Asunto(s)
Capitación , Honorarios y Precios , Estado de Salud , Salud , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Sistema de Pago Prospectivo/métodos , Anciano , Enfermedad Crónica , Recolección de Datos , Accesibilidad a los Servicios de Salud , Hospitales con 100 a 299 Camas , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , VermontRESUMEN
P6 an outpatient repeatedly sees the same practitioner, is his care influenced? This double-blind randomized trial examines the effects of outpatient health care provider continuity on the process and outcome of the medical care for 776 men aged 55 years and older. Participants were randomized to two different groups of provider care: provider discontinuity and provider continuity. The outcome of the continuity group was significantly different from that of the discontinuity group. During an 18-month period, patients who had been randomized to the continuity group had fewer emergent admissions (20% v 39%) and a shorter average length of stay (15.5 v 25.5 days). These patients also perceived that the providers were more knowledgeable, thorough, and interested in patient education. We conclude that continuity of outpatient provider care for men aged 55 years and older results in more patient satisfaction, shorter hospitalizations, and fewer emergent hospital admissions.
Asunto(s)
Atención Ambulatoria , Continuidad de la Atención al Paciente , Atención Primaria de Salud , Anciano , Atención Ambulatoria/estadística & datos numéricos , Comportamiento del Consumidor , Método Doble Ciego , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
Among the 17 offspring of a common father, overt adrenal and thyroid insufficiency developed in three brothers. In eight of the 12 siblings then examined, and also in one of the two mothers of this kindred, endocrine abnormalities were documented. Early compensated adrenal and thyroid hypofunction with organ-specific antibodies were found in asymptomatic relatives. Pernicious anemia, vitiligo, and alopecia were also seen. Age of clinical onset varied from 18 to 38 years. Familial investigations may identify asymptomatic persons at risk for the development of serious endocrine deficiencies.
Asunto(s)
Insuficiencia Suprarrenal/genética , Hipotiroidismo/genética , Adolescente , Glándulas Suprarrenales/inmunología , Adulto , Alopecia/genética , Anemia Perniciosa/genética , Autoanticuerpos/análisis , Humanos , Masculino , Linaje , Síndrome , Glándula Tiroides/inmunología , Vitíligo/genéticaRESUMEN
Coexistent sino-atrial and atrioventricular block with Wenckebach phenomenon is an extremely unusual cardiac arrhythmia. Observations on the natural history of sinus node dysfunction are rare. For over six years our elderly patient has been followed without symptoms but with increasing severity of atrio-ventricular block.