The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.

Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.

The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes.

OBJECTIVE: To explore the relationship between marital relationship domains (i.e., intimacy and adjustment) and glycemic control and psychosocial adaptation to diabetes. RESEARCH DESIGN AND METHODS: A total of 78 insulin-treated adults with both type 1 and type 2 diabetes were assessed on a single occasion. They completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) and four quality-of-life measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey, Problem Areas in Diabetes Scale, and Positive and Negative Affect Scale). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical conditions, family history, disability, and years of education) were gathered from the chart and questionnaires. RESULTS: Concerning psychosocial adaptation, both of the marital quality measures were predictors of aspects of adaptation. Better marital satisfaction was related to higher levels of diabetes-related satisfaction and less impact, as well as less diabetes-related distress and better general quality of life. Higher levels of marital intimacy were related to better diabetes-specific and general quality of life. Concerning glycemic control, there was a nonsignificant trend for marital adjustment scores to relate to HbA(1c) (P = 0.0568). CONCLUSIONS: For insulin-treated adults with diabetes, quality of marriage is associated with adaptation to diabetes and other aspects of health-related quality of life. The suggestive finding that marital adjustment may relate to glycemic control warrants further study. Future work should also explore the impact of couples-focused interventions on adaptation, adherence, and glycemic control.

Obesity, disease, and functional limitation in later life.

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.

Nursing home entry in Germany and the United States.

This paper investigates the transition into a nursing home in old age, using recent panel survey data from Germany and the United States. Among the questions addressed are: what is the incidence of nursing home entry, and how does it vary by age and sex; and to what extent are differentials in nursing home entry attributable to variations in family composition? Although the percentage of older persons living in nursing homes is similar in these two countries, the age-specific rates of movement into them appear to be much lower in Germany than in the USA, possibly due to the effects of public policies. The correlates of nursing home entry appear to be similar across countries as well, although data limitations limit our ability to make definitive comparisons.

Riluzole preserves motor function in a transgenic model of familial amyotrophic lateral sclerosis.

Riluzole was tested in a dose-ranging study for preservation of motor function in a transgenic mouse model of familial ALS. The model is based on expression of mutant human Cu,Zn superoxide dismutase in mouse brain and spinal cord. In contrast with the human ALS trials, in the mouse model, riluzole significantly preserved motor function as assessed by nightly running in a wheel. The effect of riluzole on motor performance was greater earlier in disease than later, suggesting that riluzole may have benefit for "quality-of-life" measures in ALS. Treatment with riluzole was initiated earlier in the transgenic model than in the human ALS trials, which may account for the significantly better outcome.

The influence of caregiving and employment on the voluntary activities of midlife and older women.

One factor thought to contribute to higher levels of stress among caregivers is the restriction on personal time and leisure activities that they feel. We use data from the National Survey of Families and Households (NSFH) to examine the influences that caregiving, the relationship of the care-recipient with the caregiver, and the intensity of the caregiving have on women's participation in personal, family-centered, and community activities. We find that care-giving regardless of age, does not reduce the frequency of participation in voluntary activities. In fact, among younger women, some types of caregiving are associated with significantly higher levels of participation. Based on our results, we conclude that caregiving does not necessarily result in a "loss of self." Caregivers may be using outside activities as a way to relieve the stress of the caregiving tasks; caregivers may be particularly adept at balancing roles, or most caregiving may not be at a level of intensity sufficient to interfere with other activities.

PNU-96415E, a potential antipsychotic agent with clozapine-like pharmacological properties.

The atypical antipsychotic drug clozapine interacts with multiple transmitter systems, among them the D4 subtype of dopamine receptors. PNU-96415E is chemically unrelated to clozapine and has its highest binding affinity for the D4 and 5-HT2A receptors. In comparison to clozapine, PNU-96415E is weaker in binding to D1, D2, alpha1 and muscarinic receptors. PNU-96415E inhibited exploratory locomotor activity in mice and rats, and antagonized d-amphetamine-induced locomotor stimulation in rats. It antagonized apomorphine-induced cage climbing, and blocked head and body twitch produced by 5-HTP in mice. Like clozapine, but unlike haloperidol, PNU-96415E did not antagonize stereotypic behaviors produced by a high dose of d-amphetamine or methylphenidate in rats and mice. PNU-96415E blocked conditioned avoidance in rats but produced no catalepsy, a pattern similar to clozapine but different from haloperidol. In rats trained to discriminate clozapine from saline injections, the stimulus effect generalized completely with PNU-96415E, but not haloperidol. This profile of pharmacological activities is consistent with that of an atypical antipsychotic and, as in the case with clozapine, the behavioral effects of PNU-96415E cannot be ascribed to a single receptor mechanism.

