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PubMed1983

General aviation accident rates and pilot community population size: an examination of rural-urban differences.

Most investigations of general aviation accidents involving human factors have emphasized biomedical and psychological concerns, with comparatively few contributions from other disciplines. This study derives from a social science orientation and investigates the relationship between general aviation accident rates and the population size of the involved pilots' communities of residence. After excluding agricultural, air taxi, and commercial helicopter operations, an analysis of 48 Colorado communities reporting at least one 1978 accident-involved pilot revealed a correlation of -0.51 between accident rate per 1,000 pilots and community size. The smallest, and generally most rural, communities produced total and fatal accident rates of respectively 2.55 and 5.36 times greater than those for the largest metropolitan areas. A similar trend characterizes U.S. nationwide general aviation accidents and appears as well for automobile mishaps, thus lending additional support to the present findings. Discriminant analysis of individual-level data for 92 of the accidents revealed that the conventional explanations of airport facilities, terrain, pilot qualifications and exposure, and aircraft complexity failed to exert substantial effects on differences among the categories of accidents grouped by community size. Two alternate explanations are offered which speculate that: 1) the rural-urban accident differential may represent a function of variations in "pilot density," and 2) the observed differences may be attributed to attitudinal differences between rural and urban pilots produced by the former group's exposure to a type of "rural subculture."

Accidents, Aviation↗
PubMed2005

Challenges and strategies in developing nursing research capacity: a review of the literature.

OBJECTIVES: This paper reports the findings of a critical overview of the development of nursing research capacity in academic departments. It examines the major barriers to developing research capacity, the capacity building strategies adopted (or proposed) within the literature, and considers the wider context within which such endeavours take place. DESIGN: The literature review forms part of a longitudinal project utilising case study methodology. A key word search was used to locate relevant journal articles for the period 1999-2004, derived from the project's research question and an earlier literature review. A number of manual 'shelf searches' were conducted. DATA SOURCES: Bibliographic data were retrieved from The Cumulative Index of Nursing and Allied Health literature, The Social Science Citation Index, and Medline. REVIEW METHODS: Approximately 150 articles were retrieved, of which 47 were included in the study. Given the paucity of work in this area papers were not excluded on the grounds of methodological weakness. Major themes were identified in each paper and an analytical framework was developed. RESULTS: Two main challenges affecting research capacity development were identified-material constraints and organisational contexts, and the changing roles and expectations of nurse educators. The importance of developing an overall strategic approach, clearly communicated, and accompanied by effective leadership was a point of common agreement. Debate existed on how research support should be managed, particularly the merits of inclusivity and the reconcilement of individual and organisational needs. Specific capacity strategies identified in the literature were the creation of infrastructures, the fostering of research cultures and environments, and the facilitation of training and collaboration. CONCLUSIONS: The literature offers many examples of capacity building strategies. However, more empirical studies are needed to understand the situated process of implementing and evaluating capacity building in individual academic departments, and how this process differs between geographical settings.

Education, Nursing, Continuing↗
PubMed2006

Research awareness: An important factor for evidence-based practice?

BACKGROUND: Despite the growing body of literature, the reality of getting evidence into practice remains problematic. OBJECTIVE: The purpose of this study was to establish levels of research awareness amongst registered health care professionals (RHCPs) and the influence of research awareness on evidence-based practice activities. DESIGN AND METHODS: This was a descriptive quantitative study. A convenience sample of 2,126 registered RHCPs working in a large acute hospital in Northeast England, the United Kingdom was used. A self-completion Research Awareness Questionnaire (RAQ) was directed towards measuring RHCP: attitudes towards research, understanding of research and the research process, and associations with practising using an evidence base. Data were entered into a Statistical Package for Social Science (SPSS) database and descriptive and inferential statistics were used. FINDINGS: A total of 843 questionnaires were returned. Seven hundred and thirty-three (91%) RHCPs overwhelmingly agreed with the principle that evidence-based practice has a large part to play in improving patient care. This point was reinforced by 86% (n = 701) of respondents strongly agreeing or agreeing with the idea that evidence-based practice is the way forward to change clinical practice. Significant associations were noted between levels of confidence to undertake a piece of research and whether the individual had received adequate information about the research process, had basic knowledge and understanding of the research process, or had research awareness education or training. CONCLUSIONS: The study shows that RHCPs, regardless of position or grade, have a positive attitude towards research but face many obstacles. The key obstacles are lack of time, support, knowledge, and confidence. To address these obstacles, it is imperative that the organisation adopts a structured and coordinated approach to enable and empower individuals to practice using an evidence base.

