home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-06 | 349.4 KB |
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Win98
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| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000520| 00 00 00 01 11 66 05 00 | 65 0f 00 00 00 00 00 00 |.....f..|e.......|
|00000530| 00 00 76 75 05 00 00 00 | 00 00 24 55 6e 69 71 75 |..vu....|..$Uniqu|
|00000540| 65 5f 49 44 7b 59 52 42 | 31 33 30 30 30 7d 0d 0a |e_ID{YRB|13000}..|
|00000550| 24 54 69 74 6c 65 7b 50 | 72 65 76 65 6e 74 61 62 |$Title{P|reventab|
|00000560| 6c 65 20 44 65 61 74 68 | 73 3a 20 20 57 68 6f 2c |le Death|s: Who,|
|00000570| 20 48 6f 77 20 4f 66 74 | 65 6e 2c 20 61 6e 64 20 | How Oft|en, and |
|00000580| 57 68 79 3f 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 44 |Why?}..$|Author{D|
|00000590| 75 62 6f 69 73 2c 20 52 | 57 0d 0a 42 72 6f 6f 6b |ubois, R|W..Brook|
|000005a0| 2c 20 52 48 7d 0d 0a 24 | 41 66 66 69 6c 69 61 74 |, RH}..$|Affiliat|
|000005b0| 69 6f 6e 7b 52 41 4e 44 | 20 43 6f 72 70 2c 20 4c |ion{RAND| Corp, L|
|000005c0| 6f 73 20 41 6e 67 65 6c | 65 73 3b 20 55 6e 69 76 |os Angel|es; Univ|
|000005d0| 20 6f 66 20 43 61 6c 69 | 66 6f 72 6e 69 61 2c 20 | of Cali|fornia, |
|000005e0| 4c 6f 73 20 41 6e 67 65 | 6c 65 73 7d 0d 0a 24 4a |Los Ange|les}..$J|
|000005f0| 6f 75 72 6e 61 6c 7b 41 | 6e 6e 20 49 6e 74 65 72 |ournal{A|nn Inter|
|00000600| 6e 20 4d 65 64 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |n Med}..|$Volume{|
|00000610| 31 30 39 7d 0d 0a 24 50 | 61 67 65 7b 35 38 32 2d |109}..$P|age{582-|
|00000620| 35 38 39 7d 0d 0a 24 44 | 61 74 65 7b 4f 63 74 20 |589}..$D|ate{Oct |
|00000630| 31 2c 20 31 39 38 38 7d | 0d 0a 24 59 42 56 6f 6c |1, 1988}|..$YBVol|
|00000640| 7b 31 39 39 30 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1990 Ye|ar Book |
|00000650| 6f 66 20 41 6e 65 73 74 | 68 65 73 69 61 7d 0d 0a |of Anest|hesia}..|
|00000660| 24 43 68 61 70 74 65 72 | 7b 31 2d 31 7d 0d 0a 24 |$Chapter|{1-1}..$|
|00000670| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 4d 69 |YBEditor|{Drs. Mi|
|00000680| 6c 6c 65 72 2c 20 4b 69 | 72 62 79 2c 20 4f 73 74 |ller, Ki|rby, Ost|
|00000690| 68 65 69 6d 65 72 2c 20 | 52 6f 69 7a 65 6e 2c 20 |heimer, |Roizen, |
|000006a0| 61 6e 64 20 53 74 6f 65 | 6c 74 69 6e 67 7d 0d 0a |and Stoe|lting}..|
|000006b0| 24 54 61 62 6c 65 7b 7d | 0d 0a 24 43 6f 6d 6d 65 |$Table{}|..$Comme|
|000006c0| 6e 74 61 74 6f 72 7b 7d | 0d 0a 0d 0a 43 6f 70 79 |ntator{}|....Copy|
|000006d0| 72 69 67 68 74 20 28 63 | 29 20 59 65 61 72 62 6f |right (c|) Yearbo|
|000006e0| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|000006f0| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 39 |shers, I|nc., 199|
|00000700| 30 0d 0a 0d 0a 31 39 39 | 30 20 59 65 61 72 20 42 |0....199|0 Year B|
|00000710| 6f 6f 6b 20 6f 66 20 41 | 6e 65 73 74 68 65 73 69 |ook of A|nesthesi|
|00000720| 61 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |a (R)...|.Chapter|
|00000730| 20 31 2d 2d 4f 75 74 63 | 6f 6d 65 73 20 6f 66 20 | 1--Outc|omes of |
|00000740| 4d 65 64 69 63 61 6c 20 | 43 61 72 65 0d 0a 0d 0a |Medical |Care....|
|00000750| 48 6f 73 70 69 74 61 6c | 73 20 61 6e 64 20 50 6f |Hospital|s and Po|
|00000760| 70 75 6c 61 74 69 6f 6e | 73 20 69 6e 20 47 65 6e |pulation|s in Gen|
|00000770| 65 72 61 6c 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |eral....|--------|
|00000780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007c0| 2d 2d 2d 2d 2d 2d 0d 0a | 50 72 65 76 65 6e 74 61 |------..|Preventa|
|000007d0| 62 6c 65 20 44 65 61 74 | 68 73 3a 20 20 57 68 6f |ble Deat|hs: Who|
|000007e0| 2c 20 48 6f 77 20 4f 66 | 74 65 6e 2c 20 61 6e 64 |, How Of|ten, and|
|000007f0| 20 57 68 79 3f 0d 0a 0d | 0a 44 75 62 6f 69 73 20 | Why?...|.Dubois |
|00000800| 52 57 2c 20 42 72 6f 6f | 6b 20 52 48 0d 0a 28 52 |RW, Broo|k RH..(R|
|00000810| 41 4e 44 20 43 6f 72 70 | 2c 20 4c 6f 73 20 41 6e |AND Corp|, Los An|
|00000820| 67 65 6c 65 73 3b 20 55 | 6e 69 76 20 6f 66 20 43 |geles; U|niv of C|
|00000830| 61 6c 69 66 6f 72 6e 69 | 61 2c 20 4c 6f 73 20 41 |aliforni|a, Los A|
|00000840| 6e 67 65 6c 65 73 29 0d | 0a 41 6e 6e 20 49 6e 74 |ngeles).|.Ann Int|
