RESUMEN
Usually, most of the clients who are referred to departments of rehabilitation medicine, bear firm and sound diagnoses. We describe herewith 10 patients who developed spinal cord pathologies due to unknown or uncertain etiologies. We would like to share our thoughts with the readers.
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Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Anciano , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/fisiopatología , Resultado del Tratamiento , Incertidumbre , Adulto JovenRESUMEN
Mentally retarded people usually receive care in special social, vocational, behavioral or educational facilities. Only recently, we gained some experience in the rehabilitation after trauma of those with mental retardation. We presume that with the increasing awareness of the benefits of comprehensive and early rehabilitation after trauma, orthopedic surgeons, neurosurgeons, and physicians who work in intensive care units, refer more patients who had never before gained from this specialty. We would like to share our experience of the unique rehabilitation process of this population.
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Discapacidad Intelectual/complicaciones , Rehabilitación/métodos , Heridas y Lesiones/complicaciones , Heridas y Lesiones/rehabilitación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Adults with Osteogenesis Imperfecta (OI) are rarely referred to facilities of general rehabilitation medicine. Recently, two OI patients were admitted to our department because of additional neurological disabilities: stroke and spinal cord injury. In these circumstances, the hospitalization course has different characteristics.
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Personas con Discapacidad/rehabilitación , Osteogénesis Imperfecta/rehabilitación , Humanos , Enfermedades del Sistema Nervioso/rehabilitaciónRESUMEN
BACKGROUND: Little information is available about the survival, neurological recovery, and length of stay in hospital for rehabilitation (LOS) of patients with spinal neurological deficit following disc herniation (DH). STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To report on outcomes and factors affecting these. SETTING: The Spinal Research Laboratory, Loewenstein Rehabilitation Hospital, Israel. SUBJECTS: A total of 158 patients with DH spinal neurological lesions (DHSNL). METHOD: Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method; relative mortality risk by the Cox proportional hazard model. Neurological recovery was evaluated by calculating the change in Frankel grades, and factors that affect it were assessed by logistic regression. LOS associations were analyzed with ANOVA. RESULTS: The median age at lesion onset was 48 years, and the median survival 29 years. Age and gender had a significant effect on survival, but not so lesion severity, level, or decade of onset. Of the 69 patients who had Frankel grades A, B, or C on admission, 72% achieved useful recovery to grades D or E. The severity and level of the spinal neurological lesion (SNL) had a significant effect on recovery. The mean LOS was 87 days; it was significantly affected by lesion severity and level and by the decade of admission to rehabilitation, and decreased with time. CONCLUSIONS: Patients with DHSNL who were admitted for rehabilitation have favorable survival and recovery rates compared with previously studied patients with other types of SNL. Their LOS is probably a function of medical requirements, but is decreasing with time.
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Desplazamiento del Disco Intervertebral/mortalidad , Desplazamiento del Disco Intervertebral/rehabilitación , Recuperación de la Función , Traumatismos Vertebrales/mortalidad , Traumatismos Vertebrales/rehabilitación , Factores de Edad , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Traumatismos Vertebrales/etiología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
During the last two years, 11 homeless-disabled people were treated at our rehabilitation ward. All of the patients were Jewish, six were new immigrants from Russia, their age ranged between 34 to 60 years, most of these patients had completed at least high school education, and all had managed to have a "normal" social-working life until the crisis which led them to the street. Six became alcoholics and one was a narcotic-drug user. None of these patients suffered from malnutrition or mental disorder, and after the rehabilitation process was over, they became independent, performing the activities of daily living. Most of them decided to return to their previous street--living place, despite their disabilities. This new combination of relatively young disabled-homeless people at our rehabilitation facility demands novel and different rehabilitation approaches.
