Second opinion reporting in head and neck pathology: the pattern of referrals and impact on final diagnosis.

OBJECTIVE: There is a need for second opinion histopathology referrals, especially for patients with head and neck pathology. The objective of this study was to determine the pattern and potential impact of referrals to a specialist oral and maxillofacial pathologist. STUDY DESIGN: Retrospective analysis of 566 consecutive referrals with demographic and clinical information was performed. The original diagnosis and the specialists' second opinion diagnosis were compared to assess for discrepancies and potential effect on patient management. RESULTS: Seventy-five percent of cases were referred by general pathologists. Salivary gland (30%) and odontogenic tumors (12%) were the most commonly referred categories. Of the referred cases, 58 (9%) resulted in a significant change in diagnosis, impacting patient management. In 24 cases (4%) the diagnosis was revised from benign to malignant, and in 22 (4%) from malignant to benign. CONCLUSION: This study highlights the need for referrals to oral and maxillofacial pathologists. A second opinion may assist in accurate diagnosis and patient management.

CNS development of health maintenance programs: quality improvement and cost reduction.

Several outpatient health maintenance programs were developed by CNSs that resulted in quality improvement and cost savings. Common implementation strategies, barriers to implementation, marketing issues and techniques, and revenue generation issues were found. An outpatient consultation model was used to expand enterostomal therapy and diabetic teaching services. Education and support programs include a cardiac support group and community education classes on aging. Preadmission programs include physical therapy consultation for patients scheduled for elective orthopedic surgery. Outpatient programs facilitate continuity of care in a managed care format, promote cost savings, and provide unique services that encourage patients to return to our hospital, thereby increasing market share. Key barriers encountered include inconsistent or ambiguous administrative support, budgetary constraints, lack of collaboration, communication problems, facility limitations, funding considerations, resource allocation, and territoriality. The programs are consistent with the change in focus of health care from treatment to prevention.

Preadmission self-instruction effects on postadmission and postoperative indicators in CABG patients: partial replication and extension.

Fifty adult coronary artery bypass graft surgery patients were randomly assigned to preadmission self-instruction or posthospital admission instruction of therapeutic exercises (e.g., coughing). Self-instructed subjects reported higher positive mood scores, performed correctly significantly more exercise behaviors, and required less teaching time following hospital admission. Postoperatively, no group differences were found on mood states, physical activity, analgesic use, or length of hospital stay. Both groups, however, tended to use less pain medication than that reported by other researchers and experience shorter hospital stays than that assigned under the Diagnostic Related Groups prescription.