Colonoscopy as a primary diagnostic procedure in chronic gastrointestinal tract bleeding.

We compared the use of barium enema (BE) and colonoscopy in evaluating patients with chronic gastrointestinal tract bleeding by dividing into three groups 329 consecutive colonoscopies and 207 consecutive BE examinations done with chronic gastrointestinal tract bleeding as an indication. In the first group, of 96 patients with negative results of BE studies, subsequent colonoscopy showed carcinoma of the colon in 16%, polyps larger than 1 cm in 21%, and other causes in 20%. In 43% the colonoscopy gave negative results or was incomplete. In the other two groups we directly compared findings of the 207 BE and the 233 remaining colonoscopies when each was used as a primary diagnostic test. Colonoscopy was found to have fewer negative results (74% vs 43%), fewer inconclusive examinations requiring repeat (19% vs 3%), and more positive correct findings to explain the cause of bleeding (54% vs 5%).

Colonoscopy as a routine preoperative procedure for carcinoma of the colon.

Ninety patients with cancer of the colon who had total colonoscopy in the perioperative period have been reviewed. Almost half of the examinations revealed positive findings, three being unsuspected synchronous carcinomas in an area that would not have been resected with the proposed primary cancer. In addition, 79 polyps in 36 patients, the majority of which were also undetected by barium enema, were found and removed at colonoscopy. Thus, patients with carcinoma of the colon, in view of its tendency to be associated with synchronous polypoid disease, should have colonoscopy in the perioperative period. Whenever possible, this should be carried out preoperatively to confirm the diagnosis, to remove suspected or unsuspected polyps, and to detect unsuspected synchronous carcinoma.

Impact of mammography on breast surgery in a small community hospital.

The impact of mammography on breast surgery at a small community hospital was evaluated by comparing the stage of cancer at diagnosis in a 5 year period before mammography with that in a 5 year period after its introduction. During both periods approximately the same number and stage of palpable carcinomas were diagnosed and treated. However, in the 5 year period after introduction of mammography, in addition to the 35 palpable carcinomas 11 additional nonpalpable occult carcinomas were diagnosed. These 11, with an average size of 8 mm and all in patients with negative nodes, would fit into the category of minimal breast cancer, which is associated with a 10 year disease-free interval of over 90 percent.

Use of physician's assistants in a general surgical practice.

A study has been made of three PAS employed in a rural, small town, general surgical practice during a four year period. Their work was equally divided among three areas: minor trauma, obtaining and recording data for history and physical examinations, and assisting at routine surgical procedures and endoscopies. This resulted in a significant saving of time for each surgeon who was thus freed for more time in the care of the more critically ill or injured patients.

Utilization of supervised physician's assistants in emergency room coverage in a small rural community hospital.

A study has been made of an initial 2-year experience in a 90-bed rural community hospital where emergency room primary coverage has been provided by Physician's Assistants under supervision of specialists in the field of general surgery, pediatrics, and internal medicine. Emphasis has been placed on a rigidly supervised program as well as physician supervision and availability on a patient-call basis. This supervision may take the form of immediate availability of the physician to the emergency room, telephone consultation or, in minor illnesses and injuries, continued review of the record of each individual patient seen by the Physician's Assistant. A review of the most recent 2-month ER-OPD experience showed that in a small rural hospital, a majority (62%) of the patients had an illness or injury of a minor, nonserious degree which could be handled primarily by a Physician's Assistant. This has led to emergency room care which has been judged by the patients, the emergency-room nurses, and the supervising physicians to be more efficient and prompt than had been previously provided, yet not reduced in quality. The program described was developed by physicians active in private practice working with the Physician's Assistants and RN's in the ER-OPD. The physicians' time spent in teaching, supervision and development of written policy was great, and, at times, threatened the continuation of the program. A fulltime physician in the hospital could better initiate the program of teaching, supervision, formulating written procedures, and establishing policies with different specialist.