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Atención a la Salud , Personas con Mala Vivienda/estadística & datos numéricos , Rehabilitación/métodos , Adulto , Emigración e Inmigración , Humanos , Israel/epidemiología , Persona de Mediana Edad , Pobreza , DesempleoRESUMEN
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To monitor length of stay (LOS) in a specialist spinal cord lesion (SCL) department in Israel, evaluate factors that affect it, and assess its association with other outcome measures. SETTING: Loewenstein Rehabilitation Hospital, Raanana, Israel. METHODS: In all, 1367 SCL patients treated between 1962 and 2000, and a group of 44 patients admitted between 1996 and 2002 were recruited. LOS, factors that affect it, and Spinal Cord Independence Measure second version (SCIM-II) gain and efficiency were measured. Data were collected from hospital charts and from the Population Registry of the Israel Ministry of Internal Affairs. LOS associations were analyzed with ANOVA, ANCOVA, Pearson's chi(2) test, Pearson's correlation, and Cox proportional hazard model. RESULTS: The mean LOS was 239 days for traumatic SCL (SD=168) and 106 days for non-traumatic SCL (SD=137). SCL etiology, SCL severity, and decade of admission to rehabilitation, were associated with the LOS (P<0.001). SCIM II gain correlated with LOS in the first 70 days after admission (r=0.81-0.82; P<0.001). In some patients, longer LOS was associated with a considerable increase in ability, through 5-8 months from admission. CONCLUSIONS: LOS of patients with SCL in Israel is within the customary LOS range in Europe. Longer LOS in a specialist SCL department may be positively associated with improved rehabilitation outcome. Further study is required to determine the LOS that allows optimal achievements.
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Tiempo de Internación , Traumatismos de la Médula Espinal/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores Sexuales , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/fisiopatologíaAsunto(s)
Infecciones Bacterianas/diagnóstico , Intestino Delgado/microbiología , Síndrome del Colon Irritable/tratamiento farmacológico , Síndrome del Colon Irritable/microbiología , Adulto , Anciano , Infecciones Bacterianas/epidemiología , Pruebas Respiratorias/métodos , Recuento de Colonia Microbiana , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Síndrome del Colon Irritable/epidemiología , Masculino , Persona de Mediana Edad , Medición de Riesgo , Muestreo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: This study examined characteristics of contracts between managed care organizations (MCOs) and managed behavioral health organizations (MBHOs) in terms of delegation of functions, financial arrangements between the MCO and the MBHO, and the use of performance standards. METHODS: Nationally representative administrative and clinical information about the three largest types of commercial products offered by 434 MCOs in 60 market areas was gathered by telephone survey. These products comprised services provided by health maintenance organizations, preferred provider organizations, and point-of-service plans. Chi square tests were performed between pairings of all three types of products to ascertain differences in the degree to which claims processing, maintenance of provider networks, utilization management, case management, and quality improvement were delegated to MBHOs through specialty contracts among the various types of products. Contractual specifications about capitation arrangements, risk sharing, the use of performance standards, and final utilization review decisions were also compared. RESULTS: For all types of products, almost all the major functions were contracted by the MCO to the MBHO. Although most contracts assigned some risk for the costs of services to the MBHO, the degree of this risk varied by product type. Except in the case of preferred-provider organizations, a large number of performance standards were identified in MCOs' contracts with MBHOs, although financial incentives were rarely tied to such standards. CONCLUSIONS: MCOs that contract with MBHOs place major responsibility, both financial and administrative, on the vendors.
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Servicios Contratados/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Servicios de Salud Mental/organización & administración , Garantía de la Calidad de Atención de Salud , Prorrateo de Riesgo Financiero , Toma de Decisiones en la Organización , Sistemas Prepagos de Salud/organización & administración , Humanos , Responsabilidad Legal , Organizaciones del Seguro de Salud/organización & administración , Estados UnidosRESUMEN
OBJECTIVE: This study examined the prevalence and nature of behavioral health carve-out contracts among Fortune 500 firms in 1997. METHODS: A survey was conducted of 498 companies that were listed as Fortune 500 firms in 1994 or 1995. A total of 336 firms (68 percent) responded to the survey. Univariate analyses were used to analyze prevalence, types, and amounts of covered services, cost sharing, and benefit limits. A total of 132 firms reported contracting with managed behavioral health organizations; 124 firms answered benefits questions about covered services, cost-sharing levels, and annual and lifetime limits. RESULTS: Most of the plans covered a broad range of services. Cost sharing was typically required, and for inpatient care it was often substantial. Fifteen percent of the firms offered mental health benefits that were below the limits defined in this study as minimal benefit levels, and 34 percent offered substance abuse treatment benefits that fell below minimal levels. The most generous mental health benefits and substance abuse treatment benefits, defined as no limits or a lifetime limit only of $1 million or more, were offered by 31 percent and 20 percent of the firms, respectively. CONCLUSIONS: The carve-out contracts of the Fortune 500 firms in this study typically covered a wide range of services, and the benefits appeared generous relative to those reported for other integrated and carve-out plans. However, these benefits generally did not reach the level of parity with typical medical benefits, nor did they fully protect enrollees from the risk of catastrophic expenditures.
