{"title":"Ischemic stroke is predictable and preventable.","authors":"R L Sacco","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"155-6"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Soft tissue sarcomas. Is adjuvant chemotherapy indicated?","authors":"G Guron, A I Neugut","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"156-8"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We reviewed the case records of 141 patients (134 with cancer and seven with acquired immunodeficiency syndrome) who died at Memorial Sloan-Kettering Cancer Center between July 11 and September 19, 1991. Do-not-resuscitate orders had been written on 115 (85.8%) of the patients with cancer and all of the patients with acquired immunodeficiency syndrome. The do-not-resuscitate orders appeared to be valid, in that evidence of informed consent was documented in all but two of the cases. Six additional patients who died had family consent not to resuscitate, although no do-not-resuscitate orders were written. Two other patients died unexpectedly. The remaining 11 patients all received aggressive attempts at resuscitation, which were felt to be medically appropriate in all but two cases. The interval between the do-not-resuscitate order and death was between zero and 60 days, with an average of 8.4 days and a median of 6 days; it exceeded 20 days in 14 cases. We attribute the high degree of compliance with the New York State do-not-resuscitate law observed in this study to an intensive program of consultation and education begun in 1987 by the Ethics Committee of Memorial Sloan-Kettering Cancer Center.
{"title":"Compliance with New York State's do-not-resuscitate law at Memorial Sloan-Kettering Cancer Center. A review of patient deaths.","authors":"R I Misbin, D O'Hare, M S Lederberg, J C Holland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We reviewed the case records of 141 patients (134 with cancer and seven with acquired immunodeficiency syndrome) who died at Memorial Sloan-Kettering Cancer Center between July 11 and September 19, 1991. Do-not-resuscitate orders had been written on 115 (85.8%) of the patients with cancer and all of the patients with acquired immunodeficiency syndrome. The do-not-resuscitate orders appeared to be valid, in that evidence of informed consent was documented in all but two of the cases. Six additional patients who died had family consent not to resuscitate, although no do-not-resuscitate orders were written. Two other patients died unexpectedly. The remaining 11 patients all received aggressive attempts at resuscitation, which were felt to be medically appropriate in all but two cases. The interval between the do-not-resuscitate order and death was between zero and 60 days, with an average of 8.4 days and a median of 6 days; it exceeded 20 days in 14 cases. We attribute the high degree of compliance with the New York State do-not-resuscitate law observed in this study to an intensive program of consultation and education begun in 1987 by the Ethics Committee of Memorial Sloan-Kettering Cancer Center.</p>","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"165-8"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F Rosner, H M Risemberg, P R Kark, P P Sordillo, A J Bennett, A Buscaglia, E J Cassell, P B Farnsworth, A L Halpern, J B Henry
{"title":"Fetal tissue research and transplantation.","authors":"F Rosner, H M Risemberg, P R Kark, P P Sordillo, A J Bennett, A Buscaglia, E J Cassell, P B Farnsworth, A L Halpern, J B Henry","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"174-7"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Island Peer Review Organization is the peer review organization in New York State and is under contract with the Health Care Financing Administration to monitor the quality of care rendered to Medicare patients. A severity level III is assigned when a confirmed quality problem with significant adverse effects for the patient is confirmed. A severity level II is assigned when a confirmed quality problem with the potential for significant adverse effects on the patient is found. The purpose of this study was to retrospectively analyze all 85 severity level III citations and a 12% (223) random sample of the 1,880 severity level II citations for 1991. Another objective was to characterize the providers involved in each of these two levels of quality of care problems. Among the 85 severity level III citations, 34 (40.0%) involved premature death and 33 (38.8%) readmission. Treatment (45.0%), diagnostic (16.9%), and monitoring (16.4%) problems accounted for 78.3% of the 189 problems identified in severity level III citations. The leading problem areas were the treatment of infections and the use of antibiotics (21.2%), fluid and electrolyte management (21.2%), drug use (9.4%), the use of endotracheal tubes (5.9%), the management of diabetes mellitus (5.9%), and the management of hematologic disorders (5.9%). Attending physicians (65.9%), nursing departments (16.5%), and resident physicians (7.1%) were involved in the vast majority (89.5%) of severity level III citations. Treatment problems comprised 60.5% of the 243 problems found in severity level II citations, followed by inadequate work-up (20.2%), and incomplete documentation (12.3%).(ABSTRACT TRUNCATED AT 250 WORDS)
{"title":"Quality of care problems among Medicare patients in New York State.","authors":"R P Nenner, P J Imperato, T O Will","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Island Peer Review Organization is the peer review organization in New York State and is under contract with the Health Care Financing Administration to monitor the quality of care rendered to Medicare patients. A severity level III is assigned when a confirmed quality problem with significant adverse effects for the patient is confirmed. A severity level II is assigned when a confirmed quality problem with the potential for significant adverse effects on the patient is found. The purpose of this study was to retrospectively analyze all 85 severity level III citations and a 12% (223) random sample of the 1,880 severity level II citations for 1991. Another objective was to characterize the providers involved in each of these two levels of quality of care problems. Among the 85 severity level III citations, 34 (40.0%) involved premature death and 33 (38.8%) readmission. Treatment (45.0%), diagnostic (16.9%), and monitoring (16.4%) problems accounted for 78.3% of the 189 problems identified in severity level III citations. The leading problem areas were the treatment of infections and the use of antibiotics (21.2%), fluid and electrolyte management (21.2%), drug use (9.4%), the use of endotracheal tubes (5.9%), the management of diabetes mellitus (5.9%), and the management of hematologic disorders (5.9%). Attending physicians (65.9%), nursing departments (16.5%), and resident physicians (7.1%) were involved in the vast majority (89.5%) of severity level III citations. Treatment problems comprised 60.5% of the 243 problems found in severity level II citations, followed by inadequate work-up (20.2%), and incomplete documentation (12.3%).(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"159-62"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Münchausen syndrome.","authors":"S P Licata, L A McCloskey, C L Karmen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"202-3"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The immunization crisis in New York.","authors":"P B Farnsworth","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 3","pages":"201-2"},"PeriodicalIF":0.0,"publicationDate":"1993-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19370369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reflections on the use of unproven arthritis remedies.","authors":"J M Strosberg","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 2","pages":"118-9"},"PeriodicalIF":0.0,"publicationDate":"1993-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The paradise of quacks.","authors":"J H Young","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"93 2","pages":"127-33"},"PeriodicalIF":0.0,"publicationDate":"1993-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19439007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1993-02-01DOI: 10.1016/s0140-6736(02)73832-4
J. H. Young
{"title":"The paradise of quacks.","authors":"J. H. Young","doi":"10.1016/s0140-6736(02)73832-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(02)73832-4","url":null,"abstract":"","PeriodicalId":19243,"journal":{"name":"New York state journal of medicine","volume":"77 1","pages":"127-33"},"PeriodicalIF":0.0,"publicationDate":"1993-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90521438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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