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Biomedical subjects

S Birch

Publications and source records attributed to S Birch.

At least 91 records · Page 5Linked to original sources
PubMed1989

Hypothesis: charges to patients impair the quality of dental care for elderly people.

Data on National Health Service (NHS) dental care utilization by the elderly are analysed to consider the distribution of dental care according to the charge status of the patient. Considerable and significant differences are observed in the type and amount of dental care provided to elderly patients exempt and not exempt from patient charges. Consideration is given to alternative explanations of the observed distribution and the implications for the performance of the NHS with regard to objectives.

Aged↗
PubMed1989

Towards the development of a mathematical model for acupuncture meridians.

Traditional concepts of classical acupuncture and Chinese medicine come from a culture which is very different from ours, and there has been considerable problems in their accurate presentation. Our approach is to attempt the development of a mathematical language that links these traditional concepts theoretically to models that can be experimentally tested. We first review some of Manaka's findings, confirmed also by our results, having to do with low intensity stimuli. In particular, Manaka applied polarized agents such as Cu(+) and Zn(-) to nonacupuncture points on a meridian and to the so called "mother and child" points on a meridian. In both cases he observed the pressure pain reaction which increased for one orientation of Cu and Zn on the meridian and decreased for the opposite orientation. Note that in the case of "mother and child" points the observed reaction was in agreement with the so called "five phase (five element)" theory. Also, in the case of the "mother and child" points the effect usually lasted considerably longer than in the case of nonacupuncture points on a meridian. Taking into account the connection between Manaka's results and skin electrical measurements by some electrodermal diagnostic instruments such as Motoyama's AMI, we discuss some equivalent electric circuits for a single meridian and relate them to the nervous system response. In particular, an electrical circuit model similar to the synapse membrane with two ionic channels seems to be especially useful when we try to explain Manaka's clinical results and Motoyama's results on the velocity of propagation of electrical impulses along meridians. We also develop a mathematical model in the form of a linear five dimensional dynamical system of the so called "five phase (five element)" laws such as "creative" cycle, "controlling" cycle, etc., in the case of a single meridian. We connect this model with the membrane type model mentioned above by assuming a simple mass action law, for the dependence of the conductances in the ionic channels on the input signals. This combined model is used to describe the development of a "disease" and its treatment according to the "five phase" theory. Here we interpret the "disease" as a blockage in a meridian, while the treatment initiates the unblocking process.

Acupuncture Therapy↗
PubMed1989

Estimates of general practitioner workload: a review.

This paper reviews four studies sponsored by the Department of Health which have attempted to measure workload in general practice and compares these with data from the general household survey. Despite the considerable differences in the objectives and methods employed by the four studies, they were found to contain remarkably consistent measurements of general practitioner workload. In a 'normal working week' general practitioners spend 38 hours on general medical service duties (including 24 hours of patient contact and five hours of travel to home visits), they see 150 patients or their representatives in surgery, and make 26 home visits. In an 'annual average week', taking into account holidays and sick leave, general practitioners undertake 90% of this workload. The studies show consistently large variations in the workload of general practitioners measured in this way, but fail to identify the key determinants of such variations. The reasons underlying the variation in general practitioner workload will remain unclear until we can distinguish between the expected, measurable variation and the residual, unexplained variation which may be due to the personal preferences of general practitioners.

Appointments and Schedules↗
PubMed1988

The identification of supplier-inducement in a fixed price system of health care provision. The case of dentistry in the United Kingdom.

The analysis in this paper extends the existing research on supplier-inducement by introducing a fixed price constraint on supplier behaviour and analysing output by treatment episode. Testable predictions are generated which distinguish between the inducement and traditional approaches to explaining supplier behaviour. Using data on dental care provision under the U.K. National Health Service support is found for the presence of supplier-inducement. The implications of the findings for the organisation of dental care in the U.K. are considered.

Demography↗
PubMed1988

DRGs U.K. style: a comparison of U.K. and U.S. policies for hospital cost containment and their implications for health status.

Health care cost containment in the U.K. has been characterised by the imposition of cash limits on health and personal social services. More recently performance appraisal has been introduced. The U.S. approach, on the other hand, has linked both cost containment and implicit performance appraisal by funding hospital activities on a DRG basis. Under the U.K. approach there is an internal inconsistency between the funding of hospital activities, primarily determined by the characteristics of the served population, and the appraisal of hospital performance by reference to the use of resources in relation to national norms not necessarily corresponding to the characteristics of the served population. Under the U.S. approach performance is appraised implicitly, not by the use of real resources but by the cost to the hospital of the service provision for each individual patient. Consequently the incentive is to minimise the cost of the service provision regardless of the output produced. The incentives, in both the U.K. and the U.S. approach, generate similar effects: an off-loading of responsibility for service provision at the margin onto other sectors of the health care system. They are the response to the incentive to minimise the costs incurred by the hospital in providing services to the patient. Until greater attention in paid to the monitoring of the outcomes achieved by all sectors of the health care system, and to the incentives generated to shift demands between the sectors, the respective policies will continue to be successful simply in controlling the resource cost of the hospital system.

Cost Control↗
PubMed1988

Item of service remuneration in general practice in the UK: what can we learn from dentists?

