WorldWideScience

Sample records for family physicians design

  1. Incest and the family physician.

    Science.gov (United States)

    Boekelheide, P D

    1978-01-01

    This paper is a review of incest from epidemiologic, familial, and individual points of view. The incest taboo has characterized almost every culture and society throughout the ages. Respect for the incest barrier is a cultural demand made by society and is not a physiological or biological imperative. Overt incest occurs in a dysfunctional family through tension-reducing "acting out." The family physician is in a unique position to observe and understand the family dynamics which both help maintain defenses against the incestuous wishes as well as, in some families, contribute to the practice of incest. For 2,000 years physicians have taken the Hippocratic oath, with its explicit love relationship clause, as a reminder of their ethical responsibilities towards their patients. Examples of para-incestuous relationships between vulnerable individuals and authoritative helping figures are cited. A psychodynamic rationale is offered as to why sexual relationships between patients and their family physicians are not therapeutically beneficial. Clues for assessment and ten preventive measures are presented to enable physicians to monitor themselves and the families in their practice.

  2. Patient expectations from consultation with family physician.

    NARCIS (Netherlands)

    Tähepöld, H.; Brink-Muinen, A. van den; Maaroos, H.I.

    2006-01-01

    Aim: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. Method: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped

  3. Case reviews in the family physician's office.

    Science.gov (United States)

    Kates, N; Craven, M; Webb, S; Low, J; Perry, K

    1992-02-01

    The majority of patients with emotional or psychiatric disorders are treated in the primary care setting without psychiatric input. Psychiatrists need to find ways of helping family physicians manage these patients without necessarily taking over their care. One way of achieving this is for a psychiatric consultant to visit the family physician's office on a regular basis to discuss the physician's problem cases. This paper describes such a pilot project, outlines the kinds of problems family physicians discussed and recommendations that were made, and discusses the benefits of this collaborative approach.

  4. Family physicians and HIV infection.

    Science.gov (United States)

    Hall, N; Crochette, N; Blanchi, S; Lavoix, A; Billaud, E; Baron, C; Abgueguen, P; Perré, P; Rabier, V

    2015-01-01

    We aimed to describe the current and desired involvement of family physicians (FPs) in the treatment of HIV patients (screening practices, potential training and patient follow-up) to reduce the duration and frequency of their hospital treatment. We conducted a descriptive cross-sectional survey between 2011 and 2012 with the support of COREVIH (Regional Coordinating Committee on HIV). We sent a self-assessment questionnaire to all FPs of the Pays de la Loire region to enquire about their HIV screening practices and expectations for the management of HIV patients. A total of 871 FPs completed the questionnaire (response rate: 30.4%). A total of 54.2% said to provide care to HIV patients; the mean number of HIV patients per FP was estimated at 1.4. With regard to HIV screening, 12.2% systematically suggest an HIV serology to their patients and 72.7% always suggest it to pregnant women. About 45.4% of responding FPs said to be willing to manage HIV patients (clinical and biological monitoring, compliance checks and prescription renewal). FPs mainly reported the lack of training and the low number of HIV patients as a barrier to their further involvement in the management of HIV patients. The responding FPs provide care to very few HIV patients. They are, however, willing to be more involved in the routine care of these patients. Medical training provided by COREVIH would help improve HIV screening. The management of HIV patients could thus be handed over to willing FPs. Copyright © 2015. Published by Elsevier SAS.

  5. Care partnerships between family physicians and rheumatologists.

    Science.gov (United States)

    Lou, Benjamin; DE Civita, Mirella; Ehrmann Feldman, Debbie; Bissonauth, Asvina; Bernatsky, Sasha

    2011-09-01

    To describe care partnerships between family physicians and rheumatologists. A random sample (20%, n = 478) of family physicians was mailed a questionnaire, asking if there was at least 1 particular rheumatologist to whom the physician tended to refer patients. If the answer was affirmative, the physician would be considered as having a "care partnership" with that rheumatologist. The family physician then rated, on a 5-point scale, factors of importance regarding the relationship with that rheumatologist. The questionnaire was completed by 84/462 (18.2%) of family physicians; 52/84 (61.9%) reported having rheumatology care partnerships according to our definition. Regarding interactions with rheumatologists, most respondents rated the following as important (score ≥ 4): adequate communication and information exchange (44/50, 88.0%); waiting time for new patients (40/50, 80.0%); clear and appropriate balance of responsibilities (39/49, 79.6%); and patient feedback and preferences (34/50, 68%). Male family physicians were more likely than females to accord high importance to personal knowledge of the rheumatologist, and to physical proximity of the rheumatologist's practice. Regarding relationships with rheumatologists, 30/50 (60.0%) of respondents felt communication and information exchange were adequate, and 35/50 (70.0%) felt they had a clear balance of responsibilities. Almost two-thirds of family physicians have rheumatology care partnerships, according to our definition. In this partnership, establishing adequate communication and shorter waiting time seem of paramount importance to family physicians. A balanced sharing of responsibilities and patients' preferences are also valued. Although many physicians reported adequate communication and clear and appropriate balance of responsibilities in their current interactions with rheumatologists, there appears to be room for improvement.

  6. Gender, family status and physician labour supply.

    Science.gov (United States)

    Wang, Chao; Sweetman, Arthur

    2013-10-01

    With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis. Although both male and female physicians have statistically indistinguishable hours of market work when never married and without children, married male physicians have higher market hours, and their hours are unchanged or increased with parenthood. In contrast, female physicians have lower market hours when married, and much lower hours when a parent. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcomes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician's spouse is much less likely to be employed, and if employed, has lower market hours in the presence of children. In contrast, a female physician's spouse is more likely to be employed if there are three or more children. Both male and female physicians have lower hours of work when married to another physician. Overall, there is no gender difference in physician market labour supply after controlling for family status and demographics.

  7. 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.

  8. The economic impact of rural family physicians practicing obstetrics.

    Science.gov (United States)

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  9. Do People with Disabilities Have Difficulty Finding a Family Physician?

    Directory of Open Access Journals (Sweden)

    Mary Ann McColl

    2015-04-01

    Full Text Available Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC is a government-funded agency in Ontario Canada, designed to “help Ontarians who are without a family health care provider to find one”. Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients.

  10. Do people with disabilities have difficulty finding a family physician?

    Science.gov (United States)

    McColl, Mary Ann; Aiken, Alice; Schaub, Michael

    2015-04-28

    Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC) is a government-funded agency in Ontario Canada, designed to "help Ontarians who are without a family health care provider to find one". Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients.

  11. The post-suicide family and the family physician.

    Science.gov (United States)

    Fisher, J V; Barnett, B L; Collins, J

    1976-06-01

    It is estimated that there are 750,000 people each year who are intimately affected by suicide. Prominent among these are the family survivors and their family physician. This paper offers a time frame which divides the period following the suicide into three phases: Immediate (the first ten days after the suicide); Intermediate (after the first ten days through the first year); and Extended (from the first year until restitution occurs). It identifies the chief emotional reactions which occur in each phase, explores their psychodynamic origins, and proposes suggestions for appropriate management during each of the three periods. The goal of this plan of management is to enable the family physician to function in a supportive emphatic, and restorative manner for the post-suicide family.

  12. A multifaceted education intervention for improving family physicians' case management.

    Science.gov (United States)

    Reyes-Morales, Hortensia; Flores-Hernández, Sergio; Tomé-Sandoval, Patricia; Pérez-Cuevas, Ricardo

    2009-04-01

    The Mexican Institute of Social Security (IMSS) is the largest public health care system in Mexico. IMSS family physicians' management of clinical problems is frequently not consistent with published evidence. This study aimed to evaluate the effects of a multifaceted educational intervention to improve management of acute respiratory infections (ARI) by IMSS family physicians. A non-randomized pre-post intervention with comparison group design was conducted in eight IMSS family medicine clinics in which 106 family physicians practiced. An evidence-based clinical guideline for ARI management was developed, and clinical tutors were trained. The three-stage intervention comprised interactive workshops, individual tutorials, and round-table peer-review sessions. The main outcome was appropriate ARI case management. The intervention effect was calculated by using the differences-in-differences model, adjusting for cluster of physicians. In the intervention group, the difference in mean proportion of improvement compared with baseline evaluation was 22.6% (95% confidence interval [CI]=10.3 to 34.9) for appropriate prescription of antibiotics, 29.8% (95% CI=17.2 to 42.4) for indication of worsening signs, and 19.6% (95% CI=11.2 to 28.0) for overall appropriate case management. The comparison group showed no significant changes. The educational intervention improved ARI management. Further studies are needed to analyze organizational implications, cost, sustainability, and effects on health outcomes.

  13. Pattern of Visits to Older Family Physicians in Taiwan

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    Hao-Yen Liu

    2017-05-01

    Full Text Available Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan’s National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD: 2019 and visits (mean: 9220, SD: 8600 than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5 years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.

  14. 10 CFR 712.32 - Designated Physician.

    Science.gov (United States)

    2010-01-01

    ... Designated Physician must be qualified to provide professional expertise in the area of occupational medicine... school of medicine or osteopathy; (2) Have a valid, unrestricted state license to practice medicine in... requirements; and (4) Be eligible for the appropriate DOE access authorization. (c) The Designated Physician...

  15. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

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    Beaulieu Marie-Dominique

    2009-02-01

    Full Text Available Abstract Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs. The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis and field of family medicine (macro-level of analysis. The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original

  16. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2009-01-01

    Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes

  17. Solving Problems: How Does the Family Physician Do It?

    Science.gov (United States)

    Feightner, J. W.; Barrows, H. S.; Neufeld, V. R.; Norman, G. R.

    1977-01-01

    Objective evidence exists for a model of clinical problem solving by family physicians. Previous studies have examined the activities of family physicians, but there have been no data indicating the mental process behind these activities. This study, exploring the thought processes of family physicians engaged in clinical problem solving, has lead to the model described in this paper. Its educational and clinical implications are considered. PMID:21304873

  18. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study.

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2009-02-11

    A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the

  19. Use of information sources by family physicians: a literature survey

    NARCIS (Netherlands)

    Verhoeven, A.A.H.; Boerma, E.J.; Meyboom-de Jong, B

    Analysis of the use of information sources by family physicians is important for both practical and theoretical reasons. First, analysis of the ways in which family physicians handle information may point to opportunities for improvement. Second, such efforts may lead to improvements in the

  20. Use of information sources by family physicians: a literature survey

    NARCIS (Netherlands)

    Verhoeven, A.A.H.; Boerma, E.J.; Meyboom-de Jong, B

    1995-01-01

    Analysis of the use of information sources by family physicians is important for both practical and theoretical reasons. First, analysis of the ways in which family physicians handle information may point to opportunities for improvement. Second, such efforts may lead to improvements in the methodol

  1. Multiattribute utility scores for predicting family physicians' decisions regarding sinusitis

    NARCIS (Netherlands)

    de Bock, GH; Reijneveld, SA; van Houwelingen, JC; Knottnerus, JA; Kievit, J

    1999-01-01

    To examine whether multiattribute utility (MAU) scores can be used to predict family physicians' decisions regarding patients suspected to have sinusitis and rhinitis, 100 randomly selected family physicians from the Leiden area (The Netherlands) were asked to rank a set of six attributes regarding

  2. Multiattribute utility scores for predicting family physicians' decisions regarding sinusitis

    NARCIS (Netherlands)

    de Bock, GH; Reijneveld, SA; van Houwelingen, JC; Knottnerus, JA; Kievit, J

    1999-01-01

    To examine whether multiattribute utility (MAU) scores can be used to predict family physicians' decisions regarding patients suspected to have sinusitis and rhinitis, 100 randomly selected family physicians from the Leiden area (The Netherlands) were asked to rank a set of six attributes regarding

  3. 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.

  4. Autism: A review for family physicians.

    Science.gov (United States)

    Karande, Sunil

    2006-05-01

    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.

  5. Family medicine residents' and community physicians' concerns about patient truthfulness.

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    Woolley, D; Clements, T

    1997-02-01

    To assess how often family physicians question patient truthfulness, what factors influence them to do so, and how often resident physicians experience such doubts as compared with senior physicians. In 1994-95, after half-day patient care sessions, 44 residents from the University of Kansas School of Medicine's three Wichita family practice residency programs and nine community family physicians associated with the programs recorded their impressions of each patient's truthfulness, what issues prompted concern about patient truthfulness, and their feelings about each encounter. The residents doubted patients in 54 of 277 encounters (19.5%); the senior physicians doubted patients in 16 of 183 encounters (8.7%) (p = .003). Both groups had more negative than positive emotions toward such encounters, with no significant difference in feelings. The demographics of the resident and senior physician populations differed greatly. Although preliminary, the present study suggests that family physicians question patient truthfulness fairly often, resident physicians more than senior physicians, and that these physicians have some negative feelings toward such situations. Because such feelings may contribute to inadequate patient care, the authors recommend that further research is warranted to understand contributing factors and to guide the development of resident and student education programs in this neglected area of the doctor-patient relationship.

  6. Febrile seizures: A review for family physicians

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    Karande Sunil

    2007-03-01

    Full Text Available Febrile seizures are the most common cause of convulsions in children. Most are simple in nature, although those with focal onset, prolonged duration (³15 min or those that recur within 24 h or within the same febrile illness are considered complex. Diagnosis of this condition is essentially clinical and based on its description provided by parents. Its pathophysiology remains unclear, but genetics plays a major role in conferring susceptibility. Although most febrile seizures are benign and associated with minor viral illnesses, it is critical that the child be evaluated immediately to reduce parental anxiety and to identify the cause of the fever. It is essential to exclude underlying pyogenic meningitis, either clinically or, if any doubt remains, by lumbar puncture. The risk of pyogenic meningitis is as low (< 1.3% as the risk in a febrile child without seizures. After an initial febrile seizure (simple or complex, 3-12% of children develop epilepsy by adolescence. However, the risk of developing epilepsy after an initial simple febrile seizure is low (1.5-2.4%. Since the vast majority of children have a normal long-term outcome, antiepileptic medication is not recommended to prevent recurrence of febrile seizures. Oral diazepam or clobazam, given only when fever is present, is an effective means of reducing the risk of recurrence. The family physician can play an important role in counseling the parents that most febrile seizures are brief, do not require any specific treatment or extensive work-up, the probability of frequent or possibly threatening recurrences is low and the long-term prognosis is excellent.

  7. Family physicians and patients: is effective nutrition interaction possible?

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    Truswell, A S

    2000-01-01

    This article summarizes presentations from an international workshop held in Heelsum, Netherlands, 14-16 December 1998 that was sponsored by the Dutch Dairy Foundation on Nutrition and Health, the Department of Nutrition at Wageningen Agricultural University, the Dutch College of General Practitioners, and the International Union of Nutritional Sciences. Twenty-one speakers and 12 other participants were invited from 9 countries: the Netherlands, the United States, the United Kingdom, Australia, Canada, Denmark, New Zealand, Spain, and Sweden. The workshop was chaired by GJAJ Hautvast and the scientific secretary was GJ Hiddink. Family physicians are highly trusted. Many consultations include a nutritional aspect, but physicians do not discuss nutrition with their patients as often as they could. Major barriers include short visit times, the paucity of nutrition teaching in medical schools, and poor compliance of patients with physicians' dietary prescriptions. Problems, practicalities, operational research, and some solutions were discussed at this meeting of leading family doctors with interested nutritionists. Family physicians have to distill the essentials for their patients from many different specialties ranging from ophthalmology to podiatry. They look for clarity of recommendations from nutrition researchers. Among developments discussed at the meeting that can increase nutritional work in family medicine are 1) new opportunities to teach nutrition in vocational training programs, 2) some manuals and a new journal specially written by nutritional scientists for family physicians, 3) nutritional advice being incorporated into computer software for family physicians, 4) more dietitians working with family physicians, and 5) nutrition training for practice nurses in some countries.

  8. Which Health Cares Are Related to the Family Physician? A Critical Interpretive Synthesis of Literature.

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    Yazdani, Shahram; Akbarilakeh, Maryam

    2017-05-01

    This study provided the theoretical basis for program development through a new conceptualization of the concept of family physician related health care. Critical interpretive synthesis (CIS) was used to carry out qualitative analysis and synthesis of the literature from 2006 until 2015. At the beginning of CIS, the search strategy was designed to access electronic databases such as CINAHL, Medline, Cochrane library, PsycINFO, Embase, EBMreviews, and Thomson scientific web of science database. The main review question was the clarification of the health care related to family physician in health system, which produced over related 750 articles; 60 articles related to the research objective were studied by purposive sampling. After identifying the main categories and sub-categories, synthesis of the contradictory findings in different studies was conducted. New concepts and relationships between concepts were created using CIS of documentation related to the place of family physician in health system. To define the original position of family physician in health system, clarify its related health care and determine its boundaries from other health care providers, and its use in the design and development of family physician's educational program, a frame of concepts related to the main concept and question was created. A more useful means of understanding family physician is offered by the synthetic constructs of this framework. The theoretical conceptualization of family physician position and duties in the health system can be an appropriate guide for educational program and curricula in our context.

  9. 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…

  10. 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…

  11. Educational needs of family physicians in Yazd province

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    M Karimi

    2012-02-01

    Conclusion: The gap between theory and practical training in the GP training is high with the expectation from family physicians and this needs to revised the curriculum of GP training which approved by the ministry of health.

  12. Lifestyle health risk assessment. Do recently trained family physicians do it better?

    OpenAIRE

    Haley, N; Maheux, B.; Rivard, M.; Gervais, A

    2000-01-01

    OBJECTIVE: To determine whether recently trained family physicians were more likely to routinely assess lifestyle health risks during general medical evaluations. To document physicians' perceptions of the difficulties of lifestyle risk assessment, of medical training in that area, and of how often they saw patients with lifestyle health risks. DESIGN: Anonymous mailed survey conducted in 1995. SETTING: Family practices in the province of Quebec. PARTICIPANTS: Stratified random sample of 805 ...

  13. Who gets a family physician through centralized waiting lists?

    OpenAIRE

    Breton, Mylaine; Brousselle, Astrid; Boivin, Antoine; Roberge, Dani?le; Pineault, Raynald; Berbiche, Djamal

    2015-01-01

    Background North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians? enrolment of orphan patients through centralized waiting lists, the Guichet d?acc?s aux client?les orphelines, with higher payments for vulner...

  14. Indiana family physician attitudes and practices concerning smoking cessation.

    Science.gov (United States)

    Saywell, R M; Jay, S J; Lukas, P J; Casebeer, L L; Mybeck, K C; Parchman, M L; Haley, A J

    1996-01-01

    Most physicians are aware of the health benefits of smoking cessation and agree they have a responsibility to help smokers quit. Many physicians, however, do not regularly address smoking cessation with their patients. Questionnaires were sent to 2,095 family practice physicians in Indiana. Information obtained included: demographic data; office-based smoking cessation practices; counseling; and physicians' perceptions of intervention outcomes. Most physicians (86%) asked new patients if they smoked, and 23% questioned patients about their exposure to passive smoke. Younger physicians, female physicians and urban physicians were more likely to ask new patients if they smoked. A formal smoking cessation program was used by 28% of the responding physicians. Among those not using a program, 7% reported plans to implement one in the coming year, 40% were not planning to implement one, and 53% were unsure. Physician and practice characteristics were not correlated with the use of smoking cessation programs. Only 11% of physicians considered their smoking cessation counseling skills to be excellent; 27% indicated the need for improvement in skills. One-half (52%) believed their counseling efforts were effective; almost half (45%) believed that current reimbursement policies limited their involvement in smoking cessation interventions. Most respondents have not instituted smoking cessation programs in their practices. It is likely that a combination of strategies, including both undergraduate, graduate and continuing medical education programs and reform in reimbursement practices for cessation programs, will be required to achieve significant increases in long-term smoking abstinence rates.

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

    Science.gov (United States)

    Weber, J Michael

    2013-01-01

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

  16. Investigating Awareness in Chronic Renal Failure Among Family Physicians

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    Birgül ATAMAN

    2014-05-01

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

  17. Use of clotrimazole/betamethasone diproprionate by family physicians.

    Science.gov (United States)

    Shaffer, M P; Feldman, S R; Fleischer, A B

    2000-09-01

    Clotrimazole/betamethasone diproprionate contains a fluorinated, high-potency topical corticosteroid and is the most frequently prescribed topical agent in the United States. Family physicians are more likely than pediatricians and dermatologists to use this product when faced with a common fungal infection. To better understand the settings in which US family physicians recommend the use of clotrimazole/betamethasone diproprionate, we determined the diagnoses and characteristics of patients for whom family physicians prescribe this drug. Data from the National Ambulatory Medical Care Survey were used to determine the demographic characteristics of patients who were given a prescription for clotrimazole/betamethasone diproprionate, the diagnoses of patients treated with the drug, and the potency of other topical corticosteroids by family physicians. Wholesale costs of drugs were used to estimate potential drug cost savings obtainable by switching to specific monotherapy agents. Clotrimazole/betamethasone diproprionate was prescribed at 3.1% of visits to family physicians but at only .6% of visits to dermatologists for either inflammatory or fungal/candidal conditions. Family physicians frequently prescribed clotrimazole/betamethasone diproprionate to children under age 5 and for use on genital skin disorders. Dermatologists rarely used clotrimazole/betamethasone diproprionate in these settings. The frequent use by family physicians of clotrimazole/betamethasone diproprionate in high-risk settings is of concern. Use of alternative agents with anti-inflammatory and antifungal properties without the risks associated with the use of high-potency topical corticosteroids may be the most practical approach to replacing use of clotrimazole/betamethasone diproprionate.

  18. Health promotion. Strategies for family physicians.

    OpenAIRE

    McWilliam, C. L.

    1993-01-01

    The current emphasis on health promotion raises questions among experienced health professionals. Many wonder whether such care differs from what we have always done and have doubts about cost effectiveness and government motives. This paper explores the latest meaning of the term health promotion, the evolution of strategies to promote health, and the implications of these strategies for practising family medicine.

  19. Who gets a family physician through centralized waiting lists?

    Science.gov (United States)

    Breton, Mylaine; Brousselle, Astrid; Boivin, Antoine; Roberge, Danièle; Pineault, Raynald; Berbiche, Djamal

    2015-02-05

    North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians' enrolment of orphan patients through centralized waiting lists, the Guichet d'accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians' after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled. A longitudinal quantitative analysis spanning a five-year period (2008-2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used. The number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level. Centralized waiting lists linked to financial incentives increased the number of family physicians' patient enrolments. However, although

  20. Female Physicians and the Work-Family Conflict.

    Science.gov (United States)

    Treister-Goltzman, Yulia; Peleg, Roni

    2016-05-01

    There has been a dramatic increase in the number of female physicians in all fields and specializations of medicine, but this increase has not resulted in a redistribution of domestic tasks and responsibilities. Reviewing the literature of the last two decades (April 1994 to April 2014) on how female physicians cope with the challenge of balancing their family and professional lives for the duration of their professional careers revealed that they suffer from the work-family conflict more than other professionals and that it has a more negative effect on women than on men. Women physicians consider work-family balance significantly when making career choices. These considerations affect their career success, their productivity as faculty members, their marital life, and parenthood. Having a supportive spouse at home and a facilitating mentor at work are important for a positive work-family balance among female physicians. Special career-supporting measures, such as flexible work schedules and expanded support for childcare over the course of work and when taking part in academic activities, are critical for female physicians.

  1. Work Values and Job Satisfaction of Family Physicians

    Science.gov (United States)

    Bouwkamp-Memmer, Jennifer C.; Whiston, Susan C.; Hartung, Paul J.

    2013-01-01

    Theory and prior research suggest linkages between work values and job satisfaction. The present study examined such linkages in a group of workers in a professional occupation. Family physicians (134 women, 206 men, 88% Caucasian) responded to context-specific measures of work values and job satisfaction. ANOVA results indicated a work values…

  2. Attitudes about human papillomavirus vaccine among family physicians.

    Science.gov (United States)

    Riedesel, J M; Rosenthal, S L; Zimet, G D; Bernstein, D I; Huang, B; Lan, D; Kahn, J A

    2005-12-01

    Human papillomavirus (HPV) vaccines will soon be available for clinical use, and the effectiveness of vaccine delivery programs will depend largely upon whether providers recommend the vaccine. The objectives of this study were to examine family physicians' attitudes about HPV immunization and to identify predictors of intention to recommend immunization. Cross-sectional survey instrument assessing provider and practice characteristics, knowledge about HPV, attitudes about HPV vaccination, and intention to administer two hypothetical HPV vaccines. Surveys were mailed to a national random sample of 1,000 American Academy of Family Physicians (AAFP) members. Intention to administer two hypothetical HPV vaccines (a cervical cancer/genital wart vaccine and a cervical cancer vaccine) to boys and girls of different ages. One hundred fifty-five surveys (15.5%) were returned and 145 were used in the final sample. Participants reported higher intention to recommend both hypothetical HPV vaccines to girls vs. boys (P HPV, belief that organizations such as the AAFP would endorse vaccination, and fewer perceived barriers to vaccination. Female gender, knowledge about HPV, and attitudes about vaccination were independently associated with family physicians' intention to recommend HPV vaccines. Vaccination initiatives directed toward family physicians should focus on modifiable predictors of intention to vaccinate, such as HPV knowledge and attitudes about vaccination.

  3. Work Values and Job Satisfaction of Family Physicians

    Science.gov (United States)

    Bouwkamp-Memmer, Jennifer C.; Whiston, Susan C.; Hartung, Paul J.

    2013-01-01

    Theory and prior research suggest linkages between work values and job satisfaction. The present study examined such linkages in a group of workers in a professional occupation. Family physicians (134 women, 206 men, 88% Caucasian) responded to context-specific measures of work values and job satisfaction. ANOVA results indicated a work values…

  4. Periodic health evaluation of adults: a survey of family physicians.

    Science.gov (United States)

    Luckmann, R; Melville, S K

    1995-06-01

    The routine periodic health evaluation (PHE) is a popular format in primary care practice for the delivery of clinical preventive services to adults, but knowledge of the current pattern of use and of the content of the PHE is limited. We surveyed a random sample of 567 family physicians (response rate, 60.1%) in New England regarding their approach to and attitudes about the PHE of adults. Family physicians reported spending a mean of 35.2% (11.6 hours per week) of their total ambulatory care time on adult PHEs, which were usually scheduled for 20 to 30 minutes each. All respondents recommended a PHE to men > or = 50 years old and to women > or = 40 years old, and more than 90% recommended a PHE to younger patients. Most physicians (80.7%) reported that the PHE is their primary mechanism for delivering preventive services, and 90.6% believed that the PHE should include a comprehensive physical examination. The mean number of physical examination items performed during the PHE was 11.6 to 13.9, depending on patient age and sex. As part of the PHE, most physicians (71.6% to 90.7%, depending on patient age and sex) ordered one or more screening laboratory tests not recommended by the US Preventive Services Task Force. Utilization of fewer laboratory tests was associated with residency training, employment in a health maintenance organization (HMO), and limited concern about malpractice suits. Family physicians reported spending a substantial amount of time on the PHE of adults, performing extensive screening physical examinations and many screening laboratory tests of unknown effectiveness. Among family physicians, there is considerable unexplained variation in the form and content of the PHE.

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

    Science.gov (United States)

    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 dimensions of MBI. Results In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. Conclusion There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout. PMID:25422682

  6. Knowledge of family physicians on common dermatological diseases and their diagnosis and management trends

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    Kemal Özyurt

    2014-12-01

    Full Text Available Background and Design: In clinical practice, dermatology specialists usually encounter misdiagnosis and inappropriate management approaches of other specialists for several dermatological diseases. This study aims to investigate the knowledge, diagnosis and management trends of family physicians in primary care on common dermatological diseases and their opinions about dermatology education. Materials and Methods: A multicenter study was conducted in six cities in Turkey including a total of 302 family physicians in primary care using an 82-item questionnaire through in-person interview. The questionnaire aimed at identifying demographic characteristics of family physicians, knowledge on common dermatological diseases, and their diagnosis and management trends. Results: Out of 1414 family physicians, 302 (21.53% subjects, who could be contacted and those accepted to respond the questionnaire, were included. 57.6% of participants reported that there was not a microscope, while 94.4% reported that potassium hydroxide solution was not available in their clinics. A higher rate of family physicians mentioned experience difficulties in the management of psoriasis and acne rosacea. The rate of family physicians, who assumed that hepatobiliary disorders and other visceral conditions play a role in the etiopathogenesis of atopic dermatitis, psoriasis and acne vulgaris and those who did not state an opinion about this issue, was high. Incorrect management trends for bacterial skin diseases and nail diseases were observed with higher rates. Conclusion: It is recommended that knowledge should be reinforced through both undergraduate and continuous medical education and, skills of family physicians on the management of dermatological diseases should be improved.

  7. How do family physicians measure blood pressure in routine clinical practice? National survey of Canadian family physicians.

    Science.gov (United States)

    Kaczorowski, Janusz; Myers, Martin G; Gelfer, Mark; Dawes, Martin; Mang, Eric J; Berg, Angelique; Grande, Claudio Del; Kljujic, Dragan

    2017-03-01

    To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. A Web-based cross-sectional survey distributed by e-mail. Stratified random sample of family physicians in Canada. Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. Physicians' self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both AOBP and home BP monitoring for ongoing management. Copyright© the College of Family

  8. Opinions of Primary Care Family Physicians About Family Medicine Speciality Training Program

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    Hamit Sirri Keten

    2014-04-01

    Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304

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

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    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

  10. Family physicians improve patient health care quality and outcomes.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  11. Monthly Incidence Rates of Abusive Encounters for Canadian Family Physicians by Patients and Their Families

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    Baukje (Bo Miedema

    2010-01-01

    Full Text Available Objective. The goal of this study was to examine the monthly incidence rates of abusive encounters for family physicians in Canada. Methods. A 7-page cross-sectional survey. Results. Of the entire study sample (N=720, 29% of the physicians reported having experienced an abusive event in the last month by a patient or patient family member. Abusive incidents were classified as minor, major, or severe. Of the physician participants who reported having been abused, all reported having experienced a minor event, 26% a major, and 8% a severe event. Of the physicians who experienced an abusive event, 55% were not aware of any policies to protect them, 76% did not seek help, and 64% did not report the abusive event. Conclusion. Family physicians are subjected to significant amounts of abuse in their day-to-day practices. Few physicians are aware of workplace policies that could protect them, and fewer report abusive encounters. Physicians would benefit from increased awareness of institutional policies that can protect them against abusive patients and their families and from the development of a national policy.

  12. Personal values of exemplary family physicians: implications for professional satisfaction in family medicine.

    Science.gov (United States)

    Eliason, B C; Schubot, D B

    1995-09-01

    Personal social values have been identified as important determinants of generalists' specialty choice. However, the personal values or "guiding principles" of generalist physicians have not been identified scientifically. To establish a benchmark, we measured the personal values of exemplary family physicians because they serve as role models for current and future physicians. We also explored the relationship between personal values and practice satisfaction. We obtained a list of 330 family physicians nominated for the American Academy of Family Physicians' (AAFP) Family Doctor of the Year award for the years 1988 through 1993. We asked them to complete the Schwartz Values Questionnaire, a 56-item instrument for measuring personal values. They also answered three questions concerning practice satisfaction. The return rate was 83%. The physicians' mean age was 63 years. They had been in practice an average of 34 years, 93% were male, and 52% practiced in rural areas. Honesty was rated as the most important of the 56 values, and social power as the least important. Of the 10 value types (groups of common values), the responding physicians rated "Benevolence" as most important and "Power" as least important. Practice satisfaction correlated positively with the Benevolence value type (r = .21, P = .001) and negatively with the Power value type (r = -.15, P = .023). Of the 10 value types, Benevolence was rated the most important and Power the least important by exemplary family physicians, and both value types also correlated, positively and negatively, respectively, with their practice satisfaction. These results have implications for the selection, training, and career satisfaction of generalist physicians.

  13. Effectiveness of "Primary Bereavement Care" for Widows: A Cluster Randomized Controlled Trial Involving Family Physicians

    Science.gov (United States)

    García, Jesus A.; Landa, Victor; Grandes, Gonzalo; Pombo, Haizea; Mauriz, Amaia

    2013-01-01

    Thirty-one family physicians, from 19 primary care teams in Biscay (Spain), were randomly assigned to intervention or control group. The 15 intervention family physicians, after training in primary bereavement care, saw 43 widows for 7 sessions, from the 4th to 13th month after their loss. The 16 control family physicians, without primary…

  14. Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

    Science.gov (United States)

    Dresden, Graham M.; Baldwin, Laura-Mae; Andrilla, C. Holly A.; Skillman, Susan M.; Benedetti, Thomas J.

    2008-01-01

    PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline—the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics. PMID:18195307

  15. Preconception care by family physicians and general practitioners in Japan

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    Fetters Michael D

    2005-07-01

    Full Text Available Abstract Background Preconception care provided by family physicians/general practitioners (FP/GPs can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. Methods A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. Results Two hundred and sixty-eight of 347 (77% eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%, and the least was about folic acid supplementation (12%. Many participants reported providing smoking cessation in their practice (60%, though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10% or folic acid supplementation (4%. About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. Conclusion FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

  16. Clinical Guide for Family Physicians to Manage Type 2 Diabetes

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    Seyed Esmaeil Managheb

    2015-10-01

    Full Text Available Compiling clinical guidelines is one of the requirements of family physician plan and classification of health care services.1 The high prevalence of type 2 diabetes can easily be seen in general practice so that 2.5% of referrals to general practitioners are due to diabetes. More than half of the patients with Type 2 diabetes are left undiagnosed and most of them suffer from its complications at the time of diagnosis. For example, 6.2% of patients suffer from diabetic retinopathy at the time of diagnosis.2 Most patients diagnosed with diabetes take more than one type of medication to treat the complications; about 60% take only oral medications, and 14 percent take oral medications and insulin.3 Although the principles of care for people with Type 2 diabetes is well known, there is a gap between the quality of care in general practice and optimal care so that up to 50% of patients’ condition are weakly controlled.4 Chronic care model for patients with chronic diseases explains the necessary measures to improve the care of people with chronic diseases. These elements include supporting disease management by the patients themselves, patient care, and support teams. Consultation and training are often done in general practice while it is usually a brief consultation about weight, medication or exercise. There is little evidence that mere printed texts are effective in controlling the disease. Extensive training programs are designed to develop self-management skills for diabetes control.4 The implementation of clinical guidelines in medical practice is a challenging task. But, a number of evidences have been shown to accelerate effective clinical guideline implementation and care improvement.5 Management of diabetes mellitus type 2 is shown in Figure 1.

  17. Validity of the Maslach Burnout Inventory for family practice physicians.

    Science.gov (United States)

    Rafferty, J P; Lemkau, J P; Purdy, R R; Rudisill, J R

    1986-05-01

    This study assesses the utility of Maslach's concept of burnout for family practice physicians. Maslach Burnout Inventory (MBI) subscale correlations for the 67 residents in this sample are compared with Maslach's normative sample. The residents scored in the moderate to high range on the MBI subscales. MBI interscale correlations were similar to the pattern reported by Maslach. Significant correlations between job satisfaction and five of the six MBI subscales suggest that the construct of burnout has considerable psychological import for these physicians. The validity of the emotional exhaustion subscale is demonstrated by significant correlations with self-assessed burnout, job satisfaction, and faculty assessments of resident burnout. Independent observers were most sensitive to residents' emotional exhaustion and less likely to assess accurately the less visible aspects of burnout related to depersonalization and lack of achievement, which suggests the usefulness of multiple measures for assessing the burnout phenomenon.

  18. Social media beliefs and usage among family medicine residents and practicing family physicians.

    Science.gov (United States)

    Klee, David; Covey, Carlton; Zhong, Laura

    2015-03-01

    Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.

  19. Reported practice patterns among family physicians with a geriatrics certificate of added qualifications.

    Science.gov (United States)

    Peterson, Lars E; Cochrane, Anneli; Bazemore, Andrew W; Petterson, Stephen

    2015-01-01

    Practice patterns of family physicians with additional certification are unknown but are important to workforce planners and policymakers, who may presume that all family physicians provide primary care to patients of all ages. We found that a majority of family medicine geriatricians self-report practicing primarily geriatric medicine. © Copyright 2015 by the American Board of Family Medicine.

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

    Science.gov (United States)

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

    2016-03-01

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

  1. Office Management of Chemical Dependency by Family Physicians: The role of the physician in treating chemical dependency

    OpenAIRE

    Baker, Ray

    1991-01-01

    Family physicians are in an ideal position to identify, intervene with, and treat substance use disorders. If family physicians position themselves to reflect objective evidence of consequences of substance use and offer suggestions for change while leaving responsibility for recovery with the patient, patients often choose to recover. Because the disease is characterized by exacerbations, remissions, and relapses, continued involvement with the recovering patient ensures the greatest chance ...

  2. Perspectives of family physicians on computer-assisted health-risk assessments.

    Science.gov (United States)

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

    2010-05-07

    The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions. The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians' perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic. A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective. Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients' self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included

  3. A national survey of family physicians: perspectives on collaboration with marriage and family therapists.

    Science.gov (United States)

    Clark, Rebecca E; Linville, Deanna; Rosen, Karen H

    2009-04-01

    Recognizing the fit between family medicine and marriage and family therapy (MFT), members of both fields have made significant advances in collaborative health research and practice. To add to this work, we surveyed a nationwide random sample of 240 family physicians (FPs) and asked about their perspectives and experiences of collaboration with MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-related care, but their referral to and collaboration with MFTs were limited. Through responses to an open-ended question, we gained valuable information as to how MFTs could more effectively initiate collaboration with FPs.

  4. E-Learning Readiness in Medicine: Turkish Family Medicine (FM) Physicians Case

    Science.gov (United States)

    Parlakkiliç, Alaattin

    2015-01-01

    This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…

  5. Does delivery volume of family physicians predict maternal and newborn outcome?

    Energy Technology Data Exchange (ETDEWEB)

    Klein, M.C. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Univ. of British Columbia, Dept. of Family Practice, Vancouver, British Columbia (Canada); Spence, A. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Kaczorowski, J. [McMaster Univ., Depts. of Family Medicine and of Clinical Epidemiology and Biostatistics, Hamilton, Ontario (Canada); Kelly, A. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Univ. of British Columbia, Dept. of Health Care and Epidemiology, Vancouver, British Columbia (Canada); Grzybowski, S. [Univ. of British Columbia, Dept. of Family Practice, Vancouver, British Columbia (Canada)

    2002-05-01

    The number of births attended by individual family physicians who practice intrapartum care varies. We wanted to determine if the practice-volume relations that have been shown in other fields of medical practice also exist in maternity care practice by family doctors. For the period April 1997 to August 1998, we analyzed all singleton births at a major maternity teaching hospital for which the family physician was the responsible physician. Physicians were grouped into 3 categories on the basis of the number of births they attended each year: fewer than 12, 12 to 24, and 25 or more. Physicians with a low volume of deliveries (72 physicians, 549 births), those with a medium volume of deliveries (34 physicians, 871 births) and those with a high volume of deliveries (46 physicians, 3024 births) were compared in terms of maternal and newborn outcomes. The main outcome measures were maternal morbidity, 5-minute Apgar score and admission of the baby to the neonatal intensive care unit or special care unit. Secondary outcomes were obstetric procedures and consultation patterns. There was no difference among the 3 volume cohorts in terms of rates of maternal complications of delivery, 5-minute Apgar scores of less than 7 or admissions to the neonatal intensive care unit or the special care unit, either before or after adjustment for parity, pregnancy-induced hypertension, diabetes, ethnicity, lone parent status, maternal age, gestational age, newborn birth weight and newborn head circumference at birth. High-and medium-volume family physicians consulted with obstetricians less often than low-volume family physicians (adjusted odds ratio [OR] 0.586 [95% confidence interval, CI, 0.479-0.718] and 0.739 [95% Cl 0.583-0.935] respectively). High-and medium-volume family physicians transferred the delivery to an obstetrician less often than low-volume family physicians (adjusted OR 0.668 [95% CI 0.542-0.823] and 0.776 [95% Cl 0.607-0.992] respectively). Inductions were performed

  6. A national study of factors influencing the career choice of osteopathic and allopathic family physicians.

    Science.gov (United States)

    Xu, G; Cummings, M; Veloski, J J; Brose, J

    1996-12-01

    This study examines the differences between osteopathic and allopathic physicians regarding those factors influencing their career choice of family practice. A total of 256 osteopathic physicians and 717 allopathic family physicians were surveyed. The surveyed physicians graduated in 1983 and 1984. Comparisons were made on 19 variables that influenced the physicians' decisions to enter family practice as well as on the six factor scores derived from these 19 variables. Osteopathic physicians' decisions to choose family practice was more influenced by financial obligations, medical school experiences, and family values, whereas the allopathic physicians were more influenced by personal social value. Overall, medical school experience and personal social value were two important factors that explained the largest variances of the 19 predictors influencing physicians' decisions to enter family practice. Those allopathic medical schools whose mission emphasizes the production of generalist physicians may be able to model some approaches already in place at osteopathic medical schools. Because of the influence of the personal social value factor in medical students' choosing family practice medicine, this factor warrants further study.

