WorldWideScience

Sample records for america physician assistant

  1. Physician-assisted death.

    OpenAIRE

    Senn, John S.

    1995-01-01

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

  2. Physician-Assisted Suicide

    Science.gov (United States)

    Module fourteen of the EPEC-O Self-Study Original Version focuses on the skills that the physician can use to respond both compassionately and confidently to a request, not on the merits of arguments for or against legalizing physician-assisted suicide (PAS) or euthanasia.

  3. Physician Assistant Genomic Competencies.

    Science.gov (United States)

    Goldgar, Constance; Michaud, Ed; Park, Nguyen; Jenkins, Jean

    2016-09-01

    Genomic discoveries are increasingly being applied to the clinical care of patients. All physician assistants (PAs) need to acquire competency in genomics to provide the best possible care for patients within the scope of their practice. In this article, we present an updated version of PA genomic competencies and learning outcomes in a framework that is consistent with the current medical education guidelines and the collaborative nature of PAs in interprofessional health care teams. PMID:27490287

  4. Leadership Attributes of Physician Assistant Program Directors

    Science.gov (United States)

    Eifel, Raymond Leo

    2014-01-01

    Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…

  5. Physician-assisted death and the anesthesiologist.

    Science.gov (United States)

    Mottiar, Miriam; Grant, Cameron; McVey, Mark J

    2016-03-01

    Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. It is difficult to predict the potential demand for PAD in Canada. This paper highlights other countries' experiences with PAD in order to shed light on this question and to forecast issues that Canadian physicians will face once the change to the law comes into effect. At present, there is no legislative scheme in place to regulate the conduct of PAD. Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada. PMID:26739697

  6. Physician-Assisted Death in Canada.

    Science.gov (United States)

    Browne, Alister; Russell, J S

    2016-07-01

    The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection. PMID:27348822

  7. Technical assistance in Latin America

    International Nuclear Information System (INIS)

    As in the other regions, nuclear technology development in Latin America reflects mainly the degree of technological development already existing in each country. It is quite significant that in nearly all countries in Latin America the medical profession has been the first to show interest in using nuclear techniques. As a result, a country such as Uruguay has become a source of recruitment for technical assistance experts in nuclear medicine to other developing countries, while at the same time it continues to receive assistance for new sophisticated techniques from the IAEA. Part of this assistance, in turn, comes from the neighbouring countries, Argentina and Brazil. For example, an expert from Uruguay is currently assigned under an Agency programme to Costa Rica, El Salvador and Guatemala, and experts from Argentina and Brazil have been sent to Uruguay. This is an example of 'horizontal' development, meaning mutual assistance between developing countries under programmes supported by the United Nations Agencies, which is now being emphasized by the United Nations Development Programme (UNDP). Still in the field of nuclear medicine, another significant model is provided by Bolivia. With assistance from the IAEA, and thanks to the availability of a good professional infrastructure in that country, a net of nuclear medicine services has been started, consisting of a well-developed nuclear medicine centre in La Paz and regional centres in Cochabamba, Sucre and Santa Cruz. Because of its great variations in altitude, Bolivia is in the position of being able to conduct research on the adaptation of man to diverse environmental conditions. The Agency has contributed, and continues to do so, to these programmes by sending experts, providing for training abroad of Bolivian doctors under its fellowship programmes, and providing basic equipment for all four centres. Independently of the cases described above, the IAEA has implemented or is implementing a considerable

  8. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death

    OpenAIRE

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2014-01-01

    This study reports on German physicians’ views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great ma...

  9. Physician assisted suicide and the Supreme Court: putting the constitutional claim to rest.

    Science.gov (United States)

    Mariner, W K

    1997-12-01

    Like the debate about many controversial questions of ethics and medical care in America, public debate about physician assisted suicide became focused on questions of constitutional law. On June 26, 1997, the United States Supreme Court unanimously rejected any constitutional right of terminally ill patients to physician assisted suicide. An analysis of the Court's reasoning reveals that its decisions resolved only a narrow constitutional question that affects relatively few people--mentally competent, terminally ill patients who wish to hasten their imminent deaths by having a physician prescribe medication that they intend to use to commit suicide. Although suicide is not a crime, states remain free to prohibit assisted suicide. One consequence of the Court's decisions may be renewed debate on state laws. A more productive result would be to address the broader public health concerns that gave rise to support for physician assisted suicide--inadequate care for the terminally ill and prevention of suicide. PMID:9431307

  10. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide.

    Science.gov (United States)

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.

    2001-01-01

    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  11. Physician-assisted death in psychiatric practice in the Netherlands

    NARCIS (Netherlands)

    J.H. Groenewoud (Hanny); P.J. van der Maas (Paul); G. van der Wal (Gerrit); M.W. Hengeveld (Michiel); A.J. Tholen; W.J. Schudel; A. van der Heide (Agnes)

    1997-01-01

    textabstractBACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in ps

  12. A Physician's Position on Physician-assisted Suicide

    OpenAIRE

    Quill, Timothy E.

    1997-01-01

    On April 29, 1996, Dr. Quill offered testimony at an Oversight Hearing on “Assisted Suicide in the United States,” before the Subcommittee on the Constitution of the House of Representatives Committee on the Judiciary. That testimony is reproduced here, with permission of the author.

  13. 42 CFR 414.52 - Payment for physician assistants' services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for physician assistants' services. 414.52 Section 414.52 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians...

  14. Physician-assisted death in psychiatric practice in the Netherlands

    OpenAIRE

    Groenewoud, Hanny; Maas, Paul; van der Wal, Gerrit; Hengeveld, Michiel; Tholen, A.J.; Schudel, W.J.; van der Heide, Agnes

    1997-01-01

    textabstractBACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands. METHODS: In 1996, we sent questionnaires to 673 Dutch psychiatrists - about half of all such specialists in the country - and received 552 responses from the 667 who met the study criteria...

  15. Treatment-resistant depression and physician-assisted death.

    Science.gov (United States)

    MIller, Franklin G

    2015-11-01

    In a recent article, Udo Schuklenk and Suzanne van de Vathorst argued in favour of a legal option of physician-assisted death for patients with 'treatment-resistant' depression. In this commentary, I contend that their argument neglects the important consideration of the professional integrity of physicians. In light of this consideration, coupled with uncertainty about whether additional interventions with the patient can improve quality of life and restore the will to live, it is not appropriate to include patients with 'treatment-resistant' depression within a legal option of physician-assisted death. PMID:26401050

  16. The Assisted Dying Bill and the role of the physician.

    Science.gov (United States)

    Mullock, Alexandra

    2015-08-01

    This article explores the role of the physician in the Assisted Dying Bill, which is currently progressing through the House of Lords. The Supreme Court decision in Nicklinson and Others has alerted Parliament to the possibility that the current prohibition against assisted suicide may breach Article 8 of the European Convention in relation to the right to choose how to end one's life. In this article, the role of healthcare professionals in the proposed legalisation of physician-assisted suicide is examined, together with consideration of key ethical concerns over who might be permitted to access assisted dying. Whether the proposed law presents an ethically sound alternative to the current prohibition against assisting in suicide is not clear, but Parliament must now respond in order to address human rights issues and the call to legalise medically assisted suicide. PMID:25575506

  17. PTI TECHNICAL ASSISTANCE TO REBUILD AMERICA

    Energy Technology Data Exchange (ETDEWEB)

    Unknown

    2002-04-01

    Public Technology Inc. (PTI) engaged in a cooperative agreement, DE-FC26-01NT41107, with the US Department of Energy's (DOE) Rebuild America Program to provide energy efficiency and energy conservation technical assistance to local governments across the United States. The first year of the cooperative agreement dated from April 2, 2001 to April 1, 2002, at a funding level of $375,000. This technical report covers the period of October 2001--March 2002. PTI appreciates the support that it has received from Rebuild America and plans to continue, with DOE and Rebuild America support, to serve in a strategic capacity, lending the technical experience of its staff and that of the Energy Task Force on approaches to increasing program efficiencies, furthering program development, and coordinating information sharing to help ensure that energy programs are responsive to the needs of local governments.

  18. Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants

    International Nuclear Information System (INIS)

    Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Methods: Review of the literature and personal perspective. Conclusions: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy

  19. Factors Predicting Physician Assistant Faculty Intent to Leave

    Science.gov (United States)

    Coniglio, David Martin

    2013-01-01

    An increasing demand for education of physician assistants (PAs) has resulted in rapid growth in the number of PA educational programs. Faculty for these programs may be recruited from existing programs. Understanding faculty turnover intention is important to guide faculty development and to improve faculty retention. The purpose of this research…

  20. Counselors and the Legalization of Physician-Assisted Suicide.

    Science.gov (United States)

    Kiser, Jerry D.

    1996-01-01

    With the shift in Americans' beliefs regarding legalizing physician-assisted suicide for the terminally ill, counselors must be prepared to counsel clients who have decided to end their lives. For counselors to avoid violating the ethical guidelines established by the American Counseling Association (ACA) regarding these clients, a reevaluation of…

  1. Acceptability for French People of Physician-Assisted Suicide

    Science.gov (United States)

    Frileux, Stephanie; Sastre, Maria Teresa Munoz; Antonini, Sophie; Mullet, Etienne; Sorum, Paul Clay

    2004-01-01

    Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the…

  2. Characteristics of Persons Approving of Physician-Assisted Death

    Science.gov (United States)

    Blevins, Dean; Preston, Thomas A.; Werth, James L., Jr.

    2005-01-01

    The present study describes the characteristics and attitudes of non-terminally ill persons who support physician-assisted death (PAD) along with their expectations and preferences for care in the future. Participants (N=101) completed a survey assessing current affect and attitudes and those expected if terminally ill. Participants' responses…

  3. Employment of Nurse Practitioners and Physician Assistants in Breast Cancer Care

    OpenAIRE

    Friese, Christopher R.; Hawley, Sarah T.; Griggs, Jennifer J.; Jagsi, Reshma; Graff, John; Hamilton, Ann S.; Janz, Nancy K.; Katz, Steven J.

    2010-01-01

    This study found that nurse practitioner and physician assistant employment is higher with newer physicians and in more heavily resourced practices. Employment of nurse practitioners and physician assistants is relatively modest, which suggests an opportunity for physicians to employ these providers to alleviate workloads.

  4. Physician assistant wages and employment, 2000-2025.

    Science.gov (United States)

    Quella, Alicia; Brock, Douglas M; Hooker, Roderick S

    2015-06-01

    This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025. PMID:25989436

  5. Potential of physician assistants to support primary care

    Science.gov (United States)

    Bowen, Sarah; Botting, Ingrid; Huebner, Lori-Anne; Wright, Brock; Beaupre, Beth; Permack, Sheldon; Jones, Ian; Mihlachuk, Ainslie; Edwards, Jeanette; Rhule, Chris

    2016-01-01

    Abstract Objective To determine effective strategies for introducing physician assistants (PAs) in primary care settings and provide guidance to support ongoing provincial planning for PA roles in primary care. Design Time-series research design using multiple qualitative methods. Setting Manitoba. Participants Physician assistants, supervising family physicians, clinic staff, members of the Introducing Physician Assistants into Primary Care Steering Committee, and patients receiving care from PAs. Methods The PA role was evaluated at 6 health care sites between 2012 and 2014; sites varied in size, funding models, geographic locations (urban or rural), specifics of the PA role, and setting type (clinic or hospital). Semistructured interviews and focus groups were conducted; patient feedback on quality improvement was retrieved; observational methods were employed; and documents were reviewed. A baseline assessment was conducted before PA placement. In 2013, there was a series of interviews and focus groups about the introduction of PAs at the 3 initial sites; in 2014 interviews and focus groups included all 6 sites. Main findings The concerns that were expressed during baseline interviews about the introduction of PAs (eg, community and patient acceptance) informed planning. Most concerns that were identified did not materialize. Supervising family physicians, site staff, and patients were enthusiastic about the introduction of PAs. There were a few challenges experienced at the site level (eg, front-desk scheduling), but they were perceived as manageable. Unanticipated challenges at the provincial level were identified (eg, diagnostic test ordering). Increased attachment and improved access—the goals of introducing PAs to primary care—were only some of the positive effects that were reported. Conclusion This first systematic multisite evaluation of PAs in primary care in Canada demonstrated that with appropriate collaborative planning, PAs can effectively

  6. Voluntary Euthanasia and Physician Assisted Suicide : A Critical Ethical Comparative Analysis

    OpenAIRE

    Opara, Ignatius Chidiebere

    2005-01-01

    The two most controversial ends of life decisions are those in which physicians help patients take their lives and when the physician deliberately and directly intervenes to end the patients’ life upon his request. These are often referred to as voluntary euthanasia and physician assisted suicide. Voluntary euthanasia and physician assisted suicide have continued to be controversial public issues. This controversy has agitated the minds of great thinkers including ethicians, physicians, psych...

  7. Advance directives, dementia, and physician-assisted death.

    Science.gov (United States)

    Menzel, Paul T; Steinbock, Bonnie

    2013-01-01

    Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. PMID:23802899

  8. Physicians lead the way at America's top hospitals.

    Science.gov (United States)

    Weber, D O

    2001-01-01

    The 100 Top hospitals are selected annually based on seven critical parameters for each of the 6,200-plus U.S. hospitals with 25 or more beds. They include the previous year's risk-adjusted patient mortality and complication rates, severity-adjusted average patient lengths of stay, expenses, profitability, proportional outpatient revenue, and asset turnover ratio (a measure of facility and technological pace-keeping ability). The winners are selected from five comparable size groupings--small, medium, large community, teaching, and large academic hospitals. Conspicuous among the winners at every level are physician-led organizations. Even in the majority of hospitals headed by non-physician administrators, however, the managerial capabilities of medical directors are the key to success. The most common characteristic of these award-winning hospitals is that the leadership is working together and communicating the institution's goals effectively to all levels of the organization. PMID:11387891

  9. The case for physician assisted suicide: how can it possibly be proven?

    OpenAIRE

    Dahl, E.; Levy, N.

    2006-01-01

    In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicid...

  10. The case for physician assisted suicide: how can it possibly be proven?

    Science.gov (United States)

    Dahl, E; Levy, N

    2006-01-01

    In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide. PMID:16731731

  11. New Role, New Country: introducing US physician assistants to Scotland

    Directory of Open Access Journals (Sweden)

    O'May Fiona

    2007-05-01

    Full Text Available Abstract This paper draws from research commissioned by the Scottish Executive Health Department (SEHD. It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs, as a precursor to planned "piloting" of the PA role within the National Health Service (NHS in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland.

  12. Conventional vs unconventional assisted reproductive technologies: opinions of young physicians.

    Science.gov (United States)

    Hostiuc, S

    2013-01-01

    In the last three and a half decades, an increasing number of assisted reproductive technologies (ARTs) have been developed, some of them already being used in clinical practice, while others will probably remain purely theoretical due to their associated ethical issues. The purpose of this study was to analyse the opinions of medical residents regarding various ARTs, both classical and unconventional. We conducted a multi-institutional survey among 142 medical residents in order to assess the views of young physicians of regarding ARTs. Most responders were in favour of medical procedures like gamete donation and surrogacy. When asked about more controversial procedures such as posthumous sperm procurement or reproductive cloning, most were against. Progress in reproductive medicine is made at a fast pace, as more and more couples are found infertile and as the birth rate in developed countries becomes smaller and smaller. If not carefully followed and regulated, this can easily lead to the development of highly controversial procedures, which can significantly alter the way we see human reproduction. As the law has a very traditional approach, it is often left behind by progress in this field, leaving potentially controversial procedures unregulated for long periods of time. During these periods, physicians have the very important role of analysing what is good and what is not and when to recognise procedures that go against general ethical and medical principles. PMID:23259883

  13. Physician Assisted Suicide: Knowledge and Views of Fifth-Year Medical Students in Germany

    Science.gov (United States)

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More…

  14. Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.

    Science.gov (United States)

    Nelson, Scott C; Hooker, Roderick S

    2016-06-01

    One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation. PMID:27183500

  15. Physician-assisted suicide in psychiatry and loss of hope.

    Science.gov (United States)

    Berghmans, Ron; Widdershoven, Guy; Widdershoven-Heerding, Ineke

    2013-01-01

    In the Netherlands, euthanasia and physician-assisted suicide (PAS) are considered acceptable medical practices in specific circumstances. The majority of cases of euthanasia and PAS involve patients suffering from cancer. However, in 1994 the Dutch Supreme Court in the so-called Chabot-case ruled that "the seriousness of the suffering of the patient does not depend on the cause of the suffering", thereby rejecting a distinction between physical (or somatic) and mental suffering. This opened the way for further debate about the acceptability of PAS in cases of serious and refractory mental illness. An important objection against offering PAS to mentally ill patients is that this might reinforce loss of hope, and demoralization. Based on an analysis of a reported case, this argument is evaluated. It is argued that offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be ethically acceptable. PMID:23830024

  16. Federal and Provincial Responsibilities to Implement Physician-Assisted Suicide.

    Science.gov (United States)

    Baker, David; Sharpe, Gilbert; Lauks, Rebeka

    2016-02-01

    In the most significant constitutional decision of the last generation, Carter v. Canada, the Supreme Court of Canada reversed itself and decided that it was possible for Parliament to enact safeguards that would be adequate to protect persons who are vulnerable in times of weakness, then proceeded to declare that Canadians were entitled to a s. 7 Charter right to physician-assisted death. David Baker and Gilbert Sharpe accepted the challenge issued by the Court and drafted a Bill to amend the Criminal Code in a manner they believed would strike a constitutional balance between providing access to the right declared by the Court and protecting the vulnerable. This article represents their attempt, along with co-author Rebeka Lauks, to explain many of the key provisions in their draft. Amongst the most noteworthy are their attempts to ensure that those choosing PAD are informed about quality of life, as well as treatment choices; to define vulnerability and to install safeguards adequate to protect persons while vulnerable; and finally a prior review process that would ensure both ready access to the Charter right declared by the Court and consistent and transparent application of the law. The authors have attempted to establish an alternative model to that currently in effect in the Benelux countries, which they regard as having been ineffective in achieving any of these objectives. PMID:27169208

  17. Assistance Focus: Latin America/Caribbean (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2015-01-01

    The Clean Energy Solutions Center Ask an Expert service connects governments seeking policy information and advice with one of more than 30 global policy experts who can provide reliable and unbiased quick-response advice and information. The service is available at no cost to government agency representatives from any country and the technical institutes assisting them. This publication presents summaries of assistance provided to African governments, including the benefits of that assistance.

  18. The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

    OpenAIRE

    Grossman Michael D

    2009-01-01

    Abstract The role of Emergency Medicine Physicians (EMP) in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded r...

  19. Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

    Science.gov (United States)

    Kontaxakis, Vp; Paplos, K G; Havaki-Kontaxaki, B J; Ferentinos, P; Kontaxaki, M-I V; Kollias, C T; Lykouras, E

    2009-10-01

    Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide. PMID:22218231

  20. Euthanasia or physician-assisted suicide? A survey from the Netherlands.

    OpenAIRE

    Kouwenhoven, P.S.C.; Thiel, G.J.M.W. van; Raijmakers, N.J.H.; Rietjens, J.A.C.; van der Heide, A; van Delden, J J M

    2014-01-01

    Background: Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. Objectives: To study physicians’ experiences and attitudes concerning the choice between euthanasia and PAS. Methods: A questionnaire including vignettes was sent to a random sample of 1955 Dutch general practitioners, elderly care physicians and medical specialists. Results: In total, 793 physicians (41%) part...

  1. Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

    OpenAIRE

    Gevers Joseph; van Tol Donald; Rurup Mette; Rietjens Judith; Onwuteaka-Philpsen Bregje; van Delden Johannes; Buiting Hilde; van der Maas Paul; van der Heide Agnes

    2009-01-01

    Abstract Background An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of...

  2. Ethical decision making process in euthanasia and physician assisted suicide from nurses' perspective

    OpenAIRE

    Hopia, Hilkka

    2015-01-01

    The purpose of this study was to conduct a literature review describing nurses’ role and factors affecting nurses’ involvement in ethical decision making process in euthanasia and physician assisted suicide. The aim was to illustrate the decision making process of nurses in terms of euthanasia or physician assisted suicide. The objective was to provide a synthesis of a research results to benefit the nurses who are taking care of dying patients. The research questions were: 1) How are nurses ...

  3. Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands

    OpenAIRE

    Groenewoud, Hanny; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje; Willems, Dick; Maas, Paul; van der Wal, Gerrit

    2000-01-01

    textabstractBACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclo...

  4. The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

    Directory of Open Access Journals (Sweden)

    Grossman Michael D

    2009-08-01

    Full Text Available Abstract The role of Emergency Medicine Physicians (EMP in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.

  5. Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices

    Science.gov (United States)

    ... used for these analyses. NAMCS is a national probability sample survey of nonfederal, office-based physicians in the United States conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), Division of Health Care Statistics. The target ...

  6. Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

    Directory of Open Access Journals (Sweden)

    Gevers Joseph

    2009-10-01

    Full Text Available Abstract Background An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless, the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. Methods We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Results Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65% and/or had repeated the request several times (23%. Unbearable suffering was often substantiated with physical symptoms (62%, function loss (33%, dependency (28% or deterioration (15%. In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%, a known colleague (21%, otherwise (25%, or not clearly specified in the report (24%. Review committees relatively often scrutinized the consultation (41% and the patient's (unbearable suffering (32%; they had few questions about possible alternatives (1%. Conclusion Dutch physicians substantiate their adherence to the criteria in a variable way with an

  7. Scrupulous Monitoring of Physician-Assisted Dying: The Case for Mandatory Reporting to Coroners and Medical Examiners of All Physician-Assisted Deaths in Canada.

    Science.gov (United States)

    Guichon, Juliet; Alakija, Pauline; Doig, Christopher; Mitchell, Jan; Thibeault, Pascal

    2016-02-01

    Although the practice of physician-assisted dying (hereinafter "PAD") will soon be lawful in Canada, opponents of PAD claim that it might result in involuntary deaths. The Supreme Court of Canada in Carter v. Canada (Attorney General) rejected such arguments holding that involuntary deaths are preventable provided that jurisdictions devise stringent limits to the practice of PAD and that these stringent limits are "scrupulously monitored and enforced". This article examines the question of how best to engage in scrupulous monitoring of physician-assisted dying. At present, the province of Quebec has legislated, and three expert groups have proposed the creation of new administrative offices to monitor the practice of PAD (these groups are the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the External Panel on Options for a Legislative Response to Carter v. Canada, and the Canadian Medical Association). This article argues that scrupulous monitoring can be better achieved by requiring explicit mandatory notification of all physician-assisted deaths to coroners and medical examiners, rather than by creating new administrative offices. It is more effective, efficient and prudent to use already existing coroner and medical examiner death reporting and investigative frameworks to report physician-assisted deaths than to create new, untried, parallel and potentially more expensive administrative offices. In Canada, almost all provincial and territorial statutes that govern the official actions of coroners and medical examiners currently require the reporting of non-natural deaths, which include those that will be attributable to PAD. To achieve the scrupulous monitoring of PAD required by the Supreme Court, provincial and territorial governments, in collaboration with the federal government, should. 1. review their coroner and fatality statutes to clarify that physician-assisted deaths (as non-natural deaths) are mandatorily notifiable; 2

  8. Role of non-governmental organisations in physician assisted suicide

    OpenAIRE

    Ziegler, Stephen J.; Bosshard, Georg

    2007-01-01

    Could right to die organisations be part of the solution to the many ethical difficulties doctors face over assisted suicide? Stephen Ziegler and Georg Bosshard examine how two organisations in Switzerland and Oregon help people die

  9. Physician Assistants and Nurse Practitioners Perform Effective Roles on Teams Caring for Medicare Patients with Diabetes

    OpenAIRE

    Everett, Christine M.; Thorpe, Carolyn T; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A.

    2013-01-01

    Redesigning healthcare systems to deliver team-based care is considered important to improving care for chronically ill patients. Including physician assistants and/or nurse practitioners on primary care teams is one approach to the patient-centered medical home. However, understanding of the impact of team structure on outcomes is limited. Using Medicare claims and electronic health record data from a large physician group, we compared multiple patient outcomes for older patients with diabet...

  10. Sports physicians, ethics and antidoping governance: between assistance and negligence.

    Science.gov (United States)

    Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan

    2013-07-01

    Recent positive doping cases and a series of mistakes of medical doctors of the International Federation of Basketball have reopened the debate about the role of medical doctor in elite sport. This study shows that some sports physicians involved in recent positive doping cases are insufficiently aware of the nuances of doping regulations and, most importantly, of the list of prohibited substances. Moreover, several team doctors are shown to have exercised poor judgement in relation to these matters with the consequence that athletes are punished for doping offences on the basis of doctors' negligence. In such circumstances, athletes' rights are jeopardised by a failure of the duty of care that (sports) physicians owe their athlete patients. We argue that, with respect to the World Anti Doping Code, antidoping governance fails to define, with sufficient clarity, the role of medical doctors. There is a need for a new approach emphasising urgent educational and training of medical doctors in this domain, which should be considered prior to the revision of the next World Anti Doping Code in 2013 in order to better regulate doctor's conduct especially in relation to professional errors, whether negligent or intentional. PMID:23322892

  11. Physician-assisted death: attitudes and practices of community pharmacists in East Flanders, Belgium.

    Science.gov (United States)

    Bilsen, Johan; Bauwens, Marc; Bernheim, Jan; Stichele, Robert Vander; Deliens, Luc

    2005-03-01

    This study investigates attitudes and practices of community pharmacists with respect to physician-assisted death. Between 15 February and 15 April 2002, we sent anonymous mail questionnaires to 660 community pharmacists in the eastern province of Flanders, Belgium. The response rate was 54% (n = 359). Most of the pharmacists who responded felt that patients have the right to end their own life (73%), and that under certain conditions physicians may assist the patient in dying (euthanasia: 84%; physician-assisted suicide: 61%). Under the prevailing restrictive legislation, a quarter of the pharmacists were willing to dispense lethal drugs for euthanasia versus 86% if it were legalized, but only after being well informed by the physician. The respondents-favour guidelines for pharmacists drafted by their own professional organizations (95%), and enforced by legislation (90%) to ensure careful end-of-life practice. Over the last two years, 7.3% of the responding pharmacists have received a medical prescription for lethal drugs and 6.4% have actually dispensed them. So we can conclude that community pharmacists in East Flanders were not adverse to physician-assisted death, but their cooperation in dispensing lethal drugs was conditional on clinical information about the specific case and on protection by laws and professional guidelines. PMID:15810755

  12. Perspectives of Family Physicians on Computer-assisted Health-risk Assessments

    OpenAIRE

    Ahmad, Farah; Skinner, Harvey A; Stewart, Donna E; Levinson, Wendy

    2010-01-01

    Background The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions. Objective The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians’ perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic. Methods A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All ...

  13. Advanced Practice Nursing: Is the Physician's Assistant an Accident of History or a Failure to Act?

    Science.gov (United States)

    Christman, Luther

    1998-01-01

    The responses of some nursing organizations regarding the establishment of collaborative relationships in the nursing profession may be responsible for the development of the physician assistant profession. The nursing profession should examine these responses while planning strategies to cope with the current chaos in health care. (JOW)

  14. Patient education: the role of the physician assistant and other allied health professionals

    OpenAIRE

    Alexander, Lisa Mustone

    1987-01-01

    The physician assistant (PA) has been on the leading edge in the development of midlevel health providers since the 1960s. As an allied health professional, PAs, along with nurse practitioners, midwives, nurse anesthetists, and others, emphasize patient education. Oftentimes, patient education can be introduced in the academic setting, but true learning comes with experience as a student in clinical training.

  15. Narratives and Values: The Rhetoric of the Physician Assisted Suicide Debate.

    Science.gov (United States)

    Dysart, Deborah

    2000-01-01

    Argues that the function of medicine as an art and as a social institution is impeded when the rhetorical nature of its practice is ignored. Offers a case study of two texts widely cited as landmarks in the physician-assisted suicide debate of the 1990s, examining their rhetorical organization and its impact on their reception. (SR)

  16. Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide.

    Science.gov (United States)

    Manetta, Ameda A.; Wells, Janice G.

    2001-01-01

    Presents results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. (BF)

  17. The Rivalry between Simulation and Problem-Based Learning: A Study of Learning Transfer in Physician Assistant Students

    Science.gov (United States)

    Meyer, Kimberly E.

    2010-01-01

    The purpose of this dissertation was to evaluate learning transfer achieved by physician assistant students comparing two instructional methods, human patient simulation and electronic clinical case studies. This prospective, randomized, mixed-methods study utilized first and second-year physician assistant student volunteers taking a pretest and…

  18. Assisted suicide and voluntary euthanasia: role contradictions for physicians.

    Science.gov (United States)

    Randall, Fiona; Downie, Robin

    2010-08-01

    It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents. PMID:20849002

  19. On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

    Science.gov (United States)

    Varelius, Jukka

    2016-05-01

    Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. PMID:26449985

  20. Twenty Years of Growth and Innovation: A Reflection on PACKRAT's Impact on Physician Assistant Education.

    Science.gov (United States)

    Cavanagh, Kim; Lessard, Donovan; Britt, Zach

    2015-12-01

    In its 20th year, the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) is a student self-assessment that can assist physician assistant (PA) students and PA program faculty in identifying strengths and areas in need of improvement in the didactic and clinical phases of PA education. In this reflection, we provide an overview of the history of PACKRAT and outline some of its benefits for students and PA programs, as well as its generative role in assessment within PA studies. Taking a broader view of PACKRAT's impact on assessment for the PA profession, we outline the research on its benefits and its use to maximize student performance, as well as how it has promoted the development of additional assessment tools. PMID:26599313

  1. Robotic-assisted partial Nephrectomy: initial experience in South America

    Directory of Open Access Journals (Sweden)

    Gustavo C. Lemos

    2011-08-01

    Full Text Available OBJECTIVE:To report the initial outcomes of robotic-assisted partial nephrectomy in a tertiary center in South America. MATERIAL AND METHODS: From 11/2008 to 12/2009, a total of 16 transperitoneal robotic-assisted partial nephrectomies were performed in 15 patients to treat 18 kidney tumors. One patient with bilateral tumor had two procedures, while two patients with two synchronous unilateral tumors had a single operation to remove them. Eleven (73% patients were male and the right kidney was affected in 7 (46% patients. The median patient age and tumor size were 57 years old and 30 mm, respectively. Five (28% tumors were hilar and/or centrally located. RESULTS: The median operative time, warm ischemia time and estimated blood loss was 140 min, 27 min and 120 mL, respectively. Blood transfusion was required in one patient with bilateral tumor, and one additional pyelolithotomy was performed due to a 15mm stone located in the renal pelvis. The histopathology analysis showed 15 (83% malignant tumors, which 10 (67% were clear cell carcinoma. The median hospital stay was 72 hrs and no major complication was observed. CONCLUSION: Robotic-assisted partial nephrectomy is safe and represents a valuable option to perform minimally invasive nephron-sparing surgery.

  2. Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada.

    Science.gov (United States)

    Landry, Joshua T; Foreman, Thomas; Kekewich, Michael

    2015-11-01

    On February 6th 2015 the Supreme Court of Canada (SCC) released their decision on Carter v Canada (Attorney General) to uphold a judgment from a lower court which determined that the current prohibition in Canada on physician-assisted dying violated the s. 7 [Charter of Rights and Freedoms] rights of competent adults whose medical condition causes intolerable suffering. The purpose of this piece is to briefly examine current regulations from Oregon (USA), Belgium, and the Netherlands, in which physician-assisted death and/or euthanasia is currently permitted, as well as from the province of Quebec which recently passed Bill-52, "An Act Respecting End-of-Life Care." We present ethical considerations that would be pertinent in the development of policies and regulations across Canada in light of this SCC decision: patient and provider autonomy, determining a relevant decision-making standard for practice, and explicating challenges with the SCC criteria for assisted-death eligibility with special consideration to the provision of assisted-death, and review of assisted-death cases. [It is not the goal of this paper to address all questions related to the regulation and policy development of euthanasia and assisted death in Canada, but rather to stimulate and guide the conversations in these areas for policy makers, professional bodies, and regulators.]. PMID:26518907

  3. Euthanasia and physician-assisted suicide: knowledge, attitudes and experiences of nurses in Andalusia (Spain).

    Science.gov (United States)

    Tamayo-Velázquez, María-Isabel; Simón-Lorda, Pablo; Cruz-Piqueras, Maite

    2012-09-01

    The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken. PMID:22990427

  4. How does legalization of physician assisted suicide affect rates of suicide?

    OpenAIRE

    Jones, David Albert; Paton, David

    2015-01-01

    Objectives: Several US states have legalized or decriminalised physician assisted suicide (PAS) whilst others are currently considering permitting PAS. Although it has been suggested that legalization could plausibly lead to a reduction in total suicides and to a delay in those suicides which do occur, to date no research has tested whether these effects can be identified in practice. The aim of this paper was to fill this gap by examining the association between the legalization of PAS and...

  5. Attitudes towards euthanasia and physician-assisted suicide among Pakistani and Indian doctors: A survey

    OpenAIRE

    Syed Qamar Abbas; Zafar Abbas; Stanley Macaden

    2008-01-01

    Aim: This study attempts to assess the attitude of Pakistani and Indian doctors to euthanasia and physician-assisted suicide. Methods: We used a questionnaire survey that included one case history of a patient with cancer and another of one suffering from motor neurone disease (MND). Results: Fifty-two of 100 doctors from Pakistan returned the completed questionnaires. Eight of the 52 (15.3%) doctors agreed with the concept of euthanasia being an acceptable option for the patient with...

  6. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    OpenAIRE

    Farooq Khan; George Tadros

    2013-01-01

    Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in Ind...

  7. Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications

    OpenAIRE

    Hudson, Peter; Hudson, Rosalie; Philip, Jennifer; Boughey, Mark; Kelly, Brian; Hertogh, Cees

    2015-01-01

    Objective: Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues-and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS we...

  8. Euthanasia and assisted suicide: a physician’s and ethicist’s perspectives

    OpenAIRE

    Boudreau, J. Donald

    2014-01-01

    J Donald Boudreau,1 Margaret A Somerville21Faculty of Medicine, Department of Medicine, McGill University, Montreal, QC, Canada; 2Faculty of Law, Faculty of Medicine, and Centre for Medicine, Ethics and Law, McGill University, Montreal, QC, CanadaAbstract: The debate on legalizing euthanasia and assisted suicide has a broad range of participants including physicians, scholars in ethics and health law, politicians, and the general public. It is conflictual, and despite its importance, particip...

