Search PubMed⌕ Search

Biomedical subjects

J Fowles

Publications and source records attributed to J Fowles.

31 records · Page 2Linked to original sources
PubMed1988

[Compartment syndrome of the legs and scurvy].

Old people living alone and in poverty are most at risk for developing scurvy, but the diagnosis may be missed unless the physician is aware of it. A 42-year-old immigrant living in poverty was treated surgically at the Hôtel-Dieu Hospital in Montreal for a compartment syndrome of the leg. She had ecchymoses on the skin of the leg and an interstitial hematoma in both posterior compartments. Three weeks later, she was readmitted with more swelling in the leg, gingivitis, hemorrhagic folliculitis, petechiae and gastrointestinal hemorrhage. Her response to vitamin C was remarkable and confirmed the diagnosis of scurvy.

Adult↗
PubMed1987

Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations.

Empirical evidence suggests that mortality rates for coronary artery bypass graft (CABG) surgery are lower in hospitals that perform a higher volume of the procedure. In recent years, the criteria for CABG surgery have been expanded to include patients with a wide variety of co-morbidities. To address the question of whether the volume-outcome relationship continues to exist for this new group of patients, discharge abstracts for 18,986 CABG operations at 77 hospitals in California in 1983 were analyzed using multiple-regression techniques. Higher-volume hospitals had lower in-hospital mortality (adjusted for case mix); this effect was greatest in patients who might be characterized as having "non-scheduled" CABG surgery. Higher-volume hospitals also had shorter average postoperative lengths of stay and fewer patients with extremely long stays. The results of this study suggest that the greatest improvement in average outcomes for CABG surgery would result from the closure of low-volume surgery units.

California↗
PubMed1987

Episode-of-care physician payment: a study of coronary artery bypass graft surgery.

Paying physicians for an episode of care is a possible alternative to current fee-for-service payment. We studied physician billing patterns for 512 Medicare beneficiaries who received coronary artery bypass graft (CABG) surgery in 1983. Relatively elaborate decision rules had to be created to exclude services that were not part of a routine CABG. We found that 72% of charges for an episode were associated with services provided on the day of surgery. Forty-seven percent of charges were by the primary surgeon, 15% by the assistant surgeon(s), and 9% by the anesthesiologist. Our results suggest that episode-of-care payment is a complex, and somewhat costly, alternative to other methods of prospective payment to physicians, although selective contracting by a health insurer for an episode of care for certain procedures might both reduce costs and improve quality.

California↗
PubMed1985

Satisfaction with children's medical care in six different ambulatory settings.

This article compares mothers' satisfaction with children's medical care in six widely varying settings: fee-for-service solo and group practices, prepaid group practice, public clinics, hospital outpatient departments, and emergency rooms. Data are from a household survey representing 700 children in Washington, D.C. Satisfaction with the physician's friendliness, competence, and personal care, as well as waiting time, atmosphere, and cost were examined, comparing how satisfaction levels varied in relation to patient attributes and also among medical settings. Findings revealed significant differences across settings, even controlling statistically for multiple patient characteristics. Satisfaction with interpersonal items was highest in fee-for-service settings, especially solo practice, whereas satisfaction with cost was highest in the public clinics, followed by the prepaid group practice. Previously published comparisons of utilization and health outcomes in the same settings revealed entirely different rankings. Together, these findings illustrate the multifaceted and paradoxical nature of health system performance.

Age Factors↗
PubMed1977

Development of sex-trait stereotypes among young children in the United Staes, England, and Ireland.

The Sex Stereotype Measure II (SSM II), a 32-item revision of the Williams, Bennett, and Best Sex Stereotype Measure, was developed to assess children's knowledge of conventional, sex-trait stereotypes defined by American university students. The procedure employed brief stories and human figure silhouettes which were individually administered to 5- and 8-year-old children in the United States, England, and Ireland and group administered to 11-year-olds in the United States. In the United States, knowledge of sex-trait stereotypes was found to develop in a linear fashion between the ages of 5 and 11, with more male traits than female traits being known at each age level. Cross-nationally, there was a high degree of similarity in the nature of the sex stereotypes being learned by the children in the 3 countries, although the rate of learning appeared slower among the Irish children. In all countries there was a clear progression in sex-stereotype learning from age 5 to age 8. English boys had greater knowledge of stereotypes than English girls, but this was not true in Ireland and the United States. Generally, knowledge of male stereotype traits appeared to develop earlier while knowledge of the female traits increased more rapidly between ages 5 and 8. The similarity in sex-stereotype learning in the 3 countries is discussed, and studies in progress in other countries of greater cultural diversity are noted.

Behavior↗