WorldWideScience

Sample records for cancer physicians 10-12

  1. Ultrasmall Au10-12(SG)10-12 Nanomolecules for High Tumor Specificity and Cancer Radiotherapy

    CERN Document Server

    Zhang, Xiao-Dong; Chen, Jie; Shen, Xiu; Song, Shasha; Sun, Yuanming; Fan, Saijun; Fan, Feiyue; Leong, David Tai; Xie, Jianping

    2014-01-01

    Radiosensitizers can increase the local treatment efficacy under a relatively low and safe radiation dose, thereby facilitating tumor eradication and minimizing side effects. Here, we report a new class of radiosensitizers that contain several gold (Au) atoms embedded inside a peptide shell (e.g., Au10-12(SG)10-12) and can achieve ultrahigh tumor uptake (10.86 SUV at 24 h post injection) and targeting specificity, efficient renal clearance, and high radiotherapy enhancement.

  2. Detecting cancer: Pearls for the primary care physician.

    Science.gov (United States)

    Zeichner, Simon B; Montero, Alberto J

    2016-07-01

    Five-year survival rates have improved over the past 40 years for nearly all types of cancer, partially thanks to early detection and prevention. Since patients typically present to their primary care physician with initial symptoms, it is vital for primary care physicians to accurately diagnose common cancers and to recognize unusual presentations of highly curable cancers such as Hodgkin lymphoma and testicular cancers, for which the 5-year overall survival rates are greater than 85%. This paper reviews these cancers and provides clinically relevant pearls from an oncologic perspective for physicians who are the first point of contact. PMID:27399864

  3. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    Science.gov (United States)

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  4. Colorectal cancer screening awareness among physicians in Greece

    Directory of Open Access Journals (Sweden)

    Chatzimichalis Georgios

    2006-06-01

    Full Text Available Abstract Background Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Since adjustment for stage at diagnosis markedly reduces the survival differences, a screening bias was hypothesized. Considering the important role of primary care in screening activities, the purpose of the study was to investigate the colorectal cancer screening awareness among Hellenic physicians. Methods 211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed. Results Only 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012. No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054. Conclusion Contemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality.

  5. Colorectal cancer screening awareness among physicians in Greece

    Science.gov (United States)

    Xilomenos, Apostolos; Mauri, Davide; Kamposioras, Konstantinos; Gkinosati, Athanasia; Zacharias, Georgios; Sidiropoulou, Varvara; Papadopoulos, Panagiotis; Chatzimichalis, Georgios; Golfinopoulos, Vassilis; Peponi, Christina

    2006-01-01

    Background Data comparison between SEER and EUROCARE database provided evidence that colorectal cancer survival in USA is higher than in European countries. Since adjustment for stage at diagnosis markedly reduces the survival differences, a screening bias was hypothesized. Considering the important role of primary care in screening activities, the purpose of the study was to investigate the colorectal cancer screening awareness among Hellenic physicians. Methods 211 primary care physicians were surveyed by mean of a self-reported prescription-habits questionnaire. Both physicians' colorectal cancer screening behaviors and colorectal cancer screening recommendations during usual check-up visits were analyzed. Results Only 50% of physicians were found to recommend screening for colorectal cancer during usual check-up visits, and only 25% prescribed cost-effective procedures. The percentage of physicians recommending stool occult blood test and sigmoidoscopy was 24% and 4% respectively. Only 48% and 23% of physicians recognized a cancer screening value for stool occult blood test and sigmoidoscopy. Colorectal screening recommendations were statistically lower among physicians aged 30 or less (p = 0.012). No differences were found when gender, level and type of specialization were analyzed, even though specialists in general practice showed a trend for better prescription (p = 0.054). Conclusion Contemporary recommendations for colorectal cancer screening are not followed by implementation in primary care setting. Education on presymptomatic control and screening practice monitoring are required if primary care is to make a major impact on colorectal cancer mortality. PMID:16756674

  6. Hereditary breast cancer. Psychosocial issues and family physicians' role.

    OpenAIRE

    Carroll, J. C.; Heisey, R. E.; Warner, E.; V Goel; McCready, D R

    1999-01-01

    OBJECTIVES: To outline the psychosocial issues in hereditary breast cancer (HBC) assessment and discuss the role of family physicians. QUALITY OF EVIDENCE: A literature search using MEDLINE, CINAHL, CancerLit, and HealthStar databases was conducted from January 1990 to April 1998, using the key words breast cancer or neoplasm and familial or hereditary, genetic testing or screening, primary care or family physician or counseling, genetic counseling, psychosocial or psychological. We found onl...

  7. Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

    OpenAIRE

    McFall, S L; Warnecke, R B; Kaluzny, A D; Ford, L

    1996-01-01

    OBJECTIVE. This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS. Data are combined from national...

  8. Facing death : physicians' difficulties and coping strategies in cancer care

    OpenAIRE

    Andræ, Margareta

    1994-01-01

    Even if the treatment of cancer has developed over the last decades 50% of the patients still die of their cancer. The doctor's way of dealing with his and his patient's anxiety must surely be of significance for the treatment the patient receives. In the first part of the thesis earlier studies of physicians' stress and ways of coping are reported. There is a lack of systematic studies which show how doctors working with cancer patients adjust to this work. The aim of this investigation is t...

  9. A Survey of Cancer Pain Management Knowledge and Attitudes of British Columbian Physicians

    OpenAIRE

    Gallagher, R; Hawley, P.; Yeomans, W

    2004-01-01

    INTRODUCTION: There are many potential barriers to adequate cancer pain management, including lack of physician education and prescription monitoring programs. The authors surveyed physicians about their specific knowledge of pain management and the effects of the regulation of opioids on their prescribing practices.METHODS: A questionnaire was mailed out to British Columbia physicians who were likely to encounter cancer patients. The survey asked for physicians' opinions about College of Phy...

  10. Participation of Asian-American Women in Cancer Chemoprevention Research: Physician Perspectives

    OpenAIRE

    Nguyen, Tung T.; Somkin, Carol P.; Ma, Yifei

    2005-01-01

    To the authors’ knowledge, little is known regarding the participation of Asian Americans in cancer prevention research. In 2002, the authors mailed surveys to primary care physicians in Northern California to assess their knowledge, attitudes, behaviors, and barriers concerning the participation of Asian-American women in breast cancer chemoprevention research. The response rate was 52.3% (n = 306 physicians). For physician barriers, most respondents selected lack of study knowledge (73%) an...

  11. Non-oncology physician visits after diagnosis of cancer in children

    OpenAIRE

    Heins, M.J.; Lorenzi, M.F.; Korevaar, J. C.; McBride, M. L.

    2016-01-01

    Background: Children diagnosed with cancer often require extensive care for medical, psychosocial and educational problems during and after therapy. Part of this care is provided by family physicians and non-cancer specialists, but their involvement in the first years after diagnosis has barely been studied. Studying non-oncology physician visits may provide insight into the roles of different health care providers. Methods: We included 757 children diagnosed with cancer under age 15 between ...

  12. Projected Image and Observed Behavior of Physicians in Terminal Cancer Care.

    Science.gov (United States)

    Family, Gilla

    1993-01-01

    Reports on abandoned study examining potential benefits of psychotherapy to terminal cancer patients. Preliminary feasibility study found physicians' attitudes toward their dying patients as reformed and progressive. Interest shown by physicians did not translate into tangible research effort in spite of active pursuit by investigator over period…

  13. 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

  14. Sleep Duration and Risk of Lung Cancer in the Physicians' Health Study

    OpenAIRE

    Khawaja, Owais; Petrone, Andrew B; ALEEM, Sohaib; Manzoor, Kamran; Gaziano, John M.; Djousse, Luc

    2014-01-01

    Background and Objectives: Lung cancer is the most common cancer and cancer related cause of death worldwide. However, the association between sleep duration and incident lung cancer has not been investigated in a prospective cohort study. 
Methods: We prospectively examined the association between sleep duration and incident lung cancer in a cohort of 21,026 United States (US) male physicians. Self-reported sleep duration was ascertained during 2002 annual follow-up questionnaire. Incident l...

  15. Association of physicians' knowledge and behavior with prostate cancer counseling and screening in Saudi Arabia

    International Nuclear Information System (INIS)

    To investigate the knowledge, attitudes and practices of primary care physicians towards prostate cancer counseling and screening. This cross sectional study was conducted in May 2009 to October 2009 through a survey questionnaire, which was distributed to all licensed primary care physicians in Riyadh, Saudi Arabia. The study took place in the Princes Al-Johara Al-Ibrahim Center for Cancer Research, King Saud University, Saudi Arabia. Data was obtained from 204 primary care physicians using self-reports of prostate cancer screening practices, knowledge, attitudes towards prostate cancer screening, and continuous medical education preferences. Respondents' characteristics were also collected. Approximately 54.7% of the respondents were practicing counseling and referring prostate cancer patients. The mean correct knowledge score was 54.3%, their attitude was not strong; the only statement that approximately 70% of physicians agreed upon was about the value of screening, however, the reliability and evidence to support digital rectal examination and prostatic specific antigen were in question. Our primary care physicians had self-confidence in suspecting and referring high-risk patients for screening, but not for management and treatment. Knowledge and attitude were found to be the most significant predictors that determine physicians' self practice. Physicians' practice towards a screening procedures or early detection of diseases should rely on a good background of information, which in turn enhances their self-efficacy and develops a good and positive attitude towards their practice skills (Author).

  16. Primary care physicians' use of family history for cancer risk assessment

    OpenAIRE

    Stockdale Alan; Ashikaga Takamaru; Wood Marie E; Flynn Brian S; Dana Greg S; Naud Shelly

    2010-01-01

    Abstract Background Family history (FH) assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate). Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this s...

  17. Knowledge about hereditary nonpolyposis colorectal cancer; mutation carriers and physicians at equal levels

    Directory of Open Access Journals (Sweden)

    Bendahl Pär-Ola

    2009-03-01

    Full Text Available Abstract Background Identification and adequate management of individuals at risk for hereditary nonpolyposis colorectal cancer (HNPCC is crucial since surveillance programmes reduce morbidity and mortality. We investigated knowledge about key features of HNPCC in at risk individuals and physicians in surgery, gynecology and oncology. Methods Data were collected using a questionnaire which was answered by 67 mutation carriers and 102 physicians from the southern Swedish health care region. The statements were related to colorectal cancer, heredity and surveillance and the physicians were also asked questions about cancer risks and surveillance strategies. Results Both groups answered questions on colorectal cancer risk, surveillance and genetic testing well, whereas answers about inheritance and risks for HNPCC associated cancer were less accurate. Only half of the family members and one third of the physicians correctly estimated the risk to inherit an HNPCC predisposing mutation. Among family members, young age ( Conclusion The finding of similar levels of knowledge about key features of HNPCC in at risk individuals and physicians reflect the challenge physicians face in keeping up to date on hereditary cancer and may have implications for the clinical management and professional relations with HNPCC family members.

  18. Knowledge about hereditary nonpolyposis colorectal cancer; mutation carriers and physicians at equal levels

    DEFF Research Database (Denmark)

    Domanska, Katarina; Carlsson, Christina; Bendahl, Pär-Ola;

    2009-01-01

    BACKGROUND: Identification and adequate management of individuals at risk for hereditary nonpolyposis colorectal cancer (HNPCC) is crucial since surveillance programmes reduce morbidity and mortality. We investigated knowledge about key features of HNPCC in at risk individuals and physicians in...... suggested a later starting age for surveillance than recommended. CONCLUSION: The finding of similar levels of knowledge about key features of HNPCC in at risk individuals and physicians reflect the challenge physicians face in keeping up to date on hereditary cancer and may have implications for the...... clinical management and professional relations with HNPCC family members....

  19. The Rates of Undergoing Cancer Screening Among Family Physicians Aged 40 and Older Working in Ankara Province

    OpenAIRE

    Ayşe Selda Tekiner; Gülseren Lale; A. Gülsen Ceyhun Peker2

    2016-01-01

    Aim: Family physicians, as role models for their patients, self health behaviors are important. We aimed to investigate the rate of undergoing cancer screening among family physicians. Methods: This is a descriptive and questionnaire-based study. Although we aimed to interview 1100 family physicians aged 40 or older working at family health centers of Ankara, the study was performed with 453 physicians. The questionnaire form comprised of the doctors’ opinions about cancer s...

  20. Cancer Risk Assessment for the Primary Care Physician

    OpenAIRE

    Korde, Larissa A; Gadalla, Shahinaz M.

    2009-01-01

    Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. Identification of individuals with a suspected heritable cancer syndrome can lead to additional evaluation and to interventions that can substantially decrease cancer risk. Special attention should also be paid to potentially modifiable cancer ris...

  1. Investigating Patient and Physician Delays in the Diagnosis of Head and Neck Cancers: a Canadian Perspective.

    Science.gov (United States)

    Lee, Jonghun John; Dhepnorrarat, Chris; Nyhof-Young, Joyce; Witterick, Ian

    2016-03-01

    Diagnostic delays for head and neck cancer (HNC) patients are common. Patients often disregard symptoms for long periods before seeking help, and some family physicians may not be alert to the warning symptoms and signs of HNCs. This study evaluated the factors associated with length of delays in the diagnosis of HNCs in a Canadian population. This was a mixed-method study consisting of patient interviews and surveys in an academic health center. A questionnaire requesting demographic and disease information was completed by HNC patients followed by a 30 min semi-structured interview in a private setting. Interviews were audio recorded, transcribed, anonymized, and descriptively coded for emergent themes. Twenty-eight head and neck cancer patients participated in the study. More patients experienced physician delay (71 %) than patient delay (36 %). The median physician delay and patient delay were 108 and 31 days, respectively. Two main themes regarding these delays were (1) physician lack of knowledge and (2) lack of patient awareness. Results indicate that physician delay needs to be focused on compared to patient delay, as it is more common and has longer delays. More comprehensive training in head and neck clinical examination skills during undergraduate and residency training is recommended to reduce physician delay. Patient delay could be targeted by public education programs via both physicians and dentists. PMID:25566764

  2. Urban family physicians and the care of cancer patients.

    OpenAIRE

    Dworkind, M.; Shvartzman, P; Adler, P. S.; Franco, E. D.

    1994-01-01

    Members in the Department of Family Medicine of a university teaching hospital were surveyed to find out their involvement in caring for cancer patients. Respondents indicated that many cancer patients were followed, but few cancer support services in the hospital and the community were used. The desire to take on new cancer patients was lacking, yet an interest in continuing medical education existed. Feedback from the department will help guide our Education Committee to develop continuing ...

  3. Night work, total occupational burden and cancer/cardiovascular risk factors in physicians

    Directory of Open Access Journals (Sweden)

    Nedić Olesja

    2012-01-01

    Full Text Available Introduction. Lifestyle-related risk factors: smoking, obesity, sedentariness and excess alcohol intake are among the most important known causes of cancer and cardiovascular disease. The aim of this study is to examine the relationship between these lifestyle-related risk factors for cancer/cardiovascular disease and working conditions among surgeons/anesthesiologists and other physicians. Material and Methods. The study was carried out among physicians aged 35 to 60, without diagnosed coronary heart disease or other structural heart disease, who were employed at the Novi Sad University Hospital. The participation rate was high (> 90%. The physicians completed the Occupational Stress Index. Low lifestyle-related cancer/cardiovascular risk was defined as: not a current smoker, body mass index < 28, regular recreational physical activity and not consuming alcohol every day. Analysis of covariance was performed. Results. Of 191 physicians included in this study only 23 (12.0% had a low lifestyle- related cancer/cardiovascular risk. Surgeons/anesthesiologists faced a heavier total work stressor burden than physicians in other profiles (87.7±8.8 versus 74.1±10.5, p=0.000. Among the 56 surgeons/anesthesiologists, lower nightshift work scores were associated with low lifestyle-related cancer/cardiovascular risk (F=4.19, p=0.046. A lower overall work stressor burden was associated with low risk among the other 135 physicians (F=4.06, p=0.046. Conclusion. Specific workplace intervention strategies are urgently needed. Among the surgeons/anesthesiologists these should include reduction in the frequency of night call and improvement of the overall conditions of nightshift work. Among other physicians, the total occupational burden needs to be diminished.

  4. Colorectal cancer screening of high-risk populations: A national survey of physicians

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    White Pascale M

    2012-01-01

    Full Text Available Abstract Background The incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009. Results The average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement." Conclusions There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.

  5. Physician-related barriers to cancer pain management with opioid analgesics

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Sjøgren, Per; Møldrup, Claus;

    2007-01-01

    OBJECTIVE: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics. METHODS: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full...... texts were not available in PUBMED were retrieved from the electronic databases of specific journals. RESULTS: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians' barriers to cancer pain management were studied in questionnaire surveys and in the reviews...... review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence...

  6. Physician response to financial incentives when choosing drugs to treat breast cancer.

    Science.gov (United States)

    Epstein, Andrew J; Johnson, Scott J

    2012-12-01

    This paper considers physician agency in choosing drugs to treat metastatic breast cancer, a clinical setting in which patients have few protections from physicians' rent seeking. Physicians have explicit financial incentives attached to each potential drug treatment, with profit margins ranging more than a hundred fold. SEER-Medicare claims and Medispan pricing data were formed into a panel of 4,503 patients who were diagnosed with metastatic breast cancer and treated with anti-cancer drugs from 1992 to 2002. We analyzed the effects of product attributes, including profit margin, randomized controlled trial citations, FDA label, generic status, and other covariates on therapy choice. Instruments and drug fixed effects were used to control for omitted variables and possible measurement error associated with margin. We find that increasing physician margin by 10% yields between an 11 and 177% increase in the likelihood of drug choice on average across drugs. Physicians were more likely to use drugs with which they had experience, had more citations, and were FDA-approved to treat breast cancer. Oncologists are susceptible to financial incentives when choosing drugs, though other factors play a large role in their choice of drug. PMID:23124970

  7. Cancer pain management by radiotherapists: a survey of radiation therapy oncology group physicians

    International Nuclear Information System (INIS)

    Purpose: Radiation Therapy Oncology Group (RTOG) physicians were surveyed to determine their approach to and attitudes toward cancer pain management. Methods and Materials: Physicians completed a questionnaire assessing their estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of pain management, and their report of how they manage pain in their own practice setting. Results: Eighty-three percent believed the majority of cancer patients with pain were undermedicated. Forty percent reported that pain relief in their own practice setting was poor or fair. Assessing a case scenario, 23% would wait until the patient's prognosis was 6 months or less before starting maximal analgesia. Adjuvants and prophylactic side effect management were underutilized in the treatment plan. Barriers to pain management included poor pain assessment (77%), patient reluctance to report pain (60%), patient reluctance to take analgesics (72%), and staff reluctance to prescribe opioids (41%). Conclusions: Physicians' perceptions of barriers to cancer pain management remain quite stable over time, and physicians continue to report inadequate pain treatment education. Future educational efforts should target radiation oncologists as an important resource for the treatment of cancer pain

  8. Cancer pain management: Basic information for the young pain physicians

    Directory of Open Access Journals (Sweden)

    SPS Rana

    2011-01-01

    Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

  9. Knowledge, Practices, and Perceived Barriers Regarding Cancer Pain Management Among Physicians and Nurses In Korea: A Nationwide Multicenter Survey

    OpenAIRE

    Hyun Jung Jho; Yeol Kim; Kyung Ae Kong; Dae Hyun Kim; Eun Jeong Nam; Jin Young Choi; Sujin Koh; Kwan Ok Hwang; Sun Kyung Baek; Eun Jung Park

    2014-01-01

    Purpose Medical professionals’ practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. Methods A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pai...

  10. Sleep Duration and Risk of Lung Cancer in the Physicians' Health Study

    Institute of Scientific and Technical Information of China (English)

    Owais KHAWAJA; Andrew BPETRONE; Sohaib ALEEM; Kamran MANZOOR; John MGAZIANO; Luc DJOUSSE

    2014-01-01

    Background and Objectives:Lung cancer is the most common cancer and cancer related cause of death worldwide. However, the association between sleep duration and incident lung cancer has not been investigated in a prospective cohort study. Methods:We prospectively examined the association between sleep duration and incident lung cancer in a cohort of 21,026 United States (US) male physicians. Self-reported sleep duration was ascertained during 2002 annual follow-up questionnaire. Incident lung cancer was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risk of incident lung cancer. Results:hTe average age at baseline was 68.3±8.8 yr. During a mean follow up of 7.5 (±2.2) yr, 150 cases of lung cancer occurred. Using 7 h of sleep as the reference group, multivariable adjusted hazard ratios (95%CI) for lung cancer were 1.18 (0.77-1.82), 1.0 (ref), and 0.97 (0.67-1.41) from lowest to the highest category of sleep duration (P for quadratic trend 0.697), respectively. In a secondary analysis, smoking status did not modify the sleep duration-lung cancer association (P=0.78). hTere was no evidence for an interaction between sleep duration and sleep apnea on the risk of lung cancer either (P=0.65). Conclusions:Our data failed to show a higher risk of lung cancer in association with altered sleep duration among US male physicians.

  11. Attitudes of Polish physicians and medical students toward breaking bad news, euthanasia and morphine administration in cancer patients.

    Science.gov (United States)

    Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria

    2013-12-01

    Medical students and physicians should possess basic knowledge concerning medical ethics and palliative care. The aim of the study was to explore the knowledge on the end-of-life ethics and palliative care in third-year medical students and physicians during internal medicine specialty training and their attitude towards breaking bad news and euthanasia. A voluntary and anonymous questionnaire survey with the participation of 401 students and 217 physicians filled after lectures concerning ethics for medical students and after palliative medicine course for physicians during internal medicine specialty training. A total of 28 % students and 24 % physicians (p = 0.282) were ready to reveal full information to advanced cancer patients. A total of 82 % of students and 90 % of physicians (p = 0.008) would not practice euthanasia; 67 % of students and 75 % of physicians (p = 0.039) were opponents of euthanasia legalisation. A total of 70 % doctors and 23 % students indicated oral as the most preferable route of morphine administration. A total of 74 % physicians and 43 % students stated that there is no maximal dose of morphine; 64 % of doctors and 6 % of students indicated constipation as a constant adverse effect of morphine. Breaking bad news is a significant difficulty for both students and physicians. There is a small percentage of those tending to practice euthanasia and bigger accepting its legalisation with fewer physicians than students. In contrast to medical students, the majority of physicians have knowledge concerning chronic morphine use in the treatment of cancer patients. PMID:24170311

  12. Determinants of physicians' preferences for alternative treatments in women with early breast cancer.

    Science.gov (United States)

    Liberati, A; Patterson, W B; Biener, L; McNeil, B J

    1987-12-31

    To learn about factors, that influence a physician's decision making, a mail survey was conducted asking physicians about their preferences for radical mastectomy vs. local excision plus irradiation, and for adjuvant chemotherapy vs. no adjuvant treatment for two hypothetical women with operable, clinical stage I breast cancer - one 35 years old and the other 60 years old. Two hundred and sixty-one physicians from varied specialties in Connecticut and Massachusetts returned the questionnaire. Approximately half of the respondents would accept either mastectomy or limited surgery plus radiation therapy for either patient. Adjuvant chemotherapy was recommended by 97% of respondents for the younger patient and by 66% for the older patient. Several factors appeared to be related to therapeutic preferences. An individual physician's attitude towards patient involvement in decision making was the most important predictor of surgical preference for both the patients, whereas the role of specialty (i.e., surgeons vs. other providers) was more important for the surgical management of the older patient. For the decision involving adjuvant chemotherapy, specialty, hospital size, and presence of radiotherapy equipment on site were important predictors. Factors other than survival (such as disease-free interval and cosmetic results) were viewed as important standards of effectiveness by some physicians. PMID:3433367

  13. Genetic Testing for Lung Cancer Risk: If Physicians Can Do It, Should They?

    OpenAIRE

    Marcy, Theodore W.; Stefanek, Michael; Thompson, Kimberly M.

    2002-01-01

    Advances in genetics have increased our ability to assess an individual's genetic risk for disease. There is a hypothesis that genetic test results will motivate high-risk individuals to reduce harmful exposures, to increase their surveillance for disease, or to seek preventive treatments. However, genetic testing for genes associated with an increased risk of lung cancer would not change physicians' recommendations regarding smoking cessation. Limited studies suggest that test results that d...

  14. Role of the Family Physician in the Care of Cancer Patients

    OpenAIRE

    McWhinney, Ian R.; Hoddinott, Susan N.; Bass, Martin J.; Gay, Keith; Shearer, Robin

    1990-01-01

    To assess the involvement of family physicians in the continuing care of cancer patients, 499 patients attending the London Regional Cancer Centre for follow-up appointments were questioned. Of the 493 patients with a family doctor, 282 (57.2%) reported that their family doctor had been involved in the diagnosis, 132 (26.8%) in the treatment, and 214 (43.4%) in the follow up. Only 60% thought that their family doctor was aware of their current problems, and only 31.4% had an appointment to se...

  15. Utilization of and Attitudes towards Traditional Chinese Medicine Therapies in a Chinese Cancer Hospital: A Survey of Patients and Physicians

    OpenAIRE

    McQuade, Jennifer L.; ZhiQiang Meng; Zhen Chen; Qi Wei; Ying Zhang; WenYing Bei; J. Lynn Palmer; Lorenzo Cohen

    2012-01-01

    Background. In China, the use of traditional Chinese medicine (TCM) is very popular, but little is known about how it is integrated with conventional cancer care. We conducted parallel surveys of patients and physicians on TCM utilization. Methods. Two hundred forty-five patients and 72 allopathic physicians at the Fudan University Shanghai Cancer Center completed questions on their use of and attitude towards TCM. Results. Patient mean age was 51, with 60% female. Eighty-three percent of pa...

  16. Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice.

    Science.gov (United States)

    Mejia de Grubb, Maria C; Kilbourne, Barbara; Zoorob, Roger; Gonzalez, Sandra; Mkanta, William; Levine, Robert

    2016-09-01

    Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists rather than on primary care providers (PCPs) who could be better positioned to address the issue at the preventive and community levels. The purpose of this project was to assess primary care resident physicians' self-perceived attitudes and comfort level in addressing cancer health disparities. Resident physicians in their first- through third-year of training in family, internal, preventive/occupational medicine, and obstetrics and gynecology (OB/GYN) at three academic centers responded to a 13-question survey in the spring of 2013. Descriptive and chi-square statistics were performed to analyze responses to (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. A total of 78 (70.9 %) residents responded to the survey. Twenty three (29.5 %) of the respondents felt they did not understand the socio-demographic characteristics of their patients' communities, and 20 (25.6 %) did not feel capable of discussing current cancer-related care guidelines when the patients' personal beliefs conflict with their own. Few of the relationships between residency program and location with outcome measures met the criteria for statistical significance. Family medicine residents were the most likely to report in that it was hard to interact with persons from other cultures. As PCPs will play a key role in addressing cancer health disparities, effective educational opportunities in cancer care by primary care residents are warranted. PMID:25943900

  17. Tailored information increases patient/physician discussion of colon cancer risk and testing: The Cancer Risk Intake System trial.