  9. Palliative care professionals’ willingness to perform euthanasia or physician assisted suicide

    OpenAIRE

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2015-01-01

    Background Euthanasia and physician assisted suicide (PAS) are highly debated upon particularly in the light of medical advancement and an aging society. Little is known about the professionals’ willingness to perform these practices particularly among those engaged in the field of palliative care and pain management. Thus a study was performed among those professionals. Methods An anonymous questionnaire was handed out to all participants of a palliative care congress and a pain symposium in...

  10. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    Science.gov (United States)

    Anneser, Johanna; Jox, Ralf J.; Thurn, Tamara; Borasio, Gian Domenico

    2016-01-01

    Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. Results: Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of

  11. Survey of doctors' opinions of the legalisation of physician assisted suicide

    Directory of Open Access Journals (Sweden)

    Rayner Lauren

    2009-03-01

    Full Text Available Abstract Background Assisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalising physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law. Methods We conducted a postal survey of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide. Results The corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect. Conclusion More senior doctors in England and Wales oppose any step towards the legalisation of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation.

  12. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    Science.gov (United States)

    Khan, Farooq; Tadros, George

    2013-01-01

    Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients' wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time. PMID:23833354

  13. Physician-assisted suicide and euthanasia in Indian context: Sooner or later the need to ponder!

    Directory of Open Access Journals (Sweden)

    Farooq Khan

    2013-01-01

    Full Text Available Physician-assisted suicide (PAS is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder or at least under Section 304 (punishment for culpable homicide not amounting to murder. The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients′ wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time.

  14. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    Science.gov (United States)

    Khan, Farooq; Tadros, George

    2013-01-01

    Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients’ wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time. PMID:23833354

  15. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

    Directory of Open Access Journals (Sweden)

    Hicks Madelyn

    2006-06-01

    Full Text Available Abstract Background A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. Discussion Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. Summary The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards.

  16. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

    Science.gov (United States)

    Hicks, Madelyn Hsiao-Rei

    2006-01-01

    Background A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. Discussion Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. Summary The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards. PMID:16792812

  17. Physician Assistants

    Science.gov (United States)

    ... More Sources of Data Publications Latest Publications » The Economics Daily Monthly Labor Review Beyond the Numbers Spotlight on Statistics Reports & Bulletins Commissioner's Corner Career Outlook Occupational Outlook Handbook Handbook of Methods Research Papers Copyright Information Contact & ...

  18. Legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes.

    Science.gov (United States)

    Seale, C

    2009-04-01

    This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind. PMID:19318460

  19. A national survey of 'inactive' physicians in the United States of America: enticements to reentry

    Directory of Open Access Journals (Sweden)

    Brotherton Sarah E

    2011-02-01

    Full Text Available Abstract Background Physicians leaving and reentering clinical practice can have significant medical workforce implications. We surveyed inactive physicians younger than typical retirement age to determine their reasons for clinical inactivity and what barriers, real or perceived, there were to reentry into the medical workforce. Methods A random sample of 4975 inactive physicians aged under 65 years was drawn from the Physician Masterfile of the American Medical Association in 2008. Physicians were mailed a survey about activity in medicine and perceived barriers to reentry. Chi-square statistics were used for significance tests of the association between categorical variables and t-tests were used to test differences between means. Results Our adjusted response rate was 36.1%. Respondents were fully retired (37.5%, not currently active in medicine (43.0% or now active (reentered, 19.4%. Nearly half (49.5% were in or had practiced primary care. Personal health was the top reason for leaving for fully retired physicians (37.8% or those not currently active in medicine (37.8% and the second highest reason for physicians who had reentered (28.8%. For reentered (47.8% and inactive (51.5% physicians, the primary reason for returning or considering returning to practice was the availability of part-time work or flexible scheduling. Retired and currently inactive physicians used similar strategies to explore reentry, and 83% of both groups thought it would be difficult; among those who had reentered practice, 35.9% reported it was difficult to reenter. Retraining was uncommon for this group (37.5%. Conclusion Availability of part-time work and flexible scheduling have a strong influence on decisions to leave or reenter clinical practice. Lack of retraining before reentry raises questions about patient safety and the clinical competence of reentered physicians.

  20. Set the world on fire: sparking research interest in physician assistants.

    Science.gov (United States)

    Garino, Alexandria

    2014-01-01

    The state of research within the physician assistant (PA) profession has lagged behind that of other health professions. PAs need to develop as thought leaders and conduct high quality original research if the PA profession is to continue to grow and command respect from non-PAs. However, many PAs and PA educators feel that research is an overwhelming endeavor and do not know where to start. This article explores the importance of developing expertise as a profession and offers self-reflection tools and exercises that anyone can use to discern a personal research agenda and actualize a path towards authentic scholarship. PMID:25650879

  1. Factors influencing the satisfaction of rural physician assistants: a cross-sectional study.

    Science.gov (United States)

    Filipova, Anna A

    2014-01-01

    The purpose of the study was to determine factors that attract physician assistants (PAs) to rural settings, and what they found satisfying about their practice and community. A cross-sectional survey design was used. All PAs who were practicing in both nonmetropolitan counties and rural communities in metropolitan counties, in a single midwestern US state, served as the population for the study. A total of 414 usable questionnaires were returned of the 1,072 distributed, a 39% response rate. Factor analysis, descriptive statistics, Pearson's correlation analysis, and robust regression analyses were used. Statistical models were tested to identify antecedents of four job satisfaction factors (satisfaction with professional respect, satisfaction with supervising physician, satisfaction with authority/ autonomy, and satisfaction with workload/salary). The strongest predictor of all four job satisfaction factors was community satisfaction, followed by importance of job practice. Additionally, the four job satisfaction factors had some significant associations with importance of socialization, community importance, practice attributes (years of practice, years in current location, specialty, and facility type), job responsibilities (percentage of patient load not discussed with physician, weekly hours as PA, inpatient visits), and demographics (marital status, race, age, education). PMID:24598896

  2. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    Directory of Open Access Journals (Sweden)

    Anneser, Johanna

    2016-02-01

    Full Text Available Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering. The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures.Results: Out of 301 students in total, 241 (80% participated in the survey; 109 answered the version 1 questionnaire (physical suffering and 132 answered the version 2 questionnaire (emotional suffering. The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal and euthanasia (illegal correctly (81.2% and 93.7%, respectively, while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the

  3. Mechanical circulatory assist devices: a primer for critical care and emergency physicians.

    Science.gov (United States)

    Sen, Ayan; Larson, Joel S; Kashani, Kianoush B; Libricz, Stacy L; Patel, Bhavesh M; Guru, Pramod K; Alwardt, Cory M; Pajaro, Octavio; Farmer, J Christopher

    2016-01-01

    Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU. PMID:27342573

  4. Sedation-assisted Orthopedic Reduction in Emergency Medicine: The Safety and Success of a One Physician/One Nurse Model

    Directory of Open Access Journals (Sweden)

    Vinson, David R

    2013-02-01

    Full Text Available Introduction: Much of the emergency medical research on sedation-assisted orthopedic reductions has been undertaken with two physicians—one dedicated to the sedation and one to the procedure. Clinical practice in community emergency departments (EDs, however, often involves only one physician, who both performs the procedure and simultaneously oversees the crendentialed registered nurse who administers the sedation medication and monitors the patient. Although the dual-physician model is advocated by some, evidence in support of its superiority is lacking. Methods: In this electronic health records review we describe sedation-assisted closed reductions of major joints and forearm fractures in three suburban community EDs. The type of procedure and sedation medication, need for specialty assistance, success rates, and intervention-requiring adverse events are reported. Results: During the 18-month study period, procedural sedation was performed 457 times on 442 patients undergoing closed reduction for shoulder dislocations (n=111, elbow dislocations (n=29, hip dislocations (n=101, and forearm fractures (n=201. In the vast majority of this cohort (98.4% [435/442], a single emergency physician simultaneously managed both the procedural sedation and the initial orthopedic reduction without the assistance of a second physician. The reduction was successful or satisfactory in 96.6% (425/435; 95% confidence interval [CI], 95.8-98.8% of these cases, with a low incidence of intervention-requiring adverse events (2.8% [12/435]; 95% CI, 1.5-4.8%.Conclusion: Sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely in the ED using a one physician/one nurse model. A policy that requires a separate physician (or nurse anesthetist to administer medications for all sedation-assisted ED procedures appears unwarranted. Further research is needed to determine which specific clinical scenarios

  5. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey

    Science.gov (United States)

    Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J.; Freidl, Wolfgang

    2015-01-01

    Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Results Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Conclusion Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates. PMID:25906265

  6. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey.

    Directory of Open Access Journals (Sweden)

    Erwin Stolz

    Full Text Available Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia.A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971. Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1 abstract description of euthanasia, (2 abstract description of physician-assisted suicide, (3 the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4 the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations including authoritarianism were tested via multiple logistic regression analyses.Rejection was highest in the case of the neonate (69% and lowest for the case of the older cancer patient (35%. A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate.Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates.

  7. Twenty five years of requests for euthanasia and physician assisted suicide in Dutch general practice: trend analysis.

    OpenAIRE

    Marquet, R. L.; Bartelds, A; Visser, G.J.; Spreeuwenberg, P.; Peters, L.

    2003-01-01

    Concerns have been expressed that the Dutch policy on euthanasia (E) and physician assisted suicide (PAS) may lead to an exponential increase in the number of requests and use. Many Dutch general practitioners, nursing home physicians, and pharmacists have a fairly positive attitude and have become more tolerant over the years. We investigated the effect of increasing acceptance on the number of and underlying reasons for requests for E/PAS in Dutch general practice from 1977 to 2001.

  8. Who favors legalizing physician-assisted suicide? The vote on Michigan's Proposal B.

    Science.gov (United States)

    Strate, John; Kiska, Timothy; Zalman, Marvin

    2001-09-01

    At the November 1998 general election, Michigan citizens were given the opportunity to vote on Proposal B, an initiative that would have legalized physician-assisted suicide (PAS). PAS initiatives also have been held in Washington State, California, Oregon, and Maine, with only Oregon's passing. We use exit poll data to analyze the vote on Proposal B. Attributes associated with social liberalism -- Democratic Party identification, less frequent church attendance, more education, and greater household income -- led to increased odds of a "yes" vote. Attributes associated with social conservatism -- Republican Party identification and frequent church attendance -- led to decreased odds of a "yes" vote. Similar to the abortion issue, PAS's supporters strongly value personal autonomy, whereas its opponents strongly value the sanctity of life. Voter alignments like those in Michigan will likely appear in other states with the initiative process if PAS reaches their ballots. PMID:16859330

  9. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada.

    Science.gov (United States)

    Duffy, Olivia Anne

    2015-12-01

    On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. PMID:26720829

  10. Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review.

    LENUS (Irish Health Repository)

    McCormack, Ruaidhri

    2012-01-01

    To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors\\' attitudes, and make recommendations for future research. Data sources: Three electronic databases, four pertinent journals, reference lists of included studies. Review methods: Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted.

  11. Doctor-cared dying instead of physician-assisted suicide: a perspective from Germany.

    Science.gov (United States)

    Oduncu, Fuat S; Sahm, Stephan

    2010-11-01

    The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians' duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different in content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany's recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as "due care" is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care. PMID:20652751

  12. Physician Charity Care in America: Almost Always an Illusion, Ever More Commercial

    OpenAIRE

    Bruce D. White; Marleen Eijkholt

    2015-01-01

    The first Code of Medical Ethics promulgated by the American Medical Association (AMA) in 1847 included a provision that essentially obligated physicians to care for those in their communities who could not afford to pay for professional services. The spirit of that provision remains embodied in today’s Code. However, a “charity care” ethical obligation may not make as much professional sense as it once did. Health care institutions have assumed a much greater role in providing charity care a...

  13. Physician Charity Care in America: Almost Always an Illusion, Ever More Commercial

    Directory of Open Access Journals (Sweden)

    Bruce D. White

    2015-05-01

    Full Text Available The first Code of Medical Ethics promulgated by the American Medical Association (AMA in 1847 included a provision that essentially obligated physicians to care for those in their communities who could not afford to pay for professional services. The spirit of that provision remains embodied in today’s Code. However, a “charity care” ethical obligation may not make as much professional sense as it once did. Health care institutions have assumed a much greater role in providing charity care and many physicians are now under legal and quasi-legal obligations to provide care in some cases. Under the recently enacted Affordable Care Act (ACA—if fully implemented—it is theorized that as many as 95% of Americans will be covered by some basic insurance plan. Perhaps today’s physicians should tailor the charity care mandate into a new jacket, which envisions that all doctors share equally in the care for those without adequate means. An individual obligation may have to make way for a more communal one in professional codes. Moreover, it may be wise to consider if there are any lessons to draw from other health care systems (e.g., the Dutch, where questions about charity care still exist within a universal health care system context.

  14. Informed Practice: Students' Clinical Experiences in the Undergraduate Phase of an Accelerated Physician Assistant Program.

    Science.gov (United States)

    Dereczyk, Amy; DeWitt, Rachel

    2016-06-01

    This qualitative study explored the clinical experiences of students in an accelerated physician assistant (PA) program. The participants were either certified nursing assistants (CNAs) or emergency medical technicians-basic (EMTs-B). The study was designed to elicit (1) how the participants perceived their older patients and (2) how the participants' experiences might affect their own future communications, bedside manner, and clinical preparedness as PAs. This study used a focus group to explore students' clinical experiences before the graduate phase of their accelerated PA program. Five female and 2 male PA students (N = 7) participated in the study. All participants were 23 years old and worked as either a CNA or an EMT-B. Results fell into 2 basic themes: informing practice and forming relationships. Regarding the first theme, participants felt that their experience as entry-level health care providers allowed them to improve their communication skills and bedside manner and to provide greater comfort to patients. Regarding the second theme, participants gained appreciation for older people and began to recognize the knowledge deficits and learning needs of their patients. The results suggested that a student's clinical experience as a CNA or an EMT-B before entering a PA program has a positive effect on the student's personal and professional development. The participants acquired greater appreciation and respect for older patients and members of the health care team. PMID:27123599

  15. Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis. Health Technology Case Study 37.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and…

  16. Just How Important Is the Messenger versus the Message? The Case of Framing Physician-Assisted Suicide

    Science.gov (United States)

    Haider-Markel, Donald P.; Joslyn, Mark R.

    2004-01-01

    As a political issue, death and dying topics only sometimes reach the political agenda. However, some issues, such as physician-assisted suicide (PAS) have been highly salient. This article explores attitudes toward PAS by examining the malleability of opinion when respondents are exposed to issue frames and when specific messengers present those…

  17. Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated with "Physician-Assisted Suicide"

    Science.gov (United States)

    Werth, James L., Jr.; Gordon, Judith R.

    2002-01-01

    After providing background material related to the Supreme Court cases on "physician-assisted suicide" (Washington v. Glucksberg, 1997, and Vacco v. Quill, 1997), this article presents the amicus curiae brief that was submitted to the United States Supreme Court by 2 national mental health organizations, a state psychological association, and an…

  18. Physician Charity Care in America: Almost Always an Illusion, Ever More Commercial

    OpenAIRE

    Bruce D. White; Marleen Eijkholt

    2015-01-01

    The first Code of Medical Ethics promulgated by the American Medical Association (AMA) in 1847 included a provision that essentially obligated physicians to care for those in their communities who could not afford to pay for professional services. The spirit of that provision remains embodied in today’s Code . However, a “charity care†ethical obligation may not make as much professional sense as it once did. Health care institutions have assumed a much greater role in providing charity ...

  19. Physician-Assisted Suicide and Euthanasia: Can You Even Imagine Teaching Medical Students How to End Their Patients' Lives?

    Science.gov (United States)

    Boudreau, J Donald

    2011-01-01

    The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and residents would inevitably and necessarily be implicated. It is my perspective that everyone in the profession, including those charged with educating future generations of physicians, has a critical interest in participating in this ongoing debate. I explore potential implications for medical education of a widespread sanctioning of physician-inflicted and physician-assisted death. My analysis, which uses a consequential-basis approach, leads me to conclude that euthanasia, when understood to include physician aid in hastening death, is incommensurate with humanism and the practice of medicine that considers healing as its overriding mandate. I ask readers to imagine the consequences of being required to teach students how to end their patients' lives and urge medical educators to remain cognizant of their responsibility in upholding long-entrenched and foundational professional values. PMID:22319424

  20. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  1. Attitudes towards euthanasia and physician-assisted suicide among Pakistani and Indian doctors: A survey

    Directory of Open Access Journals (Sweden)

    Syed Qamar Abbas

    2008-01-01

    Full Text Available Aim: This study attempts to assess the attitude of Pakistani and Indian doctors to euthanasia and physician-assisted suicide. Methods: We used a questionnaire survey that included one case history of a patient with cancer and another of one suffering from motor neurone disease (MND. Results: Fifty-two of 100 doctors from Pakistan returned the completed questionnaires. Eight of the 52 (15.3% doctors agreed with the concept of euthanasia being an acceptable option for the patient with MND. Six of the 52 (11.5% supported a similar approach for the cancer patient. From India, 60/100 doctors returned the completed questionnaires. Sixteen of the 60 (26.6% doctors supported euthanasia as an option for the patient with MND whereas 15 (25% supported a similar option for the cancer patient. Conclusion: We conclude that only a minority of the doctors support euthanasia. This group belongs to a younger age group. In Pakistan, they were more likely to be males. The religion of the doctors did not appear to be a determining factor.

  2. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

    Science.gov (United States)

    Duffy, Olivia Anne

    2015-01-01

    On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who “clearly consents to the termination of life” and has a “grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”1 The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry’s role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. PMID:26720829

  3. Click it: assessment of classroom response systems in physician assistant education.

    Science.gov (United States)

    Graeff, Evelyn C; Vail, Marianne; Maldonado, Ana; Lund, Maha; Galante, Steve; Tataronis, Gary

    2011-01-01

    The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness. PMID:21399841

  4. Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

    Science.gov (United States)

    Maessen, Maud; Veldink, Jan H; Onwuteaka-Philipsen, Bregje D; Hendricks, Henk T; Schelhaas, Helenius J; Grupstra, Hepke F; van der Wal, Gerrit; van den Berg, Leonard H

    2014-10-01

    The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86% considered the health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity and 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS. PMID:25022937

  5. Physician-Assisted Suicide and Other Forms of Euthanasia in Islamic Spiritual Care.

    Science.gov (United States)

    Isgandarova, Nazila

    2015-12-01

    The muteness in the Qur'an about suicide due to intolerable pain and a firm opposition to suicide in the hadith literature formed a strong opinion among Muslims that neither repentance nor the suffering of the person can remove the sin of suicide or mercy 'killing' (al-qatl al-rahim), even if these acts are committed with the purpose of relieving suffering and pain. Some interpretations of the Islamic sources even give advantage to murderers as opposed to people who commit suicide because the murderers, at least, may have opportunity to repent for their sin. However, people who commit suicide are 'labeled' for losing faith in the afterlife without a chance to repent for their act. This paper claims that Islamic spiritual care can help people make decisions that may impact patients, family members, health care givers and the whole community by responding to questions such as 'What is the Islamic view on death?', 'What is the Islamic response to physician-assisted suicide and other forms of euthanasia?', 'What are the religious and moral underpinnings of these responses in Islam?' PMID:26631521

  6. Cultural competency in a physician assistant curriculum in the United States: a longitudinal study with two cohorts

    OpenAIRE

    Barbra Beck; Matthew H. Scheel; Kathleen De Oliveira; Jane Hopp

    2014-01-01

    Purpose: Many physician assistant (PA) programs have recently integrated cultural competency into their curricula. However, there is little evidence of the longitudinal effectiveness of such curricula on culture competency. This study tested whether the amount of exposure to a cultural competency curriculum affected self-assessments of cultural awareness in two cohorts of students. Methods: Cohort 1 and Cohort 2 students completed a cultural awareness survey at the beginning of the program an...

  7. Physician-Assisted Suicide and Euthanasia: Can You Even Imagine Teaching Medical Students How to End Their Patients' Lives?

    OpenAIRE

    Boudreau, J. Donald

    2011-01-01

    The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and...

  8. The impact of the euthanasia act on the number of requests for euthanasia and physician assisted suicide.

    OpenAIRE

    Donker, G.; Van Alphen, J.; Marquet, R.

    2009-01-01

    Objective: To investigate changes in the number of and reasons for requests of Euthanasia and physician assisted suicide (E/PAS) in Dutch General Practice after implementing the Euthanasia Act in 2002. Design: Retrospective dynamic cohort study during the period 1977–2007. Participants Standardized registration forms were used to collect data annually on E/PAS via the Dutch Sentinel Practice Network. This network of 45 general practices represents 0.8% of the Dutch population and is represent...

  9. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey

    OpenAIRE

    Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J.; Freidl, Wolfgang

    2015-01-01

    Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face su...

  10. [Legal issues of physician-assisted euthanasia part I--terminology and historical overview].

    Science.gov (United States)

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2012-01-01

    Under German criminal law, euthanasia assisted by the attending physician involves the risk of criminal prosecution. However, in the absence of clear legal provisions, the law concerning euthanasia has been primarily developed by court rulings and jurisprudential literature in the last 30 years. According to a traditional classification there are four categories of euthanasia: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. However, there is still no generally accepted definition for the general term "euthanasia". The development of the law on the permissibility of euthanasia was strongly influenced by the conflict between the right of self-determination of every human being guaranteed by the Constitution and the constitutional mandate of the state to protect and maintain human life. The decisions of the German Federal Court of Justice on euthanasia in the criminal trials "Wittig" (1984), "Kempten" (1994) and "Putz" (2010) as well as the ruling of the 12th Division for Civil Matters of the Federal Court of Justice (2003) are of special importance. Some of these decisions were significantly influenced by the discussions in the jurisprudential literature. However, the German Bundestag became active for the first time as late as in 2009 when it adopted the 3rd Guardianship Amendment Act, which also contains provisions on the legal validity of a living will independent of the nature and stage of an illness. In spite of the new law, an analysis of the "Putz" case makes it especially clear that the criminal aspects of legal issues at the end of a person's life still remain controversial. It is to be expected that this issue will remain the subject of intensive discussion also in the next few years. PMID:23367790

  11. Are Dutch patients willing to be seen by a physician assistant instead of a medical doctor?

    Directory of Open Access Journals (Sweden)

    Kuilman Luppo

    2012-09-01

    Full Text Available Abstract Background The employment of physician assistants (PAs is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD under various time constraints and semi-urgent medical scenarios. Methods A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively. Results Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario. No differences emerged when analysed by gender, age, or parenthood status. Conclusion Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population.

  12. Active-duty physicians' perceptions and satisfaction with humanitarian assistance and disaster relief missions: implications for the field.

    Directory of Open Access Journals (Sweden)

    Geoffrey J Oravec

    Full Text Available BACKGROUND: The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. METHODS AND FINDINGS: An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean = 5.74. Perceived benefit was greatest for the United States (mean = 5.56 and self (mean = 5.39 compared to the target population (mean = 4.82. These perceptions were related to participants' intentions to extend their military medical service (total model R (2 = .37, with the strongest predictors being perceived benefit to self (β = .21, p<.01, the U.S. (β = .19, p<.01, and satisfaction (β = .18, p<.05. In addition, Air Force physicians reported higher levels of satisfaction (mean = 6.10 than either Army (mean = 5.27, Cohen's d = 0.75, p<.001 or Navy (mean = 5.60, Cohen's d = 0.46, p<.01 physicians. CONCLUSIONS: Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals.

  13. Assessing the academic and professional needs of trauma nurse practitioners and physician assistants.

    Science.gov (United States)

    Wilson, Laurie N; Wainwright, Gail A; Stehly, Christy D; Stoltzfus, Jill; Hoff, William S

    2013-01-01

    Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States. A 14-question electronic survey, using SurveyMonkey, was distributed to PAs/NPs at trauma centers identified through the American College of Surgeons Web site and other online resources. Demographic questions included trauma center level, provider type, level of education, and professional affiliations. Likert scale questions were incorporated to assess level of mentorship, comfort level with training, and individual perceived needs for academic and professional development. There were 120 survey respondents: 60 NPs and 60 PAs. Sixty-two respondents (52%) worked at level I trauma centers and 95 (79%) were hospital-employed. Nearly half (49%) reported working in trauma centers for 3 years or less. One hundred nineteen respondents (99%) acknowledged the importance of trauma-specific education; 98 (82%) were required by their institution to obtain such training. Thirty-five respondents (32%) reported receiving $1000 per year or less as a continuing medical education benefit. Insufficient mentorship, professional development, and academic development were identified by 22 (18%), 16 (13%), and 30 (25%) respondents, respectively. Opportunities to network with trauma PAs/NPs outside their home institution were identified as insufficient by 79 (66%). While PAs/NPs in trauma centers recognize the importance of continued contemporary trauma care and evidence-based practices, attending trauma-related education is not universally required by their employers. Financial restrictions may pose an additional impediment to academic development

  14. [Physician assistance in dying or help to die--a line of legal demarcation (from the lawyer's perspective)].

    Science.gov (United States)

    Ulsenheimer, Klaus

    2008-01-01

    The definition of the legal prerequisites for the permissible withholding/withdrawal of medical treatment, the limits to a physician's obligation to provide medical care as well as the differentiation between the aiding with suicide, which is exempt from punishment, and the punishable termination of life upon request or failure to render assistance is actually one of the most difficult medico-legal, professional-ethical, human, ideological and moral problems. The numerous views and opinions expressed are varying accordingly so that the call for legislative action comes as no surprise. Nonetheless, legal practice has provided clarity for a large number of aspects. The life of a human being scores the highest on the value scale of the Basic Law (GG) of the Federal Republic of Germany; the right to self-determination is of particular significance. It does not imply the "right to suicide", though, but suicide--and the participation in it--is not subject to punishment. But if the physician exercises control over the act ("Tatherrschaft") he is required to provide all necessary and reasonable life-saving assistance. There is general consent that assistance with dying by way of intentional killing (active direct euthanasia) is a crime whereas palliative treatment of the terminally ill while accepting the unintentional and inevitable side effect of hastening the patient's death is justified (so-called indirect euthanasia). The so-called passive euthanasia which is characterised by withholding/withdrawing treatment measures is associated with the most difficult problems. In this context the permissible ,,assistance in dying", i.e., the actual euthanasia, has to be distinguished from ,,help to die", that is, euthanasia in a broader sense, as the Federal Supreme Court (BGH) correctly pointed out in its leading decision (BGHSt 40, 257 et sqq.). Within this differentiation the advance directive is of particular importance since only subsidiary reference may be made to the

  15. Pilot Survey of Physician Assistants Regarding Lesbian, Gay, Bisexual, and Transgender Providers Suggests Role for Workplace Nondiscrimination Policies.

    Science.gov (United States)

    Ewton, Tiffany A; Lingas, Elena O

    2015-12-01

    Lesbian, gay, bisexual, and transgender (LGBT) medical providers in the United States have historically faced discrimination from their peers. To assess current workplace culture and attitudes, and to evaluate awareness of workplace and professional policies regarding LGBT discrimination, we sent a cross-sectional survey to 163 PAs (Physician Assistants). Respondents had an overall positive attitude towards LGBT providers, yet the majority was not aware of relevant policy statements (>60%). A significant association existed between policy awareness and LGBT inclusivity (Pworkplace policy standards. PMID:26788777

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

    Science.gov (United States)

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

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

  17. Survival benefit of physician-staffed Helicopter Emergency Medical Services (HEMS) assistance for severely injured patients

    NARCIS (Netherlands)

    D. den Hartog (Dennis); J. Romeo (Jamie); A.N. Ringburg (Akkie); M.H.J. Verhofstad (Michiel); E.M.M. van Lieshout (Esther)

    2015-01-01

    markdownabstractBackground: Physician-staffed Helicopter Emergency Medical Services (HEMS) provide specialist medical care to the accident scene and aim to improve survival of severely injured patients. Previous studies were often underpowered and showed heterogeneous results, leaving the subject at

  18. A protocol for consultation of another physician in cases of euthanasia and assisted suicide

    OpenAIRE

    . .

    2001-01-01

    Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity.

  19. Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension.

    Science.gov (United States)

    Komaroff, A L; Flatley, M; Browne, C; Sherman, H; Fineberg, S E; Knopp, R H

    1976-04-01

    Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely. PMID:5325

  20. Physician-assisted suicide and public virtue: a reply to the liberty thesis of "the Philosophers' Brief".

    Science.gov (United States)

    DuBois, J M

    1999-01-01

    The "Philosophers' Brief," penned by six of today's most influential philosophers, was submitted as an amicus curiae brief to the Supreme Court as it prepared to consider the cases of Washington v. Glucksberg and Vacco v. Quill. It set precedent as the first such brief submitted by a group representing itself solely as moral philosophers. The brief became an overnight gold standard statement of the liberal philosophical understanding of the relationship of the State to so-called 'private morality.' The main thesis of the brief is that physician-assisted suicide regards the deeply personal event of death, and that individuals have a constitutionally guaranteed right to make decisions for themselves about the intimate details of their lives. In this article, James DuBois calls this the 'liberty thesis,' and he argues that the brief's application of this principle is both contradictory and impracticable. The contradiction arises as the brief proposes restrictions on the right to physician-assisted suicide--restrictions that require the State to abandon neutrality on intimate value judgments about life's worth. The impracticability arises insofar as the brief fails to leave room for a compelling State interest in promoting a minimal level of public virtue. Ironically, one of the strongest arguments that can be proffered on behalf of a State interest in preserving a minimal level of public virtue stems from its role in safeguarding human liberty. PMID:10597662

  1. Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: an interview study

    OpenAIRE

    Rurup, M L; Muller, M T; Philipsen, B.D.; Heide,; Van der Wal; Maas, van der, Rien

    2005-01-01

    OBJECTIVE: To determine how often requests are made for euthanasia and physician-assisted suicide (EAS) in the absence of severe disease and how such requests are dealt with in medical practice in The Netherlands. METHOD: Retrospective interview study. Participants: 125 general practitioners (GPs), 77 nursing home physicians (NHPs), and 208 clinical specialists. RESULTS: In The Netherlands, each year approximately 400 people request EAS, because they are 'weary of life'. Thirty per cent of al...

  2. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    OpenAIRE

    Anneser, Johanna; Jox, Ralf J; Thurn, Tamara; Borasio, Gian Domenico

    2016-01-01

    Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year m...

  3. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students.

    OpenAIRE

    Anneser J.; Jox R.J.; Thurn T.; Borasio G.D.

    2016-01-01

    OBJECTIVES: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year m...

  4. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales

    OpenAIRE

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-01-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. Th...

  5. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales.

    Science.gov (United States)

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-06-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127

  6. Legalized MD-assisted suicide needed to improve care, physician tells right-to-die group

    OpenAIRE

    Elash, A

    1997-01-01

    Advocates of euthanasia say clear rules outlining procedures to follow when a terminally ill patient requests assisted suicide would help doctors provide better care without fear of legal or professional recrimination. The Canadian-born medical director of a US-based right-to die organization made the comments during the recent annual meeting of Dying With Dignity, a Canadian group.

  7. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    Science.gov (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.

    2007-01-01

    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  8. Assisted suicide and the killing of people? Maybe. Physician-assisted suicide and the killing of patients? No: the rejection of Shaw's new perspective on euthanasia.

    Science.gov (United States)

    McLachlan, Hugh V

    2010-05-01

    David Shaw presents a new argument to support the old claim that there is not a significant moral difference between killing and letting die and, by implication, between active and passive euthanasia. He concludes that doctors should not make a distinction between them. However, whether or not killing and letting die are morally equivalent is not as important a question as he suggests. One can justify legal distinctions on non-moral grounds. One might oppose physician-assisted suicide and active euthanasia when performed by doctors on patients whether or not one is in favour of the legalisation of assisted suicide and active euthanasia. Furthermore, one can consider particular actions to be contrary to appropriate professional conduct even in the absence of legal and ethical objections to them. Someone who wants to die might want only a doctor to kill him or to help him to kill himself. However, we are not entitled to everything that we want in life or death. A doctor cannot always fittingly provide all that a patient wants or needs. It is appropriate that doctors provide their expert advice with regard to the performance of active euthanasia but they can and should do so while, qua doctors, they remain hors de combat. PMID:20448006

  9. NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America

    Directory of Open Access Journals (Sweden)

    Laliberté Nancy

    2009-01-01

    Full Text Available Abstract Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get

  10. A "Suicide Pill" for Older People: Attitudes of Physicians, the General Population, and Relatives of Patients Who Died after Euthanasia or Physician-Assisted Suicide in the Netherlands

    Science.gov (United States)

    Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.; van der Wal, Gerrit; van der Heide, Agnes; van Der Maas, Paul J.

