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At least 1,063 records · Page 59Linked to original sources
PubMed1997

Nutritional evaluation of low glucosinolate mustard meals (Brassica juncea) in broiler diets.

Experiments were conducted to evaluate the nutritional value of meal derived from low glucosinolate cultivars of mustard (Brassica juncea) in comparison to samples of canola meal (Brassica napus, Brassica rapa). Samples of Brassica seed (four B. juncea, one B. napus, and one B. rapa) were processed using laboratory procedures to produce oil-extracted meals, which were examined for composition (DM basis), and nutritional value for broiler chickens as judged by nutrient retention (AMEn, ileal protein digestibility) and performance. Meals derived from B. juncea contained more CP and less total dietary fiber (TDF) on a dry basis than either B. napus or B. rapa, 45.9 vs 44.6 and 43.1% CP and 27.22 vs 29.47 and 29.67% TDF, respectively. Acid detergent fiber (ADF) and neutral detergent fiber (NDF) levels for B. juncea and B. rapa meals were similar to each other, but lower than those of B. napus, 12.79 and 13.20 vs 20.6% ADF, and 21.15 and 19.58 vs 29.47% NDF, respectively. Brassica juncea meals contained more glucosinolates than B. napus and B. rapa, 34.3 vs 21.8 and 25.5 mumol/g total glucosinolates, respectively. Brassica juncea meals were equal or superior to B. napus and B. rapa meals for AMEn and apparent ileal protein digestibility. Similarly, broilers fed B. juncea meals grew as quickly and converted feed to BW gain as efficiently to 21 d of age as those birds fed B. napus and B. rapa meals. Feeding meal from B. rapa reduced growth rate and gain to feed ratio. In conclusion, the nutritional value of meal from low glucosinolate mustard was equal or superior to that of canola meal samples derived from B. napus and B. rapa cultivars.

Analysis of Variance↗
PubMed1993

Attention, stress and negative emotion in persistent sleep-onset and sleep-maintenance insomnia.

This study investigated the relation of negative emotions, attention and stress to sleep parameters in insomniacs. It also assessed whether sleep-onset insomniacs differ from sleep-maintenance/mixed insomniacs in the relations of these variables to sleep parameters. Fourteen sleep-onset insomniacs, 13 sleep-maintenance or mixed insomniacs and 13 normal sleepers were recruited using two sequential questionnaires. The groups differed significantly on diagnostically relevant sleep parameters, assessed over 1 week by sleep diary. After completing standard anxiety, anger and depression inventories, subjects participated in two laboratory procedures during which electrophysiological responses were recorded: orienting response habituation and emotional stress elicitation. The 28 significant correlations of sleep parameters with emotion, habituation and stress measures averaged r = 0.415. In multiple regression analyses, emotion, attention and stress variables accounted for an average of 41% of the variance in sleep parameters (mean R = 0.64). Discriminant function analysis using these variables correctly classified 66% of the subjects into the three groups. It was concluded that negative emotions, stress responsiveness and attentional factors interact to influence insomnia.

Adolescent↗
PubMed1993

Physician education in sleep and sleep disorders: a national survey of U.S. medical schools.

A national survey was conducted of 126 accredited medical schools in the United States to evaluate physician education in sleep and sleep disorders and to identify potential obstacles to effective teaching in the area. Parallel survey instruments were designed to evaluate preclinical and clinical training in sleep. Instructors indicated the specific courses in which this material is taught, the format of teaching, methods of student evaluation, assigned readings and clinical experience and educational resources provided. A total of 545 responses were received, which represents an 82.6% overall response rate. Responses were obtained from all accredited medical schools, and the sample was about equally divided between preclinical and clinical course directors. Less than 2 hours of total teaching time is allocated to sleep and sleep disorders, on average, with 37 schools reporting no structured teaching time whatever in this area. Only 8% of medical students are trained in the use of sleep laboratory procedures, and 11% have participated in the clinical evaluation of sleep-disordered patients. Less than 5% of medical schools offer 4 or more hours of didactic teaching on sleep, most of which consists of 4th year elective experiences. More than two-thirds of the survey respondents stated that current education is inadequate and that additional time should be devoted to this area. The major obstacles reported are the unavailability of qualified faculty, lack of curriculum time and the need for additional clinical and educational resources. Overall, it appears that physician education in sleep and sleep disorders is largely inadequate, despite increasing evidence of the role of sleep in patient health and well-being.