    Science.gov (United States)

    Skinner, Celette Sugg; Gupta, Samir; Bishop, Wendy Pechero; Ahn, Chul; Tiro, Jasmin A; Halm, Ethan A; Farrell, David; Marks, Emily; Morrow, Jay; Julka, Manjula; McCallister, Katharine; Sanders, Joanne M; Rawl, Susan M

    2016-12-01

    Assess whether receipt of tailored printouts generated by the Cancer Risk Intake System (CRIS) - a touch-screen computer program that collects data from patients and generates printouts for patients and physicians - results in more reported patient-provider discussions about colorectal cancer (CRC) risk and screening than receipt of non-tailored information. Cluster-randomized trial, randomized by physician, with data collected via CRIS prior to visit and 2-week follow-up telephone survey among 623 patients. Patients aged 25-75 with upcoming primary-care visits and eligible for, but currently non-adherent to CRC screening guidelines. Patient-reported discussions with providers about CRC risk and testing. Tailored recipients were more likely to report patient-physician discussions about personal and familial risk, stool testing, and colonoscopy (all p cancer (+ 10%); family history (+ 15%); stool testing (+ 9%); and colonoscopy (+ 8%) (all p < 0.05). CRIS is a promising strategy for facilitating discussions about testing in primary-care settings. PMID:27413654

  18. Primary care physicians' use of family history for cancer risk assessment

    Directory of Open Access Journals (Sweden)

    Stockdale Alan

    2010-06-01

    Full Text Available Abstract Background Family history (FH assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate. Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this survey included: perceived advantages and disadvantages of collecting FH information, knowledge of management options, access to supportive resources, and confidence in ability to interpret FH. Results Reported collection of information regarding second degree blood relatives and age of diagnosis among affected relatives was low. All hypothesized predictors were associated with measures of FH quality, but not all were consistent independent predictors. Perceived advantages of taking a family history, access to supportive resources, and confidence in ability to identify and manage higher risk patients were independent predictors of both FH quality measures. Perceived disadvantages of taking a family history was independently associated one measure of FH quality. Knowledge of management options was not independently associated with either quality measure. Conclusions Modifiable perception and resource factors were independently associated with quality of FH taking in a large and diverse sample of primary care physicians. Improving FH quality for identification of high risk individuals will require multi-faceted interventions.

  19. What physicians think about the need for informed consent for communicating the risk of cancer from low-dose radiation

    International Nuclear Information System (INIS)

    The National Institute of Environmental Health Sciences, a subsidiary of the Food and Drug Administration, has declared that X-ray radiation at low doses is a human carcinogen. The purpose of our study was to determine if informed consent should be obtained for communicating the risk of radiation-induced cancer from radiation-based imaging. Institutional review board approval was obtained for the prospective survey of 456 physicians affiliated with three tertiary hospitals by means of a written questionnaire. Physicians were asked to state their subspecialty, number of years in practice, frequency of referral for CT scanning, level of awareness about the risk of radiation-induced cancer associated with CT, knowledge of whether such information is provided to patients undergoing CT, and opinions about the need for obtaining informed consent as well as who should provide information about the radiation-induced cancer risk to patients. Physicians were also asked to specify their preference among different formats of informed consent for communicating the potential risk of radiation-induced cancer. Statistical analyses were performed using the chi-squared test. Most physicians stated that informed consent should be obtained from patients undergoing radiation-based imaging (71.3%, 325/456) and the radiology department should provide information about the risk of radiation-induced cancer to these patients (54.6%, 249/456). The informed consent format that most physicians agreed with included modifications to the National Institute of Environmental Health Services report on cancer risk from low-dose radiation (20.2%, 92/456) or included information on the risk of cancer from background radiation compared to that from low-dose radiation (39.5%, 180/456). Most physicians do not know if patients are informed about cancer risk from radiation-based imaging in their institutions. However, they believe that informed consent for communicating the risk of radiation-induced cancer

  20. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  1. Utilization of and Attitudes towards Traditional Chinese Medicine Therapies in a Chinese Cancer Hospital: A Survey of Patients and Physicians

    Directory of Open Access Journals (Sweden)

    Jennifer L. McQuade

    2012-01-01

    Full Text Available Background. In China, the use of traditional Chinese medicine (TCM is very popular, but little is known about how it is integrated with conventional cancer care. We conducted parallel surveys of patients and physicians on TCM utilization. Methods. Two hundred forty-five patients and 72 allopathic physicians at the Fudan University Shanghai Cancer Center completed questions on their use of and attitude towards TCM. Results. Patient mean age was 51, with 60% female. Eighty-three percent of patients had used TCM. Use was greatest for Chinese herbal medicine (CHM; 55.8%. Only 1.3% of patients used acupuncture and 6.8% Qi Gong or Tai Qi. Sixty-three percent of patients notified their oncologist about TCM use. The most common reason for use was to improve immune function. CHM was often used with a goal of treating cancer (66.4%, a use that 57% of physicians agreed with. Physicians were most concerned with interference with treatment, lack of evidence, and safety. Ninety percent of physicians have prescribed herbs and 87.5% have used TCM themselves. Conclusion. The use of TCM by Chinese cancer patients is exceptionally high, and physicians are generally well informed and supportive of patients’ use. Botanical agents are much more commonly used than acupuncture or movement-based therapies.

  2. The Rates of Undergoing Cancer Screening Among Family Physicians Aged 40 and Older Working in Ankara Province

    Directory of Open Access Journals (Sweden)

    Ayşe Selda Tekiner

    2016-04-01

    Full Text Available Aim: Family physicians, as role models for their patients, self health behaviors are important. We aimed to investigate the rate of undergoing cancer screening among family physicians. Methods: This is a descriptive and questionnaire-based study. Although we aimed to interview 1100 family physicians aged 40 or older working at family health centers of Ankara, the study was performed with 453 physicians. The questionnaire form comprised of the doctors’ opinions about cancer screening tests, and the situations of undergoing screening tests. Results: The rates of mammography and Pap smear test were 60% and 59% respectively among female doctors. The rates of fecal occult blood testing and colonoscopy were 2.7% and 8.6% respectively. The physicians’ responses to the question “family physicians should be responsible for cancer screening tests in populations they serve” were: “I totally agree": 9.3%; “I agree ": 23.6%; “I am undecided": 21.6%; “I disagree": 36.9%; "I strongly disagree": 8.6% Conclusion: Family physicians who have the responsibility of public health should also undergo screening tests regularly. The importance of protecting own health should be stressed at both undergraduate and postgraduate training programs. Special permits granted by administrators for health checks may also be encouraging.

  3. Physician trust moderates the relationship between intolerance of uncertainty and cancer worry interference among women with Lynch syndrome.

    Science.gov (United States)

    Torbit, Lindsey A; Albiani, Jenna J; Aronson, Melyssa; Holter, Spring; Semotiuk, Kara; Cohen, Zane; Hart, Tae L

    2016-06-01

    This study investigated the extent to which intolerance of uncertainty was associated with cancer worry interference, anxiety and depression among women with Lynch syndrome (LS), and whether having greater trust in one's physician moderated those relationships. Women with confirmed LS (N = 128) were recruited from a high-risk of cancer registry and completed a one-time self-report questionnaire. Women who reported greater intolerance of uncertainty and more trust in their physician reported less cancer worry interference compared to women who had greater intolerance of uncertainty and less trust in their physician, who reported the highest worry interference, b = -1.39, t(99) = -2.27, p = .03. No moderation effect of trust in physician was found for anxiety or depression. Trust in one's physician buffered the impact of high intolerance of uncertainty on cancer worry interference, underscoring the need for supportive provider-patient relationships, particularly for LS patients. PMID:26762124

  4. Colorectal cancer early detection program integrated in practice of family physicians

    Directory of Open Access Journals (Sweden)

    Sanda Pribić

    2011-02-01

    Full Text Available Aim To present preliminary results of the colorectal cancer earlydetection program, a part of the project called „A Model of EarlyCancer Detection Integrated in a Practice of a Family Physician“,carried out by the Department of Family Medicine of the OsijekUniversity School of Medicine and the Health Centre of Osijek,Croatia. Methods The strategy of the project, based on the central role of a family physician in the implementation of the early cancer detection programs, was described and preliminary results of the colorectal cancer early detection program are presented and comparedwith the same issues of the National Program, centrally conductedand supplied by public services. Results From the beginning of April unil the end of May 2009, a total number of 516 testing cards on occult faecal blood were delivered to patients from two target groups (aged 45-50 and 75-79. A high responding rate of 69,76% (360 was recorded. This is an advantage in comparison with the low responding rates of about 20% (43 862, obtained by the National Program. In the project, there were in average 2,5% (9 positive tests, with the higher percent in the older than in the younger age group, 3,5% (12 and 1% (4 respectively. Conclusion Data obtained by the Project, and by the National Program - indicate that there could be a need for a more precise definition of risk groups who have to be invited for screening.

  5. Fertility preservation in female cancer patients: an emerging challenge for physicians.

    Science.gov (United States)

    Caserta, D; Ralli, E; Matteucci, E; Marci, R; Moscarini, M

    2014-03-01

    Fertility preservation has become an issue of great importance in female cancer patients due to increasing survival rates and delayed childbearing. It is an emerging challenge for physicians, cause of several related issues (multidisciplinary approach, doctor-patient communication, ethical, religious and legal problems) and many unresolved questions. This review aims to update the latest literature data, summarizing the effects of cancer treatments on female fertility and the various options currently available to offer cancer patients the opportunity of future pregnancies. Many strategies exist for fertility preservation in young women and they should be assessed according to the patient's age, type of cancer, partner status and time available. Some techniques are well established, others are still experimental. The established methods include embryo cryopreservation, transposition of ovaries prior to radiation therapy, radiation shielding of gonads and conservative surgical approaches. The experimental methods include oocyte cryopreservation, in vitro maturation of oocytes, ovarian tissue cryopreservation and transplantation, and ovarian suppression. Improvement of these techniques as well as better characterization of their success rates and risks, await further investigation. Oocytes donation and gestational surrogacy represent the last options. Thus, the care of these patients is challenging, complex and requires a multidisciplinary approach. A close collaboration between Oncologists, Specialists in Reproductive Medicine, Gynecologic Oncologists and Endocrinologists is crucial for always offering the best possible option. PMID:24637474

  6. 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.

  7. Evaluation of physician eye lens doses during permanent seed implant brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Treatment of low grade prostate cancer with permanent implant of radioactive seeds has become one of the most common brachytherapy procedures in use today. The implant procedure is usually performed with fluoroscopy image guidance to ensure that the seeds are deployed in the planned locations. In this situation the physician performing the transperineal implant is required to be close to the fluoroscopy unit and dose to the eye lens may be of concern. In 1991 the International Commission on Radiological Protection (ICRP) provided a recommended dose limit of 150 mSv yr−1 for occupational exposures to the lens of the eye. With more long term follow-up data, this limit was revised in 2011 to 20 mSv yr−1. With this revised limit in mind, we have investigated the dose to the lens of the eye received by physicians during prostate brachytherapy seed implantation. By making an approximation of annual workload, we have related the dose received to the annual background dose. Through clinical and phantom measurements with thermoluminescent dosimeters, it was found that the excess dose to the physician’s eye lens received for a conservative estimate of annual workload was never greater than 100% of the annual background dose. (paper)

  8. Physician perspectives on colorectal cancer surveillance care in a changing environment.

    Science.gov (United States)

    Zapka, Jane; Sterba, Katherine R; LaPelle, Nancy; Armeson, Kent; Burshell, Dana R; Ford, Marvella E

    2015-06-01

    The purpose of this formative qualitatively driven mixed-methods study was to refine a measurement tool for use in interventions to improve colorectal cancer (CRC) surveillance care. We employed key informant interviews to explore the attitudes, practices, and preferences of four physician specialties. A national survey, literature review, and expert consultation also informed survey development. Cognitive pretesting obtained participant feedback to improve the survey's face and content validity and reliability. Results showed that additional domains were needed to reflect contemporary interdisciplinary trends in survivorship care, evolving practice changes and current health policy. Observed dissonance in specialists' perspectives poses challenges for the development of interventions and psychometrically sound measurement. Implications for future research include need for a flexible care model with enhanced communication and role definitions among clinical specialists, improvements in surveillance at multilevels (patients, providers, and systems), and measurement tools that focus on multispecialty involvement and the changing practice and policy environment. PMID:25878188

  9. Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians

    Science.gov (United States)

    Black, David S.; Lam, Chun Nok; Nguyen, Nathalie T.; Ihenacho, Ugonna

    2016-01-01

    Abstract Objective: Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services. Design: Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use. Results: Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind–body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07–2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language. Conclusions: CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service. PMID:27163178

  10. 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

  11. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease

    DEFF Research Database (Denmark)

    Zachariae, R; Pedersen, C G; Jensen, A B;

    2003-01-01

    The aim of the study was to investigate the association of physician communication behaviours as perceived by the patient with patient reported satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease in cancer patients. Questionnaires measuring distress, self......-efficacy, and perceived control were completed prior to and after the consultation by 454 patients attending an oncology outpatient clinic. After the consultation, the patients also rated the physicians' communicative behaviours by completing a patient-physician relationship inventory (PPRI), and the physicians were...... associated with reduced ability of the physician to estimate patient satisfaction. The results confirm and expand previous findings, suggesting that communication is a core clinical skill in oncology....

  12. Treatment Recommendations for Locally Advanced, Non-Small-Cell Lung Cancer: The Influence of Physician and Patient Factors

    International Nuclear Information System (INIS)

    Purpose: To determine the impact of patient age, comorbidity, and physician factors on treatment recommendations for locally advanced, unresectable non-small-cell lung cancer (NSCLC). Methods and Materials: We surveyed radiation oncologists regarding their recommendations for treatment (chemoradiation, radiation alone, chemotherapy alone, or no therapy) for hypothetical patients with Stage IIIB NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, or severe chronic obstructive pulmonary disease [COPD]). Multinomial logistic regression was used to assess the impact of physician and practice characteristics on radiation oncologists' treatment recommendations for three scenarios with the least agreement. Results: Of 214 radiation oncologists, nearly all (99%) recommended chemoradiation for a healthy 55 year old. However, there was substantial variability in recommendations for a 55 year old with severe COPD, an 80-year-old with moderate COPD, and an 80-year-old with severe COPD. Physicians seeing a lower volume of lung cancer patients were statistically less likely to recommend radiotherapy for younger or older patients with severe COPD (both p < 0.05), but the impact was modest. Conclusions: Nearly all radiation oncologists report following the evidence-based recommendation of chemoradiation for young, otherwise healthy patients with locally advanced, unresectable NSCLC, but there is substantial variability in treatment recommendations for older or sicker patients, probably related to the lack of clinical trial data for such patients. The physician and practice characteristics we examined only weakly affected treatment recommendations. Additional clinical trial data are necessary to guide recommendations for treatment of elderly patients and patients with poor pulmonary function to optimize their management.

  13. Beta-carotene Antioxidant Use During Radiation Therapy and Prostate Cancer Outcome in the Physicians' Health Study

    Energy Technology Data Exchange (ETDEWEB)

    Margalit, Danielle N., E-mail: dmargalit@lroc.harvard.edu [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts (United States); Kasperzyk, Julie L. [Channing Laboratory, Department of Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts (United States); Martin, Neil E. [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Sesso, Howard D. [Division of Preventive Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Gaziano, John Michael [Division of Aging, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Division of Preventive Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Veterans' Affairs Boston Healthcare System, Boston, Massachusetts (United States); Ma, Jing [Channing Laboratory, Department of Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Stampfer, Meir J.; Mucci, Lorelei A. [Channing Laboratory, Department of Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts (United States); Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts (United States)

    2012-05-01

    Purpose: The safety of antioxidant supplementation during radiation therapy (RT) for cancer is controversial. Antioxidants could potentially counteract the pro-oxidant effects of RT and compromise therapeutic efficacy. We performed a prospective study nested within the Physicians' Health Study (PHS) randomized trial to determine if supplemental antioxidant use during RT for prostate cancer is associated with an increased risk of prostate cancer death or metastases. Methods and Materials: PHS participants (383) received RT for prostate cancer while randomized to receive beta-carotene (50 mg on alternate days) or placebo. The primary endpoint was time from RT to lethal prostate cancer, defined as prostate cancer death or bone metastases. The Kaplan-Meier method was used to estimate survival probabilities and the log-rank test to compare groups. Cox proportional hazards regression was used to estimate the effect of beta-carotene compared with that of placebo during RT. Results: With a median follow-up of 10.5 years, there was no significant difference between risk of lethal prostate cancer with the use of beta-carotene during RT compared with that of placebo (hazard ratio = 0.72; 95% confidence interval [CI], 0.42-1.24; p = 0.24). After we adjusted for age at RT, prostate-specific antigen serum level, Gleason score, and clinical stage, the difference remained nonsignificant. The 10-year freedom from lethal prostate cancer was 92% (95% CI, 87-95%) in the beta-carotene group and 89% (95% CI, 84-93%) in the placebo group. Conclusion: The use of supplemental antioxidant beta-carotene during RT was not associated with an increased risk of prostate cancer death or metastases. This study suggests a lack of harm from supplemental beta-carotene during RT for prostate cancer.

  14. The Effects of Experienced Uncertainty and Patients' Assessments of Cancer-Related Information-Seeking Experiences on Fatalistic Beliefs and Trust in Physicians.

    Science.gov (United States)

    Hong, Soo Jung; You, Kyung Han

    2016-12-01

    Using the 2013 HINTS 4 Cycle 2 data representing a general population sample, this study investigates the effects of patients' experiences of uncertainty about prostate cancer during doctor-patient communication, as well as patients' positive assessments of their cancer-related information-seeking experiences, on their fatalistic beliefs regarding cancer and their trust in physicians. Our tests show significant differences in trust in physicians among men who do and do not experience uncertainty about the prostate-specific antigen (PSA) test during doctor-patient communication. The analysis also indicates that individuals with experiences of uncertainty about the PSA test are more likely than those without such experiences of uncertainty to place their trust in doctors. However, no apparent difference or association exists when there are uncertainties relating to treatment choices regarding slow-growing cancer or treatment side effects. Nevertheless, as hypothesized, individuals who positively evaluate their cancer-related information-seeking experiences are less likely to have fatalistic beliefs about cancer. Furthermore, patients' positive assessments are highly predictive of their levels of trust in their physicians. Additionally, tests of interaction effects show that individuals' levels of education moderate the association between uncertainty experiences about the PSA test and both cancer fatalism and trust in physicians. Further implications and limitations of the study are discussed. PMID:27092867

  15. Testing personalized medicine: patient and physician expectations of next-generation genomic sequencing in late-stage cancer care.

    Science.gov (United States)

    Miller, Fiona A; Hayeems, Robin Z; Bytautas, Jessica P; Bedard, Philippe L; Ernst, Scott; Hirte, Hal; Hotte, Sebastien; Oza, Amit; Razak, Albiruni; Welch, Stephen; Winquist, Eric; Dancey, Janet; Siu, Lillian L

    2014-03-01

    Developments in genomics, including next-generation sequencing technologies, are expected to enable a more personalized approach to clinical care, with improved risk stratification and treatment selection. In oncology, personalized medicine is particularly advanced and increasingly used to identify oncogenic variants in tumor tissue that predict responsiveness to specific drugs. Yet, the translational research needed to validate these technologies will be conducted in patients with late-stage cancer and is expected to produce results of variable clinical significance and incidentally identify genetic risks. To explore the experiential context in which much of personalized cancer care will be developed and evaluated, we conducted a qualitative interview study alongside a pilot feasibility study of targeted DNA sequencing of metastatic tumor biopsies in adult patients with advanced solid malignancies. We recruited 29/73 patients and 14/17 physicians; transcripts from semi-structured interviews were analyzed for thematic patterns using an interpretive descriptive approach. Patient hopes of benefit from research participation were enhanced by the promise of novel and targeted treatment but challenged by non-findings or by limited access to relevant trials. Family obligations informed a willingness to receive genetic information, which was perceived as burdensome given disease stage or as inconsequential given faced challenges. Physicians were optimistic about long-term potential but conservative about immediate benefits and mindful of elevated patient expectations; consent and counseling processes were expected to mitigate challenges from incidental findings. These findings suggest the need for information and decision tools to support physicians in communicating realistic prospects of benefit, and for cautious approaches to the generation of incidental genetic information. PMID:23860039

  16. Physician's initial impression of elderly breast cancer patients allows appropriate treatment stratification despite lack of quantitative assessment.

    LENUS (Irish Health Repository)

    Prichard, R S

    2012-02-01

    The management of older women with breast cancer is often suboptimal based on perceived patient comorbidities. The aim of this study was to evaluate the choice of treatment modality based on clinicians \\'gut-feeling\\' compared to comorbidity scoring indices. A retrospective review of women over 70 presenting with breast cancer was performed. Presenting comorbidities (Charlson Comorbidity Index and Cumulative Illness Rating Scale) and the treatment received was documented. Sixty-six patients were identified. Forty-six had surgery while twenty patients had primary endocrine manipulation. The mean age of patients having surgery was 76.4 in comparison to 84.4 for the endocrine group (p = 0.001). The CCI scores for the surgical group and endocrine group were 6.62 and 9.26 respectively (p = 0.001). The scores for the CIRS were 8.93 and 22.68 (p = 0.001). This study has demonstrated that physician\\'s "gut feelings\\' are often correct in identifying patients who may benefit from primary hormone therapy.

  17. Selective estrogen receptor modulators (SERM: A new choice for postmenopausal women and physicians who worry on cancer

    Directory of Open Access Journals (Sweden)

    Ali Baziad

    2001-09-01

    Full Text Available The postmenopausal state is characterized by the cessation of menstruation, loss of ovarian function, and a dramatic decrease in the level of circulating estrogen. This state of estrogen deficiency contributes to the acceleration of several age-related health problems in women, including cardiovascular disease, osteoporosis, and dementia. Estrogen replacement is clearly effective in the short-term and long-term treatment and prevention of postmenopausal symptoms. However, until now, the amount of HRT user is still very low. Fear of breast cancer and endometrial cancer are the most common concern in using hormone replacement therapy (HRT, although the relationship between long-term HRT and breast cancer remains controversial. For physicians or patients, who worry on cancer, the ideal drug is now available i.e. the selective estrogen receptor modulators (SERM, with the generic name raloxifine. (Med J Indones 2001; 10: 187-90Keywords: HRT, raloxifine, osteoporosis, CVD, tamoxifen

  18. 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...

  19. Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer

    NARCIS (Netherlands)

    Hinnen, Chris; Pool, Grieteke; Holwerda, Nynke; Sprangers, Mirjam; Sanderman, Robbert; Hagedoorn, Mariet

    2014-01-01

    Objective: In the present study, we investigated individual differences in the outcome of patient-physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations w

  20. Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer

    NARCIS (Netherlands)

    Hinnen, Chris; Pool, Grieteke; Holwerda, Nynke; Sprangers, Mirjam; Sanderman, Robbert; Hagedoorn, Margriet

    2014-01-01

    Objective In the present study, we investigated individual differences in the outcome of patient–physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations wi

  1. 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...

  2. Assessment of dyspnea in terminally III cancer patients. Role of the thoracic surgeon as a palliative care physician

    International Nuclear Information System (INIS)

    Many cancer patients suffer from rapidly-progressing dyspnea that is difficult to relieve. The subjects were 26 patients who had dyspnea that was difficult to relieve. The Numeric Rating Scale was used to evaluate their dyspnea. For all patients, the cause of the dyspnea was investigated by CT and x-rays. The principal causes of the dyspnea were pleural effusion that increased daily, complications from pneumonia, massive ascites, multiple metastatic lung tumors and atelectasis, recurrent laryngeal nerve paralysis and narrowing secondary airway compression. Dyspnea was caused by a variety of conditions that overlapped over time, intensifying patients' discomfort. Among 14 patients for whom we recommended treatment with sedation, only 8 of them consented. Among the patients who were treated with sedation, the median interval between the exacerbation of dyspnea and death was 16 days; among non-sedated patients it was 18 days. Palliative care physicians who specialize in the respiratory system can, to some extent, predict the occurrence of rapidly progressive dyspnea in cancer patients. It is important to explain the methods of relieving dyspnea to the patient, the patient's family, and the oncologist early, so that decisions on how to manage dyspnea can be made in advance. (author)

  3. Challenges faced by palliative care physicians when caring for doctors with advanced cancer

    NARCIS (Netherlands)

    Noble, S. I. R.; Nelson, A.; Finlay, I. G.

    2008-01-01

    Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behavio

  4. Racial and ethnic differences in personal cervical cancer screening amongst post-graduate physicians: Results from a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Ross Joseph S

    2008-10-01

    Full Text Available Abstract Background Racial and ethnic disparities in cervical cancer screening have been attributed to socioeconomic, insurance, and cultural differences. Our objective was to explore racial and ethnic differences in adherence to cervical cancer screening recommendations among female post-graduate physicians. Methods We conducted a cross-sectional survey at one university hospital among a convenience sample of 204 female post-graduate physicians (52% of all potential participants, examining adherence to United States Preventive Services Task Force cervical cancer screening recommendations, perception of adherence to recommendations, and barriers to obtaining care. Results Overall, 83% of women were adherent to screening recommendations and 84% accurately perceived adherence or non-adherence. Women who self-identified as Asian were significantly less adherent when compared with women who self-identified as white (69% vs. 87%; Relative Risk [RR] = 0.79, 95% Confidence Interval [CI], 0.64–0.97; P Conclusion Among a small group of insured, highly-educated physicians who have access to health care, we found racial and ethnic differences in adherence to cervical cancer screening recommendations, suggesting that culture may play a role in cervical cancer screening.

