Automated problem list generation and physicians perspective from a pilot study.

PubMed

Devarakonda, Murthy V; Mehta, Neil; Tsou, Ching-Huei; Liang, Jennifer J; Nowacki, Amy S; Jelovsek, John Eric

2017-09-01

An accurate, comprehensive and up-to-date problem list can help clinicians provide patient-centered care. Unfortunately, problem lists created and maintained in electronic health records by providers tend to be inaccurate, duplicative and out of date. With advances in machine learning and natural language processing, it is possible to automatically generate a problem list from the data in the EHR and keep it current. In this paper, we describe an automated problem list generation method and report on insights from a pilot study of physicians' assessment of the generated problem lists compared to existing providers-curated problem lists in an institution's EHR system. The natural language processing and machine learning-based Watson 1 method models clinical thinking in identifying a patient's problem list using clinical notes and structured data. This pilot study assessed the Watson method and included 15 randomly selected, de-identified patient records from a large healthcare system that were each planned to be reviewed by at least two internal medicine physicians. The physicians created their own problem lists, and then evaluated the overall usefulness of their own problem lists (P), Watson generated problem lists (W), and the existing EHR problem lists (E) on a 10-point scale. The primary outcome was pairwise comparisons of P, W, and E. Six out of the 10 invited physicians completed 27 assessments of P, W, and E, and in process evaluated 732 Watson generated problems and 444 problems in the EHR system. As expected, physicians rated their own lists, P, highest. However, W was rated higher than E. Among 89% of assessments, Watson identified at least one important problem that physicians missed. Cognitive computing systems like this Watson system hold the potential for accurate, problem-list-centered summarization of patient records, potentially leading to increased efficiency, better clinical decision support, and improved quality of patient care. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Using an electronic prescribing system to ensure accurate medication lists in a large multidisciplinary medical group.

PubMed

Stock, Ron; Scott, Jim; Gurtel, Sharon

2009-05-01

Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics. In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit. Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR. The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.

Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters

PubMed Central

2010-01-01

Background The communication literature currently focuses primarily on improving physicians' verbal and non-verbal behaviors during the medical interview. The Four Habits Model is a teaching and research framework for physician communication that is based on evidence linking specific communication behaviors with processes and outcomes of care. The Model conceptualizes basic communication tasks as "Habits" and describes the sequence of physician communication behaviors during the clinical encounter associated with improved outcomes. Using the Four Habits Model as a starting point, we asked communication experts to identify the verbal communication behaviors of patients that are important in outpatient encounters. Methods We conducted a 4-round Delphi process with 17 international experts in communication research, medical education, and health care delivery. All rounds were conducted via the internet. In round 1, experts reviewed a list of proposed patient verbal communication behaviors within the Four Habits Model framework. The proposed patient verbal communication behaviors were identified based on a review of the communication literature. The experts could: approve the proposed list; add new behaviors; or modify behaviors. In rounds 2, 3, and 4, they rated each behavior for its fit (agree or disagree) with a particular habit. After each round, we calculated the percent agreement for each behavior and provided these data in the next round. Behaviors receiving more than 70% of experts' votes (either agree or disagree) were considered as achieving consensus. Results Of the 14 originally-proposed patient verbal communication behaviors, the experts modified all but 2, and they added 20 behaviors to the Model in round 1. In round 2, they were presented with 59 behaviors and 14 options to remove specific behaviors for rating. After 3 rounds of rating, the experts retained 22 behaviors. This set included behaviors such as asking questions, expressing preferences, and summarizing information. Conclusion The process identified communication tasks and verbal communication behaviors for patients similar to those outlined for physicians in the Four Habits Model. This represents an important step in building a single model that can be applied to teaching patients and physicians the communication skills associated with improved satisfaction and positive outcomes of care. PMID:20403173

Learning the preferences of physicians for the organization of result lists of medical evidence articles.

PubMed

O'Sullivan, D; Wilk, S; Michalowski, W; Slowinski, R; Thomas, R; Kadzinski, M; Farion, K

2014-01-01

Online medical knowledge repositories such as MEDLINE and The Cochrane Library are increasingly used by physicians to retrieve articles to aid with clinical decision making. The prevailing approach for organizing retrieved articles is in the form of a rank-ordered list, with the assumption that the higher an article is presented on a list, the more relevant it is. Despite this common list-based organization, it is seldom studied how physicians perceive the association between the relevance of articles and the order in which articles are presented. In this paper we describe a case study that captured physician preferences for 3-element lists of medical articles in order to learn how to organize medical knowledge for decision-making. Comprehensive relevance evaluations were developed to represent 3-element lists of hypothetical articles that may be retrieved from an online medical knowledge source such as MEDLINE or The Cochrane Library. Comprehensive relevance evaluations asses not only an article's relevance for a query, but also whether it has been placed on the correct list position. In other words an article may be relevant and correctly placed on a result list (e.g. the most relevant article appears first in the result list), an article may be relevant for a query but placed on an incorrect list position (e.g. the most relevant article appears second in a result list), or an article may be irrelevant for a query yet still appear in the result list. The relevance evaluations were presented to six senior physicians who were asked to express their preferences for an article's relevance and its position on a list by pairwise comparisons representing different combinations of 3-element lists. The elicited preferences were assessed using a novel GRIP (Generalized Regression with Intensities of Preference) method and represented as an additive value function. Value functions were derived for individual physicians as well as the group of physicians. The results show that physicians assign significant value to the 1st position on a list and they expect that the most relevant article is presented first. Whilst physicians still prefer obtaining a correctly placed article on position 2, they are also quite satisfied with misplaced relevant article. Low consideration of the 3rd position was uniformly confirmed. Our findings confirm the importance of placing the most relevant article on the 1st position on a list and the importance paid to position on a list significantly diminishes after the 2nd position. The derived value functions may be used by developers of clinical decision support applications to decide how best to organize medical knowledge for decision making and to create personalized evaluation measures that can augment typical measures used to evaluate information retrieval systems.

Advanced Technology Applications for Combat Casualty Care

NASA Technical Reports Server (NTRS)

Watkins, Sharmila; Baumann, David; Wu, Jimmy

2010-01-01

Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC s goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions.

Task delegation to physician extenders--some comparisons.

PubMed Central

Glenn, J K; Goldman, J

1976-01-01

This study uses a task delegation questionnaire to compare 1973 physician extender practices in seven primary care-oriented sites with a physician attitude survey made in 1969. One additional site using no physician extenders was included as a control. The study involves both major types of physician extenders (physician assistants and nurse practitioners) in ambulatory practices with at least one year of experience in using such personnel. With minor exceptions, actual task delegation patterns conform with the 1969 attitudes of physicians as to which tasks "could and should" be delegated to physician extenders. PMID:2022

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study.

PubMed

Niederhauser, Andrea; Zimmermann, Chantal; Fishman, Liat; Schwappach, David L B

2018-05-17

In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. Internal medicine units in two mid-sized Swiss hospitals. 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.

PubMed

Breton, Mylaine; Smithman, Mélanie Ann; Brousselle, Astrid; Loignon, Christine; Touati, Nassera; Dubois, Carl-Ardy; Nour, Kareen; Boivin, Antoine; Berbiche, Djamal; Roberge, Danièle

2017-01-05

With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance.

Characteristics of sick-listing cases that physicians consider problematic--analyses of written case reports.

PubMed

Engblom, Monika; Alexanderson, Kristina; Rudebeck, Carl Edvard

2009-01-01

The aim was to discern common characteristics in the sick-listing cases that physicians in general practice and occupational health services find problematic. Descriptive categorization within a narrative theoretical framework. Sickness-insurance course for physicians in general practice and occupational health services. A total of 195 case reports written by 195 physicians. Main outcome measures. Categories of features regarding medical, work, and social situation as well as medical interventions. Beside age and sex, the following information was often provided: family situation, stressful life events, occupation, problem at work, considerations concerning diagnoses, medical investigations, treatments, and vocational rehabilitation measures. Two-thirds of the patients had been sickness absent for more than a year. The most common type of case reports concerned women, employed in non-qualified nursing occupations, and sick listed due to mental disorders. The most common measures taken by the physicians were referrals to psychotherapy and/or physiotherapy, and prescribing antidepressants (SSRI). Facts about alcohol habits were rarely provided in the cases. Some of the circumstances, such as prolonged sick-listing, are likely to be more or less inevitable in problematic sick-listing cases. Other circumstances, such as stress-full life events, more closely reflect what the reporting physicians find problematic. The categories identified can be regarded as markers of problematic sick-listing cases in general practice and occupational health service.

Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters.

PubMed

Roberts, C A; Aruguete, M S

2000-02-01

The purpose of the present study is to assess social interaction and reciprocity theories as explanations for patient responses to a physician in a medical consultation. Social interaction theory predicts that patients mostly recognize and react to socioemotional behavior of their physicians due to a lack of understanding of physician task behaviors or a preoccupation with anxiety. Reciprocity theory predicts that patients recognize socioemotional and task behaviors of their physicians, and they respond to these behaviors in thematically similar ways. We examined these hypotheses by having subjects view one of four videotapes which varied in physician task behavior (thorough or minimum levels of explanation of etiology, symptoms, and treatment) and physician socioemotional behavior (high or low levels of concern and affection displayed verbally and non-verbally). Results supported the general proposition of social interaction theory in that high levels of socioemotional behavior of the physician increased measures of patient self-disclosure, trust, satisfaction, and likelihood of recommending the physician. Physician task behavior had no effect on patient response to the physician, a finding inconsistent with reciprocity theory.

An official American Thoracic Society/American College of Chest Physicians policy statement: the Choosing Wisely top five list in adult pulmonary medicine.

PubMed

Wiener, Renda Soylemez; Ouellette, Daniel R; Diamond, Edward; Fan, Vincent S; Maurer, Janet R; Mularski, Richard A; Peters, Jay I; Halpern, Scott D

2014-06-01

The American Board of Internal Medicine Foundation's Choosing Wisely campaign aims to curb health-care costs and improve patient care by soliciting lists from medical societies of the top five tests or treatments in their specialty that are used too frequently and inappropriately. The American Thoracic Society (ATS) and American College of Chest Physicians created a joint task force, which produced a top five list for adult pulmonary medicine. Our top five recommendations, which were approved by the executive committees of the ATS and American College of Chest Physicians and published by Choosing Wisely in October 2013, are as follows: (1) Do not perform CT scan surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines; (2) do not routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (groups II or III pulmonary hypertension); (3) for patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, do not renew the prescription without assessing the patient for ongoing hypoxemia; (4) do not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay; (5) do not perform CT scan screening for lung cancer among patients at low risk for lung cancer. We hope pulmonologists will use these recommendations to stimulate frank discussions with patients about when these tests and treatments are indicated--and when they are not.

An Analysis of Physician Assistant LibGuides: A Tool for Collection Development.

PubMed

Johnson, Catherine V; Johnson, Scott Y

2017-01-01

The Physician Assistant (PA) specialty encompasses many subject areas and requires many types of library resources. An analysis of PA LibGuides was performed to determine most frequently recommended resources. A sample of LibGuides from U.S. institutions accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) was included in this study. Resources presented on guides were tabulated and organized by resource type. Databases and point-of-care tools were the types of resources listed by the most LibGuides. There were over 1,000 books listed on the 45 guides, including over 600 unique books listed. There were fewer journals listed, only 163. Overall, while the 45 LibGuides evaluated list many unique resources in each category, a librarian can create an accepted list of the most frequently listed resources from the data gathered.

Emergency Physician Task Switching Increases With the Introduction of a Commercial Electronic Health Record.

PubMed

Benda, Natalie C; Meadors, Margaret L; Hettinger, A Zachary; Ratwani, Raj M

2016-06-01

We evaluate how the transition from a homegrown electronic health record to a commercial one affects emergency physician work activities from initial introduction to long-term use. We completed a quasi-experimental study across 3 periods during the transition from a homegrown system to a commercially available electronic health record with computerized provider order entry. Observation periods consisted of pre-implementation, 1 month before the implementation of the commercial electronic health record; "go-live" 1 week after implementation; and post-implementation, 3 to 4 months after use began. Fourteen physicians were observed in each period (N=42) with a minute-by-minute observation template to record emergency physician time allocation across 5 task-based categories (computer, verbal communication, patient room, paper [chart/laboratory results], and other). The average number of tasks physicians engaged in per minute was also analyzed as an indicator of task switching. From pre- to post-implementation, there were no significant differences in the amount of time spent on the various task categories. There were changes in time allocation from pre-implementation to go-live and go-live to pre-implementation, characterized by a significant increase in time spent on computer tasks during go-live relative to the other periods. Critically, the number of tasks physicians engaged in per minute increased from 1.7 during pre-implementation to 1.9 during post-implementation (difference 0.19 tasks per minute; 95% confidence interval 0.039 to 0.35). The increase in the number of tasks physicians engaged in per minute post-implementation indicates that physicians switched tasks more frequently. Frequent task switching behavior raises patient safety concerns. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The accuracy of the Jamaican national physician register: a study of the status of physicians registered and their countries of training

PubMed Central

Knight-Madden, Jennifer; Gray, Robert

2008-01-01

Background The number of physicians per 10,000 population is a basic health indicator used to determine access to health care. Studies from the United States of America and Europe indicate that their physician registration databases may be flawed. Clinical research activities have suggested that the current records of physicians registered to practice in Jamaica may not be accurate. Our objective was to determine whether the Medical Council of Jamaica (MCJ) accurately records and reports the identities, number and specialty designation of physicians in Jamaica. An additional aim was to determine the countries in which these physicians were trained. Methods Data regarding physicians practicing in Jamaica in 2005 were obtained from multiple sources including the MCJ and the telephone directory. Intense efforts at tracing were undertaken in a sub-sample of physicians, internists and paediatricians to further improve the accuracy of the data. Data were analysed using SPSS, version 11.5. Results The MCJ listed 2667 registered physicians of which 118 (4.4%) were no longer practicing in Jamaica. Of the subset of 150 physicians who were more actively traced, an additional 11 were found to be no longer in practice. Thus at least 129 (4.8%) of the physicians on the MCJ list were not actively practising in Jamaica. Twenty-nine qualified physicians who were in practice, but not currently on the Jamaican register, were identified from other data sources. This yielded an estimate of 2567 physicians or 9.68 physicians per 10,000 persons. Seven hundred and twenty six specialists were identified, 118 from the MCJ list only, 452 from other sources, in particular medical associations, and 156 from both the MCJ list and other sources. Sixty-six percent of registered doctors completed medical school at the University of the West Indies (UWI). Conclusion These data suggest that the MCJ list includes some physicians no longer practicing in Jamaica while underestimating the number of specialists. Difficulty in accurately estimating the number of practicing physicians has been reported in studies done in other countries but the under-reporting of the number of specialists is uncommon. Additional consideration should be given to strategies to ensure compliance with the annual registration that is mandated by law and to changing the law to include registration of specialist qualifications. PMID:19077244

The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings.

PubMed

McGrath, Robert J; Priestley, Jennifer Lewis; Zhou, Yiyun; Culligan, Patrick J

2018-04-09

Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as "America's Top Doctors" through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed "Top Doctor" versus those who were not. The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization. ©Robert J McGrath, Jennifer Lewis Priestley, Yiyun Zhou, Patrick J Culligan. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 09.04.2018.

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

PubMed Central

2010-01-01

Background 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. Methods 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. Results 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. Conclusion 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. PMID:20509903

Effort-reward imbalance and depression among private practice physicians.

PubMed

Tsutsumi, Akizumi; Kawanami, Shoko; Horie, Seichi

2012-02-01

Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians. This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association (n = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI. Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43-5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36-7.92). Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.

Weighty Problems: Predictors of Family Physicians Documenting Overweight and Obesity.

PubMed

Cyr, Peggy R; Haskins, Amy E; Holt, Christina; Hanifi, Jasmine

2016-03-01

Documenting obesity on the problem list has been shown to promote action about obesity and overweight, yet a majority of primary care providers do not record obesity on the medical problem list. With this in mind, our objectives were to determine the proportion of physicians' documentation of overweight (OW) or obesity on the problem list in our primary care teaching practice and to identify predictors of physician documentation of OW/obesity. De-identified health records of 6,195 adult patients with BMI ? 25 kg/m2 seen by a family physician over a 2-year period were included. Using multivariate logistic regression, patient age, BMI, gender, race, insurance, comorbidities, number of visits, physician gender or role, and practice site (suburban versus urban) were examined in relation to inclusion of OW/obesity on the medical problem list. Few (21.1%) patients had OW/obesity on their problem list. In the multivariate model, female PCPs were significantly more likely to document OW/obesity (OR=1.39, 95% CI=1.18--1.63) compared to male PCPs, and faculty were 26% more likely to document obesity (95% CI=1.07--1.48) compared to residents. Female patients, those with hypertension, diabetes, hyperlipidemia, and those with six or more visits were significantly more likely to have obesity on their problem lists, while patients with Medicaid were less likely to have obesity recorded. No significant difference was seen by race. Nearly 80% of OW and obese patients were not identified on the problem list. Patient gender, comorbidity, and number of visits were associated with documentation. Future research should examine automatic documentation of OW/obesity on the medical problem list.

Task Lists for Health Occupations. Radiologic Aide. Activity Aide. Optometric Assistant. Physical Therapy Aide. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lathrop, Janice

These task lists contain employability skills and tasks for the following health occupations: radiologic aide, activity aide, physical therapy aide, and optometric assistant. The duties and tasks found in these lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs. Employability skills…

Secretary/Shorthand: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of a series of 12 booklets in the secretarial/clerical area for the vocational instructor, the secretary/shorthand task list competency record contains a job description, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and…

How physicians have learned to handle sickness-certification cases.

PubMed

Löfgren, Anna; Silén, Charlotte; Alexanderson, Kristina

2011-05-01

Sickness absence is a common ''prescription'' in health care in many Western countries. Despite the significance of sick-listing for the life situation of patients, physicians have limited training in how to handle sickness-certification cases and the research about sickness-certification practices is scarce. Gain knowledge on physicians' learning regarding management of sickness certification of patients in formal, informal, and non-formal learning situations, respectively, and possible changes in this from 2004 to 2008. Data from two comprehensive questionnaires to physicians in Sweden about their sickness-certification practice in 2004 (n = 7665) and 2008 (n = 36,898); response rates: 71% and 61%, respectively. Answers from all the physicians ≤64 years old and who had sickness certification tasks (n = 4019 and n = 14,210) were analysed. ratings of importance of different types of learning situations for their sickness-certification competence. Few physicians stated that formal learning situations had contributed to a large or fairly large extent to their competence in sickness certification, e.g. undergraduate studies had done that for 17%, internship for 37%, and resident training for 46%, respectively. Contacts with colleagues had been helpful for 65%. One-third was helped by training arranged by social insurance offices. There was a significant increase between 2004 and 2008 in all items related to formal and non-formal learning situations, while there were no changes regarding informal learning situations. This study of all physicians in Sweden shows that physicians primarily attain competence in sickness certification in their daily clinical practice; through contacts with colleagues and patients.

Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan.

PubMed

Mori, Koji; Nagata, Masako; Hiraoka, Mika; Kudo, Megumi; Nagata, Tomohisa; Kajiki, Shigeyuki

2015-01-01

The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them. A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occupational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the necessary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods. All 61 competencies in the questionnaires were evaluated as "necessary". Some of the competencies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a "practical group", the members of which mainly provided occupational health services, an "academic group", the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies significantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-job training (OJT) for 30 items, and case-based learning (CBL) for 29 items. Some competencies should be added to the JSOH list. CBL should be introduced in training programs for specialist occupational physicians.

A delphi exercise to identify characteristic features of gout - opinions from patients and physicians, the first stage in developing new classification criteria.

PubMed

Prowse, Rebecca L; Dalbeth, Nicola; Kavanaugh, Arthur; Adebajo, Adewale O; Gaffo, Angelo L; Terkeltaub, Robert; Mandell, Brian F; Suryana, Bagus P P; Goldenstein-Schainberg, Claudia; Diaz-Torne, Cèsar; Khanna, Dinesh; Lioté, Frederic; Mccarthy, Geraldine; Kerr, Gail S; Yamanaka, Hisashi; Janssens, Hein; Baraf, Herbert F; Chen, Jiunn-Horng; Vazquez-Mellado, Janitzia; Harrold, Leslie R; Stamp, Lisa K; Van De Laar, Mart A; Janssen, Matthijs; Doherty, Michael; Boers, Maarten; Edwards, N Lawrence; Gow, Peter; Chapman, Peter; Khanna, Puja; Helliwell, Philip S; Grainger, Rebecca; Schumacher, H Ralph; Neogi, Tuhina; Jansen, Tim L; Louthrenoo, Worawit; Sivera, Francisca; Taylor, William J; Alten, Rieke

2013-04-01

To identify a comprehensive list of features that might discriminate between gout and other rheumatic musculoskeletal conditions, to be used subsequently for a case-control study to develop and test new classification criteria for gout. Two Delphi exercises were conducted using Web-based questionnaires: one with physicians from several countries who had an interest in gout and one with patients from New Zealand who had gout. Physicians rated a list of potentially discriminating features that were identified by literature review and expert opinion, and patients rated a list of features that they generated themselves. Agreement was defined by the RAND/UCLA disagreement index. Forty-four experienced physicians and 9 patients responded to all iterations. For physicians, 71 items were identified by literature review and 15 more were suggested by physicians. The physician survey showed agreement for 26 discriminatory features and 15 as not discriminatory. The patients identified 46 features of gout, for which there was agreement on 25 items as being discriminatory and 7 items as not discriminatory. Patients and physicians agreed upon several key features of gout. Physicians emphasized objective findings, imaging, and patterns of symptoms, whereas patients emphasized severity, functional results, and idiographic perception of symptoms.

Development of a Single List of Leadership/Management Non-MOS or Branch Specific Tasks for Officers and Noncommissioned Officers

DTIC Science & Technology

1986-02-01

RESEARCH NOTE 86-23 DEVELOPMENT OF A SINGLE LIST OF LEADERSHIP / MANAGEMENT NON-MOS OR BRANCH SPECIFIC TASKS FOR OFFICERS AND NONCOMMISSIONED OFFICERS...Noncommissioned Officers ........................ B-i APPENDIX C: Single List of Leadership / Management Tasks For Officers and Noncommissioned Officers Organized...task ita bank. 7 CONCLUS IONS A single leadership / management task list for officers and NCOs is a logical step in developing a taxonomy of tasks

Task Lists for Agricultural Occupations, 1988: Cluster Matrices for Agricultural Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Pepple, Jerry

This document contains four publications for agricultural occupations in Illinois. "Task Lists for Agricultural Occupations" provide lists of employability skills for the following: park aide; hand sprayer; gardener/groundskeeper; salesperson, parts, agricultural equipment; and dairy processing equipment operator. Each list contains skills…

Sunshine Act: shedding light on inaccurate disclosures at a gynecologic annual meeting.

PubMed

Thompson, Jennifer C; Volpe, Katherine A; Bridgewater, Lindsay K; Qeadan, Fares; Dunivan, Gena C; Komesu, Yuko M; Cichowski, Sara B; Jeppson, Peter C; Rogers, Rebecca G

2016-11-01

Physicians and hospital systems often have relationships with biomedical manufacturers to develop new ideas, products, and further education. Because this relationship can influence medical research and practice, reporting disclosures are necessary to reveal any potential bias and inform consumers. The Sunshine Act was created to develop a new reporting system of these financial relationships called the Open Payments database. Currently all disclosures submitted with research to scientific meetings are at the discretion of the physician. We hypothesized that financial relationships between authors and the medical industry are underreported. We aimed to describe concordance between physicians' financial disclosures listed in the abstract book from the 41st annual scientific meeting of the Society of Gynecologic Surgeons to physician payments reported to the Center for Medicaid and Medicare Services Open Payments database for the same year. Authors and scientific committee members responsible for the content of the 41st annual scientific meeting of the Society of Gynecologic Surgeons were identified from the published abstract book; each abstract listed disclosures for each author. Abstract disclosures were compared with the transactions recorded on the Center for Medicaid and Medicare Services Open Payments database for concordance. Two authors reviewed each nondisclosed Center for Medicaid and Medicare Services listing to determine the relatedness between the company listed on the Center for Medicaid and Medicare Services and abstract content. Abstracts and disclosures of 335 physicians meeting inclusion criteria were reviewed. A total of 209 of 335 physicians (62%) had transactions reported in the Center for Medicaid and Medicare Services, which totaled $1.99 million. Twenty-four of 335 physicians (7%) listed companies with their abstracts; 5 of those 24 physicians were concordant with the Center for Medicaid and Medicare Services. The total amount of all nondisclosed transactions was $1.3 million. Transactions reported in the Center for Medicaid and Medicare Services associated with a single physician ranged from $11.72 to $405,903.36. Of the 209 physicians with Center for Medicaid and Medicare Services transactions that were not disclosed, the majority (68%) had at least 1 company listed in the Center for Medicaid and Medicare Services that was determined after review to be related to the subject of their abstract. Voluntary disclosure of financial relationships was poor, and the majority of unlisted disclosures in the abstract book were companies related to the scientific content of the abstract. Better transparency is needed by physicians responsible for the content presented at gynecological scientific meetings. Copyright © 2016 Elsevier Inc. All rights reserved.

[Delegation of Medical Treatment to Non-physician Health Care Professionals: The Medical Care Structure agneszwei in Brandenburg - A Qualitative Acceptance Analysis].

PubMed

Schmiedhofer, M H; Brandner, S; Kuhlmey, A

2017-06-01

Backround: To address the increasing shortage of primary care physicians in rural regions, pilot model projects were tested, where general practitioners delegate certain physician tasks including house calls to qualified physician assistants. Evaluations show a high level of acceptance among participating physicians, medical assistants and patients. This study aims to measure the quality of cooperation among professionals participating in an outpatient health care delegation structure agnes zwei with a focus on case management in Brandenburg. Methods: We conducted 10 qualitative semi-structured expert interviews among 6 physicians and 4 physician's assistants. Results: Physicians and physicians' assistants reported the cooperative action to be successful and as an advantage for patients. The precondition for successful cooperation is that non-physician health care professionals strictly respect the governance of the General Practitioners. Physicians report that the delegation of certain medical tasks reduces their everyday workload. Physician assistants derive professional satisfaction from the confidential relationship they have with the patients. All physician assistants are in favor of medical tasks being delegated to them in regular medical outpatient care, while most physicians are skeptical or reluctant despite their reported positive experience. Conclusion: Despite the high level of acceptance of delegating some medical tasks to physician assistants, the negotiation process of introducing cooperative working structures in the outpatient health care system is still at the beginning. © Georg Thieme Verlag KG Stuttgart · New York.

Tool and Task Analysis Guide for Vocational Welding (150 Tasks). Performance Based Vocational Education.

ERIC Educational Resources Information Center

John H. Hinds Area Vocational School, Elwood, IN.

This book contains a task inventory, a task analysis of 150 tasks from that inventory, and a tool list for performance-based welding courses in the state of Indiana. The task inventory and tool list reflect 28 job titles found in Indiana. In the first part of the guide, tasks are listed by these domains: carbon-arc, electron beam, G.M.A.W., gas…

Graphics Design Technology Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This Idaho secondary education curriculum guide provides lists of tasks, performance objectives, and enabling objectives for instruction intended to impart entry-level employment skills in graphics design technology. The first list states all tasks for 11 areas; separate lists for each area follow. Each task on the lists is accompanied by a…

A medical book collection for physician assistants.

PubMed

Grodzinski, A

2001-07-01

Selecting resources for physician assistants is challenging and can be overwhelming. Although several core lists exist for nursing, allied health, and medical libraries, judging the scope and level of these resources in relation to the information needs of the physician assistant is difficult. Medical texts can be highly specialized and very expensive, in essence, "overkill" for the needs of the physician assistant. This bibliography is meant to serve as a guide to appropriate medical texts for physician assistants. Titles were selected from the Brandon/Hill list, Doody's Electronic Journal, and various other reference resources. Resources were evaluated based on the subject and scope, audience, authorship, cost, and currency. The collection includes 195 titles from 33 specialty areas. Standard texts in each area are also included.

Physician's assistants in primary care practices: delegation of tasks and physician supervision.

PubMed

Ekwo, E; Dusdieker, L B; Fethke, C; Daniels, M

1979-01-01

Little information is available on factors influencing physicians (MDs) to delegate health care tasks to physician's assistants (PAs). Information about assignment of tasks to PAs was sought from 19 MDs engaged in practice in primary care settings in Iowa. These MDs employed 28 PAs. Tasks assigned to PAs appeared to be those that MDs judged to require little or no supervision. Tasks that could be performed efficiently by other non-MD personnel were not asigned to PAs. However, PAs were observed at the practice sites to perform tasks which the MDs had indicated could be appropriately assigned to PAs, as well as some tasks that could be performed by other non-MD personnel. The MDs provided health care to 126 (13.6 percent) of the 925 patients seen by PAs for whom the sequences of patient-provider contact were recorded. In these settings, the PAs functioned with a high degree of autonomy in providing health care. These findings have implications for educators and potential employers of PAs.

Applied Welding Technology Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This Idaho state curriculum guide provides lists of tasks, performance objectives, and enabling objectives for instruction in welding. Following an introduction and a list of tasks, the bulk of the document consists of 10 modules, each of which is a list of tasks and the performance objectives and enabling objectives that pertain to each task. The…

Advanced Marketing 8130. Instructional Areas. Duties and Tasks. Learning Activities. Referenced Resources.

ERIC Educational Resources Information Center

Virginia State Dept. of Education, Richmond.

This resource handbook, which is designed for use by instructors of courses in advanced marketing, consists of a duty/task list with referenced resources, a duty/task list with learning activities, and a list of resources. Included in each list are materials dealing with the following topics: communication in marketing, economics in marketing,…

[Do online ratings reflect structural differences in healthcare? The example of German physician-rating websites].

PubMed

Meszmer, Nina; Jaegers, Lena; Schöffski, Oliver; Emmert, Martin

2018-04-01

Previous surveys have shown that patient satisfaction varies with the regional supply of physicians. Online ratings on physician-rating websites represent a relatively new instrument to display patient satisfaction results. The aim of this study was (1) to assess the current state of online ratings for two medical disciplines (dermatologists and ear, nose and throat (ENT) specialists), and (2) to analyze online derived patient satisfaction results according to the physician density in Germany. We collected online ratings for 420 dermatologists and 450 ear, nose, and throat (ENT) specialists on twelve German physician-rating websites. We analyzed the online ratings according to the physician density (low, medium, high physician density). For this purpose, we collected secondary data from both physician-rating websites and the regional associations of statutory health insurance physicians. Data analysis was performed using Median tests and Chi-square tests. In total, 10,239 online ratings for dermatologists and 8,168 online ratings for ENT specialists were analyzed. Almost all dermatologists (99.3 %) and ENT specialists (98.9 %) were listed on one of the physician-rating websites. A total of 93.5 % of all listed dermatologists and 96.9 % of ENT-specialists were rated on at least one of the physician-rating websites. Significant differences were found in the distribution (i.e., percentage of listed or rated physicians) of the ratings according to the regional physician density on only one physician-rating website (p<0.001). Furthermore, online ratings were shown to be better in regions with a higher physician density on two physician-rating website. On jameda.de, for example, dermatologist ratings were better in regions with a higher physician density compared to regions with a lower number of physicians (average rating: 2.16 vs. 2.67; p<0.001). Online ratings of dermatologists and ENT specialists hardly differ in terms of regional physician density. Physician-rating websites thus do not appear to be appropriate to mirror differences in the health service delivery structure. Our findings thus do not confirm the results from previously published studies. Copyright © 2018. Published by Elsevier GmbH.

Implementation of standardized time limits in sickness insurance and return-to-work: experiences of four actors.

PubMed

Ståhl, Christian; Müssener, Ulrika; Svensson, Tommy

2012-01-01

In 2008, time limits were introduced in Swedish sickness insurance, comprising a pre-defined schedule for return-to-work. The purpose of this study was to explore experienced consequences of these time limits. Sick-listed persons, physicians, insurance officials and employers were interviewed regarding the process of sick-listing, rehabilitation and return-to-work in relation to the reform. The study comprises qualitative interviews with 11 sick-listed persons, 4 insurance officials, 5 employers and 4 physicians (n = 24). Physicians, employers, and sick-listed persons described insurance officials as increasingly passive, and that responsibility for the process was placed on the sick-listed. Several ethical dilemmas were identified, where officials were forced to act against their ethical principles. Insurance officials' principle of care often clashed with the standardization of the process, that is based on principles of egalitarianism and equal treatment. The cases reported in this study suggest that a policy for activation and early return-to-work in some cases has had the opposite effect: central actors remain passive and the responsibility is placed on the sick-listed, who lacks the strength and knowledge to understand and navigate through the system. The standardized insurance system here promoted experiences of procedural injustice, for both officials and sick-listed persons.

Emergency Medical Technician Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for 12 duties in the occupation of emergency medical technician. Each duty is divided into a number of tasks. A separate page for each duty lists the task with its code number and columns to indicate whether that particular duty has been taught and to provide space for comments. The 12 duties…

Task Analysis for Health Occupations. Cluster: Nursing. Occupation: Professional Nurse (Associate Degree). Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

This document contains a task analysis for health occupations (professional nurse) in the nursing cluster. For each task listed, occupation, duty area, performance standard, steps, knowledge, attitudes, safety, equipment/supplies, source of analysis, and Illinois state goals for learning are listed. For the duty area of "providing therapeutic…

Task Analysis for Health Occupations. Cluster: Nursing. Occupation: Home Health Aide. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

This document contains a task analysis for health occupations (home health aid) in the nursing cluster. For each task listed, occupation, duty area, performance standard, steps, knowledge, attitudes, safety, equipment/supplies, source of analysis, and Illinois state goals for learning are listed. For the duty area of "providing therapeutic…

Recommendations of the national football league physician society task force on the use of toradol(®) ketorolac in the national football league.

PubMed

Matava, Matthew; Brater, D Craig; Gritter, Nancy; Heyer, Robert; Rollins, Douglas; Schlegel, Theodore; Toto, Robert; Yates, Anthony

2012-09-01

Ketorolac tromethamine (Toradol(®)) is a non-steroidal anti-inflammatory drug that has potent analgesic and anti-inflammatory properties. It can be administered orally, intravenously, intramuscularly, or via a nasal route. Ketorolac injections have been used for several years in the National Football League (NFL), in both the oral and injectable forms, to treat musculoskeletal injuries and to prevent post-game soreness. In an attempt to determine the appropriate use of this medication in NFL players, the NFL Team Physician Society appointed a Task Force to consider the best available evidence as to how ketorolac should be used for pain management in professional football players. These treatment recommendations were established based on the available medical literature taking into consideration the pharmacokinetic properties of ketorolac, its accepted indications and contraindications, and the unique clinical challenges of the NFL. The Task Force recommended that 1) ketorolac should only be administered under the direct supervision and order of a team physician; 2) ketorolac should not be used prophylactically as a means of reducing anticipated pain either during or after participation in NFL games or practices and should be limited to those players diagnosed with an injury or condition and listed on the teams' injury report; 3) ketorolac should be given in the lowest effective therapeutic dose and should not be used in any form for more than 5 days; 4) ketorolac should be given in its oral preparation under typical circumstances; 5) ketorolac should not be taken concurrently with other NSAIDs or by those players with a history of allergic reaction to ketorolac, other NSAIDs or aspirin; and 6) ketorolac should not be used by a player with a history of significant gastrointestinal bleeding, renal compromise, or a past history of complications related to NSAIDs.

Recommendations of the National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League

PubMed Central

Matava, Matthew; Brater, D. Craig; Gritter, Nancy; Heyer, Robert; Rollins, Douglas; Schlegel, Theodore; Toto, Robert; Yates, Anthony

2012-01-01

Ketorolac tromethamine (Toradol®) is a non-steroidal anti-inflammatory drug that has potent analgesic and anti-inflammatory properties. It can be administered orally, intravenously, intramuscularly, or via a nasal route. Ketorolac injections have been used for several years in the National Football League (NFL), in both the oral and injectable forms, to treat musculoskeletal injuries and to prevent post-game soreness. In an attempt to determine the appropriate use of this medication in NFL players, the NFL Team Physician Society appointed a Task Force to consider the best available evidence as to how ketorolac should be used for pain management in professional football players. These treatment recommendations were established based on the available medical literature taking into consideration the pharmacokinetic properties of ketorolac, its accepted indications and contraindications, and the unique clinical challenges of the NFL. The Task Force recommended that 1) ketorolac should only be administered under the direct supervision and order of a team physician; 2) ketorolac should not be used prophylactically as a means of reducing anticipated pain either during or after participation in NFL games or practices and should be limited to those players diagnosed with an injury or condition and listed on the teams’ injury report; 3) ketorolac should be given in the lowest effective therapeutic dose and should not be used in any form for more than 5 days; 4) ketorolac should be given in its oral preparation under typical circumstances; 5) ketorolac should not be taken concurrently with other NSAIDs or by those players with a history of allergic reaction to ketorolac, other NSAIDs or aspirin; and 6) ketorolac should not be used by a player with a history of significant gastrointestinal bleeding, renal compromise, or a past history of complications related to NSAIDs. PMID:23016110

All varieties of encoding variability are not created equal: Separating variable processing from variable tasks

PubMed Central

Huff, Mark J.; Bodner, Glen E.

2014-01-01

Whether encoding variability facilitates memory is shown to depend on whether item-specific and relational processing are both performed across study blocks, and whether study items are weakly versus strongly related. Variable-processing groups studied a word list once using an item-specific task and once using a relational task. Variable-task groups’ two different study tasks recruited the same type of processing each block. Repeated-task groups performed the same study task each block. Recall and recognition were greatest in the variable-processing group, but only with weakly related lists. A variable-processing benefit was also found when task-based processing and list-type processing were complementary (e.g., item-specific processing of a related list) rather than redundant (e.g., relational processing of a related list). That performing both item-specific and relational processing across trials, or within a trial, yields encoding-variability benefits may help reconcile decades of contradictory findings in this area. PMID:25018583

An Official American Thoracic Society/American College of Chest Physicians Policy Statement

PubMed Central

Ouellette, Daniel R.; Diamond, Edward; Fan, Vincent S.; Maurer, Janet R.; Mularski, Richard A.; Peters, Jay I.; Halpern, Scott D.

2014-01-01

The American Board of Internal Medicine Foundation’s Choosing Wisely campaign aims to curb health-care costs and improve patient care by soliciting lists from medical societies of the top five tests or treatments in their specialty that are used too frequently and inappropriately. The American Thoracic Society (ATS) and American College of Chest Physicians created a joint task force, which produced a top five list for adult pulmonary medicine. Our top five recommendations, which were approved by the executive committees of the ATS and American College of Chest Physicians and published by Choosing Wisely in October 2013, are as follows: (1) Do not perform CT scan surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines; (2) do not routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (groups II or III pulmonary hypertension); (3) for patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, do not renew the prescription without assessing the patient for ongoing hypoxemia; (4) do not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay; (5) do not perform CT scan screening for lung cancer among patients at low risk for lung cancer. We hope pulmonologists will use these recommendations to stimulate frank discussions with patients about when these tests and treatments are indicated—and when they are not. PMID:24889436

Functional assessment and performance evaluation for assistive robotic manipulators: Literature review.

PubMed

Chung, Cheng-Shiu; Wang, Hongwu; Cooper, Rory A

2013-07-01

The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to give the scope of current research and provide suggestions for future studies. We conducted a literature search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh Library System - PITTCat. Twenty relevant studies were identified. Studies were separated into two broad categories: user task preferences and user-interface performance measurements of commercialized and developing assistive robotic manipulators. The outcome measures and ICF codes associated with the performance evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the quantitative and qualitative evaluation of task efficiency and performance to build comparable measures between research groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical functional assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In addition, these outcome measures will help physicians and therapists build standardized tools while prescribing and assessing assistive robotic manipulators.

Physiological and psychological effects of delivering medical news using a simulated physician-patient scenario.

PubMed

Cohen, Lorenzo; Baile, Walter F; Henninger, Evelyn; Agarwal, Sandeep K; Kudelka, Andrzej P; Lenzi, Renato; Sterner, Janet; Marshall, Gailen D

2003-10-01

We examined the acute stress response associated with having to deliver either bad or good medical news using a simulated physician-patient scenario. Twenty-five healthy medical students were randomly assigned to a bad medical news (BN), a good medical news (GN), or a control group that read magazines during the session. Self-report measures were obtained before and after the task. Blood pressure and heart rate were measured throughout the task period. Four blood samples were obtained across the task period. The BN and GN tasks produced significant increases in self-reported distress and cardiovascular responses compared with the control group. There was also a significant increase in natural killer cell function 10 min into the task in the BN group compared with the control group. The BN task was also somewhat more stressful than the GN task, as shown by the self-report and cardiovascular data. These findings suggest that a simulated physician-patient scenario produces an acute stress response in the "physician," with the delivery of bad medical news more stressful than the delivery of good medical news.

The case for testing memory with both stories and word lists prior to dbs surgery for Parkinson's Disease.

PubMed

Zahodne, Laura B; Bowers, Dawn; Price, Catherine C; Bauer, Russell M; Nisenzon, Anne; Foote, Kelly D; Okun, Michael S

2011-04-01

Patients seeking deep brain stimulation (DBS) surgery for Parkinson's disease (PD) typically undergo neuropsychological assessment to determine candidacy for surgery, with poor memory performance interpreted as a contraindication. Patients with PD may exhibit worse memory for word lists than for stories due to the lack of inherent organization in a list of unrelated words. Unfortunately, word list and story tasks are typically developed from different normative datasets, and the existence of a memory performance discrepancy in PD has been challenged. We compared recall of stories and word lists in 35 non-demented PD candidates for DBS. We administered commonly used neuropsychological measures of word list and story memory (Hopkins Verbal Learning Test, Logical Memory), along with a second word list task that was co-normed with the story task. Age-corrected scores were higher for the story task than for both word list tasks. Compared to story recall, word list recall correlated more consistently with motor severity and composite measures of processing speed, working memory, and executive functioning. These results support the classic view of fronto-subcortical contributions to memory in PD and suggest that executive deficits may influence word list recall more than story recall. We recommend a multi-componential memory battery in the neuropsychological assessment of DBS candidates to characterize both mesial temporal and frontal-executive memory processes. One should not rely solely on a word list task because patients exhibiting poor memory for word lists may perform better with stories and therefore deserve an interdisciplinary discussion for DBS surgery.

Cooperation within physician-nurse team in occupational medicine service in Poland - Knowledge about professional activities performed by the team-partner.

PubMed

Sakowski, Piotr

2015-01-01

The goal of the study has been to learn about physicians' and nurses' awareness of the professional activities that are being performed by their colleague in the physician-nurse team. Postal questionnaires were sent out to occupational physicians and nurses in Poland. The analysis includes responses from 232 pairs of physician-nurse teams. The knowledge among occupational professionals about tasks performed by their colleagues in the physician-nurse team seems to be poor. Respondents were asked about who performs tasks from each of 21 groups mentioned in the Occupational Medicine Service Act. In the case of only 3 out of 21 groups of tasks, the rate of non-consistence in answers was lower than 30%. A specified number of professionals performed their tasks on the individual basis. Although in many cases their team colleagues knew about those activities, there was a major proportion of those who had no awareness of such actions. Polish occupational physicians and nurses perform a variety of tasks. Occupational nurses, besides medical role, also play important organizational roles in their units. The cooperation between the two professional groups is, however, slightly disturbed by the deficits in communication. This issue needs to be improved for the betterment of operations within the whole system. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Building an automated problem list based on natural language processing: lessons learned in the early phase of development.

PubMed

Solti, Imre; Aaronson, Barry; Fletcher, Grant; Solti, Magdolna; Gennari, John H; Cooper, Melissa; Payne, Tom

2008-11-06

Detailed problem lists that comply with JCAHO requirements are important components of electronic health records. Besides improving continuity of care electronic problem lists could serve as foundation infrastructure for clinical trial recruitment, research, biosurveillance and billing informatics modules. However, physicians rarely maintain problem lists. Our team is building a system using MetaMap and UMLS to automatically populate the problem list. We report our early results evaluating the application. Three physicians generated gold standard problem lists for 100 cardiology ambulatory progress notes. Our application had 88% sensitivity and 66% precision using a non-modified UMLS dataset. The systemâs misses concentrated in the group of ambiguous problem list entries (Chi-square=27.12 p<0.0001). In addition to the explicit entries, the notes included 10% implicit entry candidates. MetaMap and UMLS are readily applicable to automate the problem list. Ambiguity in medical documents has consequences for performance evaluation of automated systems.

Sharing Responsibilities within the General Practice Team - A Cross-Sectional Study of Task Delegation in Germany.

PubMed

Mergenthal, Karola; Beyer, Martin; Gerlach, Ferdinand M; Guethlin, Corina

2016-01-01

Expected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves. As part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all. The survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient's condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief. In Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This "new" role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany.

Sharing Responsibilities within the General Practice Team – A Cross-Sectional Study of Task Delegation in Germany

PubMed Central

Mergenthal, Karola; Beyer, Martin; Gerlach, Ferdinand M.; Guethlin, Corina

2016-01-01

Background Expected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves. Methods As part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all. Results The survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient’s condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief. Conclusions In Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This “new” role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany. PMID:27280415

Task Listing for Introduction to Health Occupations. Competency-Based Education.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum Center.