Adult↗
PubMed1998

The Taskforce 2000 survey on medical education in sleep and sleep disorders.

Previous research has shown evidence of a widening gap between scientific research and clinical teaching in sleep and sleep disorders. To address the deficiencies in current medical education in sleep, the Taskforce 2000 was established by the American Sleep Disorders Association. The present study was undertaken to assess the teaching activities, needs and interests of the membership of the two largest professional sleep societies (American Sleep Disorders Association and Sleep Research Society). Survey instruments included a brief, 5-item postcard survey, which was mailed to all members, followed by an in-depth, 34-item questionnaire, which was completed by 158 respondents from the intitial postcard survey (N = 808). Results indicated that the majority of respondents (65.2%) are currently involved in teaching sleep to medical students or postgraduate trainees, although the average amount of teaching time was only 2.1 hours for undergraduate and 4.8 hours for graduate education in sleep. Teaching of sleep laboratory procedures and clinical evaluation of sleep-disordered patients is limited at either an undergraduate or postgraduate level. The major deficiencies noted were the lack of time in the medical curriculum and the need for better resources and teaching facilities. A large majority of respondents indicated their willingness to be involved in sleep education for physicians, and rated this a high priority for the professional organization.

Curriculum↗
PubMed2002

Oocyte maturation in vitro.

In contrast to conventional assisted reproduction techniques in which metaphase II oocytes are retrieved for fertilization in vitro, during the in-vitro maturation of oocytes, immature germinal vesicle stage oocytes are retrieved and matured in the laboratory before fertilization and embryo transfer. Whereas in-vitro maturation is technically more demanding than in-vitro fertilization it carries many potential advantages in terms of lower treatment costs and greater safety, as a result of reducing both the number of clinical consultations and the amount of pharmacological intervention. Although the technology is still experimental, in-vitro maturation has been successfully used for the treatment of patients with polycystic ovarian syndrome, and a number of pregnancies and live births have been reported. Despite these successes and much continuing research effort, the overall efficiency of in-vitro maturation remains low, and neither clinical nor laboratory procedures can be considered to be as robust and routinely feasible as conventional in-vitro fertilization techniques. The immediate goals for in-vitro maturation programmes are therefore to increase germinal vesicle oocyte recovery rates, optimize culture conditions, improve oocyte maturation potential, and after fertilization to produce pregnancy rates that are at least equivalent to those obtained using conventional in-vitro fertilization. This review focuses on the physiology and application of human oocyte maturation in vitro, and will detail the recent advances reported in this rapidly advancing field.

Cell Culture Techniques↗
PubMed1994

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates.

PURPOSE: To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS: In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION: The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

Clinical Competence↗
PubMed1991

The association of clinical conditions and serologic tests with CD4+ lymphocyte counts in HIV-infected subjects without AIDS.

Early intervention guidelines in HIV infection require knowledge of CD4+ lymphocyte count; however, CD4+ determinations require special laboratory procedures and may not be readily available in all situations. Using data from 207 HIV-seropositive homosexual men without AIDS, we evaluated the association of difference clinical conditions or serologic tests with CD4+ count. Men with conditions including seborrheic dermatitis, hairy leukoplakia, oral candidiasis and chronic diarrhea, and men with beta2-microglobulin levels greater than or equal to 4.0 mg/l had significantly lower CD4+ counts. However, the probability that a subject with such parameters had less than 200 x 10(6)/l CD4+ cells was limited (25-63%). Although the probability that a subject with such parameters had less than 500 x 10(6)/l CD4+ cells was better (76-88%), the probability that a person without these parameters had greater than or equal to 500 x 10(6)/l CD4+ cells was only 45-50%. Clinical and serologic parameters may provide important prognostic information, but cannot be used to reliably determine the level of CD4+ cells.

Bisexuality↗
PubMed2001

Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: methods and prevalence of HIV infection.

