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Biomedical subjects

D P Black

Publications and source records attributed to D P Black.

10 recordsLinked to original sources
PubMed1984

The safety of obstetric services in small communities in northern Ontario.

The safety of the obstetric care system in the small hospitals of northern Ontario was assessed by analysing the outcomes of all obstetric cases over a 2-year period. Information was retrieved by place of residence rather than hospital of delivery so that the overall perinatal system, including the referral patterns, would be assessed. There was little difference in perinatal loss rate (stillbirths and neonatal deaths up to 28 days per 1000 births) for residents of areas served by different levels of obstetric care. Areas served by units where cesarean sections are done regularly but which do not have specialists in obstetrics or pediatrics had a perinatal loss rate of 10.43, whereas areas served by units staffed with two or more specialists in both obstetrics and pediatrics and handling more than 1000 deliveries per year had a perinatal loss rate of 12.13. Although many of the smaller hospitals did not have the minimum capabilities suggested for obstetric units relatively safe care was being provided. These results do not support the need for further centralization of obstetric services in northern Ontario.

Canada↗
PubMed1979

Management of obstetric complications at a small rural hospital.

To determine if there is a way of identifying obstetric patients in whom complications will develop, the experience of one small hospital was reviewed. It was found that there is no satisfactory method presently available that allows a hospital to select such patients so that they can be referred to a large centre. While the scoring system designed by Goodwin, Dunne and Thomas for assessing antepartum fetal risk is fairly effective in selecting fetuses at risk, its results do not correlate well with the frequency of obstetric complications. Since in a significant proportion of obstetric patients complications develop that require emergency intervention, it is important that hospital staff maintain their ability to do safe cesarean sections and to obtain blood for transfusion quickly. Hospitals in which there are fewer than 100 deliveries per year probably do not have a sufficient caseload to maintain the ability to do safe cesarean sections; it is therefore suggested that they discontinue obstetric practice. At hospitals with a larger caseload elective cesarean sections should be done so that the ability to do emergency procedures can be maintained.

Apgar Score↗
PubMed1977

A controlled trial of the impact of the family practice nurse on volume, quality, and cost of rural health services.

Rural Newfoundland communities with and without expanded role nurses were compared on a before and after basis. The rural communities are located in a geographically isolated area served by a 40-bed hospital staffed by salaried physicians. Primary care visits within the community increased by 186 per cent after establishment of the family practice nurse community clinic and attendance at the hospital decreased by 35 per cent. Acute care days in hospital decreased 5 per cent in the experimental group and increased by 39 per cent in the control group. A major portion of the community based visits provided to the experimental group were classed as preventive. The total annual health service cost per 1,000 persons in the experimental group increased slightly more than in the control group (26 versus 21 per cent). Adequate management of certain indicator conditions and drugs was maintained by the family practice nurse when compared to the adequacy rating for the physician during the same time period.

Community Health Nursing↗
PubMed1973

Management of myocardial infarction in a rural area.

In an attempt to determine the most appropriate type of facility for the treatment of myocardial infarction in a rural community, the five-year experience of a practice serving 10,000 people is reviewed. This population is found to have a low incidence of myocardial infarction, a low death rate from the condition both in hospitalized patients and in the general population, and a low incidence of complications in the survivors. None of the deaths either in or out of hospital would likely have been prevented through the use of specialized facilities. It is concluded that no such facilities are necessary in this community and that other areas considering their acquisition should justify the need on the basis of their own experience and not on accounts in the literature.

Adult↗