Diagnosis Of Primary Disease Research Articles

The differential diagnosis of primary electrical diseases from seizures in childhood

The differential diagnosis of primary electrical diseases from seizures in childhood

Hospitalization Costs Associated With Hypertension as a Secondary Diagnosis Among Insured Patients Aged 18-64 Years

We estimated the hospitalization costs associated with hypertension as a secondary diagnosis among insured adults aged 18-64 years by using data from 2005 MarketScan Commercial Claims and Encounters (CCAE) inpatient admissions. We analyzed costs for four patient groups (N = 455,944): (i) all selected patients; (ii) patients with the primary diagnosis of ischemic heart disease (IHD); (iii) patients with the primary diagnosis of cerebrovascular disease; and (iv) patients with neither IHD nor cerebrovascular disease as the primary diagnosis. We conducted propensity score matching to control possible bias in cost estimates due to sample selections and estimated the costs of hypertension by using a regression model on the matched populations that controlled for subjects' age, sex, length of hospital stay, Charlson comorbidity index (CCI), region of residence, and urbanization of residence. For all patients with hypertension as a secondary diagnosis, the estimated average annual hospitalization cost per patient was $21,094, of which $2,734 (13%; P < 0.01) was associated with hypertension. The estimated average costs were $31,106 for patients with a primary diagnosis of IHD, $17,298 for those with a primary diagnosis of cerebrovascular disease, and $18,693 for those without a primary diagnosis of IHD or cerebrovascular disease; hypertension-associated costs for these patients were $3,540 (11.4%; P < 0.01), $1,133 (6.5%; P < 0.01), and $2,254 (12.1%; P < 0.01), respectively. Hypertension-associated hospitalization costs are substantial among insured US patients aged 18-64 years with hypertension as a secondary diagnosis and suggest a need for cost-effective programs to prevent, manage, and control hypertension.

Differentiation of diagnosis and prognoses of non-coronary arterial primary myocardial diseases with left ventricular focal myocardial thinning evaluated by multislice computed tomography

This study sought to differentiate diagnosis and prognoses of non-coronary arterial primary myocardial diseases with focal left ventricular myocardial (LVM) thinning evaluated by multislice-CT. Based on the presence of fibro-fatty change and asynergy in LVM, we sought to understand the clinical significance of detection of non-coronary arterial focal LVM thinning. 766 consecutive subjects (419--male, 59±18 years) underwent enhanced ECG-gated multislice-CT. 12 subjects (8 male, mean age 58 years) with non-coronary arterial primary diseases and evidence of focal LVM thinning were selected. Non-coronary arterial primary diseases exhibiting focal LVM thinning were defined as follows: In comparison with the adjoining reference normal area, focal LVM thinning in end-diastole was less than half that of the adjoining reference normal area. On transthoracic echocardiography, LV sizes of the 12 subjects tended to be slightly enlarged and the mean LV ejection fraction (46.8%) was slightly below the normal range. There are many non-coronary arterial primary diseases which exhibit focal LVM thinning. In this study, we constructed a differential flowchart in which estimation of final diagnosis, treatment and prognosis for such subjects can usefully be based on the presence of fibro-fatty change and asynergy in thinned LVM sites by MSCT. Detection of the presence of fibro-fatty change and asynergy in thinned LVM sites may indicate the need for implantation of implantable cardioverter defibrillator or cardiac pacemakers. A differential flowchart for those subjects using the presence of fibro-fatty change and asynergy in thinned LVM sites by MSCT may be useful to differentiate prognoses of such subjects.

Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions

Diverticular disease has a changing disease pattern with limited epidemiological data. To describe diverticular disease admission rates and associated outcomes through national population study. Data were obtained from the English 'Hospital Episode Statistics' database between 1996 and 2006. Primary outcomes examined were 30-day overall and 1-year mortality, 28-day readmission rates and extended length of stay (LOS) beyond the 75th percentile (median inpatient LOS = 6 days). Multiple logistic regression analysis was used to determine independent predictors of these outcomes. Between the study dates 560 281 admissions with a primary diagnosis of diverticular disease were recorded in England. The national admission rate increased from 0.56 to 1.20 per 1000 population/year. 232 047 (41.4%) were inpatient admissions and, of these, 55 519 (23.9%) were elective and 176 528 (76.1%) emergency. Surgery was undertaken in 37 767 (16.3%). The 30-day mortality was 5.1% (n = 6735) and 1-year mortality was 14.5% (n = 11 567). The 28-day readmission rate was 9.6% (n = 21 160). Increasing age, comorbidity and emergency admission were independent predictors of all primary outcomes. Diverticular disease admissions increased over the course of the study. Patients of increasing age, admitted as emergency and significant comorbidity should be identified, allowing management modification to optimize outcomes.

