Canadian Medicare: prognosis guarded.

Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making across-the-board cuts. (3) Replace blame with praise:give health care professionals and institutions credit for their contributions. (4) Learn from the successful programs and policies already in place across the country. (5) Foster horizontal and vertical integration of services. (6) Promote physician leadership by rewarding efforts to promote the efficient use of resources. (7) Monitor the effects of cutbacks: physician groups should cooperate with government in maintaining a national "report card" on services, costs and the health status of Canadians.     

Kawasaki disease: Canadian update.

Kawasaki disease, or mucocutaneous lymph node syndrome, is a multisystem disorder that affects young children. Between 1979 and 1982, 357 patients from 15 university pediatric centres in Canada were reported to have the disease. The diagnosis of Kawasaki disease is based on six clinical features, including fever, conjunctivitis, cracked lips, reddening and swelling of the hands and feet, rash and cervical lymphadenopathy. A scoring system is described that may help predict the development of cardiovascular complications. Coronary artery involvement can be recognized early by two-dimensional echocardiography. Anti-inflammatory therapy, principally with acetylsalicylic acid, is indicated in the acute phase and antithrombotic treatment in the subacute and chronic phases of the disease if coronary artery aneurysms have developed. Prolonged follow-up for patients with aneurysms is necessary. The length of follow-up for patients without aneurysms will depend on the results of studies on patients with Kawasaki disease after they reach adulthood.     

Radiation Sterilization of Prototype Military Foods: II. Cured Ham

Ten lots of diced cured ham, packed in cans, were inoculated with approximately 10(6)Clostridium botulinum spores per can. Each lot was seeded with a different strain (five type A and five type B strains). All cans were irradiated to various dose levels with Co(60). Evidence provided by swelling, toxicity, and recoverable C. botulinum with 6,350 cans demonstrated that: (i) 4.5 Mrad was more than adequate as a sterilization dose; (ii) the minimal experimental sterilizing dose (ESD) based on nonswollen nontoxic endpoints was 2.0 < ESD 相似文献   

Ethylene Oxide Gaseous Sterilization: I. Concentration and Temperature Effects

The relationships of reaction temperature and concentration of gaseous ethylene oxide to the time required for inactivation of air-dried Bacillus subtilis var. niger spores are more complex than previously reported. A plot of temperature vs. the logarithm of “thermochemical death time” (TCDT) resulted in a straight line between 18 and 57 C for systems of “high” ethylene oxide concentration. The TCDT values were independent of ethylene oxide concentrations above certain temperature-dependent limits. A given ethylene oxide concentration produced a TCDT curve identical in the upper temperature regions with that for higher concentrations. As the temperature was lowered beyond a critical point, this curve diverged from that for higher concentrations, as a straight line of lesser slope. Thus, a series of curves exists for a range of ethylene oxide concentrations. They are characterized by two segments, both logarithmic, intersecting at a critical temperature for each concentration. The intersecting point is at a temperature inversely related to the ethylene oxide gas concentration. The temperature quotient for the high temperature segments of all systems was 1.8. This value was characteristic for ethylene oxide concentrations of 440 and 880 mg/liter at temperatures above 40.6 and 33.4 C, respectively. Below these critical temperatures, the Q₁₀ values for the respective systems were 3.2 and 2.3.     

AIDS: medicolegal considerations for Canadian hospitals.

Given the increasing endemicity of human immunodeficiency virus (HIV), the agent implicated in the causation of acquired immune deficiency syndrome (AIDS), in numerous sizeable subgroups of society, hospitals can expect increasing exposure to the legal implications presented by patients with AIDS. This paper reviews the duty of care owed by hospitals, both directly, through contractual obligations, and indirectly, through the acts of their employees and private contractors, to patients with AIDS, other patients and the public. Owing to the absence of case law directly related to AIDS or to HIV antibody reactivity, inferences were drawn from precedents set with other infectious diseases. Recommendations are made in the areas of confidentiality, informed consent, standards of care and vicarious liability.     

The paramedic ambulance: a Canadian experience.

Prehospital critical care provided by specially trained ambulance attendants in New Westminster, BC during a 27-month period was studied. Although the most important benefit of the improved care was the prevention of sudden death in a large proportion of persons with crises due to coronary artery disease, the skills learned to provide basic life support are applicable to a wide variety of other disorders that can result in death before the patient reaches hospital.