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PubMed1989

Emergence of rheumatic fever in the nineteenth century.

How do we make sense of the process of disease definition when the tools for "framing" a pathophysiologic reality and the reality to be framed may have both been changing? The sudden emergence of rheumatic fever at the end of the eighteenth century was the result of distinct biological changes that led to cardiac damage. But the identification of the disease also depended on the ability of clinicians to diagnose it in the absence of easily observable cardiac symptoms. Clinicians were able to appreciate the alteration of rheumatism into rheumatic fever through assimilation of technological changes (the stethoscope and autopsy), refinements in clinical thinking (the "typical case"), and the concentration of patients in hospitals where they were treated by physicians who were medical leaders and educators.

History, 18th Century↗

PubMedDate not supplied

[New problems in occupational medicine: findings on the risk of coronary heart disease in the services industry].

The distribution of the major coronary risk factors: total and HDL cholesterol, blood pressure, smoking and body mass index, was studied during the course of a routine screening of 1404 male bank employees in Northern Italy. The recent Italian and international consensus conferences and particularly the results from the Italian areas of the WHO-MONICA Project were taken as reference points. There was a widespread coronary risk in the bank employees who had a 5-10% excess of cholesterol, corresponding to a 10-20% increase in the theoretical risk of coronary heart disease. Compared to the data produced by the Lipid Research Clinics (USA), coronary risk appeared higher for all the surveyed factors in the Italian general population, and particularly in bank employees. Greater stress at home and at work and above all the change from the traditional, poor Mediterranean diet to a richer diet might provide an explanation for these results. A new perspective is thus opened for occupational health due to the new health problems produced by the cultural and technological changes occurring in the country.

Adult↗

PubMed1988

Using the microbiology laboratory in the diagnosis of pneumonia.

Pneumonia/influenza is one of the top ten leading causes of mortality in the United States each year. The identification of the etiologic agent responsible for lower respiratory tract infection plays an important role in the proper management of this clinical problem. The specimens submitted for evaluation are obtained in diverse ways and include expectorated sputum, material from transtracheal and bronchoscopic procedures, pleural fluid and lung aspirates, and biopsy of actual lung tissue. Processing of material can include stained smears, aerobic and anaerobic cultures, and special processing techniques for fungal, viral, Pneumocystis carinii, Legionella, mycobacterial, and mycoplasma identification. Modifications of smear preparation techniques and application of the new DNA probe technology are providing the opportunity for rapid microbiologic testing of clinical specimens with increased sensitivity and specificity, often obviating the need for invasive diagnostic procedures. Laboratory methodology is continually undergoing technological change, and optimal care of the patient with pneumonia requires close cooperation between the attending physician and the clinical laboratory.

Bacteriological Techniques↗

PubMed1978

Healthy family functioning: a cross-cultural appraisal.

It is increasingly recognized that rapid cultural, social, economic, and technological changes are imposing increasing stress on family structures, traditional values, and the ability to adapt to new environments in different societies. For the purposes of this paper, "healthy family functioning" is defined in terms of a family unit (however it is conceived in any given culture) effectively coping with cultural, environmental, psychosocial, and socioeconomic stresses throughout the family life cycle. While a review of international literature in the behavioural and biomedical sciences yields little data on comparative studies, there is growing awareness of the need for cooperative international research on family coping mechanisms and determinants of self-reliant communal coping behaviour, as well as more efficient utilization of already available knowledge. After consideration of methodological pitfalls of assessment procedures, there is a presentation of an evolving theory of healthy family functioning with the suggestion that studies of young married couples constitute a particularly promising vehicle for developing needed cooperative cross-cultural research.

Cross-Cultural Comparison↗

PubMed1987

Assessment of changing technologies in medicine.

Technology is the outcome of man's use of tools and reason to change the environment to his benefit. New technology creates opportunities for some and threats for others. New technology will be dramatically influenced by the political, social, economic, and ethical milieu in which it develops. An overriding concern in the near future may be cost. Cost-benefit analysis/cost-effectiveness analysis can be a helpful planning tool but should not be used exclusively to plan for technological change. Knowledge of the humanities as well as a science will be essential if we are to make the decisions needed as we approach the 21st century.

Cost-Benefit Analysis↗

PubMed1988

Prospective payment assessment commission. A commissioner's perspective.

The function and priorities of the Prospective Payment Assessment Commission (ProPAC) are discussed. The ProPAC's priorities include (1) safeguarding the quality of care; (2) encouraging hospital productivity and long-term cost-effectiveness; (3) facilitating innovation and appropriate technological change; (4) maintaining stability for providers, consumers, and other payers; and (5) making decisions based on reliable, timely data and information.

Cost-Benefit Analysis↗

PubMed1988

The importance of embryological research in the surgical management of the cleft lip deformity.