Diagnosis and treatment of primary pigmented nodular adrenocortical disease report of 4 cases

To study the diagnosis and treatment of primary pigmented nodular adrenocortical disease (PPNAD). The clinical data including symptom, endocrinal examination, surgical operation and prognosis of 4 cases of PPNAD hospitalized from 2000 to 2007 were analyzed respectively, relative literature were reviewed. 1 case received total adrenalectomy needed adrenocortical hormone postoperatively, 3 cases responded favorably to subtotal adrenalectomy and did not need adrenocortical hormone, however, 1 case was diagnosed of thyroid carcinoma 2 years after subtotal adrenalectomy. PPNAD is a rare subtype of ACTH-independent Cushing's syndrome, the diagnosis is depend on symptom, endocrinal examination and pathology. Total adrenalectomy is suitable to the patients with obvious symptom; subtotal adrenalectomy to the patients with mild symptom, the lesion of other endocrinal organ must be followed up postoperatively.

Early Helicobacter pylori Eradication Decreases Risk of Gastric Cancer in Patients With Peptic Ulcer Disease

Helicobacter pylori (H pylori) is a risk factor for gastric cancer. We investigated whether early H pylori eradication is associated with gastric cancer risk in patients with peptic ulcer diseases. This nationwide cohort study was based on the Taiwan National Health Insurance Database (NHID), which provided data on 80,255 patients who were hospitalized for the first time between 1997 and 2004 with a primary diagnosis of peptic ulcer diseases and received H pylori eradication therapy. The patient population was divided into early (within 1 year) and late (after 1 year) eradication cohorts; standardized incidence ratios (SIRs) and hazards ratios (HRs) were determined. There was no significant difference in gastric cancer risk between patients who received early H pylori eradication and the general population (SIR, 1.05; 95% confidence interval [CI]: 0.96-1.14), but late eradication was associated with an increased risk (SIR, 1.36; 95% CI: 1.24-1.49). In gastric ulcer patients who received early eradication, SIRs of gastric cancer decreased from 1.60 at 3-4 years to 1.05 at 7-10 years after hospitalization; the SIRs decreased from 0.57 to 0.33 for duodenal ulcer patients over the same period. Among patients who received late eradication, SIRs decreased from 2.14 to 1.32 for those with gastric ulcers and from 0.90 to 0.66 for those with duodenal ulcers. Early H pylori eradication (HR, 0.77) and frequent aspirin or nonsteroidal anti-inflammatory drug use (HR, 0.65) were independent protective factors for gastric cancer. Early H pylori eradication is associated with decreased risk of gastric cancer in patients with peptic ulcer diseases.

The changing pattern of adult primary glomerular disease

Published biopsy series have shown geographical and temporal variations in the patterns of primary glomerulonephritis (GN). IgA nephropathy is the most common type of GN in most European studies, but there is evidence suggesting that focal segmental glomerulosclerosis (FSGS) is increasingly common in the USA in all ethnic groups. We report the analysis of 30 years of native renal biopsies and the temporal pattern of primary glomerular disease in a single United Kingdom (UK) region. All 1844 adult native kidney biopsies for 30 years (1976-2005 inclusive) were analysed. The data were divided into three 10-year time frames, and trends in the biopsy rate and diagnosis of primary glomerular disease were considered. Biopsy rates increased significantly from 2.02 to 7.08 per hundred thousand population per year (php/year) (chi(2) = 55.9, P < 0.001), and the mean patient age at biopsy rose from 33 to 49 years over the study period (F = 58, P < 0.001). Primary GN was documented in 49% of biopsies; the most common diagnoses within this group were IgA nephropathy (38.8%), membranous nephropathy (29.4%), minimal change disease (9.8%), membranoproliferative GN type 1 (9.6%) and FSGS (5.7%). There was a significant increase in the proportion of IgA nephropathy (chi(2) = 9.6, P = 0.008) and a decrease in membranous nephropathy (chi(2) = 7.2, P = 0.03) over time. The population incidence of FSGS was low and unchanged at 0.18 php/ year from 1986 to 2005. Consistent with several other European studies, IgA nephropathy was the most common primary glomerular disease in this UK region. The diagnosis of FSGS was uncommon with no evidence of a rise in incidence.