  7. Acne vulgaris: diagnosis and management by the family physician

    Directory of Open Access Journals (Sweden)

    Ana Margarida Ferreira da Silva

    2014-01-01

    Full Text Available Acne vulgaris is the most common skin disease worldwide. It affects 85-100% of the population at any point in life. Consequently, it is a frequent reason for primary care visits. It usually begins at puberty, reaching its peak between the age of 14-17 in girls, and 16-19 in boys, and it is more severe and prevalent in males. Although widely discussed, Acne vulgaris still requires constant updating. We conducted a survey of clinical guidelines, systematic reviews, and meta-analyses published over the past 15 years, concerning acne vulgaris and its treatment. Acne vulgaris is usually divided in three clinical types: comedonal, papulopustular, and nodular. The diagnosis is based on clinical signs; however, other conditions should be considered. There are several pharmacological therapies available, especially retinoids, antimicrobials, and hormone therapy, which should be used after considering its indications (type of acne and its severity and side effects. Thus, the family physician plays a leading role in addressing acne vulgaris, from diagnosis to management of therapeutic options. 

  8. Attention deficit hyperactivity disorder: A review for family physicians

    Directory of Open Access Journals (Sweden)

    Karande Sunil

    2005-12-01

    Full Text Available Attention deficit hyperactivity disorder (ADHD is a chronic behavioral disorder characterized by persistent hyperactivity, impulsivity, and inattention that impairs educational achievement and/or social functioning. Its diagnosis 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. Comorbidity with psychiatric disorders such as anxiety disorder, depression, oppositional defiant disorder and conduct disorder; and with specific learning disability is not uncommon. Although medication works well in most cases of ADHD, optimal treatment requires integrated medical and behavioral treatment. Methylphenidate (MPH and atomoxetine are the two drugs being currently prescribed and their efficacy in decreasing the symptoms of ADHD is well documented. Pyschoeducational interventions in school can help increase the successful functioning of affected children and improve their academic performance. Almost half of affected children continue to show significant symptoms of the disorder into adolescence and young adulthood. The family physician can play an important role in detecting this condition early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child′s academic and psychosocial progress on a long-term basis.

  9. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

    Directory of Open Access Journals (Sweden)

    Dendukuri Nandini

    2005-04-01

    Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

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

    Science.gov (United States)

    Beagan, Brenda; Fredericks, Erin; Bryson, Mary

    2015-01-01

    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. 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. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

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

    Directory of Open Access Journals (Sweden)

    Brenda Beagan

    2015-04-01

    Full Text Available 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. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results: Three major themes emerged: 1 Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2 Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3 Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

  12. Mining reflective continuing medical education data for family physician learning needs

    Directory of Open Access Journals (Sweden)

    Denice Colleen Lewis

    2016-04-01

    Full Text Available A mixed methods research (sequential explanatory design studied the potential of mining the data from the consumers of continuing medical education (CME programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

  13. Situational Analysis of Human Resources in Family Physician Program: Survey from Iran

    Science.gov (United States)

    Kalhor, Rohollah; Azmal, Mohammad; Kiaei, Mohammad Zakaria; Eslamian, Maryam; Tabatabaee, Seyed Saeed; Jafari, Mehdi

    2014-01-01

    Introduction: Family physician is the increasing efforts to promote physician and other human resources in the health care systems. Goal: Investigate Human resources situation of the family physician program in six pilot cities in Khuzestan province in the southwest of Iran. Methods: A cross-sectional descriptive study was conducted to examine the family physician program in 2011. In this study, 15 healthcare teams in six pilot cities in Iran were assessed. Data was compiled from family physician officer document in vice treatment of Ahwaz University of medical sciences. National instructions of family physician was used to identify current gaps. Results: The survey findings indicated that there is a doctor’s shortage about 36% in the health team that deployed in the first level of referral system. Also on the team, the 34% shortage of nurses and 60% shortages of nutrition personnel are seen. Specialists with offices in cities of second referral level, there have not welcomed the program. Conclusions: It seems that to facilitate patient access to physicians under contract with family physician program and the referral system in level two and level three, adopting arrangements to attract specialists and improving their maintenance is necessary. PMID:25126016

  14. Interventions to Educate Family Physicians to Change Test Ordering

    Directory of Open Access Journals (Sweden)

    Roger Edmund Thomas MD, PhD, CCFP, MRCGP

    2016-03-01

    Full Text Available The purpose is to systematically review randomised controlled trials (RCTs to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations. We identified 29 RCTs (4,111 physicians, 175,563 patients. Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control, 14 diabetes (average 8% > control, 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%, and two to increase test groups. Intervention strategies: one study used education (no change: two feedback (one 5% increase, one 27% desired decrease; eight education + feedback (average increase in desired direction >control 4.9%, ten system change (average increase 14.9%, one system change + feedback (increases 5-44%, three education + system change (average increase 6%, three education + system change + feedback (average 7.7% increase, one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20% probably obtained real change.

  15. [Preanalytical step in bacteriology : a practical overview for family physicians].

    Science.gov (United States)

    Eyer, Myriam M; Droz, Sara

    2016-10-12

    Physicians play a key role in the accuracy of bacteriological results by appropriate prescription and the quality of sample collection, preservation and transport. Samples for diagnostic purposes are of use if analysis results have an impact on the therapeutic approach. They have minimal risk of contamination, are usually obtained invasively, and may be targeted to detection of specific bacteria. Physicians should refer to the laboratory technical manual to provide proper sample quality. Furthermore, they have to provide clinical and administrative information to the microbiologist, because the laboratory analytical process depends on these. Close collaboration between physicians and microbiologists is essential.

  16. Designing Product Families

    DEFF Research Database (Denmark)

    Pedersen, Per Erik Elgård; Miller, Thomas Dedenroth

    1998-01-01

    Manufacturing companies that operate with products aimed at different market segments and applications are experiencing an increasing demand from customers who expect products to be tailored to their exact needs rather than accepting general products based on average customer needs. This trend ha...... led to a new business paradigm, "mass customization", where companies strive to provide highly customized products while still maintaining the efficiency of the classical mass production enterprise. One of the key factors in mass customization has been efficient use of product platforms...... as a foundation for the customization process, whereby the customized products become variants of a product family with a high degree of reuse and utilization of kinship between the individual variants.With this paper, we will discuss the development of platform based product families from three points of view...

  17. Global Cardiovascular Risk Assessment by Family Physicians in Suez Canal University-Family Medicine Centers-Egypt

    OpenAIRE

    Nour-Eldein, Hebatallah; Abdelsalam, Shimaa A.; Nasr, Gamila M.; Abdelwahed, Hassan A.

    2013-01-01

    Background: The close sustained contact of family physician with their patients and local community makes preventive care an integral part of their routine work. Most cardiovascular diseases (CVD) can be prevented by addressing their risk factors. There are several guidelines that recommend different CV risk assessment tools to support CV prevention strategies. Aim: This study aimed to assess awareness and attitude of global CV risk assessment and use of their tools by family physicians; aimi...

  18. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care.

    Science.gov (United States)

    Swedlund, Matthew P; Schumacher, Jayna B; Young, Henry N; Cox, Elizabeth D

    2012-01-01

    Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9-16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

  19. Spirometry can be done in family physicians' offices and alters clinical decisions in management of asthma and COPD.

    Science.gov (United States)

    Yawn, Barbara P; Enright, Paul L; Lemanske, Robert F; Israel, Elliot; Pace, Wilson; Wollan, Peter; Boushey, Homer

    2007-10-01

    Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care. To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry. A before-and-after quasiexperimental design. Three hundred eighty-two patients from 12 family medicine practices across the United States. Patients with asthma and COPD, and staff from the 12 practices. Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing. Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD. US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.

  20. A manual for prioritizing the topics of clinical practice guidelines for family physicians

    Directory of Open Access Journals (Sweden)

    Leila Mounesan

    2016-01-01

    Full Text Available Background: Development of a manual or well-defined criterion for prioritizing the topics of clinical practice guidelines (CPGs will help validate and organize this process evermore. This study was conducted to design an applicable manual that would prioritize the CPG topics for family physicians. Methods: This study was a multi-stage method using a qualitative approach that was conducted for the manual developing. The manual development process took place in four steps, as follows: Literature review, interviews with ten experts, preparing a list of criteria and determining its appropriateness by applying the RAND/UCLA Appropriateness method, and development of the final draft of the manual and pilot study. Results: Interview transcripts went under content analysis and were classified into eight main groups, 12 subgroups, and 85 themes. A comprehensive list consisting of fifty preliminary criteria were extracted. After summarizing and classifying the criteria, 12 appropriate criteria were evaluated using the RAND appropriateness method. Eventually, based on the literature review and our own results of the interview analysis, a manual consisting of five main sections and one clause on ethics was developed. Later, a pilot study was conducted on ten family physician topics, and prioritized by nine experts. Conclusions: The manual can be eyed as a tool ensuring the quality of the process of prioritizing CPG topics for family physicians, as it takes into account the issues involved in priority-setting. Selecting informed stakeholders for rating the criteria and ranking the topics was an issue that was greatly emphasized by the experts. Eventually, the application of this manual can be the first step toward systematizing the process of prioritizing CPG topics in the country.

  1. [Mental Health in General Family Medicine - obstacles and expectations perceived by Family Physicians].

    Science.gov (United States)

    Fernandes, Liliana; Basílio, Nuno; Figueira, Sofia; Nunes, José Mendes

    2017-03-01

    This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.

  2. Short-Term Educational Intervention Improves Family Physicians' Knowledge of Depression

    Science.gov (United States)

    Kutcher, Stanley; Lauria-Horner, Bianca; MacLaren, Connie; Bujas-Bobanovic, Maja; Karlovic, Zlatko

    2003-01-01

    Introduction: Depression is frequently unrecognized and undertreated. Therefore, there is a need to increase the knowledge and skills of primary care physicians regarding management of depression. The aim of this study was to determine if a brief educational intervention can affect family physicians' knowledge of the diagnosis and treatment of…

  3. Physician extender services in family planning agencies: issues in Medicaid reimbursement.

    Science.gov (United States)

    Mondy, L W; Lutz, D B; Heartwell, S F; Zetzman, M R

    1986-01-01

    The US Social Security Amendments of 1972 mandated the inclusion of family planning services in state Medicaid plans, authorized 90% of reimbursements for family planning care, and imposed financial penalties for failure to provide these services to Medicaid-eligible clients. On the other hand, many states have retrictive policies regarding Medicaid reimbursements to family planning agencies for services provided by physician extenders (e.g.s nurse practitioners and physician assistants). There is concern that such restrictions greatly reduce accessibility to family planning services. Reasons that hae been suggested as causes of such restrictive policies include physician concern over loss of income, the uncertain status of physician extenders in some states, a fear that this step will lead to a demand for reiimbursement for the services of other allied health care providers such as social workers, and concern that care for the indigent will lead to an expensive increase in state reimbursement for family planning services. However, a review of relevant federal law and regulations indicates that Medicaid reimbursement for services provided to eligible patients by physician extenders has never been prohibited or discouraged. Physician supervision is required in reimbursement cases, but this does not mean that a physician must be on the premises while services are delivered. The Medicaid program actually allows significant latitude in establishing administrative policies and procedures. Rather, problems faced by family planning agencies in receiving Medicaid reimbursements for physician extenders' services are due to restrictions in state laws and staff misinterpretations of policy. Research has demonstrated that physcian extenders can contribute significantly to cost effectiveness, while providing types of care in localities such as rural areas that physicians tend to avoid. Given the importance of family planning services to Medicaid-eligible clients, unwarranted

  4. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    Science.gov (United States)

    Langley, G R; Till, J E

    1989-08-15

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine.

  5. Fostering excellence Roles, responsibilities, and expectations of new family physician clinician investigators

    National Research Council Canada - National Science Library

    William Hogg; Claire Kendall; Elizabeth Muggah; Liesha Mayo-Bruinsma; Laura Ziebell

    2014-01-01

    ...; and describe the results in terms of research productivity on the part of new FP-CIs. Family physician CI's achieved a high level of research productivity during their first 5 years, but most did not secure external salary support...

  6. Family physicians understanding about Mantoux test: A survey from a high endemic TB country

    Directory of Open Access Journals (Sweden)

    Ali Niloufer

    2010-05-01

    Full Text Available Abstract Background Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis. Aims This study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month. Methods A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups. Results Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses. This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69 and (Seen Conclusion Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

  7. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    OpenAIRE

    Langley, G. R.; Till, J E

    1989-01-01

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relation...

  8. Perceptions of the first family physicians to adopt advanced access in the province of Quebec, Canada.

    Science.gov (United States)

    Breton, Mylaine; Maillet, Lara; Paré, Isabelle; Abou Malham, Sabina; Touati, Nassera

    2016-09-08

    In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi-structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early-adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Ethnicity and utilization of family physicians: a case study of Mainland Chinese immigrants in Toronto, Canada.

    Science.gov (United States)

    Wang, Lu; Rosenberg, Mark; Lo, Lucia

    2008-11-01

    This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants - the most important source of immigrants to Canada since 1996 - in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations.

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

    OpenAIRE

    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...

  11. Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

    Science.gov (United States)

    Cabrera Pivaral, C E; Gutiérrez Roman, E A; Gonzalez Pérez, G; Gonzalez Reyes, F; Valadez Toscano, F; Gutiérrez Ruvalcaba, C; Rios Riebeling, C D

    2008-02-01

    There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

  12. 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

  13. Cost Efficiency of the Family Physician Plan in Fars Province, Southern Iran

    Directory of Open Access Journals (Sweden)

    Nahid Hatam

    2012-12-01

    Full Text Available Background: In recent years use of family physicians has been determined as a start point of health system reform to achieve more productive health services. In this study we aimed to assess the cost-efficiency of the implementation of this plan in Fars province, southern Iran.Methods: This cross-sectional descriptive study was done in 2007 in 18 provincial health centers as well as 224 rural health centers in Fars province. Data were collected using forms, statistics, and available evidence and analyzed by expert opinion and ratio techniques, control of process statistics, and multi indicator decision model.Results: Although in the family physician plan more attention is paid to patients and the level of health training, availability, and equity has improved and the best services are presented, it has not only decreased the costs, but also increased the referrals to pharmacies, laboratories, and radiology clinics and the costs of healthcare.Conclusion: Although the family physician plan has led to more regular service delivery, it has increased the patients’ referral to pharmacies, laboratories, and radiology centers and more referrals to family physicians. It seems that the possibility of setting regularity in health system can be gained in the following years of the family physician program mainly via planning, appropriate management and organizing correct health plans according to need assessments, and continual supervision on activities, which would happen according to current experiences in this plan.

  14. When cultures clash: physician, patient, and family wishes in truth disclosure for dying patients.

    Science.gov (United States)

    Lapine, A; Wang-Cheng, R; Goldstein, M; Nooney, A; Lamb, G; Derse, A R

    2001-01-01

    We describe two cases involving male foreign nationals (a Chinese and a Georgian) treated in a U.S. hospital. Both patients had terminal illnesses, and both cases involved clashes between families and the treating physicians, which occurred because of differing cultural beliefs about truth disclosure. Based on the specific backgrounds of these two patients, we discuss ethical and cultural considerations and make suggestions for physicians who care for ethnically diverse patients.

  15. Are family physicians the answer to ED doctor shortage, or 'blasphemy'?

    Science.gov (United States)

    2011-01-01

    Some organizations maintain that family physicians have the skills and training necessary to practice in the ED and help combat the current physician shortage, while others maintain their training is inadequate. Here are some issues to take into consideration with such candidates: Have they obtained thorough experience the necessary skills to practice in the ED? Have they received a significant amount of clinical training in an ED? Has their training progress been monitored by a teaching attending?

  16. "Sometimes I feel overwhelmed": educational needs of family physicians caring for people with intellectual disability.

    Science.gov (United States)

    Wilkinson, Joanne; Dreyfus, Deborah; Cerreto, Mary; Bokhour, Barbara

    2012-06-01

    Primary care physicians who care for adults with intellectual disability often lack experience with the population, and patients with intellectual disability express dissatisfaction with their care. Establishing a secure primary care relationship is particularly important for adults with intellectual disability, who experience health disparities and may rely on their physician to direct/coordinate their care. The authors conducted semistructured interviews with 22 family physicians with the goal of identifying educational needs of family physicians who care for people with intellectual disability. Interviews were transcribed and coded using tools from grounded theory. Several themes related to educational needs were identified. Physician participants identified themes of "operating without a map," discomfort with patients with intellectual disability, and a need for more exposure to/experience with people with intellectual disability as important content areas. The authors also identified physician frustration and lack of confidence, compounded by anxiety related to difficult behaviors and a lack of context or frame of reference for patients with intellectual disability. Primary care physicians request some modification of their educational experience to better equip them to care for patients with intellectual disability. Their request for experiential, not theoretical, learning fits well under the umbrella of cultural competence (a required competency in U.S. medical education).

  17. Global Cardiovascular Risk Assessment by Family Physicians in Suez Canal University-Family Medicine Centers-Egypt.

    Science.gov (United States)

    Nour-Eldein, Hebatallah; Abdelsalam, Shimaa A; Nasr, Gamila M; Abdelwahed, Hassan A

    2013-01-01

    The close sustained contact of family physician with their patients and local community makes preventive care an integral part of their routine work. Most cardiovascular diseases (CVD) can be prevented by addressing their risk factors. There are several guidelines that recommend different CV risk assessment tools to support CV prevention strategies. This study aimed to assess awareness and attitude of global CV risk assessment and use of their tools by family physicians; aiming to improve CV prevention service. The current study is a cross-sectional descriptive analytic. Sixty-five family physicians were asked to respond to, validated anonymous questionnaire to collect data about characteristics of family physicians, their awareness, attitude, current use, barriers, and recommendations of global CV risk assessment. Statistical Package for Social Sciences (SPSS) version 18 was used for data entry and analysis. Awareness of guidelines of global CV risk assessment was relatively higher regarding the American guidelines (30.8%) than that recommended by World Health Organization (WHO) for Egypt (20.2%). 50.8% of participants had favorable attitude. There was statistical significant relationship between attitude scores and physician characteristics; age (P = 0.003), qualification (P = 0.001) and number of patients seen per week (P = 0.009). Routine use of global CV risk assessment tools was reported only (23%) by family physicians. Relative higher attitude scores than use of global CV risk assessment tools in practice. The most frequent barriers were related to lack of resources and shortage in training/skills and the raised suggestions were towards training.

  18. Rural Women Family Physicians: Strategies for Successful Work-Life Balance.

    Science.gov (United States)

    Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather

    2016-05-01

    Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. © 2016 Annals of Family Medicine, Inc.

  19. Email communication in a developing country: different family physician and patient perspectives.

    Science.gov (United States)

    Makarem, Nisrine N; Antoun, Jumana

    2016-01-01

    Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians' and patients' use of email within the same health care setting of a developing country. A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans.

  20. Factors Impacting Transgender Patients' Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey.

    Directory of Open Access Journals (Sweden)

    Greta R Bauer

    Full Text Available Representing approximately 0.5% of the population, transgender (trans persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs via average marginal predictions, for transmasculine (n = 184 and transfeminine (n = 172 trans persons.Among the 83.1% (95% CI = 77.4, 88.9 of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77; transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15. Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among

  1. Advantages and disadvantages of educational email alerts for family physicians: viewpoint.

    Science.gov (United States)

    Badran, Hani; Pluye, Pierre; Grad, Roland

    2015-02-27

    Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians' knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants' suggestions to improve email alert services for CME. We conducted a qualitative descriptive study using the "Knowledge, Attitude, Behavior" model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

  2. The attitudes of family physicians toward a child with delayed growth and development.

    Science.gov (United States)

    Aker, Servet; Şahin, Mustafa Kürşat; Kınalı, Ömer; Şimşek Karadağ, Elif; Korkmaz, Tuğba

    2017-09-01

    Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development. Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning. This descriptive study was performed in Samsun, Turkey, in May and June 2015. In total, 325 family physicians were included. The study consisted of two parts. In the first session of the research, the story of an 18-month-old child with delayed growth and development was presented using visual materials. An interview between the child's mother and a member of primary healthcare staff was then enacted by two of the authors using role-playing. Subsequently, participants were given the opportunity to ask the mother and member of primary healthcare staff questions about the case. During the sessions, two observers observed the participants, took notes and compared these after the presentation. In the second part of the study, the participants were asked to complete a questionnaire consisting of three open-ended questions. Findings When asking questions of the mother, family physicians generally used accusatory and judgmental language. One of the questions most commonly put to the mother was 'Do you think you are a good mother?' Family physicians were keen to provide instruction for the patient and relatives. Family physicians to a large extent thought that the problem of a child with delayed growth and development can be resolved through education. Family physicians' manner of establishing relations with the patient and relatives is inappropriate. We therefore think that they should receive on-going in-service training on the subject.

  3. Communication skills of tutors and family medicine physician residents in Primary Care clinics.

    Science.gov (United States)

    Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Pérez Fuentes, María Francisca; Alcalde Molina, María Dolores; Torío Durántez, Jesús; Delgado Rodríguez, Miguel

    2016-12-01

    To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient. A descriptive multicentre study. Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva. 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients. Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed. There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: -0.1). Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Antonios H. Tzamaloukas

    2012-05-01

    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.Connaissances des spécialistes des maladies rénales chroniques : Une comparaison des internistes et des médecins de famille en Afrique de l’OuestContexte: La formation de troisi

  5. The costs of preventing the spread of respiratory infection in family physician offices: a threshold analysis

    Directory of Open Access Journals (Sweden)

    Gray David

    2007-11-01

    Full Text Available Abstract Background Influenza poses concerns about epidemic respiratory infection. Interventions designed to prevent the spread of respiratory infection within family physician (FP offices could potentially have a significant positive influence on the health of Canadians. The main purpose of this paper is to estimate the explicit costs of such an intervention. Methods A cost analysis of a respiratory infection control was conducted. The costs were estimated from the perspective of provincial government. In addition, a threshold analysis was conducted to estimate a threshold value of the intervention's effectiveness that could generate potential savings in terms of averted health-care costs by the intervention that exceed the explicit costs. The informational requirements for these implicit costs savings are high, however. Some of these elements, such as the cost of hospitalization in the event of contacting influenza, and the number of patients passing through the physicians' office, were readily available. Other pertinent points of information, such as the proportion of infected people who require hospitalization, could be imported from the existing literature. We take an indirect approach to calculate a threshold value for the most uncertain piece of information, namely the reduction in the probability of the infection spreading as a direct result of the intervention, at which the intervention becomes worthwhile. Results The 5-week intervention costs amounted to a total of $52,810.71, or $131,094.73 prorated according to the length of the flu season, or $512,729.30 prorated for the entire calendar year. The variable costs that were incurred for this 5-week project amounted to approximately $923.16 per participating medical practice. The (fixed training costs per practice were equivalent to $73.27 for the 5-week intervention, or $28.14 for 13-week flu season, or $7.05 for an entire one-year period. Conclusion Based on our conservative estimates

  6. Approach to atopic dermatitis in children by the Family Physician

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    Alysson Quitério Guilherme

    2014-05-01

    Full Text Available Atopic dermatitis (AD is a chronic and inflammatory disease that affects the skin of children in their early stages of life. Its aetiology remains little understood, but it is known that there is a dysfunction of the skin barrier, which facilitates the penetration of allergens/irritants into the epidermis, causing an inflammatory response with a predominance of Th2 response relative to Th1. The diagnosis is clinical and may be associated with previous and family medical history of atopies such as rhinitis and asthma. AD manifests itself through eczematous, pruritic injuries with the presence of erythema, papules, vesicles, and scales. The main differential diagnoses of AD are seborrheic dermatitis, contact dermatitis, psoriasis and scabies. The treatment is based on the education of patients and their families, plus the control of pruritus with antihistamines and of inflammation with corticosteroids or calcineurin inhibitors. Given the high prevalence and impact of AD on the quality of life of paediatric patients, early diagnosis and an individualized approach are paramount.

  7. Nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients

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    Abdolghani Abdollahimohammad

    2016-03-01

    Full Text Available Purpose: Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians’ knowledge, attitude, and performance on care for the family members of dying patients (FMDPs. Methods: This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results: The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05. The majority of nurses (55.4% and physician (63.6% were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81% and physicians (87.3% had a positive attitude towards caring the FMDPs. Most of the nurses (70% and physicians (86.3% had a moderate and fair performance. Conclusion: Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses’ and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care.

  8. The study of urban family physicians performance and its related factors in the south of Iran

    Directory of Open Access Journals (Sweden)

    Ozra Nourafkan

    2016-01-01

    Full Text Available Introduction: The Family Physician Program is one of the most important plans for increasing the equitable access and affordable health services. This study aimed to examine the performance of Urban Family Physicians and associated factors in the third year of its implementation. Method: A cross-sectional study was conducted on all Family Physicians (31 persons working in the private and public polyclinics and clinics in the Firoozabad, from October to December 2014. The population of the study consisted of all the physicians (31 persons who were involved in the Family Medicine Program. The main instrument for data gathering was a standard questionnaire developed by Ministry of Health and Medical Education (MOHME. Validity and reliability of the questionnaire have been confirmed by MOHME. The questionnaire had four parts including medical equipment, informing the patients, referral system rules, and protocols. The data were analyzed using SPSS statistical software, version 16, through appropriate statistical tests including Independent T-test, Pearson Correlation, One sample T-test, in a significance level of<0.05. Results: Findings of the study showed that there was not a significant association between performance of physicians and equipment (77.20 ± 22.80. Their performance based on informing patients (81.59±16.69, protocols (82.42±12.05, and total performance (82.41±13.42 was good. Their performance in terms of referral system (69.35 ±16.15 was weak. There were not any association between the performance and marital status, age, career, and sex. In contrast, there was a significant relationship between nativity and performance so that the performance of native physicians was better. Conclusion: The Urban Family Physician is an outstanding step for improving the public health but its successful implementing needs to develop an appropriate solution for employing the native physicians. It seems that applying various incentives and

  9. Knowledge and attitudes of family physicians coming to COPD continuing medical education

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    Barbara P Yawn

    2008-06-01

    Full Text Available Barbara P Yawn, Peter C WollanOlmsted Medical Center, Research Department, Rochester, MN, USAPurpose: COPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs and physician assistants (PAs working in primary care.Methods: We completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD.Results: Return rate was 62% (n = 284 including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74% of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% of respondents that appeared after age 60 (61%. Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15% or decreasing exacerbations (3% or that pulmonary rehabilitation was helpful (3%, but 13% reported they thought COPD treatment could extend longevity.Conclusions: Primary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of

  10. Evidence-based medicine in primary care: qualitative study of family physicians

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    Dantas Guilherme

    2003-05-01

    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  11. Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

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    Jia Lee, PhD, RN

    2010-12-01

    Conclusions: There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

  12. Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable

    Science.gov (United States)

    Aubrey-Bassler, Kris; Cullen, Richard M.; Simms, Alvin; Asghari, Shabnam; Crane, Joan; Wang, Peizhong Peter; Godwin, Marshall

    2015-01-01

    Background: Previous research has suggested that obstetric outcomes are similar for deliveries by family physicians and obstetricians, but many of these studies were small, and none of them adjusted for unmeasured selection bias. We compared obstetric outcomes between these provider types using an econometric method designed to adjust for unobserved confounding. Methods: We performed a retrospective population-based cohort study of all Canadian (except Quebec) hospital births with delivery by family physicians and obstetricians at more than 20 weeks gestational age, with birth weight greater than 500 g, between Apr. 1, 2006, and Mar. 31, 2009. The primary outcomes were the relative risks of in-hospital perinatal death and a composite of maternal mortality and major morbidity assessed with multivariable logistic regression and instrumental variable–adjusted multivariable regression. Results: After exclusions, there were 3600 perinatal deaths and 14 394 cases of maternal morbidity among 799 823 infants and 793 053 mothers at 390 hospitals. For deliveries by family physicians v. obstetricians, the relative risk of perinatal mortality was 0.98 (95% confidence interval [CI] 0.85–1.14) and of maternal morbidity was 0.81 (95% CI 0.70–0.94) according to logistic regression. The respective relative risks were 0.97 (95% CI 0.58–1.64) and 1.13 (95% CI 0.65–1.95) according to instrumental variable methods. Interpretation: After adjusting for both observed and unobserved confounders, we found a similar risk of perinatal mortality and adverse maternal outcome for obstetric deliveries by family physicians and obstetricians. Whether there are differences between these groups for other outcomes remains to be seen. PMID:26303244

  13. Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel

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    Amir Shmueli

    2006-01-01

    Full Text Available Higher utilization of complementary and alternative medicine (CAM is commonly explained by dissatisfaction or disappointment with conventional medical treatment. To explore, at two points in time in Israel, the associations between six domains of satisfaction (attitude, length of visits, availability, information sharing, perceived quality of care and overall with conventional family physicians' and specialists' services and the likelihood of consulting CAM providers. This is a secondary analysis of interviews, which were conducted with 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and multivariate analyses were used in the investigation. In 1993, users of CAM were less satisfied than non-users with both family physicians' and specialists' care. Lower satisfaction with the attitude of, the amount of information sharing by and in general with family physicians, and with the length of visits and perceived quality of care of specialists were significantly associated with CAM use. In 2000, lower satisfaction with specialists' attitude, length of visits, availability and in general was significantly related to the use of CAM. Lower satisfaction with family physicians and specialists is significantly associated with consulting CAM providers. However, with CAM becoming a mainstream medical care specialty in its own, lower satisfaction with conventional medicine specialists becomes the most important factor.

  14. Family physicians' diagnostic gut feelings are measurable: construct validation of a questionnaire

    NARCIS (Netherlands)

    Stolper, C.F.; Wiel, M.W.J. van de; Vet, H.C. de; Rutten, A.L.; Royen, P. Van; Bokhoven, M.A. van; Weijden, T.T. van der; Dinant, G.J.

    2013-01-01

    BACKGROUND: Family physicians perceive that gut feelings, i.e. a 'sense of reassurance' or a 'sense of alarm', play a substantial role in diagnostic reasoning. A measuring instrument is desirable for further research. Our objective is to validate a questionnaire measuring the presence of gut feeling

  15. How family physicians address diagnosis and management of depression in palliative care patients.

    NARCIS (Netherlands)

    Warmenhoven, F.C.; Rijswijk, H.C.A.M. van; Hoogstraten, E. van; Spaendonck, K.P.M. van; Lucassen, P.L.B.J.; Prins, J.B.; Vissers, K.; Weel, C. van

    2012-01-01

    PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in fa

  16. Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse.

    Science.gov (United States)

    Kavukcu, Ethem; Akdeniz, Melahat; Avci, Hasan Huseyin; Altuğ, Mehmet; Öner, Mehmet

    2015-01-01

    The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Knowledge and competency of the family physicians in managing CNCP were improved as was

  17. What do abused women expect from their family physicians? A qualitative study among women in shelter homes.

    NARCIS (Netherlands)

    Wester, W.N.; Wong, S.L.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. METHODS: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse situation

  18. What do abused women expect from their family physicians? A qualitative study among women in shelter homes.

    NARCIS (Netherlands)

    Wester, W.N.; Wong, S.L.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. METHODS: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse

  19. What do abused women expect from their family physicians? A qualitative study among women in shelter homes

    NARCIS (Netherlands)

    Wester, W.N.; Lo Fo Wong, S.H.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. METHODS: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse

  20. Chaperone use during intimate examinations in primary care: postal survey of family physicians

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    Upshur Ross EG

    2005-12-01

    Full Text Available Abstract Background Physicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use. Methods Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams. Results 276 of 500 were returned (56%, of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p Conclusion Clinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.

  1. LEVEL OF COMPETENCIES OF FAMILY PHYSICIANS IN KOSOVO FROM DIFFERENT PERSPECTIVES.

    Science.gov (United States)

    Bojaj, Gazmend; Skeraj, Fitim; Czabanowska, Katarzyna; Burazeri, Genc

    2016-10-01

    The aim of this analysis was to compare the level of self-perceived competencies of primary health care physicians in Kosovo with patients' viewpoint, as well as the necessary (required) level of such competencies from decision-makers' standpoint. Three cross-sectional studies were carried out in Kosovo in 2013 including: i) a representative sample of 1340 primary health care users aged ≥18 years (49% men; overall mean age: 50.5±17.9 years; response rate: 89%); ii) a representative sample of 597 primary health care physicians (49% men; overall mean age: 46.0±9.4 years; response rate: 90%), and; iii) a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63% men; mean age: 47.7±5.7 years). A structured self-administered questionnaire (consisting of 37 items) was used in the three surveys in order to assess physicians' competencies regarding different domains of the quality of health care. There was a significant gap in the level of self-perceived physicians' competencies and patients' perspective in transitional Kosovo. Furthermore, there was a gap in the level of self-perceived physicians' competencies and the necessary (required) level of physicians' competencies from decision-makers perspective which was less evident in Prishtina, but considerable in the other regions of Kosovo. Our analysis provides valuable evidence about the level of competencies of primary health care physicians in Kosovo from different stakeholders' perspectives. There is an urgent need for continuous professional development of family physicians in post-war Kosovo.

  2. [High prevalence of work-family conflict among female physicians: lack of social support as a potential antecedent].

    Science.gov (United States)

    Adám, Szilvia

    2009-12-13

    According to stress theory, social support from work and non-work-related sources may influence the level of perceived work-family conflict. Despite the high prevalence of work-family conflict as a source of distress among female physicians, no information is available on the associations between work-family conflict and social support in a traditional, family-centric cultural setting, where female role expectations are demanding. The author hypothesized that high prevalence of work-family conflict could be attributed to the lack of social support among female physicians. To investigate the prevalence and psychosocial characteristics of social support and its relations to work-family conflict among female physicians. Quantitative and qualitative study using questionnaires ( n = 420) and in-depth interviews ( n = 123) among female and male physicians. Female physicians reported significantly higher mean level and prevalence of work-family conflict compared to men. The predominant form of work-family was work-to-family conflict among physicians; however, significantly more female physicians experienced family-to-work conflict and strain-based work-family conflict compared to men (39% vs. 18% and 68% vs. 20%, respectively). Significantly more male physicians experienced time-based work-family conflict compared to women. Content analyses of interview data revealed that provision of support to physicians manifested itself in parental support in career selection, spousal support with household duties, peer support with enabling access to professional role models-mentors, peer support to ensure gender equity, and organizational support with family-centric policies. Female physicians reported significantly less parental, spousal, and peer support compared to men. Female physicians lacking parental, peer, or organizational support experienced significantly higher level of work-family conflict compared to appropriate control. In regression analyses, high job demands, job

  3. Knowledge and attitudes of family physicians coming to COPD continuing medical education.

    Science.gov (United States)

    Yawn, Barbara P; Wollan, Peter C

    2008-01-01

    COPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs) and physician assistants (PAs) working in primary care. We completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD. Return rate was 62% (n = 284) including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74%) of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% ofrespondents) that appeared after age 60 (61%). Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15%) or decreasing exacerbations (3%) or that pulmonary rehabilitation was helpful (3%), but 13% reported they thought COPD treatment could extend longevity. Primary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of therapy issues are addressed.

  4. Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians

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    Farhad Fakhrudin Vasanwala

    2017-07-01

    Full Text Available Male patients with lower urinary tract symptoms (LUTS and benign prostatic hyperplasia (BPH are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.

  5. The single-parent family. How an understanding physician can help.

    Science.gov (United States)

    Anstett, R; Lewis, B

    1986-08-01

    Families who have become separated from one of the parents by death or divorce face much stress and adjustment. In addition to carrying the extra burdens of parenting and running a household alone, the single parent may feel isolated from friends and family. Loneliness, depression, and confusion can manifest themselves in various physical and emotional ways. At the beginning of an office visit, the physician should try to ascertain whether any important changes have occurred in the patient's life and should record this information in the patient's chart. Once single parenthood is determined, the importance to the patient and the circumstances of the separation should be obtained. Children in different age-groups often demonstrate specific regressive disorders when a life crisis occurs, and a perceptive physician may spot such behavior and counsel both the parent and the child. Possibly the most effective treatment in such a situation is understanding, reassurance, and listening.

  6. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians

    OpenAIRE

    Rurik Imre; Torzsa Péter; Ilyés István (1943-) (gyermekgyógyász, gyermekendokrinológus, háziorvos); Szigethy Endre (1980-) (szociológus, epidemiológus); Halmy Lászlóné (orvos, Budapest); Iski Gabriella; Kolozsvári László Róbert (1977-) (háziorvos); Mester Lajos; Móczár Csaba (1966-) (háziorvos); Rinfel József; Nagy Lajos; Kalabay László

    2013-01-01

    Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In d...

  7. Emerging Role of the Army Family Physician in Primary Health Care Delivery.

    Science.gov (United States)

    1976-12-13

    ev.~ ~ ~ i Defe nse or any of its egeflC .eS. l~ iIs ~ ‘j~ Uii~ fi ~ ~~~~ ~ t e tSh5 ~S~ t t~ )i O~. efl pub hiCati0 fl unt il it has been c)eafe...family physician is educated and trained to develop and bring to bear in practice unique attitudes and skills which qualify him or her to provide

  8. The Quality Assessment of Family Physician Service in Rural Regions, Northeast of Iran in 2012

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    Ali Vafaee-Najar

    2014-04-01

    Full Text Available Background Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients’ expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. Methods This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. Results The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05. Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05. Conclusion There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients’ expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.

  9. Investigation of administrative obstacles to family physician program in urban areas of Iran

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    Javad Javan noughabi

    2017-06-01

    Full Text Available Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participants' detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without people’s acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with people’s requests; and can result in overcoming the challenges and obstacles facing the program.

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

    Science.gov (United States)

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

    2014-03-01

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

  11. 20 CFR 220.58 - Objections to the designated physician or psychologist.

    Science.gov (United States)

    2010-04-01

    ... psychologist. 220.58 Section 220.58 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE... designated physician or psychologist. A claimant or his or her representative may object to his or her being examined by a designated physician or psychologist. If there is a good reason for the objection, the...

  12. [Family health and family physician's influence on prevention psychoactive substances abuse].

    Science.gov (United States)

    Lapčević, Mirjana; Dimitrijević, Ivan

    2010-01-01

    The family, as the basic social unit, has a decisive role in the health and disease of its members. It is the primary unit where health needs are formed and solved. By its own resources the family independently resolves about 75% of the total health requirements. In the paper the authors study family characteristics which influence family health and diseases, indicators of family health and the scale of life values. Also, the study evaluates social factors, communication and the influence of the usage of psychoactive substances on family health and the quality of family life. To form the personality of a child three factors are most significant: love, the feeling of safety and the presence of harmonious relationship between the parents. Life harmony in a family also depends on the quality of structural components of the personality and the interaction of motivation of its members. Early childhood determines the future personality of the adult person. At that period, habits and partially attitudes are formed. In harmonious family relationships the parents are the role model to children. Verbal and non-verbal communication enrich the relationship among people and enable efforts in supporting understanding, compassion and care for others by mutual agreement. On the scale of life values of Serbian citizens health holds the first position. Immediately following the health issue is good relationship in the family. As healthcare is not only the task of healthcare services, but also of each individual, family and the society as a whole, it is on healthcare personnel to educate the citizens how to preserve and improve their own health and the health of their family by a continual healthcare and education. Above all, this concerns avoidance of bad habits, such as smoking, immoderate alcohol consumption, narcotic abuse, physical inactivity, hypercaloric nutrition, etc. Also, it is significant to make an early recognition of disease symptoms and to turn for help to the chosen

  13. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.

