SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
To enhance physician productivity, this Department of Pathology designed an incentive plan that addresses the diversity of the academic pathologist's responsibilities. The author tells us why the plan was necessary and how it works.
We conducted a national survey of all physicians who graduated from preventive medicine residency (PMR) programs between 1979 and 1989. We mailed a self-administered questionnaire to all PMR graduates of the 43 U.S. programs in General Preventive Medicine and Public Health, requesting information on their current professional activities. Out of 1,070 PMR graduates, 797 (75%) responded to the survey. Overall, graduates were distinguished from other physicians by both work setting and work activities. PMR graduates worked predominantly in institutional settings: in federal or state health agencies, academia, or hospitals/clinics. In addition to maintaining their involvement in clinical medicine, PMR graduates were heavily involved in epidemiologic research and program management. This unique blend of organizational skills, expertise in population-based research, and clinical experience makes PMR graduates an increasingly important human resource as health care reform increases the population of patients being cared for in a managed care setting.
German departments of anaesthesia were surveyed to determine current practice of postoperative pain management in children. The response rate of the survey was 58.6%: Questionnaires of 383 departments in which paediatric surgery was performed could be analyzed. 37.3% operated an acute pain service (APS). In 58.8% of the hospitals, postoperative pain management in children was mainly performed by surgeons or pediatricians. Anaesthesiologists or an APS were in charge for pain management in children in 38.6% of the institutions. Non-opioid analgesics were the drugs most widely used (93.4%), whereas i.v. opioids were never used in 20.9% of the hospitals and used less than once a week in 28.7%. The intramuscular route was chosen at least occasionally by 27.7% of the respondents. Peripheral and central regional techniques were performed in most of the departments, however, frequency of use varied considerably between hospitals running or not running an APS. The majority performed the techniques of regional anaesthesia less than once a week. The basic primary quality criterion of pain therapy, a regular measurement and documentation of pain scores, was performed in only 4% of the institutions. Paediatric pain management does not meet quality criteria and standards of care already established in adults. In the future, additional education of the medical staff considering analgesic techniques and measurement of pain scores has to be emphasized.
The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.
PURPOSES: To document the content and level of obstetrical hospital-based privileges for members of the American Academy of Family Physicians and to describe variations between regions, rural vs urban practices, and various physician characteristics. METHODS: About 12% of the active members of the American Academy of Family Physicians listed as offering obstetrical care by the Academy as of March 1991 were randomly sampled by mailed questionnaire. Samples were drawn from three national regions. Privileges were grouped by degree of restriction, based on whether consultation or transfer was required. RESULTS: Of 1464 surveys mailed, 1026 physicians (70%) responded. Only 740 (72%) stated that they still practiced obstetrics. Privileges ranged from least restricted (100% provided vaginal vertex delivery, with no consultation required) to most restricted (79% provided amniocentesis, with consultation or transfer required). A surprisingly large proportion of physicians reported having fewer routine and more advanced privileges without consultations being required, such as ultrasonography (53%), vaginal breech delivery (41%), and cesarean section (25%). Physicians having more advanced privileges tended to be located in the West or mountain-plains region; be trained in the Midwest, mountain-plains region, or the West; work in middle-sized, nonteaching hospitals in more rural countries; have completed advanced obstetrical training (> or = 6 months); and deliver more than 40 infants per year. CONCLUSIONS: Overall, a considerable number of hospital-based obstetrical privileges are granted to family physicians. No uniformity in privileges prevails, owing to significant regional and practice variations. Teaching hospitals reportedly restrict obstetrical care by family physicians more than other hospitals. The variations in restrictions could not be explained by degree of training.
Physicians now find it relevant to acquaint themselves with aspects of the law which heretofore were mainly of concern to the business world. One such area is antitrust, which is beginning to affect the practice of radiology. Three phases of the problem are discussed: exclusive privileges contracts; boycotts of nonphysician consultations (i.e., with chiropractors and cultists); and certificate of need requirements for acquisition of highly technical, sophisticated and expensive equipment.
BACKGROUND: The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings was developed through 9 research projects: 1 to determine the name and image, 5 to test the 12-step programs, and 3 to evaluate the Campaign. This report analyzes data from 9 projects and reports key findings. METHODS: Data from the 9 projects were analyzed by 4 topics: perceptions of the problem of antimicrobial resistance, barriers to preventing antimicrobial resistance, most and least important steps and strategies, and preferences for materials and information sources. RESULTS: Data from 21 in-depth interviews, 19 focus groups, and 3 surveys were analyzed. A total of 695 clinicians participated: 564 (81.2%) were physicians; 98 (14.1%) were nurses; and 33 (4.7%) were other healthcare professionals. Differences by both occupation and medical specialty area were observed. A majority of participants agreed that antimicrobial resistance is a problem nationally, whereas fewer agreed that it is a problem in their institution or practice. Of the Campaign's 4 strategies, "Diagnose and Treat Infection Effectively" and "Use Antimicrobials Wisely" were considered most important, whereas "Prevent Infection" and "Prevent Transmission" were considered least important. Frequently cited preferences for materials included posters and professional resources such as journal articles and presentations at conferences or annual meetings of professional societies. CONCLUSION: The findings highlight important issues that could influence the success of implementation of the Campaign to Prevent Antimicrobial Resistance in Healthcare Settings. Tailoring the campaign messages and supporting materials to individual institutions or clinician types are encouraged to address or acknowledge these issues and facilitate behavior change.
