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PubMed1982

New dental graduates: mobility and choice of dental practice arrangement. Bureau of Economic and Behavioral Research.

The key to understanding changes in the distribution of dentists through time is organizing and understanding the location decisions of recent graduates and dentists leaving the armed forces and federal service. New graduates represented approximately 57% of the new practices located between 1976 and 1979, and dentists in institutional service represented 21% of all movers. The migration rate among private practicing dentists who remain in private practice is roughly one-third the rate among all dentists. Further, practitioners who do move do not move very far. The proportion of interstate moves among all private practitioners that moved was only 28%. Apparently, migration among private practicing dentists is a statistically negligible phenomenon, at least in the short run. In contrast, more than 5,000 people have graduated from dental school each year since 1976. Of these, the majority immediately enter private practice, with most of the remainder split between specialty education and some form of institutional practice. Within approximately five years, the transition of the graduation cohort is largely complete. In the three years studied, the number of dentists entering private practice from either dental school or institutional practice is roughly four times the number of private practicing dentists who relocated. Few dentists in private practice do not own or share in the ownership of the practice where they treat patients. Although a higher percentage of the younger, less experienced dentists are in salaried, commissioned, or associate positions compared with all dentists, the majority assumes ownership positions soon after leaving dental school.

Dentists↗
PubMed2000

A practice-based approach to the selection of course content.

In an attempt to reduce the theory-practice gap, institutions have tried to base the content of nursing courses on practice. When devising courses, groups or individuals decide the course content through discussion and debate. It is proposed that courses devised in this manner reflect the subjectivity of the individuals or the power relationships within the group rather than the reality of nursing practice. The author compared the content of a current theatre nursing course, devised by an individual, against content determined through researched observation of theatre nurse practice. While the author found that the observations confirmed the relevance of most of the current course content, some subjects were not addressed. The most surprising of these, and one which appeared to have an enormous influence on theatre nurse practice, was sociology.

Attitude of Health Personnel↗
PubMed1979

Environmental change and psycholinguistic ability of mentally retarded adults.

Effects on linguistic ability of transferring retarded adults from a large institution to small "family" bungalows were examined. Effects of environmental change on linguistic ability were assessed using the Illinois Test of Psycholinguistic Abilities (ITPA) and by video-tape recordings of subjects engaging in speech. Results indicated that the bungalows had more resident-oriented as opposed to institution-oriented practices and more staff-resident interaction than did the large institution. The residents to be transferred were matched with control subjects who remained in the large institution. The ITPA was administered and resident interviews were video taped for both groups immediately before the transfer date and 9 months later. Psycholinguistic ability improved significantly more for transferred residents than for control subjects. Transferred residents increased the number of words used in affirmative and negative replies to simple questions during the videotaped interview, but there were no indications of any progression from one language stage to the next. The findings are comparable to previous studies concerning environmental change and increase in language ability of retarded children.

Adult↗
PubMedDate not supplied

House physicians. Accountabilities and possibilities.

Current house physicians' practice, responsibilities, and earnings are reviewed. House physicians are licensed, ordinarily institutionally based, typically salaried physician employees of 1 or more hospitals or systems. Many are hourly workers, often foreign medical graduates or physicians in training, with little professional status and less visibility. Yet managed care sees a new, creative role for house physicians that makes them masters of quality and models of service. No longer dependent beings shielded by an institution's coverage, house physicians can emerge as efficient, educated champions of inpatient medicine. To produce hospital generalist physicians for the patient's good, physician availability, institutional financial incentives, and patient values must align.

Career Choice↗
PubMed2003

Is administration of enteric contrast material safe before abdominal CT in children who require sedation? Experience with chloral hydrate and pentobarbital.