    2005-01-01

    In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general population, and…

  11. The killing of severely disabled newborns: the spectre behind the legalisation of physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Smith, Stephen W

    2005-12-01

    Arguments made by those in favour of the legalisation of physician-assisted suicide (PAS) and euthanasia often rely upon the idea of the quality of life. This idea states that an individual's life is not valuable as an intrinsic good, but is only good based upon the things which it allows us to do. It thus allows the argument that it is morally permissible to kill individuals whose lives have fallen below an acceptable 'quality of life.' However, this concept may require that one accept the killing of individuals who have not expressly request to be killed such as severely disabled newborns. This paper will examine the issue of whether those who utilise a quality of life approach to justify the legalisation of PAS and euthanasia must logically accept the policy of killing severely disabled newborn children. First, there will be an examination of the concept of quality of life and its importance in the arguments for the legalisation of PAS or euthanasia. This paper will then consider how notions of personhood interact with the concept of quality of life in order to create the problem faced by those who favour the legalisation of PAS or euthanasia. Finally, this paper will consider how the notion of autonomy may be used as a way to avoid this difficulty created by the quality of life approach. PMID:16440872

  12. Hospitals focus on physician relations.

    Science.gov (United States)

    Rubright, R

    1987-09-01

    Many hospital administrators are shifting their marketing focus from consumers and referral agents to the hospital's attending physicians. These new comprehensive physician relations or retention programs are much broader than those implemented in the past and are used to build mutual exchanges between hospitals and physicians, sharpen the physicians' awareness of the hospital's most appealing attributes, compete with nearby hospitals that develop their own aggressive physician relations programs, and ensure a more promising financial picture for both parties. "Cutting-edge" physician relations plans in Catholic hospitals include the following: Marketing plans for the medical staff alone or with key medical staff sections; A strong physician data base; A physician referral system; A director of medical affairs; Practice enhancement and business assistance services; A young physicians section; Continuing marketing auditing and research into physicians' opinions, attitudes, and behavior patterns; Physician inclusion in all major programs, services, policies, and events; Programs for physician office staff; Marketing committees consisting of physicians. PMID:10283486

  13. Promoting collaboration and cultural competence for physician assistant and physical therapist students: a cross-cultural decentralized interprofessional education model

    Directory of Open Access Journals (Sweden)

    Kathleen De Oliveira

    2015-05-01

    Full Text Available Purpose: As the United States health care model progresses towards medical teams and the country’s population continues to diversify, the need for health professional education programs to develop and implement culturally specific interprofessional education (IPE becomes increasingly imperative. A wide range of models exists for delivering and implementing IPE in health education, but none have included the cultural components that are vital in educating the health professional. Methods: A cross-cultural decentralized IPE model for physician assistant (PA and physical therapy (PT students was developed. This three-part IPE series was created using an established cultural curricular model and began with the exploration of self, continued with the examination of various dimensions of culture, and concluded with the exploration of the intersection between health and culture. We assessed student satisfaction of the IPE experiences and students’ engagement and attitudes towards IPE using a three-item open-ended questionnaire administered after each cross-cultural activity and the Interprofessional Education Series Survey (IESS upon the completion of the series. Results: IESS responses showed that PA and PT students reported benefits in interprofessional collaboration and cultural awareness and expressed overall satisfaction with the series. Qualitative analysis revealed growth in student response depth consistent with the scaffolded focus of each IPE module in the series. Conclusion: The trends in this three-part series suggest that institutions looking to develop culturally inclusive IPE educational initiatives may have success through a decentralized model mirroring the effective cultural progression focused on addressing exploration of self, examination of various dimensions of culture, and exploration of the intersection between health and culture.

  14. Contesting the Equivalency of Continuous Sedation until Death and Physician-assisted Suicide/Euthanasia: A Commentary on LiPuma.

    Science.gov (United States)

    Raho, Joseph A; Miccinesi, Guido

    2015-10-01

    Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma's particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility--a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. PMID:26242447

  15. Physician Assistant profession (PA)

    Science.gov (United States)

    ... primary care areas, including family practice. Other common practice areas are general surgery, surgery specialties, and emergency medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may ...

  16. Empowering Indigenous Languages and Cultures: The Impact of German Bilateral Assistance in Latin America

    Science.gov (United States)

    Cortina, Regina

    2010-01-01

    Working in Latin America for several decades to address the educational needs of poor and indigenous groups, the GTZ (Gesellschaft fur Technische Zusammenarbeit) has helped to develop the knowledge base of intercultural bilingual education. The goal of this article is to analyze Germany's impact from the mid-1970s to the present as the GTZ has…

  17. Reassessing Shelter Assistance in America. Volume I: Analysis and Findings. Project Report.

    Science.gov (United States)

    Newman, Sandra J.; Schnare, Ann B.

    The United States Department of Health and Human Services (HHS)--through the explicit and implicit shelter allowance provided under Aid to Families with Dependent Children (AFDC), Supplemental Security Income (SSI), and General Assistance--spends at least $10 billion a year on housing assistance, or about as much as the Department of Housing and…

  18. CONVERTING THE 'RIGHT TO LIFE' TO THE 'RIGHT TO PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA': AN ANALYSIS OF CARTER V CANADA (ATTORNEY GENERAL), SUPREME COURT OF CANADA.

    Science.gov (United States)

    Chan, Benny; Somerville, Margaret

    2016-01-01

    In its landmark decision Carter v Canada (Attorney General), the Supreme Court of Canada ruled that the criminal prohibition on physician-assisted suicide and euthanasia for certain persons in certain circumstances violated their rights to life, liberty, and security of the person in sec. 7 of the Canadian Charter of Rights and Freedoms and thus was unconstitutional. The Supreme Court in effect overruled its earlier decision, Rodriguez v British Columbia (Attorney General), which upheld the prohibition as constitutionally valid, on the basis of changes in Charter jurisprudence and in the social facts since Rodriguez was decided. We argue that the Supreme Court's Carter decision shows conceptual disagreements with its Rodriguez decision concerning the nature and scope of the sec. 7-protected interests and the accompanying principles of fundamental justice. Not only do these conceptual differences have little to do with the changes that the Court in Carter invoked for 'revisiting' Rodriguez, the Court's articulation of the sec. 7 interests, particularly the right to life, and the principles of fundamental justice, especially the principle of over breadth, are problematic on their own terms. Furthermore, the way in which the Court dealt with evidence regarding abuses in permissive jurisdictions is also subject to criticism. We recommend that if, as now seems inevitable, legislation is introduced, it should mandate that assisted suicide and euthanasia be performed by specially licensed non-medical personnel and only on the authorization of a Superior Court judge. We also reject the key recommendations recently issued by the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. PMID:27099364

  19. Physician Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

  20. [Legal issues of physician-assisted euthanasia. Part III--Passive euthanasia, comparison of international legislation, conclusions for medical practice].

    Science.gov (United States)

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2013-01-01

    The generic term "passive euthanasia" includes different issues dealing with the omission, discontinuation or termination of life-sustaining or life-prolonging medical treatments. The debate around passive euthanasia focuses on the constitutional right of self-determination of every human being on the one hand and the constitutional mandate of the State to protect human life on the other. Issues of passive euthanasia always require a differentiated approach. Essentially, it comes down to the following: In Germany, the human right of self-determination includes the right to prohibit the performance of life-sustaining treatments, even if this leads to the death of the patient. A physician who does not take life-sustaining treatment measures because this is the free will expressed by the patient is not subject to prosecution. On the other hand, if the physician treats the patient against his will, this can be deemed a punishable act of bodily injury. The patient's will is decisive even if his concrete state of health does no longer allow him to freely express his will. In the Patient's Living Will Act of 2009, the German legislator clarified the juridical assessment of such constellations being of particular relevance in practice. A written living will of a person in which he requests to take or not to take certain medical treatment measures in case that he is no longer able to make the decision himself shall be binding for the people involved in the process of medical treatment. If there is no living will, the supposed will of the patient shall be relevant. In its judgment in the "Putz case", the German Federal Court of Justice ruled in 2010 that actions terminating a life-sustaining treatment that does not correspond to the patient's will must be limited to letting an already ongoing disease process run its course. In this context it is not important, however, whether treatment is discontinued by an active act or by omission. Under certain circumstances, the

  1. Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America

    OpenAIRE

    Lira, Renan Bezerra; Chulam, Thiago Celestino; Koh, Yoon Woo Woo; Choi, Eun Chang Chang; Kowalski, Luiz Paulo

    2016-01-01

    Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular e...

  2. Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America.

    Science.gov (United States)

    Lira, Renan Bezerra; Chulam, Thiago Celestino; Koh, Yoon Woo Woo; Choi, Eun Chang Chang; Kowalski, Luiz Paulo

    2016-04-01

    Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results. Methods Prospective analysis of the first 11 eligible patients submitted to retroauricular endoscope-assisted approach for neck procedures in the Head and Neck Surgery Department at AC Camargo Cancer Center. Results A total of 18 patients were included in this study, comprising 7 supraomohyoid neck dissections, 8 submandibular gland excisions, 3 thyroid lobectomies, and one paraganglioma excision. There was no significant local complications, surgical accident, or need for conversion into conventional open procedure in this series. Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit. PMID:27096018

  3. Physician drug dispensing.

    Science.gov (United States)

    Lober, C W; Behlmer, S D; Penneys, N S; Shupack, J L; Thiers, B H

    1988-11-01

    We have reviewed the issue of physician drug dispensing by focusing upon quality of care, economic considerations, drug availability, patient compliance, safety, and increased governmental regulation. From a quality of care perspective, the increased use of pharmacist assistants, the tendency toward generic and therapeutic drug substitution, and the less specialized clinical education of pharmacists all pose hazards rather than safety checks upon physician prescribing. There is no evidence that pharmacists charge less than physicians. If they did, there would be no need to protect their incomes legislatively by restricting physician dispensing. Economic motivation per se is less important to a physician than providing a true convenience for his patients and thus encouraging a closer doctor-patient relationship. Physician dispensing adds to the availability of medication and may minimize the number of patients shuttling between pharmacies to obtain complex multi-ingredient preparations. Compliance is enhanced as availability increases. Prepackaged pharmaceuticals prepared under the auspices of pharmacists and dispensed by physicians are at least as safe as those prepared by the ungloved hands of a pharmacist hidden behind store counters. Thus, restricting the physician's right to dispense can negatively affect the quality of medical care, the cost of medications, safety, the availability of pharmaceuticals, and patient compliance. Such limitation is certainly not in the best interest of our patients. PMID:3056999

  4. Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 4. Clinic QPCB Task Sort for Clinical Physician Assistants--Dermatology, ENT, Opththalmology, Orthopedics, and Urology.

    Science.gov (United States)

    Technomics, Inc., McLean, VA.

    This publication is Attachment 4 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 for clinical physician assistants. (BT)

  5. Surgical Assisting

    Science.gov (United States)

    ... specific training over and above a degree in science, nursing, physician assisting, or another health profession. Prerequisites . Recommended eligibility requirements for admission into a surgical assisting program are: Bachelor of Science degree (or higher) Associate degree in an allied ...

  6. Physician Requirements-1990. For Cardiology.

    Science.gov (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

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

  7. Using PCR-based detection and genotyping to trace Streptococcus salivarius meningitis outbreak strain to oral flora of radiology physician assistant.

    Directory of Open Access Journals (Sweden)

    Velusamy Srinivasan

    Full Text Available We recently investigated three cases of bacterial meningitis that were reported from a midwestern radiology clinic where facemasks were not worn during spinal injection of contrast agent during myelography procedures. Using pulsed field gel electrophoresis we linked a case strain of S. salivarius to an oral specimen of a radiology physician assistant (RPA. We also used a real-time PCR assay to detect S. salivarius DNA within a culture-negative cerebrospinal fluid (CSF specimen. Here we extend this investigation through using a nested PCR/sequencing strategy to link the culture-negative CSF specimen to the case strain. We also provide validation of the real-time PCR assay used, demonstrating that it is not solely specific for Streptococcus salivarius, but is also highly sensitive for detection of the closely related oral species Streptococcus vestibularis. Through using multilocus sequence typing and 16S rDNA sequencing we further strengthen the link between the CSF case isolate and the RPA carriage isolate. We also demonstrate that the newly characterized strains from this study are distinct from previously characterized S. salivarius strains associated with carriage and meningitis.

  8. Using PCR-based detection and genotyping to trace Streptococcus salivarius meningitis outbreak strain to oral flora of radiology physician assistant.

    Science.gov (United States)

    Srinivasan, Velusamy; Gertz, Robert E; Shewmaker, Patricia L; Patrick, Sarah; Chitnis, Amit S; O'Connell, Heather; Benowitz, Isaac; Patel, Priti; Guh, Alice Y; Noble-Wang, Judith; Turabelidze, George; Beall, Bernard

    2012-01-01

    We recently investigated three cases of bacterial meningitis that were reported from a midwestern radiology clinic where facemasks were not worn during spinal injection of contrast agent during myelography procedures. Using pulsed field gel electrophoresis we linked a case strain of S. salivarius to an oral specimen of a radiology physician assistant (RPA). We also used a real-time PCR assay to detect S. salivarius DNA within a culture-negative cerebrospinal fluid (CSF) specimen. Here we extend this investigation through using a nested PCR/sequencing strategy to link the culture-negative CSF specimen to the case strain. We also provide validation of the real-time PCR assay used, demonstrating that it is not solely specific for Streptococcus salivarius, but is also highly sensitive for detection of the closely related oral species Streptococcus vestibularis. Through using multilocus sequence typing and 16S rDNA sequencing we further strengthen the link between the CSF case isolate and the RPA carriage isolate. We also demonstrate that the newly characterized strains from this study are distinct from previously characterized S. salivarius strains associated with carriage and meningitis. PMID:22384169

  9. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups--another perspective on Oregon's data.

    Science.gov (United States)

    Finlay, I G; George, R

    2011-03-01

    Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it-namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS. PMID:21071568

  10. Dr Kathryn Beers, Assistant Director Physical Sciences and Engineering, Office of Science and Technology Policy Executive Office of the President United States of America visit the CMS experiment at point 5.

    CERN Document Server

    Maximilien Brice

    2007-01-01

    Dr Kathryn Beers, Assistant Director Physical Sciences and Engineering, Office of Science and Technology Policy Executive Office of the President United States of America visit the CMS experiment at point 5.

  11. Prevalence of dyslipidemia in the population aged 45 to 64 years assisted by attending physician of the Institución de Asistencia Médica Colectiva

    Directory of Open Access Journals (Sweden)

    Marcelo Morales

    2011-09-01

    Full Text Available Introduction: Ischemic heart disease and cerebrovascular disease are two of the major health problems at present, dyslipidemia is one of the major vascular risk factors modifiable. Since 2009 the Ministry of Health of Uruguay to care promoted the participation of "Medical Reference", especially in the 45 to 64 years. This care is a goal to achieve by the IAMC in Uruguay, which results in a payment to the institutions achieve compliance. It is in our interest to know the prevalence of dyslipidemia in this age group and association with other vascular risk factors. A study in 2009 found a prevalence CUDAM of dyslipidemia reported 25% in this age range. Objectives: 1 Determine the prevalence of dyslipidemia among users 45 to 64 of CUDAM assisted by their referring physician. 2 To determine the percentage of patients who know their dyslipidemia and the degree of compliance with medical therapy. 3 To evaluate the association with other vascular risk factors defined. Methods: 454 patients between 45 and 64 years attended between 01/07 and 31/12/10 by the referring doctor with lipid profile. We conducted a telephone survey to find the presence of dyslipidaemia, treatment, compliance and associated vascular risk factors. Results: 454 patients with lipid profiles, mean cholesterol levels of 211 mg / dl. 25% and 18.9% of patients have LDL levels of cholesterol and triglycerides respectively the reference value. 56% reported having dyslipidemia for interrogation, of which 26% had normal levels of LDL and triglycerides. Discussion: In these patients, the prevalence of dyslipidemia and vascular risk factors consistent with the literature further analyzed. The need to be controlled by your referring doctor raised the level of detection and dyslipidemic patients' knowledge of CUDAM.

  12. British and Israeli Assistance to U.S. Strategies of Torture and Counter- insurgency in Central and Latin America, 1967-96: An Argument Against Complexification

    Directory of Open Access Journals (Sweden)

    Ian Almond

    2013-01-01

    Full Text Available Although the role of the U.S. in supporting the anti-democratic, counter-revolutionary movements, governments, and dictatorships that flourished in Latin America from the 1960s to the 1990s is well known, this article examines the support provided to the U.S. by other countries. Principally this support was provided by Israel and the United Kingdom, but other countries were also involved, such as South Africa, Taiwan, France, and even Saudi Arabia. The article argues that a clear material framework underlies the assistance given by these countries. It also identifies a number of cultural and historical reasons why anti-democratic governments in Latin America found particular political empathy in Israel.

  13. Compliance with Mandated Child Abuse Reporting: Comparing Physicians and Teachers.

    Science.gov (United States)

    Kenny, Maureen C.

    2001-01-01

    Fifty-six recently trained physicians and teachers were compared on rates and knowledge of child abuse reporting and responses to vignettes of sexual abuse. Results demonstrated differences between the groups with physicians making significantly more reports and assisting in child abuse reporting more often than teachers. Physicians reported…

  14. Should UK emergency physicians undertake diagnostic ultrasound examinations?

    OpenAIRE

    Robinson, N. A.; Clancy, M J

    1999-01-01

    From the published evidence there is no doubt that emergency physicians in America can undertake focused ultrasound examinations and that, by extrapolation, this would also be the case for UK emergency physicians. If this skill is to become part of the diagnostic armamentarium of the emergency physician, however, it needs to be demonstrated to be cost effective compared with the alternatives already available to the hospital. Trials to test for this benefit should adopt a hospital and not an ...

  15. Physicians? Opinions of Phytotherapy Products

    OpenAIRE

    Murat Kartal; Alev Yücel; Zerrin Gamsızkan; Alev Kurt

    2011-01-01

    Aim: This study has been conducted to determine of family physicians’ level of knowledge and perspectives with herbal products therapy (phytotherapy) - and herbal products.Material and Methods; Present study, which is a type of descriptive study, is designed with the participation of the family physician specialists and assistants working public or private health organizations in several cities in between June 2007 and April 2008 by via electronic mail. In this research, a specifica...

  16. [Active euthanasia in Colombia and assisted suicide in California].

    Science.gov (United States)

    Julesz, Máté

    2016-01-31

    The institution of active euthanasia has been legal in Colombia since 2015. In California, the regulation on physician-assisted suicide will come into effect on January 1, 2016. The legal institution of active euthanasia is not accepted under the law of the United States of America, however, physician-assisted suicide is accepted in an increasing number of member states. The related regulation in Oregon is imitated in other member states. In South America, Colombia is not the first country to legalize active euthanasia: active euthanasia has been legal in Uruguay since 1932. The North American legal tradition markedly differs from the South American one and both are incompatible with the Central European rule of law. In Hungary and in most European Union countries, solely the passive form of euthanasia is legal. In the Benelux countries, the active form of euthanasia is legal because the supranational law of the European Union does not prohibit it. Notwithstanding, European Union law does not prescribe legalization of either the active form of euthanasia, or the physician-assisted suicide. PMID:26801362

  17. Hospital demand for physicians.

    Science.gov (United States)

    Morrisey, M A; Jensen, G A

    1990-01-01

    This article develops a derived demand for physicians that is general enough to encompass physician control, simple profit maximization and hospital utility maximization models of the hospital. The analysis focuses on three special aspects of physician affiliations: the price of adding a physician to the staff is unobserved; the physician holds appointments at multiple hospitals, and physicians are not homogeneous. Using 1983 American Hospital Association data, a system of specialty-specific demand equations is estimated. The results are consistent with the model and suggest that physicians should be concerned about reduced access to hospitals, particularly as the stock of hospitals declines. PMID:10104050

  18. Physician buy-in for EMRs.

    Science.gov (United States)

    Yackanicz, Lori; Kerr, Richard; Levick, Donald

    2010-01-01

    Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals. PMID:20397333

  19. Physician Fee Schedule Search

    Data.gov (United States)

    U.S. Department of Health & Human Services — This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services,...

  20. Unemployment and health: physicians' role.

    Science.gov (United States)

    Guirguis, S S

    1999-01-01

    Unemployment has been documented to have detrimental impacts on a person's mental, physical and social well being. When unemployment or being out of work is due to injury or sickness, the effects are compounded by mental and social factors. In an effort to prevent prolonged unemployment due to injury or sickness, changes were made to existing disability income supplement plans to redirect their focus from basic income support to active employment measures. This is intended to reduce individual's dependency on financial assistance and encourage individuals to take personal responsibility for getting back to work. The various disability insurance plans require primary care physicians to provide opinion and participate in the recovery and safety return to work of injured or sick persons. The physician approach to medical care of the injured/sick person with employment problems should focus on return to work as a goal of treatment. The patient should be seen as part of a social or environmental system and not as an isolated individual. The physician has a significant role to play in the diagnosis, determining functional abilities and participation in the return to work plan. The physician positive participation, not only provides an intrinsic cost saving value in insurance costs, but more important, helps patients maintain gainful employment. Work often helps in regaining health. Many factors are involved in a return to work outcome and physicians need to know how to identify and track the factors that facilitate or impede return to work. The challenge for the physician is to utilize the available resources to facilitate the recovery and communicate with other parties involved in the return to work process. This paper discusses the disability insurance plans in Canada and the community expectations from physicians dealing with patients who are out of work because of injury or sickness. It is acknowledged that primary care physicians' skills are not adequate in this

  1. First and foremost, physicians: the clinical versus leadership identities of physician leaders.

    Science.gov (United States)

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

    Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

  2. Physicians: Requirements for Becoming a Physician

    Science.gov (United States)

    ... Us Contact Us A | A Text size Email Requirements for Becoming a Physician Note: We are not ... the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by ...

  3. Adjustment of Korean-American physicians in Korea: aspect of personal satisfaction.

    OpenAIRE

    Hong, S. D.

    1999-01-01

    This study was conducted to assess the psychosocial adjustment of Korean-American physicians in the aspect of personal satisfaction after returning to Korea. A questionnaire was mailed to 72 Korean-American physicians who were practicing medicine in Korea and forty physicians responded. These physicians, typically in their 50s, lived in America for 21-30 years before coming back to Korea. The most frequent motives for them to come back to Korea were giving back to their native country, longin...

  4. Why not Commercial Assistance for Suicide? On the Question of Argumentative Coherence of Endorsing Assisted Suicide.

    Science.gov (United States)

    Kipke, Roland

    2015-09-01

    Most people who endorse physician-assisted suicide are against commercially assisted suicide - a suicide assisted by professional non-medical providers against payment. The article questions if this position - endorsement of physician-assisted suicide on the one hand and rejection of commercially assisted suicide on the other hand - is a coherent ethical position. To this end the article first discusses some obvious advantages of commercially assisted suicide and then scrutinizes six types of argument about whether they can justify the rejection of commercially assisted suicide while simultaneously endorsing physician-assisted suicide. The conclusion is that they cannot provide this justification and that the mentioned position is not coherent. People who endorse physician-assisted suicide have to endorse commercially assisted suicide as well, or they have to revise their endorsement of physician-assisted suicide. PMID:25425401

  5. Hospitals' marketing challenge: influencing physician behavior.

    Science.gov (United States)

    MacStravic, R C

    1985-05-01

    Physicians' referring and admitting behavior as well as their clinical management practices are major determinants of hospitals' profitability under prospective payment. Four techniques are available to hospitals that seek to increase market share: Recruitment and retention strategies. In planning the mix of specialties represented on staff, hospitals should consider the effects of a physician's practice on the hospital's case mix. Peer pressure. Peer review programs in hospitals as well as through medical or specialty societies may help persuade physicians to alter their use of services. Education and information programs. Hospitals can assist physicians in patient management by conducting economic grand rounds, developing committees to study and communicate cost data to physicians, and providing information on alternatives to hospitalization. Incentives. Putting physicians at risk by linking planned expenditures to hospital financial performance can influence practice patterns. Other techniques include offering limited partnerships to medical staff members and merging the hospital and medical staff into one corporation. Hospitals may also need to influence physicians away from ventures that compete directly with the institution, such as ambulatory surgery centers. PMID:10271500

  6. Physicians' adjustment to retirement.

    OpenAIRE

    Virshup, B; Coombs, R H

    1993-01-01

    We address the questions, How do physicians adjust to and enjoy their retirement? What factors contribute to the well-being of retired physicians? A 60-item questionnaire mailed to 238 retired physicians in Los Angeles County with a 41.6% response rate assessed health, standard of living, relationships, activities, emotional difficulties, and general enjoyment. Health often improved after retirement, as did relationships with spouses and children. Standard of living was comfortable or better ...

  7. Burnout among physicians

    OpenAIRE

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to ...

  8. Physicians, patients, and Facebook: Could you? Would you? Should you?

    Science.gov (United States)

    Peluchette, Joy V; Karl, Katherine A; Coustasse, Alberto

    2016-01-01

    This article investigates the opinions of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. We analyzed 290 comments posted on online discussion boards and found that most (51.7%) were opposed to physicians being Facebook "friends" with patients and many (42%) were opposed to physicians having any kind of Facebook presence. Some believed that health care organizations should have a social media policy and provide social media training. We conclude with suggestions for how health care administrators can provide assistance to physicians and effectively manage their social media presence. PMID:27295007

  9. The Role of Physicians in State-Sponsored Corporal Punishment.

    Science.gov (United States)

    Muaygil, Ruaim

    2016-07-01

    The question of whether there is justification for physicians to participate in state-sanctioned corporal punishment has prompted long and heated debates around the world. Several recent and high-profile sentences requiring physician assistance have brought the conversation to Saudi Arabia. Whether a physician is asked to participate actively or to assess prisoners' ability to withstand this form of punishment, can there be an ethical justification for medical training and skills being put toward these purposes? The aim of this article is to examine aspects of Islamic law along with the different professional and religious obligations of Saudi Arabian physicians, and how these elements may inform the debate. PMID:27348832

  10. Preparing the company physician to testify at legal proceedings.

    Science.gov (United States)

    Barken, M E; Markowitz, J R

    1988-05-01

    Company physicians are frequently required to testify as to their findings and opinions in cases where employees' health jeopardizes their work status. The company physician may face conflicting ethical obligations in weighing the physician-patient relationship against the needs of the employer. If the employee seeks outside health care assistance, the company physician may have to testify against other health care professionals. The three most common forums in which the company physician may be asked to submit medical reports and/or testify are arbitration hearings, workers' claims for Social Security disability, and workers' compensation insurance benefits. Company physicians should be aware of the nature of each type of proceeding and they should be prepared to render persuasive expert testimony. PMID:2967355

  11. Physician-Owned Hospitals

    Data.gov (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  12. Physician Referral Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  13. Physician Shared Patient Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. These files represent the number of encounters a...

  14. Physician Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — This is the official dataset associated with the Medicare.gov Physician Compare Website provided by the Centers for Medicare and Medicaid Services (CMS). These data...

  15. Pregnancy complications of physicians.

    OpenAIRE

    Katz, V L; Miller, N H; Bowes, W A

    1988-01-01

    Studies indicate an increased risk of adverse late pregnancy events, such as preterm labor and preterm delivery, for practicing physicians. These adverse pregnancy outcomes also occur among pregnant women who work long hours with high levels of psychological stress, a mechanism most likely related to catecholamine and posturally mediated alterations in uterine blood flow. Further evaluation and research into the epidemiology of physicians' pregnancies are needed because of the increasing numb...

  16. Agreement among the Portuguese Republic, the Government of the United States of America and the International Atomic Energy Agency for assistance in securing nuclear fuel for a research reactor

    International Nuclear Information System (INIS)

    The text of the Agreement among the Portuguese Republic, the Government of the United States of America and the International Atomic Energy Agency for Assistance in Securing Nuclear Fuel for a Research Reactor is reproduced in this document for the information of all Members of the Agency. The Agency's Board of Governors approved the above mentioned Agreement on 14 June 2006. The Agreement was signed by the authorized representatives of Portugal on 27 June 2006 and the United States on 13 December 2006, and by the Director General of the IAEA on 14 December 2006. Pursuant to the Article XII.1 of the Agreement, the Agreement entered into force on 19 April 2007, the date on which the Agency received written notification from Portugal that its internal requirements for entry into force had been met

  17. Agreement among the Government of the Republic of Poland, the Government of the United States of America and the International Atomic Energy Agency for assistance in securing nuclear fuel for a research reactor

    International Nuclear Information System (INIS)

    The text of the Project and Supply Agreement among the Government of the Republic of Poland, the Government of the United States of America and the International Atomic Energy Agency for Assistance in Securing Nuclear Fuel for a Research Reactor is reproduced in this document for the information of all Members of the Agency. The Agency's Board of Governors approved the above mentioned Project and Supply Agreement on 14 June 2006. The Agreement was signed by the authorized representatives of Poland on 8 January 2007, the United States on 12 January 2007 and by the Director General of the IAEA on 16 January 2007. Pursuant to the Article XII of the Agreement, the Agreement entered into force on 16 January 2007, upon signature by the representatives of Poland, the United States and the Director General of the IAEA

  18. Agreement Between the International Atomic Energy Agency, the Government of Jamaica and the Government of the United States of America for Assistance in Securing Low Enriched Uranium for a Research Reactor

    International Nuclear Information System (INIS)

    The text of the Agreement between the International Atomic Energy Agency, the Government of Jamaica and the Government of the United States of America for Assistance in Securing Low Enriched Uranium for a Research Reactor is reproduced in this document for the information of all Members of the Agency. The Agency's Board of Governors approved the text of the Agreement on 6 March 2013. The Agreement was signed by the authorized representatives of Jamaica on 25 November 2013, the United States on 2 May 2013 and the Director General of the IAEA on 16 December 2013. Pursuant to the Article XI of the Agreement, the Agreement entered into force on 16 December 2013, upon signature by the Director General of the IAEA and by the authorized representatives of Jamaica and the United States

  19. Burnout among physicians.

    Science.gov (United States)

    Romani, Maya; Ashkar, Khalil

    2014-01-01

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

  20. Physician health and wellness.

    Science.gov (United States)

    McClafferty, Hilary; Brown, Oscar W

    2014-10-01

    Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training. Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training. Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted. PMID:25266440

  1. Leasing physician office space.

    Science.gov (United States)

    Murray, Charles

    2009-01-01

    When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria. PMID:19743715

  2. Building America

    Energy Technology Data Exchange (ETDEWEB)

    Brad Oberg

    2010-12-31

    IBACOS researched the constructability and viability issues of using high performance windows as one component of a larger approach to building houses that achieve the Building America 70% energy savings target.

  3. Hitler's Jewish Physicians.

    Science.gov (United States)

    Weisz, George M

    2014-07-01

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

  4. Physician Li Bo

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Li Bo,32,an attending physician at Xiyuan Hospital of the China Academy of Chinese Medical Sciences,spent a year and a half between 2008 and 2010 participating in a traditional Chinese medicine (TCM) project at the Muhimbili National Hospital in Dar Es Salaam,Tanzania.Now back in Beijing,he spoke to ChinAfrica

  5. Physicians and Insider Trading.

    Science.gov (United States)

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

    2015-12-01

    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information. PMID:26457747

  6. Physician Challenges in 2015.

    Science.gov (United States)

    Cascardo, Debra

    2015-01-01

    While the influx of new patients resulting from the ACA will increase the number of people receiving healthcare, the regulations associated with it will add to physicians' administrative duties, as will government regulations associated with HIPAA and Meaningful Use. Further stress will come from the demands of both payers and patients, requiring doctors to walk a fine line to protect themselves from litigation. Technology also will play an increasing role. The continuing move toward EHRs and the new ICD-10 coding standard will require investments in software, testing, and training staff, and may also require an investment in new computer hardware. Physicians and staff will have to teach patients how to use EHR portals and how to follow the record-keeping requirements of their insurance providers. The regulatory changes and increased costs of time and money associated with them may drive many physicians out of private practice and into hospital system-based team practices, which will face a greater challenge in recruiting and retaining top talent. Other physicians, in contrast, may continue to seek the independence of private practice; some of them may decide to stop accepting insurance because of their need for autonomy in their practices. Regardless of what decisions doctors choose to make within the changing nature of healthcare, it is important to keep abreast of the changes and develop a plan for dealing with them, in 2015 and beyond. PMID:26182706

  7. Longevity of Thai physicians.

    Science.gov (United States)

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

    2004-10-01

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

  8. Thai physicians health survey.

    Science.gov (United States)

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

    2004-10-01

    Physicians often conduct research on other occupations' health or general populations' health, but their health has hardly been studied systematically. The authors conducted a cross-sectional descriptive survey on 440 physicians systematically selected from their medical license numbers. The response rate was 86.4% (380 out of 440). Two-hundred and twenty-nine were male, and 151 were female. Their average age was 40.8 years (range: 22-74). Most of them were Buddhists (93.9%), specialists (64.2%), married only once and still lived with their spouses (59.5%), and concurrently practiced medicine (95.5%). Their overall satisfaction as physicians was 60.2% high, and 37.2% moderate. Their average sleep time was 6-8 hours per night for 58.9%. Most had eye problems (74.9%) and most were refractive errors such as myopia. Most (63.8%) of them did not have any prevalent diseases. Whereas those who had diseases had (in order) allergy, hypertension, asthma, diabetes, and cancer. Their current illnesses included respiratory tract infection. Most physicians did not smoke (94.2%) nor drink alcohol (70.5%). Most of them were not vegetarians (60.4%), did not eat fast food (99.2%). Interestingly, 41.4% of them were accounted for spending less than twice per week for exercise. As expected, 23.7% of them were exposed to blood, 14.5% to respiratory tract secretion, and 13.7% to pus/secretion from wounds. This study serves as a basis for health promotion approach to medical community and does create awareness of health among Thai physicians. PMID:21218585

  9. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... some chest pain. He went to his family physician, who did a stress test, which was markedly ... this for patients. So, here we go. My physician assistant is [Aaron Murstoka]. Head nurse of robotics ...

  10. The Physician-Patient Relationship: A patient-physician's view

    OpenAIRE

    Ennis, Jeffrey H

    1990-01-01

    The physician-patient relationship, like any human relationship, blends two types of interactions described by philosopher Martin Buber. In an “I-It” interaction, the physician objectifies the patient and his or her problem; in an “I-Thou” interaction, the physician perceives the patient as an emotional being. My encounters with medical practitioners as a patient with brachial neuritis and Guillain-Barré syndrome illustrate these forms of the physician-patient relationship.

  11. Exploring the case for assisted dying in the UK.

    Science.gov (United States)

    Haigh, Carol

    This article discusses the concepts of euthanasia, assisted suicide and physician-assisted suicide, under the umbrella term of assisted dying, from a pro-assisted dying perspective. It outlines the key principles underpinning the debate around assisted dying and refutes the main arguments put forward by those opposing legalisation of assisted dying in the UK. PMID:22272538

  12. Family physicians: supply and demand.

    OpenAIRE

    Bowman, M A

    1989-01-01

    The nation's supply of family physicians as estimated by the Graduate Medical Education National Advisory Committee appears fairly accurate. At the same time, the demands for family physicians appear to be strong, partially because case-management systems recognize the cost-effectiveness and appropriate training of family physicians for their needs. The largest factor inhibiting the supply of such physicians appears to be the relatively lower income of family practice compared to other specia...

  13. Physicians in Literature: Three Portrayals

    OpenAIRE

    Cameron, Ian A.

    1986-01-01

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

  14. Physician nutrition education.

    Science.gov (United States)

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

    2014-06-01

    Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification. PMID:24690613

  15. Physicians' experiences with end-of-life decision-making: survey in 6 European countries and Australia

    DEFF Research Database (Denmark)

    Löfmark, Rurik; Nilstun, Tore; Cartwright, Colleen;

    2008-01-01

    euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal...

