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The prognostic importance of cytogenetics was evaluated in 200 adults between 15 and 65 years of age treated on a single ALL cooperative group protocol. Among the 140 having evaluable cytogenetic data, four risk categories were devised. Philadelphia chromosome positive t(9;22), unfavorable (monosomy 7, trisomy 8 or an 11q23 rearrangement), miscellaneous and normal. Overall survival of the miscellaneous group was similar to the normal karyotype patients whereas survival was considerably worse for both unfavorable and Ph + cytogenetic groups. The traditional adverse risk factors of older age and higher presenting white blood cell count were not associated with worse survival after adjusting for cytogenetics. In adult ALL, cytogenetics categories may be the strongest factor in predicting outcome.
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In a series of 354 elderly breast cancer patients treated with conservative surgery and tamoxifen but without axillary dissection or radiotherapy followed for 15 years, the cumulative incidence of developing axillary disease was 4.2%, and of developing local recurrence was 8.3%. Of the 354 subjects, 268 had died over the 15-year period, 17% of breast cancer and (83%) from causes other than breast cancer.
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A middle-aged male patient let's call him "Tom" showed up in the emergency department at Massachusetts General Hospital in Boston about a year ago complaining of pains in his chest and legs.
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When patients are medically ready to leave the acute care hospital and have no coverage for post-acute care, it's a "no-brainer" for the hospital to pay to move the patient to a lower level of care, says Jay Cayner, director of social patient and family services at the University of Iowa Hospitals and Clinics.
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As health insurance costs escalate and employers reduce coverage for employees, raise deductibles, or stop providing health insurance altogether, hospitals are providing care for an increasing number of patients who have no means to pay.
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Due to the increased demand for more in-depth information, there is a new resource for all your discharge planning needs.
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Amajor software upgrade has dramatically increased the ability of a New Jersey health system's behavioral health call center to serve as a "one-stop connection" for local emergency departments, psychiatric emergency screening services, and a stand-alone psychiatric hospital, says Dawn Fenske, director of Saint Barnabas Management Services in Toms River, NJ.
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When chronically ill patients who have no insurance coverage and no medical home come into the emergency department at Harbor-view Medical Center in Seattle, they are referred for follow-up to a nurse case manager who links the patients to a primary care provider and helps them learn to manage their disease.
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Federally qualified community health centers: These centers are funded through federal grants to provide primary and preventive health care in medically underserved areas and must provide the uninsured if they meet guidelines.
