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PubMed1999

The effects of gender and race on practice pattern preferences of dental students.

Type of practice arrangement is an important decision for student dentists, and one that has implications for the future delivery of dental care. This study examined the effects of two student-related characteristics, gender and race, on dental student preferences for three practice arrangements: solo ownership, group ownership, and employee practice. Dental students read content-validated practice descriptions and rated each practice in terms of long-range practice preferences. The descriptions differed according to three practice-related factors: (a) decision-making autonomy, (b) income opportunity, and (c) financial risk. The independent variables were student gender and student race. The dependent variable was student rating of a dental practice. Results indicated that student preferences for different practice arrangements differ by gender and by race. Males rated the solo owner arrangement more favorably than did females and Whites rated the solo owner arrangement more favorably than did African Americans. Also, females demonstrated a stronger preference for group practice than did males, while African Americans rated the employee practice arrangement more favorably than did Whites.

Black or African American↗
PubMed1994

Phlebotomists' safety practices. A College of American Pathologists Q-Probes study of 683 institutions.

We report on phlebotomists' safety practices in 683 institutions participating in the College of American Pathologists Q-Probes program. Participants inspected 38,357 phlebotomy tourniquets and 31,952 blood collection tube holders in use and found 2098 tourniquets and 2966 holders visibly contaminated with blood. In 67.8% of the institutions, at least one tourniquet or collection tube holder was contaminated. Needlestick injuries reported by phlebotomists during 1990 through 1992 were analyzed from approximately 11 million inpatient venipuncture procedures. These injuries ranged between 9.2 and 9.8 needlesticks per 100,000 venipunctures per year. Over 99% of the participants had a policy preventing recapping of needles, 45% discarded tourniquets when contaminated with blood, and 3.3% routinely assigned tourniquets to specific patients. Between 1990 and 1992, increasing frequencies of phlebotomists using gloves, replacing gloves between each inpatient phlebotomy, and handwashing after degloving were found. We cite the lack of compliance of handwashing between glove changes as suggesting need for regulatory rereview.

Bloodletting↗
PubMed1979

Public psychiatry: the public's view.

A 1977 survey of public attitudes toward psychiatry found that the quality of institutional psychiatry was one of several factors associated with negative attitudes toward the field. Noting the shortage of psychiatrists in public institutions, the author questions whether the public associates psychiatrists with conditions in the institutions despite their lack of involvement, or because of it. He believes that the inadequate care provided in many public facilities is a result of a tacit social contract between the public and private sectors that enables private institutions to maintain their fiscal integrity and their quality of care by moving undesirable patients to public institutions that provide inadequate care. Although the problems with the system extend beyond psychiatry and the mental health field, he suggests that psychiatrists could force some positive changes by refusing as a profession to practice in institutions that provide inadequate care, and by supporting the delivery of public services by nongovernmental bodies. The ultimate answer, he believes, lies in research into more effective treatment for mental illness that would make such institutions unnecessary.

Government↗
PubMed1987

Drug Information Center network: need, effectiveness, and cost justification.

During the past 15 years, the pharmacy profession has experienced much change. Certain pharmacy roles are being challenged and others are coming into existence. Today, health-care practitioners and health-care providers are seeking services not sought before from pharmacists in the area of rational therapeutics. This need for information extends to all pharmacy practice settings: institutional, independent pharmacies, chain stores, governmental agencies, and the pharmaceutical industry. In order to meet this demand for drug and toxicology information, however, the pharmacist must use resources outside the immediate area of his practice. The Drug Information Center (DIC) can be used as such a resource by pharmacists in their daily practice to provide the best possible care with regard to the rational use of drugs for their patients/clients. Specifically, our data indicate that in Tennessee, there is a need for providing drug and toxicology information; pharmacists perceive their role to be providers of drug information as well as drugs; the DIC plays an integral and necessary role as a back-up information resource and in teaching, service, research, and continuing education programs; and the programs provided by the DIC are cost effective and cost justifiable.

Cost-Benefit Analysis↗
PubMed2000

Using ferritin levels to determine iron-deficiency anemia in pregnancy.

