Impact of home care on hospital days: a meta analysis

OBJECTIVE: To examine the impact of home care on hospital days. DATA SOURCES: Search of automated databases covering 1964-1994 using the key words "home care," "hospice," and "healthcare for the elderly." Home care literature review references also were inspected for additional citations. STUDY SELECTION: Of 412 articles that examined impact on hospital use/cost, those dealing with generic home care that reported hospital admissions/cost and used a comparison group receiving customary care were selected (N = 20). STUDY DESIGN: A meta-analytic analysis used secondary data sources between 1967 and 1992. DATA EXTRACTION: Study characteristics that could have an impact on effect size (i.e., country of origin, study design, disease characteristics of study sample, and length of follow-up) were abstracted and coded to serve as independent variables. Available statistics on hospital days necessary to calculate an effect size were extracted. If necessary information was missing, the authors of the articles were contacted. METHODS: Effect sizes and homogeneity of variance measures were calculated using Dstat software, weighted for sample size. Overall effect sizes were compared by the study characteristics described above. PRINCIPAL FINDINGS: Effect sizes indicate a small to moderate positive impact of home care in reducing hospital days, ranging from 2.5 to 6 days (effect sizes of -.159 and -.379, respectively), depending on the inclusion of a large quasi-experimental study with a large treatment effect. When this outlier was removed from analysis, the effect size for studies that targeted terminally ill patients exclusively was homogeneous across study subcategories; however, the effect size of studies that targeted nonterminal patients was heterogeneous, indicating that unmeasured variables or interactions account for variability. CONCLUSION: Although effect sizes were small to moderate, the consistent pattern of reduced hospital days across a majority of studies suggests for the first time that home care has a significant impact on this costly outcome.     

Housing Singapore's frail elderly in the next millennium

This paper looks at the design of housing for an ageing population in the coming years, particularly the frail elderly, and at criteria which an architect would need to apply to provide for their social needs and various physical disabilities which may accompany old age. Recent local and overseas initiatives in providing special housing for elderly people are discussed and some proposals are made for more universal solutions, in the form of "lifetime homes".     

The role of nitric oxide in inhibitory neurotransmission in the middle cerebral artery of the sheep

We examined the pregnancy outcome of 112 women classified as minor degrees of glucose intolerance (MDGI) in pregnancy in a screening program based on Carpenter and Coustan's criteria. The MDGI group comprised 49 women with abnormal oral glucose challenge test (OGCT) followed by normal OGTT (group A), and 63 with "borderline" OGTT (1 abnormal value, group B). No treatment was offered to 88 MDGI women, while 26 received dietary advice and metabolic monitoring. A control group was constituted from 112 age- and BMI-matched negative screenees. Similar rates of cesarean sections and macrosomia, but higher rate of large for gestational age (LGA) babies (25.9% vs 14.3%) were found in MDGI, without difference between groups A and B. When comparing treated and untreated MDGI, lower LGA incidence (11.5% vs 30.2%) and no macrosomia were found in the former. In conclusion, untreated MDGI may present excessive fetal growth, which can be normalized by dietary treatment and metabolic monitoring.     

Toxic effects of deoxynivalenol on ribosomes and tissues of the spring wheat cultivars Frontana and Casavant

The toxic effects of the Fusarium graminearum trichothecene toxin deoxynivalenol were determined on ribosomes and leaf tissues of the fusarium head blight-resistant spring wheat cultivar Frontana and the susceptible spring wheat cultivar Casavant. The use of a poly-U-directed 14C-phenylalanine and deoxynivalenol ribosome-binding assays provided evidence of resistance to the protein-synthesis inhibition effects of deoxynivalenol in the head blight-resistant cultivar Frontana. This is probably due to the existence of a mutation in the peptidyl transferase. This cultivar also exhibited resistance to the membrane-damaging properties of this toxin compared to the other cultivar. This report summarizes the evidence for various kinds of "trichothecene tolerance" mechanisms in fusarium head blight-resistant wheat genotypes.     

Intron "sliding" and the diversity of intron positions

Alignments of homologous genes typically reveal a great diversity of intron locations, far more than could fit comfortably in a single gene. Thus, a minority of these intron positions could be inherited from a single ancestral gene, but the larger share must be attributed to subsequent events of intron gain or intron "sliding" (movement from one position to another within a gene). Intron sliding has been argued from cases of discordant introns and from putative spatial clustering of intron positions. A list of 32 cases of discordant introns is presented here. Most of these cases are found to be artefactual. The spatial and phylogenetic distributions of intron positions from five published compilations of gene data, comprising 205 intron positions, have been examined systematically for evidence of intron sliding. The results suggest that sliding, if it occurs at all, has contributed little to the diversity of intron positions.     