  5. Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer

    International Nuclear Information System (INIS)

    Purpose: To assess observer-based vs. patient self-reported scoring of xerostomia after intensity-modulated radiotherapy (IMRT) of head-and-neck (HN) cancer. Methods: A total of 38 patients who had received IMRT for HN cancer underwent xerostomia evaluations 6 to 24 months after completion of therapy using three methods each time: (1) Grading by 3 observers according to the Radiotherapy Oncology Group/European Organization for Research and Therapy of Cancer (RTOG/EORTC) system; (2) patient self-reported validated xerostomia questionnaire (XQ); and (3) major salivary gland flow measurements. Results: The interobserver agreement regarding the RTOG/EORTC grades was moderate: κ-coefficient 0.54 (95% CI = 0.31-0.76). The correlations between the average RTOG/EORTC grades and the salivary flow rates were not statistically significant. A trend for significant correlation was observed between these grades and the percent (relative to the pretherapy) nonstimulated salivary flow rates (p = 0.07), but not with the percent stimulated flow rates. Better correlations were found between grading made more than the median time (15 min) after the last liquid sipping and the nonstimulated (but not the stimulated) flows compared with grading made shortly after sipping. In contrast, significant correlations were found between the XQ scores and the nonstimulated (p < 0.005) and the stimulated (p < 0.005) salivary flow rates, as well as with the percentages of the corresponding pretherapy values (p = 0.002 and 0.038, respectively). No significant correlation was found between the RTOG/EORTC grades and the XQ scores. The observer-based grades underestimated the severity of xerostomia compared with the patient self-reported scores. Conclusions: Patient self-reported, rather than physician-assessed scores, should be the main end points in evaluating xerostomia

  6. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2012-05-01

    Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

  7. Physician Evaluation of Internet Health Information on Proton Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Purpose: Many patients considering prostate cancer (PCa) treatment options report seeking proton beam therapy (PBT) based in part on information readily available on the Internet. There is, however, potential for considerable variation in Internet health information (IHI). We thus evaluated the characteristics, quality, and accuracy of IHI on PBT for PCa. Methods and Materials: We undertook a qualitative research study using snowball-purposive sampling in which we evaluated the top 50 Google search results for “proton prostate cancer.” Quality was evaluated on a 5-point scale using the validated 15-question DISCERN instrument. Accuracy was evaluated by comparing IHI with the best available evidence. Results: Thirty-seven IHI websites were included in the final sample. These websites most frequently were patient information/support resources (46%), were focused exclusively on PBT (51%), and had a commercial affiliation (38%). There was a significant difference in quality according to the type of IHI. Substantial inaccuracies were noted in the study sample compared with best available or contextual evidence. Conclusions: There are shortcomings in quality and accuracy in consumer-oriented IHI on PBT for PCa. Providers must be prepared to educate patients how to critically evaluate IHI related to PBT for PCa to best inform their treatment decisions

  8. Physician Evaluation of Internet Health Information on Proton Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Anand, E-mail: as4351@columbia.edu [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Department of Radiation Oncology, Columbia University Medical Center, New York, New York (United States); Paly, Jonathan J.; Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Bekelman, Justin E. [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-03-15

    Purpose: Many patients considering prostate cancer (PCa) treatment options report seeking proton beam therapy (PBT) based in part on information readily available on the Internet. There is, however, potential for considerable variation in Internet health information (IHI). We thus evaluated the characteristics, quality, and accuracy of IHI on PBT for PCa. Methods and Materials: We undertook a qualitative research study using snowball-purposive sampling in which we evaluated the top 50 Google search results for “proton prostate cancer.” Quality was evaluated on a 5-point scale using the validated 15-question DISCERN instrument. Accuracy was evaluated by comparing IHI with the best available evidence. Results: Thirty-seven IHI websites were included in the final sample. These websites most frequently were patient information/support resources (46%), were focused exclusively on PBT (51%), and had a commercial affiliation (38%). There was a significant difference in quality according to the type of IHI. Substantial inaccuracies were noted in the study sample compared with best available or contextual evidence. Conclusions: There are shortcomings in quality and accuracy in consumer-oriented IHI on PBT for PCa. Providers must be prepared to educate patients how to critically evaluate IHI related to PBT for PCa to best inform their treatment decisions.

  9. Attitudes of Polish Physicians and Medical Students toward Breaking Bad News, Euthanasia and Morphine Administration in Cancer Patients

    OpenAIRE

    Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria

    2013-01-01

    Medical students and physicians should possess basic knowledge concerning medical ethics and palliative care. The aim of the study was to explore the knowledge on the end-of-life ethics and palliative care in third-year medical students and physicians during internal medicine specialty training and their attitude towards breaking bad news and euthanasia. A voluntary and anonymous questionnaire survey with the participation of 401 students and 217 physicians filled after lectures concerning et...

  10. Barriers to the Use of Trastuzumab for HER2+ Breast Cancer and the Potential Impact of Biosimilars: A Physician Survey in the United States and Emerging Markets

    OpenAIRE

    Philip Lammers; Carmen Criscitiello; Giuseppe Curigliano; Ira Jacobs

    2014-01-01

    Trastuzumab in combination with chemotherapy has become a standard of care for patients with HER2+ breast cancer. The cost of therapy, however, can limit patient access to trastuzumab in areas with limited financial resources for treatment reimbursement. This study examined access to trastuzumab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia and Brazil via physician survey. The study also investigated if the availability of a biosimilar to trastuzuma...

  11. A cross-sectional observation study regarding patients and their physician willingness to wait for driver mutation report in nonsmall-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Amit Joshi

    2016-01-01

    Full Text Available Background: Palliative chemotherapy +/− targeted therapy in accordance with mutation profile is the norm in nonsmall-cell lung cancer (NSCLC. The objective of this audit was to determine the proportion of patients and physicians, who are unwilling to wait for the mutation report and the reasons thereof. Materials and Methods: All newly diagnosed NSCLC patients, post biopsy, seen at our center between November 2014 and January 2015 were included. The relationship between patient and physician decision and objective factors was explored by Fisher's exact test. The factors considered were Eastern Cooperative Oncology Group performance status (ECOG PS, the presence of a cough, hemoptysis, fatigue, and breathlessness. The agreement between patients and physician decision was tested by contingency table. Results: Out of 168 patients, 57 were unwilling to wait for driver mutation report (33.9% 95% confidence interval [CI] 27.2-41.4%. The most common reason provided by patients was symptomatic status (23, 40.1%. No other objective factor except PS (P = 0.00 was associated with patient's decision. In 56 patients (33.4% 95% CI 26.6-40.7%, physicians were unwilling to wait. Among the tested factors ECOG PS (P = 0.000, breathlessness (P = 0.00 and fatigue (P = 0.00 were associated with the decision of not waiting for the report. The percentage corrected value of contingency between patients and physician decision was 78.74%. Conclusion: At present, in our setup, nearly one-third of our NSCLC patients opt for immediate chemotherapy treatment and are unwilling to wait for mutation analysis report. The major reasons for such attitude is poor symptom control and deteriorating general condition.

  12. Rastreamento do câncer de mama: aspectos relacionados ao médico Breast cancer screening: physicians related issues.

    Directory of Open Access Journals (Sweden)

    Eduardo Rodrigues Godinho

    2004-04-01

    Full Text Available OBJETIVO: Reconhecer as características dos médicos do Estado de Goiás, suas condutas, crenças, opiniões e conhecimentos sobre câncer de mama. MATERIAIS E MÉTODOS: Foram enviados 592 questionários aos ginecologistas, mastologistas e geriatras de Goiás. Os principais aspectos pesquisados foram: 1 - características sócio-demográficas (sexo, idade, ano de formatura, atuação em serviços públicos ou particulares; 2 - capacidade de reconhecimento dos fatores de risco para câncer de mama; 3 - atividades educativas desenvolvidas pelos médicos; 4 - percepção de elementos limitadores ao rastreamento; 5 - perguntas genéricas. RESULTADOS: Os questionários respondidos totalizaram 105 (21,2%; 70,5% dos médicos eram do sexo masculino; idade média de 43,9 anos (26 a 70 anos; 73,5% tinham menos de 20 anos de formado; 88,6% ginecologistas, 4,8% ginecologistas/mastologistas, 3,8% mastologistas, 2,8% geriatras; 62,5% atuavam na rede pública e particular simultaneamente. Apenas 13,3% identificaram os cinco fatores de risco apresentados. Cerca de 95% responderam ter participado de cursos de atualização nos dois anos que antecederam a pesquisa. Outros resultados serão apresentados. CONCLUSÕES: As recomendações sobre rastreamento do câncer de mama pareceram pouco claras aos médicos. As respostas sobre atividades educativas mostraram-se algumas vezes conflitantes. As crenças e opiniões sobre rastreamento foram bastante positivas. Escassez de equipamentos e custo do exame foram identificados como obstáculos ao rastreamento do câncer de mama.OBJECTIVE: To identify the characteristics of physicians in the State of Goiás, Brazil, regarding patient management, beliefs, opinions and knowledge about breast cancer. MATERIALS END METHODS: A total of 592 questionnaires were mailed to gynecologists, mastologists and geriatricians. The survey covered the following main aspects: 1 - socio-demographic characteristics (sex, age, year of graduation

  13. Barriers in the management of cancer-related pain and strategies to overcome them: findings of a qualitative research involving physicians and nurses in Italy

    Directory of Open Access Journals (Sweden)

    Cesarina Prandi

    2015-03-01

    Full Text Available Introduction and aims. There are many barriers and obstacles that even today lead to an inadequate treatment of cancer-related pain. The aim is to describe the experiences of a group of Italian physicians and nurses as far as the nature of these barriers is concerned and the possible tools to be used to overcome them. Material and method. We run 5 focus groups with 42 healthcare professionals (11 physicians, 31 nurses working in 5 hospitals in Italy. The findings of the focus groups were analysed according to the “Content Analysis” method. Results. Five main items emerged: the importance of communication, the need for education regarding pain therapy, the ethnic/cultural/religious differences, the mutual trust and support within the working group, the daily challenges. Conclusion. In harmony with the most recent literature, physicians and nurses voice above all their need for an education more directly aimed at overcoming the prevailing barriers rooted in ignorance, prejudice and fears.

  14. Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Clouston Kathleen

    2012-05-01

    Full Text Available Abstract Background Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening and are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (disincentives to patient FOBT uptake and internet use among 50 to 74 year old males and females for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. Methods/design A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website. The primary endpoint is patient fecal occult blood test completion rate after four months (intention to treat model. Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome

  15. Evaluating Motoric Performance of 10 - 12 Age Group Football Players

    Directory of Open Access Journals (Sweden)

    Mehmet KUMARTAŞLI

    2014-08-01

    Full Text Available The aim of this study is to evaluate motoric perfromance of 10 - 12 age group football players. Akdeniz University tiny football team joined as experiment group and 80. Yıl Cumhuriyet Grammar School football team joined to the study as control group. An exercise programme with educational game format considering physical capacities and develeopment features was applied to the student as 8 weeks, 3 days a week. Standing long jump, flexibilty, 20 m. speed, handgrip strength, arm pull, vert ical jump, 10x5 shuttle run and leg strength tests were applied to the students. Handled data were compared at SPSS 10 statistic programme by using Independent Sample t Test. Students’ lenght and weight measurements were calculated. As a result of measurem ents, there were not found diffrences between experimental and control group’s standing long jump, flexibilty, 20 m. speed, handgrip strength, a vertical jump, 10x5 shuttle run and leg strength tests (p>0,05; but in arm pull test, statistically difference was found (p<0,01. While evaluating the physical performance in cihldren and adolescents, growth process is had to be considered. The results of football players that exercise regularly from small ages at physical and physiologic measurements have an importance according to their age. Performance observed in children is sudden and temporary. There are a few studies in the literature about negative psycological effects of starting trainings in early ages.

  16. 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

  17. Beta-carotene Antioxidant Use During Radiation Therapy and Prostate Cancer Outcome in the Physicians' Health Study

    International Nuclear Information System (INIS)

    Purpose: The safety of antioxidant supplementation during radiation therapy (RT) for cancer is controversial. Antioxidants could potentially counteract the pro-oxidant effects of RT and compromise therapeutic efficacy. We performed a prospective study nested within the Physicians’ Health Study (PHS) randomized trial to determine if supplemental antioxidant use during RT for prostate cancer is associated with an increased risk of prostate cancer death or metastases. Methods and Materials: PHS participants (383) received RT for prostate cancer while randomized to receive beta-carotene (50 mg on alternate days) or placebo. The primary endpoint was time from RT to lethal prostate cancer, defined as prostate cancer death or bone metastases. The Kaplan-Meier method was used to estimate survival probabilities and the log-rank test to compare groups. Cox proportional hazards regression was used to estimate the effect of beta-carotene compared with that of placebo during RT. Results: With a median follow-up of 10.5 years, there was no significant difference between risk of lethal prostate cancer with the use of beta-carotene during RT compared with that of placebo (hazard ratio = 0.72; 95% confidence interval [CI], 0.42–1.24; p = 0.24). After we adjusted for age at RT, prostate-specific antigen serum level, Gleason score, and clinical stage, the difference remained nonsignificant. The 10-year freedom from lethal prostate cancer was 92% (95% CI, 87–95%) in the beta-carotene group and 89% (95% CI, 84–93%) in the placebo group. Conclusion: The use of supplemental antioxidant beta-carotene during RT was not associated with an increased risk of prostate cancer death or metastases. This study suggests a lack of harm from supplemental beta-carotene during RT for prostate cancer.

  18. Microbial Production of Energy Colloquium- March 10-12, 2006

    Energy Technology Data Exchange (ETDEWEB)

    Merry Buckley; Judy Wall

    2006-10-01

    The American Academy of Microbiology convened a colloquium March 10-12, 2006, in San Francisco, California, to discuss the production of energy fuels by microbial conversions. The status of research into various microbial energy technologies, the advantages and disadvantages of each of these approaches, research needs in the field, and education and training issues were examined, with the goal of identifying routes for producing biofuels that would both decrease the need for fossil fuels and reduce greenhouse gas emissions. Currently, the choices for providing energy are limited. Policy makers and the research community must begin to pursue a broader array of potential energy technologies. A diverse energy portfolio that includes an assortment of microbial energy choices will allow communities and consumers to select the best energy solution for their own particular needs. Funding agencies and governments alike need to prepare for future energy needs by investing both in the microbial energy technologies that work today and in the untested technologies that will serve the world’s needs tomorrow. More mature bioprocesses, such as ethanol production from starchy materials and methane from waste digestors, will find applications in the short term. However, innovative techniques for liquid fuel or biohydrogen production are among the longer term possibilities that should also be vigorously explored, starting now. Microorganisms can help meet human energy needs in any of a number of ways. In their most obvious role in energy conversion, microorganisms can generate fuels, including ethanol, hydrogen, methane, lipids, and butanol, which can be burned to produce energy. Alternatively, bacteria can be put to use in microbial fuel cells, where they carry out the direct conversion of biomass into electricity. Microorganisms may also be used some day to make oil and natural gas technologies more efficient by sequestering carbon or by assisting in the recovery of oil and

  19. Microbial Production of Energy Colloquium- March 10-12, 2006

    Energy Technology Data Exchange (ETDEWEB)

    Merry Buckley; Judy Wall

    2006-10-01

    The American Academy of Microbiology convened a colloquium March 10-12, 2006, in San Francisco, California, to discuss the production of energy fuels by microbial conversions. The status of research into various microbial energy technologies, the advantages and disadvantages of each of these approaches, research needs in the field, and education and training issues were examined, with the goal of identifying routes for producing biofuels that would both decrease the need for fossil fuels and reduce greenhouse gas emissions. Currently, the choices for providing energy are limited. Policy makers and the research community must begin to pursue a broader array of potential energy technologies. A diverse energy portfolio that includes an assortment of microbial energy choices will allow communities and consumers to select the best energy solution for their own particular needs. Funding agencies and governments alike need to prepare for future energy needs by investing both in the microbial energy technologies that work today and in the untested technologies that will serve the world’s needs tomorrow. More mature bioprocesses, such as ethanol production from starchy materials and methane from waste digestors, will find applications in the short term. However, innovative techniques for liquid fuel or biohydrogen production are among the longer term possibilities that should also be vigorously explored, starting now. Microorganisms can help meet human energy needs in any of a number of ways. In their most obvious role in energy conversion, microorganisms can generate fuels, including ethanol, hydrogen, methane, lipids, and butanol, which can be burned to produce energy. Alternatively, bacteria can be put to use in microbial fuel cells, where they carry out the direct conversion of biomass into electricity. Microorganisms may also be used some day to make oil and natural gas technologies more efficient by sequestering carbon or by assisting in the recovery of oil and

  20. Physician Knowledge and Awareness of CA-125 As a Screen for Ovarian Cancer in the Asymptomatic, Average-Risk Population

    Science.gov (United States)

    Stewart, Sherri L.; Rim, Sun Hee; Gelb, Cynthia A.

    2012-01-01

    Effective early detection strategies for ovarian cancer do not exist. Current screening guidelines recommend against routine screening using CA-125 alone or in combination with transvaginal ultrasonography (TVS). In this study, the authors used the 2008 "DocStyles" survey to measure clinician beliefs about the effectiveness of CA-125 and TVS in…

  1. Whole Milk Intake Is Associated with Prostate Cancer-Specific Mortality among U.S. Male Physicians1234

    OpenAIRE

    Song, Yan; Chavarro, Jorge E; Cao, Yin; Qiu, Weiliang; Mucci, Lorelei; Sesso, Howard D; Meir J Stampfer; Giovannucci, Edward; Pollak, Michael; Liu, Simin; Ma, Jing

    2012-01-01

    Previous studies have associated higher milk intake with greater prostate cancer (PCa) incidence, but little data are available concerning milk types and the relation between milk intake and risk of fatal PCa. We investigated the association between intake of dairy products and the incidence and survival of PCa during a 28-y follow-up. We conducted a cohort study in the Physicians’ Health Study (n = 21,660) and a survival analysis among the incident PCa cases (n = 2806). Information on dairy ...

  2. New strategies to ensure good patient–physician communication when treating adolescents and young adults with cancer: the proposed model of the Milan Youth Project

    Directory of Open Access Journals (Sweden)

    Magni MC

    2015-08-01

    Full Text Available Maria Chiara Magni,1 Laura Veneroni,1 Carlo Alfredo Clerici,2 Tullio Proserpio,3 Giovanna Sironi,1 Michela Casanova,1 Stefano Chiaravalli,1 Maura Massimino,1 Andrea Ferrari1 1Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 2Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3Pastoral Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy Abstract: Adolescence is a particularly complex time of life, entailing physiological, psychological, and social changes that further the individual's cognitive, emotional, and social growth. Being diagnosed with cancer at this time can have important consequences on an individual's emotional and physical development, and adolescent and young adult cancer patients have particular medical and psychosocial needs. Patient–physician communications are important in any clinical relationship, but fundamental in the oncological sphere because their quality can affect the patient–physician relationship, the therapeutic alliance, and patient compliance. A major challenge when dealing with adolescent and young adult patients lies in striking the right balance between their need and right to understand their disease, treatment, and prognosis, and the need for them to remain hopeful and to protect their emotional sensitivity. We herein describe the activities of the Youth Project of the Istituto Nazionale Tumori in Milan, Italy in order to share a possible model of interaction with these special patients and the tactics our group has identified to help them communicate and share their thoughts. This model implies not only the involvement of a multidisciplinary team, including psychologists and spirituality experts, but also the constitution of dedicated creative activities to give patients the opportunity to express feelings they would otherwise never feel at ease putting into words. These efforts seek the goal to minimize the potentially

  3. Development of breast cancer-related lymphedema. Is it dependent on the patient, the tumor or the treating physicians?

    International Nuclear Information System (INIS)

    Breast cancer-related lymphedema (LE) is relatively common. The aim of this study was to identify the risk factors involved in the development of this complication. This was a cross-sectional study of breast cancer patients treated at our Center between 2004 and 2009. A total of 515 patients were included. Lymphedema was defined as a mid-arm or forearm circumference difference between both limbs of 2 cm or more. The incidence of LE in this population was 21.4%. Patients with a BMI of 25 or higher had a significantly higher risk of LE (p=0.002). The presence of lymphovascular invasion (LVI) (p=0.05) and the number of positive lymph nodes (LN) (p=0.001) were both associated with LE. Patients who underwent axillary dissection (AD) had a significantly higher incidence of LE than patients who had a sentinel LN biopsy (25 vs. 4.5%). Adjuvant radiotherapy was also a significant risk factor in patients who had a mastectomy (p=0.003). There are multiple risk factors for LE. Most of those factors can be influenced by early tumor detection. Early tumors are smaller with no LVI or axillary LN metastasis. They do not usually require AD or axillary radiotherapy, which are the strongest factors associated with the development of LE. (author)

  4. Patient, Physician, and Nurse Factors Associated With Entry Onto Clinical Trials and Finishing Treatment in Patients With Primary or Recurrent Uterine, Endometrial, or Cervical Cancer

    Science.gov (United States)

    2016-02-09

    Recurrent Cervical Carcinoma; Recurrent Uterine Corpus Carcinoma; Recurrent Uterine Corpus Sarcoma; Stage I Uterine Corpus Cancer; Stage I Uterine Sarcoma; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Uterine Corpus Cancer; Stage II Uterine Sarcoma; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Uterine Corpus Cancer; Stage III Uterine Sarcoma; Stage IV Uterine Corpus Cancer; Stage IV Uterine Sarcoma; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

  5. Barriers to the Use of Trastuzumab for HER2+ Breast Cancer and the Potential Impact of Biosimilars: A Physician Survey in the United States and Emerging Markets.

    Science.gov (United States)

    Lammers, Philip; Criscitiello, Carmen; Curigliano, Giuseppe; Jacobs, Ira

    2014-01-01

    Trastuzumab in combination with chemotherapy has become a standard of care for patients with HER2+ breast cancer. The cost of therapy, however, can limit patient access to trastuzumab in areas with limited financial resources for treatment reimbursement. This study examined access to trastuzumab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia and Brazil via physician survey. The study also investigated if the availability of a biosimilar to trastuzumab would improve access to and use of HER2 monoclonal antibody therapy. Across all countries, a subset of oncologists reported barriers to the use of trastuzumab in a neoadjuvant, adjuvant or metastatic setting. Common barriers to the use of trastuzumab included issues related to insurance coverage, drug availability and cost to the patient. Overall, nearly half of oncologists reported that they would increase the use of HER2 monoclonal antibody therapy across all treatment settings if a lower cost biosimilar to trastuzumab were available. We conclude that the introduction of a biosimilar to trastuzumab may alleviate cost-related barriers to treatment and could increase patient access to HER2-directed therapy in all countries examined. PMID:25232798

  6. Barriers to the Use of Trastuzumab for HER2+ Breast Cancer and the Potential Impact of Biosimilars: A Physician Survey in the United States and Emerging Markets

    Directory of Open Access Journals (Sweden)

    Philip Lammers

    2014-09-01

    Full Text Available Trastuzumab in combination with chemotherapy has become a standard of care for patients with HER2+ breast cancer. The cost of therapy, however, can limit patient access to trastuzumab in areas with limited financial resources for treatment reimbursement. This study examined access to trastuzumab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia and Brazil via physician survey. The study also investigated if the availability of a biosimilar to trastuzumab would improve access to and use of HER2 monoclonal antibody therapy. Across all countries, a subset of oncologists reported barriers to the use of trastuzumab in a neoadjuvant, adjuvant or metastatic setting. Common barriers to the use of trastuzumab included issues related to insurance coverage, drug availability and cost to the patient. Overall, nearly half of oncologists reported that they would increase the use of HER2 monoclonal antibody therapy across all treatment settings if a lower cost biosimilar to trastuzumab were available. We conclude that the introduction of a biosimilar to trastuzumab may alleviate cost-related barriers to treatment and could increase patient access to HER2-directed therapy in all countries examined.

  7. 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

  8. 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,...

  9. 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.

  10. 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

  11. 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 ...

  12. Patient-Physician Communication in the 21st Century.

    Science.gov (United States)

    Friedman, Claire F; Wolchok, Jedd D

    2016-06-01

    In clinical practice, a successful patient-physician partnership can improve the outcome of treatment, especially in cases of chronic disease or cancer. To establish this partnership, physicians must explain treatment options and potential outcomes, but how to best do this when treatment is based on scientific principles and findings that the lay patient will not be familiar with? Here we present a paradigm for patient-physician communication using the immunotherapy of cancer as a model. In this context, we argue for the importance of incorporating techniques in communicating science with patients into the training of early career physicians. PMID:27156780

  13. Prostate Cancer (Radiation Therapy)

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Prostate Cancer Treatment Prostate cancer overview? What are my treatment options? What ... any new developments in treating my disease? Prostate cancer overview Prostate cancer is the most common form of cancer ...

  14. 10-12 klasių mokinių užimtumas ir rekreacija laisvalaikiu

    OpenAIRE

    Imbras, Donatas

    2005-01-01

    OCCUPATION AND RECREATION ON THE SPARE-TIME OF 10-12 FORMS PUPIL Donatas Imbras It is very significant to investigate the pupil spare-time occupation models in the recreation expanse. That is why this study analyses the influence of spare-time occupation and recreation of the 10-12 forms pupil. The purpose of this study is to substantiate education theoretic view of consist to occupation and recreation conception and to investigate expression of young people in the spare-time. The ...

  15. Scanning Tunnelling Microscopy Observation on 10,12-Tricosadiynoic Acid Monolayers Deposited by Schaefer's Method

    Institute of Scientific and Technical Information of China (English)

    张耿民

    2001-01-01

    The Langmuir-Blodgett monolayers of 10, 12-tricosadiynoic acid molecules were deposited onto the basal plane of highly oriented pyrolytic graphite (HOPG) by Schaefer's method and then observed with the scanning tunnelling microscope (STM). With a view to achieving a parallel molecular arrangement on the graphite surface, the deposition was deliberately conducted at a relatively low surface pressure. As exhibited by the STM images, by this approach the 10,12-tricosadiynoic acid molecules could constitute an ordered structure with their molecular chains lying parallel to the substrate. The model of molecular dimer is put forward for the interpretation of the observed phenomena.

  16. 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 ...

  17. 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 ...

  18. Latest in classroom technologies will be explored Dec. 10-12 at the Hotel Roanoke

    OpenAIRE

    Felker, Susan B.

    2008-01-01

    The 14th annual Educational Technology Leadership Conference, aimed at demonstrating the most up-to-date and successful techniques for integrating technology into classrooms, will be held Dec. 10-12 at the Hotel Roanoke and Conference Center in Roanoke, Va.

  19. A Resource File for Social Studies in Utah. Level 10-12: U.S. Studies.

    Science.gov (United States)

    Utah State Office of Education, Salt Lake City.

    This resource file contains information for Utah secondary school teachers to help their students at level 10-12 to meet the state's instructional objectives in the social studies. This particular student level emphasizes U.S. studies. The following disciplines are covered in the resource file: psychology, anthropology, sociology, geography,…

  20. Community leaders can improve problem-solving skills at Virginia Tech Institute Feb. 10-12

    OpenAIRE

    Felker, Susan B.

    2007-01-01

    Development of better community problem-solving skills is the goal of the LeadershipPlenty¨ Institute to be hosted by Virginia Tech's Center for Organizational and Technological Advancement Feb. 10-12, 2008, at The Hotel Roanoke and Conference Center in Roanoke, Va.

  1. Testicular Self-Examination: Are Primary Care Physicians Teaching This Preventive Measure?

    OpenAIRE

    Diotallevi, Mark

    1989-01-01

    The author polled 118 family physicians about their screening procedures for testicular cancer in males at risk. Fewer physicians (63%) teach testicular self-examination (TSE) than teach breast self-examination (100%) as part of a periodic health examination. Physicians who examine their own testes or breasts regularly are more likely to examine their patients' testes during a periodic examination and to teach TSE to males at risk. Female physicians are more likely (75%) than male physicians ...