|00000850| 65 72 6e 20 4d 65 64 20 | 31 30 39 3a 35 38 32 2d |ern Med |109:582-|
|00000860| 35 38 39 2c 20 4f 63 74 | 20 31 2c 20 31 39 38 38 |589, Oct| 1, 1988|
|00000870| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008c0| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|000008d0| 20 20 20 20 20 50 6f 6c | 69 63 79 6d 61 6b 65 72 | Pol|icymaker|
|000008e0| 73 20 61 6e 64 20 72 65 | 73 65 61 72 63 68 65 72 |s and re|searcher|
|000008f0| 73 20 68 61 76 65 20 73 | 75 67 67 65 73 74 65 64 |s have s|uggested|
|00000900| 20 74 68 61 74 20 64 65 | 61 74 68 20 72 61 74 65 | that de|ath rate|
|00000910| 73 20 6d 61 79 20 69 6e | 20 70 61 72 74 0d 0a 72 |s may in| part..r|
|00000920| 65 66 6c 65 63 74 20 74 | 68 65 20 71 75 61 6c 69 |eflect t|he quali|
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|00000950| 6c 2e 20 20 49 74 20 77 | 6f 75 6c 64 20 74 68 65 |l. It w|ould the|
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|00000970| 6f 6d 65 20 68 6f 73 70 | 69 74 61 6c 20 64 65 61 |ome hosp|ital dea|
|00000980| 74 68 73 20 6d 75 73 74 | 20 62 65 20 70 72 65 76 |ths must| be prev|
|00000990| 65 6e 74 61 62 6c 65 2e | 20 20 41 20 6e 65 77 20 |entable.| A new |
|000009a0| 6d 65 74 68 6f 64 20 6f | 66 20 69 6e 76 65 73 74 |method o|f invest|
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|000009c0| 73 75 65 20 77 61 73 20 | 64 65 76 65 6c 6f 70 65 |sue was |develope|
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|000009e0| 72 64 73 20 6f 66 20 33 | 37 37 20 70 61 74 69 65 |rds of 3|77 patie|
|000009f0| 6e 74 73 20 77 69 74 68 | 20 31 20 6f 66 20 33 20 |nts with| 1 of 3 |
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|00000a10| 6f 6e 6c 79 20 61 73 73 | 6f 63 69 61 74 65 64 20 |only ass|ociated |
|00000a20| 77 69 74 68 20 68 69 67 | 68 20 64 65 61 74 68 20 |with hig|h death |
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|00000a50| 37 37 0d 0a 70 61 74 69 | 65 6e 74 73 2c 20 31 30 |77..pati|ents, 10|
|00000a60| 35 20 68 61 64 20 61 20 | 63 65 72 65 62 72 6f 76 |5 had a |cerebrov|
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|00000a80| 2c 20 31 33 32 20 68 61 | 64 20 70 6e 65 75 6d 6f |, 132 ha|d pneumo|
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|00000b30| 2e 0d 0a 41 74 20 6c 65 | 61 73 74 20 33 20 65 78 |...At le|ast 3 ex|
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|00000b50| 72 65 76 69 65 77 65 64 | 20 74 68 65 20 31 38 32 |reviewed| the 182|
|00000b60| 20 73 75 6d 6d 61 72 69 | 65 73 20 61 6e 64 20 69 | summari|es and i|
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|00000bb0| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 70 61 74 69 |... |The pati|
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|00000bd0| 66 66 65 72 65 64 20 73 | 69 67 6e 69 66 69 63 61 |ffered s|ignifica|
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|00000c00| 72 67 65 64 20 61 6c 69 | 76 65 2e 20 20 54 68 6f |rged ali|ve. Tho|
|00000c10| 73 65 20 77 68 6f 20 64 | 69 65 64 20 77 65 72 65 |se who d|ied were|
|00000c20| 20 67 65 6e 65 72 61 6c | 6c 79 20 6f 6c 64 65 72 | general|ly older|
|00000c30| 20 28 37 37 20 79 65 61 | 72 73 20 76 73 2e 20 37 | (77 yea|rs vs. 7|
|00000c40| 33 0d 0a 79 65 61 72 73 | 29 2c 20 77 65 72 65 20 |3..years|), were |
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|00000c70| 75 72 73 69 6e 67 20 68 | 6f 6d 65 20 62 65 66 6f |ursing h|ome befo|
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|00000cf0| 20 20 20 20 20 55 73 69 | 6e 67 20 61 20 6d 61 6a | Usi|ng a maj|
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|00000d10| 65 72 69 6f 6e 2c 20 69 | 2e 65 2e 2c 20 61 74 20 |erion, i|.e., at |
|00000d20| 6c 65 61 73 74 20 32 20 | 6f 66 20 33 20 65 78 70 |least 2 |of 3 exp|
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|00000d40| 61 67 72 65 65 64 2c 20 | 32 37 25 20 6f 66 20 74 |agreed, |27% of t|
|00000d50| 68 65 20 64 65 61 74 68 | 73 20 70 72 6f 62 61 62 |he death|s probab|
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|00002970| 77 65 72 65 20 6c 69 6d | 69 74 65 64 20 69 6e 20 |were lim|ited in |
|00002980| 74 68 65 69 72 20 6d 65 | 74 68 6f 64 73 20 6f 72 |their me|thods or|
