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Early-retirement incentive programs for medical school faculty.

The Association of American Medical Colleges surveyed the principal business officers of all 126 accredited U.S. medical schools in late 1991 in order to learn about their retirement benefit programs for faculty and whether early-retirement incentive programs were being used. A total of 115 of the schools provided usable responses, which the author reports for all schools, public schools, and private schools. For all schools, defined-contribution plans (based on employer's and employee's contributions plus investment earnings) were the preferred type of retirement benefit program (77%, or 89, of the responding schools). Defined-benefit plans (based on a formula that uses variables of age at retirement, years of service, and salary) were available at 37% (43) of the schools. Early-retirement incentive programs had been used by 70% of the responding schools in the five-year period 1987-1991. Sixteen schools provided descriptions of their formal early-retirement programs, which are summarized. The author observes that, although nearly three-fourths of the responding schools are familiar with the use of the incentive programs, these programs have resulted in few actual early retirements. He discusses why this may be true and compares the pros and cons of formal and ad hoc programs. He concludes that no single program can be considered best; each institution must work with its faculty to design programs to meet institutional goals and faculty interests.

Faculty, Medical

Satisfaction with hospital emergency department as a function of patient triage.

For most people, waiting is inherently dissatisfying and emergency department patients are no exception. Most patients and people accompanying the patient find the treatment waiting time in emergency medical care facilities to be a source of great dissatisfaction. The dissatisfaction is compounded in many cases by the anxiety of all associated with the patient and the discomfort or pain the patient feels. Consequently it was not surprising to find in this investigation that waiting time for treatment and treatment cost were major causes of consumer dissatisfaction. Satisfaction of emergency department patients decreased as the medical need became less urgent. This finding should be of considerable concern to hospital administrators. With the trend toward new forms of health care delivery systems such as "emergicenters" and the increase in the number of physicians per capita, the emergency department will no longer be the most attractive or the only alternative available to the patients who have a nonemergency medical need. For emergency departments to remain profitable, it will be more important than ever before to meet the needs and expectations of their current and potential users. This can be accomplished by a program designed to reduce cost and waiting time and improve communication, and by other programs to educate the user so that the user's expectations more closely conform with what is actually needed or can be economically provided.

Anxiety

A microcomputer system for the practising cardiac surgeon.

The authors present a computer program designed for the practising cardiac surgeon who wishes to computerize patient data. The program is efficient, versatile and can be adapted to individual needs. It can be used with any IBM PC-compatible machine and requires little knowledge of computer science. More than 250 items on 30 000 patients can be stored and all this information analysed simultaneously. The program can chart a patient's profile and tabulate the information of the entire registry. It can generate lists of patients with their surgeons, cardiologists, diagnoses, operations and dates of intervention. It can also be used for mailing purposes.

Cardiac Surgical Procedures

Using a computer simulation program to assess the decision-making process in child health care.

The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.

Computer Simulation

A case study in contesting the conventional wisdom: school-based fluoride mouthrinse programs in the USA.

This paper presents the events surrounding the dissemination of the results of a major preventive dentistry demonstration program designed and conducted to provide evidence of the effectiveness and actual costs of a combination of commonly used preventive procedures. It then reviews the controversy provoked when the results of that program were counter to the conventional wisdom of the day, prevailing national policy, and public health practice. An analysis of possible reasons for this reaction follows. The paper concludes with some observations about how such a situation might be approached to minimize similar controversy in the future.

Child

Hawaii Asian-American response to the Staying Healthy After Fifty program.

A nationwide project conducted by the American Association of Retired Persons, the American Red Cross, and the Dartmouth Institute for Better Health to disseminate a health promotion program for older adults included a study to test its ability to serve different ethnic minorities. This article reports how the Staying Healthy After Fifty Program, designed for the general United States population, was introduced into the State of Hawaii, how it was adapted for use with two Asian-American groups, the Japanese and Filipinos, and on the benefits reported by participants. To determine the appropriateness and effectiveness of the adapted SHAF program, a quasi-experimental design, involving a test group and a comparison group whose members completed questionnaires at three points in time, was used. The results of the data collected from the Hawaiian population were consistent with the results of the general U.S. population skills, health activities, and health care cost skills areas. Participants were very pleased with the course and its quality, as noted in the high ratings of course satisfaction.