Living arrangements of minority elders.

We used 1990 census data to examine differences in the current living arrangements of minority elderly. We found that differences among the minority populations in age, sex, and marital status account for only a small part of the observed differences in living arrangements. However, while minority groups as a whole differ substantially from the White population, national ethnic patterns within groups appear to be relatively small. Hispanic ethnic groups vary little once differences in marriage patterns are taken into account, although differences are greater within the Asian population.

Apomorphine produced more yawning in Sprague-Dawley rats than in F344 rats: a pharmacological study.

Apomorphine induced yawning in both Sprague-Dawley and F344 rats in the same dose range, but F344 rats emitted only about 1/4 as many yawns as did Sprague-Dawley rats. At higher doses, rats of both strains exhibited stereotypic behavior with a comparable intensity. Pretreatment with either SCH 23390 [R(+)-8-chloro-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-3-benzazepine-7-o l] or pindolol increased apomorphine-induced yawning further in Sprague-Dawley rats, but had little effect on the low yawning score produced by apomorphine in F344 rats. The low yawning response to apomorphine in F344 rats is, therefore, not due to a high baseline dopaminergic or adrenergic activity. Apomorphine-induced yawning in F344 rats was increased after an acute injection of physostigmine, or 24 h after an injection of reserpine. It is postulated that a low baseline cholinergic activity in F344 rats may be responsible, in part, for their lower yawning response to dopaminergic receptor stimulation.

Age patterns of mortality and cause-of-death structures in Sweden, Japan, and the United States.

This paper uses a new standard model of adult mortality to compare the mortality patterns of Swedes, Japanese, and U.S. whites between 1950 and 1985. It examines changes in the age patterns of mortality and the cause-of-death structures within the populations, and the relationships between those two factors. As Japan has reached a level of mortality similar to that in Sweden, the age patterns of mortality in the two populations have become more similar despite distinct differences in causes of death. The United States has a cause-of-death structure similar to that of Sweden, but the age pattern of mortality is very different. High mortality in the middle age range in the United States results in approximately a one-year loss of life expectancy at age 45 in comparison with Sweden.

Differences in the use of health services by metropolitan and nonmetropolitan elderly.

This study examined the importance of place of residence on the elderly's use of health services through Andersen's framework of health service utilization. The study found that nonmetropolitan elderly, both farm and nonfarm, make fewer physician visits than their metropolitan counterparts. This difference is not explained by differences in their predisposing or need characteristics. No residential differences were found in the number of short-term hospital stays or in the number of days of bed disability. No evidence was found that nonmetropolitan elderly substitute days of bed disability for physician care or for hospital stays. Also, little residential variation was found in the effect of predisposing, enabling, and need factors on physician use. The most likely explanation for the observed differences in physician use is the shortage of physicians in nonmetropolitan areas. However, without the ability to attach contextual information to national data on health status and service use, the relative importance of access to services cannot be adequately addressed.

Antagonism of hypothermia produced by benzodiazepine-related compounds by U-78875 in mice.

The benzodiazepine receptor agonists, flurazepam, zolpidem, ZK 93423, and the benzodiazepine inverse agonist, FG 7142, all produced hypothermia when injected i.p. in mice. These compounds are structurally different and do not have the same affinity for the GABAA/benzodiazepine receptor subtypes. Pretreatment with flumazenil (30 mg/kg) completely blocked the hypothermia produced by flurazepam (30 mg/kg), zolpidem (3 mg/kg), and FG 7142 (60 mg/kg), only partially reversed ZK 93423 (3 mg/kg), and was ineffective against 10 mg/kg zolpidem. In comparison, 3 mg/kg of U-78875 completely antagonized all these benzodiazepine agonists. When injected before 30 mg/kg pentobarbital, U-78875 (3 mg/kg) slightly enhanced and prolonged the hypothermic effect of pentobarbital, while flumazenil had very little effect. The results show that U-78875 is a potent antagonist against benzodiazepine receptor agonists, while having demonstrable intrinsic activity.

