Teamwork fosters successful, pleasing environment for patient accounts employees.

If a patient accounts manager can cultivate teamwork successfully--if he or she can "tear down the walls" and "open up the lines of communication"--a positive and productive working environment can be created. Too often, though, invisible barriers exist within a patient accounts department: One area is in conflict with another area, representatives from each area blaming the other for high receivables and low cash flow. If this situation exists, the atmosphere it creates ultimately is reflected in every employee's performance. Further, if a patient accounts manager is engulfed by this atmosphere, his or her support staff certainly will be affected adversely.

A reexamination of the effectiveness of self-care education for persons with arthritis.

We examined the effectiveness of 2 models of arthritis self-care intervention, the home study model and the small group model. The effects of disease diagnosis and duration, self-care behavior, perceived helplessness, social support, treatment choice, and formal education level on outcomes among persons with arthritis who participated in these programs were evaluated. A pretest-posttest control group design was utilized in the initial experimental study; comparison group designs were used in the longitudinal studies. Three hundred seventy-four subjects completed the interventions and 12 months of research followup. We found that the intervention models had a statistically significant positive impact on arthritis knowledge, self-care behavior, perceived helplessness, and pain. These findings did not vary when the effects of education level, disease diagnosis and duration, informal social support, and treatment choice were controlled. The small group intervention was more effective in bringing about initial improvements in pain and depression, whereas the home study intervention was more effective in maintaining improvements in perceived helplessness. Changes in perceived helplessness and self-care behavior appear to explain in part the observed improvement in pain.

Inpatient arthritis rehabilitation programs in the US: results from a national survey.

The implementation of prospective payment systems has severely limited the traditional practice of providing rehabilitation services to arthritis patients on rheumatic disease units; however, the admission of these patients to a designated rehabilitation unit may be appropriate. This paper presents data on the provision of inpatient rehabilitation services to patients with arthritis. Two surveys were developed for this study. The first survey sample consisted of 502 hospitals; 163 (52%) of the 313 respondents were identified as facilities providing inpatient arthritis rehabilitation. A second survey regarding patient and program characteristics was completed by 146 of the 313 facilities. The data from rehabilitation units serving arthritis patients are presented with regard to utilization, discharge disposition, sources of payment, patient demographic and diagnostic information, and specialization of the rehabilitation program. The data indicate that persons with arthritis are underrepresented in the rehabilitation population, although the diagnosis is approved for admission under rehabilitation guidelines. This underutilization is attributed to problems of reimbursement, inappropriate admission criteria, inadequately trained staff, and lack of referrals.

Decreased complement mediated binding of antibody/3H-dsDNA immune complexes to the red blood cells of patients with systemic lupus erythematosus, rheumatoid arthritis, and hematologic malignancies.

The complement mediated binding of prepared antibody/3H-dsDNA immune complexes to the red blood cells obtained from a number of patient populations has been investigated. Patients with solid tumors have binding activity similar to that seen in a normal group of individuals. However, a significant fraction of patients with systemic lupus erythematosus, rheumatoid arthritis, and hematologic malignancies have lowered binding activity compared with normal subjects. Quantitative studies indicate the lowered activity probably arises due to a decrease in complement receptors on the respective red blood cells. The potential importance and implications of these findings are briefly discussed.

Age influences the clinical and serologic expression of systemic lupus erythematosus.

The clinical and serologic characteristics of 17 patients with onset of systemic lupus erythematosus (SLE) after age 50 were compared with those of 49 younger patients. All patients were followed prospectively for a mean duration of 47 months. A clinical and serological data base was established for each patient, and information collected at each visit to a lupus clinic was analyzed by computer. The clinical featured distinguishing old-age SLE were a low incidence of significant renal disease and prominent pleuropericarditis and arthritis throughout the period of followup. Serologic abnormalities were milder in older patients. Thus, hypocomplementemia, anti-DNA antibodies, and C1q precipitins occurred less frequently, and rheumatoid factor was more often present than in younger patients with SLE. Regression analysis suggested linear change in disease expression with age rather than distinct age-related subgroups.

Rheumatoid vasculitis: effect of cyclophosphamide on the clinical course and levels of circulating immune complexes.

A study of five patients with severe rheumatoid vasculitis treated with cyclophosphamide was undertaken to determine whether immune complexes were present in serum and if their levels correlated with disease activity and response to treatment. Circulating immune complexes were measured by various techniques including the Clq binding and Raji cell radioimmunoassays and determination of the presence of cryoglobulins. Elevated levels of circulating immune complexes, hypocomplementemia, and high titer rheumatoid factor were present during active vasculitis. Clinical and serologic remissions were induced in all patients on cyclophosphamide. In two patients in remission, a rise in rheumatoid factor titer and immune complex levels was associated with an exacerbation of vasculitis and resolved on increased cyclophosphamide dosage. The Clq binding assay and rheumatoid factor titer correlated best with clinical activity. Thus, circulating immune complexes appear to be involved in the immunopathogenesis of rheumatoid vasculitis, which can be successfully treated with cyclophosphamide.

Serologic studies in patients with systemic lupus erythematosus and central nervous system dysfunction.

Serologic studies were performed on 25 patients with systemic lupus erythematosus (SLE) during 29 acute episodes of central nervous system (CNS) disease. Increased anti-DNA antibody and decreased total serum hemolytic complement activity were observed only in those patients with associated extra-CNS disease manifestations. Patients with isolated CNS disease were otherwise in apparent clinical and serological remission regarding these two indices. No special association of cold-reactive IgM antilymphocyte antibodies was demonstrable in patients with ongoing CNS injury. Of special interest was an increased incidence of anti-Sm antibodies in the patients with CNS dysfunction relative to that in a large group of patients without neuropsychiatric disease. The incidence of anti-RNP was not increased. The data do not support direct involvement in SLE brain injury of either DNA/anti-DNA complexes or of lymphocytotoxic antibodies cross-reactive with brain cells, but do suggest an association of anti-Sm with CNS disease in this disorder.

Spontaneous rupture of the liver. An unusual complication of SLE.

A patient with systemic lupus erythematosus developed an acute surgical abdomen secondary to spontaneous rupture of the liver and died. Postmortem examination revealed an arteritis of the liver, pancreas, adrenal gland, skeletal muscle, and spleen. It appeared that an arteritis of the liver produced areas of infarction that ruptured and caused the clinical findings.

Avascular necrosis in SLE. An apparent predilection for young patients.

Recent reports of avascular necrosis (AN) in systemic lupus erythematosus (SLE) have suggested that its occurrence may be most frequent in young patients. In our population of 99 patients with SLE, 7 young patients have developed AN. Patterns of prednisone therapy had no apparent relationship to the development of AN. AN may become apparent in patients who have relatively inactive lupus, when increased physical activity precipitates articular collapse. A diagnosis of AN should be considered in young patients with localized joint pain.