Within-day repeatability of the endurance shuttle walk test

Objective To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) – one practice and one test – on the same day. Design Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation. Setting Outpatient physiotherapy department of a university hospital. Participants Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation. Measurements Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation. Results The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences ( d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds. Conclusion A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day.

Randomized clinical trial of the safety and efficacy of oxymorphone extended release for degenerative disc disease in opioid-naive patients

It was previously demonstrated that oxymorphone extended release (OPANA® ER) is safe and effective for treating chronic low back pain in opioid-naive patients. This subanalysis of a multicenter, enriched-enrollment, randomized-withdrawal trial evaluated the safety and efficacy of oxymorphone ER in opioid-naive patients with primary diagnosis of degenerative disc disease (DDD). During the enrichment phase, patients received open-label 5-mg oxymorphone ER q12h for 2 days and then were titrated (increments of 5-10 mg every 3–7 d) to a stabilized dose providing adequate and tolerable analgesia (average pain intensity ≤40 mm on 100-mm Visual Analog Scale [VAS]). 107 patients entered titration; 62 (57.9%) were stabilized (median dose 40 mg). 16 (15.0%) discontinued due to an adverse event (AE). During the 12-week, double-blind, randomized phase, patients received their stabilized dose of oxymorphone ER (n = 34) or placebo (n = 28); 18 (52.9%) and 13 (46.4%), respectively, completed treatment. From baseline to final visit, the mean increase in VAS pain intensity was significantly (P < 0.001) greater in placebo group (35.0 ± 4.4) than in oxymorphone group (12.7 ± 3.9). 4 oxymorphone ER patients (11.8%) and 1 placebo patient (3.6%) discontinued due to an AE. The most frequent treatment-emergent AEs were nausea (4.7% [n = 5/107]), constipation (3.8% [n = 4/107]), and vomiting (3.8% [n = 4/107]) with oxymorphone ER and nausea, diarrhea, and upper respiratory tract infection (each 1.9% [n = 2/107]) with placebo. In this study, approximating conditions encountered by treating physicians, titration of oxymorphone ER was generally well tolerated and successful for most opioid-naive patients with DDD. Oxymorphone ER was efficacious, with a low AE rate. It was previously demonstrated that oxymorphone extended release (OPANA® ER) is safe and effective for treating chronic low back pain in opioid-naive patients. This subanalysis of a multicenter, enriched-enrollment, randomized-withdrawal trial evaluated the safety and efficacy of oxymorphone ER in opioid-naive patients with primary diagnosis of degenerative disc disease (DDD). During the enrichment phase, patients received open-label 5-mg oxymorphone ER q12h for 2 days and then were titrated (increments of 5-10 mg every 3–7 d) to a stabilized dose providing adequate and tolerable analgesia (average pain intensity ≤40 mm on 100-mm Visual Analog Scale [VAS]). 107 patients entered titration; 62 (57.9%) were stabilized (median dose 40 mg). 16 (15.0%) discontinued due to an adverse event (AE). During the 12-week, double-blind, randomized phase, patients received their stabilized dose of oxymorphone ER (n = 34) or placebo (n = 28); 18 (52.9%) and 13 (46.4%), respectively, completed treatment. From baseline to final visit, the mean increase in VAS pain intensity was significantly (P < 0.001) greater in placebo group (35.0 ± 4.4) than in oxymorphone group (12.7 ± 3.9). 4 oxymorphone ER patients (11.8%) and 1 placebo patient (3.6%) discontinued due to an AE. The most frequent treatment-emergent AEs were nausea (4.7% [n = 5/107]), constipation (3.8% [n = 4/107]), and vomiting (3.8% [n = 4/107]) with oxymorphone ER and nausea, diarrhea, and upper respiratory tract infection (each 1.9% [n = 2/107]) with placebo. In this study, approximating conditions encountered by treating physicians, titration of oxymorphone ER was generally well tolerated and successful for most opioid-naive patients with DDD. Oxymorphone ER was efficacious, with a low AE rate.