Aged

Embryo implantation rates in oocyte donation: a prospective comparison of tubal versus uterine transfers.

OBJECTIVE: To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program. DESIGN: Prospective randomized. PATIENTS: Forty-two consecutive patients who entered an oocyte donation program. INTERVENTIONS: Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET). RESULTS: Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs). CONCLUSIONS: Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.

Embryo Implantation

Physical fitness program for patients with psychiatric disorders. A clinical report.

The current practice of physical therapy rarely addresses the needs of patients with psychiatric disorders. The literature has shown that physical and psychological health are related intimately. This article describes a physical fitness training program designed for inpatients with mental illness in an acute care hospital setting. A training program consisting of group exercise sessions conducted three times a week for six weeks may enhance the patients' self-esteem and body image in a unique way. Physical therapy intervention should be broadened to address the special needs of the mentally disabled.

Adolescent

[Psychosocial intervention for persons infected with HIV].

We describe a psychosocial intervention program designed to enhance coping with the stress associated with HIV infection. The NUCARE intervention program is based on six components of coping including: cognitive reframing, problem-solving, relaxation, goal setting, social support and use of resources and services. The rationale and development of the intervention is discussed and practical case examples illustrating the benefits of each component are presented.

Adaptation, Psychological

The chemically dependent nurse.

Although exact numbers are not known, it is recognized that addiction to alcohol and other drugs occurs in nurses as it does in other occupations. There is some indication that nurses may be at greater risk for the development of addictive disease because of factors present in the profession. The nursing profession is recognizing the problem impaired practice presents and is working to develop programs to ensure that the issue of the impaired nurse is no longer denied by institutions, administrators, and individual nurses. There is a need for education of the profession in regard to the nature of addictive disease and the identification of the nurse whose practice has become impaired because of the use of alcohol or other drugs. Nurses also need to know more about intervention, treatment, and monitoring of recovery. It is the responsibility of the entire profession to see that programs designed to accomplish these tasks are in place in all states. The goals of programs for the impaired nurse are to protect the safety of individual patients, to safeguard the integrity of the profession, and to facilitate treatment and rehabilitation for the chemically dependent nurse.

Humans

The INTERNIST-1/QUICK MEDICAL REFERENCE project--status report.

INTERNIST-1 and its successor, QUICK MEDICAL REFERENCE (QMR), are computer programs designed to provide health care professionals with diagnostic assistance in general internal medicine. Both programs rely on the INTERNIST-1 computerized knowledge base, which comprehensively describes 570 diseases in internal medicine. The philosophies behind the development of each program differ. Whereas INTERNIST-1 functions solely as a high-powered diagnostic consultant program, the QMR program acts more as an information tool, providing users with multiple ways of reviewing and manipulating the diagnostic information in the program's knowledge base. At the lowest level, the program can be viewed as an electronic textbook of medicine. In addition, the QMR program has the ability to assist users with generating hypotheses in complex patient cases. The QMR program has not been evaluated formally as an information tool for practicing physicians. A preliminary study indicates that QMR's case-analysis capabilities are of potential benefit in most patients in internal medicine admitted for diagnostic evaluation.

Diagnosis, Computer-Assisted

The therapeutic applications of computerised games.

Microcomputers have great potential in therapeutic environments, but, if they are to achieve this potential, they need appropriate software (programs). This paper examines the ideas behind games software and the relevance of commercially available software to therapy. It recommends that specially designed programs are needed and lays down some guidelines for the design and development of such software.

Computers

SAPHIRE--an information retrieval system featuring concept matching, automatic indexing, probabilistic retrieval, and hierarchical relationships.