OBJECTIVE: It has been common practice to administer enteric contrast material in preparation for abdominal CT in children who require sedation to be examined. At some institutions, the practice of administering an anesthetic or enteric contrast material before sedation is being challenged because it violates the "nothing by mouth" status that is otherwise strictly enforced before sedation. Our purpose was to review our safety record in administering enteric contrast material for CT before sedation. MATERIALS AND METHODS: Radiology reports, medical records, and department incident reports were reviewed for the past 5 years from all patients who required sedation for abdominal CT. Patient age and sex, type of sedation, and complications (defined as vomiting with aspiration) related to enteric contrast material before the sedation were recorded. For routine oral contrast material, diluted Hypaque (meglumine diatrizoate) was administered in an age-based amount 1-2 hr before scanning. For sedation, depending on the patient's age, either oral chloral hydrate (70-100 mg/kg) or IV pentobarbital (3 mg/kg with repeated doses of up to 7 mg/kg) was used. RESULTS: Three hundred sixty-seven patients who received oral contrast material before sedation for abdominal CT were identified (200 boys, 167 girls; age range, 1 month-19 years; mean age, 2.9 years). Chloral hydrate was used in 30 patients and IV pentobarbital in 337 patients. No complications related to the administration of oral contrast material before sedation were identified. CONCLUSION: The practice of administering oral contrast material in children before sedation for abdominal CT appears to be safe when using the sedation drugs and protocols in place at our institution. Further study of the safety of this practice should be undertaken.

Administration, Oral↗
PubMed2005

Outcomes from intensive training in genetic cancer risk counseling for clinicians.

PURPOSE: Genetic cancer risk assessment is an emerging interdisciplinary practice that requires knowledge of genetics and oncology and specialized patient and family counseling skills. There is a growing need for cancer risk assessment practitioners, but most clinicians have inadequate cross-disciplinary training. An interdisciplinary course was developed to promote practitioner-level competency in cancer risk assessment to community-based clinicians. METHODS Participants were competitively selected from a pool of board-certified/eligible genetic counseling, masters-trained advanced practice nursing and physician applicants. Preference was given to clinicians with strong institutional backing practicing in underserved regions. The Continuing Medical Education/Continuing Education Unit-accredited course included didactic lectures, workshops, counseling practicum, and case conferences. Pre- and postcourse knowledge tests measured cancer genetics knowledge. Six month and one-year postcourse practice outcome surveys measured the impact of the program on professional self-efficacy and continued professional development. RESULTS/CONCLUSIONS: Forty clinicians completed the course (23 genetic counselors, 14 nurses, and three physicians). There was a significant overall increase of 22.6% in postcourse knowledge scores (P < 0.001). Thirty-five (88%) completed prescribed practice development activities. Of 29 respondents to 1-year postcourse survey, 76% reported increased professional self-efficacy; 66% reported increase in number of patients seen, and virtually all indicated interest in additional training. Outcomes demonstrate the value and efficacy of interdisciplinary training in genetic cancer risk assessment targeted to motivated community-based clinicians. Courses such as this can help address the need for competent cancer risk assessment services in communities outside the academic health center.

Education, Medical, Continuing↗
PubMed1976

Service delivery structure and continuity of care: a case study of a pediatric practice in process of reorganization.

The effects of the reorganization of a medical practice on continuity of care were investigated in a case study of a changing pediatric practice. Continuity, which has often been conceptualized as one indicator of quality of care, was measured by an index of which the numerator was the number of visits with own pediatrician and the denominator was the total number of pediatric visits for the year. Increased number of pediatricians and incorporation of the practice into an academic setting resulted in a decline of continuity of care accompanied by a rise in the number of doctor visits for acute illness care. Patient satisfaction, although related in some of its aspects to continuity, was by and large unaffected by the change. The consequences of changes in practice size and goal complexity for interpersonal aspects of patient care and quality of care are discussed.

Comprehensive Health Care↗
PubMedDate not supplied

The next step for physician executives?

The next step for career growth for many physician executives will be the top leadership role in a health care organization. The availability of such positions for physicians has been limited in the past but could very well open in the future. As physicians, administrators, and boards begin to trust each other more and form meaningful partnerships, the potential for physician CEOs increases. In 1997, the Physician Executive Management Center conducted surveys of physicians serving in CEO roles in hospitals and group practices throughout the country. We compared the results with earlier surveys we had conducted since 1986. This article reports the significant findings of these surveys on areas such as employment contracts, job duties, skills and talents, and remuneration.

Career Mobility↗
PubMed1985

The nutritional care of people with mental handicap.

An introduction to the changing field of mental handicap and to possible roles for the dietitian in this field illustrated with specific examples from clinical practice. The dietitian who specialises in mental handicap may work in both institutional and community settings and with all ages. Current views on prevention, treatment and rehabilitation are reviewed.

Adult↗