Integrated confocal and scanning probe microscopy for biomedical research.

Atomic force microscopy (AFM) continues to be developed, not only in design, but also in application. The new focus of using AFM is changing from pure material to biomedical studies. More frequently, it is being used in combination with other optical imaging methods, such as confocal laser scanning microscopy (CLSM) and fluorescent imaging, to provide a more comprehensive understanding of biological systems. To date, AFM has been used increasingly as a precise micromanipulator, probing and altering the mechanobiological characteristics of living cells and tissues, in order to examine specific, receptor-ligand interactions, material properties, and cell behavior. In this review, we discuss the development of this new hybrid AFM, current research, and potential applications in diagnosis and the detection of disease.

The National Home and Hospice Care Survey: 1996 summary.

OBJECTIVE: This report presents data about agencies providing home and hospice care, their current patients, and their discharges. The data are presented in 159 tables according to standard sets of descriptive variables. The tables are grouped into five categories: agencies, home health care current patients, home health care discharges, hospice care current patients, and hospice care discharges. Data are presented on agency characteristics, demographic characteristics, utilization measures, and health and functional status of current patients and discharges. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. The data were collected by personal interview using three questionnaires and two sampling lists.

An overview of home health and hospice care patients: 1996 National Home and Hospice Care Survey.

OBJECTIVE: This report presents numbers and percents of home health and hospice care agencies, their current patients, and their discharges. Agency characteristics include type of ownership, region, certification, location, and affiliation. Patient and discharge characteristics include age, sex, race, marital status admission diagnoses, and procedures. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. RESULTS: During 1996, there were an estimated 2.5 million current patients and 8.2 million discharges from 13,500 home health and hospice care agencies in the United States. The agencies tended to be proprietary, certified by Medicare and Medicaid as a home health agency, and located in a metropolitan statistical area. Almost half were part of a chain or group of agencies. The home health and hospice care patients and discharges tended to be 65 years of age and over, female, white, and married or widowed. The most common diagnoses for home health care patients were diseases of the circulatory system, and the most common diagnoses for hospice care patients were malignant neoplasms. About a third of the home health care patients and about a fifth of the hospice care patients had a surgical or diagnostic procedure related to their admission for care. The most common procedures for home health care patients were operations on the musculoskeletal system, and for hospice care patients they were miscellaneous diagnostic and therapeutic procedures.

Characteristics of hospice care users: data from the 1996 National Home and Hospice Care Survey.

OBJECTIVE: This report presents numbers and percents of hospice care current patients and discharges by characteristics of the agencies from which the care was received, patient and discharge characteristics, services provided, types of personnel that provided the services, admission diagnoses, and procedures. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of hospices and home health care agencies in the United States. RESULTS: During 1996, there were an estimated 59,400 patients receiving hospice care services from 1,800 hospices and home health care agencies in the United States. These agencies had 393,200 discharges from hospice care during the year prior to the survey. The agencies tended to be voluntary nonprofit, certified by Medicare and Medicaid, and located in a metropolitan statistical area. About a third were part of a chain or group of agencies and 40 percent were operated by a hospital. Fifty-five percent of the current patients and 50 percent of the discharges were women. Both current patients and discharges tended to be 65 years of age and over, white, married or widowed, lived in a private or semiprivate residence, and had a primary caregiver. The most common diagnoses at admission were malignant neoplasms and heart disease. About a fifth of the patients and discharges had a surgical or diagnostic procedure related to their admission for care. The most common ones were miscellaneous diagnostic and therapeutic procedures.

Characteristics of hospice care discharges: United States, 1993-94.

