Healthcare ethics: a patient-centered decision model.

A common financial model used in business decisions is the cost/benefit comparison. The costs of a proposed project are compared with the benefits, and if the benefits outweigh the costs, the project is accepted; if the costs exceed the benefits, the project is rejected. This model is applicable when tangible costs and benefits can be reasonably measured in monetary units. However, it is difficult to consider intangible factors in this model because intangible factors cannot be readily quantified in money. While some might argue that the financial model should not apply to healthcare decisions, the fact is that costs do enter into the picture. People may decide to forego needed healthcare because they cannot afford it. Healthcare providers may make choices based in part on the costs of diagnosis and treatment, rather than solely on medical information and what is best for the patient. Should financial issues enter into healthcare decisions--decisions about human health and well being? If so, how should the costs and benefits be measured and evaluated? What are some ethical issues and dilemmas involved in such decisions. This paper addresses ethical dilemmas and financial issues in healthcare. A healthcare decision model, which considers medical information, financial information, as well as ethical and other intangible factors, is proposed.

Endometriosis perineal: experiencia clínica en 8 pacientes / Perineal endometriosis: clinical experience in 8 patients

We report our experience with 8 women with perineal endometriosis managed in a period of 20 years. All were multiparae women presenting with cyclical perineal painful masses related to menstrual periods. Symptomatology started 6 months to 16 years after last delivery. Three patients had partial involvement of the anal sphincter. The endometriosis area was locally resected in all women. There were no complications and no problems with anal continence. Two patients had local recurrences. The different lapses between delivery and symptomatic presentation can be related to the amount of endometrial basal cells omplantes in the episiotomy. The treatment is always surgical. All endometrial implants must be resected and sphincteric structures must be repaired posteriorly

Importancia del material de sutura en la cirugía por incontinencia urinaria de esfuerzo genuina / Importance of the suture material in the surgery of genuine stress urinary incontinence

Entre julio de 1978 y noviembre de 1985 se realizaron 73 operaciones de Marshall-Marchetti-Frantz para la corrección quirúrgica de la incontinencia urinaria de esfuerzo genuina. En la vesicouretropexia se utilizó material de sutura irreabsorbible en 30 casos (41%) y material de sutura reabsorbible en 43 casos (59%). En el grupo de pacientes intervenidas con material de sutura irreabsorbible no se observó recidiva a dos años de seguimiento, mientras en el grupo de pacientes intervenidas con material de sutura reabsorbible la recidiva fue de 5% al mes, 14% a los seis meses, 22% al año y 44% a los dos años. Se encontró diferencia estadísticamente significativa entre ambos grupos al año (p = 0,031) y a los dos años (p = 0,012) de seguimiento. Las complicaciones postoperatorias fueron similares en ambos grupos, siendo la infección urinaria la más frecuente. Se concluye que el material de sutura irreabsorbible ofrece indudables ventajas respecto al material de sutura reabsorbible en la corrección quirúrgica por vía abdominal de la incontinencia urinaria de esfuerzo genuina

Receptores citoplasmaticos de estrogeno y progesterona en miometrio normal / Estrogen citoplasmic receptors and progesterone in normal miometrium

Se determina la concentración de receptores citoplasmáticos de estrógeno en miometrio normal del cuerpo y del cuello uterino en 15 mujeres, y la de receptores de progesterona en siete. La determinación de receptores se efectúa mediante radioinmunoensayo de acuerdo con la técnica recomendada por Bradford. Se demuestra que la concentración de recptores de estrógeno y de progesterona es significativamente menor en el cuello que en el cuerpo uterino (p = 0,03 y 0,016, respectivamente). Se observa que las concentraciones mayores de receptores de estrógeno corresponden con las menores de receptores de progesterona. En ocho pacientes se determinó estradiol plasmático: no se pudo establecer correlación con la concentración de receptores de estrógeno

[Prognostic and therapeutic considerations in intraventricular blocks in acute myocardial infarct]. / Considerazioni prognostiche e terapeutiche sui blocchi intraventricolari in corso d'infarto miocardico acuto.

Intraventricular blocks were observed in 26% of 122 cases of acute myocardial infarction in the Medical Division "S. Angelo Hospital", Messina. Mortality in hospital, which was higher in cases with RBBB + LBBB, LBBB + BAV, above all was caused by myocardial insufficiency. It's Authors' opinion that temporary electrical stimulation is useless in cases with myocardial insufficiency and useful in cases with hemodynamic compensation or with slight decompensation.

The January 1977 avian cholera epornitic in northwest California.

A total of 844 birds were observed dead at three sites in Humboldt County and an estimated 6750 birds died at three sites in Del Norte County, California. Coots were the primary species affected. The isolation of Pasteurella multocida from a snowy egret (Egretta thula) is the first reported case of avian cholera in this bird. There was evidence for a distinct sequence in the bird species dying at one site; American coots (Fulica americana) appeared to be the first species to die.

The 1975-76 avian cholera outbreaks in Humboldt County, California.

The 1975-76 avian cholera outbreaks were observed from 25 November 1975 to 17 February 1976 at three sites in Humboldt County, California. This is the first known occurrence of avian cholera on one of the sites (City of Arcata Oxidation Ponds).

[Prognostic and therapeutic considerations on intraventricular block during a course of acute myocardial infarct]. / Considerazioni prognostiche e terapeutiche sui blocchi intraventricolari in corso d'infarto miocardico acuto.

Intraventricular block was observed in 10% of a series of 250 cases of acute myocardial infarct observed at the Medical Division, S. Angelo Hospital, Messina. Mortality was not strictly related to the presence of block, though this was a negative factor in prognosis, but essentially to the degree of myocardial efficiency. It is felt that temporary pacemakers should only be fitted where myocardial insufficiency is slight, though this step can also be taken in more serious cases until further clinical evidence finally establishes the question of treatment.

[5 years of activity in a small coronary unit. Experiences and considerations]. / 5 anni di attività in una piccola unità coronarica. Esperienze e considerazioni.

Five years' experience at the coronary unit of the S. Angelo Hospital medical division is described. Practical considerations are offered with regard to the management of arrhythmia with drugs, electroconversion and electrostimulation.