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PubMed1986

Faculty practice plans. Profile and critique.

In 1910, the Flexner report signaled the end of commercialism in American medical schools, only to have it reappear in 1931. Between 1960 and 1985, access to federal, state, and private-sector funds paid to medical service plans in all 127 medical schools led to almost a 20-fold increase in faculty practice plan (FPPs)--from six to 118. All 127 US medical schools were surveyed. Wide swings in federal funding policies left medical schools with a defective management model, particularly for FPPs. Disposition of collected revenues, the role of for-profit FPPs, the personally lucrative nature of FPPs, an unwieldy number of fairly autonomous departments, ineffective governance, and hostile opposition from other parts of the university have raised questions of conflict of interest and accountability. Some 75 years after the Flexner report, a thorough evaluation of the effects of commercialism on medical education once again appears to be warranted.

Academic Medical Centers↗

PubMed2006

Research education needs of pediatric emergency nurses.

INTRODUCTION: Evidence-based practice in the emergency care of children is critical. The Pediatric Emergency Care Applied Research Network (PECARN) was developed to increase pediatric research; however, participation by emergency nurses has been limited. To identify research needs in order to increase research involvement, the Emergency Nurses Association (ENA) conducted a research needs assessment with nurses in PECARN emergency departments. METHODS: A self-administered needs assessment questionnaire was completed by 216 ED managers and nurses in 26 PECARN emergency departments between August and November of 2004. The questionnaires included items about research education, knowledge, and experience, as well as barriers to and resources for conducting research. Descriptive statistics were used to analyze the data. RESULTS: The primary barriers to nurses' research involvement included limited research knowledge and experience, limited awareness and availability of research resources, lack of dedicated time, and limited recognition for research contributions. However, the nurses reported moderate to extensive interest in research continuing education and desired moderate to extensive involvement in pediatric research. DISCUSSION: The nurses worked in research institutions with increased access to subjects and collaborative opportunities, indicating strong potential for nurses' research involvement. However, few institutions had practice models that included research recognition and dedicated research time. Furthermore, limited knowledge, experience, and awareness of research resources added to the barriers that reduced research involvement. To begin addressing the barriers, ENA developed a research curriculum based on the continuing education needs and interests identified by the nurses.

Attitude of Health Personnel↗

PubMed1995

Comparing two strategies of cardiopulmonary bypass cooling on jugular venous oxygen saturation in neonates and infants.

BACKGROUND: Cerebral protection during deep hypothermic circulatory arrest is predicted on efficient and complete cerebral cooling. Institutions approach cooling quite differently. We compared two different cooling strategies in terms of measured jugular venous bulb saturations in 39 infants undergoing deep hypothermic cardiopulmonary bypass to evaluate the effect of institutional cooling practices on jugular venous bulb saturation, an indirect measure of cerebral cooling efficiency. METHODS: The patients were grouped based on the method of core cooling. In group A (n = 17), core cooling was achieved rapidly by setting the water bath temperature of the heat exchanger at 4 degrees to 5 degrees C, and the patient was cooled until rectal temperature and nasopharyngeal temperature were 15 degrees C or lower. In group B (n = 22), the heat exchanger was initially set at 18 degrees C and slowly lowered to 12 degrees C. Hypothermic temperatures of 12 degrees C were maintained until the nasopharyngeal temperature was 18 degrees C or less and the rectal temperature was 20 degrees C or lower. Once cooling was complete, blood samples were analyzed by cooximetry for determination of arterial oxygen saturation and jugular venous bulb saturation. RESULTS: In group A, the measured jugular venous bulb saturation was 98.0% +/- 0.9% and the oxygen saturation to jugular venous bulb saturation difference was 0.3% +/- 0.5%, measured at the time that institutional cooling objectives were achieved (total cooling time, 15.0 +/- 0.45 minutes). In group B, jugular venous bulb saturation was 86.2% +/- 12% and the oxygen saturation to jugular venous bulb saturation difference was 10.8% +/- 12.2%, measured at the time that institutional cooling objectives were achieved (total cooling time, 17.5 +/- 1.1 minutes (p < 0.01). CONCLUSIONS: Differences in cardiopulmonary bypass cooling techniques may alter the rate at which jugular bulb saturations rise. We believe this represents an indirect measure of the efficiency of brain cooling and therefore of cerebral protection.