OBJECTIVE: This report presents data on hospice care discharges. Numbers and percents of discharges are shown by selected characteristics of the agencies from which the patients were discharged, by selected patient characteristics, by services provided, by types of personnel that provided the services, and by diagnoses of these discharged patients. METHODS: The data used for this report are from the National Center for Health Statistics' 1994 National Home and Hospice Care Survey. This is an annual survey through which data are collected on the use of hospices and home health care agencies in the United States. RESULTS: There were an estimated 328,000 discharges from hospice care from 1,300 hospices and home health agencies in 1993-94. Death was the reason for discharge for 88 percent of the discharges. Fifty-two percent of the discharges were for men, 73 percent were for patients 65 years of age and over, 79 percent were white, 49 percent were married, and 30 percent were widowed. Eighty-three percent of the discharged patients were living in a private or semiprivate residence during their care and 95 percent had a primary caregiver. During the last time service was provided prior to discharge, 67 percent received help from the agency with at least one activity of daily living (ADL), 53 percent with at least one instrumental activity of daily living (IADL), and 30 percent with walking. These discharges had an average of 2.2 diagnoses at admission; 69 percent had a primary diagnosis of a malignant neoplasm; and 8 percent had a primary diagnosis of heart disease.

Characteristics of patients receiving hospice care services: United States, 1994.

OBJECTIVE: This report presents data on current hospice care patients. Numbers and percents are shown by selected characteristics of the agencies from which the patients received services, by selected patient characteristics, by services provided, by types of personnel that provided the services, and by diagnoses of these patients. METHODS: The data used for this report are from the National Center for Health Statistics' 1994 National Home and Hospice Care Survey. This is an annual survey through which data are collected on the use of hospices and home health care agencies in the United States. RESULTS: An estimated 61,000 patients were receiving hospice care services from 1,300 hospices and home health agencies in 1994. Fifty-five percent were women, 69 percent were 65 years of age and over, 81 percent were white patients, 48 percent were married, and 31 percent were widowed. Eighty-four percent were living in a private or semi-private residence, and 90 percent had a primary caregiver. Sixty percent received help from the agency with at least one activity of daily living (ADL), 46 percent with at least one instrumental activity of daily living (IADL), and 26 percent with walking. At admission, there was an average of 2.2 diagnoses per patient; 57 percent had a primary diagnosis of a malignant neoplasm and 9 percent had a primary diagnosis of heart disease.

Development of the National Home and Hospice Care Survey. Series 1: programs and collection procedures.

The National Home and Hospice Care Survey began operation in 1992. This report presents the development of the survey instruments and survey procedures from a feasibility study in 1990 to the first year of operation of the National Survey.

Estimates from two survey designs: national hospital discharge survey.

The methodology for the National Hospital Discharge Survey (NHDS) has been revised in several ways. These revisions, which were implemented for the 1988 NHDS, included adoption of a different hospital sampling frame, changes in the sampling design (in particular the implementation of a three-stage design), increased use of data purchased from abstracting service organizations, and adjustments to the estimation procedures used to derive the national estimates. To investigate the effects of these revisions on the estimates of hospital use from the NHDS, data were collected from January through March of 1988 using both the old and the new survey methods. This study compared estimates based on the old and the new survey methods for a variety of hospital and patient characteristics. Although few estimates were identical across survey methodologies, most of the variations could be attributed to sampling error. Estimates from two different samples of the same population would be expected to vary by chance even if precisely the same methods were used to collect and process the data. Because probability samples were used for the old and new survey methodologies, sampling error could be measured. Approximate relative standard errors were calculated for the estimates using the old and new survey methods. Taking these errors into account, less than 10 percent of the estimates were found to differ across survey methodologies at the 0.05 level of significance. Because a large number of comparisons were made, 5 percent of the estimates could have been found to be significantly different by chance alone. When there were statistically significant differences in nonmedical data, the new methods appeared to produce more accurate estimates than the old methods did. Race was more likely to be reported using the new methods. "New" estimates for hospitals in the West Region and government-owned hospitals were more similar than the corresponding "old" estimates to data from the census of hospitals conducted by the American Hospital Association. The numerous significant differences in estimates for bed size categories between the two survey methodologies reflected the change in the universe and definition of beds for the new survey. Few statistically significant differences were found in the medical data using the old and the new survey methods. Two main differences, in estimates for cataract and alcohol dependence syndrome, may have resulted from problems with the new survey. A measurement error, reporting outpatients to the NHDS, is one possible explanation of the higher estimates for diagnosis of cataract using the new survey methods.(ABSTRACT TRUNCATED AT 400 WORDS)

Hospital discharge data used as feedback in planning research and education for primary care.

