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PubMed1991

Hospital physician assistants: past, present and future [corrected].

Expansion of the roles of PAs into the hospital setting has been the most significant recent trend in the healthcare field's use of these professionals. Initially intended to be primary-care providers, PAs have moved into the institutional domain with ease and in large numbers to assume roles as medical and surgical inpatient house-staff and as assistants to specialists and subspecialists. In most instances, they have adapted to these types of roles without formal training beyond the normal two-year educational period. PAs in hospitals have been proven to maintain or improve the existing level of quality and access to medical care, have been shown to be cost-effective in the delivery of inpatient services, and have displayed extensive clinical versatility among the various medical disciplines. Hospitals' use of PAs came about through changing forces in the health-personnel supply pool and mandated adjustments in the patterns of graduate medical education. Employing PAs has permitted hospitals to maintain the required levels of patient care in a cost-effective way, has allowed residency programs to balance the numbers of specialty-trained physicians, and has thereby contributed to a more balanced supply of specialists in overcrowded fields. The use of PAs has also contributed to increasing the continuity of care on hospital services and to measures that enrich the quality of residency education for physicians in training. To accommodate PAs as inpatient providers, medical-staff bylaws have been amended to recognize the education and expertise of PAs and to provide their institutional sanction to perform inpatient duties under the supervision of physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Credentialing↗
PubMed1993

Variables in effective CEO-medical director relations.

It is becoming commonplace that physicians are not just working in hospitals but are helping run them as well. This means that chief executive officers are working side by side with chief medical officers. What are the factors that influence the working relationship between these roles? The author presents data from a survey that helps to answer this question.

Attitude of Health Personnel↗
PubMed2005

Donkey work: women, religion, and HIV/AIDS in Malawi.

Addressed in this article are the familial, cultural and religious influences on Malawi women that contribute to HIV/AIDS. Thirty-nine adult Malawi women representing voluntary assistance groups, religious groups, and university women participated in 3 focus groups in Malawi. Interview data were taped, transcribed, and analyzed using qualitative descriptive analysis. Findings revealed that multiple burdens in the lives of Malawi women resulting from poverty and responsibility for family members are made more onerous by religious institutions, sexual practices, and cultural beliefs. In conclusion, women's "donkey work" may result in at-risk sexual behavior as a means of survival, thus increasing the incidence of HIV/AIDS. Alleviating the burdens involves efforts from religious groups and restructuring of belief systems.

Acquired Immunodeficiency Syndrome↗
PubMed2000

What colleges are doing about student binge drinking. A survey of college administrators.

In 1999, the Harvard School of Public Health College Alcohol Study surveyed 734 US college administrators to learn what colleges were doing to prevent binge drinking. Respondents rated the severity of student alcohol-abuse problems and described prevention efforts and institutional investments in prevention infrastructure. Prevention practices were widespread in the areas of general education about alcohol, use of policy controls to limit access to alcohol, restricting advertising at home-game sporting events, and allocation of living space to alcohol-free dormitories. Programming was less prevalent for more targeted alcohol education, outreach, and restrictions on alcohol advertising in campus media. Nationally, most of the surveyed colleges reported having a campus alcohol specialist, many had task forces, and about half were performing in-house data collection. Less common were program evaluations, community agreements, or neighborhood exchanges. Prevention practices varied with institutional characteristics and the surveyed administrators' perceptions of the severity of alcohol problems.

Administrative Personnel↗
PubMedDate not supplied

Zambia mental health country profile.

This country profile for Zambia was compiled between 1998 and 2002. The objectives of the exercise were to first of all avail policymakers, other key decision makers and leaders in Zambia, information about mental health in Zambia in order to assist policy and services development. Secondly, to facilitate comparative analyses of mental health services between countries. The work involved formation of a core group of experts who coordinated the collection of information from the various organizations in Zambia. The information was later shared to a broad spectrum of stakeholders for consensus. A series of focus group discussions (FGDs) supplemented the information collected. There are various factors that contribute to mental health in Zambia. It is clear from the Zambian perspective that social, demographic, economic, political, environmental, cultural and religious influences affect the mental health of the people. With a population of 10.3 million and annual growth rate of 2.9%, Zambia is one of the most urbanized countries in sub-Saharan Africa. Poverty levels stood at 72.9% in 1998. In terms of unemployment, the most urbanized provinces, Lusaka (the capital city), and the copper-belt are the most affected. The gross domestic product (GDP) is US$3.09 billion dollars while per capita income is US$300. The total budget allocation for health in the year 2002 was 15% while the proportion of the GDP per capita expenditure for health was 5.6%. The HIV/AIDS prevalence rates stand at 20% among the reproductive age group 15-49 years. Political instability and wars in neighbouring states has resulted in an influx of refugees. Environmental factors affecting the country include natural and man-made disasters such as floods and drought, mine accidents, and deforestation. To a large extent in Zambia, people who are mentally ill are stigmatized, feared, scorned at, humiliated and condemned. However, caring for mental ill health in old age is positively perceived. It is traditionally the duty and responsibility of the extended family to look after the aged. Gender based violence (GBV) is another issue. Women, who are totally dependent on their spouses economically, are forced by circumstances to continue living in abusive relationships to the detriment of their mental well-being. In Zambia, the family is considered sacrosanct and the affairs of the family members, private. It is within this context that GBV is regarded as a family affair and therefore a private affair, yet spouse beating has led to depression and in some cases death. In terms of psychiatric services, there are close to 560 beds for psychiatric patients across the country. Common mental disorders found in Zambia are acute psychotic episodes, schizophrenia, affective disorders, alcohol related problems and organic brain syndromes. About 70-80% of people with mental health problems consult traditional health practitioners before they seek help from conventional health practitioners. Over time the number of frontline mental health workers and professional staff has been declining. This is due to the 'brain drain', retirement, death and low output from training institutions. For practicing psychiatrists, only one is available for the whole country. Other key mental health workers such as psychologists, social workers and occupational therapists are also in short supply. All in all, the mental health services situation in Zambia could be described as critical, requiring urgent attention.

