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PubMed2005

Information technology and the board of directors.

Ever since the Y2K scare, boards have grown increasingly nervous about corporate dependence on information technology. Since then, computer crashes, denial of service attacks, competitive pressures, and the need to automate compliance with government regulations have heightened board sensitivity to IT risk. Unfortunately, most boards remain largely in the dark when it comes to IT spending and strategy, despite the fact that corporate information assets can account for more than 50% of capital spending. A lack of board oversight for IT activities is dangerous, the authors say. It puts firms at risk in the same way that failing to audit their books would. Companies that have established board-level IT governance committees are better able to control IT project costs and carve out competitive advantage. But there is no one-size-fits-all model for board supervision of a company's IT operations. The correct approach depends on what strategic "mode" a company is in whether its operations are extremely dependent on IT or not, and whether or not it relies heavily on keeping up with the latest technologies. This article spells out the conditions under which boards need to change their level of involvement in IT decisions, explaining how members can recognize their firms' IT risks and decide whether they should pursue more aggressive IT governance. The authors delineate what an IT governance committee should look like in terms of charter, membership, duties, and overall agenda. They also offer recommendations for developing IT policies that take into account an organization's operational and strategic needs and suggest what to do when those needs change. Given the dizzying pace of change in the world of IT, boards can't afford to ignore the state of their IT systems and capabilities. Appropriate board governance can go a long way toward helping a company avoid unnecessary risk and improve its competitive position.

Capital Expenditures↗
PubMed2002

Changes in biological anthropology: results of the 1998 American Association of Physical Anthropology Membership Survey.

In response to the results of the 1996 survey of the membership of the American Association of Physical Anthropology (AAPA), the Executive Committee of the Association sponsored a follow-up survey designed to assess gender and specialty differences in training, employment, academic status, mentoring, and research support. A total of 993 questionnaires was analyzed, representing approximately 62% of the 1998 membership of the Association. There has been a marked shift in the number of males and females in the discipline from the 1960s to the 1990s. While 51.2% of all respondents are female and 48.8% are male, 70% of the students are female. Chi-square tests indicate significant differences between males and females by highest degree, age, status, obtaining a tenure-track position, receiving tenure, and taking nontenure-track employment before receiving a tenure-track position. In recent years, there has been an increasing number of females in the ranks of assistant and associate professors; however, this is not true for the rank of professor. There are also significant differences between males and females by specialty within the discipline: researchers in primatology, human biological variation, skeletal biology, and paleopathology are primarily female, while researchers in human and primate evolution are increasingly female.

Adult↗
PubMed1998

Training resource document for curriculum development in medical oncology. Adopted on February 20, 1997 by the American Society of Clinical Oncology.

PURPOSE: Medical oncology is a rapidly growing profession, not only in its membership, but in its knowledge-base as well. In order to keep pace with the changing profile of health care delivery and still ensure uniform quality subspecialty training, a template for education is needed. DESIGN AND RESULTS: An Ad Hoc Committee was created from the American Society of Clinical Oncology (ASCO) membership. Goals of training were discussed and curriculum guidelines were created. To gain special expertise in medical oncology, the curriculum emphasizes formal instruction in the following: (1) the treatment of individual malignancies, with an emphasis on a coordinated multidisciplinary approach; (2) a clinical experience that emphasizes patient management in both the inpatient and outpatient settings; (3) the ability to perform specified procedures; and (4) the key tools in basic science that apply to patient management. This document should be considered the educational frame work around which a curriculum is developed.

Curriculum↗
PubMed1994

The future of healthcare ethics committees.

Ethics committees are fairly common in healthcare institutions in the United States. Comprised of a multidisciplinary membership, including physicians, their functions within institutions are generally threefold: policy recommendation, ethics education and case consultation. The number of such committees will grow as a result of "Patient Rights" standards established by the Joint Commission on Accreditation of Healthcare Organizations (1992 Manual). The author projects and discusses five areas of development and change in the future of healthcare ethics committees. These five areas are: 1) renewed efforts to educate healthcare professionals, 2) cooperation and collaboration among ethics committees, 3) networking with community-based ethics groups, 4) clearer delineation of responsibilities and limitations, and 5) continuous quality improvement. The ability of ethics committees to address successfully these areas of change will determine their future usefulness.

