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For those few occasions when breakthrough bleeding occurs, the fol- lowing recommendations are made: (a) Spotting. Discontinue medication and begin a new medication cycle on the fifth day. They should have some immediate impact in communities and hos- pitals not now affiliated with the medical schools and should be programmed to be geo- graphically inclusive with an indication of the phasing anticipated for total coverage. Projects must identify specific working inter- relationships and cooperative arrangements that have been developed or anticipated xvith other agencies. Patient care demonstration jjrojects must ci- ther be replicable elsewhere in the region or have a clearly defined impact throughout the region on physician cajjability through train- ing. Projects will be concerned with those aspects of the subject diseases and of the health care system in which input of funds will result in maximum benefit in improving the care of individual patients. Funding of projects relating to the care of low income urban groups will be encouraged.

However, preg- nancy should be suspected at the first missed period if the patient has deviated from instructions. These are presented here as an integral part of the emerging plan for Michigan’s Regional Medical Program. The goal of the Michigan Regional Medical Program is to advance the accessibility and tite quality of health sendees available to in- dividual patients throughout the region through regional arrangements designed to stimulate new patterns of cooperative action among physicians, hospitals, university medi- cal centers, public health and voluntary health agencies. In addition to universities, a wide range of health related community, district and state- wide agencies will be encouraged to develop projects with the proxision that applicants must have the ability to take full fiscal and operational responsibility for projects devel- oped and have recognized competence in the area of concern or a demonstrable potential. Projects to be considered for funding cannot be isolated activities but must relate to the overall development of Michigan’s Regional Program. In general, projects must provide for some im- mediate relevance for the imjirovement of pa- tient care or for better utilization of man- power. Projects must have as an objective the making of a practical contribution to the effective dif- fusion of knowledge throughout the region and to the lessening of the gap between knowledge and practice as it affects the care of individual patients.

In re- lation to breakthrough bleeding, as in all cases of irregular bleeding per vaginam, nonfunctional causes should be borne in mind.

Oracon should be used with caution in pa- tients with a history of cerebrovascular accident.

Recurring breakthrough bleeding, particularly after the first few cycles, should be reported to the physician for further investigation. Complete details on Oracon are available from Mead Johnson Laboratories. The role of the medical center in a decen- tralized ajrproach should be to work through larger or district (sidregional) hospitals or hospital centers and their staffs, which in turn accept the responsibility for the involvement within their normal area of patient referral, of the smaller community hospitals and their staffs.

Because of the rarity of frank breakthrough bleeding, especially after the first few cycles, it is not necessary to provide the patient with additional tablets to allow for doubling the dose. PROCEDURES To implement these principles, a consistent ap- proach has been defined which, incorporated in the majority of jjrojects funded, will organize what might otherwise be disconnected activities into a regional program. Inasmuch as group consensus can be more ef- fective in changing behavior than individual learning, the primary target for a decentral- ized approach to improved care of patients is the hospital staff. Working with hospital staffs will be under- taken in conformity with a logistic regionali- zation concept whereby smaller or community hospitals relate along patient referral lines to larger district (sub-regional) hospitals or hos- pital centers and these in turn relate to a university medical center.

Patients with a history of psychic depression should be carefully observed and the drug discontinued if the depression recurs to a serious degree.

In cases of undiagnosed vaginal bleeding, adequate diagnostic measures are indicated.

Administration: Counting onset of menses as Day 1, the patient starts medication on Day 5 of the cycle and takes one white tablet daily liom Day 5 through Day 20, then one pink tablet daily from Day 21 through Day 25 . How'ever, the atypical mycobacteria can still be a fooler. This partnership should make it possible for ever)’ commu- nity’s practicing physicians to share in the diagnostic, therapeutic and consultative re- sources of major medical institutions.” Then, in the opening section of Public Law 89- 239 itself, we find the purposes of the legislation defined as follows: “Sec. The Purposes of this title are — (a) “Through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including continuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases; (b) “To afford to the medical profession and the medical institutions of the Nation, throutth such cooperative arrangements, the opportu- Presented at the First Annual Conference for . CURRENT STATUS The Michigan Association for Regional Medical Programs has operated under a planning grant since June 1, 1967 — a relatively short period of time. The Michigan Department of Public Health has made a start on planning and developmental work and is developing a system of coordinated data collection and anaylsis to insure the comparability of all data collected in the region.

25-26 — Michigan State Medical Assistants Society Sept. 20 — “Ars Medica Art Exhibit” Top Medical Authorities Will Cover Timely Topics Including These . Literature on indications and dosage available on request. An aging medical profession is losing more mem- bers by death and retirement than are being re- placed by the slow influx of young men; the re- maining practitioners are overworked and unable to take on more of a work load, physically and time-wise. H.: A study of pulmonary disease with mycobac- terial tuberculosis: identification and characteriza- tion of the mycobacteria. Comjiiehensive j^rograms for the medical man- agement of persons with hypertensive disease will be developed in the same way, with the district hospital or district hospital center serving as a resource for those medical .sjjecialties, diagnostic studies and treatment facilities not available at the community hospital.

First introduced to help restore the flora of the intestinal tract in infants and adults, LACTINEX has also been shown to be useful in the treatment of fever blisters and canker sores of herpetic origin.®’ ® No untoward side effects have been reported to date. It is nationwide and is cer- tainly felt more and more in our own community. At least one training program in acute coronary care will be made available to each district hos- pital or district hospital center with tlie involve- ment of one or more community hospitals in each district area.

Digitized by the Internet Archive in 2017 with funding from The National Endowment for the Humanities and the Arcadia Fund https://archive.org/details/michiganmedicin6719mich_1 MICHIGAN MEDICINE COME TO DETROIT, SEPT. TO COMPLICATE THINGS even more, med- icine is becoming more complex and there is greater demand for highly specialized diagnostic and therapeutic procedures than e\'er before. AUGUST, 1968, MICHIGAN MEDICINE 967 CONTINUED: THE PROGRAMMATIC ASPECTS OF MARMP STROKE.

25-26, FOR MSMS ANNUAL SCIENTIFIC SESSION MICHIGAN STATE MEDICAL SOCIETY JOURNAL VOLUME 67, NUMBER 15 AUGUST 1968 BLOCK OUT YOUR CALENDAR NOW: Sept. Med- ical practice is becoming a jjractice of specialties and the institution of family jjhysician and general jjractitioner is slowly becoming a matter of the past. Comprehensive program for the medical management of stroke patients will be de- veloped in the same manner as for heart disease and will include the pre-stroke phase on through the continuing care of post-stroke patients in long term care facilities, in their own homes or in nurs- ing homes. Each district hospital or district hos- pital center will be encouraged and otherwise as- sisted in reviewing current practices in the pri- mary diagnosis and treatment of patients with can- cer, and wherever indicated will be assisted in de- veloping an adequate program for the primary diagnosis and treatment of cancer patients.

Because of the effects of estrogens on epiphyseal closure, Oracon should be used judi- ciously in young patients in whom bone growth is not complete.

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