  16. Illiterate America.

    Science.gov (United States)

    Kozol, Jonathan

    Intended for those involved in American social service and educational communities, this book addresses the widespread problem of illiteracy in the United States and the social consequences of this problem. Following an introduction, the chapters in the first section of the book discuss the growing crisis of illiterate America, specifically, the…

  17. Managing margins through physician engagement.

    Science.gov (United States)

    Sears, Nicholas J

    2012-07-01

    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication. PMID:22788036

  18. Physician leadership in changing times.

    Science.gov (United States)

    Cochran, Jack; Kaplan, Gary S; Nesse, Robert E

    2014-03-01

    Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates. PMID:26250084

  19. The conceptually-oriented physician.

    Science.gov (United States)

    Fuller, B F; Fuller, F

    1979-07-01

    This article is based on the authors' book "Physician or Magician: The Myths and Realities of Patient Care" (McGraw Hill and Hemisphere, 1978). In this paper, the authors contend that the main problem confronting medical practice and medical education today is that there is no consensus on what physicians should be doing. Should they be technologists or should they be conceptually-oriented? The authors further state that these two types of physicians are trained in different approaches to problem solving. They conclude by saying that both types of physicians are needed if the quality of patient care is to improve while containing cost, but that the conceptually-oriented physician--the primary physician--should be in charge of all treatment patients receive. This is because the primary physicians as well as the Cartesian approach. Therefore, they would be better able to determine the risks and benefits to each patient of various technological regimens. PMID:514116

  20. Hippocratic oath and conversion of ethico-regulatory aspects onto doctors as a physician, private individual and a clinical investigator

    OpenAIRE

    Mohammed Imran; Shadab Samad; Mohammad Maaz; Ashhar Qadeer; Abul Kalam Najmi; Mohammed Aqil

    2013-01-01

    Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Na...

  1. Pinta: Latin America's Forgotten Disease?

    Science.gov (United States)

    Stamm, Lola V

    2015-11-01

    Pinta is a neglected, chronic skin disease that was first described in the sixteenth century in Mexico. The World Health Organization lists 15 countries in Latin America where pinta was previously endemic. However, the current prevalence of pinta is unknown due to the lack of surveillance data. The etiological agent of pinta, Treponema carateum, cannot be distinguished morphologically or serologically from the not-yet-cultivable Treponema pallidum subspecies that cause venereal syphilis, yaws, and bejel. Although genomic sequencing has enabled the development of molecular techniques to differentiate the T. pallidum subspecies, comparable information is not available for T. carateum. Because of the influx of migrants and refugees from Latin America, U.S. physicians should consider pinta in the differential diagnosis of skin diseases in children and adolescents who come from areas where pinta was previously endemic and have a positive reaction in serological tests for syphilis. All stages of pinta are treatable with a single intramuscular injection of penicillin. PMID:26304920

  2. Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia.

    OpenAIRE

    Kinsella, T D; Verhoef, M J

    1993-01-01

    OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through ...

  3. Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey

    OpenAIRE

    Bynum Debra L; Amick Halle R; Lewis Carmen L; Kistler Christine E; Walter Louise C; Watson Lea C

    2006-01-01

    Abstract Background Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. Methods We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local re...

  4. Social media and physicians: Exploring the benefits and challenges.

    Science.gov (United States)

    Panahi, Sirous; Watson, Jason; Partridge, Helen

    2016-06-01

    Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community. PMID:25038200

  5. [Dangerous liaisons--physicians and pharmaceutical sales representatives].

    Science.gov (United States)

    Granja, Mónica

    2005-01-01

    Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class. PMID:16202335

  6. Primary-care physician compensation.

    Science.gov (United States)

    Olson, Arik

    2012-01-01

    This article reviews existing models of physician compensation and presents information about current compensation patterns for primary-care physicians in the United States. Theories of work motivation are reviewed where they have relevance to the desired outcome of satisfied, productive physicians whose skills and expertise are retained in the workforce. Healthcare reforms that purport to bring accountability for healthcare quality and value-rather than simply volume-bring opportunities to redesign primary-care physician compensation and may allow for new compensation methodologies that increase job satisfaction. Physicians are increasingly shunning the responsibility of private practice and choosing to work as employees of a larger organization, often a hospital. Employers of physicians are seeking compensation models that reward both productivity and value. PMID:22786738

  7. Consolidation guidelines for physician practices.

    Science.gov (United States)

    Bigalke, J T; Garbrecht, G H; McBee, D

    1998-03-01

    The trend of acquiring and consolidating physician practices is expected to continue for some time. The growth of physician practice management companies (PPMCs) has created accounting and financial reporting issues for these new physician organizations. The type of management arrangement ultimately affects the decision of whether or not to consolidate practices. In analyzing consolidation opportunities, PPMCs should consider the terms of the management agreement, which determine who controls the practice, and the advantages and disadvantages of consolidation. PMID:10177404

  8. Understanding physicians' response to AIDS.

    OpenAIRE

    Taylor, K M; Shapiro, M.; Skinner, H A; Eakin, J; Kelner, M

    1989-01-01

    Attempts to comprehend physicians' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians' attitudes and practices. We suggest a framework developed from the literature on physicians' and society...

  9. Building the right physician platform.

    Science.gov (United States)

    Pizzo, James J; Sullivan, Luke; Ryan, Debra L

    2015-07-01

    The challenges health systems often face in aligning physicians with organizational cost and quality goals related to the delivery of value-based care differ between employed and independent physicians. With employed physicians, the focus should be on right-sizing the service delivery network and employed medical group, building a sustainable compensation program, enhancing the revenue cycle, increasing use of midlevel providers, and implementing a common technology platform. With independent physicians, the focus should be on understanding available contracting models, participating in shared-savings arrangements, considering alternative payment distribution models, choosing the right metrics, and exploring shared branding options. PMID:26376510

  10. The physician as moral entrepreneur.

    Science.gov (United States)

    Clarke, J N

    1982-12-01

    This paper argues that the work of the contemporary physician is at least in part the work of a moral entrepreneur. The effects of religious affiliation and religiosity on the decision making of a modern doctor are examined in an analysis of the responses of 231 physicians to a mailed questionnaire. Decision-making issues were considered to be those with social/moral implications. Religious physicians tend to favor clergy involvement in social and procreative issues. Roman Catholic physicians oppose the involvement of the medical profession in birth control issues. PMID:24310078

  11. Doctor-Assisted Deaths Didn't Soar After Legalization

    Science.gov (United States)

    ... patients don't use physician-assisted suicide and euthanasia -- don't even think about it," said lead ... understand attitudes and practices regarding assisted deaths and euthanasia, Emanuel's team reviewed prior studies, surveys and other ...

  12. Physician Actuated Computerized Treatment (PACT)

    OpenAIRE

    Speck, Pat K.

    1984-01-01

    PACT was developed by clinical Physicians for practicing physicians. With PACT, you can be assured that Doctor/Computer Interface fuses smoothly and simultaneously with an on-line data-base medical record management system. PACT has been found appropriate for in out patient care delivery by all medical specialties including dentistry, physical therapy, social workers and veterinarians.

  13. Physician Education in Sleep Disorders.

    Science.gov (United States)

    Orr, William C.; And Others

    1980-01-01

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

  14. Little People of America

    Science.gov (United States)

    ... information. Our Sponsors Welcome to Little People of America Little People of America (LPA) is a nonprofit organization that provides support ... survey can be seen here. © Little People of America 250 El Camino Real Suite 218, Tustin, CA ...

  15. Investigating Awareness in Chronic Renal Failure Among Family Physicians

    Directory of Open Access Journals (Sweden)

    Birgül ATAMAN

    2014-05-01

    Full Text Available OBJECTIVE: The conditions underlying chronic renal failure have become epidemics in the world. The aim of this study was to reveal the degree of awareness of chronic renal failure among family physicians. MATERIAL and METHODS: Using data collected with a structured questionnaire and considering physicians’ socio-demographic features and their education on nephrology, we evaluated physicians’ awareness of the definition, frequency and clinical features of chronic renal failure. The questionnaire was filled in by volunteering family medicine specialists (FMS, family medicine assistants (FMA and family physicians (FP during a family medicine meeting. RESULTS: Out of 310 physicians, 25.2% (n=78 were FMS, 27.7% (n=86 FMA and 47.1% (n=146 FP. %35,2 of physicians (n=109 (FMS: % 62,8 (n=49, FMA: %52.3 (n=45, FP: %10.3 (n=15, p0.05. However, less than 15% of the physicians reported that they felt competent enough to follow patients with chronic renal failure. The rate of the physicians who felt the need to refer these patients to health institutions was high. However, the Fps did not like the patient care style of internal medicine specialists and thought that patients faced financial problems to access the nephrologist. CONCLUSION: Appropriate care and management of referrals are life-saving for patients with chronic renal failure. New strategies should be developed to increase awareness concerning chronic renal failure and the management of this condition.

  16. Improved radiation protection for physicians performing cardiac catheterization

    International Nuclear Information System (INIS)

    Physicians and their assistants performing diagnostic angiography must be concerned with the radiation exposure they receive. The introduction of hemiaxial projections for imaging has increased diagnostic accuracy but has also greatly increased the physicians' exposure to scattered radiation. This increase is especially critical for the eyes and thyroid of the physician who routinely performs these procedures. To reduce such exposure a ceiling-suspended shield (60 x 45 cm), made of 6.4 mm glass with a 19.5 kg/m2 (4 lb/ft2) lead equivalency, was developed. During procedures the shield is interposed between the physician and the region of the patient acting as the source of scattered radiation. The degree of radiation protection to the operator was assessed by measuring the distribution of scattered radiation in the vicinity of the operator with and without the shield. The effectiveness of the shield was determined in the 30 degrees right anterior oblique (RAO), 5 degrees left anterior oblique (LAO), 35 degrees LAO, and 50 degrees LAO-15 degrees cranial angulations. At critical heights such as the level of the eyes and thyroid, scattered radiation levels were reduced by 85% or greater in all angulations. Without interfering with the physician's ability to observe the patient or manipulate the catheter, this shield can significantly reduce the physician's exposure to radiation

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

    Science.gov (United States)

    MacDougall, D Robert

    2013-09-01

    Many authors have addressed the morality of physicians' strikes on the assumption that medical practice is morally different from other kinds of occupations. This article analyzes three prominent theoretical accounts that attempt to ground such special moral obligations for physicians--practice-based accounts, utilitarian accounts, and social contract accounts--and assesses their applicability to the problem of the morality of strikes. After critiquing these views, it offers a fourth view grounding special moral obligations in voluntary commitments, and explains why this is a preferable basis for understanding physicians' moral obligations in general and especially as pertaining to strikes. PMID:24199524

  18. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  19. Physicians' changing attitudes about striking.

    Science.gov (United States)

    Wassertheil-Smoller, S; Croen, L; Siegel, B

    1979-01-01

    Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation. PMID:759745

  20. Physician-assessment and physician-enhancement programs in Canada.

    Science.gov (United States)

    Page, G G; Bates, J; Dyer, S M; Vincent, D R; Bordage, G; Jacques, A; Sindon, A; Kaigas, T; Norman, G R; Kopelow, M; Moran, J

    1996-01-01

    In the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescription", based on the results of the assessment, focuses on aspects of clinical practice in which the physicians need or wish to enhance their skills. In some situations, licensure decisions are based on the assessment information. This article describes the programs in Quebec, Ontario and Manitoba. Each program comprises a different process of personal assessment and individualized continuing medical education to help physicians improve their clinical competence, and each is built on sound principles of clinical competence assessment and educational planning. PMID:23511980

  1. [Peculiarity of the occupational physician].

    Science.gov (United States)

    Pagliaro, G; Simonini, S; del Bufalo, P; Serra, A; Ramistella, E

    2011-01-01

    Aim of this contribution is to consider, although in a concise way, the peculiarity of the Occupational Physician's activity operating in Health care sector, that employs about 5% of Italian workers. Particularly, we bring into focus the global roll that the Occupational Physician must fulfil in a reality where he is the protagonist towards the safeguard of the worker's safe, already submitted to several occupational risks, and about the safety of the third parties, which is more important than in other sectors. Shared elaboration in this article shows that Occupational Physician of the Health care sector has the same problems and expectations everywhere, in our Country. PMID:23393851

  2. Physician-assessment and physician-enhancement programs in Canada.

    OpenAIRE

    Page, G.G; Bates, J.; Dyer, S M; Vincent, D R; Bordage, G; Jacques, A.; Sindon, A.; Kaigas, T; Norman, G R; Kopelow, M

    1995-01-01

    Since the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescriptio...

  3. Special article: physician burnout-the experience of three physicians

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2015-04-01

    Full Text Available No abstract available. Article truncated at 150 words. Our fellowship held a discussion on physician burnout which was facilitated by Kris Cooper PhD, a psychologist who has long experience working with struggling physicians. We were joined by three physicians who volunteered to share their personal experiences regarding burnout. Each of these three physicians are exceptional in their devotion to their profession, high self-expectation, and level of professional achievement. Yet the commendable personal characteristics they share may have actually set them up to ultimately suffer burnout. Each of them responded to burnout in a different way. The first physician is an intensivist who left work suddenly 6 months ago, likely never to return. Over a long career, this physician had earned the respect of his colleagues and was beloved by the nurses for seeming to always knowing the right thing to do and dedicating himself fully to the care of the sickest patients and their families. For most of ...

  4. Médicos e assistência médica: Estado, mercado ou regulação? Uma falsa questão Physicians and health care: state, market or regulation? A false issue

    Directory of Open Access Journals (Sweden)

    Celia Almeida

    1997-10-01

    Full Text Available A crise de custos no setor saúde colocou em discussão a assistência médica, assim como a avaliação dos seus resultados enquanto investimento setorial, sendo que a importância do principal ator nessa dinâmica ­ o médico ­ tem sido ressaltada. Este artigo faz uma revisão das principais vertentes de análise do profissionalismo médico nas últimas décadas e discute a mudança de paradigma que se operou mais recentemente, quando emergem enfoques que procuram correlacionar as novas divisões de trabalho contidas nas especializações cada vez mais fragmentadas com as mudanças estruturais históricas do mercado de trabalho profissional e a ação coletiva desenvolvida por esses grupos na sua inter-relação com o Estado. Esse último enfoque, pode-se dizer mais vinculado à economia política, tem aportado importantes contribuições a esse debate, uma vez que permite questionar as polarizações ideológicas, e sem fundamento analítico, presentes nas propostas de reforma da assistência médica, que preconizam a retirada do Estado e o reinado do mercado, assim como deslocam a regulação para uma posição externa à própria dinâmica, mutável historicamente, das relações Estado/profissionais/clientes/sistemas de saúde.A cost crisis in the health care sector has focused discussion on health care services and an assessment of the results of investments in the health sector, underlining the importance of medical doctors as key actors in this area. This article reviews the main analytical approaches to professionalism in the last decade and discusses the most recent paradigmatic shifts. New approaches have emerged for correlating the medical division of labor (contained in specialized fields which are becoming more and more fragmented with structural and historical changes in the professional market, as well as the collective action developed by these interest groups in their relationship to the state. These approaches, more closely

  5. Unique Physician Identification Number (UPIN) Directory

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and...

  6. Physician Compare National Downloadable File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician Compare National Downloadable File is organized at the individual eligible professional level; each line is unique at the professional/enrollment...

  7. American College of Emergency Physicians

    Science.gov (United States)

    ... EMBRS) Workshop Reimbursement & Coding Research Forum Simulation-based Immersive Medical (SIM) Training Course Teaching Fellowship Scientific Assembly ... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement ...

  8. Internet resources for family physicians.

    OpenAIRE

    Anthes, D. L.; Berry, R.E.; Lanning, A

    1997-01-01

    PROBLEM BEING ADDRESSED: The internet has experienced tremendous growth over the past few years and has many resources in the field of family medicine. However, many family physicians remain unaware of how the Internet can be used to enhance their practice and of how to gain access to this powerful tool. OBJECTIVE OF PROGRAM: To characterize components of the Internet, to explore how family physicians can use the Internet to enhance practice, and to increase awareness of how to gain access to...

  9. Physicians' perspectives on massage therapy.

    OpenAIRE

    Verhoef, M J; Page, S.A.

    1998-01-01

    OBJECTIVE: To examine the knowledge, opinions, and referral behaviour of family physicians with respect to massage therapy and to explore factors associated with referral. DESIGN: A random, cross-sectional mailed survey. SETTING: Alberta family practices. PARTICIPANTS: Family physicians (n = 300). MAIN OUTCOME MEASURES: A self-report survey was developed for the study. This survey contained questions about sociodemographic and practice characteristics, perceived knowledge of massage therapy, ...

  10. Traumatized by practice: PTSD in physicians.

    Science.gov (United States)

    Lazarus, Arthur

    2014-01-01

    Posttraumatic stress disorder (PTSD) is underrecognized in physicians, even though it may be more prevalent in physicians than in the general population in the United States. Five types of physicians appear to be particularly prone to developing PTSD: (1) emergency physicians; (2) physicians practicing in underserved and remote areas; (3) physicians in training (i.e., medical residents); (4) physicians involved in malpractice litigation; and (5) physicians who are "second victims" in the sense that they are indirectly exposed to trauma. In addition to experiencing trauma, the cumulative stress of practice may cause PTSD. The road to recovery for physicians with PTSD entails proper diagnosis and treatment, which includes maintaining a high index of suspicion for the occurrence of PTSD in predisposed physicians, and individual or group therapy. Physicians in leadership positions should advocate for effective support programs for their colleagues with PTSD. PMID:25807606

  11. Physician treatment decisions in a multiple treatment model. The effect of physician supply.

    Science.gov (United States)

    McCombs, J S

    1984-08-01

    This paper develops a neoclassical utility maximization model of physician behavior in which the physician determines the price of physician office and hospital visits, the utilization rates for physician office and hospital visits and hospital days, and the resources and physician time inputs in the production of visits. The model assumes that the physician acts as a perfect agent for the patient. The analysis traces substitutions between physician office visits, physician hospital visits, and hospital days in response to changes in physician supply. The analysis also traces physician supply induced changes in the input mix used to produce visits. The substitution effects of physician supply are then used to reinterpret previous statistical estimates of the physician supply elasticities of per capita utilization of physician office visits and hospital days, length of visit, waiting time, and physician workloads. PMID:10268370

  12. Perfil do médico residente atendido no Grupo de Assistência Psicológica ao Aluno (GRAPAL da Faculdade de Medicina da Universidade de São Paulo Profile of the resident physician attended by the Group of Psychological Assistance for Students at the São Paulo University School of Medicine

    Directory of Open Access Journals (Sweden)

    Emmanuel Nunes de Souza

    2009-01-01

    Full Text Available OBJETIVOS: Definir o perfil do médico residente atendido em um serviço de assistência à saúde mental a fim de contribuir para o conhecimento das necessidades deste grupo. MÉTODOS: Estudo observacional do tipo coorte retrospectivo. Os dados foram obtidos por meio de revisão de prontuários de uma série de residentes atendidos pelo Grupo de Assistência Psicológica ao Aluno (Grapal no período de 1998 a 2002 e pelo acesso ao registro geral de matrícula de residentes. Inclui a descrição da proporção de residentes atendidos segundo ano [cronológico], ano de residência, sexo, idade, especialidade, faculdade de origem e distância do núcleo familiar; e a análise das diferenças de proporções entre as categorias das variáveis investigadas. RESULTADOS: Durante o período estudado temos o registro de 2.131 residentes matriculados, totalizando 4.727 residentes-ano de seguimento. Neste conjunto, computando-se somente o primeiro atendimento, temos 104 residentes atendidos pelo Grapal (4,9% residentes atendidos, ou 2,2 atendidos para cada 100 residentes-ano de seguimento. Os dados revelam maior proporção de residentes atendidos com as seguintes características: primeiro ano de residência (4,5%, idade inferior a 26 anos (6,1%, sexo feminino (6,9%, egresso de outras escolas médicas (5,9% e residentes de especialidades cognitivas (6,7%. CONCLUSÃO: A assistência psiquiátrica mostrou-se associada ao gênero, a fatores ligados a crises adaptativas e a especialidades cognitivas. Não houve crescimento da proporção de residentes atendida pelo serviço durante o período analisado.OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs. Methods: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao

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

    Science.gov (United States)

    Eichmiller, Judith Riley

    2014-01-01

    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future. PMID:25108989

  14. Psychiatric rehabilitation education for physicians.

    Science.gov (United States)

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). PMID:23750768

  15. Building America

    Energy Technology Data Exchange (ETDEWEB)

    Brad Oberg

    2010-12-31

    Builders generally use a 'spec and purchase' business management system (BMS) when implementing energy efficiency. A BMS is the overall operational and organizational systems and strategies that a builder uses to set up and run its company. This type of BMS treats building performance as a simple technology swap (e.g. a tank water heater to a tankless water heater) and typically compartmentalizes energy efficiency within one or two groups in the organization (e.g. purchasing and construction). While certain tools, such as details, checklists, and scopes of work, can assist builders in managing the quality of the construction of higher performance homes, they do nothing to address the underlying operational strategies and issues related to change management that builders face when they make high performance homes a core part of their mission. To achieve the systems integration necessary for attaining 40% + levels of energy efficiency, while capturing the cost tradeoffs, builders must use a 'systems approach' BMS, rather than a 'spec and purchase' BMS. The following attributes are inherent in a systems approach BMS; they are also generally seen in quality management systems (QMS), such as the National Housing Quality Certification program: Cultural and corporate alignment, Clear intent for quality and performance, Increased collaboration across internal and external teams, Better communication practices and systems, Disciplined approach to quality control, Measurement and verification of performance, Continuous feedback and improvement, and Whole house integrated design and specification.

  16. Barriers to physician identification and reporting of child abuse.

    Science.gov (United States)

    Flaherty, Emalee G; Sege, Robert

    2005-05-01

    Physicians systematically underidentify and underreport cases of child abuse. These medical errors may result in continued abuse, leading to potentially severe consequences. We have reviewed a number of studies that attempt to explain the reasons for these errors. The findings of these various studies suggest several priorities for improving the identification and reporting of child maltreatment: Improve continuing education about child maltreatment. Continuing education should focus not only on the identification of maltreatment but also on management and outcomes. This education should include an explanation of the role of CPS investigator and the physician's role in an investigation. The education should provide physicians with a better understanding of the overall outcome for children reported to CPS to help physicians gain perspective on the small number of maltreated children they may care for in their practice. This education should emphasize that the majority of maltreated children will benefit from CPS involvement. New York is the only state that mandates all physicians, as well as certain other professionals, take a 2-hour course called Identification and Reporting of Child Abuse and Maltreatment prior to licensing. Cited studies in this article suggest that such a mandate might be expected to improve identification and reporting, thereby encouraging other states to adopt similar regulations. Give physicians the opportunity to debrief with a trained professional after detecting and reporting child abuse. The concept of child abuse and the gravity of the decision to report can be troubling to the reporter. The debriefing could include discussions of uncomfortable feelings physicians may experience related to their own countertransference reactions. Provide resources to assist physicians in making the difficult determination of suspected maltreatment. The role of accessible telephone consultation should be evaluated, along with formalized collaborations

  17. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Science.gov (United States)

    2010-10-01

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

  18. Ressecção hepática robótica. Relato de experiência pioneira na América Latina First robotic-assisted laparoscopic liver resection in Latin America

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. Machado

    2009-03-01

    Full Text Available Graças ao melhor conhecimento da anatomia segmentar do fígado e desenvolvimento de novas técnicas, houve aumento no número de indicações de hepatectomias. O desenvolvimento da cirurgia minimamente invasiva ocorreu paralelamente e o aumento da experiência, aliado ao desenvolvimento de novos instrumentais, resultaram no crescimento exponencial das ressecções hepáticas videolaparoscópicas. A abordagem laparoscópica pode tornar viável a ressecção hepática em pacientes cirróticos com hipertensão portal que não tolerariam este mesmo procedimento por via laparotômica. A cirurgia robótica surgiu nos últimos anos como a última fronteira de desenvolvimento técnico aplicado à videocirurgia. O presente trabalho descreve a experiência pioneira de ressecção hepática totalmente com o uso de robótica na América Latina, em paciente com carcinoma hepatocelular e cirrose hepática. A hepatectomia laparoscópica com o uso do sistema robótico Da Vinci permite refinamentos técnicos graças à visualização tridimensional do campo cirúrgico e utilização de instrumentais precisos e com grande amplitude de movimentação que simulam os movimentos da mão humana.The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this paper is to report the first known case of liver resection with use of a computer-assisted, or robotic, surgical device in Latin America. A 72-year-old male with cryptogenic liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A patient. Magnetic resonance imaging showed a 2.2 cm tumor in segment 5. Liver size was decreased and there were signs of portal hypertension, such as splenomegaly and enlarged portal vein collaterals. Preoperative upper

  19. [The pharmacist-physician collaboration for IPW: from physician's perspective].

    Science.gov (United States)

    Son, Daisuke; Kawamura, Kazumi; Nakashima, Mitsuko; Utsumi, Miho

    2015-01-01

    Interprofessional work (IPW) is increasingly important in various settings including primary care, in which the role of pharmacists is particularly important. Many studies have shown that in cases of hypertension, diabetes, dyslipidemia, and metabolic syndrome, physician-pharmacist collaboration can improve medication adherence and help to identify drug-related problems. Some surveys and qualitative studies revealed barriers and key factors for effective physician-pharmacist collaboration, including trustworthiness and role clarification. In Japan, some cases of good collaborative work between pharmacists and physicians in hospitals and primary care settings have been reported. Still, community pharmacists in particular have difficulties collaborating with primary care doctors because they have insufficient medical information about patients, they feel hesitant about contacting physicians, and they usually communicate by phone or fax rather than face to face. Essential competencies for good interprofessional collaboration have been proposed by the Canadian Interprofessional Health Collaborative (CIHC): interprofessional communication; patient/client/family/community-centered care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution. Our interprofessional education (IPE) team regularly offers educational programs to help health professionals learn interprofessional collaboration skills. We expect many pharmacists to learn those skills and actively to facilitate interprofessional collaboration. PMID:25743907

  20. [Sherlock Holmes as amateur physician].

    Science.gov (United States)

    Madsen, S

    1998-03-30

    The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs. PMID:9599503

  1. A physician's exposure to defamation.

    Science.gov (United States)

    Mandell, W J

    1992-01-01

    The article defines defamation, discusses how to avoid a defamation action, and suggests defenses against a defamation action. Several examples are given that demonstrate common situations where liability exists and how a physician should respond. The article explains that at times we have a duty to speak and differentiates between our legal, moral, and ethical duty. Defamation should not be a concern for those involved in the peer review process, as long as they are truthful or act in a good faith belief that what they are saying is true. The article should enhance peer review by encouraging physicians to participate without fear of a retaliatory law suit. PMID:1603860

  2. Why MNsure matters to physicians.

    Science.gov (United States)

    Silversmith, Janet

    2015-01-01

    MNsure, the state's health insurance exchange, has helped expand insurance coverage in Minnesota since it began operating in October 2013. To be price-competitive, many insurers developed products with more limited provider networks than those generally available before MNsure's launch. In some states, this network design strategy has led to concerns about limited access to services and prompted action on the part of physicians and lawmakers. Minnesota physicians need to be aware of changes in network design in order to support access to care for their patients. PMID:25665268

  3. Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Brian F Gage

    2011-05-01

    Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.

  4. Physicians should prepare for nuclear disaster

    International Nuclear Information System (INIS)

    In this paper, the author insists that physicians must take an active role in the civil defense of the United States. They must prepare to save lives and prevent suffering in any type of disaster including nuclear war. The author makes comparisons of America's civil defense programs and those of other nations. The United States is way behind other nations in civil defense. The author gives five advantages of civil defense. He says civil defense, unlike offensive weapons systems, cannot directly threaten the lives of Russians or any other nation. Properly designed shelter systems can serve multiple purposes, including storage and parking. Construction of shelters is likely to be labor-intensive by comparison with weapons systems and would probably result in more jobs in portions of the economy that have been distressed. If arms control and reduction negotiations are successful, there may be a transition period of fear and instability while methods of verification are checked. An adequate civil defense system could help to bridge these gaps of insecurity. The extension of the above argument would be to replace the doctrine of mutually assured destruction (MAD) with mutually assured survival

  5. Lupus Foundation of America

    Science.gov (United States)

    ... You. Learn More About the Lupus Foundation of America We are devoted to solving the mystery of ... Support for Lupus Research The Lupus Foundation of America applauds the U.S. Senate Appropriations Committee for voting ...

  6. Sarcoma Foundation of America

    Science.gov (United States)

    ... Mission The mission of the Sarcoma Foundation of America (SFA) is to advocate for sarcoma patients by ... behalf of everyone at the Sarcoma Foundation of America (SFA),THANK YOU! The Celebration of Life drew ...

  7. America's Young Adults

    Science.gov (United States)

    ... About the Forum | Publications | Data Sources | Help Search America's Children: Key National Indicators of Well-Being, 2015 ... Care Quality List of Tables List of Figures America's Children at a Glance Forum Agencies Data Source ...

  8. America's Blood Centers

    Science.gov (United States)

    ... or less. Please donate now! Full Stoplight Report America's Blood Centers is... FEATURED TODAY Support the Foundation ... purchase will be donated to the Foundation for America's Blood Centers! Simply Click Here! "We Are" This ...

  9. The physician's relationship with the pharmaceutical industry: caveat emptor...buyer beware!

    Science.gov (United States)

    Albersheim, Susan G; Golan, Agneta

    2011-07-01

    Historically physicians have had close relationships with the pharmaceutical or other medically related industry. This has come under close scrutiny by the public, with articles appearing in medical journals and the lay press. The reality is that physicians depend on industry to bring products to market as well as to assist in research and education, leaving physicians questioning what their relationship with industry should be. This review deals with this complex relationship, identifying ways that industry might affect decision making in the clinical context. We will highlight areas of potential concern in this relationship, identify attendant moral dilemmas, and provide some recommendations. Our intention in raising the consciousness of physicians and medical institutions to these potential areas of concern is to aid physicians in their efforts to provide the best medical care for patients and to practice with integrity. PMID:21838178

  10. [Suicide and euthanasia : Discourse on physician-assisted suicide].

    Science.gov (United States)

    Lewitzka, Dr U; Bauer, R

    2016-05-01

    Suicidal thoughts and behavior have been a part of human nature since the beginning of mankind. In his autobiographical work From my Life: Poetry and Truth Goethe summarized two important aspects: "Suicide is an event of human nature which, whatever may be said and done with respect to it, demands the sympathy of every man, and in every epoch must be discussed anew". The authors of this article aim to motivate the readership to question and analyze this complex topic and the accompanying multifaceted positions with a summarized presentation of historical aspects and the more recent political developments. PMID:27119531

  11. Examining the Factors Affecting PDA Acceptance among Physicians: An Extended Technology Acceptance Model

    OpenAIRE

    Basak, Ecem; Gumussoy, Cigdem Altin; Calisir, Fethi

    2015-01-01

    This study aims at identifying the factors affecting the intention to use personal digital assistant (PDA) technology among physicians in Turkey using an extended Technology Acceptance Model (TAM). A structural equation-modeling approach was used to identify the variables that significantly affect the intention to use PDA technology. The data were collected from 339 physicians in Turkey. Results indicated that 71% of the physicians’ intention to use PDA technology is explained by perceived us...

  12. Physician burnout: A neurologic crisis.

    Science.gov (United States)

    Sigsbee, Bruce; Bernat, James L

    2014-12-01

    The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments. PMID:25378679

  13. Hitler’s Jewish Physicians

    Science.gov (United States)

    Weisz, George M.

    2014-01-01

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

  14. Hitler’s Jewish Physicians

    Directory of Open Access Journals (Sweden)

    George M. Weisz

    2014-07-01

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

  15. Rural physicians' perspectives on cervical and breast cancer screening: a gender-based analysis.

    Science.gov (United States)

    Ahmad, F; Stewart, D E; Cameron, J I; Hyman, I

    2001-03-01

    Several studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians' mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients' embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians' gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives

  16. Ethical principles for physician rating sites.

    Science.gov (United States)

    Strech, Daniel

    2011-01-01

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

  17. Top 10 Things Primary Care Physicians Should Know About Maintenance Immunosuppression for Transplant Recipients.

    Science.gov (United States)

    Lien, Yeong-Hau H

    2016-06-01

    The success of organ transplantation allows many transplant recipients to return to life similar to nontransplant patients. Their need for regular health care, including preventive medicine, has switched the majority of responsibilities for their health care from transplant specialists to primary care physicians. To take care of transplant recipients, it is critical for primary care physicians to be familiar with immunosuppressive medications, their side effects, and common complications in transplant recipients. Ten subjects are reviewed here in order to assist primary care physicians in providing optimal care for transplant recipients. PMID:26714210

  18. The end of life decisions -- should physicians aid their patients in dying?

    Science.gov (United States)

    Sharma, B R

    2004-06-01

    Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia. PMID:15260998

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

    Science.gov (United States)

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

    2008-07-01

    A 2008 study focused on four key performance indicators (KPIs) and staffing levels to benchmark the FYO7 performance of physician group billing operations. A comparison of the change in the KPIs from FYO3 to FYO7 for a number of these billing operations disclosed across-the-board improvements. Billing operations did not show significant changes in staffing levels during this time, pointing to the existence of obstacles that prevent staff reductions in this area. PMID:18683420

  20. Patient–physician communication regarding electronic cigarettes

    Directory of Open Access Journals (Sweden)

    Michael B. Steinberg

    2015-01-01

    Discussion: Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  1. The Crucible of Physician Performance Reports

    OpenAIRE

    Sorokin, Rachel

    2011-01-01

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

  2. Physician equity alliances: attractive alternatives to PHOs.

    Science.gov (United States)

    Goldstein, D

    1997-04-01

    Physician equity alliances are becoming attractive alternatives to PHOs as integrative models for partnering with physicians, securing managed care contracts and increasing revenue. Unlike many PHOs, these alliances provide mechanisms for asset integration and long-term relationships along with utilization management, sophisticated information systems, access to capital and opportunities for physicians to integrate clinically. There are six major types of physician equity alliances: majority physician-owned, clinic without walls, health system joint venture, publicly held physician practice management company, specialty network, and venture capital. The type of alliance that a physician group practice ultimately develops depends on vision, values, method of capitalization, initial organizer of the alliance, level of involvement of physicians in business issues, corporate structure desired, and characteristics of the managed care market in which the alliance will operate. PMID:10166285

  3. AMA Physician Select: Online Doctor Finder

    Science.gov (United States)

    ... Membership | JAMA Network | AMA Store DoctorFinder This online physician Locator helps you find a perfect match for ... with basic professional information on virtually every licensed physician in the United States. This includes more than ...