Bioethical Issues↗
PubMed1994

Quality improvement approaches. Survey of pathologists serving the pediatric patient.

A questionnaire was circulated in 1990 by the Practice Committee of the Society for Pediatric Pathology to its membership to assess the involvement of pediatric pathology departments (PPDs) in quality improvement (QI) activities. Twenty-nine PPDs responded. Analysis of responses disclosed a wide variation in plans, although the majority (22 of 29) had developed or were in the process of developing (three of 29) a specific plan. The plans varied in sophistication and complexity. Pediatric pathologists (directors or designates) were heavily involved in assuming leadership roles for the QI activities in 25 of 28 PPDs. The PPDs with plans (25) had identified the QI indicators monitored either sporadically or on an ongoing basis. The respondents had several indicators in common, such as volume, technical, and clinical indicators, as well as indicators related to turnaround times, meetings, and internal and external consultations. The plurality of the monitors reported are related to indicators in the discipline of anatomic pathology. This review is therefore limited to QI issues in anatomic pediatric pathology. In conclusion, this survey functions to shed some light on the extent of involvement of PPDs in the management of QI. In addition, it provides a model for starting or improving the existing QI plans for PPDs.

Autopsy↗
PubMed1993

Clinical indicators for oncology, cardiovascular, and surgical patients: report of the ADA Council on Practice Quality Assurance Committee.

Clinical indicators were developed as an ADA project for use by the membership and the Joint Commission on Accreditation of Healthcare Organizations as part of its Agenda for Change. This 3-year project involved three clinical indicator task forces who developed clinical indicators for oncology, cardiovascular, and surgical adult acute-care setting patient populations. The task forces developed clinical indicators that were revised after an extensive field review and validation by field test. The following indicators were recommended: Cardiovascular--Patients at high risk for impaired nutritional status receive nutrition intervention within 5 days of admission or within consecutive 5 days on clear liquid diet/nothing by mouth; Patients make food choices consistent with therapeutic diet. Oncology--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 5 days; All patients at moderate or high risk are identified by screening and assessed within 72 hours of admission; Patients at moderate or high risk are able to implement nutrition care plan at discharge. Surgery--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 7 days; No patient has weight loss greater than 10% of admission weight at discharge; calorie and protein and/or volume goals for patients on enteral or parenteral nutrition are documented in the medical record; Patients on enteral or parenteral nutrition receive at least 1,000 kcal/day by the fourth day after an operation.

Cardiovascular Diseases↗
PubMed1982

Interdisciplinary consultation on the care of the critically ill and dying: the role of one hospital ethics committee.

Little is known about the structure and objectives of various hospital ethics committees due to their need to preserve confidentiality, their reluctance to reveal internal hospital problems, and their concern about becoming involved in the developing debate about the appropriate role and value of such committees. The evolution, functions, and goals of one distinctive hospital committee concerned with the care of the critically ill and dying are explained. Its membership and proceedings are described, and the medico-moral issues with which it has grappled are presented and discussed. An assessment is provided of the positive and negative impact of this committee within the Medical Center with which it is affiliated. The experience of this particular group illustrates that hospital ethics committees can play advisory and educational roles within a large medical center. They can provide support for patients, medical professionals, and families who face difficult dilemmas about terminal illness. They can function as forces to sensitize medical personnel to the challenges presented by medicine's growing power over death. They can serve as catalysts for interdisciplinary communication. Finally, they can promote the development of new programs for informed and humane care of the terminally ill.

Aged↗
PubMed2004

[Compressive therapy after varicose vein surgery: results of a French national inquiry].