Are medical students sufficiently vaccinated? 1

Medical students are exposed to infectious diseases during the course of their clinical training. Unfortunately, vaccination rates among medical students remain insufficient. However, immunizations against vaccine-preventable diseases should be carried out before the students enter clinical courses. This is vital in order to prevent nosocomial infections. We screened 366 medical students in their first clinical year for hospital-related viral diseases. Serum samples were collected between April and May 2007. Antibody testing was carried out using commercial ELISA systems against measles, mumps, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). Overall, 63.9% (n=234) of the students were sufficiently vaccinated against HBV. In contrast, 31.7% (n=116) had not received any HBV vaccine dosage, and 4.4% (n=16) had not completed the full vaccine cycle (&lt;3 dosage). Remarkably, two students showed serological markers of resolved HBV infection. In addition, one student was HCV-positive and one was HIV-positive, respectively. The following seronegative rates were found: measles (7.9%), mumps (17.5%), rubella (6.5%), and varicella (2.2%). Further work is needed to identify optimal strategies for improving vaccination rates among medical students. It is imperative to identify and limit possible disparities in immunity of vaccine-preventable diseases before initial patient contact. With regard to the primary diagnosis of serious virus diseases including HBV, HCV and HIV, medical students should be screened for these blood borne pathogens.

Sind Medizinstudenten ausreichend geimpft? / Are medical students sufficiently vaccinated?

Medical students are exposed to infectious diseases during the course of their clinical training. Unfortunately, vaccination rates among medical students remain insufficient. However, immunizations against vaccine-preventable diseases should be carried out before the students enter clinical courses. This is vital in order to prevent nosocomial infections. We screened 366 medical students in their first clinical year for hospital-related viral diseases. Serum samples were collected between April and May 2007. Antibody testing was carried out using commercial ELISA systems against measles, mumps, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). Overall, 63.9% (n=234) of the students were sufficiently vaccinated against HBV. In contrast, 31.7% (n=116) had not received any HBV vaccine dosage, and 4.4% (n=16) had not completed the full vaccine cycle (&lt;3 dosage). Remarkably, two students showed serological markers of resolved HBV infection. In addition, one student was HCV-positive and one was HIV-positive, respectively. The following seronegative rates were found: measles (7.9%), mumps (17.5%), rubella (6.5%), and varicella (2.2%). Further work is needed to identify optimal strategies for improving vaccination rates among medical students. It is imperative to identify and limit possible disparities in immunity of vaccine-preventable diseases before initial patient contact. With regard to the primary diagnosis of serious virus diseases including HBV, HCV and HIV, medical students should be screened for these blood borne pathogens.

The incidence of difficult intubation in 2 000 patients undergoing thyroid surgery: A single center experience

The incidence of difficult intubation (DI) is 1-10%, and DI leading to inability to intubate occurs in 0.04% of the population. The aim of this study was to evaluate the incidence of DI in thyroid surgery and to assess possible correlation of difficult tracheal intubation with sex and primary diagnosis. We studied 2000 consecutive patients (1705 females) scheduled for thyroid surgery who were assessed for DI prior to general anesthesia, with respect to primary disease diagnosis and sex. Patients were divided into four groups: patients with nodal goiter (group A), polynodal goiter (group B), hyperthyroidism (group C) and thyroid carcinoma (group D). Difficult intubation was predicted using the scoring system which included 13 parameters ranged from 0 to 2. Additive score > 5 was accepted as a predictor of DI. True DI was defined as impossible visualization of glottis with direct laryngoscopy (grade III and IV). Difficult intubation was observed in 110/2000 patients (5.5%). The incidence of DI was higher in males (26/295, 8.8%) than females (84/1705, 4.9%) (p < 0.01). The incidence of DI was highest in the group B (6.2%). Extremely DI occurred in 15/2000 patients (0.75%), the most of them in the group C (1.1%). Sensitivity of used scoring system was 91.8% and specificity 86.5%. The incidence of DI was higest in patients with polynodal goiter but extremly DI was present mostly in patients with hyperthiroidism. Men seem to be at higher risk for DI than women. Scoring system used in this study for prediction of DI may be useful in this patient population.