    Science.gov (United States)

    Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba

    2014-01-01

    Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

  14. Growing Old Together: The Influence of Population and Workforce Aging on Supply and Use of Family Physicians

    Science.gov (United States)

    Watson, Diane E.; Reid, Robert; Roos, Noralou P.; Heppner, Petra

    2005-01-01

    Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP to population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the…

  15. The role of family physicians contracted healthcare in China: A "Cardiotonic" or a "Band-Aid" for healthcare reform?

    Science.gov (United States)

    Tang, Qi; Song, Peipei; Xu, Lingzhong

    2016-09-05

    On June 6, 2016, as a mode expected to open a new prospect for tiered system of medical care in China, family physicians contracted healthcare was officially launched, intending to facilitate such healthcare be universal coverage by 2020.There are some doubts as to whether this goal is possible. The role of family physicians contracted healthcare in China should also be carefully identified. We hold that family physicians contracted healthcare will promote healthcare reform if it provides a "Cardiotonic" that alleviates the long-standing inequitable allocation of healthcare resources. However, this form of care faces many obstacles given the current state of medical care in China. It will just be a "Band-Aid" if the aforementioned issues of the shortage of family physicians, coordination with referring hospitals, and incomplete oversight are not resolved.

  16. Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study

    Science.gov (United States)

    Rosener, Stephanie E.; Barr, Wendy B.; Frayne, Daniel J.; Barash, Joshua H.; Gross, Megan E.; Bennett, Ian M.

    2016-01-01

    PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODS We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child’s physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P .05). CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child’s physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes. PMID:27401423

  17. Designing for Family Science Explorations Anytime, Anywhere

    Science.gov (United States)

    Luce, Megan R.; Goldman, Shelley; Vea, Tanner

    2017-01-01

    Families play an important role in informal science learning, but they may need supports for engaging in science that is exploratory, inquiry based, and builds on family practices. We designed resources that frame scientific sensemaking as an active and playful process of exploration in which family members are coparticipants. This approach…

  18. Designing for Family Science Explorations Anytime, Anywhere

    Science.gov (United States)

    Luce, Megan R.; Goldman, Shelley; Vea, Tanner

    2017-01-01

    Families play an important role in informal science learning, but they may need supports for engaging in science that is exploratory, inquiry based, and builds on family practices. We designed resources that frame scientific sensemaking as an active and playful process of exploration in which family members are coparticipants. This approach…

  19. Sponsoring Institutions with Five or Fewer Residency Programs Produce a Larger Proportion of General Internists and Family Physicians.

    Science.gov (United States)

    Hemeida, Sarah; Klink, Kathleen; Bazemore, Andrew; Petterson, Stephen; Peterson, Lars

    2016-01-01

    Policymakers are increasingly interested in addressing the US primary care physician shortage and achieving measurable accountability for the products of the nation's $15 billion investment in graduate medical education (GME). Using one such measure, we found that sponsoring institutions (SIs) with ≤5 residency programs produce a higher percentage of general internists and family physicians than larger SIs. © Copyright 2016 by the American Board of Family Medicine.

  20. Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians across Ontario.

    Directory of Open Access Journals (Sweden)

    Genane Loheswaran

    Full Text Available As a primary point of contact within the health care system, family physicians are able to play a vital role in identifying individuals with substance use disorders and connecting them to the appropriate treatment. However, there is very little data available on whether family physicians are actively screening for and treating substance use disorders. The objective of the current survey was to assess whether family physicians in Ontario are screening for alcohol, opioid and tobacco use disorders, using validated tools and providing treatment.An online survey consisting of a series of 38 primarily close-ended questions was circulated to family physicians in Ontario. Rates of screening for alcohol, opioid and tobacco dependence, use of validated tools for screening, providing treatment for dependent individuals and the current barriers to the prescription of pharmacotherapies for these drug dependences were assessed.The use of validated screening tools was limited for all three substances. Screening by family physicians for the substance use disorders among adolescents was much lower than screening among adults. Pharmacotherapy was more commonly used as an intervention for tobacco dependence than for alcohol and opioid dependence. This was explained by the lack of knowledge among family physicians on the pharmacotherapies for alcohol and opioid dependence.Findings from the current study suggest there is a need for family physicians to integrate screening for substance use disorders using validated tools into their standard medical practice. Furthermore, there is a need for increased knowledge on pharmacotherapies for alcohol and opioid use disorders. It is important to note that the low response rate is a major limitation to this study. One possible reason for this low response rate may be a lack of interest and awareness among family physicians on the importance of screening and treatment of substance use disorders in Ontario.

  1. The family physician and the psychologist in the office together: a response to fragmentation.

    Science.gov (United States)

    Solano, Luigi; Pirrotta, Enzo; Ingravalle, Veronica; Fayella, Paolo

    2009-06-01

    It is well known that motives for consulting the family physician, though expressed as physical symptoms, often derive from problems needing a holistic, psychosocial approach. Progressive differentiation between medicine and psychology makes co-operation through referral to the psychologist by the physician quite problematic, in terms of both which patients are referred and the modalities of referral. Acceptance of psychological referral may, in any case, be difficult, due to the social stigma that still surrounds mental distress.The authors report a possible solution in an experiment implemented by the postgraduate Health Psychology School of the Rome University 'Sapienza', entailing joint, direct co-operation between a family physician and a psychologist through the psychologist's presence in the doctor's office during consultations. This allowed direct access to a psychologist in the absence of any filter and without the need for a formal request on the patient's part and a biopsychosocial approach to distress. In a small number of cases, more formal consultation with the psychologist was proposed. Cases were always discussed between the two professionals. To date, the experiment has involved nine psychologists and seven physicians over a period of nine years. It appears to be entirely feasible, though requiring a period of adaptation between the two professionals. Patients have welcomed the presence of the psychologist and, as expected, take a broader approach in reporting their distress.An illustrative case is presented, in which finding the meaning of a symptom avoided unnecessary and costly investigations, and facilitated the patient in taking a new direction in his life.

  2. Emotional impact of patient safety incidents on family physicians and their office staff.

    Science.gov (United States)

    O'Beirne, Maeve; Sterling, Pam; Palacios-Derflingher, Luz; Hohman, Stacey; Zwicker, Karen

    2012-01-01

    The objective of this study was to investigate the emotional responses and coping strategies that family physicians and their office staff reported in response to a patient safety incident. Two questions contained in a patient safety incident report developed for a study of patient safety in family practice were analyzed. The questions asked reporters to indicate their emotional response to a patient safety incident and how they coped with it. A total of 264 confidential patient safety incident reports collected from September 2007 to August 2010 were analyzed. An emotional response was reported on 82.4% of reports. Of those reports on which an emotional response was reported, a coping strategy was reported on 62.8%. The top 4 reported emotional responses were frustration (48.3%), embarrassment (31.5%), anger (12.6%), and guilt (10.1%). Physicians reported an emotional response more often than clinic staff. An emotional response was reported more often when there was a possibility of harm. Coping strategies were reported as follows: 52% talked to someone about the incident, 37.2% did nothing in response to the incident, 17.9% told the patient about the incident, and 3.6% did something else. Female physicians reported using coping strategies less often than male physicians. A coping strategy was reported more often when there was a possibility of harm. All members of the health care team report experiencing emotions related to patient safety incidents in their practice. Incidents with minor or no harm still invoked emotional responses from the providers. It is important to understand the impact that patient safety incidents have on the medical clinic as a whole.

  3. Nine years of publications on strengths and weaknesses of Family Physician Program in rural area of Iran: A systematic review

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2016-12-01

    Full Text Available Introduction: One of the most important duties of a family physician is to provide primary health care. This is completely considered in the Family Physician Program for a target population. The aim of this study was to systematically review the Family Physician and Referral System strength and weakness in rural area of Iran. Methods: In this systematic review, Scientific Information Database (SID, Science Direct, and PubMed databases were searched and Google search engine was employed using key words such as family medicine, family physician, and referral system for the period of January 2005 to June 2013, both in English and Persian. For identifying duplicated references, Endnote Software was used and for summarizing results of fully assessed articles extraction table was employed. Results: Strengths and weaknesses of Family Physician Program and referral system in rural areas of Iran were extracted from 28 studies. In total, 115 weaknesses (3.96 per study and 103 strengths (3.55 per study were obtained. Content analysis was used and 218 items were summarized into 29 items. Strengths of Family Physician Program were: access of villagers to health services, filling health document for clients, improving services for pregnant mothers, and family planning; while its obvious weaknesses included repeated unnecessary referral of clients as well as lack of providing job stability. Conclusion: Results of studies conducted in Iran showed that Family Physician and Referral System in rural area of Iran could not be successful enough and has many shortcomings. Therefore, a growing body of effective changes must be made for a better performance and to obtain better outcomes.

  4. Practical training in family medicine in the Dalmatian hinterland: first-hand experience of four physicians

    Directory of Open Access Journals (Sweden)

    Minka Jerčić

    2012-05-01

    Full Text Available Four physicians working in private family medicine offices in Dalmatian Hinterland described their first hand experience of teaching sixthyear medical students. They supervised students during the 2010/2011 academic year, in an area that is economically undeveloped, rural, and where a number of people live in extended families. Although hesitant at first, the patients came to like the interaction with students, and later even yearned to provide students with as much information as possible. They also liked the letters that students had to write to them about their illness, because they could take them home and look for information without needing to see the doctor. The students showed diverse attitudes to different types of work in family medicine offices, mostly depending on their plans for future career. In general, they either complained or hesitated to perform duties that they did not fully master during earlier education, especially working with children. They needed several days to adapt to direct contact with the patients, and were more relaxed and cooperative when working in pairs than alone. The physicians themselves felt that they profited both from the novelty in the everyday routine and from the exchange of their experiences with the students. They liked their young colleagues and admitted they could not objectively review their own work, knowledge and skills.

  5. Perceptions of patients, families, physicians and nurses regarding challenges in cancer disclosure: A descriptive qualitative study.

    Science.gov (United States)

    Ehsani, Maryam; Taleghani, Fariba; Hematti, Simin; Abazari, Parvaneh

    2016-12-01

    The findings of numerous studies have illustrated that there is still a high proportion of cancer patients in Eastern and Middle-East countries including Iran, who are not properly informed of their disease due to the concealment atmosphere which still prevails. This descriptive qualitative study is aimed at exploring perceptions of patients, patients' family members, physicians and nurses regarding cancer disclosure challenges. Thirty-five participants (15 patients, 6 family members, 9 physicians, and 5 nurses) were selected through purposive sampling. The data were collected through in-depth interviews; after which they were analyzed using a qualitative content analysis with an inductive approach. Data analysis revealed the following three categories: first, challenges related to healthcare system which deals with the deficiencies, strains and concerns in medical setting and healthcare team training; second, challenges related to family insistence on concealment which includes their fear of cancer disclosure and its negative impact on the patients; and third, challenges related to policy making which consists of deficiencies in legislative and supportive institutions for advocacy of truth telling. Successful move from concealment to effective disclosure attitude in cancer patients in Iran requires a national determination for resolving challenges in medical education as well as other different social, cultural and policy making dimensions. Copyright © 2016. Published by Elsevier Ltd.

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

    Science.gov (United States)

    Rurik, Imre; Kalabay, László

    2008-05-11

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

  7. Knowledge of antibiotics and antibiotic resistance in patients followed by family physicians.

    Science.gov (United States)

    Robert, A; Nguyen, Y; Bajolet, O; Vuillemin, B; Defoin, B; Vernet-Garnier, V; Drame, M; Bani-Sadr, F

    2017-03-01

    We aimed to evaluate factors associated with knowledge of antibiotics and drug resistance. A questionnaire was handed out by 14 family physicians to their patients between December 20, 2014 and April 20, 2015 in Rethel (North-East of France). We conducted a cross-sectional study using a logistical regression model to assess factors associated with antibiotic knowledge. Three criteria were used to assess that knowledge. Overall, 293 questionnaires were analysed; 48% of patients had received antibiotics in the previous 12 months. Only 44% and 26% gave a correct answer for the statements "Antibiotics are effective against bacteria and ineffective against viruses" and "Antibiotic resistance decreases if the antibiotic use decreases", respectively. Characteristics such as female sex, age>30 years, high level of education, high professional categories, and having received antibiotic information by the media were associated with high level of knowledge about antibiotics and/or antibiotic resistance. In contrast, having received antibiotic information from family physicians was not associated with good knowledge. Although media awareness campaigns had an independent impact on a higher public knowledge of antibiotics, the overall public knowledge remains low. It would be necessary to strengthen antibiotic campaigns with clearer information on the relation between the excessive use of antibiotics and the increased risk of antibiotic resistance. Family physicians should be more involved to improve antibiotic knowledge among target groups such as men, young patients, and people from a poor social and cultural background. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Importance of telemedicine in diabetes care: Relationshipsbetween family physicians and ophthalmologists

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Diabetic retinopathy (DR) is the worldwide leadingcause of legal blindness. In 2010, 1.9% of diabetesmellitus (DM) patients were legally blind and 10.2%had visual impairment. The control of DM parameters(glycemia, arterial tension and lipids) is the goldstandard for preventing DR complications, although,unfortunately, DR still appeared in a 25% to 35% ofpatients. The stages of severe vision threading DR,include proliferative DR (6.96%) and diabetic macularedema (6.81%). This review aims to update ourknowledge on DR screening using telemedicine, thedifferent techniques, the problems, and the inclusion ofdifferent professionals such as family physicians in careprograms.

  9. Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

    Science.gov (United States)

    Romero-Aroca, Pedro; Sagarra-Alamo, Ramon; Pareja-Rios, Alicia; López, Maribel

    2015-01-01

    Diabetic retinopathy (DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus (DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters (glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR (6.96%) and diabetic macular edema (6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs. PMID:26240697

  10. Do family physicians retrieve synopses of clinical research previously read as email alerts?

    Science.gov (United States)

    Grad, Roland; Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

    2011-11-30

    A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved

  11. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences

    Directory of Open Access Journals (Sweden)

    Schwappach David

    2008-10-01

    Full Text Available Abstract Background Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict – namely work interfering with family conflict (WIF – which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April–July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9% participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ, work interfering with family conflict scale (WIF, and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results German hospital physicians reported elevated levels of WIF (mean = 74 compared to the general German population (mean = 45, p p Conclusion In our study, work interfering with family conflict (WIF as part of Work-Family Conflict (WFC was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.

  12. Family physicians' perceptions of academic detailing: a quantitative and qualitative study

    Directory of Open Access Journals (Sweden)

    O'Connor Nicolette

    2007-10-01

    Full Text Available Abstract Background The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs perceptions of academic detailing and the factors that affect their use of it. Methods We used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it. Results Overall response rate to the questionnaire was 33% (289/869. Response rate of non-users of academic detailing was 15% (60/393, of users was 48% (229/476. The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists. Conclusion Users of academic detailing highly value its educational

  13. City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

    Science.gov (United States)

    Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam

    2016-05-06

    To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Fostering excellence: roles, responsibilities, and expectations of new family physician clinician investigators.

    Science.gov (United States)

    Hogg, William; Kendall, Claire; Muggah, Elizabeth; Mayo-Bruinsma, Liesha; Ziebell, Laura

    2014-02-01

    A key priority in primary health care research is determining how to ensure the advancement of new family physician clinician investigators (FP-CIs). However, there is little consensus on what expectations should be implemented for new investigators to ensure the successful and timely acquisition of independent salary support. Support new FP-CIs to maximize early career research success. This program description aims to summarize the administrative and financial support provided by the C.T. Lamont Primary Health Care Research Centre in Ottawa, Ont, to early career FP-CIs; delineate career expectations; and describe the results in terms of research productivity on the part of new FP-CIs. Family physician CI's achieved a high level of research productivity during their first 5 years, but most did not secure external salary support. It might be unrealistic to expect new FP-CIs to be self-financing by the end of 5 years. This is a career-development program, and supporting new career FP-CIs requires a long-term investment. This understanding is critical to fostering and strengthening sustainable primary care research programs.

  15. Aircraft family design using enhanced collaborative optimization

    Science.gov (United States)

    Roth, Brian Douglas

    Significant progress has been made toward the development of multidisciplinary design optimization (MDO) methods that are well-suited to practical large-scale design problems. However, opportunities exist for further progress. This thesis describes the development of enhanced collaborative optimization (ECO), a new decomposition-based MDO method. To support the development effort, the thesis offers a detailed comparison of two existing MDO methods: collaborative optimization (CO) and analytical target cascading (ATC). This aids in clarifying their function and capabilities, and it provides inspiration for the development of ECO. The ECO method offers several significant contributions. First, it enhances communication between disciplinary design teams while retaining the low-order coupling between them. Second, it provides disciplinary design teams with more authority over the design process. Third, it resolves several troubling computational inefficiencies that are associated with CO. As a result, ECO provides significant computational savings (relative to CO) for the test cases and practical design problems described in this thesis. New aircraft development projects seldom focus on a single set of mission requirements. Rather, a family of aircraft is designed, with each family member tailored to a different set of requirements. This thesis illustrates the application of decomposition-based MDO methods to aircraft family design. This represents a new application area, since MDO methods have traditionally been applied to multidisciplinary problems. ECO offers aircraft family design the same benefits that it affords to multidisciplinary design problems. Namely, it simplifies analysis integration, it provides a means to manage problem complexity, and it enables concurrent design of all family members. In support of aircraft family design, this thesis introduces a new wing structural model with sufficient fidelity to capture the tradeoffs associated with component

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

    Science.gov (United States)

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

    2016-01-19

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

  17. Evaluation of the Family Physician Assistants’ Views to Sexual Dysfunction in a Training and Research Hospital

    OpenAIRE

    Yusuf A. Güçlü1; Yasemin K. Öztürk1; Özgür E. Öztürk; et al

    2016-01-01

    Aim: The aim of the study is to investigate the view of sight of the family medicine residents about the sexual education and sexual functional disorders. Methods: A sectional descriptive questionnaire form study is designed at Tepecik Training Research Hospital during May and June 2013. The questionnaire about sexual education and sexual functional disorders is applied to all the family medicine residents who agreed to participate the study. Data are decoded in Microsoft Excel program; de...

  18. Giving patients responsibility or fostering mutual response-ability: family physicians' constructions of effective chronic illness management.

    Science.gov (United States)

    Thille, Patricia H; Russell, Grant M

    2010-10-01

    Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.

  19. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

    Science.gov (United States)

    Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

    2017-04-28

    The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

  20. Use and perceptions of information among family physicians: sources considered accessible, relevant, and reliable

    Science.gov (United States)

    Kosteniuk, Julie G.; Morgan, Debra G.; D'Arcy, Carl K.

    2013-01-01

    Objectives: The research determined (1) the information sources that family physicians (FPs) most commonly use to update their general medical knowledge and to make specific clinical decisions, and (2) the information sources FPs found to be most physically accessible, intellectually accessible (easy to understand), reliable (trustworthy), and relevant to their needs. Methods: A cross-sectional postal survey of 792 FPs and locum tenens, in full-time or part-time medical practice, currently practicing or on leave of absence in the Canadian province of Saskatchewan was conducted during the period of January to April 2008. Results: Of 666 eligible physicians, 331 completed and returned surveys, resulting in a response rate of 49.7% (331/666). Medical textbooks and colleagues in the main patient care setting were the top 2 sources for the purpose of making specific clinical decisions. Medical textbooks were most frequently considered by FPs to be reliable (trustworthy), and colleagues in the main patient care setting were most physically accessible (easy to access). Conclusions: When making specific clinical decisions, FPs were most likely to use information from sources that they considered to be reliable and generally physically accessible, suggesting that FPs can best be supported by facilitating easy and convenient access to high-quality information. PMID:23405045

  1. A survey to assess family physicians' motivation to teach undergraduates in their practices.

    Directory of Open Access Journals (Sweden)

    Marcus May

    Full Text Available BACKGROUND: In Germany, family physicians (FPs are increasingly needed to participate in undergraduate medical education. Knowledge of FPs' motivation to teach medical students in their practices is lacking. PURPOSE: To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. METHODS: The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. RESULTS: A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%. 'Helping others' and 'interest' were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. CONCLUSION: German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.

  2. iPad use in Iowa Research Network family physician offices.

    Science.gov (United States)

    Daly, Jeanette M; Xu, Yinghui; Levy, Barcey T

    2015-04-01

    Through a cancer research infrastructure building grant, iPads were given to health care providers in family physician offices. The purpose of this study was to determine the use and application of iPads in the Iowa Research Network. A Qualtrics survey was sent to 81 iPad recipients after institutional review board approval. Fifty-nine percent responded and 85% reported they have used the iPad. The main reason for use of the iPad was browsing the World Wide Web for health care information. Open-ended comments supported use of the iPad for photographic documentation of wound and other skin lesions for insertion into the medical record and it helped improve clinic flow by making it easier to put orders in the system through the iPad. Tablet uses are variable in physician offices with provider's gathering health care information from the Internet and securing education material for patients as the frequent usages. © The Author(s) 2014.

  3. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  4. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions.Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues.Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased.Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  5. Working as a family physician in Canada and Portugal: How different is it?

    Directory of Open Access Journals (Sweden)

    Ana Nunes Barata

    2016-01-01

    Full Text Available Background: The work of a family physician is quite different in each country, and if we consider different continents, differences are even more remarkable. Social and cultural contexts justify a particular organization, not only of the health-care system but also its providers as well. Objectives: By analyzing different health-care systems, new ideas may come about which may trigger positive changes in a health-care service to diminish healthcare disparities. Methods: Description and comparison of the Primary Healthcare Service in Canada and Portugal. Results: Although both health-care systems are mainly public, organizational differences can be found that condition primary healthcare access. Conclusion: Exchanges in other health-care systems contribute for an active knowledge exchange that prompts participants to analyze options on how to improve healthcare access to citizens. This ultimately, leads to the development of primary care, the pillar of a well-functioning health-care system.

  6. Population-Level Equity May Not Be Achievable At the First Level of the Iranian Family Physician Program (IFPP

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    Reza Jourvand

    2015-07-01

    Full Text Available According to the current legislation and article 89 of Iran’s Fourth Development Program (I4DP, the Ministry of Health and Medical Education (MOHME is responsible for the countrywide planning of health policies. Thus, MOHME with the help of all other organizations that have direct role in provision of health care (e.g. governmental health insurance companies started to study and compile regulations of referral system and family physi-cian program, introduced later as the "Iranian Na-tional Family Physician Program"(IFPP.

  7. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians.

    Science.gov (United States)

    Rurik, Imre; Torzsa, Péter; Ilyés, István; Szigethy, Endre; Halmy, Eszter; Iski, Gabriella; Kolozsvári, László Róbert; Mester, Lajos; Móczár, Csaba; Rinfel, József; Nagy, Lajos; Kalabay, László

    2013-10-19

    Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. The knowledge about multimorbidity, a main consequence of obesity was balanced.Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue.There were wider differences regarding attitudes and practice, influenced by the the doctors' age, gender, known BMI, previous qualification, less by working location.GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients' waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors.Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for

  8. The future prospects of Lithuanian family physicians: a 10-year forecasting study

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    Padaiga Zilvinas

    2005-10-01

    Full Text Available Abstract Background When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks. Methods A computer spreadsheet simulation model was used to project the supply of FPs in 2006–2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrolment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios. Results The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrolment numbers to training programs and the retirement age. The second supply scenario, which took into

  9. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring.

    Science.gov (United States)

    Jones, Barbara L; Contro, Nancy; Koch, Kendra D

    2014-02-01

    Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

  10. Care articulation by the Family Physician: improvement in the quality of life in terminal patient

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    Luís Filipe Cavadas

    2011-02-01

    Full Text Available Introduction: According to the definition of the role of the Family Physician (FP presented in the statement of the European Wonca 2002, one of her/his features is the ability of coordination of care, and management of the interface with other specialties. However, there are serious problems of coordination between the levels of assistance, as showed by the discontinuity of care when patients are hospitalized. With the aim of raising awareness and analyze a particular case of interface between the Primary Health Care (PHC and Hospital, and how important is the success of a good collaboration, this case is reported. Description of case: Male, 50 years old, caucasian race, inserted into a nuclear family in the stage VI Duvall’s cycle. A gastric adenocarcinoma by his FP was diagnosed at 49 years old. The patient was referenced to urgent consultation of general surgery. With various surgical complications he had a long internment. A poorly differentiated and infiltrating gastric carcinoma at the stage T3 N1 Mx, with poor prognosis, was confirmed. There was serious lack of interface and gaps in information between the hospital and the PHC. There was a bad care of the patient, with worsening of his condition. At the insistence of the FP, the articulation becomes effective and there was improved in quality of care and of the general condition of the patient. Conclusion: A proper interface and coordination of care contributed to better quality of life and satisfaction of patients, with positive repercussions for their families, to health professionals involved and to the National Health Service. The completion of the FP core competencies will only be possible when his/her proper function will be recognized and known by all the other health professionals.Note: The speciality physician denomination changes according to the country; in Brazil, it receives the name of Medicina de Família e Comunidade. In Portugal, country of the author of this paper

  11. Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

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    Meyer Swanepoel

    2014-01-01

    Full Text Available Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

  12. Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Meyer Swanepoel

    2014-01-01

    Full Text Available Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

  13. Managing Disruptive Physician Behavior: First Steps for Designing an Effective Online Resource

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    Derek Puddester

    2011-03-01

    Full Text Available Interviews with physician leaders from hospitals in a mid-sized Ontario City were conducted to determine their needs with regard to managing disruptive physician behaviour. These findings were used to inform the design of a two-day skill-development workshop for physician leaders on disruptive behaviour. The workshop was evaluated using a modified version of the Learner Experience Feedback Form, which was built to align with W(eLearn, http://www.ennovativesolution.com/WeLearn/ a framework developed to guide the design, delivery, development, and evaluation of online interprofessional courses and programs (MacDonald, Stodel, Thompson, & Casimiro, 2009. The surveys gathered information related to the content, media, service, structure, and outcomes of the workshop. The findings from the focus group interviews and workshop evaluation identify physician leaders’ needs with regard to disruptive behavior and were used to inform the design of the world’s first Online Physician Health and Wellness Resource http://www.ephysicianhealth.com/ an open access learning resources currently being used globally, in 91 countries. The resource was the recipient of the winner of the International Business/Professional 2010 International eLearning Award. The findings demonstrated the importance of conducting a needs analysis and using a framework to guide the design, delivery and evaluation of effective online healthcare education.

  14. PD-atricians: Leveraging Physicians and Participatory Design to Develop Novel Clinical Information Tools.

    Science.gov (United States)

    Pollack, Ari H; Miller, Andrew; Mishra, Sonali R; Pratt, Wanda

    2016-01-01

    Participatory design, a method by which system users and stakeholders meaningfully contribute to the development of a new process or technology, has great potential to revolutionize healthcare technology, yet has seen limited adoption. We conducted a design session with eleven physicians working to create a novel clinical information tool utilizing participatory design methods. During the two-hour session, the physicians quickly engaged in the process and generated a large quantity of information, informing the design of a future tool. By utilizing facilitators experienced in design methodology, with detailed domain expertise, and well integrated into the healthcare organization, the participatory design session engaged a group of users who are often disenfranchised with existing processes as well as health information technology in general. We provide insight into why participatory design works with clinicians and provide guiding principles for how to implement these methods in healthcare organizations interested in advancing health information technology.

  15. Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

    Science.gov (United States)

    Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

    2016-10-01

    . Copyright© the College of Family Physicians of Canada.

  16. A Correlational Study of Self-Directed Learning Readiness and Learning Activity Preference for Continuing Medical Education among Family Physicians

    Science.gov (United States)

    Barrett, Theresa J.

    2014-01-01

    This quantitative, nonexperimental, correlational study sought to determine whether a relationship exists between family physicians' levels of self-directed learning readiness (SDLR) and their preferences for continuing medical education (CME) activities. The study also sought to determine whether years in clinical practice or size of clinical…

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

    Science.gov (United States)

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

    2017-01-05

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

  18. Recognition and management of common acute conditions of the oral cavity resulting from tooth decay, periodontal disease, and trauma: an update for the family physician.

    Science.gov (United States)

    Edwards, Paul C; Kanjirath, Preetha

    2010-01-01

    This article presents an overview of common and/or significant diseases of the oral cavity that the family physician is likely to encounter, with an emphasis on pathogenesis, recognition, complications, and management. Topics reviewed include the sequelae of dental caries, periodontal disease, and trauma. Prevention and early intervention strategies are emphasized. Recent updates and practical issues for the family physician are highlighted.

  19. Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec

    NARCIS (Netherlands)

    Breton, M.; Brousselle, A.; Boivin, A.; Loignon, C.; Touati, N.; Dubois, C.A.; Nour, K.; Berbiche, D.; Roberge, D.

    2014-01-01

    BACKGROUND: Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues

  20. Reconciling Air Force Physicians’ Peacetime and Wartime Capabilities, Demonstration of a Work Force Design Methodology.

    Science.gov (United States)

    1985-08-01

    physicians we interviewed during the course of our research. Lt. Col. William Tufte prc- vided essential information on peacetime manpower...are few remaining medically under- served rural areas ( Williams et al., 1983). Finally, we did not multiply the CONUS require- ment by a disperson...specialist gastroenterological exam (61/B23) Gastroentr Family MD +Internist +Pediatrician +Emer MD 0.00 0.18 0.09 0.18 0.18 Perform specialist OBST /GYN

  1. Clinical decision support for physician order-entry: design challenges.

    Science.gov (United States)

    Broverman, C A; Clyman, J I; Schlesinger, J M; Want, E

    1996-01-01

    We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.

  2. Young Doctor Movements: motives for membership among aspiring and young family physicians.

    Science.gov (United States)

    Yakubu, Kenneth; Hoedebecke, Kyle; Nashat, Nagwa

    2015-01-01

    Over the past decade, young doctor movements (YDMs) have gained recognition for their efforts in promoting the discipline of family medicine. With growth and expansion comes the need for an inquiry into the membership motives of current/intending members. This study was aimed at determining the main reasons why young and aspiring family physicians (FPs) joined their regional YDM. It was also concerned with determining the main factors that will make non-members want to join a YDM as well as assessing for differences in the responses within YDM members on the one hand, and between YDM members and non-members on the other. This was a cross-sectional web-based study. Using a list of 11 items generated following a series of discussions and feedback among selected FPs and FP trainees, respondents annotated levels of agreement on reasons for current or desired YDM membership. The Mann-Whitney U test was used to determine the distribution and differences in the mean of rank scores of the responses from YDM and non-YDM members while the Kruskal-Wallis test was used to describe same for the various YDMs. The total number of respondents was 200, out of which 102 (51.0%) were current YDM members, 97 (48.5%) were non-members and 1 (0.5%) respondent did not state his/her membership status. Non-YDM members indicated a predominantly academic/professional motive for membership while YDM members indicated the opportunity to socialise with FPs abroad and in their country as their foremost reasons for membership. A mixture of academic, professional and social motives was observed for respondents from Vasco da Gama; predominantly academic and professional motives for respondents from Spice route. While gaining recognition and improving one's practice may be the ultimate goal of an aspiring FP, socialising within a network of like-minded professionals maybe the young FP's way of coping with demands of the discipline.

  3. Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study

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    Sarah E. P. Munce

    2016-01-01

    Full Text Available Introduction. Evidence of inappropriate bone mineral density (BMD testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontario’s family physicians (FPs. Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing. Results. We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described. Conclusions. These findings lend support to what has been documented at the population level suggesting a tendency among FPs to refer menopausal women (at low risk. Emphasis on referral of high-risk groups as well as men and further clarification and education on the appropriate intervals for follow-up testing is warranted.

  4. Educating family physicians to recognize and manage depression: where are we now?

    Science.gov (United States)

    Gask, Linda

    2013-08-01

    To consider what the barriers are to effective depression education; to understand what attitudes, knowledge, and skills doctors need to acquire, and finally to examine what we currently know about effective ways of training family physicians (FPs) about depression. A narrative review of the published literature compiled from searching reviews and original articles was conducted using the following key words: education, training, attitudes, depression, and primary care. Further relevant articles were identified from reference lists. The identified barriers are FPs' attitudes and confidence toward recognizing and managing depression, the way in which they conceptualize depression, and the difficulties they face in implementing change in the systems in which they work. We, as educators, can identify what FPs need to know, and this should include novel ways of organizing care. However, of key importance is the need to address how more effective interventions may be provided, recognizing that FPs may be starting from many different points on 3 differing continua of attitude, skills, and knowledge in relation to depression. We have to not only ensure that the content of what we teach is perceived as relevant to primary care but also review exactly how we go about providing it, using methods that will engage and stimulate doctors at differing stages of readiness to acquire new attitudes, skills, and knowledge about depression. However, we still need to find better ways of helping FPs to recognize and acknowledge their educational needs. Further research is also required to thoroughly evaluate these novel approaches to tailoring educational interventions.

  5. Why do Family Physicians find it difficult to apply clinical guidelines?

    Directory of Open Access Journals (Sweden)

    Andrea Pizzini

    2007-06-01

    Full Text Available The aging of the population, in Italy as well as in all the countries of the European Union, and the increasing prevalence of chronic diseases pose challenges to the development and application of clinical guidelines. Guidelines have been developed to improve the quality of health care. Anyway, Family Physicians sometimes find many obstacles in integrating guidelines into medical practice. In the care of older individuals with several comorbid diseases, application of clinical guidelines is not only difficult, but may also lead to undesirable effects. In this article, the Author take a review, published in JAMA, as a starting point to discuss the role and the importance of guidelines in patients with comorbid disease in the Italian context. The review analyses the hypothetical case of a 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension and osteoarthritis, and describes the situation of the aggregated recommendations from the most relevant guidelines. The conclusion is that, to improve the care of older patients with complex comorbidities, developing new measures and new guidelines is extremely necessary.

  6. Preventing a Mass Disease: The Case of Gallstones Disease: Role and Competence for Family Physicians

    Science.gov (United States)

    Di Ciaula, Agostino; Grattagliano, Ignazio

    2016-01-01

    Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case–controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting. PMID:27468338

  7. Role of the family physician in the care of children with Down syndrome.

    Science.gov (United States)

    Bunt, Christopher W; Bunt, Stephanie K

    2014-12-15

    Down syndrome is the most common chromosomal abnormality, occurring in one in 691 live births in the United States each year. Prenatally, the sequential contingent test for aneuploidy screening is highly sensitive for Down syndrome and has a low false-positive rate. The diagnosis should be confirmed with fluorescent in situ hybridization followed by chromosomal karyotyping at birth. Children with Down syndrome have varied degrees of intellectual disability and more health complications than other children. However, advancements in recent decades have led to improved life expectancy, satisfaction, and quality of life. Newborns with Down syndrome require echocardiography and cardiology evaluation. Children should have annual screenings for vision and hearing, and laboratory studies for subclinical thyroid disease and blood disorders. Clinicians should provide unbiased and comprehensive culturally sensitive information regarding available services for children with Down syndrome. There is good evidence that comprehensive early intervention programs (e.g., speech, visual, physical, and occupational therapy; child psychology) enhance development. It is important to enroll children with Down syndrome in state-specific resources as early as possible. Given the advances in medical care and early intervention programs, regular health supervision by family physicians can allow children with Down syndrome to lead healthy and productive lives.

  8. Clinical Guidance on Screening Chronic Kidney Disease in Type 2 Diabetic Patients for Family Physicians

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    Seyed Esmaeil Managheb

    2015-10-01

    Full Text Available Incidence of diabetes is increasing in developing countries as well as Iran. Half of the patients are not aware of their disease so screening of diabetes is necessary. Lifestyle changes in society, high-saturated fat diet and decreased physical activity are the factors that influence the growing rate of diabetes in Iran.1 The need for addressing type 2 diabetes has been clarified for family physicians.2 Diabetes is a common disease that is associated with significant morbidity and mortality. It has an asymptomatic stage that may be present for up to several years before diagnosis.3 Diabetes is the leading cause of kidney disease.4 In a study among patients over 45 years with type 2 diabetes, these results were reported: 22% suffered from retinopathy, 7% had impaired vision, 6% had kidney diseases, 9% had clinical symptoms, and 19.1% were at risk for foot ulcers.5 Early treatment of type 2 diabetes can reduce or delay complications.6 Optimal glycemia and BP are important in the prevention of diabetic chronic kidney disease (CKD.4 Therapeutic goals in patients with complications, such as CKD, include maintaining renal function and stopping the trend of renal deterioration.5 Progression of diabetic nephropathy can be slowed through the use of some medications.4 How to screen and manage chronic kidney disease in patients with type 2 diabetes is shown in Figure 1.

  9. Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners.

    Science.gov (United States)

    Dufour, Sinéad Patricia; Brown, Judith; Deborah Lucy, S

    2014-09-01

    The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

  10. International challenges without borders: a descriptive study of family physicians' educational needs in the field of diabetes

    Directory of Open Access Journals (Sweden)

    Posel Peter

    2011-05-01

    Full Text Available Abstract Background The optimal care of persons with diabetes by general practitioners and family physicians (GP/FP is complex and requires multiple competencies. This is a fairly unrecognized key challenge in the healthcare systems. In some cases, local and national Continuous Professional Development (CPD initiatives target these challenges; however there have been few international initiatives, possibly because challenges emerging from different studies have not been linked across national boundaries. In this context, the authors have compiled data about gaps and/or barriers inherent to GP/FP care of persons with type 2 diabetes from Austria, Canada, Germany and the United Kingdom. Methods Secondary analyzes of pre-existing studies were conducted to identify challenges in the care of patients with type 2 diabetes as faced by GPs/FPs. Two sources of data were reviewed: unpublished research data from collaborating organizations and articles from a literature search (in English and German. Articles retrieved were scanned by the research team for relevance to the study objectives and to extract existing gaps and barriers. The identified challenges were then categorized along three major axes: (1 phase of the continuum of care {from screening to management}; (2 learning domain {knowledge, skills, attitudes, behavior, context}; and (3 by country/region. Compilation and categorization were performed by qualitative researchers and discrepancies were resolved through discussion until concordance was achieved. Results and discussion Thirteen challenges faced by GPs/FPs in the care for patients with type 2 diabetes were common in at least 3 of the 4 targeted countries/regions. These issues were found across the entire continuum of care and included: pathophysiology of diabetes, diagnostic criteria, treatment targets assessment, drugs' modes of action, decision-making in therapies, treatment guidelines, insulin therapy, adherence, management of

  11. Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public

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    Werner P

    2014-04-01

    Full Text Available Perla Werner,1 Jeremia Heinik,2 Shmuel Giveon,3 Dikla Segel-Karpas,1 Eliezer Kitai41Center for the Research and Study of Aging, University of Haifa, Haifa, Israel; 2Margoletz Psychogeriatric Center, Ichilov Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Clalit Health Services, Tel Aviv, Israel; 4Department of Family Medicine, Leumit Health Services, Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelBackground: Mild cognitive impairment (MCI or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer's disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management.Objectives: To compare help-seeking preferences of family physicians and the lay public in the area of MCI.Methods: A structured questionnaire was used to collect data from 197 family physicians (self-administered and 517 persons aged 45 and over from the lay public (face to face. Information regarding familiarity with MCI and help-seeking preferences was assessed.Results: The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help

  12. Innovative Peer Review Model for Rural Physicians: System Design and Implementation

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    Williams, Josie R.; Mechler, Kathy; Akins, Ralitsa B.

