PubMed Health⌕ Search

Biomedical subjects

Douglas L Wood

Publications and source records attributed to Douglas L Wood.

11 recordsLinked to original sources
PubMed2006

A total of 1,007 percutaneous coronary interventions without onsite cardiac surgery: acute and long-term outcomes.

OBJECTIVES: We sought to compare clinical outcomes of elective percutaneous coronary intervention (PCI) and primary PCI for ST-segment elevation myocardial infarction (STEMI) at a community hospital without onsite cardiac surgery to those at a tertiary center with onsite cardiac surgery. BACKGROUND: Disagreement exists about whether hospitals with cardiac catheterization laboratories, but without onsite cardiac surgery, should develop PCI programs. Primary PCI for STEMI at hospitals without onsite cardiac surgery have achieved satisfactory outcomes; however, elective PCI outcomes are not well defined. METHODS: A total of 1,007 elective PCI and primary PCI procedures performed from March 1999 to August 2005 at the Immanuel St. Joseph's Hospital-Mayo Health System (ISJ) in Mankato, Minnesota, were matched one-to-one with those performed at St. Mary's Hospital (SMH) in Rochester, Minnesota. Strict protocols were followed for case selection and PCI program requirements. Clinical outcomes (in-hospital procedural success, death, any myocardial infarction, Q-wave myocardial infarction, and emergency coronary artery bypass surgery) and follow-up survival were compared between groups. RESULTS: Among 722 elective PCIs, procedural success was 97% at ISJ compared with 95% at SMH (p = 0.046). Among 285 primary PCIs for STEMI, procedural success was 93% at ISJ and 96% at SMH (p = 0.085). No patients at ISJ undergoing PCI required emergent transfer for cardiac surgery. Survival at two years' follow-up by treatment location was similar for patients with elective PCI and primary PCI. CONCLUSIONS: Similar clinical outcomes for elective PCI and primary PCI were achieved at a community hospital without onsite cardiac surgery compared with those at a tertiary center with onsite cardiac surgery using a prospective, rigorous protocol for case selection and PCI program requirements.

Aged↗
PubMed2006

Elective percutaneous coronary intervention without on-site cardiac surgery: clinical and economic implications.

BACKGROUND: Low procedural complication rates, barriers to access, and patient preference have encouraged the development of percutaneous coronary intervention (PCI) programs at centers that are often closer to home but without on-site cardiac surgical capability. OBJECTIVES: We compared clinical and economic outcomes associated with performing low-risk elective PCI at a community hospital without on-site cardiac surgery with those obtained at a more remote tertiary care center with on-site cardiac surgery. DESIGN AND MEASURES: We matched 257 patients undergoing low-risk, elective PCI at a community hospital (Immanuel St. Joseph's Hospital [ISJ] between January 27, 2000, and July 31, 2002) to 514 PCI patients treated at a tertiary care hospital (Saint Marys Hospital [SMH] between January 27, 2000, and April 30, 2002) based on clinical and lesion criteria. Clinical outcomes (in-hospital procedural success and target vessel failure during long-term follow up) and economic outcomes (direct medical costs, billed charges, and hospital length of stay [LOS]) were compared between groups. The Mayo Clinic PCI Registry (containing clinical, angiographic, and follow-up data) and administrative data were used in matching and outcomes assessment. RESULTS: Procedural success was achieved more often among ISJ-treated patients (99% vs. 95%; P = 0.02); however, no difference in target vessel failure rates was observed during a median follow-up time of 3.1 years (estimated 1-year event rate: 15.2% vs. 14.8%; P = 0.46). ISJ-treated patients incurred, on average, $3024 more in estimated total costs ($13,771 vs. $10,746; P < 0.001) and $6084 more in billed charges (P < 0.001), but incurred similar LOS post procedure (1.53 days). CONCLUSIONS: Similar clinical outcomes were achieved at a community hospital without on-site cardiac surgery but at significantly increased direct medical cost. Patients, providers, hospitals, payers, and policymakers should consider whether the benefits associated with locally provided specialized cardiovascular services warrant this additional cost.

Cardiac Care Facilities↗
PubMed2006

Medical devices and pharmaceuticals: differences in public acceptance.

In the past 15 years, rapid technologic advances have introduced medical devices for clinical use that have transformed the care of patients with chronic diseases, especially heart disease. These devices have become truly lifesaving, and their effectiveness has been demonstrated in randomized clinical trials and cost-effectiveness studies. At the same time, a remarkable number of pharmaceutical agents with new actions and capabilities have also been introduced into clinical use. These new compounds have altered the practice of oncology and the care of patients with hematologic malignancies, sometimes with significant improvement in survival. There have been other drugs introduced to manage chronic diseases that alter quality of life but do not usually threaten survival. Recent problems related to the COX-2 anti-inflammatory drugs and ongoing controversies associated with them have raised public awareness; however, there is even more concern about device failures and recalls that have occurred during the same time frame. There is limited information as to why there is such an apparent difference in public opinion toward adverse drug events compared with device problems that lead to advisories or recalls. Among possible reasons are that an implantable device that requires a catheter-based surgical procedure, with its need for hospitalization and detailed explanation about all the potential risks, may be emotionally and intellectually processed differently by a patient/family compared with having a change in prescription from one drug to another.

Cost-Benefit Analysis↗
PubMed2005

Optimizing weekend availability for sophisticated tests and procedures in a large hospital.

The reduced availability of sophisticated tests and procedures in hospitals on weekends (the so-called "weekend effect") delays care. Addressing this problem requires hospital managers to balance the desire for timeliness with the need for efficient operations. We illustrate how a hospital can profile timeliness, demand, and capacity utilization across the week for multiple testing areas. This simple, practical method; using data extracted from the hospital's accounting system, makes visible the pattern and magnitude of delays caused by reduced availability on weekends, while also showing how capacity is deployed. We combined the analytical tool with a process of transparent feedback and local problem solving that engages multiple stakeholders in the hospital. The goal is to optimally configure capacity so as to balance the imperatives of timely availability and efficient resource utilization.

