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Biomedical subjects

C A Woodward

Publications and source records attributed to C A Woodward.

At least 19 recordsLinked to original sources
PubMed2001

Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study.

This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.

Adult↗
PubMed2001

Physicians certified in family medicine. What are they doing 8 to 10 years later?

OBJECTIVE: To determine field of medicine and location of a cohort of physicians certified in family medicine between 1989 and 1991 and residing in Ontario in 1993 and to gather information on the scope of practice of family physicians in the cohort in 1999. DESIGN: Responses to a mailed questionnaire sent in 1999 were compared with responses to a 1993 survey of this group. SETTING AND PARTICIPANTS: All family physicians in Ontario in 1993 who received certification in 1989, 1990, or 1991 after completing a family medicine residency. Seven of 557 respondents to the 1993 survey were ineligible; 293 physicians (53%) responded to the 1999 survey. MAIN OUTCOME MEASURES: Field, location, and scope of practice. RESULTS: About 91% of the cohort were still practising family medicine, although 11% of these had restricted their practices to certain areas within family medicine. Physicians migrated from Ontario (6%) in nearly equal numbers to other provinces and other countries, predominantly the United States. More family physicians offered counseling, shared antenatal care, and newborn care in 1999 than in 1993. Those with restricted family practices provided fewer types of services and were less likely to provide antenatal or intrapartum care or to provide in-hospital services. CONCLUSION: Receiving certification in family medicine does not guarantee that physicians will remain in family practice 8 to 10 years later. Loss from general family medicine to restricted practices within family medicine and specialization was greater than loss from migration.

Family Practice↗
PubMed2001

Professional activity. How is family physicians' work time changing?

OBJECTIVE: To examine hours worked professionally, work preferences, and changes in both of these and their correlates. DESIGN: Repeated surveys done in 1993 and 1999. SETTING: Ontario family practices. PARTICIPANTS: Cohort of physicians certified in family medicine between 1989 and 1991 after family medicine residency who were surveyed in 1993 when they resided in Ontario. MAIN OUTCOME MEASURES: Self-reported hours spent weekly on professional activities, desired hours of professional work, and balance between work and other activities. RESULTS: Fifty-three percent (293) of 553 physicians responded to the 1999 survey; 91% had remained family physicians; 85% of these had participated in the 1993 survey. The difference between the hours that family physicians preferred to work professionally and their actual hours of work had increased since 1993. Childless physicians, women physicians with preschool children, and women physicians married to other physicians worked fewer hours professionally than other physicians in 1999. Female physicians and physicians without children worked closer to their preferred hours than other physicians. Reporting a preference to work fewer hours professionally in 1993 was linked with a reduction in professional activities by 1999. CONCLUSION: Greater attention should be paid in physician resource planning to the family life cycle of female physicians. Lifestyle changes could lead to a reduction in professional activity among these physicians.

Analysis of Variance↗
PubMed2001

Health care system reform. Ontario family physicians' reactions.

OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medicine residency between 1989 and 1991 and were practising in Ontario in 1993. This report addresses only those members of the cohort who continued to practise family medicine in Ontario (N = 236). Four focus groups with a total of 27 family physicians. MAIN OUTCOME MEASURES: Reaction to health care system reforms. Perceived effect of reforms on practice. Current perception of quality of health care system and level of career satisfaction and changes in these variables since 1993. RESULTS: Response rate was 53% of original cohort. Only three of 13 selected health reforms were believed to have had a favourable effect. Physicians reported lower levels of satisfaction with their careers. Overall quality of the health care system was perceived by both respondents and focus group members to have declined. Several difficulties affected practice and personal life. CONCLUSION: Family physicians viewed the effect of health care reforms negatively and were significantly less satisfied with their careers than they were in 1993. Better consultation with stakeholders before implementation of reforms is needed to ensure that these stakeholders understand the likely effects of these reforms.

Adult↗
PubMed2000

Predictors of job stress and satisfaction among hospital workers during re-engineering: differences by extent of supervisory responsibilities.

