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Sample records for physician insights applications

  1. Genetics and the general physician: insights, applications and future challenges

    PubMed Central

    2009-01-01

    Scientific and technological advances in our understanding of the nature and consequences of human genetic variation are now allowing genetic determinants of susceptibility to common multifactorial diseases to be defined, as well as our individual response to therapy. I review how genome-wide association studies are robustly identifying new disease susceptibility loci, providing insights into disease pathogenesis and potential targets for drug therapy. Some of the remarkable advances being made using current genetic approaches in Crohn's disease, coronary artery disease and atrial fibrillation are described, together with examples from malaria, HIV/AIDS, asthma, prostate cancer and venous thrombosis which illustrate important principles underpinning this field of research. The limitations of current approaches are also noted, highlighting how much of the genetic risk remains unexplained and resolving specific functional variants difficult. There is a need to more clearly understand the significance of rare variants and structural genomic variation in common disease, as well as epigenetic mechanisms. Specific examples from pharmacogenomics are described including warfarin dosage and prediction of abacavir hypersensitivity that illustrate how in some cases such knowledge is already impacting on clinical practice, while in others prospective evaluation of clinical utility and cost-effectiveness is required to define opportunities for personalized medicine. There is also a need for a broader debate about the ethical implications of current advances in genetics for medicine and society. PMID:19737788

  2. Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making

    PubMed Central

    Evers-Casey, Sarah; Graden, Sarah; Schnoll, Robert

    2015-01-01

    Rationale: Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in “next steps” consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Objective: Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Methods: Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of “success” probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Measurements and Main Results: Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Conclusions: Important presuppositions regarding the potential “success” of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors. PMID:25664676

  3. Earthbound applications for NASA's physician workstation

    NASA Technical Reports Server (NTRS)

    Grams, R.; Yu, F. S.; Li, B.; Iddings, E.; Fiorentino, R.; Shao, S.; Wang, L.; Broughton, H.

    1993-01-01

    The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

  4. Earthbound applications for NASA's physician workstation

    NASA Technical Reports Server (NTRS)

    Grams, R.; Yu, F. S.; Li, B.; Iddings, E.; Fiorentino, R.; Shao, S.; Wang, L.; Broughton, H.

    1993-01-01

    The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

  5. Fostering acceptance of computerized physician order entry: insights from an implementation study.

    PubMed

    Muslin, Ivan S; Vardaman, James M; Cornell, Paul T

    2014-01-01

    Computerized physician order entry (CPOE) allows physicians to enter orders in a computer rather than handwriting them. Computerized physician order entry is touted as a major improvement in patient safety, and although the literature suggests that such systems have the potential to improve patient outcomes, studies also suggest that CPOE may have significant drawbacks that accompany those benefits. Physicians have often been resistant to accept its implementation. This study investigates the implementation of CPOE at a 217-bed rural hospital in the southeastern United States. Drawing on a mixed-method approach, we identify correlates of change acceptance and propose a set of recommendations for health care managers to foster acceptance of CPOE. Findings from physician surveys (n = 19) indicate that older physicians are less accepting of CPOE, but high-quality change communication may overcome resistance even among older physicians. With insights derived from the organizational change literature, findings bring to the fore a set of practices that managers can use to foster acceptance of CPOE. The thrust of these practices is that managers should make physicians active participants in fine-tuning CPOE within the unique needs and constraints of the local hospital setting.

  6. Insights into neurologic localization by Rhazes, a medieval Islamic physician.

    PubMed

    Souayah, Nizar; Greenstein, Jeffrey I

    2005-07-12

    Rhazes was born at Ray near modern Teheran in 864 AD. He wrote over 200 scientific treatises, many of which had a major impact on European medicine. His best known manuscript is Liber Continens, a medical encyclopedia. Herein are described Rhazes's contributions to neurology, focusing on his description of cranial and spinal cord nerves and his clinical case reports, which illustrate his use of neuroanatomy to localize lesions. Relevant passages from facsimiles of the manuscripts Kitab al-Hawi (Liber Continens) and Al-Mansuri Fi At-Tibb (Liber Al Mansoori) were translated, reviewed, and used as references. In addition, Medline, Web, and manuscript searches on Rhazes and the history of medieval and Islamic medicine and neurology were conducted. Rhazes stated that nerves had motor or sensory functions, describing 7 cranial and 31 spinal cord nerves. He assigned a numerical order to the cranial nerves from the optic to the hypoglossal nerves. He classified the spinal nerves into 8 cervical, 12 thoracic, 5 lumbar, 3 sacral, and 3 coccygeal nerves. Rhazes showed an outstanding clinical ability to localize lesions, prognosticate, and describe therapeutic options and reported clinical observations, emphasizing the link between the anatomic location of a lesion and the clinical signs. Rhazes was a pioneer in applied neuroanatomy. He combined a knowledge of cranial and spinal cord nerve anatomy with an insightful use of clinical information to localize lesions in the nervous system.

  7. Insights Into the Impact of Online Physician Reviews on Patients’ Decision Making: Randomized Experiment

    PubMed Central

    Waiguny, Martin KJ

    2015-01-01

    .44, SE 0.19), but there was no such effect when the physician received many reviews. Furthermore, we found that review style also affected the perceived expertise of the reviewer. Fact-oriented reviews (mean 3.90, SE 0.13) lead to a higher perception of reviewer expertise compared to emotional reviews (mean 3.19, SE 0.13). However, this did not transfer to the attitude toward the physician. A similar effect of review style and number on the perceived credibility of the review was observed. While no differences between emotional and factual style were found if the physician received many reviews, a low number of reviews received lead to a significant difference in the perceived credibility, indicating that emotional reviews were rated less positively (mean 3.52, SE 0.18) compared to fact-oriented reviews (mean 4.15, SE 0.17). Our analyses also showed that perceived credibility of the review fully mediated the observed interaction effect on attitude toward the physician. Conclusions Physician-rating websites are an interesting new source of information about the quality of health care from the patient’s perspective. This paper makes a unique contribution to an understudied area of research by providing some insights into how people evaluate online reviews of individual doctors. Information attributes, such as review style and review number, have an impact on the evaluation of the review and on the patient’s attitude toward the rated doctor. Further research is necessary to improve our understanding of the influence of such rating sites on the patient's choice of a physician. PMID:25862516

  8. Patient and physician asthma deterioration terminology: results from the 2009 Asthma Insight and Management survey.

    PubMed

    Blaiss, Michael S; Nathan, Robert A; Stoloff, Stuart W; Meltzer, Eli O; Murphy, Kevin R; Doherty, Dennis E

    2012-01-01

    Long-term achievement of asthma control is dependent in part on the use of mutually understandable asthma terminology in all verbal and written patient-physician communications. Using data from the Asthma Insight and Management (AIM) survey, the objective of this analysis is to provide a contemporary depiction of asthma deterioration terminology as used by current asthma patients and physicians in the United States. As part of the 2009 AIM survey, current asthma patients (≥12 years of age; weighted n = 2499) and physicians (n = 309) were queried about their recognition, understanding, and/or use of the terms "asthma attack," "asthma flare-up," and "asthma exacerbation" in telephone interviews. Nearly all patients had heard the term "asthma attack" (97%), but relatively few had heard the term "asthma exacerbation" (24%); 71% had heard "asthma flare-up." In contrast, physicians reported using the term "asthma attack" least (65%) and the term "asthma exacerbation" most (77%) when discussing asthma with their patients; 70% reported using "asthma flare-up." Among patients familiar with "asthma flare-up" and "asthma exacerbation" (n = 502), only 38% said that the terms mean the same thing; nearly all physicians (94%) said that the terms mean the same thing. Collectively, data from the AIM survey suggest that patients and physicians use different asthma deterioration terminology and, more importantly, that they do not necessarily understand each other's terms. Standardizing asthma deterioration terminology may help optimize asthma patient-physician communication to improve patient understanding of written asthma action plans and therefore, enhance patient outcomes.

  9. Adding insight: A qualitative cross-site study of physician order entry

    PubMed Central

    Ash, Joan S.; Sittig, Dean F.; Seshadri, Veena; Dykstra, Richard H.; Carpenter, James D.; Stavri, P. Zoe

    2006-01-01

    Summary The research questions, strategies, and results of a 7-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative nature of qualitative inquiry stimulates a consecutive stream of research foci, which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question “what are the success factors for implementing CPOE?” Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process. PMID:15964780

  10. Tips for a physician in getting the right job, Part IX: Interview questions for any physician job applicant.

    PubMed

    Harolds, Jay

    2014-04-01

    There are many common questions and requests, which physician applicants for either a clinical or executive position are likely to encounter on a job interview. This article enumerates many of these and offers hints on preparation and having winning answers.

  11. Insights into physician scheduling: a case study of public hospital departments in Sweden.

    PubMed

    dos Santos, Marco António Ferreira Rodrigues Nogueira; Eriksson, Henrik Kurt Olof

    2014-01-01

    The purpose of this paper is to describe current physician scheduling and concomitant opportunities for improvement in public hospital departments in Sweden. A total of 13 departments spread geographically across Sweden covering seven different specialties participated in the study. Data were collected through interviews with individuals involved in creating physician schedules. All departments investigated provided copies of the documents necessary for physician scheduling. Physician scheduling required the temporal coordination of patients, physicians, non-physician staff, rooms and equipment. A six-step process for creating physician schedules could be distinguished: capacity and demand overview, demand goal and schedule setting, vacation and leave requests, schedule creation, schedule revision, and schedule execution. Several opportunities for improvement could be outlined; e.g. overreliance on memory, lacking coordination of resources, and redundant data entering. The paucity of previous studies on physician scheduling lends an exploratory character to this study and calls for a more thorough evaluation of the feasibility and effects of the approaches proposed. The study excluded the scheduling of non-physician staff. To improve physician scheduling and enable timeliness, three approaches are proposed: reinforcing centralisation, creating learning opportunities, and improving integration. This paper is among the few to investigate physician scheduling, which is essential for delivering high quality care, particularly concerning timeliness. Several opportunities for improvement identified in this study are not exclusive to physician scheduling but are pervasive in healthcare processes in general.

  12. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries.

    PubMed

    Davis, Kourtney J; Landis, Sarah H; Oh, Yeon-Mok; Mannino, David M; Han, MeiLan K; van der Molen, Thys; Aisanov, Zaurbek; Menezes, Ana M; Ichinose, Masakazu; Muellerova, Hana

    2015-01-01

    Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians' knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists. Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios. Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P<0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively. This survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic

  13. Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data.

    PubMed

    Fleischman, William; Ross, Joseph S; Melnick, Edward R; Newman, David H; Venkatesh, Arjun K

    2016-08-01

    The Open Payments program requires reporting of payments by medical product companies to teaching hospitals and licensed physicians. We seek to describe nonresearch, nonroyalty payments made to emergency physicians in the United States. We performed a descriptive analysis of the most recent Open Payments data released to the public by the Centers for Medicare & Medicaid Services covering the 2014 calendar year. We calculated the median payment, the total pay per physician, the types of payments, and the drugs and devices associated with payments to emergency physicians. For context, we also calculated total pay per physician and the percentage of active physicians receiving payments for all specialties. There were 46,405 payments totaling $10,693,310 to 12,883 emergency physicians, representing 30% of active emergency physicians in 2013. The percentage of active physicians within a specialty who received a payment ranged from 14.6% in preventive medicine to 91% in orthopedic surgery. The median payment and median total pay to emergency physicians were $16 (interquartile range $12 to $68) and $44 (interquartile range $16 to $123), respectively. The majority of payments (83%) were less than $100. Food and beverage (86%) was the most frequent type of payment. The most common products associated with payments to emergency physicians were rivaroxaban, apixaban, ticagrelor, ceftaroline, canagliflozin, dabigatran, and alteplase. Nearly a third of emergency physicians received nonresearch, nonroyalty payments from industry in 2014. Most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  14. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

    PubMed Central

    Davis, Kourtney J; Landis, Sarah H; Oh, Yeon-Mok; Mannino, David M; Han, MeiLan K; van der Molen, Thys; Aisanov, Zaurbek; Menezes, Ana M; Ichinose, Masakazu; Muellerova, Hana

    2015-01-01

    Aim Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists. Materials and methods Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios. Results Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P<0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively. Conclusion This survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use

  15. Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation

    PubMed Central

    Shield, Renée R.; Goldman, Roberta E.; Anthony, David A.; Wang, Nina; Doyle, Richard J.; Borkan, Jeffrey

    2010-01-01

    PURPOSE Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients’ responses. METHODS We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse’s aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses. RESULTS Patient trust in the physician and security in the physician-patient relationship appeared to override most patients’ concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the “third actor” in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room. CONCLUSIONS Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information. PMID:20644186

  16. Patient as author, physician as critic. Insights from contemporary literary theory.

    PubMed

    Sorum, P C

    1994-06-01

    My wife's recent illness taught me that patients are not only texts read by their physicians but also the authors of their bodies and stories. As "reader-response" theorists point out, each reading is necessarily a reconstitution of the text. By rewriting in medical terminology, physicians, like literary critics, put patients' texts into more abstract terms, transforming patients into cases and their illnesses into diseases. Physicians can thus discuss, understand, and treat disease, although the stories may become unrecognizable to their original authors. Unlike critics, however, physicians are responsible for the well-being of their patients. They must, therefore, retranslate medical cases back into individual narratives using the patients' language. Thus, patients can retake control of their illnesses and become again the primary authors of their lives.

  17. Medical Problems Referred to a Care of the Elderly Physician: Insight for Future Geriatrics CME.

    PubMed

    Lam, Robert; Gallinaro, Anna; Adleman, Jenna

    2013-01-01

    Family physicians provide the majority of elderly patient care in Canada. Many experience significant challenges in serving this cohort. This study aimed to examine the medical problems of patients referred to a care of the elderly physician, to better understand the geriatric continuing medical education (CME) needs of family doctors. A retrospective chart review of patients assessed at an urban outpatient seniors' clinic between 2003 and 2008 was conducted. Data from 104 charts were analyzed and survey follow-up with 28 of the referring family physicians was undertaken. Main outcomes include the type and frequency of medical problems actually referred to a care of the elderly physician. Clarification of future geriatric CME topics of need was also assessed. Preventive care issues were addressed with 67 patients. Twenty-four required discussion of advance directives. The most common medical problems encountered were osteoarthritis (42), hypertension (34), osteoporosis (32), and depression or anxiety (23). Other common problems encountered that have not been highly cited as being a target of CME included musculoskeletal and joint pain (41), diabetes (23), neck and back pain (20), obesity (11), insomnia (11), and neuropathic, fibromyalgia and "leg cramps" pain (10). The referring family physicians surveyed agreed that these were topics of need for future CME. The findings support geriatric CME for the common medical problems encountered. Chronic pain, diabetes, obesity and insomnia continue to be important unresolved issues previously unacknowledged by physicians as CME topics of need. Future CME focusing more on process of geriatric care may also be relevant.

  18. Physician job satisfaction in Saudi Arabia: insights from a tertiary hospital survey.

    PubMed

    Aldrees, Turki; Al-Eissa, Sami; Badri, Motasim; Aljuhayman, Ahmed; Zamakhshary, Mohammed

    2015-01-01

    Job satisfaction refers to the extent to which people like or dislike their job. Job satisfaction varies across professions. Few studies have explored this issue among physicians in Saudi Arabia. The objective of this study is to determine the level and factors associated with job satisfaction among Saudi and non-Saudi physicians. In this cross-sectional study conducted in a major tertiary hospital in Riyadh, a 5-point Likert scale structured questionnaire was used to collect data on a wide range of socio-demographic, practice environment characteristics and level and consequences of job satisfaction from practicing physicians (consultants or residents) across different medical specialties. Logistic regression models were fitted to determine factors associated with job satisfaction. Of 344 participants, 300 (87.2%) were Saudis, 252 (73%) males, 255 (74%) married, 188 (54.7%) consultants and age [median (IQR)] was 32 (27-42.7) years. Overall, 104 (30%) respondents were dissatisfied with their jobs. Intensive care physicians were the most dissatisfied physicians (50%). In a multiple logistic regression model, income satisfaction (odds ratio [OR]=0.448 95% CI 0.278-0.723, P < .001) was the only factor independently associated with dissatisfaction. Factors adversely associated with physicians job satisfaction identified in this study should be addressed in governmental strategic planning aimed at improving the healthcare system and patient care.

  19. [THE DEVELOPMENT OF MOBILE APPLICATION OF PHYSICIAN FOR IMPLEMENTING REMOTE MONITORING].

    PubMed

    Berseneva, E A; Korsakov, I M; Mikhailova, A G

    2015-01-01

    The issues are considered concerning necessity of development and implementation of mobile application of physician within the framework of automated system of remote monitoring of indicators of human health as a mean of increasing of quality medical care of patients. The main characteristics of development of the given mobile application of physician are considered.

  20. Understanding physician acceptance of mobile technology: insights from two telephone interviews in Finland.

    PubMed

    Han, Shengnan; Harkke, Ville; Mustonen, Pekka; Seppanen, Matti

    2005-01-01

    This paper sets out to investigate physicians' perceptions and usage regarding a new mobile medical information system in a pilot trial in the Finnish healthcare sector. Two sets of data were gathered in June and October 2003 by telephone interviews. The physicians interviewed had positive perceptions of the mobile system, and started to use it frequently in their work. They showed few negative experiences of using a Nokia Communicator. They favoured using mobile technology as a way to improve spreading medical knowledge. The main contents of the system, the Evidence-Based Medical Guidelines and the Pharmaca Fennica (the pharmacopoeia), were crucial for using the system. Some differences in physicians' behaviour across time were also found. Implications for system improvement are discussed.

  1. Comportment and Communication Patterns among Hospitalist Physicians: Insight Gleaned Through Observation.

    PubMed

    Kotwal, Susrutha; Torok, Haruka; Khaliq, Waseem; Landis, Regina; Howell, Eric; Wright, Scott

    2015-08-01

    By 2014, there were more than 40,000 hospitalists delivering the majority of inpatient care in US hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients. The chiefs of hospital medicine at five different hospitals were asked to identify their best hospitalists. These hospitalists were watched during their routine clinical care of patients. An observation tool was developed that focused on elements believed to be associated with excellent comportment and communication. One observer watched the physicians, taking detailed quantitative and qualitative field notes. A total of 26 hospitalists were shadowed. The mean age of the physicians was 38 years, and their average experience in hospital medicine was 6 years. The hospitalists were observed for a mean of 5 hours, during which time they saw an average of 7 patients (patient encounters observed N = 181). Physicians spent an average of 11 minutes with each patient. There was large variation in the extent to which desirable behaviors were performed. For example, most physicians (76%) started encounters with an open-ended question, and relatively few (30%) attempted to integrate nonmedical content into conversation with patients. This study represents a first step in trying to characterize comportment and communication in hospital medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication are clearly defined and established as a goal for every encounter.

  2. Getting physicians to accept new information technology: insights from case studies.

    PubMed

    Lapointe, Liette; Rivard, Suzanne

    2006-05-23

    The success or failure of a computer information system (CIS) depends on whether physicians accept or resist its implementation. Using case studies, we analyzed the implementation of such systems in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation. We selected cases to maximize variation while allowing comparison of CIS implementations. Data were collected from observations, documentation and interviews, the last being the main source of data. Interviewees comprised 15 physicians, 14 nurses and 14 system implementers. Transcripts were produced; 45 segments of the transcripts were coded by several judges, with an appropriate level of intercoder reliability. We conducted within-case and cross-case analyses of the data. Initially, most staff were neutral or enthusiastic about the CIS implementations. During implementation, the level of resistance varied and in 2 instances became great enough to lead to major disruptions and system withdrawal. Implementers' responses to physicians' resistance behaviours played a critical role. In one case, the responses were supportive and addressed the issues related to the real object of resistance; the severity of resistance decreased, and the CIS implementation was ultimately successful. In the other 2 cases, the implementers' responses reinforced the resistance behaviours. Three types of responses had such an effect in these cases: implementers' lack of response to resistance behaviours, antagonistic responses, and supportive responses aimed at the wrong object of resistance. The 3 cases we analyzed showed the importance of the roles played by implementers and users in determining the outcomes of a CIS implementation.

  3. Asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS): structured literature review and physician insights.

    PubMed

    Ding, B; Enstone, A

    2016-01-01

    To understand the key characteristics of Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS) and to identify evidence gaps relating to the identification, treatment and management of ACOS patients. A structured literature review and 1-hour telephone interviews with specialist respiratory physicians were conducted (n=10; China, France, Germany, Japan and the USA). All 10 physicians used the term ACOS in clinical practice. ACOS was not clearly defined in the literature. Prevalence of ACOS among adult patients with COPD or asthma ranged from 12-55%. ACOS patients had severe disease, with increased exacerbations and hospitalisations compared to some asthma and COPD patients. ACOS represented a clinical challenge due to a lack of evidence-based guidelines distinguishing between asthma, COPD and ACOS. Published data quantifying ACOS costs were limited. There is a need for consensus evidence-based guidance to facilitate earlier diagnosis and to optimise the management of ACOS patients.

  4. [Medicine and humanism: insights of the Nürnberg city physician Theodericus Ulsenius regarding Morbus Gallicus].

    PubMed

    Santing, C G

    1995-01-01

    The Nuremberg physician and humanist Theodericus Ulsenius (c. 1460-1508) was the author of two works on the so-called Morbus Gallicus. In 1496 he published a Vaticinium in epidemicam scabiem, and he also wrote fifty aphorisms, entitled Cura mali francici. In this article I will characterize Ulsenius' ideas and compare these to the measures the Nuremberg town government took to diminish the dangerous effects of the epidemic. In the function of official town physician, Ulsenius was one of the chief advisers and executives of the Nuremberg health policy. As the 'Ratsverlässe' (records of the town-council meetings) give detailed information, the reactions of senate and physicians can be followed from day to day. The Vaticinium a poem of 100 hexameters was printed at the office of Hans Mair and presented as a pamphlet with a woodcut from the workshop of Albrecht Dürer. The verses refer to a dream of the poet, in which the God Apollo addresses him and talks about the terrible disease. The origin and symptoms of the illness are discussed extensively, in accordance with the prevailing medico-astrological conceptions. Nevertheless, the poem ist not a medical piece of work, but a literary-styled and humanistically appropriate description of the recent epidemic, meant for fellow members of the German respublica litteraria. Like most of Ulsenius' writings, the Cura mali francici only survived as a copy made by his colleague Hartmann Schedel. It seems that the author had different types of audience in mind. The aphorisms refer to the Aphorisms of his great example, the famous Ancient medical doctor Hippocrates of Kos. The addresses of the Cura are obviously medical professionals: the physician in the towns harassed by the Morbus Gallicus and especially the medical professors who hat to lecture on the new ailment.

  5. Physician-patient relationship and medical accident victim compensation: some insights into the French regulatory system.

    PubMed

    Ancelot, Lydie; Oros, Cornel

    2015-06-01

    Given the growing amount of medical litigation heard by courts, the 2002 Kouchner law in France has created the Office National d'Indemnisation des Accidents Médicaux (ONIAM), whose main aim is to encourage out-of-court settlements when a conflict between a physician and the victim of a medical accident occurs. More than 10 years after the implementation of this law, the statistics analysing its effectiveness are contradictory, which raises the question of the potential negative effects of the ONIAM on the compensation system. In order to address this question, the article analyses the impact of the ONIAM on the nature of settlement negotiations between the physician and the victim. Using a dynamic game within incomplete information, we develop a comparative analysis of two types of compensation systems in case of medical accidents: socialised financing granted by the ONIAM and private financing provided by the physician. We show that the ONIAM could encourage out-of-court settlements provided that the hypothesis of judicial error is relevant. On the contrary, in the case of a low probability of judicial errors, the ONIAM could be effective only for severe medical accidents.

  6. Teaching primary care obstetrics: insights and recruitment recommendations from family physicians.

    PubMed

    Koppula, Sudha; Brown, Judith B; Jordan, John M

    2014-03-01

    To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Qualitative study using in-depth interviews. Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics.

  7. Culture and organizational climate: nurses' insights into their relationship with physicians.

    PubMed

    Malloy, David Cruise; Hadjistavropoulos, Thomas; McCarthy, Elizabeth Fahey; Evans, Robin J; Zakus, Dwight H; Park, Illyeok; Lee, Yongho; Williams, Jaime

    2009-11-01

    Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one's location in the organizational hierarchy as well as one's professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses' hospital role, and the extent to which their voices were heard. These nurses suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians.

  8. A physician team's experiences in community-based participatory research: insights into effective group collaborations.

    PubMed

    Dalal, Mehul; Skeete, Rachel; Yeo, Heather L; Lucas, Georgina I; Rosenthal, Marjorie S

    2009-12-01

    Postdoctoral fellows from the Robert Wood Johnson Clinical Scholars Program are among a growing number of physician-researchers training in community-based participatory research (CBPR). These fellows are uniquely positioned to observe and evaluate CBPR training needs and the experience of collaboratively conducting a CBPR project. To describe, from the perspective of physician-researchers, experiences in intragroup and intergroup collaborations while conducting CBPR. During a 2-year fellowship, a group of seven fellows received 6 months of didactic training and then spent 18 months conducting a mentored CBPR project. The CBPR project was complemented by a 2-year facilitated leadership seminar, which allowed for reflection on intragroup (among fellows) and intergroup (fellows/community members) relationships throughout the CBPR process. Seven core principles of CBPR were found to apply to not only intergroup but also intragroup relationships: (1) building trust, (2) finding a shared interest, (3) power-sharing, (4) fostering co-learning and capacity building among partners, (5) building on existing strengths, (6) employing an iterative process, and (7) finding a balance between research and action for the mutual benefit of all partners. Establishing and maintaining relationships is at the core of CBPR. The development of intragroup relationships paralleled the development of intergroup relationships with community members. Applying the core principles of CBPR to the development of intragroup relationships provided experience that may have enhanced relationships with community partners. An a priori acknowledgement of the importance of relationships and the time needed to develop and manage those relationships may add to the CBPR training experience and assist in successfully executing collaborative projects.

  9. The hospital-physician computer communications network: an alternative application.

    PubMed

    MacStravic, R S; Covert, K; Ginsburg, D

    1992-01-01

    For more than five years hospitals have been developing computer communications networks as a physician bonding strategy because of their success in promoting hospital admissions and additional referrals to the sponsoring hospitals' specialists. An alternative, nonproprietary network may also be worthy of consideration because of the services and benefits it delivers to the total health care delivery system and to society as a whole--in addition to the advantages it offers the sponsoring hospital. An example of such a network is offered as an illustration.

  10. Industry ties in otolaryngology: initial insights from the physician payment sunshine act.

    PubMed

    Rathi, Vinay K; Samuel, Andre M; Mehra, Saral

    2015-06-01

    To characterize nonresearch payments made by industry to otolaryngologists in order to explore how the potential for conflicts of interests varies among otolaryngologists and compares between otolaryngologists and other surgical specialists. Retrospective cross-sectional database analysis. Open Payments program database recently released by Centers for Medicare and Medicaid Services. Surgeons nationwide who were identified as receiving nonresearch payment from industry in accordance with the Physician Payment Sunshine Act. The proportion of otolaryngologists receiving payment, the mean payment per otolaryngologist, and the standard deviation thereof were determined using the Open Payments database and compared to other surgical specialties. Otolaryngologists were further compared by specialization, census region, sponsor, and payment amount. Less than half of otolaryngologists (48.1%) were reported as receiving payments over the study period, the second smallest proportion among surgical specialties. Otolaryngologists received the lowest mean payment per compensated individual ($573) compared to other surgical specialties. Although otolaryngology had the smallest variance in payment among surgical specialties (SD, $2806), the distribution was skewed by top earners; the top 10% of earners accounted for 87% ($2,199,254) of all payment to otolaryngologists. Otolaryngologists in the West census region were less likely to receive payments (38.6%, P < .001). Over the study period, otolaryngologists appeared to have more limited financial ties with industry compared to other surgeons, though variation exists within otolaryngology. Further refinement of the Open Payments database is needed to explore differences between otolaryngologists and leverage payment information as a tool for self-regulation. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  11. The Residency Application Abyss: Insights and Advice

    PubMed Central

    Olson, Douglas P.; Oatts, Julius T.; Fields, Barry G.; Huot, Stephen J.

    2011-01-01

    Most medical students apply for residency training upon completion of medical school. The choice of specialty is one of a student’s first major career decisions, and the application process often results in considerable anxiety, as it is competitive, unpredictable, and requires a significant investment of time and money. This article, which addresses several important facets of the residency application using both experiential and evidence-based data, is organized chronologically into sections that describe a logical approach to applying for residency: choice of a specialty, the personal statement, the interview day, and developing a rank list. A list of relevant websites is also included. This paper is a resource that provides timely and tangible guidance to medical students applying for residency training. PMID:21966036

  12. Endoglucanases: insights into thermostability for biofuel applications

    PubMed Central

    2013-01-01

    Obtaining bioethanol from cellulosic biomass involves numerous steps, among which the enzymatic conversion of the polymer to individual sugar units has been a main focus of the biotechnology industry. Among the cellulases that break down the polymeric cellulose are endoglucanases that act synergistically for subsequent hydrolytic reactions. The endoglucanases that have garnered relatively more attention are those that can withstand high temperatures, i.e., are thermostable. Although our understanding of thermostability in endoglucanases is incomplete, some molecular features that are responsible for increased thermostability have been recently identified. This review focuses on the investigations of endoglucanases and their implications for biofuel applications. PMID:24070146

  13. PRA insights applicable to the design of the Broad Applications Test Reactor

    SciTech Connect

    Khericha, S.T.; Reilly, H.J.

    1993-01-01

    Design insights applicable to the design of a new Broad Applications Test Reactor (BATR), being studied at Idaho National Engineering Laboratory, are summarized. Sources of design insights include past probabilistic risk assessments and related studies for department of Energy-owned Class A reactors and for commercial reactors. The report includes a preliminary risk allocation scheme for the BATR.

  14. THE INTERNET AND THE WORLD WIDE WEB: APPLICATIONS FOR FAMILY PHYSICIANS IN SAUDI ARABIA

    PubMed Central

    Sebiany, Abdulaziz M.

    2001-01-01

    The introduction of the World Wide Web has revolutionized the applications of the computer and the Internet in the medical field. The Web provides an easy and cost-effective way of retrieving medical information and a more flexible way of communicating with patients and colleagues. Family practice is a specialty in which care is given to persons as individuals and members of families regardless of their age, gender or specific problems. To provide quality family practice, a family physician should be a good communicator, a critical thinker, a resource and information manager, a life-long learner, a care giver and a community advocate. Providing such high quality care requires that family practice be an information-sensitive specialty. However, the expansion of the new electronic resources on the Internet and the Web poses a real challenge to the family physician. Family physician in Saudi Arabia need to have basic skills and knowledge for easily retrieving and finding reliable Internet information for his professional development and the care of his patients. This article addresses the Web applications for family physicians in Saudi Arabia, giving examples of the most important Websites. PMID:23008644

  15. Assessing physician leadership styles: application of the situational leadership model to transitions in patient acuity.

    PubMed

    Skog, Alexander; Peyre, Sarah E; Pozner, Charles N; Thorndike, Mary; Hicks, Gloria; Dellaripa, Paul F

    2012-01-01

    The situational leadership model suggests that an effective leader adapts leadership style depending on the followers' level of competency. We assessed the applicability and reliability of the situational leadership model when observing residents in simulated hospital floor-based scenarios. Resident teams engaged in clinical simulated scenarios. Video recordings were divided into clips based on Emergency Severity Index v4 acuity scores. Situational leadership styles were identified in clips by two physicians. Interrater reliability was determined through descriptive statistical data analysis. There were 114 participants recorded in 20 sessions, and 109 clips were reviewed and scored. There was a high level of interrater reliability (weighted kappa r = .81) supporting situational leadership model's applicability to medical teams. A suggestive correlation was found between frequency of changes in leadership style and the ability to effectively lead a medical team. The situational leadership model represents a unique tool to assess medical leadership performance in the context of acuity changes.

  16. Impact of the social networking applications for health information management for patients and physicians.

    PubMed

    Sahama, Tony; Liang, Jian; Iannella, Renato

    2012-01-01

    Most social network users hold more than one social network account and utilize them in different ways depending on the digital context. For example, friendly chat on Facebook, professional discussion on LinkedIn, and health information exchange on PatientsLikeMe. Thus many web users need to manage many disparate profiles across many distributed online sources. Maintaining these profiles is cumbersome, time consuming, inefficient, and leads to lost opportunity. In this paper we propose a framework for multiple profile management of online social networks and showcase a demonstrator utilising an open source platform. The result of the research enables a user to create and manage an integrated profile and share/synchronise their profiles with their social networks. A number of use cases were created to capture the functional requirements and describe the interactions between users and the online services. An innovative application of this project is in public health informatics. We utilize the prototype to examine how the framework can benefit patients and physicians. The framework can greatly enhance health information management for patients and more importantly offer a more comprehensive personal health overview of patients to physicians.

  17. Phosphoproteomics by Mass Spectrometry: insights, implications, applications, and limitations

    PubMed Central

    Mayya, Viveka; Han, David K.

    2010-01-01

    Summary Phosphorylation of proteins is a predominant reversible post-translational modification. It is central to a wide variety of physiological responses and signaling mechanisms. Recent advances have allowed the global scope of phosphorylation to be addressed by mass spectrometry using phosphoproteomic approaches. In this perspective we discuss four aspects of phosphoproteomics; namely insights and implications from recently published phosphoproteomic studies, and applications and limitations of current phosphoproteomic strategies. As about 50,000 known phosphorylation sites do not yet have any ascribed function, we present our perspectives on a major function of protein phosphorylation that may be of predictive value in hypothesis based investigations. Finally we discuss strategies to measure stoichiometry of phosphorylation in a proteome-wide manner which is not provided by current phosphoproteomic approaches. PMID:19929607

  18. Insights into Bacteriophage Application in Controlling Vibrio Species

    PubMed Central

    Letchumanan, Vengadesh; Chan, Kok-Gan; Pusparajah, Priyia; Saokaew, Surasak; Duangjai, Acharaporn; Goh, Bey-Hing; Ab Mutalib, Nurul-Syakima; Lee, Learn-Han

    2016-01-01

    Bacterial infections from various organisms including Vibrio sp. pose a serious hazard to humans in many forms from clinical infection to affecting the yield of agriculture and aquaculture via infection of livestock. Vibrio sp. is one of the main foodborne pathogens causing human infection and is also a common cause of losses in the aquaculture industry. Prophylactic and therapeutic usage of antibiotics has become the mainstay of managing this problem, however, this in turn led to the emergence of multidrug resistant strains of bacteria in the environment; which has raised awareness of the critical need for alternative non-antibiotic based methods of preventing and treating bacterial infections. Bacteriophages – viruses that infect and result in the death of bacteria – are currently of great interest as a highly viable alternative to antibiotics. This article provides an insight into bacteriophage application in controlling Vibrio species as well underlining the advantages and drawbacks of phage therapy. PMID:27486446

  19. Physicians in literature: three portrayals.

    PubMed

    Cameron, I A

    1986-02-01

    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients.

  20. Physicians in Literature: Three Portrayals

    PubMed Central

    Cameron, Ian A.

    1986-01-01

    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients. PMID:21267273

  1. The clinical application of genetic testing in type 2 diabetes: a patient and physician survey.

    PubMed

    Grant, R W; Hivert, M; Pandiscio, J C; Florez, J C; Nathan, D M; Meigs, J B

    2009-11-01

    Advances in type 2 diabetes genetics have raised hopes that genetic testing will improve disease prediction, prevention and treatment. Little is known about current physician and patient views regarding type 2 diabetes genetic testing. We hypothesised that physician and patient views would differ regarding the impact of genetic testing on motivation and adherence. We surveyed a nationally representative sample of US primary care physicians and endocrinologists (n = 304), a random sample of non-diabetic primary care patients (n = 152) and patients enrolled in a diabetes pharmacogenetics study (n = 89). Physicians and patients favoured genetic testing for diabetes risk prediction (79% of physicians vs 80% of non-diabetic patients would be somewhat/very likely to order/request testing, p = 0.7). More patients than physicians (71% vs 23%, p < 0.01) indicated that a 'high risk' result would be very likely to improve motivation to adopt preventive lifestyle changes. Patients favoured genetic testing to guide therapy (78% of patients vs 48% of physicians very likely to request/recommend testing, p < 0.01) and reported that genetic testing would make them 'much more motivated' to adhere to medications (72% vs 18% of physicians, p < 0.01). Many physicians (39%) would be somewhat/very likely to order genetic testing before published evidence of clinical efficacy. Despite the paucity of current data, physicians and patients reported high expectations that genetic testing would improve patient motivation to adopt key behaviours for the prevention or control of type 2 diabetes. This suggests the testable hypothesis that 'genetic' risk information might have greater value to motivate behaviour change compared with standard risk information.

  2. Factors influencing patient disclosure to physicians in birth control clinics: an application of the communication privacy management theory.

    PubMed

    Lewis, Cara C; Matheson, Deborah H; Brimacombe, C A Elizabeth

    2011-09-01

    The focus of the current study is whether, and why, female patients limit or alter their personal histories when discussing sensitive subject matter with their physician in birth control clinics. Fifty-six female patients (M = 21.6 years, SD = 3.05) completed anonymous questionnaires exploring their comfort with and ability to disclose personal histories in the immediately preceding interview with the physician. The present study used communication privacy management (CPM) as the theoretical lens through which to view the interaction. Approximately one-half of the sample (46%) reported limiting or altering information. Patients with a highly permeable privacy orientation, as evidenced by a history of open communication regarding sexual issues, were those who reported fully disclosing to their physicians. Of the physician characteristics considered to map onto patient privacy rules, the physician's gender, hurriedness, friendliness, use of a first-name introduction, and open-ended questions were significantly related to patients' reported ease in fully disclosing personal information (p < .05). This study presents a novel application of CPM and has implications for training medical students and for parent-child communication regarding sexual issues.

  3. Projecting Thailand physician supplies between 2012 and 2030: application of cohort approaches

    PubMed Central

    2013-01-01

    Background This study forecasts physician supply between 2012 and 2030 using cohort analysis, based on future production capacity and losses from the profession, and assesses if, and by when, the projected numbers of physicians would meet the targets of one doctor per 1,500 population, as proposed by the 7th National Conference on Medical Education in 2001, and one per 1,800, proposed by the Ministry of Public Health (MoPH) in 2004. Methods We estimated the annual loss rate that best reflected the dynamics of existing practising doctors, then applied this rate to the existing physicians, plus the newly licensed physicians flowing into the pool over the next two decades (from 2012 to 2030). Finally, the remaining practising physicians, after adjustment for losses, were verified against demand projections in order to identify supply gaps. Results Thailand has been experiencing an expansion in the total number of physicians, with an annual loss rate of 1%. Considering future plans for admission of medical students, the number of licensed physicians flowing into the pool should reach 2,592 per annum, and 2,661 per annum, by 2019 and 2030 respectively. By applying the 1% loss rate to the existing, and future newly licensed, physicians, there are forecast to be around 40,000 physicians in active clinical service by 2016, and in excess of 60,000 by 2028. Conclusion This supply forecast, given various assumptions, would meet the targets outlined above, of one doctor per 1,800 population, and one per 1,500 population, by 2016 and 2020 respectively. However, rapid changes in the contextual environment, e.g. economic demand, physician demographics, and disease burden, may mean that the annual loss rate of 1% used in this projection is not accurate in the future. To ensure population health needs are met, parallel policies on physician production encompassing both qualitative and quantitative aspects should be in place. Improved, up-to-date information and establishment of a

  4. Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia(®) ).

    PubMed

    Capehorn, M; Polonsky, W H; Edelman, S; Belton, A; Down, S; Gamerman, V; Nagel, F; Lee, J; Alzaid, A

    2017-08-01

    To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes. As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia(®) ), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy). A total of 6753 of 9247 eligible physicians completed the IntroDia(®) survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations. Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation. © 2017 Diabetes UK.

  5. New paradigms for physician-industry relations: overview and application for SVS members.

    PubMed

    Singh, Niten; Bush, Ruth; Dalsing, Michael; Shortell, Cynthia K

    2011-09-01

    Relationships between physicians and their industry partners have ranged from spectacular collaborations that produce extraordinary advances in patient care, such as endovascular aneurysm repair, to humiliating scandals such as extravagant trips and bogus "consulting" agreements resulting in legal actions. It is the latter which have led many to call for the end of all physician-industry relationships, and the former which mandate their preservation. While these two examples are representative of extremes at each end of the spectrum of this issue, in reality the majority of physician-industry relationships are far more complex, and the line between appropriate and inappropriate, and ethical and unethical, is hard to draw. The benefits of our relationships with industry are many: partnering to develop new therapies and technologies, educating and training physicians around new therapies and technologies, support of continuing medical education (CME), fellowship training, and patient education. The pitfall and danger of this relationship is that support from industry, be it a meal, a pen, an educational grant, or flattery, may unduly and inappropriately influence physician decision making around a specific company's product. While it is clear that free trips are not within the realm of proper interaction, what about unrestricted educational grants to institutions, or support of CME activities, professional society meetings, and new device training? As a result of the intense scrutiny of relationships between physicians and industry recently, multiple diverse entities (Association of American Medical Colleges, American Medical Association, Accreditation Council for Continuing Medical Education, professional medical associations, academic medical centers, industry, and government) have generated guidelines and policies with very different perspectives, reflective of their different missions. These policies range from vague and lenient, with only basic limitation of the

  6. Smart Phone Acceptance among Physicians: Application of Structural Equation Modelling in the Largest Iranian University.

    PubMed

    Nematollahi, M; Faghiri, K; Barati, O; Bastani, P

    2017-03-01

    The present study aimed to determine attitudes and effective factors in the acceptance of smart phones by physicians of the largest University of Medical Sciences in the south of Iran. This cross-sectional study was performed using Structural Equation Modelling (SEM) in 2014. Study participants included 200 physicians working in the hospitals of Shiraz University of Medical Sciences selected through two-stage stratified sampling, but 185 participants completed the study. The study data were collected using a researcher-made questionnaire completed through a 5-point Likert scale. The content validity of the questionnaire was confirmed by a panel of experts, its construct validity by confirmatory factor analysis, and its reliability by Cronbach's alpha of 0.802. All data analyses were performed using SPSS (version 22) and LISREL (version 8.8). Results showed that most physicians had a desirable attitude towards using smart phones. Besides, the results of SEM indicated a significant relationship between attitude and compatibility, observability, personal experience, voluntariness of use and perceived usefulness. Moreover, some important fitness indices revealed appropriate fitness of the study model (p=0.26, X2/df=1.35, RMR=0.070, GFI=0.77, AGFI=0.71, NNFI=0.93, CFI=0.94). The results revealed that compatibility, observability, personal experience, voluntariness of use and perceived usefulness were effective in the physicians' attitude towards using smart phones. Thus, by preparation of the required infrastructures, policymakers in the field of health technology can enhance the utilization of smart phones in hospitals.

  7. A Physician's Practice Profile: Application for a Teaching Hospital Ambulatory Care Setting

    PubMed Central

    Retchin, Sheldon M.; Blish, Christine S.

    1984-01-01

    A computer generated report (Practice Profile) summarizing epidemiologic, demographic and utilization data from a general internal medicine practice, was developed and implemented in a teaching hospital setting. Using a computerized medical record system, the Profile displays individual and group practice data. It is used for enhancing the physicians' understanding of their ambulatory practices and for raising important quality assurance issues. The Practice Profile is also used for improving educational activities in the residency program and for stimulating research opportunities within the practice.

  8. Neural network models: Insights and prescriptions from practical applications

    SciTech Connect

    Samad, T.

    1995-12-31

    Neural networks are no longer just a research topic; numerous applications are now testament to their practical utility. In the course of developing these applications, researchers and practitioners have been faced with a variety of issues. This paper briefly discusses several of these, noting in particular the rich connections between neural networks and other, more conventional technologies. A more comprehensive version of this paper is under preparation that will include illustrations on real examples. Neural networks are being applied in several different ways. Our focus here is on neural networks as modeling technology. However, much of the discussion is also relevant to other types of applications such as classification, control, and optimization.

  9. Social and geographical boundaries around senior nurse and physician leaders: an application of social network analysis.

