Statistical versus clinical prediction: Length of neuropsychiatric hospital stay.

Statistical and clinical prediction methods are compared in a "field" situation, predicting patient stay in a psychiatric hospital. 5 statistical methods from a previous report averaged 71.92% accuracy on the cross-validation sample. 12 clinicians predicting independently in the same hospital over the following 18-mo period achieved an average accuracy of 71.94% on 499 patient predictions. Summaries of the clinicians' reasons for their judgments show some differences between the most and least accurate judges. Neither professional background nor years of professional experience of clinicians was related to predictive accuracy. Actuarial and clinical prediction were not demonstrably different in accuracy. Practical and economic aspects of this prediction problem favor clinical prediction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients in Norwegian hospitals. Length of stay and patterns of use

All 633,987 periods of admission to Norwegian general hospitals in 1991 were analyzed. The length of stay increases considerably with the patient's age. 80-year old patients stay three times as long in hospital as five-year old patients. The typical surgical patient requires 56% more resources than the typical medical patient. For surgical patients, the mean length of stay was 7.2 days, and for medical patients it was 6.8 days. Patients in the age group 70-79 years require almost twice as much resources as the youngest patients. Patients up to the age of 65 who live in a municipality where there is a hospital stay in hospital just as long as corresponding patients from municipalities without a hospital. For older patients there are significant differences in length of stay for these two categories of patients. The discharge rate for men of 70 years and older is significantly higher than the rate for women in the same age group, but the women stay longer in hospital.     

Damage control for urologic injuries

Damage control techniques are applicable to a wide range of urologic injuries. When it is determined that the patient's condition requires that additional reconstructive efforts be delayed to a subsequent operative procedure, various temporizing procedures may be instituted for urinary tract injuries, including externalized stenting and drainage. Successful institution of the damage control approach requires close communication and cooperation between the general surgery trauma team and the surgical subspecialists involved in the patient's care.     

Length of stay, neuropsychological performance, and aftercare: Influences on alcohol-treatment outcome.

Hypothesized that 245 alcohol-abusing male veterans, grouped according to levels of neuropsychological functioning, would have differential outcome following random assignment to 2- or 7-wk hospitalization in a milieu-oriented treatment program. Over the 9 mo of posthospitalization follow-up, there was significant improvement for the sample as a whole. However, outcome following 2- and 7-wk programs did not differ significantly. Neuropsychological performance was significantly but modestly related to some outcome criteria (e.g., abstinence rates and employment status), but no consistent interaction with length of stay was found. The most salient finding was the strong relationship of aftercare involvement (which was analyzed as a covariate) to most outcome criteria. Ss who attended weekly aftercare groups for 9 mo following hospitalization were 3 times more likely to remain abstinent than Ss who dropped out of aftercare (70.2 vs 23.4% abstinence, respectively). Implications for individualizing alcohol treatment and conducting future research on patient–treatment matching are discussed. (59 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of nuclear morphometry to predict prognosis in pediatric urologic malignancies: a review

Wilms tumor, the most common pediatric urologic malignancy, and genitourinary rhabdomyosarcoma, the most common soft tissue sarcoma of childhood, represent two of the most commonly diagnosed pediatric urologic malignancies. The introduction and use of multimodal therapy (surgery, radiation, and chemotherapy) by the National Wilms Tumor Study (NWTS) and the Intergroup Rhabdomyosarcoma Study (IRS) groups have greatly improved the survival among children with these malignancies. Present survival rates for Wilms tumor exceed 85% and for rhabdomyosarcoma survival rates are approaching 80% as well. For Wilms tumor, current treatment trends suggest less intense therapy for those children with favorable histology tumors who are considered at relatively low risk for tumor recurrence. Likewise, the significant morbidity associated with the present therapy regimens for rhabdomyosarcomas has prompted investigators to search for individualized management schemes for children with a high probability of responding. The need for accurate criteria to separate these high and low risk groups becomes imperative. In this review we present our work using nuclear morphometry, as a prognostic indicator, to retrospectively predict response to therapy for children with Wilms tumors and genitourinary rhabdomyosarcomas.     