This task listing is designed to be used in combination with the "Health Occupations Education Service Area Resource" in order to implement competency-based education in health occupations programs in Virginia. The task listing contains four major sections: (1) content/concept areas; (2) program and course description; (3) content…

Medical Secretary: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of a series of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the medical secretary, a task list under 17 areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators…

Receptionist: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of a series of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the receptionist, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Secretary/Non-Shorthand: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the secretary (non-shorthand), a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Office Services Aid: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the office services aid, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Data Entry Operator: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the data entry operator, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

General Office/Typist: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the general office typist, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Typist: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the typist, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in developing the…

Educational Office Personnel: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of 12 in the secretarial/clerical area, this booklet for vocational instructor contains a job description for educational office personnel, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Risk factors for the prescription of potentially inappropriate medication (PIM) in the elderly : an analysis of sickness fund routine claims data from Germany.

PubMed

Stock, Stephanie; Redaelli, Marcus; Simic, Dusan; Siegel, Martin; Henschel, Frank

2014-10-01

Elderly people are especially prone to suffer adverse drug reactions (ADR). Main reasons for the higher vulnerability of the elderly to ADR are changes in metabolism as i.e. slower renal clearance and polypharmacie which often results from multimorbidity. To prevent ADR careful prescription with special consideration of these aspects is warranted. To help physicians avoid drugs which are especially likely to cause ADR lists have been developed following the consensus method process. For Germany this list is called the PRISCUS list. It was developed based on a literature review, review of international lists such as the American Beers list, and a consensus process based on a Delphi survey. It contains 83 drugs from 18 classes which are classified as potentially inapropriate medication (PIM). It also lists alternatives for each PIM. If a drug is registered with the PRISCUS list this does not mean automatically that it is contraindicated in the elderly but that special caution should be excercised in prescribing the drug, alternatives should be considered and the patient carefully monitored.Prescription rates for PIMs in Germany in the elderly is pretty much stable at around 23% with only a small decline in the past years. Also, more than 5% of all prescriptions in the elderly are PIM prescriptions. Physicians specially trained in geriatrics tend to prescribe less PIMs compared to other physicians.

Task analysis of information technology-mediated medication management in outpatient care.

PubMed

van Stiphout, F; Zwart-van Rijkom, J E F; Maggio, L A; Aarts, J E C M; Bates, D W; van Gelder, T; Jansen, P A F; Schraagen, J M C; Egberts, A C G; ter Braak, E W M T

2015-09-01

Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. Formal task analysis: decomposition of a complex task into a set of subtasks. First, we obtained a general description of the medication management process from exploratory interviews. Secondly, we interviewed experts in-depth to further define tasks and subtasks. Outpatient care in different fields of medicine in six teaching and academic medical centres in the Netherlands and the United States. 20 experts. Tasks were divided up into procedural, cognitive and macrocognitive tasks and categorized into the three components of dynamic decision making. The medication management process consists of three components: (i) reviewing the medication situation; (ii) composing a treatment plan; and (iii) accomplishing and communicating a treatment and surveillance plan. Subtasks include multiple cognitive tasks such as composing a list of current medications and evaluating the reliability of sources, and procedural tasks such as documenting current medication. The identified macrocognitive tasks were: planning, integration of IT in workflow, managing uncertainties and responsibilities, and problem detection. All identified procedural, cognitive and macrocognitive skills should be included when designing education for IT-mediated medication management. The resulting framework supports the design of educational interventions to improve IT-mediated medication management in outpatient care. © 2015 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of The British Pharmacological Society.

The deployment of attention in short-term memory tasks: trade-offs between immediate and delayed deployment.

PubMed

Bunting, Michael F; Cowan, Nelson; Colflesh, Greg H

2008-06-01

Memory at times depends on attention, as when attention is used to encode incoming, serial verbal information. When encoding and rehearsal are difficult or when attention is divided during list presentation, more attention is needed in the time following the presentation and just preceding the response. Across 12 experimental conditions observed in several experiments, we demonstrated this by introducing a nonverbal task with three levels of effort (no task, a natural nonverbal task, or an unnatural version of the task) during a brief retention interval in a short-term digit recall task. Interference from the task during the retention interval was greater when resources were drawn away from the encoding of the stimuli by other factors, including unpredictability of the end point of the list, rapid presentation, and a secondary task during list presentation. When those conditions complicate encoding of the list, we argue, attention is needed after the list so that the contents of passive memory (i.e., postcategorical phonological storage and/or precategorical sensory memory) may be retrieved and become the focus of attention for recall.

Checking the relationship between physicians' communication skills and outpatients' satisfaction in the clinics of Isfahan Al-Zahra(S) Hospital in 2011.

PubMed

Rezaei, Fatemeh; Askari, Hedayat Allah

2014-01-01

The quality of communication skills of health care providers has a significant impact on patient treatment consequences. The present research has been conducted to check the relationship of communication skills on the rate of patients' satisfaction in the clinics of one of the hospitals in Isfahan. The checking list was completed by the researcher in the clinics by using the comments of patients or their relatives. Sampling was performed by using the regular random sampling method. This research was a descriptive-analytical study. The used tool was a standard checking list for evaluating the patients' satisfaction and also the researcher-made checking list for the measurement of effective communication skills. The researcher-made checking list for the measurement of effective communication skills was confirmed by the experts with the face validity, structure, content, and reliability (α =87%). After visiting the patient by the physician, the mentioned list was filled by using the patients' comments, and the collected data was analyzed by SPSS software version 16 with calculating the Pearson correlation coefficient and α2. The study showed that there was a significant relationship between the application of communication skills in the five areas of verbal, body language, effective communicating, establishment, patient privacy and patient participation, except for eye communication of the physician with patients' satisfaction (P < 0.05). Using the communication skills by physicians is associated with patients' satisfaction, and it is the cause of increasing the acceptance of the physician by the patient. Therefore, it is suggested that the opportunity to improve the communication skills should be provided in addition to clinical skills in continuing education programs for the medical community.

Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.

PubMed

Rose, Danielle E; Tisnado, Diana M; Tao, May L; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2012-06-01

Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411). After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). © Health Research and Educational Trust.

Dermatology Internet Yellow Page advertising.

PubMed

Francis, Shayla; Kozak, Katarzyna Z; Heilig, Lauren; Lundahl, Kristy; Bowland, Terri; Hester, Eric; Best, Arthur; Dellavalle, Robert P

2006-07-01

Patients may use Internet Yellow Pages to help select a physician. We sought to describe dermatology Internet Yellow Page advertising. Dermatology advertisements in Colorado, California, New York, and Texas at 3 Yellow Page World Wide Web sites were systematically examined. Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names. Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements (61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties. Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy not advertising claims of board certification (68%; 41/60; 32 dermatology, 9 other specialties). A total of 50 advertisements (17%) contained unverifiable or no board certification information, and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology. All Internet Yellow Page World Wide Web sites and all US states were not examined. Nonphysicians, physicians board certified in medical specialties other than dermatology, and individuals without verifiable board certification in any medical specialty are advertising in dermatology Internet Yellow Pages. Many board-certified dermatologists are not advertising this certification.

[Task delegation scenarios at national and regional levels of the French ambulatory care sector].

PubMed

Lévy, Danièle; Pavot, Jeanne; Doan, Bui Dang Ha

2009-01-01

The French sector of ambulatory care is characterized by two features: (i) health care providers are mostly independent practitioners paid on a fee-for-service basis; (ii) a large consensus is observed as concerns the shortage of health workers, particularly physicians and nurses. In such a context, if a task delegation programme is envisaged, attention should be paid, not only to the competencies of task receivers, but equally to the reluctance of health workforce. Given the current doctor shortage, it is probable that the reluctance of physicians is not vigorous. But on the side of task receivers (nurses, physiotherapists, other auxiliary workers...) reluctance should be taken into account. Shortage of nurses and physiotherapists (and consequently their growing workload) lowers their acceptance level (i.e., the proportion accepting task delegation) and reduces the time each accepting worker can devote to the activities delegated by physicians. The model shows that, in the current situation, French physicians can only expect a small reduction of their workload i they undertake to transfer to nurses some parts of their activities. When physician working time is not excessively lengthy, the overall reduction would be between 0.7% and 3.1%. When doctors have to work harder (when their shortage is acute), paradoxically, the reduction is lower, between 0.5% and 2.3%. The fact is easily understood as the stock of task receivers (the nurses) remains unchanged, but the volume of worked hours becomes larger. Other things being equal, the model shows that French southern physicians may take more profit from a task delegation programme than their counterparts practising in the northern areas of the country. As in the southern areas, the nurse/physician ratio is higher, the potential task receivers are in higher numbers and the volume of the tasks transferred may be much broader than in the northern areas. The paradox is that the workload of northern physicians is heavier, their ratio to population being lower. In 2013, if the acceptance level of nurses and the time each o them devotes to transferred tasks remain unchanged, the physician workload would not be reduced more significantly, even in case of strong growth of the nursing profession. In other words, to obtain a clear-cut success, any task delegation process should be accompanied by a large range of generous inancial rewards aimed at strongly motivating the task receivers to work harder, during a longer time and with enlarged responsibilities. In France, as in most industrialized countries, health expenditures are predominantly financed by public money (taxes and contributions from employees and employers) and their share in the Gross Domestic Product is growing steadily for decades. The weight of the health sector upon the national economy is already extremely heavy. Does wisdom lie in launching action programmes aimed at uncertain returns? No doubt that the issue of task delegation is a painful dilemma to health workforce strategists.

Task Listings Resulting from the Vocational Competency Measures Project. Memorandum Report.

ERIC Educational Resources Information Center

American Institutes for Research in the Behavioral Sciences, Palo Alto, CA.

This memorandum report consists of 14 task listings resulting from the Vocational Competency Measures Project. (The Vocational Competency Measures Project was a test development project that involved the writing and verification of task listings for 14 vocational occupational areas through over 225 interviews conducted in 27 states.) Provided in…

Office Education. North Dakota Validated Task Listing. Competency-Based Vocational Education.

ERIC Educational Resources Information Center

North Dakota State Board for Vocational Education, Bismarck.

Intended to provide a base for vocational office education instructional programs at secondary and postsecondary levels in North Dakota, this task listing describes the skills needed to be performed by program completers, from the viewpoint of workers in office occupations. A listing of task validators (name, occupation, employer, business city,…

Legal Secretary: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of a series of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the legal secretary, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

PubMed

Skaugset, L Melissa; Farrell, Susan; Carney, Michele; Wolff, Margaret; Santen, Sally A; Perry, Marcia; Cico, Stephen John

2016-08-01

Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

[Delegation of medico-administrative tasks : what do medical interns and secretaries think?

PubMed

Castioni, Julien; Hagenbuch, Angélique; Tâche, Johann; Cappai, Milva; Jovanovic, Milica; Sartori, Claudio

2017-11-22

The hospital activity of physicians in training mainly consists in direct contacts with patients, tasks indirectly linked to patients such as administration, as well as clinical and theoretical training. In our era of digitalization, an important administrative work load without any added medical value fills their daily chores. In parallel activities of medical secretaries are getting more partitioned, with their desks situated far from physicians' and tasks often limited to finalizing discharge letters. Added to multiple overtime, this reduces physicians' and secretaries' work satisfaction. This article describes the context and development of delegating medico-administrative tasks to secretaries in our department of internal medicine.

How Is Wilson Disease Diagnosed?

MedlinePlus

... Connect with Wilson Disease Association Send Email Physician Contacts List of Physicians and Institutions in Your Area View Contacts Support Contacts Individuals who can offer Support and Information View ...

Validated Competency Task Lists for Apparel and Accessories Marketing.

ERIC Educational Resources Information Center

Selke-Kern, Barbara E.

Developed by a project that validated task lists by a variety of teachers and apparel marketing business persons, this guide contains task lists for occupations in the field of apparel and accessories marketing. The guide is organized in three sections. Section 1 includes the following: (1) notes on using the information in the guide; (2) a…

Residential Carpentry Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for nine occupations in the residential carpentry series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to…

Printing Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for 10 occupations in the printing series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to provide space for…

Marketing Education/Business Management & Ownership Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for eight occupations in the marketing education/business management and ownership series. Each occupation is divided into 4 to 12 duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular…

Business & Office Accounting/Bookkeeping Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for five occupations in the business and office accounting/bookkeeping series. Each occupation is divided into four to six duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has…

Banking and Financial Services Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for five occupations in the banking and financial services series. Each occupation is divided into seven or eight duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been…

Validated Competency Task Lists for General Merchandise Retailing, Food Service Management, and Business and Personal Services Marketing.

ERIC Educational Resources Information Center

Faught, Suzanne G.

This publication contains competency task lists that address principal entry-level and career-sustaining jobs in the occupational categories of general merchandise retailing, food service management, and business and personal services marketing. Section I, Development of the Competency Task Lists, provides details on how the competencies were…

Business and Office Managerial Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for three occupations in the business and office managerial series. Each occupation is divided into seven duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to…

Task Lists for Business, Marketing and Management Occupations, 1988: Cluster Matrices for Business, Marketing and Management Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Fonseca, Linda Lafferty

Developed in Illinois, this document contains three components. The first component consists of employability task lists for the business, marketing, and management occupations of first-line supervisors and manager/supervisors; file clerks; traffic, shipping, and receiving clerks; records management analysts; adjustment clerks; and customer…

Business & Office Secretarial Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for 11 occupations in the business and office secretarial series. Each occupation is divided into three to seven duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught…

Diesel Mechanics Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for 11 occupations in the diesel mechanics series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to provide…

Auto Mechanics Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for eight occupations in the auto mechanics series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to provide…

Task Lists for Home Economics Occupations, 1988: Cluster Matrices for Home Economics Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Below, Virginia

This document contains information for home economics occupations in Illinois in seven sections. The first part provides lists of employability skills for the following: food preparation and service worker, fashion designer, dietetic technician, and service coordinator/consumer assistant/concierge. The second section contains task analyses for the…

Welding Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for six occupations in the welding series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to provide space for…

Fashion Merchandising Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for seven occupations in the fashion merchandising series. Each occupation is divided into 6 to 15 duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to…

Machine Tool Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course to prepare machine tool, drill press, grinding machine, lathe, mill, and/or power saw operators. The listing is divided into six sections, with each one outlining the tasks required to perform the duties that have been identified for the given occupation.…

Communication, Fine Arts, and Media. Occupational Analyses. Worker Task Lists and Supplementary Information for Selected Occupations.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum and Resource Center.

This publication contains worker task lists and supplementary information for four occupations in the communication, fine arts, and media cluster: (1) graphic designer; (2) newspaper reporter; (3) radio announcer; and (4) recording technologies occupations. The task lists were generated through the DACUM (Developing a Curriculum) process and/or by…

A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies

PubMed Central

Pelletier, Alexandra; Sunthara, Gajen; Gujral, Nitin; Mittal, Vandna; Bourgeois, Fabienne C

2016-01-01

Background Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. Objective The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children’s Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. Methods To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. Results Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. Conclusions The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations. PMID:27169345

A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies.

PubMed

Al Ayubi, Soleh U; Pelletier, Alexandra; Sunthara, Gajen; Gujral, Nitin; Mittal, Vandna; Bourgeois, Fabienne C

2016-05-11

Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children's Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations.

Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial.

PubMed

Volker, Daniëlle; Vlasveld, Moniek C; Anema, Johannes R; Beekman, Aartjan Tf; Roijen, Leona Hakkaart-van; Brouwers, Evelien Pm; van Lomwel, A Gijsbert C; van der Feltz-Cornelis, Christina M

2013-01-01

Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial. It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

PubMed Central

Neri, P.M.; Redden, L.; Poole, S.; Pozner, C.N.; Horsky, J.; Raja, A.S.; Poon, E.; Schiff, G.

2015-01-01

Summary Objective To understand emergency department (ED) physicians’ use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. PMID:25848411

Community Guide to Cholesterol Resources.

ERIC Educational Resources Information Center

National Heart and Lung Inst. (DHHS/NIH), Bethesda, MD.

This guide is divided into two sections, one for physicians and the other for patients. The physician section lists different resources including continuing medical education opportunities on the medical and scientific aspects of cholesterol and heart disease and on the physician's role in diagnosis and patient management. Additional materials on…

Monkeys Rely on Recency of Stimulus Repetition When Solving Short-Term Memory Tasks

ERIC Educational Resources Information Center

Wittig, John H., Jr.; Richmond, Barry J.

2014-01-01

Seven monkeys performed variants of two short-term memory tasks that others have used to differentiate between selective and nonselective memory mechanisms. The first task was to view a list of sequentially presented images and identify whether a test matched any image from the list, but not a distractor from a preceding list. Performance was best…

Functional assessment and performance evaluation for assistive robotic manipulators: Literature review

PubMed Central

Chung, Cheng-Shiu; Wang, Hongwu; Cooper, Rory A.

2013-01-01

Context The user interface development of assistive robotic manipulators can be traced back to the 1960s. Studies include kinematic designs, cost-efficiency, user experience involvements, and performance evaluation. This paper is to review studies conducted with clinical trials using activities of daily living (ADLs) tasks to evaluate performance categorized using the International Classification of Functioning, Disability, and Health (ICF) frameworks, in order to give the scope of current research and provide suggestions for future studies. Methods We conducted a literature search of assistive robotic manipulators from 1970 to 2012 in PubMed, Google Scholar, and University of Pittsburgh Library System – PITTCat. Results Twenty relevant studies were identified. Conclusion Studies were separated into two broad categories: user task preferences and user-interface performance measurements of commercialized and developing assistive robotic manipulators. The outcome measures and ICF codes associated with the performance evaluations are reported. Suggestions for the future studies include (1) standardized ADL tasks for the quantitative and qualitative evaluation of task efficiency and performance to build comparable measures between research groups, (2) studies relevant to the tasks from user priority lists and ICF codes, and (3) appropriate clinical functional assessment tests with consideration of constraints in assistive robotic manipulator user interfaces. In addition, these outcome measures will help physicians and therapists build standardized tools while prescribing and assessing assistive robotic manipulators. PMID:23820143

Teaching Competencies for Community Preceptors.

PubMed

Brink, Darin; Simpson, Deb; Crouse, Byron; Morzinski, Jeffrey; Bower, Douglas; Westra, Ruth

2018-05-01

Although community physicians provide one-fourth of the outpatient training received in medical school, usually there is no formal training of the preceptor. Currently there is no agreed-upon list of teaching competencies for community physician-preceptors. Using a modified Delphi process, the authors aimed to identify core teaching competencies for community preceptors for use in training and evaluation. A medical educator and three faculty members with expertise in faculty development created a list of teaching competencies organized in five domains. These competencies were finalized through a multiround modified Delphi technique with key stakeholder groups including (1) nonphysician medical educators, (2) academic physicians involved in faculty development, (3) community physicians who regularly precept medical students, (4) family medicine residents, (5) third-year medical students in a 9-month-long longitudinal clerkship. Proposed competencies were retained if 70% of the participants ranked it as "very or extremely important." In the first round, 24 competencies were evaluated by 40 physician preceptors participating in a rural faculty development conference. These were refined, and four additional competencies were added by the cohort. Subsequent rounds utilized a survey approach with broader audiences resulting in a final list of 21 competencies in five domains. Five competency domains with 21 teaching competencies can now be used to guide community preceptors' training and evaluation.

Assessing physician job satisfaction and mental workload.

PubMed

Boultinghouse, Oscar W; Hammack, Glenn G; Vo, Alexander H; Dittmar, Mary Lynne

2007-12-01

Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace-particularly with regard to human interaction with complex systems and tasks as seen in telemedicine-is mental workload. Workload is generally defined as the "cost" to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload.

Physician opinions regarding elective bilateral salpingectomy with hysterectomy and for sterilization.

PubMed

Gill, Sarah E; Mills, Benjie B

2013-01-01

To gather opinions about the benefits and concerns of performing bilateral salpingectomy without oophorectomy during hysterectomy for benign indications and as a sterilization procedure. Survey study (Canadian Task Force classification III). Practicing physicians in US institutions that have obstetrics and gynecology residency programs listed on the FREIDA website were surveyed electronically. A validated, standardized questionnaire designed to gather opinions about bilateral salpingectomy performed during hysterectomy or for sterilization was administered via SurveyMonkey to practitioners of obstetrics and gynecology. Results were compiled and presented as percentages of total responders. A total of 234 surveys were returned. Fifty-four percent of physicians perform bilateral salpingectomy during hysterectomy, most commonly to reduce the risks of cancer (75%) and repeat operation (49.1%). Of the 45.5% of physicians who do not perform bilateral salpingectomy during hysterectomy, most (69.4%) believe there is no benefit. Fifty-eight percent of practitioners believe that bilateral salpingectomy is the most effective method of sterilization after age 35 years but choose this method only in patients in whom one sterilization procedure has failed or because of tubal disease. Only 7.2% of surgeons prefer it as an interval sterilization procedure. Most practitioners believe that bilateral salpingectomy is beneficial. Most also believe that bilateral salpingectomy is the most effective sterilization procedure; however, only 7.2% use this method as an interval procedure. More data are needed to evaluate the prophylactic effect of bilateral salpingectomy against postoperative sequelae. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments.

PubMed

Chan, Teresa M; Mercuri, Mathew; Van Dewark, Kenneth; Sherbino, Jonathan; Schwartz, Alan; Norman, Geoff; Lineberry, Matthew

2018-05-01

Emergency physicians (EPs) regularly manage multiple patients simultaneously, often making time-sensitive decisions around priorities for multiple patients. Few studies have explored physician cognition in multipatient scenarios. The authors sought to develop a conceptual framework to describe how EPs think in busy, multipatient environments. From July 2014 to May 2015, a qualitative study was conducted at McMaster University, using a think-aloud protocol to examine how 10 attending EPs and 10 junior residents made decisions in multipatient environments. Participants engaged in the think-aloud exercise for five different simulated multipatient scenarios. Transcripts from recorded interviews were analyzed inductively, with an iterative process involving two independent coders, and compared between attendings and residents. The attending EPs and junior residents used similar processes to prioritize patients in these multipatient scenarios. The think-aloud processes demonstrated a similar process used by almost all participants. The cognitive task of patient prioritization consisted of three components: a brief overview of the entire cohort of patients to determine a general strategy; an individual chart review, whereby the participant created a functional patient story from information available in a file (i.e., vitals, brief clinical history); and creation of a relative priority list. Compared with residents, the attendings were better able to construct deeper and more complex patient stories. The authors propose a conceptual framework for how EPs prioritize care for multiple patients in complex environments. This study may be useful to teachers who train physicians to function more efficiently in busy clinical environments.

MedlinePlus FAQ: Information on Doctors or Hospitals

MedlinePlus

... section which lists directories of doctors and services relevant to the topic. The Directories page lists many sources of information about physicians, other health professionals, and health facilities. ...

The Differential Diagnosis of Pulmonary Blastomycosis Using Case Vignettes: A Wisconsin Network for Health Research (WiNHR) Study

PubMed Central

Baumgardner, Dennis J.; Temte, Jonathan L.; Gutowski, Erin; Agger, William A.; Bailey, Howard; Burmester, James K.; Banerjee, Indrani

2012-01-01

Purpose Pulmonary blastomycosis is an uncommon but serious fungal infection endemic in Wisconsin. Clinician awareness of the protean presentations of this disease may reduce diagnostic delay. This study addressed the diagnostic accuracy of physicians responding to case vignettes of pulmonary blastomycosis and the primary care differential diagnosis of this disease. Methods Eight pulmonary blastomycosis cases were developed from case files. From these, 2 vignettes were randomly selected and mailed to primary care physicians in the Wisconsin Network for Health Research. Respondents were asked to list the 3 most likely diagnoses for each case. Results Respondents listed Blastomycosis as the most likely diagnosis for 37/227 (16%) case vignettes, and 1 of the 3 most likely diagnoses for 43/227 (19%). When vignettes included patient activity in counties with an annual incidence rate of blastomycosis greater than 2/100,000, compared to counties with lower incidence rates, diagnosis was more accurate (28/61 [46%] vs 15/166 [9%]; P < 0.001). Physicians with practice locations in counties with annual blastomycosis incidence rates >2/100,000 listed blastomycosis more commonly than physicians from other counties (16/36 [44%] vs 27/177 [15%]; P < 0.001). This difference in accurate diagnosis remained significant in a multivariate model of practice demographics. Based on responses to the vignettes, pneumonia, cancer, non-infectious pulmonary disease, and tuberculosis emerged as the most-frequently noted diagnosis in the differential diagnosis of blastomycosis. Conclusion Blastomycosis was not listed as 1 of 3 primary diagnoses in a majority of cases when Wisconsin primary care physicians considered case vignettes of actual pulmonary blastomycosis cases. Diagnosis was more accurate if the patient vignette listed exposure to a higher incidence county, or if the physician practiced in a higher incidence county. In Wisconsin, failure to include blastomycosis in the differential diagnoses of illnesses associated with a wide variety of pulmonary symptoms suspected to represent infectious or non-infectious pulmonary, cardiac, or neoplastic disease, regardless of geographic exposure, could result in excess morbidity or mortality. PMID:21560560

Health-care reform's great expectations and physician reality.

PubMed

Van Mol, Andre

2010-09-01

The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

Usability Assessment of Secure Messaging for Clinical Document Sharing between Health Care Providers and Patients.

PubMed

Jahn, Michelle A; Porter, Brian W; Patel, Himalaya; Zillich, Alan J; Simon, Steven R; Russ, Alissa L

2018-04-01

 Web-based patient portals feature secure messaging systems that enable health care providers and patients to communicate information. However, little is known about the usability of these systems for clinical document sharing.  This article evaluates the usability of a secure messaging system for providers and patients in terms of its ability to support sharing of electronic clinical documents.  We conducted usability testing with providers and patients in a human-computer interaction laboratory at a Midwestern U.S. hospital. Providers sent a medication list document to a fictitious patient via secure messaging. Separately, patients retrieved the clinical document from a secure message and returned it to a fictitious provider. We collected use errors, task completion, task time, and satisfaction.  Twenty-nine individuals participated: 19 providers (6 physicians, 6 registered nurses, and 7 pharmacists) and 10 patients. Among providers, 11 (58%) attached and sent the clinical document via secure messaging without requiring assistance, in a median (range) of 4.5 (1.8-12.7) minutes. No patients completed tasks without moderator assistance. Patients accessed the secure messaging system within 3.6 (1.2-15.0) minutes; retrieved the clinical document within 0.8 (0.5-5.7) minutes; and sent the attached clinical document in 6.3 (1.5-18.1) minutes. Although median satisfaction ratings were high, with 5.8 for providers and 6.0 for patients (scale, 0-7), we identified 36 different use errors. Physicians and pharmacists requested additional features to support care coordination via health information technology, while nurses requested features to support efficiency for their tasks.  This study examined the usability of clinical document sharing, a key feature of many secure messaging systems. Our results highlight similarities and differences between provider and patient end-user groups, which can inform secure messaging design to improve learnability and efficiency. The observations suggest recommendations for improving the technical aspects of secure messaging for clinical document sharing. Schattauer GmbH Stuttgart.

Physicians' Initial Forensic Impressions of Hypothetical Cases of Pediatric Traumatic Brain Injury

ERIC Educational Resources Information Center

Laskey, Antoinette L.; Sheridan, Michael J.; Hymel, Kent P.

2007-01-01

Objective: To describe physicians' initial forensic impressions of hypothetical cases of pediatric traumatic brain injury (TBI) and to compare the responses of pathologists and pediatricians. Method: A survey was administered to physicians who attended workshops on pediatric TBI; were members of two national internet list serves; and were members…

Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

PubMed

Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter

2013-03-01

Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.

Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study.

PubMed

Westbrook, Johanna I; Raban, Magdalena Z; Walter, Scott R; Douglas, Heather

2018-01-09

Interruptions and multitasking have been demonstrated in experimental studies to reduce individuals' task performance. These behaviours are frequently used by clinicians in high-workload, dynamic clinical environments, yet their effects have rarely been studied. To assess the relative contributions of interruptions and multitasking by emergency physicians to prescribing errors. 36 emergency physicians were shadowed over 120 hours. All tasks, interruptions and instances of multitasking were recorded. Physicians' working memory capacity (WMC) and preference for multitasking were assessed using the Operation Span Task (OSPAN) and Inventory of Polychronic Values. Following observation, physicians were asked about their sleep in the previous 24 hours. Prescribing errors were used as a measure of task performance. We performed multivariate analysis of prescribing error rates to determine associations with interruptions and multitasking, also considering physician seniority, age, psychometric measures, workload and sleep. Physicians experienced 7.9 interruptions/hour. 28 clinicians were observed prescribing 239 medication orders which contained 208 prescribing errors. While prescribing, clinicians were interrupted 9.4 times/hour. Error rates increased significantly if physicians were interrupted (rate ratio (RR) 2.82; 95% CI 1.23 to 6.49) or multitasked (RR 1.86; 95% CI 1.35 to 2.56) while prescribing. Having below-average sleep showed a >15-fold increase in clinical error rate (RR 16.44; 95% CI 4.84 to 55.81). WMC was protective against errors; for every 10-point increase on the 75-point OSPAN, a 19% decrease in prescribing errors was observed. There was no effect of polychronicity, workload, physician gender or above-average sleep on error rates. Interruptions, multitasking and poor sleep were associated with significantly increased rates of prescribing errors among emergency physicians. WMC mitigated the negative influence of these factors to an extent. These results confirm experimental findings in other fields and raise questions about the acceptability of the high rates of multitasking and interruption in clinical environments. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quantifying the impact of cross coverage on physician's workload and performance in radiation oncology.

PubMed

Mosaly, Prithima R; Mazur, Lukasz M; Jones, Ellen L; Hoyle, Lesley; Zagar, Timothy; Chera, Bhishamjit S; Marks, Lawrence B

2013-01-01

To quantitatively assess the difference in workload and performance of radiation oncology physicians during radiation therapy treatment planning tasks under the conditions of "cross coverage" versus planning a patient with whom they were familiar. Eight physicians (3 experienced faculty physicians and 5 physician residents) performed 2 cases. The first case represented a "cross-coverage" scenario where the physicians had no prior information about the case to be planned. The second exposure represented a "regular-coverage" scenario where the physicians were familiar with the patient case to be planned. Each case involved 3 tasks to be completed systematically. Workload was assessed both subjectively (perceived) using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), and objectively (physiological) throughout the task using eye data (via monitoring pupil size and blink rate). Performance of each task and the case was measured using completion time. Subjective willingness to approve or disapprove the generated plan was obtained after completion of the case only. Forty-eight perceived and 48 physiological workload assessments were obtained. Overall, results revealed a significant increase in perceived workload (high NASA-TLX score) and decrease in performance (longer completion time and reduced approval rate) during cross coverage. There were nonsignificant increases in pupil diameter and decreases in the blink rate during cross-coverage versus regular-coverage scenario. In both cross-coverage and regular-coverage scenarios the level of experience did not affect workload and performance. The cross-coverage scenario significantly increases perceived workload and degrades performance versus regular coverage. Hence, to improve patient safety, efforts must be made to develop policies, standard operating procedures, and usability improvements to electronic medical record and treatment planning systems for "easier" information processing to deal with cross coverage, while recognizing strengths and limitations of human performance. Published by Elsevier Inc.

Revealing List-Level Control in the Stroop Task by Uncovering Its Benefits and a Cost

PubMed Central

Bugg, Julie M.; McDaniel, Mark A.; Scullin, Michael K.; Braver, Todd S.

2012-01-01

Interference is reduced in mostly incongruent relative to mostly congruent lists. Classic accounts of this list-wide proportion congruence effect assume that list-level control processes strategically modulate word reading. Contemporary accounts posit that reliance on the word is modulated poststimulus onset by item-specific information (e.g., proportion congruency of the word). To adjudicate between these accounts, we used novel designs featuring neutral trials. In two experiments, we showed that the list-wide proportion congruence effect is accompanied by a change in neutral trial color-naming performance. Because neutral words have no item-specific bias, this pattern can be attributed to list-level control. Additionally, we showed that list-level attenuation of word reading led to a cost to performance on a secondary prospective memory task but only when that task required processing of the irrelevant, neutral word. These findings indicate that the list-wide proportion congruence effect at least partially reflects list-level control and challenge purely item-specific accounts of this effect. PMID:21767049

Medical leaders or masters?—A systematic review of medical leadership in hospital settings

PubMed Central

Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

PubMed

Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Investigations carried out under the Director's Discretionary Fund

NASA Technical Reports Server (NTRS)

Chahine, M. T.

1985-01-01

This annual report comprises a set of summaries, describing task objectives, progress and results or accomplishments, future outlook, and financial status for each director's discretionary fund (DDF) task that was active during fiscal year 1984. Publications and conference presentations related to the work are listed. The individual reports are categorized as interim or final according to whether the task efforts are ongoing or completed. A partial list of new tasks to be initiated with fiscal year 1985 funds and a glossary of abbreviations and acronyms, used by the task authors in their summaries are included. The table of contents lists the DDF reports in sequence by their task number, which is derived from the 13-digit code assigned to account for the fund awarded to the task project.

Cognitive analysis of physicians' medication ordering activity.

PubMed

Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine

2005-01-01

Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

Agricultural Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

The duties and tasks found in these task lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs for agricultural occupations. The agricultural occupations are divided into three clusters. The clusters and occupations are: agricultural business and management cluster…

An Experimental Analysis of Memory Processing

PubMed Central

Wright, Anthony A

2007-01-01

Rhesus monkeys were trained and tested in visual and auditory list-memory tasks with sequences of four travel pictures or four natural/environmental sounds followed by single test items. Acquisitions of the visual list-memory task are presented. Visual recency (last item) memory diminished with retention delay, and primacy (first item) memory strengthened. Capuchin monkeys, pigeons, and humans showed similar visual-memory changes. Rhesus learned an auditory memory task and showed octave generalization for some lists of notes—tonal, but not atonal, musical passages. In contrast with visual list memory, auditory primacy memory diminished with delay and auditory recency memory strengthened. Manipulations of interitem intervals, list length, and item presentation frequency revealed proactive and retroactive inhibition among items of individual auditory lists. Repeating visual items from prior lists produced interference (on nonmatching tests) revealing how far back memory extended. The possibility of using the interference function to separate familiarity vs. recollective memory processing is discussed. PMID:18047230

Flight and Operational Medicine Clinic (FOMC) Task Process Mapping

DTIC Science & Technology

2014-03-01

technicians, nurses, and physician assistants to accomplish the majority of the tasks; physician level tasks are few and primarily involve application of...condition 31, 37, 81? Complete evaluation Present 469 within 5 days of positive pregnancy test Is condition duty/fitness? NO End Process YES Send to ...info to Health IT Ancillary exam module provides requirements/ sends info to Health IT (Audiology, Optometry, Dental , Mental Health) Operational

Industrial Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

The duties and tasks found in these task lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs for industrial occupations. The industrial occupations are divided into eight clusters. The clusters and occupations are: construction cluster (bricklayer, carpenter, building maintenance…

Electricity Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course in electricity. The guide outlines the tasks entailed in 10 different duties typically required of employees in the following occupations: residential electrician apprentice, material handler/supply clerk, maintenance electrician apprentice,…

Intravenous Therapy Instruction for Licensed Practical Nurses. Instructor's Guide.

ERIC Educational Resources Information Center

Springer, Pam; Carey, Jean

This Idaho instructor's guide lists tasks and enabling objectives, outlines instruction, and provides handout masters, overhead masters, and tests for intravenous therapy (IV) instruction for licensed practical nurses. Following an introduction and a list of criteria for successful completion of IV therapy courses, the document lists tasks and…

Monkeys rely on recency of stimulus repetition when solving short-term memory tasks.

PubMed

Wittig, John H; Richmond, Barry J

2014-05-16

Seven monkeys performed variants of two short-term memory tasks that others have used to differentiate between selective and nonselective memory mechanisms. The first task was to view a list of sequentially presented images and identify whether a test matched any image from the list, but not a distractor from a preceding list. Performance was best when the test matched the most recently presented image. Response rates depended linearly on recency of repetition whether the test matched a sample from the current list or a distractor from a preceding list, suggesting nonselective memorization of all images viewed instead of just the sample images. The second task was to remember just the first image in a list selectively and ignore subsequent distractors. False alarms occurred frequently when the test matched a distractor presented near the beginning of the sequence. In a pilot experiment, response rates depended linearly on recency of repetition irrespective of whether the test matched the first image or a distractor, again suggesting nonselective memorization of all images instead of just the first image. Modification of the second task improved recognition of the first image, but did not abolish use of recency. Monkeys appear to perform nonspatial visual short-term memory tasks often (or exclusively) using a single, nonselective, memory mechanism that conveys the recency of stimulus repetition. Published by Cold Spring Harbor Laboratory Press.

What Physicians Reason about during Admission Case Review

ERIC Educational Resources Information Center

Juma, Salina; Goldszmidt, Mark

2017-01-01

Research suggests that physicians perform multiple reasoning tasks beyond diagnosis during patient review. However, these remain largely theoretical. The purpose of this study was to explore reasoning tasks in clinical practice during patient admission review. The authors used a constant comparative approach--an iterative and inductive process of…

Health care management of sickness certification tasks: results from two surveys to physicians

PubMed Central

2013-01-01

Background Health care in general and physicians in particular, play an important role in patients’ sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification. Method A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty. Results The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support. Conclusions Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks. PMID:23701711

Task Analysis for Health Occupations. Cluster: Rehabilitation Services. Occupation: Physical Therapist Assistant. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lathrop, Janice

Task analyses are provided for two duty areas for the occupation of physical therapist assistant in the rehabilitation services cluster. Ten tasks are listed for the duty area "providing therapeutic measures": apply cold compress, administer hot soak, apply heat lamp, apply warm compress, apply ice bag, assist with dressing change, apply…

Primary care physicians' utilization of type 2 diabetes screening guidelines and referrals to behavioral interventions: a survey-linked retrospective study.

PubMed

Mehta, Sandhya; Mocarski, Michelle; Wisniewski, Tami; Gillespie, Karin; Narayan, K M Venkat; Lang, Kathleen

2017-01-01

To assess primary care physicians' (PCPs) knowledge of type 2 diabetes screening guidelines (American Diabetes Association (ADA) and 2008 US Preventive Services Task Force (USPSTF)), the alignment between their self-reported adherence and actual practice, and how often PCPs recommended diabetes prevention and self-management education programs (DPP/DSME). An online survey of PCPs to understand knowledge and adherence toward use of USPSTF/ADA guidelines and recommendation of DPP/DSME. Patient data from electronic medical records (EMRs) for each PCP were used to identify rates of screening in eligible patients as per guidelines and the two sources were compared to assess concordance. Of 305 surveyed physicians, 38% reported use of both guidelines (33% use ADA only, 25% USPSTF only). Approximately one-third of physicians who reported use of USPSTF/ADA guidelines had non-concordant EMR data. Similarly, while most PCPs reported they are 'very likely' to screen patients with risk factors listed in guidelines, for each criterion at least one-fourth (24%) of PCPs survey responses were non-concordant with EMRs. PCPs reported they provide referral to DPP and DSME on average to 45% and 67% of their newly diagnosed patients with pre-diabetes and diabetes, respectively. Findings show disconnect between PCPs' perceptions of adherence to screening guidelines and actual practice, and highlight limited referrals to DPP/DSME programs. More research is needed to understand barriers to guideline consistent screening and uptake of DPP/DSME, particularly in light of recent policy changes such as the linking USPSTF criteria to reimbursement and expected Medicare DPP reimbursement in 2018.

Cutting costs: the impact of price lists on the cost development at the emergency department.

PubMed

Schilling, Ulf Martin

2010-12-01

It was shown that physicians working at the Swedish emergency department (ED) are unaware of the costs for investigations performed. This study evaluated the possible impact of price lists on the overall laboratory and radiology costs at the ED of a Swedish university hospital. Price lists including the most common laboratory analyses and radiological investigations at the ED were created. The lists were distributed to all internal medicine physicians by e-mail and exposed above their working stations continually. No lists were provided for the orthopaedic control group. The average costs for laboratory and radiological investigations during the months of June and July 2007 and 2008 were calculated. Neither clinical nor admission procedures were changed. The physicians were blinded towards the study. Statistical analysis was performed using the Student's t-test. A total of 1442 orthopaedic and 1585 medical patients were attended to in 2007. In 2008, 1467 orthopaedic and 1637 medical patients required emergency service. The average costs per patient were 980.27 SKR (98€)/999.41 SKR (100€, +1.95%) for orthopaedic and 1081.36 SKR (108€)/877.3 SKR (88€, -18.8%) for medical patients. Laboratory costs decreased by 9% in orthopaedic and 21.4% in medical patients. Radiology costs changed +5.4% in orthopaedic and -20.59% in medical patients. The distribution and promotion of price lists as a tool at the ED to heighten cost awareness resulted in a major decrease in the investigation costs. A significant decrease in radiological costs could be observed. It can be concluded that price lists are an effective tool to cut costs in public healthcare.

Aircraft Mechanics Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course in aircraft mechanics. The guide outlines the tasks entailed in 24 different duties typically required of employees in the following occupations: airframe mechanic, power plant mechanic, aircraft mechanic, aircraft sheet metal worker, aircraft electrician,…

Business, Marketing and Management Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

The duties and tasks found in these task lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs for business, marketing, and management occupations. The business, marketing, and management occupations are divided into eight clusters. The clusters and occupations are:…

Task Lists for Industrial Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Dimmlich, David

These cluster matrices provide duties and tasks that form the basis of instructional content for secondary, postsecondary, and adult occupational training programs for industrial occupations. Duties and skills are presented for the following: (1) electric home appliance and power tool repairers; (2) office machine/cash register repairer; (3)…

Health Occupations. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

The duties and tasks found in these task lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs for health occupations. The health occupations are divided into five clusters. The clusters and occupations are: health occupations, nursing occupations (home health aide, geriatric aide,…

Heating, Ventilation, and Air Conditioning Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course in heating, ventilation, and air conditioning. The guide outlines the tasks entailed in eight different duties typically required of employees in the following occupations: residential installer, domestic refrigeration technician, air conditioning and…

Medical error reduction and tort reform through private, contractually-based quality medicine societies.

PubMed

MacCourt, Duncan; Bernstein, Joseph

2009-01-01

The current medical malpractice system is broken. Many patients injured by malpractice are not compensated, whereas some patients who recover in tort have not suffered medical negligence; furthermore, the system's failures demoralize patients and physicians. But most importantly, the system perpetuates medical error because the adversarial nature of litigation induces a so-called "Culture of Silence" in physicians eager to shield themselves from liability. This silence leads to the pointless repetition of error, as the open discussion and analysis of the root causes of medical mistakes does not take place as fully as it should. In 1993, President Clinton's Task Force on National Health Care Reform considered a solution characterized by Enterprise Medical Liability (EML), Alternative Dispute Resolution (ADR), some limits on recovery for non-pecuniary damages (Caps), and offsets for collateral source recovery. Yet this list of ingredients did not include a strategy to surmount the difficulties associated with each element. Specifically, EML might be efficient, but none of the enterprises contemplated to assume responsibility, i.e., hospitals and payers, control physician behavior enough so that it would be fair to foist liability on them. Likewise, although ADR might be efficient, it will be resisted by individual litigants who perceive themselves as harmed by it. Finally, while limitations on collateral source recovery and damages might effectively reduce costs, patients and trial lawyers likely would not accept them without recompense. The task force also did not place error reduction at the center of malpractice tort reform -a logical and strategic error, in our view. In response, we propose a new system that employs the ingredients suggested by the task force but also addresses the problems with each. We also explicitly consider steps to rebuff the Culture of Silence and promote error reduction. We assert that patients would be better off with a system where physicians cede their implicit "right to remain silent", even if some injured patients will receive less than they do today. Likewise, physicians will be happier with a system that avoids blame-even if this system placed strict requirements for high quality care and disclosure of error. We therefore conceive of de facto trade between patients and physicians, a Pareto improvement, taking form via the establishment of "Societies of Quality Medicine." Physicians working within these societies would consent to onerous processes for disclosing, rectifying and preventing medical error. Patients would in turn contractually agree to assert their claims in arbitration and with limits on recovery. The role of plaintiffs' lawyers would be unchanged, but due to increased disclosure, discovery costs would diminish and the likelihood of prevailing will more than triple. This article examines the legal and policy issues surrounding the establishment of Societies of Quality Medicine, particularly the issues of contracting over liability, and outlines a means of overcoming the theoretical and practical difficulties with enterprise liability, alternative dispute resolution and the imposition of limits on recovery for non-pecuniary damages. We aim to build a welfare enhancing system that rebuffs the culture of silence and promotes error reduction, a system that is at the same time legally sound, fiscally prudent and politically possible.

Examining the relationship between free recall and immediate serial recall: the effects of list length and output order.

PubMed

Ward, Geoff; Tan, Lydia; Grenfell-Essam, Rachel

2010-09-01

In 4 experiments, participants were presented with lists of between 1 and 15 words for tests of immediate memory. For all tasks, participants tended to initiate recall with the first word on the list for short lists. As the list length was increased, so there was a decreased tendency to start with the first list item; and, when free to do so, participants showed an increased tendency to start with one of the last 4 list items. In all tasks, the start position strongly influenced the shape of the resultant serial position curves: When recall started at Serial Position 1, elevated recall of early list items was observed; when recall started toward the end of the list, there were extended recency effects. These results occurred under immediate free recall (IFR) and different variants of immediate serial recall (ISR) and reconstruction of order (RoO) tasks. We argue that these findings have implications for the relationship between IFR and ISR and between rehearsal and recall. (c) 2010 APA, all rights reserved).

Analogous selection processes in declarative and procedural working memory: N-2 list-repetition and task-repetition costs.