After two years of rapid organizational change within a large teaching hospital, 83 percent of workers remained employed there. Among these "survivors," job satisfaction decreased and job stress increased regardless of whether they were employed in a supervisory position. This article examines the predictors of job satisfaction and job stress for managers, for people who indicated that they supervised others but were not managers, and for workers. There are areas of commonality in predictors across these groups, as well as some differences by level of supervisory responsibility. Examining and modifying job characteristics associated with high stress could result in healthier hospital work environments.

Hospital Administrators↗
PubMed1999

Stability and sulfur-reduction activity in non-aqueous phase liquids of the hydrogenase from the hyperthermophile Pyrococcus furiosus.

Hydrogenase from the hyperthermophilic archaeon, Pyrococcus furiosus, catalyzes the reversible activation of H(2) gas and the reduction of elemental sulfur (S degrees ) at 90 degrees C and above. The pure enzyme, modified with polyethylene glycol (PEG), was soluble (> 5 mg/mL) in toluene and benzene with t(1/2) values of more than 6 h at 25 degrees C. At 100 degrees C the PEG-modified enzyme was less stable in aqueous solution (t(1/2) approximately 10 min) than the native (unmodified) enzyme (t(1/2) approximately 1 h), but they exhibited comparable H(2) evolution, H(2) oxidation, and S degrees reduction activities at 80 degrees C. The H(2) evolution activity of the modified enzyme was twice that of the unmodified enzyme at 25 degrees C. The PEG-modified enzyme did not catalyze S degrees reduction (at 80 degrees C) in pure toluene unless H(2)O was added. The mechanism by which hydrogenase produces H(2)S appears to involve H(2)O as the proton source and H(2) as the electron source. The inability of the modified hydrogenase to catalyze S degrees reduction in a homogeneous non-aqueous phase complicates potential applications of this enzyme.

Biotechnology↗
PubMed1999

Going the distance: the influence of practice location on the Ontario Maternal Serum Screening Program.

BACKGROUND: The Ontario Maternal Serum Screening (MSS) Program was introduced by the Ontario Ministry of Health as a province-wide pilot project in 1993. The objective of this study was to determine the influence of practice location on Ontario health care providers' use of and opinions regarding MSS, access to follow-up services and recommendations about the program. METHODS: A questionnaire was mailed to a random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in Ontario between November 1994 and March 1995. RESULTS: Among providers who were eligible (those providing antenatal care or attending births) the response rates were 91.4% (778/851), 76.0% (273/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest region (71.4%) and in rural areas (81.9%) stated that they routinely offer MSS to all pregnant women in their practices compared with respondents in other regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in the northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were readily available. Respondents in the northern regions had less favourable opinions of MSS than those in the other regions in terms of its complexity, cost, the time involved in counselling and the high false-positive rate. More respondents in the Central East region (64.6%) and in urban centres (52.9%) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were controlled for in a logistic regression analysis, practice location was not the most important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offer MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that patient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67) or that follow-up services were not readily available (OR 0.33, 95% CI 0.20-0.55) were less likely to offer it. INTERPRETATION: Health care providers in northern and rural Ontario were less likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concerns about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.

Abnormalities, Multiple↗
PubMed1999

Determinants of job stress and job satisfaction among supervisory and non-supervisory employees in a large Canadian teaching hospital.

This article explores the extent to which hospital workers at a large teaching hospital at different managerial/supervisory levels (designated and non-designated supervisors, and non-supervisory staff), experienced job stress and job satisfaction prior to the re-engineering of hospital services. For all groups, increased levels of job demands were associated with higher levels of stress. Lower levels of decision latitude were associated with increased job stress for designated supervisors. Increasing levels of decision latitude were associated with both job stress and satisfaction for the other two groups. Co-worker support and teamwork contributed to increased job satisfaction for all groups.

Adaptation, Psychological↗
PubMed1999

The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study.

