Biomedical subjects
M F Lyons
Publications and source records attributed to M F Lyons.
Balancing certitude and ambiguity.
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Physician leadership. How do physician executives view themselves?
Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of mentors for their career guidance and development. Physician executives are actually becoming executives who happen to be physicians. They view themselves first as leaders, then as physicians, and finally as managers. That is a remarkable transformation in perception. To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations. The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry. The primary reasons for choosing to pursue a management role noted by most participants include a desire to be part of the health care solution and an interest in management and leadership challenges.
The MBA mystique.
Is an MBA the solution for you? Do physician executives need to have a business degree to compete in today's competitive marketplace? What are clients looking for when they make hiring decisions? The answers may surprise you. This column is an attempt to dispel myths about physician executives and the MBA degree. Clients want to attract and hire physician executives who possess sometimes intangible skills--with or without the MBA credential. These intangible skills include the ability to educate other physicians to the new health care realities, a sales orientation emphasizing effective communication that focuses on patients and payers as customers, comfort with ambiguity, flexibility, and tact and sensitivity in negotiations.
Masseter muscle relaxation rate in volunteers with a myogenous craniomandibular disorder.
Twelve volunteers were investigated to determine their masseter muscle relaxation rate following voluntary contractions. Four of these volunteers were patients diagnosed as having a myogenous craniomandibular disorder. Electromyograms were recorded from the left and right masseter muscles and maximum bite force was recorded in the midline between the incisor teeth. A sustained contraction was maintained at 50% maximum voluntary bite force for 90 s, during which there was a brief relaxation every 10 s. Recordings were continued for a 3 min recovery period. This sequence was then repeated at 25% of maximum bite force. Median power frequencies were calculated from the power spectra for the first and last 3 s of the sustained contractions. Relaxation rates were measured for each brief relaxation during the sustained contraction and for the relaxation from each brief clench during the recovery period. It was found that maximum bite force values were very similar for volunteers in both the patient and control groups. Relaxation rates slowed more and percentage changes in median frequency were greater in the controls than in the patients during the sustained contractions. However, relaxation rates returned to initial levels more quickly in the controls than in the patients.
The physician executive "arrives"--a new generation prepares for the future.
The recent rise in the number of physician executives in the health care industry vividly demonstrates that a genuinely new generation of physician executives is seeking to combine the sensitivity of their clinical skills with the business acumen that today's health care organizations need to prosper and grow. But physicians who are preparing themselves to be selected one day as chief executive officers by hospitals, integrated systems, and managed care organizations should understand that the CEO role is radically different from that of the CEO of a physician practice. The corporate CEO role requires the management of managers and responsiveness to the organization's board. Those who imagine that the corporate CEO role bears any resemblance to the autonomous, independent existence of the practitioner are certain to have a rough time.
The purpose of a job interview is a job offer.
Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.
The hinge clasp in removable partial denture design.
As a result of people keeping their teeth longer, modern dentists are encountering more partially dentate patients and difficult restorative problems. It is possible to solve some of the problems caused by the unusual angulations and undercutting when the remaining teeth of partially dentate patients start to drift by using the hinge clasp. The authors describe the types of device available and outline the advantages (and disadvantages) of its use.
The provision of hospital maxillo-facial prosthetic services in Scotland.
Maxillo-facial prosthetics can contribute much to the quality of life of patients with congenital problems or those treated surgically for a head and neck neoplasm. The availability of an adequate service varies internationally. The present study examines the current provision and requirements for such a service in Scotland. A questionnaire survey of 90 oral, plastic and ENT surgeons was carried out. Information was sought on numbers and types of cases seen, prosthetic treatment provided and involvement of Consultants in Restorative Dentistry in their management. The results show that most surgeons only treat a small number of such patients with a consequent dilution of experience, and with a possible need for supra-regional specialist centres. In addition there is a need for improvement of multi-disciplinary planning clinics for such cases.
Getting a firm grip on the realities for physician executives.