Body Temperature↗

PubMedDate not supplied

Quality assessment of transfusion practice in elective surgery.

A program of quality assurance (QA) was adopted to improve blood transfusion practice in elective surgery at a large urban hospital. For this purpose, a cooperative multidisciplinary group was formed, key indicators were identified, and an organization was set up. Data collected by this organization in the 1-year period needed for implementation of the program indicated that blood misuse was common practice. In fact, overrequest, overtransfusion, excessive reconstitution of whole blood (i.e., concurrent transfusion of red cells and fresh-frozen plasma), and underuse of predeposit were found in all ten surgical departments of the hospital. In a pilot study, data were collected from one surgical department during and after the implementation phase of the QA program; comparison of these data showed a postimplementation reduction of about two thirds in overtransfusion, whereas overrequest, reconstitution of whole blood, and predeposit rates remained unchanged. These results prompted continuation of the program in order to reach a definitive evaluation of its effectiveness.

Blood Transfusion↗

PubMed1992

Harvey A. K. Whitney Lecture. Of perceived value.

Current issues in pharmacy are discussed and recommendations are made to help pharmacy demonstrate its value in health care. There is a need for pharmacy to actively demonstrate and communicate its value in health care. Educational requirements should reflect the values of the profession. In the debate over the entry-level Pharm.D. degree, the profession must not lose sight of the principal goal of elevating the basic competencies of all pharmacists. Graduate-level education will continue to be valuable, but the degrees and programs should be modified to meet current and future needs. Residency training will become increasingly essential. A well-defined corps of pharmacy technicians is needed. The profession should strive to meet the needs of society rather than confining itself to traditional practice definitions. This will involve increased interaction with patients. Also, pharmacy directors must become more creative in allocating existing resources and building arguments for expansion. When patients recognize the value of pharmacy services, they will seek out and demand those services. Pharmacists must get involved in deliberations regarding health-care reform. They have a responsibility to promote preventive medicine and healthy life-styles. They should actively promote the rational use of all medications. Although tremendous progress has been made in advancing the concept of pharmaceutical care, the profession still has work to do in communicating its value to the public.

Awards and Prizes↗

PubMed2001

Prevalence of ocular injuries, conjunctivitis and use of eye protection among dental personnel in Riyadh, Saudi Arabia.

AIMS: To find out the prevalence of ocular injury and infection among dental personnel in Riyadh, Saudi Arabia. PARTICIPANTS: Two hundred and four dental personnel. METHOD: A questionnaire completed by researchers and observation during practice. RESULTS: The response rate was 81%. Dentists and dental technicians had a similar prevalence (42.3%) of foreign bodies in their eyes during the period of one month. Almost 50.5% of dentists rarely had foreign bodies in their eyes, while only 22.2% of dental technicians claimed the same. The majority of dental surgery assistants (73.6%) never experienced foreign bodies in their eyes. Only 27.0% of female personnel had foreign bodies in their eyes as compared to 73.0% of male personnel, while only 28.5% of females had conjunctivitis as compared to 71.4% among male personnel. 75% of regular eye protector wearers (EPW) never had foreign bodies while 67.2% EPW never had conjunctivitis. Dental technicians were more prone to ocular injury, 13.8% as compared to 4.4% of dentists. Only 30% of the regular eye protector wearers suffered ocular injury. CONCLUSIONS: Protection of the eyes should be emphasised and practised at undergraduate level. The awareness of eye protection should be highlighted at all clinical and research symposia. Further studies should be conducted to assess the financial implications of ocular injuries and infections in dental institutions and practices. Recommendations are made for universal precautions and the observation of safety at work guidelines by all dental team members.

Conjunctivitis↗

PubMed2001

Psycho-social problems faced by "frequent flyers" in a pediatric diabetes unit.