    PubMed

    West, Elizabeth; Barron, David N

    2005-09-01

    The purpose of this study was to describe the social and geographical boundaries around the networks of senior nurse executives and physician leaders and managers in acute-care hospitals in the United Kingdom. A telephone survey was conducted using standard social network methods. A random sample was drawn from a national list and repeatedly sampled until 100 respondents were interviewed. The response rate was 49.5%. Both groups tended to discuss "important professional matters" with others who were similar to themselves in terms of profession, gender, age, and seniority, with physicians being more extreme in this regard. The implication is that gaps in the network of informal ties will impede the dissemination of information and the spread of social influence between these 2 important groups. Managers (non-clinically qualified) appear to occupy a powerful "brokerage" role. Informal networks are mainly composed of local ties. The authors argue that dissemination and influence strategies that take features of the social structure into account are more likely to be successful.

  10. Iron Oxide Nanoparticles: An Insight into their Biomedical Applications

    PubMed

    Couto, Diana; Freitas, Marisa; Carvalho, Félix; Fernandes, Eduarda

    2015-05-15

    Iron oxide nanoparticles (IONs) are among the most common types of nanoparticles (NPs) used in biomedical applications. IONs can be presented in different forms [e.g. magnetite (Fe3O4), hematite (α-Fe2O3) and maghemite (γ- Fe2O3)], and are usually coated with substances and/or polymers according to the purpose for which they are intended to be used. In recent years, IONs use has been increasing exponentially in many fields of biomedicine, namely in magnetic resonance imaging, cell sorting, tissue repair, induction of hyperthermia and drug delivery, among others. This review aims to provide an update on the different IONs and the substances and/or polymers that can be used to coat the IONs core as well as their applications and biological properties, namely their biodistribution in the human body and their cellular internalization pathways.

  11. New insights into perfluorinated adsorbents for analytical and bioanalytical applications.

    PubMed

    Marchetti, Nicola; Guzzinati, Roberta; Catani, Martina; Massi, Alessandro; Pasti, Luisa; Cavazzini, Alberto

    2015-01-01

    Perfluorinated (F-) adsorbents are generally prepared by bonding perfluoro-functionalized silanes to silica gels. They have been employed for a long time essentially as media for solid-phase extraction of F-molecules or F-tagged molecules in organic chemistry and heterogeneous catalysis. More recently, this approach has been extended to proteomics and metabolomics. Owing to their unique physicochemical properties, namely fluorophilicity and proteinophilicity, and a better understanding of some fundamental aspects of their behavior, new applications of F-adsorbents in the field of environmental science and bio-affinity studies can be envisaged. In this article, we revisit the most important features of F-adsorbents by focusing, in particular, on some basic information that has been recently obtained through (nonlinear) chromatographic studies. Finally, we try to envisage new applications and possibilities that F-adsorbents will allow in the near future.

  12. [Physicians see both pros and cons of health care financial management. Questionnaire study provides more insights--with starting point in controversial DN-article series].

    PubMed

    Björk, Joar; Petersson, Christer

    2015-05-12

    In the spring of 2013, the Swedish journalist Maciej Zaremba wrote a series of articles criticizing the impact of NPM (New Public Management) on Swedish health care. The present study examines the views of experienced Swedish physicians (general practitioners and internal medicine speclialists) on the problems focused in Mr Zaremba's article series. The respondents (51 general practitioners and 61 internal medicine specialists) mention advantages as well as disadvantages with NPM in Swedish health care. The majority agrees that with NPM, physicians loose influence over health care governance to other professional groups. The majority disagree with the charge made by Mr Zaremba that NPM has had the effect of manipulating Swedish physicians away from the standards of good medical care.

  13. Mesenchymal stem cells in obesity: insights for translational applications.

    PubMed

    Matsushita, Kenichi; Dzau, Victor J

    2017-10-01

    Obesity is now a major public health problem worldwide. Lifestyle modification to reduce the characteristic excess body adiposity is important in the treatment of obesity, but effective therapeutic intervention is still needed to control what has become an obesity epidemic. Unfortunately, many anti-obesity drugs have been withdrawn from market due to adverse side effects. Bariatric surgery therefore remains the most effective therapy for severe cases, although such surgery is invasive and researchers continue to seek new control strategies for obesity. Mesenchymal stem cells (MSCs) are a major source of adipocyte generation, and studies have been conducted into the potential roles of MSCs in treating obesity. However, despite significant progress in stem cell research and its potential applications for obesity, adipogenesis is a highly complex process and the molecular mechanisms governing MSC adipogenesis remain ill defined. In particular, successful clinical application of MSCs will require extensive identification and characterization of the transcriptional regulators controlling MSC adipogenesis. Since obesity is associated with the incidence of multiple important comorbidities, an in-depth understanding of the relationship between MSC adipogenesis and the comorbidities of obesity is also necessary to evaluate the potential of effective and safe MSC-based therapies for obesity. In addition, brown adipogenesis is an attractive topic from the viewpoint of therapeutic innovation and future research into MSC-based brown adipogenesis could lead to a novel breakthrough. Ongoing stem cell studies and emerging research fields such as epigenetics are expected to elucidate the complicated mechanisms at play in MSC adipogenesis and develop novel MSC-based therapeutic options for obesity. This review discusses the current understanding of MSCs in adipogenesis and their potential clinical applications for obesity.

  14. Proteomics of ovarian cancer: functional insights and clinical applications

    SciTech Connect

    Elzek, Mohamed A.; Rodland, Karin D.

    2015-03-04

    In the past decade, there has been an increasing interest in applying proteomics to assist in understanding the pathogenesis of ovarian cancer, elucidating the mechanism of drug resistance, and in the development of biomarkers for early detection of ovarian cancer. Although ovarian cancer is a spectrum of different diseases, the strategies for diagnosis and treatment with surgery and adjuvant therapy are similar across ovarian cancer types, increasing the general applicability of discoveries made through proteomics research. While proteomic experiments face many difficulties which slow the pace of clinical applications, recent advances in proteomic technology contribute significantly to the identification of aberrant proteins and networks which can serve as targets for biomarker development and individualized therapies. This review provides a summary of the literature on proteomics’ contributions to ovarian cancer research and highlights the current issues, future directions, and challenges. In conclusion, we propose that protein-level characterization of primary lesion in ovarian cancer can decipher the mystery of this disease, improve diagnostic tools, and lead to more effective screening programs.

  15. Proteomics of ovarian cancer: functional insights and clinical applications

    DOE PAGES

    Elzek, Mohamed A.; Rodland, Karin D.

    2015-03-04

    In the past decade, there has been an increasing interest in applying proteomics to assist in understanding the pathogenesis of ovarian cancer, elucidating the mechanism of drug resistance, and in the development of biomarkers for early detection of ovarian cancer. Although ovarian cancer is a spectrum of different diseases, the strategies for diagnosis and treatment with surgery and adjuvant therapy are similar across ovarian cancer types, increasing the general applicability of discoveries made through proteomics research. While proteomic experiments face many difficulties which slow the pace of clinical applications, recent advances in proteomic technology contribute significantly to the identification ofmore » aberrant proteins and networks which can serve as targets for biomarker development and individualized therapies. This review provides a summary of the literature on proteomics’ contributions to ovarian cancer research and highlights the current issues, future directions, and challenges. In conclusion, we propose that protein-level characterization of primary lesion in ovarian cancer can decipher the mystery of this disease, improve diagnostic tools, and lead to more effective screening programs.« less

  16. Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

    PubMed

    Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

    2013-01-01

    Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

  17. Insights from the application of computational neuroimaging to social neuroscience.

    PubMed

    Dunne, Simon; O'Doherty, John P

    2013-06-01

    A recent approach in social neuroscience has been the application of formal computational models for a particular social-cognitive process to neuroimaging data. Here we review preliminary findings from this nascent subfield, focusing on observational learning and strategic interactions. We present evidence consistent with the existence of three distinct learning systems that may contribute to social cognition: an observational-reward-learning system involved in updating expectations of future reward based on observing rewards obtained by others, an action-observational learning system involved in learning about the action tendencies of others, and a third system engaged when it is necessary to learn about the hidden mental-states or traits of another. These three systems appear to map onto distinct neuroanatomical substrates, and depend on unique computational signals.

  18. Insights into lignin degradation and its potential industrial applications.

    PubMed

    Abdel-Hamid, Ahmed M; Solbiati, Jose O; Cann, Isaac K O

    2013-01-01

    -phenolic lignin model compounds. In addition to the peroxidases and laccases, fungi produce other accessory oxidases such as aryl-alcohol oxidase and the glyoxal oxidase that generate the hydrogen peroxide required by the peroxidases. Lignin-degrading enzymes have attracted the attention for their valuable biotechnological applications especially in the pretreatment of recalcitrant lignocellulosic biomass for biofuel production. The use of lignin-degrading enzymes has been studied in various applications such as paper industry, textile industry, wastewater treatment and the degradation of herbicides. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Laser Applications for Nanotechnology : Insights From Numerical Modeling

    NASA Astrophysics Data System (ADS)

    Itina, T. E.; Shcheblanov, N.; Colombier, J.-Ph.; Stoian, R.; Audouard, E.; Derrien, Th. Y.; Torres, R.; Hermann, J.; Povarnitsyn, M. E.; Khishchenko, K. V.

    2010-10-01

    Laser-produced nanoparticles have found many applications in bio-photonics, medicine and in the development of photovolvatic cells. Many experiments have been performed demonstrating the formation of these particles from solid targets in vacuum, in the presence of a gas or a liquid. However, it is still difficult to predict the size distribution of these particles. Therefore, we have performed an extensive numerical modeling of the involved physical processes. The developed models allow us to compare the relative contribution of several processes involved in the cluster production by laser ablation: (i) direct cluster ejection from a target under rapid laser interaction, (ii) condensation/evaporation; (iii) fragmentation/aggregation processes during cluster diffusion; and (iv) diffusion and coalescence if nanoparticles are deposited on a substrate. The calculation results of both hydrodynamic and molecular dynamics simulations demonstrate that an exposure of a target to a short or ultra-short laser pulse leads to an explosive target decomposition and to the ejection of nanoparticles. These cluster precursors are formed during rapid target expansion through both thermal and mechanical processes. Collisions with background species affect the cluster size distribution. The influences of the parameters, such as initial cluster temperature and size, background temperature and density, on the cluster evolution are analyzed. Laser-induced phase explosion process affects the formation of small surface structures, obtained with small number of shots. However, the non-resonant "conical" surface structures with the mean size as large as several micrometers are formed due to the presence of harder less absorbing centers. These obtained results can be used to explain many recent experimental observations.

  20. Training transfer: scientific background and insights for practical application.

    PubMed

    Issurin, Vladimir B

    2013-08-01

    Training transfer as an enduring, multilateral, and practically important problem encompasses a large body of research findings and experience, which characterize the process by which improving performance in certain exercises/tasks can affect the performance in alternative exercises or motor tasks. This problem is of paramount importance for the theory of training and for all aspects of its application in practice. Ultimately, training transfer determines how useful or useless each given exercise is for the targeted athletic performance. The methodological background of training transfer encompasses basic concepts related to transfer modality, i.e., positive, neutral, and negative; the generalization of training responses and their persistence over time; factors affecting training transfer such as personality, motivation, social environment, etc. Training transfer in sport is clearly differentiated with regard to the enhancement of motor skills and the development of motor abilities. The studies of bilateral skill transfer have shown cross-transfer effects following one-limb training associated with neural adaptations at cortical, subcortical, spinal, and segmental levels. Implementation of advanced sport technologies such as motor imagery, biofeedback, and exercising in artificial environments can facilitate and reinforce training transfer from appropriate motor tasks to targeted athletic performance. Training transfer of motor abilities has been studied with regard to contralateral effects following one limb training, cross-transfer induced by arm or leg training, the impact of strength/power training on the preparedness of endurance athletes, and the impact of endurance workloads on strength/power performance. The extensive research findings characterizing the interactions of these workloads have shown positive transfer, or its absence, depending on whether the combinations conform to sport-specific demands and physiological adaptations. Finally, cross

  1. The physician leader as logotherapist.

    PubMed

    Washburn, E R

    1998-01-01

    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  2. How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection.

    PubMed

    Stockmann, C; Rogatcheva, M; Harrel, B; Vaughn, M; Crisp, R; Poritz, M; Thatcher, S; Korgenski, E K; Barney, T; Daly, J; Pavia, A T

    2015-02-01

    The objective of this study was to compare the aetiologic yield of standard-of-care microbiologic testing ordered by physicians with that of a multiplex PCR platform. Stool specimens obtained from children and young adults with gastrointestinal illness were evaluated by standard laboratory methods and a developmental version of the FilmArray Gastrointestinal (GI) Diagnostic System (FilmArray GI Panel), a rapid multiplex PCR platform that detects 23 bacterial, viral and protozoal agents. Results were classified according to the microbiologic tests requested by the treating physician. A median of three (range 1-10) microbiologic tests were performed by the clinical laboratory during 378 unique diarrhoeal episodes. A potential aetiologic agent was identified in 46% of stool specimens by standard laboratory methods and in 65% of specimens tested using the FilmArray GI Panel (p < 0.001). For those patients who only had Clostridium difficile testing requested, an alternative pathogen was identified in 29% of cases with the FilmArray GI Panel. Notably, 11 (12%) cases of norovirus were identified among children who only had testing for Clostridium difficile ordered. Among those who had C. difficile testing ordered in combination with other tests, an additional pathogen was identified in 57% of stool specimens with the FilmArray GI Panel. For patients who had no C. difficile testing performed, the FilmArray GI Panel identified a pathogen in 63% of cases, including C. difficile in 8%. Physician-specified laboratory testing may miss important diarrhoeal pathogens. Additionally, standard laboratory testing is likely to underestimate co-infections with multiple infectious diarrhoeagenic agents.

  3. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications

    PubMed Central

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% – 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures

  4. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications.

    PubMed

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% - 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures

  5. The Kubler-Ross model, physician distress, and performance reporting.

    PubMed

    Smaldone, Marc C; Uzzo, Robert G

    2013-07-01

    Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

  6. A concise drug alerting rule set for Chinese hospitals and its application in computerized physician order entry (CPOE).

    PubMed

    Zhang, Yinsheng; Long, Xin; Chen, Weihong; Li, Haomin; Duan, Huilong; Shang, Qian

    2016-01-01

    A minimized and concise drug alerting rule set can be effective in reducing alert fatigue. This study aims to develop and evaluate a concise drug alerting rule set for Chinese hospitals. The rule set covers not only western medicine, but also Chinese patent medicine that is widely used in Chinese hospitals. A 2600-bed general hospital in China. In order to implement the drug rule set in clinical information settings, an information model for drug rules was designed and a rule authoring tool was developed accordingly. With this authoring tool, clinical pharmacists built a computerized rule set that contains 150 most widely used and error-prone drugs. Based on this rule set, a medication-related clinical decision support application was built in CPOE. Drug alert data between 2013/12/25 and 2015/07/01 were used to evaluate the effect of the rule set. Number of alerts, number of corrected/overridden alerts, accept/override rate. Totally 18,666 alerts were fired and 2803 alerts were overridden. Overall override rate is 15.0% (2803/18666) and accept rate is 85.0%. The rule set has been well received by physicians and can be used as a preliminary medical order screening tool to reduce pharmacists' workload. For Chinese hospitals, this rule set can serve as a starter kit for building their own pharmaceutical systems or as a reference to tier commercial rule set.

  7. Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context.

    PubMed

    Kirschbaum, Kristin

    2012-01-01

    Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians.

  8. Application of a Propensity Score Approach for Risk Adjustment in Profiling Multiple Physician Groups on Asthma Care

    PubMed Central

    Huang, I-Chan; Frangakis, Constantine; Dominici, Francesca; Diette, Gregory B; Wu, Albert W

    2005-01-01

    Objectives To develop a propensity score-based risk adjustment method to estimate the performance of 20 physician groups and to compare performance rankings using our method to a standard hierarchical regression-based risk adjustment method. Data Sources/Study Setting Mailed survey of patients from 20 California physician groups between July 1998 and February 1999. Study Design A cross-sectional analysis of physician group performance using patient satisfaction with asthma care. We compared the performance of the 20 physician groups using a novel propensity score-based risk adjustment method. More specifically, by using a multinomial logistic regression model we estimated for each patient the propensity scores, or probabilities, of having been treated by each of the 20 physician groups. To adjust for different distributions of characteristics across groups, patients cared for by a given group were first stratified into five strata based on their propensity of being in that group. Then, strata-specific performance was combined across the five strata. We compared our propensity score method to hierarchical model-based risk adjustment without using propensity scores. The impact of different risk-adjustment methods on performance was measured in terms of percentage changes in absolute and quintile ranking (AR, QR), and weighted κ of agreement on QR. Results The propensity score-based risk adjustment method balanced the distributions of all covariates among the 20 physician groups, providing evidence for validity. The propensity score-based method and the hierarchical model-based method without propensity scores provided substantially different rankings (75 percent of groups differed in AR, 50 percent differed in QR, weighted κ=0.69). Conclusions We developed and tested a propensity score method for profiling multiple physician groups. We found that our method could balance the distributions of covariates across groups and yielded substantially different profiles

  9. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    PubMed

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

    2016-01-19

    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  10. Advancing the application of systems thinking in health: advice seeking behavior among primary health care physicians in Pakistan.

    PubMed

    Malik, Asmat U; Willis, Cameron D; Hamid, Saima; Ulikpan, Anar; Hill, Peter S

    2014-08-26

    Using measles and tuberculosis as case examples, with a systems thinking approach, this study examines the human advice-seeking behavior of primary health care (PHC) physicians in a rural district of Pakistan. This study analyzes the degree to which the existing PHC system supports their access to human advice, and explores in what ways this system might be strengthened to better meet provider needs. The study was conducted in a rural district of Pakistan and, with a cross-sectional study design, it employed a range of research methods, namely extensive document review for mapping existing information systems, social network analysis of physicians' advice-seeking practice, and key stakeholder interviews for an in-depth understanding of the experience of physicians. Illustrations were prepared for information flow mechanism, sociographs were generated for analyzing social networks, and content analysis of qualitative findings was carried out for in-depth interpretation of underlying meanings. The findings of this study reveal that non-availability of competent supervisory staff, a focus on improving performance indicators rather than clinical guidance, and a lack of a functional referral system have collectively created an environment in which PHC physicians have developed their own strategies to overcome these constraints. They are well aware of the human expertise available within and outside the district. However, their advice-seeking behavior was dependent upon existence of informal social interaction with the senior specialists. Despite the limitations of the system, the physicians proactively used their professional linkages to seek advice and also to refer patients to the referral center based on their experience and the facilities that they trusted. The absence of functional referral systems, limited effective linkages between PHC and higher levels of care, and a focus on programmatic targets rather than clinical care have each contributed to the isolation

  11. Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

    PubMed

    Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

    2012-06-01

    The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Physicians in transition.

    PubMed

    Bluestein, P

    1995-12-01

    The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.

  13. [Neurolinguistic programming in physician-patient communication. Basic principles of the procedure--examples for application in surgery].

    PubMed

    Graf, U

    1995-09-20

    Neurolinguistic programming (NLP) is a means of improving physician-patient communication that can be learned by any doctor. The present article first describes some of the fundamentals of NLP and then provides examples taken from the field of surgery-in the first instance dealing with the treatment of painful conditions by means of trance or dissociation and, secondly, on the influencing of expectations and the restructuring (reframing) of doctrines in a patient with malignant disease.

  14. Physicians' strikes and the competing bases of physicians' moral obligations.

    PubMed

    MacDougall, D Robert

    2013-09-01

    Many authors have addressed the morality of physicians' strikes on the assumption that medical practice is morally different from other kinds of occupations. This article analyzes three prominent theoretical accounts that attempt to ground such special moral obligations for physicians--practice-based accounts, utilitarian accounts, and social contract accounts--and assesses their applicability to the problem of the morality of strikes. After critiquing these views, it offers a fourth view grounding special moral obligations in voluntary commitments, and explains why this is a preferable basis for understanding physicians' moral obligations in general and especially as pertaining to strikes.

  15. Glyco-nanomaterials: translating insights from the "sugar-code" to biomedical applications.

    PubMed

    El-Boubbou, Kheireddine; Huang, Xuefei

    2011-01-01

    Over the past decade, diagnostics and therapeutics have changed gradually towards the use of more specific and targeted approaches. The most profound impact has been in the nanotechnology sectors, where an explosion in directing biomolecules to specific biomarkers has illustrated great potentials not only in detection but also in targeted therapy. Increased knowledge of the diseases at the molecular level catalyzed a shift towards identifying new biological indicators. In particular, carbohydrate-mediated molecular recognitions using nano-vehicles are likely to increasingly affect medicine opening a new area of biomedical applications. This article provides an overview of the recent progress made in recruiting the "sugar code" functionalized on various nano-platforms to decipher cellular information for both in vitro and in vivo applications. Today's glyco-technologies are enabling better detection with great therapeutic potentials. Tomorrow they are likely to bring a full understanding of the "cell-glyconanomaterial bio-conversation" where major biomedical problems will be overcome translating insights from the "glyco-nanoworld" into clinical practice.

  16. Money management, patient safety and customer service among top concerns for physician executives. Interview by Barbara Linney.

    PubMed

    Afable, Richard F; Byrne, Frank; Coile, Russell; Grebenschikoff, Jennifer; Hickey, Martin; Tyler, Larry

    2002-01-01

    Find out what's happening today and what the future may be like for physician executives. Seasoned physician executives and well-known physician executive recruiters share their insights on the profession.

  17. Recent applications of synchrotron VUV photoionization mass spectrometry: insight into combustion chemistry.

    PubMed

    Li, Yuyang; Qi, Fei

    2010-01-19

    Combustion is one of the earliest developed human technologies and remains our primary source of energy, yet it embodies a complex suite of physical and chemical processes that are inadequately understood. Combustion chemistry involves both chemical thermodynamics and chemical kinetics, and experimental advances mostly depend on the development of combustion diagnostics, which effectively serve as the foundation of theoretical progress. The major objective of combustion diagnostics is to provide comprehensive product identification and concentration information of a flame species, which can be used to develop kinetic models for the simulation of practical combustion. However, conventional combustion diagnostic methods face difficult challenges in distinguishing isomeric species, detecting reactive radicals, obtaining real-time measurements, and so forth. Therefore, for deeper insight into combustion chemistry, a diagnostic method with high detection sensitivity, isomeric selectivity, and radical detectability is required. In this Account, we report recent applications of synchrotron vacuum ultraviolet photoionization mass spectrometry (SVUV-PIMS) in various areas of combustion chemistry research. The wide tunability of synchrotron photon energy can facilitate the selective identification of isomeric intermediates and the near-threshold detection of radicals (thus avoiding fragmentation interference). Moreover, the convenient combination of SVUV-PIMS with various laboratory-based combustion approaches demonstrates its universality in combustion studies. Recent experimental achievements have demonstrated the successful applications of this technique in premixed flames, pyrolysis in flow reactors, coflow diffusion flames, catalytic oxidation, plasma diagnostics, and analysis of polycyclic aromatic hydrocarbons (PAHs) and soot. More applications of SVUV-PIMS are expected in the near future, not only in combustion studies, but also in other research topics of chemistry

  18. Fractals for physicians.

    PubMed

    Thamrin, Cindy; Stern, Georgette; Frey, Urs

    2010-06-01

    There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment. Copyright 2010 Elsevier Ltd. All rights reserved.

  19. Application of physician-modified fenestrated stent graft in urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy

    PubMed Central

    Zeng, Rong; Ye, Wei; Liu, Changwei; Wang, Xuan; Song, Xiaojun; Ni, Leng; Liu, Bao; Li, Yongjun; Zheng, Yuehong

    2016-01-01

    Abstract Background: This study aimed to evaluate the feasibility and effectiveness of the Gore Excluder aortic stent graft (WL Gore & Associates, Inc., Flagstaff, AZ) using the C3 Delivery System after physician modification of fenestration for the urgent treatment of patients with abdominal aortic aneurysm showing hostile neck anatomy. Case summary: Three urgent cases of abdominal aortic aneurysm with hostile neck anatomy symptom with abdominal pain were reported. The same fenestration method was applied to align the target superior mesenteric artery and bilateral renal arteries with 1 scallop and 2 fenestrations, followed by the reconstruction of the target artery using a bare-metal stent or stent graft. Balloon-assisted positioning and image fusion technology were intraoperatively applied to assist the accurate release of the stent graft body. The follow-up periods for all cases exceeded 6 months, showing smooth circulation in the target arteries with no endoleaks. Conclusion: In the absence of other available treatment methods, it is feasible to use a stent graft with physician-modified fenestration for the urgent endovascular repair of abdominal aortic aneurysm with hostile neck anatomy. However, this procedure's long-term efficacy needs to be further investigated. PMID:27861397

  20. Physician recruitment: understanding what physicians want.

    PubMed

    McCullough, T; Dodge, H R; Moeller, S

    1999-01-01

    One of the more dramatic changes in the healthcare industry has been the movement of physicians, particularly younger professionals, from private practice to some type of healthcare organization. In this study we examine the importance attached to specific incentives by physicians in making an affiliation decision and healthcare administrators. Our results suggest significant differences between the importance placed on certain recruiting incentives by physicians and healthcare administrators. Further, they suggest distinct differences in importance ratings by different types of physicians. Implications of this study argue for developing different compensation packages to appeal to different segments of physicians.

  1. 36 CFR 21.4 - Registration of physicians.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Registration of physicians... INTERIOR HOT SPRINGS NATIONAL PARK; BATHHOUSE REGULATIONS § 21.4 Registration of physicians. Physicians... office of the Superintendent. Any physician may make application for registration to the...

  2. Physician transition plans: planning for physician slowdown.

    PubMed

    Walker Keegan, Deborah

    2008-01-01

    Transition is a natural progression for physicians in a medical practice. At some point, at least one physician will seek to deviate from the work norm of the group, either due to retirement, need for part-time status, or other reason. Medical practices that have a formal transition plan in place have a competitive advantage over other practices in terms of physician recruitment and retention. Not only do the formal transition plans permit physicians to proactively plan for work slowdown, but they also permit the medical practice to ensure its financial health and effectively position itself for the future. Key issues addressed in physician transition plans include governance, continuity of care, eligibility, time limits, on-call schedules, practice overhead, and physician compensation.

  3. Physician Responses to Global Physician Expenditure Budgets in Canada: A Common Property Perspective

    PubMed Central

    Hurley, Jeremiah; Lomas, Jonathan; Goldsmith, Laurie J.

    1997-01-01

    Global expenditure budgets in the fee-for-service physician sector create management problems for both funders and physicians. Global expenditure cap policies must be designed, and appropriate institutional structures created, to mitigate perverse utilization incentives, manage collective utilization, and diffuse the internal professional and the funder–profession tensions created by a capped budget. Two Canadian provinces that adopted different approaches to the design of their physician expenditure cap policies experienced different outcomes in utilization growth. The outcomes, however, are the opposite to what one would predict based on an analysis of the incentive structures embodied in the two provinces' policies. An analytic framework developed for the study of common-property resources is applied to the differing physician responses to global budgets across the two provinces. The insights offered by this framework can guide policy design for global physician budgets, and they indicate the critical importance of physician acceptance of such a policy. PMID:9290633

  4. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2...

  5. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2...

  6. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of...

  7. Insights into Participants' Behaviours in Educational Games, Simulations and Workshops: A Catastrophe Theory Application to Motivation.

    ERIC Educational Resources Information Center

    Cryer, Patricia

    1988-01-01

    Develops models for participants' behaviors in games, simulations, and workshops based on Catastrophe Theory and Herzberg's two-factor theory of motivation. Examples are given of how these models can be used, both for describing and understanding the behaviors of individuals, and for eliciting insights into why participants behave as they do. (11…

  8. Physician communication in the operating room.

    PubMed

    Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew

    2015-01-01

    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

  9. Physician-scientist, heal thyself . . .

    PubMed

    Marks, Andrew R

    2007-01-01

    Historically, physician-scientists have had dual roles in caring for patients and in performing investigative research that could potentially lead to new diagnostics and therapeutics. Physician-scientists conducted teaching rounds in the hospital, surrounded by eager house staff and medical students, and were often avidly pursued as the most important sources of new knowledge for trainees. But alas, times have changed. Now physician-scientists are rarely seen in the hospital; they are most often spotted at their desks tapping out yet another grant application. Most struggle to find the time to mentor students and clinical trainees, let alone to care for patients in the hospital, even though these interactions are often the motivating forces for scientific creativity.

  10. Physician-assisted death.

    PubMed Central

    1995-01-01

    Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death. PMID:7632208

  11. Tips for a physician in getting the right job, part XII: general questions for the applicant to ask.

    PubMed

    Harolds, Jay A

    2014-07-01

    The type and caliber of the questions asked by a job hunter is one of the ways an interviewer will evaluate the candidate. Questions that show poor preparation should not be asked, such as failure to read what the employer sent to the job seeker or not doing elementary research on the practice, the organization, or the community. Asking about insignificant details also is not helpful. Not having any good questions to ask is a negative in an interview. This article discusses many possible important questions for the applicant to ask during an interview.

  12. Role of the Physician Anesthesiologist

    MedlinePlus

    ... of the Physician Anesthesiologist Role of the Physician Anesthesiologist When preparing for surgery, many patients think of the physician anesthesiologist as just the person behind the mask who ...

  13. Current market trends in hospital/physician integration.

    PubMed

    Bauman, Randy R

    2009-01-01

    This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.

  14. [Drug dependence among physicians].

    PubMed

    Schifferdecker, M; Schmidt, R; Loevenich, A; Krahl, A

    1996-06-01

    Physicians are at higher risk of addiction compared with the general population. Worldwide about 15% of physicians may be addicted to drugs or alcohol. In Germany, accurate epidemiological data are not available. The underlying issues of this occupational risk are the dangers of "role strain", features of a "typical" personality and a high rate of burnout among physicians. Most important is therefore prevention, the need to persuade physicians to "cherish themselves" and reduce work stress as far as possible. An US-program is described regarding identification and therapy of drug users among physicians.

  15. Referral physician marketing.

    PubMed

    Lewis, A

    1993-01-01

    Marketing of specialist services to referring physicians can be highly effective at influencing referral patterns if the referring physician's needs are taken into account. Furthermore, it is possible to generate referrals from nonreferring physicians by approaching them correctly. The ideal approach is for a specialist to treat non-referring physicians as though they referred the patient, even when they didn't. This practice allows the specialist to demonstrate communications service quality in a non-aggressive, non-sales context. The United Weight Control case study summarizes the impact of a referral-generation strategy with "before" and "after" analyses of the strategy's cost and effectiveness.

  16. Confronting the disruptive physician.

    PubMed

    Linney, B J

    1997-01-01

    Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.

  17. Thermodynamic metrics for aggregation of natural resources in life cycle analysis: insight via application to some transportation fuels.

    PubMed

    Baral, Anil; Bakshi, Bhavik R

    2010-01-15

    While methods for aggregating emissions are widely used and standardized in life cycle assessment (LCA), there is little agreement about methods for aggregating natural resources for obtaining interpretable metrics. Thermodynamic methods have been suggested including energy, exergy, and emergy analyses. This work provides insight into the nature of thermodynamic aggregation, including assumptions about substitutability between resources and loss of detailed information about the data being combined. Methods considered include calorific value or energy, industrial cumulative exergy consumption (ICEC) and its variations, and ecological cumulative exergy consumption (ECEC) or emergy. A hierarchy of metrics is proposed that spans the range from detailed data to aggregate metrics. At the fine scale, detailed data can help identify resources to whose depletion the selected product is most vulnerable. At the coarse scale, new insight is provided about thermodynamic aggregation methods. Among these, energy analysis is appropriate only for products that rely primarily on fossil fuels, and it cannot provide a useful indication of renewability. Exergy-based methods can provide results similar to energy analysis by including only nonrenewable fuels but can also account for materials use and provide a renewability index. However, ICEC and its variations do not address substitutability between resources, causing its results to be dominated by dilute and low-quality resources such as sunlight. The use of monetary values to account for substitutability does not consider many ecological resources and may not be appropriate for the analysis of emerging products. ECEC or emergy explicitly considers substitutability and resource quality and provides more intuitive results but is plagued by data gaps and uncertainties. This insight is illustrated via application to the life cycles of gasoline, diesel, corn ethanol, and soybean biodiesel. Here, aggregate metrics reveal the dilemma

  18. Novel insights in biopurification system for dissipation of a pesticide mixture in repeated applications.

    PubMed

    Diez, Maria Cristina; Leiva, Bárbara; Gallardo, Felipe

    2017-09-15

    A biopurification system based on the adsorption and degradation capacity of a biomixture to degrade a mixture of pesticides (atrazine, chlorpyrifos, iprodione; 50 mg kg(-1) each) in repeated applications (0, 30, and 60 days) was evaluated. Tanks of 1 m(3) packed with a biomixture (ρ 0.29 g mL(-1)) with and without vegetal cover were used. The biomixture contained soil, peat, and wheat straw in a proportion 1:1:2 by volume, respectively. Pesticide concentrations, biological activities (urease, phenoloxidase, and dehydrogenase), and microbial community changes (DGGE and qPCR) were evaluated periodically. Pesticide dissipation was higher in tanks with vegetal cover (> 95%) and no variation was observed after the three applications; contrarily, pesticide dissipation decreased in the tank without vegetal cover after each application. The presence of vegetal cover decreased the half-life of pesticides by at least twice. Biological activities were in general not affected by the application and reapplication of pesticides in the same treatment; however, they exhibited some differences between tanks containing and lacking the vegetal cover. High similarity between microbial groups (actinobacteria, bacteria, and fungi) was observed, suggesting no influence ascribable to the successive pesticide applications. The number of copies of bacteria and actinobacteria remained almost constant during the assay. However, the number of copies of fungi was significantly higher in the uncontaminated tank without vegetal cover.

  19. Time clock requirements for hospital physicians.

    PubMed

    Shapira, Chen; Vilnai-Yavetz, Iris; Rafaeli, Anat; Zemel, Moran

    2016-06-01

    An agreement negotiated following a doctors' strike in 2011 introduced a requirement that physicians in Israel's public hospitals clock in and out when starting and leaving work. The press reported strong negative reactions to this policy and predicted doctors deserting hospitals en masse. This study examines physicians' reactions toward the clock-in/clock-out policy 6 months after its implementation, and assesses the relationship between these reactions and aspects of their employment context. 676 physicians in 42 hospitals responded to a survey assessing doctor's reactions toward the clock, hospital policy makers, and aspects of their work. Reactions to the clock were generally negative. Sense of calling correlated positively with negative reactions to the clock, and the latter correlated positively with quit intentions. However, overall, respondents reported a high sense of calling and low quit intentions. We suggest that sense of calling buffers and protects physicians from quit intentions. Differences in reactions to the clock were associated with different employment characteristics, but sense of calling did not vary by hospital size or type or by physicians' specialty. The findings offer insights into how physicians' working environment affects their reactions to regulatory interventions, and highlight medical professionalism as buffering reactions to unpopular regulatory policies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Evaluating Topic Model Interpretability from a Primary Care Physician Perspective

    PubMed Central

    Arnold, Corey W.; Oh, Andrea; Chen, Shawn; Speier, William

    2015-01-01

    Background and Objective Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician’s point of view. Methods Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. Results While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. Conclusion This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. PMID:26614020

  1. Negotiation for physicians.

    PubMed

    Hill, Micah J; DeCherney, Alan H

    2013-05-01

    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Marketing specialty physician services.

    PubMed

    Olson, E A

    1993-01-01

    Physicians take into account many factors when making referral decisions, primarily provider expertise, good communication and good patient care. This professional paper will show that provider expertise and patient care are the most important factors in referral decisions, and that physicians rely primarily on direct experience for the information necessary to make a referral choice.

  3. Antimicrobial Peptides: Insights into Membrane Permeabilization, Lipopolysaccharide Fragmentation and Application in Plant Disease Control

    PubMed Central

    Datta, Aritreyee; Ghosh, Anirban; Airoldi, Cristina; Sperandeo, Paola; Mroue, Kamal H.; Jiménez-Barbero, Jesús; Kundu, Pallob; Ramamoorthy, Ayyalusamy; Bhunia, Anirban

    2015-01-01

    The recent increase in multidrug resistance against bacterial infections has become a major concern to human health and global food security. Synthetic antimicrobial peptides (AMPs) have recently received substantial attention as potential alternatives to conventional antibiotics because of their potent broad-spectrum antimicrobial activity. These peptides have also been implicated in plant disease control for replacing conventional treatment methods that are polluting and hazardous to the environment and to human health. Here, we report de novo design and antimicrobial studies of VG16, a 16-residue active fragment of Dengue virus fusion peptide. Our results reveal that VG16KRKP, a non-toxic and non-hemolytic analogue of VG16, shows significant antimicrobial activity against Gram-negative E. coli and plant pathogens X. oryzae and X. campestris, as well as against human fungal pathogens C. albicans and C. grubii. VG16KRKP is also capable of inhibiting bacterial disease progression in plants. The solution-NMR structure of VG16KRKP in lipopolysaccharide features a folded conformation with a centrally located turn-type structure stabilized by aromatic-aromatic packing interactions with extended N- and C-termini. The de novo design of VG16KRKP provides valuable insights into the development of more potent antibacterial and antiendotoxic peptides for the treatment of human and plant infections. PMID:26144972

  4. Insights into the Biology and Therapeutic Applications of Neural Stem Cells.

    PubMed

    Harris, Lachlan; Zalucki, Oressia; Piper, Michael; Heng, Julian Ik-Tsen

    2016-01-01

    The cerebral cortex is essential for our higher cognitive functions and emotional reasoning. Arguably, this brain structure is the distinguishing feature of our species, and yet our remarkable cognitive capacity has seemingly come at a cost to the regenerative capacity of the human brain. Indeed, the capacity for regeneration and neurogenesis of the brains of vertebrates has declined over the course of evolution, from fish to rodents to primates. Nevertheless, recent evidence supporting the existence of neural stem cells (NSCs) in the adult human brain raises new questions about the biological significance of adult neurogenesis in relation to ageing and the possibility that such endogenous sources of NSCs might provide therapeutic options for the treatment of brain injury and disease. Here, we highlight recent insights and perspectives on NSCs within both the developing and adult cerebral cortex. Our review of NSCs during development focuses upon the diversity and therapeutic potential of these cells for use in cellular transplantation and in the modeling of neurodevelopmental disorders. Finally, we describe the cellular and molecular characteristics of NSCs within the adult brain and strategies to harness the therapeutic potential of these cell populations in the treatment of brain injury and disease.

  5. RNAi in Arthropods: Insight into the Machinery and Applications for Understanding the Pathogen-Vector Interface

    PubMed Central

    Barnard, Annette-Christi; Nijhof, Ard M.; Fick, Wilma; Stutzer, Christian; Maritz-Olivier, Christine

    2012-01-01

    The availability of genome sequencing data in combination with knowledge of expressed genes via transcriptome and proteome data has greatly advanced our understanding of arthropod vectors of disease. Not only have we gained insight into vector biology, but also into their respective vector-pathogen interactions. By combining the strengths of postgenomic databases and reverse genetic approaches such as RNAi, the numbers of available drug and vaccine targets, as well as number of transgenes for subsequent transgenic or paratransgenic approaches, have expanded. These are now paving the way for in-field control strategies of vectors and their pathogens. Basic scientific questions, such as understanding the basic components of the vector RNAi machinery, is vital, as this allows for the transfer of basic RNAi machinery components into RNAi-deficient vectors, thereby expanding the genetic toolbox of these RNAi-deficient vectors and pathogens. In this review, we focus on the current knowledge of arthropod vector RNAi machinery and the impact of RNAi on understanding vector biology and vector-pathogen interactions for which vector genomic data is available on VectorBase. PMID:24705082

  6. Insights From Laboratory Experiments On Simulated Faults With Application To Fracture Evolution In Geothermal Systems

    SciTech Connect

    Stephen L. Karner, Ph.D

    2006-06-01

    Laboratory experiments provide a wealth of information related to mechanics of fracture initiation, fracture propagation processes, factors influencing fault strength, and spatio-temporal evolution of fracture properties. Much of the existing literature reports on laboratory studies involving a coupling of thermal, hydraulic, mechanical, and/or chemical processes. As these processes operate within subsurface environments exploited for their energy resource, laboratory results provide insights into factors influencing the mechanical and hydraulic properties of geothermal systems. I report on laboratory observations of strength and fluid transport properties during deformation of simulated faults. The results show systematic trends that vary with stress state, deformation rate, thermal conditions, fluid content, and rock composition. When related to geophysical and geologic measurements obtained from engineered geothermal systems (e.g. microseismicity, wellbore studies, tracer analysis), laboratory results provide a means by which the evolving thermal reservoir can be interpreted in terms of physico-chemical processes. For example, estimates of energy release and microearthquake locations from seismic moment tensor analysis can be related to strength variations observed from friction experiments. Such correlations between laboratory and field data allow for better interpretations about the evolving mechanical and fluid transport properties in the geothermal reservoir – ultimately leading to improvements in managing the resource.

  7. Atomistic simulation for deforming complex alloys with application toward TWIP steel and associated physical insights

    NASA Astrophysics Data System (ADS)

    Wang, Peng; Xu, Shaofeng; Liu, Jiabin; Li, Xiaoyan; Wei, Yujie; Wang, Hongtao; Gao, Huajian; Yang, Wei

    2017-01-01

    The interest in promoting deformation twinning for plasticity is mounting for advanced materials. In contrast to disordered grain boundaries, highly organized twin boundaries are beneficial to promoting strength-ductility combination. Twinning deformation typically involves the kinetics of stacking faults, its interplay with dislocations, as well as the interactions between dislocations and twin boundaries. While the latter has been intensively studied, the dynamics of stacking faults has been rarely touched upon. In this work, we report new physical insights on the stacking fault dynamics in twin induced plasticity (TWIP) steels. The atomistic simulation is made possible by a newly introduced approach: meta-atom molecular dynamics simulation. The simulation suggests that the stacking fault interactions are dominated by dislocation reactions that take place spontaneously, different from the existing mechanisms. Whether to generate a single stacking fault, or a twinning partial and a trailing partial dislocation, depends upon a unique parameter, namely the stacking fault energy. The latter in turn determines the deformation twinning characteristics. The complex twin-slip and twin-dislocation interactions demonstrate the dual role of deformation twins as both the dislocation barrier and dislocation storage. This duality contributes to the high strength and high ductility of TWIP steels.

  8. Methylotrophy in the thermophilic Bacillus methanolicus, basic insights and application for commodity production from methanol.

    PubMed

    Müller, Jonas E N; Heggeset, Tonje M B; Wendisch, Volker F; Vorholt, Julia A; Brautaset, Trygve

    2015-01-01

    Using methanol as an alternative non-food feedstock for biotechnological production offers several advantages in line with a methanol-based bioeconomy. The Gram-positive, facultative methylotrophic and thermophilic bacterium Bacillus methanolicus is one of the few described microbial candidates with a potential for the conversion of methanol to value-added products. Its capabilities of producing and secreting the commercially important amino acids L-glutamate and L-lysine to high concentrations at 50 °C have been demonstrated and make B. methanolicus a promising target to develop cell factories for industrial-scale production processes. B. methanolicus uses the ribulose monophosphate cycle for methanol assimilation and represents the first example of plasmid-dependent methylotrophy. Recent genome sequencing of two physiologically different wild-type B. methanolicus strains, MGA3 and PB1, accompanied with transcriptome and proteome analyses has generated fundamental new insight into the metabolism of the species. In addition, multiple key enzymes representing methylotrophic and biosynthetic pathways have been biochemically characterized. All this, together with establishment of improved tools for gene expression, has opened opportunities for systems-level metabolic engineering of B. methanolicus. Here, we summarize the current status of its metabolism and biochemistry, available genetic tools, and its potential use in respect to overproduction of amino acids.

  9. Antimicrobial Peptides: Insights into Membrane Permeabilization, Lipopolysaccharide Fragmentation and Application in Plant Disease Control.