OBJECTIVE: The objective of this study was to explore whether the differences in rate of spread of HIV in different regions in sub-Saharan Africa could be explained by differences in sexual behaviour and/or factors influencing the probability of HIV transmission during sexual intercourse. METHODS: A cross-sectional, population-based study was conducted in two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia) and two cities with a relatively low HIV prevalence (Cotonou in Benin and Yaoundé in Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population. Consenting men and women were interviewed and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection and trichomoniasis (the latter for women only). In addition, a survey was conducted on a random sample of 300 sex workers in each city. The research instruments, including the questionnaires and the laboratory procedures, were standardized to permit comparison of results. RESULTS: The numbers of men interviewed were 1021 in Cotonou, 973 in Yaoundé, 829 in Kisumu, and 720 in Ndola. The corresponding figures for women were 1095, 1116, 1060 and 1130. In Yaoundé, Kisumu and Ndola, the response rates for men were lower than for women due to failure to make contact with eligible men. The proportion of eligible women who were interviewed was 86% in Yaoundé, and 89% in Kisumu and Ndola. In Yaoundé, 76% of eligible men were interviewed, along with 82% in Kisumu and 75% in Ndola. The prevalence of HIV infection in men was 3.3% in Cotonou, 4.1% in Yaoundé, 19.8% in Kisumu and 23.2% in Ndola. For women, the respective figures were 3.4, 7.8, 30.1 and 31.9%. The prevalence of HIV infection among women aged 15-19 years was 23.0% in Kisumu and 15.4% in Ndola. Among women in Kisumu who had their sexual debut 5 years before the interview, the prevalence of HIV infection was 46%; in Ndola, it was 59%. Among sex workers, the prevalence of HIV infection was 57.5% in Cotonou, 34.4% in Yaoundé, 74.7% in Kisumu and 68.7% in Ndola. CONCLUSIONS: The HIV prevalence rates in the general population confirmed our preliminary assessment of the level of HIV infection in the four cities, which was based on estimates of HIV prevalence from sentinel surveillance among pregnant women. The very high prevalence of HIV infection among young women in Kisumu and Ndola calls for urgent intervention.

Adolescent↗
PubMed1992

Bacteriology, drug stability and exchange of percutaneous delivery systems and antibacterial filters in long-term intrathecal infusion of opioid drugs and bupivacaine in "refractory" pain.

OBJECTIVE: To provide a basis for recommendations on the exchange of containers (syringes and cassettes) and antibacterial filters, and for choice of administration device in patients with "refractory" pain treated with long-term percutaneous intrathecal (IT) infusions of opioid (morphine or buprenorphine) and bupivacaine mixtures. DESIGN: Prospective, cohort, nonrandomized control trial-case series, with consecutive sample, no standard criterion, and cost-benefit analysis. SETTING: Tertiary care center, institutional practice as well as hospitalized and ambulatory care. PATIENTS: Eighty-nine (51 women and 38 men); 81 with malignant pain and 8 with benign "refractory" pain. INTERVENTIONS: (a) The chemical stability of the drugs in the containers during 30 days. (b) The results of bacteriologic culture of the residual volumes of the analgesic mixtures from used and reused (1-16 times) syringes (n = 135) and cassettes (n = 258), and of 5 ml of sterile isotonic saline filtered through the used Millipore filters (n = 149). The bacteriologic samples from the 89 patients were taken after 1-40 (median = 7), 1-86 (median = 20), and 5-78 (median = 31) days of IT treatment, respectively. MAIN OUTCOME MEASURES: Chemical stability: buprenorphine and bupivacaine concentrations-liquid chromatography; morphine concentrations--gas chromatography. Bacteriologic cultures: standard laboratory procedures. The hypothesis (repeated use of the infusion systems and their exchange once a month does not significantly affect drug concentrations or increase the infection risk) was elaborated before data collection began. RESULTS: The bupivacaine-opioid mixtures were found to be chemically stable within 3-10% of the original doses up to 30 days. Seventeen cultures (from five syringes, six cassettes, and six filters) in 13 patients (having no signs of meningeal infection) were found to be colonized with Staphylococcus aureus (n = 4), coagulase negative staphylococci (n = 7), viridans streptococci (n = 3), Neisseria sp (n = 4), Corynebacterium sp (n = 4), Enterobacter sp (n = 2), Klebsiella sp (n = 3), gram-negative bacilli (n = 1), and yeasts (n = 2). The place of IT treatment, its duration, and patient-related infection risk factors (age; malignancy; diabetes; presence of a colostomy, pyelostomy, or indwelling urinary catheter; and the presence and location of infection foci) were not related to the results of the cultures. However, 9 of the 17 positive cultures came from patients with skin ulcers, a notable incidence. The positive cultures had no connection with the cultured item, its in-use duration, the number of times of reuse, the analgesic drugs used, their concentrations or the presence of preservatives (sodium metabisulfite and sodium edetate), or the antiseptic agent (70% ethanol or 0.5% chlorhexidine gluconate) used during bacteriologic sampling. The bacterial growth was sparse in 14 and massive in 3 of the 17 positive cultures. One item (filter) from one patient with meningitis was sterile. CONCLUSIONS: In our population, exchange of the infusion systems when they are empty (within 1 month) and of the antibacterial filters once a month does not appear to affect the concentrations of, or increase the infection risk from, the opioid-bupivacaine mixtures. The risk of bacterial contamination/colonization of the syringes from syringe drivers does not seem to be higher than that of cassettes from external portable pumps.