OBJECTIVES: A survey on postoperative compression after varicose vein surgery was undertaken in 2001 among surgeons of the French-speaking Vascular Surgery Society as well as non-members with a heavy caseload in varicose vein surgery. The aims of the study were to 1) identify the various medical devices and protocols used postoperatively, 2) estimate the frequency and duration of use, and 3) identify the surgeon's rationale for prescribing postoperative compression. The first part of the inquiry was devoted to surgical procedures and has been previously published (J Mal Vasc 2003; 28: 277-86). MATERIAL AND METHODS: A questionnaire with 11 items for postoperative treatments and a patient form was mailed to 675 surgeons. RESULTS: The response rate was 41.5% (280 surgeons). Results were assessed by a scientific committee. Surgeons were classified into different groups according to their membership in the French-speaking Vascular Surgery Society or not, the type of practice (private, public hospital, mixed), and caseload. Compression was widely used (97.1%). It was the only postoperative treatment for 25.2% of the surgeons, was associated with anticoagulant treatment for 38.8% or non-steroidal antiinflammatory drugs for 11.2%. Prescription was evidence-based for only 11.6%. Compression therapy was mainly started postoperatively (93.2%). Elastic bandages (long stretch) were used by 87%. Duration of bandage therapy was variable (less than 8 days for 38.8%, 8-15 days for 24.5%). After bandage therapy, medical compression stockings (above knee 74.7%) or French class II (77.9%) were used. Compression stockings were prescribed for 8-15 days or 15-30 days by 12.7% and 84.6% of the surgeons respectively. Prolonged postoperative treatment was not common (28%) and was prescribed for patients with trophic changes.

Bandages↗
PubMed2001

Scheduled cesarean delivery and the prevention of human immunodeficiency virus transmission: a survey of practicing obstetricians.

OBJECTIVE: To characterize practice patterns among obstetrician-gynecologists with respect to delivery for human immunodeficiency virus (HIV)-seropositive women, following publication of the 1999 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion regarding scheduled cesarean delivery for HIV-infected patients. METHODS: A 25-question, multiple-choice survey was mailed to 2000 randomly selected obstetrician-gynecologists: 1000 maternal-fetal medicine specialists and 1000 general obstetrician-gynecologists. Mailing addresses were obtained from the 1999-2000 editions of the Society for Maternal-Fetal Medicine (SMFM) and ACOG membership directories. Information was requested about general perceptions of the 1999 ACOG Committee Opinion and about practice patterns with respect to management of HIV disease in pregnancy. Data were analyzed by using descriptive statistics and the chi-square test. Any P values <.05 were considered significant. RESULTS: After a single mailing we received 512 responses (25.6%), including 433 (43%) from SMFM members and 79 (8%) from ACOG members. Among the respondents, 47% disagreed with the current scientific validity of the 1999 ACOG Committee Opinion recommendation to offer cesarean delivery to all HIV-seropositive pregnant women. No statistically significant differences were detected in the demographic profiles, years of experience, or practice settings of participants who agreed with the scientific validity when compared to those who did not. Most respondents used viral load detection (87%) monitored on a trimester basis (67%) for clinical management decisions. Most practitioners (72%) do not recommend cesarean delivery for women who are compliant with antiretroviral therapy and who have undetectable viral loads regardless of CD4 counts. However, most practitioners (67%) do recommend cesarean delivery for those compliant women with detectable viral loads, irrespective of CD4 counts (67%). CONCLUSIONS: There is considerable disagreement among practicing obstetricians with respect to the 1999 ACOG Committee Opinion recommendation to offer cesarean delivery to all HIV-seropositive women. Most physicians use viral load detection to assist with the counseling in delivery options for HIV-infected pregnant women.

Adult↗
PubMed2002

Benchmarks of support in internal medicine residency training programs.

PURPOSE: To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality. METHOD: A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses. RESULTS: Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work performed by the program director (a negative predictor), and financial support from pharmaceutical companies (also a negative predictor). CONCLUSIONS: These results identify benchmarks of financial and staff support provided to internal medicine residency programs. Some of these benchmarks are correlated with board pass rate, an accepted indicator of quality in residency training. Program directors and chairs can use this information to identify areas that may benefit from enhanced financial and administrative support.