  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 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. 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

  5. Die letterlike vertolking van metaforiese taal in Josua 10:12-14

    Directory of Open Access Journals (Sweden)

    A.P.B. Breytenbach

    2002-11-01

    Full Text Available The literal understanding of metaphoric language in Joshua 10:12-14In this article the well-known passage in Joshua 10:12-14 is critically investigated within the context of the pericope of Joshua 10. A literary critical investigation shows, inter alia, that the oldest version of the pericope probably was a heroic saga of Joshua’s campaign, with the miraculous intervention of YHWH having been “written into” the narrative at a later stage. During the latter process a poetic fragment, the original of which is lost to us, was interpreted literally, thus creating a miracle account. This miracle account serves the main focus of the pericope: YHWH alone makes possible the impossible for his people.

  6. An optical fiber spool for laser stabilization with reduced acceleration sensitivity to 10-12/g

    Science.gov (United States)

    Hu, Yong-Qi; Dong, Jing; Huang, Jun-Chao; Li, Tang; Liu, Liang

    2015-10-01

    Environmental vibration causes mechanical deformation in optical fibers, which induces excess frequency noise in fiber-stabilized lasers. In order to solve such a problem, we propose an ultralow acceleration sensitivity fiber spool with symmetrically mounted structure. By numerical analysis with the finite element method, we obtain the optimal geometry parameters of the spool with which the horizontal and vertical acceleration sensitivity can be reduced to 3.25 × 10-12/g and 5.38 × 10-12/g respectively. Moreover, the structure features the insensitivity to the variation of geometry parameters, which will minimize the influence from numerical simulation error and manufacture tolerance. Project supported by the National Natural Science Foundation of China (Grant Nos. 11034008 and 11274324) and the Key Research Program of the Chinese Academy of Sciences (Grant No. KJZD-EW-W02).

  7. Texture evolution of rolled Mg–3Al–1Zn alloy undergoing a {10-12} twinning dominant strain path change

    International Nuclear Information System (INIS)

    The texture modification, caused by {10-12}–{10-12} double twinning, in rolled Mg–3Al–1Zn alloy was investigated by carrying out consecutive in-plane compressions along two orthogonal directions in combination with an electron backscatter diffraction measurement and a Schmid factor analysis. The results revealed that the Schmid law still governs twin variant selection, thereby controlling texture evolution, however, the specific crystallographic feature of {10-12} twinned region in which the c-axis orients to the compression direction with a variation of ±30° on the rolling plane and one prismatic plane including the rotation axis of {10-12} twinning, corresponding to an a-axis, is aligned almost parallel to the rolling plane gives rise to a significantly different texture evolution of {10-12}–{10-12} double twinned region as compared to {10-12} twinned region. - Highlights: • Texture evolution, caused by {10-12}–{10-12} double twinning, was investigated. • Twin variant selection during double twinning is governed by the Schmid law. • Double twinned region has a significantly different texture compared with twinned region. • It is attributed to the specific crystallographic feature of {10-12} twinned region

  8. Texture evolution of rolled Mg–3Al–1Zn alloy undergoing a {10-12} twinning dominant strain path change

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Hyuk [Light Metals Team, Korea Institute of Materials Science, Changwon 642-831 (Korea, Republic of); Hong, Seong-Gu, E-mail: sghong@kriss.re.kr [Division of Industrial Metrology, Korea Research Institute of Standards and Science, Daejeon 305-340 (Korea, Republic of); Lee, Jeong Hun [Graduate Institute of Ferrous Technology, Pohang University of Science and Technology, Pohang 790-784 (Korea, Republic of); Huh, Yong-Hak [Division of Industrial Metrology, Korea Research Institute of Standards and Science, Daejeon 305-340 (Korea, Republic of)

    2015-10-15

    The texture modification, caused by {10-12}–{10-12} double twinning, in rolled Mg–3Al–1Zn alloy was investigated by carrying out consecutive in-plane compressions along two orthogonal directions in combination with an electron backscatter diffraction measurement and a Schmid factor analysis. The results revealed that the Schmid law still governs twin variant selection, thereby controlling texture evolution, however, the specific crystallographic feature of {10-12} twinned region in which the c-axis orients to the compression direction with a variation of ±30° on the rolling plane and one prismatic plane including the rotation axis of {10-12} twinning, corresponding to an a-axis, is aligned almost parallel to the rolling plane gives rise to a significantly different texture evolution of {10-12}–{10-12} double twinned region as compared to {10-12} twinned region. - Highlights: • Texture evolution, caused by {10-12}–{10-12} double twinning, was investigated. • Twin variant selection during double twinning is governed by the Schmid law. • Double twinned region has a significantly different texture compared with twinned region. • It is attributed to the specific crystallographic feature of {10-12} twinned region.

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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

  15. a Theoretical Investigation on 10-12 Potential of Hydrogen-Hydrogen Covalent Bond

    Science.gov (United States)

    Taneri, Sencer

    2013-05-01

    This is an analytical investigation of well-known 10-12 potential of hydrogen-hydrogen covalent bond. In this research, we will make an elaboration of the well-known 6-12 Lennard-Jones potential in case of this type of bond. Though the results are illustrated in many text books and literature, an analytical analysis for these potentials is missing almost everywhere. The power laws are valid for small radial distances, which are calculated to some extent. The internuclear separation as well as the binding energy of the hydrogen molecule are evaluated with success.

  16. Massachusetts General Physicians Organization's quality incentive program produces encouraging results.

    Science.gov (United States)

    Torchiana, David F; Colton, Deborah G; Rao, Sandhya K; Lenz, Sarah K; Meyer, Gregg S; Ferris, Timothy G

    2013-10-01

    Physicians are increasingly becoming salaried employees of hospitals or large physician groups. Yet few published reports have evaluated provider-driven quality incentive programs for salaried physicians. In 2006 the Massachusetts General Physicians Organization began a quality incentive program for its salaried physicians. Eligible physicians were given performance targets for three quality measures every six months. The incentive payments could be as much as 2 percent of a physician's annual income. Over thirteen six-month terms, the program used 130 different quality measures. Although quality-of-care improvements and cost reductions were difficult to calculate, anecdotal evidence points to multiple successes. For example, the program helped physicians meet many federal health information technology meaningful-use criteria and produced $15.5 million in incentive payments. The program also facilitated the adoption of an electronic health record, improved hand hygiene compliance, increased efficiency in radiology and the cancer center, and decreased emergency department use. The program demonstrated that even small incentives tied to carefully structured metrics, priority setting, and clear communication can help change salaried physicians' behavior in ways that improve the quality and safety of health care and ease the physicians' sense of administrative burden. PMID:24101064

  17. Individual and maternal determinants of self-reported dental health among Turkish school children aged 10-12 years

    DEFF Research Database (Denmark)

    Cinar, A B; Kosku, N; Sandalli, N;

    2008-01-01

    To assess the influence of maternal and individual characteristics on self-reported dental health of Turkish school children aged 10-12 years with different socio-economic backgrounds.......To assess the influence of maternal and individual characteristics on self-reported dental health of Turkish school children aged 10-12 years with different socio-economic backgrounds....

  18. 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

  19. 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

  20. 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

  1. Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before–after and parallel group surveys

    Science.gov (United States)

    Cornuz, Jacques; Gachoud, David; Bulliard, Jean-Luc; Nichita, Cristina; Dorta, Gian; Ducros, Cyril; Auer, Reto

    2016-01-01

    Objectives Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs’ intent to offer FIT or colonoscopy on an equal basis. Design Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. Setting All PCPs in the canton of Vaud, Switzerland. Participants Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. Intervention A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. Outcome measures The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. Results Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (pcolonoscopy in equal proportions. PMID:27178977

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. A Communication Intervention for Training Southern European Oncologists to Recognize Psychosocial Morbidity in Cancer. I - Development of the Model and Preliminary Results on Physicians' Satisfaction

    OpenAIRE

    Grassi, L; Travado, L; Gil, F.; Campos, R.; P. Lluch; Baile, W

    2005-01-01

    BACKGROUND: The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology professionals. METHODS: A specific educational and experiential model (12 hours divided into 2 modules) involving formal teaching (ie, jo...

  9. 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...

  10. 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

  11. 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.

  12. 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

  13. 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

  14. 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

  15. Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions

    OpenAIRE

    Allen Laura J; Pham Jane T; Gomez Scarlett L

    2009-01-01

    Abstract Background US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT). Methods We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians complet...

  16. 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

  17. Patient Preferences and Physician Practice Patterns Regarding Breast Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: There are multiple current strategies for breast radiotherapy (RT). The alignment of physician practice patterns with best evidence and patient preferences will enhance patient autonomy and improve cancer care. However, there is little information describing patient preferences for breast RT and physician practice patterns. Methods and Materials: Using a reliable and valid instrument, we assessed the preferences of 5,000 randomly selected women (with or without cancer) undergoing mammography. To assess practice patterns, 2,150 randomly selected physician-members of American Society for Radiation Oncology were surveyed. Results: A total of 1,807 women (36%) and 363 physicians (17%) provided usable responses. The 95% confidence interval is < ±2.3% for patients and < ±5.3% for physicians. Patient preferences were hypofractionated whole breast irradiation (HF-WBI) 62%, partial breast irradiation (PBI) 28%, and conventionally fractionated whole breast irradiation (CF-WBI) 10%. By comparison, 82% of physicians use CF-WBI for more than 2/3 of women and 56% never use HF-WBI. With respect to PBI, 62% of women preferred three-dimensional (3D)-PBI and 38% favor brachytherapy-PBI, whereas 36% of physicians offer 3D-PBI and 66% offer brachytherapy-PBI. 70% of women prefer once-daily RT over 10 days vs. twice-daily RT over 5 days. 55% of physicians who use PBI do not offer PBI on clinical trial. Conclusions: HF-WBI, while preferred by patients and supported by evidence, falls behind the unproven and less preferred strategy of PBI in clinical practice. There is a discrepancy between women’s preferences for PBI modality and type of PBI offered by physicians. Further alignment is needed between practice patterns, patient preferences, and clinical evidence.

  18. Attitudes of Chinese Oncology Physicians Toward Death with Dignity

    Science.gov (United States)

    Chen, Hui-ping; Huang, Bo-yan; Yi, Ting-wu; Deng, Yao-Tiao; Liu, Jie; Zhang, Jie; Wang, Yu-qing; Zhang, Zong-yan

    2016-01-01

    Abstract Background: Death with dignity (DWD) refers to the refusal of life-prolonging measures for terminally ill patients by “living wills” forms in advance. More and more oncology physicians are receiving DWD requests from advance cancer patients in mainland China. Objective: The study objective was to investigate the attitudes of Chinese oncology physicians toward the legalization and implementation of DWD. Methods: A questionnaire investigating the understanding and attitudes toward DWD was administered to 257 oncology physicians from 11 hospitals in mainland China. Results: The effective response rate was 86.8% (223/257). The majority of oncology physicians (69.1%) had received DWD requests from patients. Half of the participants (52.5%) thought that the most important reason was the patients' unwillingness to maintain survival through machines. One-third of participants (33.0%) attributed the most important reason to suffering from painful symptoms. Most oncology physicians (78.9%) had knowledge about DWD. A fifth of respondents did not know the difference between DWD and euthanasia, and a few even considered DWD as euthanasia. The majority of oncology physicians supported the legalization (88.3%) and implementation (83.9%) of DWD. Conclusions: Many Chinese oncology physicians have received advanced cancer patients' DWD requests and think that DWD should be legalized and implemented. Chinese health management departments should consider the demands of physicians and patients. It is important to inform physicians about the difference between DWD and euthanasia, as one-fifth of them were confused about it. PMID:27022774

  19. Estudo da atitude e do conhecimento dos médicos não oncologistas em relação às medidas de prevenção e rastreamento do câncer Evaluation of non-oncologist physician's knowledge and attitude towards cancer screening and preventive actions

    Directory of Open Access Journals (Sweden)

    Luciana Tomanik Cardozo de Mello Tucunduva

    2004-09-01

    Full Text Available OBJETIVO: Avaliar o nível de informação e as atitudes preventivas em uso corrente pelos médicos ligados à FMABC. MÉTODOS: Foram entregues questionários para 120 médicos não oncologistas que lidam diretamente com pacientes adultos. RESULTADOS: A taxa de resposta foi de 58,3%. A idade média dos médicos foi de 33,9 anos, sendo 57,1% mulheres e 10% tabagistas. As práticas preventivas para os cânceres mais comuns (mama, colo de útero, próstata, colorretal e pele não-melanoma foram analisadas e comparadas com as recomendadas pelos consensos adotados (INCA, Sociedade Americana de Cancerologia e Força-Tarefa Canadense. Observou-se que a maioria das práticas (45,72% a 100% não se adequou a nenhum deles. Sobre possíveis barreiras para o adequado exercício da prevenção do câncer, 82,86% considerou falta de agentes educadores em saúde para a população, 77,14% poucos conhecimento ou treinamento e 70,15% falta de verba para custear exames. Houve uma tendência ao excesso de pedidos de exames de rastreamento. CONCLUSÕES: As práticas preventivas utilizadas pelos médicos entrevistados são heterogêneas e, em sua maioria, não preconizadas pelos consensos de condutas preventivas consultados, o que pode ser relacionado tanto à sua falta de conhecimento em relação a estes consensos como às divergências entre eles. Dessa forma, faz-se necessário um esforço educativo enfatizando a importância da prevenção do câncer no aprendizado e na prática médica.BACKGOUND: New cancer cases are most often diagnosed by non-oncologist physicians. It is therefore essential for all physicians to be aware of cancer preventive practices and use them appropriately with their patients. METHODS: Questionnaires were administered to 120 non-oncologist physicians of various specialties attending the "Faculdade de Medicina do ABC" who deal directly with adult patients. Replies were collected and classified as appropriate or not according to one of

  20. 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

  1. 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

  2. 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...

  3. Prism stacking faults observed contiguous to a {10-12} twin in a Mg–Y alloy

    International Nuclear Information System (INIS)

    Using transmission electron microscopy, we document, for the first time, the presence of stacking faults on the (10-10) prism planes in a fine-grained Mg–Y alloy. These prism stacking faults were found to be exclusively contiguous to a {10-12} deformation twin. In addition, the {10-12} twin contained a high density of basal plane stacking faults. Arguments are developed for the interrelationship between the stacking faults on the prism planes in the matrix and those on the basal planes in the twin

  4. 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

  5. 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

  6. Langmuir-Blodgett films of metal complexes of 4-(10,12-pentacosadiynamidomethyl)pyridine : A structural investigation

    NARCIS (Netherlands)

    Werkman, PJ; Wieringa, RH; Vorenkamp, EJ; Schouten, AJ

    1998-01-01

    Complex formation between 4-(10,12-pentacosadiynamidomethyl)pyridine and metal ions in the subphase results in stable Langmuir monolayers up to surface pressures of 35 mN m(-1). Electron microscopy pictures show a flat monomer monolayer before polymerization and a polymer monolayer exhibiting a more

  7. 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…

  8. 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.

  9. 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)

  10. The National Day for the Libyan Physician

    Directory of Open Access Journals (Sweden)

    Elmahdi A. Elkhammas

    2007-03-01

    Libyan society. We hope the idea will find its way to the legislators to adopt and designate a day to celebrate the Libyan Physician.This day can be any time; however, I would propose selecting a day in the summer to enable the participation of most Libyan physicians while children are out of school. Such participation could be in the form of public health screenings and information about major diseases such as diabetes, high blood pressure, strokes and breast cancer. Informational discussions of socio-medical problems such as substance abuse and drug addiction could also be included. It is my hope that my colleagues will discuss this issue, voice their opinions, and provide suggestions of other activities to commemorate our physicians on this day.

  11. Preparation of 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane from 2,6,8,12-tetraacetyl 2,4,6,8,12-hexaazaisowurtzitane using Various Nitrating Agents (Short Communication

    Directory of Open Access Journals (Sweden)

    Javad Mokhtari

    2011-02-01

    Full Text Available The 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane (HNIW, a high energy material with cage structure, is considered as the most powerful explosive today. It is usually prepared via nitration with concentrated nitric and sulphuric acid, but this technique pollutes the environment. In this study, HNIW was synthesised by nitration of 2,6,8,12-tetraacetyl 2,4,6,8,12-hexaazaisowurtzitane (TAIW various nitrating agents. Using this nitrating agent, the reaction eliminated use of concentrated sulphuric acid and was also environmental- friendly. Meanwhile, the effects of reaction temperature, time, and other factors on yield were studied. The structure of the compound was characterised by elemental analysis, Infrared, 1HNMR and MS.Defence Science Journal, 2011, 61(2, pp.171-173, DOI:http://dx.doi.org/10.14429/dsj.61.606

  12. Adsorption of 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane (CL-20) on a soil organic matter. A DFT M05 computational study.

    Science.gov (United States)

    Sviatenko, Liudmyla K; Gorb, Leonid; Shukla, Manoj K; Seiter, Jennifer M; Leszczynska, Danuta; Leszczynski, Jerzy

    2016-04-01

    Adsorption of 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane (CL-20) by soil organic matter considering the Leonardite Humic Acid (LHA) model at the M05/tzvp level of Density Functional Theory (DFT) applying cluster approximation has been investigated. Different orientations of CL-20 toward LHA surface were examined. It was found that deprotonation of LHA is required to obtain stable complexes with CL-20. Hydrogen bonds between CL-20 and deprotonated LHA were analyzed applying the atoms in molecules (AIM) theory. An attachment or removal of an electron with respect to the complex does not have significant effect on mutual orientation of the adsorbent in complexes. It was shown that adsorbed CL-20 does not undergo redox transformation and, therefore, adsorption on soil organic matter may be responsible for decrease of the degradation rate of CL-20 in soil. PMID:26814703

  13. 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

  14. 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.

  15. 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

  16. 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

  17. What Is Prostate Cancer?

    Medline Plus

    Full Text Available ... the more likely he is to develop the disease. Physician: Come on back, first room. Narrator: Most ... cancer. Prostate cancer is really a spectrum of diseases where on one end of the spectrum there ...

  18. Screening for Prostate Cancer

    Science.gov (United States)

    ... of Internal Medicine Summaries for Patients Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ... Physicians The full report is titled “Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ...

  19. [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

  20. 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...

  1. 2nd Joint GOSUD/SAMOS Workshop, U.S.Coast Guard Base, Seattle, Washington, 10-12 June 2008.

    OpenAIRE

    2008-01-01

    On 10-12 June 2008, the NOAA Climate Observation Division sponsored the 2nd Joint Global Ocean Surface Underway Data (GOSUD)/Shipboard Automated Meteorological and Oceanographic System (SAMOS) Workshop in Seattle, WA, USA. The workshop focused on the ongoing collaboration between GOSUD and SAMOS and addressing the needs of the research and operational community for highquality underway oceanographic and meteorological observations from ships. The SAMOS initiative is working to improve access ...

  2. 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 ...

  3. 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...

  4. 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...

  5. 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 ...

  6. 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...

  7. 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, ...

  8. 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

  9. 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

  10. 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

  11. Prevalence of Malocclusion among 10-12-year-old Schoolchildren in Kozhikode District, Kerala: An Epidemiological Study

    Science.gov (United States)

    Jeseem, MT; Kumar, TV Anupam

    2016-01-01

    ABSTRACT Background: A malocclusion is an irregularity of the teeth or a malrelationship of the dental arches beyond the range of what is accepted as normal. Objectives: To determine the prevalence of malocclusion in children aged 10-12 years in Kozhikode district of Kerala, South India. Materials and methods: A descriptive cross-sectional study was conducted among schoolchildren aged 10-12 years in six schools in Kozhikode district of Kerala, South India. A total of 2,366 children satisfied the inclusion criteria. Occlusal characteristics like crossbite, open bite, deep bite, protrusion of teeth, midline deviations, midline diastema and tooth rotation were recorded. The data were tabulated and analyzed using Chi-square test. Results: The results revealed that the overall prevalence of malocclusion was 83.3%. Of this, 69.8% of the children had Angle’s class I malocclusion, 9.3% had class II malocclusion (division 1 = 8.85%, division 2 = 0.5%) and 4.1% had class III malocclusion; 23.2% showed an increased overjet (>3 mm), 0.4% reverse overjet, 35.6% increased overbite (>3 mm), 0.29% open bite, 7.2% crossbite with 4.6% crossbite of complete anterior teeth, 63.3% deviation of midline, 0.76% midline diastema and 3.25% rotated tooth. No significant differences in gender distributions of malocclusions were noted except for increased overjet and overbite. Conclusion: There is high prevalence of malocclusion among schoolchildren in Kozhikode district of Kerala. Early interception and early correction of these malocclusions will eliminate the potential irregularities and malpositions in the developing dentofacial complex. How to cite this article: Narayanan RK, Jeseem MT, Kumar TVA. Prevalence of Malocclusion among 10-12-year-old Schoolchildren in Kozhikode District, Kerala: An Epidemiological Study. Int J Clin Pediatr Dent 2016;9(1):50-55. PMID:27274156

  12. Features of physiological responses on organism of football players aged 10-12 years in exercise using different training methods

    Directory of Open Access Journals (Sweden)

    Abdula A. B.

    2014-01-01

    Full Text Available Purpose : To evaluate the effect of various special exercises football players’ organism in different modes. Material : The study involved 24 young players aged 10-12 years. Results : There is a large range of load parameters for elite athletes, which necessitates evaluation exercise intensity football for young players. Found that depending on the method chosen football special exercises have different effects on the body force young players. Conclusions : It was found that by using the method of competitive gaming and heart rate and energy increases with increasing number of players. The analysis shows the existence of significant differences in terms of heart rate for game and interval method.

  13. Unstable Isomer of C90 Fullerene Isolated as Chloro Derivatives, C90 (1)Cl10/12.

    Science.gov (United States)

    Chilingarov, Norbert S; Troyanov, Sergey I

    2016-07-01

    High-temperature chlorination of C90 -containing fullerene fraction resulted in the isolation and X-ray structural characterization of C90 (1)Cl10/12 , the first derivatives of a relatively unstable isomer D5h -C90 (1) with a nanotubular shape. In the crystal structure, three isomers of both C90 (1)Cl10 and C90 (1)Cl12 with similar chlorination patterns co-crystallize in the same crystallographic site. Thus, in contrast to the previous reports, D5h -C90 (1) is present, though with a low abundance, in the fullerene soot produced by arc-discharge method with undoped graphite rods. PMID:27311795

  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. Heavy Ion Storage Ring for Atomic Physics (HISTRAP) vacuum test stand for pressures of 10-12 Torr

    International Nuclear Information System (INIS)

    HISTRAP (Heavy Ion Storage Ring for Atomic Physics) is a proposed synchrotron/cooler/storage ring accelerator optimized for advanced atomic physics research. The ring has a circumference of 46.8 m, a bore diameter of /similar to/15 cm, and requires a vacuum of 10-12 Torr to decelerate highly charged, very heavy ions down to low energies. To be able to test components and procedures to achieve this pressure, a test stand approximately modeling 1/16 of the ring vacuum chamber has been built. The 3.5-m-long test stand has been fabricated from 10-cm-diam components, with 316LN stainless-steel flanges. Prior to assembly, these components were vacuum fired at 950 0C at a pressure of 10-4 Torr. The test stand is bakable in situ at 300 0C. Pumping is achieved with two 750 l/s titanium sublimator pumps and one 60 l/s ion pump. Pressure is measured with two extractor ion gauges and a 10-4 partial pressure residual gas analyser. The roughing for the test stand consists of cryosorption pumps followed by a cryopump. A pressure of 4 x 10-12 Torr has been achieved

  16. 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....

  17. [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

  18. [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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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 ...

  11. 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...

  12. 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...

  13. 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...

  14. 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.

  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. Addressing the challenge of assessing physician-level screening performance: mammography as an example.

    Directory of Open Access Journals (Sweden)

    Elizabeth S Burnside

    Full Text Available Motivated by the challenges in assessing physician-level cancer screening performance and the negative impact of misclassification, we propose a method (using mammography as an example that enables confident assertion of adequate or inadequate performance or alternatively recognizes when more data is required.Using established metrics for mammography screening performance-cancer detection rate (CDR and recall rate (RR-and observed benchmarks from the Breast Cancer Surveillance Consortium (BCSC, we calculate the minimum volume required to be 95% confident that a physician is performing at or above benchmark thresholds. We graphically display the minimum observed CDR and RR values required to confidently assert adequate performance over a range of interpretive volumes. We use a prospectively collected database of consecutive mammograms from a clinical screening program outside the BCSC to illustrate how this method classifies individual physician performance as volume accrues.Our analysis reveals that an annual interpretive volume of 2770 screening mammograms, above the United States' (US mandatory (480 and average (1777 annual volumes but below England's mandatory (5000 annual volume is necessary to confidently assert that a physician performed adequately. In our analyzed US practice, a single year of data uniformly allowed confident assertion of adequate performance in terms of RR but not CDR, which required aggregation of data across more than one year.For individual physician quality assessment in cancer screening programs that target low incidence populations, considering imprecision in observed performance metrics due to small numbers of patients with cancer is important.

  17. 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...

  18. 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...

  19. 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)

  20. 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…

  1. 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

  2. Unified studies of chemical bonding structures and resonant scattering in light neutron-excess systems, 10,12Be

    International Nuclear Information System (INIS)

    The generalized two-center cluster model (GTCM), which can treat covalent, ionic and atomic configurations in general systems with two inert cores plus valence nucleons, is formulated in the basis of the microscopic cluster model. In this model, the covalent configurations constructed by the molecular orbital (MO) method and the atomic (or ionic) configuration obtained by the valence bonding (VB) method can be handled in a consistent manner. The GTCM is applied to the light neutron-rich system 10,12Be = α + α + Xn (X = 2, 4). The continuous and smooth changes of the neutron orbits from the covalent MO states to the ionic VB states are clearly observed in the adiabatic energy surfaces (AESs), which are the energy curves obtained with a variation of the α–α distance. The energy levels obtained from the AESs nicely reproduce the recent observations over a wide energy region. The individual spectra are characterized in terms of chemical-bonding-like structures, such as the covalent MO or ionic VB structures, according to analysis of their intrinsic wave functions. From the analysis of AESs, the formation of the mysterious 02+ states in 10,12Be, which have anomalously small excitation energies in comparison to a naive shell-model prediction, is investigated. A large enhancement in a monopole transition from a ground MO state to an ionic α + 6,8He VB state is found, which seems to be consistent with a recent observation. In the unbound region, the structure problem, which handles the total system of α + α + Xn (X = 2, 4) as a bound or quasi-bound state, and the reaction problem, induced by the collision of an asymptotic VB state of α + 6,8He, are combined by the GTCM. The properties of unbound resonant states are discussed in close connection to the reaction mechanism, and some enhancement factors originating from the properties of the intrinsic states are predicted in the reaction observables. (review article)

  3. Lesbian health care. What a primary care physician needs to know.

    OpenAIRE

    White, J. C.; Levinson, W

    1995-01-01

    Many primary care physicians take care of lesbians and women sexually active with women without being aware of their patients' sexual orientation. These women have unique medical and psychosocial needs that each physician must consider. Lesbian identity or being sexually active exclusively with women influences care in areas such as sexually transmitted diseases, risk of human immunodeficiency virus infection, counseling, cancer risk, screening, parenting, depression, alcohol use, and violenc...