Adolescent↗
PubMed1983

Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population.

Twenty-four pediatric patients undergoing corrective posterior spinal fusion surgery for idiopathic scoliosis were studied to determine the frequency with which the syndrome of inappropriate antidiuretic hormone secretion (SIADH) developed. We measured arterial blood gases, serum and urine electrolytes and osmolalities, CVP, and urine output during and after surgery. The 20 patients receiving hypotonic iv salt solution in the immediate postoperative period experienced a significant drop in serum sodium values (6.2 +/- 2.9 mEq/L) and 5 (25%) developed SIADH as diagnosed by routine laboratory procedures. Four patients were treated with iv isotonic salt solution. No patient developed hyponatremia (serum Na+ less than 130 mEq/L) and the decrease in serum sodium (3.0 +/- 0.8 mEq/L) was not statistically significant. We conclude that SIADH occurs commonly in patients undergoing corrective vertebral surgery and that vigilant attention must be paid to their fluid and electrolyte management in the postoperative period.

Adolescent↗
PubMed1995

In-situ determination of the diffusion coefficient of 222Rn in concrete.

Measurements of the effective diffusion coefficient, De, of 222Rn in concrete are important for accurate determination of transport mechanisms and computer modeling of radon entry into structures. A method for in-situ determination of De as well as the emanation fraction, F, is described. It is based on continuous measurement of the radon flux from an intact slab and the concentrations on both sides. A non-linear regression algorithm was used to fit these data to the steady state solution to Fick's law. The regression output includes estimates of both De and F. The method has the advantage over typical laboratory procedures since it measures an undisturbed surface area of concrete where the samples exhibit moisture, temperature, and loading conditions that are experienced in a real structure. Effective diffusion coefficients ranged from 1.1 x 10(-8) to 4.4 x 10(-8) m2 s-1 for measurements of concrete floor slabs in two structures. The measured emanation fraction of radon in concrete in one structure was 0.2 +/- 0.02. A sensitivity analysis indicated that the values of De and F estimated by the regression procedure are strongly dependent on the thickness of the slab. The porosity of the concrete had little affect on the regression results.

Air Pollutants, Radioactive↗
PubMed1986

Diagnosis of brain death in children.

During the last two decades, criteria have been developed for the diagnosis of brain death that are applicable to adults and children over 5 years of age. To identify brain death, EEG and evoked potentials (EPs) have been extensively used as diagnostic tools in conjunction with the clinical examination and other laboratory procedures such as four-vessel cerebral angiograms or radionuclide scans. In this report, we review the criteria for the determination of brain death. In addition, the question of applying these criteria to children under 5 years of age is critically assessed, with special emphasis on the role of EEG and EPs in confirming the cessation of all brain activities. We propose that the criteria that pertain to adults may be appropriate for children under 5 years of age as well; however, this premise needs to be validated by a large nationwide multi-institutional study.