|00002990| 20 64 61 74 61 62 61 73 | 65 2c 20 61 0d 0a 74 68 | databas|e, a..th|
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|000029b0| 77 61 73 20 6d 61 64 65 | 20 6f 66 20 74 68 65 20 |was made| of the |
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|000029d0| 49 6e 64 69 76 69 64 75 | 61 6c 20 70 61 74 69 65 |Individu|al patie|
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|00002a20| 4e 65 77 20 59 6f 72 6b | 20 53 74 61 74 65 2e 20 |New York| State. |
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|00002ab0| 73 3a 0d 0a 63 6f 72 6f | 6e 61 72 79 20 61 72 74 |s:..coro|nary art|
|00002ac0| 65 72 79 20 62 79 70 61 | 73 73 20 73 75 72 67 65 |ery bypa|ss surge|
|00002ad0| 72 79 2c 20 72 65 73 65 | 63 74 69 6f 6e 20 6f 66 |ry, rese|ction of|
|00002ae0| 20 61 62 64 6f 6d 69 6e | 61 6c 20 61 6f 72 74 69 | abdomin|al aorti|
|00002af0| 63 20 61 6e 65 75 72 79 | 73 6d 73 2c 0d 0a 70 61 |c aneury|sms,..pa|
|00002b00| 72 74 69 61 6c 20 67 61 | 73 74 72 65 63 74 6f 6d |rtial ga|strectom|
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|00002b20| 64 20 74 6f 74 61 6c 20 | 63 68 6f 6c 65 63 79 73 |d total |cholecys|
|00002b30| 74 65 63 74 6f 6d 79 2e | 0d 0a 20 20 20 20 20 46 |tectomy.|.. F|
|00002b40| 6f 75 72 20 70 72 6f 63 | 65 64 75 72 65 73 20 68 |our proc|edures h|
|00002b50| 61 64 20 61 20 6d 6f 72 | 65 20 73 69 67 6e 69 66 |ad a mor|e signif|
|00002b60| 69 63 61 6e 74 20 70 68 | 79 73 69 63 69 61 6e 2d |icant ph|ysician-|
|00002b70| 76 6f 6c 75 6d 65 20 65 | 66 66 65 63 74 3b 20 77 |volume e|ffect; w|
|00002b80| 69 74 68 0d 0a 63 68 6f | 6c 65 63 79 73 74 65 63 |ith..cho|lecystec|
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|00002c40| 66 6f 72 20 70 61 74 69 | 65 6e 74 73 20 6f 66 20 |for pati|ents of |
|00002c50| 6c 6f 77 2d 76 6f 6c 75 | 6d 65 20 70 68 79 73 69 |low-volu|me physi|
|00002c60| 63 69 61 6e 73 20 77 61 | 73 20 34 2e 39 32 25 2e |cians wa|s 4.92%.|
|00002c70| 0d 0a 49 6e 20 72 65 73 | 65 63 74 69 6f 6e 20 6f |..In res|ection o|
|00002c80| 66 20 61 62 64 6f 6d 69 | 6e 61 6c 20 61 6f 72 74 |f abdomi|nal aort|
|00002c90| 69 63 20 61 6e 65 75 72 | 79 73 6d 73 2c 20 70 61 |ic aneur|ysms, pa|
|00002ca0| 74 69 65 6e 74 73 20 6f | 66 20 6c 6f 77 2d 20 61 |tients o|f low- a|
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|00002d50| 77 61 73 0d 0a 31 33 2e | 36 30 25 20 66 6f 72 20 |was..13.|60% for |
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|00002d90| 20 20 49 6e 20 61 73 73 | 6f 63 69 61 74 69 6f 6e | In ass|ociation|
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|00002e70| 68 6f 6c 65 63 79 73 74 | 65 63 74 6f 6d 79 2c 0d |holecyst|ectomy,.|
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|00002ef0| 0a 20 20 20 20 20 41 20 | 6e 75 6d 62 65 72 20 6f |. A |number o|
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|000043f0| 72 65 0d 0a 0d 0a 52 65 | 6c 6d 61 6e 20 41 53 0d |re....Re|lman AS.|
|00004400| 0a 28 29 0d 0a 4e 20 45 | 6e 67 6c 20 4a 20 4d 65 |.()..N E|ngl J Me|
|00004410| 64 20 33 31 39 3a 31 32 | 32 30 2d 31 32 32 32 2c |d 319:12|20-1222,|
|00004420| 20 4e 6f 76 20 33 2c 20 | 31 39 38 38 0d 0a 2d 2d | Nov 3, |1988..--|
|00004430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004450| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004460| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004470| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00004480| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00004490| 20 54 68 65 20 55 6e 69 | 74 65 64 20 53 74 61 74 | The Uni|ted Stat|
|000044a0| 65 73 20 6d 65 64 69 63 | 61 6c 20 63 61 72 65 20 |es medic|al care |
|000044b0| 73 79 73 74 65 6d 20 68 | 61 73 20 75 6e 64 65 72 |system h|as under|
|000044c0| 67 6f 6e 65 20 32 20 72 | 65 76 6f 6c 75 74 69 6f |gone 2 r|evolutio|
|000044d0| 6e 73 20 73 69 6e 63 65 | 0d 0a 57 6f 72 6c 64 20 |ns since|..World |
|000044e0| 57 61 72 20 49 49 2c 20 | 74 68 65 20 66 69 72 73 |War II, |the firs|
|000044f0| 74 20 75 73 68 65 72 69 | 6e 67 20 69 6e 20 61 6e |t usheri|ng in an|
|00004500| 20 65 72 61 20 6f 66 20 | 65 78 70 61 6e 73 69 6f | era of |expansio|
