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PubMedDate not supplied

Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington.

PURPOSE: Little is known about whether different types of physician and nonphysician primary care clinicians vary in their propensity to care for underserved populations. The objective of this study was to compare the geographic distribution and patient populations of physician and nonphysician primary care clinicians. METHODS: This study was a cross-sectional analysis of 1998 administrative and survey data on primary care clinicians (family physicians, general internists, general pediatricians, nurse practitioners, physician assistants, and certified nurse-midwives) in California and Washington. For geographic analysis, main outcome measures were practice in a rural area, a vulnerable population area (communities with high proportions of minorities or low-income residents), or a health professions shortage area (HPSA). For patient population analysis, outcomes were the proportions of Medicaid, uninsured, and minority patients in the practice. RESULTS: Physician assistants ranked first or second in each state in the proportion of their members practicing in rural areas and HPSAs, and in California physician assistants also had the greatest proportion of their members working in vulnerable populations areas (P < .001). Compared with primary care physicians overall, nurse practitioners and certified nurse-midwives also tended to have a greater proportion of their members in rural areas and HPSAs (P < .001). Family physicians were much more likely than other primary care physicians to work in rural areas and HPSAs (P < .001). Compared with physicians, nonphysician clinicians in California had a substantially greater proportion of Medicaid, uninsured, and minority patients (P < .001). CONCLUSIONS: Nonphysician primary care clinicians and family physicians have a greater propensity to care for underserved populations than do primary care physicians in other specialties. Achieving a more equitable pattern of service to needy populations will require ongoing, active commitment by policy makers, educational institutions, and the professions to a mission of public service and to incentives that support and promote care to the underserved.

Adult↗
PubMedDate not supplied

The public health workforce.

Defining the public health workforce and specifying its performance requirements present equal challenges as the nation anticipates public health needs for the twenty-first century. The core group of professionals employed by government public health agencies works in close partnership with a wide range of public, private, and voluntary organizations. The wider circle includes almost all physicians, dentists, and nurses, plus many other health, environmental, and public safety professionals. The task of ensuring that this workforce is prepared with skills and knowledge to face both identified and emerging public health challenges is immense.

Education, Public Health Professional↗
PubMed2026

Digital and computational morphology in hematology: current platforms, clinical evidence, and future requirements.

INTRODUCTION: Morphologic examination of peripheral blood and bone marrow remains central to the diagnosis and classification of hematologic disorders. Conventional optical microscopy, however, is labor-intensive, dependent on operator expertise, and affected by interobserver variability. Digital morphology has developed from automated image acquisition and cell pre-classification into a broader field that includes whole-slide imaging, remote review, quantitative morphometry, and artificial intelligence-based analysis. CONTENT: This review examines current applications of digital morphology in peripheral blood, bone marrow aspirates, malaria detection, and body-fluid analysis. Commercial platforms are evaluated with particular attention to the distinction between raw automated pre-classification, expert digital post-classification, and comparison with independent optical microscopy. Digital systems generally perform well for common mature leukocyte populations but remain less reliable for rare or diagnostically critical cells, including blasts, abnormal lymphoid cells, plasma cells, and intermediate maturation stages. Research systems increasingly extend analysis from individual-cell classification to whole-slide, specimen-level, and patient-level assessment. SUMMARY: Digital morphology can improve standardization, image traceability, remote consultation, education, proficiency testing, quality assurance, and selected aspects of laboratory workflow. Its clinical value depends on appropriate validation, transparent reporting of reference methods, recognition of algorithm-specific failure modes, and clearly defined criteria for expert review and conventional microscopy. Human expertise remains essential not only for validating results but also for adapting cell taxonomies and interpretive rules to evolving classifications of hematologic diseases. OUTLOOK: Future progress will require representative multicenter datasets, harmonized morphologic terminology, external validation, interoperability with laboratory information systems, and continuous monitoring after software or hardware updates. Integration of morphology with quantitative hematology, flow cytometry, cytogenetics, genomics, and clinical data may support more comprehensive computational diagnosis. Digital platforms may also broaden access to specialist expertise, training, and quality programs in resource-limited institutions and regions, provided that infrastructure, governance, and professional competency are adequately supported.

artificial intelligence↗
PubMed1997

[Values that guide the decision process in nursing].

The aim of this study is to identify the values raised by a group of nurses from a health care institution, and to understand in which way these values can interfere in nursing management activities. This study was based on Methodological Triangle which envolves both quantitative and qualitative methods. It was held at a philantropic hospital in São José do Rio Preto with nurses who work in specialized areas with in-patients. The data were collected using a questionnaire in which three situations were presented covering usual incidents to nurses. These situations required important decisions to be made based on personal values. The results showed that for nurses, honesty, self-control and responsibility are inter-related; usually, the nurses demonstrated tolerance, understanding and solidarity. But, many times, nurses are condescending to their subordinates when their professional competence is not required. However, when trying to attain social recognition, nurses are keen and they can punish their subordinates.

