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PubMed1979

Notation of physical equations no longer a problem.

Physical quantities and equations are used to define the laws of natural and engineering sciences. Clarity has been brought in equal measure into the the theory of physical quantities and the SI-system of units due to the basic work of Wallot and that of national and international institutions. For practical use in this paper, the most important rules and definitions for the formulation of physical equations are treated in an elementary form and the ease of their use is demonstrated in the following examples: speed of a car, capacitance of a plate capacitor, thermal emission of the cathode of an x-ray tube, oxygen uptake in cardiology, mole concentration and mass concentration of a substance in a solution. In addition, some important quantities and units of cardiology were summarized in a table.

Cardiology↗
PubMed2003

Medical student indebtedness and the propensity to enter academic medicine.

This paper considers the potential impact of medical school indebtedness and other variables on the propensity of US doctors to enter academic medicine. Probit models provide some evidence that indebtedness reduces the likelihood that physicians will choose academic medicine as their primary activity. Nevertheless, the magnitude of this effect is not large. As indebtedness may be endogenous, the probits are rerun using an instrumental variables approach. These estimates imply that over time indebtedness may have an important impact on the propensity of physicians to enter academic medicine.

Academic Medical Centers↗
PubMed2003

The changing public/private mix in dentistry in the UK--a supply-side perspective.

This paper examines the factors beyond NHS dentists' remuneration which may explain the variations in the public/private mix in general dental practitioners' workload in the UK. Given that NHS dentistry is subject to a fixed price system, the study focused mainly on non-income supply-side factors. Using data from a postal survey of a national random sample of dentists practising in the NHS in England in 1997, the study found that the strategies adopted by dentists in the management of NHS lists and the evidence that dentists spent significantly more time in private consultations compared with NHS consultations support concerns over equity of access to dental care and the quality of NHS dentistry. Dentists' attitudes to NHS and private dentistry revealed considerable ambiguity towards the NHS. While, on the one hand, the lack of sufficient demand for private dentistry emerged as a strong reason for remaining in the NHS, on the other, there was evidence that equity in access to dental treatment is still seen as an important principle. The implications of these findings in the context of recent discussion of the future of NHS dentistry are considered.

Adult↗
PubMed1993

The therapeutic use of social disturbance in institutions: a sociological approach in practice.

Disturbances periodically occur in psychiatric Adolescent Units. This paper argues that by delaying full resolution of these social disturbances, maximum therapeutic benefit may be gained. Illustrated by clinical example, this paper shows how prolonging complete resolution can effect change for the adolescent, the adolescent's social network, and the Adolescent Unit itself. This phenomenon is explained in terms of the philosophy and social structure of the Adolescent Unit described, using methods taken from sociology.

Adolescent↗
PubMed1998

The determinants of health expenditure in the OECD countries: a pooled data analysis.

This paper uses international health expenditure and the latest OECD data to investigate the determinants of aggregate health expenditure. The study differs from most previous studies in two principal ways. First, it uses a somewhat larger sample for estimation, with pooled time-series, cross-section data for 22 OECD countries for a 20-year period. Most previous work has used a purely cross-section approach: in this case, the small sample size reduced the statistical reliability of results and limited the number of hypotheses that can be tested simultaneously. Second, and following from this, a more extensive range of hypotheses is tested, with particular emphasis on those relating to the contractual relations between payers, providers and patients. The findings show, for example, that the use of primary care "gatekeepers" seems to result in lower health expenditure and also that the way of remunerating physicians in the ambulatory care sector appears to influence health expenditure; capitation systems tend to lead to lower expenditure than fee-for-service systems.

Cross-Cultural Comparison↗
PubMedDate not supplied

Surgical management of traumatic retinal detachment with perfluorocarbon liquid. The Vitreon Study Group.