    PubMed

    Datta, Aritreyee; Ghosh, Anirban; Airoldi, Cristina; Sperandeo, Paola; Mroue, Kamal H; Jiménez-Barbero, Jesús; Kundu, Pallob; Ramamoorthy, Ayyalusamy; Bhunia, Anirban

    2015-07-06

    The recent increase in multidrug resistance against bacterial infections has become a major concern to human health and global food security. Synthetic antimicrobial peptides (AMPs) have recently received substantial attention as potential alternatives to conventional antibiotics because of their potent broad-spectrum antimicrobial activity. These peptides have also been implicated in plant disease control for replacing conventional treatment methods that are polluting and hazardous to the environment and to human health. Here, we report de novo design and antimicrobial studies of VG16, a 16-residue active fragment of Dengue virus fusion peptide. Our results reveal that VG16KRKP, a non-toxic and non-hemolytic analogue of VG16, shows significant antimicrobial activity against Gram-negative E. coli and plant pathogens X. oryzae and X. campestris, as well as against human fungal pathogens C. albicans and C. grubii. VG16KRKP is also capable of inhibiting bacterial disease progression in plants. The solution-NMR structure of VG16KRKP in lipopolysaccharide features a folded conformation with a centrally located turn-type structure stabilized by aromatic-aromatic packing interactions with extended N- and C-termini. The de novo design of VG16KRKP provides valuable insights into the development of more potent antibacterial and antiendotoxic peptides for the treatment of human and plant infections.

  10. Insights into the Biology and Therapeutic Applications of Neural Stem Cells

    PubMed Central

    Harris, Lachlan; Zalucki, Oressia; Piper, Michael; Heng, Julian Ik-Tsen

    2016-01-01

    The cerebral cortex is essential for our higher cognitive functions and emotional reasoning. Arguably, this brain structure is the distinguishing feature of our species, and yet our remarkable cognitive capacity has seemingly come at a cost to the regenerative capacity of the human brain. Indeed, the capacity for regeneration and neurogenesis of the brains of vertebrates has declined over the course of evolution, from fish to rodents to primates. Nevertheless, recent evidence supporting the existence of neural stem cells (NSCs) in the adult human brain raises new questions about the biological significance of adult neurogenesis in relation to ageing and the possibility that such endogenous sources of NSCs might provide therapeutic options for the treatment of brain injury and disease. Here, we highlight recent insights and perspectives on NSCs within both the developing and adult cerebral cortex. Our review of NSCs during development focuses upon the diversity and therapeutic potential of these cells for use in cellular transplantation and in the modeling of neurodevelopmental disorders. Finally, we describe the cellular and molecular characteristics of NSCs within the adult brain and strategies to harness the therapeutic potential of these cell populations in the treatment of brain injury and disease. PMID:27069486

  11. Downsizing the physician workforce.

    PubMed Central

    McClendon, B J; Politzer, R M; Christian, E; Fernandez, E S

    1997-01-01

    OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A

  12. Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

    PubMed

    Anoushiravani, Afshin A; Nunley, Ryan M

    2017-06-01

    As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

  13. The supply of physicians' services.

    PubMed

    Brown, D M; Lapan, H E

    1979-04-01

    This paper presents a model of the supply of physicians' services based upon the assumption that physicians are price-taking utility maximizers. Assuming physicians' services are produced using physicians' labor and purchased inputs, the paper shows that the impact of changes in final product or input prices on the supply of physicians' services depends on the physicians' labor-leisure choice and on the degree of substitutability between physicians' labor and purchased inputs. The empirical results presented indicate that the physicians' labor supply curve is backward-bending, but that the supply curve of physicians' services is positively sloped.

  14. Choosing and using diversity indices: insights for ecological applications from the German Biodiversity Exploratories

    PubMed Central

    Morris, E Kathryn; Caruso, Tancredi; Buscot, François; Fischer, Markus; Hancock, Christine; Maier, Tanja S; Meiners, Torsten; Müller, Caroline; Obermaier, Elisabeth; Prati, Daniel; Socher, Stephanie A; Sonnemann, Ilja; Wäschke, Nicole; Wubet, Tesfaye; Wurst, Susanne; Rillig, Matthias C

    2014-01-01

    considering analyses using multiple indices can provide greater insight into the interactions in a system. PMID:25478144

  15. Insights into operation of planar tri-gate tunnel field effect transistor for dynamic memory application

    NASA Astrophysics Data System (ADS)

    Navlakha, Nupur; Kranti, Abhinav

    2017-07-01

    Insights into device physics and operation through the control of energy barriers are presented for a planar tri-gate Tunnel Field Effect Transistor (TFET) based dynamic memory. The architecture consists of a double gate (G1) at the source side and a single gate (G2) at the drain end of the silicon film. Dual gates (G1) effectively enhance the tunneling based read mechanism through the enhanced coupling and improved electrostatic control over the channel. The single gate (G2) controls the holes in the potential barrier induced through the proper selection of bias and workfunction. The results indicate that the planar tri-gate achieves optimum performance evaluated in terms of two composite metrics (M1 and M2), namely, product of (i) Sense Margin (SM) and Retention Time (RT) i.e., M1 = SM × RT and (ii) Sense Margin and Current Ratio (CR) i.e., M2 = SM × CR. The regulation of barriers created by the gates (G1 and G2) through the optimal use of device parameters leads to better performance metrics, with significant improvement at scaled lengths as compared to other tunneling based dynamic memory architectures. The investigation shows that lengths of G1, G2 and lateral spacing can be scaled down to 25 nm, 50 nm, and 30 nm, respectively, while achieving reasonable values for (M1, M2). The work demonstrates a systematic approach to showcase the advancement in TFET based Dynamic Random Access Memory (DRAM) through the use of planar tri-gate topology at a lower bias value. The concept, design, and operation of planar tri-gate architecture provide valuable viewpoints for TFET based DRAM.

  16. State-Of in Uav Remote Sensing Survey - First Insights Into Applications of Uav Sensing Systems

    NASA Astrophysics Data System (ADS)

    Aasen, H.

    2017-08-01

    UAVs are increasingly adapted as remote sensing platforms. Together with specialized sensors, they become powerful sensing systems for environmental monitoring and surveying. Spectral data has great capabilities to the gather information about biophysical and biochemical properties. Still, capturing meaningful spectral data in a reproducible way is not trivial. Since a couple of years small and lightweight spectral sensors, which can be carried on small flexible platforms, have become available. With their adaption in the community, the responsibility to ensure the quality of the data is increasingly shifted from specialized companies and agencies to individual researchers or research teams. Due to the complexity of the data acquisition of spectral data, this poses a challenge for the community and standardized protocols, metadata and best practice procedures are needed to make data intercomparable. In November 2016, the ESSEM COST action Innovative optical Tools for proximal sensing of ecophysiological processes (OPTIMISE; http://optimise.dcs.aber.ac.uk/) held a workshop on best practices for UAV spectral sampling. The objective of this meeting was to trace the way from particle to pixel and identify influences on the data quality / reliability, to figure out how well we are currently doing with spectral sampling from UAVs and how we can improve. Additionally, a survey was designed to be distributed within the community to get an overview over the current practices and raise awareness for the topic. This talk will introduce the approach of the OPTIMISE community towards best practises in UAV spectral sampling and present first results of the survey (http://optimise.dcs.aber.ac.uk/uav-survey/). This contribution briefly introduces the survey and gives some insights into the first results given by the interviewees.

  17. The "Handling" of power in the physician-patient encounter: perceptions from experienced physicians.

    PubMed

    Nimmon, Laura; Stenfors-Hayes, Terese

    2016-04-18

    Modern healthcare is burgeoning with patient centered rhetoric where physicians "share power" equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians' awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care. Thirty physicians with a minimum five years' experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul's three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu's social theory served as analytic tools for achieving an understanding of physicians' perceptions of power in their interactions with patients. The analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians' responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant. Although the "sharing of power" is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.

  18. New insights into the application of geographical information systems and remote sensing in veterinary parasitology.

    PubMed

    Rinaldi, Laura; Musella, Vincenzo; Biggeri, Annibale; Cringoli, Giuseppe

    2006-11-01

    Over the past 10-15 years, significant advances have been made in the development and application of geographical information systems (GIS) and remote sensing (RS). In veterinary sciences, particularly in veterinary parasitology, GIS and RS offer powerful means for disease mapping, ecological analysis and epidemiological surveillance and have become indispensable tools for processing, analysing and visualising spatial data. They can also significantly assist with the assessment of the distribution of health-relevant environmental factors via interpolation and modelling. In this review, we first summarize general aspects of GIS and RS, and emphasize the most important applications of these tools in veterinary parasitology, including recent advances in territorial sampling. Disease mapping, spatial statistics, including Bayesian inference, ecological analyses and epidemiological surveillance are summarized in the next section and illustrated with a set of figures. Finally, a set of conclusions is put forward.

  19. Polymer-Based Nitric Oxide Therapies: Recent Insights for Biomedical Applications

    PubMed Central

    Jen, Michele C.; Serrano, María C.; van Lith, Robert

    2014-01-01

    Since the discovery of nitric oxide (NO) in the 1980s, this cellular messenger has been shown to participate in diverse biological processes such as cardiovascular homeostasis, immune response, wound healing, bone metabolism, and neurotransmission. Its beneficial effects have prompted increased research in the past two decades, with a focus on the development of materials that can locally release NO. However, significant limitations arise when applying these materials to biomedical applications. This Feature Article focuses on the development of NO-releasing and NO-generating polymeric materials (2006–2011) with emphasis on recent in vivo applications. Results are compared and discussed in terms of NO dose, release kinetics, and biological effects, in order to provide a foundation to design and evaluate new NO therapies. PMID:25067935

  20. Death-talks: transformative learning for physicians.

    PubMed

    Moon, Paul J

    2008-01-01

    Conversations between physicians and their patients concerning terminal conditions are undoubtedly an uneasy process. These conversations are referred in this article as death-talks. Death-talks are social engagements among meaning-making human beings, and such encounters comprise complex grief dynamics as well as opportunities for personal insight. Towards preparing for and improving upon such sensitive and crucial talks, physicians must become growingly informed of their own existential standpoints in order to exude a more authentic presence. Transformative Learning is a theory of adult learning offering a rationale for physicians to exercise critically reflexive learning towards formulating a more meaningful medical and human care for those who are dying and their grieving relations.

  1. Can complexity science inform physician leadership development?

    PubMed

    Grady, Colleen Marie

    2016-07-04

    applications for physician leadership development and emphasizes that it is incumbent upon physicians and organizations to focus attention on this to achieve improved patient and organizational outcomes. Originality/value This study pairing complexity science and physician leadership represents a unique way to view the development of physician leaders within the context of the complex system that is health care.

  2. Applications of Hobbyist Electronics in Monitoring Stemflow Processes: Preliminary Insights and Results

    NASA Astrophysics Data System (ADS)

    Carlyle-Moses, D. E.; Turner, B.; Hill, D. J.

    2016-12-01

    Leveraging the power and adaptability of inexpensive, accessible hobbyist electronics it has been possible to gain insights into the processes governing stemflow. The sensor platform utilizes an Arduino® microcontroller equipped with an ultrasonic sensor and wetness sensor as well as a GPS unit for accurate timestamps. The wetness sensor, which is attached to the terminus of a collection tube diverting water entering the stemflow collar to a collection vessel, provides the precise time in which stemflow commences. In turn, this time can be compared with the time stamp record of a high precision tipping-bucket rain gauge so that the rain depth required for stemflow generation can be derived. In addition, the ultrasonic sensor mounted above the stemflow collection vessel monitors changes in water depth over time. The changes in water depth are then converted to volumetric changes allowing for reasonable approximations of stemflow flow rates throughout the storm event. As a trial, the stemflow monitoring platform was deployed from May 1 to June 30, 2016 on an ornamental Green Ash (Fraxinus pennsylvanica Marsh.) tree on the grounds of Thompson Rivers University in Kamloops, British Columbia, Canada (500 40' 25" N, 1200 21' 50" W). The tree was in full-leaf condition, was 7.4 m in height and had a diameter at breast height of 10.8 cm. Rain totaled 77.2 mm during the study and was distributed over 15 events (mean = 5.1 mm, range = 0.2 - 14.3 mm), with the five smallest rain events (0.2 - 1.3 mm) not producing stemflow. The study period funneling ratio was 14.0 (event range = 0.0 - 40.0). Regression analysis revealed that for events in which stemflow was produced, rainfall depth explained only 50.2 percent of the variation in event stemflow volumes. The variant nature of stemflow in our study was a consequence of both highly variable mean event flow rates once stemflow had commenced (mean = 0.197 L / mm of rain, coefficient of variation = 0.67, range = 0.009 - 0.444 L

  3. Physician collective bargaining.

    PubMed

    Schiff, Anthony Hunter

    2009-11-01

    Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive

  4. Gut Microbiota and Nonalcoholic Fatty Liver Disease: Insights on Mechanism and Application of Metabolomics

    PubMed Central

    He, Xuyun; Ji, Guang; Jia, Wei; Li, Houkai

    2016-01-01

    Gut microbiota are intricately involved in the development of obesity-related metabolic diseases such as nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, and insulin resistance. In the current review, we discuss the role of gut microbiota in the development of NAFLD by focusing on the mechanisms of gut microbiota-mediated host energy metabolism, insulin resistance, regulation of bile acids and choline metabolism, as well as gut microbiota-targeted therapy. We also discuss the application of a metabolomic approach to characterize gut microbial metabotypes in NAFLD. PMID:26999104

  5. LEGAL DUTIES OF PHYSICIANS

    PubMed Central

    Sandor, Andrew A.

    1951-01-01

    The history of the physician's legal duties has been traced from the first recorded writings of the Babylonian era to the present day. There has been a transition from the days of absolute liability to the modern idea of liability based on culpability. The doctrine of stare decisis developed in early English law forms the very backbone of our own jurisprudence. Broadly, if a physician renders reasonable care and skill, he is absolved from liability. Some of the more important legal duties and proscriptions applying to physicians are discussed in particular in this presentation. PMID:14848696

  6. Remembering More Jewish Physicians

    PubMed Central

    Weisz, George M.; Grzybowski, Andrzej

    2016-01-01

    The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903–2000) and Bronislawa Fejgin (1883–1943). PMID:27487308

  7. Molecular classifications of gastric cancers: Novel insights and possible future applications

    PubMed Central

    Garattini, Silvio Ken; Basile, Debora; Cattaneo, Monica; Fanotto, Valentina; Ongaro, Elena; Bonotto, Marta; Negri, Francesca V; Berenato, Rosa; Ermacora, Paola; Cardellino, Giovanni Gerardo; Giovannoni, Mariella; Pella, Nicoletta; Scartozzi, Mario; Antonuzzo, Lorenzo; Silvestris, Nicola; Fasola, Gianpiero; Aprile, Giuseppe

    2017-01-01

    Despite some notable advances in the systemic management of gastric cancer (GC), the prognosis of patients with advanced disease remains overall poor and their chance of cure is anecdotic. In a molecularly selected population, a median overall survival of 13.8 mo has been reached with the use of human epidermal growth factor 2 (HER2) inhibitors in combination with chemotherapy, which has soon after become the standard of care for patients with HER2-overexpressing GC. Moreover, oncologists have recognized the clinical utility of conceiving cancers as a collection of different molecularly-driven entities rather than a single disease. Several molecular drivers have been identified as having crucial roles in other tumors and new molecular classifications have been recently proposed for gastric cancer as well. Not only these classifications allow the identification of different tumor subtypes with unique features, but also they serve as springboard for the development of different therapeutic strategies. Hopefully, the application of standard systemic chemotherapy, specific targeted agents, immunotherapy or even surgery in specific cancer subgroups will help maximizing treatment outcomes and will avoid treating patients with minimal chance to respond, therefore diluting the average benefit. In this review, we aim at elucidating the aspects of GC molecular subtypes, and the possible future applications of such molecular analyses. PMID:28567184

  8. Oncolytic Adenovirus: Strategies and Insights for Vector Design and Immuno-Oncolytic Applications

    PubMed Central

    Uusi-Kerttula, Hanni; Hulin-Curtis, Sarah; Davies, James; Parker, Alan L.

    2015-01-01

    Adenoviruses (Ad) are commonly used both experimentally and clinically, including oncolytic virotherapy applications. In the clinical area, efficacy is frequently hampered by the high rates of neutralizing immunity, estimated as high as 90% in some populations that promote vector clearance and limit bioavailability for tumor targeting following systemic delivery. Active tumor targeting is also hampered by the ubiquitous nature of the Ad5 receptor, hCAR, as well as the lack of highly tumor-selective targeting ligands and suitable targeting strategies. Furthermore, significant off-target interactions between the viral vector and cellular and proteinaceous components of the bloodstream have been documented that promote uptake into non-target cells and determine dose-limiting toxicities. Novel strategies are therefore needed to overcome the obstacles that prevent efficacious Ad deployment for wider clinical applications. The use of less seroprevalent Ad serotypes, non-human serotypes, capsid pseudotyping, chemical shielding and genetic masking by heterologous peptide incorporation are all potential strategies to achieve efficient vector escape from humoral immune recognition. Conversely, selective vector arming with immunostimulatory agents can be utilized to enhance their oncolytic potential by activation of cancer-specific immune responses against the malignant tissues. This review presents recent advantages and pitfalls occurring in the field of adenoviral oncolytic therapies. PMID:26610547

  9. Recent progress and challenges in nanotechnology for biomedical applications: an insight into the analysis of neurotransmitters.

    PubMed

    Shankaran, Dhesingh Ravi; Miura, Norio

    2007-01-01

    Nanotechnology offers exciting opportunities and unprecedented compatibilities in manipulating chemical and biological materials at the atomic or molecular scale for the development of novel functional materials with enhanced capabilities. It plays a central role in the recent technological advances in biomedical technology, especially in the areas of disease diagnosis, drug design and drug delivery. In this review, we present the recent trend and challenges in the development of nanomaterials for biomedical applications with a special emphasis on the analysis of neurotransmitters. Neurotransmitters are the chemical messengers which transform information and signals all over the body. They play prime role in functioning of the central nervous system (CNS) and governs most of the metabolic functions including movement, pleasure, pain, mood, emotion, thinking, digestion, sleep, addiction, fear, anxiety and depression. Thus, development of high-performance and user-friendly analytical methods for ultra-sensitive detection of neurotransmitters remain a major challenge in modern biomedical analysis. Nanostructured materials are emerging as a powerful mean for diagnosis of CNS disorders because of their unique optical, size and surface characteristics. This review provides a brief outline on the basic concepts and recent advancements of nanotechnology for biomedical applications, especially in the analysis of neurotransmitters. A brief introduction to the nanomaterials, bionanotechnology and neurotransmitters is also included along with discussions on most of the patents published in these areas.

  10. Analysis of the integration of the physician rostering problem and the surgery scheduling problem.

    PubMed

    Van Huele, Christophe; Vanhoucke, Mario

    2014-06-01

    In this paper, we present the Integrated Physician and Surgery Scheduling Problem (IPSSP) as a new approach for solving operating room scheduling problems where staff rosters for the physicians are integrated in the optimization. A mixed integer linear programming formulation is created based on the most frequently observed objective and restrictions of the surgery scheduling and the physician rostering problem in the literature. We analyze schedules by relaxing both surgery and physician related constraints. We then measure the implications of setting these physician preferences on the surgery schedule. Our experiments show two main interesting insights for physician roster schedulers as well as operating theatre scheduling managers.

  11. ISMRM Workshop on Fat–Water Separation: Insights, Applications and Progress in MRI

    PubMed Central

    Hu, Houchun Harry; Börnert, Peter; Hernando, Diego; Kellman, Peter; Ma, Jingfei; Reeder, Scott; Sirlin, Claude

    2013-01-01

    Approximately 130 attendees convened on February 19–22, 2012 for the first ISMRM-sponsored workshop on water–fat imaging. The motivation to host this meeting was driven by the increasing number of research publications on this topic over the past decade. The scientific program included an historical perspective and a discussion of the clinical relevance of water–fat MRI, a technical description of multiecho pulse sequences, a review of data acquisition and reconstruction algorithms, a summary of the confounding factors that influence quantitative fat measurements and the importance of MRI-based biomarkers, a description of applications in the heart, liver, pancreas, abdomen, spine, pelvis, and muscles, an overview of the implications of fat in diabetes and obesity, a discussion on MR spectroscopy, a review of childhood obesity, the efficacy of lifestyle interventional studies, and the role of brown adipose tissue, and an outlook on federal funding opportunities from the National Institutes of Health. PMID:22693111

  12. A structural classification of carbohydrate epimerases: From mechanistic insights to practical applications.

    PubMed

    Van Overtveldt, Stevie; Verhaeghe, Tom; Joosten, Henk-Jan; van den Bergh, Tom; Beerens, Koen; Desmet, Tom

    2015-12-01

    In recent years, carbohydrate epimerases have attracted a lot of attention as efficient biocatalysts that can convert abundant sugars (e.g.d-fructose) directly into rare counterparts (e.g.d-psicose). Despite increased research activities, no review about these enzymes has been published in more than a decade, meaning that their full potential is hard to appreciate. Here, we present an overview of all known carbohydrate epimerases based on a classification in structural families, which links every substrate specificity to a well-defined reaction mechanism. The mechanism can even be predicted for enzymes that have not yet been characterized or that lack structural information. In this review, the different families are discussed in detail, both structurally and mechanistically, with special reference to recent examples in the literature. Furthermore, the value of understanding the reaction mechanism will be illustrated by making the link to possible application and engineering targets.

  13. An assessment of silver copper sulfides for photovoltaic applications: theoretical and experimental insights.

    PubMed

    Savory, Christopher N; Ganose, Alex M; Travis, Will; Atri, Ria S; Palgrave, Robert G; Scanlon, David O

    2016-08-28

    As the worldwide demand for energy increases, low-cost solar cells are being looked to as a solution for the future. To attain this, non-toxic earth-abundant materials are crucial, however cell efficiencies for current materials are limited in many cases. In this article, we examine the two silver copper sulfides AgCuS and Ag3CuS2 as possible solar absorbers using hybrid density functional theory, diffuse reflectance spectroscopy, XPS and Hall effect measurements. We show that both compounds demonstrate promising electronic structures and band gaps for high theoretical efficiency solar cells, based on Shockley-Queisser limits. Detailed analysis of their optical properties, however, indicates that only AgCuS should be of interest for PV applications, with a high theoretical efficiency. From this, we also calculate the band alignment of AgCuS against various buffer layers to aid in future device construction.

  14. Self-nanoemulsifying drug delivery systems: formulation insights, applications and advances.

    PubMed

    Date, Abhijit A; Desai, Neha; Dixit, Rahul; Nagarsenker, Mangal

    2010-12-01

    There has been a resurgence of interest in nanoemulsions for various pharmaceutical applications since low-energy emulsification methods, such as spontaneous or self-nanoemulsification, have been described. Self-nanoemulsifying drug delivery systems (SNEDDS) are anhydrous homogenous liquid mixtures consisting of oil, surfactant, drug and coemulsifier or solubilizer, which spontaneously form oil-in-water nanoemulsion of approximately 200 nm or less in size upon dilution with water under gentle stirring. The physicochemical properties, drug solubilization capacity and physiological fate considerably govern the selection of the SNEDDS components. The composition of the SNEDDS can be optimized with the help of phase diagrams, whereas statistical experimental design can be used to further optimize SNEDDS. SNEDDS can improve oral bioavailability of hydrophobic drugs by several mechanisms. The conversion of liquid SNEDDS to solid oral dosage forms or solid SNEDDS has also been achieved by researchers. Solid SNEDDS can offer better patient compliance and minimize problems associated with capsules filled with liquid SNEDDS.

  15. Medical staff contracting: legal issues in physician-hospital arrangements.

    PubMed

    Caesar, N B

    1993-01-01

    This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship.

  16. Physician Assistant profession (PA)

    MedlinePlus

    ... medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may practice in any setting in which a physician provides care. This allows doctors to focus their skills and knowledge in a more effective way. PAs ...

  17. [Physician--where to?].

    PubMed

    Luban-Plozza, B

    1993-06-08

    These questions are addressed: What does it mean to be a physician, and how can a physician continue his education? Where is his place in family crises? The psychosomatic point of view of diseases is not a specialty, but a concept, a basic attitude, a global principle encompassing all medical specialties. In particular, disorders of relations and basic needs are discussed in the context of a novel therapeutic access. The doctor as a 'drug' corresponds to a therapeutic alliance, also in group work. The problems of communication, even as a flash, influence the language of the patient and the physician. In the tension between anxiety and trust, psychosomatic thinking and medical intervention come to life also for the experience of disease and in the search for a meaning. The physician is not as much an achiever than a provider.

  18. Hitler's Jewish Physicians.

    PubMed

    Weisz, George M

    2014-07-01

    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.

  19. Promote potential applications of nanoparticles as respiratory drug carrier: insights from molecular dynamics simulations

    NASA Astrophysics Data System (ADS)

    Lin, Xubo; Bai, Tingting; Zuo, Yi Y.; Gu, Ning

    2014-02-01

    Nanoparticles (NPs) show great promises in biomedical applications as the respiratory drug carrier system. Once reaching the alveolar region, NPs first interact with the pulmonary surfactant (PS) film, which serves as the first biological barrier and plays an important role in maintaining the normal respiratory mechanics. Therefore, understanding the interactions between NPs and PS can help promote the NP-based respiratory drug carrier systems. Using coarse-grained molecular dynamics simulations, we studied the effect of rigid spherical NPs with different hydrophobicity and sizes on a dipalmitoylphosphatidylcholine (DPPC) monolayer at the air-water interface. Four different NPs were considered, including hydrophilic and hydrophobic NPs, each with two diameters of 3 nm and 5 nm (the sizes are comparable to that of generation 3 and 5 PAMAM dendrimers, which have been widely used for nanoscale drug carrier systems). Our simulations showed that hydrophilic NPs can readily penetrate into the aqueous phase with little or no disturbance on the DPPC monolayer. However, hydrophobic NPs tend to induce large structural disruptions, thus inhibiting the normal phase transition of the DPPC monolayer upon film compression. Our simulations also showed that this inhibitory effect of hydrophobic NPs can be mitigated through PEGylation. Our results provide useful guidelines for molecular design of NPs as carrier systems for pulmonary drug delivery.Nanoparticles (NPs) show great promises in biomedical applications as the respiratory drug carrier system. Once reaching the alveolar region, NPs first interact with the pulmonary surfactant (PS) film, which serves as the first biological barrier and plays an important role in maintaining the normal respiratory mechanics. Therefore, understanding the interactions between NPs and PS can help promote the NP-based respiratory drug carrier systems. Using coarse-grained molecular dynamics simulations, we studied the effect of rigid spherical NPs

  20. Stem/progenitor cells and obstructive sleep apnea syndrome - new insights for clinical applications

    PubMed Central

    Micheu, Miruna Mihaela; Rosca, Ana-Maria; Deleanu, Oana-Claudia

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is a widespread disorder, characterized by recurrent upper airway obstruction during sleep, mostly as a result of complete or partial pharyngeal obstruction. Due to the occurrence of frequent and regular hypoxic events, patients with OSAS are at increased risk of cardiovascular disease, stroke, metabolic disorders, occupational errors, motor vehicle accidents and even death. Thus, OSAS has severe consequences and represents a significant economic burden. However, some of the consequences, as well as their costs can be reduced with appropriate detection and treatment. In this context, the recent advances that were made in stem cell biology knowledge and stem cell - based technologies hold a great promise for various medical conditions, including respiratory diseases. However, the investigation of the role of stem cells in OSAS is still recent and rather limited, requiring further studies, both in animal models and humans. The goal of this review is to summarize the current state of knowledge regarding both lung resident as well as circulating stem/progenitor cells and discuss existing controversies in the field in order to identify future research directions for clinical applications in OSAS. Also, the paper highlights the requisite for inter-institutional, multi-disciplinary research collaborations in order to achieve breakthrough results in the field. PMID:27822340

  1. Stem/progenitor cells and obstructive sleep apnea syndrome - new insights for clinical applications.

    PubMed

    Micheu, Miruna Mihaela; Rosca, Ana-Maria; Deleanu, Oana-Claudia

    2016-10-26

    Obstructive sleep apnea syndrome (OSAS) is a widespread disorder, characterized by recurrent upper airway obstruction during sleep, mostly as a result of complete or partial pharyngeal obstruction. Due to the occurrence of frequent and regular hypoxic events, patients with OSAS are at increased risk of cardiovascular disease, stroke, metabolic disorders, occupational errors, motor vehicle accidents and even death. Thus, OSAS has severe consequences and represents a significant economic burden. However, some of the consequences, as well as their costs can be reduced with appropriate detection and treatment. In this context, the recent advances that were made in stem cell biology knowledge and stem cell - based technologies hold a great promise for various medical conditions, including respiratory diseases. However, the investigation of the role of stem cells in OSAS is still recent and rather limited, requiring further studies, both in animal models and humans. The goal of this review is to summarize the current state of knowledge regarding both lung resident as well as circulating stem/progenitor cells and discuss existing controversies in the field in order to identify future research directions for clinical applications in OSAS. Also, the paper highlights the requisite for inter-institutional, multi-disciplinary research collaborations in order to achieve breakthrough results in the field.

  2. Insights into the scalability of magnetostrictive ultrasound technology for water treatment applications.

    PubMed

    Al-Juboori, Raed A; Bowtell, Leslie A; Yusaf, Talal; Aravinthan, Vasantha

    2016-01-01

    To date, the successful application of large scale ultrasound in water treatment has been a challenge. Magnetostrictive ultrasound technologies for constructing a large-scale water treatment system are proposed in this study. Comprehensive energy evaluation of the proposed system was conducted. The effects of chosen waveform, scalability and reactor design on the performance of the system were explored using chemical dosimetry. Of the fundamental waveforms tested; sine, triangle and square, the highest chemical yield resulted from the square wave source. Scaling up from the 0.5L bench-scale system to the 15 L large-scale unit resulted in a gain of approximately 50% in sonochemical efficiency (SE) for the system. The use of a reactor tank with 45° inclined sides further increased SE of the system by 70%. The ability of the large scale system in removing contaminants from natural water samples was also investigated. The results revealed that the large-scale unit was capable of achieving a maximum removal of microbes and dissolved organic carbon (DOC) of 35% and 5.7% respectively at a power density approximately 3.9 W/L. The results of this study suggest that magnetostrictive ultrasound technology excited with square wave has the potential to be competitive in the water treatment industry. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Anchoring groups for dyes in p-DSSC application: insights from DFT.

    PubMed

    Wykes, Michael; Odobel, Fabrice; Adamo, Carlo; Ciofini, Ilaria; Labat, Frédéric

    2016-12-01

    We present hybrid, periodic, spin-polarized density functional theory calculations of antiferromagnetic NiO bulk, of its clean (100) surface and of the binding on this latter of four different organic ligands, relevant for p-type dye-sensitized solar cells (p-DSSC) applications. We find evidence for a strong chemisorption of all ligands to the NiO surface in the form of short interatomic distances between surface Ni atoms and ligand atoms, confirmed by high binding energies. Although the analysis of the impact of the ligand adsorption on the density of states of the NiO substrate reveals significant modifications, the overall picture obtained is in line with the operation principles of p-DSSC in all cases. However, some of the considered ligands significantly shift the density of states to lower energies, which, in p-DSSCs employing these ligands to anchor dyes to NiO, could force the use of dyes with deeper HOMO energies and alternative redox couples capable of accepting electrons from the dye (assuming dye bandgaps in the UV/visible range).

  4. Promote potential applications of nanoparticles as respiratory drug carrier: insights from molecular dynamics simulations.

    PubMed

    Lin, Xubo; Bai, Tingting; Zuo, Yi Y; Gu, Ning

    2014-03-07

    Nanoparticles (NPs) show great promises in biomedical applications as the respiratory drug carrier system. Once reaching the alveolar region, NPs first interact with the pulmonary surfactant (PS) film, which serves as the first biological barrier and plays an important role in maintaining the normal respiratory mechanics. Therefore, understanding the interactions between NPs and PS can help promote the NP-based respiratory drug carrier systems. Using coarse-grained molecular dynamics simulations, we studied the effect of rigid spherical NPs with different hydrophobicity and sizes on a dipalmitoylphosphatidylcholine (DPPC) monolayer at the air-water interface. Four different NPs were considered, including hydrophilic and hydrophobic NPs, each with two diameters of 3 nm and 5 nm (the sizes are comparable to that of generation 3 and 5 PAMAM dendrimers, which have been widely used for nanoscale drug carrier systems). Our simulations showed that hydrophilic NPs can readily penetrate into the aqueous phase with little or no disturbance on the DPPC monolayer. However, hydrophobic NPs tend to induce large structural disruptions, thus inhibiting the normal phase transition of the DPPC monolayer upon film compression. Our simulations also showed that this inhibitory effect of hydrophobic NPs can be mitigated through PEGylation. Our results provide useful guidelines for molecular design of NPs as carrier systems for pulmonary drug delivery.

  5. Kinetics, simulation and insights for CO selective oxidation in fuel cell applications

    NASA Astrophysics Data System (ADS)

    Choi, Yongtaek; Stenger, Harvey G.

    The kinetics of CO preferential oxidation (PROX) was studied to evaluate various rate expressions and to simulate the performance the CO oxidation step of a methanol fuel processor for fuel cell applications. The reaction was carried out in a micro reactor testing unit using a commercial Engelhard Selectoxo (Pt-Fe/γ-alumina) catalyst and three self-prepared catalysts. Temperature was varied between 100 and 300 °C, and a of range feed rates and compositions were tested. A reaction model in which three reactions (CO oxidation, H 2 oxidation and the water gas shift reaction) occur simultaneously was chosen to predict the reactor performance. Using non-linear least squares, empirical power-law type rate expressions were found to fit the experimental data. It was critical to include all three reactions to determine good fitting results. In particular, the reverse water gas shift reaction had an important role when fitting the experimental data precisely and explained the selectivity decrease at higher reaction temperatures. Using this three reaction model, several simulation studies for a commercial PROX reactor were performed. In these simulations, the effect of O 2/CO ratio, the effect of water addition, and various non-isothermal modes of operation were evaluated. The results of the simulation were compared with corresponding experimental data and shows good agreement.

  6. [The "dialogic principle" as the force of the physician-patient relationship].

    PubMed

    Ritschl, D

    1992-01-01

    The discussion is opened with an analysis of the inherent problems of the concept of quality of life. Why must it be pressed into the straight jacket of a quantitative scheme? The second theme, the thesis that verbal contact and interviews in the doctor's office are an application of the philosophical programme of personalism and "dialogism", is also critically analyzed. Why must the physician (and the psychotherapist) aim so high? Is not the lack of symmetry between the physician and the patient typical of the verbal contact between the two? These factors are discussed, not-withstanding the valid insight that intense personal concern and contact are highly desirable in patient-oriented medicine.

  7. Pathogenic Mechanisms Underlying Iron Deficiency and Iron Overload: New Insights for Clinical Application

    PubMed Central

    van Velden, DP; van Rensburg, SJ; Erasmus, R

    2009-01-01

    Iron uptake, utilisation, release and storage occur at the gene level. Individuals with variant forms of genes involved in iron metabolism may have different requirements for iron and are likely to respond differently to the same amount of iron in the diet, a concept termed nutrigenetics. Iron deficiency, iron overload and the anemia of inflammation are the commonest iron-related disorders. While at least four types of hereditary iron overload have been identified to date, our knowledge of the genetic basis and consequences of inherited iron deficiency remain limited. The importance of genetic risk factors in relation to iron overload was highlighted with the identification of the HFE gene in 1996. Deleterious mutations in this gene account for 80-90% of inherited iron overload and are associated with loss of iron homeostasis, alterations in inflammatory responses, oxidative stress and in its most severe form, the disorder hereditary haemochromatosis (HH). Elucidation of the genetic basis of HH has led to rapid clinical benefit through drastic reduction in liver biopsies performed as part of the diagnostic work-up of affected patients. Today, detection of a genetic predisposition in the presence of high serum ferritin and transferrin saturation levels is usually sufficient to diagnose HH, thereby addressing the potential danger of inherited iron overload which starts with the same symptoms as iron deficiency, namely chronic fatigue. This review provides the scientific back-up for application of pathology supported genetic testing, a new test concept that is well placed for optimizing clinical benefit to patients with regard to iron status. PMID:27683335

  8. Theory of Current Transients in Planar Semiconductor Devices: Insights and Applications to Organic Solar Cells

    NASA Astrophysics Data System (ADS)

    Hawks, Steven A.; Finck, Benjamin Y.; Schwartz, Benjamin J.

    2015-04-01

    Time-domain current measurements are widely used to characterize semiconductor material properties, such as carrier mobility, doping concentration, carrier lifetime, and the static dielectric constant. It is therefore critical that these measurements be theoretically understood if they are to be successfully applied to assess the properties of materials and devices. In this paper, we derive generalized relations for describing current-density transients in planar semiconductor devices at uniform temperature. By spatially averaging the charge densities inside the semiconductor, we are able to provide a rigorous, straightforward, and experimentally relevant way to interpret these measurements. The formalism details several subtle aspects of current transients, including how the electrode charge relates to applied bias and internal space charge, how the displacement current can alter the apparent free-carrier current, and how to understand the integral of a charge-extraction transient. We also demonstrate how the formalism can be employed to derive the current transients arising from simple physical models, like those used to describe charge extraction by linearly increasing voltage (CELIV) and time-of-flight experiments. In doing so, we find that there is a nonintuitive factor-of-2 reduction in the apparent free-carrier concentration that can be easily missed, for example, in the application of charge-extraction models. Finally, to validate our theory and better understand the different current contributions, we perform a full time-domain drift-diffusion simulation of a CELIV trace and compare the results to our formalism. As expected, our analytic equations match precisely with the numerical solutions to the drift-diffusion, Poisson, and continuity equations. Thus, overall, our formalism provides a straightforward and general way to think about how the internal space-charge distribution, the electrode charge, and the externally applied bias translate into a measured

  9. Predicting success or failure of immunotherapy for cancer: insights from a clinically applicable mathematical model.

    PubMed

    Babbs, Charles F

    2012-01-01

    The objective of this study was to create a clinically applicable mathematical model of immunotherapy for cancer and use it to explore differences between successful and unsuccessful treatment scenarios. The simplified predator-prey model includes four lumped parameters: tumor growth rate, g; immune cell killing efficiency, k; immune cell signaling factor, λ; and immune cell half-life decay, μ. The predator-prey equations as functions of time, t, for normalized tumor cell numbers, y, (the prey) and immunocyte numbers, ×, (the predators) are: dy/dt = gy - kx and dx/dt = λxy - μx. A parameter estimation procedure that capitalizes on available clinical data and the timing of clinically observable phenomena gives mid-range benchmarks for parameters representing the unstable equilibrium case in which the tumor neither grows nor shrinks. Departure from this equilibrium results in oscillations in tumor cell numbers and in many cases complete elimination of the tumor. Several paradoxical phenomena are predicted, including increasing tumor cell numbers prior to a population crash, apparent cure with late recurrence, one or more cycles of tumor growth prior to eventual tumor elimination, and improved tumor killing with initially weaker immune parameters or smaller initial populations of immune cells. The model and the parameter estimation techniques are easily adapted to various human cancers that evoke an immune response. They may help clinicians understand and predict certain strange and unexpected effects in the world of tumor immunity and lead to the design of clinical trials to test improved treatment protocols for patients.

  10. PET Neuroimaging: Insights on Dystonia and Tourette Syndrome and Potential Applications

    PubMed Central

    Alongi, Pierpaolo; Iaccarino, Leonardo; Perani, Daniela

    2014-01-01

    Primary dystonia (pD) is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric developmental disorder characterized by motor and phonic tics, which could progress to behavioral changes. GTS and obsessive–compulsive disorders are often seen in comorbidity, also suggesting that a possible overlap in the pathophysiological bases of these two conditions. PET techniques are of considerable value in detecting functional and molecular abnormalities in vivo, according to the adopted radioligands. For example, PET is the unique technique that allows in vivo investigation of neurotransmitter systems, providing evidence of changes in GTS or pD. For example, presynaptic and post-synaptic dopaminergic studies with PET have shown alterations compatible with dysfunction or loss of D2-receptors bearing neurons, increased synaptic dopamine levels, or both. Measures of cerebral glucose metabolism with 18F-fluorodeoxyglucose PET (18F-FDG PET) are very sensitive in showing brain functional alterations as well. 18F-FDG PET data have shown metabolic changes within the cortico-striato-pallido-thalamo-cortical and cerebello-thalamo-cortical networks, revealing possible involvement of brain circuits not limited to basal ganglia in pD and GTS. The aim of this work is to overview PET consistent neuroimaging literature on pD and GTS that has provided functional and molecular knowledge of the underlying neural dysfunction. Furthermore, we suggest potential applications of these techniques in monitoring treatments. PMID:25295029

  11. Pathogenic Mechanisms Underlying Iron Deficiency and Iron Overload: New Insights for Clinical Application.

    PubMed

    Kotze, M J; van Velden, D P; van Rensburg, S J; Erasmus, R

    2009-08-01

    Iron uptake, utilisation, release and storage occur at the gene level. Individuals with variant forms of genes involved in iron metabolism may have different requirements for iron and are likely to respond differently to the same amount of iron in the diet, a concept termed nutrigenetics. Iron deficiency, iron overload and the anemia of inflammation are the commonest iron-related disorders. While at least four types of hereditary iron overload have been identified to date, our knowledge of the genetic basis and consequences of inherited iron deficiency remain limited. The importance of genetic risk factors in relation to iron overload was highlighted with the identification of the HFE gene in 1996. Deleterious mutations in this gene account for 80-90% of inherited iron overload and are associated with loss of iron homeostasis, alterations in inflammatory responses, oxidative stress and in its most severe form, the disorder hereditary haemochromatosis (HH). Elucidation of the genetic basis of HH has led to rapid clinical benefit through drastic reduction in liver biopsies performed as part of the diagnostic work-up of affected patients. Today, detection of a genetic predisposition in the presence of high serum ferritin and transferrin saturation levels is usually sufficient to diagnose HH, thereby addressing the potential danger of inherited iron overload which starts with the same symptoms as iron deficiency, namely chronic fatigue. This review provides the scientific back-up for application of pathology supported genetic testing, a new test concept that is well placed for optimizing clinical benefit to patients with regard to iron status.

  12. Measurement of Physicians' Performance Using Existing Techniques

    PubMed Central

    Sanazaro, Paul J.

    1980-01-01

    Existing techniques permit objective and valid measurement of limited elements of physicians' performance. These limited aspects, however, are of considerable importance to patients. The basic components of performance in medicine and surgery can be defined and used as the basis of organized programs for such evaluation. Interhospital comparisons can provide an effective impetus for assessing and improving performance of individual staff members when this is indicated. Professional auspices are needed for the development and application of methods that can provide continuing assurance that the clinical activity of physicians corresponds to contemporary standards. A system of incentives should be provided to physicians to promote their participation in voluntary programs of self-assessment. The incentives should be in the form of performance assessment credits, comparable in definition to continuing medical education credits, but granted for participation in an accredited program that objectively measures physicians' performance against national standards of the respective specialty. PMID:7222656

  13. Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia

    PubMed Central

    Awad, Susanne F.; Sgaier, Sema K.; Tambatamba, Bushimbwa C.; Mohamoud, Yousra A.; Lau, Fiona K.; Reed, Jason B.; Njeuhmeli, Emmanuel; Abu-Raddad, Laith J.

