Discharging older patients from home care: who decides and when?

Who is involved in the decisions to discharge patients from home care and how much lead-in time for planning is observed? How does the process of discharging patients from home care differ by reason for discharge? These questions are addressed in this study of 383 Medicare-funded patients discharged from home care agencies in central Ohio.

Property rights and privacy principles.

Healthcare consumers own their medical information. As paper medical folders become digital, protection of this private and confidential information falls to information specialists rather than the traditional care givers. On the basis of a nationwide market assessment study, the authors identify the key issues regarding protecting this personal digital property and outline the federal requirements stemming from the Health Insurance Portability and Accountability Act (HIPAA). Consumer informed consent over the use of specific medical data is a basic requirement, and is a concept supported by physicians and care givers who rely on consent to approve surgeries and treatment. The article concludes with a solution outline that places the patient in control of his or her personal information, meets security and privacy concerns, and facilitates the critical exchange of patient information among care givers.

Is arm span an accurate measure of height in young and middle-age adults?

Height is used to determine many important clinical measurements, but height may be difficult or impossible to measure accurately in some patients. The purpose of this study is to determine the accuracy of arm span as a measure of height in young and middle-age adults. A sample of 83 people between the ages of 20 and 61 years participated in this anthropometric study. Height and arm span were measured with a metal rule. A prediction equation was derived from regression analysis. Arm span is a valid measure of height in young and middle-age adults, and the accuracy is improved when using the prediction equation.

The analysis of the data for two-way contingency tables.

One of the best ways, if not the best way, to analyze data displayed in a two-way contingency table is to use a method originally due to Williams (1952) and later embellished upon by Guttman (1971) and others. This method applies the principles of canonical correlation analysis to contingency table data and obviates the need for the a priori specification of scale values for the two variables whose relationship is explored. In this article the method is described and compared with other approaches, and several examples of its application are provided.

Mammographic visualization of a nonpalpable breast mass through a radiolucent breast implant.

We report a woman who underwent augmentation mammaplasty as part of a clinical trial of the Trilucent (soybean oil-filled) breast implant in Genoa, Italy. Five months after surgery a mammography was performed in response to the patient's complaints of pressure and tightness in the area of her left breast. The mammogram clearly demonstrated a 5-mm fibroadenoma of the left breast. This is the first documented case of a nonpalpable breast lesion that was detected by mammography through the new radiolucent, triglyceride-filled implant.

Sex, age, height, and weight as predictors of selected physiologic outcomes.

The purpose of this study was to determine the extent to which sex, age, height, and weight predict selected physiologic outcomes, namely, forced expiratory volume in one second (FEV1), hemoglobin concentration, food intake, serum glucose concentration, total serum cholesterol concentration, and cancer-related weight change. Secondary analysis was performed on four datasets with sample sizes ranging from 60 to 8,489. FEV1 (R2 = .56), hemoglobin (R2 = .40), food intake (R2 = .25), glucose (R2 = .24), cholesterol (R2 = .21 and .15), and cancer-related weight change (R2 = .16 and .06) were predictable to varying extents. Moreover, the use of sex, age, height, and weight as covariates and in sample size determination was shown to be relevant when testing the effects of interventions or other variables on these physiologic outcomes.

The prestige value of books and journal articles.

This article has provided two formulas for the prestige rating (PR) of scholarly publications: 1. The a priori formula PR = 4 BS + 2 BDF + 1.5 BDS + RAS + 0.5 NAS + 0.8 RADF + 0.6 RADS + 0.3 NADF + 0.15 NADS + 0.6 RATF + 0.4 RATS + 0.2 RATT + 0.2 NATF + 0.1 NATS + 0.05 NATT; 2. The empirical formula PR = 0.77 The second formula is not recommended.

Long-term medical device accountability: an information technology solution.

The VigilanceTM ID System represents a new medical device accountability paradigm - one that recognizes the challenges that confront regulators, manufacturers, physicians and patients.The proposed transponder-based system casts aside the current sophistic assumptions that invoke static patient populations and notions of reliable and accessible device records held provincially. Instead, the syllogisms invoked by the VigilanceTM ID System are based on assumptions that people are mobile, surgeons retire or die, records are often inaccessible or misplaced or illegible.If the vision of harmonized global medical device accountability is to be realized, a proper paradigm such as the proposed VigilanceTM ID System or one like it, along with goodwill and cooperation, will be required.

Do people with cancer postpone death to celebrate special occasions?

Several researchers have claimed that a connection exists between deathdays and birthdays or other special occasions. Some people, especially women, appear to postpone death until after their birthdays or other special occasions to celebrate these events one more time. The purpose of this retrospective study was to determine if a deathday-birthday or deathday-Christmas connection was evident in cancer-related deaths. Data were obtained from the Rochester (New York) Regional Tumor Registry (N = 2566), the New York State Cancer Registry (N = 50,562), and the Ohio State Department of Health (N = 73,907) for three samples of individuals who died from cancer. Only a few deathday-birthday connections were evident. However, these connections were not replicated across states and years.

Ten measurement commandments that often should be broken.

Many of the measurement aspects of nursing research have been governed by rules regarding the minimum values of certain summary indexes (such as Cronbach's coefficient alpha and Cohen's kappa), the required numbers of subjects per item for factor analyses, and the like. In this article a case is made for violating these rules whenever the circumstances warrant such violations.

Pituitary and intradural spinal metastases: an unusual initial presentation of lung cancer.

The authors report the clinical and imaging findings for a 47-year-old woman who presented with the classic symptoms of a sellar or suprasellar mass; the lesion was initially diagnosed as germinoma and was treated accordingly. The patient also had intradural, extramedullary spinal metastases. Radiotherapy failed, and the patient died. Autopsy revealed that the lesions were metastatic from previously unrecognized large-cell carcinoma of the lung. This distribution of metastases from a primary lesion not located within the central nervous system is unusual but should be considered in any patient presenting with masses at these sites, particularly if the response to therapy is less than expected.

The National Survey of Families and Households: a rich data base for nursing research.

A summary of the information contained in the National Survey of Families and Households (NSFH), a public-domain data base, is provided. The representativeness of the sample with respect to sex and age and the reliability of a subset of the variables that address depression are evaluated. Suggestions for the use of this data base, with emphasis on variables of direct relevance to family health nursing research, are made.

Tumour of a peripheral nerve sheath with invasion of the lumbar spine.

Tumours of peripheral nerve sheaths are rarely malignant, and even when malignant they are only infrequently associated with extensive destruction of bone. The authors report the computed tomography and magnetic resonance imaging findings for an unusually large sheath tumour that presented with extensive destruction in the lumbar spine.