SAPHIRE (Semantic and Probabilistic Heuristic Information Retrieval Environment) is an experimental computer program designed to test new techniques in automated information retrieval in the biomedical domain. A main feature of the program is a concept-finding algorithm that processes free text to find canonical concepts. The algorithm is designed to handle a wide variety of synonyms and convert them to canonical form. This allows natural language to be used for query input and also serves as the basis for a new approach to automatic indexing based on a combination of probabilistic and linguistic methods.

Abstracting and Indexing

Issues in human immunodeficiency virus (HIV) screening programs.

Unlike test sensitivity and specificity, the false positive and negative predictive values (probabilities of mislabeling an individual being tested) depend heavily on the prevalence of the infection of the human immunodeficiency virus (HIV) as well as the quality of the kit. A consequence of this dependence is that the false positive predictive value can reach a high magnitude such as 0.9; that is, 90% of the positive tests are false. This raises many important issues pertaining to the current practice of HIV screening such as to how to control these misclassification errors, how to interpret test results, and how to estimate prevalence using test results. These issues are examined in detail here by considering the factors that dictate the quality of a screening program. Some real data examples are used to illustrate the importance of this consideration in designing programs to achieve the desired goals. The rationale behind the common two-step sequential protocol in HIV screening is examined to point out its limitations under practical situations. Finally, the use of entropy in evaluating the informativeness of a screening program is discussed.

AIDS Serodiagnosis

[Obstetric factors associated with low birth weight].

An analysis was made of 18,804 of 19,446 consecutive births of the number analysed 15.93% presented low birth-rate. Significant statistical association was found in relation to maternal age, pre-natal care, previous pregnancies, smoking and gestational age at birth. Measures with a view to the attenuation of the problem are proposed, among them being: educational programs for teenagers on human reproduction, programs designed to create awareness of the harm done by smoking, amplification of antenatal assistance, medical programs for the limitation of premature labor, all of these and others, in association with programs of socio-economic support.

Adolescent

Opinions and approaches to continuing education among obstetrician/gynecologists.

This national survey of Fellows of The American College of Obstetricians and Gynecologists found that obstetrician/gynecologists are actively involved in continuing medical education activities and appear satisfied with the resources available, yet desire additional opportunities for lifelong learning. Traditional resources (eg, journals, seminars) are used much more extensively than newer, electronic resources (eg, video cassettes, cable television), probably as a result of unfamiliarity with these latter methods and limited access to them. However, the majority of Fellows want increased exposure to these newer educational programs. Relevance of content, caliber of faculty, and potential for professional growth were important factors in choosing continuing medical education programs. Strong interest was expressed in individualized learning programs designed in collaboration with university faculty. These findings are of value in producing future educational programs for practitioners in obstetrics and gynecology.

Attitude of Health Personnel

Management preparation for nurse executives: the dual degree option.

Nurses have the clinical expertise that enables them to better understand the complex issues inherent in management of the delivery of health care. Yet without adequate preparation in management, as well as training of higher levels of nursing theory and research, nurses will be less prepared to compete at higher levels as the system continues to change. The University of Colorado offers a program designed to meet these needs, which serves as a national model for other schools of nursing considering such a curricular change. Further research needs to be conducted to identify the specific components of a graduate program that will enable the nurse executive to develop advanced nursing practice skills while developing the management skills necessary to achieve effectiveness in the practice setting. Because the long-term outcome of the dual degree model is still unknown, the effectiveness of the program in the health care system over time will be evaluated in relation to three outcomes: first, the effectiveness of program goals and objectives for producing successful nurse executives; second, the effectiveness of the curriculum design in preparing successful nurse executives; and third, satisfaction of graduates with the program and with their preparation. Participants in the dual degree program look forward to meeting this challenge.

Administrative Personnel

Interdisciplinary health education: a case study of fact and fancy.

Meeting the health needs of patients and providing comphrehensive health care services require the integration and coordination of several professional health services. Traditional methods for training students in the health professions independently are being challenged by the need for future practitioners to understand and to utilize effectively the skills offered by the other disciplines. However, the movement of educational institutions toward interdisciplinary training programs entails the careful assessment of program design, content, and basic philosophy. Two and one-half years of experience with such a program at one academic health center are reviewed.

Adult