  4. Medicares Physician Quality Reporting System (PQRS)...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...

  5. Health services utilization and physician income trends

    OpenAIRE

    Sandier, Simone

    1989-01-01

    Statistics from several Organization for Economic Cooperation and Development countries on consumption and cost of health care services, physician workload, and physician earnings are presented. Data are analyzed according to type of physician payment used: fee for service, per case, capitation, or salary. Incentives theoretically embodied in each payment method are often offset by other factors—scale of charges, patient out-of-pocket payment, and patient access or physician activity restrict...

  6. Physicians, Social Media, and Conflict of Interest

    OpenAIRE

    DeCamp, Matthew

    2012-01-01

    Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media’s potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of i...

  7. Liver transplantation for nontransplant physicians

    Directory of Open Access Journals (Sweden)

    Amany AbdelMaqsod Sholkamy

    2014-01-01

    Full Text Available Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.

  8. How nurses and physicians face ethical dilemmas--the Croatian experience.

    Science.gov (United States)

    Sorta-Bilajac, Iva; Baždarić, Ksenija; Žagrović, Morana Brkljačić; Jančić, Ervin; Brozović, Boris; Čengic, Tomislav; Ćorluka, Stipe; Agich, George J

    2011-05-01

    The aim of this study was to assess nurses' and physicians' ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N=364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services. PMID:21558110

  9. 22 CFR 62.27 - Alien physicians.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...

  10. 42 CFR 405.2412 - Physicians' services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...

  11. Physician's Death Anxiety and Patient Outcomes.

    Science.gov (United States)

    Schulz, Richard; Aderman, David

    1978-01-01

    It was shown that terminal patients of physicians with high death anxiety survive longer during their final hospital stay than terminal patients of physicians with low death anxiety. Physicians high in death anxiety seem to be less willing to accept patients' terminality and use heroic measures to keep them alive. (Author)

  12. Physician Incentives in Health Maintenance Organizations

    Science.gov (United States)

    Gaynor, Martin; Rebitzer, James B.; Taylor, Lowell J.

    2004-01-01

    Managed care organizations rely on incentives that encourage physicians to limit medical expenditures, but little is known about how physicians respond to these incentives. We address this issue by analyzing the physician incentive contracts in use at a health maintenance organization. By combining knowledge of the incentive contracts with…

  13. Foreign assistance: What's in it for Americans?

    OpenAIRE

    Business Alliance for International Economic Development

    1996-01-01

    In Foreign Assistance: Whats In It For Americans? The Business Alliance for International Economic Development documents how America's foreign assistance program is an engine for U.S. economic growth. This report also warns of the consequences of continuing cuts in foreign aid, already at its lowest real level in history.

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

    OpenAIRE

    Ruberton, PM; Huynh, HP; Miller, TA; Kruse, E.; Chancellor, J; Lyubomirsky, S

    2016-01-01

    Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical vi...

  15. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... Most people rotate through and they do fine. Robotic surgery requires a little bit of expertise and ... physician assistant is [Aaron Murstoka]. Head nurse of robotics is [Sara Harrick]. And the rest of these ...

  16. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... go. My physician assistant is [Aaron Murstoka]. Head nurse of robotics is [Sara Harrick]. And the rest ... people become more familiar and confident with their skills. 00:39:31 JOHN PENNOCK, MD: Now, this ...

  17. Physicians Behavioral Style Reshaping Mobile Banking Adoption

    Directory of Open Access Journals (Sweden)

    Manoranjan D

    2016-04-01

    Full Text Available Mobile banking provides convenient access to the banking services and mobility to health care professionals. Still, it faces many challenges in limited adoption which makes the mass usage uncertain. Behavior or personal characteristics of the individual play a vital role in the adoption of mobile banking. This research extends theexisting work by integrating the TAM model with the behavioral characteristics i.e., assertive, passive and aggressive to the attitude formation towards the mobile banking. Data was collected from 300 physicians and the research model was tested by using Partial Least Squares multivariate technique. Assertive behaviors, perceived ease of use, perceiveduseful ness were the main predictors of attitude formation towards the behavioral intention to use mobile banking. Our study contributes to the growth of understanding the acceptance of the mobile banking in health care industry and will assist bank managers in implementing different strategy for different mobile banking users for delivering their financial services. Our study also provides direction for future research on mobile banking adoption by health care professionals in the light of their personal characteristics

  18. Empowering Physicians with Financial Literacy.

    Science.gov (United States)

    Bar-Or, Yuval

    2015-01-01

    Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training. PMID:26399037

  19. Pandillas and Security in Central America

    OpenAIRE

    Thomas C. Bruneau

    2014-01-01

    This article introduces the topic of pandillas (street gangs) and their implications for security in Central America. There is minimal scholarly literature on pandillas and security. In part this is due to serious challenges in analyzing pandillas. First, pandilla members consider truth to be situational; data derived directly from them is suspect. Second, those who know most about them are involved in NGOs that rely on foreign assistance for their work. The project reports the...

  20. CORPORATE GOVERNANCE: CHALLENGES FOR LATIN AMERICA

    OpenAIRE

    FERNANDO LEFORT; EDUARDO WALKER

    2000-01-01

    Corporate Governance relates to mechanisms through which providers of resources to the firm get their share of resources in return. Adequate governance practices help develop capital markets and assist market forces in attaining efficient contracts. Convincing evidence exists that well developed capital markets have an important impact on economic performance, growth and productivity. Our motivation for studying the corporate governance challenges faced by Latin America partly arises from a c...

  1. TRACE Model in Pilot Cities in Latin America

    OpenAIRE

    World Bank

    2015-01-01

    This report, supported by the energy sector management assistance program (ESMAP), applies the tool for the rapid assessment of city energy (TRACE) to examine energy use in León, México. This study is one of three requested and conducted in 2013 by the World Bank Latin America and the Caribbean energy unit to begin a dialogue on energy efficiency (EE) potential in Latin America and Caribbe...

  2. Schooling in Capitalist America

    Science.gov (United States)

    Cohen, David K.; And Others

    1977-01-01

    The symposium transcript presents and discusses commentaries on "Schooling in Capitalist America," by Sam Bowles and Herbert Gintis. The transcript serves three functions: (1) it offers a comprehensive account of the role of schools in America; (2) critiques efforts to reform schools; and (3) suggests alternative visions of how school reform…

  3. World review: Latin America

    International Nuclear Information System (INIS)

    The article gives information on contracts announced (and to whom) throughout Latin America in all aspects of the petroleum, natural gas and petrochemicals industries. Countries specifically mentioned are Argentina, Brazil, Chile, Mexico, Trinidad and Venezuela. The future for the oil industry in Latin America is viewed as 'highly prospective'

  4. Strategies For Being A Successful Physician Administrator Of A Rehabilitation Program

    Institute of Scientific and Technical Information of China (English)

    John L.Melvin; MD,MMSc

    2008-01-01

    @@ INTRODUCTION Purpose: The purpose of this paper is to provide rehabili-tation physicians with suggestions that will assist themin becoming successful program leaders/managers/ad-ministrators. The content of this paper is based uponthe experiences and observations of the author whohas had extensive experience in developing, leadingand managing rehabilitation programs.

  5. Rebuild America Partner Update, January--February 1999

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-01-01

    Rebuild America Partner Update, the bimonthly newsletter about the Rebuild America community, covers partnership activities, industry trends, and program news. Rebuild America is a network of community partnerships--made up of local governments and businesses--that save money by saving energy. These voluntary partnerships, working with the US Department of Energy, choose the best ways to improve the energy efficiency of commercial, government and apartment buildings. Rebuild America supports them with business and technical tools and customized assistance. By the year 2003, 250 Rebuild America partnerships will be involved in over 2 billion square feet of building renovations, which will save $650 million every year in energy costs, generate $3 billion in private community investment, create 26,000 new private sector jobs, and reduce air pollution by 1.6 million tons of carbon dioxide a year.

  6. Energy sector developments in Central America and the Caribbean

    International Nuclear Information System (INIS)

    Energy sector developments in Central America and the Caribbean were discussed. Central America is composed of six small countries whose total population is 32 million. The Caribbean population is 20.5 million. Central America is generally poor in hydrocarbon reserves but the geological prospects in several of the countries are encouraging. The oil and petroleum products supply and demand picture, the main characteristics of the hydrocarbon market, structure of the oil industry, hydrocarbon market reforms, pricing issues and recent trend towards reforms in the electric power industry in Central America were discussed. An overview of the Inter-American Development Bank's (IDB) effort to provide technical assistance and loans to strengthen the energy sector development in Central America and the Caribbean was also given. 17 refs., 2 tabs., 23 figs

  7. Physician communication in the operating room.

    Science.gov (United States)

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

    2015-01-01

    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education. PMID:24885399

  8. Physician Agency and Adoption of Generic Pharmaceuticals

    OpenAIRE

    Toshiaki Iizuka

    2012-01-01

    I examine physician agency in health care services in the context of the choice between brand-name and generic pharmaceuticals. I examine micro-panel data from Japan, where physicians can legally make profits by prescribing and dispensing drugs. The results indicate that physicians often fail to internalize patient costs, explaining why cheaper generics are infrequently adopted. Doctors respond to markup differentials between the two versions, indicating another agency problem. However, gener...

  9. The Emotional Intelligence of Resident Physicians

    OpenAIRE

    McKinley, Sophia Kim

    2014-01-01

    Since academic literature indicates that emotional intelligence (EI) is tied to work performance, there is increasing interest in understanding physician EI. We studied the EI of resident physicians in surgery, pediatric, and pathology residency programs at three academic centers to describe the EI profiles of residents in different specialties and determine whether gender differences in resident physician EI profiles mirror those in the general population. 325 residents were electronically...

  10. Psychopathology in adolescent children of physicians.

    OpenAIRE

    Stein, B A; Leventhal, S. E.

    1984-01-01

    The clinical records of 27 adolescent children of physicians who were treated in a psychiatric unit for adolescents were studied. Most of the children had been referred by their physician fathers for evaluation of conduct or mood disorders. These referrals were often the focus of family distress. There appeared to be no typical syndrome presented by physicians' children. Those treating such patients should be especially sensitive to the possibility that parental denial will increase the patie...

  11. Notifiable Disease Surveillance and Practicing Physicians

    OpenAIRE

    Krause, Gérard; Ropers, Gwendolin; Stark, Klaus

    2005-01-01

    Primary care physicians in Germany are essential participants in infectious disease surveillance through mandatory reporting. Feedback on such surveillance should reflect the needs and attitudes of these physicians. These issues were investigated in a questionnaire survey among 8,550 randomly sampled physicians in Germany in 2001. Of the 1,320 respondents, 59.3% claimed not to have received any feedback on infectious disease surveillance, and 3.7% perceived feedback as not important. Logistic...

  12. Physician-patient communication in managed care.

    OpenAIRE

    Gordon, G H; Baker, L; Levinson, W

    1995-01-01

    The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

  13. Difficulties facing physician mothers in Japan.

    Science.gov (United States)

    Yamazaki, Yuka; Kozono, Yuki; Mori, Ryo; Marui, Eiji

    2011-01-01

    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. PMID:22027270

  14. Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central Pleurodesis for malignant pleural effusions: a survey of physicians in South and Central America

    Directory of Open Access Journals (Sweden)

    Evaldo Marchi

    2010-12-01

    Full Text Available OBJETIVO: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. MÉTODOS: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. RESULTADOS: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em OBJECTIVE: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. METHODS: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. RESULTS: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and

  15. [Comments on the Confucian physician].

    Science.gov (United States)

    Li, Jian-xiang

    2009-09-01

    Confucianism gradually permeated and influenced the development of TCM from the Song dynasty, and the term "Confucian physician" is still in use today. With the impact of Confucianism, whether in the compilation of the medical classics or the explanation and conclusion of the medical theories as well as in medical education and ethics, all developed dramatically. But the Confucianism had also a negative effect on the development of medicine. For example, SU Dong-po cured the epidemics with "Sheng san zi", but he exaggerated its action and recorded it. The later intellectuals learnt from him without differentiation and many people suffered. Another example is, with the influence of ideas of "serve the parents" and "help the public", adult children treated their parents by cutting their own thigh. Even some wealthy and intelligent people blindly applied the prescription without differentiation. PMID:19930954

  16. Physicians on board: an examination of physician financial interests in ASCs using longitudinal data.

    Science.gov (United States)

    Yee, Christine A

    2011-09-01

    This paper investigates physician financial interests in ambulatory surgery centers (ASCs) using novel, longitudinal data that identify board members (directors) of ASCs in Florida. Improving on prior research, the estimated models in this paper disentangle physician director selection effects from the causal impact of these financial interests. The data suggest that even prior to their financial interest, physician directors had larger procedure volumes than non-directors. Physician directors also referred more lower-risk patients. On average, ASC board membership led to a 27% increase in a physician's procedure volume and a 16% increase in a physician's colonoscopy volume. Simulations suggest that 5% of the colonoscopies performed in Florida between 1997 and 2004 may have been due to physician ASC board membership. The evidence also suggests that physician directors steered patients from hospitals to their affiliate ASCs. In addition, they referred and/or treated more lower-risk patients as a result of board membership. PMID:21855155

  17. Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Bynum Debra L

    2006-02-01

    Full Text Available Abstract Background Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. Methods We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus. Results This article reports the life-expectancy results portion of the larger study. The study group (n = 116 was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73 felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75 wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions. Conclusion The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate

  18. Feasibility and acceptability of a workers’ health surveillance program for hospital physicians

    Directory of Open Access Journals (Sweden)

    Martijn M. Ruitenburg

    2015-08-01

    Full Text Available Objectives: A Workers’ Health Surveillance (WHS program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. Material and Methods: All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. Results: One-third of the hospital physicians (34% participated in every part of the WHS. The delivered dose was 77/84 (92%. Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. Conclusions: The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers.

  19. Basic demographic and professional characteristics of US women physicians.

    OpenAIRE

    E. Frank; Rothenberg, R; Brown, W V; Maibach, H

    1997-01-01

    Women physicians are a rapidly growing percentage of the physician population in the United States; yet, their fundamental characteristics and largely unknown. The Women Physicians' Health Study is the first large, national study of US women physicians, comprising a random sample (n = 4,501 respondents) of women physicians aged 30 to 70. Data from the Women Physicians' Health Study showed that African-American and Latina or Hispanic physicians were underrepresented, and Asian-American and for...

  20. Sex coaching for physicians: combination treatment for patient and partner.

    Science.gov (United States)

    Perelman, M A

    2003-10-01

    materials to assist the physician in overcoming a patient/partner's emotional barriers to sexual success in a time efficient manner are discussed. PMID:14551580

  1. [Pedro Laín Entralgo, physician and humanist].

    Science.gov (United States)

    Goic, Alejandro

    2002-01-01

    This speech of the president of the Chilean Academy of Medicine, Dr Alejandro Goic, is a tribute to the memory of the Spanish physician, scholar, historian, writer and intellectual Dr. Pedro Laín Entralgo, who died in Madrid on June 4, 2001, at the age of 93. On that occasion, the Spanish newspaper "El Pais" defined him as the last humanist. The Spanish civil war started when Laín was 28 years old and he aligned with Franco's supporters. In 1940, when he founded the magazine "El Escorial", he was separated from the official party. He and other intellectuals declared themselves in an "interior exile". His autobiographical book, "Lightening the burden on the conscience" refers to his painful personal history. He obtained the History of Medicine chair, at the Complutense University, at the age of 34 and remained at that post until his retirement in 1978. His intellectual production is magnificent and calls to a mutual understanding, hope, friendship and love. Outstanding, among others, are his books "The wait and hope", "Theory and reality of the other", "Spain as a problem", "Medicine and history", "The clinical history", "Patient physician relationship", "Medical anthropology". He directed the collective work composed of seven volumes, called "Universal History of Medicine". He was a member of the Royal Academies for Language, History and Medicine. In Chile, he was named honorary member of the Faculty of Medicine of the University of Chile and of the Academies of Language, History and Medicine. He dictated a course of Medical Anthropology that had a profound impact on the thought of Chilean physicians. In 1949 he wrote that Chile was the most solid state of Latin America and that "Chile needs to leave his traditional calm, through a historical gesture, and create the river beds required by his magnificent spiritual and geographical gifts. There is a lack of a beautiful craziness". It was an invocation for an understanding with our neighboring countries "for ever

  2. Discussion of “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”

    DEFF Research Database (Denmark)

    Bates, D. W.; Baysari, M. T.; Dugas, M.;

    2013-01-01

    With these comments on the paper “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”, written by Martin Jung and coauthors, with Dr. Elske Ammenwerth as senior author, the journal wants to stimulate a broad discussion on computerized physician order e...

  3. Estimation of physician supply by specialty and the distribution impact of increasing female physicians in Japan

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2009-10-01

    Full Text Available Abstract Background Japan has experienced two large changes which affect the supply and distribution of physicians. They are increases in medical school enrollment capacity and in the proportion of female physicians. The purpose of this study is to estimate the future supply of physicians by specialty and to predict the associated impact of increased female physicians, as well as to discuss the possible policy implications. Methods Based on data from the 2004 and 2006 National Survey of Physicians, Dentists and Pharmacists, we estimated the future supply of physicians by specialty, using multistate life tables. Based on possible scenarios of the future increase in female physicians, we also estimated the supply of physicians by specialty. Results Even if Japan's current medical school enrollment capacity is maintained in subsequent years, the number of physicians per 1000 population is expected to increase from 2.2 in 2006 to 3.2 in 2036, which is a 46% increase from the current level. The numbers of obstetrician/gynecologists (OB/GYNs and surgeons are expected to temporarily decline from their current level, whereas the number of OB/GYNs per 1000 births will still increase because of the declining number of births. The number of surgeons per 1000 population, even with the decreasing population, will decline temporarily over the next few years. If the percentage of female physicians continues to increase, the overall number of physicians will not be significantly affected, but in specialties with current very low female physician participation rates, such as surgery, the total number of physicians is expected to decline significantly. Conclusion At the current medical school enrollment capacity, the number of physicians per population is expected to continue to increase because of the skewed age distribution of physicians and the declining population in Japan. However, with changes in young physicians' choices of medical specialties and as the

  4. How physician networks are selling themselves.

    Science.gov (United States)

    Volz, D

    1999-01-01

    A growing number of physicians are creating discount networks due to the anger they feel about their loss of professional autonomy and financial compensation to managed care. They are seeking a niche among patients who lack adequate health insurance coverage or are dissatisfied with their plans. To win patients, the physician networks are marketing services that are deeply discounted. PMID:10351396

  5. 42 CFR 410.20 - Physicians' services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physicians' services. 410.20 Section 410.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.20 Physicians'...

  6. The Physician as a Marriage Counselor

    Science.gov (United States)

    Trainer, Joseph B.

    1973-01-01

    The author describes the emergence of a new style of family physician whose education is incorporating more behavioral science and whose practice moves increasingly into the field of marital and sexual problems. Closer cooperation between physicians and clinical psychologists and marriage counselors is advocated. (Editor)

  7. Construction of a Physician Skills Inventory

    Science.gov (United States)

    Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

    2012-01-01

    The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

  8. A Study of the Educationally Influential Physician.

    Science.gov (United States)

    Kaufman, David M.; Ryan, Kurt; Hodder, Ian

    1999-01-01

    A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…

  9. Assistive Technology

    Science.gov (United States)

    ... Page Resize Text Printer Friendly Online Chat Assistive Technology Assistive technology (AT) is any service or tool that helps ... be difficult or impossible. For older adults, such technology may be a walker to improve mobility or ...

  10. Assisted Living

    Science.gov (United States)

    ... overwhelming majority of residents are female. Assisted Living Philosophy The philosophy of assisted living is to provide personalized, resident ... loved ones to learn about the care provider philosophy . Freedom of Choice The most progressive state regulations ...

  11. Can complexity science inform physician leadership development?

    Science.gov (United States)

    Grady, Colleen Marie

    2016-07-01

    Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical

  12. Prevent Child Abuse America

    Science.gov (United States)

    ... call the police . Crisis and support contacts For Child Abuse Reporting Numbers in your State please visit: Child ... suspected child abuse and neglect. Parent Resources Prevent Child Abuse America (800) CHILDREN A resource for tips, referrals, ...

  13. Donate Life America

    Science.gov (United States)

    ... Us News You Have the Power to Donate Life. Register as an Organ, Eye and Tissue Donor ... reach 30K milestone, thanks to increased donations Donate Life America Announces 2015 James S. Wolf, M.D., Courage ...

  14. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue. PMID:17502635

  15. America in the Eyes of America Watchers:

    DEFF Research Database (Denmark)

    Feng, Huiyun; He, Kai

    2015-01-01

    almost half of the survey participants thought that America would remain the global hegemon in the next ten years. Meanwhile, a large majority was also optimistic that China is a rising great power, especially in the economic sense, in the world. More than half of the respondents saw Asian military...... issues, such as the South China Sea issue, as the most difficult problem between China and the US....

  16. Hippocratic oath and conversion of ethico-regulatory aspects onto doctors as a physician, private individual and a clinical investigator.

    Science.gov (United States)

    Imran, Mohammed; Samad, Shadab; Maaz, Mohammad; Qadeer, Ashhar; Najmi, Abul Kalam; Aqil, Mohammed

    2013-10-01

    Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through "common rule" resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of "medical neutrality" by embarking some grade of "medical immunity" on the basis of the oath is necessary for ethical conduct of physicians. PMID:24381460

  17. Immigrant America: A Portrait

    OpenAIRE

    Rumbaut, RG; Portes, A.

    2014-01-01

    This revised, updated, and expanded fourth edition of Immigrant America: A Portrait provides readers with a comprehensive and current overview of immigration to the United States in a single volume. Updated with the latest available data, Immigrant America explores the economic, political, spatial, and linguistic aspects of immigration; the role of religion in the acculturation and social integration of foreign minorities; and the adaptation process for the second generation. This revised ed...

  18. 42 CFR 483.360 - Consultation with treatment team physician.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the...

  19. Family physicians: importance and relevance.

    Science.gov (United States)

    Yeravdekar, Rajiv; Yeravdekar, Vidya Rajiv; Tutakne, M A

    2012-07-01

    Due to rapid advancement in medical technology and knowledge patients today prefer treatment from specialists, if they can afford it. Medical treatment has become a purchasable commodity, to be procured as and when required, based on cost and availability.This is unfortunate but true. Specialisation tends to divide the patients into'parts' and increases the cost of treatment. Moreover no single physician is in charge of the patient as a whole to maintain long term continuity and coordinate the treatments given by different specialists. Since long term dependence on 'family doctor' has reduced, trust deficit in the profession has started creeping in. It is essential to rejuvenate the concept of family doctors equipped with skills suitable for modern technology and practice, to restore the faith of patients in medical professionals. Family doctor can provide a 'single window clearance' for all healthcare needs of an individual. Exploitation of gullible patient can be prevented when the family doctor becomes the friend and guide for all treatments being given to the individual. Society should be educated on the benefits of getting the treatment through the family doctor. The family doctor then becomes the Authorised Medical Attendant (AMA), responsible for all treatments beings provided to the patients. The Medical Council of India (MCI) may consider incorporating this in code of medical ethics. PMID:23520678

  20. Physicians' perceptions and uses of commercial drug information sources: an examination of pharmaceutical marketing to physicians.

    Science.gov (United States)

    Spiller, L D; Wymer, W W

    2001-01-01

    Data were collected from physicians attending a medical conference. This exploratory study was primarily interested in two areas. First, the investigators were interested in better understanding physicians' responses to different promotional tactics typically used by the pharmaceutical industry. Pharmaceutical representatives were most useful, followed by drug samples and infomercials in medical journals. Direct mail, promotional faxes, and promotional products were used less by physicians. Second, the investigators were interested in learning what information sources influenced physicians' drug choices. Physicians were primarily influenced by their prior experience with a drug, then by drug compendiums, and journal articles. Physicians were also influenced by information provided by the industry and other factors, like the drug's price and their patients' financial situations. Managerial implications for marketing to physicians and ideas for future research are discussed. PMID:11727295

  1. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician... HEALTH SERVICES Physicians and Other Practitioners § 414.50 Physician or other supplier billing...

  2. Psychosocial challenges facing physicians of today.

    Science.gov (United States)

    Arnetz, B B

    2001-01-01

    Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the

  3. Developing physicians as catalysts for change.

    Science.gov (United States)

    George, Aaron E; Frush, Karen; Michener, J Lloyd

    2013-11-01

    Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes. PMID:24072124

  4. Physician uncertainty and the art of persuasion.

    Science.gov (United States)

    Rizzo, J A

    1993-12-01

    Incomplete information is a chronic feature of medica markets. Much attention has focused on information asymmetries between physicians and their patients. In contrast, physician uncertainty has received far less attention. This is a significant omission. Physician uncertainty may be an even more important reason than consumer uncertainty for the high cost of health care. This paper reviews and evaluates major approaches for managing physician uncertainty. We argue that quantitative approaches alone, such as scientific advancement and the application of decision analysis to clinical reasoning, are insufficient for dealing with uncertainty. Qualitative approaches, such as forging consensus through expert panels, and teaching physicians to accept and cope with uncertainty, will play a valuable role in promoting more effective clinical decision-making under conditions of uncertainty. The current tensions between those who would eradicate physician uncertainty through quantitative approaches and those who favor qualitative methods has parallels in many other fields, including economics and mathematics. These tensions are unfortunate, since the most promising initiative to promote better clinical decision-making will likely need to draw upon both approaches. The recent initiative to implement medical practice guidelines is one example of a broad-based approach to improve clinical decision-making. Guidelines draw upon available scientific evidence, but typically involve consensus-building as well. They seek to persuade and educate physicians about appropriate treatments, without mandating changes in physician treatment patterns. Given the persistent uncertainties physicians will undoubtedly confront regarding appropriate clinical decision-making, this flexible approach may be the best way to mitigate market failures resulting from inappropriate clinical decisions.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8303329

  5. Family physicians' perspectives regarding palliative radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To assess family physicians' views on common indications for palliative radiotherapy and to determine whether this influences patient referral. Methods and materials: A 30-item questionnaire evaluating radiotherapy knowledge and training developed at the Ottawa Regional Cancer Centre (ORCC) was mailed to a random sample of 400 family physicians in eastern Ontario, Canada. The completed surveys were collected and analyzed, and form the basis of this study. Results: A total of 172 completed surveys were received for a net response rate of 50% among practicing family physicians. Almost all of the physicians (97%) had recently seen cancer patients in their offices, with 85% regularly caring for patient with advanced cancer. Fifty-four percent had referred patients in the past for radiotherapy and 53% had contacted a radiation oncologist for advice. Physicians who were more knowledgeable about the common indications for palliative radiotherapy were significantly more likely to refer patients for radiotherapy (P<0.01). Inability to contact a radiation oncologist was correlated with not having referred patients for radiotherapy (P<0.01). Only 10% of the physicians had received radiotherapy education during their formal medical training. Conclusions: Many of the family physicians surveyed were unaware of the effectiveness of radiotherapy in a variety of common palliative situations, and radiotherapy referral was correlated with knowledge about the indications for palliative radiotherapy. This was not surprising given the limited education they received in this area and the limited contact they have had with radiation oncologists. Strategies need to be developed to improve continuing medical education opportunities for family physicians and to facilitate more interaction between these physicians and radiation oncologists

  6. [Which place for physicians in blood supply?].

    Science.gov (United States)

    Danic, B; Pelletier, B

    2013-05-01

    Historically, blood transfusion has been divised, enhanced and organized by physicians. The special status of blood led to ensure that collection of blood and its components were placed under the supervision of a physician. Throughout its history, blood transfusion organization in France has established an exclusive exercise of the collection of blood and its components entrusted to doctors, thus creating the concept of "medicine of donation". This view is changing, and programmed exercise of this activity by nurses led to question about this profession perimeter, its necessary evolution, and finally about the place of physicians in blood supply. PMID:23537956

  7. Find a Physical Medicine & Rehabilitation Physician

    Science.gov (United States)

    ... searchable database that allows you to locate a practicing PM&R physician in your area. Please read ... AAPM&R Who We Are and Our Focus Leadership & Governance Volunteerism Membership Councils & Groups Member Directory Corporate ...

  8. Marketing to physicians in a digital world.

    Science.gov (United States)

    Manz, Christopher; Ross, Joseph S; Grande, David

    2014-11-13

    Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made. PMID:25390738

  9. Physician Fee Schedule Carrier Specific Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has condensed all 56 Physician Fee Schedule (PFS) carrier specific pricing files into one zip file. It is...

  10. Physician outcome measurement: review and proposed model.

    Science.gov (United States)

    Siha, S

    1998-01-01

    As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer. PMID:10339092

  11. The Exam-Room Physician Workstation

    OpenAIRE

    Russler, Daniel C.

    1989-01-01

    By combining and configuring commercially available hardware and software, we have developed a networked system of exam-room physician workstations that provides a platform for physician charting, medical reference, and patient education. The physical platform consists of IBM compatible computers and ethernet hardware. The software platform is a hypertext document management system called Idex distributed on a Novell network. Key features of the workstation include a graphical user interface,...

  12. Modeling solutions to Tanzania's physician workforce challenge

    Directory of Open Access Journals (Sweden)

    Alex J. Goodell

    2016-06-01

    Full Text Available Background: There is a great need for physicians in Tanzania. In 2012, there were approximately 0.31 physicians per 10,000 individuals nationwide, with a lower ratio in the rural areas, where the majority of the population resides. In response, universities across Tanzania have greatly increased the enrollment of medical students. Yet evidence suggests high attrition of medical graduates to other professions and emigration from rural areas where they are most needed. Objective: To estimate the future number of physicians practicing in Tanzania and the potential impact of interventions to improve retention, we built a model that tracks medical students from enrollment through clinical practice, from 1990 to 2025. Design: We designed a Markov process with 92 potential states capturing the movement of 25,000 medical students and physicians from medical training through employment. Work possibilities included clinical practice (divided into rural or urban, public or private, non-clinical work, and emigration. We populated and calibrated the model using a national 2005/2006 physician mapping survey, as well as graduation records, graduate tracking surveys, and other available data. Results: The model projects massive losses to clinical practice between 2016 and 2025, especially in rural areas. Approximately 56% of all medical school students enrolled between 2011 and 2020 will not be practicing medicine in Tanzania in 2025. Even with these losses, the model forecasts an increase in the physician-to-population ratio to 1.4 per 10,000 by 2025. Increasing the absorption of recent graduates into the public sector and/or developing a rural training track would ameliorate physician attrition in the most underserved areas. Conclusions: Tanzania is making significant investments in the training of physicians. Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized.

  13. Physician Burnout: Coaching a Way Out

    OpenAIRE

    Gazelle, Gail; Liebschutz, Jane M.; Riess, Helen

    2014-01-01

    ABSTRACT Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-o...

  14. Physician Burnout: Coaching a Way Out

    OpenAIRE

    Gazelle, Gail; Liebschutz, Jane M.; Riess, Helen

    2014-01-01

    Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-oriented a...

  15. Physician Fee Policy and Medicaid Program Costs

    OpenAIRE

    Jonathan Gruber; Kathleen Adams; Newhouse, Joseph P.

    1997-01-01

    We investigate the hypothesis that increasing access for the indigent to physician offices shifts care from hospital outpatient settings and lowers Medicaid costs (the so-called offset effect'). To evaluate this hypothesis we exploit a large increase in physician fees in the Tennessee Medicaid program, using Georgia as a control. We find that beneficiaries shifted care from clinics to offices, but that there was little or no shifting from hospital outpatient departments or emergency rooms. Th...

  16. Engaging Physicians in Risk Factor Reduction

    OpenAIRE

    Springrose, James V.; Friedman, Felix; Gumnit, Stephen A.; Schmidt, Eric J.

    2010-01-01

    OptumHealth tested the feasibility of physician-directed population management in 3 primary care practices and with 546 continuously insured patients who exhibited claims markers for coronary artery disease, diabetes, and/or hypertension. During the intervention portion of the study, we asked physicians to improve the following health measurements: blood pressure, body mass index, cholesterol, hemoglobin A1c, and smoking status. We offered a modest pay-for-outcomes incentive for each risk fac...

  17. Depression-Burnout Overlap in Physicians

    OpenAIRE

    Walter Wurm; Katrin Vogel; Anna Holl; Christoph Ebner; Dietmar Bayer; Sabrina Mörkl; Istvan-Szilard Szilagyi; Erich Hotter; Hans-Peter Kapfhammer; Peter Hofmann

    2016-01-01

    Background Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians. Methods In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire ...

  18. Evaluation of physician's attitude and knowledge

    OpenAIRE

    Sekineh Shafia; Jobin Hemati; Leila Meskini; Aliraza Khalilian

    2008-01-01

    (Received 19 Jun, 2008; Accepted 20 Oct, 2008) Abstract This study aimed to determine the knowledge and attitudes to wards homeopathy among general practitioner and specialist physicians in Sari.Our results indicate Sari physicians had not sufficient knowledge obout homeopathy; but they liked collaboration with homeopaths for treatment of their patients and have courses for homeopathy education. J Mazand Univ Med Sci 2008; 18(66): 102-103(Persian

  19. Breastfeeding Education: A Physician and Patient Assessment

    OpenAIRE

    Stolzer, J. M.; Syed Afzal Hossain

    2014-01-01

    In the study presented here, Likert scaled surveys derived from the Surgeon General’s Blueprint for Action on Breastfeeding (2000) were mailed to 400 practicing physicians in a Midwestern state to assess medical school breastfeeding education. In addition, 500 surveys were mailed to women in the same Midwestern state who had given birth within the last year to determine what type of breastfeeding information they were receiving from their attending physicians. The purpose of this study is to ...

  20. Developing physician leaders in academic medical centers.

    Science.gov (United States)

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.* PMID:10164266

  1. Association of Clinical Researchers and Educators a statement on relationships between physicians and industry.

    Science.gov (United States)

    Weber, Michael A; Black, Henry R; Fonseca, Rafael; Garber, Jeffrey; Gonzalez-Campoy, J Michael; Kimmelstiel, Carey; Markowitz, Avi B; Nakayama, Don; Stell, Lance K; Stossel, Thomas P

    2012-01-01

    Collaborations between physicians, particularly those in academic medicine, and industries that develop pharmaceutical products, medical devices, and diagnostic tests have led to substantial advances in patient care. At the same time, there is a strong awareness that these relationships, however beneficial they may be, should conform to established principles of ethical professional practice. Through a writing committee drawn from diverse disciplines across several institutions, the Association of Clinical Researchers and Educators (ACRE) has written a code of conduct to provide guidance to physicians in observing these principles. Our recommendations are not intended to be prescriptive or inflexible, but rather to be of assistance to physicians in making their own personal decisions on whether, or how, to be involved in research, education, or other collaborations with industry. PMID:22982801

  2. Solar America Cities Awards: Solar America Initiative Fact Sheet

    Energy Technology Data Exchange (ETDEWEB)

    2008-03-01

    This fact sheet provides an overview of the Solar America Cities activities within the Solar America Initiative and lists the 25 cities that have received financial awards from the U.S. Department of Energy.

