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Biomedical subjects

J G West

Publications and source records attributed to J G West.

12 recordsLinked to original sources
PubMed1997

A breast cancer care report card. An assessment of performance and a pursuit of value.

The transition to managed care raises concerns about the resulting quality of care. The report card, a publicly released, standardized report on quality, has received widespread acceptance as a method to evaluate physician performance. Current report cards provide insufficient information to allow purchasers of health care to assess accurately the performance of professionals who provide breast care. To overcome these limitations, we propose an expanded report card on breast cancer care. Mammographers and general surgeons would assess an independent series of at least 100 consecutive cases of newly diagnosed breast cancer. Mammographers would determine the percentage of invasive cancers < 15 mm detected on screening mammograms in asymptomatic women aged 50 to 74 years. Surgeons would determine the percentage of combined stages 0 and 1 breast cancers detected and the percentage of patients receiving breast-conserving surgical therapy. Performance targets are set at 60% for invasive cancers < 15 mm detected on screening mammography, 60% for combined stage 0 and 1 breast cancers, and 50% for patients receiving breast-conserving therapy.

Aged↗
PubMed1992

The cost of summer mastitis.

The incidence of summer mastitis on 95 dairy farms in southern England was monitored in the summer of 1987. Data on the type of animal infected, the fate of the animals immediately and over the succeeding lactation, and the procedures used in treating the infections were collected for 144 cases. Twenty-five per cent of cases were attended by veterinary surgeons. Most of the animals received parenteral antibiotics and on average each received five tubes of intramammary antibiotic. The incidence of infection was highest in pregnant and calving heifers, more than 2 per cent of the animals at risk, and lowest (0.04 per cent) in calves, although more than twice as many dry cows were infected. Over half of the farms reported summer mastitis, with 36 per cent suffering more than one case. The greatest economic loss, 49 per cent of the total, was from lost milk production; and 37 per cent was from lost animal value, cull and calf losses. The average loss was 192 pounds per case. Using national incidence data from England and Wales, the cost to the UK dairy industry in 1987 was 6.22 million pounds.

Animals↗
PubMed1988

Trauma systems. Current status--future challenges.

The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. Only two states were found to have all components and statewide coverage. Nineteen states and the District of Columbia lacked one or more components of a regional trauma system. The remaining 29 states had yet to initiate the process of trauma center designation. In response to these shortcomings, an attempt was made to define the barriers to trauma system implementation and a step-by-step process was outlined for the development, management, and analysis of a comprehensive system of trauma care.

Economics, Hospital↗
PubMed1986

A method for evaluating field triage criteria.

The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. During the first year's experience with the original physiologic criteria, 21% of non-CNS motor vehicle trauma deaths occurred in nondesignated hospitals. When the criteria were made more sensitive by adding non-time dependent triage criteria such as anatomic and mechanism of injury criteria, deaths in nondesignated hospitals dropped to 4.4%, but the rate of overtriage doubled. Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.

Accidents, Traffic↗
PubMed1983

Impact of regionalization. The Orange County experience.

Prior to the designation of a trauma system in Orange County, Calif, 73% of the in-hospital non-CNS deaths secondary to motor vehicular trauma were judged by the autopsy method to have been preventable. In June 1980, a regional system of trauma care with designated trauma centers was established in Orange County. We used the autopsy method to evaluate the first year's experience with this new system and compared the results with previous studies in Orange County for 1974, San Francisco County in 1974, and Orange County in 1978-1979. The results indicate a severe reduction in the number of deaths judged preventable. In addition, a more aggressive approach to the traumatized patient was noted as indicated by an increased percentage of patients who received appropriate surgical intervention.

Adult↗
PubMed1982

Validation of autopsy method for evaluating trauma care.

A previous study on the simplified autopsy method evaluated autopsies from a series of motor vehicle deaths. The results were not generally accepted by the medical and political community because of reservations concerning the validity of the autopsy data. In response, I undertook a second study evaluating a similar series, using data from hospital records as well as autopsies. Results were evaluated by the autopsy method and compared with the results obtained by the hospital records method. Seventy-one percent of the deaths were judged preventable by the autopsy method as compared with 85% by the hospital records method. All deaths judged preventable by the autopsy method were also judged preventable by the method using hospital records. This confirms that the autopsy method accurately identifies and understates the problem it exposes.

Accidents, Traffic↗
PubMed1981

An autopsy method for evaluating trauma care.

An autopsy method for evaluating trauma care is described, which records patient age, time interval from hospital arrival to death, whether operation was performed, and cause of death. The technique is inexpensive, can be performed rapidly by a small number of examiners, and utilizes data sources that are a matter of public record. The method has proven to be valuable in evaluating trauma care in Orange County and we feel it may have widespread applicability.

Adolescent↗
PubMed1979

Systems of trauma care. A study of two counties.

Cases of motor vehicle trauma victims who died after arrival at a hospital were evaluated in both Orange County (90 cases) and in San Francisco County (92 cases), Calif. All victims in San Francisco County were brought to a single trauma center, while in Orange County they were transported to the closest receiving hospital. Approximately two thirds of the non-CNS-related deaths and one third of the CNS-related deaths in Orange County were judged by the authors as potentially preventable; only one death in San Francisco County was so judged. Trauma victims in Orange County were younger on the average, and the magnitude of their injuries was less than for victims in the San Francisco County. We suggest that survival rates for major trauma can be improved by an organized system of trauma care that includes the resources of a trauma center.

Accidents, Traffic↗