Recent developments related to the laboratory diagnosis of primary immunodeficiency diseases

The rapid increases in newly recognized primary immunodeficiency diseases (PIDs), including their clinical, genetic and laboratory-associated abnormalities, make staying abreast of the latest developments a challenge. This review provides an overview of current information directly and indirectly related to the laboratory diagnosis of PIDs. The latest classification and several prevalence studies provide the framework for understanding the breadth, categories and incidence rates of over 120 recognized disease entities. The latter is followed by reviews of new information related to specific PIDs including new tests, new genetic associations and newly discovered laboratory-based abnormalities. The final section presents new PIDs and a discussion of the future potential of array-based technologies in the diagnosis of PIDs. The information provided in this review will allow a new appreciation of previously underestimated PIDs' prevalence rates and the delay in their diagnosis. Understanding the molecular causes of PIDs will lead to earlier diagnoses and new targets for improved therapeutic intervention. The presentation of new diagnostic tests should encourage other laboratories to assess their potential in their own laboratories. Ultimately, this information will lead to an increase in the understanding of novel laboratory parameters associated with specific PID and should improve the time required to attain an accurate diagnosis.

Epicardial Ultrasonic Ablation of Atrial Fibrillation During Concomitant Cardiac Surgery Is a Valid Option in Patients With Ischemic Heart Disease

Surgical therapy of atrial fibrillation concomitant to coronary bypass grafting using epicardial Ultrasound technology was assessed after a minimum 6-month follow-up. A cohort of 98 consecutive patients with a mean age of 72+/-7.58 years and a primary diagnosis of ischemic heart disease had surgery for structural disease. Coronary artery bypass grafting was isolated (n=51) or associated (n=47) with various combinations of aortic, mitral, tricuspid, and left ventricular restoration surgery. Atrial fibrillation duration ranged from 6 to 360 months (mean 71 months) and was permanent in 47 patients, paroxysmal in 34, and persistent in 17. Left atrial mean diameter was 48+/-6.71 mm. A circumferential ablation was performed off-pump, before the concomitant procedure, and was always associated with an epicardial mitral line lesion using the same technology. At 3-, 6-, and 12-month visits, patients were routinely evaluated by physical examination, ECG, chest X-ray, and 24-hour Holter. There were 1 early death (1%) and 4 extracardiac late deaths. A pacemaker was implanted in 4 patients. Mean follow-up time was 325 days, 2 patients being lost to follow-up. Freedom from atrial fibrillation and flutter at the 6-month visit was 84% for the entire population, 76% in patients with permanent, and 91% in patients with paroxysmal atrial fibrillation. At the 1-year visit, 85% were free from atrial fibrillation or flutter. Epicardial beating heart ablation using therapeutic ultrasound is safe, reliable, and can easily treat atrial fibrillation in a difficult surgical population of patients with primary ischemic heart disease.

Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality

We sought to determine patterns of hospitalizations for inflammatory bowel disease (IBD) to centers that regularly admit high volumes of IBD patients and whether they impacted health outcomes. We queried US hospital discharges in the Nationwide Inpatient Sample to identify admissions with a primary diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between 1998 and 2004. We determined patterns and predictors of hospitalization at high IBD volume admission centers (HIVACs) (>or=145 IBD admissions annually) and assessed their impact on mortality. Over 7 years the proportion of patients admitted to HIVACs increased from 2.3% to 14.8%. IBD patients were less likely to be admitted to an HIVAC if they were insured by Medicare (odds ratio [OR] 0.74; 95% confidence interval [CI]: 0.65-0.83) or Medicaid (OR 0.71; 95% CI: 0.60-0.84), or were uninsured (OR 0.42; 95% CI: 0.30-0.58) compared with those privately insured. Neighborhood income above the national median favored admission to an HIVAC (OR 1.99; 95% CI: 1.46-2.71). In-hospital mortality was lower among HIVACs compared to non-HIVACs (3.5/1000 versus 7.2/1000, P < 0.0001) and was persistent after adjustment for surgery status, age, comorbidity, and health insurance (OR 0.65; 95% CI: 0.49-0.87). When stratified by diagnosis, mortality was reduced at HIVACs among CD (OR 0.58; 95% CI: 0.37-0.90) but not UC admissions. There is a rising trend in hospitalizations for IBD at HIVACs, which confers mortality benefit for those with CD. Prospective studies are warranted to further explore the impact of these high-volume centers on IBD health outcomes.