    2015-01-01

    Background Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia. Methods and Findings A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15–49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20–24 age-group) to 36 (45–49 age-group); cost-effectiveness ranged from $888 (20–24 age-group) to $3,300 (45–49 age-group). Circumcising 10–14, 15–19, or 20–24 year old achieved the largest incidence rate reduction; prioritizing 15–24, 15–29, or 15–34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9–12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs. Conclusion Epidemic impact and efficiency of VMMC programs can be

  14. Multicomponent Solvated Triblock Copolymer Network Systems: Fundamental Insights and Emerging Applications

    NASA Astrophysics Data System (ADS)

    Krishnan, Arjun Sitaraman

    Block copolymers have received significant research attention in recent times due to their ability to spontaneously self-assemble into a variety of nanostructures. Thermoplastic elastomers composed of styrenic triblock copolymers are of great importance in applications such as adhesives and vibration dampening due to their shape memory, resilience and facile processing. The swelling of these polymers by adding midblock selective solvents or oligomers provides an easy route by which to modify the morphology and mechanical behavior of these systems. We first consider a ternary blend of a poly[styrene- b-(ethylene-co-butylene)-b-styrene] triblock copolymer (SEBS) and mixtures of two midblock selective co-solvents, with significantly different physical states. We use dynamic rheology to study the viscoelastic response of a wide variety of systems under oscillatory shear. Frequency spectra acquired at ambient temperature display viscoelastic behavior that shifts in the frequency domain depending on the co-solvent composition. For each copolymer concentration, all the frequency data can be shifted by time-composition superpositioning (tCS) to yield a single master-curve. tCS fails at low frequencies due to presence of endblock pullout, which is a fundamentally different relaxation process from segmental relaxation of the midblock. As an emerging technology, we examine SEBS-oil gels as dielectric elastomers. Dielectric elastomers constitute one class of electroactive polymers (EAPs), polymeric materials that respond to an electric stimulus by changing their macroscopic dimensions, thereby converting electrical energy into mechanical work. We use standard configuration of EAP devices involving stretching, or "prestraining," the elastomer film biaxially. The effect of experimental parameters such as film thickness and amount of prestrain on the (electro)mechanical properties of the material become apparent by recasting as-obtained electroactuation data into compressive

  15. Primary care physicians in underserved areas. Family physicians dominate.

    PubMed Central

    Burnett, W H; Mark, D H; Midtling, J E; Zellner, B B

    1995-01-01

    Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas. PMID:8553635

  16. Physician, heal thyself

    PubMed Central

    Blais, Régis; Safianyk, Catherine; Magnan, Anne; Lapierre, André

    2010-01-01

    ABSTRACT OBJECTIVE To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received. DESIGN Mailed questionnaire. SETTING Quebec. PARTICIPANTS A total of 126 physicians who used QPHP services between 1999 and 2004. MAIN OUTCOME MEASURES Users’ overall rating of the QPHP services, their opinions about the program, and whether their situations improved as a result of accessing QPHP services. RESULTS Ninety-two of the 126 physicians surveyed returned their completed questionnaires, providing a response rate of 73%. Most respondents thought that the QPHP services were good or excellent (90%), most would use the program again (86%) or recommend it (96%), and most thought the Quebec physician associations and the Collège des médecins du Québec should continue funding the QPHP (97%). Most respondents thought the service confidentiality was excellent (84%), as was staff professionalism (82%), and 62% thought the quality of the services they were referred to was excellent. However, only 57% believed their situations had improved with the help of the QPHP. CONCLUSION The QPHP received good marks from its users. Given the effects of physician burnout on patients and on the health care system, it is not only a personal problem, but also a collective problem. Thus, actions are needed not only to set up programs like the QPHP for those suffering from burnout, but also to prevent these types of problems. Because family physicians are likely to be the first ones consulted by their physician patients in distress, they play a key role in acknowledging these problems and referring those colleagues to the appropriate help programs when needed. PMID:20944027

  17. Role modeling in physicians' professional formation: reconsidering an essential but untapped educational strategy.

    PubMed

    Kenny, Nuala P; Mann, Karen V; MacLeod, Heather

    2003-12-01

    Forming technically proficient, professional, and humanistic physicians for the 21st century is no easy task. Mountains of biomedical knowledge must be acquired, diagnostic competence achieved, effective communication skills developed, and a solid and applicable understanding of the practice and role of physicians in society today must be reached. The central experience for learners in this complex and challenging terrain is the "modeling of" and "learning how to be" a caregiver and health professional. Role modeling remains one crucial area where standards are elusive and where repeated negative learning experiences may adversely impact the development of professionalism in medical students and residents. The literature is mainly descriptive, defining the attributes of good role models from both learners and practitioners' perspectives. Because physicians are not "playing a role" as an actor might, but "embodying" different types of roles, the cognitive and behavioral processes associated with successfully internalizing roles (e.g., the good doctor/medical educator) are important. In this article, the authors identify foundational questions regarding role models and professional character formation; describe major social and historical reasons for inattention to character formation in new physicians; draw insights about this important area from ethics and education theory (philosophical inquiry, apprenticeship, situated learning, observational learning, reflective practice); and suggest the practical consequences of this work for faculty recruitment, affirmation, and development.

  18. Risk perception & strategic decision making :general insights, a framework, and specific application to electricity generation using nuclear energy.

    SciTech Connect

    Brewer, Jeffrey D.

    2005-11-01

    The objective of this report is to promote increased understanding of decision making processes and hopefully to enable improved decision making regarding high-consequence, highly sophisticated technological systems. This report brings together insights regarding risk perception and decision making across domains ranging from nuclear power technology safety, cognitive psychology, economics, science education, public policy, and neural science (to name a few). It forms them into a unique, coherent, concise framework, and list of strategies to aid in decision making. It is suggested that all decision makers, whether ordinary citizens, academics, or political leaders, ought to cultivate their abilities to separate the wheat from the chaff in these types of decision making instances. The wheat includes proper data sources and helpful human decision making heuristics; these should be sought. The chaff includes ''unhelpful biases'' that hinder proper interpretation of available data and lead people unwittingly toward inappropriate decision making ''strategies''; obviously, these should be avoided. It is further proposed that successfully accomplishing the wheat vs. chaff separation is very difficult, yet tenable. This report hopes to expose and facilitate navigation away from decision-making traps which often ensnare the unwary. Furthermore, it is emphasized that one's personal decision making biases can be examined, and tools can be provided allowing better means to generate, evaluate, and select among decision options. Many examples in this report are tailored to the energy domain (esp. nuclear power for electricity generation). The decision making framework and approach presented here are applicable to any high-consequence, highly sophisticated technological system.

  19. Insights into the Rational Design of Multi-Functional Fullerene Systems for Application in Blended Heterojunction Organic Solar Cells

    NASA Astrophysics Data System (ADS)

    Cowart, John S., Jr.

    Elucidating the structure-function relationships of organic semiconductors has been central to the advancement of organic photovoltaics (OPVs). In particular, enhancing the performance of p-type materials in disordered heterojunctions is broadly acknowledged as the principal factor leading to current trends of improved power conversion efficiencies (PCEs). However, two additional factors are crucially important for the next step forward in improving PCEs. First, investigating the influence, design and synthesis of new n-type materials, specifically fullerene acceptors, is of high importance. Second, because fullerene performance is often compromised by the morphological disorder of bulk heterojunctions, developing fullerenes systems that retain fidelity within disordered blends is also of broad interest. In light of these challenges, the field has witnessed a notable shift towards developing a comprehensive understanding of the design rules needed to advance the performance of fullerene acceptors in bulk heterojunctions. This work spotlights two multi-functional fullerene systems designed for blended heterojunctions. First, the synthesis of several novel fullerene-dye adducts with enhanced photon absorption will be presented. The ability of these adducts to absorb visible light in their pure state was evaluated and systematically examined versus their capacity to complement the absorption of low band gap donors and mediate charge transport in bulk heterojunctions. Second, mixed fullerene ternary blends were introduced as a strategy to stabilize the morphology in bulk heterojunctions and prolong operational lifetimes of OPV devices. Combined, these two systems offer unique insight into the rational design of fullerenes for their application in blended systems.

  20. Cognitive evaluation of a physician data query tool for a national ICU registry: comparing two think aloud variants and their application in redesign.

    PubMed

    Peute, Linda W; de Keizer, Nicolette F; Jaspers, Monique W M

    2010-01-01

    Applying usability methods in formative evaluations of interactive healthcare information systems design is recognized as of extreme importance to the final success of these systems. However, it seems that the merits of specific methodological approaches for conducting these studies have received little attention. This study reports on a cognitive evaluation of a Physician Data Query Tool, which offers physicians the opportunity to query quality of care data collected by the Dutch National Intensive Care Evaluation (NICE) foundation. A comparison in terms of usefulness and utility of two variants of the Think Aloud method is addressed, the Concurrent and Retrospective Think Aloud. These methods are well known in the field of Human Computer Interaction in the context of usability evaluation. The results of this research indicate that though both methods have their disadvantages and benefits, in redesigning the Physician Data Query tool the Retrospective Think Aloud provided more useful input to the Tool's redesign. However, in deciding which method to apply in a formative evaluation study, end users' cognitive workload of performing the system's tasks and the system characteristics need to be considered as well.

  1. Gatekeeping: a challenge in the management of primary care physicians.

    PubMed

    Gross, R; Tabenkin, H; Brammli-Greenberg, S

    2001-01-01

    Assesses the degree of self-reported implementation of gatekeeping in clinical practice, and gains insight into primary care physicians' attitudes toward gatekeeping and their perceptions of necessary conditions for implementation of gatekeeping in daily practice. A self-administered questionnaire was mailed to a national sample of 800 primary care physicians in Israel, with a response rate of 86 per cent. Multivariate analysis indicated that sick fund affiliation was the main predictor of self-reported implementation of gatekeeping, while specialty training predicted primary care physicians' attitude toward this role. Close communication with specialists, continuous medical education, and management support of physician decisions were identified by respondents as being important conditions for gatekeeping. Discusses strategies to gain the cooperation of primary care physicians, which is necessary for implementing an effective gatekeeping system.

  2. [Insurgent physicians and surgeons].

    PubMed

    de Micheli-Serra, A

    1997-01-01

    The long way toward the Mexican Independence developed in various stages, each one characterized by the temperament of the leaders, the theater of war actions and the social instances. At the beginning of the movement, of popular and radical types, we find few physicians perhaps due to the small number of them in the cities and to their absence in the villages. The middle period shows a larger number of national and foreign physicians. They are present in a more important number during the last stage, of bourgeois and reformist characteristics. The comportment of these worthy members of the medical class, during the different stages of the national independence movement, is a clear example of the patriotism and honesty of the Mexican physicians.

  3. Healthcare and physician leadership.

    PubMed

    Sinclair, Duncan G; Carruthers, Chris; Swettenham, Julie

    2011-01-01

    At a recent social policy conference - Recovering Together? Fiscal Pressures, Federalism and Social Policy, hosted by Queen's International Institute on Social Policy - there was much discussion of "healthcare's crowding out" of others of the determinants of health, education and income security being the predominant examples. I was struck by the loose language, four words/phrases in particular, used to describe reality - healthcare, system, single-payer and publicly funded. Physicians are increasingly moving beyond their already-demanding clinical roles to become chief executive officers (CEOs), chiefs of staff, clinical leaders, board members, deans and directors. Is this a good thing, and should physician leadership be encouraged? Or as Ron Liepert (2009, August), minister of Alberta Health and Wellness, asserts, are physicians better at diagnosing and treating people than running $8 billion organizations?

  4. Dismembering the ethical physician

    PubMed Central

    Genuis, S J

    2006-01-01

    Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever‐proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for “freedom of conscience” that principled physicians require to practise medicine in keeping with their personal ethical orientation. PMID:16597808

  5. German physicians "on strike"--shedding light on the roots of physician dissatisfaction.

    PubMed

    Janus, Katharina; Amelung, Volker Eric; Gaitanides, Michael; Schwartz, Friedrich Wilhelm

    2007-08-01

    , continuous education and job security, administrative tasks and collegial relationships were highly significant, specialized technology and patient contact were significant and research and teaching and international exchange were not significant in contributing to physician job satisfaction. This study sheds light to the underlying factors that contribute to physician job satisfaction in Germany, and it provides insights into the reasons for physicians leaving medical practice. In order for a health system to recruit and retain physicians, it may be necessary for a system's physician strategy to shift from focusing primarily on hard, monetary and compensation-related factors to a broader focus that incorporates the soft, non-monetary factors. The implementation of policies and management practices that reduce the time burden on physicians, and enhance physicians' participation in the development of patient care management processes and in managerial decisions that affect patient care appears to be crucial. The result will be increased job satisfaction among physicians, which is important to the future recruitment and retention of doctors, as well as to the productivity and quality of the services provided by this essential component of our medical care systems.

  6. Mobile physician order entry.

    PubMed

    Ying, Alan

    2003-01-01

    Because both computerized physician order entry (CPOE) systems and mobile technologies such as handheld devices have the potential to greatly impact the industry's future, IT vendors, hospitals, and clinicians are simply merging them into a logical convergence--"CPOE on a handheld"--with an expectation of full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices. For these trends to succeed together, however, this expectation must be revised to establish a distinct category--mobile physician order entry (MPOE)--that is different from CPOE in form, function, and implementation.

  7. [Hippocrates' treatise physician].

    PubMed

    Frøland, Anders

    2005-01-01

    This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.

  8. Leasing physician office space.

    PubMed

    Murray, Charles

    2009-01-01

    When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria.

  9. Trigeminal neuralgia: An insight into the current treatment modalities

    PubMed Central

    Punyani, Silky Rajesh; Jasuja, Vishal Ramesh

    2012-01-01

    Trigeminal neuralgia (TN) is one of the most excruciating pain syndromes afflicting the orofacial region. Trigeminal neuralgia may be primary i.e. idiopathic or secondary, resulting from trauma or a CNS lesion. Considering the agonizing nature of the disease and TN being the commonest of the neural maladies affecting the orofacial region it is important for the oral physician to be aware of all available treatment options. This article makes an attempt to present a brief insight into the current treatment modalities that are on hand to treat this condition. From the perspective of the oral physician the pharmacotherapy constitutes the cornerstone in the management of TN. At the same time, it is also important to be aware and updated of the role of the oral surgeon and radiologist in the application of the array of interventional procedures available for treating TN. PMID:25737864

  10. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines.

    PubMed

    Lamy, Jean-Baptiste; Ebrahiminia, Vahid; Riou, Christine; Seroussi, Brigitte; Bouaud, Jacques; Simon, Christian; Dubois, Stéphane; Butti, Antoine; Simon, Gérard; Favre, Madeleine; Falcoff, Hector; Venot, Alain

    2010-05-28

    Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices.

  11. The application of change management principles to facilitate the introduction of nurse practitioners and physician assistants into six Ontario emergency departments.

    PubMed

    Ducharme, James; Buckley, Jenny; Alder, Robert; Pelletier, Cindy

    2009-01-01

    In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes. Challenges included role confusion and the learning curve for the new providers. While overall the project was a success, lessons learned included the need for physician buy-in, communication, planning for unintended consequences and management of expectations. The project emphasized the importance of a managed process, including team development, in the implementation of change.

  12. Physicians and Insider Trading.

    PubMed

    Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven

    2015-12-01

    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.

  13. Medication counselling: physicians' perspective.

    PubMed

    Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Eskildsen, Anette Gjetrup; Saedder, Eva Aggerholm; Nielsen, Lars Peter

    2013-12-01

    Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record. © 2013 Nordic Pharmacological Society. Published by John Wiley & Sons Ltd.

  14. Information for Travellers' Physicians

    PubMed Central

    Allison, David J.; Blinco, Kimberley

    1990-01-01

    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs. PMID:21233910

  15. Physician-assisted death

    PubMed Central

    Abrahao, Agessandro; Downar, James; Pinto, Hanika; Dupré, Nicolas; Izenberg, Aaron; Kingston, William; Korngut, Lawrence; O'Connell, Colleen; Petrescu, Nicolae; Shoesmith, Christen; Tandon, Anu; Vargas-Santos, Ana Beatriz

    2016-01-01

    Objective: To survey amyotrophic lateral sclerosis (ALS) health care providers to determine attitudes regarding physician-assisted death (PAD) after the Supreme Court of Canada (SCC) invalidated the Criminal Code provisions that prohibit PAD in February 2015. Methods: We conducted a Canada-wide survey of physicians and allied health professionals (AHP) involved in the care of patients with ALS on their opinions regarding (1) the SCC ruling, (2) their willingness to participate in PAD, and (3) the PAD implementation process for patients with ALS. Results: We received 231 responses from ALS health care providers representing all 15 academic ALS centers in Canada, with an overall response rate for invited participants of 74%. The majority of physicians and AHP agreed with the SCC ruling and believed that patients with moderate and severe stage ALS should have access to PAD; however, most physicians would not provide a lethal prescription or injection to an eligible patient. They preferred the patient obtain a second opinion to confirm eligibility, have a psychiatric assessment, and then be referred to a third party to administer PAD. The majority of respondents felt unprepared for the initiation of this program and favored the development of PAD training modules and guidelines. Conclusions: ALS health care providers support the SCC decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD and additional training and guidelines are required before implementation in Canada. PMID:27178703

  16. The ideal physician entrepreneur.

    PubMed

    Bottles, K

    2000-01-01

    How does the sometimes elusive and high-stakes world of venture capital really work? How can physician executives with innovative ideas or new technologies approach venture capitalists to help them raise capital to form a start-up company? These important questions are explored in this new column on the physician as entrepreneur. The ideal physician executive is described as: (1) an expert in an area that Wall Street perceives as hot; (2) a public speaker who can enthusiastically communicate scientific and business plans to a variety of audiences; (3) a team leader who is willing to share equity in the company with other employees; (4) a recruiter and a motivator; (5) an implementer who can achieve milestones quickly that allow the company to go public as soon as possible; and (6) a realist who does not resent the terms of the typical deal. The lucrative world of the venture capitalists is foreign territory for physician executives and requires a great idea, charisma, risk-taking, connections, patience, and perseverance to navigate it successfully.

  17. Selection of School Physicians.

    ERIC Educational Resources Information Center

    Childs, L. W.

    2001-01-01

    This 1930 paper discusses important considerations in selecting school physicians, cautioning that unwise appointments include elderly doctors who are no longer in practice, doctors who are more interested in money than health, and doctors with poor interpersonal skills. The paper recommends hiring well-educated, tactful, punctual, honest, and…

  18. Information for travellers' physicians.

    PubMed

    Allison, D J; Blinco, K

    1990-07-01

    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs.

  19. Physician-owned companies.

    PubMed

    Kostuik, John P

    2007-05-15

    The author relates his experience in the development of a spinal implant development company (K2M) that is significantly advised by physicians. To provide information about the development of a spinal implant company (K2M) advised by a group of professional spinal surgeons. To relate the federal laws (STARK and anti-kickback) as they pertain to surgeon-influenced companies. To discuss the role of a scientific advisory board. A self-developed company was developed together with significant, but minority physician financial input and majority scientific advice. A privately owned spinal implant development corporation (K2M) was developed 3 years ago. Physician financial participation was less than 20% (Stark laws state no more than 40%). Users of product are greater than 60% non-investor physicians. The development of a large scientific advisory board has been very influential in product development. A privately owned spinal implant company (K2M) has been developed strictly within Federal laws. Its board of scientific advisors that receives recompense commissurate only with effort significantly impacts the company policy.

  20. Famous physicians-botanists.

    PubMed

    Dubovsky, H

    1985-06-01

    Two hundred years ago a group of physicians laid the foundations of botany with their study of plants for medicinal purposes. Linnaeus of Sweden devised the binomial classification of plants, which is still in use today. Boerhaave of Leyden revitalized bedside teaching and was a major influence in the English-speaking medical schools. Sloane founded the still-existing Physic Garden in London; his natural history collection formed the foundation of the British Museum. Withering prepared digitalis from the purple foxglove and wrote a standard work on the cultivation of vegetables. The gardenia and poinsettia are named after New World physician-botanists Alexander Garden and Joel Poinsett. Swedish physicians Sparrman and Thunberg, pupils of Linnaeus, were the major and original describers of the Cape flora. Atherstone of Grahamstown--the first doctor to use a general anaesthetic (ether) outside America and Europe--is a 19th century example of the naturalist physician as an ardent botanist; he was also a geologist and identified the first diamond found in South Africa.

  1. The aeromedical physician assistant.

    PubMed

    Radi, Joshua; Brisson, Michael; Line, Michael

    2016-12-01

    The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.

  2. Informational influences on physician referrals.

    PubMed

    Beltramini, R F; Sirsi, A K

    1992-01-01

    Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed.

  3. Longevity of Thai physicians.

    PubMed

    Sithisarankul, Pornchai; Piyasing, Veera; Boontheaim, Benjaporn; Ratanamongkolgul, Suthee; Wattanasirichaigoon, Somkiat

    2004-10-01

    The objectives of this study were to explore characteristics of the long-lived Thai physicians. We sent 983 posted questionnaires to 840 male and 143 female physicians. We obtained 327 of them back after 2 rounds of mailing, yielding a response rate of 33.3 percents. The response rate of male physicians was 32.4 percents and that of female physicians was 38.5 percents. Their ages were between 68-93 years (75.1 +/- 4.86 years on average). The majority were married, implying that their spouses were also long-lived. Around half of them still did some clinical work, one-fourth did some charity work, one-fourth did various voluntary works, one-fifth did some business, one-fifth did some academic work, and some did more than one type of work. Most long-lived physicians were not obese, with BMI of 16.53-34.16 (average 23.97 +/- 2.80). Only 8 had BMI higher than 30. BMIs were not different between male and female physicians. However, four-fifths of them had diseases that required treatment, and some of them had more than one disease. The five most frequent diseases were hypertension, diabetes, ischemic heart disease, dyslipidemia, and benign prostate hypertrophy, respectively. Most long-lived physicians did exercise (87.8%), and some did more than one method. The most frequent one was walking (52.3%). Most did not drink alcohol or drank occasionally, only 9.0% drank regularly. Most of them slept 3-9 hours per night (average 6.75 +/- 1.06). Most (78.3%) took some medication regularly; of most were medicine for their diseases. Most did not eat macrobiotic food, vegetarian food, or fast food regularly. Most long-lived physicians practiced some religious activities by praying, paying respect to Buddha, giving food to monks, practicing meditation, and listening to monks' teaching. They also used Buddhist practice and guidelines for their daily living and work, and also recommended these to their younger colleagues. Their recreational activities were playing musical instruments

  4. Burnout among physicians

    PubMed Central

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians’ quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as

  5. Thai physicians health survey.

    PubMed

    Wattanasirichaigoon, Somkiat; Ruksakom, Hansa; Polboon, Navapun; Sithisarankul, Pornchai; Visanuyothin, Taweesin

    2004-10-01

    Physicians often conduct research on other occupations' health or general populations' health, but their health has hardly been studied systematically. The authors conducted a cross-sectional descriptive survey on 440 physicians systematically selected from their medical license numbers. The response rate was 86.4% (380 out of 440). Two-hundred and twenty-nine were male, and 151 were female. Their average age was 40.8 years (range: 22-74). Most of them were Buddhists (93.9%), specialists (64.2%), married only once and still lived with their spouses (59.5%), and concurrently practiced medicine (95.5%). Their overall satisfaction as physicians was 60.2% high, and 37.2% moderate. Their average sleep time was 6-8 hours per night for 58.9%. Most had eye problems (74.9%) and most were refractive errors such as myopia. Most (63.8%) of them did not have any prevalent diseases. Whereas those who had diseases had (in order) allergy, hypertension, asthma, diabetes, and cancer. Their current illnesses included respiratory tract infection. Most physicians did not smoke (94.2%) nor drink alcohol (70.5%). Most of them were not vegetarians (60.4%), did not eat fast food (99.2%). Interestingly, 41.4% of them were accounted for spending less than twice per week for exercise. As expected, 23.7% of them were exposed to blood, 14.5% to respiratory tract secretion, and 13.7% to pus/secretion from wounds. This study serves as a basis for health promotion approach to medical community and does create awareness of health among Thai physicians.

  6. Physician Information Seeking Behaviors: Are Physicians Successful Searchers?

    ERIC Educational Resources Information Center

    Swiatek-Kelley, Janice

    2010-01-01

    In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to…

  7. Women physicians as healthcare leaders: a qualitative study.

    PubMed

    Roth, Virginia R; Theriault, Anne; Clement, Chris; Worthington, Jim

    2016-06-20

    Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent.

  8. Association of American Indian Physicians

    MedlinePlus

    Association of American Indian Physicians Apply Log In Facebook Twitter YouTube About Mission Board of Directors Staff ... of AAIP student programs. Join Renew Programs The Association of American Indian Physicians provides educational programs, health ...

  9. The future for physician assistants.

    PubMed

    Cawley, J F; Ott, J E; DeAtley, C A

    1983-06-01

    Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.

  10. A Physician's Guide to Radon

    EPA Pesticide Factsheets

    This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.

  11. The Physician and Industry

    PubMed Central

    Nelson, A. John

    1964-01-01

    Many employers are interested in helping their employees improve and maintain health through a program of preventive medicine designed to supplement health services which already exist in the community. The objectives of such a health program can be attained only through team work between physicians, both within and outside industry. Such specific objectives as the development of measures for the maintenance and improvement of health and the prevention of disease; the provision of readily available diagnostic, treatment and counselling services; the rehabilitation of disabled employees; and the effective administration of sick-benefit plans require the closest communication and co-operation among the occupational health service, the private physician, and other health and welfare agencies. Only by such liaison can the maximum benefits of both preventive and curative medicine be extended to the employee—in his best interest as well as that of the community and the employer. PMID:14226113

  12. Physicians of ancient India

    PubMed Central

    Saini, Anu

    2016-01-01

    A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India. PMID:27843823

  13. Learning from Physicians with Disabilities and Their Patients.

    PubMed

    DeLisa, Joel A; Lindenthal, Jacob Jay

    2016-10-01

    Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities. It is hoped these data would be used by counselors, administrators, and admissions committees in advising medical school applicants with disabilities and in revising institutional policies with a view to increasing matriculation and graduation rates of medical students with disabilities. © 2016 American Medical Association. All Rights Reserved.

  14. A Spatial Analysis of Physician Assistant Programs.

    PubMed

    Forister, J Glenn; Stilp, Curt

    2017-06-01

    The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants. Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n = 95) was mapped using ArcGIS software. Permanent US ZIP codes for PA applicants (n = 22,603) from the 2014 to 2015 CASPA admissions cycle were also mapped. Point data were used to calculate the nearest neighbor by program type. Correlation was used to measure the association between PA applicants, program class size, and state population metrics. Most of the 95 new PA programs were geographically close to established programs. The median distance of new programs to the nearest neighboring established program was 25.6 miles (mean 39, standard deviation 38). Both established and new PA programs were found to be highly clustered (Moran's I z score < 2.58, p = .01). The geographic distribution of the CASPA applicant pool was related to distribution of the US population, certified PAs, and practicing physicians. PA program growth has exceeded projections. The close proximity of new programs to established programs will likely result in continued competition for quality applicants, PA faculty members, and clinical training sites.

  15. Analysis of counts with two latent classes, with application to risk assessment based on physician-visit records of cancer survivors.

    PubMed

    Wang, Huijing; Hu, X Joan; McBride, Mary L; Spinelli, John J

    2014-04-01

    Motivated by a cancer survivorship program, this paper explores event counts from two categories of individuals with unobservable membership. We formulate the counts using a latent class model and consider two likelihood-based inference procedures, the maximum likelihood estimation (MLE) and a pseudo-MLE procedure. The pseudo-MLE utilizes additional information on one of the latent classes. It yields reduced computational intensity and potentially increased estimation efficiency. We establish the consistency and asymptotic normality of the proposed pseudo-MLE, and we present an extended Huber sandwich estimator as a robust variance estimator for the pseudo-MLE. The finite-sample properties of the two-parameter estimators along with their variance estimators are examined by simulation. The proposed methodology is illustrated by physician-claim data from the cancer program.

  16. The Successful Application of a National Peer Advisory Committee for Physicians Who Provide Salvage Regimens to Heavily Antiretroviral-Experienced Patients in Mexican Human Immunodeficiency Virus Clinics

    PubMed Central

    Calva, Juan J.; Sierra-Madero, Juan; Soto-Ramírez, Luis E.; Aguilar-Salinas, Pedro

    2014-01-01

    Background  Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients. Methods  We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22–43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of <200 copies per mL, followed by levels above this threshold) during the follow-up assessment using an observed-failure competing risks regression analysis. Results  A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4). The probabilities of virologic failure were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively. Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4+ T-cell count was 162 cells per mL (IQR = 45–304 cells per mL). Conclusions  In routine practice, a high rate of patients with extensive ARV experience, who received an optimized salvage regimen recommended by a peer advisory committee, achieved a long-term sustained virologic response and immune reconstitution. PMID:25734149

  17. Physician nutrition education.

    PubMed

    Kiraly, Laszlo N; McClave, Stephen A; Neel, Dustin; Evans, David C; Martindale, Robert G; Hurt, Ryan T

    2014-06-01

    Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification.

  18. [Professional ethics of physicians].

    PubMed

    de Micheli-Serra, Alfredo

    2004-01-01

    Socrates is considered the great classic moralist, although he was not the first to take care of man and morality. Aristotle instituted ethics as an autonomous science and clearly defined its fields, its methods and its purposes, formulating the concept of "happy medium". In the Aristotelian methodology we find traces of Hippocrates, who believed that the physician must always consider the peculiar aspects and that the individual characteristics' determinations can be reached by sensitivity. Once these particularities have been proved, the physician must rely on the "happy medium". Only Stoics could discover, and gradually elaborate, the concept of natural law. Apparently they were the first to establish the classic distinction between the theorical or ideal morality and the practical morality, which is accessible to all people. They refused to compare wisdom, entirely turned inward, with the medical art, which does not constitute an aim by itself. Modern authors assert that, with stoicism, the notion we can denominated wisdom's humanism rised. Today it is admitted that "medicine is more than simply learning medical data.... Physicians must have a wisdom learned from human finitude. They will need this wisdom to tackle the health care policy debates in the next decades". This would be a major cultural undertaking.

  19. [Burnout in physicians].

    PubMed

    Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang

    2017-06-01

    Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

  20. Desktop and conference room VR for physicians.

    PubMed

    Ai, Zhuming; Rasmussen, Mary

    2005-01-01

    Virtual environments such as the CAVE and the ImmersaDesk, which are based on graphics supercomputers or workstations, are large and expensive. Most physicians have no access to such systems. The recent development of small Linux personal computers and high-performance graphics cards has afforded opportunities to implement applications formerly run on graphics supercomputers. Using PC hardware and other affordable devices, a VR system has been developed which can sit on a physician's desktop or be installed in a conference room. Affordable PC-based VR systems are comparable in performance with expensive VR systems formerly based on graphics supercomputers. Such VR systems can now be accessible to most physicians. The lower cost and smaller size of this system greatly expands the range of uses of VR technology in medicine.

  1. The Future Supply of Physicians.

    ERIC Educational Resources Information Center

    Ginzberg, Eli

    1996-01-01

    Reviews policy positions regarding the supply of physicians in the United States, from the 1910 Flexner Report to the present, and evaluates current policy alternatives that address the problem of physician oversupply. Maintains that, if future health care outlays increase as predicted, the demand for physicians should continue to grow. (MDM)

  2. Managing the physician revenue cycle.

    PubMed

    Sorrentino, Pat A; Sanderson, Brian B

    2011-12-01

    To be able to effectively manage physician revenue cycles, the hospital revenue cycle team must understand and address several issues in physician practices: Physician organizational structures. Payment methodology. Registration. Provider compensation modeling. Provider on-boarding process. Systems integration. Communication processes and culture.

  3. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-05

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

  4. Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

    PubMed

    Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

    2017-05-01

    To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

  5. Physician resource databank: numbers, distribution and activities of Canada's physicians

    PubMed Central

    Woodward, Christel; Adams, Orvill

    1985-01-01

    The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada's licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years). The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties—surgery, anesthesia, obstetrics and gynecology, and radiology—may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text] PMID:3995440

  6. Role of the school physician.

    PubMed

    Devore, Cynthia DiLaura; Wheeler, Lani S M

    2013-01-01

    The American Academy of Pediatrics recognizes the important role physicians play in promoting the optimal biopsychosocial well-being of children in the school setting. Although the concept of a school physician has existed for more than a century, uniformity among states and school districts regarding physicians in schools and the laws governing it are lacking. By understanding the roles and contributions physicians can make to schools, pediatricians can support and promote school physicians in their communities and improve health and safety for children.

  7. Apathy, empathy, physicians, and Chekhov.

    PubMed

    Gianakos, D

    1997-01-01

    Healing depends on a caring, involved physician. In his story "Ward Number Six," Anton Chekhov illustrated how patients suffer when physicians become apathetic. Reading this story may inspire physicians to resist apathy and assume greater responsibility for the social conditions that impact on their patients' well-being. It may also stimulate physicians' imagination in such a way as to improve their ability to empathize with their patients. Finally, the act of reading itself--particularly reading great literature such as "Ward Number Six," can help rejuvenate those physicians who struggle with their own apathy.

  8. Managed care and physician disability.

    PubMed

    Fraunfelder, F T; Fraunfelder, N

    1999-07-01

    The number of disability claims by physicians has skyrocketed during the last decade. One of the primary reasons for this escalation is decreased job satisfaction brought about by managed care. Certain physician groups are more vulnerable to the stress of advanced managed care: solo practitioners, specialists and subspecialists, certain generalists, doctors with independent personalities, middle-aged or near-retirement physicians, impaired physicians, and those whose practices are almost solely contract driven. Based on analysis of physician disability claims, certain protective measures are recommended to relieve stress and promote survival in today's health care market.

  9. Physicians and American political leadership.

    PubMed

    Jameson, M G

    1983-02-18

    Physicians have actively participated in the political processes of American democracy throughout the nation's history. The purpose of this study was to compare physicians' participation in public office during the first and second centuries of American democracy. Following the commencement of the US Congress, physicians were active members of the legislative branch. However, physicians' membership in Congress has diminished significantly in modern times. The executive and judicial branches of the federal government have recorded only marginal representation by physicians and none during the 20th century.

  10. Assessing the Health of Future Physicians: An Opportunity for Preventive Education

    ERIC Educational Resources Information Center

    Clair, Jennifer H.; Wilson, Diane B.; Clore, John N.

    2004-01-01

    Introduction: Research shows that physicians who model prevention are more likely to encourage preventive behaviors in their patients. Therefore, understanding the health of medical students ought to provide insight into the development of health promotion programs that influence the way these future physicians practice medicine. A…

  11. Assessing the Health of Future Physicians: An Opportunity for Preventive Education

    ERIC Educational Resources Information Center

    Clair, Jennifer H.; Wilson, Diane B.; Clore, John N.

    2004-01-01

    Introduction: Research shows that physicians who model prevention are more likely to encourage preventive behaviors in their patients. Therefore, understanding the health of medical students ought to provide insight into the development of health promotion programs that influence the way these future physicians practice medicine. A…

  12. The patients in recovery (PIR) perspective: teaching physicians about methamphetamine.

    PubMed

    Walley, Alexander Y; Phillips, Karran A; Gordon, Adam J

    2008-01-01

    Methamphetamine dependence is an emerging epidemic confronting physicians. In an effort to improve understanding of its impact, the authors presented an educational workshop at a national meeting for general internists featuring small group discussions with patients in recovery (PIR) from methamphetamine dependence. Participants rated the workshop highly, stating it would lead to concrete change in their teaching, research, or patient care practices and they would invite the workshop to their institution for presentation. Direct interaction with PIR was the most valued aspect of the workshop. Lessons learned included patient's fear of being "turned in" limits disclosure of methamphetamine use to physicians; active users have little insight into methamphetamine-related changes in physical appearance; and a sense of productivity reinforces ongoing methamphetamine use. Workshops that include small group discussions between physicians and PIR are an innovative, practical, and acceptable method to teach physicians about their role in helping patients with substance dependence.

  13. Ethical Dilemmas in Office Practice: Physician Response and Rationale

    PubMed Central

    Secundy, Marian Gray

    1985-01-01

    A survey of black and white family physicians in the District of Columbia is described. The survey provides insight into decision-making processes and the ability to recognize ethical dilemmas in medical practice. Comments were elicited to hypothetical case vignettes typical of ethical conflict in office practice. Findings note physician ability to recognize ethical dilemmas in day-to-day aspects of medical practice. Methods of decision making and rationale for decisions made, however, appear to be inconsistent, nonuniversal, and individualistic without evidence of specific models or criteria. No significant differences were noted between black and white physicians. The need in physician training for clarification and development of criteria is evident. PMID:4078929

  14. Manager-physician relationships: an organizational theory perspective.

    PubMed

    Kaissi, Amer

    2005-01-01

    Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of

  15. Roles of the Team Physician.

    PubMed

    Kinderknecht, James

    2016-07-01

    The roles of the team physician are much more than providing medical coverage at a sport's event. The team physician has numerous administrative and medical responsibilities. The development of an emergency action plan is an essential administrative task as an example. The implementation of the components of this plan requires the team physician to have the necessary medical knowledge and skill. An expertise in returning an athlete to play after an injury or other medical condition is a unique attribute of the trained team physician. The athlete's return to participation needs to start with the athlete's safety and best medical interests but not inappropriately restrict the individual from play. The ability to communicate on numerous levels needs to be a characteristic of the team physician. There are several potential ethical conflicts the team physician needs to control. These conflicts can create unique medicolegal issues. The true emphasis of the team physician is to focus on what is best for the athlete.

  16. RX: For Small Towns Who Need Doctors. A Manual Outlining Physician Recruitment Strategies for Rural Kentucky Communities.

    ERIC Educational Resources Information Center

    Simpson, Wood

    Strategies for recruiting physicians to rural Kentucky communities are presented in broad outlines that would also be applicable to other rural communities looking for physicians. After documenting the shortage and maldistribution of physicians in rural America, the factors are described which influence a physician's choice of place to locate--his…

  17. Medicare: Physician Compare

    MedlinePlus

    ... application. This application is not fully accessible to users whose browsers do not support or have Cascading Style Sheets (CSS) disabled. For a more optimal experience viewing this application, please enable CSS in your ...

  18. Patients' and physicians' attitudes regarding the physician's professional appearance.

    PubMed

    Gjerdingen, D K; Simpson, D E; Titus, S L

    1987-07-01

    Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.

  19. Physician satisfaction with a multi-platform digital scheduling system

    PubMed Central

    Rocha, Leonardo Lima; Lima, Alex Heitor; Santiago, Caroline Reis Maia; Terra, Jose Cláudio Cyrineu; Dagan, Alon; Celi, Leo Anthony

    2017-01-01

    Objective Physician shift schedules are regularly created manually, using paper or a shared online spreadsheet. Mistakes are not unusual, leading to last minute scrambles to cover a shift. We developed a web-based shift scheduling system and a mobile application tool to facilitate both the monthly scheduling and shift exchanges between physicians. The primary objective was to compare physician satisfaction before and after the mobile application implementation. Methods Over a 9-month period, three surveys, using the 4-point Likert type scale were performed to assess the physician satisfaction. The first survey was conducted three months prior mobile application release, a second survey three months after implementation and the last survey six months after. Results 51 (77%) of the physicians answered the baseline survey. Of those, 32 (63%) were males with a mean age of 37.8 ± 5.5 years. Prior to the mobile application implementation, 36 (70%) of the responders were using more than one method to carry out shift exchanges and only 20 (40%) were using the official department report sheet to document shift exchanges. The second and third survey were answered by 48 (73%) physicians. Forty-eight (98%) of them found the mobile application easy or very easy to install and 47 (96%) did not want to go back to the previous method. Regarding physician satisfaction, at baseline 37% of the physicians were unsatisfied or very unsatisfied with shift scheduling. After the mobile application was implementation, only 4% reported being unsatisfied (OR = 0.11, p < 0.001). The satisfaction level improved from 63% to 96% between the first and the last survey. Satisfaction levels significantly increased between the three time points (OR = 13.33, p < 0.001). Conclusion Our web and mobile phone-based scheduling system resulted in better physician satisfaction. PMID:28328958

  20. End Results What Happens Next?: The balance of wooden spoons Insights and Conundrums: Archimedes' boat: making holes in water Correction to 'de Broglie's wavelength has many applications in the study of gases'

    NASA Astrophysics Data System (ADS)

    2012-01-01

    What Happens Next?: The balance of wooden spoons David Featonby Insights and Conundrums: Archimedes' boat: making holes in water Jon Ogborn Correction to 'de Broglie's wavelength has many applications in the study of gases'

  1. Developing Canadian physician: the quest for leadership effectiveness.

    PubMed

    Comber, Scott; Wilson, Lisette; Crawford, Kyle C

    2016-07-04

    Purpose The purpose of this study is to discern the physicians' perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels. Design/methodology/approach A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity. Findings Physicians in clinical roles' PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities. Practical implications More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective. Originality/value Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum.

  2. Negotiation skills for physicians.

    PubMed

    Anastakis, Dimitri J

    2003-01-01

    As stakeholders vie for increasingly limited resources in health care, physicians would be well advised to hone their skills of negotiation. Negotiation is defined as a strategy to resolve a divergence of interests, be they real or perceived, where common interests also exist. Negotiation requires effective communication of goals, needs, and wants. The "basic needs" model of negotiation is best suited to the current health care environment. In this model, negotiator must to be able to identify their needs in the negotiation, establish their best alternative to a negotiated agreement, and identify their strategies and tactics for the negotiation.

  3. Issues in physician contracting.

    PubMed

    Fanburg, John D; Leone, Alyson M

    2005-09-01

    Dermatologists will enter into a number of different contracts during their professional careers. It is important that in each agreement they enter, dermatologists reap the benefits that they aspire for and understand the consequences of each provision. This article addresses just a few of the different issues that arise in physician contracting, such as choosing the appropriate form of business entity; the importance of a writing; term and termination of the contract; compensation models; benefits, vacation and other time off included in the contract; malpractice insurance; and restrictive covenants. Each provision should be carefully analyzed to ensure that it will protect the best interests of the dermatologist in that situation.

  4. [Adherence of type 2 diabetes patients on insulin analogues application: missed dose, time imprecision and dose reduction. The results of GAPP2TM(Global Attitudes of Physicians and Patient) survey in the Czech Republic].

    PubMed

    Prázný, Martin

    2014-11-01

    Irregular insulin dose is one of the main problems associated with insulin therapy in patients with type 2 diabetes; its extent is not known precisely. The aim of survey conducted in the Czech Republic in the international project GAPP2 - Global Attitudes of Patients and Physicians was to determine the incidence and the impact of irregular use of basal insulin analogues in patients with type 2 diabetes, to point out the reasons for these irregularities and to focus on how physicians discuss irregular application of insulin with patients. The project GAPP2 is an international cross-sectional study performed on-line via the Internet using a questionnaire filled by diabetic patients treated with insulin analogues and physicians who treat these patients. The survey was conducted in two steps in 17 countries; the first step included 6 countries and was completed in the beginning of 2012, the second step involved 11 other countries including the Czech Republic with termination in 2014. The survey was designed to obtain the views of patients and physicians on certain aspects of insulin treatment and persistent issues in this field in the real daily practice. Special focus was on the incidence and management of hypoglycaemia as well as on irregularities of insulin application. In the part dedicated to adherence to basal insulin application were observed three types of irregular insulin therapy: missed dose, time imprecision of dose (± 2 hours vs. the prescribed time) and dose reduction in all cases in the past 30 days before completing the questionnaire. In addition, it was investigated the attitude and relation of patients to these issues. The results have shown that irregular insulin dose in the Czech Republic is less frequent than in other countries involved in the GAPP2 research. Nevertheless, approximately one fifth of diabetic patients using insulin analogues in basal-bolus or only basal therapy regimen is related to this problem. The last irregular insulin

  5. A new, but old business model for family physicians: cash.

    PubMed

    Weber, J Michael

    2013-01-01

    The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

  6. How physician/administrator teams work in small groups. Six steps to make it happen.

    PubMed

    Stearns, T H

    1999-01-01

    The physician/administrator team is frequently supported as the preferred model for physician group governance. Perhaps an obvious model for large groups, it remains true that the largest percentage of physicians are practicing in groups of 10 or fewer. This article explores the applicability of the physician/administrator team concept for small group practices. The article covers the significance of the physician/administrator team in managed care settings, difference in governance structures between large and small groups, the need for physicians to be willing to share leadership in organizations they own, understanding empowerment in small groups, the manager's need to assume more responsibility and how to form the team.

  7. Team physicians in college athletics.

    PubMed

    Steiner, Mark E; Quigley, D Bradford; Wang, Frank; Balint, Christopher R; Boland, Arthur L

    2005-10-01

    There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Descriptive epidemiology study. For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P < .05). Four percent of musculoskeletal injuries required surgery. Most general medical evaluations were single visits for upper respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P < .05). Per capita, men and women sought care at an equal rate. In contrast, 10% of physician encounters with the general pool of undergraduates were for musculoskeletal diagnoses. Student athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

  8. Physician Event Reporting: Training the Next Generation of Physicians

    DTIC Science & Technology

    2005-01-01

    353 Physician Event Reporting: Training the Next Generation of Physicians Quang-Tuyen Nguyen, Joanna Weinberg, Lee H. Hilborne Abstract...and the quality of health care by explicitly educating and training the next generation of physicians in these areas. Although quality of care is...implicit in most medical and other professional school curricula, medical students generally are not given the training necessary to meet the specific

  9. Community volunteerism of US physicians.

    PubMed

    Grande, David; Armstrong, Katrina

    2008-12-01

    Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians' community volunteer activities. To measure levels of community volunteerism among US physicians. Analysis of the 2003 Current Population Survey (CPS) Volunteer Supplement, a cross-sectional, nationally-representative, in-person and telephone survey of 84,077 adult citizens, including 316 physicians. The primary outcome was whether the respondent had volunteered in the prior 12 months and if so the total number of hours. The level of community volunteer activity was compared between physicians, lawyers and the general public. In addition, predictors of physician volunteerism were identified. According to the survey, 39% of physicians had volunteered in their community in the past 12 months compared to 30% of the general public (p = 0.002) and 57% of lawyers (p < 0.001). After multivariate adjustment, physicians were half as likely as the general public (OR = 0.52, p < 0.001) or lawyers (OR = 0.44, p < 0.001) to have volunteered. Physicians were more likely to have volunteered if they worked part-time (OR = 3.35, p = 0.03), variable hours (OR = 3.16, p = 0.03), or between 45-54 hours per week (OR = 3.15, p = 0.02) compared to a 35-44 hour work week. Despite highly favorable physician attitudes toward volunteerism in prior surveys, less than half of US physicians have volunteered with community organizations in the past year. Renewed attention to understanding and increasing physician engagement in community volunteer work is needed.