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Servicios Contratados/estadística & datos numéricos , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Seguro Psiquiátrico/clasificación , Programas Controlados de Atención en Salud/economía , Servicios de Salud Mental/economía , Recolección de Datos , Humanos , Industrias , Beneficios del Seguro , Programas Controlados de Atención en Salud/normas , Estados UnidosAsunto(s)
Técnicas Biosensibles , National Institutes of Health (U.S.) , Neoplasias , Investigación , Vuelo Espacial , United States National Aeronautics and Space Administration , Biomarcadores , Biomarcadores de Tumor , Miniaturización , Neoplasias/diagnóstico , Neoplasias/prevención & control , Neoplasias/terapia , Nave Espacial , Estados UnidosAsunto(s)
Marte , Vuelo Espacial/historia , Nave Espacial/historia , United States National Aeronautics and Space Administration/historia , Autobiografías como Asunto , Exobiología/historia , Historia del Siglo XX , Vuelo Espacial/instrumentación , Nave Espacial/instrumentación , Estados Unidos , United States National Aeronautics and Space Administration/organización & administraciónAsunto(s)
Disciplinas de las Ciencias Biológicas , Exobiología , Investigación , United States National Aeronautics and Space Administration , Ingravidez , Disciplinas de las Ciencias Biológicas/organización & administración , Exobiología/organización & administración , Revisión de la Investigación por Pares , Estados Unidos , United States National Aeronautics and Space Administration/organización & administraciónRESUMEN
Many U.S. employers have carved substance abuse and mental health services out of their medical plans, changing the way millions of people access care. Employers that take this approach contract directly with specialized vendors, bypassing their general health plans. Since carving out may alter access and treatment, there is a need to understand why employers take this approach. This article reviews various hypotheses about why purchasers carve out and tests them using data from a survey of America's largest employers, the Fortune 500 firms. Size is the strongest predictor of an employer's decision to carve out behavioral health once other characteristics are controlled for. Employers that report they value coordination are less likely to carve out, while those that value special expertise are more likely to carve out. Employers are less likely to carve out enrollees in health maintenance organizations (HMOs) than those in other types of plans.
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Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/tendencias , Industrias/tendencias , Servicios de Salud Mental/economía , Servicios de Salud Mental/tendencias , Costos de Salud para el Patrón/tendencias , Planes de Asistencia Médica para Empleados/organización & administración , Encuestas de Atención de la Salud , Sistemas Prepagos de Salud/economía , Humanos , Industrias/economía , Industrias/organización & administración , Programas Controlados de Atención en Salud/economía , Estados UnidosRESUMEN
Extensive primary fibrosis precedes heart failure and death in experimental chronic aortic regurgitation. To seek the molecular basis for this observation, this study analyzed the RNA pool for genes that are up-or downregulated in aortic regurgitation fibroblasts. Differential display reverse transcriptase polymerase chain reaction was used to compare RNA extracted from cardiac fibroblasts isolated from three healthy New Zealand white rabbits and from three with aortic regurgitation. Using two base anchoring oligo d(T) primers (T11VN) together with arbitrary upstream primers, numerous differences in normal versus aortic regurgitation gene expression were apparent on differential display reverse transcriptase polymerase chain reaction. The aortic regurgitation cell cultures showed numerous differentially up-and downregulated genes compared with cell cultures of normal cardiac fibroblasts. The results showed that pathologic fibrosis in chronic experimental aortic regurgitation is associated with abnormal cardiac fibroblast gene expression, which may be pathogenic for the fibrous lesion.
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Insuficiencia de la Válvula Aórtica/genética , Regulación de la Expresión Génica/genética , Miocardio/citología , ARN/biosíntesis , Animales , Insuficiencia de la Válvula Aórtica/metabolismo , Northern Blotting , Separación Celular , Células Cultivadas , ADN Complementario , Fibroblastos/metabolismo , Miocardio/metabolismo , ARN/aislamiento & purificación , Conejos , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
OBJECTIVE: To determine the prevalence and nature of performance standards in specialty managed behavioral healthcare contracts among Fortune 500 companies. STUDY DESIGN: This was a cross-sectional survey of all companies listed on the Fortune 500 during 1994, 1995, or both. METHODS: From April 1997 to May 1998 we conducted a mailed survey with phone follow-up. Of the 68% of firms that responded, over one third reported carve-out contracts. The survey focused on whether companies had behavioral health carve-out contracts with specialty vendors and characteristics of these contracts, including the use of performance standards. RESULTS: More than three quarters of the Fortune 500 companies reporting specialty behavioral healthcare contracts used at least one performance standard. Most common were administrative standards (70.2%) and customer service standards (69.4%). About half of the companies used quality standards, whereas only a third used provider-related standards. Most (58.8%) companies using performance standards also specified financial consequences. Larger Fortune 500 firms were significantly more likely to use performance standards. Risk contracts and contracts that included all covered employees were also more likely to include some categories of standards. CONCLUSIONS: Administrative and customer service standards may be most common because companies find it easier to specify those standards, especially compared with clinical quality measures. To the extent that employers want to obtain the most value from their behavioral healthcare purchasing, we expect that more will begin to adopt quality standards in their contracts, especially as performance measures become more refined. Reliance on accreditation, however, is an alternative approach for employers.