In response to the UK Government's proposal to increase the proportion of general practitioner income accruing from capitation payments the General Medical Services Committee of the British Medical Association has called for an extension of fee for item of service provision in general practice. In this paper the allocation of resources in primary care dentistry, where fee for service provision is currently used, is analysed in order to shed light on the debate. Since dentists' fees are set in accordance with average dentist time inputs, differences in cost per treatment course reflect differences in course content. Multiple regression techniques are used to estimate a cost per treatment course function. Using cross-sectional data for family practitioner committees in England and Wales for 1982 a significant negative correlation is found between cost per course and population per dentist after allowing for patient demand and need characteristics. A 10% decrease in population per dentist is associated with a 2.5% increase in cost per course. The observation cannot be explained by dentists rationing treatment in the presence of excess demand owning to the nature of the dentist contract. These results imply that in areas of greater supplies of dentists additional course content is being induced by dentists in order to maintain workloads. Hence although fee for service provision offers a financial incentive to increase service provision it offers no incentive to allocate services efficiently, that is in accordance with greatest need. The extension of fee for service provision in general medical practice would appear to be inconsistent with an objective of allocating scarce primary care resources in accordance with patient need.

Capitation Fee↗
PubMed1987

Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice.

A non-operative method of palliation in malignant obstructive jaundice was used in 14 patients in whom a biliary stent could not be placed endoscopically. A guide wire was manipulated through the obstructing lesion through the percutaneous transhepatic route and retrieved through an endoscope. The stent was then fed through the endoscope over the guide wire and across the biliary stricture. There were no early complications, and worth-while palliation was obtained in most cases. The success rate for placing an endoscopic stent increased in this unit from 69 to 97% with the introduction of this technique.

Aged↗
PubMed1987

Applications of cost-benefit analysis to health care. Departures from welfare economic theory.

In applying the principles of cost-benefit analysis to real world problems of resource allocation particular care must be taken to ensure that the welfare economic theory which underlies the cost-benefit technique is adhered to. Major problems arise where costs and benefits are used interchangeably to represent the good and bad attributes of a programme. Furthermore, in the presence of mutually exclusive projects, focussing attention upon the net benefits (or cost-benefit ratios) of individual projects as opposed to the net benefits of the use of budgeted resources can lead to biased estimates of the shadow price of projects and, consequently, errors in analysts' conclusions. As a result, economic appraisals of individual projects are not directly relevant for choosing between mutually exclusive projects of different sizes. Both types of problem are illustrated by reference to both simple examples and published economic appraisals of health care techniques. Integer programming is proposed and demonstrated as a method of selecting between mutually exclusive projects.

Budgets↗
PubMed1987

Cost-benefit analysis: dealing with the problems of indivisible projects and fixed budgets.

The use of cost-benefit analysis in option appraisals in health care when the decision-maker is faced with indivisible projects and a fixed budget is examined. It is argued that the methods used to overcome the problem of indivisibilities, benefit-cost ratios and the net benefit method, are not suitable for choosing between alternative projects for two reasons. Firstly, the values of benefit-cost ratios are sensitive to the specification of costs and benefits, and the literature abounds with examples of averted costs being added to the benefits of a project or reduced benefits being interpreted as an additional (psychic) cost. We show that such erroneous specification can lead to a relatively inefficient project being accepted as efficient, and vice versa. Secondly, practical applications of CBA have been performed in the absence of budget constraints on available resources. We show that once budget constraints are recognised the shadow price of resources required to implement a project may be affected by the amount of resources remaining in the budget after implementation. Once the budget constraint is recognised, a project which initially appeared to be the most efficient can be rendered relatively inefficient. It is suggested that alternative uses of remaining (or residual) resources should be identified and evaluated, thus ensuring the maximisation of benefits from the use of an overall budget.

Budgets↗
PubMed1987

Five-year follow up of patients treated with inpatient psychotherapy at the Cassel Hospital for Nervous Diseases.

Twenty-eight patients who were admitted consecutively to a single-adult unit of the Cassel Hospital in 1977/8 were followed up 5 years after discharge. Those who were found to have improved at the end of treatment remained well 5 years later. These could be distinguished by their combination of neurotic psychopathology, considerable depression, superior intelligence, and lack of a chronic outpatient history. Patients who had improved 5 years after discharge did not show these characteristics, but had all spent at least 9 weeks on the waiting list and had the capacity to form close and helpful relationships. Patients who were judged to have improved were less dependent on the Health Service and their economic productivity was improved, often as a consequence of returning to education or training. Those who did not improve clinically continued to be admitted to hospital and tended to become less economically productive.

Adult↗
PubMed1987

Oronasal distribution of ventilation during exercise in normal subjects and patients with asthma and rhinitis.

This study was undertaken to determine whether the resistance to nasal airflow and differences in oronasal distribution of ventilation at rest and during exercise alter the pattern of breathing. We observed six normal subjects, six patients with symptomatic allergic rhinitis, and six patients with asymptomatic bronchial asthma (three men and three women in each group), all of whom had normal pulmonary function. At rest, five of the six normal subjects breathed nasally but 11 of the 12 patients breathed with an oronasal distribution. Five normal subjects who breathed nasally at rest breathed with an oronasal distribution of ventilation during exercise, and one normal subject who breathed oronasally at rest had slightly less oral ventilation during exercise. In the patients, the change in oral distribution of ventilation during exercise was variable. Among the three groups, there were no significant differences from the resting oronasal distribution for ventilation during exercise, and all subjects breathed oronasally during exercise. The oronasal distribution of ventilation did not correlate with the level of nasal airflow resistance. Analysis of the timing, volume, and flow components of breathing showed no statistically significant differences among the three groups at rest and exercise. Thus, neither the level of resistance to nasal airflow, even up to moderately high values, nor the nasal distribution of ventilation at rest and with moderate exercise appears to have a major role in the pattern of breathing.

Adult↗