BACKGROUND: Standard obstetrical practice has included iron therapy for patients with anemia without requiring the determination of iron deficiency. However, the proportion of pregnant women with anemia who have such a deficiency may be relatively modest. We instituted a practice protocol using serum ferritin levels to determine the proportion of women undergoing prenatal care who had both anemia and iron deficiency. METHODS: We evaluated consecutive women entering prenatal care. Those with anemia (hemoglobin level <11 mg/dL) underwent testing for serum ferritin level and other hematologic variables. RESULTS: A total of 182 patients entered prenatal care. Hemoglobin data were available for 173 (95%). Thirty-eight (22%) had anemia (hemoglobin level <11 mg/dL); 1 of those women was excluded from the study. Using a ferritin level of 12 mg per dL as the cutoff for iron deficiency, 54% (20) of the 37 remaining patients with anemia had an iron deficiency, and 46% (17) had anemia not related to such a deficiency. Use of hematologic indices provided on complete blood count were not useful in predicting iron deficiency based on serum ferritin levels. CONCLUSIONS: In our population of prenatal patients with anemia, only approximately half had an iron deficiency. Diagnostic and therapeutic approaches to screening for anemia in pregnancy should be reconsidered and further evaluated.

Adolescent↗
PubMed1994

Practice environment and resident operative experience.

An important aspect of resident training is a graduated increase in responsibility and experience. The level of resident participation in operative procedures is influenced by many factors. Our aim was to determine the effect of the practice environment and staff perception of required surgical skills on the assignment of resident operative responsibility. Questionnaires were sent to 100 surgeons affiliated with the Department of Surgery at the University of Nebraska Medical Center, and the completion rate was 72%. Data were collected on the practice environment of the surgeons and their perception of appropriate resident level and required skills for performance of 20 common general surgery procedures. Surgeons in private practice (n = 34) and affiliated hospitals (n = 15) were more likely to assign cases to higher level residents than those at the University Hospital (n = 23) (mean: 3.0 +/- 0.5 and 3.0 +/- 0.3 versus 2.7 +/- 0.3 years, P < 0.05). Surgeons more than 15 years out of training (n = 28) were more likely to assign a higher level resident to procedures than those (n = 44) more recently trained (3.1 +/- 0.5 versus 2.7 +/- 0.3 years, P < 0.05). Surgeons who worked regularly with residents (n = 44) were more likely to assign a lower level resident to a given procedure (2.8 +/- 0.3 versus 3.1 +/- 0.5 years, P < 0.05). Multivariate analysis, however, found that only time since training was an important factor in the assignment of responsibilities. Laparoscopic procedures caused the greatest disagreement and were more likely to be assigned to higher level residents than the corresponding open procedures (hernia repair 3.3 +/- 0.1 versus 1.2 +/- 0.1 and cholecystectomy 3.2 +/- 0.1 versus 2.0 +/- 0.9 years, P < 0.05). Anatomy (46%) and judgment (36%) were most commonly considered the important surgical factors in determining operative responsibility. However, there was no correlation between assignment of operative responsibility and the perception of required skills for each surgeon. Thus staff perception of the appropriate resident level to perform general surgery procedures is more heavily influenced by factors in the practice environment than surgical aspects of the procedure.

Attitude of Health Personnel↗
PubMed2004

The realities of mental health nursing in acute inpatient environments.

The purpose of this ethnographic study was to understand how nurses construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reform. During a 5-month period, fieldwork observations, interviews and discussion groups occurred in a 22-bed acute inpatient mental health facility in New South Wales, Australia. The findings demonstrate how the current role of acute care has resulted in nurses working in increasingly complex environments characterized by competing priorities and new demands. Nurses struggled to fit the changed service philosophy with traditional models of practice within this fluid and changing environment. The findings are relevant within the context of current debates and can be used to enhance the understanding of contemporary acute mental health nursing practice and inform the continued development of mental health nursing in these settings.

Acute Disease↗
PubMed2002

Research or perish?

The opportunity for sound pastoral care research is not served by the "all or nothing" approach. Professional chaplains whose training includes a thorough orientation to the research process are in a position to speak to the world of science about realities that are beyond physical research, and to the world of theology about realities that should be examined. Cloning, embryonic experimentation, and drug trials in Third World populations are among the areas without the voices of pastoral theologians. Closer to daily practice, research is an invaluable tool in helping chaplains improve their ministry.

Chaplaincy Service, Hospital↗
PubMedDate not supplied

Diagnosis and therapy for the disruptive physician.

A disruptive physician can alienate staff, drive away patients, and even land your organization in a lawsuit. Consider some practical advice on how to identify and deal with disruptive physicians.

Aggression↗
PubMed1997

Parent participation in the postanesthesia care unit: fourteen years of progress at one hospital.

