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At least 721 records · Page 40Linked to original sources
PubMed1987

Community hospital administration of intravenous tissue plasminogen activator in acute myocardial infarction: improved timing, thrombolytic efficacy and ventricular function.

As an investigational fibrinolytic agent for acute myocardial infarction, intravenous recombinant tissue-type plasminogen activator (rt-PA) has been administered primarily in tertiary care and university centers. To determine the value of early initiation of such therapy, two satellite community hospital emergency rooms were established for use of rt-PA and the experience was compared among 142 consecutive patients who were transferred to a regional center for acute cardiac catheterization after intravenous rt-PA therapy. In Group I (n = 19), patients received rt-PA after interhospital transport to the regional center, but before cardiac catheterization. In Group II (n = 70), rt-PA therapy was initiated by the helicopter physician and nurse team after their arrival at the local community hospital emergency room. Group III patients (n = 53) had rt-PA administered in the local community hospital by the emergency room physician. Group III patients had earlier initiation of therapy (2.1 +/- 0.8 hours in Group III versus 3.8 +/- 1.2 hours in combined Groups I and II, p less than 0.001) and an increased rate of infarct vessel recanalization on the 90 minute coronary angiogram (81 in Group III versus 67% in combined Groups I and II, p = 0.057). The patients in Group III had a higher acute left ventricular ejection fraction (54 +/- 8% versus 50 +/- 9.5% in combined Groups I and II, p less than 0.01) and a trend toward an increased 7 day ejection fraction (55.5 +/- 9% versus 51.7 +/- 9.5%, respectively, p = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1990

Impact of technology in health care and health administration: hospitals and alternative care delivery systems.

Applications as outlined above and many more that have not yet even been identified--but that will be invented and developed--will have an enormous impact on the health care industry. Clearly, capital requirements to purchase this technology will go up and thus exert further pressure for the reduction of personnel. Computers and robots will replace a significant percentage of health care personnel; overall health care costs as a percent of gross national product will nevertheless probably continue to rise in spite of improvements in productivity. Added costs will be offset in part by the use of technology in areas that will impact efficiency. Because of these accelerating uses of sophisticated technology, future administrators will have a greater appreciation for what technology can offer. Practical uses of robotics, expert systems, and artificial intelligence will require administrators to be technologically proficient.

Delivery of Health Care↗
PubMed1984

Esophageal carcinoma. A six-year review of the Cleveland Veterans Administration Hospital experience.

The records of 51 patients with esophageal carcinoma were reviewed. Twenty-two patients underwent attempted curative resection with a mean survival of 7.7 months. Twenty patients underwent primary radiotherapy (mean survival, 4.3 months). Nine patients received palliative therapy alone (mean survival, 2.8 months). Surgical mortality was 27%, but symptomatic palliation was complete in 59% of the surgical patients. Only 5% of the radiotherapy group, and 11% of the palliative group were completely palliated. There is only one long-term survivor (21 + months). Lesions in the middle third of the esophagus, and the presence of clinical evidence of metastatic disease were predictive of a shorter survival. Patients with metastatic disease at presentation had a mean survival of only 2.5 months from diagnosis. It is concluded that surgery should be considered a palliative, not curative procedure, and that it should be attempted only in those patients without clinical evidence of metastatic disease.

Adenocarcinoma↗