Bilateral posteroventral pallidotomy in advanced Parkinson's disease in three patients

In this report, we describe the effect of staged bilateral posteroventral pallidotomy in three patients with advanced Parkinson's disease who were all of the young-onset type. Two patients had developed response fluctuations after the use of levodopa, with severe hypokinesia, painful dystonia, and rigidity in the "off" phase and violent dyskinesias in the "on" phase. One patient, in a continuous hypokinetic rigid state, was totally unresponsive to dopaminergic medication. All were at Hoehn and Yahr stage 5 in the "off" phase before surgery. After surgery, the hypokinetic state was reversed and dyskinesias were abolished in all patients. Hoehn and Yahr stages were 3 in the "off" phase postoperatively. Overall functional improvement was marked and lasting after follow-up for 7, 12, and 13 months, respectively. Complications were visual field deficit and transient central facial paresis, both in the same patient. Bilateral posteroventral pallidotomy can ameliorate response fluctuations, hypokinesia, rigidity, and painful dystonia in advanced Parkinson's disease.     

Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer

BACKGROUND: The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care--anatomic lobectomy. METHODS: We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection (n = 42), video-assisted wedge resection (n = 60), and lobectomy (n = 117) to assess morbidity, recurrence, and survival differences between these approaches. RESULTS: There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having lobectomy (p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study (p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having lobectomy; p = 0.014). CONCLUSION: Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable "compromise" surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve.     

Glutathione levels in antigen-presenting cells modulate Th1 versus Th2 response patterns

Current thinking attributes the balance between T helper 1 (Th1) and Th2 cytokine response patterns in immune responses to the nature of the antigen, the genetic composition of the host, and the cytokines involved in the early interaction between T cells and antigen-presenting cells. Here we introduce glutathione, a tripeptide that regulates intracellular redox and other aspects of cell physiology, as a key regulatory element in this process. By using three different methods to deplete glutathione from T cell receptor transgenic and conventional mice and studying in vivo and/or in vitro responses to three distinct antigens, we show that glutathione levels in antigen-presenting cells determine whether Th1 or Th2 response patterns predominate. These findings present new insights into immune response alterations in HIV and other diseases. Further, they potentially offer an explanation for the well known differences in immune responses in "Th1" and "Th2" mouse strains.     

Evaluation of cottonseed meals prepared by extraction with acetone-hexane-water mixtures

Eleven cottonseed meals have been prepared by batch extractions of a given lot of cottonseed with various acetone-hexane-water mixtures using several different extraction schedules. These meals, together with eight meals of commercial origin and a commercial soybean meal, have been subjected to chemical evaluation and assayed for protein quality using the growing chick as a test animal. In general the acetone-hexane-water meals were superior to the commercial cottonseed meals for promoting the growth of the chicks and, considering all the meals, a linear correlation was obtained between the logarithm of the weight gains and the available lysine contents of the meals. The free and total gossypol contents of the cottonseed meals appeared to have little or no influence on the growth rates. Presented at the 52nd Annual Meeting of the American Oil Chemists' Society, St. Louis, Missouri, May 1–3, 1961. One of the laboratories of the Southern Utilization Research and Development Division, Agricultural Research Service, U. S. Department of Agriculture.     

Novel Sulfonated CNN Pincer Ligands for Facile C−H Activation at a Pt(II) Center

Two novel sulfonated CNN-pincer ligands 1b and 1c and the corresponding chloro and aqua complexes K[^CNNLPtCl] and ^CNNLPt(H₂O), 3b – 3c and 2b – 2c , were prepared and fully characterized including single crystal X-ray diffraction. Along with the previously described complexes 2a and 3a , the derivatives of a CNN pincer ligand 1a , these complexes form a family of structurally similar compounds where the pincer core rigidity increases in the series 2a (3a) < 2b (3b) < 2c ( 3c ), as deduced from their XRD data. The increased ligand rigidity affects the aqua ligand dissociation energy of the ^CNNLPt(H₂O) complexes, as it follows from DFT calculations and as is reflected in the increased reactivity of the aqua complexes 2a , 2b and 2c in processes that involve aqua ligand loss. Among these processes the formation of the presumed dinuclear complexes ^CNNL₂Pt₂ and, importantly, catalytic C−D bond cleavage in C₆D₆ were studied in 2,2,2-trifluoroethanol solutions. The C−D bond cleavage reactivity was quantified as the rate of H/D exchange between C₆D₆ and CF₃CH₂OH at 80 °C.