OBJECTIVES: To examine changes over time in the hospital staff's perceptions of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of care and services that they provide. METHODS: A random sample of hospital employees (n = 900) of a large Ontario teaching hospital participated in a longitudinal study which involved surveys at 3 measurement periods over a 2-year period. The questionnaire used in this study included scales reflecting work environment, emotional distress, personal resources, spillover from work to home and vice versa, and perceptions regarding patient care and the hospital as an employer. RESULTS: Significant increases in depression, anxiety, emotional exhaustion, and job insecurity were seen among employees, particularly during the first year of the change process. By the end of the second year, employees reported deterioration in team work, increased unclarity of role, and increased use of distraction to cope. Job demands increased throughout the period whereas little change occurred in the employee's job influence or decision latitude. Overall, the work environment was negatively affected. Although patient care was unaffected in the first year, a significant decline in perceptions of patient care, attention to quality improvement, and overall quality of care were later seen. CONCLUSIONS: This study raises questions about whether hospital re-engineering and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was increase in emotional distress among staff and a deterioration in their relationship with their employer.

Adaptation, Psychological↗
PubMed1998

Provision of preventive care to unannounced standardized patients.

OBJECTIVE: To examine the relation between physician, training and practice characteristics and the provision of preventive care as described in the guidelines of the Canadian Task Force on the Periodic Health Examination. DESIGN: Cross-sectional study. SETTING: Family practices open to new patients within 1 hour's drive of Hamilton, Ont. PARTICIPANTS: A total of 125 family physicians were randomly selected from respondents to an earlier preventive care survey. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew when they closed their practices to new patients. Sixty-two physicians thus participated in the study. INTERVENTION: Unannounced standardized patients posing as new patients to the practice visited study physicians' practices between September 1994 and August 1995, portraying 4 scenarios: 48-year-old man, 70-year-old man, 28-year-old woman and 52-year-old woman. OUTCOME MEASURES: Proportion of preventive care manoeuvres carrying grade A, B, C, D and E recommendations from the Canadian Task Force on the Periodic Health Examination that were performed, offered or advised. A standard score was computed based on the performance of grade A and B manoeuvres (good or fair evidence for inclusion in the periodic health examination) and the non-performance of grade D and E manoeuvres (fair or good evidence for exclusion from the periodic health examination). RESULTS: Study physicians performed or offered 65.6% of applicable grade A manoeuvres, 31.0% of grade B manoeuvres, 22.4% of grade C manoeuvres, 21.8% of grade D manoeuvres and 4.9% of grade E manoeuvres. The provision of evidence-based preventive care was associated with solo (v. group) practice and capitation or salary (v. fee-for-service) payment method. Preventive care performance was unrelated to physician's sex, certification in family medicine or problem-based (v. traditional) medical school curriculum. CONCLUSIONS: Preventive care guidelines of the Canadian Task Force on the Periodic Health Examination have been incompletely integrated into clinical practice. Research is needed to identify and reduce barriers to the provision of preventive care and to develop and apply effective processes for the creation, dissemination and implementation of clinical practice guidelines.

Adult↗
PubMed1998

What factors influence primary care physicians' charges for their services? An exploratory study using standardized patients.

