Geriatric house calls: relic of the past or challenge of the future?

Historically, house calls played an important role in mainstream medical practice, but since the early part of the 20th century, medical care has been increasingly focused on the acute care hospital. This focus appears to have contributed to increasing physician frustration, patient alienation, and a growing public dissatisfaction with service. The geriatric population, and in particular the frail elderly, are a unique and growing proportion of the general population, and they are also the major consumers of health care resources. Patient-oriented and professional factors point to a need for physicians to return to making more house calls. Active participation by primary care physicians in developing standards and conducting research in this area of practice is necessary.

Protection against the physiological effects of positive pressure breathing.

The degree of protection afforded by three jerkin G-suit systems (British, Canadian and Swedish) using different pressures against the adverse physiological effects produced by high levels (50 mm Hg and 70 mm Hg) of positive pressure breathing (PPB) was investigated at ground level in 10 male subjects. The British and Canadian systems were evaluated with G-suit pressure equal to breathing pressure and 3.2 times breathing pressure, whereas the Swedish system was studied only with 3.2 times breathing pressure in the G suit. The experimental design was a 10 X 10 Latin swuare. PPB produced significant increases in heart rate, peripheral resistance, and systolic, diastolic and mean arterial blood pressures, and significant decreases in stroke volume and cardiac output. These effects were directly related to the level of PPB. Our results show that the British system provides the highestdegree of protection against PPB, followed by the Swedish and the Canadian systems. It was also found that a G-suit pressure of 3.2 times breathing pressure significantly increases the degree of protection afforded by the British and Canadian systems.

Joint Committee on Aviation Pathology: II. Epidemiology of military air display accidents.

The paper examines fatal Canadian military air display accidents occurring between March 1, 1956, and March 1, 1974. They are discussed in detail from a human factors point of view. It was found that single and separated pilots tended to be at high risk compared with their married counterparts and most of the fatally injured pilots had less than 2,000 h total flying time. Time on type was shown to be less important than total flight time, and age in itself was unrelated to the incidence of fatal accidents. Spontaneity and deviation from prearranged plans was featured in many of the accidents. Human failure in the cockpit appears to be less frequent in air display fatalities than in fatal accidents occurring in routine operations; however, human failure in supervision accounted for 30% of the display accident cause factors, a figure much higher than in nonaerobatic fatal accidents. Finally, evidence indicates that it is possible to select and operate an aerobatic team in which the risk of a fatality is low, provided a few simple guidelines are observed by the team selectors and the team members.