  4. [Multidisciplinary meetings in oncology do not impact the physician-patient relationship].

    OpenAIRE

    Orgerie, Marie-Brigitte; Duchange, Nathalie; Pélicier, Nicole; Rosset, Philippe; Lemarié, Etienne; Dorval, Etienne; Chapet, Sophie; Hervé, Christian; Moutel, Grégoire

    2012-01-01

    International audience CONTEXT: The setting of multidisciplinary meeting (MDM) by the French Cancer Plan has introduced new decisional elements in the patient-physician relationship in oncology. METHODS: To assess the potential impact of MDM on this relationship, a study was conducted at the Tours Hospital: 145 questionnaires were collected from patients whose files have been discussed in MDM, 40 questionnaires were collected from physicians attending these meetings and an analysis of 324 ...

  5. 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...

  6. Radiation Dose from Medical Imaging: A Primer for Emergency Physicians

    Directory of Open Access Journals (Sweden)

    Jesse G.A. Jones, MD

    2012-05-01

    Full Text Available Introduction: Medical imaging now accounts for most of the US population’s exposure to ionizingradiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aimto provide a general overview of radiation dose from medical imaging with a focus on computedtomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposureto patients in the emergency department setting.Methods: We conducted a literature review through calendar year 2010 for all published articlespertaining to the emergency department and radiation exposure.Results: The benefits of imaging usually outweigh the risks of eventual radiation-induced cancer inmost clinical scenarios encountered by emergency physicians. However, our literature review identified3 specific clinical situations in the general adult population in which the lifetime risks of cancer mayoutweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominalpain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patientdiscussion about such risks and benefits may be warranted.Conclusion: Emergency physicians, now at the front line of patients’ exposure to ionizing radiation,should have a general understanding of the magnitude of radiation dose from advanced medicalimaging procedures and their associated risks. Future areas of research should include thedevelopment of protocols and guidelines that limit unnecessary patient radiation exposure.

  7. Let's Cure Cancer!

    OpenAIRE

    Morrison, Wallace; Schneider, Jessica; Amass, Sandra F

    2012-01-01

    From ancient Egypt to modern times, scientists have been learning new ways to prevent, diagnose, and treat cancer. In this book, you’ll learn about cancer and how veterinarians, veterinary technicians, physicians, and other scientists are working together to find a cure for cancer in people and their pets.

  8. PROCEEDINGS OF RIKEN BNL RESEARCH CENTER WORKSHOP, VOLUME 77, RBRC SCIENTIFIC REVIEW COMMITTEE MEETING, OCTOBER 10-12, 2005

    Energy Technology Data Exchange (ETDEWEB)

    SAMIOS, N.P.

    2005-10-10

    The eighth evaluation of the RIKEN BNL Research Center (RBRC) took place on October 10-12, 2005, at Brookhaven National Laboratory. The members of the Scientific Review Committee (SRC) were Dr. Jean-Paul Blaizot, Professor Makoto Kobayashi, Dr. Akira Masaike, Professor Charles Young Prescott (Chair), Professor Stephen Sharpe (absent), and Professor Jack Sandweiss. We are grateful to Professor Akira Ukawa who was appointed to the SRC to cover Professor Sharpe's area of expertise. In addition to reviewing this year's program, the committee, augmented by Professor Kozi Nakai, evaluated the RBRC proposal for a five-year extension of the RIKEN BNL Collaboration MOU beyond 2007. Dr. Koji Kaya, Director of the Discovery Research Institute, RIKEN, Japan, presided over the session on the extension proposal. In order to illustrate the breadth and scope of the RBRC program, each member of the Center made a presentation on higher research efforts. In addition, a special session was held in connection with the RBRC QCDSP and QCDOC supercomputers. Professor Norman H. Christ, a collaborator from Columbia University, gave a presentation on the progress and status of the project, and Professor Frithjof Karsch of BNL presented the first physics results from QCDOC. Although the main purpose of this review is a report to RIKEN Management (Dr. Ryoji Noyori, RIKEN President) on the health, scientific value, management and future prospects of the Center, the RBRC management felt that a compendium of the scientific presentations are of sufficient quality and interest that they warrant a wider distribution. Therefore we have made this compilation and present it to the community for its information and enlightenment.

  9. PROCEEDINGS OF RIKEN BNL RESEARCH CENTER WORKSHOP, VOLUME 77, RBRC SCIENTIFIC REVIEW COMMITTEE MEETING, OCTOBER 10-12, 2005

    International Nuclear Information System (INIS)

    The eighth evaluation of the RIKEN BNL Research Center (RBRC) took place on October 10-12, 2005, at Brookhaven National Laboratory. The members of the Scientific Review Committee (SRC) were Dr. Jean-Paul Blaizot, Professor Makoto Kobayashi, Dr. Akira Masaike, Professor Charles Young Prescott (Chair), Professor Stephen Sharpe (absent), and Professor Jack Sandweiss. We are grateful to Professor Akira Ukawa who was appointed to the SRC to cover Professor Sharpe's area of expertise. In addition to reviewing this year's program, the committee, augmented by Professor Kozi Nakai, evaluated the RBRC proposal for a five-year extension of the RIKEN BNL Collaboration MOU beyond 2007. Dr. Koji Kaya, Director of the Discovery Research Institute, RIKEN, Japan, presided over the session on the extension proposal. In order to illustrate the breadth and scope of the RBRC program, each member of the Center made a presentation on higher research efforts. In addition, a special session was held in connection with the RBRC QCDSP and QCDOC supercomputers. Professor Norman H. Christ, a collaborator from Columbia University, gave a presentation on the progress and status of the project, and Professor Frithjof Karsch of BNL presented the first physics results from QCDOC. Although the main purpose of this review is a report to RIKEN Management (Dr. Ryoji Noyori, RIKEN President) on the health, scientific value, management and future prospects of the Center, the RBRC management felt that a compendium of the scientific presentations are of sufficient quality and interest that they warrant a wider distribution. Therefore we have made this compilation and present it to the community for its information and enlightenment

  10. 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

  11. Cancer

    Science.gov (United States)

    ... Blood tests (which look for chemicals such as tumor markers) Bone marrow biopsy (for lymphoma or leukemia) Chest ... the case with skin cancers , as well as cancers of the lung, breast, and colon. If the tumor has spread ...

  12. Cancer

    Science.gov (United States)

    Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms ... be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors ...

  13. Cigarette smoking: knowledge and attitudes among Mexican physicians

    Directory of Open Access Journals (Sweden)

    TAPIA-CONYER ROBERTO

    1997-01-01

    Full Text Available Objective. To determine the prevalence of the smoking habit among Mexican physicians as well as some of their attitudes and information on specific issues concerning smoking. Material and methods. In 1993, a survey was carried out among 3 568 physicians of the three major official health care institutions in Mexico City. A questionnaire designed for The Mexican National Survey of Addictions (ENA 1993 was used. Prevalence of cigarette smoking, age of onset, number of cigarettes per day; also information and attitudes concerning smoking were assessed. Results. The mean age was 37, 66% were males. Of the 3,488 (98% surveyed, 26.9% were smokers (62% daily, 20.6% were ex-smokers and 52.5% non-smokers. There were differences related to age and sex (p< 0.05. Of daily smokers, 36% smoked between 1 and 5 cigarettes. There was a significant trend among ex-smokers that linked the time they had ceased smoking with the fear to start smoking again. Physicians were well informed of the relationship between cigarette smoking and lung cancer. Over 80% considered tobacco an addictive drug but only 65% were in favor of banning smoking from their workplaces and over 10% were not aware that it is forbidden to smoke inside health care facilities. Conclusions. These results differ from other studies that find the prevalence of smoking among physicians lower than in the general population. Our study revealed a greater prevalence of the smoking habit among female physicians and the number of cigarettes smoked per day was greater than in the general population regardless of sex.

  14. 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…

  15. 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

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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 ...

  1. 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

  2. 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

  3. [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

  4. [Cancer].

    Science.gov (United States)

    de la Peña-López, Roberto; Remolina-Bonilla, Yuly Andrea

    2016-09-01

    Cancer is a group of diseases which represents a significant public health problem in Mexico and worldwide. In Mexico neoplasms are the second leading cause of death. An increased morbidity and mortality are expected in the next decades. Several preventable risk factors for cancer development have been identified, the most relevant including tobacco use, which accounts for 30% of the cancer cases; and obesity, associated to another 30%. These factors, in turn, are related to sedentarism, alcohol abuse and imbalanced diets. Some agents are well knokn to cause cancer such as ionizing radiation, viruses such as the papilloma virus (HPV) and hepatitis virus (B and C), and more recently environmental pollution exposure and red meat consumption have been pointed out as carcinogens by the International Agency for Research in Cancer (IARC). The scientific evidence currently available is insufficient to consider milk either as a risk factor or protective factor against different types of cancer. PMID:27603890

  5. 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

  6. 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...

  7. 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...

  8. Get Tested for Colon Cancer: Here's How

    Medline Plus

    Full Text Available ... performing a CT or cat scan that yields three-dimensional images. Your physician can examine the lining ... American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Cancer.org is provided courtesy ...

  9. 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...

  10. 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

  11. 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

  12. 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'...

  13. 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)

  14. 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…

  15. 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…

  16. Report of the exploratory meeting regarding epidemiology of occupational and environmental factors associated with autoimmunity, Bilthoven, May 10-12, 2000

    OpenAIRE

    Loveren H van; Vos JG; Germolec D; Simeonova PP; Eijkemanns G; LPI

    2000-01-01

    Van 10-12 Mei 2000 werd in Bilthoven een wetenschappelijke bijeenkomst gehouden, getiteld "Exploratory Meeting Epidemiology on Occupational and Environmental Factors Associated with Autoimmunity". Het doel was te bepalen wat de optimale methodologie zou zijn voor het vaststellen van autoimmuniteit die is geassocieerd met blootstelling aan agentia op de werkplek of aan omgevingsfactoren. Bovendien werd de mogelijkheid besproken om in interdisciplinaire samenwerkingsverbanden dergelij...

  17. 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

  18. 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

  19. 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...

  20. Certain Physicians Are More Likely to Refer Patients to Clinical Trials

    Science.gov (United States)

    According to a survey-based study of more than 1,500 physicians treating patients with lung or colorectal cancer, medical oncologists were the most likely and surgeons the least likely to refer patients to, or enroll them in, clinical trials.

  1. 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

  2. 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

  3. Sleep, obesity and physicians' education

    OpenAIRE

    Ratneswaran, Culadeeban; Kadhum, Murtaza; Pengo, Martino F.; Steier, Joerg

    2016-01-01

    More than two thirds of the US population is obese or overweight, with worldwide obesity rates doubling since 1980. Obesity causes serious health risks including cardiovascular disease, diabetes and cancer (1). It is also associated with respiratory conditions like obesity hypoventilation syndrome, asthma and obstructive sleep apnoea (OSA). Obesity causes a 6-fold increase in OSA prevalence (2) and over the last two decades, has caused a rise in the prevalence of OSA to 10% in middle-aged mal...

  4. 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...

  5. 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

  6. 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

  7. 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

  8. 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

  9. [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

  10. 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

  11. EFFECT OF COMPLEX TRAINING WITH LOW-INTENSITY LOADING INTERVAL ON CERTAIN PHYSICAL VARIABLES AMONG VOLLEYBALL INFANTS (10-12 AGES)

    OpenAIRE

    KHAZHAL KAKAHAMA SAEED

    2013-01-01

    AbstractPurpose. Complex training involves the completion of a resistance exercise prior to a plyometric exercise. A classic example is to perform vertical jumps or depth jumps after the completion of a back squat exercise. The term ‘complex training’ is credited to Verkhoshansky et al. (1973). The present study was conducted to assess the outcome of complex training with low-intensity loading interval on certain physical variables among volleyball infants (10-12 ages).Methods. The sample was...

  12. 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 ...

  13. 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

  14. 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...

  15. 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

  16. New insights into the structure, assembly and biological roles of 10-12 nm connective tissue microfibrils from fibrillin-1 studies.

    Science.gov (United States)

    Jensen, Sacha A; Handford, Penny A

    2016-04-01

    The 10-12 nm diameter microfibrils of the extracellular matrix (ECM) impart both structural and regulatory properties to load-bearing connective tissues. The main protein component is the calcium-dependent glycoprotein fibrillin, which assembles into microfibrils at the cell surface in a highly regulated process involving specific proteolysis, multimerization and glycosaminoglycan interactions. In higher metazoans, microfibrils act as a framework for elastin deposition and modification, resulting in the formation of elastic fibres, but they can also occur in elastin-free tissues where they perform structural roles. Fibrillin microfibrils are further engaged in a number of cell matrix interactions such as with integrins, bone morphogenetic proteins (BMPs) and the large latent complex of transforming growth factor-β (TGFβ). Fibrillin-1 (FBN1) mutations are associated with a range of heritable connective disorders, including Marfan syndrome (MFS) and the acromelic dysplasias, suggesting that the roles of 10-12 nm diameter microfibrils are pleiotropic. In recent years the use of molecular, cellular and whole-organism studies has revealed that the microfibril is not just a structural component of the ECM, but through its network of cell and matrix interactions it can exert profound regulatory effects on cell function. In this review we assess what is known about the molecular properties of fibrillin that enable it to assemble into the 10-12 nm diameter microfibril and perform such diverse roles. PMID:27026396

  17. 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,...

  18. 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.

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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 ...

  4. 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

  5. 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 ...

  6. Physician Expectations of Treatment Outcomes for Patients With Brain Metastases Referred for Whole Brain Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: Patients with advanced cancer are referred to our Rapid Response Radiotherapy Program for quick access to palliative radiotherapy. The primary objective of this prospective study was to determine the physician expectations of the treatment outcomes for patients with brain metastases referred for whole brain radiotherapy (WBRT). The secondary objectives were to determine the factors influencing the expectations and to examine the accuracy of the physician-estimated patient survival. Methods and Materials: Patients were identified during a 17-month period. The referring physicians were sent a survey by facsimile to be completed and returned before the patient consultation. Information was sought on the patient's disease status, the physician's expectations of WBRT, the estimated patient survival and performance status, and physician demographic data. Results: A total of 137 surveys were sent out, and the overall response rate was 57.7%. The median patient age was 66 years (range, 35-87), 78.5% had multiple brain metastases, 42.3% had a controlled primary tumor, and 62.3% had extracranial disease. WBRT was thought to stabilize neurologic symptoms, improve quality of life, and allow for a Decadron (dexamethasone) taper by ≥94.9% of the referring physicians; 87.0% thought WBRT would improve performance status; 77.9% thought it would improve neurologic symptoms; and 40.8% thought it would improve survival. The referring physicians estimated patient survival as a median of 6.0 months; however, the actual survival was a median of 2.5 months, for a median individual difference of 1.9 months (p < .0001). Conclusion: Physicians referring patients with brain metastases for consideration of WBRT are often overly optimistic when estimating the clinical benefit of the treatment and overestimate patient survival. These findings highlight the need for education and additional research in this field.

  7. 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

  8. 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

  9. 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.

  10. [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

  11. 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....

  12. 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

  13. Smoking cessation intervention practices in Chinese physicians: do gender and smoking status matter?

    Science.gov (United States)

    Lam, Tai Hing; Jiang, Chaoqiang; Chan, Ya-Fen; Chan, Sophia Siu Chee

    2011-03-01

    Healthcare settings provide a major arena for administering smoking cessation interventions. However, few studies have reported differences in the frequency of practice in healthcare professionals by gender and smoking status. This might also be influenced by a difference in smoking prevalence by gender, especially in China and other developing countries. This study examined factors associated with the frequency of cessation intervention practices by smoking status among Chinese physicians in men and women. A cross-sectional survey was conducted in 2006 in physicians with direct patient contact from nine hospitals in Guangzhou with a response rate of 60.8%. Significantly more female physicians who were non-smokers (79.7%) reported "initiation and/or advice" smoking cessation interventions than male physicians who were smokers (71.2%) and non-smokers (71.6%). Factors significantly associated with "initiation and/or advice" were prior smoking cessation training (OR = 4.2, 95% CI 1.8-9.6) and lack of knowledge to help patients to quit (OR = 0.4, 95% CI 0.2-0.9) among male physicians who smoked; and organisational support (OR = 1.7, 95% CI 1.3-2.2) and successful past experience (OR = 0.4, 95% CI 0.2-1.0) among male physicians who did not smoke. Among female physicians who did not smoke, significant factors were agreeing that quitting smoking is the most cost-effective way to prevent chronic disease and cancer (OR = 3.0, 95% CI 1.4-6.1), helping patients stop smoking is part of expected role and responsibility (OR = 2.0, 95% CI 1.0-3.7), lack of knowledge to help patients to quit (OR = 0.5, 95% CI 0.2-1.0) and organisational support (OR = 1.3, 95% CI 1.0-1.6) for non-smoking female physicians. This study is the first to show that male physicians were less likely to provide smoking cessation counselling regardless of their smoking status while non-smoking female physicians were more active in advising patients on quitting. The findings highlight the need for developing

  14. 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

  15. 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.

  16. [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

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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

  4. CANCER

    Directory of Open Access Journals (Sweden)

    N. Kavoussi

    1973-09-01

    Full Text Available There are many carcinogenetic elements in industry and it is for this reason that study and research concerning the effect of these materials is carried out on a national and international level. The establishment and growth of cancer are affected by different factors in two main areas:-1 The nature of the human or animal including sex, age, point and method of entry, fat metabolism, place of agglomeration of carcinogenetic material, amount of material absorbed by the body and the immunity of the body.2 The different nature of the carcinogenetic material e.g. physical, chemical quality, degree of solvency in fat and purity of impurity of the element. As the development of cancer is dependent upon so many factors, it is extremely difficult to determine whether a causative element is principle or contributory. Some materials are not carcinogenetic when they are pure but become so when they combine with other elements. All of this creates an industrial health problem in that it is almost impossible to plan an adequate prevention and safety program. The body through its system of immunity protects itself against small amounts of carcinogens but when this amount increases and reaches a certain level the body is not longer able to defend itself. ILO advises an effective protection campaign against cancer based on the Well –equipped laboratories, Well-educated personnel, the establishment of industrial hygiene within factories, the regular control of safety systems, and the implementation of industrial health principles and research programs.

  5. Study of the 20,22Ne+20,22Ne and 10,12,13,14,15C+12C Fusion Reactions with MUSIC

    Science.gov (United States)

    Avila, M. L.; Rehm, K. E.; Almaraz-Calderon, S.; Carnelli, P. F. F.; DiGiovine, B.; Esbensen, H.; Hoffman, C. R.; Jiang, C. L.; Kay, B. P.; Lai, J.; Nusair, O.; Pardo, R. C.; Santiago-Gonzalez, D.; Talwar, R.; Ugalde, C.

    2016-05-01

    A highly efficient MUlti-Sampling Ionization Chamber (MUSIC) detector has been developed for measurements of fusion reactions. A study of fusion cross sections in the 10,12,13,14,15C+12C and 20,22Ne+20,22Ne systems has been performed at ATLAS. Experimental results and comparison with theoretical predictions are presented. Furthermore, results of direct measurements of the 17O(α, n)20Ne, 23Ne(α, p)26Mg and 23Ne(α, n)26Al reactions will be discussed.

  6. Multicomponent, solvent-free synthesis of 12-aryl-8,9,10,12-tetrahydrobenzo[]-xanthen-11-one derivatives catalysed by cyanuric chloride

    Indian Academy of Sciences (India)

    Zhan-Hui Zhang; Peng Zhang; Shu-Hong Yang; Hong-Juan Wang; Jia Deng

    2010-05-01

    An efficient and direct protocol for the preparation of 12-aryl-8,9,10,12-tetrahydro-benzo[] xanthen-11-one derivatives employing a three-component one-pot reaction of aryl aldehydes, 2-naphthol and cyclic 1,3-dicarbonyl compounds in the presence of a catalytic amount of cyanuric chloride (2,4,6-trichloro-1,3,5-triazine, TCT) under solvent-free conditions is described. The desired products are obtained in high yields with short reaction times.

  7. Efficient One-pot Synthesis of 12-Aryl-8, 9, 10, 12-tetrahydrobenzo[a]xanthen-11-ones Under Solvent-free Conditions

    Institute of Scientific and Technical Information of China (English)

    JIA Xu-dong; HAN Song-yang; DUAN Hai-feng; LIN Ying-jie; CAO Jun-gang; LIANG Da-peng; WU Mao-cheng

    2013-01-01

    Multi-component condensation of 2-naphthol,aromatic aldehydes,and cyclic 1,3-dicarbonyl compounds catalyzed by ionic liquid [NSPTEA][HSO4] was accomplished for the synthesis of a series of 12-aryl-8,9,10,12-tetrahydrobenzo[a]xanthen-1 l-ones under solvent-flee conditions.High yields,ease recovery,short reaction time and reusability of catalyst are significant advantages.ZrOCl2·8H2O was also found to act as an effective catalyst towards this transformation.

  8. (2S,7S-10-Ethyl-1,8,10,12-tetraazatetracyclo[8.3.1.18,12.02,7]pentadecan-10-ium iodide

    Directory of Open Access Journals (Sweden)

    Augusto Rivera

    2012-10-01

    Full Text Available The title chiral quaternary ammonium salt, C13H25N4+·I−, was synthesized through the Menschutkin reaction between the cage aminal (2S,7S-1,8,10,12-tetraazatetracyclo[8.3.1.18,12.02,7]pentadecane and ethyl iodide. The quaternization occurred regioselectively on the nitrogen with major sp3 character. The crystal structure consists of anions and cations separated by normal distances. Ions are not linked through C—H...I hydrogen bonds.

  9. Study of the 20,22Ne+20,22Ne and 10,12,13,14,15C+12C Fusion Reactions with MUSIC

    Directory of Open Access Journals (Sweden)

    Avila M. L.

    2016-01-01

    Full Text Available A highly efficient MUlti-Sampling Ionization Chamber (MUSIC detector has been developed for measurements of fusion reactions. A study of fusion cross sections in the 10,12,13,14,15C+12C and 20,22Ne+20,22Ne systems has been performed at ATLAS. Experimental results and comparison with theoretical predictions are presented. Furthermore, results of direct measurements of the 17O(α, n20Ne, 23Ne(α, p26Mg and 23Ne(α, n26Al reactions will be discussed.

  10. 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

  11. 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...

  12. 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...

  13. 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...

  14. 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

  15. 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

  16. 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

  17. Reducing Barriers to Use of Breast Cancer Screening

    Science.gov (United States)

    Investigation to determine whether a telephone counseling intervention aimed at women who are known to underuse breast cancer screening can with, or without, an accompanying educational intervention for their physicians, increase use of breast cancer screening.

  18. 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

  19. 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.

  20. Screening mammography beliefs and recommendations: a web-based survey of primary care physicians

    Directory of Open Access Journals (Sweden)

    Yasmeen Shagufta

    2012-02-01

    Full Text Available Abstract Background The appropriateness and cost-effectiveness of screening mammography (SM for women younger than 50 and older than 74 years is debated in the clinical research community, among health care providers, and by the American public. This study explored primary care physicians' (PCPs perceptions of the influence of clinical practice guidelines for SM; the recommendations for SM in response to hypothetical case scenarios; and the factors associated with perceived SM effectiveness and recommendations in the US from June to December 2009 before the United States Preventive Services Task Force (USPSTF recently revised guidelines. Methods A nationally representative sample of 11,922 PCPs was surveyed using a web-based questionnaire. The response rate was 5.7% (684; (41% 271 family physicians (FP, (36% 232 general internal medicine physicians (IM, (23% 150 obstetrician-gynaecologists (OBG, and (0.2% 31 others. Cross-sectional analysis examined PCPs perceived effectiveness of SM, and recommendation for SM in response to hypothetical case scenarios. PCPs responses were measured using 4-5 point adjectival scales. Differences in perceived effectiveness and recommendations for SM were examined after adjusting for PCPs specialty, race/ethnicity, and the US region. Results Compared to IM and FP, OBG considered SM more effective in reducing breast cancer mortality among women aged 40-49 years (p = 0.003. Physicians consistently recommended mammography to women aged 50-69 years with no differences by specialty (p = 0.11. However, 94% of OBG "always recommended" SM to younger and 86% of older women compared to 81% and 67% for IM and 84% and 59% for FP respectively (p = p = Conclusions A majority of physicians, especially OBG, favour aggressive breast cancer screening for women from 40 through 79 years of age, including women with short life expectancy. Policy interventions should focus on educating providers to provide tailored recommendations for

  1. 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

  2. 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

  3. 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

  4. 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...

  5. 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

  6. Cancer in pregnancy

    DEFF Research Database (Denmark)

    Han, Sileny N; Kesic, Vesna I; Van Calsteren, Kristel;

    2013-01-01

    OBJECTIVE: To evaluate physicians' attitudes and knowledge regarding the treatment possibilities for patients with cancer in pregnancy. STUDY DESIGN: A 30-item questionnaire was mailed electronically to physicians across Europe, who were potentially involved in care of pregnant patients and....../or cancer, using the membership directories of different professional societies. RESULTS: 142 surveys were eligible for analysis. A median of 2 (range 0-100) patients with cancer in pregnancy were treated per center in 2010. The vast majority of respondents (94%) agreed that management of pregnant patients...... with cancer should be decided by a multidisciplinary team. When cancer is diagnosed in the first or early second trimester of pregnancy, 44% of respondents prefer termination of pregnancy: if the patient wishes to preserve the pregnancy, 77% consider deliberate delay and treatment later in pregnancy. When...

  7. Relationship Between Perceived Risk and Physician Recommendation and Repeat Mammography in the Female Population in Tehran, Iran.

    Science.gov (United States)

    Moshki, Mahdi; Taymoori, Parvaneh; Khodamoradi, Sahmireh; Roshani, Daem

    2016-01-01

    Iranian women are at high risk of low compliance with repeat mammography due to a lack of awareness about breast cancer, negative previous experiences, cultural beliefs, and no regular visits to a physician. Thus research is needed to explore factors associated with repeated mammography participation. Applying the concept of perceived risk as the guiding model, this study aimed to test the fit and strength of the relationship between perceived risk and physician recommendation in explaining repeat mammography. A total of 601 women, aged 50 years and older referred to mammography centers in region 6, were recruited via a convenience sampling method. Using path analysis, family history of breast cancer and other types of cancer were modeled as antecedent perceived risk, and physician recommendation and knowledge were modeled as an antecedent of the number of mammography visits. The model explained 49% of the variance in repeat mammography. The two factors of physician recommendation and breast self-examination had significant direct effects (P effects on repeat mammography through physician recommendation. The results of this study provide a background for further research and interventions not only on Iranian women but also on similar cultural groups and immigrants who have been neglected to date in the mammography literature. PMID:27165251

  8. Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions

    Directory of Open Access Journals (Sweden)

    Allen Laura J

    2009-07-01

    Full Text Available Abstract Background US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT. Methods We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147 physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes. Results The most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM, tumor size (71% for MRM, 78% for BCT, cosmetic result (74% for BCT, and breast size (50% for MRM, 55% for BCT. The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%, smaller breast sizes (25%, and fear and cultural beliefs (12%. Conclusion These survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.