This article describes an exploratory study of psychosocial factors common to, and associated with, frequently readmitted pediatric patients diagnosed with Insulin Dependent Diabetes Mellitus (IDDM). This practice-based study was undertaken by a social worker providing clinical services within a tertiary health-care pediatric diabetes unit at the Royal Children's Hospital, Melbourne (RCH), Australia and utilises available data obtained through retrospective record review in order to better inform service delivery. The study identified thirteen psychosocial factors having multiple occurrences within a small, but resource intensive, sub-population of the diabetes unit. The author discusses the possible contribution of each of these factors to poor metabolic control and frequent readmission to hospital, as well as the potential implications for future targeted prevention and treatment programs.

Adolescent↗

PubMed2006

Learners' decisions for attending Pediatric Grand Rounds: a qualitative and quantitative study.

BACKGROUND: Although grand rounds plays a major educational role at academic medical centers, there has been little investigation into the factors influencing the learners' decision to attend. Greater awareness of attendees' expectations may allow grand rounds planners to better accommodate the learners' perspective, potentially making continuing education activities more attractive and inviting. METHODS: We used both qualitative (part A) and quantitative (part B) techniques to investigate the motivators and barriers to grand rounds attendance. Part A investigated contextual factors influencing attendance as expressed through attendee interviews. Transcripts of the interviews were analyzed using grounded theory techniques. We created a concept map linking key factors and their relationships. In part B we quantified the motivators and barriers identified during the initial interviews through a survey of the grand rounds audience. RESULTS: Sixteen persons voluntarily took part in the qualitative study (part A) by participating in one of seven group interview sessions. Of the 14 themes that emerged from these sessions, the most frequent factors motivating attendance involved competent practice and the need to know. All sessions discussed intellectual stimulation, social interaction, time constraints and convenience, licensure, content and format, and absence of cost for attending sessions. The 59 respondents to the survey (part B) identified clinically-useful topics (85%), continuing education credit (46%), cutting-edge research (27%), networking (22%), and refreshments (8%) as motivators and non-relevant topics (44%) and too busy to attend (56%) as barriers. CONCLUSION: Greater understanding of the consumers' perspective can allow planners to tailor the style, content, and logistics to make grand rounds more attractive and inviting.

Adult↗

PubMed2003

The Psychiatric Rehabilitation Beliefs, Goals, and Practices Scale: sensitivity to change.

This study evaluated the Psychiatric Rehabilitation Beliefs, Goals, and Practices Scale's (PRBGP) sensitivity to change. A training curriculum in the current principles and practices of Psychiatric Rehabilitation was given to 301 practitioners in Pennsylvania. Participants completed the PRBGP Scale prior to and immediately following the two-day, twelve-hour training workshop. The training curriculum was expected to convey a substantial amount of information to these participants. The comparison between the pre-training and post-training PRBGP Scale scores of the participants found a significant and substantial difference. The PRBGP Scale reflected the expected changes in the participants' information levels. This study concluded that the PRBGP Scale was sensitive to change, and it provided a reliable and valid means of assessing the effectiveness of educational curricula in psychiatric rehabilitation.

Attitude of Health Personnel↗

PubMed1991

Music therapy practices in gerontology.

A national survey was conducted using a representative sample of music therapists who work with older adults. The goals of the survey were: (a) to provide a profile of music therapists working with geriatric clients with respect to professional credentialing, regional membership, age, gender, educational background, salary, and reimbursement practices; (b) to provide a description of assessment practices used by music therapists with geriatric clients; (c) to provide clarification relative to how music therapy practices with elderly clients fit into various settings in which the therapist may be employed; and (d) to identify the types of goals and objectives that are most frequently specified for this population. An 87% response rate yielded 176 usable questionnaires (72% of original sample). Frequency analyses of dichotic and multiple choice responses were conducted and reported as percentages of respondents. Free response items, which were provided as opportunities for clarification and explanation, were presented as a simple frequency count. Comparative analyses between salaried and contractual respondents, and respondents in the eight NAMT regions were not conducted due to unequal sample sizes.