    2008-01-01

    Context: The peer review process in small rural hospitals is complicated by limited numbers of physicians, conflict of interest, issues related to appropriate utilization of new technology, possibility for conflicting recommendations, and need for external expertise. Purpose: The purpose of this project was to design, test, and implement a virtual…

  13. A cross sectional survey of urban Canadian family physicians' provision of minor office procedures

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    Rungi Arne A

    2006-03-01

    Full Text Available Abstract Background A discordance exists between the proportion of Canadian family physicians that we expect should be able to perform minor office procedures and the actual provision of care. This pattern has not been extensively studied. The objective of this study was to determine the current patterns and obstacles relating to the provision of four minor office procedures by GP/FPs in a small city in Ontario, Canada. An additional goal was to determine the impact of the remuneration method on the provision of such services. Methods A survey was mailed to all GP/FPs practising in Kingston, Ontario. The main outcomes measured in the study were work setting and remuneration method, current procedural practices with respect to four procedures, reasons for not performing procedures, current skill levels, and desire to upgrade. Results Surveys were mailed to all 108 GP/FPs in the City of Kingston. Completed surveys were collected for 82 percent (89/108 and 10 were excluded leaving 79 eligible participants. The percentages of GP/FPs who reported performing the procedure were as follows: dermatological excision (63.3%, endometrial biopsy (35.4%, shoulder injection (31.6%, and knee injection (43.0%. The majority of GP/FPs who would not do the procedure themselves would refer to a specialist colleague rather than to another GP/FP. The top reason cited for not performing a specific procedure was "lack of up to date skills" followed by "lack of time". The latter was the only statistically significant difference reported between GP/FPs working in Family Health Networks and GP/FPs working in fee for service settings (26.7% vs 47.0%, χ2 = 4.191 p = 0.041. Conclusion A large number of Kingston, Ontario GP/FPs refer patients who require one of four minor office-based procedures for specialist consultation. Referral to other GP/FP colleagues appears underutilized. A perceived lack of up to date skills and a lack of time appear to be concerns. GP/FPs working

  14. Designing Work, Family & Health Organizational Change Initiatives.

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    Kossek, Ellen Ernst; Hammer, Leslie B; Kelly, Erin L; Moen, Phyllis

    2014-01-01

    For decades, leaders and scholars have been advocating change efforts to improve work-life relationships. Yet most initiatives have lacked rigor and not been developed using scientific principles. This has created an evidence gap for employer support of work and personal life as a win-win for productivity and employees' well-being. This paper examines the approach used by the U.S. Work Family Health Network (WFRN) to develop an innovative workplace intervention to improve employee and family health. The change initiative was designed to reduce organizationally based work-family conflict in two contrasting contexts representative of major segments of today's U.S. workforce: health care employees and informational technology professionals. The WFRN Intervention (called STAR) had three theoretically based change elements. They were: 1) increase job control over work time and schedule; 2) increase supervisor social support for family and job effectiveness; and 3) improve organizational culture and job design processes to foster results orientation. Seven practical lessons for developing work-life interventions emerged from this groundbreaking endeavor.

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

    Science.gov (United States)

    2010-01-01

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

  16. Race, income, and education: associations with patient and family ratings of end-of-life care and communication provided by physicians-in-training.

    Science.gov (United States)

    Long, Ann C; Engelberg, Ruth A; Downey, Lois; Kross, Erin K; Reinke, Lynn F; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W; Back, Anthony L; Curtis, J Randall

    2014-04-01

    Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families.

  17. Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country.

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    Kersnik, J

    2001-08-01

    Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.

  18. [The study of the recognition gap on the quality of life in people with epilepsy between the affected pediatric and adolescent patient's families and the attending physicians].

    Science.gov (United States)

    Awaya, Yutaka; Kubota, Hidemoto

    2011-01-01

    The aims of this study were to investigate the recognition gap on the quality of life (QOL) in people with epilepsy (PWE) between the affected pediatric and adolescent patient's families and the attending physicians, and to devise future management strategies for epilepsy based on the results. We conducted a large-scale questionnaire survey on the QOL in 5,122 PWE/their families who were members of the Japanese Epilepsy Association in 2006 and 1,701 PWE/their families and 502 attending physicians responded. Out of the responders, 107 matched pairs of PWE aged under 16 years (with an adult family member actually responding by proxy) and their physicians responding to the questionnaire were examined. The results demonstrated that the physicians were not sufficiently aware of 1) concern about drug therapy for epilepsy from the perspective of their patients/families, 2) ictal and post-ictal symptoms recognized by the patients/their families, and 3) the worry about the disease of the patients/their families. Thus, efforts are needed to minimize the recognition gap within the limited consultation hour in routine clinical practice between children and adolescents having epilepsy/their families and physicians : physicians should efficiently acquire necessary information from PWE/their families, and should negotiate with PWE/their families about the goal of therapy and future management strategies for epilepsy.

  19. Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication

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    Scannell Margaret A

    2006-08-01

    Full Text Available Abstract Background Electronic mail (email has the potential to improve communication between physicians and patients. Methods We conducted two research studies in a family practice setting: 1 a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2 a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients. Results Sixty-eight percent of patients used email, and the majority of those (80% were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173 or telephone number (68%, n = 181. Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; those people were more likely to be black and to be insured through Medicaid. Twenty-four subjects agreed to participate, but one-third failed to return the required consent form by mail. All participants who received the intervention emails said they would like to receive health education emails in the future. Conclusion Our survey results show that patients are interested in email communication with the family practice clinic. Our feasibility study also illustrates important challenges in physician-initiated electronic communication. The 'digital divide' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication.

  20. What motivates family physicians to participate in training programs in shared decision making?

    Science.gov (United States)

    Allaire, Anne-Sophie; Labrecque, Michel; Giguere, Anik; Gagnon, Marie-Pierre; Légaré, France

    2012-01-01

    Little is known about the factors that influence family physician (FP) participation in continuing professional development (CPD) programs in shared decision making (SDM). We sought to identify the factors that motivate FPs to participate in DECISION+, a CPD program in SDM. In 2007-2008, we collected data from 39 FPs who participated in a pilot randomized trial of DECISION+. In 2010, we collected data again from 11 of those participants and from 12 new subjects. Based on the theory of planned behavior, our questionnaire assessed FPs' intentions to participate in a CPD program in SDM and evaluated FPs' attitudes, subjective norms and perceived behavioral control. We also conducted 4 focus groups to explore FPs' salient beliefs. In 2010, FPs' mean intention to participate in a CPD program in SDM was relatively strong (2.6 ± 0.5 on a scale from -3 = "strongly disagree" to +3 = "strongly agree"). Affective attitude was the only factor significantly associated with intention (r = .51, p = .04). FPs identified the attractions of participating in a CPD program in SDM as (1) its interest, (2) the pleasure of learning, and (3) professional stimulation. Facilitators of their participation were (1) a relevant clinical topic, (2) an interactive program, (3) an accessible program, and (4) decision support tools. To attract FPs to a CPD program in SDM, CPD developers should make the program interesting, enjoyable, and professionally stimulating. They should choose a clinically relevant topic, ensure that the program is interactive and accessible, and include decision support tools. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  1. Continuity of Care Evaluation: The View of Patients and Professionals about Urban Family Physician Program

    Science.gov (United States)

    Jahromi, Vahid Kohpeima; Mehrolhassani, Mohammad Hossein; Dehnavieh, Reza; Anari, Hosein Saberi

    2017-01-01

    Background: A responsibility of the family physician (FP) and one of the four aspects of the delivery of primary care services is continuity of care (COC). This study aimed to determine the COC of health care in urban health centers. Methods: Between September 2015 and March 2016, we conducted a cross-sectional study using Primary Care Evaluation Tool questionnaires with multistage stratified cluster sample of FPs (n = 141) and patients (n = 710) in two provinces in Iran, Fars and Mazandaran. The questionnaires contained essential dimensions of COC: Informational, interpersonal, and longitudinal COC. Results: Almost all FPs had a computer. The FPs hadn’t kept their patients’ medical records routinely. The software had some problems, so the FPs couldn’t produce lists of patients based on their health risk and they couldn’t monitor their population. Almost 88% of FPs have written referral letters for all referred patients but 57% of them got medical feedback from specialists. About 80% of patients’ consultation times were up to 10 min. 29% of FPs knew the past problems and illnesses of the patients. From 40% to 50% of the patients stated that their FPs asked them for their desire about prescribed medicine and gave clear explanation about their illnesses. On average, patients visited their doctor 5.5 times during the previous year. Generally, patients and FPs in Mazandaran could summarize their experiences better than Fars in most topics of COC. Conclusions: It seems that after 3 years of using urban FP program in two pilot provinces, there were still some problems in COC. Strengthen software program, introducing incentives for FPs, and promoting patients’ responsibility can be used by policy-makers when they seek to enhance COC. PMID:28299031

  2. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: an occupation and region specific approach.

    Science.gov (United States)

    Malinauskiene, Vilija; Einarsen, Staale

    2014-12-01

    The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R), other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence), behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis. A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR) of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI): 3.80-17.04). In the fully adjusted model it increased to 13.88 (95% CI: 4.68-41.13) indicating cumulative effects of all the investigated stressors. Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

  3. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: An occupation and region specific approach

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    Vilija Malinauskiene

    2014-12-01

    Full Text Available Objectives: The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. Material and Methods: With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R, other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence, behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis. Results: A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI: 3.80–17.04. In the fully adjusted model it increased to 13.88 (95% CI: 4.68–41.13 indicating cumulative effects of all the investigated stressors. Conclusions: Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

  4. Study of family physicians' practices in case of urinary tract infections caused by enterobacteriaceae secreting extended-spectrum-beta-lactamase.

    Science.gov (United States)

    Miclot, C; Antoniotti, G; Forestier, E

    2015-03-01

    Urinary tract infections caused by enterobacteriaceae secreting extended-spectrum beta-lactamase (EESBL) is an issue for most family physicians. The aim of our study was to evaluate their practice in case of EESBL discovered after urinalysis and culture (U/C). This epidemiological and retrospective study was conducted from the January 1, to December 31, 2012, in 5 laboratories of Savoie and Isere. Results of U/C prescribed by family physicians and positive for EESBL were collected. The data collected with questionnaires, concerned characteristics of the infection, antibiotic treatment adequateness, the implementation of specific hygiene measures, and risk factors for EESBL infection. One hundred and three U/C out of 19,494 were considered, and 56 questionnaires were collected. The rate of EESBL positive U/C was 0.60%. The antibiotic treatment was adequate for 35 patients (62.5%). Specific hygiene measures were implemented for 22 patients (32.3%). Both antibiotic treatment and specific hygiene measures were initiated for 13 patients (23.2%). Fourteen cases of community-acquired infections (25%) were reported. Five patients (8.9%) had traveled to an endemic zone in the previous 6 months. The concomitant initiation of both antibiotic treatment and specific hygiene measures in case of U/C positive for EESBL is insufficient when managed by family physicians. It could be improved by offering tools for the management of these infections, by developing EESBL networks between hospital and family physicians, and epidemiological surveillance in community settings. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Self-perceived level of competencies of family physicians in transitional Kosovo

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    Fitim Skeraj

    2015-12-01

    representative sample of 597 primary health care physicians (295 men and 302 women; mean age: 46.0±9.4 years; response rate: 90%. A structured self-administered questionnaire was used in order to determine physicians’ competencies regarding different domains of the quality of health care. The questionnaire included 37 items organized into six subscales/domains. Answers for each item of the tool ranged from 1 (“novice” physicians to 5 (“expert” physicians. An overall summary score (range: 37-185 and a subscale summary score for each domain were calculated for each participant. General linear model was used to assess the association of physicians’ self-perceived level of competencies with covariates. Results: The internal consistency of the whole scale (37 items was Cronbach’s alpha=0.98. Mean summary score of the 37-item instrument and subscale summary scores were all higher in men than in women. In multivariable-adjusted models, mean level of self-perceived competencies was higher among older physicians, in men, those with >10 years of working experience, physicians serving >2500 people, specialized physicians and those involved in training activities. Conclusion: Our study provides useful evidence on the self-assessed level of competencies of primary health care physicians in post-war Kosovo. Future studies in Kosovo and other transitional settings should identify the main determinants of possible gaps in self-perceived levels of physicians’ competencies vis-à-vis the level of physicians’ competencies from patients’ perspective.

  6. Design of a medication therapy management program for Medicare beneficiaries: qualitative findings from patients and physicians.

    Science.gov (United States)

    Lauffenburger, Julie C; Vu, Maihan B; Burkhart, Jena Ivey; Weinberger, Morris; Roth, Mary T

    2012-04-01

    The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals. We conducted focus groups with older adults and primary care physicians to explore (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from patient and provider perspectives. Five focus groups (4 with older adults, 1 with physicians) were conducted by a trained moderator using a semistructured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification. Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe that the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist access to the medical record, and a mutually trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM. This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include being comprehensive and addressing all medication-related needs over time. The

  7. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

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    Klaus B. von Pressentin

    2017-01-01

    Full Text Available Background: The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS from 2011.Aim: This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population on key health indicators.Setting: All 52 South African health districts were included as units of analysis.Methods: An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015.Results: Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district.Conclusion: The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term.

  8. Factors affecting the opinions of family physicians regarding generic drugs – a questionnaire based study

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    Pawel Lewek

    2014-12-01

    Full Text Available A range of factors are believed to exert a negative influence on opinions of physicians about generic drugs.The aim of this study was to survey the opinions of primary care doctors on generics, and determine the factors which may affect them. A questionnaire comprising thirty eight questions was distributed among primary care doctors working in seventy out-patient clinics of the Lodzkie province, Poland, during the period of January 1, 2010 – December 31, 2010. A total of170 of 183 participants completed the survey (average age 48.5; 70.0% women: a 92.9%response rate. While 38.8% of physicians claimed that generics were worse than brand name drugs, 54.1% considered them to be better. However, 36.5% of the doctors did not choose generics for their own use. Two key opinions were identified among the responses concerning the effectiveness of generic drugs: use of generic drugs by the physician (p<0.001, and their opinion that pharmacists do inform patients about generic drugs (p<0.05. Although existing evidence confirms that generic and brand name drugs are equally effective, many physicians doubt this, which prevents them from being used as cost effective drug therapy. In order to increase healthcare savings through the use of generics, these factors should be addressed: for example, convincing a physician to adopt generics for personal use may be an efficient way to support more cost effective treatment of his patients.

  9. Factors affecting the opinions of family physicians regarding generic drugs--a questionnaire based study.

    Science.gov (United States)

    Lewek, Pawel; Smigielski, Janusz; Kardas, Przemyslaw

    2014-12-17

    A range of factors are believed to exert a negative influence on opinions of physicians about generic drugs.The aim of this study was to survey the opinions of primary care doctors on generics, and determine the factors which may affect them. A questionnaire comprising thirty eight questions was distributed among primary care doctors working in seventy out-patient clinics of the Lodzkie province, Poland, during the period of January 1, 2010 - December 31, 2010. A total of 170 of 183 participants completed the survey (average age 48.5; 70.0% women): a 92.9% response rate. While 38.8% of physicians claimed that generics were worse than brand name drugs, 54.1% considered them to be better. However, 36.5% of the doctors did not choose generics for their own use. Two key opinions were identified among the responses concerning the effectiveness of generic drugs: use of generic drugs by the physician (pgeneric drugs (pgeneric and brand name drugs are equally effective, many physicians doubt this, which prevents them from being used as cost effective drug therapy. In order to increase healthcare savings through the use of generics, these factors should be addressed: for example, convincing a physician to adopt generics for personal use may be an efficient way to support more cost effective treatment of his patients.

  10. Can community retail pharmacist and diabetes expert support facilitate insulin initiation by family physicians? Results of the AIM@GP randomized controlled trial

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    Harris Stewart B

    2013-02-01

    Full Text Available Abstract Background Limited evidence exists on the effectiveness of external diabetes support provided by diabetes specialists and community retail pharmacists to facilitate insulin-prescribing in family practice. Methods A stratified, parallel group, randomized control study was conducted in 15 sites across Canada. Family physicians received insulin initiation/titration education, a physician-specific ‘report card’ on the characteristics of their type 2 diabetes (T2DM population, and a registry of insulin-eligible patients at a workshop. Intervention physicians in addition received: (1 diabetes specialist/educator consultation support (active diabetes specialist/educator consultation support for 2 months [the educator initiated contact every 2 weeks] and passive consultation support for 10 months [family physician initiated as needed]; and (2 community retail pharmacist support (option to refer patients to the pharmacist(s for a 1-hour insulin-initiation session. The primary outcome was the insulin prescribing rate (IPR per physician defined as the number of insulin starts of insulin-eligible patients during the 12-month strategy. Results Consenting, eligible physicians (n = 151 participated with 15 specialist sites and 107 community pharmacists providing the intervention. Most physicians were male (74%, and had an average of 81 patients with T2DM. Few (9% routinely initiated patients on insulin. Physicians were randomly allocated to usual care (n = 78 or the intervention (n = 73. Intervention physicians had a mean (SE IPR of 2.28 (0.27 compared to 2.29 (0.25 for control physicians, with an estimated adjusted RR (95% CI of 0.99 (0.80 to 1.24, p = 0.96. Conclusions An insulin support program utilizing diabetes experts and community retail pharmacists to enhance insulin prescribing in family practice was not successful. Too few physicians are appropriately intensifying diabetes management through insulin initiation, and

  11. Unto the third generation: evidence for strong familial aggregation of physicians, psychologists, and psychotherapists among first-year medical and psychology students in a nationwide Austrian cohort census.

    Science.gov (United States)

    Tran, Ulrich S; Berger, Nina; Arendasy, Martin E; Greitemeyer, Tobias; Himmelbauer, Monika; Hutzler, Florian; Kraft, Hans-Georg; Oettl, Karl; Papousek, Ilona; Vitouch, Oliver; Voracek, Martin

    2017-05-03

    Medical students present higher numbers of physician relatives than expectable from the total population prevalence of physicians. Evidence for such a familial aggregation effect of physicians has emerged in investigations from the Anglo-American, Scandinavian, and German-speaking areas. In particular, past data from Austria suggest a familial aggregation of the medical, as well as of the psychological and psychotherapeutic, professions among medical and psychology undergraduates alike. Here, we extend prior related studies by examining (1) the extent to which familial aggregation effects apply to the whole nation-wide student census of all relevant (eight) public universities in Austria; (2) whether effects are comparable for medical and psychology students; (3) and whether these effects generalize to relatives of three interrelated health professions (medicine, psychology, and psychotherapy). We investigated the familial aggregation of physicians, psychologists, and psychotherapists, based on an entire cohort census of first-year medical and psychology students (n = 881 and 920) in Austria with generalized linear mixed models. For both disciplines, we found strong familial aggregation of physicians, psychologists, and psychotherapists. As compared with previous results, directionally opposite time trends within disciplines emerged: familial aggregation of physicians among medical students has decreased, whilst familial aggregation of psychologists among psychology students has increased. Further, there were sex-of-relative effects (i.e., more male than female physician relatives), but no substantial sex-of-student effects (i.e., male and female students overall reported similar numbers of relatives for all three professions of interest). In addition, there were age-benefit effects, i.e., students with a relative in the medical or the psychotherapeutic profession were younger than students without, thus suggesting earlier career decisions. The familial

  12. Communication skills of tutors and family medicine physician residents in Primary Care clinics

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    Francisco Javier Valverde Bolívar

    2016-12-01

    Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient.

  13. Like Father, like Son? Familial Aggregation of Physicians among Medical and Psychology Students

    Science.gov (United States)

    Voracek, Martin; Tran, Ulrich S.; Fischer-Kern, Melitta; Formann, Anton K.; Springer-Kremser, Marianne

    2010-01-01

    Various research findings, mostly from Anglo-American countries, evidence the medical profession to be strongly familial and further suggest that a medical family background may be associated with study success in medical undergraduates. This study explored the familial aggregation of the medical profession among 1-year cohort samples of medical…

  14. Assessing, treating and preventing community acquired pneumonia in older adults: findings from a community-wide survey of emergency room and family physicians

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    Loeb Mark

    2005-08-01

    Full Text Available Abstract Background Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP in older adults and to describe their self-reported assessment, management and prevention strategies. Methods All active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (≥60 years of age plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians. Results Seventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5 and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6 and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0. Conclusion The findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.

  15. Family members' experiences of being cared for by nurses and physicians in Norwegian intensive care units: a phenomenological hermeneutical study.

    Science.gov (United States)

    Frivold, Gro; Dale, Bjørg; Slettebø, Åshild

    2015-08-01

    When patients are admitted to intensive care units, families are affected. This study aimed to illuminate the meaning of being taken care of by nurses and physicians for relatives in Norwegian intensive care units. Thirteen relatives of critically ill patients treated in intensive care units in southern Norway were interviewed in autumn 2013. Interview data were analysed using a phenomenological hermeneutical method inspired by the philosopher Paul Ricoeur. Two main themes emerged: being in a receiving role and being in a participating role. The receiving role implies experiences of informational and supportive care from nurses and physicians. The participating role implies relatives' experiences of feeling included and being able to participate in caring activities and decision-making processes. The meaning of being a relative in ICU is experienced as being in a receiving role, and at the same time as being in a participating role. Quality in relations is described as crucial when relatives share their experiences of care by nurses and physicians in the ICU. Those who experienced informational and supportive care, and who had the ability to participate, expressed feelings of gratitude and confidence in the healthcare system. In contrast, those who did not experience such care, especially in terms of informational care expressed feelings of frustration, confusion and loss of confidence. However, patient treatment and care outweighed relatives' own feelings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Noise-induced hearing loss: the family physician's role

    Energy Technology Data Exchange (ETDEWEB)

    Dobie, R.A.

    1987-12-01

    Noise is an environmental health problem that has not received sufficient attention. Physicians should become knowledgeable about the medical consequences of excessive noise, support legislation to reduce the problem and promote programs aimed at noise control and prevention of hearing loss. Questions about noise and hearing should be incorporated into the medical history, and pure-tone audiometry should be a part of periodic physical evaluations.

  17. Family medicine education in rural communities as a health service intervention supporting recruitment and retention of physicians

    Science.gov (United States)

    Soles, Trina Larsen; Ruth Wilson, C.; Oandasan, Ivy F.

    2017-01-01

    Abstract Objective To develop a pan-Canadian rural education road map to advance the recruitment and retention of family physicians in rural, remote, and isolated regions of Canada in order to improve access and health care outcomes for these populations. Composition of the task force Members of the task force were chosen from key stakeholder groups including educators, practitioners, the College of Family Physicians of Canada education committee chairs, deans, chairs of family medicine, experts in rural education, and key decision makers. The task force members were purposefully selected to represent a mix of key perspectives needed to ensure the work produced was rigorous and of high quality. Observers from the Canadian Medical Association and Health Canada’s Council on Health Workforce, and representatives from the Royal College of Physicians and Surgeons of Canada, were also invited to provide their perspectives and to encourage and coordinate multiorganization action. Methods The task force commissioned a focused literature review of the peer-reviewed and gray literature to examine the status of rural medical education, training, and practice in relation to the health needs of rural and remote communities in Canada, and also completed an environmental scan. Report The environmental scan included interviews with more than 100 policy makers, government representatives, providers, educators, learners, and community leaders; 17 interviews with practising rural physicians; and 2 surveys administered to all 17 faculties of medicine. The gaps identified from the focused literature review and the results of the environmental scan will be used to develop the task force’s recommendations for action, highlighting the role of key partners in implementation and needed action. Conclusion The work of the task force provides an opportunity to bring the various partners together in a coordinated way. By understanding who is responsible and the actions each stakeholder

  18. Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

    Science.gov (United States)

    Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

    2013-01-01

    We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

  19. Prognostic categories and timing of negative prognostic communication from critical care physicians to family members at end-of-life in an intensive care unit.

    Science.gov (United States)

    Gutierrez, Karen M

    2013-09-01

    Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end-of-life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision-making, drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision-making to drive prognostic communication resulted in delayed prognostic communication to families until end-of-life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision-making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end-of-life decision-making.

  20. Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

    Science.gov (United States)

    Ferrara, Gineen; Ramponi, Denise; Cline, Thomas W

    2016-01-01

    Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR.

  1. "Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik

    2013-09-22

    Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism. Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Medical tourism is creating new challenges for

  2. Home visits by family physicians during the end-of-life: Does patient income or residence play a role?

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP home visits during the end-of-life among patients with cancer. Methods Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212 in the Canadian province of Nova Scotia (NS was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. Results Over 45% of all subjects received at least one home visit (n = 3265. Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income

  3. Factors associated to the career choice of family medicine among Japanese physicians: the dawn of a new era.

    Science.gov (United States)

    Ie, Kenya; Tahara, Masao; Murata, Akiko; Komiyama, Manabu; Onishi, Hirotaka

    2014-01-01

    Despite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan. From December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization. We extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics ("self-reliance," "pioneering spirit"), career direction ("community/rural-orientedness," "multifaceted orientation") and experience (e.g., "discomfort with fragmented care"). We divided the influencing factors that were identified for career choice into supporters (e.g., "role model"), conflict of career choice (e.g., "anxiety about diverse/broad practice"), and the dawn of a new era in family medicine in Japan (e.g., "lack of social recognition," "concern about livelihood," and "too few role models"). Although the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a "pioneering spirit" and an "attitude of self-training." Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, "concern about livelihood" was specific among our respondents and was related to career choice in the dawn period. "Community

  4. Urinary incontinence and overactive bladder in patients attending the family practice physicians office: a pan-Slovenian cross-sectional, questionnaire-based survey

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    Igor But

    2013-04-01

    Conclusions: Both, UI and OAB represent a significant problem among patients attending the family practice physician office. It seems that the knowledge of both dysfunctions is satisfactory among physicians. The majority of patients would tell their doctors about UI and OAB and would also receive appropriate instructions regarding the bladder training and PFMT, both methods being very important for the prevention and treatment of these dysfunctions.

  5. Using technology to teach technology: design and evaluation of bilingual online physician education about electronic medical records.

    Science.gov (United States)

    Edmonson, Sarah R; Esquivel, Adol; Mokkarala, Pallavi; Johnson, Craig W; Phelps, Cynthia L

    2005-01-01

    The "EMR Tutorial" is designed to be a bilingual online physician education environment about electronic medical records. After iterative assessment and redesign, the tutorial was tested in two groups: U.S. physicians and Mexican medical students. Split-plot ANOVA revealed significantly different pre-test scores in the two groups, significant cognitive gains for the two groups overall, and no significant difference in the gains made by the two groups. Users rated the module positively on a satisfaction questionnaire.

  6. Promoting Chinese-speaking primary care physicians' communication with immigrant patients about colorectal cancer screening: a cluster randomized trial design.

    Science.gov (United States)

    Wang, Judy Huei-yu; Liang, Wenchi; Ma, Grace X; Gehan, Edmund; Wang, Haoying Echo; Ji, Cheng-Shuang; Tu, Shin-Ping; Vernon, Sally W; Mandelblatt, Jeanne S

    2014-08-01

    Chinese Americans underutilize colorectal cancer screening. This study evaluated a physician-based intervention guided by social cognitive theory (SCT) to inform future research involving minority physicians and patients. Twenty-five Chinese-speaking primary care physicians were randomized into intervention or usual care arms. The intervention included two 45-minute in-office training sessions paired with a dual-language communication guide detailing strategies in addressing Chinese patients' screening barriers. Physicians' feedback on the intervention, their performance data during training, and pre-post intervention survey data were collected and analyzed. Most physicians (~85%) liked the intervention materials but ~84% spent less than 20 minutes reading the guide and only 46% found the length of time for in-office training acceptable. Despite this, the intervention increased physicians' perceived communication self-efficacy with patients (p<.01). This study demonstrated the feasibility of enrolling and intervening with minority physicians. Time constraints in primary care practice should be considered in the design and implementation of interventions.

  7. Patterns of relating between physicians and medical assistants in small family medicine offices.

    Science.gov (United States)

    Elder, Nancy C; Jacobson, C Jeffrey; Bolon, Shannon K; Fixler, Joseph; Pallerla, Harini; Busick, Christina; Gerrety, Erica; Kinney, Dee; Regan, Saundra; Pugnale, Michael

    2014-01-01

    The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. We conducted an ethnographic study of 5 small family medicine offices (having career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians' roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs. Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting.

  8. Dutch physicians on the role of the family in continuous sedation

    NARCIS (Netherlands)

    van Tol, Donald G.; Kouwenhoven, Pauline; van der Vegt, Bea; Weyers, Heleen

    In order to relieve intractable suffering of a terminal patient, doctors may decide to continuously sedate a patient until the end of life. Little research is done on the role the family plays during the process of continuous sedation. This study aims to get a view of doctors' experiences with

  9. [Children's medical records, HIV and confidentiality: practices and attitudes of physicians and families].

    Science.gov (United States)

    Suesser, P; Letrait, S; Welniarz, B

    2001-12-01

    The aim of this study is to describe the attitudes and practices of doctors and families regarding the use of the individual child health journal, especially by exploring the contradictions between the validity and confidentiality of its content, in particular with respect to HIV infection. In order to accomplish this, both doctors (N = 380) and families (N = 242) were questioned, most of them living and working in Seine-Saint-Denis, the metropolitan district with the third highest prevalence rate of HIV. The findings indicate that: most families are not always prepared to make sure that the confidential use of the child's health journal is maintained, and even less so those affected by HIV; doctors refrain from recording certain psychological and even medical data in the child health journal for fear of the information's misuse within the social sphere; doctors as well as families expressed their preoccupations concerning the confidentiality of the child health journal, essentially with respect to its content and how it is used in various contexts. A number of possibilities are proposed by the study's participants: establish a vaccination record separate from the child health journal, educate parents on how to maintain its confidential use and train the health workers to this end.

  10. The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study.

    Science.gov (United States)

    Lu, Yong; Hu, Xiao-Min; Huang, Xiao-Liang; Zhuang, Xiao-Dong; Guo, Pi; Feng, Li-Fen; Hu, Wei; Chen, Long; Zou, Huachun; Hao, Yuan-Tao

    2017-05-12

    To investigate the relationship between job satisfaction, work stress, work-family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work-family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work-family conflict. Job satisfaction, work stress, work-family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. The effect of a well-designed computerized physician order entry on medication error reduction

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    Hamid Moghaddasi

    2016-10-01

    Full Text Available Introduction: Paper-based prescription orders, commonly having numerous medication errors, can increase adverse drug events (ADEs and threaten the patient’s safety. Computerized physician order entry (CPOE, as an appropriate alternative, can significantly reduce medication errors. This study aimed to investigate the effects of well-designed CPOE in reducing medication errors and ADEs. Method: Electronic databases including EBSCO Host, Web of Science, PubMed, SID, Google Scholar, Iranmedex, Irandoc were used to conduct the literature review. We reviewed all the papers published about CPOE and its impacts on medication errors from 1998 until 2015. Thus 56 articles were found. Considering the relevance of their title and abstract with the objectives of the study, and deleting repetitive cases, 32 articles were selected, among which 10 articles were directly related to the objectives of the study. Results:A number of studies indicate that CPOE can reduce the incidence of serious medication errors and ADEs. Nonetheless, there is evidence indicating that CPOE could negatively affect the patient’s health if the system is not well-designed. Conclusion: The replacement of conventional, paper-based prescription orders with well-designed CPOEs in hospitals could play a key role in minimizing medication errors and improving the patients’ safety. To this end, the CPOEs have to be designed according to recent standards and needs.

  12. Health Needs of Adults with Intellectual Disability Relevant for the Family Physician

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    Joav Merrick

    2003-01-01

    Full Text Available People with developmental disability, mental retardation, or intellectual disability are living longer and becoming prone to age-related health problems and diseases of old age much like the general population. This worldwide trend is also seen in Israel, where today 39.8% of persons with intellectual disability in residential care are 40 years old and above. There is a need for service and staff providers to receive training; a need for more research and better service for this aging population. This review presents health concerns for older persons with different levels of intellectual disability, health concerns in persons with Down syndrome, and persons with epileptic seizures and cerebral palsy in relation to general practice and family medicine. The review is concluded with recommendations on health and aging in adults with intellectual disabilities and the call for formalized training in the topic for specialists in family medicine.

  13. Common psychiatric problems in homosexual men and women consulting family physicians.

    OpenAIRE

    Myers, M. F.

    1980-01-01

    This paper describes the commoner psychiatric difficulties of homosexual patients seen in a family practice. It is written primarily to aid general practitioners in deciding who should be referred to a psychiatrist. Recent developments in the study of homosexuality indicate that homosexual persons are no more likely than heterosexuals to suffer psychiatric problems. Practical suggestions are made for management and counseling, and some of the misconceptions about the gay community are dispelled.

  14. How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats

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    Rosemann Thomas

    2011-04-01

    Full Text Available Abstract Background Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11% and visual (16% formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively. Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001. Conclusions Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education.

  15. Advances in product family and product platform design methods & applications

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    Jiao, Jianxin; Siddique, Zahed; Hölttä-Otto, Katja

    2014-01-01

    Advances in Product Family and Product Platform Design: Methods & Applications highlights recent advances that have been made to support product family and product platform design and successful applications in industry. This book provides not only motivation for product family and product platform design—the “why” and “when” of platforming—but also methods and tools to support the design and development of families of products based on shared platforms—the “what”, “how”, and “where” of platforming. It begins with an overview of recent product family design research to introduce readers to the breadth of the topic and progresses to more detailed topics and design theory to help designers, engineers, and project managers plan, architect, and implement platform-based product development strategies in their companies. This book also: Presents state-of-the-art methods and tools for product family and product platform design Adopts an integrated, systems view on product family and pro...

  16. Knowledge, attitudes, and practices of family physicians and nurses regarding unintentional injuries among children under 15 years in Cairo, Egypt.

    Science.gov (United States)

    Elboray, Shereen; Elawdy, Mohamed Yehia; Dewedar, Sahar; Elezz, Nahla Abo; El-Setouhy, Maged; Smith, Gordon S; Hirshon, Jon Mark

    2017-03-01

    Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals' role in childhood unintentional injury prevention hinders the development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes, and practices regarding unintentional injury prevention for children injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While >90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9% and 85.9%, respectively), while thinking counselling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers' knowledge, attitudes and practices regarding IPC, more training and provision of counselling tools are essential for improving IPC by Egyptian medical providers.

  17. Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making: A multi-perspective IPA design.

    Science.gov (United States)

    Borg Xuereb, Christian; Shaw, Rachel L; Lane, Deirdre A

    2016-01-01

    To explore patients' and physicians' experiences of atrial fibrillation (AF) consultations and oral anticoagulation decision-making. Multi-perspective interpretative phenomenological analyses. Participants included small homogeneous subgroups: AF patients who accepted (n = 4), refused (n = 4) or discontinued (n = 3) warfarin, and four physician subgroups (n = 4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective interpretative phenomenological analysis (IPA) analyses to attend to individuals within subgroups and making comparisons within and between groups. Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision and Negotiating systemic factors. This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

  18. Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project

    Science.gov (United States)

    Jeejeebhoy, Khursheed; Dhaliwal, Rupinder; Heyland, Daren K.; Leung, Roger; Day, Andrew G.; Brauer, Paula; Royall, Dawna; Tremblay, Angelo; Mutch, David M.; Pliamm, Lew; Rhéaume, Caroline; Klein, Doug

    2017-01-01

    Background: Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS. Methods: In this longitudinal before-after study, 305 adult patients with MetS were recruited from 3 diverse family medicine team-based organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk. Results: Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%-24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%-18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6% (95% CI 7.6%-11.6%) and 1.4% (1.1%-1.6%), respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%. Interpretation: A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.

  19. Hypertension and type 2 diabetes: what family physicians can do to improve control of blood pressure--an observational study.

    Science.gov (United States)

    Putnam, Wayne; Lawson, Beverley; Buhariwalla, Farokh; Goodfellow, Mary; Goodine, Rose Anne; Hall, Jennifer; Lacey, Kendrick; MacDonald, Ian; Burge, Frederick I; Natarajan, Nandini; Sketris, Ingrid; Mann, Beth; Dunbar, Peggy; Van Aarsen, Kristine; Godwin, Marshall S

    2011-08-11

    The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice. We conducted a practice-based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient's medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM). Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure. When primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they

  20. Recognition of anxiety disorders by family physicians after rigorous medical record case extraction: results of the Netherlands Study of Depression and Anxiety.

    NARCIS (Netherlands)

    Janssen, E.H.C.; Ven, P.M. van de; Terluin, B.; Verhaak, P.F.M.; Marwijk, H.W.J. van; Smolders, M.; Meer, K. van der; Penninx, B.W.J.H.; Hout, H.P.J. van

    2012-01-01

    Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient

  1. Recognition of anxiety disorders by family physicians after rigorous medical record case extraction Results of the Netherlands Study of Depression and Anxiety

    NARCIS (Netherlands)

    Janssen, Evelien H. C.; van de Ven, Peter M.; Terluin, Berend; Verhaak, Peter F. M.; van Marwijk, Harm W. J.; Smolders, Mirrian; van der Meer, Klaas; Penninx, Brenda W. J. H.; van Hout, Hein P. J.

    2012-01-01

    Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient

  2. Continuity of care : is the personal doctor still important? : A survey of general practitioners and family physicians in England and Wales, the United States, and The Netherlands

    NARCIS (Netherlands)

    Stokes, T.; Tarrant, C.; Mainous, A.G.; Schers, H.J.; Freeman, G.; Baker, R.

    2005-01-01

    PURPOSE: We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. METHODS: We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants we

  3. Physicians' reflections on the personal learning process and the significance of distance learning in family health.

    Science.gov (United States)

    Thumé, Elaine; Wachs, Louriele Soares; Soares, Mariangela Uhlmann; Cubas, Marcia Regina; Fassa, Maria Elizabeth Gastal; Tomasi, Elaine; Fassa, Anaclaudia Gastal; Facchini, Luiz Augusto

    2016-09-01

    The scope of the article is to present the reflections of professionals from the Mais Médicos Program (More Doctors Program) on the significance of the specialization course in Family Health in terms of professional practice and learning the most important concepts. This is an empirically based qualitative study on the statements recorded in the "Critical reflection on their personal learning process" of the final work of the specialization course at the Federal University of Pelotas. For textual analysis, 101 reports were randomly selected from a total of 1,011 reports completed in seven states of the North, Northeast and South of Brazil from June to December 2015. The initial barriers were overcome with tutor support and team integration, with emphasis on teaching tools for the improvement of clinical practice and strategic organization of work and greater understanding of the public health system. Fostering the learning of the Portuguese language and the exchange of experience in the forums were considered valuable positive aspects. Despite the difficulty in Internet access in some municipalities it reaffirmed the central role of ongoing education and the viability of the problem-solving methodology, even from a distance.

  4. Product Family Design Methodology Using Object-Oriented Approach

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The serious competition environment of global marke t requests the enterprise to change traditional product development strategy and a dopt new theory in order to meet diverse customer needs while maintaining near m ass production efficiency, which is the main philosophy of mass customization. P roduct family design is research focus at present and also is the core technolog y of DFMC (design for mass customization). Firstly, this paper explores the fund amental issues of product family, such as concepts o...

  5. [How family physicians estimate their knowledge and skills in musculoskeletal problems?].

    Science.gov (United States)

    Mashov, Rita; Tabenkin, Hava

    2011-03-01

    the curriculum time of studying musculoskeletal diseases to at least 6 weeks and developing a CME musculoskeletal program. Different CME Musculoskeletal programs are being established in Family Medicine departments in Israel. It is important to investigate all musculoskeletal programs and to develop the universal musculoskeletal program for postgraduate education.

  6. Stability Analysis and Design of Impulsive Control Lorenz Systems Family

    Institute of Scientific and Technical Information of China (English)

    YU Yong-Bin; ZHANG Hong-Bin; ZHANG Feng-Li; YU Jue-Bang; LIAO Xiao-Feng

    2009-01-01

    Lorenz systems family unifying Lorenz system, Chen system and Lu system is a typical chaotic family.In this paper, we consider impulsive control Lorenz chaotic systems family with time-varying impulse intervals. By establishing an effective tool of a set of inequalities, we analyze the asymptotic stability of impulsive control Lorenz systems family and obtain some new less conservative conditions. Based on the stability analysis, we design a novel impulsive controller with time-varying impulse intervals. Illustrative examples are provided to show the feasibility and effectiveness of our method. The obtained results not only can be used to design impulsive control for Lorenz systems family, but also can be extended to other chaotic systems.

  7. Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

    Science.gov (United States)

    Estryn-Behar, M; Fry, C; Guetarni, K; Aune, I; Machet, G; Doppia, M A; Lassaunière, J M; Muster, D; Pelloux, P; Prudhomme, Ch

    2011-01-01

    France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

  8. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania--a qualitative study.

    Science.gov (United States)

    Tomasik, Tomasz; Windak, Adam; Domagala, Alicja; Dubas, Katarzyna; Sumskas, Linas; Rosinski, Jerzy

    2011-03-25

    The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1) educational, (2) clinical, (3) organisational. A qualitative content analysis was performed. Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.

  9. Educating vocationally trained family physicians: a survey of graduates from a postgraduate medical education programme.

    Science.gov (United States)

    Cunningham, Wayne K; Dovey, Susan M

    2016-06-01

    INTRODUCTION Since 1991 the University of Otago, Dunedin, New Zealand has offered postgraduate qualifications specifically designed to educate general practitioners (GPs) about their unique work environment. AIM To determine motivations and impacts of postgraduate education for practising GPs. METHODS Survey of the 100 graduates of the University of Otago, Dunedin postgraduate general practice programme. Ninety five living graduates were approached and 70 (73.7%) responded. Quantitative data about disposition of respondents before enrolling and after completion of the programme were analysed using chi-square and paired t-tests. Free text responses about motivations, impacts and outcomes of the program were thematically analysed. RESULTS 64 GPs graduated with a postgraduate diploma and 36 with a masters degree in general practice. Although the mean number of graduates was 3.5 and 2.0 (respectively), annual enrolments averaged 25.1. Most graduates (60.9%) were aged in their 40s when they started studying and most (94.3%) had a spouse and/or children at home. DISCUSSION This voluntary postgraduate medical education complements traditional medical training but has low external value despite personal, practising and professional benefits. Graduates valued engagement above completion of a qualification. KEYWORDS Medical education; general practitioners; scholarship; professionalism.

