Over the past several decades, the pharmacologic and endoscopic treatment of peptic ulcer disease (PUD) has dramatically improved. To determine the effects of these and other changes on the operative management of PUD, we reviewed our surgical experience with gastroduodenal ulcers over the past 20 years. A computerized surgical database was used to analyze the frequencies of all operations for PUD performed in two training hospitals during four consecutive 5-year intervals beginning in 1980. Operative rates for both intractable and complicated PUD were compared with those for other general surgical procedures and operations for gastric malignancy. In the first 5-year period (1980 to 1984), a yearly average of 70 upper gastrointestinal operations were performed. This experience included 36 operations for intractability, 15 for hemorrhage, 12 for perforation, and seven for obstruction. During the same time span, 13 resections were performed annually for gastric malignancy. By the most recent 5-year interval (1994 to 1999), the total number of upper gastrointestinal operations had declined by 80% (14 cases), although the number of operations for gastric cancer had changed only slightly. Operations decreased most markedly for patients with intractability, but the prevalence of operations for bleeding, obstruction, and perforation was also decreased. We conclude that improved pharmacologic and endoscopic approaches have progressively curtailed the use of operative therapy for PUD. Elective surgery is now rarely indicated, and emergency operations are much less common. This changed paradigm poses new challenges for training and suggests different approaches for practice.

Databases, Factual↗

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Is the therapeutic community culturally relevant? Findings on race/ethnic differences in retention in treatment.

The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programming for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readiness and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.

Culture↗

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Market power and hospital pricing: are nonprofits different?

Dramatic changes in hospitals' operating environments are leading to major restructuring of hospital organizations. Hospital mergers and acquisitions are increasing each year, and conversions by hospitals to different forms of ownership also are continuing apace. Such changes require policymakers and regulators to develop and implement policies to ensure that consumers' interests are protected. An important consideration in this process is the impact on the price of hospital care following such transactions. This paper reviews empirical evidence that mergers that reduce competition will lead to price increases at both merging hospitals and their competitors, regardless of ownership status. We show that nonprofit and government hospitals have steadily become more willing to raise prices to exploit market power and discuss the implications for antitrust regulators and agencies that must approve nonprofit conversions.

Economic Competition↗

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Therapeutic communities: diversity in treatment elements.

This study addresses the need to describe the diversity of therapeutic community (TC) programs. The Survey of Essential Elements Questionnaire (SEEQ) was used to develop a typology of TC programs based on 19 programs that identified themselves as traditional or modified TCs in the Drug Abuse Treatment Outcome Studies (DATOS). These traditional and modified TCs differed in adherence to the elements of TC treatment, on operational characteristics, and in client mix. Differences in treatment philosophy and approach included the emphasis on self-reliance, and the use of work as a therapeutic agent for traditional TCs. There were also trends for traditional TC programs to utilize community-as-method, provide educational and vocational training, and include family members as part of therapy. Modified programs showed a greater tendency to rely on counselors. Implications of the findings for program quality, health care policy, and research are discussed.

Combined Modality Therapy↗

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State of the state's health care.

California leaders tell us what's right and what's wrong with our health care system. While consensus on health care reform is far from being reached, all agree that universal access, cost control and preventive services must be part of any health reform plan.

California↗

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The future of healthcare. Seven experts look ahead.

If there were ever a time to have a crystal ball, it's now. In today's healthcare environment the only thing that seems certain is change. To help marketers make some educated guesses about the future of healthcare, hospitals, and the market, PROFILES invited seven experts to prognosticate. They considered what might happen in this decade, and what could be reality in 25 to 50 years. They address topics ranging from surgery of the future to how consumers will find healthcare information. Here are a few of their predictions: 1. Managed care will dominate the market. 2. More hospitals will close. Those remaining will consolidate or collaborate and draw closer to their communities. 3. Doctors and hospitals will build partnerships. More doctors will be salaried. 4. Cost controls will increase. 5. Quality will differentiate hospitals and drive marketing. 6. Patients will become more involved in their care and in their selection of hospitals. 7. Drug treatments will play an increased role as surgery declines.

Canada↗