Are research and training programs in pediatrics, internal medicine, and obstetrics and gynecology (OB-GYN) comprehensive enough to give trainees proficiency in primary care? Controversy exists about which subject areas should be added to the training schema to make them more applicable in primary care. One approach to this controversy is to use the most frequent of serious patient problems that are outside these disciplines as feedback into the process of selecting areas for more comprehensive training. In this study, patients' serious problems were defined as those requiring hospitalization. Diagnoses from the National Hospital Discharge Survey were grouped into categories of morbidity by age and sex. The most frequent categories outside the three disciplines were identified. For pediatrics these problems were trauma, mental disorders, and unintended pregnancy; for internal medicine, trauma, mental and gynecologic disorders, and unintended pregnancy; for OB-GYN, trauma and mental, cardiovascular, pulmonary, gastrointestinal, and arthritic disorders. Since primary care is largely ambulatory care, the next step in the resolution of the controversy would be to define the competency level needed for the prevention, early recognition, and early management of these disorders in the ambulatory care setting. Once defined, competency levels can be examined among trainees in the three specialties, and areas where competency is found inadequate can be emphasized. Although hospitalization data are not the only logical criteria for choosing areas for emphasis, these feedback data offer a method of integrating patients' most frequent severe problems into the selection process.

Deliveries in short-stay hospitals: United States, 1980.

During 1980 3.8 million women with deliveries were discharged from short-stay non-Federal hospitals in the United States. These women made up a sizable portion--9.9 percent--of all the discharges (excluding newborn infants) during that year. Women with deliveries remained hospitalized an average of 3.8 days and used 14.2 million days of inpatient hospital care. This was only 5.2 percent of the total days spent in hospitals by all patients discharged during the year. Most of the women who had a delivery were in their twenties, were white, and were married. The largest percent of deliveries occurred in the South Region, followed by the North Central, Northeast, and West Regions. The percent of women with deliveries was lowest in the smallest hospitals and highest in the largest hospitals. Most of the women with deliveries were discharged from nonprofit hospitals. About half of the women had a normal delivery and about half had some sort of complication. Women more likely to have a complicated delivery were older, were races other than white, had an unknown marital status, and had delivered in the South Region. These women also stayed in the hospital longer, on the average, than did women with normal delivery. The most frequently occurring complications were forceps or vacuum extraction without mention of indication and obstetrical trauma. Episiotomy was the most common procedure. Other frequently performed procedures were low forceps or vacuum extraction with or without episiotomy, cesarean section, repair of obstetric laceration, and bilateral destruction or occlusion of fallopian tubes.

The National Reporting System for Family Planning Services.

PIP: The National Reporting System for Family Planning Services (NRSFPS) was established in 1972 to provide statistics on the status of family planning services in the United States and to supply basic data for program planning and evaluation at both the national and local levels. Each time a person receives family planning services from a participating clinic, a Clinic Visit Record for Family Planning Services is completed. Identification information, social and demographic information and family planning service information are included on the form as well as a section for agency use only. More than 1/4 of the total participating clinics are computerized and data is in the form of magnetic tape or punch cards. The NRSFPS produces statistical tabulations on a monthly, quarterly, and annual basis. More than 3200 clinics participated in the NRSFPS during 1972 and provided family planning services to more than 1.6 million patients. Of the total number of patients reported to the NRSFPS, 60% were white, 30% were black, and 4% were of other minority groups, with a median age of 23 for women and 31 for men. 99% were women with an average 2.7 children. 70% of the women used oral contraceptives; 15% used IUD'S. 14% of the men had a grade school education, 30% had 1-3 years of high school, 34% had graduated from high school, and almost 20% had some college education.^ieng