Acute Disease↗
PubMed2006

The diffusion of virtual communities in health care: concepts and challenges.

OBJECTIVE: This paper providers an overview and discussion of virtual communities in health care. Furthermore, we aim to discuss in this context ethical, legal and technical considerations and the current status of research in this domain. METHODS: We searched medical and social science literature including survey studies, randomized and non-randomized controlled interventions and reviews. RESULTS: The literature indicates that a virtual community in health care as a group of people using telecommunication with the purposes of delivering health care and education, and/or providing support, covers a wide range of clinical specialties, technologies and stakeholders. Examples include peer-to-peer networks, virtual health care delivery and research teams. Ethical challenges including the concepts of identity and deception, privacy and confidentiality and technical issues, such as sociability and usability are discussed. CONCLUSION: Virtual communities may empower patients and enhance coordination of care services; however, there is not sufficient systematic evidence of the effectiveness of virtual communities on clinical outcomes or patient empowerment. Researchers need to address issues, such as sample sizes and experimental design to further the research field in this domain. PRACTICE IMPLICATIONS: When practitioners utilize virtual community tools to communicate with patients or colleagues they have to maximize sociability and usability of this mode of communication, while addressing concerns for privacy and the fear of de-humanizing practice, and the lack of clarity or relevance of current legislative frameworks.

Attitude of Health Personnel↗
PubMed2004

Qualitative research: contributions to the study of drug use, drug abuse, and drug use(r)-related interventions.

This article describes how qualitative social science research has and can contribute to the emerging field of drug and alcohol studies. An eight-stage model of formative-reformative research is presented as a heuristic to outline the different ways in which qualitative research may be used to better understand micro and macro dimensions of drug use and distribution; more effectively design, monitor and evaluate drug use(r)-related interventions; and address the politics of drug/drug program representation. Tobacco is used as an exemplar to introduce the reader to the range of research issues that a qualitative researcher may focus upon during the initial stage of formative research. Ethnographic research on alcohol use among Native Americans is highlighted to illustrate the importance of closely examining ethnicity as well as class when investigating patterns of drug use. To familiarize the reader with qualitative research, we describe the range of methods commonly employed and the ways in which qualitative research may complement as well as contribute to quantitative research. In describing the later stages of the formative-reformative process, we consider both the use of qualitative research in the evaluation and critical assessment of drug use(r)-intervention programs, and the role of qualitative research in critically assessing the politics of prevention programs. Finally, we discuss the challenges faced by qualitative researchers when engaging in transdisciplinary research.

Anthropology, Cultural↗
PubMed2003

Examining the disablement process among older Mexican American adults.

The Disablement Process model (Verbrugge and Jette, Social Science & Medicine 38 (1994) 1) describes a pathway leading from pathology to impairment to functional limitations, and, ultimately to disability. Components of this model have been examined among older White adults; however, very little research has examined the disablement process among older adults of other ethnic groups. Our goal in this research is to evaluate the Disablement Process model using Activities of Daily Living (ADL) disability as the outcome among a representative group of older Mexican American adults in the Southwestern United States. Respondents are from two waves of the Hispanic Established Populations Epidemiologic Study of the Elderly (EPESE) (n=2439). Structural equation models (LISREL 8.30) are utilized to examine the Disablement Process model. We also investigate aspects of the original model that have potentially important effects on the process of becoming disabled, such as cognitive impairment and perceived emotional support. Findings from structural equation models suggest that the main pathway from pathology to ADL disability is through functional limitations among older Mexican Americans. Risk factors, especially age and gender, have significant indirect effects on ADL disability. The main pathway in the Disablement Process model receives preliminary support among older Mexican Americans. We discuss implications of this model for future research.

Activities of Daily Living↗
PubMed2006

Transition: a literature review.

AIM: This paper reports a comprehensive literature review exploring how the term 'transition' has been used in the health literature. BACKGROUND: The meaning of transition has varied with the context in which the term has been used. The last 3 decades have seen altered understandings in the concept of transition in the social science and health disciplines, with nurses contributing to more recent understandings of the transition process as it relates to life and health. METHOD: The CINAHL, Medline, Sociofile and Psychlit databases were accessed and papers published between 1994 and 2004 were retrieved to answer the questions 'How is the word transition used?' and 'What is the concept of transition informing?' Transition theoretical frameworks were also explored. FINDINGS: Widespread use of the word 'transition' suggests that it is an important concept. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self-identity is essential to transition. Time is an essential element in transition and therefore longitudinal studies are required to explore the initial phase, midcourse experience and outcome of the transition experience. CONCLUSION: Transition is the way people respond to change over time. People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives. Transition is a concept that is important to nursing; however, to further develop understandings, research must extend beyond single events or single responses. Longitudinal comparative and longitudinal cross-sectional inquiries are required to further develop the concept.