Diagnostic Tests, Routine↗
PubMed2004

Paradigm shifts in cardiovascular medicine.

Cardiovascular medicine is changing rapidly with the development, testing, and introduction of new diagnostic and therapeutic methods. New interventional techniques such as the use of drug-eluting stents have important implications for the care of individual patients and the delivery and economics of health care in general. Drug-eluting stents have been shown to improve outcomes among patients undergoing percutaneous coronary intervention by significantly reducing restenosis rates. Two randomized trials have documented that per 100 patients treated with the sirolimus drug-eluting stent, 12.5 to 13.6 patients avoided the need for subsequent target lesion revascularization, when compared with patients treated with conventional stents. The economic effect of the introduction of these stents, which are projected to be two to three times as expensive as conventional stents, is complex and depends on which segment of health care is considered. These stents will be favorably received by patients, physicians, employers, and society as well as payers. However, hospitals may be adversely affected by having increased procedural costs for the stents, along with fewer procedures for evaluation and treatment of restenosis and probably decreased surgical volumes. Drug-eluting stents are only the first of many new technologic advances that will affect cardiovascular care. These procedures have many features in common, including: 1). replacement of major surgical procedures with less invasive approaches; and 2). redistribution of costs, with a decrease in hospital profits but potentially lower costs of health care delivery for society as a whole.

Coronary Disease↗
PubMed2004

Lessons learned-UME-21 project.

The Undergraduate Medical Education for the 21st Century (UME-21) project evolved from two prior projects that were aimed at studying the interface between managed care and undergraduate medical education. The project provided funding for 18 US medical schools to demonstrate how they would produce graduates who eventually could practice in a rapidly changing health care environment. Medical schools were required to provide educational opportunities in nine content areas or outline why such educational opportunities could not be provided in their individual projects. Participating schools were chosen via an involved process after careful evaluation by a panel of experienced medical educators. In a project of this type, many lessons are learned. In the UME-21 project, lessons learned were gleaned from progress reports, participant annual reports, proceedings from annual project meetings and a National Symposium, findings of a National Education Group, and published papers. A lesson must have been reported by a least two involved schools to be included. The lessons learned were divided into six categories as follows: content areas, implementation, collaboration, evaluation, governance, implications- summary. Many lessons emanated from each of these categories; however, only the 10 most important lessons in each category are presented. The implications of the lessons learned are outlined and provide direction for the future of medical education innovation and research.

Clinical Clerkship↗
PubMed2003

Low-risk percutaneous coronary interventions without on-site cardiac surgery: two years' observational experience and follow-up.

BACKGROUND: We studied the safety and efficacy of performing low-risk elective and acute infarct percutaneous coronary interventions at a community hospital without cardiac surgical capability. METHODS: Immanuel St Joseph's Hospital is located 85 miles from St Mary's Hospital, which is the nearest center with on-site cardiac surgery. All components of the Mayo Clinic percutaneous coronary intervention program were replicated at Immanuel St Joseph's Hospital, including a telemedicine system to enable real-time consultation with interventional and cardiac surgical colleagues during procedures. RESULTS: From March 1999 to June 2001, 196 patients underwent elective percutaneous coronary intervention at Immanuel St Joseph's Hospital. Procedural success was achieved in 195 (99.5%) patients, with 1 (0.5%) inhospital death. At mean follow-up of 8.2 months, 2 (1.0%) additional patients died of noncardiac causes and 15 (7.7%) patients required target vessel revascularization. From March 2000 to June 2001, 89 patients underwent primary percutaneous coronary intervention for acute myocardial infarction. Procedural success was achieved in 83 (93.3%) patients, with 3 (3.4%) inhospital deaths. At 30-day follow up, no additional patients died, had recurrent myocardial infarction, or required target vessel revascularization. No patients required transfer to another facility for emergent cardiac surgery for a procedure-related complication. CONCLUSIONS: Low-risk elective and acute infarct percutaneous coronary interventions can be performed with safety and efficacy at a community hospital without cardiac surgical capability by following rigorous standards.

Aged↗
PubMedDate not supplied

Optimization of a research web environment for academic internal medicine faculty.

Usability evaluations are a powerful tool that can assist developers in their efforts to optimize the quality of their web environment. This underutilized, experimental method can serve to move applications toward true user-centered design. This article describes the usability methodology and illustrates its importance and application by describing a usability study undertaken at the Mayo Clinic for the purpose of improving an academic research web environment. Academic institutions struggling in an era of declining reimbursements are finding it difficult to maintain academic enterprises on the back of clinical revenues. This may result in declining amounts of time that clinical investigators have to spend in non-patient-related activities. For this reason, we have undertaken to design a web environment, which can minimize the time that a clinician-investigator needs to spend to accomplish academic instrumental activities of daily living. Usability evaluation is a powerful application of human factors engineering, which can improve the utility of web-based Informatics applications.

Computer Simulation↗
PubMedDate not supplied

The physician workforce: a medical school dilemma.

Richard Cooper has advanced a projection of a sizable deficit in physicians in the United States, requiring the training of as many as 10,000 additional physicians annually by the year 2025. He questions the ability of U.S. medical schools to "fill the gap." This challenge presents another important dilemma for medical education. Could the applicant pool be enlarged sufficiently to increase qualified applicants? Would medical schools be able to accommodate this increase in students? The impact of these increases could be an ultimate decrease in the quality of health care and the production of physicians who are not current with research findings, particularly in the area of genetics.

Forecasting↗