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Biomedical subjects

M L Finkel

Publications and source records attributed to M L Finkel.

32 records · Page 2Linked to original sources
PubMed1982

The efficacy of second-opinion consultation programs: a cost-benefit perspective.

This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120,000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2,284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at $534,791. Of this amount, medical care utilization savings were $361,756 and productivity savings were $173,035. The cost of the program was $203,300, yielding a benefit-cost ratio of 2.63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.

Adolescent↗
PubMed1982

Podiatric Surgery: the need for a second opinion.

A second-opinion podiatry program, designed to contain costs and enhance the quality of care, was established in the greater New York City area by the Building Service Employees' Health Fund. All nonemergency foot surgery recommended by a podiatrist that cost over $100 was included in this program. Of the 363 individuals who had a second opinion, 82 per cent were confirmed for surgery; however, the confirmation rate among those seeing a podiatrist serving as consultant was 94.3 per cent, while the confirmation rate of those seeing an orthopedists serving as consultant was 49.5 per cent. For every condition, the podiatrists overwhelmingly confirmed the need for surgery. Conversely, the orthopedists were more conservative in their recommendations regarding surgery. The program's cost was $311,813. If a second opinion consultation wasn't required for removal of corns or ingrown toenails, the total would be much less. It seems sensible (economically and medically) to encourage or require a consultation with an orthopedist for conditions such as bunions, hammertoes and heel spurs, and not to require a second opinion consultation for superficial podiatric conditions such as corns and ingrown toenails, which are treated predominantly by the podiatrist.

Adolescent↗
PubMed1981

Second opinions on elective surgery. The Cornell/New York Hospital study.

Programmes for securing second opinions on elective surgery are designed to help patients make a more informed decision once elective surgery has been recommended. The patient is assessed before surgery is performed, which allows alternatives to be considered. The Cornell/New York Hospital second opinion programme is the only one to have accumulated statistics on voluntary and mandatory programmes. Data from the mandatory programme showed that 18.7% of the 6799 patients screened were no confirmed for surgery. Follow-up data at one year showed that 67.5% of the unconfirmed patients had not in fact had surgery. A cost-benefit analysis showed that for every $1.00 spent there was a benefit of $2.63.

Cost-Benefit Analysis↗
PubMed1981

Second consultant opinion for elective orthopedic surgery.

We abstracted records of 369 patients whose recommendations for elective orthopedic surgery were not confirmed by a second opinion consultant. Six months or more after the initial recommendation for surgery, 82 per cent had not had the operation performed, irrespective of the diagnosis and the characteristics of the physician recommending surgery. Reasons for consultant non-confirmation included: use of a cast, brace, or corrective footwear preferable (26.3 per cent), symptoms not severe enough (18.4 per cent), and physical therapy/exercises preferable (17.8 per cent).

Female↗
PubMed1980

Surgical utilization in the U.S.A.

Data complied by The National Center for Health Statistics show that surgical utilization has increased dramatically, particularly during 1971-1977 (+34 per cent). Increases were greater among females than males, primarily because of an increase in gynecologic surgery. The 15-year-and-younger cohort was the only age group that did not show an increase, while surgical patients per 1,000 increased consistently with advancing age. Many factors probably have contributed to the increase in surgical utilization, yet the one factor which as been suggested more frequently than any other is surgical manpower (there may be too many doctors performing surgery for the needs of the population and this situation may lead to excessive surgery). This issue of how many physicians there should be in surgical training is widely disputed and politically volatile, however. The problems inherent in estimating future manpower requirements are many, making it hard to derive "optimal" distribution patterns.

Adolescent↗
PubMed1980

Second consultant opinion for elective gynecologic surgery.

Medical records of 516 patients not confirmed for previously recommended elective gynecologic surgery were abstracted. All had participated in the Cornell second opinion elective surgery program between 1972 and 1979. Gynecology was selected because previous analyses consistently have shown that this subspecialty has one of the highest nonconfirmation rates. Moreover, the majority of program participants follow the advice of the second opinion consultant; hence, it was deemed important to look at reasons for nonconfirmation. Findings showed that in 51% of the cases, the consultants believed either that the patient's clinical symptoms were not severe enough to warrant surgery or that further evaluation was needed. In 14.3% of the cases, no pathologic justification for surgery was evident.

Adult↗
PubMed1978

The Elective Surgery Second Opinion Program.

The results of the Cornell Elective Surgery Second Opinion Program are presented. From February 1972 to January 1978, 7053 patients were evaluated for proposed elective surgery, and in 27.6% of these, the operations were not approved. The subspecialties of orthopedics and gynecology demonstrated the highest rates of non-confirmation, while that for general surgery was 18%. A group of 318 patients with general surgical diagnosis are reviewed. The percentage of nonconfirmed surgery for this group was 15 percent. The most common reasons for not approving the operations were absence of pathology and failure to utilize medical therapy when indicated.

Female↗
PubMed1978

Second opinion elective surgery programs: outcome status over time.

Given the increasing rate of surgery and the escalating costs of hospitalization, it seems appropriate to review the necessity of recommended elective surgery before the surgery is performed. The second opinion elective surgery program is designed to screen patients before they undergo surgery. Findings are based on all not confirmed for surgery cases and an equal number of confirmed for surgery cases who were evaluated one year after their second opinion consultation. Roughly 77.9% of those not confirmed had not had the surgery and, of this, 64.4% reported no medical treatment (potential surplus surgery). Of the 710 not confirmed cases, one third (34.9%) never reported receiving medical treatment. The majority of those individuals confirmed for surgery did have the operation; however, 25.4% had not had surgery one year from their consultation. Thirty-two per cent of the confirmed cases reported never receiving medical treatment. There were 77 individuals (11.1%) who were confirmed for surgery who neither reported having surgery nor any medical treatment (population at risk). Subsequent follow up studies will present a clearer assessment of the ability of the program to screen potential surplus surgery and to realize cost savings.

Female↗
PubMedDate not supplied

Changes in reflex excitability of spinal motor neurons during day sleep in newborn infants.

A study was made of monosynaptic reflexes elicited by electrical stimulation of the ulnar and fibular nerves (H-reflexes) in newborn children, age five to seven days, during the sleeping--waking cycle. The amplitude of the H-responses was maximal and the coefficient of variation was minimal during the orthodox sleep state (OS) characterized by slow EEG waves and synchronous movement of the chest and stomach. During paradoxial sleep (PS), characterized by desynchronous EEG activity, rapid eye movements, and asynchronous breathing movements of the chest and stomach, the amplitude of the H-responses fell to 25 to 40% of the level during OS, and the coefficient of variation was in excess of 100%. The amplitude of H responses during the waking state was 60% that of the OS stage. The results of the study are considered from the point of view of existing theories about the reorganization of the system of controlling movements during the sleeping--waking cycle.

Humans↗