Adult↗
PubMed1999

Modes of cardiovascular regulation during middle childhood.

Obtaining meaningful baseline measures of children's cardiovascular activity (CVA) has been difficult because of constraints inherent to laboratory procedures that are used to assess individual differences in response to stress. To circumvent these problems, we performed repeated baseline measures of pulse rate (PR) and blood pressure for 174 children (aged 7-10 yr) in their natural school setting throughout 2 1-week periods. In addition, experimental assessments of cardiovascular reactivity (CVR) were conducted after each baseline period while children participated in a challenging cognitive task. Multivariate analyses of physiological indices revealed three primary styles of cardiovascular functioning. Two of them, characterizing children either with high PR and low blood pressure or conversely with low PR and high blood pressure, have already been described in the research literature. However, analyses also revealed a third group of children (48% of the subjects) who had both low PR and low blood pressure. Findings indicate developmental differences in cardiovascular regulation and highlight the need to consider both variations in baseline CVA as well as in CVR when examining children's physiological adaptation in everyday settings.

Age Factors↗
PubMed1997

Replacement medication for cocaine dependence: methylphenidate.

Agonists, or "replacement medications," are useful adjuncts in treatment of opiate and nicotine dependence. They have not been systematically examined in cocaine dependence. Results of early open trials with methylphenidate for treatment of cocaine dependence were equivocal. Twenty-four cocaine-dependent subjects were enrolled in an 11-week double-blind, placebo-controlled study of methylphenidate. Assignment was random. Intake included a 2-day human laboratory procedure in which subjects received initial doses of methylphenidate or placebo. Subjects attended the clinic Monday through Friday and received oral doses of methylphenidate (5 mg plus 20-mg sustained release) or placebo at 8:00 a.m., with afternoon and weekend take-home doses (20 mg sustained-release or placebo) provided in Medication Events Monitoring System bottles to monitor compliance. Clinic visits included therapy sessions, electrocardiograms, self-report measures, and twice-weekly urine screens. The two groups were equivalent in terms of retention (methylphenidate 48% and placebo 42%) and had similar cocaine use outcomes (40% benzoylecgonine-positive urine screens). There were no significant adverse effects. The doses were sufficient to permit detection of psychoactive effects ("stimulant," "more energy") and side effects ("jitteriness," "eating less") without increased "craving." Additional medications with different effects profiles are being studied to further evaluate the replacement model in cocaine dependence.

Adult↗
PubMed2001

Two methods to evaluate the antimicrobial action of calcium hydroxide paste.

The objective of this study was to analyze two methods for determining the antimicrobial effectiveness of (i) calcium hydroxide plus saline, (ii) calcium hydroxide plus polyethylene glycol, and (iii) calcium hydroxide plus camphorated paramonochlorophenol. Four microorganisms (Staphylococcus aureus (ATCC 6538), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), and Bacillus subtilis (ATCC 6633)), one yeast (Candida albicans (ICB/USP-562)), and one mixture of these organisms were used. The strains were inoculated in Brain Heart Infusion (BHI) and incubated at 37 degrees C for 24 h. Two methods, the direct exposure test and the agar diffusion test were used to evaluate antimicrobial effects. For the direct exposure test (DET) 288 paper points were contaminated with the standard microbial suspensions and exposed to the intracanal dressings for 1, 24, 48, and 72 h. The points were immersed in Letheen Broth, followed by incubation at 37 degrees C for 48 h. An inoculum of 0.1 ml obtained from Letheen Broth was then transferred to 7 ml of BHI under identical incubation conditions, and microbial growth was evaluated. Pastes showed activity between 1 and 72 h, depending on the microorganism/mixture tested. For the agar diffusion test 36 Petri plates with 20 ml of BHI agar were inoculated with 0.1 ml of the same microbial suspension used for the DET, using sterile swabs that were spread on the medium. Five cavities were made in each of two agar plates (total = 10) and completely filled with one of the calcium hydroxide pastes. The plates were preincubated for 1 h at environmental temperature and then incubated at 37 degrees C for 24 to 48 h. The inhibition zone around each well was recorded in millimeters, and the results were submitted to ANOVA and Tukey test (alpha = 0.05). All intracanal dressings induced inhibition zones (range 5.0-10.0 mm). Data obtained showed that both the DET and agar diffusion test are useful in establishing the calcium hydroxide antimicrobial spectrum, thus improving infection control protocols. The direct exposure method is independent of other variables and is a practical laboratory procedure. A complete antimicrobial effect was observed after 48 h on indicator microorganisms, in both tests, irrespective of the calcium hydroxide paste vehicle.

