ABSTRACT
The pressing issue of providing care for the uninsured indigent has been addressed in Kentucky by a unique private sector program that depends on physician donation of services. The Kentucky Physicians Care (KPC) program which provides health care to uninsured indigent patients in Kentucky was evaluated from the perspective of the participating physicians through in-depth interviews with 22 randomly selected physicians. The results of the interviews suggested that the KPC program is generally viewed by participating providers as a successful and personally rewarding enterprise. Suggestions for improving services included strategies to increase awareness of the program for both patients and providers. As state and federal policy continues to focus on the uninsured as a vulnerable population, integration of this private sector program into a partnership with the public sector may be a worthwhile strategy.
Subject(s)
Medical Indigency , Medically Uninsured , Physicians , Uncompensated Care , Interviews as Topic , Kentucky , Private SectorABSTRACT
The results of treatment in 22 patients with anal carcinoma are reviewed. The overall results are disappointing with only five (28%) surviving more than 5 years. The commonest form of treatment during the study period was an abdomino-perineal excision of rectum (APER). For patients with tumours less than 2 cm in diameter local excision is an acceptable alternative. The majority (76%) of tumours were diagnosed as common benign conditions by the referring practitioners leading to a delay in initiating definitive treatment. Most tumours (81%) were greater than 2 cm in diameter and therefore unsuitable for local excision. There was a high recurrence rate (76%) amongst the group treated by APER. This along with the poor overall survival is probably due to late presentation.
Subject(s)
Anus Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Adenocarcinoma/diagnosis , Adenocarcinoma/mortality , Adenocarcinoma/surgery , Aged , Aged, 80 and over , Anus Neoplasms/diagnosis , Anus Neoplasms/mortality , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/mortality , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/mortality , Carcinoma, Transitional Cell/surgery , Female , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
In 24 patients where the lower border of a cervical goitre was poorly defined, the value of simple lung function tests in the prediction of the presence of a retrosternal goitre was assessed. At operation there were nine patients with retrosternal extension (Group I) and 15 without (Group II). The preoperative PEF ratio (observed to predicted) was significantly different between the two groups (P = 0.004) with a positive predictive value of 90% for a retrosternal goitre. This difference was abolished after thyroidectomy. There was a significant improvement in PEF in patients with retrosternal goitres after thyroidectomy (P less than 0.001). It is concluded that the preoperative measurement of PEF is a simple method of detecting the retrosternal extension of a cervical goitre.
Subject(s)
Goiter, Substernal/diagnosis , Peak Expiratory Flow Rate , Adult , Aged , Aged, 80 and over , Female , Goiter, Substernal/pathology , Goiter, Substernal/physiopathology , Goiter, Substernal/surgery , Humans , Lung/physiopathology , Male , Middle Aged , Organ Size , Predictive Value of Tests , Prospective Studies , Thyroid Gland/pathology , ThyroidectomySubject(s)
Gastrointestinal Hemorrhage/surgery , Adult , Age Factors , Aged , Duodenal Diseases/etiology , Duodenal Diseases/surgery , Duodenal Diseases/therapy , Esophageal Diseases/etiology , Esophageal Diseases/surgery , Esophageal Diseases/therapy , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Hospitalization , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Stomach Diseases/etiology , Stomach Diseases/surgery , Stomach Diseases/therapySubject(s)
Drainage , Duodenal Ulcer/surgery , Stomach/physiopathology , Vagotomy , Adult , Aged , Chromium Radioisotopes , Duodenal Ulcer/physiopathology , Female , Gastric Juice/metabolism , Gastrointestinal Motility , Humans , Insulin , Intestines/surgery , Male , Methods , Middle Aged , Pylorus/surgery , Stomach/surgeryABSTRACT
Ninety-nine patients from a non-urgent general surgical waiting list were randomly selected for either direct admission to a hospital bed or review at a preadmission clinic. A considerable reduction in subsequent bed occupancy was shown in the latter group. The findings suggest that more detailed review of patients in the outpatient department would result in the more efficient use of hospital facilities.
