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Biomedical subjects

W D White

Publications and source records attributed to W D White.

At least 91 records · Page 5Linked to original sources
PubMed1990

Comparison of medical and surgical therapy for uncomplicated descending aortic dissection.

To guide the choice of medical versus surgical therapy for patients with descending (type B) aortic dissection (tear in the descending aorta without involvement of the ascending aorta), multivariate survival analysis was applied to 136 patients admitted to two medical centers between 1975 and 1988 with acute (n = 89) or chronic (n = 47) descending dissection: group 1, all 136 patients; group 2, 106 patients without rupture, pulse loss, or visceral organ compromise; and group 3, 56 patients from group 2 without major cardiac or renal disease (23 surgical and 33 medical). Group 3 medical and surgical subgroups were well matched for baseline characteristics and were potential candidates for either mode of therapy. By Cox model analysis, significant predictors of mortality were pleural rupture, other dissection complications, increasing age, and cardiac disease (all p less than 0.01). Surgical versus medical therapy was not an independent determinant of survival in any of the three groups for acute or chronic dissection. Survival probabilities for all group 3 patients at 1, 5, and 10 years were 0.94, 0.87, and 0.32 (medical) and 0.90, 0.80, and 0.50 (surgical). Despite the limitations of this retrospective study (including the possibility of undefined treatment selection biases), these data suggest that medical or early surgical therapy is associated with equivalent outcome in selected patients with uncomplicated acute or chronic descending aortic dissection.

Adrenergic beta-Antagonists↗
PubMed1989

Agency theory: new insights into the health care industry.

The economic theory of agency deals with the relationship that arises when one individual delegates authority to another. It offers powerful insights into the organization of health care delivery systems. This paper examines how relationships between doctors, patients, and hospitals can be explored within an agency framework and applied to institutional, fee-for-service, and HMO settings.

Contract Services↗
PubMed1987

Agency and the organization of health care delivery.

Recent developments in the theory of agency--the relationship that arises e when a principal delegates authority to an agent--offer powerful insights into the organization of health care delivery systems. In this paper we first provide an overview of the agency literature and then illustrate how relationships between doctors, patients, and hospitals can be explored within an agency framework. We find that not only the evolution of standard fee-for-service relationships but also the emergence of HMOs can be analyzed as responses to uncertainty and to difficulties in writing complete, enforceable contracts. These findings have broad implications for health policy and suggest a variety of strategies for addressing agency issues.

Contract Services↗
PubMed1983

Informed consent: ambiguity in theory and practice.

The law of informed consent expresses in legal form the ethical principle of autonomy and respect for autonomy. It is intended to enhance self-determination and rational decision-making in medicine. Three tests might be made of whether a law is a good law: (1) Is it clear and unambiguous enough to admit of fair, equal, and consistent enforcement? (2) Does it gain compliance, and widespread ideological agreement? (3) Does it enjoy a measure of success in achieving its intended goals? The law of informed consent does not impressively pass any one of these tests. It is deeply ambiguous, both in its formal structure and its pragmatic implementation. It has not won ideological agreement, doctors having been openly hostile to it, and legislatures having written statutes limiting it. There is little evidence that it has succeeded in its goals. Paradoxically, its pragmatic value might be rooted in its ostensible weakness, its ambiguity, in that this very quality keeps the discussion going. Perhaps the essential problem lies in the fact that the philosophical notion of autonomy is not a phenomenologically accurate description of the condition of the person who seeks medical help--the map is not the territory.

Attitude of Health Personnel↗
PubMed1982

Comparison of the effects of Org NC 45 and pancuronium bromide on heart rate and arterial pressure in anaesthetized man.