  10. Appropriate Osteoporosis Treatment by Family Physicians in Response to FRAX vs CAROC Reporting: Results From a Randomized Controlled Trial

    Science.gov (United States)

    Beattie, Karen A.; Ioannidis, George; MacDermid, Joy C.; Grewal, Ruby; Papaioannou, Alexandra; Adachi, Jonathan D.; Hodsman, Anthony B.

    2016-01-01

    Canadian guidelines recommend either the FRAX or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-yr fracture risk as low (20%). It is unknown whether one reporting system is more effective in helping family physicians (FPs) identify individuals who require treatment. Individuals ≥50 yr old with a distal radius fracture and no previous osteoporosis diagnosis or treatment were recruited. Participants underwent a dual-energy x-ray absorptiometry scan and answered questions about fracture risk factors. Participants’ FPs were randomized to receive either a FRAX report or the standard CAROC-derived bone mineral density report currently used by the institution. Only the FRAX report included statements regarding treatment recommendations. Within 3 mo, all participants were asked about follow-up care by their FP, and treatment recommendations were compared with an osteoporosis specialist. Sixty participants were enrolled (31 to FRAX and 29 to CAROC). Kappa statistics of agreement in treatment recommendation were 0.64 for FRAX and 0.32 for bone mineral density. The FRAX report was preferred by FPs and resulted in better postfracture follow-up and treatment that agreed more closely with a specialist. Either the clear statement of fracture risk or the specific statement of treatment recommendations on the FRAX report may have supported FPs to make better treatment decisions. PMID:24206869

  11. 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,...

  12. Emergence of protein fold families through rational design.

    Directory of Open Access Journals (Sweden)

    Feng Ding

    2006-07-01

    Full Text Available Diverse proteins with similar structures are grouped into families of homologs and analogs, if their sequence similarity is higher or lower, respectively, than 20%-30%. It was suggested that protein homologs and analogs originate from a common ancestor and diverge in their distinct evolutionary time scales, emerging as a consequence of the physical properties of the protein sequence space. Although a number of studies have determined key signatures of protein family organization, the sequence-structure factors that differentiate the two evolution-related protein families remain unknown. Here, we stipulate that subtle structural changes, which appear due to accumulating mutations in the homologous families, lead to distinct packing of the protein core and, thus, novel compositions of core residues. The latter process leads to the formation of distinct families of homologs. We propose that such differentiation results in the formation of analogous families. To test our postulate, we developed a molecular modeling and design toolkit, Medusa, to computationally design protein sequences that correspond to the same fold family. We find that analogous proteins emerge when a backbone structure deviates only 1-2 angstroms root-mean-square deviation from the original structure. For close homologs, core residues are highly conserved. However, when the overall sequence similarity drops to approximately 25%-30%, the composition of core residues starts to diverge, thereby forming novel families of protein homologs. This direct observation of the formation of protein homologs within a specific fold family supports our hypothesis. The conservation of amino acids in designed sequences recapitulates that of the naturally occurring sequences, thereby validating our computational design methodology.

  13. Physicians' Knowledge of Alcohol, Tobacco and Folic Acid in Pregnancy

    Science.gov (United States)

    Lefebvre, L. G.; Ordean, A.; Midmer, D.; Kahan, M.; Tolomiczenko, G.

    2007-01-01

    Objective: To assess: (1) physicians' knowledge and clinical confidence regarding problematic substance use in pregnancy compared to folic acid, and (2) physicians' desire for education in this area and their preferred learning modalities tools. Design: Self-administered survey. Setting: "Family Medicine Forum 2004" in Toronto, Canada.…

  14. Physicians' Knowledge of Alcohol, Tobacco and Folic Acid in Pregnancy

    Science.gov (United States)

    Lefebvre, L. G.; Ordean, A.; Midmer, D.; Kahan, M.; Tolomiczenko, G.

    2007-01-01

    Objective: To assess: (1) physicians' knowledge and clinical confidence regarding problematic substance use in pregnancy compared to folic acid, and (2) physicians' desire for education in this area and their preferred learning modalities tools. Design: Self-administered survey. Setting: "Family Medicine Forum 2004" in Toronto, Canada.…

  15. Measurement and correlates of empathy among female Japanese physicians.

    Science.gov (United States)

    Kataoka, Hitomi U; Koide, Norio; Hojat, Mohammadreza; Gonnella, Joseph S

    2012-06-22

    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. 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. 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. 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.

  16. Patients' ratings of family physician practices on the internet: usage and associations with conventional measures of quality in the English National Health Service.

    Science.gov (United States)

    Greaves, Felix; Pape, Utz J; Lee, Henry; Smith, Dianna M; Darzi, Ara; Majeed, Azeem; Millett, Christopher

    2012-10-17

    Patients are increasingly rating their family physicians on the Internet in the same way as they might rate a hotel on TripAdvisor or a seller on eBay, despite physicians' concerns about this process. This study aims to examine the usage of NHS Choices, a government website that encourages patients to rate the quality of family practices in England, and associations between web-based patient ratings and conventional measures of patient experience and clinical quality in primary care. We obtained all (16,952) ratings of family practices posted on NHS Choices between October 2009 and December 2010. We examined associations between patient ratings and family practice and population characteristics. Associations between ratings and survey measures of patient experience and clinical outcomes were examined. 61% of the 8089 family practices in England were rated, and 69% of ratings would recommend their family practice. Practices serving younger, less deprived, and more densely populated areas were more likely to be rated. There were moderate associations with survey measures of patient experience (Spearman ρ 0.37-0.48, Pquality. Although potentially flawed, patient ratings on the Internet may provide an opportunity for organizational learning and, as it becomes more common, another lens to look at the quality of primary care.

  17. Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

    Science.gov (United States)

    Tan, Amy; Manca, Donna

    2013-01-22

    Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing

  18. A Cost-Effectiveness Analysis of Low-Risk Deliveries: A Comparison of Midwives, Family Physicians and Obstetricians.

    Science.gov (United States)

    Walters, Dylan; Gupta, Archna; Nam, Austin E; Lake, Jennifer; Martino, Frank; Coyte, Peter C

    2015-08-01

    To investigate the cost-effectiveness of in-hospital obstetrical care by obstetricians (OBs), family physicians (FPs) and midwives (MWs) for delivery of low-risk obstetrical patients. Cost-effectiveness analysis from the Ministry of Health perspective using a retrospective cohort study. The time horizon was from hospital admission of a low-risk pregnant patient to the discharge of the mother and infant. Costing data included human resource, intervention and hospital case-mix costs. Interventions measured were induction or augmentation of labour with oxytocin, epidural use, forceps or vacuum delivery and caesarean section. The outcome measured was avoidance of transfer to a neonatal intensive care unit (NICU). Model results were tested using various types of sensitivity analyses. The mean maternal age by provider groups was 29.7 for OBs, 29.8 for FPs and 31.2 for MWs - a statistically higher mean for the MW group. The MW deliveries had lower costs and better outcomes than FPs and OBs. FPs also dominated OB.s The differences in cost per delivery were small, but slightly lower in MW ($5,102) and FP ($5,116) than in OB ($5,188). Avoidance of transfer to an NICU was highest for MW at 94.0% (95% CI: 91.0-97.0), compared with 90.2% for FP (95% CI: 88.2-92.2) and 89.6% for OB (95% CI: 88.6-90.6). The cost-effectiveness of the MW group is diminished by increases in compensation, and the cost-effectiveness of the FP group is sensitive to changes in intervention rates and costs. The MW strategy was the most cost-effective in this hospital setting. Given data limitations to further examine patient characteristics between groups, the overall conservative findings of this study support investments and better integration for MWs in the current system. Copyright © 2015 Longwoods Publishing.

  19. Ways of Improving the Training of Interns Pediatricians and General Practitioners — Family Physicians in «Pediatrics» Discipline

    Directory of Open Access Journals (Sweden)

    S.A. Mokiia-Serbina

    2015-10-01

    Full Text Available Graduates of medical schools having sufficient theoretical and practical skills often have difficulty in communicating with patients — children and their parents, as well as with colleagues. Objective: improving the efficiency of the educational process in the training of interns pediatricians and general practitioners — family physicians in «Pediatrics» course. Methods of the study: theoretical analysis of gathered experience. Results and discussion. During internship at the department, there are used seminars-discussions, seminars — training conferences, seminars — round tables that allows you to work out the tactics of speech, methods of discussion, reasoning of judgments, review, assessment, analysis. Interns most of the time must participate in the examination of a sick child, discussions of the results, conversations with parents. Clinical analysis of patients should be carried out using the method of structured group discussion when each intern can express his views. Interns are involved in scientific work, speak at scientific conferences. The department created a series of ambulatory pediatrics, -during which the intern talks to a child, his parents and he must to conciliate them, to inspire confidence and to prove himself as a specialist. During this course, special attention is paid to the psychological component of medical trai-ning. Clas-ses are conducted by assistant pediatrician, a graduate majoring in «Practical Psychology». Conclusions. The use of interactive teaching methods at different stages of the educational process contributes not only to improvement of theoretical activity, but also the formation in interns of professional qualities of clinical and scientific thinking, competence in the construction and development of interpersonal relations, humanism.

  20. Are family physicians comprehensively using electronic medical records such that the data can be used for secondary purposes? A Canadian perspective

    OpenAIRE

    Tu, Karen; Widdifield, Jessica; Young, Jacqueline; Oud, William; Ivers, Noah M.; Butt, Debra A.; Leaver, Chad A.; Jaakkimainen, Liisa

    2015-01-01

    Background With the introduction and implementation of a variety of government programs and policies to encourage adoption of electronic medical records (EMRs), EMRs are being increasingly adopted in North America. We sought to evaluate the completeness of a variety of EMR fields to determine if family physicians were comprehensively using their EMRs and the suitability of use of the data for secondary purposes in Ontario, Canada. Methods We examined EMR data from a convenience sample of fami...

  1. Comparison of blood pressure measurements using an automated blood pressure device in community pharmacies and family physicians' offices: a randomized controlled trial.

    Science.gov (United States)

    Chambers, Larry W; Kaczorowski, Janusz; O'Rielly, Susan; Ignagni, Sandra; Hearps, Stephen J C

    2013-01-01

    Accurate measurement of blood pressure is the foundation of appropriate diagnosis, treatment and ongoing management of hypertension. The use of automated blood pressure devices in community settings such as pharmacies provide opportunities for additional blood pressure measurement; however, it is important to ensure that these measurements are comparable to those taken in physicians' offices using the same devices. We conducted a randomized controlled trial to assess whether blood pressure readings assessed by use of an automated device differed according to the setting, specifically in community pharmacies and family physicians' offices. We included adults aged 65 years and older who did not live in long-term care facilities or in hospital. The trial was administered by volunteer peer health educators, family physicians and pharmacists in 2 midsized communities in Ontario from April to September 2010. The 5 participating family physicians mailed invitations to their eligible patients. Those who gave informed consent were randomly allocated to 1 of 2 assessment sequences: group A had their blood pressure measured at their physician's office, then at a pharmacy, then again at their physician's office; those in group B had their blood pressure measured at a pharmacy, then at their physician's office, then again at a pharmacy. An automated blood pressure device (BpTRU) was used in both settings. We calculated the differences in mean systolic and diastolic blood pressure, and we compared the readings at both settings and by sequence of assessment. In total, 275 adults completed the trial (mean age 75.9 yr, 49.5% male, 46.9% with a self-reported diagnosis of hypertension). There were no statistically significant differences in systolic or diastolic blood pressure measurements associated with the sequence of assessment or the setting. There was a significant difference in the overall mean systolic blood pressure between the 2 assessment sequences (group A 122.0 v. group

  2. Airfoil family design for large offshore wind turbine blades

    Science.gov (United States)

    Méndez, B.; Munduate, X.; San Miguel, U.

    2014-06-01

    Wind turbine blades size has scaled-up during last years due to wind turbine platform increase especially for offshore applications. The EOLIA project 2007-2010 (Spanish Goverment funded project) was focused on the design of large offshore wind turbines for deep waters. The project was managed by ACCIONA Energia and the wind turbine technology was designed by ACCIONA Windpower. The project included the design of a wind turbine airfoil family especially conceived for large offshore wind turbine blades, in the order of 5MW machine. Large offshore wind turbines suffer high extreme loads due to their size, in addition the lack of noise restrictions allow higher tip speeds. Consequently, the airfoils presented in this work are designed for high Reynolds numbers with the main goal of reducing blade loads and mantainig power production. The new airfoil family was designed in collaboration with CENER (Spanish National Renewable Energy Centre). The airfoil family was designed using a evolutionary algorithm based optimization tool with different objectives, both aerodynamic and structural, coupled with an airfoil geometry generation tool. Force coefficients of the designed airfoil were obtained using the panel code XFOIL in which the boundary layer/inviscid flow coupling is ineracted via surface transpiration model. The desing methodology includes a novel technique to define the objective functions based on normalizing the functions using weight parameters created from data of airfoils used as reference. Four airfoils have been designed, here three of them will be presented, with relative thickness of 18%, 21%, 25%, which have been verified with the in-house CFD code, Wind Multi Block WMB, and later validated with wind tunnel experiments. Some of the objectives for the designed airfoils concern the aerodynamic behavior (high efficiency and lift, high tangential coefficient, insensitivity to rough conditions, etc.), others concern the geometry (good for structural design

  3. The perceived value of clinical pharmacy service provision by pharmacists and physicians: an initial assessment of family medicine and internal medicine providers.

    Science.gov (United States)

    Wietholter, Jon P; Ponte, Charles D; Long, Dustin M

    2016-10-24

    Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists. The secondary objective was to evaluate perceived differences of clinical pharmacist benefit between IM and FM physicians. An eight-item questionnaire assessed the attitudes and beliefs of pharmacists and physicians regarding the value of clinical pharmacy services. Surveys were emailed and participants marked their responses using a 7-point Likert scale for each item. Demographic data and overall comments were collected from each participant. Overall, 167 surveys were completed. When comparing cumulative physician and pharmacist responses, none of the eight questions showed significant differences. Statistically significant differences were noted when comparing IM and FM clinical pharmacists on five of the eight survey items; for each of these items, FM pharmacists had more favourable perceptions than their IM counterparts. No statistically significant differences were noted when comparing responses of IM and FM physicians. This study found that FM pharmacists perceived a greater benefit regarding participation in inpatient acute care rounds when compared to their IM pharmacist counterparts. Future studies are necessary to determine if other medical specialties' perceptions of clinical pharmacy provision differ from our findings and to evaluate the rationale behind specific attitudes and behaviours. © 2016 Royal Pharmaceutical Society.

  4. Finding common ground to achieve a “good death”: family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study

    Directory of Open Access Journals (Sweden)

    Tan Amy

    2013-01-01

    Full Text Available Abstract Background Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a “bad death” experience for the patient and family. We aim to describe Canadian family physicians’ experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Methods Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Results Eleven family physicians with a range of 3 to 40 years in clinical practice participated. The family physicians expressed a desire to achieve a “good death” and described their role in positively influencing the experience of death. Finding Common Ground to Achieve a “Good Death” for the Patient emerged as an important process which includes 1 Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2 Understanding One Another through active listening and ultimately, and 3 Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for

  5. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

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    Sumskas Linas

    2011-03-01

    Full Text Available Abstract Background The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. Methods A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1 educational, (2 clinical, (3 organisational. A qualitative content analysis was performed. Results Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. Conclusions In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.

  6. Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Goertz Christine M

    2013-01-01

    Full Text Available Abstract Background Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. Methods/design This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits

  7. Healthy families study: design of a childhood obesity prevention trial for Hispanic families.

    Science.gov (United States)

    Zoorob, Roger; Buchowski, Maciej S; Beech, Bettina M; Canedo, Juan R; Chandrasekhar, Rameela; Akohoue, Sylvie; Hull, Pamela C

    2013-07-01

    The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. The study will enroll 272 Hispanic families with children ages 5-7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children's body mass index. Secondary outcomes are changes in children's waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time. Enrollment and data collection are in progress. This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. 社区门诊患者签约家庭医生的意愿及其影响因素研究%Factors Influencing Contracting Percentage of Family Physicians among Community Outpatients

    Institute of Scientific and Technical Information of China (English)

    赵影; 祝友元; 潘毅慧; 曹海涛; 刘登

    2012-01-01

    Objective To explore the factors that influence the contracting percentage of family physicians among community outpatients. Methods A self - designed structured questionnaire was used in a field survey among 100 outpatients selected randomly in community health care centers in Zhabei district, Shanghai. Results Out of the 900 subjects, 56. 9% were willing to sign with a family physician. The major factors affecting the signing rate were as follows: lack of knowledge about the benefits of signing, concerns about losing flexibility in choosing other medical institutions, and low credibility of the family physicians. Conclusion Family physicians should elevate their competencies to gradually gain recognition among the community residents to increase the contracting percentage.%目的 了解社区门诊患者签约家庭医生的意愿及其影响因素,为提高签约率提供理论参考.方法 采用自制的调查问卷,随机抽取上海市闸北区各社区卫生服务中心的门诊患者100名,进行现场调查.结果 社区门诊患者签约家庭医生的意愿一般,为56.9%.影响签约的因素主要有:(1)不清楚签约家庭医生可获得的好处,签约顾虑过重;(2)担心签约家庭医生实行社区首诊,影响自由就医;(3)对家庭医生的信任度较低,担心延误治疗.结论 居民对家庭医生的接受需要一定的过程,家庭医生能力的提高是其中的关键环节.

  9. Physicians' empathy and clinical outcomes for diabetic patients.

    Science.gov (United States)

    Hojat, Mohammadreza; Louis, Daniel Z; Markham, Fred W; Wender, Richard; Rabinowitz, Carol; Gonnella, Joseph S

    2011-03-01

    To test the hypothesis that physicians' empathy is associated with positive clinical outcomes for diabetic patients. A correlational study design was used in a university-affiliated outpatient setting. Participants were 891 diabetic patients, treated between July 2006 and June 2009, by 29 family physicians. Results of the most recent hemoglobin A1c and LDL-C tests were extracted from the patients' electronic records. The results of hemoglobin A1c tests were categorized into good control (9.0%). Similarly, the results of the LDL-C tests were grouped into good control (130). The physicians, who completed the Jefferson Scale of Empathy in 2009, were grouped into high, moderate, and low empathy scorers. Associations between physicians' level of empathy scores and patient outcomes were examined. Patients of physicians with high empathy scores were significantly more likely to have good control of hemoglobin A1c (56%) than were patients of physicians with low empathy scores (40%, P < .001). Similarly, the proportion of patients with good LDL-C control was significantly higher for physicians with high empathy scores (59%) than physicians with low scores (44%, P < .001). Logistic regression analyses indicated that physicians' empathy had a unique contribution to the prediction of optimal clinical outcomes after controlling for physicians' and patients' gender and age, and patients' health insurance. The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes.

  10. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

    Science.gov (United States)

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

    2015-04-01

    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  11. Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA)

    DEFF Research Database (Denmark)

    Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D

    2013-01-01

    BACKGROUND: Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most...

  12. Intergenerational families of holocaust survivors: designing and piloting a family resilience template.

    Science.gov (United States)

    Isserman, Nancy; Greene, Roberta R; Bowen, Sheryl Perlmutter; Hollander-Goldfein, Bea; Cohen, Harriet

    2014-01-01

    Researchers from the Templeton study, "Forgiveness, Resiliency, and Survivorship Among Holocaust Survivors," and the Transcending Trauma Project, combined efforts to examine six transcripts of interviews with survivors of the Nazi Holocaust. The researchers focused on the nature of parent-child family dynamics before, during, and after the Holocaust. They refined a Family Resilience Template (FRT) originally based on an ecological-systems design, adding an attachment theory component and a quantitative methodology. The goal of the research project was to pilot the FRT by further defining terms and adding a Quality of Family Dynamics Paradigm to encompass an intergenerational dimension. The researchers arrived at a consensus of item definitions, establishing the initial face validity of the FRT.

  13. Optics designs for an innovative LED lamp family system

    Science.gov (United States)

    Weiss, Herbert; Muschaweck, Julius; Hadrath, Stefan; Kudaev, Sergey

    2011-10-01

    On the general lighting market of LED lamps for professional applications there are still mainly products for single purpose solutions existing. There is a lack of standardised lamp systems like they are common for conventional lighting technologies. Therefore, an LED lamp family system was studied using high power LED with the objective to entirely substitute standard conventional lamp families in general lighting applications in the professional market segment. This comprises the realization of sets of lamp types with compact and linear shapes as well as with light distribution characteristics ranging from diffuse to extreme collimation and exceptionally high candle power. Innovative secondary optics concepts are discussed which allow both, the design of lamps with non-bulky shape and to obtain sufficient colour mixing when using multicolour LED combinations in order to achieve a very high colour rendering quality.

  14. Designing experiments to discriminate families of logic models

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    Santiago eVidela

    2015-09-01

    Full Text Available Logic models of signaling pathways are a promising way of building effective in silico functional models of a cell, in particular of signaling pathways. The automated learning of Boolean logic models describing signaling pathways can be achieved by training to phosphoproteomics data, which is particularly useful if it is measured upon different combinations of perturbations in a high-throughput fashion. However, in practice the number and type of allowed perturbations is not exhaustive. Moreover, experimental data is unavoidably subject to noise. As a result, the learning process results in a family of feasible logical networks rather than in a single model. This family is composed of logic models implementing different internal wirings for the system and therefore the predictions of experiments from this family may present a significant level of variability, and hence uncertainty.In this paper, we introduce a method based on Answer Set Programming to propose an optimal experimental design that aims to narrow down the variability (in terms of input-output behaviors within families of logical models learned from experimental data. We study how the fitness with respect to the data can be improved after an optimal selection of signaling perturbations and how we learn optimal logic models with minimal number of experiments. The methods are applied on signaling pathways in human liver cells and phosphoproteomics experimental data. Using 25% of the experiments we obtained logical models with fitness scores (mean square error 15% close to the ones obtained using all experiments, illustrating the impact that our approach can have on the design of experiments for efficient model calibration.

  15. [Opinion and Participation in the Regional Early Breast Cancer Detection Program in 2007 on the part of family physicians from a health district in the Autonomous Community of Madrid, Spain].

    Science.gov (United States)

    Garrido Elustondo, Sofía; Sánchez Padilla, Elisabeth; Ramírez Alesón, Victoria; González Hernández, Ma José; González Navarro, Andrés; López Gómez, Carlos

    2008-01-01

    Mammogram screening is the most effective method for the early detection of breast cancer. The objective of this study is to evaluate the degree of knowledge, the opinion and the participation in the early breast cancer detection program on the part of the family physicians of the Autonomous Community of Madrid. The population studied was comprised of family physicians from Madrid Health District Seven. An anonymous, self-administered questionnaire comprised of 30 questions grouped into physicians characteristics and opinion concerning the early breast cancer detection programs. A total of 46% of the physicians replied. A total of 94% of the physicians believed that it is their duty to inform their patients concerning preventive activities, including breast cancer screening, and 95% believed their advice to be useful for convincing women to have a mammogram. A total of 72% believed information to be lacking on this program. During the time when mammograms are being taken at their centres, 24% of the physicians surveyed always or almost always ask the women if they have any doubts or would like further information, 43% having set up appointments for them and 95% advising them to have a mammogram taken. The family physicians have a good opinion of the early breast cancer detection program and feel their advice to be effective for improving the participation in the program. They report lack of information and inform women about the program to only a small degree.

  16. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences

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    NAHID ZARIF SANAIEY

    2015-04-01

    Full Text Available Introduction: Assessment and prioritization are the first steps of planning. According to the family physician’s idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians’ educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. Methods: In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique. Content validity of the questionnaire and its reliability were confirmed by the experts’ opinion and Cronbach’s alpha of 80%. The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ, t-test, ANOVAs. A significance level of 0.05. The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%. In the areas of environmental and professional health and health education, compliance was zero. Conclusions: The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational needs.

  17. Medical Students' vs. Family Physicians' Assessment of Practical and Logical Values of Pathophysiology Multiple-Choice Questions

    Science.gov (United States)

    Secic, Damir; Husremovic, Dzenana; Kapur, Eldan; Jatic, Zaim; Hadziahmetovic, Nina; Vojnikovic, Benjamin; Fajkic, Almir; Meholjic, Amir; Bradic, Lejla; Hadzic, Amila

    2017-01-01

    Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors…

  18. The SGA-ER educational intervention in adolescent health care for Italian physicians: goals, content and instructional design.

    Science.gov (United States)

    De Sanctis, V; Clemente, S; Gallotta, M; Filati, G; Fiscina, B; Marsciani, A; Piacentini, G; Timoncini, G; Reggiani, L; Zucchini, A; Zunelli, C

    2012-09-01

    Adolescent medicine is a field dedicated to helping young people grow and thrive, in relation to their particular stage of development. In Italy, adolescent medicine is not a distinct speciality, but it is practised in some services for adolescents in paediatric departments. Increasing educational opportunities in adolescent health may help to accelerate the development and dissemination of new and improved therapeutic approaches for serving youth and also attract a larger cadre of physicians. Other pediatric subspecialties, e.g. oncology, rheumatology and adolescent psychiatry, have developed successfully and may represent excellent models for adolescent medicine specialists to emulate. The Adolescent Health Study Group of the Emilia and Romagna Region (SGA-ER) was established in 2010 in an effort to generate strategies and possible solutions to improve the quality and quantity of knowledge in adolescent health care for pediatricians and GPs. Several methods and approaches have been implemented to improve physicians' skills in adolescent health care. The authors report the goals, content and instructional design of an educational course in adolescent medicine. Alliances with other adolescent health groups may provide an additional opportunity for networking, interaction and exchange of ideas amongst professionals.

  19. People's major concern. The decision of couples to practice family planning is more influenced by the teachings in school and the advice given by physicians.

    Science.gov (United States)

    Mann, R

    1993-03-01

    Congressman Margarito B. Teves, who is a supporter of family planning in the Philippines, shares his ideas about the problems in society and the legislative response, the need for family planning, poverty, the Roman Catholic Church's position, economic development, and migration. The most important problems in society were identified, as poverty and overpopulation, or uncontrolled population growth, and its impact on society. The Philippine Legislators' Committee on Population and Development Foundation conducted a series of regional seminars on population problems, where family planning was one of five concerns. Family planning is not more vigorously promoted as a way to avoid antagonizing officials in the Roman Catholic Church. Recent results from a survey of couples, conducted by the Social Weather Station research organization, indicate that family planning (FP) practice is influenced more by school learning situations and physicians' advice than Church teachings. The implications are that politicians should support family planning more aggressively, but not abortion. Support for FP from the Church is more likely if natural methods are promoted as well as artificial methods. Church and government officials should discuss and focus on the common issues. It is hoped that the Church would allow couples greater freedom in choosing an appropriate method of contraception. The FP budget is inadequate; the recommended health budget set by UNICEF is 4% of central government expenditures. Scarce resources in a slow growth economy need to be managed to provide more services for the every expanding population. Economic opportunity must be provided in order to reverse the migration of skilled and semi-skilled workers abroad. Economic opportunities must be developed in rural areas in order to balance population distribution and slow the migration to urban areas. Incentives can be provided for people to set up businesses; infrastructure can be improved in areas where roads

  20.  "Maternal Health and Family Planning Distance Education" experience among physicians: a three-phase study to determine the educational needs, develop education program, and evaluate efficacy of the education administered

    Directory of Open Access Journals (Sweden)

    Ciftci B

    2016-06-01

    Full Text Available Bestami Ciftci,1 Nesibe Uzel,1 M Onur Ozel,2 Sema Zergeroglu,1 Cetin Deger,2 S Sare Turasan,1 Ayse Gul Karakoc,1 Semra Ozbalci,1 1General Directorate of Health Research (SAGEM, Turkish Ministry of Health, Ankara, Turkey; 2Bayer Türk Kimya San Ltd, Sti, Ankara, Turkey Aim: This study aims to assess the educational needs of family practitioners and evaluate the efficacy of the ongoing “Maternal Health and Family Planning Distance Education” program conducted by the General Directorate of Health Research (SAGEM of the Turkish Ministry of Health. Methods: This study consisted of three phases. In the first phase, an online survey on maternal health and family planning educational needs was sent to 20,611 physicians via e-mail. Of the 20,611 physicians, 4,729 completed the survey. In the second phase, of the 1,061 physicians registered to the education program, 632 physicians with active participation were included. In the third phase, the preeducation expectations of 287 physicians and posteducation satisfaction of 54 physicians were analyzed with a questionnaire. Results: The majority of the physicians were employed in a family health center (97.4% and practicing for 16–20 years (23.2% without any prior in-service training (60.9%. High-to-very high educational need was expressed by 56.4% of physicians for pregnancy, delivery, and puerperality. Topics that the physicians, including both those with ≥16 years in practice and without prior in-service training, expressed need for more detailed content were pregnancy, delivery, and puerperality (37.5%; emergency obstetric approach in the primary care setting (33.1%; and gynecological infectious diseases and treatment approach (32.4%. Following the education program, the participants' expectations were fulfilled in terms of refreshing their knowledge, particularly in the field of Maternal Health and Family Planning (87.1% and 75.9% and the percentage of participants who expressed that they had

  1. Physicians? Opinions of Phytotherapy Products

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    Murat Kartal

    2011-05-01

    Full Text Available 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 specifically developed questionnaire including 11 questions was applied for the physicians. Results: 150 physicians participated in to the research from 30 provinces. The half of the study participants (75 people was male. The mean age was 34.4. The 63.1% of the participating physicians stated that they applied or interested in phytotherapy. The 36.9% of physicians determined that they were against to phytotherapy or not interested. The major reasons of the opposition or indifference are lack of evidence-based and not having enough study in this subject (50.0%, the insufficient legal regulations (16.7%, only being able to be a the placebo effect (8.3%, and the thinking of being able to have harmful side effects (4.2%. There was not statistically significant difference between gender and interest in phytotherapy (p: 0.567. The 28.2% of the participating physicians stated that they ask to their patients whether using herbal products or not before their treatment or prescription. Conclusion  Phytotherapy, which is frequently mentioned and used in currently, is a fact to be considered whether it is interested or not. Many studies show that it is useful while the physicians taking medical history to inquire about if the patient use of this any product, to detect possible interactions and harms. In addition, the studies emphasize that the production and consumption of herbal products is still not designed with legal regulation, there is no standardization of quality and evidence

  2. 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...

  3. Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

    Science.gov (United States)

    2014-01-01

    Background Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress. Methods This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology. Results The participants’ responses can be captured as different dimensions of ‘closeness’, i.e. the degree to which one feels connected or ‘close’ to a certain decision or event. We distinguished four types of ‘closeness’, namely emotional, physical, decisional, and causal. Using these four dimensions of ‘closeness’ it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility. Conclusion Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these

  4. Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.

    Science.gov (United States)

    Raus, Kasper; Brown, Jayne; Seale, Clive; Rietjens, Judith A C; Janssens, Rien; Bruinsma, Sophie; Mortier, Freddy; Payne, Sheila; Sterckx, Sigrid

    2014-02-20

    Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress. This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology. The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility. Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish

  5. Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.

    Science.gov (United States)

    Tenner, C T; Herzog, K; Chaudhari, S; Bini, E J; Weinshel, E H

    2012-10-01

    Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups. A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination. Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates. © 2012 Blackwell Publishing Ltd.

  6. Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

    Directory of Open Access Journals (Sweden)

    Michael JM Allen

    2013-01-01

    Full Text Available BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP was released. To assess changes in family physicians’ (FPs prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.

  7. More Family Physicians or More Primary Care? An Analysis of the Family Practice Act (S. 3418). Health Manpower Policy Discussion Paper Series No. D.1.

    Science.gov (United States)

    Wright, George E., Jr.

    The crisis in primary care has long been discussed and the dismal litany of statistics is now familiar. The G.P. is vanishing from the medical scene. Over one-third of the active general practitioners are now over 60. In 1970 the U.S. Congress responded to the declining availability of primary health care by passing the Family Practice Act. The…

  8. "Maternal Health and Family Planning Distance Education" experience among physicians: a three-phase study to determine the educational needs, develop education program, and evaluate efficacy of the education administered.

    Science.gov (United States)

    Ciftci, Bestami; Uzel, Nesibe; Ozel, M Onur; Zergeroglu, Sema; Deger, Cetin; Turasan, S Sare; Karakoc, Ayse Gul; Ozbalci, Semra

    2016-01-01

    This study aims to assess the educational needs of family practitioners and evaluate the efficacy of the ongoing "Maternal Health and Family Planning Distance Education" program conducted by the General Directorate of Health Research (SAGEM) of the Turkish Ministry of Health. This study consisted of three phases. In the first phase, an online survey on maternal health and family planning educational needs was sent to 20,611 physicians via e-mail. Of the 20,611 physicians, 4,729 completed the survey. In the second phase, of the 1,061 physicians registered to the education program, 632 physicians with active participation were included. In the third phase, the preeducation expectations of 287 physicians and posteducation satisfaction of 54 physicians were analyzed with a questionnaire. The majority of the physicians were employed in a family health center (97.4%) and practicing for 16-20 years (23.2%) without any prior in-service training (60.9%). High-to-very high educational need was expressed by 56.4% of physicians for pregnancy, delivery, and puerperality. Topics that the physicians, including both those with ≥16 years in practice and without prior in-service training, expressed need for more detailed content were pregnancy, delivery, and puerperality (37.5%); emergency obstetric approach in the primary care setting (33.1%); and gynecological infectious diseases and treatment approach (32.4%). Following the education program, the participants' expectations were fulfilled in terms of refreshing their knowledge, particularly in the field of Maternal Health and Family Planning (87.1% and 75.9%) and the percentage of participants who expressed that they had sufficient high level knowledge increased from 55% to 68.5%. The education on Maternal Health and Family Planning refreshed the knowledge of participants and highly met the preeducation expectations. Determining the educational needs and expectations of the target population prior to the education program seems

  9. Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians.

    Science.gov (United States)

    Qaseem, Amir; Wilt, Timothy J; Rich, Robert; Humphrey, Linda L; Frost, Jennifer; Forciea, Mary Ann

    2017-03-21

    The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. This guideline is based on a systematic review of published randomized, controlled trials for primary outcomes and observational studies for harms only (identified through EMBASE, the Cochrane Database of Systematic Reviews, MEDLINE, and ClinicalTrials.gov), from database inception through January 2015. The MEDLINE search was updated through September 2016. Evaluated outcomes included all-cause mortality, morbidity and mortality related to stroke, major cardiac events (fatal and nonfatal myocardial infarction and sudden cardiac death), and harms. This guideline grades the evidence and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes all adults aged 60 years or older with hypertension. ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. (Grade: strong recommendation, high-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to

  10. Design of a family study among high-risk Caribbean Hispanics: the Northern Manhattan Family Study.

    Science.gov (United States)

    Sacco, Ralph L; Sabala, Edison A; Rundek, Tanja; Juo, Suh-Hang Hank; Huang, Jinaping Sam; DiTullio, Marco; Homma, Shunichi; Almonte, Katihurka; Lithgow, Carlos García; Boden-Albala, Bernadette

    2007-01-01

    Stroke continues to kill disproportionately more Blacks and Hispanics than Whites in the United States. Racial/ethnic variations in the incidence of stroke and prevalence of stroke risk factors are probably explained by both genetic and environmental influences. Family studies can help identify genetic predisposition to stroke and potential stroke precursors. Few studies have evaluated the heritability of these stroke risk factors among non-White populations, and none have focused on Caribbean Hispanic populations. The aim of the Northern Manhattan Family Study (NOMAFS) is to investigate the gene-environment interaction of stroke risk factors among Caribbean Hispanics. The unique recruitment and methodologic approaches used in this study are relevant to the design and conduct of genetic aggregation studies to investigate complex genetic disorders in non-White populations. The aim of this paper is to describe the NOMAFS and report enrollment and characteristics of the participants. The NOMAFS will provide a data resource for the exploration of the genetic determinants of highly heritable stroke precursor phenotypes that are less complex than the stroke phenotype. Understanding the gene environment interaction is the critical next step toward the development of new and unique approaches to disease prevention and interventions.

  11. Measurement and correlates of empathy among female Japanese physicians

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    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.

  12. "You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship.

    Science.gov (United States)

    Crooks, Valorie A; Li, Neville; Snyder, Jeremy; Dharamsi, Shafik; Benjaminy, Shelly; Jacob, Karen J; Illes, Judy

    2015-02-25

    Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship-a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship. We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants. Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism. Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients' decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.

  13. Disenfranchised Grief and Physician Burnout.

    Science.gov (United States)

    Lathrop, Deborah

    2017-07-01

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

  14. Physician Satisfaction and Physician Well-Being: Should Anyone Care?

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    Lawrence P. Casalino

    2015-05-01

    Full Text Available We present a model of hypothesized relationships between physician satisfaction, physician well-being and the quality of care, in addition to a review of relevant literature. The model suggests that physicians who are stressed, burned out, depressed, and/or have poor self-care are more likely to be dissatisfied, and vice-versa. Both poor physician well-being and physician dissatisfaction are hypothesized to lead to diminished physician concentration, effort, empathy, and professionalism. This results in misdiagnoses and other medical errors, a higher rate of inappropriate referrals and prescriptions, lower patient satisfaction and adherence to physician recommendations, and worse physician performance in areas not observed by others. Research to date largely supports the model, but high quality studies are few. Research should include studies that are prospective, larger, and have a stronger analytic design, ideally including difference in differences analyses comparing quality of care for patients of physicians who become dissatisfied to those who remain satisfied, and vice versa.Keywords: physician satisfaction, physician dissatisfaction, quality of care, physician well-being, physician burnout 

  15. Designing a New Program in Family Relations and Applied Nutrition

    Science.gov (United States)

    Devine, Sharon Mayne; Daly, Kerry; Lero, Donna; MacMartin, Clare

    2007-01-01

    Family Relations and Applied Nutrition, which is offered at the University of Guelph, is an interdisciplinary department that previously offered three undergraduate majors: child, youth, and family; applied human nutrition; and gerontology; as well as graduate programs at the master's and doctoral levels. Several factors have precipitated a review…

  16. Molecular design and QSARs/QSPRs with molecular descriptors family.

    Science.gov (United States)

    Bolboacă, Sorana D; Jäntschi, Lorentz; Diudea, Mircea V

    2013-06-01

    The aim of the present paper is to present the methodology of the molecular descriptors family (MDF) as an integrative tool in molecular modeling and its abilities as a multivariate QSAR/QSPR modeling tool. An algorithm for extracting useful information from the topological and geometrical representation of chemical compounds was developed and integrated to calculate MDF members. The MDF methodology was implemented and the software is available online (http://l.academicdirect.org/Chemistry/SARs/MDF_SARs/). This integrative tool was developed in order to maximize performance, functionality, efficiency and portability. The MDF methodology is able to provide reliable and valid multiple linear regression models. Furthermore, in many cases, the MDF models were better than the published results in the literature in terms of correlation coefficients (statistically significant Steiger's Z test at a significance level of 5%) and/or in terms of values of information criteria and Kubinyi function. The MDF methodology developed and implemented as a platform for investigating and characterizing quantitative relationships between the chemical structure and the activity/property of active compounds was used on more than 50 study cases. In almost all cases, the methodology allowed obtaining of QSAR/QSPR models improved in explanatory power of structure-activity and structure-property relationships. The algorithms applied in the computation of geometric and topological descriptors (useful in modeling physicochemical or biological properties of molecules) and those used in searching for reliable and valid multiple linear regression models certain enrich the pool of low-cost low-time drug design tools.

