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Biomedical subjects

J M Orient

Publications and source records attributed to J M Orient.

At least 37 records · Page 2Linked to original sources
PubMed1986

Civil defense in the United States: evolution and regression.

Thirty years ago, physicians were exhorted to assume a leadership role in preparedness for national emergency, including war. At that time, a system evolved to prevent certain types of casualties (due to blast and radiation), and to meet the medical challenges that would result from disaster. In recent years the system has regressed, and physicians are often leaders of the opposition to its improvement. Funding has been cut drastically, and many programs have been all but abandoned. Because this change in philosophy could cost millions of lives, the underlying assumption that all efforts would be futile in the face of modern warfare needs to be critically reexamined.

Attitude of Health Personnel↗
PubMed1986

Evaluation of abdominal pain: clinicians' performance compared with three protocols.

Clinical findings in ambulatory patients with abdominal pain, presenting themselves to general medical practitioners, were analyzed by three different protocols: an algorithm using a branched-chain logic, a linear discriminant rule, and bayesian analysis. All methods missed some serious diagnoses. None was as effective as the clinician at distinguishing nonspecific abdominal pain (NSAP) from more serious conditions.

Abdomen↗
PubMed1985

Defense against nuclear weapons: a decision analysis.

Response to the public health threat posed by nuclear weapons is a medical imperative. The United States, in contrast to other nations, has chosen a course that assures maximal casualties in the event of a nuclear attack, on the theory that prevention of the attack is incompatible with preventive measures against its consequences, such as blast injuries and radiation sickness. A decision analysis approach clarifies the risks and benefits of a change to a strategy of preparedness.

Civil Defense↗
PubMed1985

A test of a linear discriminant for identifying low-risk abdominal pain.

This study tests a previously published decision rule for identifying nonspecific abdominal pain (NSAP). The rule, developed for ambulatory male patients in two Veterans Administration (VA) facilities and a prepaid group practice, was studied in an additional 110 VA patients and in 77 patients (predominantly female) from a solo private practice. The group of 58 patients (33%) classified as "low-risk" rarely had abnormal laboratory tests or radiographs, except for upper gastrointestinal series; 15 of these patients had potentially serious disease. Peptic ulcer was the specific diagnosis most often misclassified as NSAP. The accuracy of the rule in our population is similar to the accuracy of the judgment of experienced clinicians.

Abdomen↗
PubMed1985

Disaster preparedness. An international perspective.

Establishing a national disaster medical system requires considering the goals and appropriate expenditure levels for emergency preparedness. The United States has placed a relatively low priority on national programs for disaster response. Such programs have been controversial because of their relationship to civil defense against nuclear attack. Switzerland and the Soviet Union have long-established, elaborate medical response systems that should be studied.

Budgets↗
PubMed1984

A critique of western medical commentary on the People's Republic of China.

The American medical literature generally has given favorable reviews to the Chinese Communist experiment, which has often been credited with astonishing, unprecedented achievements in public health. Improvements are explicitly attributed to the Chinese political system, despite its acknowledged shortcomings from an American perspective. A survey of articles about Chinese medicine discloses numerous scientific flaws, eg, inadequate sampling, biased reporting, inappropriate attribution of causal relationships, lack of suitable controls, and ablation of conflicting data. The promulgation of such errors results in part from imprecise euphemistic language.

China↗
PubMed1983

The effect of algorithms on the cost and quality of patient care.

In a Veterans Administration ambulatory care facility staffed by experienced nurse practitioners, we observed the length of visits, time utilization for various activities, and the use of diagnostic tests before and after introducing algorithms for 12 common chief complaints. Charges for diagnostic tests decreased as much as 40 per cent, primarily because of reduced utilization of radiographs such as spine films. Nurse practitioner productivity was unaffected once the nurse practitioners became familiar with the algorithms. Outcome of illness did not change measurably, but the process of care improved as reflected by more complete data collection documented in the medical record.

Ambulatory Care Facilities↗
PubMed1983

When do patients with chronic obstructive lung disease need hospital admission? Reflections based on a VA experience.

Over a two-year period, the management of patients with chronic obstructive lung disease was observed in the walk-in clinic of a Veterans Administration Medical Center. Of 794 visits, 279 (35%) resulted in immediate hospitalization. Of 515 patients sent home, 229 (44%) relapsed, and of these, 165 (72%) eventually required admission. The clinical and laboratory data routinely obtained, including arterial blood gas values in 69% of the visits, could not distinguish the inappropriate discharges unless acidosis or severe hypoxemia was present. About 10% of the patients accounted for 30% of the admissions. Severity of disease, especially the development of cor pulmonale, accounted only partially for high demand by a subset of patients. Psychosocial factors and inadequacy of facilities for continuing home care play an essential, though poorly defined, role in precipitating hospital admissions.

Adult↗
PubMed1982

Educating primary physicians in emergency surgical procedures.

While federal agencies explore ways to encourage physicians to enter primary care practice in underserved areas, they largely avoid the question of how well current training programs prepare physicians for the role. No systematic study has been made of skills in emergency procedures that may be needed in areas where a surgeon is not readily available. A survey of the literature and of our own primary care residents gives cause of concern. Only a third of the residents were confident of their ability to perform a set of procedures essential for stabilizing injured patients. A greater reliance on training in ambulatory clinics, as recommended by the Graduate Medical Education National Advisory Committee (GMENAC), may further decrease opportunities for learning essential technics.

Emergency Medical Services↗