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The performance of cardiac surgery in the community hospital not concerned with postgraduate medical education has not been encouraged. It has been stated that the moderate-sized community hospital cannot offer sufficient support or patient volume to maintain a cardiac surgical team. The advent of a successful myocardial revascularization procedure has been instrumental in altering this concept. The first procedure requiring cardiopulmonary bypass in a Lubbock, Texas, hospital was performed on November 24, 1970. To date, 550 cardiac procedures requiring total cardiopulmonary bypass have been performed at Methodist Hospital, Lubbock. The cumulative mortality for this group of patients has been 2.9%. The development of a comprehensive cardiac surgical program has been very well accepted, and it is our consensus that it has been not only a feasible undertaking but a strong asset to the community.

A simulation model of private dental practice has been developed to evaluate the effects of introducing expanded function auxiliary personnel. The model permits the experimental investigation of a variety of staffing patterns and facility configurations. Results of these experiments indicate that a solo practice can expand its patient volume 169% and increase net revenue by 233% by adding expanded function auxiliaries while simultaneously reducing patient waiting time and the time spent at chairside by the dentist. Field validations of the simulation results are described.

Prior to the installation of an automated chemical analysis system, one case of hyperparathyroidism was encountered each three to five years. In the first 24 months after the installation of this unit, and with approximately the same patient volume, 16 cases of primary hyperparathyroidism have been clinically diagnosed. Thirteen of these persons have undergone surgical exploration, with pathologic confirmation of the diagnosis in each instance.

For areawide health planning to be effective, the distinction between emergency and non-emergency services must be recognized. At the same time, it is important that the significant interrelationships of these services be considered in initial planning. It might appear that areawide planning simply involves estimation of the relative volume of care requiring emergency and non-emergency treatment, with an allocation of resources and a configuration of services reflecting the estimated needs. Unfortunately, such planning is more complex. Current patient volume in emergency facilities already exceeds estimates of the need for "true" emergency care, as defined by physicians, and the volume is rising. Continued adaptation of emergency departments to the increasing demand will result in their gradual conversion into ever larger impersonal health supermarkets—into second-rate health centers, ill-adapted for either emergency services or general ambulatory care. Certain adjustments in the total system of providing health services could lead to a reduction in