  10. Assessing the extent of integration achieved through physician-hospital arrangements.

    PubMed

    Dynan, L; Bazzoli, G J; Burns, R

    1998-01-01

    In this article we examine management service organizations (MSOs), physician-hospital organizations (PHOs), hospital-affiliated independent practice associations (IPAs), and hospital-sponsored "group practices without walls" (GPWWs) that allow physicians to retain their practices and link hospitals and health systems to physicians through contractual arrangements. Also examined were medical foundations (MFs), integrated salary models (ISMs), and integrated health organizations (IHOs) that own the physical assets of physician practices and contract with payors for physician and hospital services. The research provides several new insights for understanding the structure and process of physician-hospital integration. It was found that the extent of processual integration in physician-hospital organizational arrangements can be measured along six dimensions: administrative and practice management services; physician financial risk-sharing; joint ventures to create new services; computer linkages; physician involvement in strategic planning; and salaried physician arrangements. These dimensions are consistent with the conceptual and empirical dimensions developed by others. These findings refute the notion raised by some industry observers that the new physician-hospital organizational models simply formalize integrative activities already in place. Earlier studies from the 1980s reported that hospitals integrated physicians through involvement in governance, capital planning, and the provision of practice management services. In contrast, we found that current integration.

  11. The physician-surrogate relationship.

    PubMed

    Torke, Alexia M; Alexander, G Caleb; Lantos, John; Siegler, Mark

    2007-06-11

    The physician-patient relationship is a cornerstone of the medical encounter and has been analyzed extensively. But in many cases, this relationship is altered because patients are unable to make decisions for themselves. In such cases, physicians rely on surrogates, who are often asked to "speak for the patient." This view overlooks the fundamental fact that the surrogate decision maker cannot be just a passive spokesperson for the patient but is also an active agent who develops a complex relationship with the physician. Although there has been much analysis of the ethical guidelines by which surrogates should make decisions, there has been little previous analysis of the special features of the physician-surrogate relationship. Such an analysis seems crucial as the population ages and life-sustaining technologies improve, which is likely to make surrogate decision making even more common. We outline key issues affecting the physician-surrogate relationship and provide guidance for physicians who are making decisions with surrogates.

  12. Physicians' role in environmental issues.

    PubMed

    Bailey, B J

    1999-10-01

    Our health and the health of our patients are linked closely to the quality of our environment. As physicians, we ourselves must learn and then we must educate our patients about the importance of preventing health-endangering pollution of our air, water, food, and soil. As busy physicians, we need access to the most current, important new scientific information regarding environmental degradation where our patients work and live so we can appreciate the clinical problems that some patients present to us today. The National Association of Physicians for the Environment (NAPE) is an organization of physicians and 46 medical professional societies serving to promote protection of the environment as a fundamental responsibility of physicians and other health professionals. NAPE sponsors national conferences, promotes the publication of current "best practices" information in various general and specialty areas, and serves as a national forum for the discussion of issues and dissemination of scientifically valid information needed for physician and patient education.

  13. Family Violence and Family Physicians

    PubMed Central

    Herbert, Carol P.

    1991-01-01

    The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987

  14. Family Physicians and Exercise Counseling

    PubMed Central

    Wilson, Douglas M.C.; Ciliska, Donna; Singer, Joel; Williams, Kimberly; Alleyne, Julia; Lindsay, Elizabeth

    1992-01-01

    This trial took 22 volunteer family physicians and randomly exposed some to training intervention and some to no training to study the effect on frequency and quality of exercise prescription to ambulatory adults. During the 6 weeks after training, the trained physicians addressed the issue of exercise with 35.3% of patients. The untrained physicians discussed exercise with only 8.6% of their patients. PMID:21221270

  15. Disenfranchised Grief and Physician Burnout.

    PubMed

    Lathrop, Deborah

    2017-07-01

    Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential. © 2017 Annals of Family Medicine, Inc.

  16. Developing a physician needs assessment.

    PubMed

    Grages, T D

    2001-01-01

    The physician needs assessment allows a health care organization to figure the number and mix of physicians it will need, assisting in targeted, realistic recruitment efforts. It forms a key piece of your organization's strategic plan, lays out the current specialty mix, helps justify recruitment plans to your medical staff and the physicians you are recruiting, and can maintain your practice's good standing with regulatory agencies.

  17. Community Volunteerism of US Physicians

    PubMed Central

    Armstrong, Katrina

    2008-01-01

    Background Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians’ community volunteer activities. Objective To measure levels of community volunteerism among US physicians. Design and Participants Analysis of the 2003 Current Population Survey (CPS) Volunteer Supplement, a cross-sectional, nationally-representative, in-person and telephone survey of 84,077 adult citizens, including 316 physicians. Measurements The primary outcome was whether the respondent had volunteered in the prior 12 months and if so the total number of hours. The level of community volunteer activity was compared between physicians, lawyers and the general public. In addition, predictors of physician volunteerism were identified. Results According to the survey, 39% of physicians had volunteered in their community in the past 12 months compared to 30% of the general public ( = 0.002) and 57% of lawyers ( < 0.001). After multivariate adjustment, physicians were half as likely as the general public (OR = 0.52,  < 0.001) or lawyers (OR = 0.44,  < 0.001) to have volunteered. Physicians were more likely to have volunteered if they worked part-time (OR = 3.35,  = 0.03), variable hours (OR = 3.16,  = 0.03), or between 45–54 hours per week (OR = 3.15,  = 0.02) compared to a 35–44 hour work week. Conclusions Despite highly favorable physician attitudes toward volunteerism in prior surveys, less than half of US physicians have volunteered with community organizations in the past year. Renewed attention to understanding and increasing physician engagement in community volunteer work is needed. PMID:18839260

  18. Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

    PubMed Central

    Lima, Julie C; Intrator, Orna; Wetle, Terrie

    2015-01-01

    Objectives To develop a measure of the perceptions of nursing home (NH) Directors of Nursing (DON) on the adequacy of physician care and to examine its variation as well as its construct validity. Design A nationwide cross-sectional study with primary data collection Setting 2043 NHs surveyed August 2009 – April 2011 Participants Directors of Nursing (DONs) and NH Administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH. Measurements Ten items were used to create three domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called “Effectiveness of Physician Accountability and Communication” (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH Administrators. RESULTS The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of Do-Not-Resuscitate orders, the frequency that the Medical Director checked on the medical care delivered by attending physician, the tightness of nursing home's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and ER visits could be reduced with greater physician attention to resident needs. Conclusion As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting. PMID:25858283

  19. What Explains Usage of Mobile Physician-Rating Apps? Results From a Web-Based Questionnaire

    PubMed Central

    Terlutter, Ralf; Röttl, Johanna

    2014-01-01

    Background Consumers are increasingly accessing health-related information via mobile devices. Recently, several apps to rate and locate physicians have been released in the United States and Germany. However, knowledge about what kinds of variables explain usage of mobile physician-rating apps is still lacking. Objective This study analyzes factors influencing the adoption of and willingness to pay for mobile physician-rating apps. A structural equation model was developed based on the Technology Acceptance Model and the literature on health-related information searches and usage of mobile apps. Relationships in the model were analyzed for moderating effects of physician-rating website (PRW) usage. Methods A total of 1006 randomly selected German patients who had visited a general practitioner at least once in the 3 months before the beginning of the survey were randomly selected and surveyed. A total of 958 usable questionnaires were analyzed by partial least squares path modeling and moderator analyses. Results The suggested model yielded a high model fit. We found that perceived ease of use (PEOU) of the Internet to gain health-related information, the sociodemographic variables age and gender, and the psychographic variables digital literacy, feelings about the Internet and other Web-based applications in general, patients’ value of health-related knowledgeability, as well as the information-seeking behavior variables regarding the amount of daily private Internet use for health-related information, frequency of using apps for health-related information in the past, and attitude toward PRWs significantly affected the adoption of mobile physician-rating apps. The sociodemographic variable age, but not gender, and the psychographic variables feelings about the Internet and other Web-based applications in general and patients’ value of health-related knowledgeability, but not digital literacy, were significant predictors of willingness to pay. Frequency of

  20. What explains usage of mobile physician-rating apps? Results from a web-based questionnaire.

    PubMed

    Bidmon, Sonja; Terlutter, Ralf; Röttl, Johanna

    2014-06-11

    Consumers are increasingly accessing health-related information via mobile devices. Recently, several apps to rate and locate physicians have been released in the United States and Germany. However, knowledge about what kinds of variables explain usage of mobile physician-rating apps is still lacking. This study analyzes factors influencing the adoption of and willingness to pay for mobile physician-rating apps. A structural equation model was developed based on the Technology Acceptance Model and the literature on health-related information searches and usage of mobile apps. Relationships in the model were analyzed for moderating effects of physician-rating website (PRW) usage. A total of 1006 randomly selected German patients who had visited a general practitioner at least once in the 3 months before the beginning of the survey were randomly selected and surveyed. A total of 958 usable questionnaires were analyzed by partial least squares path modeling and moderator analyses. The suggested model yielded a high model fit. We found that perceived ease of use (PEOU) of the Internet to gain health-related information, the sociodemographic variables age and gender, and the psychographic variables digital literacy, feelings about the Internet and other Web-based applications in general, patients' value of health-related knowledgeability, as well as the information-seeking behavior variables regarding the amount of daily private Internet use for health-related information, frequency of using apps for health-related information in the past, and attitude toward PRWs significantly affected the adoption of mobile physician-rating apps. The sociodemographic variable age, but not gender, and the psychographic variables feelings about the Internet and other Web-based applications in general and patients' value of health-related knowledgeability, but not digital literacy, were significant predictors of willingness to pay. Frequency of using apps for health-related information

  1. Arise the systems physician.

    PubMed

    Scott, I; Phelps, G; Dalton, S

    2014-12-01

    Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills.

  2. Evaluating physicians' probabilistic judgments.

    PubMed

    Poses, R M; Cebul, R D; Centor, R M

    1988-01-01

    Physicians increasingly are challenged to make probabilistic judgments quantitatively. Their ability to make such judgments may be directly linked to the quality of care they provide. Many methods are available to evaluate these judgments. Graphic means of assessment include the calibration curve, covariance graph, and receiver operating characteristic (ROC) curve. Statistical tools can measure the significance of departures from ideal calibration, and measure the area under ROC curve. Modeling the calibration curve using linear or logistic regression provides another method to assess probabilistic judgments, although these may be limited by failure of the data to meet the model's assumptions. Scoring rules provide indices of overall judgmental performance, although their reliability is difficult to gauge for small sample sizes. Decompositions of scoring rules separate judgmental performance into functional components. The authors provide preliminary guidelines for choosing methods for specific research in this area.

  3. Physician ownership of medical equipment.

    PubMed

    Reschovsky, James; Cassil, Alwyn; Pham, Hoangmai H

    2010-12-01

    This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally rep­resentative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 phy­sicians, and the response rate was 62 percent. Since this Data Bulletin examines the extent of physician practice ownership or leasing of medical equipment, the sample was limited to 2,750 physicians practic­ing in community-based, physician-owned practices, who represent 58 percent of all physicians surveyed. Physicians employed by hospitals, who practiced in hospital-based settings or who worked in hospital-owned practices were excluded.

  4. Chemical Dependency and the Physician

    PubMed Central

    Berge, Keith H.; Seppala, Marvin D.; Schipper, Agnes M.

    2009-01-01

    Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician. PMID:19567716

  5. Medical Students and Staff Physicians: The Question of Social Media.

    PubMed

    Noller, Michael; Mai, Johnny P; Zapanta, Philip E; Camacho, Macario

    2017-07-01

    Social media's prevalence among the professional world is rapidly increasing. Its use among medical personnel-specifically, medical students, resident physicians, and staff physicians-could compromise personal-professional boundaries. Could the acceptance or lack of acceptance of a friend request bias the medical student application process? If friend requests are accepted, then medical students, resident physicians, and staff physicians are provided access to very personal aspects of one another's lives, which may not have been the intent. The question remains whether the separation of one's personal life from work is necessary. Should medical students restrict social media relationships with residents and staff physicians to professional social media networks? The suitability and opportunities of social media among medical professionals is an ongoing issue for research that needs continued evaluation.

  6. Attitudes of homoeopathic physicians towards vaccination.

    PubMed

    Lehrke, P; Nuebling, M; Hofmann, F; Stoessel, U

    2001-09-14

    Vaccinations are one of the most effective preventive procedures in modern medicine. However, earlier studies have indicated that homoeopathic physicians do not recommend or apply vaccinations as frequently as their allopathic colleagues. Few studies have been undertaken to clarify this question and most of these have not distinguished between medically and non-medically qualified homoeopathic practitioners. Therefore, misunderstandings have arisen concerning this question. In the study presented only medically qualified colleagues were included. In the course of this study, 219 medically qualified homoeopathic and 281 non-homoeopathic physicians in Germany (response rate 30.4%) returned a questionnaire about the application and recommendation of 17 different vaccinations in their practices. The answers show that the responding homoeopathic physicians do not generally refuse vaccines but rather view them with a specific hierarchy. The 'classical' vaccines against tetanus, diphtheria and poliomyelitis are applied to nearly the same degree as by non-homoeopathic colleagues. Vaccines against childhood diseases, risk group vaccinations and vaccinations judged as ineffective are applied and accepted with more restraint by homoeopathic physicians.

  7. Research in the Family Physician's Office

    PubMed Central

    Style, Alec J.

    1977-01-01

    Family medicine as a specialty has now “come of age.” To maintain its new status, the specialty must be able to survive the vigorous assessment that is given other specialties by the public, the profession, and the academic community. One way of achieving this is for the family physician to do research of excellent quality and quantity. Traditionally, medical research has been done by secondary and tertiary care specialists and little has been done on the primary care needs of the black patient. The research done is of limited value for the family physician's daily work, a reason why family practitioners must do their own research. A research methodology has been described which is readily applicable to the family physician's office. It is an extension of good record keeping and includes Problem-Oriented Medical Records, an Age-Sex Register, a Daily Worksheet or Encounter Form, and a Morbidity Index, incorporating the “Pri-Care” (ICHPPC) code. The system is simple to use and requires only a small increase in administrative time. Every family physician is encouraged to consider its use. PMID:752730

  8. The physician-insurer dynamic must shift to successfully implement value-based payments.

    PubMed

    Beveridge, Roy A; Happe, Laura E; Funk, Mike

    2016-12-01

    Decades of practice under a system that set the financial interests of physicians and insurers at odds, has resulted in physician distrust of insurers being cited a key obstacle to value-based arrangements. Insurers must work to shift the insurer-provider relationship from one that's transactional to a partnership built on trust. Even when physicians and insurers agree philosophically on quality over quantity, there are practical challenges. Insurers can provide the data, systems and analytical insights that help inform the physician's care strategy. Implementing value-based payments requires the two groups to build trust and work together to change long-established systems.

  9. Writing to Heal Thyself: Physician as Person & Person as Physician

    ERIC Educational Resources Information Center

    Kasman, Deborah L.

    2006-01-01

    An experienced physician-teacher shares her own experiences with loss in medicine and loss in her personal life. Through personal writings during her divorce, she exemplifies the healing effect writing can have during difficult transformations that occur in life. She shares her bias that physicians need to accept and own their emotions and can use…

  10. Medicare physician payments: impacts of changes on rural physicians.

    PubMed

    Mueller, Keith J; MacKinney, A Clinton; McBride, Timothy D

    2006-09-01

    Medicare payment disproportionately impacts rural physicians compared to urban. For example, 51% of rural physicians, compared to 44% of urban physicians, receive at least 38% of their payments from Medicare.1 Thus, the Medicare physician payment system is of significant rural interest. In this policy brief, we present the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Specifically, we examine the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense. We also show the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area. Our principal findings are the following: (1) Increases to the GPCI for work expense accounted for a substantial percentage of the two-year increases in total payment to physicians in rural payment areas. (2) Increases in the conversion factor (CF) (base payment) accounted for most of the increases in total payment in all but 6 of the 89 Medicare payment localities; in those 6 areas, the dominant factor was GPCI adjustment. (3) Bonus payments are a more direct means of targeting increased payments to physicians in specific areas than is a general increase in one part of the payment formula.

  11. Increasing physician engagement: start with what's important to physicians.

    PubMed

    Stark, Robert

    2014-01-01

    Physician engagement has never been more important in this environment of healthcare reform--yet few healthcare organizations can define it or identify the elements of engagement that make increasing it possible. This may explain why a recent survey of physicians on the specifics regarding engagement from their perspective found, among other things, that levels of engagement over the past three years have increased at a lukewarm pace, at best. The survey confirmed that feeling engaged was very important to physicians' job satisfaction. It delved into what was important to them--and where there are gaps between what they want and what they are currently experiencing in their organizations--at a granular level, as well as measuring their current levels of engagement with their organizations and their work. It also explored the impact that feelings of engagement have on physicians' decisions around accepting or leaving a job or practice. A companion survey with administrators pointed out areas where there were gaps between their perceptions and those of physicians. The results point to actions that healthcare organizations can take to increase engagement--and, by extension, participation and buy-in--among their physician populations to reach critical goals and achieve greater success with key initiatives at a time of increasing physician shortages and competition between health systems for top physician talent.

  12. How to select and motivate physicians in managed care.

    PubMed

    Couvillon, J

    1999-01-01

    Recruiting a physician can be an extremely beneficial or an extremely costly move for any health care organization. The emotional matching of the person is always important but the ability of the new health care provider to operate efficiently and effectively is paramount to their success. This selection process begins even before the recruitment process and includes monthly meetings with physicians to provide feedback and discuss performance while they are practicing. This article addresses the needs of the several different managed care environments and offers insights to setting up effective utilization management.

  13. Social media: physicians-to-physicians education and communication.

    PubMed

    Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

    2017-06-01

    Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

  14. Determinants of physicians' communication behaviour in disability assessments.

    PubMed

    Van Rijssen, H Jolanda; Schellart, Antonius J M; Anema, Johannes R; Van der Beek, Allard J

    2011-01-01

    Knowledge about the determinants of communication behaviour of physicians during face-to-face consultations with patients might increase our understanding of communication behaviour, and provide insight into how training might be able to change their communication behaviour. For physicians who conduct work disability assessment interviews, referred to as 'social insurance physicians', communication with patients is their most important instrument. Therefore, the aim of this study was to understand the determinants of communication behaviour of social insurance physicians, by modelling the following constructs of the Theory of Planned Behaviour: attitudes, social influence, self-efficacy, skills, barriers and intentions concerning their communication with claimants in medical disability assessments. Cross-sectional data were collected by means of questionnaires. Analyses were performed with the LISREL maximum likelihood estimation procedure. The results showed a well-fitting model in which attitudes had a significant and substantial direct effect on two intentions. Self-efficacy had a significant, but smaller direct effect on one intention. Empirical support was found for a model that describes intentions of social insurance physicians, especially intentions to give information and to consider personal aspects. Attitudes were the main determinants of physicians' intentions and therefore these may be a promising focus of communication skills training.

  15. Transference patterns of women physicians.

    PubMed

    Bernardez, T

    1985-01-01

    The focus of the paper is the female physician patient's conflicts in female identification as central to the recovery of optimum energy and creativity. The conflicts are examined as they become salient in the transference reactions to the female therapist. The role of the environment in the potentiation and reinforcement of conflicts is assessed comparatively in older and younger generations of women physicians.

  16. How consumers view physician advertising.

    PubMed

    Johns, H E; Moser, H R

    1989-01-01

    In this study, it was found that consumers generally favor advertising by physicians. They felt that newspaper and professional magazines were more appropriate media for such advertising than television, radio, billboards, telephones, direct mail, and popular magazines. Finally, most consumers have not seen physicians advertise, but of those who have, most have noticed such advertising in a newspaper.

  17. Physician Education in Sleep Disorders.

    ERIC Educational Resources Information Center

    Orr, William C.; And Others

    1980-01-01

    The lack of physician knowledge in the diagnosis and management of sleep disorders is discussed. An examination of physicians demonstrated knowledge deficiencies and a survey of medical schools showed that 46 percent offered no training in the area of sleep physiology or disorders. Recommendations for addressing the situation are offered. (JMD)

  18. Physician Requirements-1990. For Cardiology.

    ERIC Educational Resources Information Center

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  19. Communicating Drug Information to Physicians

    ERIC Educational Resources Information Center

    Herman, Colman M.; Rodowskas, Christopher A.

    1976-01-01

    Reviews the studies of researchers who have attempted to identify the sources of drug information, both professional and commercial, utilized by physicians, discussing relationship between physicians' sources and the choice of drugs and severity of conditions being treated. Also notes new sources of drug information being considered by the Food…

  20. Ethics, economics, and physician reimbursement.

    PubMed

    Baily, Mary Ann

    2004-09-01

    There has been much debate among health care professionals over how physicians should be paid for their services. This paper addresses the topic through an economic and ethical analysis. It starts from the premise that fairness and cost effectiveness should be the goals of a good physician reimbursement system. Using the goals of fairness and cost effectiveness as measures, it examines the current market model. Finding that the current model provides neither fairness nor cost effectiveness, the paper compares the structure of the physician services market to the assumptions made by economists in the idealized market model. Two major imperfections are found in the former. These imperfections are an asymmetry in information between patient and physician, and the uneven and unpredictable distribution of health needs. These two imperfections are examined in light of the goals set out in the beginning of the paper. The paper finds that, given the imperfections, physician reimbursement as it currently exists is incompatible with the goals of fairness and cost effectiveness. In conclusion, several recommendations are made, most significantly a broadening of the interpretation of physician agency, i.e., physician as "agent," and the switch from a fee-for-service physician payment system to a salaried medical practice.

  1. Abortion and compelled physician speech.

    PubMed

    Orentlicher, David

    2015-01-01

    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading.

  2. Physician Labor Market in Croatia

    PubMed Central

    Bagat, Mario; Sekelj Kauzlarić, Katarina

    2006-01-01

    Aim To analyze the physician labor market in Croatia with respect to the internship and employment opportunities, Croatian needs for physicians and specialists, and trends in physician labor market in the European Union (EU) in the context of EU enlargement. Methods Data were collected from the Ministry of Health and Social Welfare, the Croatian Employment Service, and the Croatian Institute for Public Health. We compared the number of physicians waiting for internship before and 14 months after the implementation of the State Program for Intern Employment Stimulation. Also, the number of employed specialists in internal medicine, general surgery, gynecology and obstetrics, and pediatrics was compared with estimated number of specialists that will have been needed by the end of 2007. Average age of hospital physicians in the four specialties was determined and the number of Croatian physicians compared with the number of physicians in EU countries. Results The number of unemployed physicians waiting for internship decreased from 335 in 2003 to 82 in 2004, while a total number of unemployed physicians decreased from 436 to 379 (χ2 = 338, P<0.001). In October 2004, 79.3% of unemployed physicians waited for internship <6 months; of them, 89.2% waited for internship <3 months. In February 2005, 365 unemployed physicians were registered at the Croatian Employment Service and that number has been decreasing in the last couple of years. The number of employed specialists was lower than the estimated number of specialists needed in the analyzed specialists, as defined by the prescribed standards. A shortage of 328 internists, 319 surgeons, 209 gynecologists, and 69 pediatricians in Croatian hospitals is expected in 2007. Conclusion The lack of employment incentive seems to be the main reason for the large number of unemployed physicians waiting for internship before the implementation of the Employment Stimulation Program. According to the number of physicians per 100

  3. [The changing role of physicians].

    PubMed

    Siegrist, J

    2012-09-01

    Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

  4. Physicians' Use of Compliance Gaining.

    PubMed

    Pochop, Kayla; Tyler, Jill

    2016-07-01

    A qualitative analysis was conducted exploring physicians' use of compliance gaining strategies used in attempts to change patient behaviors. Analysis revealed six sets of perceptions that describe the ways physicians manage the difficult task of compliance gaining - recognition of failure, tolerance of outside credibility, labeling the "art of medicine," assigning patient responsibility, placing patients on "their journey," and acknowledging "the event." Analysis also identified three key sets of strategies that physicians use in compliance gaining: 1) message strategies (which include direct and strategic attempts to manage interactions about behavior change); 2) relational strategies (which emerge from the relationship shared by the physician and the patient); and 3) personal strategies (which include the individual physician's approaches to compliance gaining). Eight message strategies, three relational strategies, and two personal strategies are identified and described. Copyright© South Dakota State Medical Association.

  5. Exploring Canadian Physicians' Experiences with Diabetes Care for Indigenous Patients.

    PubMed

    Crowshoe, Lynden Lindsay; Henderson, Rita I; Green, Michael E; Jacklin, Kristen M; Walker, Leah M; Calam, Betty

    2017-08-15

    The perspectives of physicians caring for Indigenous patients with diabetes offer important insights into the provision of health-care services. The purpose of this study was to describe Canadian physicians' perspectives on diabetes care of Indigenous patients, a preliminary step in developing a continuing medical education intervention described elsewhere. Through in-depth semistructured interviews, Canadian family physicians and specialists with sizeable proportions of Indigenous clientele shared their experiences of working with Indigenous patients who have type 2 diabetes. Recruitment involved a purposive and convenience sampling strategy, identifying participants through existing research and the professional relationships of team members in the provinces of British Columbia, Alberta and Ontario. Participants addressed their understanding of factors contributing to the disease, approaches to care and recommendations for medical education. The research team framed a thematic analysis through a collaborative, decolonizing lens. The participants (n=28) included 3 Indigenous physicians, 21 non-Indigenous physicians and 4 non-Indigenous diabetes specialists. They practised in urban, reserve and rural adjacent-to-reserve contexts in 5 Canadian provinces. The physicians constructed a socially framed understanding of the complex contexts influencing Indigenous patients with diabetes in tension with structural barriers to providing diabetes care. As a result, physicians adapted care focusing on social factors and conditions that take into account the multigenerational impacts of colonization and the current social contexts of Indigenous peoples in Canada. Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed. Copyright © 2017 The Authors. Published by Elsevier Inc. All

  6. Medicare program; revisions to payment policies under the Physician Fee Schedule, and other part B payment policies for CY 2008; delay of the date of applicability of the revised anti-markup provisions for certain services furnished in certain locations (Sec. 414.50). Final rule.

    PubMed

    2008-01-03

    This final rule delays until January 1, 2009 the applicability of the anti-markup provisions in Sec. 414.50, as revised at 72 FR 66222, except with respect to the technical component of a purchased diagnostic test and with respect to any anatomic pathology diagnostic testing services furnished in space that: Is utilized by a physician group practice as a "centralized building" (as defined at Sec. 411.351 of this chapter) for purposes of complying with the physician self-referral rules; and does not qualify as a "same building" under Sec. 411.355(b)(2)(i) of this chapter.

  7. Physicians beware: revisiting the physician practice acquisition frenzy.

    PubMed

    Eichmiller, Judith Riley

    2014-01-01

    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future.

  8. What makes a physician revenue cycle tick.

    PubMed

    Freeman, Thomas; Stephen, Stan

    2011-09-01

    Hospitals should boost the revenue cycle performance of acquired physician practices by: Effectively assimilating the physician practice into the overall organization. Standardizing revenue cycle processes, policies, and tools between the hospital and physician practice. Enhancing physician/patient scheduling policies and procedures. Regularly auditing physician documentation and periodically comparing hospital charges against practice charges. Improving procedures for responding to denials.

  9. Advanced physicians workbench: an X-Windows-based workstation

    NASA Astrophysics Data System (ADS)

    Braudes, Robert E.; Hauck, Kenneth E.; Mun, Seong K.; Green, Curtis E.; Horii, Steven C.

    1990-08-01

    The Advanced Physicians Workbench (APW) is a radiology image management system display workstation built upon two generally accepted software packages, namely the X Windows System and the Informix database system. Two main purposes for the APW are: (1) to explore the feasibility of building a PACS display station for referring physicians by means of standardized application software development systems and (2) to investigate the use of individual, independent windows for image display and manipulation.

  10. Translation through argumentation in medical research and physician-citizenship.

    PubMed

    Mitchell, Gordon R; McTigue, Kathleen M

    2012-06-01

    While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional resistance. As translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship.

  11. Physician Enabling Skills Questionnaire

    PubMed Central

    Hudon, Catherine; Lambert, Mireille; Almirall, José

    2015-01-01

    Abstract Objective To evaluate the reliability and validity of the newly developed Physician Enabling Skills Questionnaire (PESQ) by assessing its internal consistency, test-retest reliability, concurrent validity with patient-centred care, and predictive validity with patient activation and patient enablement. Design Validation study. Setting Saguenay, Que. Participants One hundred patients with at least 1 chronic disease who presented in a waiting room of a regional health centre family medicine unit. Main outcome measures Family physicians’ enabling skills, measured with the PESQ at 2 points in time (ie, while in the waiting room at the family medicine unit and 2 weeks later through a mail survey); patient-centred care, assessed with the Patient Perception of Patient-Centredness instrument; patient activation, assessed with the Patient Activation Measure; and patient enablement, assessed with the Patient Enablement Instrument. Results The internal consistency of the 6 subscales of the PESQ was adequate (Cronbach α = .69 to .92). The test-retest reliability was very good (r = 0.90; 95% CI 0.84 to 0.93). Concurrent validity with the Patient Perception of Patient-Centredness instrument was good (r = −0.67; 95% CI −0.78 to −0.53; P < .001). The PESQ accounts for 11% of the total variance with the Patient Activation Measure (r2 = 0.11; P = .002) and 19% of the variance with the Patient Enablement Instrument (r2 = 0.19; P < .001). Conclusion The newly developed PESQ presents good psychometric properties, allowing for its use in practice and research. PMID:26889507

  12. Physician perceptions about generic drugs.

    PubMed

    Shrank, William H; Liberman, Joshua N; Fischer, Michael A; Girdish, Charmaine; Brennan, Troyen A; Choudhry, Niteesh K

    2011-01-01

    With constrained health-care resources, there is a need to understand barriers to cost-effective medication use. To study physician perceptions about generic medications. Physicians used 5-point Likert scales to report perceptions about cost-related medication nonadherence, the efficacy and quality of generic medications, preferences for generic use, and the implications of dispensing medication samples. Descriptive statistics were used to assess physician perceptions and logistic regression models were used to evaluate predictors of physician perceptions. Among the invited sample, 839 (30.4%) responded and 506 (18.3%) were eligible and included in the final study population. Over 23% of physicians surveyed expressed negative perceptions about efficacy of generic drugs, almost 50% reported negative perceptions about quality of generic medications, and more than one quarter do not prefer to use generics as first-line medications for themselves or for their family. Physicians over the age of 55 years were 3.3 times more likely to report negative perceptions about generic quality, 5.8 times more likely to report that they would not use generics themselves, and 7.5 times more likely to state that they would not recommend generics for family members (p < 0.05 for all). Physicians reported that pharmaceutical company representatives are the most common (75%) source of information about market entry of a generic medication. Almost half of the respondents expressed concern that free samples may adversely affect subsequent affordability, yet two thirds of respondents provide free samples. A meaningful proportion of physicians expressed negative perceptions about generic medications, representing a potential barrier to generic use. Payors and policymakers trying to encourage generic use may consider educational campaigns targeting older physicians.

  13. Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.

    ERIC Educational Resources Information Center

    Klein, Lawrence E.; And Others

    1981-01-01

    Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)

  14. Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.

    ERIC Educational Resources Information Center

    Klein, Lawrence E.; And Others

    1981-01-01

    Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)

  15. Attitudes toward physician-assisted suicide among physicians in Vermont.

    PubMed

    Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E

    2007-07-01

    Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Cross-sectional mailing survey. 1052 (48% response rate) physicians licensed by the state of Vermont. Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.

  16. Multispecialty physician networks in Ontario

    PubMed Central

    Stukel, Therese A; Glazier, Richard H; Schultz, Susan E; Guan, Jun; Zagorski, Brandon M; Gozdyra, Peter; Henry, David A

    2013-01-01

    Background Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. Methods We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed “loyalty” as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. Results We identified 78 multispecialty physician networks, comprising 12 410 primary care physicians, 14 687 specialists, and 175 acute care hospitals serving a total of 12 917 178 people. Median network size was 134 723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. Interpretation We demonstrated the feasibility

  17. Multispecialty physician networks in Ontario.

    PubMed

    Stukel, Therese A; Glazier, Richard H; Schultz, Susan E; Guan, Jun; Zagorski, Brandon M; Gozdyra, Peter; Henry, David A

    2013-01-01

    Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed "loyalty" as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. We identified 78 multispecialty physician networks, comprising 12,410 primary care physicians, 14,687 specialists, and 175 acute care hospitals serving a total of 12,917,178 people. Median network size was 134,723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. We demonstrated the feasibility of identifying informal multispecialty physician

  18. Medical anthropology and the physician assistant profession.

    PubMed

    Henry, Lisa R

    2015-01-01

    Medical anthropology is a subfield of anthropology that investigates how culture influences people's ideas and behaviors regarding health and illness. Medical anthropology contributes to the understanding of how and why health systems operate the way they do, how different people understand and interact with these systems and cultural practices, and what assets people use and challenges they may encounter when constructing perceptions of their own health conditions. The goal of this article is to highlight the methodological tools and analytical insights that medical anthropology offers to the study of physician assistants (PAs). The article discusses the field of medical anthropology; the advantages of ethnographic and qualitative research; and how medical anthropology can explain how PAs fit into improved health delivery services by exploring three studies of PAs by medical anthropologists.

  19. Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention.

    PubMed

    Schneider, Suzanne; Kingsolver, Karen; Rosdahl, Jullia

    2014-01-01

    Physicians in the United States increasingly confront stress, burnout, and other serious symptoms at an alarming level. As a result, there is growing public interest in the development of interventions that improve physician resiliency. The aim of this study is to evaluate the perceived impact of Physician Well-being Coaching on physician stress and resiliency, as implemented in a major medical center. Semi-structured interviews were conducted with 11 physician-participants, and three coaches of a Physician Well-being Coaching pilot focused on three main areas: life context, impacts of coaching, and coaching process. Interviewees were physicians who completed between three and eight individual coaching sessions between October 2012 and May 2013 through the Physician Well-being Coaching pilot program. Qualitative content analysis of the 11 physician interviews and three coach interviews using Atlas.ti to generate patterns and themes. Physician Well-being Coaching helped participants increase resilience via skill and awareness development in the following three main areas: (1) boundary setting and prioritization, (2) self-compassion and self-care, and (3) self-awareness. These insights often led to behavior changes and were perceived by physicians to have indirect but positive impact on patient care. Devaluing self-care while prioritizing the care of others may be a significant, but unnecessary, source of burnout for physicians. This study suggests that coaching can potentially help physicians alter this pattern through skill development and increased self-awareness. It also suggests that by strengthening physician self-care, coaching can help to positively impact patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Find a Physical Medicine & Rehabilitation Physician

    MedlinePlus

    ... News & Publications About Physiatry About AAPM&R Education Quality ... PM&R physician in your area. You can also search for physicians by name and city/state/country on the "Find Physicians by Name" ...

  1. Explaining the unexplainable - the impact of physicians' attitude towards litigation on their incident disclosure behaviour.

    PubMed

    Renkema, Erik; Broekhuis, Manda H; Ahaus, Kees

    2014-10-01

    This study aims to provide in-depth insight into the emotions and thoughts of physicians towards malpractice litigation, and how these relate to their incident disclosure behaviour. Thirty-one Dutch physicians were interviewed and completed short questionnaires regarding malpractice litigation. We used hierarchical cluster analysis to identify physician clusters. Additional qualitative data were analysed. Physicians vary largely in their attitude towards malpractice litigation, and their attitude is not straightforward related to their disclosure behaviour. Based on their responses physicians could be divided into two clusters: one with a positive and one with a negative attitude. Physicians with a negative attitude showed often, but also 6 out of 15 not, a reluctance to disclose, whereas the majority in the positive attitude cluster (12 out of 16) showed no reluctance. If, what and how physicians disclose incidents depends on a complex interplay of their emotions and thoughts regarding litigation, and not only on their fear of litigation as many studies assume. Due to the variation among physicians in their litigation attitude and behaviour in terms of incident disclosure the oft-heard call for 'openness' about medical incidents will not be easy to achieve. A coaching system in which physicians can share and discuss their differing attitudes and disclosure principles, teaching medical students and junior physicians about disclosure, and explaining how to organize emotional and legal support for oneself in case of litigation could decrease stress feelings and support open disclosure behaviour. © 2014 John Wiley & Sons, Ltd.

  2. [Medicine is not gender-neutral: influence of physician sex on medical care].

    PubMed

    Lagro-Janssen, A L M

    2008-05-17

    Many studies have shown that men and women differ in communication styles. The question is whether these differences also play a role during medical consultation. Potential differences between male and female physicians that have been investigated, are differences in doctor-patient communication, the diagnostic process and treatment. The communication style of female physicians is more patient-oriented than that of male physicians. Male and female physicians differ in their use of additional tests; notably, intimate examinations, such as prostatic or vaginal examinations, are performed less frequently for patients of the opposite sex. Male physicians prescribe medication more frequently; notably sedatives are prescribed more often by male physicians to female patients. Therefore, whether medical care is provided by a male or a female physician makes a difference: the professional role of the physician is not gender-neutral. Within the medical profession, male and female medical students are socialised differently, and professional socialisation does not overcome differences in gender roles. Patients are generally more satisfied with female physicians than male physicians. Knowledge of and insight into these processes is essential for improving the quality of care.

  3. Application of Sociology of Education on Early Childhood Curriculum and Pedagogic Practices in Hong Kong: Insight from David Riesman

    ERIC Educational Resources Information Center

    Lau, Grace; Ho, Kwok Keung

    2016-01-01

    This paper will present multiple themes that are intermingled with one another, aiming to bring an overview of sociology of education and its application in the Hong Kong situation. One of the themes concerns how sociology of education has intertwined with the socio-political aspect of Hong Kong before and after year 1997 resulting in different…

  4. Application of Sociology of Education on Early Childhood Curriculum and Pedagogic Practices in Hong Kong: Insight from David Riesman

    ERIC Educational Resources Information Center

    Lau, Grace; Ho, Kwok Keung

    2016-01-01

    This paper will present multiple themes that are intermingled with one another, aiming to bring an overview of sociology of education and its application in the Hong Kong situation. One of the themes concerns how sociology of education has intertwined with the socio-political aspect of Hong Kong before and after year 1997 resulting in different…

  5. Physician wellness: a missing quality indicator.

    PubMed

    Wallace, Jean E; Lemaire, Jane B; Ghali, William A

    2009-11-14

    When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

  6. Stark II and physician compensation models: integrating business and legal issues.

    PubMed

    Pursell, David; Marsh, Jennifer; Thompson, David; Potter, Keith

    2005-01-01

    In March of 2004, the Centers for Medicare & Medicaid Services released new regulations that interpreted the Federal Physician Self Referral Act, otherwise known as Stark II. The new regulations, commonly referred to as the Phase II regulations, must be carefully considered when structuring physician compensation models. Stark II generally holds that physicians may not make a referral for designated health services to an entity with which they have a direct or indirect financial relationship. This Article outlines the provisions of Stark II that are applicable to physician compensation methodologies. In addition, the authors evaluate hypothetical transactions involving physician groups seeking viable compensation schemes and explore the validity and risks of each.

  7. Finite Difference Simulations of Acoustic and Gravity Wave Propagation in Mars Atmosphere: Applications to INSIGHT NASA Mission and Mars Microphone Experiments

    NASA Astrophysics Data System (ADS)

    Garcia, R.; Brissaud, Q.; Martin, R.; Rolland, L. M.; Komatitsch, D.

    2015-12-01

    A simulation tool of acoustic and gravity wave propagation through finite differences is applied to the case of Mars atmosphere.The details of the code and its validation for Earth atmosphere are presented in session SA003.The simulations include the modeling of both acoustic and gravity waves in the same run, an effects of exponential density decrease, winds and attenuation.The application to Mars requires the inclusion of a specific attenuation effect related to the relaxation induced by vibrational modes of carbon dioxide molecules.Two different applications are presented demonstrating the ability of the simulation tool to work at very different scale length and frequencies.First the propagation of acoustic and gravity waves due to a bolide explosion in the atmosphere of Mars are simulated.This case has a direct application to the atmospheric pressure and seismic measurements that will be performed by INSIGHT NASA discovery mission next year.Then, we also present simulations of sound wave propagation on a scale of meters that can be used to infer the feasability microphone measurements for future Mars missions.

  8. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

    PubMed

    Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke Jah; Schoonhoven, Lisette; Koopmans, Raymond Tcm; Laurant, Miranda Gh

    2017-06-08

    In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated

  9. [The general physician in investigation].

    PubMed

    Tamayo-Pérez, Rubén

    2004-01-01

    The general physician needs the medical specialist to train him/her to initiate clinical investigation. The National Academy of Medicine of Mexico and other institutions should collaborate in this work.

  10. [Activity Polish Physicians of Transcarpathian].

    PubMed

    Ar, Pułyk

    2015-01-01

    The article presents the history of founding of the Organisation of Polish Physicians of Transcarpathian and their participation in presentation of the achievements of Polish Medical Sciences in Ukraine.

  11. Family Homeostasis and the Physician

    PubMed Central

    Jackson, Don D.

    1965-01-01

    Physical illness, including psychosomatic disorders, often play an unexpected role in maintaining emotional balances within the family. The outbreak of such disorders, conversely, can be utilized by the physician as a barometer of family emotional difficulties. PMID:5828172

  12. Today's Physicians Seek Career Direction.

    ERIC Educational Resources Information Center

    Morgan-Haker, Veronica R.

    1998-01-01

    Changes in the role of the physician in today's society have made their career choices risky. Career specialists have an opportunity to assist those who do not normally seek career advice outside their own profession. (JOW)

  13. ERISA litigation and physician autonomy.

    PubMed

    Jacobson, P D; Pomfret, S D

    2000-02-16

    The Employee Retirement Income Security Act (ERISA), enacted in 1974 to regulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in the relationship between themselves and managed care organizations (MCOs), including how it can influence clinical decision making and physician autonomy. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional liability, utilization management, state legislative initiatives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should support efforts to amend ERISA, thus allowing greater state regulatory oversight of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.

  14. Medicare physician payments and spending.

    PubMed

    Dummit, Laura A

    2006-10-09

    The Medicare program's physician payment method is intended to control spending while ensuring beneficiary access to physician services, but there are signs that it may not be working. The physician's role in the health care delivery system as the primary source of information and treatment options, together with growing demand for services and the imperfect state of knowledge about appropriate service use, challenge Medicare's ability to achieve these two goals. This issue brief describes the history of physician spending and the contribution of escalating service use and intensity of services to the rise in Medicare outlays, setting the stage for further discussion about the use of the Medicare payment system to control spending and ensure access.

  15. Web-Based Physician Ratings for California Physicians on Probation.

    PubMed

    Murphy, Gregory P; Awad, Mohannad A; Osterberg, E Charles; Gaither, Thomas W; Chumnarnsongkhroh, Thanabhudee; Washington, Samuel L; Breyer, Benjamin N

    2017-08-22

     Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.  The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.  A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5).  A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender.  Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute

  16. [Collaboration between occupational physicians and other specialists including insurance physicians].

    PubMed

    Rijkenberg, A M; van Sprundel, M; Stassijns, G

    2013-09-01

    Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and

  17. Physician motivation, satisfaction and survival.

    PubMed

    Zimberg, S E; Clement, D G

    1997-01-01

    Physicians are working harder today and enjoying it less. What has happened to create such dissatisfaction among those in one of the most autonomous professions? What can be done to address the anger, fear and unhappiness? This article is an analysis of the factors influencing human motivation. Maslow's hierarchy of needs--physiological, safety/security, social/affiliation, esteem and self-actualization--is used to suggest ways physicians can satisfy their needs in turbulent financial and professional times.