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Planes de Asistencia Médica para Empleados/normas , Industrias/organización & administración , Servicios de Salud Mental/normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Medicina de la Conducta/organización & administración , Medicina de la Conducta/normas , Servicios Contratados/normas , Estudios Transversales , Recolección de Datos , Manejo de la Enfermedad , Planes de Asistencia Médica para Empleados/organización & administración , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Industrias/clasificación , Auditoría Administrativa/estadística & datos numéricos , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/estadística & datos numéricos , Administración de Línea de Producción/normas , Estados UnidosRESUMEN
The Intelligent Synthesis Environment (ISE), which is one of the major strategic technologies under development at NASA centers and the University of Virginia, is described. One of the major objectives of ISE is to significantly enhance the rapid creation of innovative affordable products and missions. ISE uses a synergistic combination of leading-edge technologies, including high performance computing, high capacity communications and networking, human-centered computing, knowledge-based engineering, computational intelligence, virtual product development, and product information management. The environment will link scientists, design teams, manufacturers, suppliers, and consultants who participate in the mission synthesis as well as in the creation and operation of the aerospace system. It will radically advance the process by which complex science missions are synthesized, and high-tech engineering Systems are designed, manufactured and operated. The five major components critical to ISE are human-centered computing, infrastructure for distributed collaboration, rapid synthesis and simulation tools, life cycle integration and validation, and cultural change in both the engineering and science creative process. The five components and their subelements are described. Related U.S. government programs are outlined and the future impact of ISE on engineering research and education is discussed.
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Computadores/tendencias , Ingeniería/tendencias , Sistemas Hombre-Máquina , Vuelo Espacial/tendencias , Interfaz Usuario-Computador , Astronautas/educación , Redes de Comunicación de Computadores , Simulación por Computador , Sistemas de Computación , Metodologías Computacionales , Ingeniería/educación , Ingeniería/instrumentación , Ergonomía , Humanos , Vuelo Espacial/instrumentación , Integración de Sistemas , Estados Unidos , United States National Aeronautics and Space AdministrationRESUMEN
The objective of the study was to assess the impact of psychological/psychiatric assessment in patients with chronic or intractable dermatological conditions. A diagnostic interview was undertaken in order to pin-point any temporal connection between an adverse life-event and the first appearance of the skin disorder. Following this, the dermatologist's assessment of subsequent changes in the skin disorder were noted. The three main dermatological diagnoses were atopic eczema (10), prurigo (10), and psoriasis (nine). Follow-up was for up to 5 years. A favourable response was noted in 40 out of the 64 patients who participated in the study; this was usually evident within a few weeks and maintained thereafter. Remission was achieved in 12, while 28 showed some improvement. We conclude that this liaison between dermatology and psychiatry proved a valuable adjunct to normal dermatological treatment and was followed by improvement in the majority of patients.
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Acontecimientos que Cambian la Vida , Enfermedades de la Piel/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Dermatitis Atópica/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Prurigo/psicología , Psoriasis/psicología , Psicoterapia Breve , Enfermedades de la Piel/terapiaRESUMEN
Hazardous air pollutant (HAP) emissions from electric utilities were evaluated. Cancer risks, as well as noncancer effects, due to inhalation exposure were assessed for 67 HAPs. Also, cancer risks due to multipathway exposure to radionuclide emissions were assessed. In addition, an assessment of the fate of mercury (Hg) through various environmental media was included. Results suggest arsenic, chromium, and nickel are the HAPs that present the highest cancer risk due to inhalation exposure. For noncancer effects due to inhalation exposure, hydrogen chloride appears to present the greatest potential concern. The risks due to multipathway exposure to radionuclides are estimated to be of similar magnitude to the risks posed by inhalation of arsenic and nickel. Mercury is of potential concern for multipathway exposures because it persists in the environmental and bioaccumulates in the aquatic food web. The study suggests there is a plausible link between Hg emissions from utilities and the Hg found in soil, water, and freshwater fish.