SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The Pew Health Professions Commission Task force on Health Care Workforce Regulation recently released its policy considerations for reforming the regulation of the US health care workforce. Individual copies of the report may be obtained from the Pew Health Professions Commission. This article summarizes the task force report.
PURPOSE: This project was part of a national, federally sponsored effort to create a prioritized research agenda for the chiropractic profession. An overview (and a separate comprehensive annotated bibliography) of recent social sciences, medical, chiropractic and health services research literature regarding chiropractic is presented. Based on this information, key research questions and issues were identified in the areas of health services research, practice environments and account ability/quality management. Research issues were prioritized by a multidisciplinary panel. METHODS: Qualitative review of literature gathered through searches of electronic health care database retrieval systems and citation tracking. Nominal group-process methodology with an expert panel was used to identify research priorities from a comprehensive list of potential health services research questions. RESULTS: Six recommendations for a health services research agenda for the chiropractic profession were made: determine barriers to usage of chiropractic; develop models to explain chiropractic usage; determine cost-effectiveness of different chiropractic procedures; develop valid measures and predictors of quality of chiropractic care; and examine satisfaction with chiropractic services from patients, other providers, purchasers, etc.
The therapy professions are a poorly understood or recognized resource for health, education and social care. This looks at some of the skills developed by these professions in response to their small numbers and relatively low status that could be harnessed and utilized.
An adaptation of the Delphi method was used in four parallel studies to survey chairs of baccalaureate programs in clinical laboratory sciences, health information management, occupational therapy, and physical therapy in schools of the allied health professions which held membership in the Association of Schools of the Allied Health Professions. The purpose was to assist the chairs in coming to consensus regarding requisite knowledge and skills of graduates beyond those required for professional accreditation and credentialing, and prerequisite or cognate courses that may be utilized to develop them. Three rounds of questionnaires were administered to each group. The final round was completed by 45 chairs in clinical laboratory sciences (83% of the population); 18 in health information management (86%); 18 in occupational therapy (56%); and 24 in physical therapy (67%). Statistical analysis of third round responses via one-sample, one-sided Z tests indicated consensus among the chairs in the four disciplines on 16 items of knowledge and skills as most important for graduates. Similar consensus was not evident, however, regarding courses to develop the knowledge and skills, with only two courses considered most important by all four groups of chairs.
The School of Health Related Professions (SHRP) at The University of Alabama at Birmingham (UAB) has been in existence for over a quarter of a century. During this time, it expanded and grew to offering 34 individual programs at the time of its silver anniversary. A concerted strategic planning process over two years has resulted in the School pursuing major organizational transformations to better align itself with the rest of the University's academic health center, to maximize its resources, and to refine its niche in academia. The strategic planning process used and major outcomes are described for the potential benefit of other schools of health related professions desiring to pursue introspection for future survival.
Modern quality management (QM) has evolved in industry over the last few decades to be a major factor in organizational structure and focus. The health industry has to a degree recognized or perceived merits in this model and has applied the principles of QM to many of its activities. It has also incorporated the concept of a commitment to quality improvement (QI) into its most recognized peer-review structure, hospital accreditation (ACHS). Apparent resistance exists in the medical fraternity to a transition from audit-focused quality assurance to contemporary systematic QI. An understanding of this issue may be gained from analysis of the medical profession's perception of QI, factors in the historical structures within health, and a review of the factors which hinder the transition to QI. By considering within a framework of organisational behaviour theory (OBT), some key concepts it is possible to work towards some solutions and proposals. These concepts include attitude, motivation, conflict, organizational change and development. It is likely that the appropriate focus should be broader than the 'recalcitrant group of conservative practitioners who resist change'. Indeed where a deficiency exists, QI methodology would have us look beyond an individual or single group towards the processes that create the opportunity for deficiency to occur. Within the current context, such processes are inherently structural and are historically established within the health industry. A solution to this problem requires organizational commitment and a period of analysis as well as the transformation of attitudes and practices. Organizational commitment will take the form of adequate resourcing and a developmental approach to organizational change. Internal professional change (perhaps guided by organizational development) must address the interface between the 'medical profession' and the broader group of professional health-care providers.