|00004510| 6e 2c 20 74 68 65 20 73 | 65 63 6f 6e 64 20 61 6e |n, the s|econd an|
|00004520| 20 65 72 61 20 6f 66 0d | 0a 63 6f 73 74 20 63 6f | era of.|.cost co|
|00004530| 6e 74 61 69 6e 6d 65 6e | 74 2e 20 20 48 65 61 6c |ntainmen|t. Heal|
|00004540| 74 68 20 63 61 72 65 20 | 69 73 20 6e 6f 77 20 6f |th care |is now o|
|00004550| 6e 20 74 68 65 20 76 65 | 72 67 65 20 6f 66 20 61 |n the ve|rge of a|
|00004560| 20 74 68 69 72 64 20 72 | 65 76 6f 6c 75 74 69 6f | third r|evolutio|
|00004570| 6e 2e 0d 0a 20 20 20 20 | 20 54 68 65 20 66 72 75 |n... | The fru|
|00004580| 73 74 72 61 74 69 6f 6e | 20 6f 66 20 74 68 69 72 |stration| of thir|
|00004590| 64 2d 70 61 72 74 79 20 | 70 61 79 65 72 73 20 69 |d-party |payers i|
|000045a0| 6e 20 74 68 65 69 72 20 | 65 66 66 6f 72 74 73 20 |n their |efforts |
|000045b0| 74 6f 20 63 6f 6e 74 72 | 6f 6c 20 63 6f 73 74 73 |to contr|ol costs|
|000045c0| 0d 0a 69 73 20 63 6f 6d | 70 6f 75 6e 64 65 64 20 |..is com|pounded |
|000045d0| 62 79 20 67 72 6f 77 69 | 6e 67 20 63 6f 6e 63 65 |by growi|ng conce|
|000045e0| 72 6e 20 61 62 6f 75 74 | 20 74 68 65 20 75 6e 6b |rn about| the unk|
|000045f0| 6e 6f 77 6e 20 71 75 61 | 6c 69 74 79 20 61 6e 64 |nown qua|lity and|
|00004600| 20 6f 75 74 63 6f 6d 65 | 73 20 6f 66 0d 0a 6d 65 | outcome|s of..me|
|00004610| 64 69 63 61 6c 20 73 65 | 72 76 69 63 65 73 2e 20 |dical se|rvices. |
|00004620| 20 54 68 65 20 64 69 73 | 63 6f 76 65 72 79 20 6f | The dis|covery o|
|00004630| 66 20 6c 61 72 67 65 20 | 67 65 6f 67 72 61 70 68 |f large |geograph|
|00004640| 69 63 20 76 61 72 69 61 | 74 69 6f 6e 73 20 69 6e |ic varia|tions in|
|00004650| 20 74 68 65 0d 0a 69 6e | 63 69 64 65 6e 63 65 20 | the..in|cidence |
|00004660| 6f 66 20 73 6f 6d 65 20 | 73 65 72 76 69 63 65 73 |of some |services|
|00004670| 20 75 6e 61 63 63 6f 6d | 70 61 6e 69 65 64 20 62 | unaccom|panied b|
|00004680| 79 20 64 69 73 63 65 72 | 6e 69 62 6c 65 20 64 69 |y discer|nible di|
|00004690| 66 66 65 72 65 6e 63 65 | 73 20 69 6e 20 6f 75 74 |fference|s in out|
|000046a0| 63 6f 6d 65 0d 0a 68 61 | 73 20 6c 65 64 20 74 68 |come..ha|s led th|
|000046b0| 69 72 64 2d 70 61 72 74 | 79 20 70 61 79 65 72 73 |ird-part|y payers|
|000046c0| 20 74 6f 20 73 75 73 70 | 65 63 74 20 74 68 61 74 | to susp|ect that|
|000046d0| 20 74 68 65 20 6d 65 64 | 69 63 61 6c 20 70 72 6f | the med|ical pro|
|000046e0| 66 65 73 73 69 6f 6e 20 | 73 74 69 6c 6c 20 68 61 |fession |still ha|
|000046f0| 73 0d 0a 6d 75 63 68 20 | 74 6f 20 6c 65 61 72 6e |s..much |to learn|
|00004700| 20 61 62 6f 75 74 20 74 | 68 65 20 69 6e 64 69 63 | about t|he indic|
|00004710| 61 74 69 6f 6e 73 20 66 | 6f 72 20 61 20 67 69 76 |ations f|or a giv|
|00004720| 65 6e 20 63 6f 75 72 73 | 65 20 6f 66 20 61 63 74 |en cours|e of act|
|00004730| 69 6f 6e 20 6f 72 20 74 | 68 65 0d 0a 72 65 61 73 |ion or t|he..reas|
|00004740| 6f 6e 73 20 66 6f 72 20 | 63 68 6f 6f 73 69 6e 67 |ons for |choosing|
|00004750| 20 31 20 70 72 6f 63 65 | 64 75 72 65 20 6f 76 65 | 1 proce|dure ove|
|00004760| 72 20 61 6e 6f 74 68 65 | 72 2e 20 20 54 6f 20 63 |r anothe|r. To c|
|00004770| 6f 6e 74 72 6f 6c 20 63 | 6f 73 74 73 20 77 69 74 |ontrol c|osts wit|
|00004780| 68 6f 75 74 0d 0a 61 72 | 62 69 74 72 61 72 69 6c |hout..ar|bitraril|
|00004790| 79 20 72 65 64 75 63 69 | 6e 67 20 61 63 63 65 73 |y reduci|ng acces|
|000047a0| 73 20 74 6f 20 6f 72 20 | 71 75 61 6c 69 74 79 20 |s to or |quality |
|000047b0| 6f 66 20 63 61 72 65 2c | 20 74 68 65 20 6d 65 64 |of care,| the med|
|000047c0| 69 63 61 6c 20 70 72 6f | 66 65 73 73 69 6f 6e 20 |ical pro|fession |
|000047d0| 77 69 6c 6c 0d 0a 68 61 | 76 65 20 74 6f 20 6b 6e |will..ha|ve to kn|
|000047e0| 6f 77 20 6d 6f 72 65 20 | 61 62 6f 75 74 20 74 68 |ow more |about th|
|000047f0| 65 20 73 61 66 65 74 79 | 2c 20 61 70 70 72 6f 70 |e safety|, approp|
|00004800| 72 69 61 74 65 6e 65 73 | 73 2c 20 61 6e 64 20 65 |riatenes|s, and e|
|00004810| 66 66 69 63 61 63 79 20 | 6f 66 20 64 72 75 67 73 |fficacy |of drugs|
|00004820| 2c 0d 0a 74 65 73 74 73 | 2c 20 61 6e 64 20 70 72 |,..tests|, and pr|
|00004830| 6f 63 65 64 75 72 65 73 | 2e 0d 0a 20 20 20 20 20 |ocedures|... |