  9. [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

  10. 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

  11. 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…

  12. 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

  13. 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

  14. 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...

  15. 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.

  16. 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 ….

  17. 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…

  18. 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…

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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...

  4. Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram?

    Science.gov (United States)

    Larson, Kelsey E; Cowher, Michael S; O'Rourke, Colin; Patel, Mita; Pratt, Debra

    2016-03-01

    Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients. PMID:26687763

  5. 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.

  6. 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

  7. Motivos de participación/no participación en actividades físicas de escolares de 10-12 años de Melilla. (Reasons for participation/no participation in physical activities of 10-12 years old schoolchildren from Melilla.

    Directory of Open Access Journals (Sweden)

    Juan Granda Vera

    2010-10-01

    Full Text Available ResumenEl presente artículo expone los resultados de un estudio dirigido a conocer la influencia del género en la frecuencia semanal y diaria de práctica de actividad física, así como en los motivos/no motivos de práctica de actividad física que manifiestan escolares de 10-12 años de Melilla. Los participantes han sido todos los escolares de los cursos 5º y 6º (10 - 12 años de tres colegios públicos de Melilla (n= 439. Los datos se han recogido a través del cuestionario de “Hábitos de participación en Actividades Físicas”. Los resultados muestran la existencia de diferencias significativas en función del género en la frecuencia diaria de práctica (z= 2,72, p AbstractThe present article presents the results of a study aimed at know the influence of gender in weekly and daily practice and in the reasons/non-reasons for practicing physical activity that show school age 10-12 years of Melilla. The participants were all schoolchildren in courses 5 and 6th (10-12 years from three public schools in Melilla (n= 439. Data were collected through the “Habits of Participation in Physical Activities Questionnaire”. The results show the significant differences gender in the daily frequency of practice (z= 2,72, p

  8. Synthesis and Crystal Structure of 2,6,8,12-Tetraacetyl- 2,4,6,8,10,12-hexaazatetracyclo[5.5.0.05,9.03,11]dodecane

    Institute of Scientific and Technical Information of China (English)

    孙成辉; 冯泽旺; 方涛; 赵信岐

    2005-01-01

    The title compound, 2,6,8,12-tetraacetyl-2,4,6,8,10,12-hexaazatetracyclo[5.5.0.05,9.03,11]dodecane (TAIW, C14H2oN6O4, Mr= 336.36), has been synthesized by hydrogenolysis debenzylation of tetraacetyldibenzylhexaazaisowurtzitane (TADB) and its crystal structure was determined to be monoclinic, space group C2/c with a = 28.193(6), b = 12.139(2), c = 17.678(4) (A), β= 97.44(3)°, V=5999(2) (A)3, Z= 16, Dc= 1.490 g/cm3, F(000) = 2848, μ(MoKα) = 0.112 mm-1, R = 0.0631 and wR =0.1586. X-ray investigations indicate that the molecule has different isomers and there exist intermolecular C-H…O hydrogen bonds in the crystal structure. The results of elemental analysis, IR and NMR spectroscopy are included.

  9. 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...

  10. 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...

  11. 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...

  12. 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

  13. Physician resource utilization in radiation oncology: a model based on management of carcinoma of the prostate

    International Nuclear Information System (INIS)

    Purpose: To develop a methodology to estimate the comparative cost of physician time in treating patients with localized prostate cancer, using as an example two-dimensional (2D) vs. three-dimensional (3D) conformal irradiation techniques, and to illustrate how current cost-accounting techniques can be used to quantify the cost of physician time and effort of any treatment. Methods and Materials: Activity-based costing, a recent innovation in accounting, widely recommended for estimating and managing the costs of specific activities, was used to derive physician resource utilization costs (actual cost of the physician services and related support services consumed). Results: Patients treated with 3D conformal irradiation consume about 50% more physician time than patients receiving 2D conventional radiation therapy. The average professional reimbursement for the 3D conformal irradiation is only about 26% more than for the 2D treatment. Substantial variations in cost are found depending on the total available physician working hours. In an academic institution, a physician working 40 hours a week would have to spend an average of about 60% of available time on clinical services to break even on a 2D treatment process and over 74% of available time on clinical work to break even on a 3D treatment process. The same physician working 50 hours a week would have to spend an average of about 48% of available time on 2D clinical services and about 60% of available time on 3D clinical work to break even. Current Medicare reimbursement for 3D treatment falls short of actual costs, even if physicians work 100% of a 50-hour week. Medicare reimbursement for 2D barely allows the department to break even for 2D treatments. Conclusions: Costs based on estimates of resource use can be substantially under- or overestimated. A consistent language (method) is needed to obtain and describe the costs of radiation therapy. The methodology described here can help practitioners and

  14. [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

  15. 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...

  16. Lung Cancer in the 1990s

    OpenAIRE

    Murray, Nevin

    1990-01-01

    The author reviews the investigation and staging of patients with lung cancer. Surgical, radiotherapy, and chemotherapy roles in management of non-small cell lung cancer and small cell lung cancer are discussed. The author concludes with practical guidelines for screening and prevention by family physicians.

  17. Diversity Based on Race, Ethnicity, and Sex, of the US Radiation Oncology Physician Workforce

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Christina H. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Hwang, Wei-Ting [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Deville, Curtiland, E-mail: deville@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-03-15

    Purpose: To assess the current diversity of the US radiation oncology (RO) physician workforce by race, ethnicity, and sex. Methods and Materials: Publicly available American Medical Association, American Association of Medical Colleges, and US census registries were used to assess differences by race, ethnicity, and sex for 2010 among RO practicing physicians, academic faculty, residents, and residency applicants. RO resident diversity was compared to medical school graduates and medical oncology (MO) fellows. Significant differences in diversity of RO residents by race, ethnicity, and sex were evaluated between 2003 and 2010 academic years. Results: Females and traditionally underrepresented minorities in medicine (URM), blacks, Hispanics, American Indians, Alaska Natives, Native Hawaiian, and Pacific Islanders are underrepresented as RO residents (33.3% and 6.9%, respectively), faculty (23.8%, 8.1%), and practicing physicians (25.5%, 7.2%) levels compared with the US population (50.8%, 30.0%; P<.01). Although females and URMs remain underrepresented at the resident trainee level compared with their proportions as medical school graduates (48.3%, 15.6%) and MO fellows (45.0%, 10.8%; P<.01), females are significantly increased in proportion as RO residents compared with RO practicing physicians (P<.01), whereas representation of individual URM groups as RO residents is no different than current practicing physicians. There is no trend toward increased diversification for female or URM trainees over 8 years, suggesting underrepresentation is not diminishing. Conclusions: Females and URM are underrepresented in the RO physician workforce. Given existing cancer disparities, further research and efforts are needed to ensure that the field is equipped to meet the needs of an increasingly diverse society.

  18. Diversity Based on Race, Ethnicity, and Sex, of the US Radiation Oncology Physician Workforce

    International Nuclear Information System (INIS)

    Purpose: To assess the current diversity of the US radiation oncology (RO) physician workforce by race, ethnicity, and sex. Methods and Materials: Publicly available American Medical Association, American Association of Medical Colleges, and US census registries were used to assess differences by race, ethnicity, and sex for 2010 among RO practicing physicians, academic faculty, residents, and residency applicants. RO resident diversity was compared to medical school graduates and medical oncology (MO) fellows. Significant differences in diversity of RO residents by race, ethnicity, and sex were evaluated between 2003 and 2010 academic years. Results: Females and traditionally underrepresented minorities in medicine (URM), blacks, Hispanics, American Indians, Alaska Natives, Native Hawaiian, and Pacific Islanders are underrepresented as RO residents (33.3% and 6.9%, respectively), faculty (23.8%, 8.1%), and practicing physicians (25.5%, 7.2%) levels compared with the US population (50.8%, 30.0%; P<.01). Although females and URMs remain underrepresented at the resident trainee level compared with their proportions as medical school graduates (48.3%, 15.6%) and MO fellows (45.0%, 10.8%; P<.01), females are significantly increased in proportion as RO residents compared with RO practicing physicians (P<.01), whereas representation of individual URM groups as RO residents is no different than current practicing physicians. There is no trend toward increased diversification for female or URM trainees over 8 years, suggesting underrepresentation is not diminishing. Conclusions: Females and URM are underrepresented in the RO physician workforce. Given existing cancer disparities, further research and efforts are needed to ensure that the field is equipped to meet the needs of an increasingly diverse society

  19. Distributive Justice and Attitudes of Intensive Care Physicians towards Distribution of Intensive Care Beds in Turkey

    Directory of Open Access Journals (Sweden)

    Akpınar A et al.

    2013-06-01

    Full Text Available Objective: To assess intensive care physicians’ attitudes about the importance of various factors in decisions to use intensive care in Turkey according to distributive justice. Methods: The study was conducted between 2004 and 2006 in two medical congresses in Turkey and via e-mail. A-self-administered questionnaire was presented to the intensive care physicians and they asked to make admission/discharge decisions for 13 cases, and to ascribe importance to 20 criteria. The relationship between characteristics of physicians and their decisions was analyzed by chi-square test and p<0.05 was accepted significant. Results: A total of 228 physician participated to the study. Eighty-three percent of physicians were contributing the admission /discharge decision-making process, 76% were making triage decisions because of resource scarcity. Most (69% of the physicians state that they would accept the case who has a living will regarding treatment refusal and 46% made the same decision for the patient in persistent vegetative state, the later rate is higher than the lung cancer patients. The leading discharge decisions were made for the postoperative patient with aortic aneurism (41% and the child with brain death (40%. Physicians mostly ascribed importance to medical criteria, then to the cost of the treatment to the family and to the public. Criteria which may cause discrimination were also regarded by some. Physicians’ characteristics affected their answers. Conclusion: We conclude that patient’s autonomy could be disregarded in intensive care, risky solutions and unacceptable criteria could be used when resource scarcity increases, and biased decisions could be made in intensive care.

  20. 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...

  1. 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...

  2. 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

  3. 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

  4. 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

  5. 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”.

  6. Get Tested for Colon Cancer: Here's How

    Medline Plus

    Full Text Available ... the types of tests then discuss each in detail. Tests that find cancer early: These tests detect ... your physician can be sure to examine every detail and not miss any abnormal growths. Barium enema ...

  7. Minimally Invasive Treatment for Lung Cancer

    Medline Plus

    Full Text Available ... the physicians, the nurse practitioners and the nursing staff, but we’re also very rigorous in maintaining ... both cancers, my case was taken before the staff board and I was discussed at the staff ...

  8. 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...

  9. 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...

  10. 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...

  11. 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)

  12. 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.

  13. 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...

  14. 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.

  15. 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…

  16. 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

  17. 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…

  18. 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...

  19. 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

  20. 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)

  1. 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…

  2. 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…

  3. 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...

  4. 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

  5. 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

  6. [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

  7. 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

  8. Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting

    International Nuclear Information System (INIS)

    Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients’ discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.

  9. 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 ...

  10. Chemotherapy and Targeted Therapy for Gall Bladder Cancer

    OpenAIRE

    Sirohi, Bhawna; Singh, Ashish; Jagannath, P.; Shrikhande, Shailesh V.

    2014-01-01

    Gall bladder cancer is a common cancer in the Ganges belt of North-eastern India. In view of incidental diagnosis of gall bladder cancer by physicians and surgeons, the treatment is not optimised. Most patients present in advanced stages and surgery remains the only option to cure. This review highlights the current evidence in advances in systemic therapy of gall bladder cancer.

  11. Detecting Prostate Cancer

    Medline Plus

    Full Text Available ... an abnormality in their rectal examination does not mean that they have prostate cancer. It means that we're concerned about it and they ... tissue with a needle. Physician: Now there's a little pressure -- you can probably feel that. Then you' ...

  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. Cancer Basics

    Science.gov (United States)

    ... Cancer? Breast Cancer Colon/Rectum Cancer Lung Cancer Prostate Cancer Skin Cancer Show All Cancer Types News and Features Cancer Glossary ACS Bookstore Cancer Information Cancer Basics Cancer Prevention & Detection Signs & Symptoms of Cancer Treatments & Side Effects ...

  18. Physical and underway data collected aboard the ENDEAVOR during cruise EN500 in the North Atlantic Ocean from 2011-10-12 to 2011-10-18 (NODC Accession 0103987)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NODC accession 0103987 includes physical and underway data collected aboard the ENDEAVOR during cruise EN500 in the North Atlantic Ocean from 2011-10-12 to...

  19. 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

  20. 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

  1. TO ASSESS NUTRITIONAL STATUS OF ADOLESCENTS (10-12 YEARS) FROM NON GOVERNMENT FUNDED SCHOOLS (PRIVATE) OF AN URBAN INDIAN CITY & KAP OF PARENTS/ TEACHERS REGARDING HEALTHY DIETARY AND LIFESTYLE BEHAVIORS FOR ADOLESCENTS.

    OpenAIRE

    Somila Surabhi; Meenakshi Bakshi Mehan; Sirimavo Nair

    2013-01-01

    To assess nutritional status of adolescents (10-12 years) from non government funded schools (private) of Gujarat, India. Teachers & parents of adolescent children were assessed regarding their knowledge, attitude and practices of healthy dietary & lifestyle behaviours. School canteen services were also critically evaluated. Parent’s willingness, to start a nutrition program in the school was also assessed. A cross sectional study was conducted on adolescents (10-12 years) from two selected p...

  2. Natural History of HPV and Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2009-10-12

    Dr. Phil Castle, an intramural research scientist at the National Institutes of Health, talks about the natural history of human papillomavirus (HPV) infections, and cervical cancer and other anogenital cancers.  Created: 10/12/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. Prediction of galactic cosmic ray intensity variation for a few (up to 10-12) years ahead on the basis of convection-diffusion and drift model

    International Nuclear Information System (INIS)

    We determine the dimension of the Heliosphere (modulation region) radial diffusion coefficient and other parameters of convection-diffusion and drift mechanisms of cosmic ray (CR) long-term variation, depending on particle energy, the level of solar activity (SA) and general solar magnetic field. This important information we obtain on the basis of CR and SA data in the past, taking into account the theory of convection-diffusion and drift global modulation of galactic CR in the Heliosphere. By using these results and predictions which are regularly published elsewhere of expected SA variation in the near future and prediction of next future SA cycle, we may make a prediction of the expected in the near future long-term cosmic ray intensity variation. We show that by this method we may make a prediction of the expected in the near future (up to 10-12 years, and may be more, in dependence for what period can be made definite prediction of SA) galactic cosmic ray intensity variation in the interplanetary space of different distances from the Sun, in the Earth's magnetosphere, and in the atmosphere at different altitudes and latitudes. (orig.)

  8. Characterization of 10,12-pentacosadiynoic acid Langmuir–Blodgett monolayers and their use in metal–insulator–metal tunnel devices

    Directory of Open Access Journals (Sweden)

    Saumya Sharma

    2014-11-01

    Full Text Available The characterization of Langmuir–Blodgett thin films of 10,12-pentacosadiynoic acid (PDA and their use in metal–insulator–metal (MIM devices were studied. The Langmuir monolayer behavior of the PDA film was studied at the air/water interface using surface tension–area isotherms of polymeric and monomeric PDA. Langmuir–Blodgett (LB, vertical deposition and Langmuir–Schaefer (LS, horizontal deposition techniques were used to deposit the PDA film on various substrates (glass, quartz, silicon, and nickel-coated film on glass. The electrochemical, electrical and optical properties of the LB and LS PDA films were studied using cyclic voltammetry, current–voltage characteristics (I–V, and UV–vis and FTIR spectroscopies. Atomic force microscopy measurements were performed in order to analyze the surface morphology and roughness of the films. A MIM tunnel diode was fabricated using a PDA monolayer assembly as the insulating barrier, which was sandwiched between two nickel layers. The precise control of the thickness of the insulating monolayers proved critical for electron tunneling to take place in the MIM structure. The current–voltage characteristics of the MIM diode revealed tunneling behavior in the fabricated Ni–PDA LB film–Ni structures.

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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.  

  14. 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.

  15. Contrary to Evidence, Some Doctors Recommend Ovarian Cancer Screening | Division of Cancer Prevention

    Science.gov (United States)

    One in three doctors believes that screening for ovarian cancer is effective, according to a recently published survey of practicing physicians, even though substantial evidence to the contrary exists. |

  16. 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

  17. 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

  18. 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

  19. [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

  20. Breast Cancer Risk Reduction, Version 2.2015.

    Science.gov (United States)

    Bevers, Therese B; Ward, John H; Arun, Banu K; Colditz, Graham A; Cowan, Kenneth H; Daly, Mary B; Garber, Judy E; Gemignani, Mary L; Gradishar, William J; Jordan, Judith A; Korde, Larissa A; Kounalakis, Nicole; Krontiras, Helen; Kumar, Shicha; Kurian, Allison; Laronga, Christine; Layman, Rachel M; Loftus, Loretta S; Mahoney, Martin C; Merajver, Sofia D; Meszoely, Ingrid M; Mortimer, Joanne; Newman, Lisa; Pritchard, Elizabeth; Pruthi, Sandhya; Seewaldt, Victoria; Specht, Michelle C; Visvanathan, Kala; Wallace, Anne; Bergman, Mary Ann; Kumar, Rashmi

    2015-07-01

    Breast cancer is the most frequently diagnosed malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. To assist women who are at increased risk of developing breast cancer and their physicians in the application of individualized strategies to reduce breast cancer risk, NCCN has developed these guidelines for breast cancer risk reduction. PMID:26150582

  1. Minimising radiation exposure to physicians performing fluoroscopically guided cardiac catheterisation procedures: A review

    International Nuclear Information System (INIS)

    What is known about radiation exposure to physicians who perform cardiac interventions is reviewed and various factors that affect their exposure are discussed. There are wide variations in the radiation dose (up to 1000-fold) per procedure. Despite extensive improvements in equipment and technology, there has been little or no reduction in dose over time. The wide variation and lack of reduction in operator doses strongly suggests that more attention must be paid to factors influencing the operator dose. Numerous patient, physician and shielding factors influence the operator dose to different degrees. Operators can change some of these factors immediately, at minimal or no cost, with a substantial reduction in dose and potential cancer risk. (authors)

  2. Improving empathy of physicians through guided reflective writing

    Directory of Open Access Journals (Sweden)

    Anita D. Misra-Hebert

    2012-04-01

    Full Text Available 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 received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2 neither received the reading materials nor participated in the sessions. Qualitative analysis of the physicians' reflective writings was performed to identify major themes. The Jefferson Scale of Empathy was administered three times during the course. Results: Qualitative analysis of physicians' writings showed themes of both compassionate solidarity and detached concern. Exploration of negative emotions occurred more frequently than positive ones. The most common writing style was case presentation. A total of 36 staff physicians completed the Jefferson Scale of Empathy. Results of statistical analysis suggested an improvement in empathy in the intervention group at the end of the course (p < 0 .05. Conclusions: These results suggest a faculty development program using guided narrative writing can promote reflection and may enhance empathy among practicing physicians. These findings should encourage medical educators to design additional strategies for enhancing reflection and empathic behavior in trainees and specifically practicing physicians who can role model these behaviors to achieve the ultimate goal of improving the quality of patient care.

  3. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  4. Evaluation of the UP4FUN intervention: a cluster randomized trial to reduce and break up sitting time in European 10-12-year-old children.

    Directory of Open Access Journals (Sweden)

    Frøydis N Vik

    Full Text Available The UP4FUN intervention is a family-involved school-based intervention aiming at reducing and breaking up sitting time at home (with special emphasis on screen time, and breaking up sitting time in school among 10-12 year olds in Europe. The purpose of the present paper was to evaluate its short term effects.A total of 3147 pupils from Belgium, Germany, Greece, Hungary and Norway participated in a school-randomized controlled trial. The intervention included 1-2 school lessons per week for a period of six weeks, along with assignments for the children and their parents. Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry. The effect of the intervention on these behaviors was evaluated by multilevel regression analyses. All analyses were adjusted for baseline values and gender. Significance level was p≤0.01. No significant intervention effects were observed, neither for self-reported TV/DVD or computer/game console time, nor for accelerometer-assessed total sedentary time and number of breaks in sitting time. The intervention group, however, reported more positive attitudes towards (β = 0.25 (95% CI 0.11, 0.38 and preferences/liking for (β = 0.20 (95% CI 0.08, 0.32 breaking up sitting time than the control group.No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed, but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group. Overall, these results do not warrant wider dissemination of the present UP4FUN intervention.International Standard Randomized Controlled Trial Number Registry ISRCTN34562078.

  5. El dolor de espalda como lesión deportiva en jóvenes de 10-12 años

    Directory of Open Access Journals (Sweden)

    Josep Vidal-Conti

    2014-01-01

    Full Text Available El objetivo de esta investigación es analizar la incidencia de dolor de espalda en jóvenes de entre 10 y 12 años en función de si practican o no algún deporte, cuál practican, con qué frecuencia, y las posibles diferencias entre género. El estudio se llevó a cabo en 2270 escolares (1214 niños y 1056 niñas de 10-12 años de Mallorca. La muestra se obtuvo por conglomerados (centros escolares por muestreo intencional. El cuestionario y la metodología de recogida de datos fueron previamente validados mediante el método test-retest. Los resultados obtenidos muestran que la existencia de dolor de espalda fue del 38.3% (34.5% en niños y 42.8% en niñas. Existe una relación significativa entre dolor de espalda y practicar deporte o no, en niños positiva y en niñas negativa, pudiendo ser explicado por las diferencias del tipo de deportes practicados según el género. Los mayores índices de incidencia de dolor de espalda aparecen entre los que practican voleibol, gimnasia deportiva y natación más de 4 horas semanales, y los que practican gimnasia rítmica. Este estudio sugiere, a partir de los resultados obtenidos, que el dolor de espalda es un mal que afecta de manera importante a la población juvenil, en especial al género femenino, y que el tipo de deporte practicado, así como su frecuencia, es determinante a la hora de definir si un deporte puede ser o no un factor de riesgo asociado al dolor de espalda.

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

    Institute of Scientific and Technical Information of China (English)

    Da-Hai Zhao; Ke-Qin Rao; Zhi-Ruo Zhang

    2016-01-01

    Background:Patient trust in physicians,which can be considered a collective good,is necessary for an effective health care system.However,there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide.This article aimed to assess patient trust in physicians through a quantitative study in Shanghai,China,and to provide appropriate suggestions for improving the trust in China.Methods:The data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital,which are two tertiary public hospitals in Shanghai,were used in this study.Patient trust in physicians was the dependent variable.Furthermore,a 10-item scale was used to precisely describe the dependent variable.The demographic characteristics were independent variables of trust in physicians.Binomial logistic regression was employed to analyze the factors associated with the dependent variable,which was divided into two categories on the basis of the responses (1:Strongly agree or agree and 0:Strongly disagree,disagree,or neutral).Results:This study found that 67% of patients trusted or strongly trusted physicians.The mean score of patient trust in physicians was 35.4 from a total score of 50.Furthermore,patient trust in physicians was significantly correlated with the age,education level,annual income,and health insurance coverage of the patients.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 physicianpatient relationship,rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

  7. Gambling in the south: implications for physicians.

    Science.gov (United States)

    Westphal, J R; Johnson, L J; Stodghill, S; Stevens, L

    2000-09-01

    Three historical cycles of legalized gambling have occurred in the South. Currently, every southern state has legalized some form of gaming. Adult past-year prevalence rates of problem gambling in southern states are within the national range. Higher prevalence rates occur in states with casinos and multiple forms of legalized gambling. States with lotteries have higher prevalence rates of adolescent problem gambling. Problem gambling can cause stress-induced physical diseases and psychiatric symptoms in gamblers and their families. Physicians can reduce personal, family, and social costs of problem gambling through increased awareness, strategic screening, and early intervention. Treatment approaches include inpatient treatment centers, self-help fellowship groups, and cognitive-behavioral and addiction-based psychotherapies. Although no standard pharmacologic treatments for gambling disorders exist, use of selective serotonin re-uptake inhibitors is under investigation. Referral resources are available to physicians in states with state-funded treatment programs for problem gamblers and/or state councils for problem gambling. PMID:11005341

  8. Violence against women: the physician's role.

    Science.gov (United States)

    Schmuel, E; Schenker, J G

    1998-10-01

    Violence against women is one reflection of the unequal power relationship between men and women in societies. Reflections of this inequality include marriage at a very young age, lack of information or choice about fertility control and forced pregnancy within marriage. The different forms of violence against women are: domestic violence and rape, genital mutilation or, gender-based violence by police and security forces, gender-based violence against women during armed conflict, gender-based violence against women refugees and asylum-seekers, violence associated with prostitution and pornography, violence in the workplace, including sexual harassment. Violence against women is condemned, whether it occurs in a societal setting or a domestic setting. It is not a private or family matter. The FIGO Committee for the Study of Ethical Aspects of Human Reproduction released statements to physicians treating women on this issue. Physicians are ethically obliged to inform themselves about the manifestations of violence and recognize cases, to treat the physical and psychological results of violence, to affirm to their patients that violent acts toward them are not acceptable and to advocate for social infrastructures to provide women the choice of seeking secure refuge and ongoing counselling. PMID:9846677

  9. The physician's civil liability under Danish law.

    Science.gov (United States)

    Fenger, N; Broberg, M

    1991-01-01

    The physician's liability in Danish law is based on negligence, which is assessed by the courts largely on the basis of expert opinions. Such opinions are provided primarily by the Medico-Legal Council rather than by experts selected by the parties. The evaluation of negligence is based on a "reasonable man" standard and the performance expected of a competent colleague; a hospital will be responsible for the negligence of its employees. The burden of proof generally lies with the plaintiff; negligence will not be presumed and the assessment of the evidence of negligence will be adapted to the individual situation, e.g. factors such as the degree of specialization involved, the time which the physician had at his disposal to make his decision and the resources available to him will be taken into consideration. The courts have shown themselves willing to allow for the fact that doctors differ, i.e. recognizing that there must be scope for reasonable discretion. Because the culpa principle is central, the standard applied to medical knowledge will be that which pertained at the time of the treatment. Where a non-specialist is confronted with a problem which may go beyond the knowledge of his limits and experience, he is under an obligation to refer the patient. The principle of informed consent to treatment is accepted in Danish law, but such consent will readily be considered to have been given tacitly. PMID:23511859

  10. Legal liability of physicians in medical research.

    Science.gov (United States)

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

    1994-04-01

    The intent of this paper is to provide an overview, in layperson's language, of the concepts in law which may be applicable to a physician who undertakes research. The paper is divided into 2 parts. Part I deals with liability issues and standards of care. It is meant to enable the physician/researcher to recognize a potential liability situation. Part II examines insurance and related issues such as the role of the Canadian Medical Protective Association (CMPA). The paper begins with a review of 2 potential categories of liability: criminal and civil tort. Next, legal issues surrounding the consent process, which form the majority of negligence claims, are dealt with. The research process is then discussed with emphasis on the Medical Research Council of Canada Guidelines on Human Experimentation. Part II covers how research projects are funded and identifies the parties from whom insurance coverage may be sought. Information is provided from the various sources offering insurance and quasi-insurance protection with special attention on the CMPA. Each source details the circumstances necessary for its particular coverage to be triggered. Other issues addressed include those arising when research is conducted outside Canada and multiple coverage. PMID:8004852

  11. 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 ...

