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Biomedical subjects

D W MacEwan

Publications and source records attributed to D W MacEwan.

12 recordsLinked to original sources
PubMed1992

Policy development for CT and MRI services in Manitoba.

Economic forces are changing Canadian medicine. There are four hospitals in Manitoba with CT services and eight were planning to add services based on public subscription, internal transfer of resources and expected growth. The Ministry of Health requested an in depth report and review. Analysis of clinical activity for 287 disease categories from 13,996,240 physician claims and 149,480 hospital discharges reveal that 33,552 CT examinations are reasonable for 1.1 million people. The cost of operating each scanner is one million dollars per year. A formal review process of the report by the 12 hospitals and 7 selected experts was conducted. An advisory committee of all interested parties recommended that no further resources be allocated without proven clinical need and that a strong management committee be reactivated. MRI growth for nervous disease is expected to replace much CT activity in the next five years.

Disease↗
PubMed1992

Screening mammography program delay recommended by Manitoba working group: issues for radiology.

UNLABELLED: Assignment: A working group, appointed by government, examined the advisability of implementing a mammography screening program and prepared a cost analysis. ANALYSIS: Present Manitoba activity (45,695) is a mixture of clinical mammography (10,000) and unorganized screening, mammographies (35,695) at an annual screening cost of $2.8 million. Canadian policy reports, program descriptions in other countries and critical reviews were analyzed. A steady-state clinical and financial model was constructed. A controlled screening program enrolling 80% of women 50-69 years will cost $2.6 million per year plus $0.65 million new clinical costs limited to 4 years. Recommendations; Six were made: delay implementation awaiting more evidence of benefit, discourage use in asymptomatic women under 50 years, develop information programs for women and health professionals, establish an advisory group and participate in research directed to a eventual decision.

Adult↗
PubMed1991

Physician payment reform: issues for Canadian radiologists.

Policy decisions taken by the US Congress in the 1980s to restrain health care costs included the designation of diagnostic-related groups, the creation of scales of relative value and legislation to introduce free-for-service payment to physicians in 1992; discrepancies in the system are to be corrected by 1996. Under federal contract a system of resource-based relative-value scales was created for all medical disciplines except radiology, which by special legislation prepared its own experience-based relative-value scale. The scales are based on magnitude estimation of the work of physicians and analyses of actual costs. Codes for medical services have been published, which include a weighting for each service in relation to all others. Multiplication by a conversion factor establishes the fee to be paid by the carriers acting for the Health Care Financing Administration. The relative values will be updated every 5 years. Publication of this information for US Medicare patients (the disabled, the elderly and those with end-stage renal disease) will likely have a profound effect on the physician payment system in Canada. Under the reformed system the lifetime earnings of all physicians will become more similar. Four problem areas are discussed in the paper: self-referral, administrative complexity, malpractice and the plight of those without medical coverage. Resolution of these problems is being actively sought.

Canada↗
PubMed1979

A head holder for operative serial angiography.

An apparatus was developed to combine two functions--a versatile neurosurgical head clamp and a compact film changer for operative serial angiography. The construction costs were +15,000, and provided a programmer, six cassettes, and attachments to position the film changer over much of the skull surface. Exposures are obtained by a mobile x-ray machine.

Cerebral Angiography↗
PubMed1978

Manitoba barium enema efficacy study.

Claims analysis and efficacy study are two new methods of evaluating medical services. In Manitoba, with a 1974 population of 1,053,382, approximately 100,000 patient-physician interfaces resulted in 16,594 barium enema examinations; 1,000 significant abnormalities were discovered, and the referring physician was unusally perceptive in predicting the likelihood of these abnormalities. It is estimated that a 10% reduction in the use of barium enemas could be achieved by referring physicians with no deterioration in the care of patients.

Adolescent↗
PubMed1978

Education and practice location of Canadian diagnostic radiologist.

At the 1977 Annual Meeting of The Canadian Association of Radiologists, a survey of all practicing diagnostic radiologists was made. Information was also obtained from Royal College and Corporation Professionnelle records. The medical school, postgraduate program, and present location of practice were established for over 98% of active radiologists. This information has been collected to assist program directors, medical faculties, provincial governments, and radiologists in recognizing manpower needs.

Canada↗
PubMed1976

Urography during pregnancy.

A review of 22,971 pregnancies from 1969-74 reveals that the reasons for requesting excretory urography were renal colic of pregnancy 11, pyelonephritis 8, renal contusion 2, threatened abortion 1, and suspected degeneration of fibroid 1. The final diagnoses were similar except that two patients with torsion of ovarian cysts and a renal calculus were discovered. The only intravenous pyelographic examination that was decisive for diagnosis was in a patient with a ureteric calculus. Careful clinical correlation should reduce excretory urography during pregnancy.

Adult↗