Osler L. Peterson

End Results, Cost and Productivity of Coronary-Care Units

Abstract The use of coronary-care units for the treatment of patients with myocardial infarction has increased explosively with little attention to efficacy, need, or cost. A study of 32 hospital u...

Doctors who perform operations. A study on in-hospital surgery in four diverse geographic areas (second of two parts).

To facilitate manpower planning in the surgical field, a study was c onducted into the work loads of surgeons in various specialities in 4 different geographical areas. Surgeons in group practice and surgeons who were Board-certified specialists carried a statistically significant larger work load of surgery. The certified surgeons performed more and more complex operations. The mean operative work load increased steeply with age, reaching a maximum at 40-44 years, and fell linearly after that age. Approximately 18 years following medical school graduation were needed for a surgeon to achieve his maximum work load. The geographic factor had no appreciable effect on work loads. Tables which broke down frequencies for each major type of operation for each type of surgical specialist indicated that even commonplace operations were not frequent events on the average for any individual surgeon. It is concluded from the study that work loads are relatively low due to excessive supply of surgeons. This is of concern because there is some doubt about maintenance of surgical skills by those doctors who perform infrequent operations. The widest variation in practice was evident between ophthalmologists and thoracic surgeons, indicating that manpower planning in this field would have to be done on a specialty-by-specialty basis. 3 plans for redistributing the operative work load and reducing the number of specialist surgeons are considered.

Surgeons and operating rooms: underutilized resources.

A classification of surgical procedures, based on degree of complexity and the need for facilities and personnel, was applied to all 50,782 surgical interventions performed in the Valle del Cauca, Colombia during 1974. Three-fourths of all operations were of low levels of complexity, and most could be performed on an ambulatory basis with immediate discharge after recovery from anesthesia. Mean numbers of operations per year for surgical specialists and other physicians were 119.7 and 18.1, respectively. The 76 existing operating rooms were utilized only 41.6 per cent of the time. The implications of underutilization of personnel and facilities and low productivity of surgeons are discussed.

Sulfadiazine ; Further Clinical Studies of its Efficacy and Toxic Effects in 460 Patients.

Excerpt Evidence for the effectiveness of sulfadiazine in many of the common bacterial infections has now been obtained in several large clinics by a number of observers, all of whom have attested ...

Myocardial Infarction: Unit Care or Home Care?

Excerpt About 1940, the late Maurice B. Strauss, then a junior faculty member of Harvards Thorndike Laboratory, presented a graph showing the natural history of a new drugs use. His graph showed ...

Physician Manpower Expansionism: A Policy Review

A lack of national health goals has allowed physician manpower policy to be dominated by an expansionist philosophy. Scarce resources have been channeled into the production of specialist physicians trained to provide complex and expensive care for uncommon diseases, using other scare and expensive resources and adding to the steep rise in medical care costs. Society seems to want access to primary care--a lack it views with dismay--and simultaneously fears increasing costs of care. Lack of access plus high cost might lead to rash implementation of other inappropriate policies. Success of policy decisions is pure serendipity if made without reliable and relevant information or based on inappropriate data, such as opinions alone. If information is unavailable, then physician manpower decisions should be delayed or, if made, implemented cautiously.

COLD AGGLUTININS. III. OBSERVATIONS ON CERTAIN SEROLOGICAL AND PHYSICAL FEATURES OF COLD AGGLUTININS IN CASES OF PRIMARY ATYPICAL PNEUMONIA AND OF HEMOLYTIC ANEMIA

Some of the properties of cold agglutinins in certain human sera have been listed in a recent review (1). The knowledge concerning these properties is based on studies of the phenomenon by various methods in serum or plasma from isolated cases of a large variety of conditions. With respect to the cold agglutinins in cases of primary atypical pneumonia, limited studies of certain aspects were reported in 1918 (2) in one case of atypical bronchopneumonia, in 1938 (3) in a similar case, and recently (4) in a few cases which more closely resemble those of primary atypical pneumonia of unknown etiology with which we have been concerned in the previous papers of this series. In the course of serological studies of cases of atypical pneumonia beginning in the fall of 1942, a number of observations were made on certain features of the cold agglutinin reaction and on the methods used for demonstrating and titrating these agglutinins. Circumstances did not permit extensive and complete studies of all the aspects of this reaction which were contemplated. A number of the observations that were made are of sufficient interest, however, to warrant a presentation of the results at this time, even though some of them are only of a preliminary nature. The investigations which are reported in this paper deal with two broad categories: (1) some serological properties of the cold agglutinins, particularly their relation to the human group isoagglutinins and to cold agglutinins for erythrocytes of other animals, and (2) certain physical properties of the cold agglutinins. Data concerning certain features of the technique are presented in the paper which follows.

CATEGORICAL PROGRAMS FOR HEART DISEASE, CANCER AND STROKE. LESSONS FROM INTERNATIONAL DEATH-RATE COMPARISONS.

THE report of the Presidents Commission on Heart Disease, Cancer and Stroke, published in late 1964, has proposed a program to effect a reduction of unnecessary deaths from heart disease, cancer a...

ANTIBODY RESPONSE OF PATIENTS WITH PNEUMOCOCCIC PNEUMONIA TREATED WITH SULFADIAZINE AND SULFATHIAZOLE

Excerpt The results of immunological studies of a large number of patients with pneumococcic pneumonia treated with sulfapyridine were reported recently from this laboratory.1As far as could be det...

UROLOGISTS AND THEIR SURGICAL PRACTICE

The work characteristics of urologists were studied as part of a national study of surgeon manpower. Urologists were found to work short hours relative to other surgical specialties, and their operative work load ranked sixth among the ten surgical specialties. The major conclusion was that the supply of urologists was greater than necessary to meet the need for urologic consultants.