BACKGROUND: To evaluate the effect of perfluoroperhydrophenanthrene on the outcome of traumatic retinal detachment with proliferative vitreoretinopathy, a retrospective study of 111 patients was performed at 35 tertiary care centers, both private practice and institutional. We believed that perfluoroperhydrophenanthrene would assist in manipulating the retina during surgery, removing intraocular foreign bodies, draining suprachoroidal hemorrhage, and reattaching the retina because of the perfluorocarbon's high specific gravity. METHODS: Of the 700 patients in the Vitreo study group, 111 with a history of trauma (109 had retinal detachment, 50 had proliferative vitreoretinopathy) were chosen for this study. Perfluoroperhydrophenanthrene was used intraoperatively to manipulate the retina hydrokinetically, remove intraocular foreign bodies, drain suprachoroidal hemorrhage, and to reattach the retina in the case of giant tears. RESULTS: Logistic multiple regression analysis was used to identify factors as being predictive of poor visual outcome. Factors predictive of poor visual outcome were: type of trauma (p = 0.0065) (ruptured globe); presence of giant retinal tear (p = 0.0253); and low preoperative visual acuity (p = 0.044). At the last follow-up examination, the reattachment rate was 75.6% (i.e., 84 eyes). Of those 84 eyes, 55 (49.5%) had achieved a visual acuity of > or = 5/200 and 34 (30.6%) had a visual acuity of > or = 20/200. In cases complicated by proliferative vitreoretinopathy, the final reattachment rate was 66%, with 40% of the eyes studied obtaining a visual acuity of > or = 5/200. CONCLUSIONS: Perfluoroperhydrophenanthrene has been used intraoperatively in the management of traumatic retinal detachments without any apparent ill effects.

Adolescent↗
PubMed1985

Some necessary assumptions in private psychiatric treatment centers: the functions and dysfunctions of myths.

The functions and dysfunctions of myths in private psychiatric inpatient treatment are examined. Myths are here defined as beliefs given uncritical analysis by members of a group in support of traditional practices and institutions. Myths give inspiration to the ongoing work of the psychiatric center, and without them the work could not successfully proceed. The following myths are examined: the Myth of the Higher Order, the Myth of Uniqueness and Superiority, the Myth of Omnipotence, the Myth of the Psychotic Patient and the Healthy Staff, and the Myth of the Family. Myths provide the comforting language of absolutes, but may become anachronistic and proven false by reality. They will then no longer drive away chaos, and individuals will feel betrayed.

Adolescent↗
PubMed1986

Hôpital Albert Schweitzer and the Republic of Haiti.

The Hôpital Albert Schweitzer was established near the village of Deschapelles in Haiti in 1956 by Dr. and Mrs. William Larimer Mellon of Arizona. The hospital currently has 162 acute care beds and provides inpatient and outpatient services to a district of about 160,000 people. In 1983, visits to the hospital and its dispensaries totaled 39,163. Since its founding the hospital has evolved into a tertiary care facility but has also established primary care programs through seven satellite dispensaries. Health agents and midwives play an important role in the hospital's field programs. Outreach programs concentrate on health and nutrition education, immunizations, supplementary food programs, tuberculosis screening, oral rehydration for infants with diarrheal diseases and cord cutting clinics for the prevention of neonatal tetanus. This paper describes the principal causes of morbidity and mortality in this area of Haiti, the functioning of the hospital and both its medical and non-medical programs. The latter include agricultural irrigation and well digging projects, and wood working, weaving and ceramic facilities to encourage local artisans.

Community Health Services↗
PubMed1993

A descriptive study of healthcare ethics consultants in Canada: results of a national survey.

As part of a project to examine health care ethics consultation in Canada, we surveyed individuals who were considered by themselves or others to play a significant role in health care ethics consultation. Since one goal of the project was to examine the education and abilities necessary for consultants, we sought to determine the qualifications and skills currently possessed by persons considered to be ethics consultants. For the purposes of the questionnaire, 'health care ethics consultation' was defined broadly to include consultation on ethical issues in clinical care or in clinical research, ethics consultation to Clinical Ethics Committees, Research Ethics Committees, and policy formulation committees in health care institutions; 'clinical ethics work' was defined more broadly still to include, in addition to the above, ethics education, administration, research and writing on bioethics other than the above, and public speaking. Three hundred and fifty questionnaires were sent to individuals and institutions across Canada that were thought to have some involvement in health care ethics consultation. Two hundred and fifty-three questionnaires were returned for a response rate of 72%. This report presents initial findings of the study and attempts to provide a comprehensive overview of the current state of ethics consultation within Canada. The survey examines demographics, educational background, time spent on ethics, institutional affiliations, approaches to the role of consultation, research related issues, and attitudes toward certification. Of the 253 questionnaires returned, 162 were completed by individuals who indicated that they provided some kind of ethics consultation. Of these, 43 indicated that they spent 30% or more of their time in clinical ethics work. These individuals are quite heterogeneous in background, training and activities, and while the great majority of them are based in an academic setting (university or teaching hospital), many act as resources to community hospitals, long-term care facilities and other organizations. Finally, the survey found that respondents' views on the advisability of certification for those offering ethics consultation were split evenly between those in favour of and those against certification. This report serves, then, as a reference point for studying the roles, responsibilities, training and accreditation of ethics consultants in health care.

