Milieu therapy: toward a definition for reimbursement

The authors identify certain essential elements and processes within the milieu therapy approach that could provide the basis for reimbursement of this treatment modality under insurance. They also examine a philosophical framework, various guidelines, and a mechanism for accountability in the use of this form of treatment.     

Peripheral arterial injuries: a reassessment

Ninety-four patients with peripheral arterial injuries were subjected to acute repair, negative exploration, or late repair of the complications of the arterial injury (false aneurysm, A-V fistula, and/or limb ischemia). The causes of failure after acute injury include extensive local soft tissue and bony damage, severe concomitant head, chest or abdominal wounding, stubborn reliance on negative arteriograms in patients with probable arterial injury, failure to repair simultaneous venous injuries, or harvesting of a vein graft from a severely damaged extremity. There is a positive correlation between non-operative expectant treatment and the incidence of late vascular complications requiring late arterial repair. Delayed complications of arterial injuries occurred most frequently in wounds below the elbow and knee.     

Clinical evaluation and noninvasive electroencephalography. Preoperative evaluation

Epilepsy surgery has been shown to be a safe and effective alternative to antiepileptic drug therapy for many patients with medical refractory partial seizure disorders. Surgical treatment should be considered when the patients experience and impairment in the quality of life related to the seizures, medical therapy, or both. Surgically remediable epileptic syndromes include medical temporal lobe epilepsy and lesional epilepsy. A comprehensive presurgical evaluation is performed to identify appropriate candidates for epilepsy surgery.     

A computerized method for assessment of musculoskeletal discomfort in the workforce: a tool for surveillance

A musculoskeletal discomfort survey was conducted to assess musculoskeletal discomforts among rural mail carriers in two post offices. Perceived musculoskeletal discomfort was collected directly from the workforce by means of a computerized discomfort assessment system (DAS). This investigation aimed at: (1) assessing the rural mail carrier's perception of DAS; and (2) assessing the rural mail carrier's musculoskeletal discomforts resulting from work. Most participants in the study found the computer tool easy to learn and easy to use. The information collected by DAS was used: (1) to determine the number of participating employees who were experiencing some kind of musculoskeletal problem; (2) to determine subtasks associated with discomfort; (3) to determine the body areas most affected by different subtasks; and (4) to investigate the patterns of discomfort that occurred with time.     

The prevalence and clinical impact of fibromyalgia in systemic lupus erythematosus

OBJECTIVE: To ascertain the prevalence of fibromyalgia syndrome (FMS) in systemic lupus erythematosus (SLE) and to evaluate its clinical impact and relationship to SLE disease activity. METHODS: A cross-sectional analysis of 102 patients from a public hospital SLE clinic. Information was obtained on symptoms of FMS, disability, tender points, pain thresholds, and SLE disease activity. RESULTS: Twenty-two SLE patients (22%) met the American College of Rheumatology criteria for FMS, and another 24 (23%) had clinical FMS but did not meet the classification criteria. The patients who met the criteria for FMS had a significantly increased frequency and severity of symptoms commonly associated with FMS, and were much more likely to be unable to perform daily activities. The FMS patients also were less likely to be employed, and more likely to be divorced and to be receiving welfare or medical disability benefits. However, patients with and those without FMS did not differ in measures of SLE activity. CONCLUSION: FMS is very common in SLE patients, and accounts for many of the symptoms and much of the disability in these patients.