Adaptation, Psychological↗
PubMedDate not supplied

Quality of life and coping styles in Chinese nasopharyngeal cancer patients after hospitalization.

The objective of the study was to describe the quality of life (QOL) and coping style of nasopharyngeal carcinoma (NPC) patients after hospitalization and to explore the relationship between coping style and health-related QOL of NPC patients. A descriptive correlational design was used in this study. Ninety-eight NPC patients were investigated by a convenient sampling method. Three instruments were employed for data collection. Demographic Information Sheet was used to collect the subjects' demographic characteristics. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H & N) was used to measure health-related QOL. The Jalowiec Coping Scale (JCS) was used to measure coping styles. Descriptive analysis and Spearman correlation analyses were performed using the Statistical Package for Social Science (SPSS) 10.0. Data collection was done from September 2002 to December 2002. The standard score of FACT-H & N for subjects was 67.83%. Patients scored lowest on the Head and Neck subscale. With a mean score of 2.09 +/- 0.53, patient scored the "optimistic" highest on JCS. Some other coping styles scored were "self-reliant"(1.68 +/- 0.49), "palliative" (1.51 +/- 0.60), "emotive"(0.84 +/- 0.59), "fatalistic"(0.92 +/- 0.70), and "evasive"(1.27 +/- 0.44). There were positive correlations between "optimistic," "palliative," and QOL; the coefficient r were 0.456 and 0.324, respectively. There were negative correlations between "emotive," "fatalistic," "evasive," and QOL; the coefficient r were -0.465, -0.427, and -0.271, respectively. No significant correlations were found among "confrontative," "self-reliant," "supportive," and QOL, P > .05. The adverse effects of radiation remain the major problems that affect the health-related QOL of NPC patients posttherapy. Positive emotion-focused coping styles were positively correlated to QOL, and negative emotion-focused ones negatively correlated. Problem-focused coping styles were not statistically correlated to QOL among NPC patients posttherapy. The findings of this study suggest that nurses need to pay attention to the QOL of NPC patients posttherapy, including appropriate education to minimize ongoing adverse effects and support the use of effective coping styles.

Adaptation, Psychological↗
PubMed1977

Human rights, ideology and population policies.

Only too often ideology means fanaticism, intolerance, even violence, but the term can be used also to denote sets of preconceptions and presuppositions which act as a stimulus and a guide to scientific innovation, particularly in the field of social science. This sort of insight into the realities of life and the world is a contribution to knowledge and the search for truth, also in the field of human rights. These are taken in the paper as those rights whose infringement constitutes a "vulnus" of the essential characteristics of human beings and those which assume the role of a basic safeguard of them. The meaning of the insistence on the human rights theme in the United Nations system is briefly touched upon, but the main effort is spent in trying to find a firm base for both fundamental rights and duties, shown as strictly and simmetrically linked. Various examples of population policies - broadly defined as governmental interventions influencing demographic variables - are then examined in the light of the basic principles laid down in the said effort. The fields taken up in succession for consideration are international and internal migration, mortality, marriage, fertility in countries at different stages of demographic transition, and growth. Rather than trying an extensive coverage of the whole horizon, a line of critical and deep thought about typical problematic themes is preferred. One of the main conclusions which may be quoted is a statement according to which the problem remains wide open of discovering acceptable ways aiming at a modification of fertility patterns which combine a reduction of the average family size with the maintenance of its variability in order to respect free and responsible individual choices. How important and urgent this task is, is underscored by the observations advanced in the final section of the paper including a meditation on the limits that human sexuality appears to have imposed on itself.

Contraception Behavior↗
PubMed1995

A twin-family study of self-report symptoms of panic-phobia and somatization.

