Consolidation of community hospitals

The largest component of U.S. health care expenditures is the cost of hospital care. Evidence seems to indicate that community hospital costs can be reduced through the consolidation of some, or even all, hospital services. Although no discernible set of relevant minimal costs for the hospital industry has been established as yet, significant economies of scale can be attributed to the consolidation process. In addition to potential economic benefits, medical benefits can also accure to the community as well when inefficient, low-volume services are combined to provide more attractive resources to highly qualified specialists. Many independent community hospitals operate autonomously, often to the detriment of community health needs and economy. Those hospitals that fail to take advantage of the opportunities offered by consolidation may not be keeping faith with the population they claim to serve.     

Relationship Between Heart Rate and Minute Ventilation, Tidal Volume and Respiratory Rate During Brief and Low Level Exercise

The correlation between heart rate (HR) and three respiratory parameters, minute ventilation (VE), tidal volume (Vt), and respiratory rate (RR), were studied. Four healthy subjects performed four exercise tests duration 30 seconds at 50, 100, 150, or 200 W), in random order. Cardio-respiratory parameters were recorded respiratory cycle by respiratory cycle. The results of these low level exercise tests showed that oxygen consumption (VO₂) was strongly correlated with VE (r = 0.91 ± 0.10; P < 0.01) (except in one test) and Vt (r =0.91 ± 0.07; P < 0.001) (except in one test). There was no significant correlation between VO² and RR. At exercise onset HR, VE, and Vt were modified in a matter of a few heart beats while RR varied depending on the subject and the level of exercise. During exercise average HR, VE, and Vt were significantly higher than at rest in most cases; but RR was not significantly changed by exercise. The correlations between HR and VE, Vt and RR varied from one individual to another. Nevertheless, the correlation coefficients were positive for VE and Vt, while they were negative for RR. Sensing respiratory rate thus appears to be insufficient for responsive pacing of exercise onset, but sensing respiratory volumes (Vt, VE) should give satisfactory results.     

Transcatheter Modulation of Atrioventricular Nodal Conduction by Radiofrequency Current

A new technique is presented in which atrioventricular (A V) nodal conduction properties can be altered in a controlled way through the application of radiofrequency current. In 13 patients with supraventricular arrhythmias (maximal heart rate 215/min) radiofrequency current was delivered to the A V node via a catheter. Nine patients had atrial fibrillation, three had A V nodal reentrant tachycardia, and one patient had accessory pathway mediated A V tachycardia. Radiofrequency current application in these patients increased AV nodal conduction time and antegrade A V nodal effective refractory period significantly. In three patients radiofrequency current had no effect, and the A V node was ablated with direct current shocks. During a mean follow-up period of 10 ± 3 months, all ten patients in whom radiofrequency current application had been successful were asymptomatic without antiarrhythmic medication. No complications were observed, neither during nor after the procedure.     

Oral Hygiene Instruction and Health Risk Assessment in Dental Practice

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.