  17. The Comparison of Maternal and Child Health Indicators before and after the Family Physician Program in Shiraz, from 2001 to 2012

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    nasrin shokrpour

    2017-01-01

    Full Text Available Introduction: One of the aims of the family physician program (FPP is to improve the maternal and child health indicators. this study aimed to comparison maternal and child health indicators in Shiraz rural areas before and after implementation of FPP during 2001 to 2012. Methods: This applicable study was conducted in Shiraz in the south west of Iran in 2014. The child and maternal health indicators before (2001 to 2005 and after FPP (from 2006 to 2012 were gathered from the Health Center (Enghelab and Shohadaye Valfajr. The instrument for data collection was a questionnaire consisted of 20 maternal and child health indicators. Descriptive statistics was used and for analyzing the data, Excel and Stata software and comparisons of rates and joint point regression tests were employed. Results: the results showed that The FPP lead to decrease in stillbirth, infant mortality and child under one-year mortality in the rural area. Also all the vital horoscope indicator (mortality under one month, mortality under one year, the frequency of the infants under one year, the percentage of stillbirths, crude death percentage, crude birth percentage, general fertility percentage, total fertility percentage have improved after FPP in Health Center rather than Enghelab Health Center . Conclusion: the maternal and child health indicators had improvement after FPP implementation. Therefore, it is recommended to continue the program.

  18. Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey

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    Klassen Anne F

    2005-03-01

    Full Text Available Abstract Background Little is known about general and family practitioners' (GP/FPs' involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD, and mood disorders; and to identify factors associated with GP/FPs' involvement, comfort and skill. Methods Postal survey of a representative sample of 801 GP/FPs in British Columbia, Canada, which enquired about level of involvement (from primarily refer out to deal with case oneself; ratings of comfort/skill with assessment/diagnosis and management; beliefs regarding psychosocial problems in children; basic demographics; and practice information. Results Surveys were completed by 405 of 629 eligible GP/FPs (64.4%. Over 80% of respondents reported collaborative arrangements with specialists across problem and condition types, although for children with behavior problems or ADHD, more physicians primarily refer (χ2 (1 = 9.0; P 2 (1 = 103.9; P Conclusion Supporting GP/FPs in their care for children with common psychosocial and mental health problems should include efforts to bolster their confidence and modify attitudes in relation towards these problems, especially behavior problems and ADHD, possibly within innovative continuing education programs.

  19. Improvements in staff quality of work life and family satisfaction following the move to single-family room NICU design.

    Science.gov (United States)

    Watson, Jo; DeLand, Marion; Gibbins, Sharyn; MacMillan York, Elizabeth; Robson, Kate

    2014-04-01

    The purpose of this study was to determine whether there were differences in staff quality of work life and parent satisfaction when a neonatal intensive care unit moved from an open-bay design to a single-room model of care. This descriptive study measured staff quality of work life and family satisfaction before and at 2 time periods after the relocation of a perinatal centre and the introduction of single-family room care. Differences in work life quality and satisfaction were determined using 2-sample t-tests. There were improvements in staff quality of work life and family satisfaction at both time periods following the move. Lessons learned may be of value to other units considering such a move. A neonatal intensive care unit designed to contribute to parental and staff well-being is a model to be considered for future neonatal designs.

  20. Physician care patterns and adherence to postpartum glucose testing after gestational diabetes mellitus in Oregon.

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    Monica L Hunsberger

    Full Text Available OBJECTIVE: This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. RESEARCH DESIGN AND METHODS: In November-December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. RESULTS: Routine postpartum glucose tolerance testing by both family physicians (19.3% and obstetrician/gynecologists physicians (35.3% was reportedly low among the 285 respondents (42% response rate. Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69-7.94 and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65-11.69. Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. CONCLUSIONS: Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.

  1. Family and Consumer Sciences: A Facility Planning and Design Guide for School Systems.

    Science.gov (United States)

    Maryland State Dept. of Education, Baltimore.

    This document presents design concepts and considerations for planning and developing middle and high school family and consumer sciences education facilities. It includes discussions on family and consumer sciences education trends and the facility planning process. Design concepts explore multipurpose laboratories and spaces for food/nutrition…

  2. Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2009-04-01

    Full Text Available Abstract Background Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined. Methods/Design The research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience. Discussion The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic

  3. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients

    Directory of Open Access Journals (Sweden)

    Anne Kittler

    2004-11-01

    Conclusions Physicians’ fears about being overwhelmed with messages were not realised. While physicians were generally enthusiastic about the application, none used it directly to communicate with patients. Over three-quarters of respondents indicated that they would be more enthusiastic about electronic communication with patients if this time were compensated.

  4. [Burnout syndrome among family physicians].

    Science.gov (United States)

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon

    2013-01-01

    Introducción: el síndrome de agotamiento profesional es un estado de agotamiento físico y emocional que puede presentarse en trabajadores que interactúan con otras personas. El objetivo de esta investigación fue conocer la prevalencia de este síndrome y los factores relacionados en médicos familiares de Mérida, Yucatán, México. Métodos: se realizó una encuesta transversal en la que se aplicó el Maslach Burnout Inventory a médicos familiares seleccionados mediante muestreo no probabilístico por conveniencia. Se analizaron las medidas de tendencia central y dispersión y se determinó la prevalencia del síndrome de agotamiento profesional. La significación estadística de los factores asociados se determinó mediante χ(2). Resultados: se obtuvieron 59 casos de síndrome de agotamiento profesional: 36 con afectación en un componente del Maslach Burnout Inventory, 15 en dos y ocho en los tres. El 35 % de los casos indicó trabajar en promedio 10 turnos extra al mes (p = 0.013); tener un segundo trabajo también se relacionó con el síndrome. Conclusiones: los resultados son consistentes con los obtenidos en estudios similares. Trabajar turnos extra o tener otro trabajo fueron los factores relacionados con el síndrome de agotamiento profesional.

  5. Rare variant analysis for family-based design.

    Directory of Open Access Journals (Sweden)

    Gourab De

    Full Text Available Genome-wide association studies have been able to identify disease associations with many common variants; however most of the estimated genetic contribution explained by these variants appears to be very modest. Rare variants are thought to have larger effect sizes compared to common SNPs but effects of rare variants cannot be tested in the GWAS setting. Here we propose a novel method to test for association of rare variants obtained by sequencing in family-based samples by collapsing the standard family-based association test (FBAT statistic over a region of interest. We also propose a suitable weighting scheme so that low frequency SNPs that may be enriched in functional variants can be upweighted compared to common variants. Using simulations we show that the family-based methods perform at par with the population-based methods under no population stratification. By construction, family-based tests are completely robust to population stratification; we show that our proposed methods remain valid even when population stratification is present.

  6. Alteraciones fondoscópicas en pacientes hipertensos en un Consultorio del Médico de la Familia Funduscopic alterations in hypertensive patients at a family physician's office

    Directory of Open Access Journals (Sweden)

    Lisi Osorio Illas

    2003-06-01

    Full Text Available Con vistas a estudiar más profundamente el papel de la hipertensión arterial en el desarrollo de alteraciones retinianas, se realizó un estudio de 69 pacientes dispensarizados como hipertensos del Consultorio del Médico de la Familia no. 23 del policlínico "Elpidio Berovides"del municipio La Lisa desde enero a junio del año 2002. Todos los pacientes fueron evaluados desde el punto de vista general y fondoscópico donde se encontró un predominio del sexo femenino, con una mayor incidencia en mayores de 60 años. El mayor porcentaje de afecciones fondoscópicas se observó en los pacientes hipertensos moderados con más de 10 años de evolución. En el control de la hipertensión arterial influyó el tipo de tratamiento indicado y su cumplimiento; se demostró que la actividad preventiva es fundamental para modificar en gran medida la evolución de la enfermedad y la aparición de las alteraciones retinianas.In order to go deep into the role of arterial hypertension in the development of retinal alterations, a study was conducted among 69 patients classified as hypertensive at the Family Physician's Office no. 23 of "Elpidio Berovides" Polyclinic, in La Lisa municipality, from January to June, 2002. All the patients were evaluated from the general and fundoscopic point of view. It was found a predominance of females with a higher incidence in those over 60. The greatest percentage of fundoscopic affections was found in moderate hypertensive patients with more than 10 years of evolution. The type of treatment indicated and its fulfillment influenced the control of arterial hypertension. It was proved that the preventive activity is fundamental to modify considerably the evolution of the disease and the appearance of retinal alterations.

  7. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers.

    Science.gov (United States)

    Hoerger, Michael; Epstein, Ronald M; Winters, Paul C; Fiscella, Kevin; Duberstein, Paul R; Gramling, Robert; Butow, Phyllis N; Mohile, Supriya G; Kaesberg, Paul R; Tang, Wan; Plumb, Sandy; Walczak, Adam; Back, Anthony L; Tancredi, Daniel; Venuti, Alison; Cipri, Camille; Escalera, Gisela; Ferro, Carol; Gaudion, Don; Hoh, Beth; Leatherwood, Blair; Lewis, Linda; Robinson, Mark; Sullivan, Peter; Kravitz, Richard L

    2013-04-09

    Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Clinical Trials Identifier: NCT01485627.

  8. Design and stability of a family of deployable structures

    OpenAIRE

    Lessinnes, Thomas; Goriely, Alain

    2016-01-01

    A large family of deployable filamentary structures can be built by connecting two elastic rods along their length. The resulting structure has interesting shapes that can be stabilized by tuning the material properties of each rod. To model this structure and study its stability, we show that the equilibrium equations describing unloaded states can be derived from a variational principle. We then use a novel geometric method to study the stability of the resulting equilibria. As an example w...

  9. An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing.

    Science.gov (United States)

    Pinto, Daniel; Heleno, Bruno; Rodrigues, David S; Papoila, Ana Luísa; Santos, Isabel; Caetano, Pedro A

    2014-01-15

    The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese

  10. Language Impairment, Family Interaction and the Design of a Game

    Science.gov (United States)

    Noel, Guillermina

    2008-01-01

    This case study describes a user-centered design approach in the area of aphasia. Aphasia is a language impairment that can take many forms, so a particular case provides the foundation for this work. The particularities of the individual with this condition and his social context are key to developing and designing an intervention that supports…

  11. A Mixed-Methods Social Networks Study Design for Research on Transnational Families

    Science.gov (United States)

    Bernardi, Laura

    2011-01-01

    This paper advocates the adoption of a mixed-methods research design to describe and analyze ego-centered social networks in transnational family research. Drawing on the experience of the "Social Networks Influences on Family Formation" project (2004-2005; see Bernardi, Keim, & von der Lippe, 2007a, 2007b), I show how the combined use of network…

  12. Primary care physicians shortage: a Korean example.

    Science.gov (United States)

    Cho, Kyung-Hwan; Roh, Yong-Kyun

    2003-01-01

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

  13. Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study

    Directory of Open Access Journals (Sweden)

    Hylander Ingrid

    2009-06-01

    Full Text Available Abstract Background District nurses (DNs provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions. Methods Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM was used in the analyses. Results The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment. Conclusion The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to

  14. Systematic design of mouse Vh gene family-specific oligonucleotides

    NARCIS (Netherlands)

    Seijen, AM; Seijen, HG; Bos, NA

    2001-01-01

    Kabat's database has often been used to design mouse Vh gene-specific 5 ' primers. The emphasis was mostly on constructing a universal (degenerate) 5 ' primer or 5 ' primer set, which would be able to match every mouse Vh gene. We were interested in finding oligonucleotides that could be used as pri

  15. Systematic design of mouse Vh gene family-specific oligonucleotides

    NARCIS (Netherlands)

    Seijen, AM; Seijen, HG; Bos, NA

    2001-01-01

    Kabat's database has often been used to design mouse Vh gene-specific 5 ' primers. The emphasis was mostly on constructing a universal (degenerate) 5 ' primer or 5 ' primer set, which would be able to match every mouse Vh gene. We were interested in finding oligonucleotides that could be used as pri

  16. Design and development of a family of explosive ordnance disposal (EOD) robots

    Science.gov (United States)

    Reichard, Karl; Simpson, Tim; Rogan, Chris; Merenich, John; Brennan, Sean; Crow, Ed

    2008-10-01

    Across many consumer product industries, the prevailing practice is to design families of product variants that exploit commonality to provide the ability to easily customize a base platform for particular uses and to take advantage of commonality for streamlining design, manufacturing, maintenance and logistic; examples include Black & Decker, Seagate, and Volkswagen. This paper describes the application of product family concepts to the design and development of a family of robots to satisfy requirements for explosive ordnance disposal. To facilitate this process, we have developed a market segmentation grid that plots the desired capabilities and cost versus the target use cases. The product family design trade space is presented using a multi-dimensional trade space visualization tool which helps identify dependencies between different design variables and identify Pareto frontiers along which optimal design choices will lie. The EOD robot product family designs share common components and subsystems yet are modularized and scalable to provide functionality to satisfy a range of user requirements. This approach has been shown to significantly reduce development time and costs, manufacturing costs, maintenance and spare parts inventory, and operator and maintainer training.

  17. Custom designed type family for corporat visual identity

    OpenAIRE

    Veršnik, Anže

    2012-01-01

    Recognition in a wide public area can invoke a lot of factors. Visual identity of every formal and informal organization is only one of those. In order to successfully communicate trough visual messages, they have to be designed systematically and thoughtfully, as only this way all aspects of a visual message will be achieved. The overview of the history of visual messages, with emphasis on the development of the written word is highlighted. This includes everything between the first pict...

  18. Analysis of the design concept of 'Nora' family artillery weapons

    Directory of Open Access Journals (Sweden)

    Anastas L. Paligorić

    2011-10-01

    Full Text Available The development of the NORA family started as far as back to 1976 at the Military Technical Institute of the Yugoslav's People's Army. The programme covered development of several types of the main artillery weapon: the 152 mm NORA-A towed gun-howitzer, the 152 mm NORA-B self-propelled gun-howitzer and the 152 mm gun-howitzer with APU. Under the same programme, the conversion of the Russian 130 mm towed gun M46 into the 155 mm M46/84 gun (for export needs and the 152 mm M46/86 gun respectively (for the needs of the YPA was completed. Only the 152 mm M84 (NORA-A towed howitzer was introduced in service, while the development of the NORA-B and NORA-C weapons was carried on until 1992. After it had been suspended for many years, the development of the NORAB weapon was continued in 2003, followed by serial production of the 155 mm NORA-B52 self-propelled system for the export needs.

  19. Two-Phase and Family-Based Designs for Next-Generation Sequencing Studies

    Directory of Open Access Journals (Sweden)

    Duncan C Thomas

    2013-12-01

    Full Text Available The cost of next-generation sequencing is now approaching that of early GWAS panels, but is still out of reach for large epidemiologic studies and the millions of rare variants expected poses challenges for distinguishing causal from non-causal variants. We review two types of designs for sequencing studies: two-phase designs for targeted follow-up of genomewide association studies using unrelated individuals; and family-based designs exploiting co-segregation for prioritizing variants and genes.Two-phase designs subsample subjects for sequencing from a larger case-control study jointly on the basis of their disease and carrier status; the discovered variants are then tested for association in the parent study. The analysis combines the full sequence data from the substudy with the more limited SNP data from the main study. We discuss various methods for selecting this subset of variants and describe the expected yield of true positive associations in the context of an on-going study of second breast cancers following radiotherapy.While the sharing of variants within families means that family-based designs are less efficient for discovery than sequencing unrelated individuals, the ability to exploit co-segregation of variants with disease within families helps distinguish causal from non-causal ones. Furthermore, by enriching for family history, the yield of causal variants can be improved and use of identity-by-descent information improves imputation of genotypes for other family members. We compare the relative efficiency of these designs with those using unrelated individuals for discovering and prioritizing variants or genes for testing association in larger studies. While associations can be tested with single variants, power is low for rare ones. Recent generalizations of burden or kernel tests for gene-level associations to family-based data are appealing. These approaches are illustrated in the context of a family-based study of

  20. [Cooperation between the family physician, rheumatologist, hospital and rehabilitation clinic. Contribution of regional cooperative rheumatic disease centers for total quality management].

    Science.gov (United States)

    Hülsemann, J L

    1998-12-01

    The building-up of multipurpose arthritis centers in Germany led to a network including outpatient and inpatient services, primary care physicians, rheumatologists, physiotherapists, occupational therapists, psychologists, acute care clinics, and rehabilitation centers. The structural improvement in the care of patients with chronic inflammatory rheumatic diseases has to be followed by an improvement of processes in the care of these patients and by an improvement of outcome. Coordination offices can help not only to further improve cooperation between primary care physicians, specialized rheumatologists and hospitals but also to establish a comprehensive clinical quality management.

  1. FPGA Based Efficient Design of Traffic Light Controller using Frequency Scaling for Family of HSTL

    DEFF Research Database (Denmark)

    Sharma, Shivani; Khan, Sadiq; Das, Bhagwan

    2016-01-01

    utilizes least amount of power and is well tested in hardware using Xilinx Virtex6 Field Programmable gate array. FPGA designs are not only cheaper than ASIC designs but have many positive features like speed and performance. So the factors that contribute to power consumption for family of HSTL...

  2. Family in Focus: On Design and Field Trial of the Dynamic Collage [DC

    NARCIS (Netherlands)

    Jeurens, Jasper; Turnhout, Koen van; Bakker, René

    2014-01-01

    In this paper we present the design and field trial of the Dynamic Collage. The Dynamic Collage was designed to facilitate and to stimulate participation of family members in the informal care of an elderly person. The Dynamic Collage enabled relatives to update their current activity by sending a p

  3. A new family of covariate-adjusted response adaptive designs and their properties

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-Xin; HU Fei-fang

    2009-01-01

    It is often important to incorporate covariate information in the design of clinical trials. In literature there are many designs of using stratification and covariate-adaptive randomization to balance certain known covaxiate. Recently, some covariate-adjusted response-adaptive (CARA) designs have been proposed and their asymptotic properties have been studied (Ann.Statist. 2007). However, these CARA designs usually have high variabilities. In this paper, a new family of covariate-adjusted response-adaptive (CARA) designs is presented. It is shown that the new designs have less variables and therefore are more efficient.

  4. Continuous sedation until death: The everyday moral reasoning of physicians, nurses and family caregivers in the UK, the Netherlands and Belgium

    NARCIS (Netherlands)

    K. Raus (Kasper); J. Brown (Jayne); C. Seale (Clive); J.A.C. Rietjens (Judith); R. Janssens (Roel); S.M. Bruinsma (Sophie); F. Mortier (Freddy); S. Payne (Sheila); S. Sterckx (Sigrid)

    2014-01-01

    textabstractBackground: Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what

  5. A Case Retrieval Projection Pursuit Model for Configuration Design of a Product Family%A Case Retrieval Projection Pursuit Model for Configuration Design of a Product Family

    Institute of Scientific and Technical Information of China (English)

    XU Zi-rong; ZHANG Yi-fei

    2011-01-01

    The paper studies on case-based reasoning of uncertain product attributes in configuration design of a product family. Interval numbers characterize uncertain product attributes. By interpolating a number of certain values randomly to replace interval numbers and making projection pursuit analysis on source cases and target cases of expanded numbers, we can get a projection value in the optimal projection direction. Based on projection value, we can construct a case retrieval model of projection pursuit that can handle coexisting certain and uncertain product attributes. The application examples of chainsaw configuration design show that case retrieval is highly sensitive to reliable results.

  6. Relation Between Physicians' Work Lives and Happiness.

    Science.gov (United States)

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

    2016-04-01

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

  7. Nursing medication administration and workflow using computerized physician order entry.

    Science.gov (United States)

    Tschannen, Dana; Talsma, Akkeneel; Reinemeyer, Nicholas; Belt, Christine; Schoville, Rhonda

    2011-07-01

    The benefits of computerized physician order entry systems have been described widely; however, the impact of computerized physician order entry on nursing workflow and its potential for error are unclear. The purpose of this study was to determine the impact of a computerized physician order entry system on nursing workflow. Using an exploratory design, nurses employed on an adult ICU (n = 36) and a general pediatric unit (n = 50) involved in computerized physician order entry-based medication delivery were observed. Nurses were also asked questions regarding the impact of computerized physician order entry on nursing workflow. Observations revealed total time required for administering medications averaged 8.45 minutes in the ICU and 9.93 minutes in the pediatric unit. Several additional steps were required in the process for pediatric patients, including preparing the medications and communicating with patients and family, which resulted in greater time associated with the delivery of medications. Frequent barriers to workflow were noted by nurses across settings, including system issues (ie, inefficient medication reconciliation processes, long order sets requiring more time to determine medication dosage), less frequent interaction between the healthcare team, and greater use of informal communication modes. Areas for nursing workflow improvement include (1) medication reconciliation/order duplication, (2) strategies to improve communication, and (3) evaluation of the impact of computerized physician order entry on practice standards.

  8. 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.

  9. Design of the new Risoe-A1 airfoil family for wind turbines

    Energy Technology Data Exchange (ETDEWEB)

    Fuglsang, P.; Dahl, K.S. [Risoe National Lab., Wind Energy and Atmospheric Physics Dept., Roskilde (Denmark)

    1999-03-01

    A new airfoil family for wind turbines was developed by use of a design method using numerical optimization and the flow solver, XFOIL. The results were evaluated with the Navier-Stokes solver EllipSys2D. The airfoil family constitutes 6 airfoils ranging in thickness from 15% to 30%. The airfoils were designed to have a maximum lift coefficient around 1.5 in natural conditions and high lift-drag ratios below maximum lift. Insensitivity to leading edge roughness was obtained by securing that transition from laminar to turbulent flow on the suction side occurred close to the leading edge just before stall. The airfoil family was designed for a 600 kW wind turbine and provides a basis for further enhancing the characteristics of airfoils for wind turbines and to tailor airfoils for specific rotor sizes and power regulation principles. (au) EFP-95; EFP-98. 16 refs.

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Physician empathy: definition, components, measurement, and relationship to gender and specialty.

    Science.gov (United States)

    Hojat, Mohammadreza; Gonnella, Joseph S; Nasca, Thomas J; Mangione, Salvatore; Vergare, Michael; Magee, Michael

    2002-09-01

    There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores. A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians' gender and specialty were examined. Three meaningful factors emerged (perspective taking, compassionate care, and standing in the patient's shoes) to provide support for the construct validity of the empathy scale that was also found to be internally consistent with relatively stable scores over time. Women scored higher than men to a degree that was nearly significant. With control for gender, psychiatrists scored a mean empathy rating that was significantly higher than that of physicians specializing in anesthesiology, orthopedic surgery, neurosurgery, radiology, cardiovascular surgery, obstetrics and gynecology, and general surgery. No significant difference was observed on empathy scores among physicians specializing in psychiatry, internal medicine, pediatrics, emergency medicine, and family medicine. Empathy is a multidimensional concept that varies among physicians and can be measured with a psychometrically sound tool. Implications for specialty selection and career counseling are discussed.

  12. The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

    Science.gov (United States)

    Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen

    2007-01-01

    Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be

  13. The Ontario printed educational message (OPEM trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Grimshaw Jeremy

    2007-11-01

    Full Text Available Abstract Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM; however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1 angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2 retinal screening for diabetes; and 3 diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi

  14. Study designs for identification of rare disease variants in complex diseases: the utility of family-based designs.

    Science.gov (United States)

    Ionita-Laza, Iuliana; Ottman, Ruth

    2011-11-01

    The recent progress in sequencing technologies makes possible large-scale medical sequencing efforts to assess the importance of rare variants in complex diseases. The results of such efforts depend heavily on the use of efficient study designs and analytical methods. We introduce here a unified framework for association testing of rare variants in family-based designs or designs based on unselected affected individuals. This framework allows us to quantify the enrichment in rare disease variants in families containing multiple affected individuals and to investigate the optimal design of studies aiming to identify rare disease variants in complex traits. We show that for many complex diseases with small values for the overall sibling recurrence risk ratio, such as Alzheimer's disease and most cancers, sequencing affected individuals with a positive family history of the disease can be extremely advantageous for identifying rare disease variants. In contrast, for complex diseases with large values of the sibling recurrence risk ratio, sequencing unselected affected individuals may be preferable.

  15. The Mindful Physician and Pooh

    Science.gov (United States)

    Winter, Robin O.

    2013-01-01

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

  16. Interior design preferences of residents, families, and staff in two nursing homes.

    Science.gov (United States)

    Miller, D B; Goldman, L E; Woodman, S A

    1985-01-01

    The small number of respondents and the absence of specific demographic data concerning the three categories of respondents represented definite limitations. Further investigation in other long-term care facilities clearly is indicated. However, as a preliminary survey of preferences in nursing home interior design, several interesting findings have emerged: Patients, staff and families all emphasized patient safety and function over aesthetics. Yet, more residents than staff and families were concerned with appearance. Although experts advocate creating a home-like atmosphere in the nursing home, 50% or more of each group applied different criteria for specific design elements for private homes and for long-term care institutions. Design preferences for the three groups were similar, with an emphasis on modern furniture, painted walls, resilient tile rather than carpet, blinds, pastel and warm colors, and the use of paintings as accessories. Contrary to study assumptions, design features that promote patient individuality (e.g., patient artwork) received much greater emphasis from staff than from patients and families. Environmental change was considered an important aspect of interior design. Of the three constituencies, staff was most aware of periodic changes in decor and considered change as "very important" more often than did families or patients. As the nature of the nursing home patient population has changed--with residents presenting more disability and less rehabilitation potential and less likelihood of returning home--the ambiance of facilities has assumed even more importance. Clearly, the design preferences of residents who live in the facility are of paramount importance. However, it is also helpful to have an environment that is pleasing to family members who often experience difficulty in ongoing visitations, particularly to intellectually impaired relatives. Maintaining staff morale at a high level is a constant challenge in a long-term care

  17. Primary care physicians' perspectives on facilitating older patients' access to community support services: Qualitative case study.

    Science.gov (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

    2017-01-01

    To understand how family physicians facilitate older patients' access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Qualitative, multiple-case study design using semistructured interviews. Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. Copyright© the College of Family Physicians of Canada.

  18. Design of a randomized controlled trial on the effects of Counseling of mental health problems by Occupational Physicians on return to work: the CO-OP-study

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2007-07-01

    Full Text Available Abstract Background Mental health problems often lead to prolonged sick leave. In primary care, the usual approach towards these patients was the advice to take rest and not return to work before all complaints had disappeared. When complaints persist, these patients are often referred to psychologists from primary and specialized secondary care. As an alternative, ways have been sought to activate the Dutch occupational physician (OP in primary care. Early 2000, the Dutch Association of Occupational Physicians (NVAB published a guideline concerning the management by OPs of employees with mental health problems. The guideline received positive reactions from employees, employers and Dutch OPs. This manuscript describes the design of a study, which aims to assess the effects of the guideline, compared with usual care. Methods/Design In a randomized controlled trial (RCT, subjects in the intervention group were treated according to the guideline. The control group received usual care, with minimal involvement of the OP and easy access to a psychologist. Subjects were recruited from two Dutch police departments. The primary outcomes of the study are return to work and treatment satisfaction by the employee, employer, and OP. A secondary outcome is cost-effectiveness of the intervention, compared with usual care. Furthermore, prognostic measures are taken into account as potential confounders. A process evaluation will be done by means of performance indicators, based on the guideline. Discussion In this pragmatic trial, effectiveness instead of efficacy is studied. We will evaluate what is possible in real clinical practice, rather than under ideal circumstances. Many requirements for a high quality trial are being met. Results of this study will contribute to treatment options in occupational health practice for employees on sick leave due to mental health problems. Additionally, they may contribute to new and better-suited guidelines and stepped

  19. Supporting Product Family Design in a 3D CAD/PDM Integrated System

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fen; CHEN Zhuo-ning; YAN Xiao-guang; BIN Hong-zan

    2006-01-01

    This paper addresses some key issues in supporting product family design in a 3D CAD/PDM integrated system and introduces the techniques developed or adopted in building the integrated system. The general architecture of a 3D CAD/PDM integrated system is organized as five tiers. Multi-agent technology is applied with a collaborative design environment. The rule-based product family architecture (PFA) and tabular layouts of article characteristics (TLAC) technique are applied to represent the knowledge for product families. They make the knowledge understandable, simplified and can be exchanged among heterogeneous information systems. A transparently concentric integrated mode is put forward to enable the heterogeneous processes to interact and communicate regardless of the language used to construct each process. With the mode, function calling and information exchanging among different processes are carried out via message translation/parse approach. Currently, the integrated system is implemented in the platform of Windows NT and 2000.

  20. Practicing End-of-Life Conversations: Physician Communication Training Program in Palliative Care.

    Science.gov (United States)

    Rucker, Bronwyn; Browning, David M

    2015-01-01

    A Physician Communication Training Program (PCTP) utilizing scripts based on actual family conferences with patients, families, and the health care team was developed at one medical center in the Northeast. The program was designed, adapted, and directed by a palliative care social worker. The primary goal of the program is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning. The scripts focus on improving physicians' basic skills in conducting family meetings, discussing advance directives, prognosis, brain death, and withdrawal of life support. Excerpts from the scripts utilized in the program are included. Feedback from participants has been positive, with all respondents indicating improvement in their capacity to take part in these challenging conversations.

  1. Retrofitting: Learning Theory and Instructional Design in Marriage and Family Counseling Curricula.

    Science.gov (United States)

    Bourdeau, Beth; Mooney, Matthew E.

    2002-01-01

    Many current marriage and family trainers focus on issues related to counseling theory, special issues, and techniques. This article proposes an integrative, comprehensive model of instructional design, using concepts based in learning theory and development. When implemented, this model can provide a consistent, developmentally sensitive training…

  2. Stakeholder Collaboration in the Design and Implementation of a Family Literacy Portfolio Assessment.

    Science.gov (United States)

    Johnson, Robert L.; Willeke, Marjorie J.; Steiner, Deila J.

    1998-01-01

    Describes the collaborative process and the lessons learned when the staff of a family-literacy program and an evaluator worked together to design and implement a portfolio assessment that was used to collect program-evaluation information for the Even Start program over two years. Discusses opportunities to collaborate in the development of this…

  3. A methodological approach for designing and sequencing product families in Reconfigurable Disassembly Systems

    Directory of Open Access Journals (Sweden)

    Ignacio Eguia

    2011-10-01

    Full Text Available Purpose: A Reconfigurable Disassembly System (RDS represents a new paradigm of automated disassembly system that uses reconfigurable manufacturing technology for fast adaptation to changes in the quantity and mix of products to disassemble. This paper deals with a methodology for designing and sequencing product families in RDS. Design/methodology/approach: The methodology is developed in a two-phase approach, where products are first grouped into families and then families are sequenced through the RDS, computing the required machines and modules configuration for each family. Products are grouped into families based on their common features using a Hierarchical Clustering Algorithm. The optimal sequence of the product families is calculated using a Mixed-Integer Linear Programming model minimizing reconfigurability and operational costs. Findings: This paper is focused to enable reconfigurable manufacturing technologies to attain some degree of adaptability during disassembly automation design using modular machine tools. Research limitations/implications: The MILP model proposed for the second phase is similar to the well-known Travelling Salesman Problem (TSP and therefore its complexity grows exponentially with the number of products to disassemble. In real-world problems, which a higher number of products, it may be advisable to solve the model approximately with heuristics. Practical implications: The importance of industrial recycling and remanufacturing is growing due to increasing environmental and economic pressures. Disassembly is an important part of remanufacturing systems for reuse and recycling purposes. Automatic disassembly techniques have a growing number of applications in the area of electronics, aerospace, construction and industrial equipment. In this paper, a design and scheduling approach is proposed to apply in this area. Originality/value: This paper presents a new concept called Reconfigurable Disassembly System

  4. InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation.

    Science.gov (United States)

    Diehl, Leandro Arthur; Souza, Rodrigo Martins; Alves, Juliano Barbosa; Gordan, Pedro Alejandro; Esteves, Roberto Zonato; Jorge, Maria Lúcia Silva Germano; Coelho, Izabel Cristina Meister

    2013-01-21

    Physicians´ lack of knowledge contributes to underuse of insulin and poor glycemic control in adults with diabetes mellitus (DM). Traditional continuing medical education have limited efficacy, and new approaches are required. We report the design of a trial to assess the educational efficacy of InsuOnline, a game for education of primary care physicians (PCPs). The goal of InsuOnline was to improve appropriate initiation and adjustment of insulin for the treatment of DM. InsuOnline was designed to be educationally adequate, self-motivating, and attractive. A multidisciplinary team of endocrinologists, experts in medical education, and programmers, was assembled for the design and development of InsuOnline. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Adjustments will be made based on these results. An unblinded randomized controlled trial with PCPs who work in the city of Londrina, Brazil, will be conducted to assess the educational validity of InsuOnline on the Web. In this trial, 64 PCPs will play InsuOnline, and 64 PCPs will undergo traditional instructional activities (lecture and group discussion). Knowledge on how to initiate and adjust insulin will be assessed by a Web-based multiple choice questionnaire, and attitudes regarding diabetes/insulin will be assessed by Diabetes Attitude Scale 3 at 3 time points-before, immediately after, and 6 months after the intervention. Subjects´ general impressions on the interventions will be assessed by a questionnaire. Software logs will be reviewed. To our knowledge, this is the first research with the aim of assessing the educational efficacy of a computer game for teaching PCPs about insulin therapy in DM. We describe the development criteria used for creating InsuOnline. Evaluation of the game using a randomized controlled trial design will be done in future studies. We demonstrated that the design and development of a game for

  5. 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 ...

  6. Defining competency-based evaluation objectives in family medicine

    Science.gov (United States)

    Allen, Tim; Brailovsky, Carlos; Rainsberry, Paul; Lawrence, Katherine; Crichton, Tom; Carpentier, Marie-Pierre; Visser, Shaun

    2011-01-01

    Abstract Objective To develop a definition of competence in family medicine sufficient to guide a review of Certification examinations by the Board of Examiners of the College of Family Physicians of Canada. Design Delphi analysis of responses to a 4-question postal survey. Setting Canadian family practice. Participants A total of 302 family physicians who have served as examiners for the College of Family Physicians of Canada’s Certification examination. Methods A survey comprising 4 short-answer questions was mailed to the 302 participating family physicians asking them to list elements that define competence in family medicine among newly certified family physicians beginning independent practice. Two expert groups used a modified Delphi consensus process to analyze responses and generate 2 basic components of this definition of competence: first, the problems that a newly practising family physician should be competent to handle; second, the qualities, behaviour, and skills that characterize competence at the start of independent practice. Main findings Response rate was 54%; total number of elements among all responses was 5077, for an average 31 per respondent. Of the elements, 2676 were topics or clinical situations to be dealt with; the other 2401 were skills, behaviour patterns, or qualities, without reference to a specific clinical problem. The expert groups identified 6 essential skills, the phases of the clinical encounter, and 99 priority topics as the descriptors used by the respondents. More than 20% of respondents cited 30 of the topics. Conclusion Family physicians define the domain of competence in family medicine in terms of 6 essential skills, the phases of the clinical encounter, and priority topics. This survey represents the first level of definition of evaluation objectives in family medicine. Definition of the interactions among these elements will permit these objectives to become detailed enough to effectively guide assessment. PMID

  7. Knowledge acquisition method for case-knowledge-based product family design

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Knowledge acquisition has always been the bottleneck of artificial intelligence. It is the critical point in product family design. Here a knowledge acquisition method was introduced based on scenario model and repository grid and attribute ordering table technology. This method acquired knowledge through providing product design cases to expert, and recording the means and knowledge used by the expert to describe and resolve problems. It used object to express design entity, used scenario to describe the design process, used Event-Condition-Action (ECA) rule to drive design process, and with the help of repository grid and attribute ordering table technology to acquire design knowledge. It's a good way to capture explicit and implicit knowledge. And its validity is proved with respective examples.

  8. Personalized design and virtual evaluation of physician-modified stent grafts for juxta-renal abdominal aortic aneurysms

    Science.gov (United States)

    Sanathkhani, Soroosh; Shroff, Sanjeev G.; Menon, Prahlad G.

    2017-02-01

    Endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms (JAA) is particularly challenging owing to the requirement of suprarenal EVAR graft fixation, which has been associated with significant declines in long term renal function. Therefore, the ability to design fenestrated EVAR grafts on a personalized basis in order to ensure visceral and renal perfusion, is highly desirable. The objectives of this study are: a) To demonstrate novel 3D geometric methods to virtually design and deploy EVAR grafts into a virtually designed JAA, by applying a custom surface mesh deformation tool to a patient-specific descending aortic model reconstructed from computed tomographic (CT) images; and b) To virtually evaluate patient-specific renal flow and wall stresses in these patient-specific virtually EVAR geometries, using computational fluid dynamics (CFD). The presented framework may provide the modern cardiovascular surgeon the ability to leverage non-invasive, pre-operative imaging equipment to personalize and guide EVAR therapeutic strategy. Our CFD studies revealed that virtual EVAR grafting of a patient-specific JAA, with optimal fenestration sites and renal stenting, led to a 179.67±15.95% and 1051.43±18.34% improvement in right and left renal flow rates, respectively, when compared with the baseline patient-specific aortic geometry with renal stenoses, whereas a right and left renal flow improved by 36.44±2.24% and 885.93±12.41%, respectively, relative to the equivalently modeled JAA with renal stenoses, considering averages across the three simulated inflow rate cases. The proposed framework have utility to iteratively optimize suprarenal EVAR fixation length and achieve normal renal wall shear stresses and streamlined juxtarenal hemodynamics.

  9. Family learning with mobile devices in the outdoors: Designing an e-Trailguide to facilitate families' joint engagement with the natural world

    Science.gov (United States)

    McClain, Lucy R.

    This study describes the implementation of a self-guiding mobile learning tool designed to support families' engagements with the natural world as they explored the flora and fauna along one nature trail at an environmental center. Thirty-one family groups (n = 105 individuals) participated in this study during the summer season and used an iPad-based e-Trailguide during their nature walk. Design-based research methods guided this study's design, which focused on the third iteration of the e-Trailguide. Data included evaluation of families' content knowledge gains related to the local biodiversity as revealed through post-hike interviews, while videorecords of each family's nature walk experience were also collected. Qualitative analyses focused on the design features within the e-Trailguide that supported the families' technology-mediated engagements with nature and their interactions with each other at one Discovery Spot along the nature trail. Findings include: (a) open-ended interviews after the e-Trailguide experience provided a descriptive understanding of the families' conceptual knowledge gains; (b) four place-based design features within the e-Trailguide enabled and supported families' observational, pointing, and tactile investigation engagements with the natural world; (c) parents took on teacher-like roles for their children by connecting information from the e-Trailguide to the natural objects nearby as evidenced through their frequency of pointing gestures; and (d) the development of an analytical framework related to joint observation strategies used between family members to support science-related sense making. Design recommendations for the future implementation of e-Trailguides in outdoor settings include the incorporation of place-based observational questions, place-based textual prompts for focusing observations, drawing activities to record observations, and place-based images to support identification of wildlife. Key words: family learning

  10. Design of the wind turbine airfoil family RISOe-A-XX

    Energy Technology Data Exchange (ETDEWEB)

    Dahl, K.S.; Fuglsang, P.

    1998-12-01

    A method for design of wind turbine airfoils is presented. The design method is based on direct numerical optimization of a B-spline representation of the airfoil shape. For flexibility, the optimization algorithm relies on separate, stand alone tools for the analysis of aerodynamic and structural properties. The panel method based XFOIL is used during the optimization whereas the Navier-Stokes solver EllipSys2D is used in the evaluation of the results. The method is demonstrated by the design of an airfoil family composed of 7 airfoils ranging in thickness from 12% to 30%. The design is based on Reynolds and Mach numbers representative of a 600 kW wind turbine. The airfoils are designed to have maximum lift-drag ratio until just below stall, a design lift coefficient of about 1.55 at an angle of attack of 10 deg. and a maximum lift coefficient of 1.65. The airfoils are made insensitive to leading edge roughness by securing that transition from laminar to turbulent flow on the suction side occurs close to the leading edge for post stall angles of attack. The design method and the airfoil family provides a sound basis for further enhancing the characteristics of airfoils for wind turbines and to tailor airfoils for specific rotor sizes and power regulation principles. (au) EFP-95. 3 tabs., 24 ills., 31 refs.

  11. A new family of soft transition converters: Design and dynamic model

    Indian Academy of Sciences (India)

    N Lakshminarasamma; V Ramanarayanan; P Sidharthan

    2008-10-01

    The soft switching converters evolved through the resonant load, resonant switch, resonant transition and active clamp converters to eliminate switching losses in power converters. This paper briefly presents the operating principle of the new family of soft transition converters; the methodology of design of these converters is presented through an example. In the proposed family of converters, the switching transitions of both the main switch and auxiliary switch are lossless. When these converters are analysed in terms of the pole current and throw voltage, the defining equations of all converters belonging to this family become identical. Such a description allows one to define simple circuit oriented model for these converters. These circuit models help in evaluating the steady state and dynamic model of these converters. The standard dynamic performance functions of the converters are readily obtainable from this model. This paper presents these dynamic models and verifies the same through measurements on a prototype converter.

