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Study: Hospital size may determine care

Large hospitals in big cities provide better care and have lower death rates than small rural hospitals, a study of more than 14,000 patients in five states has found. Death rates in rural or suburban hospitals with fewer than 100 beds were 25 percent higher than in large, non-teaching hospitals in cities and 29 percent higher than in major teaching hospitals, the researchers said Tuesday. "If I had a serious illness and it wasn't an emergency, these results would certainly make me think twice about going to the nearest hospital" with fewer than 100 beds, said the study's chief author, Emmett Keeler. The study, published in Wednesday's Journal of the American Medical Association, was carried out for the federal agency that runs Medicare. The researchers studied the records and death rates of 14,008 elderly patients admitted to 297 hospitals in California, Florida, Texas, Indiana and Pennsylvania during 1981-82 and 1985-86.

FDA approves drug for AIDS patients

WASHINGTON _ The Food and Drug Administration on Monday approved expanded use of an experimental drug for AIDS patients who cannot take AZT or DDI, the two chief drugs used in treating the disease. The drug, stavudine, also called d4T, inhibits progress of the human immunodeficiency virus, which causes AIDS, the agency said in a statement. The drug, made by Bristol-Myers Squibb Co., is being tested to determine if it can extend life or delay the onset of AIDS. Early results from those clinical trials on 259 patients indicate at least a temporary beneficial effect of the drug, the FDA said. The agency decided to allow expanded use of d4T after finding that the potential benefits outweigh the risks and the drug fills a health need. AIDS patients who were ineligible for getting the drug before should have their doctors contact the manufacturer to ask about getting it now, the agency said.

Laser surgery may detach eye's retina

WASHINGTON _ Up to 2 percent of patients who undergo a common laser eye surgery procedure following cataract removal will experience a detached retina, a new study says. A detached retina can cause loss of vision, particularly if not treated early. Dr. Jonathan Javitt of Georgetown University Medical Center said Tuesday an analysis of 57,103 Medicare patients who had cataracts removed found that there was a fourfold increase in retinal complications among those who had a follow-up procedure called YAG laser capsulotomy.

Study cast doubt on blood clot risks

CHICAGO _ Women may not run a higher risk than men of developing blood clots in the lung, even though some studies have said they do, researchers said Tuesday. An investigation of 496 women and 406 men conducted by Massachusetts General Hospital in Boston found that women aged 50 and younger actually had a lower frequency of pulmonary embolism than men, and that there was no difference between the sexes over age 50. The study was published in this week's Journal of the American Medical Association. The researchers said the conflict between their finding and other studies could be due to the specific patients used, who were taken from clinical centers in six states, or to differences in classification methods used. But they said it showed the need for more research into women's health issues. Women have been believed to run more of a risk for pulmonary embolisms partly because of estrogen exposure, both in birth control pills and in estrogen replacement drugs after menopause.