Radiology literature indexes were searched for articles concerning socioeconomic and political issues published during two 21-year periods: 1920-1940 and 1970-1990. Of 200 articles found, 96 were considered appropriate for study, 40 from 1920-1940 and 56 from 1970-1990. All except two of the articles were from Radiology or the American Journal of Roentgenology. The articles were organized into 16 categories. By quantifying the number of times these socioeconomic and political issues appeared and comparing quotations from the articles, the authors demonstrated many common issues in the two periods, despite drastic differences in radiology practice. Analysis of historical literature provides perspective on current socioeconomic and political issues and may help formulate solutions to current problems. Documentation of such issues facilitates historical analysis and is an important function of the radiology literature.
BACKGROUND: At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM) has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. METHODS: Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. RESULTS: Gaps (difference between importance and preparation) were demonstrated in many of the CanMEDS 2000/2005 competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation) had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office), health advocate (counseling for prevention, for example smoking cessation), and professional (end of life issues, ethics). CONCLUSION: Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps between training and important areas for practice. They have identified competencies that should be emphasized in Canadian GIM programs. Ongoing review of graduate's perceptions of training programs as it applies to their current practice is important to ensure ongoing appropriateness of training programs. This information will be used to strengthen GIM training programs in Canada.
Information about the use of research by rehabilitation professionals to make clinical decisions in everyday practice is limited. This study compared perceived research use and knowledge sources across professions, practice situations, and work environments. Participants were 165 randomly selected Canadian occupational therapists, physical therapists, and speech-language pathologists. Self-report ratings during an interview, an interviewer rating, and questionnaire scores (Edmonton Research Orientation Survey, General Use of Research, Knowledge Acquisition Survey) were compared. Speech-language pathologists had the most education and the highest research use ratings. Research use was highest during program planning. Programs to encourage research use must consider the research available to guide practice and therapists' education level. Facility size and location (rural, urban) do not affect perceived research use.
Conflicts of interest serve as a cipher for a radical rupture in the Flexnerian paradigm of medicine, and they can only be addressed if we recognize that health care is now practiced by institutions, not just individual physicians. By showing how "appropriate utilization of services" or "that which is medically indicated" is a function of socioeconomic factors related to institutional responsibilities, I point toward an administrative and organizational ethic as a needed component for addressing conflicts of interest. The argument is developed by reviewing three important books. First, I consider Mark Rodwin's attempt to configure the economic structures of medicine so that classical fiduciary and scientific ideals can be fostered. Second, I consider E. Haavi Morreim's attempt to modify the classical ideals in order to account for new economic realities. Finally, by considering essays in a recent volume on conflicts of interest edited by Spece, Shimm, and Buchanan, I argue for a constructive dialectic between the approaches of Rodwin and Morreim. In order to properly address conflicts of interest, there must be a radical reassessment of medicine that accounts for the interrelation between scientific, ethical, and economic concerns. Until institutions come into view and professional ethics is developed to account for their role, legitimate interests and obligations of diverse parties cannot be harmonized.
The release of asbestos during maintenance and removal of resilient floor covering is of concern to health professionals and many regulators. This study assesses the asbestos levels observed during removal of resilient floor covering products using the "Recommended Work Practices" (1995) of the Resilient Floor Covering Institute or other methods requiring containment (Controls). The 1995 "work practices" require wet removal or dry heat removal but do not require the use of respirators. Wet removals of sheet vinyl/separated backing, 12" x 12" vinyl asbestos tile/mastic, and 9" x 9" asphalt tiles/mastic were conducted and the air was sampled during each procedure. Settled dust samples were collected at the sites of RFCI square tile removal and pieces of each type of tile were broken in a mini-enclosure to evaluate asbestos emissions. Analyses of the air samples collected during the removals showed that the RFCI methods did not produce asbestos counts significantly different from the Control methods requiring containment. Only a small number (0.7%) of fibers and structures, counted and measured by Analytical Transmission Electron Microscopy, would have been counted using the rules for Phase Contrast Microscopy in the 7400 method specified by Occupational Safety and Health Administration regulations. This indicates workers in similar situations without respirators are likely to have unknown exposure levels. A high percentage of these fibers and structures are 5 micrometers or less in length, smaller than 0.5 micrometer in diameter, and are easily inhaled. The RFCI air sample and settled dust data may cause regulators to consider requiring respiratory protection, cleanup procedures, and methods to control asbestos migration. Other areas that might be addressed are clearance levels and their measurement, removal area size, bulk sample analysis by transmission electron microscopy if polarized light microscopy reports less than 1 percent asbestos, better worker exposure evaluation, and supervisor/worker training in accordance with the Model Accreditation Plan.