The effects of Org NC 45 and pancuronium bromide on heart rate and arterial pressure were studied in anaesthetized man. A bolus of either Org NC 45 0.1 mg kg-1 or pancuronium 0.1 mg kg-1 was administered to lightly anaesthetized unstimulated subjects. Following Org NC 45 heart rate decreased in the majority of subjects (mean and SEM 3.78 +/- 1.36), whereas after pancuronium heart rate was increased (mean and SEM 11.91 +/- 1.9). The changes in mean arterial pressure observed were minimal. The effect of endotracheal intubation on mean arterial pressure was then studied. Increase of mean arterial pressure was observed in all subjects. The increase was more marked in those patients who had received pancuronium and was significantly higher than in those patients who had received Org NC 45 (P less than 0.01). We conclude that Org NC 45 is devoid of vagal blocking action, and that the difference in response to the stimulus of endotracheal intubation is a result of the different effects exerted on the sympathetic nervous system by Org NC 45 and pancuronium.

Adult↗
PubMed1981

A laboratory report on iron supplementation in blood donors. I.

Blood donation at the accepted frequency of one donation every 8 weeks is generally regarded as excessive for preservation of donor iron reserves, especially in women. A double-blind study was conducted of 627 individuals who had previously donated blood to determine the effect of iron supplementation on iron reserves. Half the donors received ferrous fumarate at a dosage of 66.6 mg elemental iron daily for 45 days. The other half received placebo. Eight blood variables reflecting the iron status of the donors were determined at the time of the initial donation and again 2 months later at the time of their second donation. Statistical analysis of the blood variables indicated that the prescribed amount of ferrous fumarate should be considered the minimal effective dose for maintenance of reduced iron storage in blood donors. However, the data are furnished for the analysis of panels of experts for any conclusions and recommendations concerning this study. Feostat, the iron supplement, was tolerated well by the participating donors. Gastrointestinal upset occurred in eight donors receiving Feostat and in 10 donors receiving placebo.

Adolescent↗
PubMed1979

Postoperative analgesia: a comparison of intravenous on-demand fentanyl with epidural bupivacaine.

In a randomised trial postoperative pain relief was provided by either epidural injections of bupivacaine or an infusion of fentanyl adjusted by the patient to achieve adequate pain relief. Both techniques produced satisfactory analgesia without respiratory depression after peripheral arterial surgery. The technique of infusing intravenously a potent analgesic in a dose adjusted by the patient appears to offer several advantages in postoperative care.

Blood Gas Analysis↗
PubMed1979

Why is regulation introduced in the health sector? A look at occupational licensure.

Economic theories suggest that the introduction of regulation can be analyzed in terms of the magnitude and distribution of its economic impact. This article uses this approach to consider the introduction of licensure in the health sector for clinical laboratory personnel. At the micro level, there is no evidence of active consumer support for licensure and it seems to have been introduced mainly at the behest of members of the occupation and bureaucrats involved in the regulation of laboratories. Bureaucrats appear to have acted largely on their own initiative and are the single most important group involved in the introduction of licensure. The large role of the occupation supports a "producer protection" model of licensure over a "consumer protection" model. But the independent role of bureaucrats suggests that actors in the public sector are also a major interest group who need to be included in any model of regulation. Their motives are complex, but in the past one of the attractions of licensure seems to have been low direct administrative costs, despite large indirect costs to consumers. At the macro level, recent changes in social policy, which may reflect broad class interests, have shifted these indirect costs increasingly to the public sector through programs like Medicare. These changes in the distribution of costs may explain a growing concern by bureaucrats about the efficiency of licensure and a shift away from this type of regulation.

Allied Health Personnel↗
PubMed1978

The impact of occupational licensure of clinical laboratory personnel.

This paper develops a model of the economic impact of occupational licensure. The model is then used to estimate the effects of occupational licensure on wages and the division of labor in clinical laboratories and to generate a low-bound estimate of the welfare impact of licensure. Estimates are based on cross-section and time-series data on areas with and without licensure of laboratory personnel. Recent licensure laws have no effect on wages or employment, but older, more stringent laws sharply increase the wages and employment of skilled personnel in laboratories.

Allied Health Personnel↗