Benchmarking↗
PubMed2001

From petting zoos to electronic classrooms: meeting the technology learning needs of family medicine teachers.

BACKGROUND AND OBJECTIVES: To meet the need for faculty development in the use of information technology for its membership, the Society of Teachers of Family Medicine (STFM) Program Committee implemented a pilot, fee-supported, electronic classroomformat at STFM's 2000 Annual Spring Conference. We assessed the characteristics of those who attended the sessions, the satisfaction of participants with the venue both from expressed satisfaction and enrollment, the financial viability of electronic classrooms, and whether participants used acquired skills 6 months after the conference. METHODS: An evaluation instrument was used to collect the demographic data on attendees and their satisfaction with the sessions they attended. This data was compiled and compared with the demographics of overall conference attendees. The enrollment and revenues for the electronic classrooms were totaled and compared with expenses. A 6-month post-conference phone survey was conducted to assess continued use of learned skills. RESULTS: Attendees were more likely to be physicians from community-based residencies. The program was filled to 80% capacity. Survey results indicated that the program was satisfying to attendees. Registration fees covered costs. Most participants were still using their new skills 6 months after the program. CONCLUSIONS: The electronic classroom pilot was successful and provides skills that participants use months after the program. This program can be used to meet the educational technology training needs of STFM members.

Adult↗
PubMed2001

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process.

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) "Minimum Standards for Health Sciences Libraries in Hospitals." In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team.

Accreditation↗
PubMed2002

Genetics and insurance.

Both the membership and terms of reference of the Genetics and Insurance Committee (GAIC) are under review. The Department of Health is currently seeking twelve new members of the committee, as part of its response to a Select Committee report last year on the use of genetic tests by the insurance industry. This article reproduces the Select Committee's recommendations and some of the Government's response, and sets them in context.

Advisory Committees↗
PubMed1996

[Brief history of the Spanish Society of Microbiology. III. From 1977 to 1983].

This is the third article of the series about the history of the SEM. It comprises the period from 1977 to 1983. During that period, the 7th and 8th SEM national congresses took place in Cádiz (1979) and Madrid (1981) respectively, and other scientific meetings and activities of the specialized sections were organized. The executive committees of the SEM over that period are listed. SEM membership during that period increased significantly.

Congresses as Topic↗
PubMed2007

Establishing procedures for institutional oversight of stem cell research.

Academic health centers (AHCs), which are at the forefront of stem cell research, need to establish institutional stem cell research oversight committees (SCROs) to comply with 2005 National Academy of Sciences (NAS) recommendations and to establish public trust in this sensitive research. Institutional review boards (IRBs) typically lack the expertise and time to adequately review the specific ethical issues raised by stem cell research. To assure careful, timely, and coordinated review of the science and ethics of stem cell protocols, AHCs need to address many practical procedural issues, such as SCRO membership, quorum, conflicts of interest, and procedures for protocol review. The SCRO committee at the University of California San Francisco (UCSF), established in 2003, has developed detailed policies and procedures on these issues. The UCSF SCRO has broad scientific expertise and uses ad hoc reviewers to strengthen the review process. Studies receiving full SCRO review have three lead reviewers: a scientist, a reviewer with ethics expertise, and a public representative. Studies introducing human stem cells into nonhuman blastocysts receive full review, even if the stem cells are anonymized. Some protocols are eligible for expedited review. The SCRO neither replaces nor duplicates review by the IRB and institutional animal care and use committees. Other AHCs can draw on the UCSF experience when developing their own policies and procedures for stem cell research oversight.

Academic Medical Centers↗
PubMed1989

Ethics consultants and ethics committees.