Today, physician executives can be found in every health care setting-group practices, hospitals and academic medical centers, insurance companies, drug companies, airlines, the government, and more. But before physicians land these positions, they must negotiate the often difficult passage from clinician to manager to executive to business-minded leader. To manage this transition successfully, physicians must be aware of and understand some basic realities of management positions. The nature of these realities and how physicians interested in management can deal with them are the subject of this article.
Foreign bodies of the gastrointestinal tract.
The majority of foreign bodies in the gastrointestinal tract require no medical or surgical intervention for removal. Prior to the era of modern gastrointestinal endoscopy, the management of ingested objects or nontherapeutic objects placed in the rectum required general anesthesia and was relegated to the general surgeon or otolaryngologist. With the advancement of therapeutic endoscopy, fewer affected individuals require surgical intervention. The physician involved with the initial evaluation of these patients must have a working knowledge of foreign bodies of the gastrointestinal tract to facilitate appropriate and timely management and referral.
Fatigue and EMG changes in the masseter and temporalis muscles during sustained contractions.
Local muscle fatigue was investigated in the anterior temporal and masseter muscles during sustained isometric contractions. The volunteers' subjective perception of fatigue or pain was recorded at intervals during the sustained contractions, and this level was then compared to objective measures of fatigue. These objective measures included shift in median frequency of the power spectrum of the surface-detected EMG signal, and change in signal amplitude. The relationship was investigated while closing on a bite force meter placed between the second premolars and first molars unilaterally, and while simply clenching with the teeth together without the bite force meter. It was found that the subjective perception of fatigue, as measured on a visual analogue scale (VAS), had a nearly linear relationship with time, and that the relationship between the VAS score and median frequency shift was rather closer than the relationship with amplitude change.
Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days.
The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN). Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily. Initially, all patients also received GM every 8 h iv (mean, 606 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001). Both regimens produced a satisfactory bacteriologic and clinical response in all cases. Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients. No patient experienced relapsing infection. The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.
Clinical and laboratory aspects of the three-part sectional denture.
The three-part sectional denture is becoming increasingly popular in the treatment of partially dentate patients who present with particular problems. It is a design concept which can be very successful if used with care, but is prone to failure if certain aspects of design and construction are overlooked. A discussion of pertinent clinical and laboratory details is presented, illustrated by a case where the patient's requirements were very specific.
Clinical and laboratory aspects of the three-part sectional denture.
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Reduction of extracellular methemoglobin by erythrocytes.
Erythrocytes, suspended in a glucose-containing buffer, catalyzed the partial reduction of extracellular methemoglobin. Physiological concentrations of ascorbic acid or dehydroascorbic acid greatly enhanced the rate of reaction and the ultimate extent of reduction. The relationship between erythrocyte concentration and initial reaction rate was nonlinear, which suggested that the rate limiting factor was not an erythrocyte membrane enzyme. Also, significant dehydroascorbate-stimulated reduction occurred even when the erythrocytes and methemoglobin were separated by a dialysis membrane. The above observations indicate that the transfer of reducing equivalents across the erythrocyte membrane and reduction of extracellular methemoglobin can be accomplished by release and recycling of ascorbic acid.
A preliminary electromyographic study of bite force and jaw-closing muscle fatigue in human subjects with advanced tooth wear.
The maximum bite force was recorded in five experimental volunteers with advanced tooth wear and five control volunteers who showed no abnormal wear. All subjects were then asked to maintain a force of 50% of the maximum for as long as possible while surface electromyograms from the masseter and temporalis muscles were recorded. The bite force and endurance time were found to be slightly increased in the experimental group, but no conclusions could be drawn regarding the state of fatigue. Two significant problems with regard to fatigue studies of the jaw-closing muscles emerged from the study, namely the use of the canine position for recording of the force, and the thickness of the force meter.
An electromyographic study of masticatory muscle activity at increased occlusal vertical dimension in complete denture wearers.
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