General pediatricians, pediatric subspecialists, and pediatric primary care

OBJECTIVE: To assess the respective roles of general pediatricians and pediatric subspecialists in the provision of primary pediatric care. DESIGN AND METHODS: A practice characteristics questionnaire that included questions about primary care was sent to a random sample of 1616 board-certified and board-eligible active Fellows of the American Academy of Pediatrics; 1145 (70.9%) responded. Analyses pertain to those pediatricians who provided ambulatory patient care and were not in graduate medical education training at the time of the survey. Respondents were divided into 2 groups for purposes of analysis: the 527 pediatricians whose practice was primarily in general pediatrics (defined as 80% of time spent in general pediatrics or any time spent in adolescent medicine) and the 213 pediatricians whose practice was subspecialty focused (all others). These groups were then further stratified according to whether they provided primary care. The resultant subgroups contained 518 general pediatricians and 98 subspecialists who provided primary care. RESULTS: Among the entire sample, general pediatricians indicated that general pediatricians provide 93% of the primary care delivered by their practice and that pediatric subspecialists provide 2% of the primary care. In contrast, pediatric subspecialists reported that general pediatricians provide 53% of the primary care delivered by their practice and that subspecialists provide 32% of such care (P<.001). Among the subsample of pediatricians who provide primary care, general pediatricians reported delivering 88% of the primary care received by their patients and subspecialists reported delivering 74% of the primary care received by their patients (P<.001). CONCLUSION: Perspectives on the degree to which pediatric subspecialists provide primary pediatric care vary depending on generalist vs subspecialist self-identification.     

Monitoring in the system of specialized medical care management (exemplified by the study of burns--specialized care for burn victims)

Technological revolution involves an increased risk of negative impact of adverse factors on human health in the whole world. The authors analyze the tendencies of burn traumas incidence in Russia in the latest decade. They necessitate creation in each district of centers for monitoring burnt patients, which should be engaged in registration of burn traumas, organization of emergency care and specialized outpatient and inpatient care, medical and sociopsychological rehabilitation of the victims.     

Ongoing challenges in pediatric hospice care

Reports have begun to proliferate throughout the world which describe various models of pediatric hospice care. While encouraging, these reports identify universal obstacles that continue to compromise effective care. Challenges persist in areas of pain management, medical ethics, program administration, cost analysis, staff development and bereavement follow-up. Cooperative efforts are encouraged to address these issues.     

Length of stay and program component effects in the treatment of alcoholism: A comparison of two techniques for process analyses.

Evaluated the effects of length of treatment and specific treatment components (therapy sessions, Alcoholics Anonymous meetings, and films and lectures on alcoholism) of 3 residential alcoholism programs. Two statistical techniques—partial correlation and treatment-effect correlation—were compared for their estimates of treatment effects after controlling for patient background characteristics and functioning at intake. Longer periods of treatment were associated with better outcome for the 59 residents of a halfway house but not for the 92 patients at a milieu-oriented program or the 97 males at a Salvation Army center. Evidence suggest that the 3 program components tended to have moderately beneficial effects on outcome, although the results varied in some cases, depending on whether partial or treatment-effect correlation was used in the analysis. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosing pediatric epilepsy: an update for the primary care clinician

Epilepsy is a chronic disorder that first appears in childhood. Seizure types and presentation vary from dramatic and obvious to subtle and discrete. Accurate identification of the seizure type is imperative to ensure proper disease management. The International league Against Epilepsy has developed two classification systems--the classification of Epileptic Seizures and the classification of Epilepsies and Epileptic Syndromes--to assist in the provision of an International language of epilepsy, to improve the diagnosis and management of seizures, and to establish prognostic criteria. Knowledge of the classification systems of seizures, seizure types, and management of seizures is essential in the delivery of health promotion, disease prevention, and anticipatory guidance for the child with epilepsy. The primary care practitioner is often the first person consulted when medical questions or problems arise, and therefore is in a key position to detect seizures, monitor treatment, and educate the family. A comprehensive knowledge of pediatric epilepsy will allow the practitioner to provide the additional resources needed to coordinate the care of this special population.     

Problems with resistance in pediatric intensive care

Antibiotic resistance in the neonatal and pediatric intensive care environments has not been rigorously investigated. There is reason to believe that the epidemiology of antibiotic resistance in these settings may be different from that in other hospital settings because the patients' preadmission health status, the maturity of their immune systems, and their outpatient exposure to antibiotics are different from those seen in adults. At the present time, the areas of greatest concern are the outbreaks of infection caused by methicillin-resistant Staphylococcus aureus in the neonatal ICUs and the emergence of antibiotic-resistant Gram-negative bacteria in pediatric intensive care units (PICU). In the former, colonization and transmission by nursery personnel remains one of the great challenges in infection control. In the latter, new information is emerging which challenges the notion that antibiotic-restriction policies might be an effective means for modulating the emergence of antibiotic-resistant Gram-negative pathogens in the pediatric intensive care environment. It appears that these organisms are largely imported into the ICU from the community and are not a result of antibiotic practices within the unit itself. This observation requires that strategies to control these organisms in the PICU be reassessed.