Attitude of Health Personnel↗
PubMed2006

[Reflections on nursing teaching and students' first contact with the profession].

Nursing teaching has been characterized by constant discussions on pedagogical proposals and implementation of curricular changes. The aim of this study was to reflect on nursing students' experience related to their first contacts with the profession, considering traditional perspectives and current tendencies that imprint values and attitudes in learning and practice. Nowadays, the complexity of human beings and the environment they live in is considered within a biopsychosocial, economic and cultural context, constituting resources that allow for the formation of competent professionals in order to deal with the challenges of the XXIst century. Thus, nursing schools have to follow a teaching philosophy to form trained people to attend to local and regional demands and are socially committed to change. What is aimed for is participative learning, in which teacher and student, articulated in the knowledge improvement process, do not forget about humanitarian views.

Education, Nursing↗
PubMed2004

[Evidence based clinical practice. Part 1--well structured clinical questions].

Clinical decisions in daily practice, to resolve patient's problem, are usually based at the conscious use of the available information, through explicit determined rules. Evidence based clinical practice recognize the explicit and tacit knowledge, understanding that it is impossible all the aspects of professional competence become explicit. The doubt becomes part of the decision process, identifying initially the unconscious component involved and after the explicit knowledge used. When we make a structured clinical question with a possible answer, it is necessary to remember that the doubt can be related to basics and of definition aspects of the disease or related to the patient's manager, like diagnose, treatment and prognosis. Along our medical life, both types of question are present, with proportional change as the experience increase along the clinical practice. The process to find an appropriate answer to the doubt, came out at patient's care, depends on how the parts of this process will be structured. The recommended form is known by PICO abbreviation, that means: P: patient or population, I: intervention or indicator, C: comparison or control and O: outcome, or the answer expected found at the scientific information bases. This is the first basic need to a successful search, and the second need is to find the key words that better describe each of the four components of the questions. Without this caution, the search at compute databases results in absence of information or in a lot of information that it is not related to our interest.

Decision Making↗
PubMed2005

Continuing medical education in Brazil: what about obstetricians and gynecologists?

CONTEXT: In Brazil, obstetricians and gynecologists are not required to submit to periodical evaluations to ascertain their professional competence in dealing with new concepts and therapies. OBJECTIVES: To evaluate the performance of a group of obstetricians and gynecologists on a written evidence-based obstetrics test and determine their opinions and use of systematic reviews. TYPE OF STUDY: Prospective cohort. SETTING: Brazilian Obstetrics and Gynecology Congress 2001. METHODS: 230 doctors agreed to participate in the study during a national obstetrics and gynecology congress. Participants took an individual anonymous written multiple-choice test with seven questions on clinical obstetrics, one question on the interpretation of a meta-analysis graph and two questions on their opinions and actual use of systematic reviews. Scores were analyzed and compared after grouping the participants according to year of graduation, residence training, doctoral program and faculty status. RESULTS: The general average score was 49.2 +/- 17.4. The scores tended to decline as the years since graduation advanced. Doctors who graduated in the last five years had higher scores than those who graduated over 25 years ago (52.2 versus 42.9). The performance did not vary according to medical residence, postgraduate program or teaching status. While 98.2% considered systematic reviews relevant, only 54.9% said that they routinely used this source of information. DISCUSSION: The participants' average score was low, even though they were highly qualified and trained. Despite the limitations of the study, the results are worrisome. If motivated physicians participating in a national congress obtained such low scores, we can speculate that the results might be even worse among other doctors that do not attend these events. CONCLUSIONS: These findings suggest that Brazilian obstetricians and gynecologists could benefit from continuing medical education and raise questions about the recycling methods currently available.

Brazil↗
PubMed2002

Checking the pulse: Midwestern reporters' opinions on their ability to report health care news.

OBJECTIVES: Newspapers play a key role in disseminating information and shaping perceptions about health, research, and policies. Inadequate or misleading reporting constitutes a public health threat that can jeopardize individual health and lead to harmful health policies. METHODS: Surveys were mailed to 165 reporters at 122 newspapers in 5 Midwest states. The association of training, newspaper size, and experience with reporter's self-perceived reporting ability was assessed. RESULTS: The response rate was 69.6% (115/165). Between 66% and 85% of the reporters assessed 4 tasks vital to sound health reporting as "sometimes difficult" to "nearly always difficult." No significant differences in perceived ability were found by training or newspaper size. Respondents with less experience reported higher perceived ability. CONCLUSIONS: These findings show that reporters may have difficulty understanding complex health issues and interpreting statistics because they are inadequately trained.

Attitude to Health↗
PubMedDate not supplied

Overcoming barriers to access and utilization of hospice and palliative care services in African-American communities.

