Hospital closure and insights into patient dispersion: the closure of Saint Vincent's Catholic Medical Center in New York City.

BACKGROUND: Hospital closures are becoming increasingly common in the United States. Patients who received care at the closing hospitals must travel to different, often farther hospitals for care, and nearby remaining hospitals may have difficulty coping with a sudden influx of patients. OBJECTIVES: Our objectives are to analyze the dispersion patterns of patients from a closing hospital and to correlate that with distance from the closing hospital for three specific visit types: emergency, inpatient, and ambulatory. METHODS: In this study, we used data from a health information exchange to track patients from Saint Vincent's Medical Center, a hospital in New York City that closed in 2010, to determine where they received emergency, inpatient, and ambulatory care following the closure. RESULTS: We found that patients went to the next nearest hospital for their emergency and inpatient care, but ambulatory encounters did not correlate with distance. DISCUSSION: It is likely that patients followed their ambulatory providers as they transitioned to another hospital system. Additional work should be done to determine predictors of impact on nearby hospitals when another hospital in the community closes in order to better prepare for patient dispersion.

Promising therapies for treating and/or preventing androgenic alopecia.

Androgenetic alopecia (AGA) may affect up to 70% of men and 40% of women at some point in their lifetime. While men typically present with a distinctive alopecia pattern involving hairline recession and vertex balding, women normally exhibit a diffuse hair thinning over the top of their scalps. The treatment standard in dermatology clinics continues to be minoxidil and finasteride with hair transplantation as a surgical option. Here we briefly review current therapeutic options and treatments under active investigation. Dutasteride and ketoconazole are also employed for AGA, while prostaglandin analogues latanoprost and bimatoprost are being investigated for their hair growth promoting potential. Laser treatment products available for home use and from cosmetic clinics are becoming popular. In the future, new cell mediated treatment approaches may be available for AGA. While there are a number of potential treatment options, good clinical trial data proving hair growth efficacy is limited.

A pilot study on usability analysis of emergency department information system by nurses.

OBJECTIVES: Employing new health information technologies while concurrently providing quality patient care and reducing risk is a major challenge in all health care sectors. In this study, we investigated the usability gaps in the Emergency Department Information System (EDIS) as ten nurses differentiated by two experience levels, namely six expert nurses and four novice nurses, completed two lists of nine scenario-based tasks. METHODS: Standard usability tests using video analysis, including four sets of performance measures, a task completion survey, the system usability scale (SUS), and sub-task analysis were conducted in order to analyze usability gaps between the two nurse groups. RESULTS: A varying degree of usability gaps were observed between the expert and novice nurse groups, as novice nurses completed the tasks both less efficiently, and expressed less satisfaction with the EDIS. The most interesting finding in this study was the result of 'percent task success rate,' the clearest performance measure, with no substantial difference observed between the two nurse groups. Geometric mean values between expert and novice nurse groups for this measure were 60% vs. 62% in scenario 1 and 66% vs. 55% in scenario 2 respectively, while there were some marginal to substantial gaps observed in other performance measures. In addition to performance measures and the SUS, sub-task analysis highlighted navigation pattern differences between users, regardless of experience level. CONCLUSION: This study will serve as a baseline study for a future comparative usability evaluation of EDIS in other institutions with similar clinical settings.

The wrist in rheumatoid arthritis.

In the rheumatoid wrist, cartilage loss, synovial expansion with erosive disease and ligamentous laxity, result in loss of carpal height and stability and development in varying amounts of ulnar/palmar translocation and supination of the carpus on the distal forearm. This results in a painful wrist which influences deformity development distally. The aims of surgery are relief of pain and adequate stability while retaining as much motion as possible consistent with the degree of destruction present. A variety of procedures from soft-tissue reconstruction to total arthrodesis are available to achieve these aims.

Relationship of squamosal suture to asterion in pongids (Pan): relevance to early hominid brain evolution.

