Biomedical subjects
Publications and source records attributed to C Hogan.
This draft joint statement by the Royal Australian College of General Practitioners and the Pharmaceutical Society of Australia Ltd is published here for comment as a national initiative. All suggestions received will be considered before a final statement is adopted.
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In a general practice setting managing the emergency call for a collapsed patient begins with the doctor talking to the caller. This article reviews the steps taken and the equipment needed to ensure a successful outcome when managing a patient who has 'collapsed' outside a practice or hospital setting.
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BACKGROUND: We developed a new approach to measuring access to care that examines post-hospitalization follow-up care. It reveals differences in receipt of follow-up care among different subsets of the Medicare population. METHODS: Medicare administrative databases from 1986, 1988, and 1990 were used to construct three retrospective cohorts. Each cohort consisted of patients from a random 1% sample of Medicare beneficiaries admitted with selected conditions that almost always require timely follow-up care. Various "vulnerable populations" within these cohorts were defined on the basis of age, sex, race, and other demographic factors. Merged outpatient records were used to determine receipt of postdischarge follow-up physician services, follow-up services in outpatient departments, and any follow-up care for these different Medicare populations. RESULTS: Beneficiaries aged 85 years or older, black beneficiaries, Medicaid/Qualified Medicare Beneficiaries, residents of urban core counties, residents of the highest-poverty ZIP codes, and residents of Health Professional Shortage Areas were less likely to receive follow-up physician services. Beneficiaries aged 85 years or older, black beneficiaries, residents of the highest-poverty ZIP codes, and residents of Health Professional Shortage Areas were less likely to receive any follow-up care. CONCLUSIONS: This method identified some Medicare populations who failed to receive needed follow-up services, suggesting problems with access to care. This method may be useful in tracking changes in access under the new Medicare fee schedule.
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This DataWatch estimates physicians' net incomes under various scenarios for universal adoption of the Medicare fee schedule. American Medical Association (AMA) data on physicians' gross incomes by payer are adjusted for differences in fees across Medicare, Medicaid, and private payers. Net income (gross income net of practice costs) is shown under several alternatives. Average net incomes would range from roughly $100,000 to $200,000, depending on specialty and the particular assumptions used. General practitioners' incomes would typically rise, and income differences across specialties would be narrowed significantly. The Medicare fee schedule, as intended, would increase incomes of primary care physicians relative to specialists.
There is no effective therapy available for stage D2 prostate cancer once patients become refractory to hormonal therapy. In a pilot study, we treated 17 patients with hormone-refractory stage D2 prostate cancer using autolymphocyte therapy, an outpatient form of adoptive immunotherapy in which patients are treated with autologous T cells that have been activated ex vivo. Feasibility and safety were documented. Transient PSA reductions up to 66% were noted, suggesting biological activity. Further studies to test the safety and efficacy of autolymphocyte therapy in the treatment of prostate cancer are warranted.
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The posterior continuous curvilinear capsulorhexis technique has been advocated in cases of posterior capsule rupture during extracapsular cataract extraction. The authors compared posterior continuous curvilinear capsulorhexis with posterior capsular sharp-edged tears. Two different types of forces were experimentally created on the posterior capsule of 30 human eyes obtained after death: (1) implantation and dialing of posterior chamber intraocular lenses (PC IOLs) and (2) increased intravitreal pressure by injection of balanced salt solution. All posterior capsular tears extended toward the equator, causing major capsular defects. In contrast, the posterior continuous curvilinear capsulorhexis remained intact in all cases. This experimental study proves that in cases where an inadvertent posterior capsular tear occurs, a posterior continuous curvilinear capsulorhexis is useful in preventing further capsular damage. Also, in cases where a posterior capsulotomy is indicated, a smooth edge created by a posterior continuous curvilinear capsulorhexis may be useful to maintain the integrity of the capsular bag for PC IOL capsular implantation.
We have constructed a genetic linkage map of human chromosome 16 based on 46 DNA markers that detect restriction fragment length polymorphisms. Segregation data were collected on a set of multigenerational families provided by the Centre d'Etude du Polymorphisme Humain, and maps were constructed using recently developed multipoint analysis techniques. The map spans 115 centimorgans (cM) in males and 193 cM in females. Over much of the chromosome there is a significantly higher frequency of recombination in females than males. Near the alpha-globin locus on the distal part of the short arm, however, there is a significant excess of male recombination. Twenty-seven (59%) of the markers on the map have heterozygosities greater than or equal to 0.50. The largest interval between loci on the sex-average map is 14 cM and the average marker spacing is 3 cM. Using loci on this map, one could detect linkage to a dominant disease on chromosome 16 with as few as 10-15 phase-known meioses.
Certification for oncology nurses shares many similarities with board certification in medicine. Within the specialty of oncology nursing, certification provides one measure of excellence and signals a commitment to oncology nursing practice. Since the beginning of oncology nursing certification in 1986, over 7,200 nurses have become certified. This article describes the certification process for oncology nurses and discusses ways in which physicians can assist in this process.
Facioscapulohumeral muscular dystrophy (FSHMD) is a neuromuscular disorder characterized by autosomal dominant inheritance and clinical onset in the muscles of the face and shoulder girdle. Using a set of RFLP markers spaced at approximately 20 centimorgans, we have begun a systematic search for markers linked to the disease. A total of 81 RFLP loci on six autosomes (1, 2, 5, 7, 10, and 16) have been examined for linkage to FSHMD in 13 families. With the computer program CRI-MAP, two-point and multipoint analyses have not resulted in any LOD score indicative of linkage to FSHMD. However, these analyses have allowed us to exclude 909 centimorgans (sex average) of our genetic maps in intervals where the LOD score is less than -2.0. We estimate our data have excluded 23% of the human genome.
Historically, cost-based reimbursement encouraged hospitals to compete on the basis of quality, leading to duplication of services and other inefficient behavior. More recently, prospective payment, selective contracting, and other innovations in reimbursement have strengthened incentives for more efficient hospital operations. In principle, hospitals may be able to reduce their costs by limiting the array of services they provide, but there has been little empirical evidence that U.S. hospitals are moving toward greater specialization or that specialization leads to cost savings. This article explores recent changes in case-mix specialization and the relationship of these changes to hospital costs. It first describes an index of specialization derived from Information Theory and shows that this index provides intuitively reasonable results in characterizing patterns of specialization across hospitals. The analysis then demonstrates that specialization, as measured by this index, in fact increased from 1980 through 1985; that specialization can indeed lower hospital costs; and that increases in specialization have been largest in those hospitals with the greatest incentives to reduce costs.