While there is ample evidence to support the need for hospice and palliative care services for African Americans, only 8% of patients who utilize those services are from African-American communities. The underutilization of end-of-life and palliative care can be attributed to several barriers to service access including incompatibility between hospice philosophy and African-American religious, spiritual, and cultural beliefs; health care disparities; distrust of the medical establishment; physician influence; financial disincentives, and hospice admission criteria. Suggestions for dismantling barriers to care access include developing culturally competent professionals in the health and human services, expanding the philosophy of hospice to include spiritual advisors from client communities, and funding national initiatives to promote improved access to health care at all stages in the life cycle of members of all underserved communities.

Attitude of Health Personnel↗
PubMed1998

Characteristics of APA Division 40 Fellows and ABPP Diplomates in clinical neuropsychology.

Diplomate and Fellow status in clinical neuropsychology reflect professional competency and a record of significant contributions to the field. This present study provides a snapshot of the pathways to these distinctions and focuses on the educational history and demographic description of ABPP Diplomates and APA Division 40 Fellows. Identification of degree-granting institutions of these psychologists provides distal outcome data for training programs. Both credentials were identified as midcareer markers, as attainment of either required over 12 years of postdoctoral experiences. The pool of Fellows is significantly older than the Diplomates, but these data are confounded as 53 individuals hold both a diploma and Fellow status. Women were underrepresented in both groups. In regard to degree specialty, clinical psychology was the most prevalent degree program represented; however, the groups appear to be permeable to psychologists who received formal training in other subspecialties.

Adult↗
PubMed1990

Defining fitness and aptitude to practice medicine.

This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as 'fitness and aptitude', that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Aptitude↗
PubMed1990

A three-year training programme for primary health care physicians in Poland.

A three-year training programme was developed and implemented by the Medical Centre of Postgraduate Education in Poland with the aim of improving the knowledge and skills of primary health care physicians working in the State Health Services' community centres. The programme creates several learning and self-assessment opportunities with the general principle of not distracting a doctor from his daily duties in a community health centre for more than one day a month. Preliminary assessment of the programme revealed its positive impact on both the health services system and primary health care physicians themselves. It increased health authorities' activity in creating new learning opportunities and doctors' motivation to learn. Self-assessment made by the first group of trainees who completed the three-year programme (results obtained by means of a questionnaire) revealed substantial increase in professional competence resulting from the participation in the programme.

Curriculum↗
PubMed1991

General practitioners' attitudes to a recent change in their remuneration system.

The study examines the attitudes of general practitioners in Copenhagen to a recent change in their remuneration system from capitation to a mixed capitation and fee-for-service system. The study was based on two questionnaires, one before and one 18 months after the change, distributed to a primarily self-selected sample of 100 general practioners in Copenhagen City. The questionnaires provided information about certain basic characteristics of the respondents, attitudes to the new remuneration system as compared with the former, and possible changes in attitudes towards professional competence and responsibilities in secondary versus primary care. The majority of the respondents did not feel any changes under the new remuneration system in terms of diagnostic and curative possibilities and their relations to colleagues and patients. Attitudes to secondary versus primary care responsibilities also changed little. The majority felt that there had been an increase in their total work load, but also an improved economic situation in their practice. 21% felt that there was more competition with colleagues and 30% that doctor-patient relationships had suffered as a result of the introduction of a fee-for-service.

Adult↗
PubMed2004

[Nursing practice in the context of geographic isolation: implications for training].

A survey on the characteristics of the unique working context of nursing practice in remote areas of French Polynesia and semi-remote areas of northern Quebec demonstrates the importance of a specific training to best prepare the professionals who find themselves in this type of setting. Twenty professionals were interviewed: six nurses practicing in isolated stations in French Polynesia (Tuamotu Archipelago, Marquesas Islands and Austral Islands), six nurses practicing in semi-remote areas within northern Quebec (namely among the Algonquins, the Crees and the Attikameks), four officials of the French Polynesian Health Directorate and four training programme designers from Quebec who were encountered during an expedition to Montreal, Mistissini and Trois-Rivieres. The authors identified ten characteristics which were then regrouped into two categories for both of the practice contexts: first, those inherently linked to professional practice in an isolated context (including the characteristics of nursing practice, the working conditions, the community's health problems, their forms of socio-professional relations, their way of life, and their perception and responses to isolation); and second, those pertaining to the social and natural environment, the economic conditions and the community's cultural specificities. All of the results strongly demonstrate that the specificities of the skills utilised by these nurses are indeed very different than those which they received in their initial preparatory training. If a training programme specific to nursing practice in isolated settings seems essential for these nurses, their individual predisposition to practice in such a complex environment and the acknowledgement of their professional competencies are equally to be considered within the perspective of human resources management.

Adult↗