RN "business managers" of mini product lines characterize case management at St. Peter's Medical Center, New Brunswick, New Jersey.
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Cost Savings↗
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Osteopontin: Role in Cell Signalling and Adhesion. Proceedings of a conference. New Brunswick, New Jersey, October 21-23, 1994.
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Animals↗
Health service regionalization in New Brunswick, Canada: a bold move.
New Brunswick moved swiftly in 1992 to regionalize hospital and physician services along with the reform and expansion of other health care services. The dissolution of 51 hospital and community health services center boards and the establishment of eight region hospital corporations to oversee services in the seven health regions set the tone for regionalization in the province. The plan provides the flexibility to meet specific regional needs. The initial regionalization of hospital services was followed by the determination of the appropriate number, mix, and distribution of physician resources for each region, also to be managed by the region hospital corporation. The provincial government's central role not only guides the regions, but also uses incentives and disincentives to ensure that regional goals are.met. While regionalization is not new and some components of the New Brunswick plan have been used elsewhere, the effort offers an integrated model for the regionalization of hospital and physician services, with the expansion of complementary services.
Community Health Centers↗
Antibodies to the California group of arboviruses in animal populations of New Brunswick.
Wild and domestic animals of New Brunswick were tested serologically for antibodies to the California group (CAL) of arboviruses. Deer (Odocoileus virginianus) blood collected during 1976 showed 6 of 129 (4.7%) sera with neutralizing antibodies to the snowshoe hare strain (SSH) of CAL. Neutralization tests on moose (Alces alces americana Clinton) sera collected during 1979 indicated 94 of 127 (74%) with antibodies to SSH, 4 of 127 (3.2%) with antibodies to the Jamestown Canyon Strain (JC) of CAL, and 17 of 127 (13.4%) with equal antibody titers to SSH and JC. Hemagglutination inhibition tests on house blood collected during 1977 showed 54 of 204 (26.5%) with antibodies to SSH; of these, 36 also had neutralizing antibodies to SSH. This study is the first indication of CAL activity in New Brunswick and supports evidence of JC activity in northeastern North America.
Animals↗
Relation between physician characteristics and prescribing for elderly people in New Brunswick.
OBJECTIVE: To determine whether there is a relation between physician characteristics and prescribing for elderly patients. DESIGN: Descriptive study linking two provincial databases. SETTING: New Brunswick. PARTICIPANTS: All general practitioners (GPs) in New Brunswick who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program between Apr. 1, 1990, and Mar. 31, 1991; eligible GPs accounted for 376 (40%) of all physicians with a general licence in New Brunswick. MAIN OUTCOME MEASURES: GPs' personal and professional characteristics (age, sex, family practice accreditation, country of training and number of years in practice), practice characteristics (number of practice days, number of patients seen and medical services provided per day, average amount of billing per patient, total number of patients seen and their average age, and total amount of billings) and number of prescriptions by category of drug. RESULTS: High prescribers and low prescribers did not differ significantly in age, number of years in practice, mean practice size or patient age. Compared with the low prescribers the high prescribers were more likely to be male, have been trained in Canada and be qualified by the Canadian College of Family Physicians. Also, they had more practice days, saw more patients per day, performed more services per day, billed more per patient and billed on average 30% more during the study period. Overall, the high prescribers ordered on average 45% more prescriptions than the low prescribers. CONCLUSION: There is a significant relation between certain physician characteristics and prescribing behaviour. Further study is required to examine the relation between these variables and patient outcomes.
Accounting↗
Seroepidemiology of Q fever in New Brunswick and Manitoba.
A seroepidemiological survey, using an indirect immunofluorescence test, was carried out on serum samples obtained from New Brunswick and Manitoba blood donors during 1986. The antigens were Coxiella burnetii phase I and phase II from strain Nine Mile. Eighty of the 503 (15.9%) Manitoba blood donors had a phase II antibody titer of greater than or equal to 1:8, while 41 (4.2%) of the 966 New Brunswick blood donors had such antibodies. We have recently diagnosed three cases of Q fever in New Brunswick but none have been diagnosed in Manitoba. Our data suggest that Q fever may be increasing in New Brunswick and repeated seroepidemiological studies are indicated. It is likely that undetected cases of Q fever are occurring in Manitoba.
Antibodies, Bacterial↗
The earliest ether anaesthetic in British North America--a first for Saint John, New Brunswick?
Literature relating the early history of ether anaesthesia in New Brunswick which, as part of British North America was a British colony until 1867, is reviewed. There is documentary evidence that the first ether anaesthetic for dental surgery in what is now Canada, was administered in 1844 in St. John, New Brunswick. There is also documentary evidence that the first ether anaesthetic for general surgery was administered in St. John on Monday, January 18, 1847, rather than in Montreal in March, 1847.