OBJECTIVE: To determine the extent of variation in physicians' charges for health care encounters with unannounced standardized patients and factors associated with the variation. DESIGN: Cross-sectional study. SETTING: Family practices open to new patients within 1 hour's drive of Hamilton, Ont. PARTICIPANTS: A stratified random sample of 125 physicians who had responded to an earlier survey regarding preventive care were invited to participate. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew because they closed their practices to new patients. Sixty-two physicians thus participated in the study. INTERVENTION: Unannounced standardized patients posing as new patients to the practice visited study physicians' practices between September 1994 and August 1995, portraying 4 scenarios: 28-year-old woman, 52-year-old woman, 48-year-old man and 70-year-old man. OUTCOME MEASURES: Physician characteristics, encounter characteristics and charges made for services. RESULTS: The 62 physicians had 246 encounters with the standardized patients. Charges were made to the health insurance plan for services by 59 physicians for up to 4 encounters (215 encounters in all). Charges varied considerably both within and across patient scenarios. Time spent with the patient was an important factor predicting charges made (p < 0.01), although the effect of time spent on charges varied across scenarios (p < 0.01). Fee-for-service physicians charged more for their services than physicians who usually had alternative billing arrangements (p < 0.01). Female physicians charged more for their services than their male colleagues (p = 0.03). No relation was found between quality of preventive care and charges made (p = 0.15). CONCLUSIONS: Physician-related factors are better able to account for the variability in charges for their services than patient-related factors. Physicians seeing comparable patients may earn much more or less than their colleagues because of differences in the services they provide and the way they apply the fee schedule. Quality-assurance techniques are likely needed to reduce the variability in charges seen and increase value for money spent in health care.

Adult↗
PubMed1998

Fielding standardized patients in primary care settings: lessons from a study using unannounced standardized patients to assess preventive care practices.

OBJECTIVES: To document detection and suspicion rates of unannounced standardized patients visiting community-based practices. DESIGN: Primary care physicians were recruited to participate in a study using standardized patients. Four standardized patient scenarios were used. SETTING: Community-based primary care physicians' practices in southern Ontario between September 1994 and August 1995. STUDY PARTICIPANTS: Sixty-two primary care physicians. MAIN OUTCOME MEASURES: A 'believability' questionnaire completed after all four standardized patients had visited the practices. RESULTS: Of the primary care physicians approached, 50% (62) agreed to participate. Twenty-one per cent of all visits were suspected as standardized patient encounters. Forty-six per cent suspected one or more standardized patients. Only five physicians (8%) suspected all four standardized patients. Reasons for suspecting standardized patients were associated with the characteristics of the physician's practices, the physician's practice profile and the standardized patient cover story. CONCLUSION: The portrayal of asymptomatic patients seeking a new primary care physician presents unique challenges. Carefully constructed cover stories, and detailed knowledge of the local area and of the practices of the participating physicians is required to allow standardized patients cases to be tailored to fit into primary care settings without arousing suspicion.

Adult↗
PubMed1997

Ontario Maternal Serum Screening Program: practices, knowledge and opinions of health care providers.

OBJECTIVE: To determine the practices, knowledge and opinions of health care providers regarding a prenatal genetic screening program in Ontario. DESIGN: Cross-sectional self-reported survey. SETTING: Ontario. PARTICIPANTS: Random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in the province. Among subjects who were eligible (those providing antenatal care or attending births) the response rates were 91% (778/851), 76% (273/359) and 78% (46/59) respectively. MAIN OUTCOME MEASURES: Which patients were offered maternal serum screening (MSS), how results were being communicated, knowledge of the test's sensitivity, likes and dislikes about MSS and recommendations regarding the program. RESULTS: Most (97%) of respondents stated that they were offering MSS to the pregnant women in their practices; 88% were offering it routinely to all pregnant women (87% of the family physicians, 90% of the obstetricians and 100% of the midwives). Most (92%) of the respondents stated that they communicate positive results to their patients personally as soon as they are received; 23% did so for negative results. The respondents correctly identified the initial positive rate but underestimated the false-positive rate. About one-third did not respond to these knowledge questions. Of those who gave feedback on the screening program, 50% recommended that it not be changed, 29% suggested that it be changed, and 22% recommended that it be scrapped. CONCLUSIONS: Participation in the Ontario Maternal Serum Screening Program by health care providers has been good, although knowledge about MSS is far from ideal. Many providers have reservations about the program. In light of concerns raised about the high false-positive rate and the anxiety such results generate in pregnant women, there is a need for more education of providers and patients and a better understanding of women's experiences with genetic screening.

Abnormalities, Multiple↗
PubMed1997

Cohort, gender and practice organization: examining the bounds of collaborative medicine among newly established female and male family physicians in Ontario.