Aged↗

PubMed2006

Boundaries obscured and boundaries reinforced: incorporation as a strategy of occupational enhancement for intensive care.

Medical dominance is a recurring theme in sociological analyses of healthcare work. One example of a theoretical framework by which the medical profession is said to dominate other healthcare occupations is Turner's (1995: 138) enumeration of the modes of subordination, limitation and exclusion. As Elston (1991) has noted, however, such frameworks tend to be rather speculative and there is not a great deal of evidence on how these strategies are exercised, for example, at a micro-level. There is also a tendency to portray healthcare occupations as monolithic entities, without acknowledging differences within healthcare occupations, and the relationships between them, which can arise in different clinical locales. Through a micro-level analysis of the practice of intensive care, using ethnographic data collected on three intensive care units (ICUs) in England, this paper proposes a hitherto unidentified strategy -incorporation- for medical dominance at a micro-level. Paradoxically, an enhanced position for both intensive care medicine and intensive care nursing arises, relative to proximal healthcare groups. The argument of this paper is that within the ICU an occupational boundary (doctor-nurse) is obscured, while an organisational boundary which differentiates the ICU from the wider hospital is reinforced. Overall, the power relationship between medicine and nursing in intensive care is not 'zero-sum': the influence of both groups in the wider hospital is increased by this strategy of incorporation.

Anthropology, Cultural↗

PubMed1997

Use of breast core biopsy in the United States: results of a national survey.

OBJECTIVE: We analyzed the results of a national survey to determine the current use and practice of breast core biopsy. MATERIALS AND METHODS: A survey was mailed to 1700 members of the Society of Breast Imaging who reside in the United States. The questions included frequency of biopsy, specialty of responsible physician, type of guidance used, physician credentialing, method and duration of follow-up, referral patterns, scheduling practices, and types of lesions biopsied. Opinions about the future usefulness of breast core biopsy were solicited. RESULTS: We received 458 responses (27% response rate) from 48 states and the District of Columbia. Eighty-one percent of the respondents indicated that breast core biopsy is performed at their practice or institution: among these, 85% are performed solely by radiologists. Of those performing the procedure, 61% do not have special credentials. Seventy-one percent use both stereotaxic and sonographic guidance. For follow-up after the procedure, patients are tracked manually and by computer in near-equal proportions. The median period of patient follow-up is 12 months: 11% of the respondents track indefinitely. Surgeons and primary care physicians most commonly refer patients for core biopsy. The procedure is most often performed after notification of the referring physician (76%), and 80% of the respondents schedule core biopsy without prior surgical consultation. Masses and calcifications categorized as probably benign to highly suspicious are included as indications for core biopsy. Forty percent of the respondents offer core biopsy on the same visit as when an abnormality is found. Eighty percent of the respondents believe the procedure will increase in use 48% believe that core biopsy will replace most surgical biopsies for nonpalpable lesions. CONCLUSIONS: Breast core biopsy is widely used in the United States for sampling a broad spectrum of imaging abnormalities. Both sonographic and stereotaxic guidance are commonly used. Credentialing requirements, practice patterns, and follow-up after the core biopsy procedure vary considerably among different sites.

Biopsy, Needle↗

PubMed1996

Managing the occupational environment of managed care.

The emergence of managed care has resulted in a practice environment buffeted by rapid and sweeping changes. Shifts in philosophy and approach to payment for health care affect the nature of the service and the method of its delivery. The occupational adaptation frame of reference is used to illustrate the challenges imposed by the physical, social, and cultural components of the changing occupational environment. Perceptions, observations, and concerns of middle level occupational therapy, physical therapy, social work, and nursing managers illustrate the impact of this new environment. Therapists are challenged to understand their own changing work setting and to apply the same effort to mastering its challenges as they would to examining the context of their patient's occupational performance and to designing and implementing an appropriate clinical intervention.

Health Services Needs and Demand↗

PubMed2005

Post-craniotomy analgesia: current practices in British neurosurgical centres--a survey of post-craniotomy analgesic practices.

