Arch Intern Med
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Medicare currently pays for "indirect costs" of medical education to support the higher costs of care in teaching hospitals. To investigate whether indirect costs are higher earlier in the training year when house officers might be less efficient--the "July phenomenon"--we compared utilization by 1251 patients hospitalized during July and August with 1338 patients hospitalized during April and May from 1982 through 1984 at Brigham and Women's Hospital, Boston, Mass. ⋯ Using analysis of covariance to correct for age, sex, diagnosis related group, urgency of admission, temporal change, and mortality, we found no differences in length of stay, total charges, or categories of ancillary charges. These results suggest that there is no substantial increase in the cost of care early in the training year; there was no evidence of a "July phenomenon."
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Hypertension was evaluated longitudinally in a nationally representative sample of the US population. This study, based on the data from the National Health and Nutrition Examination Survey NHANES I Epidemiologic Follow-up Study, analyzed changes in blood pressure and frequency of treatment, hypertension incidence, and ten-year survival of the cohort relative to hypertension status at baseline. Higher prevalence rates for each older age group, especially in women, as previously reported on data from community studies were confirmed. ⋯ Incidence rates for blacks were at least twice the rates for whites for almost every age-sex group. Decreased survival in older hypertensive men probably explained the higher prevalence in older women. Treatment and location of measurement in clinic or household must be major considerations in the calculation of incident cases.
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Review
Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value.
Preoperative spirometry is commonly ordered before abdominal surgery, with the goal of predicting and preventing postoperative pulmonary complications. We assessed the evidence for this practice with a systematic literature search and critical appraisal of published studies. The search identified 135 clinical articles, of which 22 (16%) were actual investigations of the use and predictive value of preoperative spirometry. ⋯ The available evidence indicates that spirometry's predictive value is unproved. Unanswered questions involve (1) the yield of spirometry, in addition to history and physical examination, in patients with clinically apparent lung disease; (2) spirometry's yield in detecting surgically important occult disease; and (3) its utility, or beneficial effect on patient outcome. Spirometry's full potential for risk assessment in the individual patient has not yet been realized.
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Blood was obtained before and after ten healthy male nonsmokers sat for 20 minutes in open hospital corridors beside men who were already there smoking by their own initiative. Mean values before and after passive smoking were 0.87 and 0.78 for the platelet aggregate ratio, 2.8 and 3.7 per counting chamber for the endothelial cell count, 0 and 2.8 ng/mL for the plasma nicotine concentration, and 0.9% and 1.3% for the carboxyhemoglobin level. No variable changed significantly during control periods in which the subjects sat in a room where smoking was prohibited. Passive exposure to tobacco smoke affected the endothelial cell count and platelet aggregate ratio in a manner similar to that previously observed with active smoking.