Canada↗
PubMed2003

Explicit approach to rounds in an ICU improves communication and satisfaction of providers.

OBJECTIVE: To evaluate an explicit approach to responsibilities and reporting during bedside rounds in the intensive care unit (ICU). DESIGN AND SETTING: Before-after comparison in the 15-bed medical-surgical ICU in a tertiary teaching hospital. PATIENTS: All patients in the ICU during two 1-month periods: 2 months before and 16 months after the intervention. INTERVENTIONS: Explicit approach to clinical and educational responsibilities and to reporting assessments and plans during bedside rounds. MEASUREMENTS AND RESULTS: Surveys of all ICU staff (attending physicians, residents, nurses, respiratory therapists, pharmacists, and medical students) were conducted during rounds on each patient. After the intervention, more respondents agreed that there was a long-term plan for each patient (74% vs. 53% before), that the long-term plan was clear (76% vs. 54% before), that there was structured teaching around each patient (46% vs. 30% before), that discussions other than structured teaching around each patient were useful (79% vs. 65% before), and that they were satisfied with the process and outcome of rounds (95% vs. 86% before). In contrast, slightly fewer respondents were aware of a problem list for the patients (96% vs. 99% before), and fewer residents and medical students had examined their patients before rounds (76% vs. 88% before). CONCLUSIONS: An explicit approach to bedside rounds in an ICU improves communication and satisfaction of health care providers.

British Columbia↗
PubMed1998

A profile of European ICU nursing.

OBJECTIVE: To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. DESIGN: A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to be passed on to the nurse-in-charge of their ICU. RESULTS: 156 completed questionnaires were analyzed: 49% were from university hospitals, 26% from university-affiliated hospitals, and 25% from community hospitals; 42% of the hospitals had more than 700 beds, 67% of the ICUs had between 6 and 12 beds, and 54% were mixed medical-surgical units. Among British units, 79% had more than three full-time nursing equivalents (FTE) per ICU bed, while in Sweden 75% of units had less than two FTE/ICU bed. University hospitals had more nursing staff per bed than community hospitals. As regards training, 33% of nurses followed a training course before starting work on the ICU and 64% after starting on the unit, and 85% had easy access to continuing education, particularly in the university hospitals. In an emergency, more than 70% of nurses regularly initiated oxygen administration, mask ventilation, or cardiac massage. In Sweden 100% of nurses and in Switzerland 91% of nurses regularly inserted peripheral intravenous catheters, but only 7% of German nurses did. No German nurses and only 12% of British nurses regularly performed arterial puncture, but in Sweden 75% of nurses regularly did. CONCLUSION: Even though the number of participants were limited, our questionnaire revealed variations in nurse staffing patterns among European countries and in their systems of training and education. Nurse autonomy also varies widely between countries.

Clinical Competence↗
PubMed2006

Incompatible land uses and the topology of cumulative risk.