PubMed

Gade, Miriam; Souza, Alessandra S; Druey, Michel D; Oberauer, Klaus

2017-01-01

Working memory (WM) holds and manipulates representations for ongoing cognition. Oberauer (Psychology of Learning and Motivation, 51, 45-100, 2009) distinguishes between two analogous WM sub-systems: a declarative WM which handles the objects of thought, and a procedural WM which handles the representations of (cognitive) actions. Here, we assessed whether analogous effects are observed when participants switch between memory sets (declarative representations) and when they switch between task sets (procedural representations). One mechanism assumed to facilitate switching in procedural WM is the inhibition of previously used, but currently irrelevant task sets, as indexed by n-2 task-repetition costs (Mayr & Keele, Journal of Experimental Psychology: General, 129(1), 4-26, 2000). In this study we tested for an analogous effect in declarative WM. We assessed the evidence for n-2 list-repetition costs across eight experiments in which participants switched between memory lists to perform speeded classifications, mental arithmetic, or a local recognition test. N-2 list-repetition costs were obtained consistently in conditions assumed to increase interference between memory lists, and when lists formed chunks in long-term memory. Further analyses across experiments revealed a substantial contribution of episodic memory to n-2 list-repetition costs, thereby questioning the interpretation of n-2 repetition costs as reflecting inhibition. We reanalyzed the data of eight task-switching experiments, and observed that episodic memory also contributes to n-2 task-repetition costs. Taken together, these results show analogous processing principles in declarative and procedural WM, and question the relevance of inhibitory processes for efficient switching between mental sets.

Orientation to Health Occupations: Year One Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This Idaho state curriculum document for the first year of the secondary educations health occupations program contains the following introductory material: (1) a description of the program design; (2) a list of first-year areas of competency; (3) a foundation and job-readiness skills task list; and (4) a core curriculum task list. The curriculum…

Military Interoperable Digital Hospital Testbed (MIDHT)

DTIC Science & Technology

2013-01-01

users of the PACS system in terms of viewing images originating from Miners and Meyersdale are Emergency Medicine and Trauma physicians. This...conditions, over the counter/ herbal medications, physician list, and emergency contacts. Through secure messaging with their physician, patients...et al. (1999). Impact of a patient-centered, computer- based health information/support system. American Journal of Preventive Medicine , 16(1), 1- 9

Top 200 Prescribed Drugs Mostly Prescribed by the Physician in Pharmacies at Medan City

NASA Astrophysics Data System (ADS)

Tanjung, H. R.; Nasution, E. S.

2017-03-01

The drug information literatures usually contains thousands of drugs, which much of them were rare or never prescribed by the physicians. It caused pharmacy students must learn thousands of drugs that will depleted resources and the study result was not effective. The aim of the study was to identify 200 items of drugs that mostly prescribed by the physicians in the pharmacies at Medan City. The study was a descriptive study that used a cross sectional survey methodology. The 200 items of drugs that mostly prescribed by the physician obtained from the pharmacies selected regarding to random sampling method. The study was conducted from August to September 2016. The 200 items of drugs that mostly prescribed by the physician resulted from 21.962 prescribed drugs item of 16.352 prescriptions of 100 pharmacies. The list revealed that the most prescribed drugs was amoxicilline (5.55 %), followed by dexamethasone (4.44%), mefenamic acid (3.73%), cetirizine (3.16%), and ciprofloxacine (2.97%). It shows that the antibiotic drug was the most prescribed drug by the physician in pharmacies at Medan City. Further studies are required to develop the study card from the list.

Task demand influences relationships among sex, clustering strategy, and recall: 16-word versus 9-word list learning tests.

PubMed

Sunderaraman, Preeti; Blumen, Helena M; DeMatteo, David; Apa, Zoltan L; Cosentino, Stephanie

2013-06-01

We compared the relationships among sex, clustering strategy, and recall across different task demands using the 16-word California Verbal Learning Test-Second Edition (CVLT-II) and the 9-word Philadelphia (repeatable) Verbal Learning Test (PrVLT). Women generally score higher than men on verbal memory tasks, possibly because women tend to use semantic clustering. This sex difference has been established via word-list learning tests such as the CVLT-II. In a retrospective between-group study, we compared how 2 separate groups of cognitively healthy older adults performed on a longer and a shorter verbal learning test. The group completing the CVLT-II had 36 women and 26 men; the group completing the PrVLT had 27 women and 21 men. Overall, multiple regression analyses revealed that semantic clustering was significantly associated with total recall on both tests' lists (P<0.001). Sex differences in recall and semantic clustering diminished with the shorter PrVLT word list. Semantic clustering uniquely influenced recall on both the longer and shorter word lists. However, serial clustering and sex influenced recall depending on the length of the word list (ie, the task demand). These findings suggest a complex nonlinear relationship among verbal memory, clustering strategies, and task demand.

Task Demand Influences Relationships Among Sex, Clustering Strategy, and Recall: 16-Word Versus 9-Word List Learning Tests

PubMed Central

Sunderaraman, Preeti; Blumen, Helena M.; DeMatteo, David; Apa, Zoltan; Cosentino, Stephanie

2013-01-01

Objective We compared the relationships among sex, clustering strategy, and recall across different task demands using the 16-word California Verbal Learning Test–Second Edition (CVLT-II) and the 9-word Philadelphia (repeatable) Verbal Learning Test (PrVLT). Background Women generally score higher than men on verbal memory tasks, possibly because women tend to use semantic clustering. This sex difference has been established via word-list learning tests such as the CVLT-II. Methods In a retrospective between-group study, we compared how 2 separate groups of cognitively healthy older adults performed on a longer and a shorter verbal learning test. The group completing the CVLT-II had 36 women and 26 men; the group completing the PrVLT had 27 women and 21 men. Results Overall, multiple regression analyses revealed that semantic clustering was significantly associated with total recall on both tests’ lists (P < 0.001). Sex differences in recall and semantic clustering diminished with the shorter PrVLT word list. Conclusions Semantic clustering uniquely influenced recall on both the longer and shorter word lists. However, serial clustering and sex influenced recall depending on the length of the word list (ie, the task demand). These findings suggest a complex nonlinear relationship among verbal memory, clustering strategies, and task demand. PMID:23812171

Yellow pages advertising by physicians. Are doctors providing the information consumers want most?

PubMed

Butler, D D; Abernethy, A M

1996-01-01

Yellow pages listing are the most widely used form of physician advertising. Every month, approximately 21.6 million adults in the United States refer to the yellow pages before obtaining medical care. Mobile consumers--approximately 17% of the U.S. population who move each year--are heavy users of yellow pages. Consumers desire information on a physician's experience, but it is included in less than 1% of all physician display ads.

Adult age differences in predicting memory performance: the effects of normative information and task experience.

PubMed

McDonald-Miszczak, L; Hunter, M A; Hultsch, D F

1994-03-01

Two experiments addressed the effects of task information and experience on younger and older adults' ability to predict their memory for words. The first study examined the effects of normative task information on subjects' predictions for 30-word lists across three trials. The second study looked at the effects of making predictions and recalling either an easy (15) or a difficult (45) word list prior to making predictions and recalling a moderately difficult (30) word list. The results from both studies showed that task information and experience affected subjects' predictions and that elderly adults predicted their performance more accurately than younger adults.

Task shifting for non-communicable disease management in low and middle income countries--a systematic review.

PubMed

Joshi, Rohina; Alim, Mohammed; Kengne, Andre Pascal; Jan, Stephen; Maulik, Pallab K; Peiris, David; Patel, Anushka A

2014-01-01

One potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shifting- the training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC. A search strategy with the following terms "task-shifting", "non-physician healthcare workers", "community healthcare worker", "hypertension", "diabetes", "cardiovascular disease", "mental health", "depression", "chronic obstructive pulmonary disease", "respiratory disease", "cancer" was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data. Our search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was cost-effective. Task-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.

Opening the Black Box: Cognitive Strategies in Family Practice

PubMed Central

Christensen, Robert E.; Fetters, Michael D.; Green, Lee A.

2005-01-01

PURPOSE We wanted to describe the cognitive strategies used by family physicians when structuring the decision-making tasks of an outpatient visit. METHODS This qualitative study used cognitive task analysis, a structured interview method in which a trained interviewer works individually with expert decision makers to capture their stages and elements of information processing. RESULTS Eighteen family physicians of varying levels of experience participated. Three dominant themes emerged: time pressure, a high degree of variation in task structuring, and varying degrees of task automatization. Based on these data and previous research from the cognitive sciences, we developed a model of novice and expert approaches to decision making in primary care. The model illustrates differences in responses to unexpected opportunity in practice, particularly the expert’s use of attentional surplus (reserve capacity to handle problems) vs the novice’s choice between taking more time or displacing another task. CONCLUSIONS Family physicians have specific, highly individualized cognitive task-structuring approaches and show the decision behavior features typical of expert decision makers in other fields. This finding places constraints on and suggests useful approaches for improving practice. PMID:15798041

Parts Counterperson. Auto, Agriculture & Truck. Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

Developed by industry representatives and educators for use by vocational instructors, this guide focuses on the tasks and competencies necessary for a student to develop in order to secure employment as a counterperson in automobile, agriculture, and truck parts. The task list is an outline of various skills and proficiencies and covers sales,…

Brick and Stone Masonry Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course in brick and stone masonry. The tasks required for 15 different duties performed by bricklayers and 13 different duties typically performed by rocklayers are outlined. The following bricklaying duties are covered: estimating materials for and laying out a…

Task Listing for Piano Technology for the Visually Impaired. Competency-Based Education.

ERIC Educational Resources Information Center

Virginia State Dept. of Education, Richmond. Div. of Vocational and Adult Education.

This task listing was developed for use in Piano Technology, a course offered to visually impaired students at the Virginia School for the Deaf and Blind. The listing is intended to be used with the "Trade and Industrial Education Service Area Resource Guide" in the implementation of competency-based education for this population. The…

What factors are most relevant to the assessment of work ability of employees on long-term sick leave? The physicians' perspective.

PubMed

Dekkers-Sánchez, Patricia M; Wind, Haije; Sluiter, Judith K; Frings-Dresen, Monique H W

2013-07-01

To reach insurance physician (IPs) consensus on factors that must be taken into account in the assessment of the work ability of employees who are sick-listed for 2 years. A Delphi study using online questionnaires was conducted from October 2010 to March 2011. One hundred and two insurance physicians reached a consensus on important factors for return to work (RTW) of employees on long-term sick leave; from those factors, the most relevant for the assessment of work ability was determined. From a total of 22 relevant factors considered for the return to work of long-term sick-listed employees, consensus was reached on nine relevant factors that need to be taken into account in the assessment of the work ability of employees on long-term sick leave. Relevant factors that support return to work are motivation, attitude towards RTW, assessment of cognitions and behaviour, vocational rehabilitation in an early stage and instruction for the sick-listed employee to cope with his disabilities. Relevant factors that hinder RTW are secondary gain from illness, negative perceptions of illness, inefficient coping style and incorrect advice of treating physicians regarding RTW. Non-medical personal and environmental factors may either hinder or promote RTW and must be considered in the assessment of the work ability of long-term sick-listed employees. Assessment of work ability should start early during the sick leave period. These factors may be used by IPs to improve the quality of the assessment of the work ability of employees on long-term sick leave.

A Labor and Delivery Patient Classification System Based on Direct Nursing Care Time

DTIC Science & Technology

1991-08-01

physician 2409 Internal or external monitoring--uterine contraction/ fetal heart tones 2410 Manual contraction assessment 2411 Pitocin induction...assisting physician 2412 Fetal heart tones, manual 2413 Fetal heart tones, doppler 2414 Fetal scalp sampling, assisting physician 241E Routine delivery room... heart tones, ultrasonic transducer 2437 Monitoring fetal heart tones, ultrasonic transducer and uterine contraction, tocotransducer 69 Appendix B: List

The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists.

PubMed

Scullin, Michael K; Krueger, Madison L; Ballard, Hannah K; Pruett, Natalya; Bliwise, Donald L

2018-01-01

Bedtime worry, including worrying about incomplete future tasks, is a significant contributor to difficulty falling asleep. Previous research showed that writing about one's worries can help individuals fall asleep. We investigated whether the temporal focus of bedtime writing-writing a to-do list versus journaling about completed activities-affected sleep onset latency. Fifty-seven healthy young adults (18-30) completed a writing assignment for 5 min prior to overnight polysomnography recording in a controlled sleep laboratory. They were randomly assigned to write about tasks that they needed to remember to complete the next few days (to-do list) or about tasks they had completed the previous few days (completed list). Participants in the to-do list condition fell asleep significantly faster than those in the completed-list condition. The more specifically participants wrote their to-do list, the faster they subsequently fell asleep, whereas the opposite trend was observed when participants wrote about completed activities. Therefore, to facilitate falling asleep, individuals may derive benefit from writing a very specific to-do list for 5 min at bedtime rather than journaling about completed activities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

42 CFR 414.314 - Monthly capitation payment method.

Code of Federal Regulations, 2010 CFR

2010-10-01

... are limited to the following: (i) Administration of hepatitis B vaccine. (ii) Covered physician... SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Determination of... cover all professional services furnished by the physician, except those listed in paragraph (b) of this...

Primary care physicians' use of an electronic medical record system: a cognitive task analysis.

PubMed

Shachak, Aviv; Hadas-Dayagi, Michal; Ziv, Amitai; Reis, Shmuel

2009-03-01

To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. Cognitive task analysis using semi-structured interviews and field observations. Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped. There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.

Student Assessment System. Student Performance Record. Task Detailing. Cosmetology. Georgia Vocational Education Program Articulation.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Div. of Vocational Education.

This booklet lists tasks and functions the cosmetology student should be able to do upon entering an employment situation or a postsecondary school. (Listings are also available for the areas of allied health occupations/practical nursing and transportation/automotive mechanics.) Tasks are coded to correspond to those on the Student Performance…

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

PubMed

Sinsky, Christine; Colligan, Lacey; Li, Ling; Prgomet, Mirela; Reynolds, Sam; Goeders, Lindsey; Westbrook, Johanna; Tutty, Michael; Blike, George

2016-12-06

Little is known about how physician time is allocated in ambulatory care. To describe how physician time is spent in ambulatory practice. Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours). U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington). 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries. Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work. During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks. Data were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics. For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work. American Medical Association.

A novel computer based expert decision making model for prostate cancer disease management.

PubMed

Richman, Martin B; Forman, Ernest H; Bayazit, Yildirim; Einstein, Douglas B; Resnick, Martin I; Stovsky, Mark D

2005-12-01

We propose a strategic, computer based, prostate cancer decision making model based on the analytic hierarchy process. We developed a model that improves physician-patient joint decision making and enhances the treatment selection process by making this critical decision rational and evidence based. Two groups (patient and physician-expert) completed a clinical study comparing an initial disease management choice with the highest ranked option generated by the computer model. Participants made pairwise comparisons to derive priorities for the objectives and subobjectives related to the disease management decision. The weighted comparisons were then applied to treatment options to yield prioritized rank lists that reflect the likelihood that a given alternative will achieve the participant treatment goal. Aggregate data were evaluated by inconsistency ratio analysis and sensitivity analysis, which assessed the influence of individual objectives and subobjectives on the final rank list of treatment options. Inconsistency ratios less than 0.05 were reliably generated, indicating that judgments made within the model were mathematically rational. The aggregate prioritized list of treatment options was tabulated for the patient and physician groups with similar outcomes for the 2 groups. Analysis of the major defining objectives in the treatment selection decision demonstrated the same rank order for the patient and physician groups with cure, survival and quality of life being more important than controlling cancer, preventing major complications of treatment, preventing blood transfusion complications and limiting treatment cost. Analysis of subobjectives, including quality of life and sexual dysfunction, produced similar priority rankings for the patient and physician groups. Concordance between initial treatment choice and the highest weighted model option differed between the groups with the patient group having 59% concordance and the physician group having only 42% concordance. This study successfully validated the usefulness of a computer based prostate cancer management decision making model to produce individualized, rational, clinically appropriate disease management decisions without physician bias.

Assessing the limitations of the existing physician directory for measuring electronic health record (EHR) adoption rates among physicians in Connecticut, USA: cross-sectional study.

PubMed

Tikoo, Minakshi

2012-01-01

To assess the limitations of the existing physician directory in measuring electronic health record adoption rates among a cohort of Connecticut physicians. A population-based mailing assessed the number of physicians practising in Connecticut. Information about practice site, practises pertaining to storing of patient information, sources of revenue and preferred method for receiving survey. Practice status in Connecticut, measured by yes and no. Demographic information was collected on gender, year of birth, race and ethnicity. The response rate for the postcard mailing was 19% (3105/16 462). Of the 16 462 unduplicated consumers, 233 (1%) were retired and 5828 (35%) did not practise in Connecticut. Of the 3105 valid postcard responses we received, 2159 were for physicians practising in Connecticut. Nine (0.4%) of these responses did not specify a preferred method for receiving the full physician survey; 91 physicians refused to participate in the survey; 2159 surveys were sent out using each physician's requested method for receiving the survey, that is, web-based, regular mail or telephone. As of August 2012, 898 physicians had returned surveys, resulting in a response rate of 42%. The postcard response rate based on the unduplicated lists adjusted for exclusions, such as death, retired and do not practise in Connecticut, is 30%, which is low. We may be missing physicians' population which could greatly affect the indicators being used to measure change in electronic health record adoption rates. It is difficult to obtain an accurate physician count of practising physicians in Connecticut from the existing lists. States that are participating in the projects funded under various Office of the National Coordinator for Health Information Technology (ONC) initiatives must focus on getting an accurate count of the physicians practising in their state, since their progress is being measured based on this key number.

42 CFR 418.22 - Certification of terminal illness.

Code of Federal Regulations, 2010 CFR

2010-10-01

... certification of terminal illness for each of the periods listed in § 418.21, even if a single election... certification. Certification will be based on the physician's or medical director's clinical judgment regarding... certification or recertification form, in addition to the physician's signature on the certification or...

LifeBridge new publication: Md.MD. Listing of 1,200 physicians a major part of consumer-type magazine.

PubMed

Botvin, Judith D

2004-01-01

LifeBridge Health, Baltimore, created a directory of its physicians, which developed into a 100-page consumer magazine titled Md.MD A Directory of the Region's Finest Physicians. Written and designed in-house, the premier edition paid for itself, thanks to publishing partner, Alter Communications. The premier edition was mailed to 50,000 Baltimore area homes last September.

A computerized Stroop task to assess cancer-related cognitive biases.

PubMed

DiBonaventura, Marco DaCosta; Erblich, Joel; Sloan, Richard P; Bovbjerg, Dana H

2010-01-01

Biases in processing information related to sources of stress have widely been demonstrated with the use of Stroop emotional color word tasks. One study reported such biases among women with histories of breast cancer in a first-degree relative (FH+) who were given a Stroop cancer word task. This study aimed to replicate and extend these findings with a computerized version of the task. Response latencies and errors were recorded during administration of the task to FH+ and FH- women. A cancer list and 5 comparison lists were administered. Results indicated that FH+ women exhibited longer response latencies for cancer words than did FH- women (p < 0.04), providing further support for cognitive biases in FH+ women. Confirming the psychometric properties of the task, lists exhibited high reliability for both latency (alphas 0.96-0.98) and error rate (alphas 0.61-0.79). In sum, results support the favorable psychometrics and predictive validity of the Stroop cancer word task.

The Costs and Benefits of Testing and Guessing on Recognition Memory

PubMed Central

Huff, Mark J.; Balota, David A.; Hutchison, Keith A.

2016-01-01

We examined whether two types of interpolated tasks (i.e., retrieval-practice via free recall or guessing a missing critical item) improved final recognition for related and unrelated word lists relative to restudying or completing a filler task. Both retrieval-practice and guessing tasks improved correct recognition relative to restudy and filler tasks, particularly when study lists were semantically related. However, both retrieval practice and guessing also generally inflated false recognition for the non-presented critical words. These patterns were found when final recognition was completed during a short delay within the same experimental session (Experiment 1) and following a 24-hr delay (Experiment 2). In Experiment 3, task instructions were presented randomly after each list to determine whether retrieval-practice and guessing effects were influenced by task-expectancy processes. In contrast to Experiments 1 and 2, final recognition following retrieval practice and guessing was equivalent to restudy, suggesting that the observed retrieval-practice and guessing advantages were in part due to preparatory task-based processing during study. PMID:26950490

Success and Failure in Dynamic Decision Environments: Understanding Treatment Strategies for Patients with a Chronic Disease

ERIC Educational Resources Information Center

Ramsey, Gregory W.

2010-01-01

This dissertation proposes and tests a theory explaining how people make decisions to achieve a goal in a specific task environment. The theory is represented as a computational model and implemented as a computer program. The task studied was primary care physicians treating patients with type 2 diabetes. Some physicians succeed in achieving…

Student Assessment System. Student Performance Record. Task Detailing. Transportation/Automotive Mechanics. Georgia Vocational Education Program Articulation.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Div. of Vocational Education.

This booklet lists tasks and functions the student in the transportation cluster should be able to do upon entering an employment situation or a postsecondary school. (Listings are also available for the areas of allied health occupations/practical nursing and cosmetology.) Tasks are coded to correspond to those on the Student Performance Record,…

Simple and Complex Memory Spans and Their Relation to Fluid Abilities: Evidence from List-Length Effects

ERIC Educational Resources Information Center

Unsworth, Nash; Engle, Randall W.

2006-01-01

Complex (working memory) span tasks have generally shown larger and more consistent correlations with higher-order cognition than have simple (or short-term memory) span tasks. The relation between verbal complex and simple verbal span tasks to fluid abilities as a function of list-length was examined. The results suggest that the simple…

Operational and Research Musculoskeletal Summit: Summit Recommendations

NASA Technical Reports Server (NTRS)

Scheuring, Richard A.; Walton, Marlei; Davis-Street, Janis; Smaka, Todd J.; Griffin, DeVon

2006-01-01

The Medical Informatics and Health Care Systems group in the Office of Space Medicine at NASA Johnson Space Center (JSC) has been tasked by NASA with improving overall medical care on the International Space Station (ISS) and providing insights for medical care for future exploration missions. To accomplish this task, a three day Operational and Research Musculoskeletal Summit was held on August 23-25th, 2005 at Space Center Houston. The purpose of the summit was to review NASA#s a) current strategy for preflight health maintenance and injury screening, b) current treatment methods in-flight, and c) risk mitigation strategy for musculoskeletal injuries or syndromes that could occur or impact the mission. Additionally, summit participants provided a list of research topics NASA should consider to mitigate risks to astronaut health. Prior to the summit, participants participated in a web-based pre-summit forum to review the NASA Space Medical Conditions List (SMCL) of musculoskeletal conditions that may occur on ISS as well as the resources currently available to treat them. Data from the participants were compiled and integrated with the summit proceedings. Summit participants included experts from the extramural physician and researcher communities, and representatives from NASA Headquarters, the astronaut corps, JSC Medical Operations and Human Adaptations and Countermeasures Offices, Glenn Research Center Human Research Office, and the Astronaut Strength, Conditioning, and Reconditioning (ASCR) group. The recommendations in this document are based on a summary of summit discussions and the best possible evidence-based recommendations for musculoskeletal care for astronauts while on the ISS, and include recommendati ons for exploration class missions.

Whose job is it anyway? Swedish general practitioners' perception of their responsibility for the patient's drug list.

PubMed

Rahmner, Pia Bastholm; Gustafsson, Lars L; Holmström, Inger; Rosenqvist, Urban; Tomson, Göran

2010-01-01

Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.

Revisiting speech rate and utterance length manipulations in stuttering speakers.

PubMed

Blomgren, Michael; Goberman, Alexander M

2008-01-01

The goal of this study was to evaluate stuttering frequency across a multidimensional (2x2) hierarchy of speech performance tasks. Specifically, this study examined the interaction between changes in length of utterance and levels of speech rate stability. Forty-four adult male speakers participated in the study (22 stuttering speakers and 22 non-stuttering speakers). Participants were audio and video recorded while producing a spontaneous speech task and four different experimental speaking tasks. The four experimental speaking tasks involved reading a list of 45 words and a list 45 phrases two times each. One reading of each list involved speaking at a steady habitual rate (habitual rate tasks) and another reading involved producing each list at a variable speaking rate (variable rate tasks). For the variable rate tasks, participants were directed to produce words or phrases at randomly ordered slow, habitual, and fast rates. The stuttering speakers exhibited significantly more stuttering on the variable rate tasks than on the habitual rate tasks. In addition, the stuttering speakers exhibited significantly more stuttering on the first word of the phrase length tasks compared to the single word tasks. Overall, the results indicated that varying levels of both utterance length and temporal complexity function to modulate stuttering frequency in adult stuttering speakers. Discussion focuses on issues of speech performance according to stuttering severity and possible clinical implications. The reader will learn about and be able to: (1) describe the mediating effects of length of utterance and speech rate on the frequency of stuttering in stuttering speakers; (2) understand the rationale behind multidimensional skill performance matrices; and (3) describe possible applications of motor skill performance matrices to stuttering therapy.

Competency-Based Horticulture: Turfgrass Maintenance Worker.

ERIC Educational Resources Information Center

College of DuPage, Glen Ellyn, IL.

This competency-based horticulture curriculum guide is designed to provide secondary and postsecondary horticulture teachers with a task-oriented program for training turfgrass maintenance workers. It contains a master resource list, a listing of turfgrass maintenance resources available from various states, and 59 competency task sheets organized…

Competency-Based Horticulture: Gardening--Groundskeeping.

ERIC Educational Resources Information Center

College of DuPage, Glen Ellyn, IL.

This competency-based horticulture curriculum guide is designed to provide secondary and postsecondary horticulture teachers with a task-oriented program in gardening/groundskeeping. It contains a master resource list, a listing of gardening/groundskeeping resources available from various states, and 87 competency task sheets organized into 10…

Competency-Based Horticulture: Floriculture.

ERIC Educational Resources Information Center

College of DuPage, Glen Ellyn, IL.

This competency-based horticulture curriculum guide is designed to provide secondary and postsecondary horticulture teachers with a task-oriented program in floriculture. It contains a master resource list, a listing of floriculture resources available from various states, and 89 competency task sheets organized into nine competency areas. These…

Autobody Technology Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This Idaho state curriculum guide provides lists of tasks, performance objectives, and enabling objectives for instruction in auto body technology. Following a curriculum framework that explains major content, laboratory activities, and intended outcomes, the document lists all tasks covered in the curriculum. The bulk of the document consists of…

Temporal and subjective work demands in office-based patient care: an exploration of the dimensions of physician work intensity.

PubMed

Jacobson, C Jeff; Bolon, Shannon; Elder, Nancy; Schroer, Brian; Matthews, Gerald; Szaflarski, Jerzy P; Raphaelson, Marc; Horner, Ronnie D

2011-01-01

Physician work intensity (WI) during office-based patient care affects quality of care and patient safety as well as physician job-satisfaction and reimbursement. Existing, brief work intensity measures have been used in physician studies, but their validity in clinical settings has not been established. Document and describe subjective and temporal WI dimensions for physicians in office-based clinical settings. Examine these in relation to the measurement procedures and dimensions of the SWAT and NASA-TLX intensity measures. A focused ethnographic study using interviews and direct observations. Five family physicians, 5 general internists, 5 neurologists, and 4 surgeons. Through interviews, each physician was asked to describe low and high intensity work responsibilities, patients, and events. To document time and task allotments, physicians were observed during a routine workday. Notes and transcripts were analyzed using the editing method in which categories are obtained from the data. WI factors identified by physicians matched dimensions assessed by standard, generic instruments of work intensity. Physicians also reported WI factors outside of the direct patient encounter. Across specialties, physician time spent in direct contact with patients averaged 61% for office-based services. Brief work intensity measures such as the SWAT and NASA-TLX can be used to assess WI in the office-based clinical setting. However, because these measures define the physician work "task" in terms of effort in the presence of the patient (ie, intraservice time), substantial physician effort dedicated to pre- and postservice activities is not captured.

Physician Manpower in Georgia: Report of the Task Force for Physician Manpower to the Georgia Comprehensive Health Planning Council.

ERIC Educational Resources Information Center

Georgia State Dept. of Public Health, Atlanta. Office of Comprehensive Health Planning.

This report is a result of a study of the state's physician manpower by representatives of the fields of medical education and professional practice in Georgia. Contents include introduction and principal findings, recommendations, and analysis of present supply of physicians and other data. Recommendations suggest improvement of the utilization…

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units.

PubMed

Weiss, Manfred; Marx, Gernot; Iber, Thomas

2017-08-04

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

Inter-physician agreement on the readiness of sick-listed employees to return to work.

PubMed

Schreuder, Jolanda A H; Roelen, Corné A M; de Boer, Mintje; Brouwer, Sandra; Groothoff, Johan W

2012-01-01

To determine the agreement between occupational physician (OP) ratings of an employee's readiness to return to work (RRTW). Anonymized written vignettes of 132 employees, sick-listed for at least 3 weeks, were reviewed by 5 OPs. The OPs intuitively rated RRTW as the ability (knowledge and skills) and willingness (motivation and confidence) of sick-listed employees to resume work. Inter-OP percentages of agreement were calculated and Cohen's kappas (κ) were determined to correct for agreement by chance. The percentage of agreement between OPs was 57% (range 39-89%) on the ability and 63% (range 48-87%) on the willingness of sick-listed employees to resume work. The mean κ was 0.14 (range from -0.21 to 0.79) for ability and 0.25 (range from -0.11 to 0.74) for willingness. The OP-rating of RRTW of employees sick-listed with mental disorders did not differ from the OP-rating of RRTW of employees with musculoskeletal disorders. The inter-OP agreement on intuitively rated RRTW showed a wide variability, which accentuates the need for instruments to establish an employee's RRTW and for training in giving well founded return to work recommendations.

International Medical Graduates: Learning for Practice in Alberta, Canada

ERIC Educational Resources Information Center

Lockyer, Jocelyn; Hofmeister, Marianna; Crutcher, Rodney; Klein, Douglas; Fidler, Herta

2007-01-01

Introduction: There is little known about the learning that is undertaken by physicians who graduate from a World Health Organization-listed medical school outside Canada and who migrate to Canada to practice. What do physicians learn and what resources do they access in adapting to practice in Alberta, a province of Canada? Methods: Telephone…

42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

Code of Federal Regulations, 2013 CFR

2013-10-01

... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

Code of Federal Regulations, 2014 CFR

2014-10-01

... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

Code of Federal Regulations, 2012 CFR

2012-10-01

... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

Effects of Delay and Number of Related List Items on Implicit Activation for DRM Critical Items in a Speeded Naming Task

ERIC Educational Resources Information Center

Meade, Michelle L.; Hutchison, Keith A.; Rand, Kristina M.

2010-01-01

Two experiments examined decay and additivity of semantic priming produced by DRM false memory lists on a naming task. Subjects were presented with study lists containing 14 DRM items that were either all 14 related, the first 7 related, the second 7 related, or all 14 unrelated to the non-presented critical item. Priming was measured on a naming…

Tank vapor mitigation requirements for Hanford Tank Farms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rakestraw, L.D.

1994-11-15

Westinghouse Hanford Company has contracted Los Alamos Technical Associates to listing of vapors and aerosols that are or may be emitted from the High Level Waste (HLW) tanks at Hanford. Mitigation requirements under Federal and State law, as well as DOE Orders, are included in the listing. The lists will be used to support permitting activities relative to tank farm ventilation system up-grades. This task is designated Task 108 under MJB-SWV-312057 and is an extension of efforts begun under Task 53 of Purchase Order MPB-SVV-03291 5 for Mechanical Engineering Support. The results of that task, which covered only thirty-nine tanks,more » are repeated here to provide a single source document for vapor mitigation requirements for all 177 HLW tanks.« less

The phonological neighbourhood effect on short-term memory for order.

PubMed

Clarkson, L; Roodenrys, S; Miller, L M; Hulme, C

2017-03-01

There is a growing body of literature that suggests that long-term memory (LTM) and short-term memory (STM) structures that were once thought to be distinct are actually co-dependent, and that LTM can aid retrieval from STM. The mechanism behind this effect is commonly argued to act on item memory but not on order memory. The aim of the current study was to examine whether LTM could exert an influence on STM for order by examining an effect attributed to LTM, the phonological neighbourhood effect, in a task that reduced the requirement to retain item information. In Experiment 1, 18 participants completed a serial reconstruction task where neighbourhood density alternated within the lists. In Experiment 2, 22 participants completed a serial reconstruction task using pure lists of dense and sparse neighbourhood words. In Experiment 3, 22 participants completed a reconstruction task with both mixed and pure lists. There was a significant effect of neighbourhood density with better recall for dense than sparse neighbourhood words in pure lists but not in mixed lists. Results suggest that LTM exerts an influence prior to that proposed by many models of memory for order.

Dissociating the influence of familiarity and meaningfulness from word frequency in naming and lexical decision performance.

PubMed

Colombo, Lucia; Pasini, Margherita; Balota, David A

2006-09-01

Performance in two experiments was compared on a list of words of high and low frequency in which familiarity/meaningfulness (FM) was balanced and on a list of high- and low-frequency words in which FM was confounded with frequency (i.e., high frequency--high familiarity vs. low frequency--low familiarity). Both repetition and task (lexical decision and naming) were investigated. In the lexical decision task of Experiment 1, both frequency and repetition effects were larger in the list with FM confounded than in the list with FM matched. In the naming task, frequency and repetition effects and their interaction were significant, but there was no influence of FM list context. In Experiment 2, in which the repetitions occurred across blocks, as opposed to randomly intermixed within a list, similar results were found; however, there was no interaction between list and repetition. The results suggest that an evaluation of items in terms of their meaning and familiarity explains a large part of the variance, only in lexical decision. These dimensions may be cued both by subjective feelings of familiarity and the extent to which semantic information is available and by episodic traces due to recent encounters with the item.

Reducing Patients’ Unmet Concerns in Primary Care: the Difference One Word Can Make

PubMed Central

Robinson, Jeffrey D.; Elliott, Marc N.; Beckett, Megan; Wilkes, Michael

2007-01-01

Context In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed. Objective To test an intervention to reduce patients’ unmet concerns. Design Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys. Setting Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania. Participants A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition. Intervention After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: “Is there anything else you want to address in the visit today?” (ANY condition) and “Is there something else you want to address in the visit today?” (SOME condition). Main Outcome Measures Patients’ unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys. Results Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients’; expression of unanticipated concerns not listed in previsit surveys. Conclusions Patients’ unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time. PMID:17674111

Program Improvement Project for Industrial Education. Annual Report.

ERIC Educational Resources Information Center

Shaeffer, Bruce W.

Designed to improve industrial education programs through the development of minimum uniform quality standards, a project developed a task list, educationally sequenced the identified tasks, and developed a recommended shop layout and equipment list for four occupational areas: diesel repair, appliance repair, office machine repair, and small…

Automotive Technology Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This Idaho state curriculum guide provides lists of tasks, performance objectives, and enabling objectives for instruction in automotive technology. The document begins with a list of all tasks covered by the curriculum, a short course outline, and a curriculum framework that explains major content, laboratory activities, and intended outcomes.…

Teamwork: relevance and interdependence of interprofessional education

PubMed Central

Tamayo, M; Besoaín-Saldaña, A; Aguirre, M; Leiva, J

2017-01-01

ABSTRACT OBJECTIVE Determine the perception of university students regarding interprofessional and interdependent work between team members in their inclusion in primary care. METHODS Analytical cross-sectional study. The sampling had a probabilistic, stratified random type with 95% confidence and 5% margin of error. Seven-hundred and four students of Public Universities in Santiago (Chile) answered self-administered questionnaire. RESULTS Ninety-seven point eight of students say that interprofessional work is important; 27.1% of them declare that their university did not seem to show that their study plans were important. The professionals listed as most important in teams are physicians and nurses. CONCLUSIONS Spaces for development and institutional support are key elements to promote interprofessional work. If this competence can involve each academic unit in their different formative spaces there will be a significant contribution to said promotion. Teamwork is a pending task. PMID:28489187

Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations

PubMed Central

Eckstrand, Kristen L.; Potter, Jennifer; Bayer, Carey Roth; Englander, Robert

2016-01-01

Delineating the requisite competencies of a 21st-century physician is the first step in the paradigm shift to competency-based medical education. Over the past two decades, more than 150 lists of competencies have emerged. In a synthesis of these lists, the Physician Competency Reference Set (PCRS) provided a unifying framework of competencies that define the general physician. The PCRS is not context or population specific; however, competently caring for certain underrepresented populations or specific medical conditions can require more specific context. Previously developed competency lists describing care for these populations have been disconnected from an overarching competency framework, limiting their uptake. To address this gap, the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development adapted the PCRS by adding context- and content-specific qualifying statements to existing PCRS competencies to better meet the needs of diverse patient populations. This Article describes the committee’s process in developing these qualifiers of competence. To facilitate widespread adoption of the contextualized competencies in U.S. medical schools, the committee used an established competency framework to develop qualifiers of competence to improve the health of individuals who are lesbian, gay, bisexual, transgender; gender nonconforming; or born with differences in sexual development. This process can be applied to other underrepresented populations or medical conditions, ensuring that relevant topics are included in medical education and, ultimately, health care outcomes are improved for all patients inclusive of diversity, background, and ability. PMID:26796092

Evaluation of Physicians' Cognitive Styles.

PubMed

Djulbegovic, Benjamin; Beckstead, Jason W; Elqayam, Shira; Reljic, Tea; Hozo, Iztok; Kumar, Ambuj; Cannon-Bowers, Janis; Taylor, Stephanie; Tsalatsanis, Athanasios; Turner, Brandon; Paidas, Charles

2014-07-01

Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an exhaustive search for solutions. However, they appeared to have maintained their "mindware" for effective problem solving. © The Author(s) 2014.

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

PubMed

Yeh, James S; Franklin, Jessica M; Avorn, Jerry; Landon, Joan; Kesselheim, Aaron S

2016-06-01

Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed. Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol. Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011. The exposure variable was a physician's industry payments as listed in the Massachusetts database. The outcome was the physician's rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians' industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments. Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P < .001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not. Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

The Hebb repetition effect in simple and complex memory span.

PubMed

Oberauer, Klaus; Jones, Timothy; Lewandowsky, Stephan

2015-08-01

The Hebb repetition effect refers to the finding that immediate serial recall is improved over trials for memory lists that are surreptitiously repeated across trials, relative to new lists. We show in four experiments that the Hebb repetition effect is also observed with a complex-span task, in which encoding or retrieval of list items alternates with an unrelated processing task. The interruption of encoding or retrieval by the processing task did not reduce the size of the Hebb effect, demonstrating that incidental long-term learning forms integrated representations of lists, excluding the interleaved processing events. Contrary to the assumption that complex-span performance relies more on long-term memory than standard immediate serial recall (simple span), the Hebb effect was not larger in complex-span than in simple-span performance. The Hebb effect in complex span was also not modulated by the opportunity for refreshing list items, questioning a role of refreshing for the acquisition of the long-term memory representations underlying the effect.

An Experimental Analysis of Memory Processing

ERIC Educational Resources Information Center

Wright, Anthony A.

2007-01-01

Rhesus monkeys were trained and tested in visual and auditory list-memory tasks with sequences of four travel pictures or four natural/environmental sounds followed by single test items. Acquisitions of the visual list-memory task are presented. Visual recency (last item) memory diminished with retention delay, and primacy (first item) memory…

Principles of Technology, Units 1-7. Curriculum Guide.

ERIC Educational Resources Information Center

Campbell, Robert, Comp.

This Idaho secondary education curriculum guide provides lists of tasks, performance objectives, and enabling objectives for instruction intended to impart entry-level employment skills in industrial technology. The first list is a general job competencies task profile, followed by a sheet on which teachers can evaluate students' general job…

Impaired List Learning Is Not a General Property of Frontal Lesions

ERIC Educational Resources Information Center

Alexander, Michael P.; Stuss, Donald; Gillingham, Susan

2009-01-01

Background: List-learning tasks are frequently used to provide measures of "executive functions" that are believed necessary for successful memory performance. Small sample sizes, confounding anomia, and incomplete representation of all frontal regions have prevented consistent demonstration of distinct regional frontal effects on this task.…

Nursing Assistant. Curriculum Guide. Invest in Success.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

Under the Idaho state system for curriculum development in vocational education, Technical Committees made up solely of industry personnel are responsible for drawing up task lists for each program. Based on a task list specific to the field, this curriculum guide provides the competencies needed by nursing assistants enrolled in postsecondary,…

Correspondence Supervisor: Task List Competency Record.

ERIC Educational Resources Information Center

Minnesota Instructional Materials Center, White Bear Lake.

One of a series of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the correspondence supervisor (also known as a senior correspondence secretary/specialist, word processing supervisor, or word processing center specialist), a task list under 20 areas of competency, an occupational…

[Preferences of general practitioners in metropolitan France with regard to the delegation of medico-administrative tasks to secretaries assisting medico-social workers: Study in conjoint analysis].

PubMed

Chanu, A; Caron, A; Ficheur, G; Berkhout, C; Duhamel, A; Rochoy, M

2018-05-01

A general practitioner's office is an economic unit where task delegation is an essential component in improving the quality and performance of work. To classify the preferences of general practitioners regarding the delegation of medical-administrative tasks to assistant medical-social secretaries. Conjoint analysis was applied to a random sample of 175 general practitioners working in metropolitan France. Ten scenarios were constructed based on seven attributes: training for medical secretaries, logistical support during the consultation, delegation of management planning, medical records, accounting, maintenance, and taking initiative on the telephone. A factorial design was used to reduce the number of scenarios. Physicians' socio-demographic variables were collected. One hundred and three physicians responded and the analysis included 90 respondents respecting the transitivity of preferences hypothesis. Perceived difficulty was scored 2.8 out of 5. The high rates of respondents (59%; 95% CI [51.7-66.3]) and transitivity (87.5%; 95% CI [81.1-93.9]) showed physicians' interest in this topic. Delegation of tasks concerning management planning (OR=2.91; 95% CI [2.40-13.52]) and medical records (OR=1.88; 95% CI [1.56-2.27]) were the two most important attributes for physicians. The only variable for which the choice of a secretary was not taken into account was logistical support. This is a first study examining the choices of general practitioners concerning the delegation of tasks to assistants. These findings are helpful to better understand the determinants of practitioners' choices in delegating certain tasks or not. They reveal doctors' desire to limit their ancillary tasks in order to favor better use of time for "medical" tasks. They also expose interest for training medical secretaries and widening their field of competence, suggesting the emergence of a new professional occupation that could be called "medical assistant". Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Strategic planning in healthcare: the experience of the University of Wisconsin Hospital and Clinics.

PubMed

Sollenberger, Donna K

2006-01-01

In 1999, after 25 years of stable leadership from a single CEO, the University of Wisconsin Hospital and Clinics (UWHC) Authority Board named a new CEO. The 471-bed academic medical center had recently experienced significant change and challenges. In 1996, it had emerged as a public authority, a statutory designation by the state of Wisconsin that moved the hospital and clinics from the University of Wisconsin and the state of Wisconsin, and created it as a quasi-public entity with its own board. In 1999, when the new CEO was named, the hospital was experiencing a loss of revenue and market share, operating deficits, a 22 percent nurse vacancy rate, and patient satisfaction scores below the 40th percentile. The first task assigned to the new CEO by the board was the development of a new strategic plan that would reverse these trends and position UWHC as a premier academic hospital. The CEO began a strategic planning process that involved leaders, physicians, and staff from throughout the hospital and clinics, its affiliated medical school, and the physician practice plan. This article describes the collaborative, integrative, and communicative strategic planning process UWHC used; details the organization of the process; describes the results achieved by UWHC; and lists the lessons learned along the way.

Frequency and nature of problems associated with sickness certification tasks: A cross-sectional questionnaire study of 5455 physicians

PubMed Central

Löfgren, Anna; Hagberg, Jan; Arrelöv, Britt; Ponzer, Sari; Alexanderson, Kristina

2007-01-01

Objective To study the frequency and nature of problems associated with physicians’ sickness certification practices. Design Cross-sectional questionnaire study. Setting Stockholm and Östergötland Counties in Sweden. Subjects Physicians aged ≤64 years, n =7665, response rate 71% (n =5455). Main outcome measures The frequency of consultations involving sickness certification, the frequency and nature of problems related to sickness certification. Results A total of 74% (n =4019) of the respondents had consultations including sickness certification at least a few times a year. About half of these physicians had sickness certification cases at least six times a week, and 1 out of 10 (9.4%) had this more than 20 times a week. The items that the highest percentage of physicians rated as very or fairly problematic included: handling conflicts with patients over certification, assessing work ability, estimating optimal length and degree of absence, and managing prolongation of sick leave initially certified by another physician. There were large differences in frequency and nature of problems between different types of clinics/practices. General practitioners had the highest frequency of problems concerning sickness certification while the lowest was found among specialists in internal medicine and surgery. Conclusion Sickness certification should be recognized as an important task also for physicians other than general practitioners. The physicians experienced problems with numerous tasks related to sickness certification and these varied considerably between types of clinics. The high rate of problems experienced may have consequences for the physicians’ work situation, for patients, and for society. PMID:17846937

Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units.

PubMed

Henrich, Natalie; Ayas, Najib T; Stelfox, Henry T; Peets, Adam D

2016-09-01

Fatigue is common among physicians and adversely affects their performance. To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU). We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada. In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions. ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.

Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know.

PubMed

Heller, Justin; Gabbay, Joubin S; Ghadjar, Kiu; Jourabchi, Mickel; O'Hara, Catherine; Heller, Misha; Bradley, James P

2006-02-01

Widespread use of herbal medications/supplements among the presurgical population may have a negative effect on perioperative patient care. Thus, the authors' goal was to identify the prevalence of such use in a cosmetic surgery patient population compared with use among the general public; to assess physician awareness of proper management of these herbal medications/supplements; and to review the literature to provide rational strategies for managing perioperative patients taking these remedies. To assess patient (n = 100) and general public (n = 100) usage rates, open-ended lists of (1) the most common herbal medications/supplements and (2) homeopathic treatments were compiled. Board-certified plastic surgeons (n = 20) were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects. The usage rate for cosmetic versus public surveys for herbal medicines/supplements was 55 percent versus 24 percent (p < 0.001), with 35 percent versus 8 percent (p < 0.001) engaging in homeopathic practices, respectively. Cosmetic patients' top four herbal/supplements of usage were chondroitin (18 percent), ephedra (18 percent), echinacea (14 percent), and glucosamine (10 percent). The top four used by the general public were echinacea (8 percent), garlic (6 percent), ginseng (4 percent), and ginger (4 percent). The physician survey demonstrated awareness of 54 percent of the listed supplements/herbal medicines, 85 percent of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100 percent physician discontinuation preoperatively. Herbal medicines and supplements displayed greater prevalence in the cosmetic surgery population than in the population at large. Furthermore, side effects and potential complications warrant addressing these remedies as pharmaceuticals rather than as safe and "natural." Thus, a descriptive "top-10" list with perioperative recommendations was compiled for the plastic surgeon.

Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital

PubMed Central

2010-01-01

Background In the modern hospital environment, increasing possibilities in medical examination techniques and increasing documentation tasks claim the physicians' energy and encroach on their time spent with patients. This study aimed to investigate how much time physicians at hospital wards spend on communication with patients and their families and how much time they spend on other specific work tasks. Methods A non-participatory, observational study was conducted in thirty-six wards at the University Medical Center Freiburg, a 1700-bed academic hospital in Germany. All wards belonging to the clinics of internal medicine, surgery, radiology, neurology, and to the clinic for gynaecology took part in the study. Thirty-four ward doctors from fifteen different medical departments were observed during a randomly chosen complete work day. The Physicians' time for communication with patients and relatives and time spent on different working tasks during one day of work were assessed. Results 374 working hours were analysed. On average, a physician's workday on a university hospital ward added up to 658.91 minutes (10 hrs 58 min; range 490 - 848 min). Looking at single items of time consumption on the evaluation sheet, discussions with colleagues ranked first with 150 minutes on average. Documentation and administrative requirements took an average time of 148 minutes per day and ranked second. Total time for communication with patients and their relatives was 85 minutes per physician and day. Consequently, the available time for communication was 4 minutes and 17 seconds for each patient on the ward and 20 seconds for his or her relatives. Physicians assessed themselves to communicate twice as long with patients and sevenfold with relatives than they did according to this study. Conclusions Workload and time pressure for physicians working on hospital wards are high. To offer excellent medical treatment combined with patient centred care and to meet the needs of patients and relatives on hospital wards, physicians should be given more time to focus on core clinical tasks. Time and health care management solutions to minimize time pressure are required. Further research is needed to assess quality of communication in hospital settings. PMID:20380725

Information Resources in Clinical Medicine: Family Practice, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine.

ERIC Educational Resources Information Center

Schwank, Jean; Allen, Joyce

Designed for beginning health science librarians, this continuing education course syllabus presents a guide to information resources for answering physicians' questions about patient care. Sources from standard core lists, such as the Alfred Brandon list, are highlighted and described, along with additional titles. General resources covered…

[Medical institutions and physicians in the district of Garwolin during the period the II Republic of Poland].

PubMed

Kocon, T

2001-01-01

Presentation of the District Hospital in Garwolin and the Regional Council Hospital in Maciejowice. List of names of physicians working in hospitals, public health centers and sick-fund centers. Biographies of physicians proceeding from the district and related somehow with it during the period of the II Republic, namely: Feliks Malinowski, Czesłow Bogucki, Józef Kenig, Stefan Niziński, Stefan Soszka, Władysław Galasiński, Józef Mazurek.

Urban Alabama Physicians and the Electronic Medical Record: A Qualitative Study

ERIC Educational Resources Information Center

Tiggle, Michele

2012-01-01

The electronic medical record (EMR) is an information technology tool supporting the examination, treatment, and care of a patient. The EMR allows physicians to view a patient's record showing current medications, a history of visits from health care providers with notes from those visits, a problem list, a functional status assessment, a schedule…

Natural language processing and inference rules as strategies for updating problem list in an electronic health record.

PubMed

Plazzotta, Fernando; Otero, Carlos; Luna, Daniel; de Quiros, Fernan Gonzalez Bernaldo

2013-01-01

Physicians do not always keep the problem list accurate, complete and updated. To analyze natural language processing (NLP) techniques and inference rules as strategies to maintain completeness and accuracy of the problem list in EHRs. Non systematic literature review in PubMed, in the last 10 years. Strategies to maintain the EHRs problem list were analyzed in two ways: inputting and removing problems from the problem list. NLP and inference rules have acceptable performance for inputting problems into the problem list. No studies using these techniques for removing problems were published Conclusion: Both tools, NLP and inference rules have had acceptable results as tools for maintain the completeness and accuracy of the problem list.

Space station human productivity study. Volume 5: Management plans

NASA Technical Reports Server (NTRS)

1985-01-01

The 67 Management Plans represent recommended study approaches for resolving 108 of the 305 Issues which were identified. Each study Management Plan is prepared in three formats: Management Plan Overview (lists the subsumed Issues, study background, and related overview information); Study Plan (details the study approach by tasks, lists special needs, and describes expected study products); Schedule-Task Flow (provides a time-lined schedule for the study tasks and resource requirements). The Management Relationships Matrix, included in this volume, shows the data input-output relationships among all recommended studies. A listing is also included which cross-references the unresolved requirements to Issues to management plans. A glossary of all abbreviations utilized is provided.

An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence-Powered Medication Reconciliation Tool.

PubMed

Long, Ju; Yuan, Michael Juntao; Poonawala, Robina

2016-05-16

Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. In this study, we developed iPad-based software tools, with AI decision support, to engage patients to "self-service" medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool's user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool's usability afterward. All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians.

Removal of paper-based health records from Norwegian hospitals: effects on clinical workflow.

PubMed

Lium, Jan Tore; Faxvaag, Arild

2006-01-01

Several Norwegian hospitals have, plan, or are in the process of removing the paper-based health record from clinical workflow. To assess the impact on usage and satisfaction of electronic health record (EHR) systems, we conducted a survey among physicians, nurses and medical secretaries at selected departments from six Norwegian hospitals. The main feature of the questionnaire is the description of a set of tasks commonly performed at hospitals, and respondents were asked to rate their usage and change of ease compared to previous routines for each tasks. There were 24 tasks for physicians, 19 for nurses and 23 for medical secretaries. In total, 64 physicians, 128 nurses and 57 medical secretaries responded, corresponding to a response rate of 68%, 58% and 84% respectively. Results showed a large degree of use among medical secretaries, while physicians and nurses displayed a more modest degree of use. Possibly suggesting that the EHR systems among clinicians still is considered more of an administrative system. Among the two latter groups, tasks regarding information retrieval were used more extensively than tasks regarding generating and storing information. Also, we observed large differences between hospitals and higher satisfaction with the part of the system handling regular electronic data than scanned document images. Even though the increase in use among clinicians after removing the paper based record were mainly in tasks where respondents had no choice other than use the electronic health record, the attitude towards EHR-systems were mainly positive. Thus, while removing the paper based record has yet to promote new ways of working, we see it as an important step towards the EHR system of tomorrow. Several Norwegian hospitals have shown that it is possible.

Perspectives of key stakeholders regarding task shifting of care for HIV patients in Mozambique: a qualitative interview-based study with Ministry of Health leaders, clinicians, and donors.

PubMed

Rustagi, Alison S; Manjate, Rosa Marlene; Gloyd, Stephen; John-Stewart, Grace; Micek, Mark; Gimbel, Sarah; Sherr, Kenneth

2015-04-01

Task shifting is a common strategy to deliver antiretroviral therapy (ART) in resource-limited settings and is safe and effective if implemented appropriately. Consensus among stakeholders is necessary to formulate clear national policies that maintain high-quality care. We sought to understand key stakeholders' opinions regarding task shifting of HIV care in Mozambique and to characterize which specific tasks stakeholders considered appropriate for specific cadres of health workers. National and provincial Ministry of Health leaders, representatives from donor and non-governmental organizations (NGOs), and clinicians providing HIV care were intentionally selected to represent diverse viewpoints. Using open- and closed-ended questions, interviewees were asked about their general support of task shifting, its potential advantages and disadvantages, and whether each of seven cadres of non-physician health workers should perform each of eight tasks related to ART provision. Responses were tallied overall and stratified by current job category. Interviews were conducted between November 2007 and June 2008. Of 62 stakeholders interviewed, 44% held leadership positions in the Ministry of Health, 44% were clinicians providing HIV care, and 13% were donors or employed by NGOs; 89% held a medical degree. Stakeholders were highly supportive of physician assistants performing simple ART-related tasks and unanimous in opposing community health workers providing any ART-related services. The most commonly cited motives to implement task shifting were to increase ART access, decrease physician workload, and decrease patient wait time, whereas chief concerns included reduced quality of care and poor training and supervision. Support for task shifting was higher among clinicians than policy and programme leaders for three specific task/cadre combinations: general mid-level nurses to initiate ART in adults (supported by 75% of clinicians vs. 41% of non-clinicians) and in pregnant women (75% vs. 34%, respectively) and physician assistants to change ART regimens in adults (43% vs. 24%, respectively). Stakeholders agreed on some ART-related task delegation to lower health worker cadres. Clinicians were more likely to support task shifting than policy and programme leaders, perhaps motivated by their front-line experiences. Harmonizing policy and programme managers' views with those of clinicians will be important to formulate and implement clear policy.

Drafting and Design Technology Curriculum Guide.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

This document provides lists of tasks, performance objectives, and enabling objectives for 1,800 hours of postsecondary instruction or 900 hours of secondary instruction in the drafting and design technology program. Following a list of tasks and an explanation of the program, the bulk of the document consists of 25 modules, each of which is a…

Printing/Graphic Arts Technology. Curriculum Guide. Invest in Success.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

Under the Idaho state system for curriculum development in vocational education, Technical Committees made up solely of industry personnel are responsible for drawing up task lists for each program. A Technical Committee Report is prepared on completion of the Committee's assignment. This report presents a task list that reflects current trends…

Reference Guide for Teaching Selected Duty Areas from Business, Marketing and Management Occupations.

ERIC Educational Resources Information Center

Rich, John H.

This reference guide was designed to assist business, marketing, and management educators in locating textbook/instructional materials for use in teaching duty areas and task lists for grades 11-14. Duty areas and task lists are matched with selected textbook/instructional publications for the secretarial, general office clerk, and information…

The effect of concurrent semantic categorization on delayed serial recall.

PubMed

Acheson, Daniel J; MacDonald, Maryellen C; Postle, Bradley R

2011-01-01

The influence of semantic processing on the serial ordering of items in short-term memory was explored using a novel dual-task paradigm. Participants engaged in 2 picture-judgment tasks while simultaneously performing delayed serial recall. List material varied in the presence of phonological overlap (Experiments 1 and 2) and in semantic content (concrete words in Experiment 1 and 3; nonwords in Experiments 2 and 3). Picture judgments varied in the extent to which they required accessing visual semantic information (i.e., semantic categorization and line orientation judgments). Results showed that, relative to line-orientation judgments, engaging in semantic categorization judgments increased the proportion of item-ordering errors for concrete lists but did not affect error proportions for nonword lists. Furthermore, although more ordering errors were observed for phonologically similar relative to dissimilar lists, no interactions were observed between the phonological overlap and picture-judgment task manipulations. These results demonstrate that lexical-semantic representations can affect the serial ordering of items in short-term memory. Furthermore, the dual-task paradigm provides a new method for examining when and how semantic representations affect memory performance.

The Effect of Concurrent Semantic Categorization on Delayed Serial Recall

PubMed Central

Acheson, Daniel J.; MacDonald, Maryellen C.; Postle, Bradley R.

2010-01-01

The influence of semantic processing on the serial ordering of items in short-term memory was explored using a novel dual-task paradigm. Subjects engaged in two picture judgment tasks while simultaneously performing delayed serial recall. List material varied in the presence of phonological overlap (Experiments 1 and 2) and in semantic content (concrete words in Experiment 1 and 3; nonwords in Experiments 2 and 3). Picture judgments varied in the extent to which they required accessing visual semantic information (i.e., semantic categorization and line orientation judgments). Results showed that, relative to line orientation judgments, engaging in semantic categorization judgments increased the proportion of item ordering errors for concrete lists but did not affect error proportions for nonword lists. Furthermore, although more ordering errors were observed for phonologically similar relative to dissimilar lists, no interactions were observed between the phonological overlap and picture judgment task manipulations. These results thus demonstrate that lexical-semantic representations can affect the serial ordering of items in short-term memory. Furthermore, the dual-task paradigm provides a new method for examining when and how semantic representations affect memory performance. PMID:21058880

Maltreated and non-maltreated children's true and false memories of neutral and emotional word lists in the Deese/Roediger-McDermott task.

PubMed

Baugerud, Gunn Astrid; Howe, Mark L; Magnussen, Svein; Melinder, Annika

2016-03-01

Maltreated (n=26) and non-maltreated (n=31) 7- to 12-year-old children were tested on the Deese/Roediger-McDermott (DRM) false memory task using emotional and neutral word lists. True recall was significantly better for non-maltreated than maltreated children regardless of list valence. The proportion of false recall for neutral lists was comparable regardless of maltreatment status. However, maltreated children showed a significantly higher false recall rate for the emotional lists than non-maltreated children. Together, these results provide new evidence that maltreated children could be more prone to false memory illusions for negatively valenced information than their non-maltreated counterparts. Copyright © 2015 Elsevier Inc. All rights reserved.

Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis.

PubMed

Emdin, Connor A; Chong, Nicholas J; Millson, Peggy E

2013-07-03

A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed. Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88-1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: -12.7-17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65-1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56-0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. Non-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.

Multisociety task force recommendations of competencies in Pulmonary and Critical Care Medicine.

PubMed

Buckley, John D; Addrizzo-Harris, Doreen J; Clay, Alison S; Curtis, J Randall; Kotloff, Robert M; Lorin, Scott M; Murin, Susan; Sessler, Curtis N; Rogers, Paul L; Rosen, Mark J; Spevetz, Antoinette; King, Talmadge E; Malhotra, Atul; Parsons, Polly E

2009-08-15

Numerous accrediting organizations are calling for competency-based medical education that would help define specific specialties and serve as a foundation for ongoing assessment throughout a practitioner's career. Pulmonary Medicine and Critical Care Medicine are two distinct subspecialties, yet many individual physicians have expertise in both because of overlapping content. Establishing specific competencies for these subspecialties identifies educational goals for trainees and guides practitioners through their lifelong learning. To define specific competencies for graduates of fellowships in Pulmonary Medicine and Internal Medicine-based Critical Care. A Task Force composed of representatives from key stakeholder societies convened to identify and define specific competencies for both disciplines. Beginning with a detailed list of existing competencies from diverse sources, the Task Force categorized each item into one of six core competency headings. Each individual item was reviewed by committee members individually, in group meetings, and conference calls. Nominal group methods were used for most items to retain the views and opinions of the minority perspective. Controversial items underwent additional whole group discussions with iterative modified-Delphi techniques. Consensus was ultimately determined by a simple majority vote. The Task Force identified and defined 327 specific competencies for Internal Medicine-based Critical Care and 276 for Pulmonary Medicine, each with a designation as either: (1) relevant, but competency is not essential or (2) competency essential to the specialty. Specific competencies in Pulmonary and Critical Care Medicine can be identified and defined using a multisociety collaborative approach. These recommendations serve as a starting point and set the stage for future modification to facilitate maximum quality of care as the specialties evolve.

Shared decision-making in pediatric otolaryngology: Parent, physician and observational perspectives.

PubMed

Hong, Paul; Maguire, Erin; Gorodzinsky, Ayala Y; Curran, Janet A; Ritchie, Krista; Chorney, Jill

2016-08-01

To describe physician and parent behavior during pediatric otolaryngology surgical consultations, and to assess whether perceptions of shared decision-making and observed behavior are related. Parents of 126 children less than 6-years of age who underwent consultation for adeontonsillectomy or tympanostomy tube insertion were prospectively enrolled. Parents completed the Shared Decision-Making Questionnaire-Patient version (SDM-Q-9), while surgeons completed the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) after the consultation. Visits were video-recorded and analyzed using the Roter Interaction Analysis System to quantify physician and parent involvement during the consultation. Perceptions of shared decision-making between parents (SDM-Q-9) and physicians (SDM-Q-Doc) were significantly positively correlated (p = 0.03). However, there was no correlation between parents' perceptions of shared decision-making and observations of physician and parent behavior/involvement (proportion of physician socioemotional talk, task-focused talk, or proportion of parent talk). Surgeons' perceptions of shared decision-making were correlated with physician task-focused talk and proportion of parent talk. Parents and physicians had similar perceptions of the degree of shared decision-making to be taking place during pediatric otolaryngology consultations. However, there was variability in the degree to which parents participated, and parent perceptions of shared decision-making were not correlated with actual observed involvement. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Old-fashioned responses in an updating memory task.

PubMed

Ruiz, M; Elosúa, M R; Lechuga, M T

2005-07-01

Errors in a running memory task are analysed. Participants were presented with a variable-length list of items and were asked to report the last four items. It has been proposed (Morris & Jones, 1990) that this task requires two mechanisms: the temporal storage of the target set by the articulatory loop and its updating by the central executive. Two implicit assumptions in this proposal are (a) the preservation of serial order, and (b) participants' capacity to discard earlier items from the target subset as list presentation is running, and new items are appended. Order preservation within the updated target list and the inhibition of the outdated list items should imply a relatively higher rate of location errors for items from the medial positions of the target list and a lower rate of intrusion errors from the outdated and inhibited items from the pretarget positions. Contrary to these expectations, for both consonants (Experiment 1) and words (Experiment 2) we found recency effects and a relatively high rate of intrusions from the final pretarget positions, most of them from the very last. Similar effects were apparent with the embedded four-item lists for catch trials. These results are clearly at odds with the presumed updating by the central executive.

Emulation of Physician Tasks in Eye-Tracked Virtual Reality for Remote Diagnosis of Neurodegenerative Disease.

PubMed

Orlosky, Jason; Itoh, Yuta; Ranchet, Maud; Kiyokawa, Kiyoshi; Morgan, John; Devos, Hannes

2017-04-01

For neurodegenerative conditions like Parkinson's disease, early and accurate diagnosis is still a difficult task. Evaluations can be time consuming, patients must often travel to metropolitan areas or different cities to see experts, and misdiagnosis can result in improper treatment. To date, only a handful of assistive or remote methods exist to help physicians evaluate patients with suspected neurological disease in a convenient and consistent way. In this paper, we present a low-cost VR interface designed to support evaluation and diagnosis of neurodegenerative disease and test its use in a clinical setting. Using a commercially available VR display with an infrared camera integrated into the lens, we have constructed a 3D virtual environment designed to emulate common tasks used to evaluate patients, such as fixating on a point, conducting smooth pursuit of an object, or executing saccades. These virtual tasks are designed to elicit eye movements commonly associated with neurodegenerative disease, such as abnormal saccades, square wave jerks, and ocular tremor. Next, we conducted experiments with 9 patients with a diagnosis of Parkinson's disease and 7 healthy controls to test the system's potential to emulate tasks for clinical diagnosis. We then applied eye tracking algorithms and image enhancement to the eye recordings taken during the experiment and conducted a short follow-up study with two physicians for evaluation. Results showed that our VR interface was able to elicit five common types of movements usable for evaluation, physicians were able to confirm three out of four abnormalities, and visualizations were rated as potentially useful for diagnosis.

Bhagavad Gita for the Physician.

PubMed

Kalra, Sanjay; Joshi, Ameya; Kalra, Bharti; Shanbhag, Vivekanand G; Bhattacharya, Rajib; Verma, Komal; Baruah, Manash P; Sahay, Rakesh; Bajaj, Sarita; Agrawal, Navneet; Chakraborty, Ashim; Balhara, Yatan Pal Singh; Chaudhary, Sandeep; Khandelwal, Deepak; Aggarwal, Sameer; Ram, Nanik; Jacob, Jubbin; Julka, Sandeep; Priya, Gagan; Bhattacharya, Shelley; Dalal, Komal

2017-01-01

This communication presents verses from the Bhagavad Gita which help define a good clinician's skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership) and supported by thoughts written in the Gita.

Defining the eHealth Information Niche in the Family Physician/Patient Examination and Knowledge Transfer Process

ERIC Educational Resources Information Center

Ellington, Virginia Beth Elder

2012-01-01

This research study was undertaken to gain a richer understanding of the use of patient-introduced online health information during the physician/patient examination and knowledge transfer process. Utilizing qualitative data obtained from ten family physician interviews and workflow modeling using activity diagrams and task structure charts, this…

Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 1. Radiation QPCB Task Sort for Radiation.

ERIC Educational Resources Information Center

Technomics, Inc., McLean, VA.

This publication is Attachment 1 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties in radiation. (BT)

Family physicians' interests in special features of electronic publication

PubMed Central

Torre, Dario M.; Wright, Scott M.; Wilson, Renee F.; Diener-West, Marie; Bass, Eric B.

2003-01-01

Objective: Because many of the medical journals read by family physicians now have an electronic version, the authors conducted a survey to determine the interest of family physicians in specific features of electronic journal publications. Setting and Participants: We surveyed 175 family physicians randomly selected from the American Academy of Family Physicians. Results: The response rate was 63%. About half of family physicians reported good to excellent computer proficiency, and about one quarter used online journals sometimes or often. Many respondents reported high interest in having links to: an electronic medical text (48% for original articles, 56% for review articles), articles' list of references (52% for original articles, 56% for review articles), and health-related Websites (48% for original and review articles). Conclusion: Primary care–oriented journals should consider the interests of family physicians when developing and offering electronic features for their readers. PMID:12883561

The Use of Electronic Medical Records

PubMed Central

Makoul, Gregory; Curry, Raymond H.; Tang, Paul C.

2001-01-01

Objective: To assess physician–patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. Design: An exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews. Setting: General internal medicine practice at an academic medical center. Participants: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician). Main Outcome Measures: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart. Results: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians. Summary: An EMR system may enhance the ability of physicians to complete informationintensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified. PMID:11687567

The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study.

PubMed

Zhou, Yuan; Ancker, Jessica S; Upadhye, Mandar; McGeorge, Nicolette M; Guarrera, Theresa K; Hegde, Sudeep; Crane, Peter W; Fairbanks, Rollin J; Bisantz, Ann M; Kaushal, Rainu; Lin, Li

2013-01-01

The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.

Computer multitasking with Desqview 386 in a family practice.

PubMed Central

Davis, A E

1990-01-01

Computers are now widely used in medical practice for accounting and secretarial tasks. However, it has been much more difficult to use computers in more physician-related activities of daily practice. I investigated the Desqview multitasking system on a 386 computer as a solution to this problem. Physician-directed tasks of management of patient charts, retrieval of reference information, word processing, appointment scheduling and office organization were each managed by separate programs. Desqview allowed instantaneous switching back and forth between the various programs. I compared the time and cost savings and the need for physician input between Desqview 386, a 386 computer alone and an older, XT computer. Desqview significantly simplified the use of computer programs for medical information management and minimized the necessity for physician intervention. The time saved was 15 minutes per day; the costs saved were estimated to be $5000 annually. PMID:2383848

[Breaking bad news in oncology: the Belgian experience].

PubMed

Delevallez, F; Lienard, A; Gibon, A-S; Razavi, D

2014-10-01

Breaking bad news is a complex and frequent clinical task for physicians working in oncology. It can have a negative impact on patients and their relatives who are often present during breaking bad news consultations. Many factors influence how the delivery of bad news will be experienced especially the communication skills used by physicians. A three-phase process (post-delivery phase, delivery phase, pre-delivery phase) has been developed to help physician to handle this task more effectively. Communication skills and specific breaking bad news training programs are both necessary and effective. A recent study conducted in Belgium has shown their impact on the time allocated to each of the three phases of this process, on the communication skills used, on the inclusion of the relative in the consultation and on physicians' physiological arousal. These results underscore the importance of promoting intensive communication skills and breaking bad news training programs for health care professionals.

Measuring the success of electronic medical record implementation using electronic and survey data.

PubMed Central

Keshavjee, K.; Troyan, S.; Holbrook, A. M.; VanderMolen, D.

2001-01-01

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically. PMID:11825201

Academic physicians' assessment of the effects of computers on health care.

PubMed Central

Detmer, W. M.; Friedman, C. P.

1994-01-01

We assessed the attitudes of academic physicians towards computers in health care at two academic medical centers that are in the early stages of clinical information-system deployment. We distributed a 4-page questionnaire to 470 subjects, and a total of 272 physicians (58%) responded. Our results show that respondents use computers frequently, primarily to perform academic-oriented tasks as opposed to clinical tasks. Overall, respondents viewed computers as being slightly beneficial to health care. They perceive self-education and access to up-to-date information as the most beneficial aspects of computers and are most concerned about privacy issues and the effect of computers on the doctor-patient relationship. Physicians with prior computer training and greater knowledge of informatics concepts had more favorable attitudes towards computers in health care. We suggest that negative attitudes towards computers can be addressed by careful system design as well as targeted educational activities. PMID:7949990

[Expertise level of occupational health physician, implementation of occupational safety and health management system (OSHMS) and occupational safety and health activity level in Japan in the companies listed on Tokyo Stock Exchange first section].

PubMed

Ikeda, Yukiko; Kameda, Takashi; Shirakawa, Chie; Nagata, Tomohisa; Zama, Satoko; Kayashima, Koutarou; Kobayashi, Yuuichi; Mori, Koji

2007-12-01

By enforcement of the revised Japanese Industrial Safety and Health Law on April, 2006, the implementation of OSHMS seems to be expanding and encouraged. In OSHMS of Japan, however, the occupational health aspects have not been put into operated, while only occupational safety aspects have been prioritized. To clarify the issues to deploy OSHMS with occupational health aspects, we conducted a mail survey of 1,581 companies listed on the Tokyo Stock Market First Section in December, 2004. The effective responses were 267 (16.9%). The number of companies which had installed OSHMS, those that planned to install OSHMS and those had no plan for OSHMS were 62 (23.2%), 82 (30.7%) and 123 (46.1%), respectively. Only 12 companies include the complete OH activities in the installed OSHMS. A significant relationship was observed among expertise of OH physicians, actual role and responsibility of OH physicians, installation of OSHMS and OH services quality level. To deploy OSHMS well-balanced for health and safety aspects in present Japan, it was suggested that the education regarding OH operation in OSHMS was necessary to the person in charge of OSHMS in each company, and the participation by OH physicians to operate OSHMS, especially OH physicians with expertise, was essential.

Information Operations

DTIC Science & Technology

2006-02-13

restricted frequency list (JRFL). This list specifies protected, guarded, and taboo frequencies that should not normally be disrupted without prior... frequency list JROC Joint Requirement Oversight Council JSC Joint Spectrum Center JTCB joint targeting coordination board JTF joint task force JWAC joint

The VA Computerized Patient Record — A First Look

PubMed Central

Anderson, Curtis L.; Meldrum, Kevin C.

1994-01-01

In support of its in-house DHCP Physician Order Entry/Results Reporting application, the VA is developing the first edition of a Computerized Patient Record. The system will feature a physician-oriented interface with real time, expert system-based order checking, a controlled vocabulary, a longitudinal repository of patient data, HL7 messaging support, a clinical reminder and warning system, and full integration with existing VA applications including lab, pharmacy, A/D/T, radiology, dietetics, surgery, vitals, allergy tracking, discharge summary, problem list, progress notes, consults, and online physician order entry. PMID:7949886

The word-frequency paradox for recall/recognition occurs for pictures.

PubMed

Karlsen, Paul Johan; Snodgrass, Joan Gay

2004-08-01

A yes-no recognition task and two recall tasks were conducted using pictures of high and low familiarity ratings. Picture familiarity had analogous effects to word frequency, and replicated the word-frequency paradox in recall and recognition. Low-familiarity pictures were more recognizable than high-familiarity pictures, pure lists of high-familiarity pictures were more recallable than pure lists of low-familiarity pictures, and there was no effect of familiarity for mixed lists. These results are consistent with the predictions of the Search of Associative Memory (SAM) model.

Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy].

PubMed

Suzan-Monti, M; Blanche, J; Boyer, S; Kouanfack, C; Delaporte, E; Bonono, R-C; Carrieri, P M; Protopopescu, C; Laurent, C; Spire, B

2015-05-01

The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon. Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation for task-shifting. © 2015 British HIV Association.

Delivery of Operative Pediatric Surgical Care by Physicians and Non-Physician Clinicians in Malawi

PubMed Central

Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

2014-01-01

Background Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. Methods We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. Results A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Discussion Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. PMID:24560846

Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries.

PubMed

Barr, Ronald; Robertson, Jane

2016-02-01

The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries. Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined. Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0-18) in low income countries (n = 26) and 14 in lower-middle (n = 42), upper-middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0-8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000). There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries. © 2015 Wiley Periodicals, Inc.

Automotive Mechanics Articulation. A List of Tasks for Industrial Arts, Trades & Industry and Community College Instruction.

ERIC Educational Resources Information Center

Arizona State Univ., Tempe. Div. of Industrial Design and Technology.

A list of twenty-six major categories of tasks to be accomplished by automotive mechanics students at the secondary level in industrial arts and/or trades and industry programs and at the postsecondary level in community college programs is provided. The twenty-six categories are as follow: accessories--air conditioning, accessories--heaters,…

Fundamentals of Dental Assisting and Expanded Functions. Curriculum Guide. Volumes 1-2. [Revised.] Invest in Success.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

Under the Idaho state system for curriculum development in vocational education, Technical Committees made up solely of industry personnel are responsible for drawing up task lists for each program. Accordingly, a task list for dental assistants was drawn up and used as a basis for revising the curriculum guide for fundamentals of dental assisting…

Training Providers of Services to Persons with Developmental Disabilities. Level I. Technical Committee Report and Curriculum Guide. Invest in Success.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

Under the Idaho state system for curriculum development in vocational education, Technical Committees made up solely of industry personnel are responsible for drawing up task lists for each program. A Technical Committee Report is prepared on completion of the committees assignment. This Technical Committee Report presents a task list that…

Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 9. Laboratory QPCB Task Sort for Medical Laboratory Technology.

ERIC Educational Resources Information Center

Technomics, Inc., McLean, VA.

This publication is Attachment 9 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties in medical laboratory technology. (BT)

The Developmental Influence of Primary Memory Capacity on Working Memory and Academic Achievement

PubMed Central

2015-01-01

In this study, we investigate the development of primary memory capacity among children. Children between the ages of 5 and 8 completed 3 novel tasks (split span, interleaved lists, and a modified free-recall task) that measured primary memory by estimating the number of items in the focus of attention that could be spontaneously recalled in serial order. These tasks were calibrated against traditional measures of simple and complex span. Clear age-related changes in these primary memory estimates were observed. There were marked individual differences in primary memory capacity, but each novel measure was predictive of simple span performance. Among older children, each measure shared variance with reading and mathematics performance, whereas for younger children, the interleaved lists task was the strongest single predictor of academic ability. We argue that these novel tasks have considerable potential for the measurement of primary memory capacity and provide new, complementary ways of measuring the transient memory processes that predict academic performance. The interleaved lists task also shared features with interference control tasks, and our findings suggest that young children have a particular difficulty in resisting distraction and that variance in the ability to resist distraction is also shared with measures of educational attainment. PMID:26075630

The developmental influence of primary memory capacity on working memory and academic achievement.

PubMed

Hall, Debbora; Jarrold, Christopher; Towse, John N; Zarandi, Amy L

2015-08-01

In this study, we investigate the development of primary memory capacity among children. Children between the ages of 5 and 8 completed 3 novel tasks (split span, interleaved lists, and a modified free-recall task) that measured primary memory by estimating the number of items in the focus of attention that could be spontaneously recalled in serial order. These tasks were calibrated against traditional measures of simple and complex span. Clear age-related changes in these primary memory estimates were observed. There were marked individual differences in primary memory capacity, but each novel measure was predictive of simple span performance. Among older children, each measure shared variance with reading and mathematics performance, whereas for younger children, the interleaved lists task was the strongest single predictor of academic ability. We argue that these novel tasks have considerable potential for the measurement of primary memory capacity and provide new, complementary ways of measuring the transient memory processes that predict academic performance. The interleaved lists task also shared features with interference control tasks, and our findings suggest that young children have a particular difficulty in resisting distraction and that variance in the ability to resist distraction is also shared with measures of educational attainment. (c) 2015 APA, all rights reserved).

Junior physician skill and behaviour in resuscitation: a simulation study.

PubMed

Høyer, Christian Bjerre; Christensen, Erika F; Eika, Berit

2009-02-01

Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education. An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age < or =5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians. 72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210 s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively). Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership.

An Improved Measure of Cognitive Salience in Free Listing Tasks: A Marshallese Example

ERIC Educational Resources Information Center

Robbins, Michael C.; Nolan, Justin M.; Chen, Diana

2017-01-01

A new free-list measure of cognitive salience, B', is presented, which includes both list position and list frequency. It surpasses other extant measures by being normed to vary between a maximum of 1 and a minimum of 0, thereby making it useful for comparisons irrespective of list length or number of respondents. An illustration of its…

Integrating dietary supplements into cancer care.

PubMed

Frenkel, Moshe; Abrams, Donald I; Ladas, Elena J; Deng, Gary; Hardy, Mary; Capodice, Jillian L; Winegardner, Mary F; Gubili, J K; Yeung, K Simon; Kussmann, Heidi; Block, Keith I

2013-09-01

Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient's perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today's informed patients truly value physicians who appreciate them as equal participants in making their own health care choices. To reach a mutually informed decision about the use of these supplements, the Clinical Practice Committee of The Society of Integrative Oncology undertook the challenge of providing basic information to physicians who wish to discuss these issues with their patients. A list of leading supplements that have the best suggestions of benefit was constructed by leading researchers and clinicians who have experience in using these supplements. This list includes curcumin, glutamine, vitamin D, Maitake mushrooms, fish oil, green tea, milk thistle, Astragalus, melatonin, and probiotics. The list includes basic information on each supplement, such as evidence on effectiveness and clinical trials, adverse effects, and interactions with medications. The information was constructed to provide an up-to-date base of knowledge, so that physicians and other health care providers would be aware of the supplements and be able to discuss realistic expectations and potential benefits and risks.

Longitudinal effects of bilingualism on dual-tasking

PubMed Central

Josefsson, Maria; Marsh, John E.; Hansson, Patrik; Ljungberg, Jessica K.

2017-01-01

An ongoing debate surrounds whether bilinguals outperform monolinguals in tests of executive processing. The aim of this study was to investigate if there are long-term (10 year) bilingual advantages in executive processing, as indexed by dual-task performance, in a sample that were 40–65 years at baseline. The bilingual (n = 24) and monolingual (n = 24) participants were matched on age, sex, education, fluid intelligence, and study sample. Participants performed free-recall for a 12-item list in three dual-task settings wherein they sorted cards either during encoding, retrieval, or during both encoding and retrieval of the word-list. Free recall without card sorting was used as a reference to compute dual-task costs. The results showed that bilinguals significantly outperformed monolinguals when they performed card-sorting during both encoding and retrieval of the word-list, the condition that presumably placed the highest demands on executive functioning. However, dual-task costs increased over time for bilinguals relative to monolinguals, a finding that is possibly influenced by retirement age and limited use of second language in the bilingual group. PMID:29281654

Microgravity Science and Applications. Program Tasks and Bibliography for FY 1993

NASA Technical Reports Server (NTRS)

1994-01-01

An annual report published by the Microgravity Science and Applications Division (MSAD) of NASA is presented. It represents a compilation of the Division's currently-funded ground, flight and Advanced Technology Development tasks. An overview and progress report for these tasks, including progress reports by principal investigators selected from the academic, industry and government communities, are provided. The document includes a listing of new bibliographic data provided by the principal investigators to reflect the dissemination of research data during FY 1993 via publications and presentations. The document also includes division research metrics and an index of the funded investigators. The document contains three sections and three appendices: Section 1 includes an introduction and metrics data, Section 2 is a compilation of the task reports in an order representative of its ground, flight or ATD status and the science discipline it represents, and Section 3 is the bibliography. The three appendices, in the order of presentation, are: Appendix A - a microgravity science acronym list, Appendix B - a list of guest investigators associated with a biotechnology task, and Appendix C - an index of the currently funded principal investigators.

Novices in surgery are the target group of a virtual reality training laboratory.

PubMed

Hassan, Iyad; Maschuw, Katja; Rothmund, Matthias; Koller, Michael; Gerdes, Berthold

2006-01-01

This study aims to establish which physicians represent the suitable target group of a virtual training laboratory. Novices (48 physicians with fewer than 10 laparoscopic operations) and intermediate trainees (19 physicians who performed 30-50 laparoscopic operations) participated in this study. Each participant performed the basic module 'clip application' at the beginning and after a 1-hour short training course on the LapSim. The course consisted of the tasks coordination, lift and grasp, clip application, cutting with diathermy and fine dissection at increasing difficulty levels. The time taken to complete the tasks, number of errors, and economy of motion parameters (path length and angular path) were analyzed. Following training with the simulator, novices completed the task significantly faster (p = 0.001), demonstrated a greater economy of motion [path length (p = 0.04) and angular path (p = 0.01)]. In contrast, the intermediate trainees showed a reduction of their errors, but without reaching statistical significance. They showed no improvement in economy of motion and completed the task significantly slower (p = 0.03). Novices, in comparison to intermediate trainees, tend to benefit most during their first exposure to a laparoscopy simulator.

The importance of training strategy adaptation: a learner-oriented approach for improving older adults' memory and transfer.

PubMed

Bottiroli, Sara; Cavallini, Elena; Dunlosky, John; Vecchi, Tomaso; Hertzog, Christopher

2013-09-01

We investigated the benefits of strategy-adaptation training for promoting transfer effects. This learner-oriented approach--which directly encourages the learner to generalize strategic behavior to new tasks--helps older adults appraise new tasks and adapt trained strategies to them. In Experiment 1, older adults in a strategy-adaptation training group used 2 strategies (imagery and sentence generation) while practicing 2 tasks (list and associative learning); they were then instructed on how to do a simple task analysis to help them adapt the trained strategies for 2 different unpracticed tasks (place learning and text learning) that were discussed during training. Two additional criterion tasks (name-face associative learning and grocery-list learning) were never mentioned during training. Two other groups were included: A strategy training group (who received strategy training and transfer instructions but not strategy-adaptation training) and a waiting-list control group. Both training procedures enhanced older adults' performance on the trained tasks and those tasks that were discussed during training, but transfer was greatest after strategy-adaptation training. Experiment 2 found that strategy-adaptation training conducted via a manual that older adults used at home also promoted transfer. These findings demonstrate the importance of adopting a learner-oriented approach to promote transfer of strategy training. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery.

PubMed

Lafata, Jennifer Elston; Shay, L Aubree; Brown, Richard; Street, Richard L

2016-04-01

The use of physician office-based tools such as electronic health records (EHRs), health risk appraisal (HRA) instruments, and written patient reminder lists is encouraged to support efficient, high-quality, patient-centered care. We evaluate the association of exam room use of EHRs, HRA instruments, and self-generated written patient reminder lists with patient-physician communication behaviors, recommended preventive health service delivery, and visit length. Observational study of 485 office visits with 64 primary care physicians practicing in a health system serving the Detroit metropolitan area. Study data were obtained from patient surveys, direct observation, office visit audio-recordings, and automated health system records. Outcome measures included visit length in minutes, patient use of active communication behaviors, physician use of supportive talk and partnership-building communication behaviors, and percentage of delivered guideline-recommended preventive health services for which patients are eligible and due. Simultaneous linear regression models were used to evaluate associations between tool use and outcomes. Adjusted models controlled for patient characteristics, physician characteristics, characteristics of the relationship between the patient and physician, and characteristics of the environment in which the visit took place. Prior to adjusting for other factors, visits in which the EHR was used on average were significantly (p < .05) longer (27.6 vs. 23.8 minutes) and contained fewer preventive services for which patients were eligible and due (56.5 percent vs. 62.7 percent) compared to those without EHR use. Patient written reminder lists were also significantly associated with longer visits (30.0 vs. 26.5 minutes), and less use of physician communication behaviors facilitating patient involvement (2.1 vs. 2.6 occurrences), but more use of active patient communication behaviors (4.4 vs. 2.6). Likewise, HRA use was significantly associated with increased preventive services delivery (62.1 percent vs. 57.0 percent). All relationships remained significant (p > .05) in adjusted models with the exception of that between HRA use and preventive service delivery. Office-based tools intended to facilitate the implementation of desired primary care practice redesign are associated with both positive and negative cost and quality outcomes. Findings highlight the need for monitoring both intended and unintended consequences of office-based tools commonly used in primary care practice redesign. © Health Research and Educational Trust.

Comparing cognition by integrating concept learning, proactive interference, and list memory.

PubMed

Wright, Anthony A; Kelly, Debbie M; Katz, Jeffrey S

2018-06-01

This article describes an approach for training a variety of species to learn the abstract concept of same/different, which in turn forms the basis for testing proactive interference and list memory. The stimulus set for concept-learning training was progressively doubled from 8, 16, 32, 64, 128 . . . to 1,024 different pictures with novel-stimulus transfer following learning. All species fully learned the same/different abstract concept: capuchin and rhesus monkeys learned more readily than pigeons; nutcrackers and magpies were at least equivalent to monkeys and transferred somewhat better following initial training sets. A similar task using the 1,024-picture set plus delays was used to test proactive interference on occasional trials. Pigeons revealed greater interference with 10-s than with 1-s delays, whereas delay time had no effect on rhesus monkeys, suggesting that the monkeys' interference was event based. This same single-item same/different task was expanded to a 4-item list memory task to test animal list memory. Humans were tested similarly with lists of kaleidoscope pictures. Delays between the list and test were manipulated, resulting in strong initial recency effects (i.e., strong 4th-item memory) at short delays and changing to a strong primacy effect (i.e., strong 1st-item memory) at long delays (pigeons 0-s to 10-s delays; monkeys 0-s to 30-s delays; humans 0-s to 100-s delays). Results and findings are discussed in terms of these species' cognition and memory comparisons, evolutionary implications, and future directions for testing other species in these synergistically related tasks.

A New Semantic List Learning Task to Probe Functioning of the Papez Circuit

PubMed Central

Schallmo, Michael-Paul; Kassel, Michelle T.; Weisenbach, Sara L.; Walker, Sara J.; Guidotti-Breting, Leslie M.; Rao, Julia A.; Hazlett, Kathleen E.; Considine, Ciaran M.; Sethi, Gurpriya; Vats, Naalti; Pecina, Marta; Welsh, Robert C.; Starkman, Monica N.; Giordani, Bruno; Langenecker, Scott A.

2016-01-01

Introduction List learning tasks are powerful clinical tools for studying memory, yet have been relatively underutilized within the functional imaging literature. This limits understanding of regions such as the Papez circuit which support memory performance in healthy, non-demented adults. Method The current study characterized list learning performance in 40 adults who completed a Semantic List Learning Task (SLLT) with a Brown-Peterson manipulation during functional MRI (fMRI). Cued recall with semantic cues, and recognition memory were assessed after imaging. Internal reliability and convergent and discriminant validity were evaluated. Results Subjects averaged 38% accuracy in recall (62% for recognition), with primacy but no recency effects observed. Validity and reliability were demonstrated by showing that the SLLT was correlated with the California Verbal Learning test (CVLT), but not with executive functioning tests, and high intraclass correlation coefficient across lists for recall (.91). fMRI measurements during Encoding (vs. Silent Rehearsal) revealed significant activation in bilateral hippocampus, parahippocampus, and bilateral anterior and posterior cingulate cortex. Post-hoc analyses showed increased activation in anterior and middle hippocampus, subgenual cingulate, and mammillary bodies specific to Encoding. In addition, increasing age was positively associated with increased activation in a diffuse network, particularly frontal cortex and specific Papez regions for correctly recalled words. Gender differences were specific to left inferior and superior frontal cortex. Conclusions This is a clinically relevant list learning task that can be used in studies of groups for which the Papez circuit is damaged or disrupted, in mixed or crossover studies at imaging and clinical sites. PMID:26313512

Diagnosis and treatment of dementia: 2. Diagnosis

PubMed Central

Feldman, Howard H.; Jacova, Claudia; Robillard, Alain; Garcia, Angeles; Chow, Tiffany; Borrie, Michael; Schipper, Hyman M.; Blair, Mervin; Kertesz, Andrew; Chertkow, Howard

2008-01-01

Background Dementia can now be accurately diagnosed through clinical evaluation, cognitive screening, basic laboratory evaluation and structural imaging. A large number of ancillary techniques are also available to aid in diagnosis, but their role in the armamentarium of family physicians remains controversial. In this article, we provide physicians with practical guidance on the diagnosis of dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. Methods We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that pertained to key diagnostic issues in dementia. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. Results Of the 1591 articles we identified on all aspects of dementia diagnosis, 1095 met our inclusion criteria; 620 were deemed to be of good or fair quality. From a synthesis of the evidence in these studies, we made 32 recommendations related to the diagnosis of dementia. There are clinical criteria for diagnosing most forms of dementia. A standard diagnostic evaluation can be performd by family physicians over multiple visits. It involves a clinical history (from patient and caregiver), a physical examination and brief cognitive testing. A list of core laboratory tests is recommended. Structural imaging with computed tomography or magnetic resonance imaging is recommended in selected cases to rule out treatable causes of dementia or to rule in cerebrovascular disease. There is insufficient evidence to recommend routine functional imaging, measurement of biomarkers or neuropsychologic testing. Interpretation The diagnosis of dementia remains clinically integrative based on history, physical examination and brief cognitive testing. A number of core laboratory tests are also recommended. Structural neuroimaging is advised in selected cases. Other diagnostic approaches, including functional neuroimaging, neuropsychological testing and measurement of biomarkers, have shown promise but are not yet recommended for routine use by family physicians. PMID:18362376

Proactive interference in a semantic short-term memory deficit: role of semantic and phonological relatedness.