To address moral questions in patient care, hospitals and health care systems have enlisted the help of hospital ethicists, ethics committees, and ethics consultation services. Most physicians have not been trained in the concepts, skills, or language of clinical ethics, and few ethicists have been trained in clinical medicine, so neither group can fully identify, analyze, and resolve clinical ethical problems. Some ethics committees have undertaken clinical consultations themselves, but liability concerns and variable standards for membership hinder their efforts. An ethics consultation service comprising both physician-ethicists and nonphysician-ethicists brings complementary viewpoints to the management of particular cases. If they are to be effective consultants, however, nonphysician-ethicists need to be "clinicians": professionals who understand an individual patient's medical condition and personal situation well enough to help in managing the case. Ethics consultants and ethics committees may work together, but they have separate identities and distinct objectives: ethics consultants are responsible for patient care, while ethics committees are administrative bodies whose primary task is to advise in creating institutional policy.

Consultants↗
PubMed2006

Respiratory care manpower issues.

OBJECTIVE: Although respiratory care is a relatively new profession, its practitioners are deeply involved in providing patient care in the critical care. In preparation for writing this article, we sought to explore the respiratory therapy manpower needs and activities designed to fulfill those needs in critical care practice. MATERIALS AND METHODS: We began by delineating the historical development of respiratory care as a profession, the development of its education, and the professional credentialing system. We then conducted several literature reviews with few articles generated. We requested and received data from the American Association for Respiratory Care (AARC), The National Board for Respiratory Care (NBRC), and the Committee on Accreditation of Respiratory Care education (CoARC) relative to their membership, number of credentialed individuals, and educational program student and graduate data for 2000 through 2004. We then conducted two electronic surveys. Survey 1 was a six-item survey that examined the use of mandatory overtime in respiratory care departments. We used a convenience sample of 30 hospitals stratified by size ( or=500 beds). Survey 2 was a five-item instrument distributed by blast E-mail to the Society of Critical Care Medicine's Respiratory Care Section members and members of the RC_World list serve. This survey elicited 51 usable and non-duplicative responses from geographically and size-varied institutions. We analyzed these data in several ways from distribution analysis to one-way analysis of variance procedure and appropriate post hoc analysis techniques. Where appropriate, a matched-pairs analysis was performed and these were compared across the variables intensive care unit (ICU) beds per actual number of respiratory care practitioners (RCPs) and ICU beds per preferred number of RCPs. RESULTS: The data gathered from the professional organizations indicated a relatively stable attrition rate (35.2%+/-1.7-3.1%), even in the face of varying enrollments (6,231 in 2004 vs. 4,589 in 2002). In survey 1, we looked at the institution of mandatory overtime policies and their use in 30 size-stratified hospitals. Mandatory overtime was selected as a survey topic under the supposition that manpower shortages might lead to the development of such procedures and also to their utilization. Fourteen of the 30 hospitals responding indicated that they had a policy addressing mandatory over time. Of the 14 hospitals with policies, only ten had disciplinary actions specific to refusing the overtime. Seven of the 30 hospitals indicated that they used mandatory overtime monthly of more frequently. Survey 2 data revealed that there was a wide variation in bed size, number of ICUs, and number of RCP staff assigned to the ICU. Serendipitously, our 51 responding centers were distributed among small (16), medium (19), and large (16) hospitals in a manner that appeared to reflect the national distribution pattern. We were able to use these data to develop a closeness of fit diagram ICU beds to preferred numbers of RCPs (DF=48; p<.0001; RSq=0.77; RMSE=4.114). The number of beds per preferred number of RCPs was 9.445 to 1.0 while the actual bed to RCP ratio was 10.75 to 1. CONCLUSION: This article provides a short history of the development of respiratory care and its historical relationship with critical care. We have, perhaps for the first time, provided a unified data set of key demographic information from the three professional bodies guiding the development of the respiratory therapy profession. This data set provides time-linked data on admissions and graduations from the CoARC, membership numbers for the AARC, and the numbers of active credentialed RCP from the NBRC. By two focused surveys, we were able to show that while mandatory overtime is a common practice in respiratory care departments, it was not overwhelming utilized. We also learned that in most hospitals, regardless of bed size, there is a perceived need for 1.3 RCPs more than the actual staff and that it appears that the critical staffing level between actual to preferred RCP to beds is between 9 and 11 beds.

Attitude of Health Personnel↗