Self-report symptoms of anxiety are widely used in mental health and social science research as an index of current psychiatric state. Previous twin studies have suggested that genetic factors account for a significant proportion of the variance in these symptoms. To replicate and extend these findings, we examined self-report symptoms of panic-phobia and somatization in the "Virginia 30,000" twin-family sample. Model fitting applied to 80 unique relationships in the twin-family pedigree produced the following major results: (i) genetic effects were significant for both symptom factors, accounting for between 25 and 49% of the total variance, with the exception of symptoms of panic-phobia in females, where they accounted for 15-16% of the variance; (ii) familial environmental effects were absent for symptoms of somatization, while for symptoms of panic-phobia they accounted for a very small proportion of variance in males (< or = 1.2%) and a modest proportion in females (6-17%); (iii) spousal correlations were present for both factors, ranging from +0.05 to +0.20; (iv) genetic factors which influenced symptoms were generally the same in males and females, although their effect was greater in males; (v) heritability estimates were lower in the population-based than in the volunteer sample; and (vi) when test-retest reliability was included in the model, results suggest that genetic factors account for at least half of the stable variance for all symptom factors, except panic-phobia in females. Our results support the validity of previous twin studies of self-report symptoms of anxiety and suggest that genetic factors significantly influence these symptoms but familial-environmental factors play little or no etiologic role.

Adult↗
PubMedDate not supplied

Communicating with patients about medical errors: a review of the literature.

BACKGROUND: Ethical and professional guidelines recommend disclosure of medical errors to patients. The objective of this study was to review the empirical literature on disclosure of medical errors with respect to (1) the decision to disclose, (2) the process of informing the patient and family, and (3) the consequences of disclosure or nondisclosure. METHODS: We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and Social Sciences Citations Index) and the reference lists of relevant articles for English-language studies on disclosure of medical errors. From more than 800 titles reviewed, we identified 17 articles reporting original empirical data on disclosure of medical errors to patients and families. We examined methods and results of the articles and extracted study designs, data collection procedures, populations sampled, response rates, and definitions of error. RESULTS: Available research findings suggest that patients and the public support disclosure. Physicians also indicate support for disclosure, but often do not disclose. We found insufficient empirical evidence to support conclusions about the disclosure process or its consequences. CONCLUSIONS: Empirical research on disclosure of medical errors to patients and families has been limited, and studies have focused primarily on the decision stage of disclosure. Fewer have considered the disclosure process, the consequences of disclosure, or the relationship between the two. Additional research is needed to understand how disclosure decisions are made, to provide guidance to physicians on the process, and to help all involved anticipate the consequences of disclosure.

Attitude to Health↗
PubMed1989

The pregnant adolescent prostitute.

The issue of teenage pregnancy is one of paramount concern and has been covered extensively in the professional literature. Teenage prostitution, as well, has drawn attention from medical and social science researchers. An increasing number of teenage prostitutes are becoming pregnant and delivering infants. These young women constitute a high-risk group that merits professional investigation and requires sensitive clinical approaches. We describe the pregnancy and early postpartum outcomes of 61 teenage prostitutes (age range, 13 to 18 years) in Seattle, Wash, during the period from January 1987 to February 1988. The subjects' environment, prenatal care, drug use, contraceptive practices, repeated pregnancies, and risk for sexually transmitted diseases (including acquired immunodeficiency syndrome) are discussed. Two case examples are used for illustration.

Adolescent↗
PubMed1978

Epidemiology of mental disorders: emerging trends in the United States.

Psychiatric epidemiology in the United States currently is being influenced by developments in genetics, psychopharmacology, neurobiology, and particularly psychopathology after the heavy influences of the social sciences during the post-World War II period. The integration of recent scientific developments in psychiatry, with the methodological precision that characterized the earlier studies of the 50s and 60s promises to provide new knowledge on the epidemiology of mental disorders in the community, which will have important implications both for professional practices in medicine and public health and for public policy in the planning of mental health services, training, and research.

Epidemiologic Methods↗
PubMed2000

Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

OBJECTIVE: Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. PARTICIPANTS: Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. EVIDENCE: We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. CONSENSUS PROCESS: From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. CONCLUSIONS: The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.

Epidemiology↗
PubMed2000

Assessing faculty financial relationships with industry: A case study.