PubMed

Hamilton, A Cris; Martin, Randi C

2007-01-01

Previous research has indicated that patients with semantic short-term memory (STM) deficits demonstrate unusual intrusions of previously presented material during serial recall tasks (Martin and Lesch, 1996). These intrusions suggest excessive proactive interference (PI) from previous lists. Here, we explore one such patient's susceptibility to PI. Experiment 1 demonstrated patient M.L.'s extreme susceptibility to PI using a probe recognition task that manipulates the recency of negative probes (the recent negatives task). When stimuli consisted of letters, M.L. showed greatly exaggerated effects of PI, well outside of the range of healthy control participants. Experiment 2 used a variation of the recent negatives task to examine the relative contribution of semantic and phonological relatedness in PI. This task manipulated semantic and phonological relatedness of probes and recently presented list items. Relative to healthy control participants, patient M.L. showed exaggerated interference effects for both phonological and semantically related probes, both for probes related to the current list and for probes related to the previous list. These data have important implications for theories of semantic STM deficits. Specifically, these data suggest that it is not the rapid decay of semantic representations that is responsible for difficulties in short-term recall, but rather the abnormal persistence of previously presented material. We propose that this susceptibility to PI is the result of a deficit in control processes acting on STM.

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.

Can We Do That Here? Establishing the Scope of Surgical Practice at a New Safety-Net Community Hospital Through a Transparent, Collaborative Review of Physician Privileges.

PubMed

O'Neill, Sean M; Seresinghe, Sarah; Sharma, Arun; Russell, Tara A; Crawford, L'Orangerie; Frencher, Stanley K

2018-01-01

Stewarding of physician privileges wisely is imperative, but no guidelines exist for how to incorporate system-level factors in privileging decisions. A newly opened, safety-net community hospital tailored the scope of surgical practice through review of physician privileges. Martin Luther King, Jr. Community Hospital is a public-private partnership, safety-net institution in South Los Angeles that opened in July 2015. It has 131 beds, including a 28-bed emergency department, a 20-bed ICU, and 5 operating rooms. Staff privileging decisions were initially based only on physicians' training and experience, but this resulted in several cases that tested the boundaries of what a small community hospital was prepared to handle. A collaborative, transparent process to review physician privileges was developed. This began with physician-only review of procedure lists, followed by a larger, multidisciplinary group to assess system-level factors. Specific questions were used to guide discussion, and unanimous approval from all stakeholders was required to include a procedure. An initial list of 558 procedures across 11 specialties was reduced to 321 (57.5%). No new cases that fall outside these new boundaries have arisen. An inclusive process was crucial for obtaining buy-in and establishing cultural norms. Arranging transfer agreements remains a significant challenge. Accumulation of institutional experience continues through regular performance reviews. As this hospital's capabilities mature, a blueprint has been established for expanding surgical scope of practice based explicitly on system-level factors. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Surveys on minimum practical abilities required by nonspecialist occupational physicians in Japan

PubMed Central

Nagata, Masako; Mori, Koji; Ishikawa, Asako; Nagata, Tomohisa

2016-01-01

Objectives: This study aimed to identify the practical abilities required by nonspecialist occupational physicians and specify the priorities for training programs. Methods: A practical abilities list was developed through a focus group meeting of specialists. We created a survey questionnaire and asked three groups, namely, occupational physicians, occupational health nurses, and health officers, to rate the importance of each practical ability. Results: The mean scores for all 45 items were greater than 4, i.e., in the middle of the 7-point Likert scale, for all the three groups. The occupational physicians' responses had a correlation with the other groups' responses. However, there were differences with regard to some practical abilities between the three groups. Five practical abilities from the top quartile were marked "A" by all the three groups: "Submit opinions on fitness for duty and work accommodation on the basis of data from health examination," "Respect employee privacy," "Submit opinion on fitness for duty and work accommodation on the basis of data from face-to-face interviews with employees," "Submit opinions on fitness for duty and work accommodation on the basis of data from health surveillance," and "Implement face-to-face interviews for employees who have worked overtime and evaluate the subjects' conditions including mental and physical health status, degree of accumulated fatigue, and depression." Conclusions: This study resulted in a rank-ordered list of 45 practical abilities that are required by nonspecialist occupational physicians. This result may be useful to review and redesign the existing training program for nonspecialist occupational physicians. PMID:27108644

10 CFR 712.36 - Medical assessment process.

Code of Federal Regulations, 2010 CFR

2010-01-01

... assigned duties. (b) Employers must provide a job task analysis for those individuals involved in HRP... performed if a job task analysis has not been provided. (c) The medical process by the Designated Physician...

Cosmetology: Task Analyses. Competency-Based Education.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum Center.

These task analyses are designed to be used in combination with the "Trade and Industrial Education Service Area Resource" in order to implement competency-based education in the cosmetology program in Virginia. The task analysis document contains the task inventory, suggested task sequence lists, and content outlines for the secondary…

Commercial Photography: Task Analyses. Competency-Based Education.

ERIC Educational Resources Information Center

Endo, Paula; Morrell, Linda

These task analyses are designed to be used in combination with the "Trade and Industrial Education Service Area Resource" in order to implement competency-based education in the commercial photography program in Virginia. The task analysis document contains the task inventory, suggested task sequence lists, and content outlines for the…

Nurse's Assistant: Task Analyses. Competency-Based Education.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum Center.

These task analyses are designed to be used in combination with the "Health Occupations Education Service Area Resource" in order to implement competency-based education in the nurse's assistant program in Virginia. The task analysis document contains the task inventory, suggested task sequence lists, and content outlines for Nursing…

Masonry: Task Analyses. Competency-Based Education.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum Center.

These task analyses are designed to be used in combination with the "Trade and Industrial Education Service Area Resource" in order to implement competency-based education in the masonry program in Virginia. The task analysis document contains the task inventory, suggested task sequence lists, and content outlines for the secondary…

Intact and impaired conceptual memory processes in amnesia.

PubMed

Keane, M M; Gabrieli, J D; Monti, L A; Fleischman, D A; Cantor, J M; Noland, J S

1997-01-01

To examine the status of conceptual memory processes in amnesia, a conceptual memory task with implicit or explicit task instructions was given to amnesic and control groups. After studying a list of category exemplars, participants saw category labels and were asked to generate as many exemplars as possible (an implicit memory task) or to generate exemplars that had been in the prior study list (an explicit memory task). After incidental deep or shallow encoding of exemplars, amnesic patients showed normal implicit memory performance (priming), a normal levels-of-processing effect on priming, and impaired explicit memory performance. After intentional encoding of exemplars, amnesic patients showed impaired implicit and explicit memory performance. Results suggest that although amnesic patients can show impairments on implicit and explicit conceptual memory tasks, their deficit does not generalize to all conceptual memory tasks.

Evaluating the contributions of task expectancy in the testing and guessing benefits on recognition memory.

PubMed

Huff, Mark J; Yates, Tyler J; Balota, David A

2018-05-03

Recently, we have shown that two types of initial testing (recall of a list or guessing of critical items repeated over 12 study/test cycles) improved final recognition of related and unrelated word lists relative to restudy. These benefits were eliminated, however, when test instructions were manipulated within subjects and presented after study of each list, procedures designed to minimise expectancy of a specific type of upcoming test [Huff, Balota, & Hutchison, 2016. The costs and benefits of testing and guessing on recognition memory. Journal of Experimental Psychology: Learning, Memory, and Cognition, 42, 1559-1572. doi: 10.1037/xlm0000269 ], suggesting that testing and guessing effects may be influenced by encoding strategies specific for the type of upcoming task. We follow-up these experiments by examining test-expectancy processes in guessing and testing. Testing and guessing benefits over restudy were not found when test instructions were presented either after (Experiment 1) or before (Experiment 2) a single study/task cycle was completed, nor were benefits found when instructions were presented before study/task cycles and the task was repeated three times (Experiment 3). Testing and guessing benefits emerged only when instructions were presented before a study/task cycle and the task was repeated six times (Experiments 4A and 4B). These experiments demonstrate that initial testing and guessing can produce memory benefits in recognition, but only following substantial task repetitions which likely promote task-expectancy processes.

An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence–Powered Medication Reconciliation Tool

PubMed Central

Yuan, Michael Juntao; Poonawala, Robina

2016-01-01

Background Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. Objective The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. Methods In this study, we developed iPad-based software tools, with AI decision support, to engage patients to “self-service” medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool’s user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool’s usability afterward. Results All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. Conclusions We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians. PMID:27185210

Examining the Relationship between Free Recall and Immediate Serial Recall: The Effects of List Length and Output Order

ERIC Educational Resources Information Center

Ward, Geoff; Tan, Lydia; Grenfell-Essam, Rachel

2010-01-01

In 4 experiments, participants were presented with lists of between 1 and 15 words for tests of immediate memory. For all tasks, participants tended to initiate recall with the first word on the list for short lists. As the list length was increased, so there was a decreased tendency to start with the first list item; and, when free to do so,…

Educational and Behavioral Interventions in Management of Autism Spectrum Disorder.

PubMed

Sengupta, Koyeli; Lobo, Leera; Krishnamurthy, Vibha

2017-01-01

The increasing prevalence of autism spectrum disorder (ASD) makes early recognition, evaluation and management an important task for pediatricians, physicians and other professionals caring for children. Educational interventions form the mainstay of management for children with autism spectrum disorder. Such interventions focus on improving social interaction, communication and challenging behaviors, thereby promoting learning and independence in children. This article provides an overview of educational and behavioral interventions in autism spectrum disorder, with special reference to challenges and feasible solutions in the Indian context. Articles were retrieved from various databases including Google Scholar, Medscape, Cochrane, PubMed using the search terms 'autism spectrum disorder OR autism AND educational interventions'; 'autism spectrum disorder OR autism, educational interventions AND India' and 'autism spectrum disorder OR autism AND India'. Reference lists from retrieved articles as well as websites of organizations working in this space in India were also searched. Extracted manuscripts were analysed for content related to various aspects of educational and behavioral interventions in autism spectrum disorder. Intervention models for autism spectrum disorder are based on various theoretical orientations and target specific deficits associated with the disorder. In addition, evidence-based principles for effective intervention are highlighted. In developing countries like India, access to interventions is a challenge and resources are limited. In such settings, the pediatrician's or physician's role is vital in supporting families choose programs that are evidence-based, target individual needs and result in improved outcomes.

Depression in Visual Impairment Trial (DEPVIT): A Randomized Clinical Trial of Depression Treatments in People With Low Vision.

PubMed

Nollett, Claire L; Bray, Nathan; Bunce, Catey; Casten, Robin J; Edwards, Rhiannon T; Hegel, Mark T; Janikoun, Sarah; Jumbe, Sandra E; Ryan, Barbara; Shearn, Julia; Smith, Daniel J; Stanford, Miles; Xing, Wen; Margrain, Tom H

2016-08-01

The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms. This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory. At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London. Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.

Cognitive imitation in 2-year-old children (Homo sapiens): a comparison with rhesus monkeys (Macaca mulatta).

PubMed

Subiaul, Francys; Romansky, Kathryn; Cantlon, Jessica F; Klein, Tovah; Terrace, Herbert

2007-10-01

Here we compare the performance of 2-year-old human children with that of adult rhesus macaques on a cognitive imitation task. The task was to respond, in a particular order, to arbitrary sets of photographs that were presented simultaneously on a touch sensitive video monitor. Because the spatial position of list items was varied from trial to trial, subjects could not learn this task as a series of specific motor responses. On some lists, subjects with no knowledge of the ordinal position of the items were given the opportunity to learn the order of those items by observing an expert model. Children, like monkeys, learned new lists more rapidly in a social condition where they had the opportunity to observe an experienced model perform the list in question, than under a baseline condition in which they had to learn new lists entirely by trial and error. No differences were observed between the accuracy of each species' responses to individual items or in the frequencies with which they made different types of errors. These results provide clear evidence that monkeys and humans share the ability to imitate novel cognitive rules (cognitive imitation).

Associations between non-discrimination and training policies and physicians' attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals.

PubMed

Jabson, Jennifer M; Mitchell, Jason W; Doty, S Benjamin

2016-03-12

Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians' knowledge, attitudes, and gender and sexual minority affirmative practices. A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians' attitudes and knowledge about SGM patients. Policies that mandate non-discrimination and training as they currently exist may not improve physicians' attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians' SGM affirmative practices.

Formative evaluation of a patient-specific clinical knowledge summarization tool.

PubMed

Del Fiol, Guilherme; Mostafa, Javed; Pu, Dongqiuye; Medlin, Richard; Slager, Stacey; Jonnalagadda, Siddhartha R; Weir, Charlene R

2016-02-01

To iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians' perceived decision quality compared with standard search of UpToDate and PubMed. Mixed-methods observations of the interactions of 10 physicians with the CKS prototype vs. standard search in an effort to solve clinical problems posed as case vignettes. The CKS tool automatically summarizes patient-specific and actionable clinical recommendations from PubMed (high quality randomized controlled trials and systematic reviews) and UpToDate. Two thirds of the study participants completed 15 out of 17 usability tasks. The median time to task completion was less than 10s for 12 of the 17 tasks. The difference in search time between the CKS and standard search was not significant (median=4.9 vs. 4.5m in). Physician's perceived decision quality was significantly higher with the CKS than with manual search (mean=16.6 vs. 14.4; p=0.036). The CKS prototype was well-accepted by physicians both in terms of usability and usefulness. Physicians perceived better decision quality with the CKS prototype compared to standard search of PubMed and UpToDate within a similar search time. Due to the formative nature of this study and a small sample size, conclusions regarding efficiency and efficacy are exploratory. Published by Elsevier Ireland Ltd.

Is that your pager or mine: a survey of women academic family physicians in dual physician families.

PubMed

Schrager, Sarina; Kolan, Anne; Dottl, Susan L

2007-08-01

This study explored the unique challenges and strategies of women in academic family medicine who are in dual physician families. An e-mail survey was sent to all female physician members of the Society of Teachers of Family Medicine (STFM) who were listed in the on-line database. The survey collected demographic information, details of job descriptions and family life, and included 3 open-ended questions about the experiences of dual physician families. Over 1200 surveys were sent to women physicians in academic family medicine. One hundred fifty-nine surveys were returned. Half of all women worked full time compared to 87% of their partners. Most women reported benefits of having a physician partner including support and having an understanding person at home, though scheduling conflicts and childcare responsibilities contributed to the need for job compromises. Women prioritized finding work-life balance and having supportive partners and mentors as most important to their success as academic family physicians. Dual physician relationships involve rewards and conflicts. More research should explore the competing demands of family life with success in academic medicine.

How does running memory span work?

PubMed

Bunting, Michael; Cowan, Nelson; Saults, J Scott

2006-10-01

In running memory span, a list ends unpredictably, and the last few items are to be recalled. This task is of increasing importance in recent research. We argue that there are two very different strategies for performing running span tasks: a low-effort strategy in which items are passively held until the list ends, when retrieval into a capacity-limited store takes place; and a higher-effort strategy in which working memory is continually updated using rehearsal processes during the list presentation. In two experiments, we examine the roles of these two strategies and the consequences of two types of interference.

Understanding Emergency Medicine Physicians Multitasking Behaviors Around Interruptions.

PubMed

Fong, Allan; Ratwani, Raj M

2018-06-11

Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). Understanding physician behaviors before, during, and after interruptions is important to the design and promotion of safe and effective workflow solutions. However, traditional human factors based interruption models do not accurately reflect the complexities of real-world environments like the ED and may not capture multiple interruptions and multitasking. We present a more comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: Interruption Start Transition, Interruption Engagement, and Interruption End Transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. We apply this framework in categorizing 457 interruption episodes. 457 interruption episodes were captured during 36 hours of observation. The interrupted task was immediately suspended 348 (76.1%) times. Participants engaged in new self-initiated tasks during the interrupting task 164 (35.9%) times and did not directly resume the interrupted task in 284 (62.1%) interruption episodes. Using this framework provides a more detailed description of the types of physician behaviors in complex environments. Understanding the different types of interruption and resumption patterns, which may have a different impact on performance, can support the design of interruption mitigation strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Personality Differences in Career Choice Patterns

ERIC Educational Resources Information Center

Borges, Nicole J.; Roth, Karl S.; Seibel, Hugo R.

2004-01-01

Vocational identity is an important construct for physician career development. Physician vocational development has been grouped into three tasks (crystallization, specification, and implementation) pertaining to career choice and specialty choice (1) In defining the construct of vocational identity, it has been suggested that the relation…

The Multi-Feature Hypothesis: Connectionist Guidelines for L2 Task Design

ERIC Educational Resources Information Center

Moonen, Machteld; de Graaff, Rick; Westhoff, Gerard; Brekelmans, Mieke

2014-01-01

This study focuses on the effects of task type on the retention and ease of activation of second language (L2) vocabulary, based on the multi-feature hypothesis (Moonen, De Graaff, & Westhoff, 2006). Two tasks were compared: a writing task and a list-learning task. It was hypothesized that performing the writing task would yield higher…

Using a Delphi process to establish consensus on emergency medicine clerkship competencies.

PubMed

Penciner, Rick; Langhan, Trevor; Lee, Richard; McEwen, Jill; Woods, Robert A; Bandiera, Glen

2011-01-01

Currently, there is no consensus on the core competencies required for emergency medicine (EM) clerkships in Canada. Existing EM curricula have been developed through informal consensus or local efforts. The Delphi process has been used extensively as a means for establishing consensus. The purpose of this project was to define core competencies for EM clerkships in Canada, to validate a Delphi process in the context of national curriculum development, and to demonstrate the adoption of the CanMEDS physician competency paradigm in the undergraduate medical education realm. Using a modified Delphi process, we developed a consensus amongst a panel of expert emergency physicians from across Canada utilizing the CanMEDS 2005 Physician Competency Framework. Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). This study demonstrated that a modified Delphi process can result in a strong consensus around a realistic number of core competencies for EM clerkships. We propose that such a method could be used by other medical specialties and health professions to develop rotation-specific core competencies.

[Effects of the Internet on the dissemination of medical information: some thoughts on applied ethics].

PubMed

Lucas, Jacques

2009-10-01

Learned and professional societies as well as health authorities must attempt to provide free access to their databases for physicians, by a simple repertory of key words and, if necessary, by portals. Although information available for physicians may not be intended to be secret, it often requires some professional training to be interpreted appropriately. The principles of the Code of Medical Ethics, as transcribed in the Public Health Code, apply to all forms and media of information and communication. In public spaces, readers must be guaranteed that information written by physicians corresponds to the state of the art, that it is not advertising or self-promotion or commercial, that it was developed by a process ensuring quality, and that it distinguishes clearly between a popularized description of scientific data and what remains uncertain because research is on-going. The public should be informed about the source of the information they see, the editorial quality of the site, and any potential financial dependence or conflicts of interest. According to the medical association, prudence is recommended for physicians who moderate chat-rooms and discussion lists. List moderation, like any other type of medical activity, must not be improvised; it requires prudence, thought, and training.

Revealing List-Level Control in the Stroop Task by Uncovering Its Benefits and a Cost

ERIC Educational Resources Information Center

Bugg, Julie M.; McDaniel, Mark A.; Scullin, Michael K.; Braver, Todd S.

2011-01-01

Interference is reduced in mostly incongruent relative to mostly congruent lists. Classic accounts of this list-wide proportion congruence effect assume that list-level control processes strategically modulate word reading. Contemporary accounts posit that reliance on the word is modulated poststimulus onset by item-specific information (e.g.,…

Beginning at the beginning: Recall order and the number of words to be recalled.

PubMed

Tan, Lydia; Ward, Geoff; Paulauskaite, Laura; Markou, Maria

2016-08-01

When participants are asked to recall a short list of words in any order that they like, they tend to initiate recall with the first list item and proceed in forward order, even when this is not a task requirement. The current research examined whether this tendency might be influenced by varying the number of items that are to be recalled. In 3 experiments, participants were presented with short lists of between 4 and 6 words and instructed to recall 1, 2, 3, or all of the items from the lists. Data were collected using immediate free recall (IFR, Experiment 1), immediate serial recall (ISR, Experiment 2), and a variant of ISR that we call ISR-free (Experiment 3), in which participants had to recall words in their correct serial positions but were free to output the words in any order. For all 3 tasks, the tendency to begin recall with the first list item occurred only when participants were required to recall as many items from the list as they could. When participants were asked to recall only 1 or 2 items, they tended to initiate recall with end-of-list items. It is argued that these findings show for the first time a manipulation that eliminates the initial tendency to recall in forward order, provide some support for recency-based accounts of IFR and help explain differences between single-response and multiple-response immediate memory tasks. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Business Economics: Task Analyses. Competency-Based Education.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum Center.

This task analyses guide is designed to be used in combination with the "Business Education Service Area Resource" in order to implement competency-based education in the Business Economics course in Virginia. The task analyses guide contains the task inventory, suggested task sequence list, and content outline for the specific course in business…

Job satisfaction among primary care physicians: results of a survey.

PubMed

Behmann, Mareike; Schmiemann, Guido; Lingner, Heidrun; Kühne, Franziska; Hummers-Pradier, Eva; Schneider, Nils

2012-03-01

A shortage of primary care physicians (PCPs) seems likely in Germany in the near future and already exists in some parts of the country. Many currently practicing PCPs will soon reach retirement age, and recruiting young physicians for family practice is difficult. The attractiveness of primary care for young physicians depends on the job satisfaction of currently practicing PCPs. We studied job satisfaction among PCPs in Lower Saxony, a large federal state in Germany. In 2009, we sent a standardized written questionnaire on overall job satisfaction and on particular aspects of medical practice to 3296 randomly chosen PCPs and internists in family practice in Lower Saxony (50% of the entire target population). 1106 physicians (34%) responded; their mean age was 52, and 69% were men. 64% said they were satisfied or very satisfied with their job overall. There were particularly high rates of satisfaction with patient contact (91%) and working atmosphere (87% satisfied or very satisfied). In contrast, there were high rates of dissatisfaction with administrative tasks (75% dissatisfied or not at all satisfied). The results were more indifferent concerning payment and work life balance. Overall, younger PCPs and physicians just entering practice were more satisfied than their older colleagues who had been in practice longer. PCPs are satisfied with their job overall. However, there is significant dissatisfaction with administrative tasks. Improvements in this area may contribute to making primary care more attractive to young physicians.

Job Satisfaction Among Academic Family Physicians.

PubMed

Agana, Denny Fe; Porter, Maribeth; Hatch, Robert; Rubin, Daniel; Carek, Peter

2017-09-01

Family physicians report some of the highest rates of burnout among their physician peers. Over the past few years, this rate has increased and work-life balance has decreased. In academic medicine, many report lack of career satisfaction and have considered leaving academia. Our aim was to explore the factors that contribute to job satisfaction and burnout in faculty members in a family medicine department. Six academic family medicine clinics were invited to participate in this qualitative study. Focus groups were conducted to allow for free-flowing, rich dialogue between the moderator and the physician participants. Transcripts were analyzed in a systematic manner by independent investigators trained in grounded theory. The constant comparison method was used to code and synthesize the qualitative data. Six main themes emerged: time (62%), benefits (9%), resources (8%), undervalue (8%), physician well-being (7%), and practice demand (6%). Within the main theme of time, four subthemes emerged: administrative tasks/emails (61%), teaching (17%), electronic medical records (EMR) requirements (13%), and patient care (9%). Academic family physicians believe that a main contributor to job satisfaction is time. They desire more resources, like staff, to assist with increasing work demands. Overall, they enjoy the academic primary care environment. Future directions would include identifying the specific time restraints that prevent them from completing tasks, the type of staff that would assist with the work demands, and the life stressors the physicians are experiencing.

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.

Physician work intensity among medical specialties: emerging evidence on its magnitude and composition.

PubMed

Horner, Ronnie D; Szaflarski, Jerzy P; Ying, Jun; Meganathan, Karthikeyan; Matthews, Gerald; Schroer, Brian; Weber, Debra; Raphaelson, Marc

2011-11-01

Similarities and differences in physician work intensity among specialties are poorly understood but have implications for quality of care, patient safety, practice organization and management, and payment. To determine the magnitude and important dimensions of physician work intensity for 4 specialties. Cross-sectional assessment of work intensity associated with actual patient care in the examination room or operating room. A convenience sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons, located in Kansas, Kentucky, Maryland, Ohio, and Virginia. Work intensity measures included the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Subjective Work Assessment Technique (SWAT), and Multiple Resource Questionnaire. Stress was measured by the Dundee Stress State Questionnaire. Physicians reported similar magnitude of work intensity on the NASA-TLX and Multiple Resource Questionnaire. On the SWAT, general internists reported work intensity similar to surgeons but significantly lower than family physicians and neurologists (P=0.035). Surgeons reported significantly higher levels of task engagement on the stress measure than the other specialties (P=0.019), significantly higher intensity on physical demand (P < 0.001), and significantly lower intensity on the performance dimensions of the NASA-TLX than the other specialties (P=0.003). Surgeons reported the lowest intensity for temporal demand of all specialties, being significantly lower than either family physicians or neurologists (P=0.014). Family physicians reported the highest intensity on the time dimension of the SWAT, being significantly higher than either general internists or surgeons (P=0.008). Level of physician work intensity seems to be similar among specialties.

[Syncope and work: role of the occupational physician and global risk stratification].

PubMed

Barbic, F; Angaroni, L; Orlandi, M; Costantino, G; Dipaola, E; Borleri, D; Borchini, R; D'Adda, F; Perego, F; Borella, M; Galli, A; Solbiati, M; Scanella, E; Casazza, G; Seghizzi, P; Furlan, R

2011-01-01

Safety risk for subjects suffering from syncope while working has not been as yet addressed by occupational medicine. The present study was aimed at evaluating a new developed methodology for job tasks risk stratification in patients with syncope. During a work-shop on syncope and occupational risk, 149 occupational physicians (OP) with about 10 years of clinical experience were asked to fulfil a Visual Analogue Scale (VAS) concerning the doctor's estimated potential damage (D) to the worker and the probability of a damage to occur (P) should syncope take place during the job task. Five job tasks characterized by different risk for safety (1, driving; 2, toxic products handling; 3, job performed closed to hot surfaces o free flames; 4, surgical activity; 5, office job) were identified. OP correctly stratified the risk associated to the different job tasks in patients with syncope. Unexpectedly, task #3 was given a risk similar to that obtained in drivers. This might be of paramount clinical and social importance when patients with syncope have to return to their job tasks.

Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 5. Biotronics QPCB Task Sort for Cardio-Pulmonary, EEG, EKG, Inhalation Therapy.

ERIC Educational Resources Information Center

Technomics, Inc., McLean, VA.

This publication is Attachment 5 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties in cardio-pulmonary, EEG, EKG, and inhalation therapy. (BT)

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

PubMed

Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2004-10-16

Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report

PubMed Central

Lærum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2004-01-01

Background Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS. PMID:15488150

Workflow and Electronic Health Records in Small Medical Practices

PubMed Central

Ramaiah, Mala; Subrahmanian, Eswaran; Sriram, Ram D; Lide, Bettijoyce B

2012-01-01

This paper analyzes the workflow and implementation of electronic health record (EHR) systems across different functions in small physician offices. We characterize the differences in the offices based on the levels of computerization in terms of workflow, sources of time delay, and barriers to using EHR systems to support the entire workflow. The study was based on a combination of questionnaires, interviews, in situ observations, and data collection efforts. This study was not intended to be a full-scale time-and-motion study with precise measurements but was intended to provide an overview of the potential sources of delays while performing office tasks. The study follows an interpretive model of case studies rather than a large-sample statistical survey of practices. To identify time-consuming tasks, workflow maps were created based on the aggregated data from the offices. The results from the study show that specialty physicians are more favorable toward adopting EHR systems than primary care physicians are. The barriers to adoption of EHR systems by primary care physicians can be attributed to the complex workflows that exist in primary care physician offices, leading to nonstandardized workflow structures and practices. Also, primary care physicians would benefit more from EHR systems if the systems could interact with external entities. PMID:22737096

Intrusive effects of implicitly processed information on explicit memory.

PubMed

Sentz, Dustin F; Kirkhart, Matthew W; LoPresto, Charles; Sobelman, Steven

2002-02-01

This study described the interference of implicitly processed information on the memory for explicitly processed information. Participants studied a list of words either auditorily or visually under instructions to remember the words (explicit study). They were then visually presented another word list under instructions which facilitate implicit but not explicit processing. Following a distractor task, memory for the explicit study list was tested with either a visual or auditory recognition task that included new words, words from the explicit study list, and words implicitly processed. Analysis indicated participants both failed to recognize words from the explicit study list and falsely recognized words that were implicitly processed as originating from the explicit study list. However, this effect only occurred when the testing modality was visual, thereby matching the modality for the implicitly processed information, regardless of the modality of the explicit study list. This "modality effect" for explicit memory was interpreted as poor source memory for implicitly processed information and in light of the procedures used. as well as illustrating an example of "remembering causing forgetting."

Backwards Fading to Speed Task Learning

DTIC Science & Technology

2013-09-01

estimates.) Table 1 Finalized Task List Task Domain Task Name Knot Tying Hand Cuff Rappel First Aid Fracture Bleed Map Reading* Resection...materials used. Hand Cuff . There are 10 steps in this task. To complete this task, the learner must manipulate a short length of rope (e.g...Design for Experiment 1 – Step Fade Experiment 1 (Step Fade) Task Type: Knot Tying Task Type: First Aid Task Complexity: Low (1) Hand Cuff (10

Job analysis of maintenance-mechanic position for the nuclear power plant maintenance personnel reliability model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Siegel, A.I.; Bartter, W.D.; Kopstein, F.F.

1982-06-01

The task list method of job survey was used. In collaboration with BWR and PWR personnel, a list of 107 tasks performed by maintenance mechanics was developed, grouped into: remove and install, test and repair, inspect and perform preventive maintenance, miscellaneous, communication, and report preparation. For each listed task, the questionnaire form inquired into: frequency of performance, task completion time, safety consequences of improper performance, and the amount of training required to perform the task proficiently. Scaled information was requested about seven abilities: (1) visual speed, accuracy, and recognition; (2) gross motor coordination; (3) fine manual dexterity; (4) strength andmore » stamina; (5) cognition; (6) memory; and (7) problem solving required for function completion. Survey forms were distributed to 27 nuclear power plants. Thirty-one maintenance mechanics representing 17 plants returned the completed forms. Frequency of performing tasks was bimodally distributed: (1) between once a year and once every six months, and (2) about once a week. More than half of the tasks have potential risk consequences if improperly performed. The five tasks with the greatest risk implications in the case of inadequate performance were: (1) remove and install reactor and dry-well heads, (2) test and repair reactor system components, (3) remove and install pressurizer mechanical relief valves, (4) test and repair pressurizer relief valves, (5) remove and install core spray pumps, seals, and valves. Hierarchically, the public risk associated with the various functions was: (1) remove and install, (2) test and repair, (3) preventive maintenance, (4) miscellaneous tasks, (5) communication, and (6) report preparation.« less

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

PubMed Central

Weiss, Manfred; Marx, Gernot; Iber, Thomas

2017-01-01

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician’s workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs. PMID:28828300

A matrix for the qualitative evaluation of nursing tasks.

PubMed

Durosaiye, Isaiah O; Hadjri, Karim; Liyanage, Champika L; Bennett, Kina

2018-04-01

To formulate a model for patient-nurse interaction; to compile a comprehensive list of nursing tasks on hospital wards; and to construct a nursing tasks demand matrix. The physical demands associated with nursing profession are of growing interest among researchers. Yet, it is the complexity of nursing tasks that defines the demands of ward nurses' role. This study explores nursing tasks, based on patient-nurse interaction on hospital wards. Extant literature was reviewed to formulate a patient-nurse interaction model. Twenty ward nurses were interviewed to compile a list of nursing tasks. These nursing tasks were mapped against the patient-nurse interaction model. A patient-nurse interaction model was created, consisting of: (1) patient care, (2) patient surveillance and (3) patient support. Twenty-three nursing tasks were identified. The nursing tasks demand matrix was constructed. Ward managers may use a nursing tasks demand matrix to determine the demands of nursing tasks on ward nurses. While many studies have explored either the physical or the psychosocial aspects of nursing tasks separately, this study suggests that the physicality of nursing tasks must be evaluated in tandem with their complexity. Ward managers may take a holistic approach to nursing tasks evaluation by using a nursing tasks demand matrix. © 2017 John Wiley & Sons Ltd.

Enhanced Critical Care Air Transport Team Training for Mitigation of Task Saturation

DTIC Science & Technology

2013-03-01

specialized members (physician, critical care nurse , and respiratory therapist) trained to handle the complex, critical nature of patients in hemodynamic ...with complex medical conditions have been poorly studied. 3.0 BACKGROUND Teams are composed of three medical personnel (a physician, a nurse , and

Physicians' communication styles as correlates of elderly cancer patients' satisfaction with their doctors.

PubMed

Finkelstein, A; Carmel, S; Bachner, Y G

2017-01-01

Physician-patient communication style is of utmost importance to patients with life-threatening diseases. This study identifies the most desired physician communication style by older cancer patients; and examines which of the studied communication styles significantly explains cancer patients' satisfaction with family physicians. A total of 200 older cancer patients, with average age of 75 years, participated in the study, yielding a response rate of 42%. Prospective respondents were randomly selected from the list of cancer patients in the central geographical district of Israel's second largest Health Maintenance Organization fund. Respondents rated their satisfaction with physicians as relatively high. All three communication styles studied were found to be associated with patient's satisfaction. Associations were found between self-rated health, time since the diagnosis of cancer and satisfaction. Women were less satisfied than men with their physicians. Two variables emerged as significant predictors of satisfaction: the physician's caring communication style and patient's gender. Intervention programmes should focus on elevating physicians' awareness of the importance of their communication with cancer patients in general, and of the caring communication style in particular. © 2015 John Wiley & Sons Ltd.

Prescribing patterns of rural family physicians: a study in Kermanshah Province, Iran.

PubMed

Ahmadi, Fariba; Zarei, Ehsan

2017-11-28

The inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran. In this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined. As stated, an analysis was done for rational use indicators suggested by World Health Organization (WHO): e.g., the percentage of prescriptions containing antibiotics, injections, and those prescribed by a generic name and from a national essential medicine list, plus the average number of drugs per prescription; these factors were all taken into account. Rational drug use was studied with the IRDP. The average number of drugs per prescription was 3.14 (± 1.2) and the average cost per prescription was 116,740 IRR (USD 3.6). Around 19% of prescriptions had more than four drugs, while the percentage of prescriptions involving antibiotics and injections was 52.1% and 24.4%, respectively. There was 95.1% drugs prescribed by their generic name and 95.9% were retrieved from the essential drugs list. The value of the IRDP was 3.70 out of 5. The findings of this study showed that some degree of irrational drug prescribing exists among family physicians, especially in terms of injections, antibiotics, and polypharmacy. It is recommended that there be continuing education programs for physicians regarding rational prescribing for different kinds of medical indications. Clinical practice guidelines should also assist with the rational use of medicine.

Adherence and health literacy as related to outcome of patients treated for rheumatoid arthritis : Analyses of a large-scale observational study.

PubMed

Kuipers, J G; Koller, M; Zeman, F; Müller, K; Rüffer, J U

2018-04-24

Disabilities in daily living and quality of life are key endpoints for evaluating the treatment outcome for rheumatoid arthritis (RA). Factors possibly contributing to good outcome are adherence and health literacy. The survey included a representative nationwide sample of German rheumatologists and their patients with RA. The physician questionnaire included the disease activity score (DAS28) and medical prescriptions. The patient questionnaire included fatigue (EORTC QLQ-FA13), health assessment questionnaire (HAQ), quality of life (SF-12), health literacy (HELP), and patients' listings of their medications. Adherence was operationalized as follows: patient-reported (CQR5), behavioral (concordance between physicians' and patients' listings of medications), physician-assessed, and a combined measure of physician rating (1 = very adherent, 0 = less adherent) and the match between physicians' prescriptions and patients' accounts of their medications (1 = perfect match, 0 = no perfect match) that yielded three categories of adherence: high, medium, and low. Simple and multiple linear regressions (controlling for age, sex, smoking, drinking alcohol, and sport) were calculated using adherence and health literacy as predictor variables, and disease activity and patient-reported outcomes as dependent variables. 708 pairs of patient and physician questionnaires were analyzed. The mean patient age (73% women) was 60 years (SD = 12). Multiple regression analyses showed that high adherence was significantly associated with 5/7 outcome variables and health literacy with 7/7 outcome variables. Adherence and health literacy had weak but consistent effects on most outcomes. Thus, enhancing adherence and understanding of medical information could improve outcome, which should be investigated in future interventional studies.

Leaders produce leaders and managers produce followers. A systematic review of the desired competencies and standard settings for physicians' leadership.

PubMed

Khoshhal, Khaid I; Guraya, Salman Y

2016-10-01

To elaborate the desired qualities, traits, and styles of physician's leadership with a deep insight into the recommended measures to inculcate leadership skills in physicians.   The databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for the full-text English-language articles published during the period 2000-2015. Further search, including manual search of grey literature, was conducted from the bibliographic list of all included articles. Medical Subject Headings (MeSH) keywords "Leadership" AND "Leadership traits" AND "Leadership styles" AND "Physicians' leadership" AND "Tomorrow's doctors" were used for the literature search. This search followed a step-wise approach defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The retrieved bibliographic list was analyzed and non-relevant material such as abstracts, conference proceedings, letters to editor, and short communications were excluded. Finally, 21 articles were selected for this review.  The literature search showed a number of leadership courses and formal training programs that can transform doctors to physician leaders. Leaders can inculcate confidence by integrating diverse views and listening; supporting skillful conversations through dialogue and helping others assess their influence and expertise. In addition to their clinical competence, physician leaders need to acquire the industry knowledge (clinical processes, health-care trends, budget), problem-solving skills, and emotional intelligence.    This review emphasizes the need for embedding formal leadership courses in the medical curricula for fostering tomorrow doctors' leadership and organizational skills. The in-house and off-campus training programs and workshops should be arranged for grooming the potential candidates for effective leadership.

Clothing Management.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for clothing management is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a career ladder, a matrix relating duty/task numbers to job titles, and a task list. Each task is…

Ensuring effective medication reconciliation in home healthcare.

PubMed

Fuji, Kevin T; Abbott, Amy A

2014-10-01

A patient was readmitted two days after discharge with severe hypoglycemia. The treating team discharged the patient on a new insulin regimen without realizing that the patient also had insulin 70/30 at home. The patient continued to take her previous regimen as well as the new one, and was found unresponsive by her husband. The patient was in the ICU with the incident likely resulting in permanent neurological deficits. ()A patient was admitted to a hospital from a home health agency. The list of medications provided by the agency did not completely match the list provided by the patient's family physician (i.e., the antihypertensive agent metoprolol tartrate [Lopressor] was not listed by the agency as one of the medications that the patient was currently taking). Therefore, metoprolol tartrate was not initially ordered. The patient developed atrial fibrillation shortly after hospital admission and required a transfer to the ICU [intensive care unit]. A diltiazem (Cardizem) infusion was started and the patient's family physician became aware that the patient had not been receiving their antihypertensive medication and initiated an order for the metoprolol tartrate ().

Sentinel Health Events (occupational): a basis for physician recognition and public health surveillance.

PubMed Central

Rutstein, D D; Mullan, R J; Frazier, T M; Halperin, W E; Melius, J M; Sestito, J P

1983-01-01

A Sentinel Health Event (SHE) is a preventable disease, disability, or untimely death whose occurrence serves as a warning signal that the quality of preventive and/or therapeutic medical care may need to be improved. A SHE (Occupational) is a disease, disability, or untimely death which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required. The present SHE(O) list encompasses 50 disease conditions that are linked to the workplace. Only those conditions are included for which objective documentation of an associated agent, industry, and occupation exists in the scientific literature. The list will serve as a framework for developing a national system for occupational health surveillance that may be applied at the state and local level, and as a guide for practicing physicians caring for patients with occupational illnesses. We expect to update the list periodically to accommodate new occupational disease events which meet the criteria for inclusion. PMID:6881402

Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative.

PubMed

Penciner, Rick; Woods, Robert A; McEwen, Jill; Lee, Richard; Langhan, Trevor; Bandiera, Glen

2013-01-01

There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators. We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada. Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided. This study established a national consensus defining the core competencies for EM clerkship in Canada.

Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation

PubMed Central

Altschuler, Justin; Margolius, David; Bodenheimer, Thomas; Grumbach, Kevin

2012-01-01

PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician members of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive and chronic care services were delegated to nonphysician team members. RESULTS Using 3 assumptions about the degree of task delegation that could be achieved (77%, 60%, and 50% of preventive care, and 47%, 30%, and 25% of chronic care), we estimated that a primary care team could reasonably care for a panel of 1,947, 1,523, or 1,387 patients. CONCLUSIONS If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce. PMID:22966102

Estimating a reasonable patient panel size for primary care physicians with team-based task delegation.

PubMed

Altschuler, Justin; Margolius, David; Bodenheimer, Thomas; Grumbach, Kevin

2012-01-01

PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician members of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive and chronic care services were delegated to nonphysician team members. RESULTS Using 3 assumptions about the degree of task delegation that could be achieved (77%, 60%, and 50% of preventive care, and 47%, 30%, and 25% of chronic care), we estimated that a primary care team could reasonably care for a panel of 1,947, 1,523, or 1,387 patients. CONCLUSIONS If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.

Development of a matrix to evaluate the threat of biological agents used for bioterrorism.

PubMed

Tegnell, A; Van Loock, F; Baka, A; Wallyn, S; Hendriks, J; Werner, A; Gouvras, G

2006-10-01

Adequate public health preparedness for bioterrorism includes the elaboration of an agreed list of biological and chemical agents that might be used in an attack or as threats of deliberate release. In the absence of counterterrorism intelligence information, public health authorities can also base their preparedness on the agents for which the national health structures would be most vulnerable. This article aims to describe a logical method and the characteristics of the variables to be brought in a weighing process to reach a priority list for preparedness. The European Union, in the aftermath of the anthrax events of October 2001 in the United States, set up a task force of experts from multiple member states to elaborate and implement a health security programme. One of the first tasks of this task force was to come up with a list of priority threats. The model, presented here, allows Web-based updates for newly identified agents and for the changes occurring in preventive measures for agents already listed. The same model also allows the identification of priority protection action areas.

Task Analysis for Health Occupations. Cluster: Nursing. Occupation: Geriatric Aide. Education for Employment Task Lists.

ERIC Educational Resources Information Center

Lake County Area Vocational Center, Grayslake, IL.

This task analysis for nursing education provides performance standards, steps to be followed, knowledge required, attitudes to be developed, safety procedures, and equipment and supplies needed for 13 tasks performed by geriatric aides in the duty area of performing diagnostic measures and for 30 tasks in the duty area of providing therapeutic…

A Submodularity Framework for Data Subset Selection

DTIC Science & Technology

2013-09-01

37 7 List of Language Modeling Corpora in thet Arabic -to-English NIST Task ............. 37 8...Task ( Arabic -to-English) ................. 39 10 Baseline BLEU (%) PER Scores on Transtac Task (English-to- Arabic ) ................. 39 11...Comparison of BLEU (%) PER Scores on Transtac Task ( Arabic -to-English) ....... 39 12 Comparison of BLEU (%) PER Scores on Transtac Task (English-to- Arabic

Making pharmacogenomic-based prescribing alerts more effective: A scenario-based pilot study with physicians.

PubMed

Overby, Casey Lynnette; Devine, Emily Beth; Abernethy, Neil; McCune, Jeannine S; Tarczy-Hornoch, Peter

2015-06-01

To facilitate personalized drug dosing (PDD), this pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. We employed a conceptual framework and measurement model to access the impact of physician characteristics (previous experience, awareness, relative advantage, perceived usefulness), technology characteristics (methods of implementation-semi-active/active, actionability-low/high) and a task characteristic (drug prescribed) on communication effectiveness (usefulness, confidence in prescribing decision), and clinical impact (uptake, prescribing intent, change in drug dosing). Physicians performed prescribing tasks using five simulated clinical case scenarios, presented in random order within the prototype PGx-CDS system. Twenty-two physicians completed the study. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83% at the start and 94% at the conclusion of our study. Physicians used semi-active alerts 74-88% of the time. There was no association between previous experience with, awareness of, and belief in a relative advantage of using PGx-CDS and improved uptake. The proportion of physicians reporting confidence in their prescribing decisions decreased significantly after using the prototype PGx-CDS system (p=0.02). Despite decreases in confidence, physicians perceived a relative advantage to using PGx-CDS, viewed semi-active alerts on most occasions, and more frequently changed doses toward doses supported by published evidence. Specifically, sixty-five percent of physicians reduced their dosing, significantly for capecitabine (p=0.002) and mercaptopurine/thioguanine (p=0.03). These findings suggest a need to improve our prototype such that PGx CDS content is more useful and delivered in a way that improves physician's confidence in their prescribing decisions. The greatest increases in communication effectiveness and clinical impact of PGx-CDS are likely to be realized through continued focus on content, content delivery, and tailoring to physician characteristics. Copyright © 2015 Elsevier Inc. All rights reserved.

On the role of verbalization during task set selection: switching or serial order control?

PubMed

Bryck, Richard L; Mayr, Ulrich

2005-06-01

Recent task-switching work in which paper-and-pencil administered single-task lists were compared with task-alternation lists has demonstrated large increases in task-switch costs with concurrent articulatory suppression (AS), implicating a crucial role for verbalization during switching (Baddeley, Chincotta, & Adlam, 2001; Emerson & Miyake, 2003). Experiment 1 replicated this result, using computerized assessment, albeit with much smaller effect sizes than in the original reports. In Experiment 2, AS interference was reduced when a sequential cue (spatial location) that indicated the current position in the sequence of task alternations was given. Finally, in Experiment 3, switch trials and no-switch trials were compared within a block of alternating runs of two tasks. Again, AS interference was obtained mainly when the endogenous sequencing demand was high, and it was comparable for no-switch and switch trials. These results suggest that verbalization may be critical for endogenous maintenance and updating of a sequential plan, rather than exclusively for the actual switching process.

