Paul Wing

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating ≤7 than it is in patients with a GCS rating >7 (p= .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score ≤7 who do not undergo craniotomy and are otherwise stable.

Workforce shortages in breast imaging: impact on mammography utilization.

OBJECTIVE The objective of this study was to develop reliable forecasts of the future supply of radiologists and radiologic technologists practicing mammography under different assumptions about future introduction of new practitioners. In addition, this article includes basic mammography workforce statistics to provide a context for the forecasts. MATERIALS AND METHODS The forecasts were developed using an age cohort flow model based on data provided by the American College of Radiology (ACR) on the numbers and age distribution of radiologists and on data provided by the American Society of Radiologic Technologists (ASRT) on radiologic technologists providing mammography services. RESULTS The forecasts show that the current rates of production of new mammography professionals will result in dramatic reductions in mammography professionals per woman age 40 years old and older over the next 15-20 years. CONCLUSION Unless the number of new mammography professionals entering practice every year increases beyond the current levels, there will be a growing gap between the supply of and demand for mammography professionals over the next two decades.

Projections of the Supply of and Demand for Podiatric Physicians in the United States, 2005 to 2030

BACKGROUND An unanticipated decrease in applications to podiatric medical schools in the late 1990s has resulted in a decline in the number of podiatric physicians per capita in the United States. This study explores the implications of five possible scenarios for addressing this decline. METHODS With the help of an advisory committee and data from the American Podiatric Medical Association, projections of the supply of podiatric physicians were developed using five different scenarios of the future. Projections of several factors related to the demand for podiatric physicians were also developed based on a review of the literature. RESULTS The projections reveal that unless the number of graduations of new podiatric physicians increases dramatically, the supply will not keep up with the increasing demand for their services. CONCLUSION The growing supply-demand gap revealed by this study will be an important challenge for the podiatric medical profession to overcome during the next couple of decades.