|00004840| 41 20 73 74 72 6f 6e 67 | 20 6e 65 77 20 63 6f 6e |A strong| new con|
|00004850| 73 65 6e 73 75 73 20 6f | 6e 20 74 68 65 20 6e 65 |sensus o|n the ne|
|00004860| 65 64 20 66 6f 72 20 61 | 73 73 65 73 73 6d 65 6e |ed for a|ssessmen|
|00004870| 74 20 61 6e 64 20 61 63 | 63 6f 75 6e 74 61 62 69 |t and ac|countabi|
|00004880| 6c 69 74 79 0d 0a 73 65 | 65 6d 73 20 74 6f 20 62 |lity..se|ems to b|
|00004890| 65 20 62 75 69 6c 64 69 | 6e 67 2c 20 75 73 68 65 |e buildi|ng, ushe|
|000048a0| 72 69 6e 67 20 69 6e 20 | 61 20 6e 65 77 20 65 72 |ring in |a new er|
|000048b0| 61 2e 20 20 41 20 6e 65 | 77 20 6e 61 74 69 6f 6e |a. A ne|w nation|
|000048c0| 61 6c 20 68 65 61 6c 74 | 68 20 63 61 72 65 0d 0a |al healt|h care..|
|000048d0| 69 6e 69 74 69 61 74 69 | 76 65 20 69 73 20 6e 65 |initiati|ve is ne|
|000048e0| 65 64 65 64 2e 20 20 44 | 72 2e 20 50 61 75 6c 20 |eded. D|r. Paul |
|000048f0| 45 6c 77 6f 6f 64 20 68 | 61 73 20 63 61 6c 6c 65 |Elwood h|as calle|
|00004900| 64 20 66 6f 72 20 61 20 | 6d 61 6a 6f 72 20 6e 61 |d for a |major na|
|00004910| 74 69 6f 6e 61 6c 20 70 | 72 6f 67 72 61 6d 0d 0a |tional p|rogram..|
|00004920| 6f 66 20 22 6f 75 74 63 | 6f 6d 65 73 20 6d 61 6e |of "outc|omes man|
|00004930| 61 67 65 6d 65 6e 74 2c | 22 20 61 20 73 79 73 74 |agement,|" a syst|
|00004940| 65 6d 20 6c 69 6e 6b 69 | 6e 67 20 6d 65 64 69 63 |em linki|ng medic|
|00004950| 61 6c 20 6d 61 6e 61 67 | 65 6d 65 6e 74 20 64 65 |al manag|ement de|
|00004960| 63 69 73 69 6f 6e 73 20 | 74 6f 0d 0a 6e 65 77 2c |cisions |to..new,|
|00004970| 20 73 79 73 74 65 6d 61 | 74 69 63 20 64 61 74 61 | systema|tic data|
|00004980| 20 6f 6e 20 6f 75 74 63 | 6f 6d 65 73 2e 20 20 54 | on outc|omes. T|
|00004990| 68 65 20 66 65 64 65 72 | 61 6c 20 67 6f 76 65 72 |he feder|al gover|
|000049a0| 6e 6d 65 6e 74 20 68 61 | 73 20 61 6e 20 69 6e 63 |nment ha|s an inc|
|000049b0| 72 65 61 73 69 6e 67 0d | 0a 69 6e 74 65 72 65 73 |reasing.|.interes|
|000049c0| 74 20 69 6e 20 74 68 65 | 20 61 73 73 65 73 73 6d |t in the| assessm|
|000049d0| 65 6e 74 20 6f 66 20 6d | 65 64 69 63 61 6c 20 65 |ent of m|edical e|
|000049e0| 66 66 65 63 74 69 76 65 | 6e 65 73 73 20 61 6e 64 |ffective|ness and|
|000049f0| 20 69 6d 70 72 6f 76 65 | 6d 65 6e 74 20 6f 66 0d | improve|ment of.|
|00004a00| 0a 63 6c 69 6e 69 63 61 | 6c 20 70 72 61 63 74 69 |.clinica|l practi|
|00004a10| 63 65 73 20 61 6e 64 20 | 70 6c 61 6e 73 20 74 6f |ces and |plans to|
|00004a20| 20 75 73 65 20 74 68 65 | 20 4d 65 64 69 63 61 72 | use the| Medicar|
|00004a30| 65 20 64 61 74 61 62 61 | 73 65 20 66 6f 72 20 74 |e databa|se for t|
|00004a40| 68 69 73 20 70 75 72 70 | 6f 73 65 2e 0d 0a 20 20 |his purp|ose... |
|00004a50| 20 20 20 41 6e 20 65 72 | 61 20 6f 66 20 61 73 73 | An er|a of ass|
|00004a60| 65 73 73 6d 65 6e 74 20 | 61 6e 64 20 61 63 63 6f |essment |and acco|
|00004a70| 75 6e 74 61 62 69 6c 69 | 74 79 20 69 73 20 64 61 |untabili|ty is da|
|00004a80| 77 6e 69 6e 67 2e 20 20 | 54 68 69 73 20 69 73 20 |wning. |This is |
|00004a90| 74 68 65 20 74 68 69 72 | 64 0d 0a 61 6e 64 20 6c |the thir|d..and l|
|00004aa0| 61 74 65 73 74 20 70 68 | 61 73 65 20 69 6e 20 74 |atest ph|ase in t|
|00004ab0| 68 65 20 6d 65 64 69 63 | 61 6c 20 70 72 6f 66 65 |he medic|al profe|
|00004ac0| 73 73 69 6f 6e 27 73 20 | 65 66 66 6f 72 74 73 20 |ssion's |efforts |
|00004ad0| 74 6f 20 61 63 68 69 65 | 76 65 20 61 6e 20 65 71 |to achie|ve an eq|
|00004ae0| 75 69 74 61 62 6c 65 0d | 0a 68 65 61 6c 74 68 20 |uitable.|.health |
|00004af0| 63 61 72 65 20 73 79 73 | 74 65 6d 20 6f 66 20 73 |care sys|tem of s|
|00004b00| 61 74 69 73 66 61 63 74 | 6f 72 79 20 71 75 61 6c |atisfact|ory qual|
|00004b10| 69 74 79 20 61 74 20 61 | 6e 20 61 66 66 6f 72 64 |ity at a|n afford|
|00004b20| 61 62 6c 65 20 70 72 69 | 63 65 2e 0d 0a 0d 0a 50 |able pri|ce.....P|
|00004b30| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00004b40| 20 20 20 20 54 68 69 73 | 20 61 72 74 69 63 6c 65 | This| article|
|00004b50| 20 28 41 62 73 74 72 61 | 63 74 20 31 2d 34 29 20 | (Abstra|ct 1-4) |
|00004b60| 61 6e 64 20 74 68 65 20 | 65 64 69 74 6f 72 69 61 |and the |editoria|
|00004b70| 6c 20 28 41 62 73 74 72 | 61 63 74 20 31 2d 35 29 |l (Abstr|act 1-5)|
