Biomedical subjects
J M Orient
Publications and source records attributed to J M Orient.
A wolf in sheep's clothing: the Clinton health reform plan.
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Halting the managed-care juggernaut.
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What private-practice doctors can do to contain costs. Steps you can take to preserve a free market.
Not all of the costs of private practice, particularly those related to government regulation, are within your control. However, there are steps, both large and small, that you can take to get fees under control and to eliminate or reduce expenditures. Dr Orient suggests a number of these.
Health Reform Consensus Act of 1994.
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Is there a duty to accept Medicare payment?
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Medical poll-bearers and statistical malpractice.
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How the relative value scale could save medicine.
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Efficacy of bomb shelters: with lessons from the Hamburg firestorm.
Shelters for protection against the effects of nuclear weapons are often stated to be useless, largely because of firestorms. Recent models purport to show that nuclear weapons are more likely to cause firestorms than previously thought. These controversial models are based on uncertain assumptions, which are difficult or impossible to test. Regardless of the predictive validity of fire models, conclusions about the ability of shelters to protect their occupants against firestorms, if they occur, are based primarily on historical experience. A review of the original data from the Hamburg firestorm shows that almost all persons in adequate shelters survived, contradicting a currently prevailing belief that all died. The results of the strategic bombing during World War II and of nuclear weapons tests show that a considerable level of population protection can be achieved through attention to proper shelter design.
Assessing the risk of occupational acquisition of the human immunodeficiency virus: implications for hospital policy.
In determining infection control policy, it is essential to quantitatively assess the risk of transmission of human immunodeficiency virus (HIV) to health care workers and their families. The risk should be placed in perspective by comparing it with other occupational hazards. The risk of seroconversion from a needlestick injury can be calculated from the probability of a needlestick occurrence, the probability that the source patient is infected, and the probability of seroconversion, given an exposure. The risk of seroconversion due to drawing 1000 blood specimens from seropositive patients is between 86 and 470 in 100,000. The risk to surgeons from performing 25 operations on infected patients is approximately 272 in 100,000. The risk of fatal injury in the course of one year's work on a Louisiana oil rig is between 188 and 283 per 100,000.
What is a doctor's relative worth?
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Chemical and biological warfare. Should defenses be researched and deployed?
The threat of chemical and biological weapons of mass destruction has intensified because of improved delivery systems and advances in chemistry, genetics, and other sciences. Possible US responses to this threat include deterrence, defenses, and/or disarmament, including a reaffirmation of the Biological and Toxin Weapons Convention of 1972, which is now in jeopardy. This article discusses the history of chemical and biological warfare, existing and potential weapons, the proliferation of weapons and delivery systems, ways to prevent the use of these weapons, and ways to protect populations from their effects.
International Physicians for the Prevention of Nuclear War: Messiahs of the nuclear age?
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New Medicare criteria for hospital admission.
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Civil defense in the United States: evolution and regression.
Thirty years ago, physicians were exhorted to assume a leadership role in preparedness for national emergency, including war. At that time, a system evolved to prevent certain types of casualties (due to blast and radiation), and to meet the medical challenges that would result from disaster. In recent years the system has regressed, and physicians are often leaders of the opposition to its improvement. Funding has been cut drastically, and many programs have been all but abandoned. Because this change in philosophy could cost millions of lives, the underlying assumption that all efforts would be futile in the face of modern warfare needs to be critically reexamined.
Evaluation of abdominal pain: clinicians' performance compared with three protocols.
Clinical findings in ambulatory patients with abdominal pain, presenting themselves to general medical practitioners, were analyzed by three different protocols: an algorithm using a branched-chain logic, a linear discriminant rule, and bayesian analysis. All methods missed some serious diagnoses. None was as effective as the clinician at distinguishing nonspecific abdominal pain (NSAP) from more serious conditions.