Future caregivers: projected family structures of older persons.

Elderly persons depend upon spouses and children for emotional, physical, and financial support. In particular, the use of institutional long-term care has been shown to vary by family status. Changes in past and future levels of mortality, fertility, marriage, and divorce will influence the probability that elderly persons of the future have surviving spouses and children. This research uses multiple decrement life tables and component projection methods to project the future family status of elderly persons until the year 2020. The high level of fertility among women during the 1950s will result in greater proportions of future elderly persons having surviving children. Declines in mortality, coupled with increases in rates of marriage, increase the probability that both men and women will have spouses surviving in their old age.

An overview of demographic analysis as a method for evaluating census coverage in the United States.

"Since the 1950 U.S. census, demographic methods based on the fundamental balancing equation of demography have played an important role in the evaluation of the census net undercount. Application of this set of methods, called demographic analysis, results in national estimates of the net undercount for age-race-sex groups. Although results of demographic analysis are readily available in Bureau of the Census publications, the procedures used to estimate each of the components of population change are less well-known. In this paper we review the historical foundation of demographic analysis, beginning with Coale's 1950 census evaluation project and concluding with the recent evaluation of the 1990 census. We examine each of the components of the method, how their estimation has changed over time, and how they were estimated for the 1990 census."

Behavioral effects of U-78875, a quinoxalinone anxiolytic with potent benzodiazepine antagonist activity.

U-78875 (3-(5-cyclopropyl-1,2,4-oxadiazol-3-yl)-5-(1-methylethyl) imidazo[1,5-a]-quinoxalin-4(5H)-one) is a chemically novel compound with a high affinity for the benzodiazepine receptors. It has anticonflict effects in both the Vogel and Cook-Davidson models of anxiety, with a potency similar to that of diazepam (1-3 mg/kg, i.p.). In unanesthetized rats implanted with cortical electrodes for EEG recording, i.p. injections of U-78875 (3-10 mg/kg) increased the EEG power density in frequencies above 12 Hz, and decreased EEG power at lower frequencies. This EEG effect is similar to that of diazepam, and was completely antagonized by pretreatment with flumazenil. In animal models measuring central nervous system depression, U-78875 is much weaker than diazepam. It produced minimal impairment of rotarod performance in rats at doses up to 30 mg/kg, but at lower doses completely reversed the impairment from 10 mg/kg of diazepam. In rats trained to avoid shocks in a shuttle box, U-78875 (3-10 mg/kg) increased avoidance responses and antagonized the suppression of avoidance from diazepam (10 mg/kg). In the mouse one-trial passive avoidance task, pretreatment with U-78875 (1-10 mg/kg) before training produced no anterograde amnesia, but completely blocked the amnesic effect from diazepam (10 mg/kg). The diazepam antagonist potency for U-78875 is 10 to 100 times that of flumazenil. This unusual profile of mixed agonist/antagonist activities suggests U-78875 to be a unique anxiolytic agent with a minimum of central nervous system depression.

Demographic conditions responsible for population aging.

This article develops and applies two expressions for the rate of change of a population's mean age. In one, aging is shown to be negatively related to contemporary birth rates and death rates. In a general sense, aging occurs when vital rates are too low, as illustrated through applications to the United States, the Netherlands, and Japan. The other expression relates the rate of aging to a population's demographic history, in particular to changes in mortality, migration, and the annual number of births. Applications to the United States and Sweden show that the dominant factor in current aging in these countries is a history of declining mortality. Migration also contributes significantly but in opposite directions in the two countries. The two approaches are integrated after recognizing that the rate of change in the mean age is equal to the covariance between age and age-specific growth rates. A decomposition of this covariance shows that the two seemingly unrelated expressions contain exactly the same information about the age pattern of growth rates.