Anesthesia, Inhalation↗
Comparison of CMA joint statement on resuscitative interventions and New Brunswick hospital corporations' policies on end-of-life treatments.
Why do most physicians have so much difficulty respecting the wishes of their terminally ill patients who refuse treatment? The normative pluralism model is introduced to answer this question. Comparative content analysis serves as the theoretical framework for evaluating the Canadian Medical Association Joint Statement on Resuscitative Interventions against the corresponding administrative policies of New Brunswick hospital corporations and relevant New Brunswick law. Despite protection afforded patients by law, fully 75% of New Brunswick hospital corporations' administrative policies permit physicians to ignore patients' expressed objection to treatments. The futility-of-treatment criteria in the CMA joint statement and in all provincial hospital corporations' policies authorize physicians to substitute their judgment for patients' expressed refusal of CPR. The author concludes that when medical professional norms conflict with the law, physicians tend to follow their professional normative order.
Guideline Adherence↗
Physician characteristics and prescribing for elderly people in New Brunswick: relation to patient outcomes.
OBJECTIVE: To examine the relation between physician characteristics, prescribing behaviour and patient outcomes. DESIGN: Descriptive study linking four provincial databases. SETTING: New Brunswick. PARTICIPANTS: All 366 general practitioners (GPs) (accounting for 40% of all physicians with a general licence in New Brunswick) who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program and saw at least 20 elderly patients in an office setting between Apr. 1, 1990, and Mar. 31, 1991. Physicians with palliative care practices were excluded. OUTCOME MEASURES: GPs' personal, professional and practice characteristics, their prescribing patterns, and mortality, morbidity (number of days in hospital per patient) and hip-fracture rates among their elderly patients. RESULTS: Compared with the GPs who had a lower mortality rate, those with a higher mortality rate prescribed more drugs overall (p < 0.001), specifically antidepressants, bronchodilators, cholesterol-lowering agents, gastrointestinal drugs, neuroleptics and nonsteroidal anti-inflammatory drugs (NSAIDs). They also were more likely to be male (p < 0.01), had larger practices (p < 0.001), saw more patients per day (p < 0.05) and billed more per year (p < 0.001). Compared with the GPs who had a lower morbidity rate, those with a higher morbidity rate prescribed more drugs overall (p < 0.005), specifically bronchodilators, gastrointestinal drugs and NSAIDs. They also were more likely to be younger (p < 0.005) and male (p < 0.01), had fewer years in practice (p < 0.001), saw more patients per day (p < 0.05) and billed more per patient (p < 0.01). The GPs who had a higher hip-fracture rate prescribed more drugs overall (p < 0.001), notably antihypertensives, bronchodilators, cholesterol-lowering agents, gastrointestinal drugs and NSAIDs, than those who had a lower hip-fracture rate. They also had a larger practice (p < 0.001), practised more days per year (p < 0.005), had more patient visits per year (p < 0.05) and billed more per year (p < 0.001). Younger male GPs who practised with relatively more intensity and prescribed more drugs per patient had practices with higher morbidity, mortality and hip-fracture rates among their elderly patients than the other GPs. CONCLUSIONS: There is a significant relation between certain physician characteristics, their prescribing behaviour and patient outcomes. Further study is required to determine what physician characteristics and prescribing behaviours for specific illnesses contribute to patient outcomes. Regional differences should also be examined, as should incentives in this fee-for-service system. Linkage of these types of provincial databases may help in the evaluation of physicians' performance and in the development of strategic interventions and practice guidelines.
Adult↗
Early medicine and surgery in New Brunswick.
The author discusses some of the major events in medicine and surgery in New Brunswick prior to 1900. The influences of Indian medicine, of early French and Acadian surgeons, of the British colonial surgeons at the siege of Fort Beausejour, of the pre-Loyalist and Loyalist surgeons all led up to the building of marine hospitals and quarantine stations. The introduction of anesthesia with ether and chloroform hastened progress towards"modern surgery" which was carried out in the many general hospitals that were built following the opening, in 1865, of New Brunswick's first general hospital, the General Public Hospital (now the saint John General Hospital).
England↗
Physician recruitment in rural Canada: programs in New Brunswick, Newfoundland, and Nova Scotia.
This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.
Medically Underserved Area↗
Care of the newborn in perinatal units in New Brunswick.