  12. Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

    Directory of Open Access Journals (Sweden)

    Juan E Corral

    Full Text Available BACKGROUND: Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. METHODS: A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals. RESULTS: In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. CONCLUSION: Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

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

    Directory of Open Access Journals (Sweden)

    Pallerla Harini

    2006-12-01

    Full Text Available 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 use of the term error. The National Library of Medicine was systematically searched for medical error definitions. Survey participants were a random sample of active members of the American Academy of Family Physicians (AAFP and a selected sample of family physician patient safety "experts." A survey consisting of 5 clinical scenarios with problems (wrong test performed, abnormal result not followed-up, abnormal result overlooked, blood tube broken and missing scan results was sent by mail to AAFP members and by e-mail to the experts. Physicians were asked to judge if an error occurred. A qualitative analysis was performed via "immersion and crystallization" of emergent insights from the collected data. Results While one definition, that originated by James Reason, predominated the literature search, we found 25 different definitions for error in the medical literature. Surveys were returned by 28.5% of 1000 AAFP members and 92% of 25 experts. Of the 5 scenarios, 100% felt overlooking an abnormal result was an error. For other scenarios there was less agreement (experts and AAFP members, respectively agreeing an error occurred: 100 and 87% when the wrong test was performed, 96 and 87% when an abnormal test was not followed up, 74 and 62% when scan results were not available during a patient visit, and 57 and 47% when a blood tube was broken. Through qualitative analysis, we found that three areas may affect how physicians make decisions about error: the

  14. 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

  15. Physician Leadership: A Central Strategy to Transforming Healthcare.

    Science.gov (United States)

    Oostra, Randall D

    2016-01-01

    As the role of the physician leader becomes increasingly important in the transformation of healthcare, how hospitals, health systems, and other healthcare organizations define that role is undergoing radical change. Traditional physician leadership roles no longer are effective, and the independent medical staff approach is changing to a collaborative, team-oriented model. The dyad relationship between physician leaders and operational leaders is shifting from a rigid, siloed set of responsibilities to a model characterized by a distributed, situational framework of accountabilities, and the scope of influence of the physician leader and operational leader fluctuates depending on the situation and individuals involved. In addition, the focus of the physician leader is moving to one founded in servant leadership, with an increased emphasis on creating supportive models to enhance physicians' success and place them in the roles of leader and integrator of health. PMID:27125046

  16. 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

  17. Determining medical fitness to drive: physicians' responsibilities in Canada.

    Science.gov (United States)

    Coopersmith, H G; Korner-Bitensky, N A; Mayo, N E

    1989-01-01

    Current legislation indicates that physicians in Canada have a legal responsibility to know which medical conditions may impede driving ability, to detect these conditions in their patients and to discuss with their patients the implications of these conditions. The requirements to report unfit drivers vary among the provinces, and the interpretations of the law vary among the courts; therefore, physicians' risks of liability are unclear. Physicians may be sued by their patients if they fail to counsel the patients on the dangers of driving associated with certain medications or medical conditions. Physicians may also face legal action by victims of motor vehicle accidents caused by their patients if the court decides that the physicians could have foreseen the danger of their patients' continuing to drive. Physicians' legal responsibilities to report patients with certain medical conditions override their ethical responsibilities to keep patients' medical histories confidential. PMID:2914258

  18. The significance of appearance in physician-nurse collaboration

    DEFF Research Database (Denmark)

    Konradsen, H.; Christensen, O.M.; Berthelsen, C.

    2009-01-01

    INTRODUCTION: According to nurses' assessment, physician-nurse collaboration is problematic. The aim of the study was to investigate whether nurses believe physicians' appearances is significant for their ability to collaborate. MATERIAL AND METHODS: This is a single-blinded, quasi......-experimental intervention study. All physicians included will undergo a total plastic surgical body makeover. Half of the included physicians are to be operated with a view to enhance their physical features, half to weaken their physical features. Multifactorial ANOVA analysis will be used to secure the division. The...... Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration will be used for baseline and follow-up study of the nurses' assessment. RESULTS: Due to ethical considerations, researchers had difficulties finding surgeons prepared to perform procedures aiming at weakening the physicians' physical...

  19. 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

  20. 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.

  1. Encounters in cancer treatment

    DEFF Research Database (Denmark)

    Høybye, Mette Terp; Tjørnhøj-Thomsen, Tine

    2014-01-01

    Based on extensive ethnographic material from in-depth interviews with Danish cancer patients after treatment, this study analyzes their stories to explore how interactions with the physician configures and situates a need for rehabilitation. We identify three themes in the illness stories: (1...... this encounter. The significance of the social encounters in cancer treatment is elucidated through this analysis, and we demonstrate how the need for recognition of the complex effects of cancer on one's life is central to counter experiences of objectification and dehumanization....

  2. 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 ...

  3. Challenges and opportunities for reinvigorating the physician-scientist pipeline

    OpenAIRE

    Daye, Dania; Patel, Chirag B.; Ahn, Jaimo; Nguyen, Freddy T.

    2015-01-01

    Physician-scientists, with in-depth training in both medicine and research, are uniquely poised to address pressing challenges at the forefront of biomedicine. In recent years, a number of organizations have outlined obstacles to maintaining the pipeline of physician-scientists, classifying them as an endangered species. As in-training and early-career physician-scientists across the spectrum of the pipeline, we share here our perspective on the current challenges and available opportunities ...

  4. Attitudes and behaviors of Family Physicians regarding use of antibiotics

    OpenAIRE

    KARABAY, Oğuz; Özdemir, Davut; GÜÇLÜ, ERTUĞRUL; Yıldırım, Mustafa; İnce, Nevin; Küçükbayrak, Abdulkadir; Çakır, Selma; Gülenç, Mustafa; İnce, Mehmet; Demirli, Keziban

    2011-01-01

    Objectives: Antimicrobials are the most widely used drug groups and antibiotic resistance due to irrational antimicrobial usage is a major problem in the world. The aim of this study is to evaluate attitudes of family physicians antimicrobial prescribing. Materials and methods: This study was conducted in November 2006 in Bolu and Duzce provinces where the first family physician practices were initiated in Turkey. The records of family physicians were reviewed retrospectively. Patients\\' ...

  5. Attitudes and behaviors of Family Physicians regarding use of antibiotics

    OpenAIRE

    Selma Çakır; Keziban Demirli; Mehmet İnce; Mustafa Gülenç; Abdulkadir Küçükbayrak; Nevin İnce; Ertuğrul Güçlü; Mustafa Yıldırım; Davut Özdemir; Oğuz Karabay

    2011-01-01

    Objectives: Antimicrobials are the most widely used drug groups and antibiotic resistance due to irrational antimicrobial usage is a major problem in the world. The aim of this study is to evaluate attitudes of family physicians antimicrobial prescribing.Materials and methods: This study was conducted in November 2006 in Bolu and Duzce provinces where the first family physician practices were initiated in Turkey. The records of family physicians were reviewed retrospectively. Patients’ data, ...

  6. Early detection and treatment of hyperlipidemia: physician practices in Canada.

    OpenAIRE

    Tannenbaum, T N; Sampalis, J S; Battista, R N; Rosenberg, E R; Joseph, L.

    1990-01-01

    We surveyed primary care physicians in Canada to determine their current practices regarding the detection and treatment of hyperlipidemia in asymptomatic adults 20 years of age or more and to determine the role of selected patient characteristics (age, sex and the presence of coronary heart disease [CHD] risk factors) in their management decisions. The self-administered questionnaire was completed by 428 of 804 family physicians and general practitioners. The proportion of physicians who rep...

  7. Listening to native patients. Changes in physicians' understanding and behaviour.

    OpenAIRE

    2002-01-01

    OBJECTIVE: To discover how physicians develop an understanding of Native patients and communities that enables them to communicate better with these patients. DESIGN: Qualitative method of in-depth interviews. SETTING: Native communities across Canada. PARTICIPANTS: Ten non-Native physicians providing primary care to Native patients and communities. METHOD: In-depth, semistructured interviews explored communication strategies developed by primary care physicians working with Native patients. ...

  8. "ARZT IM GANZEN SPEKTRUM" ["PHYSICIAN IN THE FULL SPEKTRUM"

    OpenAIRE

    Mitzkat, Anika; Schulz, Christian; Kasenda, Benjamin; Langer, Thorsten; Schnell, Martin W

    2006-01-01

    [english] For more than 20 years teaching in the medical program at Witten/Herdecke Private University has followed the goal of introducing students to the reality of patient care by a practical approach. The “adaptive physician personality” describes the educational objective of a physician who is able to orient towards “the full spectrum” of his professional core competencies. In regard to the “adaptive physician personality” four Integrated Curricula (Communication, Science, Ethics, and He...

  9. Epistemological Beliefs and Knowledge among Physicians: A Questionnaire Survey

    OpenAIRE

    Pe�a, Adolfo; Paco, Ofelia; Peralta, Carlos

    2009-01-01

    Background: All sciences share a common underlying epistemological domain, which gives grounds to and characterizes their nature and actions. Insofar as physicians depend on scientific knowledge, it would be helpful to assess their knowledge regarding some theoretical foundations of science. Objectives: 1.To assess resident physicians? knowledge of concepts and principles underlying all sciences. 2. To determine, to what extent physicians? epistemological beliefs and attitudes are compatible ...

  10. EPISTEMOLOGICAL BELIEFS AND KNOWLEDGE AMONGST PHYSICIANS: A QUESTIONNAIRE SURVEY

    OpenAIRE

    Dr. Adolfo Peña.

    2002-01-01

    Background: All sciences share a common underlying epistemological domain, which gives grounds to and characterizes their nature and actions. Insofar as physicians depend on scientific knowledge, it would be helpful to assess their knowledge regarding some theoretical foundations of science. Objectives: 1.To assess resident physicians' knowledge of concepts and principles underlying all sciences. 2. To determine, to what extent physicians' epistemological beliefs and attitudes are compatible ...

  11. Physician Office Readiness for Managing Internet Security Threats

    OpenAIRE

    Keshavjee, K; Pairaudeau, N; Bhanji, A

    2006-01-01

    Internet security threats are evolving toward more targeted and focused attacks. Increasingly, organized crime is involved and they are interested in identity theft. Physicians who use Internet in their practice are at risk for being invaded. We studied 16 physician practices in Southern Ontario for their readiness to manage internet security threats. Overall, physicians have an over-inflated sense of preparedness. Security practices such as maintaining a firewall and conducting regular virus...

  12. Substance-impaired physicians probationary and voluntary treatment programs compared.

    OpenAIRE

    H. D. Nelson; Matthews, A M; Girard, D. E.; Bloom, J D

    1996-01-01

    We compared the characteristics and treatment outcomes of substance-impaired physicians monitored by two different programs in Oregon: a probationary program administered by the Oregon Board of Medical Examiners and the confidential, voluntary Diversion Program for Health Professionals. Demographic, substance use, and treatment outcome variables were obtained by a retrospective medical record review from 41 physicians monitored by the Oregon board and 56 physicians monitored by the diversion ...

  13. Clinical decision-making: physicians' preferences and experiences

    OpenAIRE

    White Martha; Pollack Lance; Murray Elizabeth; Lo Bernard

    2007-01-01

    Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence b...

  14. Auto-Faxing imaging reports to referring physicians

    OpenAIRE

    Robertson, Pauline; Day, Dennis; Leung, Desmond; Chien, Eugene; Lima-Simao, Fatima

    1997-01-01

    One of the major service issues within Medical Imaging is delivering reports quickly to referring physicians. As an effort to improve service, Mount Sinai Hospital’s Department of Medical Imaging implemented Auto-Fax to distribute imaging reports to physicians instead of the postal service. When a report is transcribed and then verified by the dictating radiologist, the radiology information system will automatically fax the result report to the referring physicians if subscribed to the Auto-...

  15. Physician participation in capital punishment: A question of professional integrity

    OpenAIRE

    Sikora, Andrew; Fleischman, Alan R.

    1999-01-01

    The death penaltyis legal in 36 states, and physicians are expected to attend and participate in executions. Yet, every major medical and health-related organization opposes physician participation in capital punishment. This article argues that it is unethical for physicians within the role as medical professional to participate in capital punishment, and that such acts erode the foundation of trust at the heart of medical practice. We believe that it is important for professional groups and...

  16. The Impact of Pain on Patient and Physician

    OpenAIRE

    Longhurst, Mark F.

    1984-01-01

    A patient's pain has lost its status as an expression of personal suffering and is seen by both physician and patient as a strictly physical attribute. Because of this, their communication may become oblique and subversive, effectively destroying a therapeutic relationship. The patient's failure to recover causes the physician to suffer unease and begin assuming pain-reducing postures of anger, indifference and assertiveness. The physician, to avoid this scenario, must acknowledge the existen...

  17. Burnout, Job Satisfaction, and Medical Malpractice among Physicians

    OpenAIRE

    Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

    2013-01-01

    Objectives: Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. Methods: We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians...

  18. Legal examination of physician advertising on the internet.

    Science.gov (United States)

    Carroll, Jenny

    2006-02-01

    The Internet provides an invaluable resource to physicians seeking to market healthcare services to consumers. No longer considered an unethical practice, physician advertising has transformed over the years into an indispensable business tool in the medical community. While the Internet creates opportunities to reach vast numbers of individuals in a timely and cost-effective manner, physicians must be vigilant in adhering to laws, rules, and regulations designed to protect the public from false and deceptive practices. PMID:16732508

  19. A time for reexamination: advertising of physician services.

    Science.gov (United States)

    Hite, R E

    1984-01-01

    How do consumers respond to advertising of physician services? In a thorough study undertaken by the author, this area is explored as well as the importance of consumer demographic characteristics and the appropriateness of the advertising media. The major implication of the study is that it is now time for reexamination of physicians' traditional abstinence from advertising. Tasteful advertisement of physician services cannot only provide benefits to the medical group, but also can answer the cries of consumers for more information. PMID:10265882

  20. Physician payment methods: a focus on quality and cost control

    OpenAIRE

    Rudmik, Luke; Wranik, Dominika; Rudisill-Michaelsen, Caroline

    2014-01-01

    With rising health care costs, governments must develop innovative methods to deliver efficient and equitable health care services. With physician remuneration being the third largest health care expense, the design of remuneration methods is a priority in health care policy. Otolaryngology-Head and Neck surgeons should have an understanding of the behavioural incentives associated with different physician payment methods. This article will outline the different physician payment methods with...

  1. Determining medical fitness to drive: physicians' responsibilities in Canada.

    OpenAIRE

    Coopersmith, H G; Korner-Bitensky, N A; Mayo, N E

    1989-01-01

    Current legislation indicates that physicians in Canada have a legal responsibility to know which medical conditions may impede driving ability, to detect these conditions in their patients and to discuss with their patients the implications of these conditions. The requirements to report unfit drivers vary among the provinces, and the interpretations of the law vary among the courts; therefore, physicians' risks of liability are unclear. Physicians may be sued by their patients if they fail ...

  2. Incorporating statistical uncertainty in the use of physician cost profiles

    OpenAIRE

    McGlynn Elizabeth A; Thomas J William; Adams John L; Mehrotra Ateev

    2010-01-01

    Abstract Background Physician cost profiles (also called efficiency or economic profiles) compare the costs of care provided by a physician to his or her peers. These profiles are increasingly being used as the basis for policy applications such as tiered physician networks. Tiers (low, average, high cost) are currently defined by health plans based on percentile cut-offs which do not account for statistical uncertainty. In this paper we compare the percentile cut-off method to another method...

  3. Potential for patient-physician language discordance in Ontario

    OpenAIRE

    Sears, Jennifer; Khan, Kamran; Ardern, Chris I.; Tamim, Hala

    2013-01-01

    Background Patient-Physician language discordance occurs when the patient and physician lack proficiency in the same language(s). Previous literature suggests language discordant clinical encounters compromise patient quality of care and health outcomes. The objective of this study was to quantify and visualize the linguistic and spatial mismatch between Ontario’s population not proficient in English or French but proficient in one of the top five non-official languages and the physicians who...

  4. Strategic Planning with Family Physicians: A Case Study

    OpenAIRE

    Fried, Bruce; Nelson, Wendy

    1987-01-01

    Family physicians at Sunnybrook Medical Centre were engaged in a strategic planning process to develop a practice philosophy, mission statement, short-term goals, and plan for future programming. Numerous issues were identified in relation to the need for planning, the successful involvement of family physicians in the planning process, and the traditional relationship between physicians and managers which, in the past, has inhibited productive collaboration. Strategies were developed to over...

  5. Managing erotic feelings in the physician-patient relationship.

    OpenAIRE

    Golden, G. A.; Brennan, M.

    1995-01-01

    In spite of prohibitions against the sexual involvement of physicians with their patients, erotic feelings sometimes arise in physician-patient relationships. The authors suggest that physicians can protect themselves and their patients from the harm that results from sexual involvement by establishing behavioural limits for their professional relationships, responding to patients' sexual overtures in a firm but nonjudgemental manner, examining their own sexual feelings rationally, seeking co...

  6. Health care system reform. Ontario family physicians' reactions.

    OpenAIRE

    2001-01-01

    OBJECTIVE: To determine the effect on a cohort of family physicians of health care system reforms in Ontario and the relationship of reforms to their career satisfaction. DESIGN: Follow-up survey in 1999 of a cohort initially studied in 1993, posing many of the original questions along with some new ones. Four focus groups of other Ontario family physicians. SETTING: Family practices in Ontario. PARTICIPANTS: All family physicians who had received certification after completing a family medic...

  7. Low-visibility light-intensity laser-triggered release of entrapped calcein from 1,2-bis (tricosa-10,12-diynoyl-sn-glycero-3-phosphocholine liposomes is mediated through a type I photoactivation pathway

    Directory of Open Access Journals (Sweden)

    Yavlovich A

    2013-07-01

    Full Text Available Amichai Yavlovich,1,* Mathias Viard,1,2,* Kshitij Gupta,1,* Jessica Sine,1,* Mylinh Vu,1 Robert Blumenthal,1 Darrell B Tata,3 Anu Puri1,*1Center for Cancer Research Nanobiology Program, National Cancer Institute, Frederick, MD, USA; 2Basic Science Program, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA; 3Centre for Devices and Radiological Health (CDRH/Office of Science and Engineering Laboratories(OSEL/Division of Physics, US Food and Drug Administration, White Oak, MD, USA*These authors contributed equally to this workAbstract: We recently reported on the physical characteristics of photo-triggerable liposomes containing dipalmitoylphosphatidylcholine (DPPC, and 1,2-bis (tricosa-10,12-diynoyl-sn-glycero-3-phosphocholine (DC8,9PC carrying a photo agent as their payload. When exposed to a low-intensity 514 nm wavelength (continuous-wave laser light, these liposomes were observed to release entrapped calcein green (Cal-G; Ex/Em 490/517 nm but not calcein blue (Cal-B; Ex/Em 360/460 nm. In this study, we have investigated the mechanism for the 514 nm laser-triggered release of the Cal-G payload using several scavengers that are known specifically to inhibit either type I or type II photoreaction pathways. Liposomes containing DPPC:DC8,9PC: distearoylphosphatidylethanolamine (DSPE-polyethylene glycol (PEG-2000 (86:10:04 mole ratio were loaded either with fluorescent (calcein or nonfluorescent (3H-inulin aqueous markers. In addition, a non-photo-triggerable formulation (1-palmitoyl-2-oleoyl phosphatidylcholine [POPC]:DC8,9PC:DSPE-PEG2000 was also studied with the same payloads. The 514 nm wavelength laser exposure on photo-triggerable liposomes resulted in the release of Cal-G but not that of Cal-B or 3H-inulin, suggesting an involvement of a photoactivated state of Cal-G due to the 514 nm laser exposure. Upon 514 nm laser exposures, substantial hydrogen peroxide (H2O2, ≈100 µM levels were detected from

  8. 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.

  9. Physician offices marketing: assessing patients' views of office visits.

    Science.gov (United States)

    Emmett, Dennis; Chandra, Ashish

    2010-01-01

    Physician offices often lack the sense of incorporating appropriate strategies to make their facilities as marketer of their services. The patient experience at a physician's office not only incorporates the care they receive from the physician but also the other non-healthcare related aspects, such as the behavior of non-health professionals as well as the appearance of the facility itself. This paper is based on a primary research conducted to assess what patients assess from a physician office visit. PMID:20054734

  10. 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

  11. Market power and contract form: evidence from physician group practices.

    Science.gov (United States)

    Town, Robert; Feldman, Roger; Kralewski, John

    2011-06-01

    We examine how the market power of physician groups affects the form of their contracts with health insurers. We develop a simple model of physician contracting based on 'behavioral economics' and test it with data from two sources: a survey of physician group practices in Minnesota; and the physician component of the Community Tracking Survey. In both data sets we find that increases in groups' market power are associated with proportionately more fee-for-service revenue and less revenue from capitation. PMID:21562732

  12. Spanning a Decade of Physician Boundary Violations: Are We Improving?

    Science.gov (United States)

    Swiggart, William; Dewey, Charlene; Ghulyan, Marine; Spickard, Anderson

    2016-06-01

    Sexual boundary violations can negatively impact the culture of safety within a medical practice or healthcare institution and severely compromise the covenant of care and physician objectivity. Lack of education and training is one factor associated with physician misconduct that leads to high financial and personal cost. This paper presents a follow-up study of physicians referred to a professional development course in 2001 and presents demographic data from 2001 to present. The paper focuses on the education and remediation progress regarding sexual misconduct by physicians. PMID:26013843

  13. 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

  14. Validity and reliability of the Vietnamese Physician Professional Values Scale.

    Science.gov (United States)

    Sang, Nguyen Minh; Hall, Alix; Huong, Tran Thi Thanh; Giang, Le Minh; Hinh, Nguyen Duc

    2015-01-01

    Physician values influence a physician's clinical practice and level of medical professionalism. Currently, there is no psychometrically valid scale to assess physician values in Vietnam. This study assessed the initial validity and reliability of the Vietnamese Physician Professional Values Scale (VPPVS). Hartung's original Physician Values in Practice Scale (PVIPS) was translated from English into Vietnamese and adapted to reflect the cultural values of Vietnamese physicians. A sample of clinical experts reviewed the VPPVS to ensure face and content validity of the scale, resulting in a draft 37-item measure. A cross-sectional survey of 1086 physicians from Hanoi, Hue and Ho Chi Minh City completed a self-report survey, which included the draft of the VPPVS. Exploratory Factor Analysis was used to assess construct validity, resulting in 35 items assessing physician's professional values across five main factors: lifestyle, professionalism, prestige, management and finance. The final five-factor scale illustrated acceptable internal consistency, with Cronbach's alpha coefficients ranging from 0.73 to 0.86 and all item-total correlations >0.2. Limited floor or ceiling effects were found. This study supports the application of the VPPVS to measure medical professional values of Vietnamese physicians. Future studies should further assess the psychometric properties of the VPPVS using large samples. PMID:25465039

  15. Physician-induced demand for surgery.

    Science.gov (United States)

    Cromwell, J; Mitchell, J B

    1986-12-01

    Following up the earlier findings by Fuchs on surgeon-induced demand, this paper makes numerous data and econometric improvements in conducting a test of neoclassical and inducement theories. A simultaneous equation model is used to estimate physician demand and equilibrium fees for surgery from a sample of 350 PSUs over the 1969-76 period. The results provide definite support for the notion of competitive market failure--particularly in large metropolitan areas. Other things equal, fees and utilization are higher in surgeon-rich areas although our estimated shift elasticities were only about one-third those found by Fuchs. A statistically significant, albeit small price elasticity of demand for surgery was also obtained, in contrast to Fuchs. Increasing monopoly and disequilibrium models are also tested without altering the basic findings. Where surgeons were in short supply, their availability significantly affected surgery rates, although a small supply effect was found in plentiful areas as well. PMID:10317903

  16. Qualitative Research on Emergency Medicine Physicians

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Musaeus, Peter

    2012-01-01

    with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and...... cross references were reviewed. The key words used were emergency medicine, qualitative, ethnography, observation, interview, video, anthropology, simulation, and simulation-based. Results: 820 papers were identified and 46 studies were included in this review. This literature review found that the......Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...

  17. Metabolic emergencies and the emergency physician.

    Science.gov (United States)

    Fletcher, Janice Mary

    2016-02-01

    Fifty percent of inborn errors of metabolism are present in later childhood and adulthood, with crises commonly precipitated by minor viral illnesses or increased protein ingestion. Many physicians only consider IEM after more common conditions (such as sepsis) have been considered. In view of the large number of inborn errors, it might appear that their diagnosis requires precise knowledge of a large number of biochemical pathways and their interrelationship. As a matter of fact, an adequate diagnostic approach can be based on the proper use of only a few screening tests. A detailed history of antecedent events, together with these simple screening tests, can be diagnostic, leading to life-saving, targeted treatments for many disorders. Unrecognised, IEM can lead to significant mortality and morbidity. Advice is available 24/7 through the metabolic service based at the major paediatric hospital in each state and Starship Children's Health in New Zealand. PMID:27062628

  18. Zygosity Diagnosis: When Physicians and DNA Disagree.

    Science.gov (United States)

    Segal, Nancy L

    2015-10-01

    Physicians and other medical professionals do not always provide new parents with an accurate diagnosis of their twins' zygosity. An overview of this problem is presented, supplemented by an interview with a mother who recently learned that her 2-year-old 'dizygotic (DZ)' twin girls are actually 'monozygotic (MZ)'. Reviews of two case studies, one of twins with sex-discordance and chimerism and the other of twins with congenital amegakaryotic thrombocytopenia, follow. Two additional studies, one a twin analysis of attractiveness to mosquitoes and the other a study of twins coping with crisis, are also described. Several articles and letters from the popular media, concerning less favored twins, paternity issues surrounding superfecundation, twins with late-onset Tay-Sachs disease, and triplets admitted to MIT are informative and insightful. PMID:26323370

  19. [Physician versus 'off-label" ordinance].