  3. Bioethics for clinicians: 11. Euthanasia and assisted suicide

    OpenAIRE

    Lavery, J V; Dickens, B. M.; Boyle, J. M.; Singer, P A

    1997-01-01

    Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would b...

  4. Low Job Satisfaction Among Physicians in Egypt

    Directory of Open Access Journals (Sweden)

    Amira Gamal Abdel-Rahman

    2008-04-01

    Full Text Available AIM/BACKGROUND: Physician’s job satisfaction is a cornerstone for improving the quality of health care, and its continuity. To identify the extent of job satisfaction and explain its main components among physicians, together with finding out the main indicators for job satisfaction. METHODS: We randomly selected physicians from the Egyptian Ministry of Health and Population Hospitals. All participants were asked to fill a self administrated questionnaire which included data pertaining socio-demographic characteristics and job satisfaction regarding salaries/incentives, monitoring, administration system, management, career satisfaction, relationship with colleagues, social support, opportunities for promotion, and job responsibilities. Satisfied was defined as satisfaction of>60%. RESULTS: Two hundred and thirty eight physicians participated in this study; with mean age of 37.1+ 9.4 years, and 70.2% were males. Only 42.9% of the physicians’ reported job satisfaction. Relationship with colleagues was the most important component of satisfaction with mean of 81.3+19.6 while, salaries/incentives were the least one with mean of 16.2+ 14. The overall current satisfying domains were not significantly associated with marital status or educational level, however it was significantly associated with specialty. Neither age nor gender was significantly associated with the degree of job satisfaction. CONCLUSION: Our results call for paying more attention to improve physicians’ job satisfaction in Egypt, to meet needed higher standards in health care. [TAF Prev Med Bull. 2008; 7(2: 91-96

  5. Physician-patient communication: breaking bad news.

    Science.gov (United States)

    Fields, Scott A; Johnson, W Michael

    2012-01-01

    Physicians often struggle with how to manage the task of breaking bad news with patients. Moreover, the arduous nature of the task can contribute to physician detachment from the patient or an avoidance of breaking the news in a timely manner. A plan of action can only improve physician confidence in breaking bad news, and also make the task more manageable. Over a decade ago, Rabow and McPhee offered a strategy; the ABCDE plan, which provided a patient centered framework from which to deliver troubling news to patients and families. At the heart of this plan was the creation of a safe environment, the demonstration of timely communication skills, and the display of empathy on the physician's part. Careful consideration of the doctor's own reactions to death and dying also played an important role. A close review of the five tenets of this plan indicates the relevance of Rabow and McPhee's strategy today. The patient base in our nation and state continues to be older, on average, and physicians are faced with numerous patients who have terminal illness. A constructive plan with specific ideas for breaking bad news can help physicians effectively navigate this difficult task. PMID:22655433

  6. Family physician perspectives on primary immunodeficiency diseases

    Directory of Open Access Journals (Sweden)

    Jordan eOrange

    2016-03-01

    Full Text Available Primary immunodeficiency diseases (PID include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed family practice physicians, of whom 44% reported following ≥1 patient with a PID. Selective immunoglobulin A (IgA, deficiency (21%, and chronic granulomatous disease (11% were most common and were followed by significantly more subspecialist immunologists (P<.0001. Use of intravenously administered Ig, and live viral vaccinations across PID was significantly different (P<.0001. Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4% vs. 79% of subspecialist immunologists, P<.0001. Family practice physicians will likely encounter patients with a PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.

  7. [The physician in the Greek city].

    Science.gov (United States)

    Koelbing, H M

    1989-01-01

    In the cities of ancient Greece, as well as later in Rome, the doctor's responsibility was already a controversial subject. The practice of healing was not subject to any official regulation: no protection of good physicians, no punishment of malpractice. While physicians often lead an itinerant life, cities endeavoured to secure the presence of a good one by appointing him town or public physician on the basis of a one-year contract. This did not mean, however, a "health service" free of charge for patients. The variety of healing persons including midwives and medicals slaves is reviewed. Some short texts which were added in later times to the "Works of Hippocrates" ("Physician", "Precepts", "Decorum") provide us with some information on a physician's daily life (see also H.M. Koelbing, The Hippocratic physician at his patient's bedside, in Practitioner 224, 1980, 551-554). From Hippocrates ("Prognostic") to the hellenistic period ("Decorum"), we note an important change as to the revelation of a bad prognosis: Hippocrates advocates the blunt information of the patient when there is no hope for him; but his follower in a later century takes into consideration the patient's psychology. He hides the cruel truth from him while informing openly his relatives and near friends. This is the first time in history we come across the principle of the doctor's double truth, strongly, advocated e.g. by Thomas Percival in his "Medical Ethics" (1803), but much disputed today. PMID:2673940

  8. Family physician perceptions of working with LGBTQ patients: physician training needs

    OpenAIRE

    Beagan, Brenda; Fredericks, Erin; Bryson, Mary

    2015-01-01

    Background Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. Method In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care....

  9. Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

    Science.gov (United States)

    Colt, H G; Solot, J A

    1989-02-01

    To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED. PMID:2783838

  10. [Legal liability in failed sterilization from the physician's viewpoint].

    Science.gov (United States)

    Hammerstein, J

    1995-11-01

    Recanalization of oviducts as well as spermatic ducts occur at a low promille rate after sterilization even if correctly performed. Therefore, pregnancies after unsuccessful sterilization cannot be taken as an immediate proof for a faulty surgical procedure. The surgeon is recommended to have the correctness of a sterilization confirmed in writing by competent witness of the operation (assistant doctor, nurse). Whenever possible, tissues of the occluded organs should be sent to the pathologist for histologic proof. In addition, special attention must be payed to a proper information of the patient on the failure rate in order to avoid the risk to become sued subsequently for incomplete information if the woman becomes pregnant. In the German jurisdiction, a child born after a faulty performed sterilization is classified as damage or cause of a damage according to the law of contract. Based on this judicial principle, a physicians may be sentenced to pay alimonies. This is felt by many physicians as an abasement of their professional engagement. It is also criticized, that suffering from an unwanted but otherwise normal pregnancy following faulty sterilization entitles a woman to financial compensations. Very recently, judicial differences in this respect have become known between the Federal Constitutional Court and the Federal Court. At present, it is still open which of the judicial points of view will finally predominate. PMID:8588445

  11. Boys & Girls Clubs of America

    Science.gov (United States)

    ... Group Teams Up With Boys & Girls Clubs of America to Support Young Alumni Through New Program Engaging ... million national partnership MORE» Boys & Girls Clubs of America Inducts Top Entertainers, Athletes and Business Leaders into ...

  12. Economic integration in the Americas

    OpenAIRE

    1997-01-01

    This pioneering study shows that economic integration in the Americas is not simply a matter of removing trade barriers. Economic Integration in the Americas addresses the pervasive effects of economic integration on the economy as a whole.

  13. America's Children and the Environment

    Science.gov (United States)

    ... Protection Agency Search Search America's Children and the Environment Share Facebook Twitter Google+ Pinterest Contact Us America's Children and the Environment is an EPA report that presents key information ...

  14. Two Visions of America

    Science.gov (United States)

    Capaldi, Nicholas

    2012-01-01

    Since the seventeenth century, there have been two narratives about modernity in general and America in particular. The author uses the term "narrative" to include (a) facts, (b) arguments, and most important, (c) a larger vision of how one sees the world and chooses to engage the world. The first and originalist narrative is the Lockean Liberty…

  15. Only "In America"

    Science.gov (United States)

    Miranda, Maria Eugenia

    2011-01-01

    As the daughter of an interracial couple growing up in a middle-class town on Long Island in the 1970s, Soledad O'Brien learned not to let inappropriate or racist comments throw her. Now as the anchorwoman of CNN's "In America" documentary unit, she says she asks those uncomfortable questions about race all the time. She shines spotlight on…

  16. Still Teaching for America

    Science.gov (United States)

    Kronholz, June

    2013-01-01

    In this article, June Kronholz talks to co-chief executives of Teach For America (TFA), Elisa Villanueva Beard and Matt Kramer about how TFA has managed to keep its forward momentum for almost 24 years. Four primary reasons are discussed: (1) Common Vision, Regional Innovation; (2) Data-Driven Improvement; (3) Global Reach; and (4) Stoking the…

  17. An Idea Called America

    Science.gov (United States)

    Hartoonian, Michael; Van Scotter, Richard; White, William E.

    2007-01-01

    America evolved out of the principles of the eighteenth-century Enlightenment, suggesting that individuals could govern themselves and that people were "endowed" with "unalienable rights" such as life, liberty, and the pursuit of happiness. To secure these principles, Americans would continue to work on forming a more perfect Union, by…

  18. Strengthening America's Families.

    Science.gov (United States)

    Alvarado, Rose; Kumpfer, Karol

    2000-01-01

    Improving parenting practices and the family environment is the most effective, enduring strategy for combating juvenile delinquency. Describes the Office of Juvenile Justice and Delinquency Prevention's Strengthening America's Families Initiative. Highlights several family-focused prevention programs identified as exemplary, explaining how they…

  19. Americas at Odds

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Despite lingering disputes,the United States keeps a firm grip on Latin America During his presidential campaign,Evo Morales said his election would be a "nightmare" for the United States.The Bolivian president honored his words. On September 10, Morales declared U.S.

  20. The Mediterranean fruit fly in Central America

    International Nuclear Information System (INIS)

    Various methods of controlling the medfly are available and include the use of insecticides, bait sprays and the sterile insect technique (SIT). Each of these control strategies may be used alone or in sequence. With regard to the application of the SIT, the Joint FAO/IAEA Division of Atomic Energy in Food and Agriculture through its Insect and Pest Control Section and Entomology Laboratory is in an excellent position to assist in containing the medfly in Central America. For the past 12 years, the laboratory has participated in all phases of medfly control by sterile insect releases in various climates. This involvement has included planning of medfly campaigns, development of pre-release techniques (bait spraying, trapping, etc.) and shipment and release of sterilized medflies. Small-scale field tests utilizing the SIT have been carried out by nine countries: Italy (Procida, Capri), Spain, Cyprus, Israel, Tunisia, Peru, Panama, Costa Rica and Nicaragua. Other field projects presently being counselled and serviced are located in Argentina, Venezuela and the Canary Islands. The research and development that are still needed to effectively stabilize and gain control of the medfly situation in Central America include: The development and use of effective quarantine procedures in various countries; Development of effective conventional medfly control procedures under the conditions found in Central America; Development of methods to determine the geographic origin of medflies introduced into new areas; Medfly mass production (viz. all aspects of rearing Central American strains); Assessing the performance (competitiveness, etc.) of various strains; Logistics, including the development of systems for releasing pre-adult stages; Genetic rearing methods: developmental research in this area is particularly promising since the preferential production of males would allow considerable savings in the rearing costs of medflies for release; Development of adequate surveillance

  1. Lateinamerika oder -amerikas? Latin America or Americas?

    Directory of Open Access Journals (Sweden)

    Ana Belén García Timón

    2008-07-01

    Full Text Available Anhand interdisziplinärer und empirischer Studien wird Lateinamerika als Bühne für die Entwicklung transkultureller Phänomene präsentiert. Geschlechterverhältnisse in unterschiedlichen Kontexten stehen im Mittelpunkt der Untersuchung. Begriffe wie Macht, Rasse oder Raum werden mit dem Ziel, weg von der bisherigen Vorstellung von homogenen kulturellen Einheiten zu kommen, revidiert.Latin America is presented as a stage for the development of transcultural phenomena through the use of interdisciplinary and empirical studies. Gender relations in different contexts lie at the heart of this study. Terms such as power, race, or space are revised with the goal of moving away from current perceptions of homogenous cultural unities.

  2. Clinical Criteria for Physician Aid in Dying.

    Science.gov (United States)

    Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A

    2016-03-01

    More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period. PMID:26539979

  3. Opinions of Family Physicians about Family Counseling

    Directory of Open Access Journals (Sweden)

    Kenan Taştan1

    2016-04-01

    Full Text Available Objective: As of mission, Family physician is responsible for all the health problems of the family members. In this sense, it is necessary to counsel individuals and families in need. In this study, it is aimed to evaluate the knowledge and thoughts of family physicians about family counseling in Turkey. Methods: The Research was conducted among the family physicians working in Turkey in 2013. In order to get demographic characteristics, opinions and suggestions of the family physicians about family counseling, a questionnaire was developed by the researchers. The survey was administered to the participants via the internet. Data from 421 participants were evaluated. Results: The mean age of participants was 41.7 ± 7.2 years. 67.1% of them were male and 32.9% female. Of the participants, while 11.3% stated that they received training in family counseling, 88.7% stated not received. When the frequency of family counseling need was questioned, 3.4% of the participants pointed out that they have never needed, 44% is rarely needed, 39.9% frequently needed, 12.7% very frequently needed. Of the family physicians, while 21.7% was thinking that they are competent about solving family problems, 78.3% was not competent. Meanwhile, 76.3% of family physicians wanted to have training on the family counseling, while 23.7% stated that they do not want. Conclusion: It was found that there is a shortage of training of the family physicians on the subject of family counseling. In order to compensate this shortage, it would be beneficial to include the subject of family counseling in the curriculum of medical faculty and arrange in-service training to the family doctors working in the primary care.

  4. [Physician practice patterns and attitudes to euthanasia in Germany. A representative survey of physicians].

    Science.gov (United States)

    Kirschner, R; Elkeles, T

    1998-04-01

    Growing life expectancy and increasing pharmaceutical and technical methods in medicine are leading to more and more discussions among the general population and among physicians as to whether methods to shorten the sufferings of mortally ill persons should be legalised further. In Australia 60% of physicians wish to be able to perform active euthanasia if this would be legal. In the Netherlands physicians do not commit an offence if they perform euthanasia on the basis of ethically consented rules. In the FRG the National Board of Physicians (Bundesärztekammer) still rejects any liberalisation concerning active euthanasia. However, little is known of the attitudes and behaviour of physicians concerning the questions of active and passive euthanasia. Sponsored by Gruner and Jahr publishers for a magazine "Stern" publication we conducted a representative study among physicians working in hospitals and their colleagues in free practices concerning this topic. Beginning with qualitative interviews with 50 physicians we tested the questionnaire developed and looked for the data production method best fitting for this difficult matter resulting in telephone interviews or a self-administered questionnaire. In the main study a representative sample of n = 282 physicians in free practices and n = 191 physicians in hospitals were interviewed. The response rates were 94% and 51% respectively. Analysis of non-responses did not indicate any bias. Half of the physicians think that a broader discussion on euthanasia is necessary, 34% disagree and 17% consider even a discussion already dangerous. 6% of the physicians in hospitals and 11% in free practices have already experienced methods of active euthanasia. Half of the physicians have seen patients who strongly wished euthanasia, a situation which happens once in every two years. The majority of physicians feel a deep understanding but only a minority of 4% comply with the wish. The vast majority of physicians advocate

  5. Informatics-based Medical Procedure Assistance during Space Missions

    OpenAIRE

    Iyengar, M S; Carruth, T N; Florez-Arango, J; Dunn, K

    2008-01-01

    Currently, paper-based and/or electronic together with telecommunications links to Earth-based physicians are used to assist astronaut crews perform diagnosis and treatment of medical conditions during space travel. However, these have limitations, especially during long duration missions in which telecommunications to earth-based physicians can be delayed. We describe an experimental technology called GuideView in which clinical guidelines are presented in a structured, interactive, multi-mo...

  6. Patient Trust in Physicians: Empirical Evidence from Shanghai, China

    Directory of Open Access Journals (Sweden)

    Da-Hai Zhao

    2016-01-01

    Conclusions: Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician–patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

  7. Using natural language processing to analyze physician modifications to data entry templates.

    OpenAIRE

    Wilcox, Adam B.; Narus, Scott P; Bowes, Watson A.

    2002-01-01

    Efficient data entry by clinicians remains a significant challenge for electronic medical records. Current approaches have largely focused on either structured data entry, which can be limiting in expressive power, or free-text entry, which restricts the use of the data for automated decision support. Text-based templates are a semi-structured data entry method that has been used to assist physicians in manually entering clinical notes, by allowing them to edit predefined example notes. We an...

  8. Ecosystem and population health: the role of Canadian physicians at home and abroad.

    OpenAIRE

    Woollard, R F

    1995-01-01

    Seemingly intractable problems of overpopulation, ecologic degradation, diminishing resources and regional warfare are having a profound effect on global population health. Canadian physicians can assist in ameliorating these problems by helping to modify the overconsumption of natural resources at home and by participating in international health projects focused at the community level, where the health of individuals and that of their environment intersect. The author describes the work of ...

  9. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families

    Science.gov (United States)

    2010-01-01

    In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). PMID:20668949

  10. Motivational determinants among physicians in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Souares Aurélia

    2010-07-01

    Full Text Available Abstract Introduction Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. Methods A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Results Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Conclusion Motivational determinants differed

  11. DIABETIC RETINOPATHY: HOW AWARE ARE THE PHYSICIANS?

    Directory of Open Access Journals (Sweden)

    Narendra P

    2014-05-01

    Full Text Available PURPOSE: The purpose of the study was to assess the awareness of physicians in rural Kolar district towards diabetes and diabetic retinopathy. MATERIALS AND METHODS: A cross sectional survey was conducted in rural Kolar district during May 2013. The study participants were 38 physicians and 2 general practitioners who had special training in diabetes. The data were collected by means of filling up of pre-tested specially designed questionnaires focused on awareness towards Diabetes Mellitus and Diabetic retinopathy. The assessment was done by total score as satisfactory (Diabetic retinopathy awareness index >12, moderately satisfactory (DRAI 9-11 or unsatisfactory if index 12 was attained by only 55% (22/40 practitioners. Nearly 62.5% of physicians refer the diabetics to ophthalmologists only when they develop significant vision problems. CONCLUSION: This survey highlighted some of the lacunae in the knowledge about referral system of the general physicians and identified the need for improvement in awareness regarding the management of the patients with diabetes and diabetic retinopathy. To improve patient compliance, physician needs to educate their diabetic patients about the importance of setting an annual eye examination routinely before the development of vision loss.

  12. The physician's response to climate change.

    Science.gov (United States)

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being. PMID:19418286

  13. Do emergency physicians trust their patients?

    Science.gov (United States)

    Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Ammirati, Christine; Bertrand, Catherine; Charlin, Bernard; Dory, Valérie

    2016-06-01

    The primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an "own point of view perspective". The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients' accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as "reliable" or "unreliable" on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making. PMID:26907536

  14. Physician-Hospital Alignment in Orthopedic Surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. PMID:26375539

  15. The occupational hazards of emergency physicians.

    Science.gov (United States)

    Dorevitch, S; Forst, L

    2000-05-01

    Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout. PMID:10830687

  16. Physician boundary violations in a physician's health program: a 19-year review.

    Science.gov (United States)

    Brooks, Elizabeth; Gendel, Michael H; Early, Sarah R; Gundersen, Doris C; Shore, Jay H

    2012-01-01

    Managing and treating physicians with professional boundary violations is of paramount importance with vast implications for public safety. Physician Health Programs (PHPs) evaluate and monitor many, if not most, physicians receiving care for these abuses. We conducted a chart review of 120 physicians monitored for boundary violations. We made intergroup and intragroup comparisons (i.e., examining nonpatient, patient nonsexual, and patient sexual offenses). The violator group as a whole differed from the general PHP population, in that more were men between 40 and 49 years of age. More of the violators were mandated for evaluation and reported an abusive history. The rate of psychiatrists exceeded that typically seen by the PHP. Other differences were found according to the type of violation committed. Post hoc analysis revealed that physician-patients with a history of prior boundary violations were more likely to commit violations of a sexual nature. No further incidents were reported for 88 percent of the cohort. PMID:22396343

  17. Smart power and foreign policy of the People's Republic of China: the case of Central America

    Directory of Open Access Journals (Sweden)

    Manuel Villegas Mendoza

    2016-02-01

    Full Text Available This paper presents the most relevant aspects of the academic debate on smart power, in order to apply this concept to analyze the foreign policy of the Republic of China on Latin America and the Caribbean, but especially to Central America; where the dispute between China and Taiwan for international recognition is evident. It is argued that the smart power of China to Central America is expressed in the attractiveness of having privileged access to the Chinese market and its funding programs and official development assistance. While this country has a large presence in Latin America and the Caribbean, in Central America such influence is counteracted in the light of the close relationship that all Central American countries except Costa Rica, maintain with Taiwan. Based on the development of China as a world power, it is expected that this condition changed, so that this country would increase its influence in Central America.

  18. Anger Management and Factors that Influence Anger in Physicians

    OpenAIRE

    Emel Koçer; Abdulkadir Koçer; Fatih Canan

    2011-01-01

    Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Düzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expression Invento...

  19. Anger Management and Factors that Influence Anger in Physicians

    OpenAIRE

    Koçer, Emel; Koçer, Abdulkadir; Canan, Fatih

    2011-01-01

    Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Düzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expressi...

  20. Determinants of increasing trends of self-medication: physicians, perspectives

    OpenAIRE

    Khan, Hafeezullah; Maheen, Safirah; Bashir, Sajid; Abbas, Ghulam; Sher, Muhammad; Ashraf, Zaman; Mahmood, Asif; Sarfraz, Mohammad K.

    2012-01-01

    The objective of study was to take and evaluate opinions of the physicians about various aspects of self-medication. A self-fabricated questionnaire of 38 questions was distributed among 292 physicians. Prominent involvement of females in self-medication was suggested by 176 (60 %) physicians. The self-medication trend is more common in financially lower class as reported by 146 (50 %) physicians and in uneducated community as suggested by 165 (57 %) physicians. Family habits and easy to reme...

  1. Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

    Science.gov (United States)

    Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

    2016-01-01

    State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health. PMID:26813489

  2. Still on physicians' attitude to medical marijuana

    Directory of Open Access Journals (Sweden)

    Olukayode Abayomi

    2014-12-01

    Full Text Available Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescription appears to mirror the position of psychiatrists in developing countries. For instance, in a recent survey of psychiatrists in Nigeria, up to 55% of psychiatrists were against the medical use of marijuana. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1098-1098

  3. Physician unionization: a threat to integration?

    Science.gov (United States)

    1999-08-01

    Physicians, primarily those salaried by hospitals and health systems, are increasingly turning to labor unions to help them in their frustration over what they see as eroding clinical autonomy as well as diminishing compensation. Significantly, non-salaried physicians are also looking to the concept of collective bargaining as a tool in their negotiations with health insurers. The pro-labor doctors may get some of what they're looking for in the coming months and years, with a combination of economic and political forces driving the nascent trend forward regionally and nationwide. But victory won't come without a struggle and some major legal and regulatory hassles. And what will physician unionization mean for integrated health systems and other large healthcare organizations? Plenty, say industry observers and those in the trenches. PMID:10557405

  4. Low Job Satisfaction Among Physicians in Egypt

    Directory of Open Access Journals (Sweden)

    Amira Gamal Abdel-Rahman

    2008-04-01

    Full Text Available AIM/BACKGROUND: Physician’s job satisfaction is a cornerstone for improving the quality of health care, and its continuity. To identify the extent of job satisfaction and explain its main components among physicians, together with finding out the main indicators for job satisfaction. METHODS: We randomly selected physicians from the Egyptian Ministry of Health and Population Hospitals. All participants were asked to fill a self administrated questionnaire which included data pertaining socio-demographic characteristics and job satisfaction regarding salaries/incentives, monitoring, administration system, management, career satisfaction, relationship with colleagues, social support, opportunities for promotion, and job responsibilities. Satisfied was defined as satisfaction of>60%. RESULTS: Two hundred and thirty eight physicians participated in this study; with mean age of 37.1+ 9.4 years, and 70.2% were males. Only 42.9% of the physicians’ reported job satisfaction. Relationship with colleagues was the most important component of satisfaction with mean of 81.3+19.6 while, salaries/incentives were the least one with mean of 16.2+ 14. The overall current satisfying domains were not significantly associated with marital status or educational level, however it was significantly associated with specialty. Neither age nor gender was significantly associated with the degree of job satisfaction. CONCLUSION: Our results call for paying more attention to improve physicians’ job satisfaction in Egypt, to meet needed higher standards in health care. [TAF Prev Med Bull 2008; 7(2.000: 91-96

  5. The Artistic Activities of Family Physicians

    Directory of Open Access Journals (Sweden)

    Adem Özkara1,2

    2015-03-01

    Full Text Available Objective: Medicine and art have been intertwined throughout history. Physicians who are interested in art are known more successful and satisfied than others. The aim of this study is to detect the interest of family doctors about art; to find out branch of art interested in and to determine the importance of the art in medical practice. Methods: This cross-sectional study was accessing with conducted family physicians via e-mail in January-February 2012. A questionnaire, which determines the interest of Family Physicians of art, was administered to physicians. 272 (18%. Participants replied to our descriptive questionnaire study. Results: There were 133 (48.9% male and 139 (51.1% female. 156 (57.4% participants were interested in arts. The most common three interests of participants are: 26.5% (n=72 photography, 14.7% (n=40 literacy, 14.0% (n=38 painting. Artistic activities, which the participants wanted to do, 26.4% (n=72, play a musical instrument, 16.2% (n=44, painting, 7% (n=19, and theater. There’s a statistically significant relation between thinking “medicine is an art” and being interested in arts. Conclusion: Our study confirms the most interested art forms are photography and writing and the most wanted art form to do are playing musical instruments and painting. In our study, communication with patients was emphasized as an art in family medicine at descriptions of majority of the physicians. Therefore, family physicians are needed to support the arts orientation.

  6. Making America Great Again?

    OpenAIRE

    Leth, Aksel N.; Lykke, Lærke G.; Dyrbye, Zachary R.; Jordahn, Sally E.; Egholm, Marcus

    2016-01-01

    This study aims at uncovering the discourses in Donald Trump’s announcement speech and their relation to his campaign slogan Make America Great Again. Through a thorough analysis of his speech, we have identified thematic categories and used critical discourse studies (CDS), to denaturalise the discourses he produces and reproduces in a socio-cultural and socio-political context. Our method of Critical Discourse Analysis is based on Fairclough, complemented by Wodak, Richardson and van Dijk, ...

  7. Build America Bonds

    OpenAIRE

    Andrew Ang; Vineer Bhansali; Yuhang Xing

    2010-01-01

    Build America Bonds (BABs) are a new form of municipal financing introduced in 2009. Investors in BAB municipal bonds receive interest payments that are taxable, but issuers receive a subsidy from the U.S. Treasury. The BAB program has succeeded in lowering the cost of funding for state and local governments with BAB issuers obtaining finance 54 basis points lower, on average, compared to issuing regular municipal bonds. For institutional investors, BAB issue yields are 116 basis points highe...

  8. Assisted Ventilation.

    Science.gov (United States)

    Dries, David J

    2016-01-01

    Controlled Mechanical Ventilation may be essential in the setting of severe respiratory failure but consequences to the patient including increased use of sedation and neuromuscular blockade may contribute to delirium, atelectasis, and diaphragm dysfunction. Assisted ventilation allows spontaneous breathing activity to restore physiological displacement of the diaphragm and recruit better perfused lung regions. Pressure Support Ventilation is the most frequently used mode of assisted mechanical ventilation. However, this mode continues to provide a monotonous pattern of support for respiration which is normally a dynamic process. Noisy Pressure Support Ventilation where tidal volume is varied randomly by the ventilator may improve ventilation and perfusion matching but the degree of support is still determined by the ventilator. Two more recent modes of ventilation, Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist (NAVA), allow patient determination of the pattern and depth of ventilation. Proposed advantages of Proportional Assist Ventilation and NAVA include decrease in patient ventilator asynchrony and improved adaptation of ventilator support to changing patient demand. Work of breathing can be normalized with these modes as well. To date, however, a clear pattern of clinical benefit has not been demonstrated. Existing challenges for both of the newer assist modes include monitoring patients with dynamic hyperinflation (auto-positive end expiratory pressure), obstructive lung disease, and air leaks in the ventilator system. NAVA is dependent on consistent transduction of diaphragm activity by an electrode system placed in the esophagus. Longevity of effective support with this technique is unclear. PMID:25501776

  9. Screening for hepatocellular carcinoma by Egyptian physicians

    Institute of Scientific and Technical Information of China (English)

    Sahar; M; Hassany; Ehab; F; Abdou; Moustafa; Mohamed; El; Taher; Afaf; Adel; Abdeltwab; Hubert; E; Blum

    2015-01-01

    AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians

  10. Healthcare economics for the emergency physician.

    Science.gov (United States)

    Propp, Douglas A; Krubert, Christopher; Sasson, Andres

    2003-01-01

    Although the principles of healthcare economics are not usually part of the fundamental education of emergency physicians, an understanding of these elements will enhance our ability to contribute to improved health-care value. This article introduces the practical aspects of microeconomics, insurance, the supply-and-demand relationship, competition, and costs as they affect the practice of medicine on a daily basis. Being cognizant of how these elements create a dynamic interplay in the health-care industry will allow physicians to better understand the expanded role they need to assume in the ongoing cost and quality debate. PMID:12563583

  11. Physicians practicing other occupations, especially literature.

    Science.gov (United States)

    Green, J P

    1993-03-01

    Literature has been the favored nonmedical pursuit of physicians probably because the practice of medicine is suffused with narratives, the patient's history being one. Arthur Conan Doyle regarded medicine as a "grim romance," Somerset Maugham as an opportunity to see "life in the raw," and William Carlos Williams treated "the patient as a work of art." These sentiments may be linked to humanistic medicine. At some medical schools, literature is taught in the context of and integrated with medicine in an attempt to enhance ethics and empathy which were explicitly expressed by some physician-writers. PMID:8469245

  12. Regional and individual differences in physician practices for joint-ventured versus non-joint-ventured physicians.

    OpenAIRE

    Ahern, M; Scott, E.

    1994-01-01

    OBJECTIVE. This article compares characteristics of physicians who have invested in health care business (joint ventures) to characteristics of physicians who have not, based on a survey of Florida physicians. DATA SOURCES/STUDY SETTING. In early 1990, a survey was mailed to a stratified random sample of 1,000 Florida physicians. Half were randomly selected from lists of joint-ventured physicians who had been identified as owners in a previous study by the Florida Health Care Cost Containment...

  13. [Ethics and occupational physicians: ethics and mission required for occupational physicians].

    Science.gov (United States)

    Fujino, Akihiro

    2013-10-01

    The ethics of occupational physicians are considered from the following three viewpoints: (1) their legal standing and ethics in job execution; (2) ethics in research in occupational medicine; and (3) ethics in the 21st century and fundamental issues. We discuss: in (1), the contract types of occupational physicians and their independency and neutrality, the protection of health information and privacy, and the use of authority and the security measures; in (2), ethical standards of medical research in Japanese and international organizations, the significance and role of ethics committees, and issues characteristic of occupational health research; and in (3), occupational physicians and politic ethics, the practical abilities and ethics necessary for occupational physicians, and the practice and philosophy of occupational medicine as an art. These considerations suggest that occupational physicians, who have a special status based on the governmental policy of the occupational physician system, should develop an ethical consciousness at the core of their duties and perform their mission with responsibility to employees and employers, all of whom are Japanese citizens. Finally, we propose that the ultimate mission of occupational physicians is "to practice occupational medicine as a branch of the humanities." PMID:24107330

  14. Should assisted dying be legalised?

    Science.gov (United States)

    2014-01-01

    When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework. PMID:24423249

  15. A survey of attitudes toward clinical research among physicians at Kyoto University Hospital

    Directory of Open Access Journals (Sweden)

    Yokode Masayuki

    2009-12-01

    Full Text Available Abstract Background In Japan, only clinical research related to investigational new drug trials must be notified to regulatory bodies, and this lack of a uniform standard for clinical research has caused a number of difficulties. The objective of this study was to assess the willingness of physicians to participate in clinical research and to identify effective methods to promote and enhance clinical research. Methods We conducted a cross-sectional survey by administrating questionnaires to physicians in 31 departments in Kyoto University Hospital from October through November 2007. Results A total of 51.5% (310 of 602 of physicians completed the questionnaire. More than two-thirds of them reported currently participating in clinical research, and nearly all believed that clinical research is necessary for physicians. Less than 20% of respondents had specific training regarding clinical research, and most reported a need to acquire concepts and skills regarding clinical research, especially those related to statistics. "Paperwork was complicated and onerous" was the most frequently cited obstacle in conducting clinical research, followed by "few eligible patients" and "lack of time". Previous participation in and prospective participation in clinical research, previous writing a research protocol were positively associated with current participation in clinical research. Conclusions Physicians in university hospitals need more training regarding clinical research, particularly in biostatistics. They also require administrative assistance. Our findings indicate that the quality of clinical research could be improved if training in clinical research methodology and biostatistics were provided, and if greater assistance in the preparation of study documents requested by the institutional Independent Ethics Committee were available.

  16. Empathetic Orientation in Dentistry students from Latin America. Literature review.

    Directory of Open Access Journals (Sweden)

    Constanza Vera

    2014-06-01

    Full Text Available ABSTRACT Empathy, defined as ‘the capacity to relate to someone else’s perspective or mental state’, has a strong impact on the physician-patient relationship and has the potential to improve the quality of health care. The Jefferson Scale of Empathy (JSE measures empathy in terms of quantity. It was created to assist medical students, physicians, and people related to health care in general and it has been validated into Spanish showing adequate psychometric properties. The concern for empathy in dentistry students is related to the need for training not only technically, but also socially skilled professionals, since social abilities have a strong impact on performance as well as in the patient’s appreciation and satisfaction. The goal of this report is to show all the studies using the JSE scale for measuring empathy in dentistry students from Latin America.The reviewed studies show the empathy levels vary in Latin-American dentistry students when comparing gender and class year variables. Also, there is a tendency to find higher empathy levels when it comes to women’s performance and that of those soon to be graduate. However, the criteria did not account for more than 20% of the variance of empathy in these studies. Therefore, it would be necessary to keep researching in this field, taking different predictor variables into consideration in order to understand what factors are associated with the presence and intensity of empathy, and their impact in clinical practice. RESUMEN La empatía, definida como la "Identificación mental y afectiva de un sujeto con el estado de ánimo de otro" tiene un fuerte impacto en la relación médico-paciente y tiene el potencial de mejorar la calidad de la atención en salud. La Jefferson Scale of Empathy (JSE, es una escala que mide cuantitativamente la empatía. Fue creada para estudiantes de medicina, médicos y estudiantes y trabajadores de otras carreras de la salud y fue validada al idioma

  17. Instrumental and affective aspects of physician behavior.

    NARCIS (Netherlands)

    Bensing, J.M.; Dronkers, J.