Parent participation in postanesthesia nursing practice was instituted in 1983 at Boston's Children's Hospital as part of a continuing emphasis on family participation in the care of hospitalized children throughout the hospital. This report describes the evolution and implementation of this practice. The success of this program is supported by data from quality improvement monitors of the comfort levels of PACU patients before and after their parents were invited to the bedside. Quality improvement monitors of parent satisfaction with involvement in their child's care were also conducted. Nursing exemplars illustrate parental and nursing responses to this program.

Child, Hospitalized↗
PubMed2001

Social work practice with pre- and post-liver transplant patients: a retrospective self study.

This paper describes a retrospective, practice-based research study of social work interventions with liver transplant candidates and recipients. This study is based on a retrospective chart review conducted to examine psychosocial risk factors, interventions and medical outcomes. Psychosocial interventions provided to patients and families before and after transplant will be described as well as their relationship to medical outcomes. Research Findings and practice implications will be discussed.

Counseling↗
PubMedDate not supplied

When disaster strikes: getting ready for the next big one: part I.

This two-part article deals with the role of the physician when disaster strikes. The first part concentrates on disaster planning and emergency preparedness as it pertains to the staff and the practice. It suggests points to consider in preparing a disaster plan for the practice or institution so that everyone knows what to do in the event of a crisis. This disaster plan is also a blueprint for recovery once the disaster has passed that will assure the financial health of the practice.

Communication↗
PubMed1989

The impact of corporate structures on physician inclusion and participation.

This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associated with low physician inclusion and high participation. There is no indication that corporatization of healthcare restricts the physician's freedom of movement or decision-making role. It is instead argued that health care corporations do just the opposite in order to please physicians, promote physician welfare, and to gain legitimacy.

Data Collection↗
PubMed1993

Response to the National Cancer Institute Alert. The effect of practice guidelines on two hospitals in the same medical community.

BACKGROUND: Despite the recent increase in medical practice guideline development and dissemination, physician compliance with the guidelines has often been low. Previous research has suggested that physicians at hospitals with low volumes of cases and weakened financial status were more likely to omit indicated diagnostic testing or appropriate treatment. The authors sought to determine whether differences in compliance to a widely disseminated set of guidelines would exist even among the most dominant hospital providers within the same medical community. METHODS: Two hospitals, together providing nearly half of the cancer surgery within a metropolitan area, were studied for their compliance to the May 1988 National Cancer Institute (NCI) Clinical Alert regarding adjuvant therapy after primary treatment for node negative breast cancer. A case series consecutive collection of 549 women treated at the study hospitals for 2 years before and two years after the Alert determined those patients who had received any form or combination of adjuvant therapy after primary surgical treatment (lumpectomy or modified radical mastectomy). RESULTS: Following modified radical mastectomy, for women age 50 and older, the university hospital (U) provided adjuvant therapy to a higher percentage of patients than the community hospital (C) both before (25.6% versus 4.7%, P < 0.005) and after (58.9% versus 23.2%, P < 0.001) the Alert. For women younger than 50 years of age, the two hospitals were equally likely to provide adjuvant therapy both before and after the Alert. Following lumpectomy, hospital U increased the percentage of women receiving adjuvant therapy following the Alert in women younger than 50 years of age (25-75.8%, P < 0.001) and in women age 50 and older (33.3-56.5%, P < 0.025). Hospital C provided no adjuvant therapy before or after the Alert. Preferences for breast conserving surgical treatment were significantly (P < 0.001) different with hospital U performing a higher percentage of lumpectomies than hospital C both before (50.9% versus 14.9%) and after (57.6% versus 16.8%) the Alert. CONCLUSIONS: Significant differences in compliance with practice guidelines may be found even among the most dominant hospital providers of cancer services within the same medical community. The role of the surgeon in referring patients to the oncologist greatly influences the ultimate provision of adjuvant therapy. Strategies for enhancing compliance should be considered integral to the process of guideline development.

Age Factors↗
PubMed1988

Utilization of nurse clinicians and physician assistants by Active members and Fellows of the American Academy of Neurology.

A study of 343 Active members and Fellows of the American Academy of Neurology revealed that among 285 responders who spent over 10 hours per week in direct patient care, 198 were in private practice, 69 worked exclusively for institutions, and 18 worked part time in each setting. Eighty-three (29%) used extenders in their practice. Institutionally based neurologists were significantly more likely to use extenders than those in private practice.

Ambulatory Care Facilities↗