The prevalence of hematologic and metabolic abnormalities during chronic kidney disease stages in different ethnic groups

We conducted an observational cross-sectional study to determine if the prevalence of hematologic and metabolic abnormalities in chronic kidney disease (CKD) varied in different ethnic groups. We used a CKD provincial database where a complete data set at the time of registration was available as well as an estimated glomerular filtration rate (eGFR), which showed using the abbreviated MDRD formula that the patients had CKD of stages 3-5. We included patients with self-reported race of Caucasian, Oriental Asian, or South Asian. Primary outcomes were the prevalence of at least one of the following: anemia, hypocalcemia, hyperphosphatemia, hyperparathyroidism, hypoalbuminemia, and three or more laboratory abnormalities. All definitions were consistent with K/DOQI guidelines. When compared with Caucasians, Oriental Asians and South Asians had a higher prevalence of many of the metabolic abnormalities during most stages of CKD and were more likely to have any abnormality at all levels of eGFR. The prevalence of three or more laboratory abnormalities was higher in Oriental Asians at all stages and in South Asians at some levels of eGFR. These results were unchanged or exaggerated when controlled for age, gender, diabetes, and a primary diagnosis of renal disease. Hence, it appears that South Asians and Oriental Asians have more laboratory abnormalities compared with Caucasians at most levels of eGFR.

Racial Disparities in the Development of Dysphagia After Stroke: Analysis of the California (MIRCal) and New York (SPARCS) Inpatient Databases

Gonzalez-Fernandez M, Kuhlemeier KV, Palmer JB. Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases. Objectives To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity. Design Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had primary diagnosis of cerebrovascular disease ( International Classification of Disease, 9th Revision [ICD-9] codes 430–438.9, excluding transient [435–435.9] and late-effects [438–438.9]), and self-identified race was white, black, or Asian. Two comparison groups were selected: (1) Parkinson's disease (ICD-9 codes 332–332.1) and (2) oral cancer (ICD-9 codes 141–149). Setting Inpatient admissions in the respective states. Participants Cases with primary diagnosis of cerebrovascular disease whose self-identified race was white, black, or Asian. Interventions Not applicable. Main Outcome Measure Dysphagia, defined by ICD-9 codes 787.2 (dysphagia), 507.0 (aspiration pneumonia), or presence of a feeding tube in the absence of a diagnosis of coma (Current Procedural Terminology codes 432.46 or 437.50 without ICD-9 code 780.01). Results In the stroke group, the adjusted odds ratio (OR) with 95% confidence interval (CI) for dysphagia was significantly higher for Asians than whites in New York (OR=1.64; 95% CI, 1.50–1.79) and California (OR=1.69; 95% CI, 1.34–2.13). The adjusted OR was slightly but significantly higher for blacks than whites in New York (OR=1.15; 95% CI, 1.03–1.28), but not in California (OR=1.08; 95% CI, 0.97–1.19). No statistically significant differences among racial groups were found in patients with Parkinson's disease or oral cancer. Other factors strongly associated with dysphagia included hemiplegia (OR=2.19; 95% CI, 2.07–2.32) and aphasia (OR=1.97; 95% CI, 1.83–2.11). Conclusions Asians were more likely to have dysphagia after stroke. This association was statistically significant after adjusting for age, sex, stroke severity indicators, comorbidities, and stroke type.

Differences in HIV-Related Hospitalization Among White, Black, and Hispanic Men and Women of Florida

ABSTRACT Patients hospitalized for Human immunodeficiency virus (HIV) disease among the multi-ethnic population of Florida have been incompletely characterized to date. The objectives of the present study were to determine the race/ethnic (whites, blacks, Hispanics) differences in characteristics of patients by gender and the correlates of HIV-related mortality among them. A retrospective analysis of 9,113 discharge records (January to December 2001) with primary diagnosis of HIV disease was performed. Characteristics of patients in six sex-race/ethnic groups were compared using the χ2 tests and multiple regression models. A multiple logistic regression modeling was used to evaluate the odds of HIV-related death associated with these characteristics. Approximately 64%, 23%, and 13% of records were for blacks, whites, and Hispanics, respectively. The adjusted length of stay (LOS) and hospital charges significantly differed only between black men and women. The insurance status, LOS, and age were significant correlates of HIV-related deaths. The potential causes of disparities between sex-ethnic groups of patients should be further explored.