  18. Sex role ideology among physicians.

    PubMed Central

    Leichner, P.; Harper, D.

    1982-01-01

    Physicians have been accused by some feminist writers of having traditional views on sex roles that make them part of society's oppressive power structure and therefore responsible in part for the high incidence of psychologic problems and drug dependency among women. To assess whether physicians' attitudes towards women are indeed polarized in a traditional fashion, a sex role ideology questionnaire was given to all practising physicians belonging to the Manitoba Medical Association. Overall the physicians were found to be more feminist than male college students and a group of women with traditional beliefs. Psychiatrists, who had the highest adjusted group mean score on a sex role ideology scale (high indicating feminist beliefs), were found to be significantly more feminist than family practitioners, surgeons, and obstetricians and gynecologists, although not more so than internists, radiologists, pediatricians and anesthesiologists. These findings do not support the assumption that physicians have traditional views that reflect those of society. However, the significant differences between specialties emphasize the need for educating physicians and medical students in the behaviour of women. PMID:7104916

  19. Work in progress. Integrating physicians' services in the home.

    PubMed Central

    McWilliam, C. L.; Stewart, M.; Sangster, J.; Cohen, I.; Mitchell, J.; Sutherland, C.; Ryan, B.

    2001-01-01

    OBJECTIVE: While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN: A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING: Home care in London, Ont. PARTICIPANTS: Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD: In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS: Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION: Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians. PMID:11785281

  20. Kappa statistic for clustered dichotomous responses from physicians and patients.

    PubMed

    Kang, Chaeryon; Qaqish, Bahjat; Monaco, Jane; Sheridan, Stacey L; Cai, Jianwen

    2013-09-20

    The bootstrap method for estimating the standard error of the kappa statistic in the presence of clustered data is evaluated. Such data arise, for example, in assessing agreement between physicians and their patients regarding their understanding of the physician-patient interaction and discussions. We propose a computationally efficient procedure for generating correlated dichotomous responses for physicians and assigned patients for simulation studies. The simulation result demonstrates that the proposed bootstrap method produces better estimate of the standard error and better coverage performance compared with the asymptotic standard error estimate that ignores dependence among patients within physicians with at least a moderately large number of clusters. We present an example of an application to a coronary heart disease prevention study.

  1. An experimental insight into the evolution of permeability at high temperatures and applications for shallow conduit and lava dome degassing

    NASA Astrophysics Data System (ADS)

    Chadderton, Amy; Sammonds, Peter; Meredith, Philip; Smith, Rosanna; Tuffen, Hugh; Gaunt, Elizabeth

    2016-04-01

    Two recent eruptions in Chile, at Chaitén Volcano in 2008-10 and Cordón Caulle in 2011-12, allowed the first detailed observations of rhyolitic activity and provided insights into the evolution of highly silicic eruptions. Both events exhibited simultaneous explosive and effusive activity, with both lava and ash plumes emitted from the same vent [1]. The permeability of fracture networks that act as fluid flow pathways is key to understanding such eruptive behaviour. Here, we report results from a systematic experimental investigation of permeability in volcanic rocks at magmatic temperatures and pressures, in the presence of pore fluids using our newly-developed high-temperature permeability facility. Enhancements to the High Temperature Triaxial Deformation Cell at UCL [2] have enabled us to make permeability measurements on 25mm x 50mm cores at both elevated temperature and elevated hydrostatic pressure [3]. We present results from several suites of permeability measurements on samples of dome dacite from the 2004-08 eruption of Mount St Helens, and rhyolite collected from the lava dome formed during the 2008-10 eruption of Chaitén, Chile. Tests were conducted at temperatures up to 900oC and under an effective pressure of 5 MPa, using the steady-state flow technique. Samples were cooled to room temperature between each high temperature test, and the permeability of each sample was re-measured before heating to the next temperature increment in the series. Additional longer duration high temperature tests were also conducted to investigate the development of a permeable network at high temperatures over time. The results show a complex permeability evolution that includes a reduction in permeability by approximately 3 orders of magnitude up to 600oC. Together with thermal cracking tests, AE data and SEM/thin section analysis these new experimental permeability results are applied to enhance our understanding of the complex issue of shallow conduit and lava

  2. Balancing practicality and hydrologic realism: Insights from applications of a parsimonious model of unsaturated-zone preferential flow

    NASA Astrophysics Data System (ADS)

    Mirus, B. B.; Perkins, K. S.; Nimmo, J. R.

    2011-12-01

    Simple assessments are often needed to inform local land-management decisions. Preferential flow, a crucial process in many land-management decisions, presents a considerable challenge to the parameterization and evaluation of commonly used hydrologic models. Traditional unsaturated flow theory (i.e., Richards equation) does not accurately represent the physics of preferential flow and often underestimates the arrival time and magnitude of fluxes when applied in situations where preferential flow is important. Another shortcoming of traditional modeling approaches is the considerable data required to characterize the distribution of subsurface hydraulic properties. A source-responsive model has been developed based on film-flow theory to provide more realistic approximations of unsaturated-zone preferential flow when limited data and site characterization are available. The term source-responsive is used to describe the sensitivity of preferential flow to changing conditions at the source of water input, which are typically better quantified than hydraulic properties. We present applications of this parsimonious model for sites in Idaho and Nevada with heterogeneous vadose zones (40 m and 1000 m in thickness, respectively) where radionuclide contamination poses a threat to groundwater quality. Despite differences in input data for each application, results from both applications provide reasonable flux estimates, which are useful for characterizing worst-case scenarios for advective transport of conservative contaminants. We contrast the results for the two applications in terms of the data employed for each and discuss the advantages of the model parameterization, which relies heavily on the quantity and timing of net infiltration. There are several opportunities for improvements in model performance, but these involve greater model complexity with a corresponding increase in free parameters and data requirements. The tradeoff between hydrologic realism and

  3. Prosocial motivation and physicians' work attitudes. Effects of a triple synergy on prosocial orientation in a healthcare organization.

    PubMed

    Kim, Young Shin

    2015-01-01

    Employees work attitudes are key determinants to organizational performance. This article proposes a model integrating servant leadership, prosocial motivation, and corporate social responsibility (CSR) in order to explain a mechanism through which prosocial motivation plays a central role in enhanding physicians' work attitudes. A cross sectional survey from a sample of physicians indicates that (1) prosocial motivation can be shaped from servant leadership when physicians perceive high value fit with their supervisors, (2) prosocial motivation improves physicians' job satisfaction. Its effects is strengthened when physicians perceive high CSR, and (3) job satisfaction improves organizational commitment. The results provide meaningful insights that a triple synergy of prosocial orientation among physicians, supervisors and organization enhances physicians' work attitudes.

  4. Insights into the Regulation of Rhizosphere Bacterial Communities by Application of Bio-organic Fertilizer in Pseudostellaria heterophylla Monoculture Regime.

    PubMed

    Wu, Linkun; Chen, Jun; Wu, Hongmiao; Qin, Xianjin; Wang, Juanying; Wu, Yanhong; Khan, Muhammad U; Lin, Sheng; Xiao, Zhigang; Luo, Xiaomian; Zhang, Zhongyi; Lin, Wenxiong

    2016-01-01

    The biomass and quality of Pseudostellariae heterophylla suffers a significant decline under monoculture. Since rhizosphere miobiome plays crucial roles in soil health, deep pyrosequencing combined with qPCR was applied to characterize the composition and structure of soil bacterial community under monoculture and different amendments. The results showed compared with the 1st-year planted (FP), 2nd-year monoculture of P. heterophylla (SP) led to a significant decline in yield and resulted in a significant increase in Fusarium oxysporum but a decline in Burkholderia spp. Bio-organic fertilizer (MT) formulated by combining antagonistic bacteria with organic matter could significantly promote the yield by regulating rhizosphere bacterial community. However, organic fertilizer (MO) without antagonistic bacteria could not suppress Fusarium wilt. Multivariate statistics analysis showed a distinct separation between the healthy samples (FP and MT) and the unhealthy samples (SP and MO), suggesting a strong relationship between soil microbial community and plant performance. Furthermore, we found the application of bio-organic fertilizer MT could significantly increase the bacterial community diversity and restructure microbial community with relatively fewer pathogenic F. oxysporum and more beneficial Burkholderia spp. In conclusion, the application of novel bio-organic fertilizer could effectively suppress Fusarium wilt by enriching the antagonistic bacteria and enhancing the bacterial diversity.

  5. New insights into the microemulsion-based chromatographic NMR resolution mechanism and its application to fragrance/flavor molecules

    NASA Astrophysics Data System (ADS)

    Hoffman, Roy E.; Aserin, Abraham; Garti, Nissim

    2012-07-01

    The NMR chromatography method is applied to a class of molecules with similar physical properties. We correlate the separation ability of microemulsions to the physical properties of the analyzed molecules. Flavor and aroma compounds are very widespread. Compositional analysis is in many cases tedious. Any new method of analysis is always useful and challenging. Here we show a new application to a class of fragrance molecules, with only a moderate variation in their chemical and physical characteristics. Up to 11 selected compounds in one mixture are resolved in one spectrum by NMR chromatography, despite the similarity of the compounds. The differences between O/W and W/O microemulsions and their resolution mechanism as applied to fragrance molecules are explained in terms of hydrophilicity and lipophilicity and effective critical packing parameters of the microemulsions. The observed diffusion rates are shown to correlate with solvation parameters. These results can be used to estimate the diffusion rates of molecules to be separated, allowing selection of the microemulsion or NMR chromatography solvent appropriate for each specific application.

  6. Application of the design of experiments in optimization of drug layering of pellets with an insight into drug polymer interactions.

    PubMed

    Kovacevic, Jovana; Ibric, Svetlana; Djuris, Jelena; Kleinebudde, Peter

    2016-06-15

    This study consists of two experimental designs. Within the first one, suitable technique for application of model drug onto inactive pellets was evaluated and formulation and process parameters with greatest impact to process efficency and useful yield were determined. Results of experiments showed that formulation characteristics were the ones with the greatest impact on coating efficiency and that suspension layering technique was significantly better for drug application onto inactive pellets in comparison to solution layering during which pronounced agglomeration of pellets occurred. Analysis of drug-polymer interactions by differential scanning calorimetry was performed to explain the results of experiments. The reason for agglomeration of pellets during solution layering was formation of low Tg amorphous form of model drug. The second set of experiments was performed according to central composite design experimental plan in order to optimize level of binder and concentration of solids in the coating liquid which were found to have greatest positive impact on process efficiency and useful yield in the screening study. Statistically significant models were obtained by response surface methodology and it was possible to use them to define optimal levels of excipients in the formulation.

  7. Insights into the Regulation of Rhizosphere Bacterial Communities by Application of Bio-organic Fertilizer in Pseudostellaria heterophylla Monoculture Regime

    PubMed Central

    Wu, Linkun; Chen, Jun; Wu, Hongmiao; Qin, Xianjin; Wang, Juanying; Wu, Yanhong; Khan, Muhammad U.; Lin, Sheng; Xiao, Zhigang; Luo, Xiaomian; Zhang, Zhongyi; Lin, Wenxiong

    2016-01-01

    The biomass and quality of Pseudostellariae heterophylla suffers a significant decline under monoculture. Since rhizosphere miobiome plays crucial roles in soil health, deep pyrosequencing combined with qPCR was applied to characterize the composition and structure of soil bacterial community under monoculture and different amendments. The results showed compared with the 1st-year planted (FP), 2nd-year monoculture of P. heterophylla (SP) led to a significant decline in yield and resulted in a significant increase in Fusarium oxysporum but a decline in Burkholderia spp. Bio-organic fertilizer (MT) formulated by combining antagonistic bacteria with organic matter could significantly promote the yield by regulating rhizosphere bacterial community. However, organic fertilizer (MO) without antagonistic bacteria could not suppress Fusarium wilt. Multivariate statistics analysis showed a distinct separation between the healthy samples (FP and MT) and the unhealthy samples (SP and MO), suggesting a strong relationship between soil microbial community and plant performance. Furthermore, we found the application of bio-organic fertilizer MT could significantly increase the bacterial community diversity and restructure microbial community with relatively fewer pathogenic F. oxysporum and more beneficial Burkholderia spp. In conclusion, the application of novel bio-organic fertilizer could effectively suppress Fusarium wilt by enriching the antagonistic bacteria and enhancing the bacterial diversity. PMID:27899917

  8. Planning and managing the physician workforce.

    PubMed

    Schoenbaum, Stephen C

    2012-03-12

    National planning and management of the physician workforce is a multifaceted, difficult, and even controversial activity. It is an important subset of overall health workforce planning and management, which contributes to a country's having an effective and efficient health care system. This commentary builds on a new survey of specialty considerations by Israeli medical students early in their clinical training, places it in the broader context of health workforce planning, and provides examples of some approaches and activities being taken in the United States that are applicable to other developed countries.This is a commentary on http://www.ijhpr.org/content/1/1/13.

  9. Heavy physician workloads: impact on physician attitudes and outcomes.

    PubMed

    Williams, Eric S; Rondeau, Kent V; Xiao, Qian; Francescutti, Louis H

    2007-11-01

    The intensity of physician workload has been increasing with the well-documented changes in the financing, organization and delivery of care. It is possible that these stressors have reached a point where they pose a serious policy issue for the entire healthcare system through their diminution of physician's ability to effectively interact with patients as they are burned out, stressed and dissatisfied. This policy question is framed in a conceptual model linking workloads with five key outcomes (patient care quality, individual performance, absenteeism, turnover and organizational performance) mediated by physician stress and satisfaction. This model showed a good fit to the data in a structural equation analysis. Ten of the 12 hypothesized pathways between variables were significant and supported the mediating role of stress and satisfaction. These results suggest that workloads, stress and satisfaction have significant and material impacts on patient care quality, individual performance, absenteeism, turnover and organizational performance. Implications of these results and directions for future research are discussed.

  10. Physician recruitment success: how to acquire top physician talent.

    PubMed

    Rosman, Judy

    2011-01-01

    This article provides step-by-step instructions on how to complete the strategic planning needed to ensure success in physician recruitment efforts, outlines how to build a successful recruitment team, and provides helpful advice to avoid common recruiting mistakes that can sabotage the recruitment efforts of even the best practices. This article discusses the role of the in-house hospital recruiter in the recruitment process, how to evaluate independent search firms, how to make use of the physicians in your group to ensure success during a site visit, and how to ensure that your new hire will be able to successfully develop a practice. The article also discusses how to find and use benchmarking data to ensure that your compensation package is competitive, and provides advice on how to help your new physician hit the ground running.

  11. Carbon and nitrogen dynamics in a soil profile: Model insights and application to a restored Swiss riparian area

    NASA Astrophysics Data System (ADS)

    Brovelli, Alessandro; Batlle-Aguilar, Jordi; Luster, Jörg; Shrestha, Juna; Huber, Benjamin; Niklaus, Pascal; Barry, D. Andrew

    2010-05-01

    soil properties measured at one location of the RECORD experimental site, in a mixed forest dominated by ash and maple characteristic for the transition from riparian to upland forest, was used to validate the model and to gain insights into the key factors controlling the nutrient turnover. The site is located next to the Thur River where a revitalization project involving removal of levees has been implemented to create more natural conditions in the riparian zone. Soil water content and temperature at several depths were monitored continuously between October 2008 and October 2009. In October 2008, January 2009 and in biweekly frequency between April and October 2009, topsoil and soil solution at several depths were sampled. The soil solution samples were analysed for major carbon and nitrogen species, and the soil samples for denitrification enzyme activity, potential nitrification and related properties. In addition, soil respiration and N2O emissions were measured at each sampling event. Preliminary modelling results are shown, together with a discussion of the most influential parameters and processes controlling C and N turnover in riparian soils.

  12. Physician wages across specialties: informing the physician reimbursement debate.

    PubMed

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L

    2010-10-25

    Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

  13. Psychiatric rehabilitation education for physicians.

    PubMed

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011).

  14. Recruiting physicians without inviting trouble.

    PubMed

    Hoch, L J

    1989-05-01

    Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

  15. Career changes among Saskatchewan physicians.

    PubMed Central

    Shaw, S; Goplen, G; Houston, D S

    1996-01-01

    OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring. PMID:8625024

  16. [Erasmian influences among renaissance physicians].

    PubMed

    de Micheli, Alfredo

    2002-01-01

    The fundamental aspects of Erasmus's ethic humanism consisted of ideals of universal peace and tolerance. These ideals are exposed in the great works of his maturity Colloquia and Adagia read and meditated on by renaissance physicians in England, Spain, Germany, Italy, and also in the New Spain. Erasmus's readers were learned and numerous. Among his pupils and supporters in Spain were humanist physicians of Madrid such as Doctors Suárez and Juan de Jarava. Other supporters were in the group of the Sevillian physicians and naturalists. Among the Erasmist physicians, residing in other regions was doctor Andrés Laguna, who translated into Spanish the Dioscorides treatise on medical botany. Many physicians living in New Spain owned copies of Erasmian works, such as Doctors Pedro López (the second) and Juan de la Fuente, who was in charge of the first medical chair at the University of Mexico. The protophysician Francisco Hernández, in response to a petition of Archbishop Pedro Moya de Contreras, wrote a Christian catechism of Erasmian influence, destined for humanists in NewSpain. As asserted by Johan Huizinga, Erasmus was the sole humanist who really wrote for everyone, i.e. for all cultured people.

  17. Physicians' recognition of death in the foreseeable future in patients with intellectual disabilities.

    PubMed

    Vrijmoeth, C; Christians, M G M; Festen, D A M; Groot, M; Tonino, M; Echteld, M A

    2016-03-01

    Physicians are increasingly confronted with people with intellectual disabilities (ID) who are facing life-threatening diseases. We aimed to explore when and based on which information sources and signals physicians recognised that a patient with ID would die in the foreseeable future. Insights may help in identifying patients in need of palliative care. In this study, 81 physicians for people with ID and 16 general practitioners completed a retrospective survey about their last case of a patient with ID with a non-sudden death. More than 20% of all physicians foresaw death not until the last week of life. In 30% of all patients, the physician did not discuss the start of the palliative care phase until the last week. The most reported information sources based on which physicians foresaw death were the physicians themselves and professional caregivers. We found 40 different signals that lead to physicians' foreseeing death. These were not only medical signals but also behavioural and physical signals. Results indicate that the physicians' ability to foresee death is a result of a process of growing awareness in which multiple signals from different information sources converge. This demands continuous multi-disciplinary communication because people involved have their own unique interactions with the patient and can therefore contribute to a growing and timely awareness of patients' death in the future. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  18. Development and Validation of a Computer Application to Aid the Physician's Decision-Making Process at the Start of and during Treatment with Insulin in Type 2 Diabetes: A Randomized and Controlled Trial

    PubMed Central

    Sáenz, Antonio; Brito, Miguel; Morón, Ignacio; Torralba, Amalia; García-Sanz, Elena; Redondo, Jesus

    2012-01-01

    Background Achieving optimum blood glucose control in patients with type 2 diabetes mellitus (T2DM) is difficult. Some primary care physicians (PCPs) delay the start of insulin use because of the uncertainty in intensifying insulin therapy. The objective was to develop and validate a computer application (CA) that helps PCPs to make decisions about insulin therapy in order to achieve a significant improvement in glycated hemoglobin (HbA1c). Methods This was a cluster-randomized clinical trial. Fourteen primary care centers (PCCs) in Madrid with 66 PCPs and 697 T2DM patients on insulin therapy were randomly divided into two groups of seven PCCs each. In the intervention group, seven PCCs included 39 PCPs and 365 T2DM patients on insulin therapy. These PCPs were free to use the CA. A further seven PCCs were assigned to the control group with 27 PCPs and 332 T2DM patients on insulin therapy. The control group did not use the CA. The duration of the trial was 18 months to validate the CA. The outcome was a change in HbA1c from baseline. Results In the intervention group, the final HbA1c was 7.19% (standard deviation [SD] ± 0.93), with a difference from the start of -0.69% (p = .001). In the control group, it was 7.71% (SD ± 1.37), with a difference from the start of -0.09% (p not significant). Conclusions This CA helps to improve HbA1c figures of T2DM patients with insulin when it is used by PCPs to make decisions when starting, continuing, or changing insulin and its dosage. PMID:22768889

  19. Fluorescence of the Flavin group in choline oxidase. Insights and analytical applications for the determination of choline and betaine aldehyde.

    PubMed

    Ortega, E; de Marcos, S; Sanz-Vicente, I; Ubide, C; Ostra, M; Vidal, M; Galbán, J

    2016-01-15

    Choline oxidase (ChOx) is a flavoenzyme catalysing the oxidation of choline (Ch) to betaine aldehyde (BA) and glycine betaine (GB). In this paper a fundamental study of the intrinsic fluorescence properties of ChOx due to Flavin Adenine Dinucleotide (FAD) is presented and some analytical applications are studied in detail. Firstly, an unusual alteration in the excitation spectra, in comparison with the absorption spectra, has been observed as a function of the pH. This is ascribed to a change of polarity in the excited state. Secondly, the evolution of the fluorescence spectra during the reaction seems to indicate that the reaction takes place in two consecutive, but partially overlapped, steps and each of them follows a different mechanism. Thirdly, the chemical system can be used to determine the Ch concentration in the range from 5×10(-6)M to 5×10(-5)M (univariate and multivariate calibration) in the presence of BA as interference, and the joint Ch+BA concentration in the range 5×10(-6)-5×10(-4)M (multivariate calibration) with mean errors under 10%; a semiquantitative determination of the BA concentration can be deduced by difference. Finally, Ch has been successfully determined in an infant milk sample.

  20. Sol-Gel Microspheres Doped with Glycerol: A Structural Insight in Light of Forthcoming Applications in the Polyurethane Foam Industry

    PubMed Central

    Ciriminna, Rosaria; Fidalgo, Alexandra; Ilharco, Laura M; Pagliaro, Mario

    2015-01-01

    Porous silica-based microspheres encapsulating aqueous glycerol can be potential curing agents for one-component foams (OCFs). Such agents have the advantage of an enhanced sustainability profile on top of being environmentally friendly materials. A synthetically convenient and scalable sol-gel process was used to make silica and organosilica microspheres doped with aqueous glycerol. These methyl-modified silica microspheres, named “GreenCaps”, exhibit remarkable physical and chemical stability. The microspheres were characterized by scanning electron microscopy, transmission electron microscopy at reduced pressure, and cryogenic nitrogen adsorption—desorption analysis. The structure of the materials was also analyzed at the molecular level by diffuse reflectance infrared Fourier transform (DRIFT) spectroscopy. As expected, the degree of methylation affects the degree of encapsulation and pore structure. Microspheres similarly methylated, however, can differ considerably in surface area and pore size due to the templating effect of glycerol on the organosilica structure. The results of the structure analysis reveal that glycerol is efficiently encapsulated, acts as a template, barely leaches over time, but is released by depressurization. A proper application of these microspheres can later on enhance both the environmental and health profile, as well as the technical performance (curing speed, foam quality, and froth thixotropy) of spray polyurethane foams. PMID:25969809

  1. Large ensemble and large-domain hydrologic modeling: Insights from SUMMA applications in the Columbia River Basin

    NASA Astrophysics Data System (ADS)

    Ou, G.; Nijssen, B.; Nearing, G. S.; Newman, A. J.; Mizukami, N.; Clark, M. P.

    2016-12-01

    The Structure for Unifying Multiple Modeling Alternatives (SUMMA) provides a unifying modeling framework for process-based hydrologic modeling by defining a general set of conservation equations for mass and energy, with the capability to incorporate multiple choices for spatial discretizations and flux parameterizations. In this study, we provide a first demonstration of large-scale hydrologic simulations using SUMMA through an application to the Columbia River Basin (CRB) in the northwestern United States and Canada for a multi-decadal simulation period. The CRB is discretized into 11,723 hydrologic response units (HRUs) according to the United States Geologic Service Geospatial Fabric. The soil parameters are derived from the Natural Resources Conservation Service Soil Survey Geographic (SSURGO) Database. The land cover parameters are based on the National Land Cover Database from the year 2001 created by the Multi-Resolution Land Characteristics (MRLC) Consortium. The forcing data, including hourly air pressure, temperature, specific humidity, wind speed, precipitation, shortwave and longwave radiations, are based on Phase 2 of the North American Land Data Assimilation System (NLDAS-2) and averaged for each HRU. The simulation results are compared to simulations with the Variable Infiltration Capacity (VIC) model and the Precipitation Runoff Modeling System (PRMS). We are particularly interested in SUMMA's capability to mimic model behaviors of the other two models through the selection of appropriate model parameterizations in SUMMA.

  2. Selection of the Family Physician

    PubMed Central

    Christ, L. W. A. C.; Harris, A. L.; Korchinski, E. D.

    1976-01-01

    This study was conducted to examine the characteristics of ‘initial visits’ by patients, contrasted with ‘average visits’, to discover what is needed to establish a satisfactory patient-physician relationship leading to long term continuous care. In the initial visit, the patient presents with a relatively simple problem which will enable the physician to demonstrate his ability without unduly taxing his skills. This suggests that patients create an opportunity for a thorough face-to-face contact to provide an opportunity for the physician to display his ability so that the patient's desire for a long term relationship can be achieved. The study also suggests that patients' expectations have changed in proportion to changes in the mode of medical practice. PMID:21308071

  3. An intelligent assistant for physicians.

    PubMed

    Gavrilis, Dimitris; Georgoulas, George; Vasiloglou, Nikolaos; Nikolakopoulos, George

    2016-08-01

    This paper presents a software tool developed for assisting physicians during an examination process. The tool consists of a number of modules with the aim to make the examination process not only quicker but also fault proof moving from a simple electronic medical records management system towards an intelligent assistant for the physician. The intelligent component exploits users' inputs as well as well established standards to line up possible suggestions for filling in the examination report. As the physician continues using it, the tool keeps extracting new knowledge. The architecture of the tool is presented in brief while the intelligent component which builds upon the notion of multilabel learning is presented in more detail. Our preliminary results from a real test case indicate that the performance of the intelligent module can reach quite high performance without a large amount of data.

  4. Physician business deals: surveying the new landscape.

    PubMed

    Harris, John M; Kaplan, Karin Chernoff

    2009-05-01

    Strong hospitals and health systems should be on the lookout for opportunities today to acquire physician businesses at depressed fair market values. In some instances, an outright purchase of physicians' interest in a physician-hospital joint venture may be preferable; in others, the hospital may benefit more from simply increasing its interest in the venture. A critical part of the strategy should be taking steps to ensure the physicians remain engaged, including addressing physicians' income goals and need for control.

  5. Analysis of physicians' perspectives versus patients' preferences: direct assessment and discrete choice experiments in the therapy of multiple myeloma.

    PubMed

    Mühlbacher, Axel C; Nübling, Matthias

    2011-06-01

    , followed by emotional quality of life (specified as "Not always think of the disease") and therapy-free intervals. Especially further treatment options and dosage were more important to patients than physicians believed. In this case, the physicians had quite obviously underestimated the importance of these attributes from the perspective of those affected. Physicians ranked prolonged life expectancy as relatively the most important and significantly more important than all other treatment attributes. Further treatment options were the second most important attribute and significant compared to the attributes breaks in therapy and physical quality of life, whereas the patients ordered these two attributes in reverse order. Similarly, the patients gave the opposite relative importance to the next two priorities: self-application of treatment and emotional quality of life. Asking patients or physicians about the multiple myeloma patients' treatment preferences, the combination of direct assessment and DCE proves to be a valid survey technique. Over a broad range of treatment attributes, the physicians' perceptions of preferences were very close to those of multiple myeloma patients. Both the direct assessment of importance in order to rank the patient perceptions and the DCE provide important insights into the preference structure of patients with multiple myeloma. The findings can subsequently be used as a basis for tailoring health care services for multiple myeloma patients in reference to their preferences.

  6. Primary care physicians shortage: a Korean example.

    PubMed

    Cho, Kyung-Hwan; Roh, Yong-Kyun

    2003-01-01

    A mismatch in the demand and supply of primary care physicians could give rise to a disorganization of the health care system and public confusion about health care access. There is much evidence in Korea of the existence of a primary care physician shortage. The appropriate required ratio of primary care physicians to the total number of physicians is estimated by analyzing data for primary care insurance consumption in Korea. Sums of primary care expenditure and claims were calculated to estimate the need for primary care physicians by analyzing the nationwide health insurance claims data of the Korean National Medical Insurance Management Corporation (KNMIMC) between the years 1989-1998. The total number of physicians increased 183% from 1989 to 1998. However, the number of primary care physicians including general physicians, family physicians, general internists, and general pediatricians showed an increase of only 169% in those 10 years. The demand for primary care physicians reaches at least 58.6%, and up to 83.7%, of the total number of physicians in Korea. However, the number of primary care physicians comprises up to 22.0% of the total number of active physicians during the same research period, which showed a large gap between demand and supply of primary care physicians in Korea. To provide high quality care overall, a balanced supply of primary care physicians and specialists is required, based on the nation's demand for health services.

  7. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...

  8. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians....

  9. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...

  10. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians....

  11. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...

  12. [Sherlock Holmes as amateur physician].

    PubMed

    Madsen, S

    1998-03-30

    The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs.

  13. Euthanasia and physicians' moral duties.

    PubMed

    Seay, Gary

    2005-10-01

    Opponents of euthanasia sometimes argue that it is incompatible with the purpose of medicine, since physicians have an unconditional duty never to intentionally cause death. But it is not clear how such a duty could ever actually be unconditional, if due consideration is given to the moral weight of countervailing duties equally fundamental to medicine. Whether physicians' moral duties are understood as correlative with patients' moral rights or construed noncorrelatively, a doctor's obligation to abstain from intentional killing cannot be more than a defeasible duty.

  14. Towards the proletarianization of physicians.

    PubMed

    McKinlay, J B; Arches, J

    1985-01-01

    The thesis of this article is that in general where most other workers were quickly and easily proletarianized, physicians - through the use of a variety of tactics at the disposal of some elite groups - have, until now, been able to postpone or minimize this process in their own case. Now, as a result of the bureaucratization which is being forced on medical practice as a consequence of the logic of capitalist expansion, physicians are slowly being reduced to a proletarian function, and their formerly self-interested activities subordinated to the broader requirements of the capitalist control of highly profitable medical production.

  15. How Is Physician Work Valued?

    PubMed

    Jacobs, Jeffrey P; Lahey, Stephen J; Nichols, Francis C; Levett, James M; Johnston, George Gilbert; Freeman, Richard K; St Louis, James D; Painter, Julie; Yohe, Courtney; Wright, Cameron D; Kanter, Kirk R; Mayer, John E; Naunheim, Keith S; Rich, Jeffrey B; Bavaria, Joseph E

    2017-02-01

    Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist

  16. Triage practices in stroke units: Physicians' perceptions and ethical issues.

    PubMed

    Yger, M; Crozier, S; Dubourdieu, S; Vivien, B; Dolveck, F; Samson, Y

    2016-02-01

    We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France. In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations. In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities). Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine. Copyright © 2015. Published by Elsevier Masson SAS.

  17. A review of instruments measuring nurse-physician collaboration.

    PubMed

    Dougherty, Mary B; Larson, Elaine

    2005-05-01

    To review instruments used to measure nurse-physician collaboration and compare the strengths and potential opportunities of each instrument. Nurse-physician collaboration has been studied using a variety of instruments. The ability to generalize the outcomes of studies and build on the findings is predicated on acceptable validity and reliability metrics of these instruments. A literature search using PubMed and Health and Psychological Instruments databases was conducted for articles published between 1990 and May 2004 to identify instruments measuring staff nurse-physician collaboration. After the instruments were identified, a second search was conducted to identify at least one peer-reviewed article describing the psychometrics of the instrument. Articles identified were then entered into the ISI Web of Science Citation Index to identify the instruments that had been used in at least 2 other studies. These selected instruments were then reviewed for the following information: background for the development of the tool, description of the tool, initial psychometric testing, and strengths and potential applications for each instrument. Five instruments met study criteria: the Collaborative Practice Scale, Collaboration and Satisfaction About Care Decisions, ICU Nurse-Physician Questionnaire, Nurses Opinion Questionnaire, and the Jefferson Scale of Attitudes Toward Physician Nurse Collaboration. The identified instruments have undergone initial reliability and validity testing and are recommended for future research on nurse-physician collaboration.

  18. Physicians' opinions following pharmacogenetic testing for psychotropic medication.

    PubMed

    Walden, Lucas M; Brandl, Eva J; Changasi, Amtul; Sturgess, Jessica E; Soibel, Alexander; Notario, Janna Fe D; Cheema, Sheraz; Braganza, Nicole; Marshe, Victoria S; Freeman, Natalie; Tiwari, Arun K; Kennedy, James L; Müller, Daniel J

    2015-10-30

    Pharmacogenetics seeks to improve patient drug response and decrease side effects by personalizing prescriptions using genetic information. Since 2012, by one estimate, the number of patients who have had pharmacogenetic testing has doubled and this number is expected to double again by 2015. Given the increasing evidence for genetic influences on treatment response, we deemed it important to study physicians' opinions of pharmacogenetic testing. Surveys were completed by 168 Canadian physicians who had ordered at least one pharmacogenetic test (in particular for CYP2D6 or CYP2C19) for the prescription of psychiatric medication. Our results indicated that 80% of respondents believe genetic testing would become common standard in psychiatric drug treatment and 76% of respondents reported satisfactory or higher than satisfactory understanding of the pharmacogenetic report provided. Significantly more male physicians believed they had a higher understanding of the pharmacogenetic report compared to female physicians. To our knowledge, this is the only study that has assessed physicians' opinions of pharmacogenetic testing for psychotropic medication after they had received a pharmacogenetic report. Our results demonstrate a positive opinion of physicians on pharmacogenetics and indicate great potential for future clinical application.

  19. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    PubMed Central

    Brehaut, Jamie C; Poses, Roy; Shojania, Kaveh G; Lott, Alison; Man-Son-Hing, Malcolm; Bassin, Elise; Grimshaw, Jeremy

    2007-01-01

    variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey), and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey), for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete. Discussion This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments. PMID:17555586

  20. The Soil and Water Assessment Tool (SWAT) Ecohydrological Model Circa 2015: Global Application Trends, Insights and Issues

    NASA Astrophysics Data System (ADS)

    Gassman, P. W.; Arnold, J. G.; Srinivasan, R.

    2015-12-01

    The Soil and Water Assessment Tool (SWAT) is one of the most widely used watershed-scale water quality models in the world. Over 2,000 peer-reviewed SWAT-related journal articles have been published and hundreds of other studies have been published in conference proceedings and other formats. The use of SWAT was initially concentrated in North America and Europe but has also expanded dramatically in other countries and regions during the past decade including Brazil, China, India, Iran, South Korea, Southeast Asia and eastern Africa. The SWAT model has proven to be a very flexible tool for investigating a broad range of hydrologic and water quality problems at different watershed scales and environmental conditions, and has proven very adaptable for applications requiring improved hydrologic and other enhanced simulation needs. We investigate here the various technological, networking, and other factors that have supported the expanded use of SWAT, and also highlight current worldwide simulation trends and possible impediments to future increased usage of the model. Examples of technological advances include easy access to web-based documentation, user-support groups, and SWAT literature, a variety of Geographic Information System (GIS) interface tools, pre- and post-processing calibration software and other software, and an open source code which has served as a model development catalyst for multiple user groups. Extensive networking regarding the use of SWAT has further occurred via internet-based user support groups, model training workshops, regional working groups, regional and international conferences, and targeted development workshops. We further highlight several important model development trends that have emerged during the past decade including improved hydrologic, cropping system, best management practice (BMP) and pollutant transport simulation methods. In addition, several current SWAT weaknesses will be addressed and key development needs will be

  1. The process of earthflow propagation: insights from an application of the SPH technique to a case history

    NASA Astrophysics Data System (ADS)

    Lollino, Piernicola; Giordan, Daniele; Allasia, Paolo; Pastor, Manuel

    2016-04-01

    An intense reactivation of a large earthflow (about 6 million m3 of soil debris) took place in Montaguto (Southern Apennines, Italy) between 2005 and 2006 as a consequence of the retrogression of a sliding process in the source area at the top of the slope. The earthflow run-out was approximately 2-2.5 km long, with the landslide mass thickness approximately ranging between 5 m and 30 m. Relevant damages were produced at the toe of the slope, since important infrastructures hereby located were covered by large volumes of landslide detritum. In the transition area, that is just downslope the source area, the landslide soil mass was channelized and transformed into a viscous soil flowing down through a natural depression channel, with an average displacement rate estimated to range between 3 and 7 m/day. In this work an application of the Smoothed Particle Hydrodynamics method has been carried out in order to simulate both the main features of the earthflow propagation, that is the direction and the thickness of the flowing mass, as well as to investigate some factors of the soil mechanical behavior that might have controlled the earthflow mobility. In particular, two different assumptions concerning the soil rheology, i.e. Bingham visco-plasticity and frictional-consolidating soil, the first complying more with the assumption of a flow-like behavior and the latter with a soil-like behavior of the landslide mass, have been made for comparison purposes. Based on the experiences gained from previous authors concerning the in-situ features of similar earthflow soil masses, these landslides are thought to behave more as a viscous fluid during the very first stages of propagation due to phase transition processes and, later on, to recover a soil-like behavior, therefore characterized by sliding mechanism, due to soil consolidation processes. Field evidences of consolidation processes have indeed been observed in situ in recent years based on pore water pressure monitoring

  2. [Systematic training for occupational physicians in schools of public health in the US and its application to Japan's system--Master of Public Health Program at Harvard School of Public Health].

    PubMed

    Tsuji, Hiroshi; Usuda, Kan; Kono, Koichi

    2011-01-01

    Globalization has progressed tremendously resulting in far-reaching changes in the work environment. In Japan, occupational health and safety (OSH) activities are performed under and improved by regulations. However, this system is not likely to satisfy the unceasing diversification of social demand for OSH in recent years. The US adopts a self-imposed OSH system with responsibility carried by employers under a system of minimum regulation. This paper introduces the systematic training for occupational physicians in schools of public health in the US, which is creating a base of OSH professionals who can meet social demand. To satisfy the diverse demand for recent OSH, it is essential to improve the basic skills of occupational physicians and other OSH professionals by offering systematic training in Japan. Some examples of systematic training for occupational physicians in schools of public health in the US are discussed with the goal of improving Japan's future OSH.

  3. Choosing among the physician databases.

    PubMed

    Heller, R H

    1988-04-01

    Prudent examination and knowing how to ask the "right questions" can enable hospital marketers and planners to find the most accurate and appropriate database. The author compares the comprehensive AMA physician database with the less expensive MEDEC database to determine their strengths and weaknesses.

  4. Training Physicians in Palliative Care.

    ERIC Educational Resources Information Center

    Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

    1999-01-01

    Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

  5. [The tragic fate of physicians].

    PubMed

    Ohry, Avi

    2013-10-01

    Physicians and surgeons were always involved in revolutions, wars and political activities, as well as in various medical humanities. Tragic fate met these doctors, whether in the Russian prisons gulags, German labor or concentration camps, pogroms or at the hands of the Inquisition.

  6. Marketer's forgotten challenge: physician recruitment.

    PubMed

    Plank, D

    1997-01-01

    As marketing department missions continue to expand, more and more people are finding themselves not just recruiting customers, but doctors. The good news: May of the tips and tricks of direct marketing can be used to reach out to in-demand physicians.

  7. Individual Physician Profile. Final Report.

    ERIC Educational Resources Information Center

    Wisconsin Univ., Madison. Dept. of Postgraduate Medical Education.

    This document reports the procedures and data of a study designed to examine the hypotheses that medical practices do vary significantly. Detailed data on 76 participants were collected; three mechanisms were developed to determine the needs of primary care physicians. These mechanism were: subjective analysis by both participants and study staff,…

  8. Information Searching Behavior of Physicians.

    ERIC Educational Resources Information Center

    Trueswell, R.W.; Rubenstein, A.H.

    The purpose of this study was to provide some preliminary data about the information-searching behavior of the physician in order to (1) facilitate the development of models describing the search behavior and (2) provide the behavioral data necessary for the development of effective information retrieval systems for use by the medical profession.…

  9. Training Physicians in Palliative Care.

    ERIC Educational Resources Information Center

    Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

    1999-01-01

    Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

  10. Physician Migration: Donor Country Impact

    ERIC Educational Resources Information Center

    Aluwihare, A. P. R.

    2005-01-01

    Physician migration from the developing to developed region of a country or the world occurs for reasons of financial, social, and job satisfaction. It is an old phenomenon that produces many disadvantages for the donor region or nation. The difficulties include inequities with the provision of health services, financial loss, loss of educated…

  11. The Mindful Physician and Pooh

    ERIC Educational Resources Information Center

    Winter, Robin O.

    2013-01-01

    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  12. Addressing physicians' impaired communication skills.

    PubMed

    Egener, Barry

    2008-11-01

    Deficient physician communication skills can lead to complaints by patients and colleagues. While there are many communication training courses for physicians, there are few descriptions of programs that address their deficiencies. This report describes the use of a coaching model developed by the author to remediate inadequate communication skills. The coaching model consists of a discrete set of communication skills that are gradually integrated into professional activities while debriefing that process in a supportive relationship. Outcomes are provided for the first 13 physicians coached after the approach was standardized. On a Likert scale (range, 1-7), with 7 expressing "high satisfaction," all participants rated the consultation in the 5-7 range (mean, 6.3), and all supervisors rated the consultation in the 6-7 range (mean, 6.7). A coaching model is effective in improving communication skills deemed inadequate by physicians' patients and colleagues. Future work should evaluate the impact of integrating coaching into health care organizations and on developing new tools to augment coaching.

  13. Physician Requirements-1990. For Nephrology.

    ERIC Educational Resources Information Center

    Rosenbach, Joan K.

    Professional requirements for physicians specializing in nephrology were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for nephrology, a nephrology Delphi panel reviewed reference and incidence-prevalence and utilization data for 34 conditions that are treated in the…

  14. Physician burnout: A neurologic crisis.

    PubMed

    Sigsbee, Bruce; Bernat, James L

    2014-12-09

    The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments. © 2014 American Academy of Neurology.

  15. A physician assistant rheumatology fellowship.

    PubMed

    Hooker, Roderick S

    2013-06-01

    A rheumatology postgraduate fellowship for physician assistants was inaugurated in 2004 as a pilot initiative to supplement shortages in rheumatologists. An administrative analysis documented that each PA trainee achieved a high level of rheumatology exposure and proficiency. Classes in immunology, rheumatology, and internal medicine augmented clinical training. Faculty and trainees considered PA postgraduate training in rheumatology worthwhile.

  16. Physician Requirements-1990. For Allergy.

    ERIC Educational Resources Information Center

    Thorner, Robert N.; Rudzinski, Karen

    Professional requirements for physicians specializing in allergy were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for allergy, an allergy Delphi panel reviewed reference and incidence-prevalence and utilization data for 21 conditions that affect the ambulatory care…

  17. Physician Requirements-1990. For Pediatrics.

    ERIC Educational Resources Information Center

    Rudzinski, Karen; Thorner, Robert N.

    Professional requirements for physicians specializing in pediatrics were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for pediatrics, the pediatrics Delphi panel reviewed reference and incidence-prevalence and utilization data for 230 conditions that affect the…

  18. Strategies for redesigning physician compensation.

    PubMed

    Corneliuson, Susan K; Hackman, Brian

    2014-07-01

    Five principles should guide a health system's efforts to redesign its physician compensation plan: Goals should be aligned. Goals should not focus solely on productivity. Metrics should be not only individual, but also team-based. Initial metrics should be selected from among those currently being used. Compensation plans should avoid long-term commitments.

  19. Business plan writing for physicians.

    PubMed

    Cohn, Kenneth H; Schwartz, Richard W

    2002-08-01

    Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.

  20. Physician-centered management guidelines.

    PubMed

    Pulde, M F

    1999-01-01

    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

  1. Hitler’s Jewish Physicians

    PubMed Central

    Weisz, George M.

    2014-01-01

    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler. PMID:25120923

  2. Costs of Physician-Hospital Integration

    PubMed Central

    Cho, Na-Eun

    2015-01-01

    Abstract Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration. PMID:26496300

  3. Costs of Physician-Hospital Integration.

    PubMed

    Cho, Na-Eun

    2015-10-01

    Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration.

