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Recruiting physicians without inviting trouble.

Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

Institutional Practice↗

From research to practice. Role of a research institution in the development of the work environment.

To conclude, all the signals from the future working life and the society at large speak for the growing importance of research in the areas of environmental health and occupational health. This research, in order to have the best impact, should be guided by solid strategy based on the soundest health values presenting clear priorities, and directed to the preventive impact-oriented actions, and using the competence of highly motivated researchers. The researchers should be well supported by their research institutes with good operational capacity and facilities and be provided with close contacts with the consumers of the research. This would facilitate the application of research results in the practical work environment. If all these criteria are met we can also expect an impact. We are all called upon to take part in this exciting effort, and I am happy to state that the response of UOEH during its over 13 years of activity has been a most beautiful example for all of us. Let me transmit the warmest congratulations to UOEH for the past and wishes of success in the future.

International Cooperation↗

Compliance with the 24-hour, in-house attending coverage requirement. A survey.

Fifty-six residency training programs in Region I Council on Resident Education in Obstetrics and Gynecology/Association of Professors in Gynecology and Obstetrics were surveyed for compliance with the 24-hour, in-house attending coverage requirement, which took effect July 1991. Forty-six program directors responded to a questionnaire, for a response rate of 82.1%. Each had plans to implement this coverage in the 1991-1992 academic year. Two programs were unable to implement coverage because of inadequate financing or insufficient staffing. There were no differences in the types of programs (community, university, public or private university, or New York State program) in respondents as compared to non respondents. All the programs had overnight staff coverage for an average of 13 hours (range, 12-15) and had 24-hour, continuous coverage on the weekend. There was a wide variation in the attending/resident ratio. Twenty-eight programs (60.8%) reported that they compensated their attendings. Revenue for this compensation came from the hospitals (14), direct billing (8), faculty practice plans (6) or New York State (3). Of the 28 programs that offered compensation, 20 were private community hospitals, 6 were private university programs, 1 was a public university program and 1 was a public community hospital. Of the 28 programs compensating faculty, 17 were able to cite figures that had been approved by their respective institutions or practice plans. The annual cost ranged from $130,300 to $901,887 per program for institutions that compensated their attendings (mean, $340,402).

Gynecology↗

Hypertension detection and control: population and policy implications.

The decline in cardiovascular diseases is by far the most remarkable achievement of medicine in the last half of the twentieth century. It can even be said that the treatment of hypertension is the only known medical intervention to have left a clear imprint on mortality trends. Much more remains to be accomplished, however, before even the majority of patients in the United States will be controlled with pharmacologic therapy [27,28]. Significant changes are needed to improve the practice of institutions, the adherence of physicians to appropriate guidelines, and the consistency of pill taking on the part of patients. Global risk evaluation is currently being used more widely in clinical practice to target therapy and improve its overall effectiveness; however, it is perhaps too early to assess its practical value. On theoretic grounds alone, much more needs to be done to refine prediction of cardiovascular risk as a clinical tool. Improvement in information technology, including an electronic medical record and on-line risk equations, will also be required before its full value can be realized.

Female↗

Creating a halo traction wheelchair resource manual: using the EBP approach.

This article describes a clinically based project that used evidence-based practice (EBP). It follows the EBP process of: (1) identifying a clinical problem and stating a clinical question that focuses the process; (2) doing a literature search for best research evidence; (3) using query techniques, such as phone calls and e-mails, to determine best clinical practice among similar institutions; and (4) drawing a practice conclusion-to accept the status quo, to instigate change of practice, or to do more research. This project was an interdisciplinary effort orchestrated by the surgical programs nurses at Boston Children's Hospital.

Adolescent↗

Caveats in interpreting and applying pharmacoeconomic data.

Cautions in the interpretation and application of pharmacoeconomic data are discussed. Cost containment is driving outcomes research and can cause pharmacoeconomic study methods to be manipulated to support preordained conclusions. The usual tactic is to adopt a narrow perspective in assessing benefits and costs. For example, many calculations ignore financial and physical pain borne by the patient. Before the results of any pharmacoeconomic analysis are embraced, the perspective adopted should be carefully examined. Each provider must look at a product or service from all relevant angles and in the context of its own standards. Although outcomes research may indeed make it possible to provide high-quality care for less money in the long term, in the short term these studies are devoted largely to the goal of spending less, even if some patients may suffer. In such circumstances, legal issues unavoidably arise. Principal among them is tort liability, the risk of being deemed negligent either in providing care or in obtaining informed consent. Any topic pressing enough to be included in outcomes research agendas and debates is going to require decisions that consider (1) the positions of national medical specialty societies, (2) the relevant catchment area or other defining cohort, (3) the specific institution, and (4) the professionals practicing in that institution. The inhouse professional who disagrees with rationing can become a credible whistle blower, and the judiciary may go to extraordinary lengths to empower patients, even without whistle blowers. Complete honesty in obtaining informed consent can help avoid legal actions. Pharmacoeconomic research can be useful in describing value for money spent. It is important to remember, however, that perspective matters in any analysis and that honesty is vital in policymaking and in sharing information with patients.

Data Interpretation, Statistical↗

Reflections on a young offenders institution: communication--a need, a want, a right.

In this article, it is demonstrated that a dichotomy exists between wider societal movements to develop communication between individuals and among institutions and management practices within a young offenders institution. The principle aim of the article is to illustrate how young offenders are being systematically denied the opportunity to socially interact with others at an appropriate level. The significance of social exchange for these prisoners and how they achieve this is highlighted. The article concludes by suggesting some recommendations in relation to communication within young offenders institutions.

Adolescent↗

Caudal anesthesia in pediatric surgical practice.

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

Anesthesia, Caudal↗

[Observations on medical quality assurance in hospital medicine].

The main belgian laws about quality of health care are explained. The political and social reasons of these recent laws are discussed, as are the consequences on medical practice. The general process and some programs managing the quality of health care are given as examples.

Belgium↗

The use of negative indexes of health to evaluate quality of care in a primary-care group practice.

A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.

Adult↗