A survey of 23 perinatal units in New Brunswick hospitals was conducted by means of a mailed questionnaire to determine the type of care provided to newborns. The results showed various degrees of conformity with published guidelines for the care of newborns. Deficiencies were noted in several areas of care: failing to give or improperly giving vitamin K1 prophylaxis (in 7 of the units), flushing the eyes after silver nitrate prophylaxis (in 10), using hexachlorophene to bathe newborns (in 11) and delaying the first feeding up to 12 hours (in 3). It is essential to provide appropriate support to newborns as they adjust to a new environment and to ensure that alternative practices are in keeping with current scientific knowledge.
Baths↗
Seroepidemiology of Q fever among cats in New Brunswick and Prince Edward Island.
The indirect microimmunofluorescence test was used to determine the presence of antibodies to phase I and phase II Coxiella burnetii antigens in New Brunswick and Prince Edward Island cats. Twenty of 104 (19.2%) New Brunswick cats tested had antibodies to phase II antigen; five of these (4.8%) also had antibodies to phase I antigen. Six of 97 (6.2%) Prince Edward Island cats tested had antibodies to phase I and phase II antigens. Our data suggest that cats may be important in the epidemiology of Q fever in these provinces.
Animals↗
Myoelectric control systems research at the Bio-Engineering Institute, University of New Brunswick.
Myoelectric controls research began at the University of New Brunswick in 1960, and has continued without interruption since that time. The Bio-Engineering Institute has emphasized control systems which meet special clinical needs. These have included systems for amputees with only a single muscle remnant with which to control a prosthesis and, more recently, systems which provide the best possible appearance for children and for infants as young as 15 months of age. Throughout this work, however, the Institute has maintained a fundamental interest in the problem of control of complex multifunction prostheses. With recent developments in electromechanical systems this more advanced controls research will find clinical application shortly.
Artificial Limbs↗
Parasites of red foxes in New Brunswick and Nova Scotia.
Sixty-one red foxes from New Brunswick and Nova Scotia were examined for helminths. Alaria americana, A. arisaemoides, A. mustelae, Cryptocotyle lingua, Echinostoma revolution and Metorchis conjunctus, Capillaria aerophila, Crenosoma vulpis, Toxocara canis, Uncinaria stenocephala and Taenia crassiceps were found. Approximately 67% of the foxes examined were clinically affected with Sarcoptes scabiei mange.
Animals↗
Patterns of preventive practice in New Brunswick.
A survey of active general practitioners was conducted in New Brunswick to ascertain their patterns of preventive practice with respect to cancer of four anatomic sites: the breast, the cervix, the colon and rectum, and the lung. Ninety-two percent of the physicians reported that they taught breast self-examination to their female patients, 98% that they performed breast examinations, 98% that they did Papanicolaou smears routinely, and 97% that they provided counselling against smoking. Few of the physicians reported that they submitted women aged 50 to 59 years to annual mammography (3%) or examined stool samples from asymptomatic patients over 44 years of age for occult blood (20%). Many (77%) said they still routinely performed chest roentgenography for early detection of lung cancer; an estimated 49% of the physicians said they performed cytologic screening of sputum samples for the same purpose. Preventive practices, when used, were usually carried out during major encounters with patients, such as general check-ups. The potential for prevention through this clinically based approach is still largely unrealized.
Breast Neoplasms↗
Cost-effectiveness: the case of home health care physician services in New Brunswick, Canada.
Home health care programs have direct and indirect effects within a health care system. A complete cost-benefit evaluation would include all such effects. A study of New Brunswick's Extra-Mural Hospital (EMH) home health care program used population-based administrative data on physician services utilization to examine whether home care services act indirectly as substitutes for physician services. Evidence suggests that the introduction and expansion of New Brunswick's EMH home health care program had unanticipated substitution effects, which reduced health system costs by reducing the rate of growth of per-capita utilization of physician services.
Age Distribution↗
Chemicals, birth defects and stillbirths in New Brunswick: associations with agricultural activity.
We describe a series of investigations that were conducted in support of the Task Force on Chemicals in the Environment and Human Reproductive Problems in New Brunswick. Geographic and temporal analyses and case-control studies, with the use of vital statistics, hospital records, the Canadian Congenital Anomalies Surveillance System and chemical databases, revealed no association between pesticides used in forestry and reproductive problems. Evidence of an association between the potential exposure to agricultural chemicals and three major anomalies combined as well as spina bifida without hydrocephalus was found. More plausible was an association between stillbirths and such exposure during the second trimester of pregnancy. This finding, along with the cyclic patterns of stillbirth in the agricultural Saint John River basin and the somewhat higher stillbirth rates in New Brunswick than in adjacent provinces or in Canada as a whole, suggests that further attention should focus on possible associations between agricultural activity and stillbirths.
Abnormalities, Drug-Induced↗