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R H McNeilly

Publications and source records attributed to R H McNeilly.

6 recordsLinked to original sources

The diffusion of new medical technologies in the private sector of the U.K. health care system.

Eleven percent of the U.K. population holds private health care insurance, and 2.2 billion Pounds are spent annually in the acute sector of private health care. Although isolated from policy discussions about new medical technology in the National Health Service, the private sector encounters these interventions regularly. During 18 months in one company, a new medical technology was encountered on average every week; 59 leading edge technologies were submitted for authorization (18 on multiple occasions). There are certain constraints on purchasers of health care in the private sector in dealing with new technology; these include fragmentation of the sector, differing rationalities within companies about limitations on eligibility of new procedures while competing for business, the role and expertise of the medical adviser, and demands of articulate customers. A proactive approach by the private sector to these challenges is hampered by its independence. Poor communication between the public and private sectors, and the lack of a more inclusive approach to policy centrally, undermine the rational diffusion and use of new medical technology in the U.K. health care system.

Communication↗

Duration of last attack in 998 fatal cases of coronary artery disease and its relation to possible cardiac resuscitation.

All the deaths attributed to coronary artery disease and occurring in Belfast during one year were studied.The frequency distributions of the cases by interval of time between onset of the last attack and death are given for those not admitted to hospital, for those admitted to hospital, and for those already in hospital for some other cause of illness.Sixty per cent. of all the deaths occurred outside hospital. This indicates that the problem of cardiac resuscitation in coronary artery disease is to a considerable extent an extra-hospital one.Twenty-seven per cent. of the men and 22% of the women died within 15 minutes, but the median period of survival was 3 hours 30 minutes for men and 6 hours 18 minutes for women.The median time interval from the onset of the attack to sending for medical aid was 1 hour 17 minutes for men and 1 hour 6 minutes for women, and from summoning medical aid to sending for the ambulance 59 minutes for men and 1 hour 26 minutes for women. Ninety-six per cent. of the ambulance journeys to the patient were accomplished in less than 20 minutes.It was found among men, but not among women, that the duration of survival tended to be longer in older patients and in second or subsequent attacks.Of the 596 who did not gain admission to hospital 229 (23% of all the 998 patients) were known to have survived for more than half an hour after the onset of the fatal attack; 182 (18%) survived for more than one hour; and 143 (14%) survived for more than two hours. It is among these that there would appear to be special scope for the cardiac ambulance, providing that medical aid is sought and the ambulance is summoned without delay.

Adolescent↗