Analysis of Variance↗
PubMed1981

Cefamandole for prophylaxis against infection in closed tube thoracostomy.

During an 18-month period, antibiotic prophylaxis in 120 patients undergoing closed tube thoracostomy was evaluated by a prospective, randomized double-blind technique. Forty-six subjects had sustained penetrating chest trauma. Either placebo (n = 60) or 1 gm/6 hours cefamandole (n = 60) was begun intravenously at the time of tube insertion and was continued intravenously or intramuscularly until the second day following tube removal. Cultures were taken of the pleural drainage, usually blood, at tube insertion, on tube removal, and on several occasions between those times. Antibiotic concentrations were determined biologically on the same specimens of pleural fluid as well as selectively on concomitant venous blood samples. Cultures were also obtained from all subsequent foci of infection, including the wound, any empyema, bronchial secretions, urine, or infected intravenous sites. Aerobic and anaerobic isolation and identification were carried out according to standard laboratory procedures with sensitivity testing (disc and tube dilution) only of the aerobes. Results demonstrated that infection of the lung and/or pleural space was eight times more common in the placebo groups (13.3%) than in the group receiving cefamandole (1.7%) (p less than 0.01). In addition, the single infection that developed despite use of the antibiotic was due to a susceptible organism. No major adverse drug reactions were noted.

Adolescent↗
PubMed1975

The orginization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings.

Data are presented on office-based general practitioners and pediatricians working in varying practice settings. Fee-for-service physicians spend more time in direct patient care activities than those in prepaid practice, and devote more time to each patient. The data suggest that the patient load characteristic of general practice in prepaid groups encourages a more assembly line practice which is less responsive to patients than the pattern characteristic of fee-for-service practice. Prepaid physicians work during scheduled hours and may deal with increased load by processing patients more rapidly. Fee-for-service physicians tend to respond to increased demand by working longer hours. The responsiveness of primary care physicians to patient problems seems to reflect primarily their social orientations to medical practice and the time pressures they face. Varying practice settings result in different techniques of coping with the pressures of practice. Data are also presented on sociodemographic and professional characteristics of primary care physicians in varying settings, workload, use of diagnostic and laboratory procedures, social orientations to medical practice, satisfactions and dissatisfactions, and attitudes toward sociopolitical aspects of medical care. Suggestions are offered for improving the responsiveness of prepaid practice.

Adult↗
PubMed1976

The effect of prepaid group practice on physicians' utilization behavior.

The study is concerned with the practice of physicians in a prepaid group practice setting. Specifically, it is concerned 1) with investigating the extent of variation in physician behavior concerning use of clinical resources, that is, office visits and telephone calls, and technical resources, that is, x-rays and laboratory procedures, and 2) with determining the factors that account for such variation. The universe of this study consists of all internists practicing in 1970 in the prepaid group setting of Kaiser Permanente at Portland, Oregon, a total of 34. The overall framework for the study is based on the belief that medical training and the setting in which physicians work are significant determinants of their use of clinical and technical resources in different disease situations. Specifically, the framework posits that different sets of organizational variables are important in determining use of resources for acute and undiagnosed conditions. The findings reported in the study suggest that while the teaching environment in which a physician is trained is important in shaping his clinical personality, the setting in which he actually works contains its own source of influence over his professional activity. These results also provide supportive evidence for the widely held notion that prepaid group practice, through changing the nature of the incentives to physicians and introducing professional regulation, leads to a more efficient way of providing medical care by reducing the use of costly resources.

Consumer Behavior↗