|00004b80| 20 61 72 65 0d 0a 69 6d | 70 6f 72 74 61 6e 74 2e | are..im|portant.|
|00004b90| 20 20 54 68 65 20 61 72 | 74 69 63 6c 65 20 69 73 | The ar|ticle is|
|00004ba0| 20 77 72 69 74 74 65 6e | 20 62 79 20 74 68 65 20 | written| by the |
|00004bb0| 70 65 72 73 6f 6e 20 77 | 68 6f 20 63 6f 6e 74 72 |person w|ho contr|
|00004bc0| 6f 6c 73 20 33 30 25 20 | 6f 66 20 61 6c 6c 0d 0a |ols 30% |of all..|
|00004bd0| 64 6f 6c 6c 61 72 73 20 | 73 70 65 6e 74 20 6f 6e |dollars |spent on|
|00004be0| 20 6d 65 64 69 63 61 6c | 20 63 61 72 65 2e 20 20 | medical| care. |
|00004bf0| 44 72 2e 20 57 69 6c 6c | 69 61 6d 20 4c 2e 20 52 |Dr. Will|iam L. R|
|00004c00| 6f 70 65 72 2c 20 61 20 | 70 65 64 69 61 74 72 69 |oper, a |pediatri|
|00004c10| 63 69 61 6e 2c 20 49 0d | 0a 62 65 6c 69 65 76 65 |cian, I.|.believe|
|00004c20| 2c 20 69 73 20 68 65 61 | 64 20 6f 66 20 74 68 65 |, is hea|d of the|
|00004c30| 20 48 65 61 6c 74 68 20 | 43 61 72 65 20 46 69 6e | Health |Care Fin|
|00004c40| 61 6e 63 69 6e 67 20 41 | 64 6d 69 6e 69 73 74 72 |ancing A|dministr|
|00004c50| 61 74 69 6f 6e 20 28 48 | 43 46 41 29 3b 20 74 68 |ation (H|CFA); th|
|00004c60| 65 0d 0a 65 64 69 74 6f | 72 69 61 6c 2c 20 77 72 |e..edito|rial, wr|
|00004c70| 69 74 74 65 6e 20 62 79 | 20 74 68 65 20 65 64 69 |itten by| the edi|
|00004c80| 74 6f 72 20 61 6e 64 20 | 63 68 69 65 66 20 6f 66 |tor and |chief of|
|00004c90| 20 74 68 65 20 4e 65 77 | 20 45 6e 67 6c 61 6e 64 | the New| England|
|00004ca0| 20 4a 6f 75 72 6e 61 6c | 20 6f 66 0d 0a 4d 65 64 | Journal| of..Med|
|00004cb0| 69 63 69 6e 65 2c 20 69 | 73 20 61 6c 73 6f 20 69 |icine, i|s also i|
|00004cc0| 6d 70 6f 72 74 61 6e 74 | 2e 20 20 54 68 65 20 65 |mportant|. The e|
|00004cd0| 64 69 74 6f 72 69 61 6c | 20 73 61 79 73 20 74 68 |ditorial| says th|
|00004ce0| 61 74 20 74 68 65 20 74 | 68 69 72 64 20 72 65 76 |at the t|hird rev|
|00004cf0| 6f 6c 75 74 69 6f 6e 20 | 69 6e 0d 0a 68 65 61 6c |olution |in..heal|
|00004d00| 74 68 20 63 61 72 65 20 | 69 73 20 67 6f 69 6e 67 |th care |is going|
|00004d10| 20 74 6f 20 62 65 20 6d | 65 61 73 75 72 69 6e 67 | to be m|easuring|
|00004d20| 20 69 74 73 20 65 66 66 | 65 63 74 69 76 65 6e 65 | its eff|ectivene|
|00004d30| 73 73 2e 20 20 44 72 2e | 20 52 65 6c 6d 61 6e 20 |ss. Dr.| Relman |
|00004d40| 64 65 73 63 72 69 62 65 | 73 0d 0a 74 68 65 20 66 |describe|s..the f|
|00004d50| 69 72 73 74 20 72 65 76 | 6f 6c 75 74 69 6f 6e 20 |irst rev|olution |
|00004d60| 61 73 20 74 68 65 20 45 | 72 61 20 6f 66 20 45 78 |as the E|ra of Ex|
|00004d70| 70 61 6e 73 69 6f 6e 20 | 77 69 74 68 20 69 6d 70 |pansion |with imp|
|00004d80| 72 6f 76 65 6d 65 6e 74 | 73 20 69 6e 20 62 61 73 |rovement|s in bas|
|00004d90| 69 63 0d 0a 72 65 73 65 | 61 72 63 68 2e 20 20 48 |ic..rese|arch. H|
|00004da0| 65 20 72 65 66 65 72 73 | 20 74 6f 20 74 68 65 20 |e refers| to the |
|00004db0| 73 65 63 6f 6e 64 20 61 | 73 20 74 68 65 20 52 65 |second a|s the Re|
|00004dc0| 76 6f 6c 74 20 6f 66 20 | 74 68 65 20 50 61 79 65 |volt of |the Paye|
|00004dd0| 72 73 2c 20 6f 72 20 74 | 68 65 20 45 72 61 20 6f |rs, or t|he Era o|
|00004de0| 66 0d 0a 43 6f 73 74 20 | 43 6f 6e 74 61 69 6e 6d |f..Cost |Containm|
|00004df0| 65 6e 74 2e 20 20 54 68 | 65 20 74 68 69 72 64 20 |ent. Th|e third |
|00004e00| 65 72 61 20 68 65 20 63 | 61 6c 6c 73 20 74 68 65 |era he c|alls the|
|00004e10| 20 45 72 61 20 6f 66 20 | 45 66 66 65 63 74 69 76 | Era of |Effectiv|
|00004e20| 65 6e 65 73 73 2e 20 20 | 57 68 61 74 20 44 72 2e |eness. |What Dr.|
|00004e30| 0d 0a 52 6f 70 65 72 20 | 73 61 79 73 20 69 73 20 |..Roper |says is |
|00004e40| 74 68 61 74 20 68 65 20 | 64 6f 65 73 6e 27 74 20 |that he |doesn't |
|00004e50| 62 65 6c 69 65 76 65 20 | 74 68 61 74 20 64 6f 63 |believe |that doc|
|00004e60| 74 6f 72 73 20 61 72 65 | 20 69 6e 68 65 72 65 6e |tors are| inheren|
|00004e70| 74 6c 79 20 65 76 69 6c | 20 6f 72 0d 0a 67 72 65 |tly evil| or..gre|
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|00004e90| 63 74 6f 72 73 20 64 6f | 20 6d 61 6e 79 20 6f 66 |ctors do| many of|
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|00004ec0| 20 64 6f 6e 27 74 20 6b | 6e 6f 77 0d 0a 77 68 61 | don't k|now..wha|