  4. Attitudes toward physician advertising among rural consumers.

    PubMed

    Kviz, F J

    1984-04-01

    The issue of whether physicians should advertise their services has been the subject of much debate among health policymakers. This study reports data from a survey of rural residents in Illinois regarding attitudes toward physician advertising and reasons for opposition or support of the practice. The results indicate neither strong opposition nor strong support for physician advertising. While those who are opposed are largely nonspecific regarding their reasons, those in favor primarily expect that it will aid in the selection of a physician. However, few respondents indicate a predisposition to shop for a physician. Although the major concern about physician advertising is a danger of false advertising by some physicians, it appears that the respondents are not trusting of advertising in general rather than of advertising by physicians in particular. These findings suggest that regardless of its potential advantages, physician advertising may be relatively ineffective because consumers may be inattentive, unresponsive, or distrusting .

  5. Heuristic estimation of dust devil vortex parameters and trajectories from single-station meteorological observations: Application to InSight at Mars

    NASA Astrophysics Data System (ADS)

    Lorenz, Ralph D.

    2016-06-01

    A physically-realistic migrating vortex model is developed and applied to generate pressure and wind speed and direction histories for dust devil passage. The asymmetric character of wind histories is noted, and we examine how these combined data constrain the solution space of dust devil parameters (migration velocity, diameter and intensity), ambient wind, and miss distance. These histories are compared with a new terrestrial field dataset of high-time resolution pressure and wind measurements of over twenty dust devil encounters in New Mexico. This new dataset is made available electronically and it is found that model fits can be typically achieved with simultaneous root-mean-square errors of ∼0.05 hPa (∼5-10% of the peak pressure signature), ∼20°of wind azimuth, and ∼2 m/s windspeed. The fits are not unique, however, and some heuristic aspects of resolving the intrinsic degeneracies of the problem and nonideal features of real encounters are discussed. The application of this approach to the InSight lander is noted, offering the possibility of defining the context for any possible detections of electromagnetic and seismic signatures of dust devils on Mars.

  6. Challenges in developing physician leadership and management.

    PubMed

    Guthrie, M B

    1999-01-01

    Many of the issues confronting healthcare organizations require physician involvement and understanding, and the physician executive is a tool to achieving physician participation. Physician leaders can become the mediators between physicians and organizational management, minimizing miscommunication and maximizing agreement and understanding. Yet few doctors seem willing to stand up and speak positively for the plans and proposals that will move the institution forward, and healthcare executives are often frustrated by physician leadership that fails to articulate and implement the vision and objectives of the organization. Understanding physician leadership and exploring the challenges in managing and leading physicians require an understanding of the physician mindset--a completely different mindset than that of the typical healthcare executive. Beginning with a discussion of the unique situation faced by physicians in leadership positions, this article attempts to define the obstacles faced by both the physician and the executive in developing the role of physician executive. After reviewing the opportunities open to physician executives for improving leadership ability, the author presents the essential characteristics and core skills for effective leadership. The second half of the article suggests ways in which an organization can reemphasize physician leadership development within an organization from selection of potential candidates to creating training and networking opportunities and offering appropriate incentives.

  7. Medical interviewing by exemplary family physicians.

    PubMed

    Marvel, M K; Doherty, W J; Weiner, E

    1998-11-01

    Little is known about the extent to which models of ideal physician-patient interviews are actually practiced by physicians. This study examined physician-patient communication during medical interviews by exemplary family physicians. We performed a cross-sectional study of verbal exchanges using 300 transcripts of office visits made to two groups of family physicians: 9 exemplars and 20 controls. The exemplars were family physicians with fellowship training in family therapy; the control group consisted of a convenience sample of board-certified family physicians with no special training in communication skills or counseling. Data were collected from June 1995 to July 1996. Physician statements were rated according to the Level of Physician Involvement model, which measures physicians' abilities to collaborate with patients and address the psychosocial concerns of patients and their families. Patient satisfaction ratings were obtained by a research assistant immediately after the visit. Compared with the control physicians, the exemplars showed higher levels of psychosocial involvement with patients during routine office visits. In particular, they involved patients more in the medical interview, offered more emotional support, and showed more family involvement. Despite this greater depth of involvement, the length of office visits did not differ between the two physician groups. Our findings show that exemplars were more involved with their patients and provided more family-oriented care than community physicians. Exemplars routinely applied a biopsychosocial approach, collaborating with patients and addressing psychosocial topics without sacrificing efficiency, while community physicians focused on biomedical issues.

  8. Self-Directed Learning in Physician Assistant Education: Learning Portfolios in Physician Assistant Programs.

    PubMed

    Neal, Jeremy H; Neal, Laura D M

    2016-12-01

    Self-directed learning (SDL) portfolios are underused in the educational process and should be considered by physician assistant (PA) programs. Clinicians such as PAs are responsible for self-identifying their learning needs, competencies, and ongoing educational requirements. This article introduces an outline for SDL in the PA profession, for direct use by learners and indirect use by educators. Without a plan, many professionals may lack the insight, motivation, and knowledge needed to improve their skill set and establish goals for individual lifelong learning. This study conducted a review of the literature. Then, by incorporating SDL portfolios into PA educational methodologies, it constructed a concept map for individuals to monitor, self-direct, and actively participate in their own learning in academic settings and throughout their career.

  9. Mystery patient insight into clinical laboratory service.

    PubMed

    O'Malley, John

    2003-01-01

    Gone are the days when most patients tolerated impersonal service from their physicians and health-care providers in general. Every day, customer and patient satisfaction becomes more critical to a health-care provider's success and survival. Open communications, Internet-informed patients, and aggressive watch groups reveal those health-care providers who consistently deliver poor service. Most health-care providers employ patient satisfaction surveys to monitor their level of service; however, written and telephone surveys seldom provide the surveyor the insight necessary to provide differentiating service because of a large illiteracy rate and fear of reprisal. Toward this end, a well-trained mystery patients offers the health-care provider greater insight into how service is dispensed to its customers and patients. This article offers an aggregate of mystery patient insights into delivering clinical laboratory services both in hospital and medical practice environments, supported with insightful information into creating winning service strategies.

  10. Exploring personal interests of physicians in hospitals and specialty clinics.

    PubMed

    Koelewijn, Wout T; Ehrenhard, Michel L; Groen, Aard J; van Harten, Wim H

    2014-01-01

    Physicians' interests substantially influence intra-organizational dynamics in hospitals, though little is known about the actual content and structure of these interests. The objective of this study was to both identify and build a structured model of physicians' interests. Based on literature and 27 semi-structured interviews with physicians, a questionnaire containing 10 interests was developed. Next, 1475 physicians in the Netherlands filled out an online survey. Analyses of the data revealed a distinction between the primary interest of 'helping patients as well as possible' and nine secondary interests. Factor analysis identified the main secondary interest dimensions as work-related, setting-related, and life-related. Value attached to interests differs between specialties and types of hospitals. The influence of hospital type on the value attached to interests is stronger than the influence of specialty group on the value attached to interests. Insight in the relative importance of different interests may help policy-makers make decisions that foster shared interests. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. The dilemma of physician shortage and international recruitment in Canada.

    PubMed

    Islam, Nazrul

    2014-06-01

    The perception of physician shortage in Canada is widespread. Absolute shortages and relative discrepancies, both specialty-wise and in urban-rural distribution, have been a daunting policy challenge. International Medical Graduates (IMGs) have been at the core of mitigating this problem, especially as long as shortage of physicians in rural areas is concerned. Considering such recruitment as historical reality is naïve annotation, but when it is recommended per se, then the indication of interest overweighs the intent of ethically justified solution. Such a recommendation has not only invited policy debate and disagreement, but has also raised serious ethical concerns. Canadian healthcare policy-makers were put into a series of twisting puzzles-recruiting IMGs in mitigating physician shortage was questioned by lack of vision for Canada's self-sufficiency. In-migration of IMGs was largely attributed to Canada's point-based physician-friendly immigration system without much emphasizing on IMGs' home countries' unfavorable factors and ignoring their basic human rights and choice of livelihood. While policy-makers' excellence in integrating the already-migrated IMGs into the Canadian healthcare is cautiously appraised, its logical consequence in passively drawing more IMGs is loudly criticised. Even the passive recruitment of IMGs raised the ethical concern of source countries' (which are often developing countries with already-compromised healthcare system) vulnerability. The current paper offers critical insights juxtaposing all these seemingly conflicting ideas and interests within the scope of national and transnational instruments.

  12. Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study

    PubMed Central

    Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

    2002-01-01

    Objective To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Data Sources Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. Study Design A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. Principle Findings The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. Conclusions These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both “physician friendly” and “family friendly” seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

  13. Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers.

    PubMed

    McCarthy, G J

    1993-12-01

    The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them.

  14. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study.

    PubMed

    Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

    2002-02-01

    To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

  15. Ethical principles for physician rating sites.

    PubMed

    Strech, Daniel

    2011-12-06

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for

  16. Physician stress: is it inevitable?

    PubMed

    Orman, M C

    1989-01-01

    Early attempts to understand the causes of physician stress focused almost exclusively upon the role of external stressors and demands. Recent psychosocial and behavioral research, however, suggests that individual attitudes, beliefs, personality factors, and learned coping strategies probably play a more important role. In addition, such cognitive and behavioral tendencies are within the control of each individual, and clinical experience has shown that these factors can indeed be modified. Freudenberger noted that most health professionals who are experiencing high levels of stress fail to identify the role that they themselves play in generating such symptoms. Instead, they tend to blame others as the cause of their problems and tend to react cynically toward suggestions that they could benefit from help. A large-scale study of family physicians in North Carolina, conducted by May, Revicki, and Jones in 1983, confirmed the fact that most physicians who reported a high level of professional stress also tended to score high on measures of external locus of control--i.e. the perception that external or environmental factors are mainly responsible for one's problems or successes. My own experience in treating physicians and other people with stress tends to confirm these findings. More importantly, I have found that once individuals are helped to identify the role that their own cognitive and behavioral tendencies play in the origin of their stress, they can usually bring about impressive reductions in stress and tension without significant changes in environmental factors or demands. While many people advocate stress-releasing and other relaxation skills for physicians, I have found that such approaches are often counterproductive.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Nurses' and Physicians' Perceptions of Nurse-Physician Collaboration: A Systematic Review.

    PubMed

    House, Sherita; Havens, Donna

    2017-03-01

    The purpose of this systematic review was to explore nurses' and physicians' perceptions of nurse-physician collaboration and the factors that influence their perceptions. Overall, nurses and physicians held different perceptions of nurse-physician collaboration. Shared decision making, teamwork, and communication were reoccurring themes in reports of perceptions about nurse-physician collaboration. These findings have implications for more interprofessional educational courses and more intervention studies that focus on ways to improve nurse-physician collaboration.

  18. [An international comparison of physician control systems].

    PubMed

    Jian, Wei-yan; Xiong, Xian-jun; Li, Jing-hu; Ding, Yang; Wang, Li-li; Guo, Yan

    2011-04-18

    This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.

  19. Financial implications of serving as team physician.

    PubMed

    Lemak, Larry

    2007-04-01

    Time is the greatest negative financial burden that you accept as a sports medicine physician, because the only way to produce revenue as a physician is with your time. This cost measured in time of doing business as a team physician can be high. Unless being a team physician is very rewarding to you through personal satisfaction or the other intangible indirect benefits associated with the role, being a team physician may not be a good financial decision for you as a person and a physician, or for your practice and your family.

  20. Molecular biology for the critical care physician part I: terminology and technology.

    PubMed

    Santis, G; Evans, T W

    1999-04-01

    The past few years have seen a profound revolution in biological sciences. The enormous advances in molecular biology are providing novel insights into the etiology and treatment of human disease. These insights will undoubtedly have implications for intensive care research and practice. In this first of two articles, the basic principles and techniques of molecular biology are discussed to provide the intensive care physician with background information on the subject.

  1. The relationship between physician humility, physician-patient communication, and patient health.

    PubMed

    Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

    2016-07-01

    Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. NIH research funding and early career physician scientists: continuing challenges in the 21st century

    PubMed Central

    Garrison, Howard H.; Deschamps, Anne M.

    2014-01-01

    Physician scientists (researchers with either M.D. or M.D.-Ph.D. degrees) have the unique potential to combine clinical perspectives with scientific insight, and their participation in biomedical research has long been an important topic for policymakers and educators. Given the recent changes in the research environment, an update and extension of earlier studies of this population was needed. Our findings show that physician scientists are less likely to take a major role in biomedical research than they were in the past. The number of physician scientists receiving postdoctoral research training and career development awards is at an all-time low. Physician scientists today, on average, receive their first major research award (R01 equivalent) at a later age than in the 1980s. The number of first-time R01-equivalent awards to physicians is at the same level as it was 30 yr ago, but physicians now represent a smaller percentage of the grant recipients. The long-term decline in the number of physicians entering research careers was temporarily halted during the period of substantial U.S. National Institutes of Health (NIH) budget growth (1998–2003). These gains are lost, however, in the subsequent years when NIH budgets failed to keep pace with rising costs.— Garrison, H. H., Deschamps, A. M. NIH research funding and early career physician scientists: continuing challenges in the 21st century. PMID:24297696

  3. The Lexington physicians of General Robert E. Lee.

    PubMed

    Mainwaring, Richard D; Riley, Harris D

    2005-08-01

    General Robert E. Lee has been interpreted by history as one of the most intriguing personalities of the American Civil War era. In more recent years, there has been much speculation regarding General Lee's health during the war and the possible influence this had on his decision making and performance. Lee's personal letters during and after the war provide some documentation about his health condition, albeit through the eyes of a lay person. The history that was recorded by his personal physicians in Lexington, Virginia provides invaluable insights into his medical history. This manuscript focuses on the lives of these two physicians, Drs. Howard Barton and Robert Madison, and their interactions with their famous patient.

  4. A physician's due: measuring physician billing performance, benchmarking results.

    PubMed

    Woodcock, Elizabeth W; Browne, Robert C; Jenkins, Jennifer L

    2008-07-01

    A 2008 study focused on four key performance indicators (KPIs) and staffing levels to benchmark the FYO7 performance of physician group billing operations. A comparison of the change in the KPIs from FYO3 to FYO7 for a number of these billing operations disclosed across-the-board improvements. Billing operations did not show significant changes in staffing levels during this time, pointing to the existence of obstacles that prevent staff reductions in this area.

  5. [Physicians and scientific research: slight decline of the numbers of physicians with a doctoral degree].

    PubMed

    Stukart, M J; Strijbosch, M P W; Hooiveld, M H W; van Rees-Wortelboer, M M; Vandenbroucke, J P; Klasen, E C

    2006-07-08

    To establish whether the number of physicians interested in a career in academia (i.e. research) is declining. Descriptive. The researchers analysed the pre- and post-doctoral careers of PhD students at 3 university medical centres (VU Amsterdam, Nijmegen and Maastricht) in 4 separate reference years (1989, 1994, 1999 and 2003), using information from doctoral dissertations and the Dutch medical address book. The researchers recorded the gender of the students and the timing of the doctorate in relation to specialist training, university education and employment, as applicable. The total number of dissertations produced at the 3 medical faculties in the 4 reference years increased gradually by nearly a factor of 2 (1989: 112; 1994: 152; 1999: 198; 2003: 213). In terms of absolute numbers, the number of dissertations authored by physicians increased from 1989 to 1994 and again in 1999 (64, 90 and 105), but decreased slightly in 2003 (96). The percentage of female physicians obtaining a doctorate doubled during this period (1989: 9/64 (14); 2003: 28/96 (29)). Increasingly, physicians prepared their dissertation before or during their training as specialists or general practitioners (1989: 15/64 (23%); 2003: 51/96 (53%)). Ofthe clinical specialists who had received their doctorate, approximately half continued to work in an academic setting after obtaining their degree. This percentage remained approximately the same in all reference years (1989: 13/26 (50); 1994:19/35 (54); 1999: 21/45 (47); 2003: 21/40 (53)). Although the number of physicians performing scientific research as part of their doctoral degree project declined slightly in 2003 following an initial rise, our data indicate no cause for major concern. One reason may be increased interest in Clinical Research Fellow programmes. However, the future of medical research would look brighter if young physicians with doctorates had better career prospects within academic centres. To follow the academic careers of

  6. Relation Between Physicians' Work Lives and Happiness.

    PubMed

    Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

    2016-04-01

    Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

  7. Physicians' adoption of information technology: a consumer behavior approach.

    PubMed

    Eger, M S; Godkin, R L; Valentine, S R

    2001-01-01

    Studies report physician resistance to information technology in a time when the practice of medicine could benefit from technological support. Anecdotally, it is suspected that lack of training, discomfort with technological innovations, a perceived shift in the doctor/patient relationship, or medical/legal issues may account for this circumstance. Empirical studies attribute this lag to age, personality factors, behavioral issues, and occupational influences. This paper integrates the information technology and consumer behavior literatures to discuss physicians' acceptance, adoption, and application of IT.

  8. Legal considerations for protecting the physician's assets.

    PubMed

    Wolf, Jerome L

    2011-01-01

    Most states require that as a consideration of obtaining and maintaining a medical license, all applicants must demonstrate "financial responsibility." Usually this includes: (1) establishing an escrow account of cash and/or readily marketable securities; (2) an irrevocable, non-transferable letter of credit; or (3) in most cases, medical malpractice insurance coverage. In recent years, some states have passed legislation that provides that under certain circumstances, a physician may qualify to forego any of the financial requirements, commonly referred to as "going bare." In this regard, much of the impetus for the recently enacted Obama healthcare plan was the rising cost of healthcare in the United States arising from the extensive, and, to some, unnecessary and extraneous testing and retesting to confirm medical diagnosis and treatment-for the patient's benefit but, as importantly, to forestall a potential medical malpractice claim. As the political challenge to what is commonly referred to as "Obamacare" proceeds, and in the absence of any legislative support for "tort reform" and limitations on frivolous malpractice claims, it is abundantly clear that an integral part of any professional's "estate planning" should include and incorporate the asset protection and exempt property statutes available under the laws of the jurisdiction where the physician resides.

  9. Legal liability of physicians in medical research.

    PubMed

    Sava, H; Matlow, P T; Sole, M J

    1994-04-01

    The intent of this paper is to provide an overview, in layperson's language, of the concepts in law which may be applicable to a physician who undertakes research. The paper is divided into 2 parts. Part I deals with liability issues and standards of care. It is meant to enable the physician/researcher to recognize a potential liability situation. Part II examines insurance and related issues such as the role of the Canadian Medical Protective Association (CMPA). The paper begins with a review of 2 potential categories of liability: criminal and civil tort. Next, legal issues surrounding the consent process, which form the majority of negligence claims, are dealt with. The research process is then discussed with emphasis on the Medical Research Council of Canada Guidelines on Human Experimentation. Part II covers how research projects are funded and identifies the parties from whom insurance coverage may be sought. Information is provided from the various sources offering insurance and quasi-insurance protection with special attention on the CMPA. Each source details the circumstances necessary for its particular coverage to be triggered. Other issues addressed include those arising when research is conducted outside Canada and multiple coverage.

  10. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.404 Physician defined. The term physician includes doctors of medicine (MD), surgeons, podiatrists...

  11. What's a Primary Care Physician (PCP)?

    MedlinePlus

    ... and the Internet What's a Primary Care Physician (PCP)? KidsHealth > For Parents > What's a Primary Care Physician ( ... getting the right amount of exercise. Types of PCPs Different types of PCPs treat kids and teens. ...

  12. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  13. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  14. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...

  15. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render medical...

  16. The Crucible of Physician Performance Reports

    PubMed Central

    2010-01-01

    Individualized physician performance reports are an emerging phenomena. The narrative piece examines one physician’s experience with individualized physician performance reports. Reforming the data collection process could enhance the value of the reports to stakeholders. PMID:20838915

  17. AMA launches partnership to lease physician database.

    PubMed

    2000-12-01

    A joint venture is allowing the AMA to refine the physician data it sells to marketers. Physicians in the organization's heavily used database get some latitude in how information about them is distributed.

  18. How many physicians can we afford?

    PubMed

    Grumbach, K; Lee, P R

    1991-05-08

    We project physician costs for the year 2,000 under several alternative scenarios, using different assumptions about the future supply of physicians and gross income (or expenditures) per physician. The supply of active, posttraining patient-care physicians is projected to increase from a ratio of 144 per 100,000 population in 1986 to 176 per 100,000 in 2,000. Depending on whether expenditures per physician increase at the rate of the consumer price index, the gross national product, or the historical 1982 through 1987 expenditure trends, there will be an additional cost (in constant 1986 dollars) of $21 billion, $30 billion, or $40 billion, respectively, compared with projected physician costs under a scenario of a constant physician-to-population ratio. The disproportionate growth of costs for practice overhead will pose a particular problem for efforts to restrain inflation of expenditures per physician.

  19. Altruism and physician assisted death.

    PubMed

    Gunderson, M; Mayo, D J

    1993-06-01

    We assume that a statute permitting physician assisted death has been passed. We note that the rationale for the passage of such a statute would be respect for individual autonomy, the avoidance of suffering and the possibility of death with dignity. We deal with two moral issues that will arise once such a law is passed. First, we argue that the rationale for passing an assistance in dying law in the first place provides a justification for assisting patients to die who are motivated by altruistic reasons as well as patients who are motivated by reasons of self-interest. Second, we argue that the reasons for passing a physician assisted death law in the first place justify extending the law to cover some nonterminal patients as well as terminal patients.

  20. Communicating drug information to physicians.

    PubMed

    Herman, C M; Rodowskas, C A

    1976-03-01

    In this paper the authors present a review of the multitudinous studies of researchers who have attempted to identify the sources of drug information utilized by physicians. Consideration is given to both professional sources (for example, journal articles, colleagues, meetings, and pharmacists) and commercial sources (for example, detailmen, journal advertisements, mail advertisements, and samples). Also included is a discussion of the relationship between physicians' sources of drug information and their choice of drugs and of the relationship between the sources of information and the severity of the conditions being treated. The paper concludes with a brief review of some of the new sources of drug information being considered for utilization by the Food and Drug Administration.

  1. [Imhotep--builder, physician, god].

    PubMed

    Mikić, Zelimir

    2008-01-01

    The medicine had been practiced in ancient Egypt since the earliest, prehistoric days, many millenia before Christ, and was quite developed in later periods. This is evident from the sceletal findings, surgical instruments found in tombs, wall printings, the reliefs and inscriptions, and most of all, from the sparse written material known as medical papyri. However, there were not many physicians from that time whose names had been recorded. The earliest physician in ancient Egypt known by name was Imhotep. WHO WAS IMHOTEP?: Imhotep lived and worked during the time of the 3rd Dynasty of Old Kingdom and served under the pharaoh Djoser (reigned 2667-2648 BC) as his vizier or chief minister, high priest, chief builder and carpenter. He obviously was an Egyptian polymath, a learned man and scribe and was credited with many inventions. As one of the highest officials of the pharaoh Djoser Imhotep is credited with designing and building of the famous Step Pyramid of Djoser at Saqqarah, near the old Egyptian capital of Memphis. Imhotep is also credited with inventing the method of stone-dressed building and using of columns in architecture and is considered to be the first architect in history known by name. It is believed that, as the high priest, Imhotel also served as the nation's chief physician in his time. As the builder of the Step Pyramid, and as a physician, he also had to take medical care of thousands of workers engaged in that great project. He is also credited with being the founder of Egyptian medicine and with being the author of the so-called Smith papirus containing a collection of 48 specimen clinical records with detailed accurate record of the features and treatment of various injuries. As such he emerges as the first physician of ancient Egypt known by name and, at the same time, as the first physician known by name in written history of the world. GOD: As Imhotep was considered by Egyptian people as the "inventor of healing", soon after the death, he

  2. Accessibility of the team physician.

    PubMed

    Kuster, Tom; Knitter, David; Navitskis, Lenny

    2007-04-01

    The transition to the care of the college student-athlete carries with it a number of adjustments. In private practice it is customary to make medical decisions and initiate therapies from the confines of the examination room. The doctor-patient relationship is the principal focus. Although this relationship remains paramount in college athletics, the world of concerned and affected parties dramatically expands. It is in this context that the authors explore the concept of access in the role of a team physician. To use what is becoming an over used cliché, what makes one a valued team physician is being "the right person, in the right place at the right time."

  3. Organizational commitment of military physicians.

    PubMed

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay

    2009-09-01

    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  4. Colonoscopy: Perspectives for Family Physicians

    PubMed Central

    Cameron, R. D. A.

    1983-01-01

    Fiber-optic endoscopy is an important investigation of the lower gastrointestinal tract, whether or not the radiologist has discovered a lesion. Colonoscopy affords a unique opportunity to visualize the entire colonic mucosa. At the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli. Most experienced endoscopists can reach the cecum in over 90% of patients. If colonoscopy is properly performed, it has a low risk of complications, such as perforation and bleeding. The few absolute contraindications include serious illnesses such as acute myocardial infarction and severe acute inflammatory bowel diseases. Family physicians referring patients for investigations of lower gastrointestinal problems should explain that colonoscopy is an adjunct to, not a replacement for, a barium enema examination. If possible they should find out what preparation the patient will require. PMID:21283399

  5. Expansion of Physician Assistant Education.

    PubMed

    Cawley, James F; Eugene Jones, P; Miller, Anthony A; Orcutt, Venetia L

    2016-12-01

    Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

  6. Facing requests for physician-assisted suicide: toward a practical and principled clinical skill set.

    PubMed

    Emanuel, L L

    1998-08-19

    Requests for physician-assisted suicide are not a new phenomenon, and many physicians are likely to face this challenging situation. This article proposes for professionals an 8-step approach to respond to requests for physician-assisted suicide. The approach seeks to identify and treat the root causes of the request and aims to present a plan for consistent application of a set of clinical skills. Justification for the steps requires only 2 noncontentious principles: the patient should be free of unwanted intervention, and the physician is obligated to provide suffering patients with comfort care. Care based on these 2 principles alone does not include physician-assisted suicide. The approach does, however, justify patient refusal of oral intake in specific circumstances. The approach could resolve a majority of requests for physician-assisted suicide and should be tested further for clinical efficacy.

  7. [Attitudes to insomnia by Primary Care physicians of Majorca (Spain)].

    PubMed

    Torrens, Isabel; Ortuño, Marina; Guerra, Juan Ignacio; Esteva, Magdalena; Lorente, Patricia

    2016-01-01

    To describe the current clinical management of insomnia by family physicians. Cross-sectional study. Majorca Health Area, 2011-2012. Family physicians (FP). Paediatricians, resident physicians and emergency physicians were excluded. Using a self-administered questionnaire, the following variables were collected: social, demographic, professional, training in insomnia, prescription preferences, and its clinical management. A total of 322 of 435 physicians answered (74%), of whom 55% were female. The mean age was 48 years with a mean of 21 years in the profession. Most of them consider insomnia as a major health problem, and refer to asking patients about sleep habits and its impact on daily life. About one third have been trained in insomnia in the last 5 years. Very few (0.6%) refers patients to a psychiatrist, and 1.9% to a psychologist. The most prescribed drugs are benzodiazepines (33.4%) and Z drugs (25.7%), with 69.4% of them claiming to have checked the treatment after month of onset. Most refer to advice about sleep hygiene measures (85.1%), 15.1% prescribe herbal remedies, and 14.2% behavioural cognitive therapy (CBT). Seven out of ten physicians consider CBT as effective and applicable by both physicians and nurses. The older FPs prescribe benzodiazepines with less frequency, while female FPs prescribe more sleep hygiene measures and herbal remedies. Most FPs consider insomnia as a major health problem, in which they usually get involved. The most commonly used treatments are sleep hygiene advice, followed by benzodiazepines and Z drugs. The CBT is considered effective but not widely used. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Empowering Physicians with Financial Literacy.

    PubMed

    Bar-Or, Yuval

    2015-01-01

    Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training.

  9. Transitioning to value-based physician compensation.

    PubMed

    Epstein, Johanna

    2014-12-01

    An effective strategy for creating a viable physician compensation plan should include nine key steps or tactics: Get physicians on board early. Engage a physician champion. Create a compensation committee. Address department-level issues and differences. Verify the plan's affordability. Adopt a routine review schedule. Understand the payer environment and keep in contact with payers. Stay abreast of industry trends. Maintain an ongoing dialogue with physicians.

  10. The physician as perfect agent: a comment.

    PubMed

    Rochaix, L

    1998-08-01

    This comment is focused on the nature of the agency relationship between the physician and the patient. Beyond the discussion of the relative merits of the empowered physician versus empowered patient model. it is argued here that two features need to be integrated for an adequate account of this complex interaction: the two stages of the physician's action (the diagnosis and the treatment) and the physician's double agency (to the patient and to the representative of the collective interest).

  11. Public challenge of physician authority.

    PubMed

    Haug, M R; Lavin, B

    1979-08-01

    A sample survey of the public in a midwestern state substantiates the existence of widespread challenges to the authority of physicians, a phenomenon previously reported only impressionistically in the media. Attitudes tending to reject physicians' right to direct their interaction with patients characterized more than half the sample and were related to younger age, higher educational level, and greater health knowledge, with a consumerist and anti-authority stance also explanatory. Actual challenging behavior occurred at least once for about half the group, but in this instance was related less to age and knowledge than to more extensive experience with the health care system, as well as a lack of trust in people in general and doctors' competence in particular. However, explained variance was modest, arguing that other variables, not identified in this study, are at work. Surprisingly, respondents' health status, race, sex, and pattern of insurance coverage had little impact on either attitude or behavior, while both knowledge and a general tendency to reject authority were influential factors. Implications for physician-patient relations in the future are discussed in light of a number of social changes, including the rising educational level of the American public.

  12. Physician participation in TQM in geriatric medicine.

    PubMed

    Miller, D K; Coe, R M

    2000-08-01

    Quality improvement (QI) approaches such as total quality management (TQM) and continuous quality improvement (CQI) have great potential for improving the care provided to older people. Geriatricians have the necessary experience and skills to initiate and lead these QI efforts. A national sample of practicing geriatricians was surveyed in 1998 regarding involvement in, satisfaction with, and insights regarding TQM processes in four care settings. Of 537 questionnaires returned in time for analysis, 497 were included for analysis after omitting questionnaires that were undeliverable or unusable (n = 25) and those from respondents who worked fewer than 20 hours per week (n = 15). More than one-third of the respondents (37.1%) reported no TQM activity at all. For the remainder, the primary site for TQM activity was the nursing home (33.0%), the hospital (22.5%), the office (11.4%), and the patient's home (3.7%). A majority of the respondents spent two hours per week or less on TQM projects. Planning an intervention and acting to maintain it in practice after its evaluation were the two stages of the improvement cycle these respondents engaged in most frequently. More geriatricians should be encouraged to participate in TQM training and in specific projects to improve systems of care for older people. Incentives to increase participation should be made available. Rapid-cycle improvement may fit better with physicians' culture of working for outcomes that have relatively short turnaround times.

  13. American College of Physicians Ethics Manual: sixth edition.

    PubMed

    Snyder, Lois

    2012-01-03

    Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.

  14. Physician's Death Anxiety and Patient Outcomes.

    ERIC Educational Resources Information Center

    Schulz, Richard; Aderman, David

    1978-01-01

    It was shown that terminal patients of physicians with high death anxiety survive longer during their final hospital stay than terminal patients of physicians with low death anxiety. Physicians high in death anxiety seem to be less willing to accept patients' terminality and use heroic measures to keep them alive. (Author)

  15. Understanding the business of employed physician practices.

    PubMed

    Sanford, Kathleen D

    2013-09-01

    Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices.

  16. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate medical...

  17. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate medical...

  18. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate medical...

  19. Revealing a Child's Pathology: Physicians' Experiences

    ERIC Educational Resources Information Center

    Scelles, Regine; Aubert-Godard, Anne; Gargiulo, Marcela; Avant, Monique; Gortais, Jean

    2010-01-01

    In this study, 12 physicians and 12 care-givers were interviewed using semi-structured interviews. We explored physicians' experiences when they revealed a diagnosis. We also tried to understand which family members the physician was thinking of, with whom they identified themselves, and their first choice of the person to whom they prefer to…

  20. Opinion and Special Articles: "Physician debtor".

    PubMed

    Scharf, Eugene L; Jones, Lyell K

    2016-01-19

    The increasing cost of attending medical school has contributed to increasing physician indebtedness. The burden of medical school debt has implications for physician career choice, professional satisfaction, and burnout. This opinion discusses the impact of physician indebtedness, the importance of improving debt awareness among neurology trainees, and program- and policy-level solutions to the debt crisis.

  1. Mentoring to Help Prevent Physician Burnout.

    PubMed

    Herring, Malcolm; Forbes Kaufman, Rachel; Bogue, Richard

    2016-07-01

    The importance of a person's spirit and eternal destiny are eclipsed in American medi- cine. The most alarming effect of this eclipse is that the prevalence of burnout among physicians is high (about 46 percent) and growing.' It is alarming because trends that deplete the physician's spirit tragically impair the physician's capacity as a healer and as one who renews the spirit.

  2. How to start a physician relations program.

    PubMed

    Coker, J C

    1990-08-01

    An effective physician relations program focuses on providing good customer service rather than raising hospital admissions and revenue. If good service is provided, increased admissions can follow. The principles behind a strong physician relations program include adequate staffing, proper training of physician representatives, and an ability to address varying needs of medical practices.

  3. Exploring Deliberate Practice in Medicine: How Do Physicians Learn in the Workplace?

    ERIC Educational Resources Information Center

    van de Wiel, Margje W. J.; Van den Bossche, Piet; Janssen, Sandra; Jossberger, Helen

    2011-01-01

    Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians…

  4. Barriers Facing Physicians Practicing Evidence-Based Medicine in Saudi Arabia

    ERIC Educational Resources Information Center

    Al-Almaie, Sameeh M.; Al-Baghli, Nadira

    2004-01-01

    Introduction: Tremendous advances in health care have been made through the development of evidence-based medicine (EBM). Studies show that physicians face barriers in practice, preventing the effective use of the best evidence available. Insight into these barriers should pave the way for an action plan to remove them. The aim of this study was…

  5. Exploring Deliberate Practice in Medicine: How Do Physicians Learn in the Workplace?

    ERIC Educational Resources Information Center

    van de Wiel, Margje W. J.; Van den Bossche, Piet; Janssen, Sandra; Jossberger, Helen

    2011-01-01

    Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians…

  6. Measuring physicians' productivity in a Veterans' Affairs Medical Center.

    PubMed

    Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

    2003-07-01

    The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

  7. Turkey's physicians' attitudes toward euthanasia: a brief research report.

    PubMed

    Ozkara, Erdem; Hanci, Hamit; Civaner, Murat; Yorulmaz, Coskun; Karagoz, Mustafa; Mayda, Atilla Senih; Goren, Suleyman; Kok, Ahmet Nezih

    2004-01-01

    Euthanasia and assisted suicide are subject to an ongoing debate and discussed with various aspects. Because physicians are in a profession closely related to euthanasia, their attitudes toward this subject are significant. Thus, research intending to explore their opinions is carried out in many countries. In this study, opinions of the physicians regarding euthanasia's definition, contents, legal aspects, and acceptable conditions for its application are addressed. The questionnaire was given to 949 physicians, more than 1% of the total working in Turkey. Of the physicians who participated in the study, 49.9% agreed with the opinion that euthanasia should be legal in certain circumstances. In addition, 19% had come across a euthanasia request and the majority of physicians (55.9%) believed that euthanasia is applied secretly in the country despite the prohibitory legislation. In conclusion, the authors infer from the study itself and believe that euthanasia should be legal in certain circumstances and that the subject, which is not in the agenda of the Turkish population, should continue to be examined.

  8. Understanding MRI: basic MR physics for physicians.

    PubMed

    Currie, Stuart; Hoggard, Nigel; Craven, Ian J; Hadjivassiliou, Marios; Wilkinson, Iain D

    2013-04-01

    More frequently hospital clinicians are reviewing images from MR studies of their patients before seeking formal radiological opinion. This practice is driven by a multitude of factors, including an increased demand placed on hospital services, the wide availability of the picture archiving and communication system, time pressures for patient treatment (eg, in the management of acute stroke) and an inherent desire for the clinician to learn. Knowledge of the basic physical principles behind MRI is essential for correct image interpretation. This article, written for the general hospital physician, describes the basic physics of MRI taking into account the machinery, contrast weighting, spin- and gradient-echo techniques and pertinent safety issues. Examples provided are primarily referenced to neuroradiology reflecting the subspecialty for which MR currently has the greatest clinical application.

  9. Ethical Principles for Physician Rating Sites

    PubMed Central

    2011-01-01

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial

  10. Integrating personal computers into family practice: a comparison of practicing physicians and residents.

    PubMed Central

    Cook, M C; Hartman, J A; Russell, L R

    1998-01-01

    A survey was used to assess levels of experience with personal computers and interest in learning personal computer applications among Alabama family practice physicians and residents in 1994. The study compared responses of 272 physicians and 77 residents as well as responses of physicians and residents in a sample of respondents thirty-eight years old or younger, including 77 physicians and 73 residents. Almost 25% of physicians reported never having used a computer, compared to 7.9% of residents. Respondents had learned computer skills through various combinations of methods, with over half of each group claiming to be self-taught through reading and hands-on experience. More than 86% of both groups expressed interest in learning more; interest increased in the population thirty-eight years or younger. Respondents, especially physicians, reported using professional applications less often than personal applications. Overall, there was a high level of interest in learning various practice-related applications; however, a significantly larger proportion of residents reported interest in each type of application than did physicians. PMID:9681166

  11. Physician specialty societies and the development of physician performance measures.

    PubMed

    Ferris, Timothy G; Vogeli, Christine; Marder, Jessica; Sennett, Cary S; Campbell, Eric G

    2007-01-01

    Efforts to increase accountability in the delivery of care include attempts to measure performance of individual doctors. Although physician specialty societies may be best positioned to define best practices, they have not yet played a major role in the development of measures. We examined specialty society involvement in measure development through interviews and review of Web sites. We found that a minority (35 percent) of societies were engaged in developing performance measures. Key barriers included member reluctance, lack of resources for development, and problems with data collection; facilitators included strong leadership and the perception of increasing pressure for accountability.

  12. Managed care relationships from the physician's perspective.

    PubMed

    Mack, J M

    1993-01-01

    In response to health care reform proposals as well as health plans, hospitals and individual physicians are affiliating into models that will favorably position them in the evolving managed care marketplace. The development of integrated delivery vehicles requires a merging of physician and hospital cultures. To manage this process the relationship between hospitals and physicians must receive the greatest attention. This chapter describes physician perceptions of specific aspects in the evolving managed care marketplace. Understanding reactions to various initiatives will enable readers to overcome resistance to change and improve their managed care relationships with physicians.

  13. Aligning physician compensation with strategic goals.

    PubMed

    Bunkers, Brian; Koch, Mark; McDonough, Becky; Whited, Brian

    2014-07-01

    In 2012, Mayo Clinic Health System (MCHS) had 13 different physician compensation models among its operating units, with most based on productivity metrics. MCHS aimed to transition all physicians to a single compensation model that would facilitate its integration with Mayo Clinic and promote physician engagement with emerging value-based payment models. The new model, which was implemented this past January, incorporates quality metrics, provides physicians with regular reports of their performance, and already has resulted in greater physician attention to outcomes, safety, and patient experience.

  14. Doctors for the world: Indian physician emigration.

    PubMed

    Mullan, Fitzhugh

    2006-01-01

    Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.

  15. Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians.

    PubMed

    DeFlavio, Jeffrey R; Rolin, Stephanie A; Nordstrom, Benjamin R; Kazal, Louis A

    2015-01-01

    Opioid abuse has reached epidemic levels. Evidence-based treatments such as buprenorphine maintenance therapy (BMT) remain underutilized. Offering BMT in primary care settings has the potential to reduce overall costs of care, decrease medical morbidity associated with opioid dependence, and improve treatment outcomes. However, access to BMT, especially in rural areas, remains limited. This article will present a review of barriers to adoption of BMT among family physicians in a primarily rural area in the USA. An anonymous survey of family physicians practicing in Vermont or New Hampshire, two largely rural states, was conducted. The survey included both quantitative and qualitative questions, focused on BMT adoption and physician opinions of opioids. Specific factors assessed included physician factors, physicians' understanding of patient factors, and logistical issues. One-hundred and eight family physicians completed the survey. Approximately 10% were buprenorphine prescribers. More than 80% of family physicians felt they regularly saw patients addicted to opiates. The majority (70%) felt that they, as family physicians, bore responsibility for treating opiate addiction. Potential logistical barriers to buprenorphine adoption included inadequately trained staff (88%), insufficient time (80%), inadequate office space (49%), and cumbersome regulations (37%). Common themes addressed in open-ended questions included lack of knowledge, time, or interest; mistrust of people with addiction or buprenorphine; and difficult patient population. This study aims to quantify perceived barriers to treatment and provide insight expanding the community of family physicians offering BMT. The results suggest family physicians are excellent candidates to provide BMT, as most report regularly seeing opioid-addicted patients and believe that treating opioid addiction is their responsibility. Significant barriers remain, including inadequate staff training, lack of access to

  16. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study.

    PubMed

    Horppu, Ritva; Martimo, K P; MacEachen, E; Lallukka, T; Viikari-Juntura, E

    2017-04-08

    Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.

  17. Professionalism and physician interactions with industry.

    PubMed

    Collins, Jannette

    2006-05-01

    Many gifts from industry to physicians and medical organizations serve important and beneficial functions. However, the spiraling cost of health care is resulting in increasing governmental and medical scrutiny of legal and ethical issues concerning relationships between commercial companies and physicians. Professional oversight bodies are updating standards concerning the ethical responsibilities of physicians. This article presents a broad framework for understanding the professional and legal responsibilities of physicians when interacting with industry. Physicians have unique responsibilities based on the "fiduciary" nature of the patient-physician relationship and specified laws regarding health care. Physicians must protect the best interests of patients, with clinical decisions free of undue influence. Physicians have special obligations related to receiving gifts from industry or receiving payments that may be construed as "kickbacks" or fraud. To ensure that gifts do not compromise (or seem to compromise) professional judgment, physicians should generally not accept personal gifts from industry and consider accepting only those that primarily entail a benefit to patients, are not of substantial value, and have no "strings" attached. After reading this article, the reader should be able to describe the impact gifts have on physicians' behavior, the privileges and obligations of physicians, and conflicts between professional obligations and personal gifts.

  18. Physicians' fees and public medical care programs.

    PubMed Central

    Lee, R H; Hadley, J

    1981-01-01

    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  19. Improving physician-patient interactions: a review.

    PubMed

    Strecher, V J

    1983-01-01

    The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.

  20. Physicians' attitudes about their professional appearance.

    PubMed

    Gjerdingen, D K; Simpson, D E

    1989-01-01

    Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.

  1. Physicians in health care management: 6. Physician *bytes* computer.

    PubMed Central

    Bolley, H B

    1994-01-01

    Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics. PMID:8199976

  2. HMO employment and African-American physicians.

    PubMed Central

    Briscoe, Forrest; Konrad, Thomas R.

    2006-01-01

    OBJECTIVES: To assess the level and determinants of African-American physicians' employment in health maintenance organizations (HMOs), particularly early in their careers. METHODS: We analyzed data from the 1991 and 1996 Young Physicians Surveys to assess racial differences in the likelihood of HMO employment (n = 3,705). Using multinomial logistic regression, we evaluated four explanations for an observed relationship between African-American physicians and HMO employment: human capital stratification among organizations, race-based affinity between physicians and patients, financial constraints due to debt burden, and different organizational hiring practices. Using binomial logistic regression, we also evaluated differences in the odds of being turned down for a prior practice position, of subsequently leaving the current practice organization and of later having career doubts. RESULTS: Without any controls, African-American physicians were 4.52 times more likely to practice in HMOs than Caucasian physicians. After controlling for human capital stratification, racial concordance and financial constraints, African-American physicians remained 2.48 times more likely to practice in HMOs than Caucasian physicians. In addition, 19.2% of African-American physicians in HMOs reported being turned down for another job, far more than any other racial/ethnic group in the HMO setting and any racial/ethnic group, including African-American physicians in the non-HMO setting (including all other practice locations). Five years later, those same African-American physicians from HMOs also reported significantly more turnover (7.50 times more likely than non-HMO African-American physicians to leave their current practice) and doubt about their careers (2.17 times more likely than non-HMO African-American physicians to express serious career doubts). CONCLUSIONS: African-American physicians were disproportionately hired into HMO settings, impacting their subsequent careers. PMID

  3. [Are American physicians more satisfied?--results from an International Study of Physicians in University Hospitals].