    1992-01-01

    In a semi-replication study, 103 videotaped real-life general practice consultations of patients with hypertension were observed with Roter's interaction Analysis System (RIAS). RIAS consists of a detailed category system meant to measure each verbal utterance of physician and patient (distinguished

  18. Physician-patient communication: a lost art?

    Science.gov (United States)

    Frymoyer, John W; Frymoyer, Nan P

    2002-01-01

    In the face of rapid advances in technology, there has been a progressive deterioration of effective physician-patient communication. The American Academy of Orthopaedic Surgeons has identified that patients rate the orthopaedic profession as high in technical and low in communication skills. Poor communication, especially patient-interviewing skills, has been identified in medical students as well as in practicing physicians. Effective communication is associated with improved patient and physician satisfaction, better patient compliance, improved health outcomes, better-informed medical decisions, and reduced malpractice suits, and it likely contributes to reduced costs of care. Recognition of the importance of communication has influenced medical schools to revise curricula and to teach communication skills in residency training and continuing medical education programs. National certifying examinations also are being designed to incorporate these skills. Although written material is useful in increasing awareness of the importance of good physician-patient communication, behavioral change is more likely to occur in a workshop environment. The American Academy of Orthopaedic Surgeons is taking leadership in designing and implementing such an approach for its membership. PMID:11929204

  19. Physician Fee Schedule National Payment Amount File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The significant size of the Physician Fee Schedule Payment Amount File-National requires that database programs (e.g., Access, dBase, FoxPro, etc.) be used to read...

  20. Industrial hygiene protection for the podiatric physician

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, B.S.

    1987-07-01

    The podiatrist should remain alert to the potential for exposure to hazardous agents such as those discussed in this article. Exposures in the office or hospital may be evaluated by the methods of industrial hygiene. If control is needed, simple measures can frequently effect substantial reduction in exposure and afford protection to the physician, staff, and patient.

  1. Interference with the patient-physician relationship

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….

  2. Physician Self-Audit: A Scoping Review

    Science.gov (United States)

    Gagliardi, Anna R.; Brouwers, Melissa C.; Finelli, Antonio; Campbell, Craig E.; Marlow, Bernard A.; Silver, Ivan L.

    2011-01-01

    Introduction: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The…

  3. Navigating Government Service as a Physician

    Science.gov (United States)

    Koh, Howard K.

    2016-01-01

    Working in government can be a remarkable life experience for anyone but particularly for those who have trained in the worlds of medicine and public health. This article describes some lessons learned from a physician initially based in academic medicine and public health who has since spent more than a decade serving in leadership positions at…

  4. Parasitic Skin Infections for Primary Care Physicians.

    Science.gov (United States)

    Dadabhoy, Irfan; Butts, Jessica F

    2015-12-01

    The 2 epidermal parasitic skin infections most commonly encountered by primary care physicians in developed countries are scabies and pediculosis. Pediculosis can be further subdivided into pediculosis capitis, corporis, and pubis. This article presents a summary of information and a review of the literature on clinical findings, diagnosis, and treatment of these commonly encountered parasitic skin infestations. PMID:26612378

  5. The Impaired Physician: Some Coping Mechanisms

    OpenAIRE

    Nicholson, J. F.

    1980-01-01

    Doctoring is a stressful way of life. Both normal and neurotic needs can increase the complexity of the family physician's life. Certain vulnerable doctors seek easement in tranquilizers, sedatives or alcohol, and can become addicted. Impairment may be episodic or steady, leading to deterioration in personality and ability

  6. The National Day for the Libyan Physician

    Directory of Open Access Journals (Sweden)

    Elmahdi A. Elkhammas

    2007-03-01

    Full Text Available The health sector is a vital component of the growth and maintenance of every economy. When you examine any country’s annual budget, you immediately recognize that a large proportion goes to the healthcare sector. You may also see it is a part of expenditure and not of productivity. In other words, healthcare is a liability item when it comes to the budget. Libya is no exception.The goal of the health planners is to allocate the healthcare budget in ways that will ultimately result in a healthier society. In Libya, unfortunately, it is not clear how much of the budget goes to the health profession and health care delivery, and how much of it is spent on administrative issues. When you focus on the health sector you discover that it is really a significant mover of the productivity line. It is very simple. Healthy citizens are more likely to go to school and be educated. They are also more likely to have steady employment and be productive members of the society. That is not the subject of these comments. No one can deny that the Libyan physicians are on the frontline when it comes to criticism of the health services in Libya. I agree that they should be on the frontline. After all, medical schools in Libya started many years before the creation of other colleges for allied health professionals. They have a major share of responsibility in keeping our citizens healthy. It is also their responsibility to treat those who become sick. This requires a health system with a solid, transparent, ethical, and well organized structure. This is not the subject of my comments either. The purpose of my comments today is to draw attention to the Libyan physicians and recognize them once a year. I feel that they are busy with their work and the basic ingredients of life in a developing country. I also believe that they are relatively forgotten by society. What I would like to propose is the creation of a national observation for the Libyan physician. I think

  7. Depression-Burnout Overlap in Physicians

    Science.gov (United States)

    Wurm, Walter; Vogel, Katrin; Holl, Anna; Ebner, Christoph; Bayer, Dietmar; Mörkl, Sabrina; Szilagyi, Istvan-Szilard; Hotter, Erich; Kapfhammer, Hans-Peter; Hofmann, Peter

    2016-01-01

    Background Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians. Methods In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis. Results Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21–4.06) for physicians with mild, 10.14 (95% CI 7.58–13.59) for physicians with moderate, 46.84 (95% CI 35.25–62.24) for physicians with severe burnout and 92.78 (95% CI 62.96–136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three “core” components (adj.R2 = 0.85) of burnout combined. Cronbach’s alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three

  8. Depression-Burnout Overlap in Physicians.

    Directory of Open Access Journals (Sweden)

    Walter Wurm

    Full Text Available Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI, the Hamburg Burnout Inventory (HBI, as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8% participated. The data of 5897 participants were suitable for analysis.Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06 for physicians with mild, 10.14 (95% CI 7.58-13.59 for physicians with moderate, 46.84 (95% CI 35.25-62.24 for physicians with severe burnout and 92.78 (95% CI 62.96-136.74 for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components. The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92 explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85 of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.This study demonstrates the

  9. Attitudes toward Euthanasia and Related Issues among Physicians and Patients in a Multi-cultural Society of Malaysia

    Science.gov (United States)

    Rathor, Mohammad Yousuf; Abdul Rani, Mohammad Fauzi; Shahar, Mohammad Arif; Jamalludin, A. Rehman; Che Abdullah, Shahrin Tarmizi Bin; Omar, Ahmad Marzuki Bin; Mohamad Shah, Azarisman Shah Bin

    2014-01-01

    Introduction: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. Materials and Methods: Questionnaire based survey among consenting patients and physicians. Results: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P legalization P legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine. PMID:25374860

  10. Attitudes toward Assisted Suicide: Does Family Context Matter?

    Science.gov (United States)

    Frey, Laura M; Hans, Jason D

    2016-01-01

    Little is known about how family-related contextual variables impact attitudes toward assisted suicide. A probability sample (N = 272) responded to a multiple-segment factorial vignette designed to examine the effects of 6 variables-patient sex, age, type of illness, relationship status, parenthood status, and family support-on attitudes toward physician- and family-assisted suicide. Respondents were more likely to support physician-assisted suicide if they heard about an older patient or a patient experiencing physical pain than a younger patient or one suffering from depression, respectively. For family-assisted suicide, respondent support was higher when the patient had physical pain than depression, and when the patient's spouse or friend was supportive of the wish to die than unsupportive. Attitudes about physician and family obligation to inform others were affected by type of illness, relationship status, family support, and respondent education and religiosity. The experience of pain, motivations for family involvement, confidentiality issues, and physicians' biases concerning assisted suicide are discussed. PMID:25751503

  11. Hearing Assistive Technology

    Science.gov (United States)

    ... for the Public / Hearing and Balance Hearing Assistive Technology Hearing Assistive Technology: FM Systems | Infrared Systems | Induction ... Assistive Technology Systems Solutions What are hearing assistive technology systems (HATS)? Hearing assistive technology systems (HATS) are ...

  12. Emigrated neuroscientists from Berlin to North America.

    Science.gov (United States)

    Holdorff, Bernd

    2016-01-01

    The highest number of German scholars and physicians, forced by the National Socialist regime to emigrate for "race" or political reasons, were from Berlin. Language and medical exams were requested differently in their new host country-the United States-leading to a concentration of immigrants in the New York and Boston areas. Very early Emergency Committees in Aid of German Scholars and Physicians were established. Undergraduate students (like F. A. Freyhan, H. Lehmann, and H.-L. Teuber) from Berlin seemed to integrate easily, in contrast to colleagues of more advanced age. Some of the former chiefs and senior assistants of Berlin's neurological departments could achieve a successful resettlement (C. E. Benda, E. Haase, C. F. List, and F. Quadfasel) and some a minor degree of success (F. H. Lewy and K. Goldstein). A group of neuropsychiatrists from Bonhoeffer's staff at the Berlin Charité Hospital could rely on the forceful intercession of their former chief. The impact of the émigré colleagues on North American neuroscience is traced in some cases. Apart from the influential field of psychoanalysis, a more diffuse infiltration of German and European neuropsychiatry may be assumed. The contribution to the postwar blossoming of neuropsychology by the émigré neuroscientists K. Goldstein, F. Quadfasel, and H.-L. Teuber is demonstrated in this article. PMID:26853762

  13. Rehabilitation Engineering and Assistive Technology Society of North America

    Science.gov (United States)

    ... CRT Catalog App News and Events Annual Conference Advertising Member News News Archives Events Calendar Support Us Founders Fund Founders Joey Wallace Educational Scholarship Fund Gifting Options Make a Donation Connect with Resna Facebook Twitter Linkedin Google + RSS Feed Contact Sitemap Privacy ...

  14. CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being

    Directory of Open Access Journals (Sweden)

    Kenneth VanDewark

    2010-06-01

    Full Text Available The textbook, CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being, recently published by The Royal College of Physicians and Surgeons of Canada sheds light on the depth and scope of the CanMEDS competencies and how they relate to the personal health and the well-being of the medical doctor. This text is the latest addition to a growing library of College publications which serve as professional development resources pertaining to the CanMEDS roles. This particular text has developed a conceptual framework of physician health and evaluates and proposes concise strategies to address personal health issues that any medical student, resident or attending may encounter throughout his career.

  15. Factors affecting physician loyalty and exit: a longitudinal analysis of physician-hospital relationships.

    Science.gov (United States)

    Burns, L R; Wholey, D R

    1992-04-01

    This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using models of employee commitment and consumer buying behavior. We test several hypotheses drawn from these literatures using data on physician admissions at hospitals over a two-year period. Results indicate that admitting patterns are explained primarily by convenience and inertia processes characteristic of consumer behavior. On the other hand, factors believed to influence organizational commitment (e.g., decision-making involvement, conflict, economic investments) have little effect on loyalty and exit. The findings question the utility of hospital strategies to improve the climate of physician-hospital relations, and suggest several qualifications for research on the commitment of professionals. PMID:1563950

  16. Let's Go to America!

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

      The United States and China have signed an agreement to facilitate Chinese group leisure travel to the United States. This agreement provides the necessary framework to permit group leisure travel from China to the United States. U.S. companies can now enter into business relationships with Chinese travel agencies to organize and market travel packages for group leisure travel to the United States. It also attracts more and more Chinese to go to America, as more and more convenience and comforts are coming up during the travel.……

  17. Let's Go to America!

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The United States and China have signed an agreement to facilitate Chinese group leisure travel to the United States. This agreement provides the necessary framework to permit group leisure travel from China to the United States. U.S. companies can now enter into business relationships with Chinese travel agencies to organize and market travel packages for group leisure travel to the United States. It also attracts more and more Chinese to go to America, as more and more convenience and comforts are coming up during the travel.

  18. Knight Capital Americas LLC

    DEFF Research Database (Denmark)

    Austin, Robert D.; Meister, Darren

    2015-01-01

    It took 19 years to build Knight Capital Americas LLC into the largest market maker on the New York Stock Exchange, but on August 1, 2012, it took only 45 minutes for the firm to be wiped out by an information technology (IT) problem: a change in the company's software caused it to lose more than...... officer, other managers and the board of directors have done differently? What lessons does this story hold for how firms should be managed and governed? And what does it say about our ability to manage risk in large modern corporations operating in increasingly fast-moving and complex global markets?...

  19. Mosques in North America

    Directory of Open Access Journals (Sweden)

    Omar Khalidi

    2008-12-01

    Full Text Available The following article derived from an exhibit catalogue put together by Public Affairs Germany in the U.S. Embassy in Berlin and the U.S. Consulates in Frankfurt and Düsseldorf and accompanied Dr. Omar Khalidi’s photo exhibit “Mosques in America.” There are over 2,000 mosques in the United States, mostly housed in buildings originally built for other purposes. American mosques built in the last few decades, however, in the period in which Islam has begun to feel at home in the United States, are almost universally architect-designed.

  20. Chinese Food in America

    OpenAIRE

    Jou, Diana T.

    2011-01-01

    How did Chinese food get to look like this? With more than 41,000 Chinese restaurants in America - 3 times the number of McDonald’s restaurants - Chinese food is one of the most accepted and misunderstood cuisines in the United States. From large cities to small towns, locals can always count on an order of orange chicken in a takeout box, with a few fortune cookies thrown in the bag. But what Americans view as Chinese food is far from a traditional Chinese meal, wh...

  1. Eating in America

    Institute of Scientific and Technical Information of China (English)

    康海燕

    2007-01-01

    Americans are too busy to cook at home.They often eat outside.Eating culture is one of the important parts in America.There are many kinds of restaurants.Some are open for breakfast. Others are open twenty-four hours a day. A number of restaurants call themselves"family restaurants".They serve no alcohol~* and have fairly restricted~* menus.They serve steaks,hamburgers and sandwiches.Besides these,there are some special restaurants.They serve only or mainly steaks,seafood,etc.

  2. Timekeeping in the Americas

    Science.gov (United States)

    López, J. M.; Lombardi, M. A.

    2015-10-01

    Time and its measurement belong to the most fundamental core of physics, and many scientific and technological advances are directly or indirectly related to time measurements. Timekeeping is essential to everyday life, and thus is the most measured physical quantity in modern societies. Time can also be measured with less uncertainty and more resolution than any other physical quantity. The measurement of time is of the utmost importance for many applications, including: global navigation satellite systems, communications networks, electric power generation, astronomy, electronic commerce, and national defense and security. This paper discusses how time is kept, coordinated, and disseminated in the Americas.

  3. SURVEY OF SHORT-TERM ORAL CORTICOSTEROID ADMINISTRATION BY ORTHOPAEDIC PHYSICIANS IN COLLEGE AND HIGH SCHOOL ATHLETES

    Directory of Open Access Journals (Sweden)

    Albert W. Pearsall IV

    2009-03-01

    Full Text Available The use of oral corticosteroid (OCS drugs is advocated because of their potent anti-inflammatory effects. They also possess many potential adverse effects. No study has assessed physician prescribing practices of OCS therapy in high school (HS or college (COL athletes. This paper reports the prescribing patterns of sports medicine physicians who used short-term OCS therapy and to describe associated complications in HS and COL athletes within a 24- month period. An internet link to a descriptive epidemiology survey was included in an e-mail to all members of the Arthroscopy Association of North America and the American Orthopaedic Society for Sports Medicine. Descriptive statistics and correlation analysis were used to examine responses. Total response rate was 32% (615/1,928. Sixty-six percent of the physicians indicated prescribing OCS to both groups of athletes, while 29% reported prescribing OCS to COL athletes and 5% to HS athletes for musculoskeletal injuries. Physicians who prescribed multiple OCS regimens to the same athlete within the same season (P = 0.01 and physicians who prescribed OCS to the skeletally immature athlete (P = 0.009 reported more complications than other physicians. Among the 412 physicians who did not prescribe OCS in the treatment of athletic induced musculoskeletal injury, 251 (61% cited a risk of developing medical complications as the primary reason for avoiding use. The reported number of medical complications was low with no cases of avascular necrosis reported for the 2-year recall period. Orthopaedic surgeons who treated athletic induced musculoskeletal injuries with a short-term course of oral corticosteroids reported that high school and college athletes benefited with few medical complications

  4. Hippocratic oath and conversion of ethico-regulatory aspects onto doctors as a physician, private individual and a clinical investigator

    Directory of Open Access Journals (Sweden)

    Mohammed Imran

    2013-01-01

    Full Text Available Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through "common rule" resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of "medical neutrality" by embarking some grade of "medical immunity" on the basis of the oath is necessary for ethical conduct of physicians.

  5. Global physician budgets as common-property resources: some implications for physicians and medical associations.

    OpenAIRE

    Hurley, J; Card, R

    1996-01-01

    Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resource...

  6. What do family physicians consider an error? A comparison of definitions and physician perception

    OpenAIRE

    Pallerla Harini; Elder Nancy C; Regan Saundra

    2006-01-01

    Abstract Background Physicians are being asked to report errors from primary care, but little is known about how they apply the term "error." This study qualitatively assesses the relationship between the variety of error definitions found in the medical literature and physicians' assessments of whether an error occurred in a series of clinical scenarios. Methods A systematic literature review and pilot survey results were analyzed qualitatively to search for insights into what may affect the...

  7. Popularity of internet physician rating sites and their apparent influence on patients’ choices of physicians

    OpenAIRE

    Burkle, Christopher M.; Keegan, Mark T.

    2015-01-01

    Background There has been a substantial increase in the number of on-line health care grading sites that offer patient feedback on physicians, staff and hospitals. Despite a growing interest among some consumers of medical services, most studies of Internet physician rating sites (IPRS) have restricted their analysis to sampling data from individual sites alone. Our objective was to explore the frequency with which patients visit and leave comments on IPRS, evaluate the nature of comments wri...

  8. Marketing pharmaceutical products to physicians. Sales reps influence physicians' impressions of the industry.

    Science.gov (United States)

    Creyer, E H; Hrsistodoulakis, I

    1998-01-01

    A survey conducted at a large, Midwest teaching hospital provides a better understanding of how marketing activities influence physicians' impressions of the pharmaceutical industry; in particular, the extent to which physicians believe that the pharmaceutical industry understands their needs and the extent to which it is concerned about improving the overall quality of health in the United States. Also, the authors explore the motivation of the pharmaceutical industry: Is it primarily concerned with patients or with its own self-interest? PMID:10180333

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

    Science.gov (United States)

    Kirschbaum, Kristin

    2012-01-01

    Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians. PMID:21899403

  10. Integrated Water Resources Management in Latin America and the Caribbean

    OpenAIRE

    Inter-American Development Bank (IDB)

    1998-01-01

    This technical study contains the strategy of the Inter-American Development Bank for its involvement in integrated water resources management in Latin America and the Caribbean. The strategy was developed through an iterative step by step procedure in consultation with country water resource officials, Bank staff, nongovernmental organizations, and international lending and technical assistance organizations. The first part of the study is an overview of water resource management in Latin Am...

  11. [International and Israeli physicians' health--information and action plan].

    Science.gov (United States)

    Reis, Shmuel; Sayag, Shlomit; Karkabi, Khalid; Alroi, Gideon

    2008-03-01

    Physician health is a matter of interest for patients' physicians and their teams, managers and policy-makers. It has an impact on public health, physician impairment, patient safety, resource allocation and malpractice litigation. International medical literature, unlike Israel publications, is extensively preoccupied with the domain. Based on 2 MD thesis dissertations, Ministry of Health data and a literature search, the present review addresses many issues. It deals with: physicians' physical and mental health internationally and in Israel, prevention and health promotion, burn-out, the professional lifespan and career, health services utilization, legal and administrative aspects, boundaries, physicians' characteristics and vulnerability, interpersonal relations, care provided by physicians, physicians as patients and finally the impaired physician. International recommendations as well as a proposal for a local action plan are presented. PMID:18488866

  12. Medicare FFS Physician Feedback Program Value-Based Payment

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician Feedback - Value-Based Modifier Program provides comparative performance information to physicians as one part of Medicares efforts to improve the...

  13. Nutrition Education Practices and Opinions of Alberta Family Physicians

    OpenAIRE

    Kelly, S. Ann; Joffres, Michel R

    1990-01-01

    A questionnaire was mailed to a random sample of 532 members of the Alberta Chapter of the College of Family Physicians in order to assess the role of physicians in providing nutrition education to their patients. Of the 255 respondents (53% response rate), over 97% agreed that “educating patients about nutrition is an important role for physicians.” Physicians most often gave nutrition information on obesity, constipation, heart disease and hypertension, alcohol, coffee, infant feeding, oste...

  14. Improving empathy of physicians through guided reflective writing

    OpenAIRE

    Anita D. Misra-Hebert; J. Harry Isaacson; Martin Kohn; Alan L. Hull; Mohammadreza Hojat; Papp, Klara K.; Leonard Calabrese

    2012-01-01

    Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians. Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1...

  15. Natural gas commercialization in South America and its role as a regional integration factor

    International Nuclear Information System (INIS)

    This paper reviews the development of the existing natural gas businesses in various parts of the world. Lessons that have been learnt are used as pointers to assist in further development of the gas potential in South America. The healthy prospects for gas in South America are reviewed together with the provisions that are essential for gas business development in the future. (author). 1 fig

  16. Natural gas commercialization in South America and its role as a regional integration factor

    Energy Technology Data Exchange (ETDEWEB)

    Stanton, Ed; Rotte, Jooste [Shell International Gas (Brazil)

    1994-12-31

    This paper reviews the development of the existing natural gas businesses in various parts of the world. Lessons that have been learnt are used as pointers to assist in further development of the gas potential in South America. The healthy prospects for gas in South America are reviewed together with the provisions that are essential for gas business development in the future. (author). 1 fig.

  17. Transplantation and the primary care physician.

    Science.gov (United States)

    McGill, Rita L; Ko, Tina Y

    2011-11-01

    Increasing appreciation of the survival benefits of kidney transplantation, compared with chronic dialysis, has resulted in more patients with kidney disease being referred and receiving organs. The evolving disparity between a rapidly increasing pool of candidates and a smaller pool of available donors has created new issues for the physicians who care for kidney patients and their potential living donors. This article outlines current efforts to address the growing number of patients who await transplantation, including relaxation of traditional donation criteria, maximization of living donation, and donation schemas that permit incompatible donor-recipient pairs to participate through paired donation and transplantation chains. New ethical issues faced by donors and recipients are discussed. Surgical advances that reduce the morbidity of donors are also described, as is the role of the primary physician in medical issues of both donors and recipients. PMID:22098662

  18. How to divest acquired physician practices.

    Science.gov (United States)

    O'Hare, P K

    1999-02-01

    When an integrated delivery system (IDS) determines it must divest itself of a previously acquired physician practice, it must manage the transaction with care. The IDS most likely will want to maintain a positive ongoing relationship with the physician practice, while avoiding concessions to the practice that could be construed as violations of state and Federal laws. Before proceeding, the IDS should evaluate the reasons for divesting the practice, assess legal issues involved in terminating contracts with the practice, decide how to deal with the practice's assets and office facilities, consider whether covenants not to compete should be enforced, ensure continued access to essential medical records, consider whether to incorporate a "non-disparagement" clause in the termination agreement, and determine what mutual general releases may be necessary. PMID:10345614

  19. Transitioning from physician to nurse practitioner

    Directory of Open Access Journals (Sweden)

    Flowers M

    2014-01-01

    Full Text Available Monica Flowers, Maria OlenickCollege of Nursing and Health Sciences, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USAAbstract: Foreign-educated physicians (FEPs, also known as "international medical graduates", represent a rich source of potential primary-care providers. Despite their high level of medical knowledge and skills as well as ethnic and cultural diversity suited to meet the demands of patients, FEPs face many barriers in their attempt to continue to practice medicine in the USA. The program of study at Florida International University's Nicole Wertheim College of Nursing and Health Sciences provides FEPs the opportunity to have an impact on health care and continue to practice medicine in the USA by becoming nurse practitioners.Keywords: foreign-educated physician, FEP, international medical graduate, IMG, nurse practitioner, NP

  20. Resident physicians in Mexico: tradition or humiliation

    Directory of Open Access Journals (Sweden)

    Donovan Casas Patiño

    2013-08-01

    Full Text Available Mexico has a great history and tradition in relation to the training of resident physicians, but what we find behind this process?, Power relations implied and not implied, unnoticed or ignored for convenience by the academic and health institutions, with the aggravation of forgetting its commitment to the training of men and women "professionals" and limited to meet another indicator of "human resources for health." The resident physician in academic and scientific training is immersed in this dehumanized maelstrom and ends up becoming a character for the domain of knowledge as power, forgetting that his act and its rationale lies in the principle of "primum non nocere" to that we would add: nor your person, nor your fellowman, much less whom you have the moral, ethical and civic responsibility to convey some of your knowledge and your experience, that is, part of your essence”.

  1. Evaluation of physicians' professional performance: An iterative development and validation study of multisource feedback instruments

    Directory of Open Access Journals (Sweden)

    Overeem Karlijn

    2012-03-01

    Full Text Available Abstract Background There is a global need to assess physicians' professional performance in actual clinical practice. Valid and reliable instruments are necessary to support these efforts. This study focuses on the reliability and validity, the influences of some sociodemographic biasing factors, associations between self and other evaluations, and the number of evaluations needed for reliable assessment of a physician based on the three instruments used for the multisource assessment of physicians' professional performance in the Netherlands. Methods This observational validation study of three instruments underlying multisource feedback (MSF was set in 26 non-academic hospitals in the Netherlands. In total, 146 hospital-based physicians took part in the study. Each physician's professional performance was assessed by peers (physician colleagues, co-workers (including nurses, secretary assistants and other healthcare professionals and patients. Physicians also completed a self-evaluation. Ratings of 864 peers, 894 co-workers and 1960 patients on MSF were available. We used principal components analysis and methods of classical test theory to evaluate the factor structure, reliability and validity of instruments. We used Pearson's correlation coefficient and linear mixed models to address other objectives. Results The peer, co-worker and patient instruments respectively had six factors, three factors and one factor with high internal consistencies (Cronbach's alpha 0.95 - 0.96. It appeared that only 2 percent of variance in the mean ratings could be attributed to biasing factors. Self-ratings were not correlated with peer, co-worker or patient ratings. However, ratings of peers, co-workers and patients were correlated. Five peer evaluations, five co-worker evaluations and 11 patient evaluations are required to achieve reliable results (reliability coefficient ≥ 0.70. Conclusions The study demonstrated that the three MSF instruments produced

  2. Interactions between non-physician clinicians and industry: a systematic review.

    Directory of Open Access Journals (Sweden)

    Quinn Grundy

    2013-11-01

    Full Text Available BACKGROUND: With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. METHODS AND FINDINGS: We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the

  3. What Does Professionalism Mean to the Physician?

    OpenAIRE

    Kanter, Michael H; Nguyen, Miki; Klau, Marc H; Spiegel, Nancy H; Ambrosini, Virginia L

    2013-01-01

    Professionalism, which is a core competency for physicians, can be described as a spectrum of behaviors and may have a significant impact on the problems in today’s changing health care climate. In this article, we discuss the meaning of professionalism and its role in the Southern California Permanente Medical Group (SCPMG) and consider how it may be applied to integrated care delivery systems such as Kaiser Permanente. To understand professionalism, one must consider Stern’s definition, whi...

  4. Changing Physician Practice of Physical Activity Counseling

    OpenAIRE

    Eckstrom, Elizabeth; Hickam, David H.; Lessler, Daniel S; Buchner, David M.

    1999-01-01

    We conducted a prospective controlled trial to determine whether an educational intervention could improve resident physician self-efficacy and counseling behaviors for physical activity and increase their patients’ reported activity levels. Forty-eight internal medicine residents who practiced at a Department of Veterans Affairs hospital received either two workshops on physical activity counseling or no intervention. All residents completed questionnaires before and 3 months after the works...

  5. Transitioning from physician to nurse practitioner

    OpenAIRE

    Flowers M; Olenick M

    2014-01-01

    Monica Flowers, Maria OlenickCollege of Nursing and Health Sciences, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USAAbstract: Foreign-educated physicians (FEPs), also known as "international medical graduates", represent a rich source of potential primary-care providers. Despite their high level of medical knowledge and skills as well as ethnic and cultural diversity suited to meet the demands of patients, FEPs face many barri...

  6. Justification: How to get referring physicians involved

    International Nuclear Information System (INIS)

    Barriers to involvement of clinicians in the process of justification include an already overloaded knowledge base, lack of time, inconsistent guidance and disproportionate patient expectations. Strategies to improve referring physicians' input include education, use of imaging referral guidelines, clinical audit and regulation. This article discusses and reviews evidence for approaches to encourage greater participation in justification by clinicians. Approaches are best summarised by 'Awareness, appropriateness and audit'. (authors)

  7. Homophobia: How Physicians Treat Homosexual Patients

    OpenAIRE

    Kuntz, Christiane

    1982-01-01

    Doctors tend to be uncomfortable with homosexual patients, who make up a large part of an average practice. Homosexuality lies along the continuum of sexual expression and should not be considered a perversion. To a greater or lesser extent, it is present in all people, and is acted upon in a variety of ways. Physicians should be aware of the homosexual patient's lifestyle in order to give the best medical care. The epidemiology of disease differs in the homosexual and heterosexual population.

  8. Physician self-awareness: the neglected insight.

    OpenAIRE

    Longhurst, M.

    1988-01-01

    Self-awareness is vital to a physician's development. Understanding the impact of our internal subjective world on our attitudes and values and on the fantasies we have of reality is important to us as doctors. Some of the means of acquiring this self-knowledge include accurately perceiving the reflection of one's self in patients, understanding one's learning style, studying and enjoying the humanities, expressing one's self creatively, maintaining a sense of humour and examining one's react...

  9. Anaglyph, South America

    Science.gov (United States)

    2003-01-01

    This anaglyph (stereoscopic view) of South America was generated with data from the Shuttle Radar Topography Mission (SRTM). It is best viewed at or near full resolution with anaglyph glasses. For this broad view the resolution of the data was first reduced to 30 arcseconds (about 928 meters north-south but variable east-west), matching the best previously existing global digital topographic data set called GTOPO30. The data were then resampled to a Mercator projection with approximately square pixels (about one kilometer, or 0.6 miles, on each side). Even at this decreased resolution the variety of landforms comprising the South American continent is readily apparent.Topographic relief in South America is dominated by the Andes Mountains, which extend all along the Pacific Coast. These mountains are created primarily by the convergence of the Nazca and South American tectonic plates. The Nazca Plate, which underlies the eastern Pacific Ocean, slides under western South America resulting in crustal thickening, uplift, and volcanism. Another zone of plate convergence occurs along the northwestern coast of South America where the Caribbean Plate also slides under the South American Plate and forms the northeastern extension of the Andes Mountains.East of the Andes, much of northern South America drains into the Amazon River, the world's largest river in terms of both watershed area and flow volume. Topographic relief is very low in much of the Amazon Basin but SRTM data provide an excellent detailed look at the basin's three-dimensional drainage pattern, including the geologic structural trough (syncline) that hosts the eastern river channel.North of the Amazon, the Guiana Highlands commonly stand in sharp contrast to the surrounding lowlands, indeed hosting the world's tallest waterfall, Angel Falls (979 meters or 3212 feet). Folded and fractured bedrock structures are distinctive in the topographic pattern.South of the Amazon, the Brazilian Highlands show a mix of

  10. Anger Management and Factors that Influence Anger in Physicians

    Directory of Open Access Journals (Sweden)

    Emel Koçer

    2011-03-01

    Full Text Available Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Düzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expression Inventory, and the Beck Anxiety and Depression Inventories were administered to all participants. The physicians (n=158 were evaluated and compared with controls (n=105 in terms of anger control and sociodemographic variables. Results: Anger-control scores were higher in physicians (p<0.01 and in those who willingly chose the medical profession (p<0.05. Age, number of years as a physician, and the specialty were negatively correlated with anger management in physicians working in the surgical disciplines (p<0.01. Only Beck anxiety and depression scores were positively correlated with anger-trait scores and anger-in scores for physicians working in the internal medicine disciplines (p<0.01.Conclusion: Physicians were relatively successful in coping with anger. A willingness to choose the medical profession was a factor influencing anger control. Age was the major factor affecting anger management in physicians.

  11. The hospital's lifeline: recruiting well-qualified physicians.

    Science.gov (United States)

    Dismuke, B J

    1989-01-01

    A hospital's success in today's competitive and unstable environment depends directly on its ability to recruit well-qualified physicians. Just consider that a physician controls from 70 to 80 percent of healthcare dollars through admissions and referrals. Even the most creative advertising campaign to attract patients cannot increase admissions if there are no physicians to deliver care. PMID:10304008

  12. Suicide Compared to Other Causes of Mortality in Physicians

    Science.gov (United States)

    Torre, Dario M.; Wang, Nae-Yuh; Meoni, Lucy A.; Young, J. Hunter; Klag, Michael J.; Ford, Daniel E.

    2005-01-01

    Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results…

  13. 42 CFR 417.479 - Requirements for physician incentive plans.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for physician incentive plans. 417.479... incentive plans. (a) The contract must specify that an HMO or CMP may operate a physician incentive plan... are met. (b) Applicability. The requirements in this section apply to physician incentive...

