RESUMO
In summary then, many of the changes that have accompanied the massive shift to outpatient care in the past decade have been good. However, change itself is not inherently good, and the effect of change upon the individual physician is extremely important. In my opinion, the increasing hassle, overregulation, and second guessing that have accompanied recent changes have had a significant negative effect upon physicians. The signs of this happening are clear. This in turn does not bode well for patients and the quality of medical care that will be available to them in the future. I would submit that the focus of any scrutiny of the benefits of changes in our medical care delivery system should be the practicing physician. The impact of such changes upon physicians and their ability to carry out their mission of patient care will provide our best guide for the course that we choose for our future.
Assuntos
Assistência Ambulatorial/tendências , Papel do Médico , Emprego/tendências , Prática Institucional/tendências , Administração da Prática Médica/tendências , Mudança Social , Estados UnidosAssuntos
Ponte de Artéria Coronária/métodos , Parada Cardíaca Induzida/métodos , Veias/transplante , Ponte de Artéria Coronária/mortalidade , Circulação Coronária , Doença das Coronárias/mortalidade , Circulação Extracorpórea , Seguimentos , Parada Cardíaca Induzida/mortalidade , Humanos , Veia Safena , Técnicas de Sutura , Transplante AutólogoRESUMO
Cardiac valve replacement (single or double) was carried out in 138 consecutive patients with valvular heart disease over a six-year period at the Wadsworth Veterans Administration Hospital. All but a few had functional class III or IV disease. Hospital mortality was 3.6 percent.Normothermia, coronary perfusion and beating of the heart were maintained throughout the procedure. All patients were followed at least one year and the average follow-up was four and a half years. The late mortality was 27 percent. Seventy-five percent of the late deaths were due to progressive cardiac disease. The mortality due to prosthetic valve dysfunction was 4 percent. Subjective evaluation of survivors revealed that a high percentage remained symptomatic. Only 50 percent of the total group of patients were significantly improved. The high incidence of late mortality and poor long-term functional results are contrasted to the low operative risk and improved reliability of prosthetic valves. The rationale of delaying operation until functional class III limitation develops is questioned. Earlier operation is recommended before irreversible myocardial hypertrophy and fibrosis develop.