    PubMed

    Janus, K; Amelung, V E; Baker, L C; Gaitanides, M; Rundall, T G; Schwartz, F W

    2009-04-01

    Understanding the factors that affect physicians' job satisfaction is important not only to physicians themselves, but also to patients, health system managers, and policy makers. Physicians represent the crucial resource in health-care delivery. In order to enhance efficiency and quality in health care, it is indispensable to analyse and consider the motivators of physicians. Physician job satisfaction has significant effects on productivity, the quality of care, and the supply of physicians. The purpose of our study was to assess the associations between work-related monetary and non-monetary factors and physicians' work satisfaction as perceived by similar groups of physicians practicing at academic medical centres in Germany and the U.S.A., two countries that, in spite of differing health-care systems, simultaneously experience problems in maintaining their physician workforce. We used descriptive statistics, factor and correlation analyses to evaluate physicians' responses to a self-administered questionnaire. Our study revealed that overall German physicians were less satisfied than U.S. physicians. With respect to particular work-related predictors of job satisfaction we found that similar factors contributed to job satisfaction in both countries. To improve physicians' satisfaction with working conditions, our results call for the implementation of policies that reduce the time burden on physicians to allow more time for interaction with patients and colleagues, increase monetary incentives, and enhance physicians' participation in the development of care management processes and in managerial decisions that affect patient care.

  4. NIH research funding and early career physician scientists: continuing challenges in the 21st century.

    PubMed

    Garrison, Howard H; Deschamps, Anne M

    2014-03-01

    Physician scientists (researchers with either M.D. or M.D.-Ph.D. degrees) have the unique potential to combine clinical perspectives with scientific insight, and their participation in biomedical research has long been an important topic for policymakers and educators. Given the recent changes in the research environment, an update and extension of earlier studies of this population was needed. Our findings show that physician scientists are less likely to take a major role in biomedical research than they were in the past. The number of physician scientists receiving postdoctoral research training and career development awards is at an all-time low. Physician scientists today, on average, receive their first major research award (R01 equivalent) at a later age than in the 1980s. The number of first-time R01-equivalent awards to physicians is at the same level as it was 30 yr ago, but physicians now represent a smaller percentage of the grant recipients. The long-term decline in the number of physicians entering research careers was temporarily halted during the period of substantial U.S. National Institutes of Health (NIH) budget growth (1998-2003). These gains are lost, however, in the subsequent years when NIH budgets failed to keep pace with rising costs.

  5. [Pharmacological knowledge among general physicians].

    PubMed

    López-Valpuesta, F J; Hevia, A; Castellanos, A; Vázquez, J A

    1993-07-01

    We inquired to 200 physicians about the 50 pharmaceutical products most dispensed in Seville during 1989. The most significative results were: 68.5% of the inquired answered the questionnaire. 98.5% knew the product, but only 80.3% prescribed it. The principal sources of information to know the drug were books and scientific journals (67.3%), followed by detailers (62%). 86.1% knew the composition of the product, and 94.9% knew its indications. 71.5% described the side effects, 66.4% the contraindications, and 25.5% the interactions with other drugs. Only 56.9% mentioned a therapeutic alternative.

  6. Communication and the laboratory physician

    PubMed Central

    Penistan, J. L.

    1973-01-01

    A clinical laboratory documentation system is described, suitable for community hospitals without computer services. The system is cumulative and is designed to provide the laboratory physician with the clinical information necessary for intelligent review and comment on the laboratory's findings. The mode of presentation of requests to the laboratory and lay-out of the reports to the clinicians are designed to make the two-way communication as close and personal as possible; to encourage the selection of those investigations likely to prove rewarding, and to discourage unnecessary investigation. The possibility of important data escaping notice is minimized. The system is economical in capital equipment, labour and supplies. PMID:4758594

  7. December financial checkup for physicians.

    PubMed

    Miller, Rita

    2014-01-01

    December is a busy month for holiday fun, but don't neglect your financial health! Physicians should review their business and personal finances at year end to ensure they are on target both for income generated and taxes paid. Preparing for the April 15 tax filing is aided by a thorough review in December. Payroll items such as W2s, 1099s, and employee benefits need to be reviewed. Retirement savings should be analyzed. Make sure to look at your business profit/loss statement and balance sheet. Personal contributions and other tax planning strategies need to be completed by the end of the year. Your CPA can help!

  8. Physicians, triage, and nuclear war.

    PubMed

    Leaning, J

    1988-07-30

    Difficult ethical choices imposed by triage, the process of sorting casualties according to severity of illness (need) and priority for treatment (allocation), are discussed in the context of recent disasters such as an Amtrak collision and the Mexico city earthquake. The question of medical response to nuclear war raises issues of professional duty to assist in making plans for morally repugnant events such as mass destruction; the feasibility of triage, as a conscious professional act, during a time of extreme stress and carnage; and fundamental differences among physicians in their beliefs about themselves, their roles, and their moral obligation to the world.

  9. Adding flexibility to physician training.

    PubMed

    Mahady, Suzanne E

    2011-05-02

    Demographic changes among junior doctors are driving demand for increased flexibility in advanced physician training, but flexible training posts are lacking. Suitable flexible training models include flexible full-time, job-share and part-time positions. Major barriers to establishing flexible training positions include difficulty in finding job-share partners, lack of funding for creating supernumerary positions, and concern over equivalence of educational quality compared with full-time training. Pilot flexible training positions should be introduced across the medical specialties and educational outcomes examined prospectively.

  10. [Human rights of the physician].

    PubMed

    García-Romero, H

    1995-01-01

    The physician rights may be classified in those related with his quality as a person, and those derived from his relationship with his patients and the institution to which he belongs. Among the first, liberty of expression, legal security, right of free association, the right of a dignified social position and neutral attitude towards the commitment of giving medical attention to whomever the patient may be. He has the right to receive a full and up-to-date training oriented to serve the community, supported by health institutions, and to have the means of utmost quality to give medical attention of the highest standard.

  11. Associate physician selection: perception & reality.

    PubMed

    Freeman, C Kay

    2008-01-01

    Whatever real or perceived margin for error without consequence in associate physician selection there has been in the past is now one. Reasons include the indisputable fact that competition for first- and second-tier associates continues to escalate with no end in sight. It is, therefore, a rational conclusion that the options for practices that do not become organized to get associate selection right the first time will be limited and could include arrival at a destination not envisioned. This article addresses practice dynamics that trigger adverse associate selection and presents creative selection tactics--to get it right the first time.

  12. Wanted: Well-Rounded Physicians.

    PubMed

    Sorrel, Amy Lynn

    2015-10-01

    The Association of American Medical Colleges has revamped the MCAT for the first time in nearly three decades. While the new exam retains the science-based testing historically included, it adds new topics and approaches meant to keep up with a rapidly changing health care delivery system. It aims to test and train aspiring physicians based less on memorizing scientific facts and more on competency: putting that scientific knowledge into practice. Questions on the new MCAT pertain to concepts such as self-identity, social stratification, and multiculturalism and ask students to apply them to certain scenarios.

  13. Electronic health record innovations: Helping physicians - One less click at a time.

    PubMed

    Guo, Uta; Chen, Lu; Mehta, Parag H

    2017-09-01

    Physician burnout is becoming an epidemic, due to the pressures of being productive, an imperfect electronic health record (EHR) system, and limited face-to-face time with patients. Poor usability in EHR-user interface can force users to go through more steps (i.e. more clicks on the computer) in accomplishing a task. This increased 'click burden' is a source of frustration for physicians. In the light of increased click burden and time due to meaningful use requirements, there is a need to improve the physician's experience by creating innovations in EHR. This case study describes an attempt by physicians at NewYork-Presbyterian Brooklyn Methodist Hospital to enhance the EHR experience with more efficient methods of documentation, chart review, ordering and patient safety. The EHR innovations trialled in this study were: a mobile documentation application; abnormal test results auto-populated into an EHR patient summary; physician alerts to reduce inappropriate test ordering; and a system of safety alerts on a dashboard. These innovations led to decreased click burden and allowed physicians to spend less time on the computer and more time with patients. Physician-driven changes to EHR systems have the potential to streamline virtual workflows and the management of health information and to improve patient safety, reduce physician burnout and increase physician job satisfaction.

  14. Invited Article: Threats to physician autonomy in a performance-based reimbursement system.

    PubMed

    Larriviere, Daniel G; Bernat, James L

    2008-06-10

    Physician autonomy is currently threatened by the external application of pay for performance standards and required conformity to practice guidelines. This phenomenon is being driven by concerns over the economic viability of increasing per capita health care expenditures without a concomitant rise in favorable health outcomes and by the unjustified marked variations among physicians' practice patterns. Proponents contend that altering the reimbursement system to encourage physicians to make choices based upon the best available evidence would be one way to ensure better outcomes per health care dollar spent. Although physician autonomy is most easily justified when decisions are made by appealing to the best available evidence, incentivizing decision-making risks sacrificing physician autonomy to political and social forces if the limitations of evidence-based medicine are not respected. Any reimbursement system designed to encourage physicians to utilize the best available evidence by providing financial incentives must recognize physicians who try to play to the numbers as well as physicians who refuse to follow the best available evidence if doing so would conflict with good medicine or patient preferences. By designing, promulgating, and updating evidence-based clinical practice guidelines, medical specialty societies can limit threats to physician autonomy while improving medical practice.

  15. Kidney disease physician workforce: where is the emerging pipeline?

    PubMed

    Pogue, Velvie A; Norris, Keith C; Dillard, Martin G

    2002-08-01

    A predicted increase in the number of patients with end-stage renal disease in coming years, coupled with significant numbers of qualified nephrologists reaching retirement age, will place great demands on the renal physician workforce. Action is required on several fronts to combat the predicted shortfall in full-time nephrologists. Of particular importance is the need to recruit and train greater numbers of physicians from ethnic minority groups. Changes in the demographics of kidney disease make it increasingly a disease of ethnic minorities and the poor. These demographic changes, together with the existing racial disparities in the diagnosis and treatment of kidney disease, highlight the specific need for nephrologists who are cognizant of the issues and barriers that prevent optimal care of high-risk minority populations. The current lack of academic role models and the drive by medical schools and residency programs to encourage minority group physicians to become primary care providers, rather than specialists, are issues that must be urgently addressed. Equally, changes in the training of renal fellows are required to merge the critical need for cutting edge research activity in renal science and with the insights and sensitivity to equip clinicians with the necessary skills for the team-based approach to patient care that increasingly characterizes the management and care of the patient with chronic kidney disease.

  16. The Geographic Distribution of Physicians Revisited

    PubMed Central

    Rosenthal, Meredith B; Zaslavsky, Alan; Newhouse, Joseph P

    2005-01-01

    Context While there is debate over whether the U.S. is training too many physicians, many seem to agree that physicians are geographically maldistributed, with too few in rural areas. Objective Official definitions of shortage areas assume the market for physician services is based on county boundaries. We wished to ascertain how the picture of a possible shortage changes using alternative measures of geographic access. We measure geographic access by the number of full-time equivalent physicians serving a community divided by the expected number of patients (possibly both from within the community and outside) receiving care from those physicians. Moreover, we wished to determine how the geographic distribution of physicians had changed since previous studies, in light of the large increase in physician numbers. Design Cross-sectional data analyses of alternative measures of geographic access to physicians in 23 states with low physician–population ratios. Results Between 1979 and 1999, the number of physicians doubled in the sample states. Although most specialties experienced greater diffusion everywhere, smaller specialties had not yet diffused to the smallest towns. Multiple measures of geographic access, including physician-to-population ratios, average distance traveled to the nearest physician, and projected average caseload per physician, confirm that residents of metropolitan areas have better geographic access to physicians. Physician-to-population ratios exhibit the largest degree of geographic disparity, but ratios in rural counties adjacent to metropolitan areas are smaller than in those not adjacent to metropolitan areas. Distance-traveled and caseload models that allow patients to cross county lines show less disparity and indicate that residents of isolated rural counties have less access than those living in counties adjacent to metropolitan areas. Conclusion Geographic access to physicians has continued to improve over the past two decades

  17. Workaholism: are physicians at risk?

    PubMed

    Rezvani, A; Bouju, G; Keriven-Dessomme, B; Moret, L; Grall-Bronnec, M

    2014-09-01

    Work addiction (WA), often called 'workaholism', is a relatively recent concept that has not yet been clearly defined. Ongoing studies have found prevalence rates that are highly variable due to the diversity of the models used and the populations studied. To assess the characteristics of WA among hospital medical staff. All physicians practising at a French university hospital were invited to participate in a survey based on two questionnaires: the Work Addiction Risk Test (WART) for WA and the Job Contents Questionnaire (JCQ) to assess psychosocial constraints at work. There were 444 responding physicians. The response rate was 45%. Thirteen per cent of respondents were considered to be highly work addicted and a further 35% were considered mildly work addicted. Professors had the highest average WART score, but neither age nor sex was associated with WA. Furthermore, all 3D scores obtained using the JCQ correlated with the WART score; the highest correlation coefficient being obtained between the WART score and the job demands score, indicating that workaholics experienced high job demands. WA especially affects professors, who have the highest status amongst doctors in the hospital hierarchy. This study highlights the importance of constraints and workload, which are consistent with individual vulnerability factors. These factors may help identify ways of preventing and managing this type of addiction, through improvement of working conditions and organizational structures. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. [Burnout syndrome among family physicians].

    PubMed

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon

    2013-01-01

    burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians. a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test. there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome. the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

  19. Perspective: Physician leadership in quality.

    PubMed

    Pronovost, Peter J; Miller, Marlene R; Wachter, Robert M; Meyer, Gregg S

    2009-12-01

    While advances in biomedicine are awesome, progress in patient safety and quality of care has proven slow and arduous. One factor contributing to the labored progress is the paucity of physician-leaders who can help advance the science and practice of quality and safety. This limited talent pool, which has particularly serious consequences in academic medical centers (AMCs), stems from insufficient training in quality and safety, which in turn owes to our collective failure to view the delivery of health care as a science. Even when AMCs have trained and skilled quality and safety leaders, the infrastructure to support their work is deficient, with poorly defined job descriptions, competing responsibilities, and limited formal roles in the medical school compared with the hospital. Though there is limited empiric evidence to guide recommendations, the authors support four initiatives to accelerate national progress on quality and safety: (1) invest in quality and safety science, (2) revise quality and safety governance in AMCs, and (3) integrate roles within the hospital and medical school. Many of these shortcomings can be addressed by creating a newly integrated role: the vice dean for quality and hospital director of quality and safety. For AMCs to achieve significant improvements in quality and safety, they must invest in physician-leaders and in the support these leaders need to carry out their educational and operational roles.

  20. [Physician and freedom of conscience].

    PubMed

    Munzarová, Marta

    2012-01-01

    In the arena of bioethics we can find the ideas trying to deny the right to freedom of conscience to physicians. This is an attack upon morality itself. It is therefore urgent to outline the basic knowledge dealing with conscience and to be aware of the fact that violation of conscience leads to breakdown of conscience. The present article deals with Socrates daimonion and his conviction of objective truth as well as with other similar thoughts of great philosophers and theologians in this context: everybody is able to recognize good and evil, some basic knowledge of the common truth exists in the heart of everyone. The feeling of guilt and the capacity to recognize guilt should not be suppressed: the silence of conscience is the greatest tragedy of man. It is quite clear, that the doctor should not agree with the patients every wish, no matter how destructive it is. His own conscience and personal integrity as well as the fact, that the doctor should be the person of integrity, is a more fundamental notion than the respect to autonomy of the patient. Being engaged in killing [euthanasia] serves as an example of bewildering and silencing of conscience. The right to and the importance of physicians freedom of conscience are emphasized in many international documents; the relevant quotations are presented in the text. Key words: conscience, truth, euthanasia, autonomy, conscientious objection.

  1. Developing Physician Migration Estimates for Workforce Models.

    PubMed

    Holmes, George M; Fraher, Erin P

    2017-02-01

    To understand factors affecting specialty heterogeneity in physician migration. Physicians in the 2009 American Medical Association Masterfile data were matched to those in the 2013 file. Office locations were geocoded in both years to one of 293 areas of the country. Estimated utilization, calculated for each specialty, was used as the primary predictor of migration. Physician characteristics (e.g., specialty, age, sex) were obtained from the 2009 file. Area characteristics and other factors influencing physician migration (e.g., rurality, presence of teaching hospital) were obtained from various sources. We modeled physician location decisions as a two-part process: First, the physician decides whether to move. Second, conditional on moving, a conditional logit model estimates the probability a physician moved to a particular area. Separate models were estimated by specialty and whether the physician was a resident. Results differed between specialties and according to whether the physician was a resident in 2009, indicating heterogeneity in responsiveness to policies. Physician migration was higher between geographically proximate states with higher utilization for that specialty. Models can be used to estimate specialty-specific migration patterns for more accurate workforce modeling, including simulations to model the effect of policy changes. © Health Research and Educational Trust.

  2. Attitudes and habits of highly humanistic physicians.

    PubMed

    Chou, Carol M; Kellom, Katherine; Shea, Judy A

    2014-09-01

    Humanism is fundamental to excellent patient care and is therefore an essential concept for physicians to teach to learners. However, the factors that help attending physicians to maintain their own humanistic attitudes over time are not well understood. The authors attempted to identify attitudes and habits that highly humanistic physicians perceive allow them to sustain their humanistic approach to patient care. In 2011, the authors polled internal medicine residents at the University of Pennsylvania to identify attending physicians who exemplified humanistic patient care. In this cross-sectional, qualitative study, the authors used a semistructured script to interview the identified attending physicians to determine attitudes and habits that they believed contribute to their sustenance of humanistic patient care. Attitudes for sustaining humanism in this cohort of humanistic physicians included humility, curiosity, and a desire to live up to a standard of behavior. Many of the physicians deliberately worked at maintaining their humanistic attitudes. Habits that humanistic physicians engaged in to sustain their humanism included self-reflection, connecting with patients, teaching and role modeling, and achieving work-life balance. Physicians believed that treating their patients humanistically serves to prevent burnout in themselves. Identification of factors that highly humanistic attending physicians perceive help them to sustain a humanistic outlook over time may inform the design of programs to develop and sustain humanism in teaching faculty.

  3. Medical informed consent: general considerations for physicians.

    PubMed

    Paterick, Timothy J; Carson, Geoff V; Allen, Marjorie C; Paterick, Timothy E

    2008-03-01

    Medical informed consent is essential to the physician's ability to diagnose and treat patients as well as the patient's right to accept or reject clinical evaluation, treatment, or both. Medical informed consent should be an exchange of ideas that buttresses the patient-physician relationship. The consent process should be the foundation of the fiduciary relationship between a patient and a physician. Physicians must recognize that informed medical choice is an educational process and has the potential to affect the patient-physician alliance to their mutual benefit. Physicians must give patients equality in the covenant by educating them to make informed choices. When physicians and patients take medical informed consent seriously, the patient-physician relationship becomes a true partnership with shared decision-making authority and responsibility for outcomes. Physicians need to understand informed medical consent from an ethical foundation, as codified by statutory law in many states, and from a generalized common-law perspective requiring medical practice consistent with the standard of care. It is fundamental to the patient-physician relationship that each partner understands and accepts the degree of autonomy the patient desires in the decision-making process.

  4. Health information technology and physician career satisfaction.

    PubMed

    Elder, Keith T; Wiltshire, Jacqueline C; Rooks, Ronica N; Belue, Rhonda; Gary, Lisa C

    2010-09-01

    Health information technology (HIT) and physician career satisfaction are associated with higher-quality medical care. However, the link between HIT and physician career satisfaction, which could potentially reduce provider burnout and attrition, has not been fully examined. This study uses a nationally representative survey to assess the association between key forms of HIT and career satisfaction among primary care physicians (PCPs) and specialty physicians. We performed a retrospective, cross-sectional analysis of physician career satisfaction using the Community Tracking Study Physician Survey, 2004-2005. Nine specific types of HIT as well as the overall adoption of HIT in the practice were examined using multivariate logistic regression. Physicians who used five to six (odds ratio [OR] = 1.46) or seven to nine (OR = 1.47) types of HIT were more likely than physicians who used zero to two types of HIT to be "very satisfied" with their careers. Information technology usages for communicating with other physicians (OR = 1.31) and e-mailing patients (OR = 1.35) were positively associated with career satisfaction. PCPs who used technology to write prescriptions were less likely to report career satisfaction (OR = 0.67), while specialists who wrote notes using technology were less likely to report career satisfaction (OR = 0.75). Using more information technology was the strongest positive predictor of physicians being very satisfied with their careers. Toward that end, healthcare organizations working in conjunction with providers should consider exploring ways to integrate various forms of HIT into practice.

  5. Physician professionalism for a new century.

    PubMed

    Holsinger, James W; Beaton, Benjamin

    2006-07-01

    During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society.

  6. Why do physicians volunteer to be OSCE examiners?

    PubMed

    Humphrey-Murto, Susan; Wood, Timothy J; Touchie, Claire

    2005-03-01

    Recruitment of physician examiners for an objective structured clinical examination (OSCE) can be difficult. The following study will explore reasons why physicians volunteer their time to be OSCE examiners. A questionnaire was collected from 110 examiners including a fourth year formative student OSCE (SO) (n=49), formative internal medicine OSCE (IM) (n=21) and the Medical Council of Canada Qualifying Exam Part II (MCCQE II) (n=40). A 5-point Likert scale was used. Statements with high mean ratings overall included: enjoy being an examiner (4.05), gain insights into learners' skills and knowledge (4.27), and examine out of a sense of duty (4.10). The MCC participants produced higher ratings (p<0.05). Overall, OSCE examiners volunteer their time because they enjoy the experience, feel a sense of duty and gain insight into learners' skills and knowledge. The MCC examiners appear to value the experience more. The ability to provide feedback and the provision of CME credits were not significant factors for increasing examiner satisfaction.

  7. Physician leadership in e-health? A systematic literature review.

    PubMed

    Keijser, Wouter; Smits, Jacco; Penterman, Lisanne; Wilderom, Celeste

    2016-07-04

    Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.

  8. Medical liability of the physician in training.

    PubMed

    Wegman, Brian; Stannard, James P; Bal, B Sonny

    2012-05-01

    Lawsuits alleging medical negligence by postgraduate physicians in training (residents) arise from treatment received by aggrieved patients at teaching hospitals. A threshold question in determining liability is whether or not the standard of care has been violated. Courts have questioned whether the proper standard governing resident physician conduct should be that of a reasonably competent generalist physician, that of a specialty physician, or whether the standard should be some subjective determination that addresses the resident level of training. We examined legal cases in which the standard of care for a physician in training has been questioned. Additionally, we address how resident conduct can extend liability to supervising physicians and employer hospitals. Westlaw and LexisNexis, two major legal databases used by law professionals, were searched to identify existing case law and law review articles related to the standard of care that applies to physicians in training. Of 57 sources initially identified, 15 legal cases and 10 law review papers addressed the standard of care pertaining to physicians in training. These selected cases and papers form the basis of the present article. The standard by which the professional conduct of a physician in training is measured has varied; most recent legal cases have applied a specialty physician standard. Relevant court rulings have tried to strike a balance between patient interests versus the societal need to train physicians. Physician representation, nature of conduct, and extent of supervision of that conduct are relevant factors used by courts to determine liability. However, the recent standards are those of the physician who directly supervises the professional conduct of a resident in a given situation.

  9. Shifting Patterns of Physician Home Visits.

    PubMed

    Sairenji, Tomoko; Jetty, Anuradha; Peterson, Lars E

    2016-04-01

    Home visits have been shown to improve quality of care and lower medical costs for complex elderly patients. We investigated trends in physician home visits and domiciliary care visits as well as physician characteristics associated with providing these services. Longitudinal analysis of Medicare Part B claims data for a national sample of direct patient care physicians in 2006 and 2011. Descriptive statistics were used to characterize the physician sample and to determine numbers of home visits and domiciliary visits in total and by physician specialty. Patient homes, nursing homes, and domiciliary care facilities. Direct patient care physicians (n = 22,186). Physician demographics, specialty, practice characteristics (practice type, geographic location), number of home visits, and domiciliary visits in 2006 and 2011. We found a small increase (n = 63,501) in total number of home visits made to Medicare beneficiaries between 2006 and 2011 performed by a decreasing percentage of physicians (5.1%, n = 18,165 in 2006; 4.5%, n = 15,296 in 2011). There was substantial growth in domiciliary care visit numbers (n = 218,514) and a small increase in percentage of physicians delivering these services (2.0% in 2006, 2.3% in 2011). Physicians who performed home visits were more likely to be older, in rural locations, specialists in primary care, and more likely to provide nursing home and domiciliary care compared with physicians who did not make any home visits (P < .05). Home visits and domiciliary visits to Medicare beneficiaries are increasing. General internal medicine physicians provided the highest number of home and domiciliary care visits in 2006, and family physicians did so in 2011. Such delivery models show promise in lowering medical costs while providing high-quality patient care. © The Author(s) 2015.

  10. Verbal Aggressiveness Among Physicians and Trainees.

    PubMed

    Lazarus, Jenny Lynn; Hosseini, Motahar; Kamangar, Farin; Levien, David H; Rowland, Pamela A; Kowdley, Gopal C; Cunningham, Steven C

    2016-01-01

    To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences. The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type. The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed. Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a

  11. Mobile tablet use among academic physicians and trainees.

    PubMed

    Sclafani, Joseph; Tirrell, Timothy F; Franko, Orrin I

    2013-02-01

    The rapid adoption rate and integration of mobile technology (tablet computing devices and smartphones) by physicians is reshaping the current clinical landscape. These devices have sparked an evolution in a variety of arenas, including educational media dissemination, remote patient data access and point of care applications. Quantifying usage patterns of clinical applications of mobile technology is of interest to understand how these technologies are shaping current clinical care. A digital survey examining mobile tablet and associated application usage was administered via email to all ACGME training programs. Data regarding respondent specialty, level of training, and habits of tablet usage were collected and analyzed. 40% of respondents used a tablet, of which the iPad was the most popular. Nearly half of the tablet owners reported using the tablet in clinical settings; the most commonly used application types were point of care and electronic medical record access. Increased level of training was associated with decreased support for mobile computing improving physician capabilities and patient interactions. There was strong and consistent desire for institutional support of mobile computing and integration of mobile computing technology into medical education. While many physicians are currently purchasing mobile devices, often without institutional support, successful integration of these devices into the clinical setting is still developing. Potential reasons behind the low adoption rate may include interference of technology in doctor-patient interactions or the lack of appropriate applications available for download. However, the results convincingly demonstrate that physicians recognize a potential utility in mobile computing, indicated by their desire for institutional support and integration of mobile technology into medical education. It is likely that the use of tablet computers in clinical practice will expand in the future. Thus, we believe

  12. Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

    PubMed

    Rosenthal, David A; Layman, Elizabeth J

    2008-02-13

    The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

  13. [Town physician or physician in a town? Three early modern physicians and their understanding of their municipal function].

    PubMed

    Schilling, Ruth; Schlegelmilch, Sabine; Splinter, Susan

    2011-01-01

    The institution of the town physician has been up to now discussed mostly on the limited scale of regional studies. In this article three early modern period town physicians are compared regarding their own understanding of their office. Their individual approach towards medical practice is examined on a broader spatio-temporal range within the context of medicalization, which was an integral part of the development of early modern territorial states. This comparison shows that beyond contemporary normative concepts town physicians also claimed particular roles within their social context. By achieving these, they often broadened or even transgressed the assumed delineation of the function subscribed to town physicians.

  14. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2014-12-01

    This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.

  15. Implications of Good Samaritan laws for physicians.

    PubMed

    Paterick, Timothy J; Paterick, Barbara B; Paterick, Timothy E

    2008-01-01

    Good Samaritan laws are designed to encourage individuals, including physicians, to gratuitously render medical care in emergency situations. Through these laws, immunity from civil liability is provided to physicians who act in good faith to provide emergency care gratis. Historically, emergency care involved medical assistance given to persons in motor vehicle crashes or other emergency situations in which bystanders were present. Protection of physicians from allegations of negligence was a tactic of the legislative and judicial systems to encourage active clinical participation, rather than cautious nonparticipation, in emergency care. In some states and under defined circumstances, the immunity may apply in the hospital setting, as well as in the physician's office. Legislatures have continued to amend the statutes to expand the protection provided to physicians who offer emergency care. Judicial construction of the nature and scope of physician immunity has similarly expanded.

  16. Physicians in transition: practice due diligence.

    PubMed

    Paterick, Timothy E

    2013-01-01

    The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization.

  17. Physicians' "right of conscience"- beyond politics.

    PubMed

    Gold, Azgad

    2010-01-01

    During the past few months, the discussion over the physicians' "Right of Conscience" (ROC) has been on the rise. The intervention of politics in this issue shifts the discussion to a very specific and narrow area, namely the "reproductive health laws" which bear well-known predisposing attitudes. In this article, the physician's ROC is discussed in the context in which it naturally belongs: the Patient Physician Relationship (PPR). I suggest that the physicians' rights demand is a comprehensible, predictable, and even inevitable step as part of the "evolution" of the PPR. Thus, the most appropriate way to comprehend and tackle the demand for physicians' ROC is within the context of medical professionalism. While searching for practical solutions to the "reproductive health" problems, there is a need to recognize the ethical and practical implications of the change in the PPR and balance between patient and physician rights.

  18. Addressing the phenomenon of disruptive physician behavior.

    PubMed

    Piper, Llewellyn E

    2003-01-01

    This timely article provides current information on an age-old issue of disruptive physician behavior within the hospital setting. Documented in medical literature over 100 years ago, disruptive physician behavior has been an ongoing challenge to the hospital staff and the quality of patient care in the hospital. Covered in this article are the negative consequences of disruptive physician behavior and the call to respond. If allowed to go unchecked, a physician exhibiting disruptive behavior may threaten a hospital's image, staff morale, finance, and quality of care. Failure to respond undermines the leadership of the hospital and the trust of the community in the hospital's mission. Included in this article are suggestions obtained from the literature and from the author's experience in responding to disruptive physician behavior. Of emphasis is a methodology that includes supporting bylaws and policies to manage disruptive physician behavior.

  19. Preparing for the physician payment sunshine act.

    PubMed

    Dickerson, David M; Naidu, Ramana K

    2014-01-01

    In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Centers for Medicare and Medicaid Services any payments or transfers of value to physicians. These reports are not meant to prohibit relationships between physicians and industry, but rather to generate a searchable public database illustrating the purpose of the payment, the entities involved, and the timing of each occurrence. Although the bill is meant to reveal physician-industry relationships, the question of how society at large and the medical field will interpret these data are unknown. The purpose of this article is to inform physicians of the components of the Physician Payment Sunshine Act. We discuss several resultant challenges and suggest a framework for preparing for transparency reporting and its potential effects.

  20. 360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: A critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers.

    PubMed

    Kamangar, Faranak; Davari, Parastoo; Parsi, Kory K; Li, Chin-Shang; Wang, Qinlu; Mathis, Stephen; Fazel, Nasim

    2016-07-15

    ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves.

  1. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

    ERIC Educational Resources Information Center

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  2. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

    ERIC Educational Resources Information Center

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  3. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints.

    PubMed

    Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang

    2015-01-01

    The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS.

  4. [Karen Blixen and her physicians].

    PubMed

    Søgaard, Ib

    2002-01-01

    In March 1941, two months after her wedding, Karen Blixen was diagnosed as having syphilis in the second stage. She was treated initially with mercury and later on in Denmark with salvarsan. Years later she received more treatment with mercury, salvarsan and bismuth, but in fact she was cured already in 1915 and told so by her venerologist Carl Rasch. However, she did not believe him, and several physicians, including well-known specialists in internal medicine and neurology told her many years later that she had to accept the diagnosis tabes dorsalis, i.e., syphilis in the third chronic stage. This paper claims, based on her medical records from several hospitals, that her physicians' attitude resulted in the delay of right treatment for her real disease for many years and led to at least one unwarrented surgical procedure (chordotomy). In 1956 she finally received surgical treatment of her stomach ulcer which for many years had caused her attacks of abdominal pain. The procedure was delayed for ten years because of a lumbar sympathectomy, which removes the pain for some years but not the ulcer itself, nor the bout of vomiting. Many doctors (and biographers) have been puzzled by her life-long bowel symptoms. It was often called tropic dysentery, in spite of the fact that this diagnosis was never confirmed by stool analyses. Instead it is suggested that most likely the Baroness caused the symptoms. She misused strong laxatives during her whole adult life. She did not tell her doctors about this until very late in her life and then it was far too late. Many times barium enemas showed a severe chronic condition with dehaustration and dilatation. The reason for her misuse was the fact that she was afraid of gaining too much weight. She used amphetamine during her life in Denmark after her return in 1931 in order to reduce her appetite, and probably she used Chat in Africa. She also constantly smoked cigarettes which in combination with minimal food intake facilitated

  5. Interpersonal factors affecting communication in clinical consultations: Canadian physicians' perspectives.

    PubMed

    Lovell, Brenda L; Lee, Raymond T; Brotheridge, Celeste M

    2012-01-01

    This study seeks to determine how process and latent errors in the interpersonal, organizational, health system, and public health domains impact doctor/patient communication and patient safety. There were 278 physicians from Manitoba, Canada who completed a self-report questionnaire during 2006. The largest specialty was family medicine, followed by internal medicine and pediatrics. Mean years of practice was 16, and 60 percent of the respondents were male. Respondents indicated the extent to which difficulties were encountered when communicating with patients. The study finds that physicians had more difficulties with patients in the 0-20 year age bracket on 12 of the 18 communication statements. Psychiatry and pediatrics reported more difficulties with language interpreters. Pediatrics reported more difficulties with patients using culturally-based alternative medicine. Internal medicine had more difficulty with patients not appearing to trust or participate in treatment decisions. Patients in the 41-60 years age bracket had the highest mean for non-adherence to treatment plans, health maintenance and needed lifestyle change. The female physician-female patient dyad had fewer communication difficulties on all statements. Further research should examine how family structure influences health-care delivery and health outcomes. Health care organizations can contribute to improving quality of care by seeking out and correcting sources of latent errors, and by supporting professional development and practice interventions. Few studies exist that have linked communication difficulties to adverse events. This study provides insight on sources of interpersonal errors in communication that directly impact the physician/patient relationship and which may represent threats to patient safety.

  6. Useful but Different: Resident Physician Perceptions of Interprofessional Feedback.

    PubMed

    Vesel, Travis P; O'Brien, Bridget C; Henry, Duncan M; van Schaik, Sandrijn M

    2016-01-01

    Phenomenon: Based on recently formulated interprofessional core competencies, physicians are expected to incorporate feedback from other healthcare professionals. Based on social identity theory, physicians likely differentiate between feedback from members of their own profession and others. The current study examined residents' experiences with, and perceptions of, interprofessional feedback. In 2013, Anesthesia, Obstetrics-Gynecology, Pediatrics, and Psychiatry residents completed a survey including questions about frequency of feedback from different professionals and its perceived value (5-point scale). The authors performed an analysis of variance to examine interactions between residency program and profession of feedback provider. They conducted follow-up interviews with a subset of residents to explore reasons for residents' survey ratings. Fifty-two percent (131/254) of residents completed the survey, and 15 participated in interviews. Eighty percent of residents reported receiving written feedback from physicians, 26% from nurses, and less than 10% from other professions. There was a significant interaction between residency program and feedback provider profession, F(21, 847) = 3.82, p < .001, and a significant main effect of feedback provider profession, F(7, 847) = 73.7, p < .001. On post hoc analyses, residents from all programs valued feedback from attending physicians higher than feedback from others, and anesthesia residents rated feedback from other professionals significantly lower than other residents. Ten major themes arose from qualitative data analysis, which revealed an overall positive attitude toward interprofessional feedback and clarified reasons behind residents' perceptions and identified barriers. Insights: Residents in our study reported limited exposure to interprofessional feedback and valued such feedback less than intraprofessional feedback. However, our data suggest opportunities exist for effective utilization of

  7. Learning from Moshe, Hu Hu Zhu and Khokha: Insights into the Global Application of the Formative Research Component of the Sesame Workshop Model. Introduction to the Special Issue.

    ERIC Educational Resources Information Center

    Cole, Charlotte, Frances

    2002-01-01

    Provides examples from six studies to illustrate how the formative research element of the Sesame Workshop production model has been used to create effective educational media in the United States, South Africa, Egypt, and China. Shows how lessons learned from formative studies provide insights into the development of new research methodologies…

  8. Learning from Moshe, Hu Hu Zhu and Khokha: Insights into the Global Application of the Formative Research Component of the Sesame Workshop Model. Introduction to the Special Issue.

    ERIC Educational Resources Information Center

    Cole, Charlotte, Frances

    2002-01-01

    Provides examples from six studies to illustrate how the formative research element of the Sesame Workshop production model has been used to create effective educational media in the United States, South Africa, Egypt, and China. Shows how lessons learned from formative studies provide insights into the development of new research methodologies…

  9. [Regional distribution of physicians in Croatia].

    PubMed

    Drakulić, Velibor; Bagat, Mario; Golem, Ante-Zvonimir

    2009-01-01

    The aim of this study was to show regional distribution of physicians in Croatia. Number of physicians members of the Croatian medical chamber and number of physicians in the system of mandatory health insurance were compared between the counties. In 2006 in Croatia there were 276 physicians per 100,000 inhabitants, i.e., 215 physicians per 100,000 inhabitants in the system of mandatory health insurance. The fewer number of physicians per 100,000 inhabitants in the system of mandatory health insurance, less then 150, were in Koprivnica-Krizevci County, Lika-Senj County and Vukovar-Srijem County, while the greatest number of physicians, more than 250 per 100,000 inhabitants, were in the City of Zagreb and Zagreb County, and Primorje-Gorski kotar County. There were significant differences in the number of physicians per 100,000 inhabitants between the counties (chi2 = 148.7, DF = 19, P < 0.001, chi2-test). Number of general practitioners (GPs) per 100,000 inhabitants in Croatia were 54.2, with range from 47.1 in Pozega-Slavonia County to 61.8 in Primorje-Gorski kotar County. Number of physician specialties in four basic specialties per 100,000 inhabitants in Croatian hospitals were for internal medicine 19.1, general surgery 11.0, gynecology and obstetrics 6.7 and pediatrics 7.8. There were significant differences in the number of physicians in four specialties (internal medicine, general surgery, gynecology and obstetrics and pediatrics) per 100,000 inhabitants between the counties (chi2 = 76.0, DF = 19, P < 0.001, chi2-test). Apart from the insufficient number of physicians in Croatia, an inadequate allocation of physicians in certain counties is also evident.

  10. Physician communication coaching effects on patient experience.

    PubMed

    Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

    2017-01-01

    Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001). A simulation based physician communication coaching method focused on specific "etiquette

  11. PCBs and the Family Physician

    PubMed Central

    Cappon, I.D.

    1986-01-01

    Pcbs are widespread environmental contaminants present in virtually every mammal on earth. Great controversy and debate has been evoked over the past two decades concerning their potential toxicity. They, along with other organochlorine compounds such as DDT, have been reasonably well studied in field and experimental situations. In general, PCBs are not very toxic, especially in concentrations to which most people are exposed, even those who work in the industrial setting or who eat contaminated fish. In terms of environmental hazards to health, PCBs should be considered as relatively low on the list. The public cannot depend on media information as a source of objective knowledge on controversial compounds like PCBs. The family physician should be able to provide to concerned individuals objective information on the definition, sources and relative toxicity of PCBs. PMID:21267326

  12. Bioterrorism for the respiratory physician.

    PubMed

    Waterer, Grant W; Robertson, Hannah

    2009-01-01

    Terrorist attacks by definition are designed to cause fear and panic. There is no question that a terrorist attack using biological agents would present a grave threat to stability of the society in which they were released. Early recognition of such a bioterrorist attack is crucial to containing the damage they could cause. As many of the most likely bioterrorism agents present with pulmonary disease, respiratory physicians may be crucial in the initial recognition and diagnosis phase, and certainly would be drawn into treatment of affected individuals. This review focuses on the biological agents thought most likely to be used by terrorists that have predominantly respiratory presentations. The primary focus of this review is on anthrax, plague, tularaemia, ricin, and Staphylococcal enterotoxin B. The pathogenesis, clinical manifestations and treatment of these agents will be discussed as well as historical examples of their use. Other potential bioterrorism agents with respiratory manifestations will also be discussed briefly.

  13. [Comments on the Confucian physician].

    PubMed

    Li, Jian-xiang

    2009-09-01

    Confucianism gradually permeated and influenced the development of TCM from the Song dynasty, and the term "Confucian physician" is still in use today. With the impact of Confucianism, whether in the compilation of the medical classics or the explanation and conclusion of the medical theories as well as in medical education and ethics, all developed dramatically. But the Confucianism had also a negative effect on the development of medicine. For example, SU Dong-po cured the epidemics with "Sheng san zi", but he exaggerated its action and recorded it. The later intellectuals learnt from him without differentiation and many people suffered. Another example is, with the influence of ideas of "serve the parents" and "help the public", adult children treated their parents by cutting their own thigh. Even some wealthy and intelligent people blindly applied the prescription without differentiation.

  14. Childhood bullying: implications for physicians.

    PubMed

    Lyznicki, James M; McCaffree, Mary Anne; Robinowitz, Carolyn B

    2004-11-01

    Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities.

  15. The Internet for Louisiana physicians.

    PubMed

    Ellis, M S

    2000-09-01

    Fewer than 50% of Louisiana physicians actively use the Internet, and many of them confine their usage to e-mailing among family and friends. The purpose of this article is to acquaint the reader with many of the benefits of exploiting the incredible potential of this technological invention. I provide addresses and information about sites that I believe warrant usage by our colleagues. Of the vast smorgasbord of data available we highlight educational Web sites for professionals and the public, how to determine credibility of information, clinical research of scientific articles, computer security, federal and state government sites, newspapers, political and socioeconomic functions, medical supply shops, e-mail and other computerized communication, electronic medical records, personal or professional Web sites, and future medical internet uses. It is hoped that this process will encourage nonparticipating colleagues to begin using this modality while also supplying sites that current users may not yet have discovered.

  16. The Physician of the Future

    PubMed Central

    Thomas, Edward Llewellyn

    1966-01-01

    The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician. He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics. PMID:5908727

  17. Producing physicians for south Texas.

    PubMed

    Thomson, W A; Denk, J P; Ferry, P G; Martinez-Wedig, C; Michael, L H

    1999-01-01

    South Texas, one of the fastest growing regions in the country, remains among the most medically underserved, in part, because few students from South Texas enter medical school. To address this issue and to increase the diversity of the matriculant pool, Baylor College of Medicine (BCM) and The University of Texas-Pan American (UT-PA) established in 1994 the Premedical Honors College (PHC), a rigorous undergraduate program at UT-PA for students from South Texas high schools. Students who complete all PHC requirements and BCM prerequisites are accepted into BCM upon graduation from UT-PA. Those in good standing receive counseling, enrichment experiences, and tuition and fee waivers from UT-PA and BCM. The program is increasing the number of students from South Texas universities matriculating into medical school, and is expanding the involvement of local physicians in undergraduate education, heightening visibility for partner institutions, and becoming an effective, replicable bachelor of science/doctor of medicine model.

  18. The physician of the future.

    PubMed

    Thomas, E L

    1966-04-09

    The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.

  19. A method of estimating physician requirements.

    PubMed

    Scitovsky, A A; McCall, N

    1976-01-01

    This article describes and applies a method of estimating physician requirements for the United States based on physician utilization rates of members of two comprehensive prepaid plans of medical care providing first-dollar coverage for practically all physician services. The plan members' physician utilization rates by age and sex and by field of specialty of the physician were extrapolated to the entire population of the United States. On the basis of data for 1966, it was found that 34 percent more physicians than were available would have been required to give the entire population the amount and type of care received by the plan members. The "shortage" of primary care physicians (general practice, internal medicine, and pediatrics combined) was found to be considerably greater than of physicians in the surgical specialties taken together (41 percent as compared to 21 percent). The paper discusses in detail the various assumptions underlying this method and stresses the need for careful evaluation of all methods of estimating physician requirements.

  20. Case reviews in the family physician's office.

    PubMed

    Kates, N; Craven, M; Webb, S; Low, J; Perry, K

    1992-02-01

    The majority of patients with emotional or psychiatric disorders are treated in the primary care setting without psychiatric input. Psychiatrists need to find ways of helping family physicians manage these patients without necessarily taking over their care. One way of achieving this is for a psychiatric consultant to visit the family physician's office on a regular basis to discuss the physician's problem cases. This paper describes such a pilot project, outlines the kinds of problems family physicians discussed and recommendations that were made, and discusses the benefits of this collaborative approach.