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|00004ee0| 68 65 69 72 20 70 61 74 | 69 65 6e 74 2e 20 20 57 |heir pat|ient. W|
|00004ef0| 68 61 74 20 52 6f 70 65 | 72 20 69 73 20 63 61 6c |hat Rope|r is cal|
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|00004f10| 72 61 2c 20 69 66 20 79 | 6f 75 0d 0a 77 69 6c 6c |ra, if y|ou..will|
|00004f20| 2c 20 6f 66 20 61 20 73 | 79 73 74 65 6d 20 6c 69 |, of a s|ystem li|
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|00004f60| 61 74 69 63 0d 0a 69 6e | 66 6f 72 6d 61 74 69 6f |atic..in|formatio|
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|00004f80| 65 6e 74 73 20 64 6f 20 | 61 66 74 65 72 20 74 68 |ents do |after th|
|00004f90| 65 69 72 20 6f 70 65 72 | 61 74 69 6f 6e 73 2e 20 |eir oper|ations. |
|00004fa0| 20 48 65 20 62 65 6c 69 | 65 76 65 73 20 74 68 61 | He beli|eves tha|
|00004fb0| 74 20 77 65 0d 0a 73 68 | 6f 75 6c 64 20 6f 70 65 |t we..sh|ould ope|
|00004fc0| 6e 20 74 68 65 20 66 65 | 64 65 72 61 6c 20 67 6f |n the fe|deral go|
|00004fd0| 76 65 72 6e 6d 65 6e 74 | 20 64 61 74 61 62 61 73 |vernment| databas|
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|00005020| 74 73 20 73 6f 6d 65 20 | 76 65 72 79 20 69 6e 74 |ts some |very int|
|00005030| 65 72 65 73 74 69 6e 67 | 20 64 61 74 61 2c 20 77 |eresting| data, w|
|00005040| 69 74 68 6f 75 74 20 64 | 65 73 63 72 69 62 69 6e |ithout d|escribin|
|00005050| 67 0d 0a 68 6f 77 20 68 | 65 20 6f 62 74 61 69 6e |g..how h|e obtain|
|00005060| 65 64 20 74 68 65 6d 2e | 20 20 54 68 65 20 64 61 |ed them.| The da|
|00005070| 74 61 20 68 65 20 70 72 | 65 73 65 6e 74 73 20 6f |ta he pr|esents o|
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|000050b0| 63 6f 72 6f 6e 61 72 79 | 20 61 72 74 65 72 79 20 |coronary| artery |
|000050c0| 62 79 70 61 73 73 20 73 | 75 72 67 65 72 79 20 61 |bypass s|urgery a|
|000050d0| 6e 64 20 61 6e 67 69 6f | 70 6c 61 73 74 79 20 72 |nd angio|plasty r|
|000050e0| 65 76 65 61 6c 0d 0a 74 | 68 61 74 2c 20 77 68 65 |eveal..t|hat, whe|
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|00005130| 0a 61 6e 67 69 6f 70 6c | 61 73 74 79 20 69 73 20 |.angiopl|asty is |
|00005140| 6e 6f 20 64 69 66 66 65 | 72 65 6e 74 20 74 68 61 |no diffe|rent tha|
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|00005160| 6f 6e 61 72 79 20 62 79 | 70 61 73 73 20 73 75 72 |onary by|pass sur|
|00005170| 67 65 72 79 20 69 6e 20 | 74 68 65 0d 0a 4d 65 64 |gery in |the..Med|
|00005180| 69 63 61 72 65 20 70 6f | 70 75 6c 61 74 69 6f 6e |icare po|pulation|
|00005190| 3b 20 74 68 65 20 64 69 | 66 66 65 72 65 6e 63 65 |; the di|fference|
|000051a0| 20 73 68 6f 77 6e 20 69 | 6e 20 6d 6f 72 74 61 6c | shown i|n mortal|
|000051b0| 69 74 79 20 72 65 73 75 | 6c 74 73 20 66 72 6f 6d |ity resu|lts from|
|000051c0| 20 74 68 65 20 66 61 63 | 74 0d 0a 74 68 61 74 20 | the fac|t..that |
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|00005fa0| 62 6c 6f 6f 64 20 70 48 | 20 77 69 74 68 69 6e 20 |blood pH| within |
|00005fb0| 32 34 20 68 6f 75 72 73 | 20 62 65 66 6f 72 65 0d |24 hours| before.|
|00005fc0| 0a 64 69 73 63 68 61 72 | 67 65 2e 20 20 54 68 65 |.dischar|ge. The|
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|00005ff0| 68 65 20 6d 6f 73 74 20 | 66 72 65 71 75 65 6e 74 |he most |frequent|
|00006000| 6c 79 20 65 6e 63 6f 75 | 6e 74 65 72 65 64 0d 0a |ly encou|ntered..|
|00006010| 6e 6f 6e 63 6f 6d 70 6c | 69 61 6e 63 65 20 65 76 |noncompl|iance ev|
|00006020| 65 6e 74 2e 20 20 42 79 | 20 66 61 72 2c 20 74 68 |ent. By| far, th|
|00006030| 65 20 6d 6f 73 74 20 63 | 6f 6d 6d 6f 6e 20 64 65 |e most c|ommon de|
|00006040| 66 69 63 69 65 6e 63 79 | 20 69 6e 20 74 72 65 61 |ficiency| in trea|
|00006050| 74 69 6e 67 0d 0a 68 79 | 73 74 65 72 65 63 74 6f |ting..hy|sterecto|
|00006060| 6d 79 20 70 61 74 69 65 | 6e 74 73 20 77 61 73 20 |my patie|nts was |
|00006070| 74 68 65 20 66 61 69 6c | 75 72 65 20 74 6f 20 70 |the fail|ure to p|
|00006080| 65 72 66 6f 72 6d 20 70 | 72 65 6f 70 65 72 61 74 |erform p|reoperat|
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|000060a0| 74 68 65 0d 0a 65 6e 64 | 6f 6d 65 74 72 69 75 6d |the..end|ometrium|