  12. Algunas ideas y reflexiones sobre la atención primaria y el Médico de Familia Some ideas and reflexions on primary health care an the family physician

    Directory of Open Access Journals (Sweden)

    José Díaz Novás

    2004-12-01

    Full Text Available Se exponen algunas ideas y reflexiones recogidas por los autores a lo largo de 20 años en jornadas, talleres, seminarios, reuniones y debates que han abordado el tema de la atención primaria de salud y el médico de familia. Se exponen ideas relacionadas con este médico, su trabajo, evaluación y control de las actividades que realiza, el diagnóstico y tratamiento, la docencia e investigaciones. La intención es divulgar un material que puede ser de utilidadd para los que trabajan en la atención primaria de salud.Some ideas and reflexions collected by the authors along 20 years of participation in scientific meetings, workshops, seminars and debates, where the topic of primary health care and the the family physician has been approached, are exposed. Ideas related to this physician, his work, evaluation and control of the activities he carries out, diagnosis and treatment, teaching and research, are given aimed at disseminating a material that may be useful for those working at the primary health care level.

  13. The 2017 Academic College of Emergency Experts and Academy of Family Physicians of India position statement on preventing violence against health-care workers and vandalization of health-care facilities in India.

    Science.gov (United States)

    Chauhan, Vivek; Galwankar, Sagar; Kumar, Raman; Raina, Sunil Kumar; Aggarwal, Praveen; Agrawal, Naman; Krishnan, S Vimal; Bhoi, Sanjeev; Kalra, O P; Soans, Santosh T; Aggarwal, Vandana; Kubendra, Mohan; Bijayraj, R; Datta, Sumana; Srivastava, R P

    2017-01-01

    There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it.

  14. Solar energy heating system design package for a single-family residence at New Castle, Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)

    1977-08-01

    The design of a solar heating and hot water system for the New Castle Redevelopment Authority's single-family dwelling located at New Castle, Pennsylvania is described. Documentation submitted by the contractor for Government review of plans, specifications, cost trade studies and verification status for approval to commit the system to fabrication is presented. Also included are system integration drawings, major subsystems drawings, and architect's specifications and plans.

  15. Notes on the Design of an Integrated Object—Oriented DBMS Family

    Institute of Scientific and Technical Information of China (English)

    商陆军; 许立辉

    1991-01-01

    This paper summarizes the design and implementation notes of the CodDdBase system,which is a combinative distributed database management system family based on an integrated object model.CoDdBase is implemented in CLUSTER 86,a general purposed object-oriented programming language designed by the authors.The CoDdBase environment is actually a part of the CLUSTER 86 programming environment,which offers various object-based models,supplies miscellaneous building blocks for constructing different distributed DBMS's,and provides integrated programming tools to develop new ways and new models in response to changing application needs.

  16. Satisfação no trabalho e rotatividade dos médicos do Programa de Saúde da Família Job satisfaction and physician turnover in the Family Health Program

    Directory of Open Access Journals (Sweden)

    Claudia Valentina de Arruda Campos

    2008-04-01

    Full Text Available Um dos problemas mais graves identificados na implantação do Programa de Saúde da Família no Brasil é a rotatividade do médico generalista. Já que o modelo se fundamenta no vínculo entre profissionais da equipe e população, a alta rotatividade dos médicos pode comprometer a efetividade do modelo. Pesquisa realizada no município de São Paulo para verificar a existência de correlação entre satisfação no trabalho dos médicos do programa e a rotatividade desses profissionais confirmou a hipótese da existência de correlação negativa. O prestígio da instituição parceira do município na implantação do programa foi o fator mais importante na determinação da rotatividade dos médicos. Outros fatores de satisfação no trabalho que apresentaram correlação com a rotatividade foram: capacitação, distância das unidades de saúde e disponibilidade de materiais e equipamentos para realização das atividades profissionais.One of the greatest problems of the Family Health Program in Brazil is the high turnover of its physicians. Given that the program is based on the relationship between health professionals and citizens, these high rates affect the model's effectiveness. A survey to identify the correlation between job satisfaction and physician turnover in the city of São Paulo, Brazil, confirmed the hypothesis that there is a negative correlation between these indicators. The prestige of the partner institutions is the most important factor in determining the program's physician turnover in São Paulo. Other job satisfaction factors that showed correlation with physician turnover were: training, commuting time, and lack of adequate equipment and materials.

  17. Economics and energy conservation in the design of new single-family housing

    Science.gov (United States)

    Petersen, S. R.

    1981-08-01

    The extent to which certain energy conservation modifications to the envelope design of a new, single family house are economically justified for a wide range of climates and projected energy costs were investigated factors that give rise to space heating and cooling loads in buildings are provided thermal inter-dependencies within and among envelope components that can greatly affect heating and cooling loads are examined. Economic criteria for determining a minimum life cycle cost building envelope design are formulated and a priority ranking method is developed to assist in the calculation of these designs. An expanded version of the NBS load determination program is used to calculated the annual heating and cooling requirements and maximum heating and cooling loads for a 1200 square foot, wood frame house with a wide range of thermal improvements in 14 geographic locations. It is demonstrated that the optimal envelope design configuration varies over a wide rang depending on climate, energy costs, and modification costs.

  18. Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey

    OpenAIRE

    Klassen Anne F; Johnston Charlotte; Miller Anton R; Fine Stuart; Papsdorf Michael

    2005-01-01

    Abstract Background Little is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD), and mood disorders; and to identify factors as...

  19. El médico de familia y el control de la sífilis después de una estrategia de intervención The family physician and the control of syphilis after an intervention strategy

    Directory of Open Access Journals (Sweden)

    Denis Berdasquera Corcho

    2006-09-01

    Full Text Available Se realizó un estudio experimental con control histórico antes y después de la intervención durante los meses de mayo de 2001 a agosto de 2003. El universo lo constituyeron los 39 Médicos de Familia que laboran en los consultorios del municipio. En Guanajay, desde hace varios años se han presentado dificultades en el tratamiento de las infecciones de transmisión sexual por parte de los Médicos de Familia, hecho que ha propiciado que se incumplan indicadores del Programa de Control de la Sífilis. Por tales razones se decidió intervenir, y realizar primeramente un estudio para determinar el nivel de conocimientos que sobre el control de la sífilis tenían los médicos del municipio, y aplicar posteriormente una intervención para disminuir las deficiencias encontradas. Solo el 43,6 % de los médicos obtuvieron evaluaciones satisfactorias antes de la intervención, que aumentaron a un 94,6 % de respuestas correctas después de aplicada la estrategia. Las mayores deficiencias se encontraron en el dominio de las funciones y objetivos del Programa, en el diagnóstico clínico y de laboratorio, en la vigilancia y grupos de riesgo, en el diagnóstico clínico y tratamiento, así como en las acciones de educación para la salud y la gravedad de la sífilis. El nivel de conocimientos sobre el Programa no era satisfactorio en la mayoría de los encuestados antes de la intervención. La estrategia empleada resultó ser eficaz en lograr conocimientos más sólidos por parte de los médicos en cuanto al control de la sífilis en su comunidad, lo que pudiera favorecer un mejor control de los pacientes que la padecen en el municipio.An experimental study with historical control before and after the intervention was conducted from May to August, 2003.The universe was composed of 39 family physicians working in the offices of the municipality. The family physicians have had difficulties to treat sexually transmitted diseases for some years, and as a

  20. What Patients Think About Their Interventional Radiologists: Assessment Using a Leading Physician Ratings Website.

    Science.gov (United States)

    Obele, Chika C; Duszak, Richard; Hawkins, C Matthew; Rosenkrantz, Andrew B

    2017-05-01

    The aim of this study was to evaluate patient satisfaction scores for interventional radiologists (IRs) across the United States using a leading physician ratings website. The physician ratings website Healthgrades was manually queried for all 2,774 Medicare-participating self-designated IRs. All patient-reviewed IRs for whom the primary "likelihood of recommending to family and friends" field was scored were included, resulting in 781 included IRs. Physician characteristics were extracted from Medicare data sets. All available patient satisfaction scores (1 [poor] to 5 [excellent]: likelihood to recommend, ease of scheduling, office environment, staff friendliness, trust in physician's decisions, how well physician explains condition, how well physician listens and answers questions, whether physician spends appropriate time with patients) and wait times were extracted from Healthgrades. Associations among measures were explored. IRs' mean likelihood-to-recommend score was 4.3 ± 1.2 (median, 5.0; 64.5% received a score of 5; 10.5% received scores office-related factors and from 4.3 to 4.5 for physician-related factors. Likelihood-to-recommend scores showed substantial correlations with office-related factors (r = 0.738 to 0.780) and physician-related factors (r = 0.918 to 0.946). Likelihood to recommend was significantly higher for IRs with shorter wait times (P leaving reviews are likely to recommend their own IRs to friends or family members. The likelihood to recommend is strongly associated with differences in wait times. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Value-Based Assessment of Radiology Reporting Using Radiologist-Referring Physician Two-Way Feedback System-a Design Thinking-Based Approach.

    Science.gov (United States)

    Shaikh, Faiq; Hendrata, Kenneth; Kolowitz, Brian; Awan, Omer; Shrestha, Rasu; Deible, Christopher

    2017-06-01

    In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

  2. 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).

  3. Review article: burnout in emergency medicine physicians.

    Science.gov (United States)

    Arora, Manit; Asha, Stephen; Chinnappa, Jason; Diwan, Ashish D

    2013-12-01

    Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.

  4. Design of a family of new advanced airfoils for low wind class turbines

    Science.gov (United States)

    Grasso, Francesco

    2014-12-01

    In order to maximize the ratio of energy capture and reduce the cost of energy, the selection of the airfoils to be used along the blade plays a crucial role. Despite the general usage of existing airfoils, more and more, families of airfoils specially tailored for specific applications are developed. The present research is focused on the design of a new family of airfoils to be used for the blade of one megawatt wind turbine working in low wind conditions. A hybrid optimization scheme has been implemented, combining together genetic and gradient based algorithms. Large part of the work is dedicated to present and discuss the requirements that needed to be satisfied in order to have a consistent family of geometries with high efficiency, high lift and good structural characteristics. For each airfoil, these characteristics are presented and compared to the ones of existing airfoils. Finally, the aerodynamic design of a new blade for low wind class turbine is illustrated and compared to a reference shape developed by using existing geometries. Due to higher lift performance, the results show a sensitive saving in chords, wetted area and so in loads in idling position.

  5. Using internal communication as a marketing strategy: gaining physician commitment.

    Science.gov (United States)

    Heine, R P

    1990-01-01

    In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.

  6. Accelerating Families of Fuzzy K-Means Algorithms for Vector Quantization Codebook Design

    Directory of Open Access Journals (Sweden)

    Edson Mata

    2016-11-01

    Full Text Available The performance of signal processing systems based on vector quantization depends on codebook design. In the image compression scenario, the quality of the reconstructed images depends on the codebooks used. In this paper, alternatives are proposed for accelerating families of fuzzy K-means algorithms for codebook design. The acceleration is obtained by reducing the number of iterations of the algorithms and applying efficient nearest neighbor search techniques. Simulation results concerning image vector quantization have shown that the acceleration obtained so far does not decrease the quality of the reconstructed images. Codebook design time savings up to about 40% are obtained by the accelerated versions with respect to the original versions of the algorithms.

  7. The Influence of Physician Communication Style on Overweight Patients’ Perceptions of Length of Encounter and Physician Being Rushed

    Science.gov (United States)

    Gulbrandsen, Pål; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Tulsky, James A.; Alexander, Stewart C.; Pollak, Kathryn I.

    2012-01-01

    BACKGROUND AND OBJECTIVES Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. METHODS We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. RESULTS Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. CONCLUSIONS There is wide variation in patients’ ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family

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

    Science.gov (United States)

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

    2010-10-25

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

  9. Usage and design evaluation by family caregivers of a stroke intervention web site.

    Science.gov (United States)

    Pierce, Linda L; Steiner, Victoria

    2013-10-01

    Four of five families are affected by stroke. Many caregivers access the Internet and gather healthcare information from Web-based sources. The purpose of this descriptive evaluation was to assess the usage and design of the Caring∼Web site, which provides education/support for family caregivers of persons with stroke residing in home settings. Thirty-six caregivers from two Midwest states accessed this intervention in a 1-year study. The average participant was 54 years old, White, woman, and the spouse of the care recipient. In a telephone interview, four Web site questions were asked twice a month/bimonthly, and a 33-item survey at the conclusion of the study evaluated the Web site usage and design of its components. Descriptive analysis methods were used, and statistics were collected on the number of visits to the Web site. On average, participants logged on to the Web site 1-2 hours per week, although usage declined after several months for some participants. Participants positively rated the Web site's appearance and usability that included finding the training to be adequate. Web site designers can replicate this intervention for other health conditions.

  10. Equal modal damping design for a family of resonant vibration control formats

    DEFF Research Database (Denmark)

    Krenk, Steen; Høgsberg, Jan Becker

    2013-01-01

    The principle of equal modal damping is used to give a unified presentation and calibration of resonant control of structures for different control formats, based on velocity, acceleration–position or position feedback. When introducing a resonant controller the original resonant mode splits...... into two, and if these are required to have the same modal damping ratio, the characteristic equation conforms to a two-parameter format. By selecting a suitable relative separation of the modal frequencies, the design problem defines a one-parameter family – determined, for example, in terms...

  11. Evaluation of two evidence-based knowledge transfer interventions for physicians. A cluster randomized controlled factorial design trial: the CardioDAS Study.

    Science.gov (United States)

    Amsallem, Emmanuel; Kasparian, Christelle; Cucherat, Michel; Chabaud, Sylvie; Haugh, Margaret; Boissel, Jean-Pierre; Nony, Patrice

    2007-12-01

    To investigate the potential benefits of two modes of evidence-based knowledge transfer ('active' and 'passive' modes) in terms of improvement of intention of prescription, knowledge, and real prescription in practice, we performed an open randomized controlled trial (CardioDAS) using a factorial design (two tested interventions: 'active' and 'passive' knowledge transfer) and a hierarchical structure (cluster of physicians for each department level). The participants were cardiologists working in French public hospitals. In the 'passive' transfer group, cardiologists received evidence-based knowledge material (available on Internet) every week for a duration of 1 year. In the 'active' transfer group, two knowledge brokers (EA, PN) visited the participating departments (every 2 months for 1 year, 2 h per visit). The primary outcome consisted in the adjusted absolute mean variation of score (difference between post- and pre-study session) of answers to simulated cases assessing the intention to prescribe. Secondary outcomes were the variation of answers to a multiple-choice questionnaire (MCQ) assessing knowledge and of the conformity of real prescriptions to evidence-based reference assessing the behavioral change. Twenty-two French units (departments) of cardiology were randomized (72 participating cardiologists). In the 'active' transfer group, the primary outcome was more improved than that in the control (P = 0.031 at the department level, absolute mean improvement of 5 points/100). The change in knowledge transfer (MCQ) was also significant (P = 0.039 at the department level, absolute mean improvement of 6 points/100). However, no benefit was shown in terms of prescription conformity to evidence. For the 'passive' mode of knowledge transfer and for the three outcomes considered, no improvement was identified. CardioDAS findings confirm that 'active' knowledge transfer has some impact on participants' intent to prescribe and knowledge, but no effect on

  12. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek

    2017-06-01

    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  13. Hierarchical Management of Diabetes Patients in Family Physician Office%家庭医生工作室分级管理糖尿病患者的效果研究

    Institute of Scientific and Technical Information of China (English)

    张敏; 李虹; 陈华; 乌日娜; 蔡红月

    2014-01-01

    Objective To explore the effectiveness of hierarchical management model for diabetes patients in family physician office. Methods A total of 433 diabetes patients managed by" Zhangmin's Office" of Zhoujiaqiao Community Health Service Center from February 2013 to January 2014 were enrolled in this study. One questionnaire,1 laboratory examination,1 physical examination were performed in the patients managed by family physician' office before management and 1 year after. The awareness of diabetes-related knowledge and the control rate of diabetes were observed and compared before management and 1 year after. Results The patients' awareness of the significance of glycated hemoglobin,macrovascular complications,diabetic nephropathy,lack of exercises affecting blood sugar metabolism,high -glycemic -index food influencing glucose metabolism was higher 1 year after management than before(P0. 05 ). The control rates of fasting blood glucose and glycosylated hemoglobin were higher 1 year after management than before(P0. 05 ). Conclusion Hierarchical management of diabetes patients in family physician office can effectively improve the patients' awareness of diabetes-related knowledge and the control rate of diabetes management.%目的:探讨家庭医生工作室分级管理模式对糖尿病患者管理的效果。方法选取上海市周家桥街道社区卫生服务中心“张敏工作室”2013年2月—2014年1月运用家庭医生工作室分级管理的糖尿病患者433例为研究对象。患者在经家庭医生工作室分级管理前及管理后1年各进行1次问卷调查、实验室检查和体格检查。对比家庭医生工作室分级管理前及管理后1年患者对糖尿病相关知识的知晓率(包括糖尿病诊断标准,糖尿病并发症,糖化血红蛋白检测意义,缺乏锻炼影响血糖代谢,高糖指数食品摄入影响糖代谢)和糖尿病管理达标率(包括空腹血糖、糖化血红蛋白、体质指数达标

  14. Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships.

    Science.gov (United States)

    Hojat, Mohammadreza; Gonnella, Joseph S; Nasca, Thomas J; Fields, Sylvia K; Cicchetti, Americo; Lo Scalzo, Alessandra; Taroni, Francesco; Amicosante, Anna Maria Vincenza; Macinati, Manuela; Tangucci, Massimo; Liva, Carlo; Ricciardi, Gualtiero; Eidelman, Shmuel; Admi, Hanna; Geva, Hana; Mashiach, Tanya; Alroy, Gideon; Alcorta-Gonzalez, Adelina; Ibarra, David; Torres-Ruiz, Antonio

    2003-05-01

    This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.

  15. Design and verification of the Risø-B1 airfoil family for wind turbines

    DEFF Research Database (Denmark)

    Fuglsang, P.; Bak, C.; Gaunaa, M.

    2004-01-01

    This paper presents the design and experimental verification of the Risø-B1 airfoil family for MW-size wind turbines with variable speed and pitch control. Seven airfoils were designed with thickness-to-chord ratios between 15% and 53% to cover the entire span of a wind turbine blade. The airfoils...... were designed to have high maximum lift and high design lift to allow a slender flexible blade while maintaining high aerodynamic efficiency. The design was carried out with a Risø in-house multi disciplinary optimization tool. Wind tunnel testing was done for Risø-B1-18 and Risø-B1-24 in the VELUX...... wind tunnel, Denmark, at a Reynolds number of 1.6x10(6). For both airfoils the predicted target characteristics were met. Results for Risø-B1-18 showed a maximum lift coefficient of 1.64. A standard case of zigzag tape leading edge roughness caused a drop in maximum lift of only 3.7%. Cases of more...

  16. System Design for Demand Controlled Ventilation in Multi-Family Dwellings

    DEFF Research Database (Denmark)

    Mortensen, Dorthe Kragsig; Nielsen, Toke Rammer

    2011-01-01

    This paper presents an investigation into solutions for the system design of a centralized DCV system in multi-family dwellings. The design focused on simple and inexpensive solutions. A cost benefit estimate showed that the initial cost of implementing DCV in a system with an efficient heat...... are typically controlled by maintaining the static pressure at a fixed level at a selected point in the main duct. However, sustaining the static pressure at a fixed level at part load leads to throttling of all control components and thereby unnecessary energy consumption. Resetting the static pressure at part...... load reduces throttling and energy can be saved. A static pressure reset strategy was applied to a dwelling-specific DCV system where the airflow varied between three fixed rates. The system performance was evaluated for two diffusers. The annual electricity consumption was reduced by 20% to 30% when...

  17. Using Behavioral Science to Design a Peer Comparison Intervention for Postabortion Family Planning in Nepal.

    Science.gov (United States)

    Spring, Hannah; Datta, Saugato; Sapkota, Sabitri

    2016-01-01

    Despite the provision of free and subsidized family planning services and clients' demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal's largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN's stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN's centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools' usability and features to select a variant of the tool that also leverages and reinforces providers' strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention's effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN's 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake.

  18. The observed association between maternal anxiety and adolescent asthma: children of twin design suggest familial effects.

    Directory of Open Access Journals (Sweden)

    Ida Havland

    Full Text Available BACKGROUND: Previous studies indicate that maternal anxiety is associated with asthma in the adolescent child, but mechanisms are unclear. OBJECTIVE: To investigate the association between maternal anxiety and maternal, self- and register-based report of asthma in the adolescent child, and whether the association remains after control of familial confounding (shared environmental and genetic factors. METHOD: From the Twin and Offspring Study of Sweden, 1691 mothers (1058 twins and their adolescent child were included. The association between maternal self-reported anxiety (Beck Anxiety Inventory (BAI and Karolinska Scales of Personality (KSP somatic or psychic anxiety and asthma based on subjective (maternal or child report or objective (register-based diagnosis and medication measures were analysed using logistic regression. The children-of-twins design was used to explore whether genes or environment contribute to the association. RESULTS: Maternal BAI anxiety (OR 2.02, CI 1.15-3.55 was significantly associated with adolescent asthma reported by the mother. Maternal KSP somatic anxiety (OR 1.74, CI 1.04-2.91 and psychic anxiety (OR 1.74, CI 1.05-2.86 was significantly associated with breathlessness reported by the adolescent child. In contrast, maternal anxiety was not associated with increased risk for the register-based outcomes of asthma diagnosis or medication. The results remained also after adjusting for covariates and the children-of-twins analyses which indicate that the association was due to familial confounding. CONCLUSIONS: We found some associations between maternal anxiety and subjectively reported offspring asthma or breathlessness which may be due to familial effects. A likely candidate for explaining this familial confounding is heritable personality traits associated with both anxiety and subjective measures of asthma.

  19. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

    Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

  20. Knowledge and attitudes about emergency contraception among pharmacist and physician preceptors in South Carolina

    Directory of Open Access Journals (Sweden)

    Sarah Shrader

    2010-08-01

    Full Text Available Sarah Shrader1,2, Ann M Rodden1, Lisa Carroll3, Lars E Peterson11Medical University of South Carolina, Department of Family Medicine, Charleston, SC, USA; 2South Carolina College of Pharmacy, Department of Clinical Pharmacy and Outcomes Sciences, Charleston, SC, USA; 3Spartanburg Regional Family Medicine Residency Program, Department of Family Medicine, Spartanburg, SC, USABackground: Emergency contraception (EC may reduce unintended pregnancies if patients are informed and have access. A great deal of medical education occurs during medical and pharmacy training community clerkships. This study concurrently assesses knowledge and attitudes about EC between community physician and pharmacist preceptors who prescribe/dispense EC.Study design: Electronic survey of demographic information, knowledge-based, and attitude questions related to EC was completed by 182 (36.6% response rate South Carolina ­community physicians and pharmacists who precept students. Comparisons were performed using chi-square or Fischer’s exact test.Results: In the study population, approximately 62% of pharmacists dispense EC while only 28% of physicians prescribe it. More physicians than pharmacists believe repetitive use is not harmful (48.3% vs 28.0%, P = 0.010, while more pharmacists believe it causes birth defects (22.6% vs 7.9%, P = 0.008.Conclusion: Overall, both physicians and pharmacists have poor knowledge about EC. ­Further education for both groups may be needed so future physicians and pharmacists are not taught incorrectly during their training and so patient access is not hampered by prescriber misunderstanding.Keywords: emergency contraception, levonorgestrel, pharmacist, physician

  1. La medición de la presión intrabdominal, una herramienta diagnóstica para el médico de familia Intra-abdominal pressure measurement, a diagnostic tool for family physician

    Directory of Open Access Journals (Sweden)

    Nizahel Estévez Álvarez

    2010-09-01

    Full Text Available Resulta muy oportuno establecer un diagnóstico precoz de las afecciones intrabdominales agudas, por eso consideramos prudente poner en manos de nuestro personal de salud que labora en el sistema de urgencia del nivel primario, una herramienta diagnóstica más para el Médico de Familia, como es la medición de la presión intrabdominal, por no existir prácticamente experiencias de su empleo fuera de las unidades de atención al paciente grave. Es este un método perfectamente implementable en nuestro medio por su fácil aplicabilidad técnica y su alta especificidad diagnóstica, que permite inferir, en las primeras horas de evolución de los pacientes con cuadros dolorosos abdominales, cuáles resultarían potencialmente necesitados de tratamiento quirúrgico, y de esta manera, ganar en resolutividad. La imposibilidad de realizar esta técnica nunca debería de retrasar la remisión del paciente para su valoración por un especialista en cirugía general, por tanto, esta solo pudiera ser considerada como un complemento más del arsenal diagnóstico al alcance del Médico de Familia, en centros acondicionados para su implementación y con el entrenamiento previo adecuado.It is very appropriate to establish an early diagnosis of acute intra-abdominal infections, thus, authors believe cautious that our health staff working in the primary level of emergence system to count on another diagnostic tool for Family Physician, the intra-abdominal pressure measurement, due to practically the lack of experience of its job out of the care units for the severe patient. This is a method perfectly applicable in our environment by its easy technical application and its high diagnostic specificity allowing inferring during the first hours of evolution of patients presenting with abdominal painful symptoms, who will be potentially needed of surgical treatment and so to achieve a solution. The impossibility to perform this technique never must to retard the

  2. Physician communication coaching effects on patient experience.

    Science.gov (United States)

    Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

    2017-01-01

    Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001). A simulation based physician communication coaching method focused on specific "etiquette

  3. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

    Science.gov (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

    2016-07-01

    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  4. Physician participation in clinical research and trials: issues and approaches

    Directory of Open Access Journals (Sweden)

    Sami F Shaban

    2011-03-01

    Full Text Available Sayeeda Rahman1, Md Anwarul Azim Majumder1, Sami F Shaban2, Nuzhat Rahman3, Moslehuddin Ahmed4, Khalid Bin Abdulrahman5, Urban JA D’Souza61Department of Clinical Sciences, School of Life Sciences, University of Bradford, West Yorkshire, Bradford, UK; 2Department of Medical Education, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; 3Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Community Medicine, Uttara Adhunik Medical College, Dhaka, Bangladesh; 5Department of Family Medicine and Medical Education, College of Medicine, Al-Imam University, Riyadh, Saudi Arabia; 6Department of Post Graduate Studies, School of Medicine, University Malaysia Sabah, Kota Kinabalu, Sabah, MalaysiaAbstract: The rapid development of new drugs, therapies, and devices has created a dramatic increase in the number of clinical research studies that highlights the need for greater participation in research by physicians as well as patients. Furthermore, the potential of clinical research is unlikely to be reached without greater participation of physicians in research. Physicians face a variety of barriers with regard to participation in clinical research. These barriers are system- or organization-related as well as research- and physician-related. To encourage physician participation, appropriate organizational and operational infrastructures are needed in health care institutes to support research planning and management. All physicians should receive education and training in the fundamentals of research design and methodology, which need to be incorporated into undergraduate medical education and postgraduate training curricula and then reinforced through continuing medical education. Medical schools need to analyze current practices of teaching–learning and research, and reflect upon possible changes needed to develop a ‘student-focused teaching–learning and

  5. The Jefferson Scale of Physician Empathy: a preliminary psychometric study and group comparisons in Korean physicians.

    Science.gov (United States)

    Suh, Dae Hun; Hong, Jong Soo; Lee, Dong Hun; Gonnella, Joseph S; Hojat, Mohammadreza

    2012-01-01

    Empathy is an important element of professionalism in medicine. Thus, evaluation and enhancement empathy in physicians is important, regardless of geographical boundaries. This study was designed to evaluate the psychometrics of a Korean version of the Jefferson Scale of Physician Empathy (JSPE) among Korean physicians. The Korean version of JSPE was completed by 229 physicians in Korea. Item-total score correlations were all positive and statistically significant. Cronbach's coefficient alpha was 0.84. The mean score was 98.2 (SD = 12.0), which was lower than that reported for American and Italian physicians. The emerged factor structure of the translated version was somewhat similar to that reported for American physicians, although the order was different. Significant differences in the mean empathy scores were observed between men and women and among physicians in different specialties. Our findings provide evidence in support of reliability and construct validity of the Korean version of JSPE for assessing empathy among Korean physicians. The disparity between Korean physicians and physicians from other countries may be explained by differences in the culture of medical education and medical practice. It suggests an exploration of cross-cultural differences in physician empathy.

  6. Seizures and spells: physician awareness of Minnesota driving laws.

    Science.gov (United States)

    Selmo, K K; Asp, D S; Anderson, D C

    1997-05-01

    Personal physicians are the primary source of information about state driving regulations for individuals with episodic disturbances of neurologic function (e.g., epilepsy, syncope, hypoglycemia). However, a May 1994 survey of Twin Cities metro-area neurologists and a sample of family practice physicians statewide revealed that many Minnesota physicians are unfamiliar with the relevant laws, and what knowledge doctors have of these laws is influenced by their specialties. Some physicians thought the regulations were more restrictive than they actually are, some less. Even physicians familiar with the laws didn't know which spells should be reported.

  7. 76 FR 49279 - Energy Efficiency Design Standards for New Federal Commercial and Multi-Family High-Rise...

    Science.gov (United States)

    2011-08-10

    ... 1904-AC41 Energy Efficiency Design Standards for New Federal Commercial and Multi-Family High-Rise... such buildings be designed to achieve energy consumption levels that are at least 30 percent below the... parts 433 and 435. Section 306(a) of ECPA provides that each Federal agency and the Architect of...

  8. Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder.

    Science.gov (United States)

    Gaines, Robin; Missiuna, Cheryl; Egan, Mary; McLean, Jennifer

    2008-01-24

    Developmental Coordination Disorder (DCD) is a chronic neurodevelopmental condition that affects 5-6% of children. When not recognized and properly managed during the child's development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD. The intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention. Physicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD. Physicians receiving educational outreach visits significantly improved their knowledge about DCD and their ability to identify and

  9. Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder

    Directory of Open Access Journals (Sweden)

    Missiuna Cheryl

    2008-01-01

    Full Text Available Abstract Background Developmental Coordination Disorder (DCD is a chronic neurodevelopmental condition that affects 5–6% of children. When not recognized and properly managed during the child's development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD. Methods The intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention. Results Physicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD. Conclusion Physicians receiving educational outreach visits significantly

  10. Hope and persuasion by physicians during informed consent.

    Science.gov (United States)

    Miller, Victoria A; Cousino, Melissa; Leek, Angela C; Kodish, Eric D

    2014-10-10

    To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain. © 2014 by American Society of Clinical Oncology.

  11. 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.

  12. Confronting the disruptive physician.

    Science.gov (United States)

    Linney, B J

    1997-01-01

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

  13. 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.

  14. Motivations for Physician-assisted Suicide

    Science.gov (United States)

    Pearlman, Robert A; Hsu, Clarissa; Starks, Helene; Back, Anthony L; Gordon, Judith R; Bharucha, Ashok J; Koenig, Barbara A; Battin, Margaret P

    2005-01-01

    OBJECTIVE To obtain detailed narrative accounts of patients' motivations for pursuing physician-assisted suicide (PAS). DESIGN Longitudinal case studies. PARTICIPANTS Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. SETTING Participants' homes. MEASUREMENTS AND RESULTS We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. CONCLUSIONS Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient's request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients' concerns over time, and tailoring care accordingly. PMID:15836526

  15. Insurance Medicine: Introduction for the Family Physician

    OpenAIRE

    Williamson, Elliot A.

    1983-01-01

    Insurance companies request reports on patients' health to corroborate and clarify information on insurance application forms. Illegible or vague reports, or one that varies from the patient's understanding of his health, can result in patients being offered substandard policies at increased premiums. Reports, even if brief, must include known risk factors, disease history, and information on stability of medical conditions.

  16. Febrile seizures: A review for family physicians

    OpenAIRE

    2007-01-01

    Febrile seizures are the most common cause of convulsions in children. Most are simple in nature, although those with focal onset, prolonged duration (³15 min) or those that recur within 24 h or within the same febrile illness are considered complex. Diagnosis of this condition is essentially clinical and based on its description provided by parents. Its pathophysiology remains unclear, but genetics plays a major role in conferring susceptibility. Although most febrile seizures are ben...

  17. [Income of family physicians in Western Europe].

    Science.gov (United States)

    van der Zee, J; Groenewegen, P P; van Haaften, R

    1991-05-04

    Although doctors tend to belong to the best paid categories of professionals, considerable differences between countries in average remuneration can be found. This study is focused on incomes (1985) of general practitioners (GP) in II Western European countries (Austria, Belgium, Denmark, Finland, France, West Germany, Italy, United Kingdom, the Netherlands, Norway and Sweden). Beside a description of the incomes (before taxation) as such, an attempt is made to correlate the income figures with some characteristics of the general practitioner's position in each country. The average GP income per country (before taxes) was ECU 43,600. The German (ECU 67,000), Austrian (ECU 56,000) and Danish (ECU 55,000) form the top, the Italian (ECU 14,000), Belgian (ECU 31,000) and Swedish (ECU 34,500) doctors the bottom-three. Correcting for OECD purchasing power parities does not change the rank order of the GP income in the different countries essentially. The more doctors per inhabitant, the lower the income, and the more different tasks the GP has to perform, the higher the income. Direct access of specialist care has no relationship with GP incomes.

  18. Autism: A review for family physicians

    OpenAIRE

    Karande Sunil

    2006-01-01

    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 sti...

  19. The Army Wants More Family Physicians.

    Science.gov (United States)

    1988-03-23

    Otolaryngology, Rheumatology, Dermatology, Gastroenterology, Pulmonology, Cardiology, Urology, Neurology, 12’- Psychology# Podiatry , and Preventive...examinations for Dad; immunizations and well baby exams; treatment for colds and ear infections for the younger childeren; sports physicals and orthopedic

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

    Science.gov (United States)

    Frey, Laura M; Hans, Jason D

    2016-01-01

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

  1. Physicians' perceptions of doctor shopping in West Virginia.

    Science.gov (United States)

    Shaffer, E Gail; Moss, Alvin H

    2010-01-01

    Prescription drug abuse and diversion continue to be serious problems in West Virginia and nationwide. Doctor shopping (visiting multiple doctors in a short time frame with the intent to deceive them to obtain controlled substances) is illegal and one way that patients gain access to prescription drugs. We surveyed West Virginia physicians in emergency medicine, family medicine, and internal medicine to determine their experience with and attitudes toward doctor shopping, and to assess attitudes toward proposed legislation to protect physicians who report doctor shoppers to law enforcement officials. Of 452 physicians surveyed, 258 responded (57%). Emergency medicine physicians had the highest response rate (61%) and most frequent encounters (once a week or more often) with doctor shoppers compared to family medicine and internal medicine physicians (88% vs 25% vs 14%, P doctor shoppers. If the law protected them, 85 percent of all physicians reported they would be likely to report doctor shoppers.

  2. Negotiation for physicians.

    Science.gov (United States)

    Hill, Micah J; DeCherney, Alan H

    2013-05-01

    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools.

  3. The Development of a Physician Vitality Program: A Brief Report.

    Science.gov (United States)

    Hernandez, Barbara Couden; Thomas, Tamara L

    2015-10-01

    We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work-life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial-spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract.

  4. Physician Suicide in Taiwan, 2000–2008: Preliminary Findings

    Directory of Open Access Journals (Sweden)

    Yi-Ju Pan

    2009-04-01

    Full Text Available Research regarding physician suicide in Taiwan is lacking. Using national physician insurance data from January 1, 2000 to April 30, 2008, the present study aimed to explore the association between physicians' suicide and their characteristics, including age, sex, specialties, area of residence, hospital types, and suicide methods. The majority (53.1–70.6% of suicide cases occurred among physicians in their 40s. More suicides were reported among physicians serving in the community, living in urban areas, and from specialties such as general practice, family practice, psychiatry, and surgery. The leading suicide methods were hanging/suffocation, drowning, jumping from heights, charcoal burning and drug poisoning. In conclusion, physicians committing suicide were likely to be in their 40s, to serve in the community and to live in urban areas. Future efforts should focus on exploring the causes and possible interventions for physician suicide.

  5. The Changing Distribution of Physicians in Regionville.

    Science.gov (United States)

    Sorensen, Andrew A.; Kunitz, Stephen J.

    1978-01-01

    The consequences of medical reform, the myth of the family doctor, the importance of foreign medical graduates in providing medical care, the importance of facilities and innovative practice settings for the attraction of physicians, and the significance of suburbanization in influencing the growth of the local service sector are addressed in this…

  6. 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

  7. Teen CHAT: Development and Utilization of a Web-Based Intervention to Improve Physician Communication with Adolescents About Healthy Weight

    Science.gov (United States)

    Bravender, Terrill; Tulsky, James A.; Farrell, David; Alexander, Stewart C.; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Coffman, Cynthia J.; Bilheimer, Alicia; Lin, Pao-Hwa; Pollak, Kathryn I.

    2013-01-01

    Objective To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician-adolescent communication about healthy weight. Methods Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. Results Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54 minutes to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. Conclusion The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. Practice Implications If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated. PMID:24021419

  8. Health is primary: Family medicine for America's health.

    Science.gov (United States)

    Phillips, Robert L; Pugno, Perry A; Saultz, John W; Tuggy, Michael L; Borkan, Jeffrey M; Hoekzema, Grant S; DeVoe, Jennifer E; Weida, Jane A; Peterson, Lars E; Hughes, Lauren S; Kruse, Jerry E; Puffer, James C

    2014-10-01

    More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support

  9. Understanding Dying Patients and Their Families

    Science.gov (United States)

    Librach, S.L.; Talbot, Yves

    1991-01-01

    Caring for dying patients and their families presents unique opportunities and challenges for the family physician. The family FIRO model provides a simple way of assessing families and providing appropriate, individualized care. This article outlines the model, discusses the care of dying patients and their families from the FIRO perspective, and provides a guideline for the family physician. A framework is suggested for teaching residents to support families. PMID:21228989

  10. Can complexity science inform physician leadership development?

    Science.gov (United States)

    Grady, Colleen Marie

    2016-07-04

    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

  11. Involve physicians in marketing.

    Science.gov (United States)

    Randolph, G T; Baker, K M; Laubach, C A

    1984-01-01

    Many everyday problems in medical group practice can be attacked by a marketing approach. To be successful, however, this kind of approach must have the full support of those involved, especially the physicians, since they are the principal providers of healthcare services. When marketing is presented in a broad context, including elements such as patient mix, population distribution, and research, physicians are more likely to be interested and supportive. The members of Geisinger Medical Center's Department of Cardiovascular Medicine addressed their patient appointment backlog problem with a marketing approach. Their method is chronicled here and serves as a fine example of how physician involvement in marketing can lead to a positive outcome.

