Biomedical subjects

E M Lewit

Publications and source records attributed to E M Lewit.

At least 37 records · Page 2Linked to original sources

PubMed1991

Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis.

Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy.

Adult↗

PubMed1991

Isoniazid preventive therapy for tuberculosis. Decision analysis considering ethnicity and gender.

The decision to prescribe or withhold isoniazid (INH) preventive therapy for low-risk tuberculin reactors has been highly controversial, primarily due to isoniazid's possible hepatotoxic effects. Previous analyses have explored the INH decision only from the perspective of patient age, recognizing that the risks of INH-induced hepatotoxicity are age related. Decision analyses presented in this paper assess the impact of gender and ethnic group, as well as age, on the INH decision. Results for low-risk patients favor prescribing INH preventive therapy for all 20-yr-olds, all 35-yr-olds except black women, and no 50-yr-olds, projecting life expectancy benefits that range from 3 to 19 days. A comparison set of analyses performed for high-risk patients favors prescribing INH for all groups except 50-yr-old black women. These findings suggest that ethnicity, gender, and age should be considered when making the decision to prescribe or withhold INH preventive therapy.

Adult↗

PubMed1989

U.S. tobacco taxes: behavioural effects and policy implications.

This paper examines U.S. tobacco taxation, the effect of cigarette taxes on smoking and on the health effects of smoking, and equity and efficiency considerations that arise when cigarette excise taxes are used to reduce smoking. Cigarette excise taxes, imposed by the Federal Government, all State governments, and nearly 400 cities and counties, add approximately 34 cents per pack to the price of cigarettes. Real cigarette excise tax rates have fallen because tax increases have not kept pace with inflation. Increases in the price of cigarettes decrease smoking, particularly by adolescents. An estimated 100,000 additional persons may live to the age of 65 as a result of doubling the Federal cigarette tax in 1983. Because cigarette taxes are regressive and are borne primarily by smokers, inequities may arise when they are used to reduce smoking. Success in achieving a tobacco-free society will require that tobacco taxes be replaced with alternative sources of revenue.

Health Policy↗

PubMed1986

The diffusion of surgical technology. Who's on first?

Explore the source record for details and available documents.

Communication↗

PubMed1986

Promotion of tobacco products: issues and policy options.

During the past year, several prominent voluntary health organizations and professional medical associations have called for a ban on all forms of promotion of tobacco products. The proposal raises complex issues, ranging from determination of the effects of tobacco promotion to assessment of the constitutionality of banning advertising of a legal product. We identify the issues that underlie the concern of health professionals, review evidence addressing these issues, and describe and discuss frequently mentioned policy options, especially the ban proposal.

Advertising↗

PubMed1986

Public policy on smoking and health: toward a smoke-free generation by the year 2000. A statement of a working group to the Subcommittee on Smoking of the American Heart Association.

On May 20, 1984, the Surgeon General challenged the health community to work toward attainment of a smoke-free society by the year 2000. The leadership of the nation's three major voluntary organizations joined numerous associations of health professionals in accepting the challenge. The Subcommittee on Smoking of the American Heart Association (AHA) has concluded that attaining this objective requires the development and implementation of public policies designed to facilitate the transition from a smoking to a nonsmoking society. To study the relevant issues and recommend appropriate policies, the subcommittee commissioned a working group of distinguished experts in the field of smoking and health to prepare a policy statement. The statement, published here, has received the enthusiastic endorsement of the Subcommittee on Smoking and the leadership of the AHA. The working group discusses and recommends four policies: Increase the federal cigarette excise tax. Eliminate or restrict tobacco advertising and other forms of promotion. Assure the rights of nonsmokers to clean air through legislative means. Identify mechanisms to ease and assist the transition of tobacco farmers to other crops or careers.

Humans↗

PubMed1982

An evaluation of a plastic strip thermometer.

The Clinitemp Fever Detector (a registered trademark for the Clinitemp Co, Indianapolis) is a plastic strip thermometer designed to be placed on the forehead and to detect body temperature by changing color. In a sample of 613 patients, we evaluated the ability of the Clinitemp to detect fevers detected by traditional mercury/glass thermometers. When a Clinitemp reading of 37.8 degrees C (100 degrees F) was used to demark fever, the Clinitemp detected 34% of the clinically significant fevers detected by the mercury/glass thermometers. The sensitivity of the Clinitemp rose to .81 when a Clinitemp reading of 37.2 degrees C (99 degrees F) was used to demark fever. The accuracy of the Clinitemp was affected by variations in ambient air temperature. A reassessment of previously published evaluations of plastic strip thermometers suggest that our results are consistent with other experimental findings. We conclude that the Clinitemp is unacceptable as a substitute for the mercury/glass thermometer.

Body Temperature↗

PubMed1980

A comparison of surgical assisting in a prepaid group practice and a community hospital.

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

General Surgery↗

PubMed1977

"The study on surgical services for the United States": a valid prescription for American surgery?

The overall approach of SOSSUS to the study of surgical services, the interpretation of findings, and policy recommendations are rightly called into question. But singular concern with the consequences of monopolistic control by the profession is no substitute for analysis of the dynamics among demand, production, and supply of surgery. Any delivery system--and many models are feasible--involving consumers, providers, and payers is a market in which multidimensional behavior must be anticipated.

Clinical Competence↗

PubMed1976

Time utilization of a population of general surgeons in a prepaid group practice.

Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surgeons also devoted a mean of 6.7 evening hours per week to professional activities for a mean net professional week of 57.4 hours. Comparisons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to produce a surgical output more than double that of the community surgeons while devoting only one and a half as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from: 1) restriction of practice setting to a single geographic location, 2) restriction of patients to surgical patients, 3) reduced surgeon waiting time in the office, and 4) the utilization of paraprofessional personnel for selected operative assisting. These economies were achieved while the prepaid group surgeons were observed to average more time per patient visit both on rounds and in the office than the community surgeons.

Adult↗

PubMed1975

Time utilization of a population of general surgeons in community practice.

A time-motion study was performed on a population of general surgeons in suburban community practice whose median weekly operative work load had been previously determined to be 3.1 hernia equivalents (HE). The mean observed 6 day working week of this population of general surgeons was found to be 34.5 hours, of which 28.7 hours were devoted to professional activities for the total work week of 44.3 hours. Thirty-five percent of the mean observed working week was spent in office activities and 50 percent spent in hospital activities. During the mean observed week, 18.5 hours (54 percent) were devoted to patient care, of which 16.5 hours were judged to be devoted to surgical care. Surgeons with above-median operative work loads in the previous study devoted 67 percent more time to professional activities and twice as much time to surgical activities as surgeons with below-median work loads. The findings support the hypothesis that there appears to be an underutilization of costly and highly specialized medical skills in the particular community and suggest that the HE methodology is a valid measure not only of the operative work of surgeons in community practice but of total time devoted to surgical care.

Delivery of Health Care↗

PubMed1974