BACKGROUND: The professional relationship between general practitioners (GPs) and hospital consultants (sometimes referred to as 'specialists') is important in a health care system based upon the generalist as the first point of contact for patients and the gatekeeper for hospital services. This relationship has been the subject of considerable interest over the years, but little empirical research has been carried out. AIM: To investigate the professional relationship in terms of the balance between cooperation and conflict between GPs and specialists in clinical contact. METHOD: A qualitative study using 24 semistructured interviews and four focus group interviews with a purposeful sample of clinicians working in the south-west of England. A content analysis of the data was performed. RESULTS: There is a high level of mutual respect and cooperation between the two branches of the profession and a strong desire to build a personal relationship over a long period of time. There are few areas of significant disagreement; indeed, most members of both branches of the profession try hard to deal with, or avoid, potential conflict. CONCLUSION: The professional relationship between GPs and specialists is better than the literature and anecdotal stories might suggest.
The federal legislation mandating Professional Standards Review Organizations to monitor the decision making of physicians regarding their patients is a method unique to the United States to control medical care costs according to prevailing professional criteria. Other countries, so far, depend largely on health service structures, reimbursement methods, and arbitrary government budget limitations. Our dislike of highly structured delivery systems has pragmatically moved us in the direction of monitoring diagnostic and therapeutic decision making. PSRO is mandated at a time when there is no systematic methodology with validated criteria for monitoring medical practice. This will likely lead to subtle sabotage of PSRO by the medical profession justified by quality standards which are the professions' prerogative. It is conceivable that quality standards will rise and, therefore, costs. The drive for monitoring physician decision making is understandable even when there is no methodology. It then behooves medical schools to conduct research on methodologies of monitoring services, a possible favorable side-effect of the legislation. An unfavorable side-effect may likely be that the criteria will be based exclusively on technical medical considerations and ignore the personal and social attributes of patients which should affect the decision making of physicians. Medicine will then become even more technocratic than it is now. All countries are converging at various degrees of intensity in establishing planned limits to expansion, examining possibilities of monitoring physician decision making and capping this off with arbitrary budget ceilings. The state of the art of health services management appears to permit no other recourse.
... The main topic of this publication is the involvement of professional medical doctors in the course of torture in, generally speaking, the following ways: 1. Medical scientific knowledge and experience is used in the design of the methods and techniques of torture, for example pharmacological torture; 2. Doctors teach the torturers/perpetrators regarding the practical application of these methods; 3. Doctors actively participate in carrying out torture and in executions in relation to the death penalty; 4. Doctors are present -- "passive" -- during the implementation of torture (in more than sixty per cent of cases) for example monitoring the clinical condition of the victim in order to prevent death; are present when the death sentence is carried out, and then write out death certificates. Many of these are later shown by forensic documentation to be false.... This supplement is based on an international symposium, Torture and the Medical Profession, which was held at the University of Tromsø in June 1990....
INTRODUCTION: This article critiques the questions asked and methods used in research syntheses in continuing education (CE) in the health professions, summarizes the findings of the syntheses, and makes recommendations for future CE research and practice. METHODS: We identified 15 research syntheses published after 1993 in which primary CE studies were reviewed and the performance (behavior) of health professionals and/or patient health outcomes were examined. RESULTS: The syntheses were categorized by the research questions they asked using a wave metaphor. Wave One (n = 3) syntheses sought to establish a general descriptive causal connection between CE and impact variables, asking, "Is CE effective, and for what outcomes?" Wave Two syntheses (n = 12) sought to explain the relationship between CE and impacts by identifying causal moderators, asking, "What kinds of CE are effective?" DISCUSSION: Wave One findings confirm previous research that CE can improve knowledge, skills, attitudes, behavior, and patient health outcomes. Wave Two syntheses show that CE, which is ongoing, interactive, contextually relevant, and based on needs assessment, can improve knowledge, skills, attitudes, behavior, and health care outcomes. The most important implication of the present review is that there are differential impacts of CE programs, and the reasons for those impacts cannot be fully understood unless the context of the program is considered.
Although quality assurance (QA) programming in Canada is still at an early stage of development, health professionals are increasingly being called upon to substantiate the value of the services they provide. A body of research showing wide variations in the rates of service provision and significant amounts of inappropriate care have convinced many policy makers about the need to improve quality in the Canadian health system. Recent and severe economic pressures on provincial government funders could foster a more rational approach to resource allocation, including the consideration that better quality care is more efficient care. The bulk of health care in Canada is delivered in the private offices of practitioners, where quality assurance programming is relatively undeveloped. Although some licensing organizations do conduct proactive routine audits of their members' practices, a national survey, based on self-report, indicated that most of these programmes do not conform to recommendations found in the quality assurance literature. Although there have been some new initiatives in Canadian QA, it remains to be seen how these will influence the evolution of quality assurance programming conducted by Canada's health professions.
Physicians' interest in congenital malformations has varied greatly during the last two centuries. After an acme in the 19th century, teratology was of little inteerest to the medical profession during the first four decades of the 20th century. Since then a variety of events have again made birth defects important. An attempt is made to explain the waxing and waning of the physicians' attention to this age-old problem.