  12. Burnout entre médicos da Saúde da Família: os desafios da transformação do trabalho Burnout among Family Healthcare physicians: the challenge of transformation in the workplace

    Directory of Open Access Journals (Sweden)

    Katia Virginia de Oliveira Feliciano

    2011-08-01

    Full Text Available Compreender como os conflitos com a instituição e desacordos quanto às atribuições de membros da equipe, são apreendidos e reconstruídos pelos médicos da Saúde da Família, sob a perspectiva do "burnout". Métodos: Pesquisa qualitativa desenvolvida no Recife, entre agosto de 2005 e novembro de 2006, com 24 médicos. Foram selecionadas quatro equipes a partir de avaliação da gerência (acesso geográfico, conflitos na equipe, entre equipe e Distrito, entre equipe e comunidade e violência pública na área, em cada um dos seis Distritos Sanitários. Foram realizadas entrevistas semiestruturadas. Resultados: Os médicos revelam enorme discrepância entre expectativas e realidade do trabalho. Rejeitam a priorização institucional da consulta e cobrança de produtividade. Sofrem diante do que consideram à perda da identidade profissional: atribuições da enfermeira questionam o núcleo histórico da sua prática -o diagnóstico e o tratamento da doença. Sobretudo entre aqueles com maiores expectativas na conversão do modelo, existe descrédito quanto às mudanças e há o desejo de desistir. Observa-se amplo conjunto de elementos que favorecem o desenvolvimento simultâneo de esgotamento e ineficácia profissional, e que provocam atitudes negativas, reforçando a necessidade da promoção da saúde no trabalho.The scope of this paper is to understand how conflicts with the institution and disagreements regarding team members'attributions are interpreted by Family Healthcare physicians from the burnout perspective. Qualitative research was conducted with 24 doctors in Recife between August 2005 and November 2006 based on management evaluation (geographic access, conflicts within the team, between teams and the District, between the team and the community and public violence in the area, and four teams were selected in each of the six Health Districts. Semi-structured interviews were then conducted. An enormous discrepancy between the

  13. 医师肠易激综合征诊断相关因素的问卷设计%Design of questionnaire on factors for diagnosis of irritable bowel syndrom for physicians

    Institute of Scientific and Technical Information of China (English)

    乔宇琪; 陈光榆; 周惠清; 陈颖伟; 李定国

    2009-01-01

    Objective To design a questionnaire on factors that affect diagnosis of irritable bowel syndrome for physicians, and determine the retest reliability. Methods The questionnaire was completed after literature review, and 9 experts were invited to revise the questionnaire. Thirty-four physicians filled the questionnaire for pre-test and did it again for re-test 4 weeks later. Kappa value of each question of the questionnaire was calculated. Results Content validity and face validity were assured by experts. Kappa values were over 0.61 in all items, which achieved substantial level. Conclusion The questionnaire designed has fairly good reliability and validity, and can be used in investigation of irritable bowel syndrome for physicians.%目的 针对影响肠易激综合征诊断的相关因素设计一份医师问卷,并进行信度复测.方法 通过文献复习,完成问卷设计,9名专家参与考评.由34名医师进行预填写,间隔4周后使用相同问卷再次填写,计算问卷各题的Kappa值.结果 专家考评基本保证问卷的表面效度和内容效度.所有条目的 复测Kappa>0.61,达到高度吻合.结论 所设计的问卷具有较好的信度和效度,可用于医师肠易激综合征诊断的调查.

  14. The medical home: locus of physician formation.

    Science.gov (United States)

    Daaleman, Timothy P

    2008-01-01

    Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of "placing patients within contexts over time" as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge's emphasis on learning organizations-organizations where people are continually learning how to learn together-presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians.

  15. Physician Practices Regarding SIDS in Kansas.

    Science.gov (United States)

    Thornhill-Scott, Fannette; Dong, Frank; Redmond, Michelle; Ablah, Elizabeth

    2017-07-01

    Sudden infant death syndrome (SIDS) is the leading cause of death among infants aged 1 to 12 months. The purpose of this study was to assess prenatal and postnatal physicians' knowledge about SIDS in a county with high rates of SIDS deaths. A cross-sectional survey was conducted of pediatricians, family practitioners, and obstetricians in Sedgwick County, Kansas. Most physicians reported correctly that there were effective measures to reduce SIDS. Most respondents agreed it was important to discuss SIDS with parents. Pediatricians were more likely than family practitioners and obstetricians to recognize that pacifier use is important for infants in their first year to reduce SIDS and 2 to 4 months is the age range for peak incidence of SIDS. Pediatricians, family practitioners, and obstetricians are knowledgeable about SIDS and SIDS risk reduction. However, they are not allocating adequate time for discussing SIDS and SIDS reduction efforts with patients.

  16. 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...

  17. 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...

  18. Physicians' Job Satisfaction.

    African Journals Online (AJOL)

    AmL

    the workplace, these conditions can lead to increased absenteeism, conflict and ..... need to encourage and acknowledge teamwork and information sharing. ... demonstrated in terms of both pay and benefits physicians at private hospitals.

  19. 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.

  20. 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...

  1. 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...

  2. An optimized group mating design and determination of the admixture rate in Nile tilapia families

    Directory of Open Access Journals (Sweden)

    Yan Zhao

    2016-05-01

    Full Text Available The Nile tilapia is the most productive and internationally traded food fish in the world. Many Nile tilapia families are needed to develop breeding programs for this species. The aim of this study was to develop Nile tilapia families using the Oreochromis species unique breeding characteristics (male territory establisher and female mouth brooders and determine the mixing rate within each family. Both male and female fish were cultured in one pond in the reproductive season and the female mouths were checked every 5–8 days. When embryos were present, they were removed and cultivated independently as a family. As a result, 45 families were developed from the 60 female fish sampled. The embryo survival rate in aerated water varied from 85.5 to 100.0%. Seven polymorphic microsatellite loci were selected from a set of 31 for paternity identification. The CPE (combined paternity exclusion probability of two microsatellite loci was higher than 0.93 and the CPE for the seven loci used in this study was as high as 0.9999. There were no unrelated individuals in five of the seven families analyzed and only one mixed individual in F29 and F30. The overall admixture rate was very low (2.2%. In this study, we developed an optimized group mating system. Furthermore, we verified that for group mating systems there were no mixed individuals in most families and the admixture rate of some families was very low according to the paternity analysis.

  3. Community family physicians in the performances of different management models of chronic disease%社区全科医生慢性病管理不同模式探索与研究

    Institute of Scientific and Technical Information of China (English)

    李震宇; 易春涛; 朱莉珍; 田文栋; 陈志刚

    2013-01-01

    对于社区全科医生采用不同模式进行慢性病管理的成效进行比较.2011年6月至2012年4月间,采用以全科医生为主体的3种管理模式(A、B、C)对慢性病患者进行管理,并与以公卫医师为主体的传统管理模式作对比.以全科医生为主体的3种模式下的慢性病管理人数、人次、平均参与慢性病有效工作时间均各有不同;模式C的高血压和糖尿病规范管理率以及门诊及非上门管理率均高于模式A、B(P<0.05);同时模式A的非上门管理率明显低于模式B、C(P<0.05);模式C的高血压控制率、血糖控制率、社区居民慢性病知晓率明显优于其他两种模式(P<0.05).各模式互为补充,各具优势,但模式C更能体现居民慢性病自我管理的服务理念.%To compare the performances of community family physicians in different patterns of chronic disease management.From June 2011 to April 2012,3 different models (A,B,C) of chronic disease management were employed for a total of 4972 patients.Statistics analyses were performed.The number of participants,session and average effective working time were different.In terms of standard management of hypertension,diabetic management rate and non on-site management rate,model C was superior to models A and B (P < 0.01).And model A had the lowest rate of non on-site management (P <0.05).Though with each own advantage,three models are complementary.But model C reflects the residents' self-management concept of chronic disease.

  4. Comportamiento de las enfermedades bucales y necesidades de tratamiento en un consultorio médico del Vedado Behavior of oral diseases and needs of treatment at a family physician's office in Vedado

    Directory of Open Access Journals (Sweden)

    Leticia Espinosa González

    2004-12-01

    Full Text Available Se realizó un estudio descriptivo tranversal del Consultorio 103-1 del Policlínico "Moncada" desde enero de 1999 a agosto del 2001 con el objetivo de evaluar el estado de salud bucal de la población. El conocimiento del estado de salud bucal de la población resulta indispensable para la correcta planificación, organización y control de la atención estomatológica. Se seleccionó una muestra de 441 personas estratificadas por grupos de edades a las que se les realizó el examen clínico; para la recolección de los datos se utilizó una adaptación de la encuesta básica de la OMS. En la población estudiada las maloclusiones que predominan son las ligeras y la enfermedad parodontal es más frecuente en el grupo de 35-59 años. En relación con las necesidades de tratamiento, se observó que hay un comportamiento similar en la atención primaria y secundaria desde el punto de vista ortodóncico y periodontal. En las necesidades de tratamiento protésico, el grupo más necesitado es de 35-59 años y el tipo de prótesis, la parcial removible.The knowledge of the oral health status of the population is indispensable for a correct planning, organization and control of dental care. A cross-sectional descriptive study was conducted at the family physician's office 103-1 of "Moncada" Polyclinic from January, 1999 to August, 2001, to evaluate the oral health status of the population. To this end, it was selected a sample of 441 individuals stratified by age group that underwent clinical examination. An adaptation of the WHO basic survey was used to collect data. It was observed a predominance of mild malocclusions in the studied population. The periodontal disease was the most common in the group aged 35-39. As regards the treatment needs it was found that there is a similar behavior of primary and secondary attention from the periodontal and orthodontic point of view. In relation to prosthetic treatment, the group aged 35-39 needed the most

  5. [Lifestyles of primary care physicians: perception and implications on cardiovascular prevention].

    Science.gov (United States)

    Fonseca, M; Fleitas, G; Tamborero, G; Benejam, M; Leiva, A

    2013-01-01

    To analyze the lifestyles of family physicians, their influence on cardiovascular prevention activities carried out on their patients and the difficulties in carrying them out. Design cross-sectional study, using as an anonymous ad hoc questionnaire, implemented in 2010. Primary care of Mallorca. Representative sample of 185 primary care medical professionals of Mallorca. There was a response rate of 78.9% (146/185). Characteristics of physicians surveyed: the mean age was 43.6 years, 24.6% following a healthy diet, 18.6% were smokers, 32.7% did not consume alcohol, and 80.8% performed physical exercise. The most frequent prevention activity on their patients was anti-smoking advice (52.3%), followed by those related to cardiovascular risk factors, hypertension, diabetes, dyslipidemia (22.7%), dietary advice (14.4%), advice about exercise (5.3%), and alcohol consumption (0.8%). Doctors who smoked and drank more alcohol offered less preventive activities to their patients (Pfactor to properly perform prevention activities. There is a relationship between lifestyle habits of primary care physicians and preventive activities carried out with their patients. Family physicians have relatively healthy lifestyles and promote preventive activities among their patients. The limited investigation into alcohol consumption should be noted. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  6. Study of the awareness and compliance about signing Family Physicians for Residents in Communities of Urumqi%乌鲁木齐市社区就医居民对家庭医生契约服务的认知情况及签约意愿调查分析

    Institute of Scientific and Technical Information of China (English)

    潘候梅; 史建平; 李卫星

    2016-01-01

    目的:了解乌鲁木齐市社区就医居民对家庭医生契约服务的认知情况及签约意愿,为当地发展家庭医生契约服务政策提供参考依据。方法采用自行设计的调查问卷,随机抽取乌鲁木齐市10家社区卫生服务中心门诊患者500名,调查其对家庭医生的了解程度、签约意愿、签约时考虑和担心的因素以及签约意愿的主要影响因素。结果所调查的社区就医居民中签约率为75.81%,签约时主要考虑因素为社区医生的医疗技术水平(73.39%),签约意愿的主要影响因素是文化程度、职业、医疗保险类型、对家庭医生制服务的知晓程度、就诊是否便利以及对社区首诊的接受度。结论若要可行地推广和开展此项工作,应加强宣传、提高医疗水平和建立社区诊制度。%Objective To explore the residents′awareness and compliance about signing family physicians among ommunity outpatients and to provide a theoretical basis for the future development and policy mak-ing of the contracted family doctor system in the local.Methods A self-designed structured questionnaire was used in a field survey among 500 outpatients selected randomly in 10 of community health care centers in Urumqi to investigate awareness,contracting willing,consideration ,and main influence factors.Res-ults The results was the compliance rate about signing of family physicians was 75.81% and main factor effected signing for community doctor was medical technology level of the doctors.which accounted for 73.39%.The main influence factors were level of education,profession,type of medical treatment insur-ance,the extent know,the referral experience and acceptance of community first diagnosis.Conclusion If it is to be feasible to promote and carry out the job,the government should strengthen the propaganda, raise the level of medical diagnosis system and the establishment of community first diagnosis.

  7. The influence of day care centres designed for people with dementia on family caregivers - a qualitative study.

    Science.gov (United States)

    Tretteteig, Signe; Vatne, Solfrid; Rokstad, Anne Marie Mork

    2017-01-05

    Dementia is one of the most challenging age-related illnesses for family caregivers, whose care-related burden is well known. Research indicates that day care centres (DCCs) can reduce the caregiver burden and help family caregivers to cope with demands; however, the current body of knowledge is still tentative and inconsistent, and more research is recommended. The aim of this study is to provide an extended understanding of the situation of family caregivers and to examine to what extent DCCs can meet their need for support and respite. This study has a qualitative descriptive design using in-depth interviews with 17 family caregivers of people with dementia attending DCCs. The data analysis was undertaken using systematic text condensation. Caregivers experience a complex role, with added responsibilities, new tasks, and emotional and relational challenges that are expressed through distressing emotions and demands for interaction. Additionally, the caregiving role leads to positive experiences, such as acceptance and adaptation, support and help, and positive changes in the relationship. Day care relieves family caregivers by meeting the person with dementia's needs for social community, nutrition, physical activity, and structure and variety in everyday life. Using a DCC led to a higher quality of time spent together and easier cooperation, but it also produced some hard feelings and challenging situations. DCCs gave the caregivers a feeling of freedom and increased the time available to be spent on their own needs, to be social and to work or do practical tasks undisturbed. DCCs for people with dementia can give family caregivers support and relief and have a positive impact on the relationship between the family caregiver and the person with dementia. A more individualized program, in addition to flexible opening hours, would make DCCs even more effective as a respite service, positively influencing the family caregiver's motivation and ability to care and

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

    Science.gov (United States)

    Mikić, Zelimir

    2008-01-01

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

  9. A "Community Fit" Community-Based Participatory Research Program for Family Health, Happiness, and Harmony: Design and Implementation.

    Science.gov (United States)

    Soong, Cissy Ss; Wang, Man Ping; Mui, Moses; Viswanath, Kasisomayajula; Lam, Tai Hing; Chan, Sophia Sc

    2015-10-28

    A principal factor in maintaining positive family functioning and well-being, family communication time is decreasing in modern societies such as Hong Kong, where long working hours and indulgent use of information technology are typical. The objective of this paper is to describe an innovative study protocol, "Happy Family Kitchen," under the project, "FAMILY: A Jockey Club Initiative for a Harmonious Society," aimed at improving family health, happiness, and harmony (3Hs) through enhancement of family communication. This study employed the community-based participatory research (CBPR) approach, and adopted 5 principles of positive psychology and the traditional Chinese concepts of cooking and dining, as a means to connect family members to promote family health, happiness, and harmony (3Hs). In-depth collaboration took place between an academic institution and a large nongovernmental community organization association (NGO association) with 400 social service agency members. Both groups were deeply involved in the project design, implementation, and evaluation of 23 community-based interventions. From 612 families with 1419 individuals' findings, significant increases in mean communication time per week (from 153.44 to 170.31 minutes, P=.002) at 6 weeks after the intervention and mean communication scores (from 67.18 to 69.56 out of 100, Phappiness scores 12 weeks after the intervention (from 7.80 to 7.82 out of 10, P<.001), and mean health scores (from 7.70 to 7.73 out of 10, P<.001) and mean harmony scores (from 7.70 to 8.07 out of 10, P<.001) 6 weeks after the intervention. This was the first CBPR study in a Hong Kong Chinese community. The results should be useful in informing collaborative intervention programs and engaging public health researchers and community social service providers, major stakeholders, and community participants in the promotion of family well-being. Furthermore, this study has generated an effective practice model for the improvement

  10. In their own words: describing Canadian physician leadership.

    Science.gov (United States)

    Snell, Anita J; Dickson, Graham; Wirtzfeld, Debrah; Van Aerde, John

    2016-07-04

    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.

  11. Understanding Dying Patients and Their Families: Using the family FIRO model.

    Science.gov (United States)

    Librach, S L; Talbot, Y

    1991-02-01

    Caring for dying patients and their families presents unique opportunities and challenges for the family physician. The family FIRO model provides a simple way of assessing families and providing appropriate, individualized care. This article outlines the model, discusses the care of dying patients and their families from the FIRO perspective, and provides a guideline for the family physician. A framework is suggested for teaching residents to support families.

  12. A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties.

    Science.gov (United States)

    McKay, Mary McKernan; Gopalan, Geetha; Franco, Lydia; Assael, Kara Dean; Chacko, Anil; Jackson, Jerrold; Fuss, Ashley

    2011-11-01

    This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.

  13. The Family Spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics.

    Science.gov (United States)

    Mullany, Britta; Barlow, Allison; Neault, Nicole; Billy, Trudy; Jones, Tanya; Tortice, Iralene; Lorenzo, Sherilynn; Powers, Julia; Lake, Kristin; Reid, Raymond; Walkup, John

    2012-10-01

    The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The goal of the trial is to evaluate the impact of the paraprofessional-delivered "Family Spirit" home-visiting intervention to reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research (CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006 and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian paraprofessionals to teen mothers from 28 weeks gestation until the baby's third birthday. A mixed methods assessment administered at nine intervals measures intervention impact on parental competence, mother's and children's social, emotional and behavioral risks for drug use, and maladaptive functioning. Participants are young (mean age = 18.1 years), predominantly primiparous, unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug use were ~2-4 times higher and ~5-6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced communities.

  14. Analysis of advanced conceptual designs for single-family-size absorption chillers

    Energy Technology Data Exchange (ETDEWEB)

    Macriss, R.A.; Zawacki, T.S.; Kouo, M.T.; Sneed, D.M.

    1978-01-01

    The objective of this research study is the development of radically new fluid systems, specifically tailored to the needs and requirements of solar-absorption cooling for single-family-size residences. Progress is reported.

  15. Analysis of advanced conceptual designs for single-family-size absorption chillers

    Energy Technology Data Exchange (ETDEWEB)

    Macriss, R.A.; Zawacki, T.S.; Kouo, M.T.; Sneed, D.M.

    1978-01-01

    The objective of this research study is the development of radically new fluid systems, specifically tailored to the needs and requirements of solar-absorption cooling for single-family-size residences. Progress is reported.

  16. Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

    Science.gov (United States)

    Hasebrook, Joachim; Hahnenkamp, Klaus; Buhre, Wolfgang F F A; de Korte-de Boer, Dianne; Hamaekers, Ankie E W; Metelmann, Bibiana; Metelmann, Camila; Bortul, Marina; Palmisano, Silvia; Mellin-Olsen, Jannicke; Macas, Andrius; Andres, Janusz; Prokop-Dorner, Anna; Vymazal, Tomáš; Hinkelmann, Juergen; Rodde, Sibyll; Pfleiderer, Bettina

    2017-08-02

    All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women's academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on "personal construct theory" through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. A discussion group on gender equality in academic medicine will be established on an internationally renowned open

  17. 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.

  18. ACHESS – The Australian study of child health in same-sex families: background research, design and methodology

    Directory of Open Access Journals (Sweden)

    Crouch Simon

    2012-08-01

    Full Text Available Abstract Background There are an increasing number of children in Australia growing up with same-sex attracted parents. Although children from same-sex parent families do in general perform well on many psychosocial measures recent research is beginning to consider some small but significant differences when these children are compared with children from other family backgrounds. In particular studies suggest that there is an association between the stigma that same-sex parent families experience and child wellbeing. Research to date lacks a holistic view with the complete physical, mental and social wellbeing of children not yet addressed. In addition, most studies have focused only on families with lesbian parents and have studied only small numbers of children. Methods/design The Australian Study of Child Health in Same-Sex Families (ACHESS is a national study that aims to determine the complete physical, mental and social wellbeing of Australian children under the age 18 years with at least one parent who self identifies as being same-sex attracted. There will be a particular focus on the impact that stigma and discrimination has on these families. Parent and child surveys will be used to collect data and will be available both online and in paper form. Measures have been chosen whenever possible that have sound conceptual underpinnings, robust psychometric properties and Australian normative data, and include the Child Health Questionnaire (CHQ, the Strengths and Difficulties Questionnaire (SDQ and the Kessler Psychological Distress Scale (K10. Discussion ACHESS aims to be the largest study of its kind and will for the first time produce a detailed quantitative analysis of Australian children with same-sex attracted parents. By inviting participants to take part in further research it will also establish a valuable cohort of children, and their families, to launch future waves of research that will help us better understand the health and

  19. 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

    of the physicians correctly estimated the risk to inherit an HNPCC predisposing mutation. Among family members, young age (... 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...

  20. Health seeking behavior of physicians at the Jos University Teaching Hospital

    Directory of Open Access Journals (Sweden)

    P A Agaba

    2011-01-01

    Full Text Available Background: Physicians who have the task of caring for the sick also need to be cared for when they take ill. Healthseeking habits of physicians have been found to be poor in most developed countries. Utilization of health services by physicians in developing countries is not known. We sought to describe the health seeking habits of physicians in Nigeria. Materials and Methods: A cross-sectional survey was carried out among physicians at the Jos University Teaching Hospital, a tertiary referral health facility in North-central Nigeria. A pre-tested questionnaire was administered to physicians to get information on their self-reported health seeking habits. Results: Self prescription was practiced by 98.6% of the physicians, with antimalarials being the most prescribed drugs (62.5%. Only 46.9% consulted another physician when they take ill, although 78.2% felt they needed a family physician. Many (23.8% of respondents treated their family members when last sick. The major factors considered by the respondents in choosing the physician they consulted were the specialty of the physician consulted (42.2%; the physician being in the same unit with them (38.5%, and friendship (15.6%. Four (3.7% of the respondents would not consider any particular factor for choosing a physician if they have to. Conclusion: This study showed that a large proportion of physicians self-medicate and a few have family physicians. Guidelines need to be instituted to regulate self-prescribing among physicians in Nigeria. The role of family physicians in primary care needs to be emphasized.

  1. Peer-support writing group in a community family medicine teaching unit: Facilitating professional development.

    Science.gov (United States)

    Al-Imari, Lina; Yang, Jaisy; Pimlott, Nicholas

    2016-12-01

    Aspiring physician writers need an environment that promotes self-reflection and can help them improve their skills and confidence in writing. To create a peer-support writing group for physicians in the Markham-Stouffville community in Ontario to promote professional development by encouraging self-reflection and fostering the concept of physician as writer. The program, designed based on a literature review and a needs assessment, was conducted in 3 sessions over 6 months. Participants included an emergency physician, 4 family physicians, and 3 residents. Four to 8 participants per session shared their projects with guest physician authors. Eight pieces of written work were brought to the sessions, 3 of which were edited. A mixed quantitative and qualitative evaluation model was used with preprogram and postprogram questionnaires and a focus group. This program promoted professional development by increasing participants' frequency of self-reflection and improving their proficiency in writing. Successful elements of this program include creating a supportive group environment and having a physician-writer expert facilitate the peer-feedback sessions. Similar programs can be useful in postgraduate education or continuing professional development. Copyright© the College of Family Physicians of Canada.

  2. Phase Transitions in Planning Problems: Design and Analysis of Parameterized Families of Hard Planning Problems

    Science.gov (United States)

    Hen, Itay; Rieffel, Eleanor G.; Do, Minh; Venturelli, Davide

    2014-01-01

    There are two common ways to evaluate algorithms: performance on benchmark problems derived from real applications and analysis of performance on parametrized families of problems. The two approaches complement each other, each having its advantages and disadvantages. The planning community has concentrated on the first approach, with few ways of generating parametrized families of hard problems known prior to this work. Our group's main interest is in comparing approaches to solving planning problems using a novel type of computational device - a quantum annealer - to existing state-of-the-art planning algorithms. Because only small-scale quantum annealers are available, we must compare on small problem sizes. Small problems are primarily useful for comparison only if they are instances of parametrized families of problems for which scaling analysis can be done. In this technical report, we discuss our approach to the generation of hard planning problems from classes of well-studied NP-complete problems that map naturally to planning problems or to aspects of planning problems that many practical planning problems share. These problem classes exhibit a phase transition between easy-to-solve and easy-to-show-unsolvable planning problems. The parametrized families of hard planning problems lie at the phase transition. The exponential scaling of hardness with problem size is apparent in these families even at very small problem sizes, thus enabling us to characterize even very small problems as hard. The families we developed will prove generally useful to the planning community in analyzing the performance of planning algorithms, providing a complementary approach to existing evaluation methods. We illustrate the hardness of these problems and their scaling with results on four state-of-the-art planners, observing significant differences between these planners on these problem families. Finally, we describe two general, and quite different, mappings of planning

  3. Solar heating system design package for a single-family residence at William O'Brien State Park, Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    1977-07-01

    Honeywell, Inc. has undertaken the design, fabrication, installation, and monitoring of a prototype solar heating and hot water system for the Minnesota Department of Natural Resources' single-family dwelling located at O'Brien State Park, 30 miles east of Minneapolis, Minnesota. Documentation submitted by Honeywell for government review of plans, specifications, cost trade studies and verification status in order to provide the contractor with approval to commit the system to fabrication are included.

  4. Instrumentation problems for physicians.

    Science.gov (United States)

    Turner, G O

    1980-01-01

    The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.

  5. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier

    1998-01-01

    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  6. Marital stability among physicians.

    Science.gov (United States)

    Rose, K D; Rosow, I

    1972-03-01

    Analysis of 57,514 initial complaints for divorce, separate maintenance, and annulment filed in California during the first six months of 1968 reveals that physicians are considerably less prone to marital failure than men of comparable age in the general population. Furthermore, when compared to professionals in general, doctors also appear less prone to marital collapse. For physicians, marriages break down in the greatest numbers and at the greatest rate between the ages of 35 and 44. Women doctors are at least 40% more prone to marital instability than men, and black physicians are nearly 70% more prone to divorce than their white colleagues. Of the individual specialists, orthopedists and psychiatrists possibly have the highest rates of marital demise.

  7. [The design of a family of ultrasonic diagnostic units based on up-to-date computer technologies].

    Science.gov (United States)

    Trukhanov, A I; Nagulin, N E

    1996-01-01

    Small ultrasonic devices are now being used in medical practice. However, the vast majority of them represent designingly completed systems which cannot include additional soft- and hardwares to accumulate measurements and to set up databases, to make additional postprocessing, to transmit measurements along networks and telephone lines, etc. On the other hand, in our and foreign countries, work is under way in designing the systems of archiving and treating ultrasonic images, working places for a physician engaged in radiation diagnosis. But at the same time direct joining of ultrasonic equipment with standard computer facilities is impossible in many practical cases. To design ultrasonic devices by using Multimedia IBM PC technology which may integrate various informational media, such as display, sonic information, and textual data is one of the ways of solving this problem. With this, the hardwares of ultrasonic devices are realized in the construction of standard IBM PC modules. Sonomed ultrasonic devices may be considered to be alternatives of Multimedia IBM PC-based devices.

  8. [Hippocrates' treatise physician].

    Science.gov (United States)

    Frøland, Anders

    2005-01-01

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

  9. 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.

  10. Accuracy of self-reported family history is strongly influenced by the accuracy of self-reported personal health status of relatives

    NARCIS (Netherlands)

    Janssens, A.C.J.W.; Henneman, L.; Detmar, S.B.; Khoury, M.J.; Steyerberg, E.W.; Eijkemans, M.J.C.; Mushkudiani, N.; Oostra, B.A.; Duijn, C.M. van; MacKenbach, J.P.

    2012-01-01

    Objective: We investigated the accuracy of self-reported family history for diabetes, hypertension, and overweight against two reference standards: family history based on physician-assessed health status of relatives and on self-reported personal health status of relatives. Study Design and Setting

  11. Accuracy of self-reported family history is strongly influenced by the accuracy of self-reported personal health status of relatives

    NARCIS (Netherlands)

    Janssens, A.C.J.W.; Henneman, L.; Detmar, S.B.; Khoury, M.J.; Steyerberg, E.W.; Eijkemans, M.J.C.; Mushkudiani, N.; Oostra, B.A.; Duijn, C.M. van; MacKenbach, J.P.

    2012-01-01

    Objective: We investigated the accuracy of self-reported family history for diabetes, hypertension, and overweight against two reference standards: family history based on physician-assessed health status of relatives and on self-reported personal health status of relatives. Study Design and

  12. Accuracy of self-reported family history is strongly influenced by the accuracy of self-reported personal health status of relatives

    NARCIS (Netherlands)

    Janssens, A.C.J.W.; Henneman, L.; Detmar, S.B.; Khoury, M.J.; Steyerberg, E.W.; Eijkemans, M.J.C.; Mushkudiani, N.; Oostra, B.A.; Duijn, C.M. van; MacKenbach, J.P.

    2012-01-01

    Objective: We investigated the accuracy of self-reported family history for diabetes, hypertension, and overweight against two reference standards: family history based on physician-assessed health status of relatives and on self-reported personal health status of relatives. Study Design and Setting

  13. EAT-UP™ Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors: A Single-Case Experimental Design Replicated across Three Families of Children with Autism Spectrum Disorder

    Science.gov (United States)

    Cosbey, Joanna; Muldoon, Deirdre

    2017-01-01

    This study evaluated the effectiveness of a family-centered feeding intervention, Easing Anxiety Together with Understanding and Perseverance (EAT-UP™), for promoting food acceptance of children with autism spectrum disorder at home. A concurrent multiple-baseline design was used with systematic replication across three families. Baseline was…

  14. Interactions between physicians and drug industry

    Directory of Open Access Journals (Sweden)

    Begul Yagci Kupeli

    2016-12-01

    Full Text Available Ethical issues involving drug industry physician relationship have resulted in an ongoing debate about its appropriateness for many years in medical World. The most familiar marketing strategies of drug companies include individual gifts for physicians and sponsorship for educational and social activities. This interaction begins during medical school years of doctors and types of interactions are modified according to factors such as physician's position, title and number of patients. Although data reveal the opposite, most doctors deny or underestimate the influence of drug companies on their drug prescription. Both sides have common interests such as effective drug usage and observation, conduction of creative scientific studies. However, they have conflict of interests in some aspects. Physicians mostly care about patients' well-being and scientific improvement while drug companies are mostly involved in commercial benefit. Furthermore, some of the marketing strategies may have significant consequences on health of society such as rising drug costs, wrong or excessive usage of drugs. Regulations and guidelines have been designed in order to overcome these issues. However, the most important role in modelling of physician-drug industry interaction belongs to physicians. [Cukurova Med J 2016; 41(4.000: 777-781

  15. Estado de salud bucal de 5 consultorios del municipio “Mella”, Santiago de Cuba, 2006 Oral health status at 5 family physician's offices of “Mella” municipality, Santiago de Cuba

    Directory of Open Access Journals (Sweden)

    Yanisette Mónica Calleja Martínez

    2006-09-01

    Full Text Available Se realizó un estudio descriptivo y transversal sobre el estado de salud bucal en 5 consultorios del municipio “Mella” durante el período comprendido entre enero y abril del 2006, cuyo universo estuvo constituido por todos los habitantes de estos consultorios. Se seleccionó una muestra de 475 pacientes estratificados por grupos de edades. Para la recolección de información se utilizó la encuesta de salud bucodental de la Organización Mundial de la Salud modificada del 2003. Se realizó un examen físico extraoral e intraoral para determinar el estado de salud bucal de cada individuo. Predominó el sexo masculino con el 59,3 % y las enfermedades sistémicas que mayor incidencia presentaron fueron las respiratorias y la hipertensión arterial. Las maloclusiones mostraron un comportamiento similar en todos los grupos, con predominio de las formas ligeras. Se utilizó el índice periodontal de Russell para evaluar la prevalencia relativa de la enfermedad, y se obtuvo que el 9,5 % y 11,8 % presentaban gingivitis leves o severas, respectivamente. El índice de COP-D mostró un valor favorable hasta los 18 años, pero no ocurrió así en los grupos de 35-44 y de 60-74, donde el valor fue de 11,2 y 25,0, respectivamente.A descriptive and cross-sectional study on the oral health status at 5 family physicians' offices of “Mella” municipality was undertaken from January through April, 2006. The universe was composed of all the inhabitants of the area corresponding to these offices. A sample of 475 patients stratified by age groups was selected. To collect the information, it was used a modified buccodental health survey of the World Health Organization of 2003. An intraoral and extraoral physical examination was made to determine the oral health status of each individual. Males predominated with 59.3 % and the systemic diseases with the highest incidence were the respiratory diseases and arterial hypertension. The malocclusions showed a

  16. The Palliative Treatment Plan as a Bone of Contention between Attending Physicians and Nurses

    Directory of Open Access Journals (Sweden)

    Wolfgang Lederer

    2015-10-01

    Full Text Available Acute vital crisis in end-of-life situations may result in hospitalization and intensive care without recognizable benefit in many cases. Advance directives regarding indications for resuscitation, hospitalization, and symptomatic treatment help ensure that acute complications can be managed quickly and satisfactorily in the patient’s customary surroundings. A plan was designed and implemented in Austrian nursing homes to provide emergency physicians with rapidly obtainable information on the patient’s current situation, and whether resuscitation attempts and hospitalization are advised or not. This palliative treatment plan is arranged by a physician together with caregivers, close relatives, and the patient or his court-appointed health care guardian or holder of power of attorney. Four years after implementation of the plan, a user satisfaction survey was carried out. The majority of participating nurses, emergency physicians and family doctors judged application and design of the palliative treatment plan positively. However, the low response rate of family doctors indicates nonconformity. In particular, the delegation of symptomatic treatment to nurses proved to be controversial. There is still a need to provide up-to-date information and training for health professionals in order for them to understand advance directives as extended autonomy for patients who have lost their ability to make their own decisions.

  17. American College of Physicians Ethics Manual. Third edition.

    Science.gov (United States)

    1992-12-01

    Medicine, law, and social values are not static and must be re-examined periodically. This edition of the ACP Ethics Manual covers emerging issues in medical ethics and revisits some old issues. The overview of the evolution of medical ethics, which appeared in previous editions of the Manual, has been eliminated to allow more space for the consideration of today's ethical dilemmas. Other changes include a revised chapter on end-of-life care, discussion of physician-assisted suicide, revised sections on conflicts of interest and on medical risk to the physician and patient, given developments in human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS), and discussion of sexual contact between physician and patient. A statement on disclosure of errors and a section on care of the physician's family have also been added. The sections on confidential information told by a patient's family or friend to the physician; on physician-pharmaceutical industry relations; on physicians in training; and on the impaired physician have been expanded. Sections on advertising, peer review, and resource allocation have been revised. The literature of biomedical ethics expands at a rate that does not allow a bibliography to remain current, so an exhaustive list of references or suggested readings is not included in this manual. Instead, only cited references are listed.

  18. Physicians' evaluations of patients' decisions to refuse oncological treatment

    Science.gov (United States)

    van Kleffens, T; van Leeuwen, E

    2005-01-01

    Objective: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. PMID:15738431

  19. Career satisfaction and retention of a sample of women physicians who work reduced hours.

    Science.gov (United States)

    Barnett, Rosalind C; Gareis, Karen C; Carr, Phyllis L

    2005-03-01

    To better understand the career satisfaction and factors related to retention of women physicians who work reduced hours and are in dual-earner couples in comparison to their full-time counterparts. Survey of a random sample of female physicians between 25 and 50 years of age working within 25 miles of Boston, whose names were obtained from the Board of Registration in Medicine in Massachusetts. Interviewers conducted a 60-minute face-to-face closed-ended interview after interviewees completed a 20-minute mailed questionnaire. Fifty-one full-time physicians and 47 reduced hours physicians completed the study; the completion rate was 49.5%. The two groups were similar in age, years as a physician, mean household income, number of children, and presence of an infant in the home. Reduced hours physicians in this sample had a different relationship to experiences in the family than full-time physicians. (1) When reduced hours physicians had low marital role quality, there was an associated lower career satisfaction; full-time physicians report high career satisfaction regardless of their marital role quality. (2) When reduced hours physicians had low marital role or parental role quality, there was an associated higher intention to leave their jobs than for full-time physicians; when marital role or parental role quality was high, there was an associated lower intention to leave their jobs than for full-time physicians. (3) When reduced hours physicians perceived that work interfering with family was high, there was an associated greater intention to leave their jobs that was not apparent for full-time physicians. Women physicians in this sample who worked reduced hours had stronger relationships between family experiences (marital and parental role quality and work interference with family) and professional outcomes than had their full-time counterparts. Both career satisfaction and intention to leave their employment are correlated with the quality of home life for

  20. Selection of Aptamers for CED-9/Bcl-2 Family Cell Death Regulations and Their Application in Study of Apoptosis Regulation and Drug Design for Breast Cancer

    Science.gov (United States)

    2005-07-01

    Apoptosis Regulation and Drug Design for Breast Cancer PRINCIPAL INVESTIGATOR: Ding Xue, Ph.D. Chonglin Yang, Ph.D. Nathan Camp CONTRACTING ORGANIZATION...Aptamers for CED-9/Bcl-2 Family Cell Death Regulations and Their Application in Study of Apoptosis Regulation and Drug Design for Breast Cancer 5b. GRANT...aptamers for CED-9/Bcl-2 family cell death regulators and their application in study of apoptosis regulation and drug design for breast cancer. The 4th Era

  1. Information for travellers' physicians.

    Science.gov (United States)

    Allison, D J; Blinco, K

    1990-07-01

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

  2. Information for Travellers' Physicians

    OpenAIRE

    Allison, David J; Blinco, Kimberley

    1990-01-01

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

  3. Medication counselling: physicians' perspective.

    Science.gov (United States)

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

    2013-12-01

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

  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.

  5. Physicians in transition.

    Science.gov (United States)

    Bluestein, P

    1995-12-01

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

  6. Counties Without a Physician.

    Science.gov (United States)

    Getz, Virginia

    1982-01-01

    Uses a budgeting technique to determine if free-market incentives or forces would provide an economic base sufficient to support medical professionals who might practice in the approximately 140 U.S. counties that lack a physician (located mainly in a narrow band from west Texas north through South Dakota). (AH)

  7. The ideal physician entrepreneur.

    Science.gov (United States)

    Bottles, K

    2000-01-01

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

  8. Tunable Hydrophobicity in DNA Micelles : Design, Synthesis, and Characterization of a New Family of DNA Amphiphiles

    NARCIS (Netherlands)

    Anaya, Milena; Kwak, Minseok; Musser, Andrew J.; Muellen, Klaus; Herrmann, Andreas; Müllen, Klaus

    2010-01-01

    This work describes the synthesis and characterization of a new family of DNA amphiphiles containing modified nucleobases. The hydrophobicity was imparted by the introduction of a dodec-1-yne chain at the 5-position of the uracil base, which allowed precise and simple tuning of the hydrophobic

  9. Tunable Hydrophobicity in DNA Micelles : Design, Synthesis, and Characterization of a New Family of DNA Amphiphiles

    NARCIS (Netherlands)

    Anaya, Milena; Kwak, Minseok; Musser, Andrew J.; Muellen, Klaus; Herrmann, Andreas; Müllen, Klaus

    2010-01-01

    This work describes the synthesis and characterization of a new family of DNA amphiphiles containing modified nucleobases. The hydrophobicity was imparted by the introduction of a dodec-1-yne chain at the 5-position of the uracil base, which allowed precise and simple tuning of the hydrophobic prope

  10. 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.

  11. Parent-offspring transaction: Mechanisms and the value of within family designs.

    Science.gov (United States)

    Jenkins, Jennifer M; McGowan, Patrick; Knafo-Noam, Ariel

    2016-01-01

    This article is part of a Special Issue "Parental Care". Parenting is best understood as a transactional process between parents and their offspring. Each responds to cues in the other, adapting their own behavior to that of their partner. One of the goals of parenting research in the past twenty years has been to untangle reciprocal processes between parents and children in order to specify what comes from the child (child effects) and what comes from the parent (parent effects). Child effects have been found to relate to genetic, pre and perinatal, family-wide, and child-specific environmental influences. Parent effects relate to stresses in the current context (e.g. financial strain, marital conflict), personality and ethnicity but also to adverse childhood experiences (e.g. parental mental health and substance abuse, poverty, divorce). Rodent models have allowed for the specification of biological mechanisms in parent and child effects, including neurobiological and genomic mechanisms, and of the causal role of environmental experience on outcomes for offspring through random assignment of offspring-mother groupings. One of the methods that have been developed in the human and animal models to differentiate between parent and child effects has been to study multiple offspring in the family. By holding the parent steady, and studying different offspring, we can examine the similarities and differences in how parents parent multiple offspring. Studies have distinguished between family average parenting, child-specific parenting and family-wide dispersion (the within family standard deviation). These different aspects of parenting have been differentially linked to offspring behavioral phenotypes.

  12. [Short course for primary physicians care].

    Science.gov (United States)

    Eshet, I; Van Relta, R; Margalit, A; Baharir, Z

    1995-11-15

    This department of family medicine has been challenged with helping a group of Russian immigrant physicians find places in primary care clinics, quickly and at minimal expense. A 3-month course was set up based on the Family Practice Residency Syllabus and the SFATAM approach, led by teachers and tutors from our department. 30 newly immigrated Russian physicians participated. The course included: lectures and exercises in treatment and communication with patients with a variety of common medical problems in the primary care setting; improvement of fluency in Hebrew relevant to the work setting; and information on the function of primary care and professional clinics. Before-and-after questionnaires evaluating optimal use of a 10- minute meeting with a