Among the collective as well as individual responsibilities of nurses as professionals is that of maintaining and improving the quality of nursing care. In exchange for monopoly status and professional authority to control nursing practice, the profession is charged with the responsibility of meeting the nursing care needs of the community. If one claims, as I do, that one of the collective responsibilities of nurses is maintenance of high nursing standards, we must examine what action is required of nurses who find themselves in work contexts in which standards and practice are deficient. Specifically, is the strike weapon one that may or even ought to be used? In this essay, answers to the following two questions are advanced: (a) What conditions must obtain for it to be (morally) right for nurses in a particular health care facility to strike? (b) Does their collective responsibility with regard to nursing standards and practice ever entail that a group of nurses has a (moral) duty to strike? The essay concludes with a consideration of how one balances the collective responsibility to maintain and improve the quality of nursing care with an individual nurse's responsibility to her/his own patients.
OBJECTIVE: Pediatric hospitalist systems are being implemented widely. Their implementation may be influenced by physician attitudes, which may vary according to practice type (eg, community or hospital-based practice) and personal characteristics (eg, age and practice location). Little evidence exists to describe factors relevant to pediatric systems. The objective of this study was to determine physicians' attitudes regarding hospitalists and associated physician and practice characteristics. METHODS: We used a cross-sectional survey of all physicians with admitting privileges at a tertiary-care, pediatric, teaching hospital in the Intermountain West in April 2002. Outcomes included survey responses indicating attitudes toward the effects of the hospitalist system on quality of care, patient satisfaction, and teaching. RESULTS: A total of 313 of 368 physicians (85%) responded, 191 of whom (61%) were community physicians; 224 respondents (72%) spent the majority of their time in outpatient care. Community physicians more often characterized inpatient care as an inefficient use of time (45% vs 25%) but were less likely to think that hospitalists would improve the quality of care (49% vs 68%) or increase patient satisfaction (10% vs 30%). In multivariate models examining predictors of overall attitudes toward hospitalists, being a community physician (6.4 points more negative) and admitting patients at >1 hospital (3.3 points more negative) were associated with less favorable attitudes. Being <40 years of age (4.5 points more positive) and practicing >13 miles from the hospital (4.3 points more positive) were associated with more positive attitudes. CONCLUSIONS: Attitudes regarding hospitalist systems differ between physician groups and are influenced by practice characteristics. Understanding these differences and tailoring hospitalist systems to address them will be important as pediatric hospitalist systems are implemented nationwide.
The provision of medical care is assuming some of the characteristics of retail services delivery. This article outlines some of the factors that impact consumer (patient) decision-making in selecting providers. It focuses on measures that practices and institutions may adopt to improve patient satisfaction and to establish and maintain the referral chain. These actions range from promoting word-of-mouth referrals to enhancing relationship with primary care providers.
"This article describes and analyses recent changes in the social institutions and cultural practices which have traditionally supported high fertility among the Kikuyu of Central Province, Kenya, and assesses the extent to which such institutions and practices retain their significance in the context of the changing value of children. The material and symbolic value of children to the Kikuyu is analysed, using methods and concepts derived from social anthropology.... After briefly profiling each of the communities of study, the article is organised around three themes which correspond to the key social institutions that shape fertility motives: marriage, kinship and religion. A fourth theme which runs throughout the article is the changing strategic role played by these same institutions in regulating or enhancing fertility." (SUMMARY IN FRE)
Orthopaedic practices are under increasing pressure to improve productivity in the ambulatory setting. Best practice use of portable radios or walkie-talkies help to achieve a near 50% reduction in patient visit time without reducing the time spent with the care provider. More patients may be seen or the same number in less time. Increased staff communication saves wasted steps and decreases the response time in patient emergencies. A variety of radios and accessory equipment may be needed to meet the needs of each user and to overcome any structural interference. Successfully instituting this practice change involves time-motion studies, assigning a project manager, and full leadership support. The emission of radio frequency waves by portable radios or their transmitting power may interfere with implanted pacemakers or external medical equipment. But the risk is low when radios are used away from individual patients.
Greater use of GPs, both in general practice and hospitals, could reduce waiting times for hospital services. PCGs might consider developing some specialist services. The development of GP specialists should be considered. Allowing GPs with a special interest in surgery to perform some hospital surgery would reduce pressure on consultants' lists.