When does a good working memory counteract proactive interference? Surprising evidence from a probe recognition task.

PubMed

Cowan, Nelson; Saults, J Scott

2013-02-01

It is often proposed that individuals with high working memory span overcome proactive interference (PI) from previous trials, saving working memory for task-relevant items. We examined this hypothesis in word-list probe recognition. We found no difference in PI related to span. Instead, ex-gaussian analysis of reaction time showed speed advantages for high spans specific to short lists (3 or 4 items) but absent from longer lists (6 or 8 items). We suggest that high-span advantages in reaction time are based on finesse during easy trials, not on overcoming PI. 2013 APA, all rights reserved

Are Physicians Likely to Adopt Emerging Mobile Technologies? Attitudes and Innovation Factors Affecting Smartphone Use in the Southeastern United States

PubMed Central

Putzer, Gavin J; Park, Yangil

2012-01-01

The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs. PMID:22737094

The role of reminding in the effects of spaced repetitions on cued recall: sufficient but not necessary.

PubMed

Wahlheim, Christopher N; Maddox, Geoffrey B; Jacoby, Larry L

2014-01-01

Three experiments examined the role of study-phase retrieval (reminding) in the effects of spaced repetitions on cued recall. Remindings were brought under task control to evaluate their effects. Participants studied 2 lists of word pairs containing 3 item types: single items that appeared once in List 2, within-list repetitions that appeared twice in List 2, and between-list repetitions that appeared once in List 1 and once in List 2. Our primary interest was in performance on between-list repetitions. Detection of between-list repetitions was encouraged in an n-back condition by instructing participants to indicate when a presented item was a repetition of any preceding item, including items presented in List 1. In contrast, detection of between-list repetitions was discouraged in a within-list back condition by instructing participants only to indicate repetitions occurring in List 2. Cued recall of between-list repetitions was enhanced when instructions encouraged detection of List 1 presentations. These results accord with those from prior experiments showing a role of study-phase retrieval in effects of spacing repetitions. Past experiments have relied on conditionalized data to draw conclusions, producing the possibility that performance benefits merely reflected effects of item selection. By bringing effects under task control, we avoided that problem. Our results provide evidence that reminding resulting from retrieval of earlier presentations plays a role in the effects of spaced repetitions on cued recall. However, our results also reveal that such retrievals are not necessary to produce an effect of spacing repetitions.

The Role of Reminding in the Effects of Spaced Repetitions on Cued Recall: Sufficient but not Necessary

PubMed Central

Wahlheim, Christopher N.; Maddox, Geoffrey B.; Jacoby, Larry L.

2014-01-01

Three experiments examined the role of study-phase retrieval (reminding) in the effects of spaced repetitions on cued recall. Remindings were brought under task control to evaluate their effects. Participants studied two lists of word pairs containing three item types: single items that appeared once in List 2, within-list repetitions that appeared twice in List 2, and between-list repetitions that appeared once in List 1 and once in List 2. Our primary interest was in performance on between-list repetitions. Detection of between-list repetitions was encouraged in an n-back condition by instructing participants to indicate when a presented item was a repetition of any preceding item, including items presented in List 1. In contrast, detection of between-list repetitions was discouraged in a within-list back condition by instructing participants only to indicate repetitions occurring in List 2. Cued recall of between-list repetitions was enhanced when instructions encouraged detection of List 1 presentations. These results accord with those from prior experiments showing a role of study-phase retrieval in effects of spacing repetitions. Past experiments have relied on conditionalized data to draw conclusions, producing the possibility that performance benefits merely reflected effects of item selection. By bringing effects under task control, we avoided that problem. Our results provide evidence that reminding resulting from retrieval of earlier presentations plays a role in the effects of spaced repetitions on cued recall. However, our results also reveal that such retrievals are not necessary to produce an effect of spacing repetitions. PMID:23937236

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

PubMed Central

Arndt, Brian G.; Beasley, John W.; Watkinson, Michelle D.; Temte, Jonathan L.; Tuan, Wen-Jan; Sinsky, Christine A.; Gilchrist, Valerie J.

2017-01-01

PURPOSE Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. METHODS We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from “event logging” records over a 3-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. RESULTS Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). CONCLUSIONS Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. PMID:28893811

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.

PubMed

Arndt, Brian G; Beasley, John W; Watkinson, Michelle D; Temte, Jonathan L; Tuan, Wen-Jan; Sinsky, Christine A; Gilchrist, Valerie J

2017-09-01

Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. © 2017 Annals of Family Medicine, Inc.

Telephone word-list recall tested in the rural aging and memory study: two parallel versions for the TICS-M.

PubMed

Hogervorst, Eva; Bandelow, Stephan; Hart, John; Henderson, Victor W

2004-09-01

Parallel versions of memory tasks are useful in clinical and research settings to reduce practice effects engendered by multiple administrations. We aimed to investigate the usefulness of three parallel versions of ten-item word list recall tasks administered by telephone. A population based telephone survey of middle-aged and elderly residents of Bradley County, Arkansas was carried out as part of the Rural Aging and Memory Study (RAMS). Participants in the study were 1845 persons aged 40 to 95 years. Word lists included that used in the telephone interview of cognitive status (TICS) as a criterion standard and two newly developed lists. The mean age of participants was 61.05 (SD 12.44) years; 39.5% were over age 65. 78% of the participants had completed high school, 66% were women and 21% were African-American. There was no difference in demographic characteristics between groups receiving different word list versions, and performances on the three versions were equivalent for both immediate (mean 4.22, SD 1.53) and delayed (mean 2.35 SD 1.75) recall trials. The total memory score (immediate+delayed recall) was negatively associated with older age (beta = -0.41, 95%CI=-0.11 to -0.04), lower education (beta = 0.24, 95%CI = 0.36 to 0.51), male gender (beta = -0.18, 95%CI = -1.39 to -0.90) and African-American race (beta = -0.15, 95%CI = -1.41 to -0.82). The two RAMS word recall lists and the TICS word recall list can be used interchangeably in telephone assessment of memory of middle-aged and elderly persons. This finding is important for future studies where parallel versions of a word-list memory task are needed. (250 words).

Automap User’s Guide 2013

DTIC Science & Technology

2013-06-03

dairyFarm.txt Ted runs a dairy farm. He milks the cows , runs the office, and cleans the barn. 136 dairyFarmDeleteList.txt There are some...applying the delete list, the text appears in the display like this: Ted runs dairy farm. He milks cows , runs office, cleans ...in the file. dairyFarmMeta.csv Ted,agent runs,task dairy,resource farm,location He,agent milks ,task cows ,resource office,location cleans

Short-term memory in autism spectrum disorder.

PubMed

Poirier, Marie; Martin, Jonathan S; Gaigg, Sebastian B; Bowler, Dermot M

2011-02-01

Three experiments examined verbal short-term memory in comparison and autism spectrum disorder (ASD) participants. Experiment 1 involved forward and backward digit recall. Experiment 2 used a standard immediate serial recall task where, contrary to the digit-span task, items (words) were not repeated from list to list. Hence, this task called more heavily on item memory. Experiment 3 tested short-term order memory with an order recognition test: Each word list was repeated with or without the position of 2 adjacent items swapped. The ASD group showed poorer performance in all 3 experiments. Experiments 1 and 2 showed that group differences were due to memory for the order of the items, not to memory for the items themselves. Confirming these findings, the results of Experiment 3 showed that the ASD group had more difficulty detecting a change in the temporal sequence of the items. (c) 2010 APA, all rights reserved.

What's a Primary Care Physician (PCP)?

MedlinePlus

... a relationship with a PCP you like and trust, taking your child for scheduled checkups and vaccines , ... and doctors or nurses you already know and trust. Once you have a list of candidates, learn ...

Professional or administrative value patterns? Clinical pathways in medical problem-solving processes.

PubMed

Holmberg, Leif

2007-11-01

A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current administrative level guidelines impose uniform structural features that meet the requirement for low task uncertainty. Within these structural constraints, physicians must organize medical problem-solving processes to meet any task uncertainty that may be encountered. Medical problem-solving processes with low task uncertainty need to be organized independently of processes with high task uncertainty. Each process must be evaluated according to different performance standards and needs to have autonomous administrative guideline models. Although clinical pathways seem appropriate when there is low task uncertainty, other kinds of guidelines are required when the task uncertainty is high.

ACR-SNM Task Force on Nuclear Medicine Training: report of the task force.

PubMed

Guiberteau, Milton J; Graham, Michael M

2011-06-01

The expansion of knowledge and technological advances in nuclear medicine and radiology require physicians to have more expertise in functional and anatomic imaging. The convergence of these two specialties into the new discipline of molecular imaging has also begun to place demands on residency training programs for additional instruction in physiology and molecular biology. These changes have unmasked weaknesses in current nuclear medicine and radiology training programs. Adding to the impetus for change are the attendant realities of the job market and uncertain employment prospects for physicians trained in nuclear medicine but not also trained in diagnostic radiology. With this background, the ACR and the Society of Nuclear Medicine convened the Task Force on Nuclear Medicine Training to define the issues and develop recommendations for resident training.

Motor cortical encoding of serial order in a context-recall task.

PubMed

Carpenter, A F; Georgopoulos, A P; Pellizzer, G

1999-03-12

The neural encoding of serial order was studied in the motor cortex of monkeys performing a context-recall memory scanning task. Up to five visual stimuli were presented successively on a circle (list presentation phase), and then one of them (test stimulus) changed color; the monkeys had to make a single motor response toward the stimulus that immediately followed the test stimulus in the list. Correct performance in this task depends on memorization of the serial order of the stimuli during their presentation. It was found that changes in neural activity during the list presentation phase reflected the serial order of the stimuli; the effect on cell activity of the serial order of stimuli during their presentation was at least as strong as the effect of motor direction on cell activity during the execution of the motor response. This establishes the serial order of stimuli in a motor task as an important determinant of motor cortical activity during stimulus presentation and in the absence of changes in peripheral motor events, in contrast to the commonly held view of the motor cortex as just an "upper motor neuron."

Physician activity during outpatient visits and subjective workload.

PubMed

Calvitti, Alan; Hochheiser, Harry; Ashfaq, Shazia; Bell, Kristin; Chen, Yunan; El Kareh, Robert; Gabuzda, Mark T; Liu, Lin; Mortensen, Sara; Pandey, Braj; Rick, Steven; Street, Richard L; Weibel, Nadir; Weir, Charlene; Agha, Zia

2017-05-01

We describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. We collected temporally-resolved activity data including audio, video, EHR activity, and eye-gaze along with post-visit assessments of workload. These data are then analyzed through a combination of manual content analysis and computational techniques to temporally align streams, providing a range of process measures of EHR usage, clinical workflow, and physician-patient communication. Data was collected from primary care and specialty clinics at the Veterans Administration San Diego Healthcare System and UCSD Health, who use Electronic Health Record (EHR) platforms, CPRS and Epic, respectively. Grouping visit activity by physician, site, specialty, and patient status enables rank-ordering activity factors by their correlation to physicians' subjective work-load as captured by NASA Task Load Index survey. We developed a coding scheme that enabled us to compare timing studies between CPRS and Epic and extract patient and visit complexity profiles. We identified similar patterns of EHR use and navigation at the 2 sites despite differences in functions, user interfaces and consequent coded representations. Both sites displayed similar proportions of EHR function use and navigation, and distribution of visit length, proportion of time physicians attended to EHRs (gaze), and subjective work-load as measured by the task load survey. We found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload. We discuss implications of our study for methodology, clinical workflow and EHR redesign. Copyright © 2017 Elsevier Inc. All rights reserved.

Sickness certification of patients--a work environment problem among physicians?

PubMed

Ljungquist, T; Hinas, E; Arrelöv, B; Lindholm, C; Wilteus, A L; Nilsson, G H; Alexanderson, K

2013-01-01

According to several studies, physicians find sickness certification of patients to be problematic, and some smaller studies suggest that this is a psychosocial work environment problem (WEP). To explore to what extent physicians experience sickness certification as a WEP and the associations of this with the type of clinic and other workplace factors. Analyses of data from a questionnaire sent to all physicians who were living and working in Sweden. The study group consisted of physicians aged <65 years who performed sickness certification tasks (SCTs). Prevalence rates (PR) and 95% confidence intervals (CI) of finding SCTs as a WEP in relation to background factors were calculated. The response rate was 61%. The final study group consisted of 14 210 responders. Half of the physicians (50%) experienced SCTs as a WEP, and 11% found them as a WEP to a great extent. The proportion of physicians experiencing certification tasks as a WEP varied with the type of clinic and were highest in general practice (73%), orthopaedics (68%), rheumatology (67%), neurology (59%) and psychiatry (58%). Using internal medicine as a reference group, the PRs for finding SCTs as a WEP to a great extent were 4.05 (95% CI 3.23-5.09) in general practice, 2.67 (2.05-3.47) in psychiatry and 2.66 (2.04-3.47) in orthopaedics, after adjusting for educational level and frequency of sickness certification consultations. In ear, nose and throat clinics, the PR was 0.43 (0.21-0.88). The findings underline the importance of measures to improve the work situation for physicians regarding sickness certification practices.

Serial Recall, Word Frequency, and Mixed Lists: The Influence of Item Arrangement

ERIC Educational Resources Information Center

Miller, Leonie M.; Roodenrys, Steven

2012-01-01

Studies of the effect of word frequency in the serial recall task show that lists of high-frequency words are better recalled than lists of low-frequency words; however, when high- and low-frequency words are alternated within a list, there is no difference in the level of recall for the two types of words, and recall is intermediate between lists…

Self-assessment of intercultural communication skills: a survey of physicians and medical students in Geneva, Switzerland.

PubMed

Hudelson, Patricia; Perron, Noelle Junod; Perneger, Thomas

2011-09-01

Physicians working with multicultural populations need to know how to elicit the patient's understanding of the illness; determine the patient's sociocultural context and identify any issues that might affect care; communicate effectively across patient-provider social and cultural differences; and collaborate effectively with an interpreter. Skills self-assessment can contribute to identifying training needs and monitoring skills development in these areas. As part of a larger study exploring the knowledge, attitudes and practices of Geneva physicians and medical students regarding the care of immigrant patients, we asked respondents to self-rate their ability to perform a range of common yet challenging intercultural communication tasks. Overall, respondents rated themselves less competent at intercultural tasks than at basic medical skills and less competent at specific intercultural communication skills than at general intercultural skills. Qualified doctors (as opposed to students), those with greater interest in caring for immigrants, and those who rarely encountered difficulties with immigrants rated themselves significantly more competent for all clinical tasks. Having a higher percentage of immigrant patients and previous cultural competence training predicted greater self-rated intercultural communication skills. Our self-assessment results suggest that students and physicians should be provided with the opportunity to practice intercultural skills with immigrant patients as part of their cultural competence training. To strengthen the validity of self-assessment measures, they should ideally be combined with more objective methods to assess actual skills.

Hawai‘i Physician Workforce Assessment 2010

PubMed Central

Dall, Tim; Sakamoto, David

2012-01-01

Background National policy experts have estimated that the United States will be 15–20% short of physicians by the year 2020. In 2008, the Big Island of Hawai‘i was found to be 15% short of physicians. The current article describes research to determine the physician supply and demand across the State of Hawai‘i. Methods The researchers utilized licensure lists, all available sources of physician practice location information, and contacted provider offices to develop a database of practicing physicians in Hawai‘i. A statistical model based on national utilization of physician services by age, ethnicity, gender, insurance, and obesity rates was used to estimate demand for services. Using number of new state licenses per year, the researchers estimated the number of physicians who enter the Hawai‘i workforce annually. Physician age data were used to estimate retirements. Results Researchers found 2,860 full time equivalents of practicing, non-military, patient-care physicians in Hawai‘i (excluding those still in residency or fellowship programs). The calculated demand for physician services by specialty indicates a current shortage of physicians of over 600. This shortage may grow by 50 to 100 physicians per year if steps are not taken to reverse this trend. Physician retirement is the single largest element in the loss of physicians, with population growth and aging playing a significant role in increasing demand. Discussion Study findings indicate that Hawai‘i is 20% short of physicians and the situation is likely to worsen if mitigating steps are not taken immediately. PMID:22737636

The Ethics of Organ Tourism: Role Morality and Organ Transplantation.

PubMed

Adams, Marcus P

2017-11-15

Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician." This role results from transplant physicians' participation in a system that depends on organ donors' voluntary act of donation. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Task Analysis in Optical & Contact Lens Dispensing. Dispensing Opticians.

ERIC Educational Resources Information Center

Hrushowy, Eugene; Stanley, Dale

A task force of opticians and educators in British Columbia was assembled to determine the knowledge and skills required of dispensing opticians and contact lens specialists. The ideas generated by the task force were analyzed and distilled into the standardized tasks listed in this document, using Krathwohl's taxonomy. The document contains 36…

Physician anger, Part 2. More on the dance of anger.

PubMed

Dwyer, C E

1999-01-01

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.

Does the radiologically isolated syndrome exist? A dual-task cost pilot study.

PubMed

Dattola, Vincenzo; Logiudice, Anna Lisa; Bonanno, Lilla; Famà, Fausto; Milardi, Demetrio; Chillemi, Gaetana; D'Aleo, Giangaetano; Marino, Silvia; Calabrò, Rocco Salvatore; Russo, Margherita

2017-11-01

Simultaneous performance of motor and cognitive tasks may compete for common brain network resources in aging or patients with some neurological diseases, suggesting the occurrence of a cognitive-motor interference. While this phenomenon has been well described for multiple sclerosis (MS) patients, it never has been tested on asymptomatic subject with magnetic resonance imaging (MRI) findings suggestive of demyelinating disease (i.e., radiologically isolated syndrome: RIS). In this pilot study, 10 RIS subjects and 10 sex/age-matched healthy controls were tested by means of static posturography under eyes opened (single-task trial) and while performing two different cognitive tasks (semantic modified word list generation for first dual-task trial and phonemic semantic modified word list generation for second dual-task trial), to estimate the dual-task cost (DTC) of standing balance. In our sample, under cognitive interference (without any substantial differences between semantic and phonemic modified word list generation), the RIS group showed significance differences in CoP (center of pressure) total sway area, ellipse eccentricity, CoP sway path length, CoP median sway velocity along the AP (anteroposterior) axis and along the ML (mediolateral) axis, reflecting a higher negative DTC respect to healthy subjects (which have simply shown a statistical trend, failing to reach a significance, in some trials). The phenomenon of cognitive-motor interference might be unmasked by a dual-task posturography in RIS subjects, too. We hypothesize that this approach could be useful to early reveal the presence of a demyelinating disease and to reach a MS diagnosis in subjects otherwise classified as RIS.

Self-help memory training for healthy older adults in a residential care center: specific and transfer effects on performance and beliefs.

PubMed

Cavallini, Elena; Bottiroli, Sara; Capotosto, Emanuela; De Beni, Rossana; Pavan, Giorgio; Vecchi, Tomaso; Borella, Erika

2015-08-01

Cognitive flexibility has repeatedly been shown to improve after training programs in community-dwelling older adults, but few studies have focused on healthy older adults living in other settings. This study investigated the efficacy of self-help training for healthy older adults in a residential care center on memory tasks they practiced (associative and object list learning tasks) and any transfer to other tasks (grocery lists, face-name learning, figure-word pairing, word lists, and text learning). Transfer effects on everyday life (using a problem-solving task) and on participants' beliefs regarding their memory (efficacy and control) were also examined. With the aid of a manual, the training adopted a learner-oriented approach that directly encouraged learners to generalize strategic behavior to new tasks. The maintenance of any training benefits was assessed after 6 months. The study involved 34 residential care center residents (aged 70-99 years old) with no cognitive impairments who were randomly assigned to two programs: the experimental group followed the self-help training program, whereas the active control group was involved in general cognitive stimulation activities. Training benefits emerged in the trained group for the tasks that were practiced. Transfer effects were found in memory and everyday problem-solving tasks and on memory beliefs. The effects of training were generally maintained in both practiced and unpracticed memory tasks. These results demonstrate that learner-oriented self-help training enhances memory performance and memory beliefs, in the short term at least, even in residential care center residents. Copyright © 2014 John Wiley & Sons, Ltd.

Ornamental Horticulture Production Occupations. Curriculum Guide.

ERIC Educational Resources Information Center

Reneau, Fred; And Others

This curriculum guide contains guidesheets for the ornamental horticulture production occupations. Each guidesheet provides a job-relevant task; performance objective, with task, performance standard, source of standard, and conditions for performance of task; enabling objectives; a list of resources; teaching activities; a criterion-referenced…

Physicians' prescribing responses to a restricted formulary: the impact of Medicaid preferred drug lists in Illinois and Louisiana.

PubMed

Virabhak, Suchin; Shinogle, Judith A

2005-01-01

To determine the extent to which the strictness of the criteria used to control utilization of drugs not on a Medicaid preferred drug list (PDL) changes physician prescribing habits for non-Medicaid patients. Quasi-experimental design based on different timing of states' enactment of PDLs for cardiovascular medications. A regression model was developed to analyze the effect that PDL implementation had on off-PDL product market share across 3 patient types (Medicaid, third-party insurance, and cash paying). The models included data from 2 states (Illinois and Louisiana) with different PDL prior-authorization criteria. The data allowed examination of different physician responses according to the proportion of Medicaid patients treated by the physician. The analysis also followed prescribing patterns longitudinally to determine whether the PDL-induced prescribing behaviors changed over time. There was a decrease of 9 percentage points (67.7%) and 6.2 percentage points (40.5%) in the Medicaid prescription share of restricted cardiovascular drugs post-PDL for Illinois and Louisiana, respectively. In the third-party insurance market, prescription shares of off-PDL drugs decreased 0.9 percentage points (6.8%) in Illinois and 1.3 percentage points (8.6%) in Louisiana. For physicians with a high percentage of prescriptions paid for by Medicaid, the share loss for off-PDL drugs was estimated to be more than 37% for the non-Medicaid portion of the practice. The effects of a Medicaid PDL on prescribing behavior extend beyond the Medicaid population. The health outcomes and economic consequences of these "spillover" effects are poorly understood and warrant further research.

A procedure for testing prospective remembering in persons with neurological impairments.

PubMed

Titov, N; Knight, R G

2000-10-01

A video-based procedure for assessing prospective remembering (PR) in brain-injured clients is described. In this task, a list of instructions is given, each comprising an action (buy a hamburger) and a cue (at McDonalds), which are to be recalled while watching a videotape segment showing the view of a person walking through a shopping area. A group of 12 clients with varying degrees of memory impairment undergoing rehabilitation completed both a video test and a comparable task in real-life. Significant correlations were found between the two measures, indicating that a video-based analogue can be used to estimate prospective remembering in real life. Scores on the PR task were associated with accuracy of recall on a word-list task, but not with the Working Memory Index of the Wechsler Memory Scale-III, suggesting that the task is sensitive to levels of amnesic deficit.

Task-sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire.

PubMed

McNairy, Margaret L; Bashi, Jules B; Chung, Hannah; Wemin, Louise; Lorng, Marie-Nicole Akpro; Brou, Hermann; Nioble, Cyprien; Lokossue, A; Abo, Kouame; Achi, Delphine; Ouattara, Kiyali; Sess, Daniel; Sanogo, Pongathie Adama; Ekra, Alexandre; Ettiegne-Traore, Virginie; Diabate, Conombo J; Abrams, Elaine J; El-Sadr, Wafaa M

2017-04-01

We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services. Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics. A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care. Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire. © 2017 John Wiley & Sons Ltd.

[Administrative and reporting tasks of family physicians in Europe. Comparison with the Hungarian system].

PubMed

Rurik, Imre; Kalabay, László

2008-05-11

Administrative tasks are continuously increasing in the different health systems worldwide and also in the primary care. The administrative and reporting tasks of family physicians in Hungary are regulated by laws and rules. The aim of the study was to compare the recent Hungarian administrative tasks to those of other European countries in the primary care. Family physicians from 22 countries of the European General Practice Research Network were asked to fill a questionnaire regarding their countries. The results of their answers were presented and analyzed. Doctors are paid by capitation or fee for services, sometimes by the combination of both. They are obliged to prepare reports which depend on the respective countries, contain identification data of patients, diagnoses to be set up, and treatments. Administrative duties and the national characteristics of drug-prescriptions, referral systems to specialist or hospital were also analyzed. Conclusions were made in comparison with the European and Hungarian regulations. Reports needed by the Hungarian authorities are more complex and detailed, with many overlaps. The reasons why data are needed are often not clear and do not fit for the purpose. The time available for medical treatment is decreased by administrative duties making the gate-keeper function ineffective. There is no time for real prevention. Without official (governmental) version of primary care softwares, family physicians use too many softwares with different quality, which are not compatible with each other. It is suggested to check and modify the data obliged in reporting systems. Only data relevant in epidemiological or economical points of view should be reported with more focus to personal protection of privacy rights.

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

PubMed

Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

2012-05-01

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

HIV Task Sharing Between Nurses and Physicians in Nigeria: Examining the Correlates of Nurse Self-Efficacy and Job Satisfaction.

PubMed

Iwu, Emilia Ngozi; Holzemer, William L

A global shortfall of 12.9 million health care workers has been predicted to occur in the next two decades. Task sharing between physicians and nurses, a method used to help compensate for provider shortages, was shown to improve access to antiretroviral therapy in Africa, but led to nurses performing beyond their scopes of practice. We surveyed 508 nurses in task-shifted roles in Nigeria. Respondents (n = 399) provided information on age, years in practice, gender, registration status, employment site, and access to task-sharing training and mentoring. Years in practice negatively influenced task-sharing self-efficacy. Positive correlates of job satisfaction were years in practice, older age, male gender, single licensure, employment at a tertiary hospital, mentoring, and duration of training. System challenges and employment in faith-based and nontertiary hospitals increased likelihood of job dissatisfaction. Supportive practice and policy interventions are needed to minimize negative effects of disparities in job satisfaction across facilities. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

The Systems Approach to Functional Job Analysis. Task Analysis of the Physician's Assistant: Volume I--Task Analysis Methodology and Techniques.

ERIC Educational Resources Information Center

Wake Forest Univ., Winston Salem, NC. Bowman Gray School of Medicine.

Utilizing a systematic sampling technique, the professional activities of small groups of pediatricians, family practitioners, surgeons, obstetricians, and internists were observed for 4 or 5 days by a medical student who checked a prearranged activity sheet every 30 seconds to: (1) identify those tasks and activities an assistant could be trained…

Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study.

PubMed

Maier, Claudia B; Aiken, Linda H

2016-12-01

Primary care is in short supply in many countries. Task shifting from physicians to nurses is one strategy to improve access, but international research is scarce. We analysed the extent of task shifting in primary care and policy reforms in 39 countries. Cross-country comparative research, based on an international expert survey, plus literature scoping review. A total of 93 country experts participated, covering Europe, USA, Canada, Australia and New Zealand (response rate: 85.3%). Experts were selected according to pre-defined criteria. Survey responses were triangulated with the literature and analysed using policy, thematic and descriptive methods to assess developments in country-specific contexts. Task shifting, where nurses take up advanced roles from physicians, was implemented in two-thirds of countries (N = 27, 69%), yet its extent varied. Three clusters emerged: 11 countries with extensive (Australia, Canada, England, Northern Ireland, Scotland, Wales, Finland, Ireland, Netherlands, New Zealand and USA), 16 countries with limited and 12 countries with no task shifting. The high number of policy, regulatory and educational reforms, such as on nurse prescribing, demonstrate an evolving trend internationally toward expanding nurses' scope-of-practice in primary care. Many countries have implemented task-shifting reforms to maximise workforce capacity. Reforms have focused on removing regulatory and to a lower extent, financial barriers, yet were often lengthy and controversial. Countries early on in the process are primarily reforming their education. From an international and particularly European Union perspective, developing standardised definitions, minimum educational and practice requirements would facilitate recognition procedures in increasingly connected labour markets. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Running with emotion: when affective content hampers working memory performance.

PubMed

Fairfield, Beth; Mammarella, Nicola; Di Domenico, Alberto; Palumbo, Rocco

2015-03-01

This study tested the hypothesis that affective content may undermine rather than facilitate working memory (WM) performance. To this end, participants performed a running WM task with positive, negative and neutral words. In typical running memory tasks, participants are presented with lists of unpredictable length and are asked to recall the last three or four items. We found that accuracy with affective words decreased as lists lengthened, whereas list length did not influence recall of neutral words. We interpreted this pattern of results in terms of a limited resource model of WM in which valence represents additional information that needs to be manipulated, especially in the context of difficult trials. © 2014 International Union of Psychological Science.

False recall and recognition of brand names increases over time.

PubMed

Sherman, Susan M

2013-01-01

Using the Deese-Roediger-McDermott (DRM) paradigm, participants are presented with lists of associated words (e.g., bed, awake, night). Subsequently, they reliably have false memories for related but nonpresented words (e.g., SLEEP). Previous research has found that false memories can be created for brand names (e.g., Morrisons, Sainsbury's, Waitrose, and TESCO). The present study investigates the effect of a week's delay on false memories for brand names. Participants were presented with lists of brand names followed by a distractor task. In two between-subjects experiments, participants completed a free recall task or a recognition task either immediately or a week later. In two within-subjects experiments, participants completed a free recall task or a recognition task both immediately and a week later. Correct recall for presented list items decreased over time, whereas false recall for nonpresented lure items increased. For recognition, raw scores revealed an increase in false memory across time reflected in an increase in Remember responses. Analysis of Pr scores revealed that false memory for lures stayed constant over a week, but with an increase in Remember responses in the between-subjects experiment and a trend in the same direction in the within-subjects experiment. Implications for theories of false memory are discussed.

Generalizing attentional control across dimensions and tasks: evidence from transfer of proportion-congruent effects.

PubMed

Wühr, Peter; Duthoo, Wout; Notebaert, Wim

2015-01-01

Three experiments investigated transfer of list-wide proportion congruent (LWPC) effects from a set of congruent and incongruent items with different frequency (inducer task) to a set of congruent and incongruent items with equal frequency (diagnostic task). Experiments 1 and 2 mixed items from horizontal and vertical Simon tasks. Tasks always involved different stimuli that varied on the same dimension (colour) in Experiment 1 and on different dimensions (colour, shape) in Experiment 2. Experiment 3 mixed trials from a manual Simon task with trials from a vocal Stroop task, with colour being the relevant stimulus in both tasks. There were two major results. First, we observed transfer of LWPC effects in Experiments 1 and 3, when tasks shared the relevant dimension, but not in Experiment 2. Second, sequential modulations of congruency effects transferred in Experiment 1 only. Hence, the different transfer patterns suggest that LWPC effects and sequential modulations arise from different mechanisms. Moreover, the observation of transfer supports an account of LWPC effects in terms of list-wide cognitive control, while being at odds with accounts in terms of stimulus-response (contingency) learning and item-specific control.

Ambulatory EHR functionality: a comparison of functionality lists.

PubMed

Drury, Barbara M

2006-01-01

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

Reframing professional boundaries in healthcare: a systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain.

PubMed

Niezen, Maartje G H; Mathijssen, Jolanda J P

2014-08-01

To explore the main facilitators and barriers to task reallocation. One of the innovative approaches to dealing with the anticipated shortage of physicians is to reallocate tasks from the professional domain of medicine to the nursing domain. Various (cost-)effectiveness studies demonstrate that nurse practitioners can deliver as high quality care as physicians and can achieve as good outcomes. However, these studies do not examine what factors may facilitate or hinder such task reallocation. A systematic literature review of PubMed and Web of Knowledge supplemented with a snowball research method. The principles of thematic analysis were followed. The 13 identified relevant papers address a broad spectrum of task reallocation (delegation, substitution and complementary care). Thematic analysis revealed four categories of facilitators and barriers: (1) knowledge and capabilities, (2) professional boundaries, (3) organisational environment, and (4) institutional environment. Introducing nurse practitioners in healthcare requires organisational redesign and the reframing of professional boundaries. Especially the facilitators and barriers in the analytical themes of 'professional boundaries' and 'organisational environment' should be considered when reallocating tasks. If not, these factors might hamper the cost-effectiveness of task reallocation in practice. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Expectations, requirements and limitations of future task sharing between the nursing profession and the medical profession: results from the Care-N Study M-V].

PubMed

Dreier, Adina; Rogalski, Hagen; Homeyer, Sabine; Oppermann, Roman Frank; Hingst, Peter; Hoffmann, Wolfgang

2015-10-01

The aging population causes a sustained increase in demand of medical and nursing care services. At the same time health care professionals are aging, too. This leads to a growing number of health care gaps. Therefore, the health care system needs to be reformed. This includes a reallocation of task between some of the health care professions. This article addresses developments, potentials and limitations in the context of the future allocation of tasks between the nursing and the medical profession. Aim is to specify the future task sharing between nurses and physicians regarding expectations, requirements and limitations. We conducted questionnaire based Delphi interviews with an interdisciplinary group of experts. (type aggregation of ideas). In the future, to expert’s point of view, nurses will take over routine tasks in the medical and nursing health care supply. Task sharing by substitution is regarded with skepticism by experts. It requires a long time perspective and an early involvement of all stakeholders. Germany is at the beginning of the process of the future task sharing between nurses and physicians. The realization requires a comprehensive political support and further development of concepts including scientific implementation and evaluation.

A TASK UNIT CONCEPT FOR ON-THE-JOB TRAINING IN FOOD SERVICE.

ERIC Educational Resources Information Center

WELCH, JOHN

INDUSTRIAL TRAINING PROCEDURES ARE COMPARED WITH THOSE OF FOOD AND OTHER SERVICE INDUSTRIES TO ASCERTAIN RELEVANT TRAINING METHODS. HELPFUL PROCEDURES WERE--DESCRIBING EACH EMPLOYEE'S JOB BY LISTING HIS TASKS AND BREAKING DOWN EACH TASK INTO ITS SEPARATE OPERATIONS. THEN THE BEST METHOD OF TRAINING FOR EACH TASK CAN BE DETERMINED. A TIME AND…

Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education).

PubMed

Holden, Mark D; Buck, Era; Luk, John; Ambriz, Frank; Boisaubin, Eugene V; Clark, Mark A; Mihalic, Angela P; Sadler, John Z; Sapire, Kenneth J; Spike, Jeffrey P; Vince, Alan; Dalrymple, John L

2015-06-01

The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.

Recruitment of private practices for primary care research: experience in a preventive services clinical trial.

PubMed

McBride, P E; Massoth, K M; Underbakke, G; Solberg, L I; Beasley, J W; Plane, M B

1996-10-01

Recruitment of community primary care practices for studies to improve health service delivery is important to many health care organizations. Prior studies have focused on individual physician recruitment or academic settings. This descriptive study evaluated the efficiency and utility of three different recruitment methods to encourage community practice participation in a preventive services research trial. Primary care practices in four midwestern states were recruited using different sources for initial mailings (physician lists, practice lists, and a managed care organization's primary care network) and different recruiting methods. Outcome measures included response rates, participation rates, and comparative costs of each method. Of the 86 eligible practices contacted, 52 (60%) consented to participate. Mailing to individual physicians was the most cumbersome and expensive method and had the lowest response rate. Initial contacts with practice medical directors increased the participation rate substantially, and practice recruitment meetings improved both study participation and practice-project communication. Experience with these three methods suggests that the most efficient way to recruit practices for participation in a preventive services research trial involves targeted mailings and phone calls to medical directors, followed by on-site practice meetings.

[Another profession in the Ottoman period dealing with pharmaceutics: surgery].

PubMed

Altintaş, Ayten

2004-01-01

We have realized in many documents that in the Ottoman period surgeons were involved in pharmaceutics as much as physicians and herbalists. Surgeons employed by the state ordered more drugs than physicians, and it is interesting that in their order list there were mostly singular drugs instead of ready-made ones. In addition to drugs used by surgeons in preparing ointments and plasters, pans and filters were utilized in the process of production, and earthenware pots, tin and wooden boxes with various kinds of paper were ordered for the purpose of packaging. We have determined that most of the single drugs placed onto the lists of surgeons were "ointment of rust" that dries the pus, and "red ointment" that is good for all kinds of pus. The preparation of the ointments were specified in detail in books of surgery (Cerrahnames)We have observed that parallel to the Regulation of 1826, surgeons were given the title of pharmacist when they were appointed to military bodies. 100 kurus (piaster) were paid to surgeons for performing surgery and 50 kurus for preparing drugs, which is another important document indicating that surgeons were more responsible than physicians in preparing drugs.

Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial.

PubMed

van Beurden, Karlijn M; Brouwers, Evelien P M; Joosen, Margot C W; Terluin, Berend; van der Klink, Jac J L; van Weeghel, Jaap

2013-03-06

Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders. This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence. If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs. ISRCTN86605310.

Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial

PubMed Central

2013-01-01

Background Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders. Methods/design This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence. Discussion If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs. Trial registration ISRCTN86605310 PMID:23496948

Relating physician's workload with errors during radiation therapy planning.

PubMed

Mazur, Lukasz M; Mosaly, Prithima R; Hoyle, Lesley M; Jones, Ellen L; Chera, Bhishamjit S; Marks, Lawrence B

2014-01-01

To relate subjective workload (WL) levels to errors for routine clinical tasks. Nine physicians (4 faculty and 5 residents) each performed 3 radiation therapy planning cases. The WL levels were subjectively assessed using National Aeronautics and Space Administration Task Load Index (NASA-TLX). Individual performance was assessed objectively based on the severity grade of errors. The relationship between the WL and performance was assessed via ordinal logistic regression. There was an increased rate of severity grade of errors with increasing WL (P value = .02). As the majority of the higher NASA-TLX scores, and the majority of the performance errors were in the residents, our findings are likely most pertinent to radiation oncology centers with training programs. WL levels may be an important factor contributing to errors during radiation therapy planning tasks. Published by Elsevier Inc.

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP).

PubMed

Ko, Emily M; Havrilesky, Laura J; Alvarez, Ronald D; Zivanovic, Oliver; Boyd, Leslie R; Jewell, Elizabeth L; Timmins, Patrick F; Gibb, Randall S; Jhingran, Anuja; Cohn, David E; Dowdy, Sean C; Powell, Matthew A; Chalas, Eva; Huang, Yongmei; Rathbun, Jill; Wright, Jason D

2018-05-01

Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record.

PubMed

Joukes, Erik; Abu-Hanna, Ameen; Cornet, Ronald; de Keizer, Nicolette F

2018-01-01

Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations. This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations. We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression. We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (-8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (-4.6%). The effect on dedicated documentation time significantly differed between centers. Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care. Schattauer GmbH Stuttgart.

Task Descriptions in Diagnostic Radiology. Research Report No. 7. Volume 4, Index of Tasks by Code Number and Extended Name.

ERIC Educational Resources Information Center

Gilpatrick, Eleanor

The fourth of four volumes in Research Report No. 7 of the Health Services Mobility Study (HSMS), this book contains the extended task names of all the tasks whose descriptions can be found in the three prior volumes. It serves as an index to all the tasks by listing the volume in which each task description appears. Chapter 1 of this volume…

Who Are the Most Influential Emergency Physicians on Twitter?

PubMed Central

Riddell, Jeff; Brown, Alisha; Kovic, Ivor; Jauregui, Joshua

2017-01-01

Introduction Twitter has recently gained popularity in emergency medicine (EM). Opinion leaders on Twitter have significant influence on the conversation and content, yet little is known about these opinion leaders. We aimed to describe a methodology to identify the most influential emergency physicians (EP) on Twitter and present a current list. Methods We analyzed 2,234 English-language EPs on Twitter from a previously published list of Twitter accounts generated by a snowball sampling technique. Using NodeXL software, we performed a network analysis of these EPs and ranked them on three measures of influence: in-degree centrality, eigenvector centrality, and betweenness centrality. We analyzed the top 100 users in each of these three measures of influence and compiled a list of users found in the top 100 in all three measures. Results Of the 300 total users identified by one of the measures of influence, there were 142 unique users. Of the 142 unique users, 61 users were in the top 100 on all three measures of influence. We identify these 61 users as the most influential EM Twitter users. Conclusion We both describe a method for identifying the most influential users and provide a list of the 61 most influential EPs on Twitter as of January 1, 2016. This application of network science to the EM Twitter community can guide future research to better understand the networked global community of EM. PMID:28210365

Who Are the Most Influential Emergency Physicians on Twitter?

PubMed

Riddell, Jeff; Brown, Alisha; Kovic, Ivor; Jauregui, Joshua

2017-02-01

Twitter has recently gained popularity in emergency medicine (EM). Opinion leaders on Twitter have significant influence on the conversation and content, yet little is known about these opinion leaders. We aimed to describe a methodology to identify the most influential emergency physicians (EP) on Twitter and present a current list. We analyzed 2,234 English-language EPs on Twitter from a previously published list of Twitter accounts generated by a snowball sampling technique. Using NodeXL software, we performed a network analysis of these EPs and ranked them on three measures of influence: in-degree centrality, eigenvector centrality, and betweenness centrality. We analyzed the top 100 users in each of these three measures of influence and compiled a list of users found in the top 100 in all three measures. Of the 300 total users identified by one of the measures of influence, there were 142 unique users. Of the 142 unique users, 61 users were in the top 100 on all three measures of influence. We identify these 61 users as the most influential EM Twitter users. We both describe a method for identifying the most influential users and provide a list of the 61 most influential EPs on Twitter as of January 1, 2016. This application of network science to the EM Twitter community can guide future research to better understand the networked global community of EM.

The effects of a patient shortage on general practitioners' future income and list of patients.

PubMed

Iversen, Tor

2004-07-01

The literature on physician-induced demand (PID) suffers from an inability to distinguish between the effect of better access and the effect of patient shortage. Data from the Norwegian capitation trial in general practice give us an opportunity to make this distinction and hence, study whether service provision by physicians is partly income-motivated. In the capitation trial, each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and a fee for service. The data set has information on patient shortage, i.e. a positive difference between a GP's preferred and actual list size, at the individual practice level. From a model of a GP's optimal choice we derive the GP's optimal practice profile contingent on whether the GP experiences a shortage of patients or not. To what extent GPs, who experience a shortage, will undertake measures to attract patients or embark on a service-intensive practice style depends on the costs of the various measures relative to their expected benefit. The model classifies GPs into five types. In the empirical analysis a panel of GPs is followed for 5 years. Hence, transitory effects should have been exhausted. We show that GPs who experience a shortage of patients have a higher income per listed person than their unrationed colleagues.

Agriculture. Sheep Livestock.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for agricultural production, specifically for sheep, is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a task sheet for developing leadership skills, and a task list. Each…

Agriculture. Poultry Livestock.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for agricultural production, specifically for poultry, is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a task sheet for developing leadership skills, and a task list.…

Agriculture. Swine Livestock.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for agricultural production, specifically for swine, is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a task sheet for developing leadership skills, and a task list. Each…

Featuring: It Works! Competency Based Instruction.

ERIC Educational Resources Information Center

Elston, Teri

1979-01-01

Describes a competency based curriculum approach for ornamental horticulture. A horticulture cluster core consisting of 18 tasks was developed with competency sheets for each task. The competency sheet contains six columns: skills to be attained, task list, materials required, student activities, evaluation methods, and a recommended time period.…

Make your small practice thrive. Physicians moving from big practices to small must know the business side of medicine.

PubMed

Cowan, D

2001-01-01

Trying to gain a measure of control over their working lives, some physicians are abandoning large group practices for smaller groups. Large groups enjoy whole teams of people performing vital business tasks. Small practices rely on one or two key physicians and managers to tackle everything from customer service to marketing, medical records to human resources. Learn valuable tips for thriving in a small environment and using that extra control to achieve job satisfaction.

LUNSORT list of lunar orbiter data by LAC area

NASA Technical Reports Server (NTRS)

Hixon, S.

1976-01-01

Lunar orbiter (missions 1-5) photographic data are listed sequentially according to the number (1 to 147) LAC (Lunar Aeronautical Chart) areas by use of a computer program called LUNSORT. This listing, as well as a similar one from Apollo would simplify the task of identifying images of a given Lunar area. Instructions and sample case are included.

Common Modality Effects in Immediate Free Recall and Immediate Serial Recall

ERIC Educational Resources Information Center

Grenfell-Essam, Rachel; Ward, Geoff; Tan, Lydia

2017-01-01

In 2 experiments, participants were presented with lists of between 2 and 12 words for either immediate free recall (IFR) or immediate serial recall (ISR). Auditory recall advantages at the end of the list (modality effects) and visual recall advantages early in the list (inverse modality effects) were observed in both tasks and the extent and…

Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.

PubMed

Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2003-01-01

It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

The effect of cognitive load and patient race on physicians' decisions to prescribe opioids for chronic low back pain: a randomized trial.