BACKGROUND AND OBJECTIVE: An evaluation of post-craniotomy analgesia within the University Hospital of Wales Neurosurgical Unit, Cardiff, found that many patients were experiencing moderate to severe pain post-craniotomy. It was therefore decided to undertake a nationwide survey of analgesic practices in order to establish best practice guidelines and benchmark with other units. METHOD: A postal questionnaire was sent to the senior nurse of every Neurosurgical Directorate within the UK inquiring about the current, standard analgesic practices for post-craniotomy patients in their unit. RESULTS: Completed replies were received from 23 of the 33 centres (70%). Intramuscular (i.m.) codeine phosphate was found to be the principal first-line analgesic used post-craniotomy. Only three centres used morphine as the first-line analgesic and only one centre used patient controlled analgesia routinely. The majority of centres (82%) used balanced analgesia. Pain assessments were only carried out in 57% of centres and no centre used a validated pain assessment tool specifically for dysphasic patients. CONCLUSIONS: Codeine phosphate continues to be the mainstay of post-craniotomy analgesia, however, it is proposed that patient controlled analgesia with morphine is an efficacious and safe alternative.

Analgesia↗

PubMed1990

Modifying clinical practice: two initiatives in the English National Health Service.

Two information systems in the English National Health Service (NHS) are described and discussed. The performance indicator scheme enables service inputs and activity to be readily compared between district health authorities (DHAs) or hospitals. Quality of care is not measured directly by performance indicators but in certain circumstances a limited assessment may be inferred from the health service input and activity data. Experiments in management budgeting and resource management are reported in which the NHS accounting system is being changed to one which is more patient-based and from which costs can be identified for clinically meaningful groups of patients. Variation in service activity, derived from the performance indicator system, has been used by the government with other evidence to make the case for NHS reform. Realistic implementation of the proposed NHS reforms will depend on the success of the budgeting experiments.

Budgets↗

PubMed2004

From bedside to boardroom - nursing shared governance.

A brand-new nursing shortage is revitalizing shared governance. This innovative organizational model gives staff nurses control over their practice and can extend their influence into administrative areas previously controlled only by managers. But nursing shared governance is hard to define. Its structures and processes are different in every organization; and its implementation is like pinning Jell-O to a wall. Is it appropriate for every situation? Is it worth the price? And can it really measure up to its glowing reputation? This article presents an overview of nursing shared governance, looking at themes and experiences from its rich 25-year tradition. The author identifies its essential elements, provides guidance for professionals who wish to embark on the journey, and describes the current status of shared governance as of 2004.

Cost-Benefit Analysis↗

PubMed2001

Comparing social work's role in renal dialysis in Israel and the United States: the practice-based research potential of available clinical information.

This paper demonstrates the use of clinical data-mining in a study of social work interventions with dialysis patients in two countries, the US and Israel. We aimed to examine the role of social workers in improving kidney patient outcomes and to determine the potential of readily available patient information for studying this process. The findings showed considerable differences between the patient samples in both countries, as far as the socio-demographic background was considered. In spite of this, there were numerous similarities in the type of psycho-social problems and reactions, as well as the social workers' interventions. Differences which arose in various patient states and outcomes were examined in light of variations in the health care systems and socio-cultural contexts of renal dialysis in both sites.

Adult↗

PubMed1977

Job satisfaction-dissatisfaction. A comparison of private practitioners and organizational physical therapists.

Job factors which results in feelings of satisfaction or dissatisfaction were studied in a sample of 25 physical therapists engaged in private practice and 25 physical therapists employed as chiefs of departments. Our purpose was to determine the meaningfulness of work for physical therapists and to compare private practitioners with therapists who work within an organization. Ten factors of the sixteen studied were found to be significantly satisfying or dissatisfying for all therapists. In addition, organizational therapists were satisfied with the work itself and valued recognition for their efforts, whereas private practitioners were more concerned with personal responsibility. Organizational therapists experienced periods of unhappiness with some aspects of interpersonal relationships and with some policies of the organization, and private practitioners were unhappy with long working hours. There was no significant difference in salaries, achievement, possibilities for growth, status, or security.

Achievement↗