The cleft lip deformity has been present throughout mankind, and has entered into the folklore of Nations. There has been a multitude of described repairs. Still they do not provide the hoped for final results. Some of the changes have been based on "thought out" ideas, others on futile guesses. The last few years have seen changes in the surgical direction due to a clearer understanding of the basic embryology. These changes have been made possible by advances in equipment and technology. Changes in animal research, both intra- and extra-uterine, have made possible experiments which may answer some of the suppositions put forward covering both development and healing. The classification of cleft lip places all the deformities in one group, but there may in fact be several groups with different actual causes and failures leading to the same clinical picture. The understanding of the failure or failures that occur in development should lead to a logical approach to the repair of the cleft deformity.

Cleft Lip↗

PubMed1988

Teaching medical professionals to retrieve and manage medical information.

Popularity of the personal computer has prompted physician interest in direct access to the medical literature from sophisticated electronic data retrieval systems. This paper describes the educational programs developed by the library at the George Washington University Medical Center in response to this interest and growing national trend. As a result of these programs, the role of the librarian has changed permanently. Librarians are now perceived by faculty as educational specialists and information consultants. The evolution in libraries parallels the technological changes taking place in other biomedical communications units. The authors recommend the positive outcomes from adapting traditional roles to meet user's needs in a changing environment.

Humans↗

PubMed1986

Health care in transition. Consequences for young physicians. Council on Long-Range Planning and Development.

Individuals planning for a career in medicine must weigh a number of factors into their decisions. Increasingly, they must understand the nature of the socioeconomic environment of health care, including the extent of competition with other physicians and other health professionals; the degree of autonomy from health care institutions, government, and third-party payers; the impact of demographic or technological changes; and the economics of medical practice. This report analyzes the environment of medicine, emphasizing those elements that will be most important to medical students and resident physicians. It focuses on three stages of a physician's career: obtaining a medical education, beginning to practice medicine, and maintaining a viable practice.

Adolescent↗

PubMed1985

High technology medicine: how defined and how regarded.

High technology--complex, expensive, restricted in availability, and requiring some form of explicit rationing--is bound to influence the medical task. Diagnosis, prognosis, decision, and management have all incorporated high technology, changing the hospital physician's role from one of private contractor to one of team member. Attitudes toward the balance between burden and benefit of high technology are as varied as are the conflicting vested interests among patients, professionals, society, industry, and government. Above all, it will take time for both patients and professionals to learn how to redefine expectations in a changing relationship.

Attitude↗

PubMed1966

Regulatory agencies and food safety.

Prior to Confederation, food control legislation in Canada consisted of only a few simple laws governing the quality, grading, packing and inspection of certain staple foods. The Inland Revenue Act of 1875 provided the first real control in Canada over adulteration of liquor, foods and drugs. Since then, food legislation has evolved in scope and complexity as the industries involved have developed, as consumers have become better informed, and as scientific advances have provided a sound basis for regulations. Present regulations under the Food and Drugs Act are intended to give consumers broad protection against health hazards and fraud in the production, manufacture, labelling, packaging, advertising, and sale of foods. This principle is well illustrated by present requirements for the control of pesticide residues, chemical additives, and the addition of vitamins to foods. In today's era of rapid technological change, application of current scientific knowledge to the food industry obviously involves the possibility of hazards to health. Regulatory agencies with responsibility for food safety must, therefore, fully utilize scientific knowledge in order to reduce the risks involved to a minimum.

Canada↗

PubMed1978

Assessing trends in perinatology.

Hospital administrators must respond as the medical profession renews its efforts to reduce newborn mortality rates. Technological changes in the case of obstetric and newborn patients, pressures for the regionalization of service, and consumer demands for a more humane birth environment are factors the administrator must consider.

Consumer Behavior↗

PubMed1984

Radiology 1984. A conflict of high technology and high cost.

Radiology is confronted now by exciting but challenging times. The excitement derives from dramatic technological advance; the challenge from the economic constraints on health care delivery. The large and growing expense of providing health care is readily apparent and high technology medicine can too easily be blamed for the growth. The pressures for improved service at no extra cost will demand much of the negotiating skills of our specialty and our ability to survive administrative confusion and fragmentation. Equally, manpower planning is a feature of modern medicine. Often this is done from inadequate data and as a specialty we must continue to think constructively about our own future in this context, not least in recognizing the contribution of women to our specialty. Forces also to be recognized are decentralization, electronic information transfer, concerns about radiation exposure and litigation. Not least we need to be better able to define our specialty as its scope is now changing rapidly. For the future I hope that we can be part of the development of the controls which we must inevitably face; we should lead in instituting cost-accounting in our departments; we must be at the leading edge of technological change in both imaging and data transfer, and we must be both more business-like as well as act effectively as the patient's advocate. Radiology has an important and growing responsibility in patient care and most of the technological advances both improve that care and can be justified economically. I am proud to be a radiologist in 1984.

Canada↗

PubMed1984

Challenges for dietitians in a high tech/high touch society.