Metastatic carcinoid tumour (MCT): 20 years experience at the Queen Elizabeth Hospital. Does management by a medical oncology unit (MOU) improve outcome?

15581 Background: MCTs have unique treatment approaches and often have an indolent course. Until recently, data on survival and treatment outcome was limited by the infrequent nature of these tumors. We aim to retrospectively assess the impact of care by a MOU (as a measure of active multidisciplinary intervention) on patient outcome. Methods: Patients diagnosed with carcinoid tumors at the QEH/LMH after 1/1/1985 were identified from the SA cancer registry. For patients with MCT the following data was collected; histology, primary site, treatment and survival. Patients with MCT were classified into two groups; those managed by a MOU, and those managed by an alternative specialist (other). The characteristics and outcomes of these groups were compared. Results: 90 patients with carcinoid were identified; mean age = 63, M/F=50/40. The primary site of disease (MCT v local) was: small bowel 54% v 20%, lung 2% v 30%, large bowel 17% v 2%, appendix 0% v 18%. Of the patients with MCT (n=46), 25 were referred to a MOU. The median age for MOU v other was 62 v 75 yrs. Treatment received by the two groups (MOU v other) was; octreotide LAR (76% v 10%), resection of primary tumor (76% v 86%), liver resection (4% v 5%), chemotherapy (8% v 0%), and MIBG (12% v 5%). The median time from diagnosis to commencement of octreotide LAR was 19.6 mths for functional MCT, with >50% reduction in 5HIAA to initial treatment in 79% of patients and no deaths in responders. Median overall survival (MOU v other) was 112 mths v 32 mths (HR 3.07 (1.43 - 7.65), p=0.005), and 10yr survival was 40% v 17%. Survival increased with octreotide LAR use (112 mths v 53 mths, p=0.017) and resection of primary (93 mths v 21 mths, p=0.02). Using Cox proportional hazards regression analysis, age at diagnosis and site of primary disease did not significantly affect survival. The impact of year of diagnosis on outcome will be presented. Conclusions: This single centre experience suggests active multidisciplinary intervention improves survival. Patients not seen in a MOU received minimal observation and few received octreotide LAR. Outcome may reflect referral bias, as referral to a MOU increased in the past 10 years, when more interventions have become available. No significant financial relationships to disclose.

Hospital Charges Attributable to a Primary Diagnosis of Infectious Diseases in Older Adults in the United States, 1998 to 2004

To describe total and average hospital charges associated with infectious disease (ID) hospitalizations and specific ID categories and to estimate ID hospitalization rates in adults aged 65 and older in the United States from 1998 through 2004. Retrospective analysis of hospital discharge data obtained from the Nationwide Inpatient Sample for 1998 through 2004. United States. Older adults hospitalized in the United States from 1998 through 2004. Hospital charges and hospitalization rates for IDs described according to year, age group, sex, U.S. Census region, and ID category. Charges for non-ID hospitalizations were also described. Hospital charges were adjusted for inflation. From 1998 through 2004, total charges for ID hospitalizations exceeded $261 billion and accounted for 13% of all hospital charges for older adults. Total charges for ID hospitalizations increased from $31.4 billion in 1998 to $45.7 billion in 2004. The average annual ID hospital charge was lower than the average annual non-ID hospital charge during the study period ($21,342 vs $22,787, P<.001). The average annual rate for ID hospitalizations was 503 per 10,000 older adults, which remained stable during the study period. The total charges for ID hospitalizations and for all hospitalizations in older adults in the United States increased 45% and nearly 40%, respectively, during the 7-year study period, whereas the population of older adults grew by only 5%. Sustained increases of such magnitude will have major implications for the U.S. healthcare system as it prepares for the more than doubling of the older U.S. adult population during the first 30 years of this century.