This paper analyzes data from a 1993 survey of 395 newly established female and male family physicians in Ontario, Canada, to examine the relationship between practice organization and gender. Previous research suggests that younger physicians, particularly women, tend to enter group practice. Compared to solo practice, groups may offer more predictable incomes, more manageable workloads, peer collaboration and review, and economies of scale. Further, female physicians in groups may develop distinctive styles of collaborative medicine. The results show that a majority of physicians in our cohort are in private community-based group practice. However, while many groups share premises, staff and expenses, and many have common charts and practice guidelines, only a minority incorporate regular meetings to discuss business or patient care, have shared care of hospitalized patients, or audits of physicians' practices. Few gender differences are observed in private group practice: although women physicians attract larger proportions of female patients than do their male colleagues, women and men organize their groups in similar ways and have similarity strong patient-centered attitudes.

Attitude of Health Personnel↗
PubMed1997

Maternity care and maternal serum screening. Do male and female family physicians care for women differently?

OBJECTIVE: To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program. DESIGN: Mailed survey fielded between October 1994 and March 1995. SETTING: Ontario family practices. PARTICIPANTS: Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded. MAIN OUTCOME MEASURES: Attitudes toward, knowledge about, and behaviour toward MSS. RESULTS: Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P < or = 0.001). CONCLUSIONS: Among family physicians caring for pregnant women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.

Delivery, Obstetric↗
PubMed1997

Closed and restricted practices.

OBJECTIVE: To determine the proportion of recently certificated Ontario family physicians who have closed their practices to new patients or restricted their services. DESIGN: Cross-sectional survey mailed between September 1993 and January 1994. SETTING: Ontario family practices. PARTICIPANTS: All family medicine residency-trained certificants of the College of Family Physicians of Canada from 1989 to 1991 currently practising in Ontario. Response rate was 70% (395 of 564 eligible physicians). Otherwise eligible physicians practising as locums, emergency room physicians, or military physicians were excluded. MAIN OUTCOME MEASURES: Self-report of practices being closed to new patients and of various restrictions placed on practices. RESULTS: Nearly one third of respondents had closed their practices to new patients. Although the decision to close a practice correlated with length of time in practice, physicians in metropolitan Toronto were significantly less likely to report closed practices than physicians practising in other regions of Ontario. Restrictions reported related to patients and problems, geographic area, and type of setting(s) serviced. About 45% of respondents did not provide one or more of a defined set of five services. CONCLUSIONS: Results of this study suggest that family physicians restrict their practices in various ways within the first 5 years after certification.

Certification↗
PubMed1996

Clinical practice guidelines. New-to-practice family physicians' attitudes.

OBJECTIVE: To examine the attitudes toward clinical practice guidelines of a group of family physicians who had recently entered practice in Ontario, and to compare them with the attitudes of a group of internists from the United States. DESIGN: Mailed questionnaire survey of all members of a defined cohort. SETTING: Ontario family practices. PARTICIPANTS: Certificants of the College of Family Physicians of Canada who received certification in 1989, 1990, and 1991 and who were practising in Ontario. Of 564-cohort members, 395 (70%) responded. Men (184) and women (211) responded at the same rate. MAIN OUTCOME MEASURES: Levels of agreement with 10 descriptive statements about practice guidelines and analyses of variance of these responses for several physician characteristics. RESULTS: Of respondents in independent practice, 80% were in group practice. Women were more likely to have chosen group practice, in which they were more likely to use practice guidelines than men. Generally favourable attitudes toward guidelines were observed. Physician characteristics occasionally influenced agreement with the descriptors. The pattern of agreement was similar to that noted in the study of American internists, but, in general, Ontario physicians were more supportive. CONCLUSIONS: This group of relatively new-to-practice Ontario family physicians shows little resistance to guidelines and appears to read less threat of external control in them than does the US group.

Attitude of Health Personnel↗