Aged↗
PubMed2003

Functional electrical stimulation for walking in paraplegia: 17-year follow-up of 2 cases.

OBJECTIVE: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes. DESIGN: Case study with more than 17 years of follow-up. SETTING: Institutional rehabilitation practice. STUDY PARTICIPANTS: Two long-term (17 years) volunteer participants with paraplegia who were able to stand and walk using FES. INTERVENTION: Chronically indwelling percutaneous intramuscular wire electrodes connected to a portable microprocessor-controlled stimulator were used to exercise muscles while controlling trunk, hips, knees, and ankles and develop activation patterns to produce standing and walking. MAIN OUTCOME MEASURES: Clinical complications, electrode performance and survival probability, and functional performance. RESULTS: The most noted clinical complications included localized inflammation at the electrode site and superficial infection that responded well to topical and oral antibiotic treatment. The change from coil-wire electrodes, with a survival of 35% after 1 year, to double-helix electrodes improved electrode survival to 80% at 1 year and 48% at 5 years. Maintenance of the multichannel percutaneous FES walking system required replacement of an average of 2 electrodes every 6 months. Participants were able to use their system for independent exercise and standing and for walking with standby assistance. CONCLUSION: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years. Two long-time users of the system had no adverse effects to their skeletal system. The most common problems were daily care of electrodes at exit sites, frequent irritation of the skin around electrodes, and replacement of failed electrodes. The percutaneous system has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.

Electric Stimulation Therapy↗
PubMed2002

Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: an institutional tuberculosis outbreak.

The use of rifamycins is limited by drug interactions in human immunodeficiency virus (HIV)-infected persons who are receiving highly active antiretroviral therapy (HAART). During a tuberculosis (TB) outbreak at a prison housing HIV-infected inmates, rifabutin was used to treat 238 men (13 case patients and 225 contacts). Steady-state peak plasma rifabutin concentrations were obtained after rifabutin dosages were adjusted for men receiving single-interacting HAART (with either 1 protease inhibitor [PI] or efavirenz), multi-interacting HAART (with either 2 PIs or > or =1 PI with efavirenz), and for noninteracting HAART (>1 nucleoside reverse-transcriptase inhibitor or no HAART) without rifabutin dose adjustments. Low rifabutin concentrations occurred in 9% of those receiving noninteracting HAART, compared with 19% of those receiving single-interacting and 29% of those receiving multi-interacting HAART (chi2, 3.76; P=.05). Of 225 contacts treated with rifabutin-pyrazinamide, 158 (70%) completed treatment while incarcerated. Rifabutin-pyrazinamide therapy was difficult to implement, because of the need for dosage adjustments and expert clinical management.

Adult↗
PubMed2005

Control of vancomycin-resistant enterococci in the neonatal intensive care unit.

BACKGROUND AND OBJECTIVE: Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants. METHODS: Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness. RESULTS: Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater. CONCLUSIONS: Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU.

Cross Infection↗
PubMed2001

Possibilities.

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Clinical Pharmacy Information Systems↗
PubMed2000

Family physician job satisfaction in different medical care organization models.

OBJECTIVES: The aim of the present study was to estimate physician job satisfaction at the Mexican Institute of Social Security (IMSS), the Ministry of Health (SSA) and in the private sector, and to measure the association between these different family medical care organization models. METHODS: A comparative cross-sectional design was used to investigate the job satisfaction of family physicians in private and institutional family medicine clinics. Satisfaction was measured with a previously constructed and validated instrument. The instrument measures the satisfaction in four areas: 'global satisfaction', 'institution where the physician works', 'the patients' and 'themselves as physicians'. RESULTS: One hundred and seven IMSS physicians, 106 SSA physicians and 97 private physicians were selected randomly from a census according to the sample size. The sample was weighted. Fifty-one percent of IMSS and SSA physicians were dissatisfied, against 25% in the private sector, in the first three areas. Comparing the private model and the IMSS, differences were found (P < 0.0001) in the area of 'global satisfaction' [odds ratio (OR) = 2.47, 95% confidence interval (CI) 1.69-3.67], 'institution where the physician works' (OR = 2.12, CI 1. 45-3.13) and 'themselves as physicians' (OR = 1.84, CI 1.28-2.65). When the private/SSA groups were compared, the differences were similar (P < 0.0001). No differences were found in terms of 'the patients'. When stratifying, the risks increased in females, in the group aged 31-40 years and in specialists in family medicine. CONCLUSIONS: The organization model is associated with dissatisfaction in all areas, except in 'the patients'.

Adult↗