发挥工程承包的作用,保证安全生产,结合多年工作经验和管理中存在的问题,对工程承包施工企业深化管理进行了归纳和评述,可为其他矿山提供借鉴。     

Competition in the NHS internal market: an overview of its effects on hospital prices and costs

Two-year stability coefficients were computed for several measures of borderline personality disorder within a nonclinical sample (n = 65) that included individuals with significant borderline features. Overall, the stability coefficients were modest (r ranging from .28 to .62; intraclass correlations ranging from .26 to .62). Stability values for each of the self-report measures under study were higher than those for the interview-based measure of BPD features, and, in some cases, these values varied as a function of the prototypicality of the subsamples examined. Analyses conducted to identify moderator effects provided no evidence that the stability of BPD scores was moderated by change in personal distress level; however, changes in BPD self-report scores were related to changes in level of negative affectivity.     

APA guidelines on physical and social accessibility.

These guidelines state the policy of the American Psychological Association (APA) regarding persons with disabilities, bring the following goals to the attention of APA members, and urge them to implement these goals as rapidly as possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)