    Science.gov (United States)

    Kordus, Katarzyna; Spiewak, Radosław

    2015-01-01

    Polish physicians are obliged by legislation to prescribe drugs authorized for the sale in the Republic of Poland, based on registration documentation, including the Summaries of Product Characteristics (SPC). So called 'off label' treatment occurs in case of the conflict between prescription and information contained in the SPC, which may be considered as a 'medical experiment'. In case of adverse drug reactions, such classification excludes the responsibility of the marketing authorization holders, and damages are not covered by obligatory third party insurance, which can pose financial and legal consequences to the doctor. Deviations from SPC-compliant prescription may include a different way of drug administration, drug administration compliant with the indications yet in patients for whom there is no specified drug dosage, or in case of an indication not contained in the SPC. Medicinal products with equivalent active component, form and dose can have different registration indications in the SPC, and the actively promoted dispensation of less expensive substitutes by the pharmacists may, against doctor's will, result in the use that is non-compliant with registration of the substitute drug. Pharmacotherapy of 'orphan diseases', for which there are no registered medicinal products, also becomes an essential issue as it forces doctors into 'off-label' prescriptions. Moreover, the reimbursement of drugs in most cases is limited to medicinal products that are prescribed according to the registration indications. The pleas by medical professionals to make ordination and reimbursement of drugs depend on active pharmaceutical ingredient and evidence of efficacy, as well as to introduce Evidence Based Medicine (EBM) standards for the treatment of diseases, did not receive proper attention from the governing bodies. Therefore, a fundamental question remains unanswered as to what should be the principal gauge for physicians' therapeutic decision: the ethics, conscience

  20. [Struensee--physician and missjudged social reformer].

    Science.gov (United States)

    Nordlander, N B

    1996-01-01

    Johann Friedrich Struensee was born in 1737 in the German town of Halle where he graduated as doctor of Medicine at the age of 19. In 1757 he was appointed to be town physician in the big Danish town Altona, close to Hamburg. There he had a large medical practice among the poor, but he also succeeded in curing some important persons, which influenced his further career. During his eleven years in Altona he made many friends among the liberal circles and evolved an extensive writing of medical and social publications, where he called for reforms of housing, of hygiene, of fresh air and a sounder living. He organised a delivery clinic for single mothers and took care of the orphans. His opinions met with furious opposition from older doctors, whom he attacked for their greed and ignorance. In 1768 he was appointed to be the danish king Christian VII's physician during the kings visit to England. King Christian was mentally disturbed with fits of violence and confusion, but Struensee succeeded in gaining his confidence and after return to Denmark he was soon to be the absolute ruler of the country during three years. He started an intensive reform period with total freedom of the press, abolished peasant slavery and the death penalty, got rid of nepotism in the civil service, where only real competence should decide. He put an end to the great waste of money for luxury and superfluous staff in the court and in military units in order to improve the heavily indebted Danish economy. His reforms affronted many important persons and he never succeeded in gaining the confidence of the ordinary people, whose benefit he struggled for. By a sudden revolt Struensee's adversaries arrested him and forced the week and frightened king to sign the doctor's death sentence which was carried out April 28 1772 in spite of his noble document of defence. PMID:11624970

  1. Physician Cross-Cultural Nonverbal Communication Skills, Patient Satisfaction and Health Outcomes in the Physician-Patient Relationship

    OpenAIRE

    Ken Russell Coelho; Chardee Galan

    2012-01-01

    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 physici...

  2. The metrics and correlates of physician migration from Africa

    Directory of Open Access Journals (Sweden)

    Arah Onyebuchi A

    2007-05-01

    Full Text Available Abstract Background Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration. Methods Ranking and correlational analyses were conducted on African physician migration data adjusted for bilateral net flows, and supplemented with developmental, economic and health system data. The setting was the 53 African birth countries of African-born physicians working in nine wealthier destination countries. Three metrics of physician migration were used: total number of physician émigrés; emigration fraction defined as the proportion of the potential physician pool working in destination countries; and physician migration density defined as the number of physician émigrés per 1000 population of the African source country. Results Rankings based on any of the migration metrics differed substantially from those based on the other two metrics. Although the emigration fraction and physician migration density metrics gave proportionality to the migration crisis, only the latter was consistently associated with source countries' workforce capacity, health, health spending, economic and development characteristics. As such, higher physician migration density was seen among African countries with relatively higher health workforce capacity (0.401 ≤ r ≤ 0.694, p ≤ 0.011, health status, health spending, and development. Conclusion The perceived magnitude of physician migration is sensitive to the choice of metrics. Complementing the emigration fraction, the physician migration density is a metric

  3. Measurement and correlates of empathy among female Japanese physicians

    Directory of Open Access Journals (Sweden)

    Kataoka Hitomi U

    2012-06-01

    Full Text Available Abstract Background The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. Methods The Jefferson Scale of Empathy (JSE was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. Results The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach’s coefficient alpha was .81. Female physicians who were practicing in “people-oriented” specialties obtained a significantly higher mean empathy score than their counterparts in “procedure-” or “technology-oriented” specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. Conclusions Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians’ empathy may help physicians to avoid career burnout.

  4. Development of a Scale for Measuring Physician Perception: Physician Related Health Care Perception Scale

    Directory of Open Access Journals (Sweden)

    Meryem Heybet1

    2016-04-01

    Full Text Available Aim: Recently increased incidence of workplace violence in health care highlights the need for investigating the causes of such changes in clinical practice settings. The focus on the changes in attitudes of patients let us wonder whether the physician perception of the patients has changed and what the current perception is. The objective was to build up a scale to measure patients’ perceptions of health care. Methods: For developing a new scale we decided eight factors to be included in the scale; respect, trust, patient-doctor relation, medical practice skills, being knowledgeable about the medicine as a job, the perceptions and reflections of doctors in media, thoughts about violence against physicians and comply to rules of hospital. 77 attitude sentences were created. The draft scale with these attitude sentences were reviewed by two psychiatrists and a family physician who have experience with scale development. According to received feedbacks, the attitude sentences were further revised. Randomly selected 93 patients, who are above 18 years of age and who are willing to participate, were included in the study. We measured sentences by 5 fold Likert scale. We analyzed data by factor and reliability methods in SPSS 13.00 for Windows and evaluated for validity. Principal Component Analysis and Varimax rotation were used. Results: We obtained a scale with 6 factors and 34 attitude sentences. Cronbachalpha value was 0.891 (corrected 0.894. Factors were; respect, trust, patientdoctor relation, being knowledgeable about the medicine as a job, thoughts about violence against physicians and comply to rules of hospital. According to Principal Component Analysis, total variance explained rate 58.8%. Conclusions: There is no scale in the literature to measure patients’ perception of health care, so this scientific scale makes a high contribution to the current literature.

  5. Talent management and physician leadership training is essential for preparing tomorrow's physician leaders.

    Science.gov (United States)

    Satiani, Bhagwan; Sena, John; Ruberg, Robert; Ellison, E Christopher

    2014-02-01

    Talent management and leadership development is becoming a necessity for health care organizations. These leaders will be needed to manage the change in the delivery of health care and payment systems. Appointment of clinically skilled physicians as leaders without specific training in the areas described in our program could lead to failure. A comprehensive program such as the one described is also needed for succession planning and retaining high-potential individuals in an era of shortage of surgeons. PMID:24360239

  6. Development of a Scale for Measuring Physician Perception: Physician Related Health Care Perception Scale

    OpenAIRE

    Meryem Heybet1; Oğuz Tekin1; Rabia Kahveci1; et al.

    2016-01-01

    Aim: Recently increased incidence of workplace violence in health care highlights the need for investigating the causes of such changes in clinical practice settings. The focus on the changes in attitudes of patients let us wonder whether the physician perception of the patients has changed and what the current perception is. The objective was to build up a scale to measure patients’ perceptions of health care. Methods: For developing a new scale we decided eight factors to ...

  7. Physicians in health care management: 5. Payment of physicians and organization of medical services.

    OpenAIRE

    Vayda, E

    1994-01-01

    The financing, payment and organization of medical services are closely related. Canada's health care system is financed publicly, from tax revenue, and administered in each province by a single government payer. Although the chief method of payment to physicians is fee for service (FFS), the need to control costs and organize practice more efficiently has led to increased interest in FFS variants, such as capping payments at a certain level or fixing a budget, and alternative payment methods...

  8. Physicians in health care management: 1. Physicians as managers: roles and future challenges.

    OpenAIRE

    Leatt, P

    1994-01-01

    Physicians are increasingly expected to assume responsibility for the management of human and financial resources in health care, particularly in hospitals. Juggling their new management responsibilities with clinical care, teaching and research can lead to conflicting roles. However, their presence in management is crucial to shaping the future health care system. They bring to management positions important skills and values such as observation, problem-solving, analysis and ethical judgeme...

  9. Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals

    OpenAIRE

    Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

    2014-01-01

    Introduction The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. Methods This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a “high“ score on at least 2 of the three dimensio...

  10. Effect of carbon content on carbide morphology and mechanical properties of A.R. white cast iron with 10-12% tungsten

    Energy Technology Data Exchange (ETDEWEB)

    Heydari, D. [Department of Materials Science and Engineering, Sharif University of Technology, Tehran (Iran, Islamic Republic of); Skandani, A. Alipour [Department of Engineering Science and Mechanics, Virginia Tech, Blacksburg, VA 24061 (United States); Al Haik, M., E-mail: alhaik@vt.edu [Department of Engineering Science and Mechanics, Virginia Tech, Blacksburg, VA 24061 (United States)

    2012-04-30

    Highlights: Black-Right-Pointing-Pointer Effect of W and C variation in A.R. white cast iron was studied up to 12 wt% W. It never exceeded 10 wt% in previous investigations. Black-Right-Pointing-Pointer Carbide morphologies with 2.2-3.2 wt% carbon shows that W has dominating effect on carbide morphology. Black-Right-Pointing-Pointer New carbide microstructures (GA and IA) appear in some range of carbon and its volume fraction is function of carbon content. Black-Right-Pointing-Pointer After heat treatment, new carbide morphology turns to continuous chromium carbide. Black-Right-Pointing-Pointer Wear resistance and hardness of the new alloys depends on both IA appearance presence and tungsten carbide precipitation. - Abstract: Carbide morphologies of white cast iron containing 22% Cr and 10-12% tungsten with different carbon contents (2.34-3.20 wt.%) were investigated. Results indicated that for the as-cast alloys with no heat treatments, the addition of carbon changes the morphology of carbides during air-cooling in the presence of tungsten. Light microscopy analysis revealed that for an alloy with 2.3 wt% carbon, chromium carbides possess coarse gray appearance (GA). Increasing the carbon content reduced the coarse GA zones volume fraction while a finer GA zones emerged. The coexistence of coarse and fine GA phases came to an end at 2.8 wt% carbon, at which only fine GA zones spread throughout the chromium carbide phase. Scaling up the carbon content to 3.2 wt% led to the formation of tungsten carbide and austenite in a eutectic reaction. Both fine and coarse GA zones vanished while the tungsten carbides acquired fishbone-like morphology. Upon heat treatment, the coarse GA zones vanished completely and turned into island appearance (IA) of chromium carbide. On the contrary, the finer GA zones remained unchanged after heat treatment and they coexisted with the IA. After heat treatment, the fishbone morphology shattered apart, however, the hyper chromium carbides

  11. Physician and patient perceptions of cultural competency and medical compliance.

    Science.gov (United States)

    Ohana, S; Mash, R

    2015-12-01

    To examine the relationship between the different perceptions of medical teams and their patients of the cultural competence of physicians, and the influence of this relationship on the conflict between them. Physicians' cultural competence (Noble A. Linguistic and cultural mediation of social services. Cultural competence of health care. Echo New Studio 2007; 91:18-28) might reduce this phenomenon. Structured questionnaires were distributed to 90 physicians working in outpatient clinics in a central hospital in Israel, and to 417 of their patients. Each physician had four to six sampled patients.The findings showed a significant negative correlation (r = -0.50, P < 0.05) between the physicians' perception of their cultural competence and the patients' perception of physician competence. The more patients perceive the physician as culturally competent, the more they comply with their medical recommendations. In addition, the findings show that ethnicity significantly affects patients' perception of the cultural competence of physicians, and their satisfaction with the medical care they receive. PMID:26590243

  12. 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

  13. Training Physician-Scientists for the 1990s.

    Science.gov (United States)

    Martin, Joseph B.

    1991-01-01

    The article examines trends in the supply of physician-scientists, with emphasis on M.D.-Ph.D. programs to train biomedical researchers. New initiatives, such as the National Institutes of Health Physician-Scientist Training Awards and the Dana Foundation Training Program in the Neurosciences, are described and general recommendations are offered.…

  14. The Patient-Physician Relationship and Medical Utilization

    OpenAIRE

    Lynch, Denis J.; McGrady, Angele V.; Nagel, Rollin W.; Wahl, Elmer F.

    2007-01-01

    Objective: The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2) evaluate the relationship between physician perception of patient difficulty, chronic medical problems, and patient somatizing tendencies.

  15. 78 FR 22270 - Special Fraud Alert: Physician-Owned Entities

    Science.gov (United States)

    2013-04-15

    ... correction to the OIG Federal Register ] notice published on March 29, 2012 (78 FR 19271), on our recently issued Special Fraud Alert on Physician-Owned Entities. Specifically, the Special Fraud Alert addressed... HUMAN SERVICES Office of Inspector General Special Fraud Alert: Physician-Owned Entities AGENCY:...

  16. Educating Physicians for the Twenty-First Century.

    Science.gov (United States)

    Greenlick, Merwyn R.

    1995-01-01

    Changes in medical and health care since 1935 are reviewed and factors affecting medicine and physician training in the future are examined, including technology, economic factors, role of government, physician social responsibility, and the medical culture. Oregon Health Sciences University's efforts to develop clinical and population-based…

  17. Final Report. [Training of Physicians for Rural Areas

    Energy Technology Data Exchange (ETDEWEB)

    McLaughlin, Max, MD

    2004-07-23

    The purpose of the Southwest Alabama Medical Education Consortium (SAMEC) is to create an organization to operate a medical residency program focused on rural physician training. If successful, this program would also serve as a national model to address physician placement in other rural and underserved areas.

  18. 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...

  19. Estate and business planning for the retiring physician.

    Science.gov (United States)

    Kingma, Kenneth W; Vaughn, Thomas D

    2012-01-01

    Retiring physicians have much to think about for estate planning purposes. The authors stand ready to help physicians sell or close their medical practice, navigate the 2010 Tax Act, take advantage of current planning opportunities, and prepare appropriate estate planning documents. Every estate is unique, so it is important to contact an estate planning advisor before taking any action. PMID:22428444

  20. Episiotomy: Differences in practice between family physicians and obstetricians

    OpenAIRE

    Ruderman, James; Carroli, June C.; Reid, Anthony J; Murray, Michael A.

    1992-01-01

    A review of 2188 records compared the numbers and types of episiotomies and tears in low-risk women delivered by family physicians and obstetricians. Family physicians performed significantly fewer episiotomies and were more likely to rely on the mediolateral procedure; obstetricians varied episiotomy type more often. The rates of third-degree tears and intact perineum were very similar.

  1. 49 CFR 386.48 - Medical records and physicians' reports.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Medical records and physicians' reports. 386.48... HAZARDOUS MATERIALS PROCEEDINGS General Rules and Hearings § 386.48 Medical records and physicians' reports... results, and other medical records that a party intends to rely upon shall be served on all other...

  2. CMA leads drive to improve physicians' management skills

    OpenAIRE

    Wharry, S

    1997-01-01

    The Physician Manager Institute, developed 12 years ago by the CMA and the Canadian College of Health Service Executives, provides training that is designed to improve physicians' management and leadership skills. Changes within health care are prompting more doctors to seek this training in order to become managers within a reformed health care system.

  3. How Physicians Can Introduce Sex Education in Schools

    OpenAIRE

    Savage, John

    1985-01-01

    In 1981 the author described the introduction of a Human Growth and Development section in a school health program in Dartmouth, Nova Scotia. This article describes the step by step progress a community physician can take to negotiate with school boards the introduction of such a program. The emphasis is on preventive medicine in the community where the physician practices.

  4. Returning Physicians to the Workforce: History, Progress, and Challenges

    Science.gov (United States)

    Varjavand, Nielufar; Novack, Dennis H.; Schindler, Barbara A.

    2012-01-01

    There is growing recognition of the need to reeducate clinically inactive physicians seeking to return to practice and in the facilitation of this return. Physicians seeking to return to practice face many challenges: maneuvering the various requirements of licensing, medical, and credentialing boards; finding an appropriate educational program to…

  5. Specialist physician knowledge of chronic kidney disease: A comparison of internists and family physicians in West Africa

    Directory of Open Access Journals (Sweden)

    Emmanuel I. Agaba

    2012-02-01

    Full Text Available Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD. We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists. Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians.Results: Only 19 (27.5% of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2% of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28. Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians.Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians.

  6. Issues on training of physicians/technologists

    International Nuclear Information System (INIS)

    Full text: With the rapid advances of technology and radiopharmaceutical development training must be constantly adapted to meet the necessary quality standards. According to a recent survey of the European Association of Nuclear Medicine (EANM) Board exams are requested for nuclear medicine physicians in 21/28 European countries, in 9 and 8 countries for physicists and radiopharmacists, respectively and 14 countries for technologists. Furthermore, the European Board of Nuclear Medicine organises each year a European Board exam that confers the title of European fellow to European specialists in Nuclear Medicine who have successfully passed the written and oral parts of these exams. In recent years this exam has been made available also to colleagues from non-European countries that by passing the exam are attested that their knowledge and ability fulfils European standards. Concerning the content of training, the revised version of the syllabus, is a condensed catalogue of training requirements, has been published in the European Journal of Nuclear Medicine (2007;34:433436). It clearly states the scopes and limits of the medical specialty of nuclear medicine on which are based the formative objectives that include basic and specific theoretical, as well as integrative objectives. Finally the requirements in basic science and clinical training are enumerated. nuclear medicine is a complex speciality, which is characterised by extensive transversality asking for broad basic, clinical and technological knowledge. Training programmes must take this diversity into consideration. The arrival of multimodality imaging, today PET and SPECT coupled to CT, tomorrow also to magnetic resonance scanners represent an additional challenge. It is the absolute right of the patient to have his/her imaging study interpreted by the most competent physician. It is, however, with the increasing workload not possible to have all PET or SPECT-CT studies interpreted by both, a specialist

  7. Determinants of increased primary health care use in cancer survivors.

    NARCIS (Netherlands)

    Heins, M.; Schellevis, F.; Rijken, M.; Hoek, L. van der; Korevaar, J.

    2012-01-01

    Purpose: The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of

  8. Physicians' Professionally Responsible Power: A Core Concept of Clinical Ethics.

    Science.gov (United States)

    McCullough, Laurence B

    2016-02-01

    The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power--the legitimation of physicians' power--a core concept of clinical ethics. In the absence of legitimation, the physician's power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians' power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. PMID:26671961

  9. Expansion of On-Line Database Use by the Cancer Information Service

    OpenAIRE

    Davis, Sharon Watkins; Fox, Laurie

    1987-01-01

    Vincent DeVita, the director of the National Cancer Institute, has been promoting the use of the user-friendly cancer database system, Physician's Data Query (PDQ), both by physicians and by the public. Because on-line access to PDQ is limited to physicians or other qualified health care professionals, the Cancer Information Service, through its toll-free 1-800-4-CANCER telephone number, provides a major point of access to this system. This paper analyzes changes in the patterns of PDQ use ov...

  10. Marketing factors affecting physician choice as related to consumers' extent of use and predisposition toward use of physician services.

    Science.gov (United States)

    Wotruba, T R; Haas, R W; Oulhen, H

    1985-01-01

    This study explores the relationship between predisposition toward, and the extent of actual use of, physician services. Factors in a physician's marketing offering of most importance to consumers in various predisposition and use categories are identified along with their demographic differences, and marketing strategy implications are noted. PMID:10275160

  11. 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…

  12. PATIENT CHARACTERISITCS AND PHYSICIAN FACTORS DETERMINING THE UTILIZATION OF AUTOMATIC CLINICAL ANALYZER

    Directory of Open Access Journals (Sweden)

    Tri Juni Angkasawati

    2012-11-01

    Full Text Available The changing of disease patterns from infectious diseases to heart, cancer, and degenerative diseases needs advanced technologies to support diagnosis and to give therapies. The Automatic Clinical Analyzer (ACA is one of modem laboratory equipments which continuously developed to enhance patient service outcomes. Previous researches showed its utilization rates varied 20-46.6% from total capacities per year. It indicated low utilization problems. So this research aimed patient characteristics and physician factors determining the utilization of the ACA. This was a descriptive study with a to-cross sectional design. Data were collected by interview to patients visited laboratories and physicians who referred patients for determine laboratory examinations using the ACA. The study was conducted in 2 (two public hospital laboratories and 4(four private clinical laboratories in Surabaya and Malang, East Java Province. Data were analyzed descriptively. Results showed that the patient characteristics who used ACA were higher proportion of those with older aged, women and senior high school to above education levels. Access to the services was also a determining factor of the ACA use because further distance increased transportation cost to reach the facilities. It also showed that the higher patient income received more services from the ACA and likely to visit private laboratories. From the physician view points, the factor determining the ACA use were that exmination results supported diagnosis, quickly be knew or received and easy to get. The study recommends to conduct further ACA studies associated with feasibility and effective cost to respond equity problems and the efficiency of ACA use. Key words: utilization, Automatic Clinical Analyzer, patients, physicians

  13. Autism: A review for family physicians

    Directory of Open Access Journals (Sweden)

    Karande Sunil

    2006-05-01

    Full Text Available Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child′s specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child′s progress on a long term basis.

  14. Ethics and responsibility of the physics physician

    International Nuclear Information System (INIS)

    Professional ethics in radiation protection is characterized by high set of standards governing the conduct of any professional who is responsible for enforcing o accomplish with a set of laws and rules aimed at protecting the individuals health and the physical security of radiation sources. Without losing sight of the fulfillment of these obligations are not limited to such minimum standards and expressed as active all have a right to recognize and accept the consequences of an act done freely. There are a number of institutions that function as moral and ethics authorities in radiation protection, such as the IAEA, the Committee on Radiation Protection and Public Health at the NEA, the UNSCEAR, in addition to national authorities in each country. There are also a reference regulatory framework which includes the Regulatory Law to Article 27 of the Constitution in the Nuclear Matter, the General Regulation of Radiation Safety and the Mexican Official Standards. The use of radiation sources representing a wide range of charitable purposes but their use involves risks due to possible radiations exposure. Hence arises the need to protect individuals, society and environment against the adverse effects of possible accidents and malicious acts involving radioactive sources. In the case of the physics physician, there is a matrix of responsibilities under obligations not only in terms of treatment planing, but also equipment, dosimetry, radiation protection and even some kinds of academic and administrative. (Author)

  15. A public health physician named Walter Leser.

    Science.gov (United States)

    Mello, Guilherme Arantes; Bonfim, José Ruben de Alcântara

    2015-09-01

    A brief review of the career of the public health physician Walter Sidney Pereira Leser, who died in 2004 aged 94. Self-taught, from his 1933 doctoral thesis he became a country reference in the field of statistics and epidemiology, with dozens of studies and supervisions. In the clinical field he is one of the founders of Fleury Laboratory, and participates in the creation of CREMESP. As an academic, Leser was a professor at the Escola de Sociologia e Política de São Paulo, Escola Paulista de Medicina e Faculdade de Farmácia e Odontologia da USP. Also, Leser introduced objective tests in the college entrance examination, and led the creation of CESCEM and Carlos Chagas Foundation. In the Escola Paulista de Medicina he created the first Preventive Medicine Department of the country. As a public official, he was secretary of the State Department of Health of São Paulo between 1967 and 1971 and between 1975 and 1979, responsible for extensive reforms and innovations. Among the most remembered, the creation of sanitary medical career. Throughout this legacy, he lent his name to the "Medal of Honor and Merit Public Health Management" of the State of São Paulo. PMID:26331506

  16. How Digital Health Technology Aids Physicians

    Directory of Open Access Journals (Sweden)

    Nik Tehrani

    2015-06-01

    Full Text Available There is so much health and medical information available today that physicians cannot be expected to know it all. Thus, advances in technology have become a necessity for doctors to track patient information and care, and add to patient databases for reference and to conduct research. It is important to understand the new language of digital health, such as Personal Health Record (PHR, Electronic Medical Record (EMR and Electronic Health Record (EHR, all of which sound similar, but are not interchangeable. The ideal comprehensive IT system would empower patients, advance healthcare delivery and transform patient data into life-saving research (Kaiser, 2015. OmniFluent Health is language translation software that will allow for better patient/practitioner communication and avoid errors. Digital technology employs the use of big data that is shared, accessed, compiled and applied using analytics. However, information transfer, especially as mandated by current ethics of use of technology, has resulted into breach of patient privacy. Improved digital technology is providing the health care field with upgrades that are necessary, electronic files and health records, from mobile apps, and remote monitoring devices.

  17. Incentives for cost-effective physician behavior.

    Science.gov (United States)

    Maynard, A

    1987-04-01

    The objective of the National Health Service is to maximise improvements in the health status of patients regardless of their willingness and ability to pay. To achieve this objective it is necessary to identify those procedures which maximise improvements in health or quality adjusted life years (QALYs) and direct scarce resources to those therapies with the best cost-QALY characteristics. Unfortunately in the NHS and elsewhere cost-QALY characteristics are largely unknown and the structure of the health service and its provider remuneration systems are such that objectives are vague, behavior perverse due to the haphazard construction of incentive systems, and health status outcomes often unknown due to the failure to evaluate input-outcome relationships. To reform the NHS, in particular ensure more efficient practice by physicians, existing perverse incentives will have to be replaced by the use of buyer (NHS) power and by budgeting mechanisms which induce economizing behavior. It is not clear which type of incentive mechanism will produce outcomes consistent with NHS goals. To remedy this ignorance experimentation with careful evaluation would seem appropriate. PMID:10312074

  18. 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

  19. Aelius Aristides as Informed Patient and Physician.

    Science.gov (United States)

    Petridou, Georgia

    2016-01-01

    Aelius Aristides, one of the most renowned orators of the so-called second sophistic, has often been thought of as the paradigmatic patient who surrendered his physical and psychological health to Asclepius, and spent a large part of his life in the temple of the god at Pergamum blindly following divine orders on diet and regimen. This study looks at the Hieroi Logoi as an illness narrative and argues against such a simplistic view and in favour of a more complex picture: Aristides is a far cry far from the submissive patient, who idly resided in the Pergamene Asclepieion relying exclusively on the therapeutic powers of the god and his human helpers. In fact, through a close reading of a selection of passages from the Hieroi Logoi a whole new image of Aristides emerges: the informed patient who is not only in possession of the basics of the medical discourse but who also functions as a physician of sorts, taking both his own life and the lives of others into his hands. This new type of patient, the knowledgeable patient, who is well-versed in medical matters and envisages himself as an active agent of the healing process and an equally important partner in the medical encounter, ties well with other testimonies we have about knowledgeable patients mostly to be found amongst the members of the socio-political elite of the time. PMID:26946690

  20. 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