|000060b0| 2e 20 20 43 61 73 65 73 | 20 6f 66 20 62 6f 6e 79 |. Cases| of bony|
|000060c0| 20 6e 6f 6e 75 6e 69 6f | 6e 20 77 65 72 65 20 74 | nonunio|n were t|
|000060d0| 68 65 20 6e 65 78 74 20 | 6d 6f 73 74 20 66 72 65 |he next |most fre|
|000060e0| 71 75 65 6e 74 20 6e 6f | 6e 63 6f 6d 70 6c 69 61 |quent no|ncomplia|
|000060f0| 6e 63 65 0d 0a 65 76 65 | 6e 74 2e 0d 0a 20 20 20 |nce..eve|nt... |
|00006100| 20 20 54 68 65 20 71 75 | 61 6c 69 74 79 20 6f 66 | The qu|ality of|
|00006110| 20 63 61 72 65 20 69 6e | 20 55 6e 69 74 65 64 20 | care in| United |
|00006120| 53 74 61 74 65 73 20 6d | 69 6c 69 74 61 72 79 20 |States m|ilitary |
|00006130| 68 6f 73 70 69 74 61 6c | 73 2c 20 61 73 20 6d 65 |hospital|s, as me|
|00006140| 61 73 75 72 65 64 20 62 | 79 0d 0a 63 6f 6d 70 6c |asured b|y..compl|
|00006150| 69 61 6e 63 65 20 77 69 | 74 68 20 73 74 61 6e 64 |iance wi|th stand|
|00006160| 61 72 64 73 20 65 6e 64 | 6f 72 73 65 64 20 62 79 |ards end|orsed by|
|00006170| 20 63 69 76 69 6c 69 61 | 6e 20 70 68 79 73 69 63 | civilia|n physic|
|00006180| 69 61 6e 20 73 70 65 63 | 69 61 6c 69 73 74 73 2c |ian spec|ialists,|
|00006190| 20 61 70 70 65 61 72 73 | 0d 0a 68 69 67 68 2c 20 | appears|..high, |
|000061a0| 61 73 20 6c 65 73 73 20 | 74 68 61 6e 20 31 25 20 |as less |than 1% |
|000061b0| 6f 66 20 74 68 65 20 6f | 76 65 72 61 6c 6c 20 73 |of the o|verall s|
|000061c0| 61 6d 70 6c 65 64 20 63 | 61 73 65 73 20 77 65 72 |ampled c|ases wer|
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|000061f0| 20 73 74 61 6e 64 61 72 | 64 73 2e 0d 0a 0d 0a 50 | standar|ds.....P|
|00006200| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00006210| 20 20 20 20 54 68 69 73 | 20 69 73 20 61 20 66 69 | This| is a fi|
|00006220| 72 73 74 20 73 74 65 70 | 2c 20 62 75 74 20 63 6c |rst step|, but cl|
|00006230| 65 61 72 6c 79 20 69 74 | 27 73 20 6f 6e 6c 79 20 |early it|'s only |
|00006240| 61 20 66 69 72 73 74 20 | 73 74 65 70 2e 20 20 57 |a first |step. W|
|00006250| 68 61 74 20 74 68 65 0d | 0a 61 75 74 68 6f 72 73 |hat the.|.authors|
|00006260| 20 73 68 6f 77 65 64 20 | 77 61 73 20 6e 6f 74 20 | showed |was not |
|00006270| 74 68 61 74 20 74 68 65 | 20 74 68 65 72 61 70 79 |that the| therapy|
|00006280| 20 77 61 73 20 61 70 70 | 72 6f 70 72 69 61 74 65 | was app|ropriate|
|00006290| 20 6f 72 20 74 68 61 74 | 20 74 68 65 20 71 75 61 | or that| the qua|
|000062a0| 6c 69 74 79 20 6f 66 0d | 0a 63 61 72 65 20 69 6e |lity of.|.care in|
|000062b0| 20 74 68 65 20 68 6f 73 | 70 69 74 61 6c 73 20 77 | the hos|pitals w|
|000062c0| 61 73 20 61 70 70 72 6f | 70 72 69 61 74 65 2c 20 |as appro|priate, |
|000062d0| 62 75 74 20 6a 75 73 74 | 20 74 68 61 74 20 74 68 |but just| that th|
|000062e0| 65 20 69 6e 64 69 63 61 | 74 69 6f 6e 73 20 66 6f |e indica|tions fo|
|000062f0| 72 0d 0a 74 72 65 61 74 | 69 6e 67 20 74 68 65 20 |r..treat|ing the |
|00006300| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 74 68 |patients| with th|
|00006310| 6f 73 65 20 64 69 73 65 | 61 73 65 73 20 77 65 72 |ose dise|ases wer|
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|00006330| 49 20 64 6f 6e 27 74 20 | 6b 6e 6f 77 20 68 6f 77 |I don't |know how|
|00006340| 0d 0a 77 65 6c 6c 20 61 | 6e 79 20 6f 66 20 6f 75 |..well a|ny of ou|
|00006350| 72 20 70 72 61 63 74 69 | 63 65 73 20 77 6f 75 6c |r practi|ces woul|
|00006360| 64 20 66 61 72 65 20 75 | 6e 64 65 72 20 74 68 69 |d fare u|nder thi|
|00006370| 73 20 64 65 67 72 65 65 | 20 6f 66 20 61 6e 61 6c |s degree| of anal|
|00006380| 79 73 69 73 2e 20 20 43 | 6c 65 61 72 6c 79 2c 0d |ysis. C|learly,.|
|00006390| 0a 74 68 69 73 20 69 73 | 20 6a 75 73 74 20 61 20 |.this is| just a |
|000063a0| 22 73 63 72 61 74 63 68 | 69 6e 67 20 74 68 65 20 |"scratch|ing the |
|000063b0| 73 75 72 66 61 63 65 22 | 20 74 79 70 65 20 6f 66 |surface"| type of|
|000063c0| 20 61 6e 61 6c 79 73 69 | 73 20 74 68 61 74 20 74 | analysi|s that t|
|000063d0| 68 65 20 44 65 70 61 72 | 74 6d 65 6e 74 0d 0a 6f |he Depar|tment..o|
|000063e0| 66 20 44 65 66 65 6e 73 | 65 20 68 61 73 20 70 65 |f Defens|e has pe|
|000063f0| 72 66 6f 72 6d 65 64 2e | 20 20 4d 79 20 67 75 65 |rformed.| My gue|
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