Based on 244 measurements of the relationship of the squamosal suture to the landmark asterion in 49 chimpanzee skulls, it is shown that in the normal lateral view the squamosal suture is very rarely inferior to asterion. In hominid crania, the squamosal suture is always well superior to asterion. Even in Pan, that part of the squamosal suture most homologous with the remnant found on the Hadar AL 162-28 Australopithecus afarensis hominid cranial fragment is very rarely inferior to asterion. Such variability suggests that Falk's (Nature 313:45-47, 1985) orientation of the Hadar specimen is incorrect; she places asterion superior to the position of the squamosal suture if projected endocranially. The implication for the brain endocast is that, however the fragment is oriented, the posterior aspect of the intraparietal (IP) sulcus is in a very posterior position relative to any chimpanzee brain. The distance from the posterior aspect of IP to occipital pole is twice as great in chimpanzee brain casts than on the Hadar AL 162-28 endocast, even though the chimpanzee brain casts are smaller in overall size. This suggests that brain reorganization, at least as exemplified as a reduction in primary visual striate cortex (area 17 of Brodmann), occurred early in hominid evolution, prior to any major brain expansion.

Sarcoidosis: current concepts and case reports.

Sarcoidosis is a systemic granulomatous disease of unknown etiology associated with various immune alterations and biochemical changes. This article reports recent advances in the conceptualization of the immune dysfunction with emphasis on helper T-cell overactivity in the lungs. Because 90 percent of patients with sarcoidosis have intrathoracic disease, the mode of presentation, radiographic findings, clinical course, and treatment of pulmonary involvement are discussed. Case reports are used to demonstrate the typical course of the disease and generally favorable outcome of the vast majority of patients seen in the non-referral setting. A rare case of neurosarcoidosis with neuroendocrine features is presented.

Breast cancer presenting as periostitis.

A previously healthy 69-year-old woman presented with progressive and unremitting distal leg pain that was confirmed by biopsy to be periostitis. Ten months after the onset of symptoms, carcinoma of the breast was diagnosed. Surgical removal of the neoplasm was followed by complete relief of leg pain within 24 hours. Hypertrophic osteoarthropathy must be considered in adult patients presenting with unexplained joint or distal extremity symptoms, and a vigilant search for underlying malignancy should be undertaken.

Power staple fixation in hand and wrist surgery: new applications of an old fixation device.

After laboratory testing power driven staples were used in metaphyseal type bone 39 times from December 1983 through April 1985 in 33 patients with hand or wrist problems. Applications included arthrodeses, nonunions, and osteotomy fixation. Diagnoses included rheumatoid and degenerative arthritis, scaphoid, and interphalangeal nonunions. There were no infections, and only one staple has broken. There has been little evidence of loosening or inflammation. Shattering of bone has not occurred; osteoporotic bone appears to be ideal tissue in which to use this fixation.

Wrist involvement in rheumatoid swan-neck deformity.

Two observations have led to the consideration of another possible factor in the etiology of rheumatoid swan-neck deformity. Distraction of the rheumatoid wrist with correctable carpal collapse and reversible swan-neck deformities resulted in easier initiation of proximal interphalangeal joint flexion, not found in hands with boutonniere deformity or lack of deformity. Review of x-rays of rheumatoid patients with swan-neck deformity indicates that most have evidence of carpal collapse. With carpal collapse and proximal migration of the carpal-hand unit, long or extrinsic motor systems are no longer working at physiological length or optimal efficiency. An imbalance is created, resulting, in effect, in an "extrinsic-minus" phenomena and swan-neck finger deformity.

Benign intracranial hypertension.

Although antecedent factors are occasionally implication, most cases of benign intracranial hypertension are idiopathic and occur in young adult women who otherwise appear healthy. The natural course is usually one of spontaneous recovery, although medical intervention may accelerate improvement. Computerized tomographic scanning is the procedure of choice for excluding more ominous conditions, such as brain tumors. The most serious complication of this syndrome is visual loss and in these patients the disease is not "benign."