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Biomedical subjects

R J Doherty

Publications and source records attributed to R J Doherty.

6 recordsLinked to original sources
PubMedDate not supplied

The potential impact of health care reform on emergency department utilization.

How will emergency department utilization and costs be affected by universal coverage provisions? Proponents of health care reform predict that the number of ED visits will decline when currently uninsured Americans become eligible for primary physicians' care. However, economic concepts indicate the contrary: that ED volume and costs will actually escalate upon implementation of health care reform initiatives. These basic concepts include: 1) the insulation of most consumers from the true cost of health care, fostering higher demands for that care; 2) the financial benefits afforded physicians and health maintenance organizations by ED's ability, and legal responsibility, to assess and treat any patient at any time; and 3) access to ED personnel and material by individuals with urgent and nonurgent conditions, which generates fixed costs, regardless of patient volume. These effects of health care reform on EDs must be anticipated by hospital administrators to avoid compromise of patient care quality and consumer satisfaction.

Emergency Medical Services↗
PubMedDate not supplied

Cerebral ventricular shunts.

Cerebral ventricular shunts are siphoning devices used to treat hydrocephalus. They are placed within cerebral ventricles and peripheral cavities such as the ventricular atrium or peritoneal cavity. Complications include obstruction of cerebral spinal fluid (malfunction) and infection. Morbidity and mortality rates are high when shunt malfunction and infection are not treated emergently. This report summarizes the physical examination of patients with ventricular shunts, reviews the type of shunts commonly used, discusses shunt malfunctions (causing overshunting or undershunting of cerebrospinal fluid) and infections, and makes recommendations concerning empiric antibiotic therapy for shunt infection. The technique of tapping a shunt is presented for management of patients with elevated intracranial pressure that does not respond to non-invasive maneuvers to lower the pressure.

Bacterial Infections↗
PubMedDate not supplied

Reengineering the emergency evaluation of chest pain.

This article presents strategies for enhancing the emergency department care delivered to patients with chest pain and suspected acute myocardial infarction. It also describes the planning and implementation of an emergency department reengineering project at a university medical center. The establishment of chest pain evaluation centers within emergency departments has been associated with improved clinical outcomes and cost control. Creating such a center requires careful revamping of diagnostic and treatment algorithms, a process that must be based on information from all departments affected by the changes.

Baltimore↗