  14. In their own words: describing Canadian physician leadership.

    Science.gov (United States)

    Snell, Anita J; Dickson, Graham; Wirtzfeld, Debrah; Van Aerde, John

    2016-07-01

    Purpose This is the first study to compile statistical data to describe the functions and responsibilities of physicians in formal and informal leadership roles in the Canadian health system. This mixed-methods research study offers baseline data relative to this purpose, and also describes physician leaders' views on fundamental aspects of their leadership responsibility. Design/methodology/approach A survey with both quantitative and qualitative fields yielded 689 valid responses from physician leaders. Data from the survey were utilized in the development of a semi-structured interview guide; 15 physician leaders were interviewed. Findings A profile of Canadian physician leadership has been compiled, including demographics; an outline of roles, responsibilities, time commitments and related compensation; and personal factors that support, engage and deter physicians when considering taking on leadership roles. The role of health-care organizations in encouraging and supporting physician leadership is explicated. Practical implications The baseline data on Canadian physician leaders create the opportunity to determine potential steps for improving the state of physician leadership in Canada; and health-care organizations are provided with a wealth of information on how to encourage and support physician leaders. Using the data as a benchmark, comparisons can also be made with physician leadership as practiced in other nations. Originality/value There are no other research studies available that provide the depth and breadth of detail on Canadian physician leadership, and the embedded recommendations to health-care organizations are informed by this in-depth knowledge. PMID:27397749

  15. Impacts of Changes in the Physician Manpower Sex Ratio

    Science.gov (United States)

    Stern, Maxine Springer

    1976-01-01

    The findings of a study comparing the types of medical careers of female and male physicians in North Carolina in 1973 are reported. The main question addressed is whether female physicians have different medical careers, in terms of primary specialities and the settings of practice, from male physicians. (LBH)

  16. Are Physicians and Patients in Agreement? Exploring Dyadic Concordance

    Science.gov (United States)

    Coran, Justin J.; Koropeckyj-Cox, Tanya; Arnold, Christa L.

    2013-01-01

    Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance--the extent of agreement in physician and patient responses regarding patient…

  17. Physician-Based Tobacco Smoking Cessation Counseling in Belgrade, Serbia

    Science.gov (United States)

    Merrill, Ray; Harmon, Tanner; Gagon, Heather

    2009-01-01

    This study examined physician attitudes and practices pertaining to patient counseling about smoking in Belgrade, Serbia. Data were collected using a cross-sectional survey of 86 physicians at multiple health care facilities. Approximately 74% of physicians agreed that they should routinely ask patients about their smoking habits and 79% agreed…

  18. 42 CFR 415.60 - Allocation of physician compensation costs.

    Science.gov (United States)

    2010-10-01

    ... Physician Services § 415.60 Allocation of physician compensation costs. (a) Definition. For purposes of this... or the carrier. (2) Report the information on which the physician compensation allocation is based to the intermediary or the carrier on an annual basis and promptly notify the intermediary or carrier...

  19. Education in America. Opposing Viewpoints.

    Science.gov (United States)

    Cozic, Charles P., Ed.

    This book, part of a series about differing viewpoints on education in America, examines how education can be improved for this and future generations of America's youth. The following papers and their authors are included: "Public Education Needs Extensive Reform" (John Taylor Gatto); "Public Education Does Not Need Extensive Reform" (Gerald…

  20. Locking in on Latin America

    Institute of Scientific and Technical Information of China (English)

    MICHAEL; RICE

    2006-01-01

    China cautious as it sets up generous investment in Latin America The United States is keeping a watchful eye as China bolsters political and economic ties with Latin America. The situation has U.S. political analysts trying to determine just how China s emerging influence

  1. Physician information seeking: improving relevance through research.

    Science.gov (United States)

    Gruppen, L D

    1990-04-01

    Health sciences libraries have considerable potential as resources for both formal continuing professional education, as well as the informal continuing education that results from the professional's efforts to solve problems in daily practice. While there is a growing interest in making the resources of health sciences libraries more accessible to practitioners on a routine, day-to-day basis, there also needs to be more awareness of how, when, where, and why professionals look for information in the context of practical problems. This paper reviews recent research that identifies the context in which physicians seek information and advice from external sources, the information sources that physicians access, and the factors that influence which particular sources are sought. The results indicate that physicians vary in their information needs, preferences, motivations, and strategies for seeking information. This diversity suggests that health sciences libraries, in their efforts to be more accessible, should consider "market research" to determine the needs, preferences, and use patterns of the library's targeted users. Libraries may also benefit from exploring alternative methods of improving access to their resources. PMID:2183904

  2. [Physicians' households in the 16th century].

    Science.gov (United States)

    Walter, Tilmann

    2008-01-01

    16th-century's medicine was marked by a wave of professionalization: besides scientific influences--evident by new ambitious texts on botany, anatomy, and chemiatry--functions of medical expertise for political purposes were an important factor. Based on findings made in my DFG-funded project "Arztliche Autorität in der Frühen Neuzeit" (medical authority in early modem times) is discussed how these influences altered the professional conditions for physicians. "Haushalt" (household) can be understood as a social community as well as a monetary budget in this context: physicians earned their money with a lot of different ventures beside medical practice, as commerce, farming, banking, or mining etc. Expenses for houses, gardens, interior etc. were based on needs of everyday life but could also be signs of luxury. Thus the physicians demonstrated the high social status they had acquired, and some of them thereby placed themselves at one social level with the nobility. Even scientific books can be estimated as a special case of such a conspicuous consumption for in most cases publishing made high investments without monetary benefit necessary. Thus scientific reputation was to some degree foreseeable: epoch-making books like above all Andreas Vesalius' "De humani Corporis fabrica libri septem" (Basel 1543) had to be financed out of the assets of the family (in Vesalius' case: a high-standing family in the emperor's services). Other sources show clearly that many doctors were not able to afford publishing comparable elaborated and expensive books. PMID:19830955

  3. South America Geologic Map (geo6ag)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — South America is part of Region 6 (Central and South America) for the World Energy Assessment. The geologic map of South America was digitized so that we could use...

  4. Physicians and euthanasia: a Canadian print-media discourse analysis of physician perspectives

    Science.gov (United States)

    Wright, David Kenneth; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen

    2015-01-01

    Background Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. Methods We conducted a discourse analysis of print media on physicians’ perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician’s perspective. Results We identified 3 predominant discourses about physicians’ public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Interpretation Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies. PMID:26389090

  5. Foreign assistance

    International Nuclear Information System (INIS)

    This paper reports that providing energy assistance to developing countries remains a relatively low priority of the Agency for International Development. AID is helping some developing countries meet their energy needs, but this assistance varies substantially because of the agency's decentralized structure. Most AID energy funding has gone to a handful of countries-primarily Egypt and Pakistan. With limited funding in most other countries, AID concentrates on providing technical expertise and promoting energy policy reforms that will encourage both energy efficiency and leverage investment by the private sector and other donors. Although a 1989 congressional directive to pursue a global warming initiative has had a marginal impact on the agency's energy programming, many AID energy programs, including those directed at energy conservation, help address global warming concerns

  6. Development of a handoff continuity score to improve pediatric ICU physician schedule design for enhanced physician and patient continuity

    OpenAIRE

    Smalley, Hannah K; Keskinocak, Pinar; Vats, Atul

    2011-01-01

    Introduction Few studies investigate the benefits of familiarity or continuity during physician-to-physician handoff of inpatients. Factors such as how recently physicians (MDs) have worked and successive days caring for patients increase continuity, and thus could lead to enhanced handoff efficiency. Evaluating the efficacy of MD scheduling to enhance continuity is currently subjective. Methods An MD group consisting of 9 attending physicians and 7 fellows redesigned its pediatric intensive ...

  7. America plans nuclear reprisal

    International Nuclear Information System (INIS)

    The demand for uranium to be used in the world's nuclear power stations is barely increasing, but the supply is rocketing up. Much of it is coming from the countries of the former Soviet Union and some of it is so cheap that republics such as Russia, the Ukraine and Kazakhstan are being accused of dumping it. The strain is being felt in the uranium-producing countries of southern Africa, Australia and North America. Companies involved in various stages of the nuclear fuel cycle claim that unfairly priced imports form the former Soviet Union are damaging them and they have been busily lobbying authorities in the US and Europe for weeks. US uranium-producing firms, backed by the country's Oil, Chemical and Atomic Worker's Union, have asked the Department of Commerce to impose anti-dumping duties on deliveries of uranium and enriched uranium from the former Soviet republics to the US. (Author)

  8. Fermilab and Latin America

    International Nuclear Information System (INIS)

    As Director of Fermilab, starting in 1979, I began a series of meetings with scientists in Latin America. The motivation was to stir collaboration in the field of high energy particle physics, the central focus of Fermilab. In the next 13 years, these Pan American Symposia stirred much discussion of the use of modern physics, created several groups to do collaborative research at Fermilab, and often centralized facilities and, today, still provides the possibility for much more productive North-South collaboration in research and education. In 1992, I handed these activities over to the AAAS, as President. This would, I hoped, broaden areas of collaboration. Such collaboration is unfortunately very sensitive to political events. In a rational world, it would be the rewards, cultural and economic, of collaboration that would modulate political relations. We are not there yet

  9. [Female responsibilities: midwives, nurses and mothers in the works of some antique and Renaissance physicians].

    Science.gov (United States)

    Bacalexi, Dina

    2005-01-01

    In his De morborum causis Galen presents the very moment of childbirth, in order to emphasise that the midwife's act of reception is instrumental in preventing malformations of the infant's "humid" limbs; nurses are also responsible for future malformations. The role of the midwife as the physician's assistant with female patients is stressed by Hippocrates and Soranos. The French Renaissance physicians Simon de Vallambert, Jacques and Charles Guillemeau refer to Galen in order to criticise the incompetence of midwives and nurses, as opposed to biological mothers, who have to breast-feed their babies because nurses lack moral integrity. Galen's commentator François Valleriole explains that nurses swaddle girls differently from boys because they aim at artificial (immoral) beauty. Leonhart Fuchs underlines that improper swaddling causes girls to lose their femininity. Thus, medical commentary changes into moralising remarks in order to maintain the moral and social status quo concerning women. PMID:16201319

  10. Fostering renewable electricity markets in North America

    International Nuclear Information System (INIS)

    This paper provided an overview of key market demand and supply drivers for the renewable electricity in Canada, the United States and Mexico. The aim of the paper was to assist North American governments in supporting the development of renewable electricity by addressing barriers that currently contribute to higher costs as well as challenges related to policy implementation. The paper outlined regulatory mandates and discussed issues related to voluntary purchases, and financial incentives. Current policy frameworks for renewable electricity were also examined. Opportunities for developing the renewable electricity market North America were explored. Wind power environmental standards were reviewed. Various green pricing schemes were discussed. The paper also included recommendations for the current electricity market as well as for members of the North American Agreement on Environmental Cooperation. 84 refs., 4 tabs., 7 figs

  11. REBUILD AMERICA PROGRAM SCOPE OF WORK

    Energy Technology Data Exchange (ETDEWEB)

    Jeffrey Brown; Bruce Exstrum

    2004-12-01

    This report summarizes the activities carried out by Aspen Systems Corporation in support of the Department of Energy's Rebuild America program during the period from October 9, 1999 to October 31, 2004. These activities were in accordance with the Scope of Work contained in a GSA MOBIS schedule task order issued by the National Energy Technology Laboratory. This report includes descriptions of activities and results in the following areas: deployment/delivery model; program and project results; program representative support activities; technical assistance; web site development and operation; business/strategic partners; and training/workshop activities. The report includes conclusions and recommendations. Five source documents are also provided as appendices.

  12. Case study of physician leaders in quality and patient safety, and the development of a physician leadership network.

    Science.gov (United States)

    Hayes, Chris; Yousefi, Vandad; Wallington, Tamara; Ginzburg, Amir

    2010-01-01

    There is increasing recognition of the need for physician leadership in quality and patient safety, and emerging evidence that physician leadership contributes to improved care. Hospitals are beginning to establish physician leader positions; however, there is little guidance on how to define these roles and the strategies physician leaders can use toward improving care. This case study examines the roles of four physician leaders, describes their contribution to the design and implementation of hospital quality and patient safety agendas and discusses the creation of a physician network to support these activities. The positions were established between July 2006 and April 2009. All are corporate roles with varying reporting and accountability structures. The physician leads are involved in strategic planning, identifying and leading quality and safety initiatives, physician engagement and culture change. All have significantly contributed to the implementation of hospital improvement activities and are seen as influential among their peers as resources and mentors for local project success. Despite their accomplishments, these physician leads have been challenged by ambiguous role descriptions and difficulty identifying effective improvement strategies. As such, an expanding physician network was created with the goal of sharing approaches and tools and creating new strategies. Physician leaders are an important factor in the improvement of safety and quality within hospitals. This case study provides a template for the creation of such positions and highlights the importance of networking as an effective strategy for improving local care and advancing professional development of physician leaders in quality and patient safety. PMID:20959733

  13. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Final Report.

    Science.gov (United States)

    Musgrave, Gerald L.

    The potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services is addressed in detail in this final research report. Econometric modeling and analyses of economic activity within the health sector were undertaken. An eight equation model of the hospital and physician sectors…

  14. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Executive Summary.

    Science.gov (United States)

    Musgrave, Gerald L.

    A study that forecast the consequences of the projected growth in the number of practicing U.S. physicians during the 1980s and beyond is summarized. Attention was directed to the potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services. Econometric modeling and analysis of…

  15. 20 CFR 10.316 - After selecting a treating physician, may an employee choose to be treated by another physician...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false After selecting a treating physician, may an employee choose to be treated by another physician instead? 10.316 Section 10.316 Employees' Benefits... Benefits Medical Treatment and Related Issues § 10.316 After selecting a treating physician, may...

  16. 20 CFR 30.405 - After selecting a treating physician, may an employee choose to be treated by another physician...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false After selecting a treating physician, may an employee choose to be treated by another physician instead? 30.405 Section 30.405 Employees' Benefits... § 30.405 After selecting a treating physician, may an employee choose to be treated by...

  17. Building America Industrialized Housing Partnership (BAIHP)

    Energy Technology Data Exchange (ETDEWEB)

    McIlvaine, Janet; Chandra, Subrato; Barkaszi, Stephen; Beal, David; Chasar, David; Colon, Carlos; Fonorow, Ken; Gordon, Andrew; Hoak, David; Hutchinson, Stephanie; Lubliner, Mike; Martin, Eric; McCluney, Ross; McGinley, Mark; McSorley, Mike; Moyer, Neil; Mullens, Mike; Parker, Danny; Sherwin, John; Vieira, Rob; Wichers, Susan

    2006-06-30

    This final report summarizes the work conducted by the Building America Industrialized Housing Partnership (www.baihp.org) for the period 9/1/99-6/30/06. BAIHP is led by the Florida Solar Energy Center of the University of Central Florida and focuses on factory built housing. In partnership with over 50 factory and site builders, work was performed in two main areas--research and technical assistance. In the research area--through site visits in over 75 problem homes, we discovered the prime causes of moisture problems in some manufactured homes and our industry partners adopted our solutions to nearly eliminate this vexing problem. Through testing conducted in over two dozen housing factories of six factory builders we documented the value of leak free duct design and construction which was embraced by our industry partners and implemented in all the thousands of homes they built. Through laboratory test facilities and measurements in real homes we documented the merits of 'cool roof' technologies and developed an innovative night sky radiative cooling concept currently being tested. We patented an energy efficient condenser fan design, documented energy efficient home retrofit strategies after hurricane damage, developed improved specifications for federal procurement for future temporary housing, compared the Building America benchmark to HERS Index and IECC 2006, developed a toolkit for improving the accuracy and speed of benchmark calculations, monitored the field performance of over a dozen prototype homes and initiated research on the effectiveness of occupancy feedback in reducing household energy use. In the technical assistance area we provided systems engineering analysis, conducted training, testing and commissioning that have resulted in over 128,000 factory built and over 5,000 site built homes which are saving their owners over $17,000,000 annually in energy bills. These include homes built by Palm Harbor Homes, Fleetwood, Southern Energy

  18. Physician response to fee changes with multiple payers.

    Science.gov (United States)

    McGuire, T G; Pauly, M V

    1991-01-01

    This paper develops a general model of physician behavior with demand inducement encompassing the two benchmark cases of profit maximization and target-income behavior. It is shown that when income effects are absent, physicians maximize profits, and when income effects are very strong, physicians seek a target income. The model is used to derive own and cross-price expressions for the response of physicians to fee changes in the realistic context of more than one payer under the alternative behavior assumptions of profit maximization and target income behavior. The implications for public and private fee policy, and empirical research on physician response to fees, are discussed. PMID:10117011

  19. Assessment of Requests for Assisted Suicide by a Swiss Right-to-Die Society

    Science.gov (United States)

    Bosshard, Georg; Ulrich, Esther; Ziegler, Stephen J.; Bar, Walter

    2008-01-01

    Non-physician volunteers of Exit, the largest right-to-die organization in Switzerland, play an important role in assisted suicide. They conduct assessments and deliver lethal medications for a member to self-administer. This study analyses the content of 114 intake sheets (checklists) of Exit members whose requests for assisted suicide were…

  20. PDA Use by Physicians: Where Do They Fit with Emerging Technologies and Use of Electronic Health Records in Office Practices?

    Directory of Open Access Journals (Sweden)

    Kimberly A. Galt

    2012-01-01

    Full Text Available This cross-sectional study explores physicians' attitudes and beliefs about the use of personal digital assistant (PDA in the context of other health information technology (HIT use and HIT-based applications safety in ambulatory care practices. The relationship of PDA use and patient safety is also explored. Ambulatory care physicians in Nebraska and South Dakota were surveyed from July to November of 2007 using a modified Dillman technique. Respondents were in one of three groups: PDA Users (those using a PDA for patient care, Other Technology Users (those not using a PDA, but using other technologies for patient care, and Non-Users (those not using any technology for patient care. PDAs are used by 43% of responding physicians, who tend to be younger and salaried. PDA Users exposed to PDAs during training continued use in practice. PDA Users believed the device enabled them to provide more efficient and better care, reduce errors, and improve patient safety.

  1. Assessing the Strengths & Weaknesses of Family Physician Program

    Directory of Open Access Journals (Sweden)

    ALI JANATI

    2010-01-01

    Full Text Available Introduction: This study was carried out to evaluate the family physicians program (strengths and weaknesses in Maragheh. Methods: In this descriptive cross-sectional study, the study population included 375 under care people, family physicians, health system managers and staffs from Rural Health Centers in Maragheh. Data collection instruments were questionnaire and checklist which have already been confirmed for reliability& validity. SPSS software was used for date analysis. Results: About %97 of participants had awareness about family physician implementation; 97/6% used family physician services and 96/8 had health insurance. The major strengths of family physician program were: developing the health files for all people, improving prenatal and child care, increasing easy access to physician and medicine, and decreasing health expenditure for people. However, the major weaknesses were: increasing health houses customers, lack of job security and delay in salary payment for family physician team members, and limited availability of physician in health houses. Conclusion: The study results imply some suggestions that can solve family physician weaknesses, improve quality of delivered care, and increase customer’s satisfaction: 1. developing electronic health files for family physician clients. 2. Motivating and briefing specialists on the manners of dealing with referred patients and giving appropriate feedback. 3. Revising and redefining the target population. 4. Solving financial problems of family physician team members.

  2. Determinants of physicians' prescribing behaviour of methylphenidate for cognitive enhancement.

    Science.gov (United States)

    Ponnet, Koen; Wouters, Edwin; Van Hal, Guido; Heirman, Wannes; Walrave, Michel

    2014-01-01

    The non-medical use of methylphenidate for cognitive enhancement becomes a more and more common practice among college and university students. Although physicians are a source of access, little is known about the underlying mechanisms that might lead to physicians' intention and behaviour of prescribing methylphenidate to improve students' academic performance. Applying Ajzen's theory of planned behaviour (TPB), we tested whether attitudes, subjective norms (controllability and self-efficacy) and perceived behavioural control predicted the intention and the prescribing behaviour of physicians. Participants were 130 physicians (62.3% males). Structural equation modelling was used to test the ability of TPB to predict physicians' behaviour. Overall, the present study provides support for the TPB in predicting physicians' prescribing behaviour of methylphenidate for cognitive enhancement. Subjective norms, followed by attitudes, are the strongest predictors of physicians' intention to prescribe methylphenidate. To a lesser extent, controllability predicts the intention of physicians, and self-efficacy predicts the self-reported behaviour. Compared to their male colleagues, female physicians seem to have more negative attitudes towards prescribing methylphenidate for cognitive enhancement, feel less social pressure and perceive more control over their behaviour. Intervention programmes that want to decrease physicians' intention to prescribe methylphenidate for improving academic performance should primarily focus on alleviating the perceived social pressure to prescribe methylphenidate and on converting physician neutral or positive attitudes towards prescribing methylphenidate into negative attitudes. PMID:23713799

  3. Liabilities of a physician confronted with child abuse.

    Science.gov (United States)

    Vansweevelt, Thierry

    2013-06-01

    Several research questions raises when physicians are confronted with a possible case of child abuse. First, there is a problem of professional secrecy. In most European countries, physicians have the right to speak when confronted with a state of emergency. In other countries, physicians have a duty to speak and alert the police when the life or physical integrity of a person is at stake. A second topic to be discussed involves the possible liability of physicians who do not report child abuse. By not reporting a case of possible child abuse, the physician is respecting the family life of the parents, even though the child might continue to suffer damages. Third and essentially, I analyse the possible liability of physicians who do inform the prosecutor ofa suspected child abuse. Specific criteria are elaborated to establish negligence when physicians report child abuse to the prosecutor. PMID:23984493

  4. Toward accommodating physicians' conscientious objections: an argument for public disclosure.

    Science.gov (United States)

    Harter, Thomas D

    2015-03-01

    This paper aims to demonstrate how public disclosure can be used to balance physicians' conscientious objections with their professional obligations to patients--specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians' conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians' conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians' conscientious objections are briefly addressed--potential harassment of physicians, workplace discrimination, and mischaracterising physicians' professional aptitude--concluding that each of these concerns requires further deliberation in the realm of business ethics. PMID:24567421

  5. Refocusing the hospital/physician relationship. It's time for physicians to share the risk.

    Science.gov (United States)

    Rosenfield, R H

    1988-01-01

    Market forces are destroying the traditional hospital/physician relationship and replacing it with something far better suited to a price-sensitive environment marked by severe excess capacity. Many hospitals are exploring ways to alter a hospital/physician relationship that has survived--more of less unchanged--for nearly 70 years. Managing change of this magnitude is a difficult task and many hospital/physician communities have been seriously divided by resulting conflicts. On the other hand, a price competitive environment frequently rewards innovation and leadership and penalizes conservatism. Charting a course in these troubled waters is a challenge for healthcare executives, but if we are successful in managing this change, our facilities, our communities and our patients will benefit. PMID:10303128

  6. 76 FR 54802 - Sony Music Holdings, Inc., D/B/A Sony DADC Americas a Subsidiary of Sony Corporation of America...

    Science.gov (United States)

    2011-09-02

    ... Employment and Training Administration Sony Music Holdings, Inc., D/B/A Sony DADC Americas a Subsidiary of... Reconsideration for the workers and former workers of Sony Music Holdings, Inc. (``SMHI''), d/b/a Sony DADC... Assistance. The Department's Notice was published in the Federal Register on July 8, 2011 (76 FR...

  7. Use of spirometry among chest physicians and primary care physicians in India.

    Science.gov (United States)

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep

    2016-01-01

    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice. PMID:27385406

  8. Nuclear options in Latin America

    International Nuclear Information System (INIS)

    An account is given of the Treaty of Tlatelolco, 1967, providing for the designation of Latin America as a Nuclear Weapon-Free Zone (NWFZ); additional protocols attached to the Treaty are available for signature by States outside the region. The Treaty is administered by the Organisation for the Prohibition of Nuclear Weapons in Latin America (OPANAL). Reference is made to its latest meeting, held in May 1983. The present paper also discusses the following: Non-Proliferation Treaty (with references to safeguards agreements concluded between each State and the IAEA); nuclear suppliers' group; peaceful nuclear explosions; nuclear energy programmes in Latin America. (U.K.)

  9. What Do Patients Expect from Their Physicians?

    Directory of Open Access Journals (Sweden)

    T Dormohammadi

    2010-03-01

    Full Text Available "nBackground:  To identify the most important expectations that patients have from their physicians."nMethods: We collected data from 199 hospitalized and 201 ambulatory patients (response rates 88% and 93% respectively. We used random sampling for selection of hospitalized patients and systematic sampling for the ambulatory ones. The questionnaire consisted of 18 different expectation items categorized in 5 domains. The participants scored each item from 1 to 9 using a VAS scale and ranked domains based on their importance. We analyzed the data using univariate and regression analyses."nResults: Among the ambulatory patients, the mean±standard error of the most important expectations was as follows: com­petency (8.9±0.01, courteousness (8.8±0.04, consultation in case of need (8.8±0.4, clear explanation of the disease (8.8± 0.05 and attentiveness (8.8±0.04. In hospitalized patients, the following items were the most important: competency (8.4± 0.08, courteousness (8.4±0.09, availability of physician (8.4±0.09, consultation in case of need (8.2±0.11, setting follow­ing appointments (8.2±0.1, and disease follow-up (8.2±0.09. In both groups, the most important domain of expecta­tions was "competency and quality of care" followed by "availability" in hospitalized and "giving information and patient auton­omy" among ambulatory patients."nConclusions: Our findings are similar to what reported in the literature from other countries and cultures. In addition to physician expertise and knowledge, patients value giving information and efficient doctor-patient relationship.  

  10. Helioclimatology of the Americas

    Science.gov (United States)

    Nurtaev, B. S.; Yakubov, M.; Shermatov, E.

    2013-05-01

    During the last 4 billion years, the Earth's climate has changed many times. There have been periods of warming and there have been ice ages. These large-scale climatic changes are shaped by factors like the tilt of the Earth's axis and tectonic plate movement. These major changes were driven by cyclical changes in the Earth's orbit, which altered the distribution of solar energy between the seasons and across the Earth. Milankovitch cycles explain well changes in climate over periods hundreds of thousands of years and are related to ice age cycles, but these cycles cannot explain the current rapid warming. The Sun is the most driving force for causing climate change. Much of the Sun energy evaporates water and causes atmospheric convection. Solar radiation, general circulation of atmosphere, geographical location of continents, oceans and the largest forms of a relief are the primary factors influencing on climate of lands. The purpose of this study is to identify contribution of the Sun on climate variability in the two continents, North and South America during instrumental records of air temperature. There were compared air temperatures of different weather stations in dependence from solar activity during the period 1878-1996. The high correlation between averaged temperature and solar activity was found for many weather stations of Americas. Air temperature in dependence from solar activity over the period 1878-1996 can be described by following equations: In Buenos Aires: T° = 0,04W+ 15,05, r-0,9; Caracas, Venezuela: T° = 0,03W + 18,88, r-0,73; Cordoba, Argentina: T° = 0,03W + 16,16, r-0,93; New York, Central Park: T° = 0,04W + 9,86, r-0,82; Toronto, T = 0,03W+ 6,66, r-0,81; Santiago Pudahuel, T= 0,019W + 13, 01, r - 0, 91; Rio de Janeiro:T°= 0,02W + 21,95, r= 0,88; Mexico over 1923-1986, T°= 0,021W+ 14,05, r-0,78; Miami over 1902-1996, T = 0,012W + 12,87 r-0,75; In our study, we used stations with reasonably long, consistently measured time records

  11. Physician Cross-Cultural Nonverbal Communication Skills, Patient Satisfaction and Health Outcomes in the Physician-Patient Relationship

    Directory of Open Access Journals (Sweden)

    Ken Russell Coelho

    2012-01-01

    Full Text Available Recent empirical findings document the role of nonverbal communication in cross-cultural interactions. As ethnic minority health disparities in the United States continue to persist, physician competence in this area is important. We examine physicians' abilities to decode nonverbal emotions across cultures, our hypothesis being that there is a relationship between physicians' skill in this area and their patients' satisfaction and outcomes. First part tested Caucasian and South Asian physicians' cross-cultural emotional recognition ability. Physicians completed a fully balanced forced multiple-choice test of decoding accuracy judging emotions based on facial expressions and vocal tones. In the second part, patients reported on satisfaction and health outcomes with their physicians using a survey. Scores from the patient survey were correlated with scores from the physician decoding accuracy test. Physicians, regardless of their ethnicity, were more accurate at rating Caucasian faces and vocal tones. South Asian physicians were no better at decoding the facial expressions or vocal tones of South Asian patients, who were also less likely to be satisfied with the quality of care provided by their physicians and to adhere to their physicians' recommendations. Implications include the development of cultural sensitivity training programs in medical schools, continuing medical education and public health programs.

  12. Shedding light on physician performance transparency.

    Science.gov (United States)

    Norris, David

    2016-02-01

    Healthcare providers can use performance data already being collected to: Manage risk more proactively by identifying high-risk, high-cost areas. Make call centers more effective and websites work better, thereby improving the patient experience. Embrace the trend toward consumerism by enabling patients with performance data. Modify behavior and make systemic improvements where weaknesses are identified. Improve the level of care by better matching patients and providers. Regain public trust and confidence by sharing real data as an alternative to subjective commentary on physician performance. PMID:26999978

  13. Essentials of finance for occupational physicians.

    Science.gov (United States)

    Miller, K; Fallon, L F

    2001-01-01

    Comprehending the principles of finance is paramount to understanding the way an organization chooses to generate and use its financial resources. Financial principles may be employed in the same way a physician reviews fundamental systems to gauge a person s health. Just as basic anatomical and physiological components are used to assess the health of an individual, basic financial elements exist to ascertain the health of an organization. This chapter explains risk assessment, accounts receivable management, inventory, depreciation, capital formation, ratio analysis, and more. PMID:11401789

  14. Autism Speaks Toolkits: Resources for Busy Physicians.

    Science.gov (United States)

    Bellando, Jayne; Fussell, Jill J; Lopez, Maya

    2016-02-01

    Given the increased prevalence of autism spectrum disorders (ASD), it is likely that busy primary care providers (PCP) are providing care to individuals with ASD in their practice. Autism Speaks provides a wealth of educational, medical, and treatment/intervention information resources for PCPs and families, including at least 32 toolkits. This article serves to familiarize PCPs and families on the different toolkits that are available on the Autism Speaks website. This article is intended to increase physicians' knowledge on the issues that families with children with ASD frequently encounter, to increase their ability to share evidence-based information to guide treatment and care for affected families in their practice. PMID:26149848

  15. [Poet-physicians in German literature].

    Science.gov (United States)

    Perels, C

    1991-12-17

    Starting with standards arising from the relationship between medicine and art in classical antiquity, biblical tradition and teutonic-pagan antiquity, this article roams through german literature from the Middle Ages up to the 20th century, from Hildegard of Bingen to Gottfried Benn and Alfred Döblin, guided by the question, how strongly medical knowledge and medical practise are reflected in the poetry of writing physicians. Individual dispositions and epoque-specific features are discussed. Special attention is given to Paul Fleming and Angelus Silesius, Albrecht von Haller and Friedrich Schiller, romanticism and Georg Büchner. PMID:1754781

  16. Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada

    OpenAIRE

    GOREY, KEVIN M.; Kanjeekal, Sindu M; Wright, Frances C; Hamm, Caroline; Luginaah, Isaac N.; Bartfay, Emma; Zou, Guangyong; Holowaty, Eric J.; Richter, Nancy L.

    2015-01-01

    Background Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California. Methods We analyzed registry data for people wi...

  17. An Unwilling Partnership With the Great Society Part II: Physicians Discover Malnutrition, Hunger and the Politics of Hunger.

    Science.gov (United States)

    deShazo, Richard D; Smith, Robert; Minor, Wilson F Bill; Skipworth, Leigh Baldwin

    2016-07-01

    The civil rights and social legislation of the Great Society following the Civil Rights Act of 1964 was slow to provide relief for black in the South. Mississippi Senator James Eastland led an effort to defund Head Start, including his state's program, Child Development Group of Mississippi (CDGM), a program with a strong medical component. A senatorial committee, including Robert Kennedy, came to investigate CDGM in 1967. The unimaginable poverty, hunger, malnutrition and chronic disease found in black families was vehemently denied by Eastland. Visits of physician groups then corroborated the findings. The Mississippi delegation made sure that food relief never came and funding for CDGM ceased. Health services were lost to 6000 impoverished children. The epic television documentary, Hunger in America, soon premiered on network television. It triggered ongoing efforts to address health disparities, including implementation of the National Nutrition and Health Survey (NHANES). Similar physician leadership is needed to address the lasting health disparities in our country. PMID:27432045

  18. Geoparks in Latin America

    International Nuclear Information System (INIS)

    A Geopark is a territory delimited part of a holistic concept of protection, education and sustainable development, based on geological sites of particular importance, rarity or aesthetic geological sites. A Geopark achieves its goals through three main areas: geoconservation, education and geotourism. The first network of Geoparks born in Europe in 2000, and from 2004 UNESCO is promoting the creation of a Global Geoparks Network (Global Geoparks Network, GGN ). Currently, there are 64 Global Geoparks in 19 countries, and the movement is in full development. In Latin America there is hardly Araripe Geopark in Brazil. Presented in this work, projects and studies related to the development of Geoparks in Argentina, Brazil, Chile, Costa Rica, Peru and Venezuela. We understand that Colombia, Cuba, Ecuador, Mexico and Nicaragua have projects in this line, but the details are not yet readily available. The authors invite geoscientists and professionals in related fields to join a movement for the creation of the Latin American Network of Geoparks, intended as a framework for the conservation, sustainable use and disclosure of our national geological heritage

  19. Wind Powering America

    International Nuclear Information System (INIS)

    At the June 1999 Windpower Conference, the Secretary of Energy launched the Office of Energy Efficiency and Renewable Energy's Wind Powering America (WPA) initiative. The goals of the initiative are to meet 5% of the nation's energy needs with wind energy by 2020 (i.e., 80,000 megawatts installed), to double the number of states that have more than 20 megawatts (MW) of wind capacity to 16 by 2005 and triple it to 24 by 2010, and to increase wind's contribution to Federal electricity use to 5% by 2010. To achieve the Federal government's goal, DOE would take the leadership position and work with its Federal partners. Subsequently, the Secretary accelerated the DOE 5% commitment to 2005. Achieving the 80,000 MW goal would result in approximately$60 billion investment and$1.5 billion of economic development in our rural areas (where the wind resources are the greatest). The purpose of this paper is to provide an update on DOE's strategy for achieving its goals and the activities it has undertaken since the initiative was announced

  20. Heart Failure Society of America

    Science.gov (United States)

    ... Site Terms and Conditions Copyright © 2016 Heart Failure Society of America. All Rights Reserved 2016 Board Review ... Membership Membership Information Membership in the Heart Failure Society is open to all health care professionals with ...