PubMed

Burgess, Diana J; Phelan, Sean; Workman, Michael; Hagel, Emily; Nelson, David B; Fu, Steven S; Widome, Rachel; van Ryn, Michelle

2014-06-01

To test the hypothesis that racial biases in opioid prescribing would be more likely under high levels of cognitive load, defined as the amount of mental activity imposed on working memory, which may come from environmental factors such as stressful conditions, chaotic workplace, staffing insufficiency, and competing demands, one's own psychological or physiological state, as well as from demands inherent in the task at hand. Two (patient race: White vs Black) by two (cognitive load: low vs high) between-subjects factorial design. Ninety-eight primary care physicians from the Veterans Affairs Healthcare System. Web-based experimental study. Physicians were randomly assigned to read vignettes about either a Black or White patient, under low vs high cognitive load, and to indicate their likelihood of prescribing opioids. High cognitive load was induced by having physicians perform a concurrent task under time pressure. There was a three-way interaction between patient race, cognitive load, and physician gender on prescribing decisions (P = 0.034). Hypotheses were partially confirmed. Male physicians were less likely to prescribe opioids for Black than White patients under high cognitive load (12.5% vs 30.0%) and were more likely to prescribe opioids for Black than White patients under low cognitive load (30.8% vs 10.5%). By contrast, female physicians were more likely to prescribe opioids for Black than White patients in both conditions, with greater racial differences under high (39.1% vs 15.8%) vs low cognitive load (28.6% vs 21.7%). Physician gender affected the way in which patient race and cognitive load influenced decisions to prescribe opioids for chronic pain. Future research is needed to further explore the potential effects of physician gender on racial biases in pain treatment, and the effects of physician cognitive load on pain treatment. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Ascertaining top evidence in emergency medicine: A modified Delphi study.

PubMed

Bazak, Stephanie J; Sherbino, Jonathan; Upadhye, Suneel; Chan, Teresa

2018-06-21

CLINICIAN'S CAPSULE What is known about the topic? EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. What did the study ask? What list of "top papers" was formulated in the field of EM using a national Canadian Delphi approach to achieve an expert consensus? What did the study find? A list was produced of top studies relevant for Canadian EM physicians in training. Why does this study matter to clinicians? The list produced can be used as an educational resource for junior residents.

The effect of deep brain stimulation of the subthalamic nucleus on executive functions: impaired verbal fluency and intact updating, planning and conflict resolution in Parkinson's disease.

PubMed

Demeter, Gyula; Valálik, István; Pajkossy, Péter; Szőllősi, Ágnes; Lukács, Ágnes; Kemény, Ferenc; Racsmány, Mihály

2017-04-24

Although the improvement of motor symptoms in Parkinson's disease (PD) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) is well documented, there are open questions regarding its impact on cognitive functions. The aim of this study was to assess the effect of bilateral DBS of the STN on executive functions in PD patients using a DBS wait-listed PD control group. Ten PD patients with DBS implantation (DBS group) and ten PD wait-listed patients (Clinical control group) participated in the study. Neuropsychological tasks were used to assess general mental ability and various executive functions. Each task was administered twice to each participant: before and after surgery (with the stimulators on) in the DBS group and with a matched delay between the two task administration points in the control group. There was no significant difference between the DBS and the control groups' performance in tasks measuring the updating of verbal, spatial or visual information (Digit span, Corsi and N-back tasks), planning and shifting (Trail Making B), and conflict resolution (Stroop task). However, the DBS group showed a significant decline on the semantic verbal fluency task after surgery compared to the control group, which is in line with findings of previous studies. Our results provide support for the relative cognitive safety of the STN DBS using a wait-listed PD control group. Differential effects of the STN DBS on frontostriatal networks are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Subjective and objective quantification of physician's workload and performance during radiation therapy planning tasks.

PubMed

Mazur, Lukasz M; Mosaly, Prithima R; Hoyle, Lesley M; Jones, Ellen L; Marks, Lawrence B

2013-01-01

To quantify, and compare, workload for several common physician-based treatment planning tasks using objective and subjective measures of workload. To assess the relationship between workload and performance to define workload levels where performance could be expected to decline. Nine physicians performed the same 3 tasks on each of 2 cases ("easy" vs "hard"). Workload was assessed objectively throughout the tasks (via monitoring of pupil size and blink rate), and subjectively at the end of each case (via National Aeronautics and Space Administration Task Load Index; NASA-TLX). NASA-TLX assesses the 6 dimensions (mental, physical, and temporal demands, frustration, effort, and performance); scores > or ≈ 50 are associated with reduced performance in other industries. Performance was measured using participants' stated willingness to approve the treatment plan. Differences in subjective and objective workload between cases, tasks, and experience were assessed using analysis of variance (ANOVA). The correlation between subjective and objective workload measures were assessed via the Pearson correlation test. The relationships between workload and performance measures were assessed using the t test. Eighteen case-wise and 54 task-wise assessments were obtained. Subjective NASA-TLX scores (P < .001), but not time-weighted averages of objective scores (P > .1), were significantly lower for the easy vs hard case. Most correlations between the subjective and objective measures were not significant, except between average blink rate and NASA-TLX scores (r = -0.34, P = .02), for task-wise assessments. Performance appeared to decline at NASA-TLX scores of ≥55. The NASA-TLX may provide a reasonable method to quantify subjective workload for broad activities, and objective physiologic eye-based measures may be useful to monitor workload for more granular tasks within activities. The subjective and objective measures, as herein quantified, do not necessarily track each other, and more work is needed to assess their utilities. From a series of controlled experiments, we found that performance appears to decline at subjective workload levels ≥55 (as measured via NASA-TLX), which is consistent with findings from other industries. Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Commentary: deconstructing gender difference.

PubMed

Carnes, Molly

2010-04-01

In Japan, as in the United States, a growing proportion of physicians are women. Hence, the different social roles that men and women occupy and the gendered norms for behavior are increasingly relevant in ensuring that male and female physicians have equal opportunity to participate and advance in all aspects of medicine. Elsewhere in this issue, Nomura and colleagues report on a large survey of primary care residents in Japan. They found that on average women's self-rated confidence on many clinical tasks was lower than men's. This is not surprising given similar gender differences in self-assessed competence in other research and the socialization of women in virtually all cultures to be modest. The actual differences in average scores were small suggesting considerable overlap in the distributions of responses from male and female residents. In addition, research from other countries finds no association between physicians' self-reported confidence in clinical tasks and objective measures of competence on which female physicians rate at or above the level of their male counterparts. Congruent with different social roles for men and women, Nomura and colleagues also found gender differences in the average responses about work-family priorities and aspirations toward leadership, but some women indicated a desire for research careers and some men were "life-oriented." The author of this commentary argues that to draw conclusions about all male or all female physicians from average differences of a large group of residents may reinforce gender stereotypes that continue to impede each individual female physician's career advancement and each individual male physician's struggle for work-life balance.

The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem?

PubMed

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B; Ahmed, Adil

2017-01-25

Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient's problem list for patients with eligible body mass indexes (BMI) as contained in the patients' electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.

Employed family physician satisfaction and commitment to their practice, work group, and health care organization.

PubMed

Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L

2010-04-01

Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.

Self-assessment of intercultural communication skills: a survey of physicians and medical students in Geneva, Switzerland

PubMed Central

2011-01-01

Background Physicians working with multicultural populations need to know how to elicit the patient's understanding of the illness; determine the patient's sociocultural context and identify any issues that might affect care; communicate effectively across patient-provider social and cultural differences; and collaborate effectively with an interpreter. Skills self-assessment can contribute to identifying training needs and monitoring skills development in these areas. Methods As part of a larger study exploring the knowledge, attitudes and practices of Geneva physicians and medical students regarding the care of immigrant patients, we asked respondents to self-rate their ability to perform a range of common yet challenging intercultural communication tasks. Results Overall, respondents rated themselves less competent at intercultural tasks than at basic medical skills and less competent at specific intercultural communication skills than at general intercultural skills. Qualified doctors (as opposed to students), those with greater interest in caring for immigrants, and those who rarely encountered difficulties with immigrants rated themselves significantly more competent for all clinical tasks. Having a higher percentage of immigrant patients and previous cultural competence training predicted greater self-rated intercultural communication skills. Conclusion Our self-assessment results suggest that students and physicians should be provided with the opportunity to practice intercultural skills with immigrant patients as part of their cultural competence training. To strengthen the validity of self-assessment measures, they should ideally be combined with more objective methods to assess actual skills. PMID:21884609

The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

PubMed Central

Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

2016-01-01

OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

Task Shifting and Skin Punch for the Histologic Diagnosis of Kaposi's Sarcoma in Sub-Saharan Africa: A Public Health Solution to a Public Health Problem.

PubMed

Laker-Oketta, Miriam O; Wenger, Megan; Semeere, Aggrey; Castelnuovo, Barbara; Kambugu, Andrew; Lukande, Robert; Asirwa, F Chite; Busakhala, Naftali; Buziba, Nathan; Diero, Lameck; Wools-Kaloustian, Kara; Strother, Robert Matthew; Bwana, Mwebesa; Muyindike, Winnie; Amerson, Erin; Mbidde, Edward; Maurer, Toby; Martin, Jeffrey

2015-01-01

Fueled by HIV, sub-Saharan Africa has the highest incidence of Kaposi's sarcoma (KS) in the world. Despite this, KS diagnosis in the region is based mostly on clinical grounds. Where biopsy is available, it has traditionally been excisional and performed by surgeons, resulting in multiple appointments, follow-up visits for suture removal, and substantial costs. We hypothesized that a simpler approach - skin punch biopsy - would make histologic diagnosis more accessible. To address this, we provided training and equipment for skin punch biopsy of suspected KS to three HIV clinics in East Africa. The procedure consisted of local anesthesia followed by a disposable cylindrical punch blade to obtain specimens. Hemostasis is facilitated by Gelfoam®. Patients removed the dressing after 4 days. From 2007 to 2013, 2,799 biopsies were performed. Although originally targeted to be used by physicians, biopsies were performed predominantly by nurses (62%), followed by physicians (15%), clinical officers (12%) and technicians (11%). There were no reports of recurrent bleeding or infection. After minimal training and provision of inexpensive equipment (USD 3.06 per biopsy), HIV clinics in East Africa can integrate same-day skin punch biopsy for suspected KS. Task shifting from physician to non-physician greatly increases access. Skin punch biopsy should be part of any HIV clinic's essential procedures. This example of task shifting may also be applicable to the diagnosis of other cancers (e.g., breast) in resource-limited settings.

Challenges to ethics and professionalism facing the contemporary neurologist.

PubMed

Bernat, James L

2014-09-30

Challenges to ethics and professionalism that can harm neurologists and their patients include the commercialization of medicine, poorly designed Medicare regulations, conflicts of interest, physician employment by hospitals, faulty measurement of medical quality care, electronic health records, electronic communications with patients, and the demotion of the role of physician beneficence. These threats can lead to inaccurate medical record-keeping, unnecessary medical care, a decline in the primacy of patients' interests, and damage to the sanctity of the patient-physician relationship. The increasing frequency of physician burnout can be attributed at least partially to unmitigated stresses on practicing physicians, particularly the growing time pressures for patient visits, the mounting daily requirements of documentation, and the increasing burden of time-consuming but unproductive tasks. Recommended correctives include reforming billing documentation regulations, improving electronic health records, designing proper quality indicators integrating physician wellness, and incorporating reasonable physician workflows in the design of accountable care organizations. © 2014 American Academy of Neurology.

Domain-specific and domain-general constraints on word and sequence learning.

PubMed

Archibald, Lisa M D; Joanisse, Marc F

2013-02-01

The relative influences of language-related and memory-related constraints on the learning of novel words and sequences were examined by comparing individual differences in performance of children with and without specific deficits in either language or working memory. Children recalled lists of words in a Hebbian learning protocol in which occasional lists repeated, yielding improved recall over the course of the task on the repeated lists. The task involved presentation of pictures of common nouns followed immediately by equivalent presentations of the spoken names. The same participants also completed a paired-associate learning task involving word-picture and nonword-picture pairs. Hebbian learning was observed for all groups. Domain-general working memory constrained immediate recall, whereas language abilities impacted recall in the auditory modality only. In addition, working memory constrained paired-associate learning generally, whereas language abilities disproportionately impacted novel word learning. Overall, all of the learning tasks were highly correlated with domain-general working memory. The learning of nonwords was additionally related to general intelligence, phonological short-term memory, language abilities, and implicit learning. The results suggest that distinct associations between language- and memory-related mechanisms support learning of familiar and unfamiliar phonological forms and sequences.

The effect of strategic memory training in older adults: who benefits most?

PubMed

Rosi, Alessia; Del Signore, Federica; Canelli, Elisa; Allegri, Nicola; Bottiroli, Sara; Vecchi, Tomaso; Cavallini, Elena

2017-12-07

Previous research has suggested that there is a degree of variability among older adults' response to memory training, such that some individuals benefit more than others. The aim of the present study was to identify the profile of older adults who were likely to benefit most from a strategic memory training program that has previously proved to be effective in improving memory in healthy older adults. In total, 44 older adults (60-83 years) participated in a strategic memory training. We examined memory training benefits by measuring changes in memory practiced (word list learning) and non-practiced tasks (grocery list and associative learning). In addition, a battery of cognitive measures was administered in order to assess crystallized and fluid abilities, short-term memory, working memory, and processing speed. Results confirmed the efficacy of the training in improving performance in both practiced and non-practiced memory tasks. For the practiced memory tasks, results showed that memory baseline performance and crystallized ability predicted training gains. For the non-practiced memory tasks, analyses showed that memory baseline performance was a significant predictor of gain in the grocery list learning task. For the associative learning task, the significant predictors were memory baseline performance, processing speed, and marginally the age. Our results indicate that older adults with a higher baseline memory capacity and with more efficient cognitive resources were those who tended to benefit most from the training. The present study provides new avenues in designing personalized intervention according to the older adults' cognitive profile.

Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

PubMed Central

Dresden, Graham M.; Baldwin, Laura-Mae; Andrilla, C. Holly A.; Skillman, Susan M.; Benedetti, Thomas J.

2008-01-01

PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline—the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics. PMID:18195307

Word list and story recall elicit different patterns of memory deficit in patients with Alzheimer's disease, frontotemporal dementia, subcortical ischemic vascular disease, and Lewy body dementia.

PubMed

Perri, Roberta; Fadda, Lucia; Caltagirone, Carlo; Carlesimo, Giovanni Augusto

2013-01-01

Different roles have been attributed to mesio-temporal areas and frontal lobes in declarative memory functioning, and qualitative differences have been observed in the amnesic symptoms due to pathological damage of these two portions of the central nervous system. The aim of the present study was to look for memory profiles related to pathological involvement in the temporal and frontal structures in patients with different dementia syndromes on word-list and prose memory tasks. 20 patients with Alzheimer's disease (AD), 20 with frontal variant of FTD (fvFTD), 20 with subcortical ischemic vascular dementia (SIVD), and 20 with Lewy body dementia (LBD) and 34 healthy subjects (NCs) were submitted to word-list and prose memory tasks. All groups performed similarly on both the immediate and delayed recall of the word-list. Conversely, AD patients performed worse than all the other dementia groups on the immediate prose recall. On delayed prose recall, AD patients performed worse than fvFTD and SIVD patients but similar to LBD patients. Differential scores between word-list and prose tests were minimal in the AD group and very pronounced in fvFTD and SIVD groups. The combined use of the prose and word-list tasks evidenced a "mesio-temporal" memory profile in AD patients as opposed to a "frontal" one in fvFTD and SIVD patients and a mixed profile in the LBD patients. In particular, a differential score between the two tests can be useful in differentiating AD patients from patients with other forms of dementia.

75 FR 52487 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... practice reporting option I (GPRO I) measures, we inadvertently omitted hypertension from the list of... preventive care services.'' is corrected to read ``heart failure; hypertension; and preventive care services...

Point-of-care ultrasonography by pediatric emergency medicine physicians.

PubMed

Marin, Jennifer R; Lewiss, Resa E

2015-04-01

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews. Copyright © 2015 by the American Academy of Pediatrics.

A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis.

PubMed

Cook, Nicola A; Kim, Jin Un; Pasha, Yasmin; Crossey, Mary Me; Schembri, Adrian J; Harel, Brian T; Kimhofer, Torben; Taylor-Robinson, Simon D

2017-01-01

Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients' quality of life and the ability to drive and operate machinery (with societal consequences). We compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis. This was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance. Strong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis. Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice.

Influence of working memory and executive function on stair ascent and descent in young and older adults.

PubMed

Gaillardin, Florence; Baudry, Stéphane

2018-06-01

This study assessed the influence of attention division, working memory and executive function on stair ascent and descent in young and older adults. Twenty young (25.5 ± 2.1 yrs) and 20 older adults (68.4 ± 5.4 yrs) ascended and descended a 3-step staircase with no simultaneous cognitive task (single-motor task) or while performing a cognitive task (dual-task condition). The cognitive task involved either 1) recalling a word list of the subject's word-span minus 2 words (SPAN-2) to assess the attention division effect, 2) a word list of subject's word-span (SPAN-O) to assess the working memory effect, or 3) recalling in alphabetical order, a word list of the subject's word-span (SPAN-A) to assess the executive function effect. Word-span corresponds to the longest string of words that can be recalled correctly. The duration of ascent and descent of stairs was used to assess the cognitive-motor interaction. Stair ascent and descent duration did not differ between age groups for the single-motor task, and was similar between single-motor task and SPAN-2 in both groups (p > 0.05). In contrast, stair ascent and descent duration increased with SPAN-O compared with SPAN-2 for both groups (p < 0.01). Stair ascent (p = 0.017) and descent (p = 0.008) were longer in SPAN-A than SPAN-O only in older adults. Healthy aging was not associated with a decrease in the capacity to perform motor-cognitive dual tasks that involved ascending and descending of stairs when the cognitive task only required working memory. However, the decrease in dual-task performance involving executive functioning may reflect a subclinical cognitive decline in healthy older adults. Copyright © 2018 Elsevier Inc. All rights reserved.

Important questions asked by family members of intensive care unit patients.

PubMed

Peigne, Vincent; Chaize, Marine; Falissard, Bruno; Kentish-Barnes, Nancy; Rusinova, Katerina; Megarbane, Bruno; Bele, Nicolas; Cariou, Alain; Fieux, Fabienne; Garrouste-Orgeas, Maite; Georges, Hugues; Jourdain, Merce; Kouatchet, Achille; Lautrette, Alexandre; Legriel, Stephane; Regnier, Bernard; Renault, Anne; Thirion, Marina; Timsit, Jean-Francois; Toledano, Dany; Chevret, Sylvie; Pochard, Frédéric; Schlemmer, Benoît; Azoulay, Elie

2011-06-01

Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit. This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering. The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients. This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.

The Role of Reminding in the Effects of Spaced Repetitions on Cued Recall: Sufficient but Not Necessary

ERIC Educational Resources Information Center

Wahlheim, Christopher N.; Maddox, Geoffrey B.; Jacoby, Larry L.

2014-01-01

Three experiments examined the role of study-phase retrieval (reminding) in the effects of spaced repetitions on cued recall. Remindings were brought under task control to evaluate their effects. Participants studied 2 lists of word pairs containing 3 item types: single items that appeared once in List 2, within-list repetitions that appeared…

A survey of U.S. physicians and their partners regarding the impact of work-home conflict.

PubMed

Dyrbye, Liselotte N; Sotile, Wayne; Boone, Sonja; West, Colin P; Tan, Litjen; Satele, Daniel; Sloan, Jeff; Oreskovich, Mick; Shanafelt, Tait

2014-01-01

Work-home conflicts (WHC) threaten work-life balance among physicians, especially those in dual career relationships. In this study, we analyzed factors associated with WHC for physicians and their employed partners. We surveyed 89,831 physicians from all specialty disciplines listed in the Physician Masterfile. Of the 7,288 (27.7 %) physicians who completed the survey, 1,644 provided the e-mail contact information of their partner. We surveyed these partners and 891 (54 %) responded. Burnout, quality of life (QOL), and depression were measured using validated instruments in both surveys. Satisfaction with career, work-life balance, and personal relationships, as well as experience of WHC were also evaluated. WHC within the previous 3 weeks were commonly experienced by physicians and their employed partners (44.3 % and 55.7 %, respectively). On multivariate analysis, greater work hours for physicians and their employed partners were independently associated with WHC (OR 1.31 and 1.23 for each additional 10 h, respectively, both p < 0.0001). Physicians and partners who had experienced a recent WHC were more likely to have symptoms of burnout (47.1 % vs. 26.6 % for physicians with and without WHC; 42.4 % vs. 23.8 % for partners with and without WHC, both p < 0.0001). WHC are commonly experienced by physicians and their employed partners. These conflicts may be a major contributor to personal distress for physicians and their partners.

48 CFR 2052.211-71 - Technical progress report.

Code of Federal Regulations, 2010 CFR

2010-10-01

... investigator, the contract period of performance, and the period covered by the report. Each report must include the following for each discrete task/task order: (a) A listing of the efforts completed during the...

Finnish physicians' experiences with computer-supported patient information exchange and communication in clinical work.

PubMed

Viitanen, Johanna; Nieminen, Marko; Hypponen, Hannele; Laaveri, Tinja

2011-01-01

Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer-supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians? experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange-related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross-organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician?nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.

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.

Usability problems do not heal by themselves: National survey on physicians' experiences with EHRs in Finland.

PubMed

Kaipio, Johanna; Lääveri, Tinja; Hyppönen, Hannele; Vainiomäki, Suvi; Reponen, Jarmo; Kushniruk, Andre; Borycki, Elizabeth; Vänskä, Jukka

2017-01-01

Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland. Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010. Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

IRS proposes ruling on physician recruitment. How a hospital recruits physicians would affect its tax-exempt status.

PubMed

Griffith, G M

1996-01-01

On March 15, 1995, the Internal Revenue Service (IRS) announced a proposed revenue ruling stating how certain physician recruitment practices could be implemented without threatening hospitals' tax-exemption. As proposed, the IRS ruling would provide flexibility for recruitment incentives rather than a list of strict physician recruitment guidelines. The proposed ruling is not legally binding until issued in final form, and there is no deadline for finalizing it. In the meantime, however, the standards outlined in the proposed ruling reflect arrangements the IRS likely would approve, which should be an incentive for tax-exempt hospitals to follow reasonable physician recruitment practices. Assuming a hospital complies with other legal requirements such as fraud and abuse laws, it must answer two key tax-exempt status questions for its recruitment or retention package: Will the incentives result in a disguised distribution of profits from the operation of the organization? Is the total incentive package reasonable under all the facts and circumstances, both in absolute total value for physician(s) recruited and in relation to services required by the hospital and the community? The proposed ruling also provides guidance on basic documentation requirements and a process for approving recruitment arrangements.

A Comparison of Two Methods Used for Ranking Task Exposure Levels Using Simulated Multi-Task Data

DTIC Science & Technology

1999-12-17

OF OKLAHOMA HEALTH SCIENCES CENTER GRADUATE COLLEGE A COMPARISON OF TWO METHODS USED FOR RANKING TASK EXPOSURE LEVELS USING SIMULATED MULTI-TASK...COSTANTINO Oklahoma City, Oklahoma 1999 ^ooo wx °^ A COMPARISON OF TWO METHODS USED FOR RANKING TASK EXPOSURE LEVELS USING SIMULATED MULTI-TASK DATA... METHODS AND MATERIALS 9 TV. RESULTS 14 V. DISCUSSION AND CONCLUSION 28 LIST OF REFERENCES 31 APPENDICES 33 Appendix A JJ -in Appendix B Dl IV

The Costs and Benefits of Testing and Guessing on Recognition Memory

ERIC Educational Resources Information Center

Huff, Mark J.; Balota, David A.; Hutchison, Keith A.

2016-01-01

We examined whether 2 types of interpolated tasks (i.e., retrieval-practice via free recall or guessing a missing critical item) improved final recognition for related and unrelated word lists relative to restudying or completing a filler task. Both retrieval-practice and guessing tasks improved correct recognition relative to restudy and filler…

77 FR 12907 - Visual-Manual NHTSA Driver Distraction Guidelines for In-Vehicle Electronic Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... impact of task performance while driving on driving safety and time-based acceptance criteria for... feedback). The proposed NHTSA Guidelines list certain secondary, non-driving related tasks that, based on... cannot be used by the driver to perform such tasks while the driver is driving. For all other secondary...

A Degradation Analysis Methodology for Maintenance Tasks

DTIC Science & Technology

1985-05-12

Support Maintenance Company ......... ................... ...... 115 ................. .................. ,.... - ’ vi LIST OF FIGURES Figure Page 1-I...Versus Individual Effectiveness ..................... 115 5-4. Effectiveiess Results for Threat One ..................... 117 5-5. Effectiveness...model does not differenti - ate between a task which requires a high degree of fine finger dexteri- ty from another task involving only gross body

Medical Laboratory Assistant. Laboratory Occupations Cluster.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for medical laboratory assistant is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a career ladder, a matrix relating duty/task numbers to job titles, and a task list. Each…

Histologic Technician. Laboratory Occupations Cluster.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. Coll. of Agriculture and Natural Resources Education Inst.

This task-based curriculum guide for histologic technician is intended to help the teacher develop a classroom management system where students learn by doing. Introductory materials include a Dictionary of Occupational Titles job code and title sheet, a career ladder, a matrix relating duty/task numbers to job titles, and a task list. Each task…

Industrial Arts Instructional Tasks/Competencies for Energy and Power. Competency-Based Education.

ERIC Educational Resources Information Center

George Mason Univ., Fairfax, VA.

This instructional task/competency package is designed to help teachers and administrators in developing competency-based instructional materials for an energy and power course. Part 1 contains a description of the industrial arts program and a course description, instructional task/competency list, and content outline for energy and power. The…

Industrial Electrical Maintenance Learning Guides and Task Listing by Occupational Titles.

ERIC Educational Resources Information Center

Whitmer, Melvin

Seven student learning guides are provided for an industrial electrical maintenance program at the secondary, postsecondary, or adult level. Each learning guide is composed of these component parts: a title page that states the task, purpose, program and task numbers, estimated time, and prerequisites; an optional learning contract that includes…

Advanced Marketing Core Curriculum. Test Items and Assessment Techniques.

ERIC Educational Resources Information Center

Smith, Clifton L.; And Others

This document contains duties and tasks, multiple-choice test items, and other assessment techniques for Missouri's advanced marketing core curriculum. The core curriculum begins with a list of 13 suggested textbook resources. Next, nine duties with their associated tasks are given. Under each task appears one or more citations to appropriate…

Role of optimization in the human dynamics of task execution

NASA Astrophysics Data System (ADS)

Cajueiro, Daniel O.; Maldonado, Wilfredo L.

2008-03-01

In order to explain the empirical evidence that the dynamics of human activity may not be well modeled by Poisson processes, a model based on queuing processes was built in the literature [A. L. Barabasi, Nature (London) 435, 207 (2005)]. The main assumption behind that model is that people execute their tasks based on a protocol that first executes the high priority item. In this context, the purpose of this paper is to analyze the validity of that hypothesis assuming that people are rational agents that make their decisions in order to minimize the cost of keeping nonexecuted tasks on the list. Therefore, we build and analytically solve a dynamic programming model with two priority types of tasks and show that the validity of this hypothesis depends strongly on the structure of the instantaneous costs that a person has to face if a given task is kept on the list for more than one period. Moreover, one interesting finding is that in one of the situations the protocol used to execute the tasks generates complex one-dimensional dynamics.

Differences in day and night shift clinical performance in anesthesiology.

PubMed

Cao, Caroline G L; Weinger, Matthew B; Slagle, Jason; Zhou, Chuan; Ou, Jennie; Gillin, Shakha; Sheh, Bryant; Mazzei, William

2008-04-01

This study examined whether anesthesia residents (physicians in training) performed clinical duties in the operating room differently during the day versus at night. Fatigue from sleep deprivation and working through the night is common for physicians, particularly during residency training. Using a repeated-measures design, we studied 13 pairs of day-night matched anesthesia cases. Dependent measures included task times, workload ratings, response to an alarm light latency task, and mood. Residents spent significantly less time on manual tasks and more time on monitoring tasks during the maintenance phase at night than during the day. Residents reported more negative mood at night than during the day, both pre- and postoperation. However, time of day had no effect on the mood change between pre- and postoperation. Workload ratings and the response time to an alarm light latency task were not significantly different between night and day cases. Because night shift residents had been awake and working for more than 16 hr, the observed differences in task performance and mood may be attributed to fatigue. The changes in task distribution during night shift work may represent compensatory strategies to maintain patient care quality while keeping perceived workload at a manageable level. Fatigue effects during night shifts should be considered when designing work-rest schedules for clinicians. This matched-case control scheme can also be applied to study other phenomena associated with patient safety in the actual clinical environment.

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.

Developing an effective business plan.

PubMed

Lehman, L B

1996-06-01

At some time, virtually all managed care executives, and most physician executives, will be asked to develop business plans. Business plans are thoughtful, comprehensive, and realistic descriptions of the many aspects of the formulation of a new business product or line for market. The author describes what goes into the writing of a business plan and how the physician executive should approach this task.

Free recall of word lists under total sleep deprivation and after recovery sleep.

PubMed

de Almeida Valverde Zanini, Gislaine; Tufik, Sérgio; Andersen, Monica Levy; da Silva, Raquel Cristina Martins; Bueno, Orlando Francisco Amodeo; Rodrigues, Camila Cruz; Pompéia, Sabine

2012-02-01

One task that has been used to assess memory effects of prior total sleep deprivation (TSD) is the immediate free recall of word lists; however, results have been mixed. A possible explanation for this is task impurity, since recall of words from different serial positions reflects use of distinct types of memory (last words: short-term memory; first and intermediate words: episodic memory). Here we studied the effects of 2 nights of TSD on immediate free recall of semantically unrelated word lists considering the serial position curve. Random allocation to a 2-night TSD protocol followed by one night of recovery sleep or to a control group. Study conducted under continuous behavioral monitoring. 24 young, healthy male volunteers. 2 nights of total sleep deprivation (TSD) and one night of recovery sleep. Participants were shown five 15 unrelated word-lists at baseline, after one and 2 nights of TSD, and after one night of recovery sleep. We also investigated the development of recall strategies (learning) and susceptibility to interference from previous lists. No free recall impairment occurred during TSD, irrespective of serial position. Interference was unchanged. Both groups developed recall strategies, but task learning occurred earlier in controls and was evident in the TSD group only after sleep recovery. Prior TSD spared episodic memory, short-term phonological memory, and interference, allowed the development of recall strategies, but may have decreased the advantage of using these strategies, which returned to normal after recovery sleep.

“Going Episodic”: Collaborative Inhibition and Facilitation When Long-Married Couples Remember Together

PubMed Central

Harris, Celia B.; Barnier, Amanda J.; Sutton, John; Keil, Paul G.; Dixon, Roger A.

2017-01-01

Two complementary approaches to the study of collaborative remembering have produced contrasting results. In the experimental “collaborative recall” approach within cognitive psychology, collaborative remembering typically results in ‘collaborative inhibition’: laboratory groups recall fewer items than their estimated potential. In the cognitive ageing approach, collaborative remembering with a partner or spouse may provide cuing and support to benefit older adults’ performance on everyday memory tasks. To combine the value of experimental and cognitive ageing approaches, we tested the effects of collaborative remembering in older, long-married couples who recalled a non-personal word list and a personal semantic list of shared trips. We scored amount recalled as well as the kinds of details remembered. We found evidence for collaborative inhibition across both tasks when scored strictly as number of list items recalled. However, we found collaborative facilitation of specific episodic details on the personal semantic list, details which were not strictly required for the completion of the task. In fact, there was a trade-off between recall of specific episodic details and number of trips recalled during collaboration. We discuss these results in terms of the functions of shared remembering and what constitutes memory success, particularly for intimate groups and for older adults. PMID:28071300

Predictors of laparoscopic simulation performance among practicing obstetrician gynecologists.

PubMed

Mathews, Shyama; Brodman, Michael; D'Angelo, Debra; Chudnoff, Scott; McGovern, Peter; Kolev, Tamara; Bensinger, Giti; Mudiraj, Santosh; Nemes, Andreea; Feldman, David; Kischak, Patricia; Ascher-Walsh, Charles

2017-11-01

While simulation training has been established as an effective method for improving laparoscopic surgical performance in surgical residents, few studies have focused on its use for attending surgeons, particularly in obstetrics and gynecology. Surgical simulation may have a role in improving and maintaining proficiency in the operating room for practicing obstetrician gynecologists. We sought to determine if parameters of performance for validated laparoscopic virtual simulation tasks correlate with surgical volume and characteristics of practicing obstetricians and gynecologists. All gynecologists with laparoscopic privileges (n = 347) from 5 academic medical centers in New York City were required to complete a laparoscopic surgery simulation assessment. The physicians took a presimulation survey gathering physician self-reported characteristics and then performed 3 basic skills tasks (enforced peg transfer, lifting/grasping, and cutting) on the LapSim virtual reality laparoscopic simulator (Surgical Science Ltd, Gothenburg, Sweden). The association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category) were examined with regression models. The average number of laparoscopic procedures per month was a significant predictor of total time on all 3 tasks (P = .001 for peg transfer; P = .041 for lifting and grasping; P < .001 for cutting). Average monthly laparoscopic surgical volume was a significant predictor of 2 efficiency scores in peg transfer, and all 4 efficiency scores in cutting (P = .001 to P = .015). Surgical volume was a significant predictor of errors in lifting/grasping and cutting (P < .001 for both). Self-rated laparoscopic skill level was a significant predictor of total time in all 3 tasks (P < .0001 for peg transfer; P = .009 for lifting and grasping; P < .001 for cutting) and a significant predictor of nearly all efficiency scores and errors scores in all 3 tasks. In addition to total time, there was at least 1 other objective performance measure that significantly correlated with surgical volume for each of the 3 tasks. Higher-volume physicians and those with fellowship training were more confident in their laparoscopic skills. By determining simulation performance as it correlates to active physician practice, further studies may help assess skill and individualize training to maintain skill levels as case volumes fluctuate. Copyright © 2017 Elsevier Inc. All rights reserved.

What Do Academic Primary Care Physicians Want in an Electronic Journal?

PubMed Central

Torre, Dario M; Wright, Scott M; Wilson, Renée F; Diener-West, Marie; Bass, Eric B

2003-01-01

To determine the interest of academic general internists and family physicians in specific features of electronic journal publications, we surveyed 350 physicians, 175 randomly selected from each of 2 medical societies: the Society of General Internal Medicine, and the Society of Teachers of Family Medicine. The response rate was 70%. Most general internists and family physicians used online journals sometimes or often. Most general internists and family physicians reported moderate to high interest in having links from original articles, reviews, or editorials to listed references (77% to 89% of internists and 65% to 81% of family physicians) and electronic medical reference texts (73% to 78% of internists and 65% to 83% of family physicians). Less than 25% of both groups reported moderate to high interest in having links to initiate dialog with other readers or to communicate comments to the author or editor. General internists were more likely than were family physicians to have moderate to high interest in having links to appendices and supportive material (e.g., 66% of general internists versus 46% of family physicians for original articles; P < .05) and less likely to have moderate to high interest in links to health-related web sites (44% of general internists versus 69% of family physicians for original articles; P < .05). We conclude that academic general internists and family physicians have strong but not identical interests in specific features of electronic publication that primary care–oriented journals should consider. PMID:12648253

Barriers to vitamin D supplementation among military physicians.

PubMed

Sherman, Eric M; Svec, Rita V

2009-03-01

We surveyed military pediatricians and family physicians about barriers to vitamin D supplementation. We obtained lists of uniformed members of the American Academy of Pediatrics (AAP) and American Academy of Family Practice (AAFP). Three hundred individuals were randomly selected from each group and surveyed about: (1) practice habits; (2) vitamin D use and barriers to supplementation; (3) demographic factors. Pediatricians were 40% more likely to be aware of AAP recommendations about vitamin D (p < 0.001) and 40% more likely to prescribe vitamin D to exclusively breastfed infants (p < 0.001). The most common reason for not recommending vitamin D was the belief that breastfed infants received adequate sunlight. Most military pediatricians supplement breastfed infants with vitamin D. Military family physicians are less likely to supplement breastfed infants and are targets for educational interventions. Many physicians mistakenly believe that adequate sunlight exposure prevents vitamin D deficiency, another focus for future interventions.

Work-related stress management between workplace and occupational health care.

PubMed

Kinnunen-Amoroso, Maritta; Liira, Juha

2016-06-13

Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services. The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises. From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0. The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies' own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress. Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.

[Legal aspects of Web 2.0 in the health field].

PubMed

Beslay, Nathalie; Jeunehomme, Marie

2009-10-01

Web 2.0 sites are considered to be hosting providers and not publishers of user-generated content. The liability of hosting providers' liability is defined by the law enacted on June 21, 2004, on confidence in the digital economy. Hosting providers must promptly remove the information they host or make its access impossible once they are informed of its illegality. They are required to obtain and retain data to enable identification of any person who has contributed to content hosted by them. The liability of hosting providers has arisen in numerous disputes about user-produced content in various situations (discussion lists, blogs, etc.). The National Board of Physicians has developed specific ethical guidelines for web sites devoted to health issues and specifically for physician-authored content. The National Board of Physicians acknowledges that physicians can present themselves, their office, and their specific practice on their web site, notwithstanding any restrictions otherwise applicable to advertising.

Fundamentals of Welding. Teacher Edition.

ERIC Educational Resources Information Center

Fortney, Clarence; And Others

These instructional materials assist teachers in improving instruction on the fundamentals of welding. The following introductory information is included: use of this publication; competency profile; instructional/task analysis; related academic and workplace skills list; tools, materials, and equipment list; and 27 references. Seven units of…

E-health: transforming the physician/patient relationship.

PubMed

Ball, M J; Lillis, J

2001-04-01

Healthcare delivery is being transformed by advances in e-health and by the empowered, computer-literate public. Ready to become partners in their own health and to take advantage of online processes, health portals, and physician web pages and e-mail, this new breed of consumer is slowly redefining the physician/patient relationship. Such changes can effect positive results like improved clinical decision-making, increased efficiency, and strengthened communication between physicians and patients. First, however, physicians and the organizations that support them must fully understand their role in the e-health revolution. Both must advance their awareness of the new consumers and their needs and define specific action items that will help them realize the benefits of e-health. Through a combination of timely research and advice, this article will aid them in fulfilling both tasks.

78 FR 74229 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-10

...This major final rule with comment period addresses changes to the physician fee schedule, clinical laboratory fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs. (See the Table of Contents for a listing of the specific issues addressed in the final rule with comment period.)

[The travelling sports physician].

PubMed

Jenoure, Peter

2016-07-13

Travelling around your own country or even further abroad with a sports team or individual athletes as a sports physician is to be considered as a fundamental part of the various activities of a sports medicine practitioner.However, in our modern and quickly changing world, it is imperative to understand the different aspects of caring for athletes, also the legal ones. These may include licensing issues, malpractice coverage, access to care at outside institutions and prescribing and transporting medication of all sorts, including narcotics and substances of the list of prohibited ones (doping).With significant changes in healthcare at state and national levels, physicians must be aware of how these policy differences can affect their way of working, their ability to provide the expected care.

Students as Assets.

ERIC Educational Resources Information Center

Lipsky, Martin S.; Egan, Mari

1999-01-01

Lists ten ways in which having medical students in the community physician's office can be of value to preceptors, including providing valuable but time-consuming patient services, following up on phone calls, providing computer skills, performing minor office procedures, reviewing medical records, helping with paperwork, stimulating preceptor…

Examining the relationship between immediate serial recall and immediate free recall: common effects of phonological loop variables but only limited evidence for the phonological loop.

PubMed

Spurgeon, Jessica; Ward, Geoff; Matthews, William J

2014-07-01

We examined the contribution of the phonological loop to immediate free recall (IFR) and immediate serial recall (ISR) of lists of between one and 15 words. Following Baddeley (1986, 2000, 2007, 2012), we assumed that visual words could be recoded into the phonological store when presented silently but that recoding would be prevented by concurrent articulation (CA; Experiment 1). We further assumed that the use of the phonological loop would be evidenced by greater serial recall for lists of phonologically dissimilar words relative to lists of phonologically similar words (Experiments 2A and 2B). We found that in both tasks, (a) CA reduced recall; (b) participants recalled short lists from the start of the list, leading to enhanced forward-ordered recall; (c) participants were increasingly likely to recall longer lists from the end of the list, leading to extended recency effects; (d) there were significant phonological similarity effects in ISR and IFR when both were analyzed using serial recall scoring; (e) these were reduced by free recall scoring and eliminated by CA; and (f) CA but not phonological similarity affected the tendency to initiate recall with the first list item. We conclude that similar mechanisms underpin ISR and IFR. Critically, the phonological loop is not strictly necessary for the forward-ordered recall of short lists on both tasks but may augment recall by increasing the accessibility of the list items (relative to CA), and in so doing, the order of later items is preserved better in phonologically dissimilar than in phonologically similar lists. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Free Recall of Word Lists under Total Sleep Deprivation and after Recovery Sleep

PubMed Central

de Almeida Valverde Zanini, Gislaine; Tufik, Sérgio; Andersen, Monica Levy; da Silva, Raquel Cristina Martins; Bueno, Orlando Francisco Amodeo; Rodrigues, Camila Cruz; Pompéia, Sabine

2012-01-01

Study Objectives: One task that has been used to assess memory effects of prior total sleep deprivation (TSD) is the immediate free recall of word lists; however, results have been mixed. A possible explanation for this is task impurity, since recall of words from different serial positions reflects use of distinct types of memory (last words: short-term memory; first and intermediate words: episodic memory). Here we studied the effects of 2 nights of TSD on immediate free recall of semantically unrelated word lists considering the serial position curve. Design: Random allocation to a 2-night TSD protocol followed by one night of recovery sleep or to a control group. Setting: Study conducted under continuous behavioral monitoring. Participants: 24 young, healthy male volunteers. Intervention: 2 nights of total sleep deprivation (TSD) and one night of recovery sleep. Measurements and Results: Participants were shown five 15 unrelated word-lists at baseline, after one and 2 nights of TSD, and after one night of recovery sleep. We also investigated the development of recall strategies (learning) and susceptibility to interference from previous lists. No free recall impairment occurred during TSD, irrespective of serial position. Interference was unchanged. Both groups developed recall strategies, but task learning occurred earlier in controls and was evident in the TSD group only after sleep recovery. Conclusion: Prior TSD spared episodic memory, short-term phonological memory, and interference, allowed the development of recall strategies, but may have decreased the advantage of using these strategies, which returned to normal after recovery sleep. Citation: Zanini GAV; Tufik S; Andersen ML; da Silva RCM; Bueno OFA; Rodrigues CC; Pompéia S. Free recall of word lists under total sleep deprivation and after recovery sleep. SLEEP 2012;35(2):223-230. PMID:22294812

The use of cognitive task analysis to reveal the instructional limitations of experts in the teaching of procedural skills.

PubMed

Sullivan, Maura E; Yates, Kenneth A; Inaba, Kenji; Lam, Lydia; Clark, Richard E

2014-05-01

Because of the automated nature of knowledge, experts tend to omit information when describing a task. A potential solution is cognitive task analysis (CTA). The authors investigated the percentage of knowledge experts omitted when teaching a cricothyrotomy to determine the percentage of additional knowledge gained during a CTA interview. Three experts were videotaped teaching a cricothyrotomy in 2010 at the University of Southern California. After transcription, they participated in CTA interviews for the same procedure. Three additional surgeons were recruited to perform a CTA for the procedure, and a "gold standard" task list was created. Transcriptions from the teaching sessions were compared with the task list to identify omitted steps (both "what" and "how" to do). Transcripts from the CTA interviews were compared against the task list to determine the percentage of knowledge articulated by each expert during the initial "free recall" (unprompted) phase of the CTA interview versus the amount of knowledge gained by using CTA elicitation techniques (prompted). Experts omitted an average of 71% (10/14) of clinical knowledge steps, 51% (14/27) of action steps, and 73% (3.6/5) of decision steps. For action steps, experts described "how to do it" only 13% (3.6/27) of the time. The average number of steps that were described increased from 44% (20/46) when unprompted to 66% (31/46) when prompted. This study supports previous research that experts unintentionally omit knowledge when describing a procedure. CTA is a useful method to extract automated knowledge and augment expert knowledge recall during teaching.

Medical team interdependence as a determinant of use of clinical resources.

PubMed Central

Sicotte, C; Pineault, R; Lambert, J

1993-01-01

OBJECTIVE. Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources. DATA SOURCES/STUDY SETTING. Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec. STUDY DESIGN. Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks. PRINCIPAL FINDINGS. Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork. CONCLUSIONS. Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked. PMID:8270423

Identifying the Priority Topics for the Assessment of Competence in Care of the Elderly

PubMed Central

Frank, Chris C.; Allen, Tim; Lozanovska, Tatjana; Arcand, Marcel; Feldman, Sidney; Lam, Robert E.; Mehta, Pravinsagar G.; Mangal, Nadia Y.

2018-01-01

Background With Canada’s senior population increasing, there is greater demand for family physicians with enhanced skills in Care of the Elderly (COE). The College of Family Physicians Canada (CFPC) has introduced Certificates of Added Competence (CACs), one being in COE. Our objective is to summarize the process used to determine the Priority Topics for the assessment of competence in COE. Methods A modified Delphi technique was used, with online surveys and face-to-face meetings. The Working Group (WG) of six physicians acted as the nominal group, and a larger group of randomly selected practitioners from across Canada acted as the Validation Group (VG). The WG, and then the VG, completed electronic write-in surveys that asked them to identify the Priority Topics. Responses were compiled, coded, and tabulated to identify the topics and to calculate the frequencies of their selection. The WG used face-to-face meetings and iterative discussion to decide on the final topic names. Results The correlation between the initial Priority Topic list identified by the VG and that identified by the WG is 0.6793. The final list has 18 Priority Topics. Conclusion Defining the required competencies is a first step to establishing national standards in COE. PMID:29581816

Do state physician health programs encourage referrals that violate the Americans with Disabilities Act?