CONTEXT: A growing number of academic researchers receive industry funding for clinical and basic research, but little is known about the personal financial relationships of researchers with their industry sponsors. OBJECTIVES: To assess the extent to which faculty researchers have personal financial relationships with the sponsors of their research, the nature of those financial relationships, and efforts made at the institutional level to address disclosed financial relationships and perceived conflicts of interest. DESIGN AND SETTING: Case study of the University of California, San Francisco (UCSF). Data sources included disclosure forms and official documents maintained by the UCSF Office of Research Administration from December 1980 to October 1999, including decisions made by the UCSF Chancellor's Advisory Panel on Relations with Industry. MAIN OUTCOME MEASURES: Number and types of personal financial relationships with external sponsors (positive financial disclosures from all clinical, basic, or social science faculty who were principal investigators), amount of annual income received from sponsors, and decisions and management strategies used by the advisory panel. RESULTS: By 1999, almost 7.6% of faculty investigators reported personal financial ties with sponsors of their research. Throughout the study period, 34% of disclosed relationships involved paid speaking engagements (range, $250-$20, 000 per year), 33% involved consulting agreements between researcher and sponsor (range, <$1000-$120,000 per year), and 32% involved the investigator holding a position on a scientific advisory board or board of directors. Fourteen percent involved equity ownership, and 12% involved multiple relationships. The advisory panel recommended managing perceived conflicts of interest in 26% of the cases, including recommending the sale of stock, refusing additional payment for talks, resigning from a management position, or naming a new principal investigator for a project. CONCLUSIONS: Faculty researchers are increasingly involved in financial relationships with their research sponsors. Guidelines for what constitutes a conflict and how the conflict should be managed are needed if researchers are to have consistent standards of behavior among institutions. JAMA. 2000;284:2209-2214.

Biomedical Research↗
PubMed2000

Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group.

Quantitative research is designed to test well-specified hypotheses, determine whether an intervention did more harm than good, and find out how much a risk factor predisposes persons to disease. Equally important, qualitative research offers insight into emotional and experiential phenomena in health care to determine what, how, and why. There are 4 essential aspects of qualitative analysis. First, the participant selection must be well reasoned and their inclusion must be relevant to the research question. Second, the data collection methods must be appropriate for the research objectives and setting. Third, the data collection process, which includes field observation, interviews, and document analysis, must be comprehensive enough to support rich and robust descriptions of the observed events. Fourth, the data must be appropriately analyzed and the findings adequately corroborated by using multiple sources of information, more than 1 investigator to collect and analyze the raw data, member checking to establish whether the participants' viewpoints were adequately interpreted, or by comparison with existing social science theories. Qualitative studies offer an alternative when insight into the research is not well established or when conventional theories seem inadequate. JAMA. 2000;284:357-362

Data Collection↗
PubMed2004

Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis.

CONTEXT: Comprehensive discharge planning plus postdischarge support may reduce readmission rates for older patients with congestive heart failure (CHF). OBJECTIVE: To evaluate the effect of comprehensive discharge planning plus postdischarge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), and medical costs. DATA SOURCES: We searched MEDLINE (1966 to October 2003), the Cochrane Clinical Trials Register (all years), Social Science Citation Index (1992 to October 2003), and other databases for studies that described such an intervention and evaluated its effect in patients with CHF. Where possible we also contacted lead investigators and experts in the field. STUDY SELECTION: We selected English-language publications of randomized clinical trials that described interventions to modify hospital discharge for older patients with CHF (mean age > or =55 years), delineated clearly defined inpatient and outpatient components, compared efficacy with usual care, and reported readmission as the primary outcome. DATA EXTRACTION: Two authors independently reviewed each report, assigned quality scores, and extracted data for primary and secondary outcomes in an unblinded standardized manner. DATA SYNTHESIS: Eighteen studies representing data from 8 countries randomized 3304 older inpatients with CHF to comprehensive discharge planning plus postdischarge support or usual care. During a pooled mean observation period of 8 months (range, 3-12 months), fewer intervention patients were readmitted compared with controls (555/1590 vs 741/1714, number needed to treat = 12; relative risk [RR], 0.75; 95% confidence interval [CI], 0.64-0.88). Analysis of studies reporting secondary outcomes found a trend toward lower all-cause mortality for patients assigned to an intervention compared with usual care (RR, 0.87; 95% CI, 0.73-1.03; n = 14 studies), similar initial LOS (mean [SE]: 8.4 [2.5] vs 8.5 [2.2] days, P =.60; n = 10), greater percentage improvement in QOL scores compared with baseline scores (25.7% [95% CI, 11.0%-40.4%] vs 13.5% [95% CI, 5.1%-22.0%]; n = 6, P =.01), and similar or lower charges for medical care per patient per month for the initial hospital stay, administering the intervention, outpatient care, and readmission (-359 dollars [95% CI, -763 dollars to 45 dollars]; n = 4, P =.10 for non-US trials and -536 dollars [95% CI, -956 dollars to -115 dollars]; n = 4, P =.03, for US trials). CONCLUSION: Comprehensive discharge planning plus postdischarge support for older patients with CHF significantly reduced readmission rates and may improve health outcomes such as survival and QOL without increasing costs.

Aged↗
PubMed2006

Health industry practices that create conflicts of interest: a policy proposal for academic medical centers.

Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.

Academic Medical Centers↗