The extensive literature on environmental justice has, by now, well defined the essential ingredients of cumulative risk, namely, incompatible land uses and vulnerability. Most problematic is the case when risk is produced by a large aggregation of small sources of air toxics. In this article, we test these notions in an area of Southern California, Southeast Los Angeles (SELA), which has come to be known as Asthmatown. Developing a rapid risk mapping protocol, we scan the neighborhood for small potential sources of air toxics and find, literally, hundreds of small point sources within a 2-mile radius, interspersed with residences. We also map the estimated cancer risks and noncancer hazard indices across the landscape. We find that, indeed, such large aggregations of even small, nondominant sources of air toxics can produce markedly elevated levels of risk. In this study, the risk profiles show additional cancer risks of up to 800 in a million and noncancer hazard indices of up to 200 in SELA due to the agglomeration of small point sources. This is significant (for example, estimates of the average regional point-source-related cancer risk range from 125 to 200 in a million). Most importantly, if we were to talk about the risk contour as if they were geological structures, we would observe not only a handful of distinct peaks, but a general "mountain range" running all throughout the study area, which underscores the ubiquity of risk in SELA. Just as cumulative risk has deeply embedded itself into the fabric of the place, so, too, must intervention seek to embed strategies into the institutions and practices of SELA. This has implications for advocacy, as seen in a recently initiated participatory action research project aimed at building health research capacities into the community in keeping with an ethic of care.

Air Pollutants↗
PubMed2006

Threatened and endangered species: at what cost? The corps of engineers looks at expenditures and priorities.

Current political conditions, primarily budgetary uncertainty, and the related reluctance to make funding commitments for future generations, have raised questions about the costs of conservation and environmental protection that have not previously been asked. As Federal investments are scrutinized and budgets become ever more constrained, the costs associated with environmental requirements could begin to be of greater importance and to influence decisions on Federal projects. In response to concerns about the U.S. Army Corps of Engineers (Corps) spending under the Endangered Species Act (P.L. 93-205) (ESA), a limited investigation was performed to determine the accuracy of reported Corps expenditures. The investigation showed that, for particular groups of species, actual conservation costs for threatened and endangered species may be twice the amounts previously reported in the annual ESA expenditure reporting to the U.S. Fish and Wildlife Service. In light of this finding, the Corps has sought a means to provide more accurate and consistent reporting of expenditures for addressing threatened and endangered species. A Species Costs Template (template) has been developed to identify the types and magnitude of costs related to the ESA and to counteract the impediments (legal, institutional, and practical) to underreporting costs. The template will be used by the Corps for reporting ESA costs beginning with Fiscal Year 2005 (FY05) (reported in January 2006). Five broad categories of expenditures (effects determination costs, ESA protection and conservation costs, equipment costs, opportunity costs, and other species costs) are identified by the template.

Biodiversity↗
PubMed2006

Factors affecting students' evaluation in a community service-learning program.

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students' attitude and learning activities affected students' satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students' attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.

Attitude of Health Personnel↗
PubMed1988

Community outbreak of thyrotoxicosis: epidemiology, immunogenetic characteristics, and long-term outcome.

Between January and March 1984, the first community outbreak of transient thyrotoxicosis in the United States was documented in a seven-county area of southeastern Nebraska; 36 of the total 49 patients resided in York County (2.4 cases per 1,000 population). The median age of patients was 36 years, range six to 82 years; 51 percent were women. By definition, all patients were symptomatic, visited a physician, and had a newly identified elevated serum concentration of thyroxine or triiodothyronine of unknown cause. None had a goiter or a painful thyroid gland. Low 131I uptake measurements were found in all nine patients studied. Six patients were hospitalized; none died. Investigation of all 12 household contacts of eight selected patients revealed five additional persons with thyrotoxicosis and four with asymptomatic hyperthyroxinemia. A case-control study revealed that illness was associated with a significantly higher frequency of a reported recent respiratory viral-like condition. In another case-control study, the HLA-DR3 antigen was present in more case subjects (39 percent) than control subjects (14 percent). In addition, a significantly higher proportion of patients than control subjects purchased beef from one of the three supermarkets in York Country. Concomitant with the outbreak, the supermarket implicated in the outbreak purchased an unusually large quantity of beef (7,000 pounds) from a nonregular supplier in Nebraska, which had reportedly instituted the practice of trimming gullets (a procedure that removes the muscles from bovine larynx for beef) about three months earlier. Thus, it is concluded that the Nebraska outbreak, like one in Minnesota that occurred 18 months later, probably resulted from patients having eaten ground beef that was contaminated with bovine thyroid gland. This form of thyrotoxicosis, perhaps misdiagnosed as painless thyroiditis in the past, probably represents a previously under-recognized public health problem.

Adult↗