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Biomedical subjects

B S Bloom

Publications and source records attributed to B S Bloom.

At least 91 records · Page 5Linked to original sources
PubMed1980

Health and medical care for the elderly and aged population: the state of the evidence.

Emerging statistics emphasize the special needs of the elderly for health and medical care services. A variety of services are being recommended to meet these needs, but few of them have been subjected to rigorous study for determining efficacy, effectiveness or cost. Examination of about 1,000 studies of health and medical services for the elderly published between 1967 and 1978 revealed only 7 that met predetermined criteria for well-designed and executed investigations. The varied needs of the elderly are finally being recognized, and undoubtedly pressure will be increased for meeting these needs. In this era of finite monetary resources and budgetary restraints, we need better data upon which to base the selection of medical care services for the aged. Resources needed to provide care of known benefit should not be diverted to provide care of unknown benefit.

Aged↗
PubMed1979

Physician manpower expansionism: a policy review.

A lack of national health goals has allowed physician manpower policy to be dominated by an expansionist philosophy. Scarce resources have been channeled into the production of specialist physicians trained to provide complex and expensive care for uncommon diseases, using other scare and expensive resources and adding to the steep rise in medical care costs. Society seems to want access to primary care--a lack it views with dismay--and simultaneously fears increasing costs of care. Lack of access plus high cost might lead to rash implementation of other inappropriate policies. Success of policy decisions is pure serendipity if made without reliable and relevant information or based on inappropriate data, such as opinions alone. If information is unavailable, then physician manpower decisions should be delayed or, if made, implemented cautiously.

Health Planning↗
PubMed1979

General surgeons and their surgical practices.

The work characteristics of general surgeons were studied as part of a national study of surgeon manpower. General surgeons were found to work long hours relative to other surgical specialists. Although general surgeons' operative workloads ranked fourth among the 10 surgical specialties, they were only modest in comparison with the surgeons with the highest operative loads (thoracic surgeons). The major conclusion is that the supply of general surgeons is more than adequate to meet the need for general surgeon consultants.

Certification↗
PubMed1979

Thoracic surgeons and their surgical practice.

The work characteristics of thoracic surgeons were studied as part of a national study of surgeon manpower. Thoracic surgeons were found to have the greatest operative work loads, longest workweeks, and equivalent median incomes compared with all other surgical specialties. The major conclusion that the number of thoracic surgeons was adequate concurs with the findings of the National Thoracic Surgery Manpower Study on number of practitioners.

Certification↗
PubMed1978

Otolaryngologists and their surgical practice.

Practice characteristics of otolaryngologists, studied as part of a national survey of surgeon manpower, are compared with those of other surgical specialists. Otolaryngologists had relatively short workweeks and spent more professional time in their offices than in hospitals compared with other surgeons. Their California relative value (CRV)-weighted surgical work load ranked eighth among all surgeons. Although otolaryngologists performed, on the average, more operations annually than did other surgical specialists, their procedures were generally less complex (low CRV weights). The per capita rate for tonsillectomy, the procedure that comprised more than one third of the weighted work load of otolaryngologists, has declined precipitously. The conclusion drawn from this study is that a reduction in the number of trainees in otolaryngology would be in the best interest of the young and other otolaryngologists whose capabilities are now seriously underutilized.

Age Factors↗
PubMed1978

Surgeons in the United States. Practice characteristics.

Data on practice characteristics were obtained as part of a national questionnaire study of surgeons in the United States. These included location and organization of surgeons' practices, use of nonphysician personnel, provision of ambulatory care, other professional activities, and variables associated with work load volume. A multivariate analysis was done to examine the relation between operative work loads and various practice characteristics. The variables associated with larger operative work loads were group or partnership practice, principal office not in a hospital, more nonphysician assistants in direct contact with patients, more hospitals in which operations were regularly done, and smaller proportions of nonsurgical patients. Group or partnership practice and nonsurgical practice were found to be most strongly related to operative work load.

Ambulatory Care↗
PubMed1978

Urologists and their surgical practice.

The work characteristics of urologists were studied as part of a national study of surgeon manpower. Urologists were found to work short hours relative to other surgical specialties, and their operative work load ranked sixth among the ten surgical specialties. The major conclusion was that the supply of urologists was greater than necessary to meet the need for urologic consultants.

Age Factors↗
PubMed1978

Distributing medical care services. Coronary care units in the United States and Sweden.

Planning in the United States is based on an institution's perceived need, whereas in many other countries it is based on population need. These unique approaches to planning have led to widely differing distributions of facilities and services. Planning by the U.S. method leads to a more generous provision of services than does population-based planning. In both planning systems, the planning process appears of paramount importance, while the fundamental questions of effectiveness outcome and impact of medical care services are usually ignored. Even population-based planning either cannot or will not deal with the conflict between professional desire for highly developed technology on the one hand and treatment effectiveness on the other. Nevertheless, population-based planning has at least the virtue of providing a less expensive yet more efficient system. Physicians and the public appear able to adjust to the quite different resource provisions of the two planning systems; both the abundant U.S. supply and the restricted supply in Sweden are perceived as adequate.

Cardiovascular Diseases↗
PubMed1977

Utilization of coronary care units in Sweden.

Coronary care unit usage has expanded rapidly in all high income countries with little attention to effectivity or cost. A study of six randomly chosen Swedish units showed that larger units in teaching hospitals had significantly lower age-adjusted mortality rates, higher proportions of myocardial infarction patients, and greater productivity and efficiency. Comparisons with a study from the United States showed better results in the Swedish hospital units according to all variables measured. Although proof of effectiveness of CCU's is lacking, their continued use is assured. A less than optimal solution is a rational distribution of units based upon epidemiologically determined need, while stressing good organization and efficiency.

Coronary Care Units↗
PubMed1976

Doctors who perform operations. A study on in-hospital surgery in four diverse geographic areas (first of two parts).

The generous supply of surgeons in the United States stimulated a study of their operative work based on all operations performed by all physicians in hospitals of four geographic areas. Each operation was assigned a California Relative Value to permit work-load comparisons between specialties and practices. General practitioners constituted more than one quarter of physicians who performed operations but accounted for less than one tenth of total work. Surgical specialists, about half the physicians in the study, performed about 80 per cent of total operative work. Work loads of surgical specialists varied by certification, specialty, age and practice organization status. We conclude that far too many physicians perform surgical operations and that work loads of surgical specialists are modest. Calculations involving reallocation of operative work loads suggest that the total volume of operations in this study could have been handled by a substantially smaller cadre of busier surgical specialists.

Certification↗
PubMed1976

Surgeons in the United States. Activities, output and income.

In a national surgical manpower questionnaire survey, 76% of those MD and DO surgeons who were contactable returned questionnaires that included a log diary reporting details of their daily activities. Comparisons were made of allocation of professional time, number of operations performed, and net income of respondents by physician classification (including certification), specialty, practice arrangement, age, and census division. The mean professional workweek was estimated at 46 hours for all respondents. More than two thirds of the total professional time was spent in direct patient care; about half the surgeon's time was spent in the hospital, with nearly 20% in the operating room. The median annual work load of respondents was 170 operations. Their median annual net income was $45,700.

Adult↗