Treatable abdominal pathologic conditions and unsuspected malignant neoplasms at autopsy in veterans who received mechanical ventilation
Article Abstract:
As part of a study of the factors that predict outcome in veterans receiving mechanical ventilation (machine-assisted breathing) in medical intensive care units of Veterans Hospitals, the unexpected findings at autopsy were evaluated for 172 patients (of 401 who died after receiving ventilation). The study was performed by reviewing medical records for the patients; information regarding patients' ages, sex, diagnoses, physiological status, and resuscitation status was included. Of interest were class I and class II errors: class I errors are unrecognized major findings that, if treated, would probably have led to survival, while class II errors are unrecognized findings that would have probably not have influenced treatment or survival. A third class, IIB, comprised unrecognized findings that would not have influenced survival, but would probably have influenced treatment. Results showed that the predicted mortality among this group (based on the APACHE II score, a measure of physiologic function) was 63 percent. Class I and II error rates were 12.2 percent and 15.5 percent, respectively; of the latter group, 42 percent were class IIB errors (unsuspected malignancies). Class I errors tended to be diagnoses such as pulmonary emboli (blood clots that block the pulmonary artery, which carries blood from the heart to the lungs), abdominal disease, or infection. The rate of these errors in the Veterans Hospitals was similar to the class I error rate in university and community hospitals; in all cases, pulmonary embolus is the most frequently misdiagnosed condition. Thirty-nine percent of these class I errors, however, were treatable abdominal conditions, such as abscesses, bowel perforations, or infarctions (loss of blood supply to a section of bowel). Although many of these patients had complained of abdominal pain, investigations were not pursued when examination or initial tests revealed no clear abnormality. The results show that patients with terminal, undiagnosed conditions are often placed in intensive care. If autopsy information had been obtained before death, it would have changed the ways patients were managed in 18 percent of these cases. It is therefore important to continue to gather such information. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings
Article Abstract:
Cataract surgery rates seem to vary depending on whether the patient is enrolled in an HMO or uses a fee-for-service program such as Medicare. Researchers analyzed cataract surgery rates in 1993 in elderly patients covered by Medicare, an HMO and an independent practice association (IPA). HMOs and IPAs are examples of managed care organizations. The patients covered by Medicare were twice as likely to have cataract surgery as those in HMOs or IPAs. Among HMO or IPA patients, men and women were equally likely to have cataract surgery. Among Medicare patients, women were twice as likely to have surgery as men.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1997
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Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults
Article Abstract:
A study among veteran patients to ascertain the association of nonpolypoid (flat and depressed) colorectal neoplasms with colorectal cancer was conducted. Results showed that patients with nonpolypoid (flat and depressed) colorectal neoplasms had a higher risk of colorectal cancer that those with only polypoid neoplasms.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2008
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