In Switzerland the ambulatory care system considered as a whole, is not sufficiently known, especially as regards number and location of institutions and professionals, forms of cooperation and measures of activity. The research team "Ambulatory care" of the Swiss National Research Programme No. 8 tries to fill that gap in the cantons of Fribourg and Vaud in pointing out to the recent but lasting numeric growth in all professions contributing to ambulatory care. The latter represent 42% of all health workers, and among them the physicians are 1/7. This study attracts attention to institutions and organizations like those providing home care and outpatient departments of regional hospitals.
BACKGROUND: Studies suggest that high levels of stress and psychological morbidity occur in health care profession students. This study investigates stressors and psychological morbidity in students of medicine, dentistry, physiotherapy and nursing at the University of Ibadan. METHODS: The students completed a questionnaire about their socio-demographic characteristics, perceived stressors and the 12-item General Health Questionnaire. Qualitative methods were used initially to categorise stressors. Data was then analysed using univariate and logistic regression to determine odds ratios and 95% confidence intervals. RESULTS: Medical and dental students were more likely to cite as stressors, overcrowding, strikes, excessive school work and lack of holidays while physiotherapy and nursing students focused on noisy environments, security and transportation. Medical and dental students (1.66; SD: 2.22) had significantly higher GHQ scores than the physiotherapy and nursing students (1.22; SD: 1.87) (t = 2.3; P = 0.022). Socio-demographic factors associated with psychological morbidity after logistic regression include being in a transition year of study, reporting financial distress and not being a 'Pentecostal Christian'. Although males were more likely to perceive financial and lecturer problems as stressors and females to perceive faculty strikes and overcrowding as source of stress, gender did not have any significant effect on psychological morbidity. Stressors associated with psychological distress in the students include excessive school work, congested classrooms, strikes by faculty, lack of laboratory equipment, family problems, insecurity, financial and health problems. CONCLUSION: Several identified stressors such as financial problems, academic pressures and their consequent effect on social life have an adverse effect on the mental health of students in this environment especially for students of medicine and dentistry. While stressors outside the reach of the school authorities are difficult to control, academic support including providing a conducive learning environment, advice on means for sustenance, added support during periods of transition are key areas for interventions.
The article discusses changes in the context within which the social professions are exercised. The chances for a refinancing of social work and indeed its very locations change in line with the transition to new steering elements in the social body and the new implementation of competitive elements in the realm of public law. With the economising of the social sphere social work is questioned under economic aspects. Simultaneously it gains normative significance. This is true with regard to standards for the quality of services and institutions, and further in the context of the discussion concerning the revitalisation of local social policy for the elderly. Precisely the economising of the social sphere raises the question whether the municipalities may be excused from their responsibility to form, preserve and support the obligations of social work with the elderly. This article denies this.
The professions have sought to formulate and maintain their own codes of conduct and ethics, in order to safeguard relationships of trust between client and professional and uphold a commitment to care and service. Recent court decisions reviewed here have asserted the supremacy of competition in professional as well as commercial relationships, where it is up to the buyer to "beware." The implications of these decisions have posed a moral challenge. By adhering to high standards, physicians will merit the trust of the public, so that the traditional distinction between the ethics of service and the ethics of the marketplace may be preserved.
In a longitudinal study conducted as part of a broad project dealing with socialization of health professionals in Israel, it was observed that during the course of professional socialization several major transformations occur in the dental student's image of the 'competent' dentist and in his self-image as a professional. Although students initially emphasized people-oriented traits as important to the competent dentist, this emphasis gradually decreased as their professional socialization advanced, concomitant with an increase in importance placed on status-oriented traits. The people-oriented elements likewise decreased in importance with regard to the student's self-image as professionals as they became more accustomed to professional reality. The correlation between these variables indicates the changes occurring in the students' acceptance or rejection of various aspects of their chosen profession throughout their years of study.
An empirical study of the dynamics of clinical clerkships in professional education is offered, with particular attention to ancillary professions. For students to eventually establish innovative practices within professional organizations, they need skills in the technical aspects of their fields, as well as in role-making and interprofessional negotiation. In examining a clinical clerkship in pharmacy, it was found that faculty overwhelmingly focus on technical matters, and assume that technical competence alone is enough to attain role expansion. The experiences of students, simulating participation in a complex organization as members of clinical teams, give good reason to question this and other assumptions constituting the structure of clerkships. Several recommendations issue from the analysis for strengthening the objectives of professional training.