In our society, the coming decades will represent a period of great change and transition. Dietitians will come to realize that we have moved from an industrial to an information society. We are moving in the dual direction of high tech/high touch, matching each new technology with a compensatory human response. Institutional help will be replaced by self-reliance in all aspects of our lives. People whose lives are affected by a decision must be part of the process of arriving at that decision. We are giving up our dependence on hierarchical structures in favor of informal networks. For dietitians to prosper in this era of rapid technological change, they must more than keep pace; they must stay ahead, exploit technology aggressively and imaginatively, and apply it experimentally to new ideas.

Adolescent↗

PubMedDate not supplied

Nursing and technology.

Nursing began as an effort to provide care and comfort to the sick and injured. As our society developed, technological change began to increasingly affect the practice of nursing. Nurses found themselves caring for machines in addition to, or instead of, patients. All areas of nursing were affected by the technological explosion of the past 25 years. But nursing education and agency orientation programs have not prepared the nurse to work closely with sophisticated equipment. Conventional sex-role sterotyping contributes to the problem. Changes in academic training, employer practices, and nurses themselves are necessary. Nurses are the chief users of health care technology. They should have the skills to manage that technology.

Education, Nursing↗

PubMed1995

Achieving and sustaining full employment.

Human rights and public health considerations provide strong support for policies that maximize employment. Ample historical and conceptual evidence supports the feasibility of full employment policies. New factors affecting the labor force, the rate of technological change, and the globalization of economic activity require appropriate policies--international as well as national--but do not invalidate the ability of modern states to apply the measures needed. Among these the most important include: (I) systematic reduction in working time with no loss of income, (2) active labor market policies, (3) use of fiscal and monetary measures to sustain the needed level of aggregate demand, (4) restoration of equal bargaining power between labor and capital, (5) social investment in neglected and outmoded infrastructure, (6) accountability of corporations for decisions to shift or reduce capital investment, (7) major reductions in military spending, to be replaced by socially needed and economically productive expenditures, (8) direct public sector job creation, (9) reform of monetary policy to restore emphasis on minimizing unemployment and promoting full employment. None are without precedent in modern economies. The obstacles are ideological and political. To overcome them will require intellectual clarity and effective advocacy.

Economic Competition↗

PubMed1994

Research into hand-arm vibration syndrome and its prevention in Japan.

Research on vibration syndrome in Japan began in the 1930s with studies of the disorder among railway, mining and shipyard workers. In 1947, the Ministry of Labor decided vibration syndrome among operators of rock drills and riveters etc. was an occupational disease. Industrial developments in the 1950s and 1960s promoted the survey of vibration syndrome in mining, stone quarrying and forestry. The Ministry of Labor (1965) and the National Personnel Agency (1966) legally recognized vibration syndrome among chain saw operators as an occupational disease. Guidelines for prevention and early therapy were issued in the 1970s and 80s. From the late 1970s into the 1980s, research focused on the clinical picture, diagnostic methods and therapy. In pathophysiology, advances were made in research into the autonomic nervous system during the 1980s. The 1970s and 80s saw a steady reduction in risk from technological change and working conditions, and advances in medical care, education and meteorological forecasting. A comprehensive prevention system established in the 1980s in the Japanese forest industry involved: 1) work restrictions, 2) an improved health care system, 3) advances in the design of vibrating tools, handle-warming devices, and 4) improved worker education. This comprehensive preventive system was legally introduced into other industries, resulting in a rapid decrease in the incidence of vibration syndrome in Japan.

Arm↗

PubMed1994

The impact of clinical practice patterns on hospital charges for orthognathic surgery.

To assess the impact of changes in practice patterns, hospital charges (overall and component charges excluding professional fees) for 1992 were compared to 1985 data for three orthognathic surgical procedures: bilateral sagittal split osteotomy (BSSO), Le Fort I osteotomy (LFI), and a combination of both (BSSO/LFI). Data for 1992 were obtained for 59 patients (26 BSSO, 18 LFI, 15 BSSO/LFI). Secondary analysis of similar data for 1985 included 77 patients (27 BSSO, 16 LFI, 34 BSSO/LFI). Changes in clinical practice from 1985 to 1992 reduced mean length of stay (days): BSSO 3.2 to 1.2, LFI 3.7 to 1.4, BSSO/LFI 4.1 to 1.8. Mean total charges (dollars) increased: BSSO 3,086 to 5,023, LFI 3,538 to 6,784, BSSO/LFI 4,778 to 8,816. If 1992 charges are expressed in 1985 dollars, ancillary, pharmacy, and room charges all are reduced. Charges attendant to the surgical procedure (anesthesia, operating room, supply, and recovery) were just over half of total charges in 1985. By 1992, these components escalated to 80% of total charges. Most notable was the increase in supply charges. Charges for rigid fixation were a major component of increased supply charges in 1992. Surgeons minimally influence charges attendant to the operating room and postanesthesia recovery, the major components of total charges in 1992. Quality can be maintained with reduction in some charge categories, but these components total less than 25% of the patient's bill. Technology changes benefit patients, but a judgment must be made weighing benefits against increased health care costs.

Cost-Benefit Analysis↗