PubMed

Lawson, Nicholas D; Boyd, J Wesley

The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians' employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

Violations of medical confidentiality: opinions of primary care physicians

PubMed Central

Elger, Bernice S

2009-01-01

Background Physicians should be able to distinguish situations where they need to protect confidentiality from those where they could be obligated to reveal information. Data are scarce concerning physician's attitudes in daily situations where violations of confidentiality are avoidable. Physicians should be aware of situations where patients are identifiable. Aim To solicit participation of primary care physicians in a teaching intervention and to explore participants' opinions on violations of confidentiality. Design of study A questionnaire presented seven vignettes describing avoidable violations of confidentiality (for example, without patient consent a physician mentions a politician's illness their spouse). Participants answered on a scale of 0–3 (0 = no violation and 3 = serious violation). All contacted physicians were invited to a teaching session during which the study results were discussed. Method Three-hundred and seventy-eight members of the Association of Physicians in Geneva (community physicians) working in primary care medicine, and 130 GPs and internists working at the University Hospital of Geneva (hospital physicians) took part. Physicians' answers were compared to responses from Swiss, UK, and other European law professors, and from 311 medical and law students in Geneva. Results Between 4% (case 6) and 57% (case 2), of physicians thought that no violation occurred. Law professors attributed the scores to each case as 3, 3, 2, 3, 2, 3, 3; the means of physicians were: 1.9, 1.4, 0.7, 1.4 (hospital physicians)/1.9 (community physicians), 0.4, 1.6, 2.6. In most cases, physicians' and students' answers were similar. A significantly higher percentage of community physicians than hospital physicians and students thought that a physician violates confidentiality if they provide the list of their patients to the police for the investigation of the theft of a purse in the waiting room. Conclusion Physicians need to be fully aware of their obligations towards patient confidentiality. Avoidable breaches of confidentiality occur when colleagues and authorities (such as police and those in a judicial context) ask for information. PMID:19843415

The prevalence of obesity documentation in Primary Care Electronic Medical Records

PubMed Central

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B.

2017-01-01

Summary Background Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient’s problem list for patients with eligible body mass indexes (BMI) as contained in the patients’ electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. Method This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Results Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Conclusion Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese. PMID:28119990

Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties

PubMed Central

Villar, Jesús; Pérez-Méndez, Lina

2007-01-01

Background The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. We evaluated the rate of errors in the completion of death certificates among medical residents from various specialties, before and after an educational intervention which was designed to improve the accuracy in the certification of the cause of death. Methods A 90-min seminar was delivered to seven mixed groups of medical trainees (n = 166) from several health care institutions in Spain. Physicians were asked to read and anonymously complete a same case-scenario of death certification before and after the seminar. We compared the rates of errors and the impact of the educational intervention before and after the seminar. Results A total of 332 death certificates (166 completed before and 166 completed after the intervention) were audited. Death certificates were completed with errors by 71.1% of the physicians before the educational intervention. Following the seminar, the proportion of death certificates with errors decreased to 9% (p < 0.0001). The most common error in the completion of death certificates was the listing of the mechanism of death instead of the cause of death. Before the seminar, 56.8% listed respiratory or cardiac arrest as the immediate cause of death. None of the participants listed any mechanism of death after the educational intervention (p < 0.0001). Conclusion Major errors in the completion of the correct cause of death on death certificates are common among medical residents. A simple educational intervention can dramatically improve the accuracy in the completion of death certificates by physicians. PMID:18005414

Task Analysis of Tactical Leadership Skills for Bradley Infantry Fighting Vehicle Leaders

DTIC Science & Technology

1986-10-01

The Bradley Leader Trainer is conceptualized as a device or set of de - vices that can be used to teach Bradley leaders to perform their full set of...experts. The task list was examined to de - termine critical training requirements, requirements for training device sup- port of this training, and...Functions/ j ITask | |Task | |Task | [Training j , To Further De - | ;Critical Train- | iTninir

Performance on a computerized shopping task significantly predicts real world functioning in persons diagnosed with bipolar disorder.

PubMed

Laloyaux, Julien; Pellegrini, Nadia; Mourad, Haitham; Bertrand, Hervé; Domken, Marc-André; Van der Linden, Martial; Larøi, Frank

2013-12-15

Persons diagnosed with bipolar disorder often suffer from cognitive impairments. However, little is known concerning how these cognitive deficits impact their real world functioning. We developed a computerized real-life activity task, where participants are required to shop for a list of grocery store items. Twenty one individuals diagnosed with bipolar disorder and 21 matched healthy controls were administered the computerized shopping task. Moreover, the patient group was assessed with a battery of cognitive tests and clinical scales. Performance on the shopping task significantly differentiated patients and healthy controls for two variables: Total time to complete the shopping task and Mean time spent to consult the shopping list. Moreover, in the patient group, performance on these variables from the shopping task correlated significantly with cognitive functioning (i.e. processing speed, verbal episodic memory, planning, cognitive flexibility, and inhibition) and with clinical variables including duration of illness and real world functioning. Finally, variables from the shopping task were found to significantly explain 41% of real world functioning of patients diagnosed with bipolar disorder. These findings suggest that the shopping task provides a good indication of real world functioning and cognitive functioning of persons diagnosed with bipolar disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis

PubMed Central

Cook, Nicola A; Kim, Jin Un; Pasha, Yasmin; Crossey, Mary ME; Schembri, Adrian J; Harel, Brian T; Kimhofer, Torben; Taylor-Robinson, Simon D

2017-01-01

Background Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients’ quality of life and the ability to drive and operate machinery (with societal consequences). Aim We compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis. Methods This was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance. Results Strong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis. Conclusion Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice. PMID:28919805

The ironic effect of guessing: increased false memory for mediated lists in younger and older adults

PubMed Central

Coane, Jennifer H.; Huff, Mark J.; Hutchison, Keith A.

2016-01-01

Younger and older adults studied lists of words directly (e.g., creek, water) or indirectly (e.g., beaver, faucet) related to a nonpresented critical lure (CL; e.g., river). Indirect (i.e., mediated) lists presented items that were only related to CLs through nonpresented mediators (i.e., directly related items). Following study, participants completed a condition-specific task, math, a recall test with or without a warning about the CL, or tried to guess the CL. On a final recognition test, warnings (vs. math and recall without warning) decreased false recognition for direct lists, and guessing increased mediated false recognition (an ironic effect of guessing) in both age groups. The observed age-invariance of the ironic effect of guessing suggests that processes involved in mediated false memory are preserved in aging and confirms the effect is largely due to activation in semantic networks during encoding and to the strengthening of these networks during the interpolated tasks. PMID:26393390

The Working Group on Meteor Showers Nomenclature: a History, Current Status and a Call for Contributions

NASA Technical Reports Server (NTRS)

Jopek, T. J.; Jenniskens, P. M.

2011-01-01

During the IAU General Assembly in Rio de Janeiro in 2009, the members of Commission 22 established the Working Group on Meteor Shower Nomenclature, from what was formerly the Task Group on Meteor Shower Nomenclature. The Task Group had completed its mission to propose a first list of established meteor showers that could receive officially names. At the business meeting of Commission 22 the list of 64 established showers was approved and consequently officially accepted by the IAU. A two-step process is adopted for showers to receive an official name from the IAU: i) before publication, all new showers discussed in the literature are first added to the Working List of Meteor Showers, thereby receiving a unique name, IAU number and three-letter code; ii) all showers which come up to the verification criterion are selected for inclusion in the List of Established Meteor Showers, before being officially named at the next IAU General Assembly.

The ironic effect of guessing: increased false memory for mediated lists in younger and older adults.

PubMed

Coane, Jennifer H; Huff, Mark J; Hutchison, Keith A

2016-01-01

Younger and older adults studied lists of words directly (e.g., creek, water) or indirectly (e.g., beaver, faucet) related to a nonpresented critical lure (CL; e.g., river). Indirect (i.e., mediated) lists presented items that were only related to CLs through nonpresented mediators (i.e., directly related items). Following study, participants completed a condition-specific task, math, a recall test with or without a warning about the CL, or tried to guess the CL. On a final recognition test, warnings (vs. math and recall without warning) decreased false recognition for direct lists, and guessing increased mediated false recognition (an ironic effect of guessing) in both age groups. The observed age-invariance of the ironic effect of guessing suggests that processes involved in mediated false memory are preserved in aging and confirms the effect is largely due to activation in semantic networks during encoding and to the strengthening of these networks during the interpolated tasks.

76 FR 41657 - Airworthiness Directives; Airbus Model A330-342 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

... production. As a result, ALI [Airworthiness Limitation Item] task 533105-01- 02 has not been performed on the... products. The MCAI states: Airworthiness Limitation Item (ALI) task 533105-01-02 is applicable to... embodied in production. As a result, ALI task 533105-01-02 has not been performed on the MSN listed in the...

Age Differences in Recall and Information Processing in Verbal and Spatial Learning.

ERIC Educational Resources Information Center

Mungas, Dan; And Others

1991-01-01

Three age groups of 24 people each completed verbal word list tasks and spatial learning tasks 5 times each. Significant age differences were found for total recall and type of task. Younger subjects showed increased levels of clustering--organizing information according to semantic or spatial clusters. Age was not related to temporal order of…

Locus of Control and Sex Differences in Performance on an Instructional Task.

ERIC Educational Resources Information Center

Holloway, Richard L.; Robinson, Beatrice

1979-01-01

Used locus of control, ability, sex, task selection, task structure, and recall in a regression model to predict affective response to type of instruction of 104 high school seniors. Results showed a main effect for recall, and interaction effects for recall x sex and recall x ability. References are listed. (Author/JEG)

A Task-Content Analysis of an Introductory Entomology Curriculum.

ERIC Educational Resources Information Center

Brandenburg, R.

Described is an analysis of the content, tasks, and strategies needed by students to enable them to identify insects to order by sight and to family by use of a standard dichotomous taxonomic key. Tasks and strategies are broken down and arranged progressively in the approximate order in which students should progress. Included are listings of…

School-Based Management with or without Instructional Leadership: Experience from Sweden

ERIC Educational Resources Information Center

Lindberg, Erik; Vanyushyn, Vladimir

2013-01-01

This study sets out to examine schools principals' perception of the importance of school-based management (SBM) and instructional leadership tasks and their assessment of the performance of those tasks in Swedish upper secondary schools. A review of the literature on SBM and instructional leadership results in a list of twenty one tasks grouped…

Radiology Physician Extenders: A Literature Review of the History and Current Roles of Physician Extenders in Medical Imaging.

PubMed

Sanders, Vicki L; Flanagan, Jennifer

2015-01-01

The purpose of the literature review was to assess the origins of radiology physician extenders and examine the current roles found in the literature of advanced practice physician extenders within medical imaging. Twenty-six articles relating to physician assistants (PAs), nurse practitioners (NPs), radiologist assistants (RAs), and nuclear medicine advanced associates (NMAAs) were reviewed to discern similarities and differences in history, scope of practice, and roles in the medical imaging field. The literature showed PAs and NPs are working mostly in interventional radiology. PAs, NPs, and RAs perform similar tasks in radiology, including history and physicals, evaluation and management, preprocedure work-up, obtaining informed consent, initial observations/reports, and post-procedure follow-up. NPs and PAs perform a variety of procedures but most commonly vascular access, paracentesis, and thoracentesis. RAs perform gastrointestinal, genitourinary, nonvascular invasive fluoroscopy procedures, and vascular access procedures. The review revealed NMAAs are working in an advanced role, but no specific performances of procedures was found in the literature, only suggested tasks and clinical competencies. PAs, NPs, and RAs are currently the three main midlevel providers used in medical imaging. These midlevel providers are being used in a variety of ways to increase the efficiency of the radiologist and provide diagnostic and therapeutic radiologic procedures to patients. NMAAs are being used in medical imaging but little literature is available on current roles in clinical practice. More research is needed to assess the exact procedures and duties being performed by these medical imaging physician extenders.

Emergency/disaster medical support in the restoration project for the Fukushima nuclear power plant accident

PubMed Central

Morimura, Naoto; Asari, Yasushi; Yamaguchi, Yoshihiro; Asanuma, Kazunari; Tase, Choichiro; Sakamoto, Tetsuya; Aruga, Tohru

2013-01-01

The Fukushima Daiichi Nuclear Power Plant (1F) suffered a series of radiation accidents after the Great East Japan Earthquake on 11 March 2011. In a situation where halting or delaying restoration work was thought to translate directly into a very serious risk for the entire country, it was of the utmost importance to strengthen the emergency and disaster medical system in addition to radiation emergency medical care for staff at the frontlines working in an environment that posed a risk of radiation exposure and a large-scale secondary disaster. The Japanese Association for Acute Medicine (JAAM) launched the ‘Emergency Task Force on the Fukushima Nuclear Power Plant Accident’ and sent physicians to the local response headquarters. Thirty-four physicians were dispatched as disaster medical advisors, response guidelines in the event of multitudinous injury victims were created and revised and, along with execution of drills, coordination and advice was given on transport of patients. Forty-nine physicians acted as directing physicians, taking on the tasks of triage, initial treatment and decontamination. A total of 261 patients were attended to by the dispatched physicians. None of the eight patients with external contamination developed acute radiation syndrome. In an environment where the collaboration between organisations in the framework of a vertically bound government and multiple agencies and institutions was certainly not seamless, the participation of the JAAM as the medical academic organisation in the local system presented the opportunity to laterally integrate the physicians affiliated with the respective organisations from the perspective of specialisation. PMID:23184925

A theoretical framework to describe communication processes during medical disability assessment interviews

PubMed Central

van Rijssen, H Jolanda; Schellart, Antonius JM; Anema, Johannes R; van der Beek, Allard J

2009-01-01

Background Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. Objective The objective of this paper is to describe the conceptualisation of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. Conceptualisation The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. Conclusion The conceptualisation of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments. PMID:19807905

Assessing the prospects for physician supply and demand in Canada: Wishing it was rocket science.

PubMed

Adams, Owen; Chauhan, Tara S; Buske, Lynda

2017-07-01

"It's not rocket science" is an often used phrase to describe tasks that are not very difficult. Although rocketry has proven to be an exacting science with highly predictable results, the same cannot be said for physician workforce planning in Canada. The "boom" in physician supply in the 1960s and 1970s was followed by a "bust" in the early 1990s and a further boom in the 2000s. A large generational shift in the physician population is anticipated between now and 2030; the proportion of "boomers" (1946-1964) will drop from 43% to 16% of the practising profession. Canada has not been alone in increasing physician supply. Any judgement as to whether too many or too few physicians are being trained must consider the drivers and mitigators of both supply and demand. Although there are current concerns about a shortage of practice opportunities for some specialties, the available data do not indicate a physician surplus on the horizon in Canada.

Serial-position effects on a free-recall task in bilinguals.

PubMed

Yoo, Jeewon; Kaushanskaya, Margarita

2016-01-01

In this study, we examined mechanisms that underlie free-recall performance in bilinguals' first language (L1) and second language (L2) through the prism of serial-position effects. On free-recall tasks, a typical pattern of performance follows a U-shaped serial-position curve, where items from the beginning of the list (the primacy effect) and items from the end of the list (the recency effect) are recalled with higher accuracy than items from the middle of the list. The present study contrasted serial-position effects on the free-recall task in Korean-English bilinguals' L1 vs. L2 and examined the relationship between an independent working memory (WM) measure and serial-position effects in bilinguals' two languages. Results revealed stronger pre-recency (primacy and middle) effects in L1 than in L2, but similar recency effects in the two languages. A close association was observed between WM and recall performance in the pre-recency region in the L1 but not in the L2. Together, these findings suggest that linguistic knowledge constrains free-recall performance in bilinguals, but only in the pre-recency region.

A sub-process view of working memory capacity: evidence from effects of speech on prose memory.

PubMed

Sörqvist, Patrik; Ljungberg, Jessica K; Ljung, Robert

2010-04-01

In this article we outline a "sub-process view" of working memory capacity (WMC). This view suggests that any relationship between WMC and another construct (e.g., reading comprehension) is actually a relationship with a specific part of the WMC construct. The parts, called sub-processes, are functionally distinct and can be measured by intrusion errors in WMC tasks. Since the sub-processes are functionally distinct, some sub-process may be related to a certain phenomenon, whereas another sub-process is related to other phenomena. In two experiments we show that a sub-process (measured by immediate/current-list intrusions) is related to the effects of speech on prose memory (semantic auditory distraction), whereas another sub-process (measured by delayed/prior-list intrusions), known for its contribution to reading comprehension, is not. In Experiment 2 we developed a new WMC task called "size-comparison span" and found that the relationship between WMC and semantic auditory distraction is actually a relationship with a sub-process measured by current-list intrusions in our new task.

Development and validation of EMP-3: an instrument to measure physician's attitudes toward ethnic minority patients.

PubMed

De Maesschalck, Stephanie; Willems, Sara; De Maeseneer, Jan; Deveugele, Myriam

2010-04-01

The growing diversity of patient populations challenges health care providers. Physicians' attitudes and perceptions toward cultural diversity in health care could be partly contributing to difficulties in communication between physicians and ethnic minority patients. To evaluate these attitudes and perceptions, an instrument was developed and validated. A preliminary version of the instrument was developed through literature research and expert consultation and completed by 112 family physicians. Factor analysis was performed and reliability and construct validity tested. The instrument revealed three factors that were interpreted as: (1) physicians' task perception and ideas on cultural differences in health and health care, (2) physicians' attitudes toward physician-patient communication with minority patients, and (3) physicians' perception of minority patients' needs in communication. Moderate but significant correlations were found between factors of the EMP-3 and practice organization, practice location, and physicians' gender. Several factors of the Jefferson Empathy Scale, the Patient Practitioner Orientation Scale, and the Health Beliefs and Attitude Scale related to the first two factors of the EMP-3. This instrument, designed specifically to measure physicians' attitudes toward cultural diversity, showed moderate validity and reliability results. Further adaptations and evaluation could be useful.

Integrated cluster- and case-based surveillance for detecting stage III zoonotic pathogens: an example of Nipah virus surveillance in Bangladesh.

PubMed

Naser, A M; Hossain, M J; Sazzad, H M S; Homaira, N; Gurley, E S; Podder, G; Afroj, S; Banu, S; Rollin, P E; Daszak, P; Ahmed, B-N; Rahman, M; Luby, S P

2015-07-01

This paper explores the utility of cluster- and case-based surveillance established in government hospitals in Bangladesh to detect Nipah virus, a stage III zoonotic pathogen. Physicians listed meningo-encephalitis cases in the 10 surveillance hospitals and identified a cluster when ⩾2 cases who lived within 30 min walking distance of one another developed symptoms within 3 weeks of each other. Physicians collected blood samples from the clustered cases. As part of case-based surveillance, blood was collected from all listed meningo-encephalitis cases in three hospitals during the Nipah season (January-March). An investigation team visited clustered cases' communities to collect epidemiological information and blood from the living cases. We tested serum using Nipah-specific IgM ELISA. Up to September 2011, in 5887 listed cases, we identified 62 clusters comprising 176 encephalitis cases. We collected blood from 127 of these cases. In 10 clusters, we identified a total of 62 Nipah cases: 18 laboratory-confirmed and 34 probable. We identified person-to-person transmission of Nipah virus in four clusters. From case-based surveillance, we identified 23 (4%) Nipah cases. Faced with thousands of encephalitis cases, integrated cluster surveillance allows targeted deployment of investigative resources to detect outbreaks by stage III zoonotic pathogens in resource-limited settings.

Handbook of Common Poisonings in Children.

ERIC Educational Resources Information Center

Food and Drug Administration (DHEW), Washington, DC.

This handbook for physicians, emergency room personnel and pharmacists lists the manufacturer, description, toxicity, symptoms and findings, treatment, and references for 73 poison substances considered by the Subcommittee on Accidental Poisoning of the American Academy of Pediatrics to be most significant in terms of accidental poisoning of…

Impact of drug shortages on U.S. health systems.

PubMed

Kaakeh, Rola; Sweet, Burgunda V; Reilly, Cynthia; Bush, Colleen; DeLoach, Sherry; Higgins, Barb; Clark, Angela M; Stevenson, James

2011-10-01

A study was performed to quantify the personnel resources required to manage drug shortages, define the impact of drug shortages on health systems nationwide, and assess the adequacy of information resources available to manage drug shortages. An online survey was sent to the 1322 members of the American Society of Health-System Pharmacists who were identified as directors of pharmacy. Survey recipients were asked to identify which of the 30 most recent drug shortages listed affected their health system, to identify actions taken to manage the shortage, and to rate the impact of each shortage. Employees responsible for completing predefined tasks were identified, and the average time spent by each type of employee completing these tasks was estimated. Labor costs associated with managing shortages were calculated. A total of 353 respondents completed the survey, yielding a response rate of 27%. Pharmacists and pharmacy technicians spent more time managing drug shortages than did physicians and nurses. There was a significant association between the time spent managing shortages and the size of the institution, the number of shortages managed, and the institution's level of automation. Overall, 70% of the respondents felt that the information resources available to manage drug shortages were not good. The labor costs associated with managing shortages in the United States is an estimated $216 million annually. A survey of directors of pharmacy revealed that labor costs and the time required to manage drug shortages are significant and that current information available to manage drug shortages is considered suboptimal.

CLT and CLS job responsibilities: current distinctions and updates.

PubMed

Doig, K; Beck, S J; Kolenc, K

2001-01-01

This study was undertaken to address the following questions: 1. What tasks distinguish the job of a clinical laboratory scientist (CLS) from that of a clinical laboratory technician (CLT)? 2. What changes in role distinctions, have occurred for entry-level CLS and CLT practitioners over the five-year period 1993-98? 3. What tasks have been deleted from the CLT and CLS content outlines because they were not frequently performed or not considered entry-level? 4. What changes in practice are reflected in the current job analyses? A national job analysis of tasks constituting the job of clinical laboratory scientists (CLSs) and clinical laboratory technicians (CLTs) was conducted in 1998-99 as part of a standard setting process for the certifying examinations of the National Credentialing Agency for Laboratory Personnel (NCA). The job analyses relied upon mail surveys to 1200 individuals for each job level asking respondents to identify tasks significant to effective practice at job entry. The task lists resulting from statistical analysis of those surveys were examined to answer the study questions. The sample for each survey included 1200 practitioners, educators and laboratory managers selected at random from membership in professional organizations or from NCA certificant lists. Sampling was stratified to insure adequate practitioner representation. The mean rating on a four point scale for each item on the surveys was evaluated for overall significance as well as significance across geographic regions. The tasks meeting specified criteria were retained in the final task lists. Tasks were counted and their content evaluated to compare CLS and CLT job tasks. The response rates to the surveys were 33% for CLT and 21% for CLS. Reliability was judged based on average intraclass correlation coefficients of .86 and .82 for the CLT and CLS surveys, respectively. There were 952 tasks retained on the CLS content outline and 725 retained on the CLT content outline of the 1151 tasks on the original survey. Seven hundred and twenty two tasks were found on content outlines of both job levels, representing a 76% overlap. Tasks found only on the CLS outline included advanced technical tasks, a few management tasks, and more communication tasks. The jobs of CLS and CLT practitioners are distinct at job entry level with CLSs performing a broader array of technical and communication tasks as well as some management tasks. Though CLS staff uses few management skills at job entry, those tasks are performed by CLS staff in the laboratory and curricula must help prepare graduates for these tasks expected of experienced staff. CLTs perform tasks requiring problem solving and high level reasoning. CLT curricula must address the need for CLTs to perform these tasks.

Toward a better understanding of task demands, workload, and performance during physician-computer interactions.

PubMed

Mazur, Lukasz M; Mosaly, Prithima R; Moore, Carlton; Comitz, Elizabeth; Yu, Fei; Falchook, Aaron D; Eblan, Michael J; Hoyle, Lesley M; Tracton, Gregg; Chera, Bhishamjit S; Marks, Lawrence B

2016-11-01

To assess the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment. Two experiments were performed in 2 different electronic medical record (EMR) environments: WebCIS (n = 12) and Epic (n = 17). Each participant was instructed to complete a set of prespecified tasks on 3 routine clinical EMR-based scenarios: urinary tract infection (UTI), pneumonia (PN), and heart failure (HF). Task demands were quantified using behavioral responses (click and time analysis). At the end of each scenario, subjective workload was measured using the NASA-Task-Load Index (NASA-TLX). Physiological workload was measured using pupillary dilation and electroencephalography (EEG) data collected throughout the scenarios. Performance was quantified based on the maximum severity of omission errors. Data analysis indicated that the PN and HF scenarios were significantly more demanding than the UTI scenario for participants using WebCIS (P < .01), and that the PN scenario was significantly more demanding than the UTI and HF scenarios for participants using Epic (P < .01). In both experiments, the regression analysis indicated a significant relationship only between task demands and performance (P < .01). Results suggest that task demands as experienced by participants are related to participants' performance. Future work may support the notion that task demands could be used as a quality metric that is likely representative of performance, and perhaps patient outcomes. The present study is a reasonable next step in a systematic assessment of how task demands and workload are related to performance in EMR-evolving environments. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A task analysis of emergency physician activities in academic and community settings.

PubMed

Chisholm, Carey D; Weaver, Christopher S; Whenmouth, Laura; Giles, Beverly

2011-08-01

We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error. This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions. There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients). Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community counterparts. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Commercial Truck/Equipment Technician. Occupational Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Occupational Competency Analysis Profile (OCAP) for commercial truck and equipment technician is an employer-verified competency list that evolved from a modified DACUM (Developing a Curriculum) job analysis process involving business, industry, labor, and community agency representatives throughout Ohio. The task list of the National…

The effect of orthographic neighborhood in the reading span task.

PubMed

Robert, Christelle; Postal, Virginie; Mathey, Stéphanie

2015-04-01

This study aimed at examining whether and to what extent orthographic neighborhood of words influences performance in a working memory span task. Twenty-five participants performed a reading span task in which final words to be memorized had either no higher frequency orthographic neighbor or at least one. In both neighborhood conditions, each participant completed three series of two, three, four, or five sentences. Results indicated an interaction between orthographic neighborhood and list length. In particular, an inhibitory effect of orthographic neighborhood on recall appeared in list length 5. A view is presented suggesting that words with higher frequency neighbors require more resources to be memorized than words with no such neighbors. The implications of the results are discussed with regard to memory processes and current models of visual word recognition.

Medical judgement analogue studies with applications to spaceflight crew medical officer

PubMed Central

McCarroll, Michele L; Ahmed, Rami A; Schwartz, Alan; Gothard, Michael David; Atkinson, Steven Scott; Hughes, Patrick; Brito, Jose Cepeda; Assad, Lori; Myers, Jerry; George, Richard L

2017-01-01

Background The National Aeronautics and Space Administration (NASA) developed plans for potential emergency conditions from the Exploration Medical Conditions List. In an effort to mitigate conditions on the Exploration Medical Conditions List, NASA implemented a crew medical officer (CMO) designation for eligible astronauts. This pilot study aims to add knowledge that could be used in the Integrated Medical Model. Methods An analogue population was recruited for two categories: administrative physicians (AP) representing the physician CMOs and technical professionals (TP) representing the non-physician CMOs. Participants completed four medical simulations focused on abdominal pain: cholecystitis (CH) and renal colic (RC) and chest pain: cardiac ischaemia (STEMI; ST-segment elevation myocardial infarction) and pneumothorax (PX). The Medical Judgment Metric (MJM) was used to evaluate medical decision making. Results There were no significant differences between the AP and TP groups in age, gender, race, ethnicity, education and baseline heart rate. Significant differences were noted in MJM average rater scores in AP versus TP in CH: 13.0 (±2.25), 4.5 (±0.48), p=<0.001; RC: 12.3 (±2.66), 4.8 (±0.94); STEMI: 12.1 (±3.33), 4.9 (±0.56); and PX: 13.5 (±2.53), 5.3 (±1.01), respectively. Discussion There could be a positive effect on crew health risk by having a physician CMO. The MJM demonstrated the ability to quantify medical judgement between the two analogue groups of spaceflight CMOs. Future studies should incorporate the MJM in a larger analogue population study to assess the medical risk for spaceflight crewmembers. PMID:29354280

Medical judgement analogue studies with applications to spaceflight crew medical officer.

PubMed

McCarroll, Michele L; Ahmed, Rami A; Schwartz, Alan; Gothard, Michael David; Atkinson, Steven Scott; Hughes, Patrick; Brito, Jose Cepeda; Assad, Lori; Myers, Jerry; George, Richard L

2017-10-01

The National Aeronautics and Space Administration (NASA) developed plans for potential emergency conditions from the Exploration Medical Conditions List. In an effort to mitigate conditions on the Exploration Medical Conditions List, NASA implemented a crew medical officer (CMO) designation for eligible astronauts. This pilot study aims to add knowledge that could be used in the Integrated Medical Model. An analogue population was recruited for two categories: administrative physicians (AP) representing the physician CMOs and technical professionals (TP) representing the non-physician CMOs. Participants completed four medical simulations focused on abdominal pain: cholecystitis (CH) and renal colic (RC) and chest pain: cardiac ischaemia (STEMI; ST-segment elevation myocardial infarction) and pneumothorax (PX). The Medical Judgment Metric (MJM) was used to evaluate medical decision making. There were no significant differences between the AP and TP groups in age, gender, race, ethnicity, education and baseline heart rate. Significant differences were noted in MJM average rater scores in AP versus TP in CH: 13.0 (±2.25), 4.5 (±0.48), p=<0.001; RC: 12.3 (±2.66), 4.8 (±0.94); STEMI: 12.1 (±3.33), 4.9 (±0.56); and PX: 13.5 (±2.53), 5.3 (±1.01), respectively. There could be a positive effect on crew health risk by having a physician CMO. The MJM demonstrated the ability to quantify medical judgement between the two analogue groups of spaceflight CMOs. Future studies should incorporate the MJM in a larger analogue population study to assess the medical risk for spaceflight crewmembers.

National questionnaire study on clinical ICT systems proofs: physicians suffer from poor usability.

PubMed

Viitanen, Johanna; Hyppönen, Hannele; Lääveri, Tinja; Vänskä, Jukka; Reponen, Jarmo; Winblad, Ilkka

2011-10-01

In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field. A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems. Physicians' estimates of their EHR systems were very critical. With the rating scale from 4 or fail to 10 or excellent, the average of the grades varied from 6.1 to 8.4 dependent on the kind of facility the physician is working. Questionnaire results indicated several usability problems and deficiencies which considerably hindered the efficiency of clinical ICT use and physician's routine work. Systems lacked the appropriate features to support typical clinical tasks, such as decision making, prevention of medical errors, and review of a patient's treatment chart. The systems also required physicians to perform fixed sequences of steps and tasks, and poorly supported the documentation and retrieval of patient data. The findings on ICT support for collaboration showed mainly negative results, aside from collaboration between co-located physicians. In addition, the study results pointed out physicians suffering from system failures and a lack of integration between the systems. The described study and related results are unique in several ways. A national usability study with nearly 4000 respondents had not been conducted in other countries in which healthcare technologies are widely adopted. The questionnaire study provided a generalized picture about the usability problems, however, it should be noted that there were significant differences between legacy systems in use. Previously, researchers had not approached contextual aspects of usability the context of clinical work, where numerous systems are in use. The described usability dimensions and the presented study results can be considered as the first step towards conceptualizing ICT usability in the unique setting of clinical work. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A task-based support architecture for developing point-of-care clinical decision support systems for the emergency department.

PubMed

Wilk, S; Michalowski, W; O'Sullivan, D; Farion, K; Sayyad-Shirabad, J; Kuziemsky, C; Kukawka, B

2013-01-01

The purpose of this study was to create a task-based support architecture for developing clinical decision support systems (CDSSs) that assist physicians in making decisions at the point-of-care in the emergency department (ED). The backbone of the proposed architecture was established by a task-based emergency workflow model for a patient-physician encounter. The architecture was designed according to an agent-oriented paradigm. Specifically, we used the O-MaSE (Organization-based Multi-agent System Engineering) method that allows for iterative translation of functional requirements into architectural components (e.g., agents). The agent-oriented paradigm was extended with ontology-driven design to implement ontological models representing knowledge required by specific agents to operate. The task-based architecture allows for the creation of a CDSS that is aligned with the task-based emergency workflow model. It facilitates decoupling of executable components (agents) from embedded domain knowledge (ontological models), thus supporting their interoperability, sharing, and reuse. The generic architecture was implemented as a pilot system, MET3-AE--a CDSS to help with the management of pediatric asthma exacerbation in the ED. The system was evaluated in a hospital ED. The architecture allows for the creation of a CDSS that integrates support for all tasks from the task-based emergency workflow model, and interacts with hospital information systems. Proposed architecture also allows for reusing and sharing system components and knowledge across disease-specific CDSSs.

Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions.

PubMed

Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S

2015-10-01

The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Working memory capacity predicts the beneficial effect of selective memory retrieval.

PubMed

Schlichting, Andreas; Aslan, Alp; Holterman, Christoph; Bäuml, Karl-Heinz T

2015-01-01

Selective retrieval of some studied items can both impair and improve recall of the other items. This study examined the role of working memory capacity (WMC) for the two effects of memory retrieval. Participants studied an item list consisting of predefined target and nontarget items. After study of the list, half of the participants performed an imagination task supposed to induce a change in mental context, whereas the other half performed a counting task which does not induce such context change. Following presentation of a second list, memory for the original list's target items was tested, either with or without preceding retrieval of the list's nontarget items. Consistent with previous work, preceding nontarget retrieval impaired target recall in the absence of the context change, but improved target recall in its presence. In particular, there was a positive relationship between WMC and the beneficial, but not the detrimental effect of memory retrieval. On the basis of the view that the beneficial effect of memory retrieval reflects context-reactivation processes, the results indicate that individuals with higher WMC are better able to capitalise on retrieval-induced context reactivation than individuals with lower WMC.

Teaching medical students to use simple language when talking with patients.

PubMed

Cohen, I

1989-01-01

Physicians know much about health and illness. The information is often complicated and difficult to understand. Part of the physician's task is to help the patient understand the information so that the patient may help himself. The accurate transfer of the information requires that physicians have excellent communication skills. One such skill is the ability to use language which is easily understood by the patient. This study suggests that, after preclinical medical students assume a formal teaching role in secondary schools, they are more likely to use simpler language when talking with patients during their final undergraduate year.

Crew Integration & Automation Testbed and Robotic Follower Programs

DTIC Science & Technology

2001-05-30

Evolving Technologies for Reduced Crew Operation” Vehicle Tech Demo #1 (VTT) Vehicle Tech Demo #2 ( CAT ATD) Two Man Transition Future Combat...Simulation Advanced Electronic Architecture Concept Vehicle Shown with Onboard Safety Driver Advanced Interfaces CAT ATD Exit Criteria...Provide 1000 Hz control loop for critical real-time tasks CAT Workload IPT Process and Product Schedule Crew Task List Task Timelines Workload Analysis

Health and Human Services Cluster. Task Analyses. Physical Therapist Aide and Physical Therapist Assistant. A Competency-Based Curriculum Guide.

ERIC Educational Resources Information Center

Henrico County Public Schools, Glen Allen, VA. Virginia Vocational Curriculum and Resource Center.

Developed in Virginia, this publication contains task analysis guides to support selected tech prep programs that prepare students for careers in the health and human services cluster. Occupations profiled are physical therapist aide and physical therapist assistant. Each guide contains the following elements: (1) an occupational task list derived…

Materials processing in space program tasks

NASA Technical Reports Server (NTRS)

Naumann, R. J. (Editor)

1980-01-01

The history, strategy, and overall goal of NASA's Office of Space and Terrestrial Applications program for materials processing in space are described as well as the organizational structures and personnel involved. An overview of each research task is presented and recent publications are listed.

Spacecraft software training needs assessment research, appendices

NASA Technical Reports Server (NTRS)

Ratcliff, Shirley; Golas, Katharine

1990-01-01

The appendices to the previously reported study are presented: statistical data from task rating worksheets; SSD references; survey forms; fourth generation language, a powerful, long-term solution to maintenance cost; task list; methodology; SwRI's instructional systems development model; relevant research; and references.

29 CFR 825.125 - Definition of health care provider.

Code of Federal Regulations, 2014 CFR

2014-07-01

...; (2) Nurse practitioners, nurse-midwives, clinical social workers and physician assistants who are... under State law; (3) Christian Science Practitioners listed with the First Church of Christ, Scientist... Science practitioner, an employee may not object to any requirement from an employer that the employee or...

Quality of Life: An Exploratory Study.

ERIC Educational Resources Information Center

Lankhorst, Gustaaf J.

1989-01-01

A 12-item list of human abilities/activities was developed to measure quality of life of 9 rheumatoid arthritis adults from 2 aspects: "present condition" and "relative importance" of each item. Pilot testing indicated that importance and present condition represent different aspects. Differences between self-assessments and physicians'…

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol.

PubMed

Yu, Catherine H; Stacey, Dawn; Sale, Joanna; Hall, Susan; Kaplan, David M; Ivers, Noah; Rezmovitz, Jeremy; Leung, Fok-Han; Shah, Baiju R; Straus, Sharon E

2014-01-22

Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care - systematic decision aid development and study protocol

PubMed Central

2014-01-01

Background Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. Objectives To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. Methods 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice. 2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness. 3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity. 4. Usability testing: This will be done using cognitive task analysis. 5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Discussion Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach. PMID:24450385

Food Production, Management, and Services. Baking. Teacher Edition. Second Edition.

ERIC Educational Resources Information Center

Gibson, LeRoy

These instructional materials are intended for a course on food production, management, and services involved in baking. The following introductory information is included: use of this publication; competency profile; instructional/task analysis; related academic and workplace skills list; tools, materials, and equipment list; 13 references; and a…

Creation of a list of homonyms in Brazilian Portuguese for linguistic processing tasks.

PubMed

Rossi, Suélen Graton; Hackerott, Maria Mercedes Saraiva; Avila, Clara Regina Brandão de

2017-01-01

Purpose This paper presents procedures and steps to create a list of homonyms, their meanings and representative images. Methods One hundred and three homonyms in Brazilian Portuguese were secluded through searches in text books and dictionaries and the meanings were verified. The homonyms were analyzed and selected according pre-established criteria. Twenty-six homonyms with two meanings were selected and one image was used to represent each meaning. To test the instrument, twenty elementary school children in 4th (n = 10) and 5ht (n = 10) grades were selected from a private school in São Paulo. To identify the meanings of major and minor occurrence, the students gave their understanding of the words presented to them orally. The students were also asked to name the fifty-two images to determine the degree of recognition. Percentages of accuracy were calculated. Results Among the 26 homonyms, two were excluded because the students were unable to name them. Two images were little recognized and, therefore, replaced with others that better represented the homonyms. Conclusion A list of 24 homonyms and 48 images (one for each meaning) was developed. The results of the presentation of these items to elementary school children in the 4th and 5th grades proved the adequacy of the list. The material is seen as efficient for use in recognition tasks and can be applied in semantic priming tasks.

Smoking: attitudes of Costa Rican physicians and opportunities for intervention.

PubMed Central

Grossman, D. W.; Knox, J. J.; Nash, C.; Jiménez, J. G.

1999-01-01

The aim of this study was to obtain information, using a written questionnaire, on the knowledge, smoking behaviour, and attitudes of Costa Rican physicians about smoking as a health issue. A random sample of 650 physicians was chosen from a list of active physicians; 287 of them were covered by survey between August 1993 and October 1994, and 217 (76%) responded with data for the study. While 40% of the physicians who participated were ex-smokers, 19% were current smokers; 67% of these two groups combined reported smoking in the workplace. Only 49% believed that physicians could be a nonsmoking role model; the majority (87%) had asked patients about their smoking status. The only cessation technique consistently used (90%) was counselling about the dangers of smoking. Measures such as setting a date to quit smoking and nicotine replacement were rarely recommended (< or = 2%). Nearly all the physicians (99%) considered smoking to be a major health issue. These results showed a high prevalence of smoking among Costa Rican physicians, with little recognition of the need for them to set an example as a role model. While they were knowledgeable about the health risks of smoking, they did not recommend any of the proven techniques to help their patients to quit smoking. A clear consensus for more strict tobacco regulation exists, but to date little has been done to act on this. PMID:10327710

Patient satisfaction in the emergency department and the use of business cards by physicians.

PubMed

Olsen, Jon C; Olsen, Eric C

2012-03-01

Emergency departments (EDs) across the country become increasingly crowded. Methods to improve patient satisfaction are becoming increasingly important. To determine if the use of business cards by emergency physicians improves patient satisfaction. A prospective, convenience sample of ED patients were surveyed in a tertiary care, suburban teaching hospital. Inclusion criteria were limited to an understanding of written and spoken English. Excluded patients included those with altered mental status or too ill to complete a survey. Patients were assigned to receive a business card on alternate days in the ED from the treating physician(s) during their patient introductions. The business cards listed the physician's name and position (resident or attending physician) and the institution name and phone number. Before hospital admission or discharge, a research assistant asked patients to complete a questionnaire regarding their ED visit to determine patient satisfaction. Three hundred-twenty patients were approached to complete the questionnaire and 259 patients (81%) completed it. Patient demographics were similar in both the business card and non-business-card groups. There were no statistically significant differences for patient responses to any of the study questions whether or not they received a business card during the physician introduction. The use of business cards during physician introduction in the ED does not improve patient satisfaction. Copyright © 2012 Elsevier Inc. All rights reserved.

Why do older people oppose physician-assisted dying? A qualitative study.

PubMed

Malpas, Phillipa J; Wilson, Maria K R; Rae, Nicola; Johnson, Malcolm

2014-04-01

Physician-assisted dying at the end of life has become a significant issue of public discussion. While legally available in a number of countries and jurisdictions, it remains controversial and illegal in New Zealand. The study aimed to explore the reasons some healthy older New Zealanders oppose physician-assisted dying in order to inform current debate. Recorded interviews were transcribed and analysed by the authors after some edits had been made by respondents. In all, 11 older participants (over 65 years) who responded to advertisements placed in Grey Power magazines and a University of Auckland email list were interviewed for around 1 h and asked a number of open-ended questions. Four central themes opposing physician-assisted dying were identified from the interviews: one's personal experience with health care and dying and death, religious reasoning and beliefs, slippery slope worries and concern about potential abuses if physician-assisted dying were legalised. An important finding of the study suggests that how some older individuals think about physician-assisted dying is strongly influenced by their past experiences of dying and death. While some participants had witnessed good, well-managed dying and death experiences which confirmed for them the view that physician-assisted dying was unnecessary, those who had witnessed poor dying and death experiences opposed physician-assisted dying on the grounds that such practices could come to be abused by others.

Final Report: Demographic Tools for Climate Change and Environmental Assessments

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Neill, Brian

2017-01-24

This report summarizes work over the course of a three-year project (2012-2015, with one year no-cost extension to 2016). The full proposal detailed six tasks: Task 1: Population projection model Task 2: Household model Task 3: Spatial population model Task 4: Integrated model development Task 5: Population projections for Shared Socio-economic Pathways (SSPs) Task 6: Population exposure to climate extremes We report on all six tasks, provide details on papers that have appeared or been submitted as a result of this project, and list selected key presentations that have been made within the university community and at professional meetings.

Using a terminology server and consumer search phrases to help patients find physicians with particular expertise.

PubMed

Cole, Curtis L; Kanter, Andrew S; Cummens, Michael; Vostinar, Sean; Naeymi-Rad, Frank

2004-01-01

To design and implement a real world application using a terminology server to assist patients and physicians who use common language search terms to find specialist physicians with a particular clinical expertise. Terminology servers have been developed to help users encoding of information using complicated structured vocabulary during data entry tasks, such as recording clinical information. We describe a methodology using Personal Health Terminology trade mark and a SNOMED CT-based hierarchical concept server. Construction of a pilot mediated-search engine to assist users who use vernacular speech in querying data which is more technical than vernacular. This approach, which combines theoretical and practical requirements, provides a useful example of concept-based searching for physician referrals.

Characterizing novice-expert differences in macrocognition: an exploratory study of cognitive work in the emergency department.

PubMed

Schubert, Christiane C; Denmark, T Kent; Crandall, Beth; Grome, Anna; Pappas, James

2013-01-01

The objectives of this study are to elicit and document descriptions of emergency physician expertise, to characterize cognitive differences between novice and expert physicians, and to identify areas in which novices' skill and knowledge gaps are most pronounced. The nature of the differences between novices and experts needs to be explored to develop effective instructional modalities that accelerate the learning curve of inexperienced physicians who work in high-complexity environments. We interviewed novice emergency physicians (first-year residents) and attending physicians with significant expertise, working in an academic Level I trauma center in Southern California. With cognitive task analysis, we used task diagrams to capture nonroutine critical incidents that required the use of complex cognitive skills. Timelines were constructed to develop a detailed understanding of challenging incidents and the decisions involved as the incident unfolded, followed by progressive deepening to tease out situation-specific cues, knowledge, and information that experts and novices used. A thematic analysis of the interview transcripts was conducted to identify key categories. Using classification techniques for data reduction, we identified a smaller set of key themes, which composed the core findings of the study. Five interns and 6 attending physicians participated in the interviews. Novice physicians reported having difficulties representing the patient's story to attending physicians and other health care providers. Overrelying on objective data, novice physicians use linear thinking to move to diagnosis quickly and are likely to discount and explain away data that do not "fit" the frame. Experienced physicians draw on expertise to recognize cues and patterns while leaving room for altering or even changing their initial diagnosis. Whereas experts maintain high levels of spatial, temporal, and organizational systems awareness when overseeing treatment modalities of multiple patients, novices have difficulty seeing and maintaining the "big picture." Novice physicians use sense-making styles that differ from those of experts. Training novices to respond to the high cognitive demand of complex environments early in their careers requires instructional modalities that not only increase their knowledge base but also accelerate the integration of knowledge and practice. Simulation and custom-designed avatar-mediated virtual worlds are a promising new technology that may facilitate such training. Future research should expand on the results of this study through the use of larger sample sizes and interviews conducted at multiple sites to increase generalizability. Copyright © 2012. Published by Mosby, Inc.

Towards a collaborative filtering approach to medication reconciliation.

PubMed

Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2008-11-06

A physicians prescribing decisions depend on knowledge of the patients medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patients medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patients medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation.